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The [[mental disorder|psychiatric diagnosis]] of gender identity disorder (now gender dysphoria) was introduced in DSM-III in 1980. [[Arlene Istar Lev]] and [[Deborah Rudacille]] have characterized the addition as a political maneuver to re-stigmatize homosexuality.<ref>{{cite book| vauthors = Lev AI |url= https://books.google.com/books?id=LwxvazLRmiEC&q=homosexuality+dsm-iii+transsexuality&pg=PA172 |title=Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families|publisher=Haworth Press|year=2004|isbn=978-0-7890-2117-5|page=172|author-link=Arlene Istar Lev|access-date=2020-11-11|archive-date=2021-01-23|archive-url=https://web.archive.org/web/20210123073430/https://books.google.com/books?id=LwxvazLRmiEC&q=homosexuality+dsm-iii+transsexuality&pg=PA172|url-status=live}}</ref><ref>{{cite book| vauthors = Rudacille D |title=The Riddle of Gender: Science, Activism, and Transgender Rights|date=February 2005|publisher=Pantheon|isbn=978-0-375-42162-4|author-link=Deborah Rudacille}}{{page needed|date=May 2016}}</ref> (Homosexuality was [[Homosexuality in the DSM|declassified as a mental disorder]] in the DSM-II in 1974.) By contrast, [[Kenneth Zucker]] and [[Robert Spitzer (psychiatrist)|Robert Spitzer]] argue that gender identity disorder was included in DSM-III because it "met the generally accepted criteria used by the framers of DSM-III for inclusion."<ref name="Historical Note">{{cite journal | vauthors = Zucker KJ, Spitzer RL | title = Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note | journal = Journal of Sex & Marital Therapy | volume = 31 | issue = 1 | pages = 31–42 | date = Jan–Feb 2005 | pmid = 15841704 | doi = 10.1080/00926230590475251 | author2-link = Robert Spitzer (psychiatrist) | s2cid = 22589255 | author-link = Kenneth Zucker }}</ref> Some researchers, including Spitzer and Paul J. Fink, contend that the behaviors and experiences seen in transsexualism are abnormal and constitute a dysfunction.<ref name="PsychNews">{{cite news | vauthors = Hausman K | date = 18 July 2003 |title=Controversy Continues to Grow Over DSM's GID Diagnosis|publisher=Psychiatric News|url=http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=106462|access-date=2014-05-22|archive-date=2014-05-22|archive-url=https://web.archive.org/web/20140522142507/http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=106462|url-status=live}}</ref> The American Psychiatric Association stated that [[gender nonconformity]] is not the same thing as gender dysphoria,<ref name="What Is"/> and that "gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition."<ref name="DSM-5 fact sheet"/>
Individuals with gender dysphoria may or may not regard their own cross-gender feelings and behaviors as a disorder. Advantages and disadvantages exist to classifying gender dysphoria as a disorder.<ref name="Standards of Care" /> Because gender dysphoria had been classified as a disorder in medical texts (such as the previous DSM manual, the DSM-IV-TR, under the name "gender identity disorder"), many insurance companies are willing to cover some of the expenses of sex reassignment therapy. Without the classification of gender dysphoria as a medical disorder, sex reassignment therapy may be viewed as a cosmetic treatment, rather than medically necessary treatment, and may not be covered.<ref name="Zack Ford">{{cite web| vauthors = Ford Z |title=APA Revises Manual: Being Transgender is No Longer a Mental Disorder|website=[[ThinkProgress]]|url=http://thinkprogress.org/lgbt/2012/12/03/1271431/apa-revises-manual-being-transgender-is-no-longer-a-mental-disorder/?mobile=nc|url-status=dead|archive-url=https://web.archive.org/web/20130202082602/http://thinkprogress.org/lgbt/2012/12/03/1271431/apa-revises-manual-being-transgender-is-no-longer-a-mental-disorder/?mobile=nc|archive-date=February 2, 2013|access-date=April 7, 2013}}</ref> In the United States, transgender people are less likely than others to have health insurance, and often face hostility and insensitivity from healthcare providers.<ref>{{Cite book| vauthors = Mallon GP |title=Social Work Practice with Transgender and Gender Variant Youth|publisher=Routledge|year=2009|isbn=978-0-415-99482-8|location=New Jersey}}</ref> Gender dysphoria being considered a disorder also means it is sometimes covered by the [[Americans with Disabilities Act]] (in 2022, the [[United States Court of Appeals for the Fourth Circuit]] stated that the Americans with Disabilities Act covers individuals with gender dysphoria) which may aid transgender people in accessing legal protections they otherwise may be unable to.<ref>{{cite news |author=Devan Cole |title=Federal appeals court says Americans with Disabilities Act protections cover 'gender dysphoria,' handing a win to trans people |url= https://www.cnn.com/2022/08/16/politics/americans-with-disabilities-act-transgender-gender-dysphoria/index.html |access-date=5 September 2022 |work=CNN |agency=CNN}}</ref> Some researchers and transgender people support declassification of the condition because they say the diagnosis [[pathologizes]] gender variance and reinforces the [[Gender binary|binary model of gender]].<ref name="Karl Bryant" />
An analysis of the Samoan third gender ''fa'afafine'' suggests that the DSM-IV-TR diagnostic component of distress is not inherent in the cross-gender identity; rather, it is related to social rejection and discrimination suffered by the individual.<ref name="fa'afafine" /> Psychology professor Darryl Hill insists that gender dysphoria is not a mental disorder, but rather that the diagnostic criteria reflect psychological distress in children that occurs when parents and others have trouble relating to their child's gender variance.<ref name="PsychNews" /> Transgender people have often been harassed, socially excluded, and subjected to discrimination, abuse and violence, including murder.<ref name="Davidson-2012" /><ref name="Giordano-2012" />
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