Assessing Andi’s Presentation: Understanding Gender Identity and Potential Diagnoses

QUESTION

Andi appears to be a male, but he is dressed in a skirt, is wearing make-up, and a wig. On intake forms, Andi leaves the gender space blank. He reports to be in his mid-40s but is elusive with his age. When you ask what pronoun, he would prefer (he, she, etc.) Andi says it doesn’t matter. Andi’s reason for coming has to do with parenting his 17-year-old daughter and coping with a recent divorce. How would you diagnose Andi? Refer to the specific criteria in your text for your diagnosis if you deem a diagnosis necessary. What differential diagnoses are possible? In other words, what else have you ruled out that is similar and why?

ANSWER

Assessing Andi’s Presentation: Understanding Gender Identity and Potential Diagnoses

Introduction

In working with Andi, it is essential to approach their situation with sensitivity and an open mind, recognizing the complexity of their gender identity. Andi’s unique appearance, ambiguous gender presentation, and refusal to specify pronouns indicate a potential exploration of gender nonconformity or genderqueer identity. However, it is crucial to avoid rushing to conclusions and consider various differential diagnoses to ensure a comprehensive understanding of their concerns.

Potential Diagnosis: Gender Dysphoria

Andi’s gender presentation, characterized by wearing feminine clothing and makeup despite appearing male, suggests a possible exploration of gender identity. Gender Dysphoria is a condition defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as significant distress experienced by an individual due to a mismatch between their assigned gender at birth and their experienced gender identity. However, it is essential to note that not all individuals who defy gender norms or express fluidity have Gender Dysphoria.

Gender Nonconformity and Fluidity

Gender nonconformity refers to behaviors, appearances, or identities that do not align with societal expectations for one’s assigned gender. Gender fluidity implies a flexible and evolving sense of gender identity that may shift over time. Andi’s presentation of a masculine appearance while dressing in traditionally feminine attire and expressing a neutral pronoun suggests a potential exploration of these aspects of gender identity.

Differential Diagnoses: Avoiding Hasty Conclusions

It is crucial to consider other possible diagnoses while avoiding assumptions about Andi’s gender identity or mental health. Some potential differential diagnoses include:

Major Depressive Disorder: Andi’s recent divorce and parenting stressors might contribute to depressive symptoms, such as low mood, lack of interest, and difficulty coping.

Adjustment Disorder: The challenges surrounding divorce and parenting could lead to an adjustment disorder, characterized by emotional and behavioral difficulties in response to significant life changes.

 Personality Disorders: Some personality disorders may manifest with atypical behavior and emotional expression, which could contribute to Andi’s presentation.

Conclusion

Diagnosing Andi requires a careful and sensitive approach, considering their unique gender presentation and experiences. While Gender Dysphoria, gender nonconformity, and gender fluidity may be relevant considerations, it is crucial to avoid making hasty conclusions. Instead, a comprehensive assessment should be conducted to understand Andi’s mental health, emotions, and experiences related to their parenting challenges and divorce. An empathetic and non-judgmental therapeutic approach will enable Andi to explore their feelings, identity, and coping mechanisms more openly, promoting a positive therapeutic outcome and well-being.