Marked incongruence between one's experienced/expressed gender and assigned gender, ≥6 months; in adolescents/adults: ≥2 of: incongruence between experienced gender and primary/secondary sex characteristics; strong desire to be rid of primary/secondary sex characteristics; strong desire for sex characteristics of experienced gender; strong desire to be of experienced gender; strong desire to be treated as experienced gender; strong conviction of having typical feelings/reactions of experienced gender
AOver ≥6 months, recurrent and intense sexual arousal from cross-dressing, as manifested by fantasies, urges, or behaviours
BMarked incongruence between one's experienced/expressed gender and assigned gender, ≥6 months; in adolescents/adults: ≥2 of: incongruence between experienced gender and primary/secondary sex characteristics; strong desire to be rid of primary/secondary sex characteristics; strong desire for sex characteristics of experienced gender; strong desire to be of experienced gender; strong desire to be treated as experienced gender; strong conviction of having typical feelings/reactions of experienced gender
Additional criteria
AB. Fantasies, urges, or behaviours cause clinically significant distress or impairment
BB. Condition is associated with clinically significant distress or impairment
Key features
AA. Over ≥6 months, recurrent and intense sexual arousal from cross-dressing, as manifested by fantasies, urges, or behaviours B. Fantasies, urges, or behaviours cause clinically significant distress or impairment
BA. Marked incongruence between one's experienced/expressed gender and assigned gender, ≥6 months; in adolescents/adults: ≥2 of: incongruence between experienced gender and primary/secondary sex characteristics; strong desire to be rid of primary/secondary sex characteristics; strong desire for sex characteristics of experienced gender; strong desire to be of experienced gender; strong desire to be treated as experienced gender; strong conviction of having typical feelings/reactions of experienced gender B. Condition is associated with clinically significant distress or impairment
Common specifiers
AWith fetishism; With autogynephilia; In a controlled environment; In remission
BWith a disorder of sex development; Posttransition; Mild; Moderate
Differential flags
AGender dysphoria (persistent gender incongruence; not primarily sexual arousal; may overlap); Non-distressing cross-dressing or drag (cultural/social; no sexual arousal or distress - not a disorder); Fetishistic disorder (object arousal without specific cross-dressing theme)
BNormal gender nonconformity (without distress or impairment - not a disorder); Transvestic disorder (sexually arousing cross-dressing; without gender incongruence); Body dysmorphic disorder (preoccupation with appearance features; not gender identity)