Charles, an 8-year-old child

assigned male at birth, has consistently expressed a desire to be a girl. Over

the past 7 months, her caregivers report that she insists she is a girl and

becomes distressed when referred to by her birth name or male pronouns. Charles

prefers to wear dresses and often pretends to be a mother or a princess during

fantasy play. She shows a strong preference for playing with girls and avoids

rough-and-tumble play with boys. Her parents report that she becomes upset

during bath time and avoids looking at her genitalia. Teachers note that

Charles has started withdrawing in class and is being teased by peers, impacting

her school performance.

Which

of the following symptoms in the case best satisfies Criterion A1 of DSM-5-TR

for Gender Dysphoria in Children?