A marked incongruence between one's experienced/expressed gender and assigned gender, of at least 6 months' duration, as manifested by at least six of the following (one of which must be Criterion A1):
A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one's assigned gender).
In boys (assigned gender), a strong preference for cross-dressing or simulating female attire: or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing.
A strong preference for cross-gender roles in make-believe play or fantasy play.
A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.
A strong preference for playmates of the other gender.
In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities.
A strong dislike of one's sexual anatomy.
A strong desire for the primary and/or secondary sex characteristics that match one's experienced gender.
The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning.
With a disorder of sex development (e.g., a congenital adrenogenital disorder such as 255.2 [E25.0] congenital adrenal hyperplasia or 259.50 [E34.50] androgen insensitivity syndrome).
Coding note: Code the disorder of sex development as well as gender dysphoria.