Gender Identity Disorders



Gender Identity Disorders





The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the text revised fourth edition of the DSM (DSM-IV-TR) define gender identity disorders as a group whose common feature is a strong, persistent preference for living as a person of the other sex. The affective component of gender identity disorders is gender dysphoria, which is discontent with one’s designated birth sex and a desire to have the body of the other sex and to be regarded socially as a person of the other sex. Gender identity disorder in adults was referred to in early versions of the DSM as transsexualism.

Interest in gender identity disorders grew from several sources. Behaviors distinguished between male and female children are a focus of developmental psychologists studying conventional patterns of psychosexual differentiation. Transsexuals became popularly known with the sex change of George Jorgensen into Christine Jorgensen in 1952. The 1966 book by Harry Benjamin, the pioneer who evaluated or treated many hundreds of patients, and the introduction of sex reassignment surgery at the Johns Hopkins Hospital in that year were great strides in transsexualism’s medical recognition and treatment. Work with sexually atypical adults, including transsexuals and homosexuals who recalled extensive cross-gender behavior in childhood, brought clinical interest to this area.

Students should study the questions and answers below for a useful review of these disorders.



Helpful Hints

Students should know the gender identity syndromes and terms listed below.



  • adrenogenital syndrome


  • agenesis


  • ambiguous genitals


  • androgen insensitivity syndrome


  • asexual


  • assigned sex


  • Barr chromatin body


  • bisexuality


  • buccal smear


  • cross-dressing


  • cross-gender


  • cryptorchid testis


  • dysgenesis


  • effeminate boys and masculine girls


  • gender confusion


  • gender identity


  • disorder not otherwise specified


  • gender role


  • genotype


  • hermaphroditism


  • heterosexual orientation


  • homosexual orientation


  • hormonal treatment


  • intersex conditions


  • Klinefelter’s syndrome


  • male habitus


  • phenotype


  • prenatal androgens


  • pseudohermaphroditism


  • rough-and-tumble play


  • sex of rearing


  • sex-reassignment surgery


  • sex steroids


  • sexual object choice


  • testicular feminization syndrome


  • transsexualism


  • transvestic fetishism


  • Turner’s syndrome


  • virilized genitals


  • X-linked




Questions


Directions

Each of the questions or incomplete statements below is followed by five suggested responses or completions. Select the one that is best in each case.



21.1 Which of the following is true?


A. Girls with congenital virilizing adrenal hyperplasia are less interested in dolls.


B. Polycystic ovaries has not been considered as associated with transsexualism.


C. Mothers, more than fathers, give negative responses to boys playing with dolls.


D. Boys with gender identity disorders (GIDs) are more likely to be right-handed than control boys.


E. Boys with GID generally tend to have more sisters than brothers.

View Answer

21.1 The answer is A

Evidence for hormonal influence in gender identity disorder (GID) derives from several sources. Girls with congenital virilizing adrenal hyperplasia overproduce adrenal androgen in utero and, as girls, are less interested in dolls and more likely to be considered tomboys than girls who do not have the disorder. Reports describe polycystic ovaries as more common in female-to-male transsexuals than in the typical female population. In social learning theories that focus on the differential reinforcement of sex-typed behavior by parents, starting shortly after birth, it has been noted that fathers, more than mothers, give negative responses to boys playing with dolls. Handedness may relate to prenatal sex steroid levels, and boys with GID are significantly more likely to be left-handed than control boys. Similarly, boys with GID have been reported to have significantly more brothers than sisters.



21.2 In a patient with Turner’s syndrome, all of the following are common findings except


A. atypical female sex identification


B. gonadal dysgenesis


C. female genitalia


D. small uterus


E. dyspareunia

View Answer

21.2 The answer is A

Patients with Turner’s syndrome have typical female identification. The majority report heterosexual identification, although they tend to have fewer sexual relationships. During adolescence, many patients have difficulties reading social cues and experience social isolation and anxiety. Most patients with Turner’s syndrome have gonadal dysgenesis and require exogenous estrogen to complete growth and develop secondary sex characteristics. However, in patients with 45,X0/46,XX mosaicism, spontaneous menarche is common (40 percent), and in rare cases, pregnancy is possible. These patients typically experience ovarian failure at a later date. Patients with Turner’s syndrome have female genitalia. The uterus may be small, but structural abnormalities are not typical. The lack of estrogen may shorten the vagina and contribute to dyspareunia.




21.3 Sex reassignment


A. is often the best solution in treating gender dysphoria


B. usually involves a full-time social transition to living in the desired gender before hormonal treatment


C. includes daily doses of oral estrogen in persons born male


D. may involve sex reassignment surgery


E. all of the above

View Answer

21.3 The answer is E (all)

No drug treatment has been shown to be effective in reducing cross-gender desire, and when gender dysphoria is severe and intractable, sex reassignment may be the best solution. This involves an extensive set of clinical management guidelines, and many clinicians require that the patient begin the Real Life Test or Real Life Experience before hormonal treatment. The Real Life Test is typically 1 to 2 years of full-time cross-gender living, including at least 1 year of employment in the desired gender role and 1 year on high doses of cross-sex hormones. For biological males, this includes high doses of oral estrogens; biological women are treated with monthly or three weekly injections of testosterone. Sex reassignment surgery is often the last stage in the reassignment process.



21.4 Gender constancy


A. is a task of separation-individuation


B. has no age-related stage-like sequence because it is inherent


C. includes a sense of “gender stability”


D. cannot be tested in the clinical situation


E. none of the above

View Answer
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Jun 8, 2016 | Posted by in PSYCHIATRY | Comments Off on Gender Identity Disorders

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