In a working paper, dated 2006, Grüsser and Thalemann describe the diagnostic characteristics model to distinguish a phenomenon as a behavioral addiction. In virtually all diagnostic characteristics below, transsexualism and the underlying cause, automorphophilia, satisfies the criteria of being a behavioral addiction. [1]

1. The behavior is exhibited over a long period of time (at least 12 months) in an excessive, aberrant form, deviating from the norm or extravagant (e.g., regarding its frequency and intensity)
   A transsexual's feelings towards gender transition generally intensify as time progresses. It is extremely rare to see a transsexual, who is committed to a gender transition, veer off. As it is extremely rare to see a transsexual veer off, transsexuals easily surpass twelve months where the behavior becomes more extreme. Ironically, in the vast majority of cases of male to female transsexuals, transsexualism was barely on the radar screen prior to the onset of their cross-gender variant behavior. Transsexualism satisfies this diagnostic characteristic of being a behavioral addiction.
2. Loss of control over the excessive behavior (duration, frequency, intensity, risk) when the behavior started
   Transsexuals, who begin a gender transition, have difficulty turning off their intense feeling towards gender transition. Their personal gender transition emerges in virtually all aspects of their life. Transsexuals, also, generally fail to appreciate the risk they are taking in the pursuit of in a gender transition. In the case of transsexuals, who are gainfully employed, transsexuals generally do not weigh the issues surrounding re-entering the workforce, should they lose their jobs for one reason or another. Transsexualism satisfies this diagnostic characteristic of being a behavioral addiction.
3. Reward effect (the excessive behavior is instantly considered to be rewarding)
   As the person takes steps in their respective gender transition, each one seems the correct one. As the person regards each step in their respective gender transition as being well founded, he/she experiences reward. Over time the individual has to act out in ever increasing degrees to feel the same degree of satisfaction. Transsexualism satisfies this diagnostic characteristic of being a behavioral addiction.
4. Development of tolerance (the behavior is conducted longer, more often and more intensively in order to achieve the desired effect; in unvaried form, intensity and frequency the desired effect fails to appear)
   As a transsexual progresses through a change in gender appearance, he/she often opts to undergo more procedures and not less, indicating the degree of satisfaction derived from each procedure diminishes in intensity, requiring the individual to act out in ever increasing degrees. Transsexualism satisfies this diagnostic characteristic of being a behavioral addiction.
5. The behavior that was initially perceived as pleasant, positive and rewarding is increasingly considered to be unpleasant in the course of the addiction
   Virtually all transsexuals publicly cross-dress prior to undergoing a gender transition. The vast majority of transsexuals report their former cross-dressing experiences as being fun and exciting, However, as transsexuals advance in their respective gender transitions, the thought of periodic cross-dressing is abhorrent. Transsexualism satisfies this diagnostic characteristic of being a behavioral addiction.
6. Irresistible urge/craving to execute the behavior
   The drivers, underlying transsexualism, are psychological and sexual in nature. Sexual urges are irrepressible. Transsexualism satisfies this diagnostic characteristic of being a behavioral addiction.
7. Function (the behavior is primarily employed as a way to regulate emotions/mood)
   The vast majority of transsexuals cannot emotionally function if precluded from acting out cross-gender behavior due to one circumstance or another. Transsexualism satisfies this diagnostic characteristic of being a behavioral addiction.
8. Expectancy of effect (expectancy of pleasant/positive effects by carrying out the excessive behavior)
   As a transsexual takes steps in his/her gender transition each one seems the correct one. Transsexuals often report their life "improving" in the period leading up to a major surgical procedure, which matches their expectations. Transsexualism satisfies this diagnostic characteristic of being a behavioral addiction.
9. Limited pattern of behavior (also applies to buildup and follow-up activities)
   See 10.
10. Cognitive occupation with the build-up, execution and follow-up activities of the excessive behavior and possibly the anticipated effects of the excessively executed behavior
    Transsexuals find gender transition and the associated steps-which is a process and not a state of existence-exciting. Transsexualism satisfies this diagnostic characteristic of being a behavioral addiction.
11. Irrational, contorted perception of different aspects of the excessive behavior
    The vast majority of transsexuals are utterly incapable of realizing their masturbation thoughts are not indigenous to those of a member of the opposite sex. Further, the vast majority of transsexuals have no real construct of what it means to be a member of the opposite sex. Transsexualism satisfies this diagnostic characteristic of being a behavioral addiction.
12. Withdrawal symptoms (psychological and physical)
    When circumstances preclude transsexuals from acting out cross-gender variant behavior, they report discomfort and psychological withdrawals. Ironically, the vast majority of transsexuals report that they had no difficult living as members of their assigned gender prior the consideration of a change in sex. Transsexualism satisfies this diagnostic characteristic of being a behavioral addiction.
13. Continued execution of the excessive behavior despite negative consequences (health-related, occupational, social)
    On the lose of employment or similar crisis, transsexuals typically do not opt to revert to living as a member of their assigned gender role even on circumstances where doing so would be in their best interest. Transsexualism satisfies this diagnostic characteristic of being a behavioral addiction.
14. Conditioned / learned reactions (resulting from the confrontation with internal and external stimuli associated with the excessive behavior as well as from cognitive occupation with the excessive behavior)
    Transsexuals are very resistant to pleas from friends, family members and intimacy partners to discontinue what are often ill conceived gender transitions and consider alternative treatments. They often seize on the concept that gender dysphoria is an accurate portray of their feelings and experiences. They also seize on the prescribed treatment regiments for gender dysphoria as set down by the Harry Benjamin International Gender Dysphoria Association (HBIGDA), including hormone replacement therapy (HRT) and genital surgery. As gender identity disorder in sexually developed individuals is fundamentally flawed, so too is the prescribed treatment regiment set down by the HBIGDA. Transsexualism (coupled with the currently flawed medical response) satisfies this diagnostic characteristic of being a behavioral addiction.
15. Suffering (desire to alleviate perceived suffering)
    The vast majority of male to female transsexuals regard any obstruction to surgical procedures that aid in their respective gender transitions as a form of suffering. A number of male to female transsexuals regard gender reassignment surgical (GRS) procedures as "life saving" surgery and sacrosanct to their health interests, indicating a degree of discomfort in the absence of the procedure. Further, a number of transsexuals report they will commit suicide, if they are unsuccessful with respect to being approved to undergo a GRS procedure or similar procedure that protracts the testes. male to female transsexuals rarely commit suicide in the period leading up to a major surgical procedure that protracts the testes. In fact the vast majority of cases of transsexuals who commit suicide do so after undergoing a GRS procedure and not prior. 5% of all post-operative, male to female transsexuals commit suicide, which is 50 times higher than that of the greater population. In the vast majority of cases of suicide the reasons had nothing to do with prejudice. Whether the individual suffers or not is immaterial. The perception is all that matters. Transsexualism satisfies this diagnostic characteristic of being a behavioral addiction.

Transsexualism satisfies all of the diagnostic characteristics of a behavioral addiction. In the case of all sexually developed individuals transsexualism is a behavioral addiction.