DSM-5 distinguishes gender dysphoria from paraphilias (paraphilic disorders). Which statement accurately reflects this distinction as codified in DSM-5?

• A Gender dysphoria (F64.0 equivalent) is a separate chapter focused on incongruence between experienced/expressed gender and assigned gender, and is not categorised as a paraphilic disorder; a paraphilia becomes a paraphilic disorder only if it causes distress or harm to self or others ✓
• B Gender dysphoria is classified under sexual dysfunctions; paraphilias are normalised variants
• C Both gender dysphoria and paraphilias are classified as somatic symptom disorders in DSM-5
• D Paraphilic disorder diagnosis requires the paraphilia to be present for at least 2 years

Explanation

DSM-5 placed gender dysphoria in its own chapter, separate from both sexual dysfunctions and paraphilic disorders, reflecting destigmatisation. The diagnosis centres on marked incongruence between one's experienced/expressed gender and assigned gender for ≥6 months, causing clinically significant distress or impairment. A critical DSM-5 principle for paraphilic disorders is the distinction between a paraphilia (an atypical sexual interest — not inherently disordered) and a paraphilic disorder (a paraphilia causing distress to the individual or harm to others). Many paraphilias (e.g., fetishism) are not disorders unless they cause impairment. The 6-month duration criterion applies to gender dysphoria, not to paraphilic disorders.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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