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Gender identity disorder
Gender identity is defined as the psychological state reflecting a sense of being male or female. It’s culturally based on determined sets of attitude and behavioral patterns as well as other attributes usually associated with masculinity or femininity. Gender identity disorder involves persistent cross-gender identification (longer than 2 years) and feelings of discomfort and dissatisfaction (gender dysphoria). The disorder shouldn’t be confused with the more common feelings of inadequacy in fulfilling the expectations normally associated with a particular sex. Among some practitioners and transgender people, the diagnosis of gender identity disorder is controversial because it creates a pathologic label. Indeed, some believe the label should be eliminated.
CAUSES AND INCIDENCE
The incidence of gender identity disorder is relatively rare—it affects only 1 in 10,000 males and 1 in 30,000 females in the United States. Current theories about gender identity disorder and its causes suggest a combination of predisposing factors, such as heredity, prenatal hormone influences (occurring particularly during brain formation in utero), and environmental and social influences. Research shows that the number of neurons in the limbic nucleus of female-to-male transgender individuals is in the male range. This suggests that there may be changes in hormone levels in the brain that drive some individuals to be males.
SIGNS AND SYMPTOMS
Gender identity disorder may emerge at an early age. A child may express the desire to be—or insist that he or she is—the opposite sex. For example, a male child may express disgust with his genitalia.
Men with gender identity disorder may describe a lifelong history of feeling feminine and pursuing feminine activities. Women report similar propensities for opposite-sex activities and discomfort with the female role. For both sexes, the conflict intensifies during puberty and can cause intense anxiety and depression.
COMPLICATIONS
• Anxiety
• Depression
• Social isolation
• Legal problems (many states do not recognize gender reassignment)
• Discrimination (Individuals are not legally protected from discrimination
in employment or housing based on gender identity or gender expression.)
in employment or housing based on gender identity or gender expression.)
DIAGNOSING GENDER IDENTITY DISORDERS
The diagnosis of gender identity disorder is confirmed when the patient’s symptoms meet the following criteria established in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision:
▪ A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex).
In children, the disturbance is manifested by at least four of the following:
– repeatedly stated desire to be, or insistence that he or she is, the other sex
– in boys, preference for crossdressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
– strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex
– intense desire to participate in the stereotypical games and pastimes of the other sex
– strong preference for playmates of the other sex.
In adolescents and adults, the disturbance is manifested by such symptoms as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex.
▪ Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.
In children, the disturbance is manifested by any of the following:
– in boys, assertion that his penis or testes are disgusting or will disappear or he’d be better off not to have a penis, rejection of rough-andtumble play, and rejection of male stereotypical toys, games, and activities
– in girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she doesn’t want to grow breasts or menstruate, or marked aversion toward feminine clothing.
In adolescents and adults, the disturbance is manifested by such symptoms as preoccupation with getting rid of primary and secondary sex characteristics or the belief that he or she was born the wrong sex.
▪ The disturbance isn’t concurrent with a physical intersex condition.
▪ The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
DIAGNOSTIC CRITERIA
For specific diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, see Diagnosing gender identity disorders.
TREATMENT
Treatment may include:
• psychotherapy to consider the range of options, set realistic life goals, and define conflicts
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