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Gatekeepers Gatekeeping Themselves

by Elisa "Smod" Modica

Elisa "Smod" Modica, agender fat person, licensed social psychologist and sex counselor, specialized in Gender Relationship Sexual Diversity (GRSD)

"This is my dysphoria diagnosis: as a psychologist I can't do it by myself so I want to make it and publish as a critique of the system, a piece of art, a poem, a letter, a clinical document, a facsimile, a cry for help, a bare soul, a story, a dissociation of the person, a political act"

IG: @smoodi



Psychologist and sex counselor

Orders of Italian Psychologists, license no. xxxxxx

I undersigned Dr. Elisa M., psychologist and sexual counselor, I certify that Elisa M., born in XXXXXXX

(XX) on XX/XX/199X, the day after her birth underwent a psychological counseling and embarked on a course of psychological support, currently underway, for its gender affirmation.

From the collected clinical history it emerges that the person expresses a strong discomfort

related to the inconsistency between the gender assigned at birth and the experienced one, such as to satisfy the criteria established by the DSM V for gender dysphoria.

The criteria established by the Standards of Care (version 8) of the World Professional Associations for Transgender Health (WPATH) are also met, in particular the presence of dysphoria of gender, the ability to make informed decisions and to give consent to the processing.

On the occasion of the psychological interviews Elisa always presented herself as an agender person, she showed a collaborative attitude within the psychological consultation, maintaining eye contact and behavior appropriate to the context. No psychomotor disorder occurred; the volume, tone and frequency of his voice were regular, he expressed his difficulties thoughtfully, articulately and clearly, showing awareness and self- confidence. No disorder of a dissociative nature and no psychotic phenomena occurred.

There is a strong gender dysphoria with a clinically significant body discomfort above all because it is the criterion that the scientific and legal community expects from her, but in reality the only problems are related to fat phobia and how society defines the intersection between the fat bosy, gender identity and gender expression, and the only dysphoria they experience is sometimes related to genitalia.

The intensity of the dysphoria is sometimes such as to involve depressive-type mood alterations and a tendency to social isolation as a coping strategy mostly, and substantially, aimed at avoiding situations of misrecognition of their identity in which he would not be able to express herself, both in social presentation than in the more personal psychological qualities that he feels she cannot manifest spontaneously, leading him to hide some parts of themself and become invisible. Elisa is aware of her dysphoria and how it has strong implications on his mental health and quality of life.

He has NOT been waiting for several years to be able to embark on the path of affirmation of medicalized gender, does NOT want to start hormonal treatment to allow her body to develop the somatic characteristics consistent with their identity, as he wants to free herself from the social impositions of a social construction. They do NOT want and nor does she plan to access top surgery and bottom surgery, but would like to have his personal data changed in order to eliminate the gender category from her documents. These elements do not make their experience as a trans person, and her dysphoria any less valid.

Based on the clinical data collected and the life history I confirm the diagnosis of GENDER DYSPHORIA (302.85 – according to DSM-5 and WPATH – Version 8). From the moment of the first evaluation no psychopathological aspects have emerged such as to contraindicate the autodetermination of their own l i fe . I can say that gender incongruity has been constant for years, as the evolution of a process of gender variance that began in childhood and clearly emerged in adolescence in a persistent and constant way.

The absence of identification in a genre, but rather the identification with its own identity, is extremely stable and positively integrated on a psychic level. The changes in the society would allow Elisa to be able to live fully and be socially recognized in her gender and personal identity, guaranteeing him a better quality of life and the possibility of full personal and professional self-realization. These interventions constitute the most suitable procedure to ensure that state of health, understood in its broadest sense, as an integration of the somatic and affective, intellectual and social aspects of being.

Based on what has been said:

I support my own decision to continue the affirmative path;

I confirm that I, myself, have read and approved the contents of this fake clinical documentation since not even the gatekeepers, can open the gate for themselves in a world that has issue with trans lives.

In the event that it could be of further help in the management of medical care or in the event that clarifications

on this assessment should

be appropriate, I remain available at the number XXXXXX and via the email address xxxxxxx .

Place and date Verona, 06/30/2023



Editor's note: in this fac-simile of an Italian diagnosis for gender dysphoria, the author refers to the DSM V. The DSM V is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association in 2013, and it is considered the standard by the global scientific community. As noted by prof. M. C. Amoretti (2020, The Notion of Gender in Psychiatry: a Focus on DSM-5, "Notizie di Politeia" 139, 70-82), while the DSM V does not pathologise genderqueer people per se, and assumes a general gender pluralist stance, it still retains aspects of gender binarism and essentialism in regard to diagnostic criteria. Moreover, the DSM V definition of gender dysphoria is in contradiction with its definition of pathology, and while it does not pathologise trans* people, it should be removed from the Manual. However, since access to gender-affirming and life-saving healthcare is in many states conditional on the presence of a diagnosis. Given the binarist and essentialist aspects of the DSM V diagnostic criteria, access to healthcare is especially difficult for non-binary* trans people.

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