According to the Diagnostic and Statistical Manual of Mental Disorders,people who express a strong and persistent cross-gender identification as well as discomfort with their own biological sex or gender role have

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The Diagnostic and Statistical Manual of Mental Disorders (DSM) currently recognizes "gender identity disorder" as a diagnosis for individuals who experience a persistent and strong identification with the opposite gender, and significant distress or impairment related to this identity. While the term "gender identity disorder" has been criticized by some transgender individuals and advocates, it is currently the official diagnostic criteria in the DSM. Transsexualism and transgenderism are broader terms that can encompass a range of experiences and identities related to gender, including those that may not necessarily involve significant distress or impairment. "Bigendered identities" refers specifically to individuals who identify with two genders or gender expressions simultaneously, which may or may not be related to gender dysphoria or a diagnosis of gender identity disorder.