GENDER IDENTITY DISORDERS
The essential feature of the disorders included in this subclass is an
incongruence between assigned sex (i.e., the sex that is recorded on the birth
certificate) and gender identity. Gender identity is the sense of knowing to which
sex one belongs, that is, the awareness that "I am a male," or l am a female."
Gender identity is the private experience of gender role, and gender role is the
public expression of gender identity. Gender role can be defined as everything
that one says and does to indicate to others or to oneself the degree to which one
is male or female.
Some forms of gender identity disturbance are on a continuum, whereas
others may be discrete. When gender identity disturbance is mild, the person is
aware that he is a male or that she is a female, but discomfort and a sense of
inappropriateness about the assigned sex are experienced. When severe, as in
Transsexualism, the person not only is uncomfortable with the assigned sex but
has the sense of belonging to the opposite sex.
Disturbance in gender identity is rare, and should not be contused with the far
more common phenomena of feelings of inadequacy in fulfilling the expectations
associated with one's gender role. An example of the latter would be a person
who perceives himself or herself as being sexually unattractive yet experiences
himself or herself unambiguously as a man or a woman in accordance with his or
her assigned sex.
Although people who first present clinically with gender identity problems may
be of any age, in the vast majority of cases the onset of the disorder can be
traced back to childhood. In rare cases, however, an adult will present clinically
for the first time with a gender identity problem and report that the first sign; of the
disturbance were in adult life.
Gender Identity Disorder of Childhood
The essential features of this disorder are persistent and intense distress in a
child about his or her assigned sex and the desire to be, or insistence that he or
she is of the other sex. (This disorder is not merely a child's nonconformity to
stereotypic sex-role behavior as, for example, in "tomboyishness" in girls or
"sissyish" behavior in boys, but rather a profound disturbance of the normal sense
of maleness or femaleness.) In addition, in a girl there is either persistent marked
aversion to normative feminine clothing and insistence on wearing stereotypic
masculine clothing, or persistent repudiation of her female anatomic
characteristics. In a boy, there is either preoccupation with female stereotypic
activities, or persistent repudiation of his male anatomic characteristics. this
diagnosis is not given after the onset of puberty.
Girls with this disorder regularly have male companions and an avid interest
in sports and rough-and-tumble play; they show no interest in dolls or playing
"house" (unless they play the father or another male role). More rarely, a girl with
this disorder refuses to urinate in a sitting position, claims that she has, or will
grow, a penis, does not
want to grow breasts or menstruate, or asserts that she will grow up to become a
man (not merely in role).
Boys with this disorder usually are preoccupied with female stereotypic
activities. They may have a preference for dressing in girls' or women's clothes,
or may improvise such items from available material when genuine articles are
unavailable. (The cross-dressing typically does not cause sexual excitement, as
in Transvestic Fetishism.) They often have a compelling desire to participate in
the games and pastimes of girls. Female dolls are often their favorite toy, and
girls are regularly their preferred playmates. when playing "house," the role of a
female is typically adopted. Rough-and-tumble play or sports are generally
avoided. Gestures and actions are often judged against a cultural stereotype of
femininity, and the boy is usually subjected to male peer group teasing and
rejection, whereas the same rarely occurs among girls until adolescence. Boys
with this disorder may assert that they will grow up to become women (not merely
in role). In rare cases a boy with this disorder claims that his penis or testes are
disgusting or will disappear, or that it would be better not to have a penis or
testes.
Some children refuse to attend school because of teasing or pressure to
dress in attire stereotypical of their assigned sex. Most children with this disorder
deny being disturbed by it, except that it brings them into conflict with the
expectations of their family or peers.
Associated features. Some of these children, particularly girls, show no other
signs of psychopathology. Others may display serious signs of disturbance, such
as social withdrawal, separation anxiety, or depression.
Age at onset and course. The majority of the boys with this disorder begin to
develop it before their fourth birthday. Social ostracism increases during the early
grades of school, and social conflict is significant at about age seven or eight.
During the later grade-school years, grossly feminine behavior may lessen.
Studies indicate that from one-third to two-thirds or more of boys with the disorder
develop a homosexual orientation during adolescence.
For females the age at onset is also early, but most give up an exaggerated
insistence on male activities and attire during late childhood or adolescence. A
minority retain a masculine identification, and some of these develop a
homosexual orientation.
Whereas most adult people with Transsexualism report having had a gender
identity problem during childhood, prospective studies of children with Gender
ldentity Disorder of Childhood indicate that very few develop Transsexualism in
adolescence or adulthood.
Complications. In a small number of cases, the disorder becomes continuous
with Transsexualism or Gender Identity Disorder of Adolescence or Adulthood,
Nontrans-sexual Type.
Impairment. Positive peer relations with members of the same sex are absent
or difficult to establish. The amount of impairment varies from none to extreme,
and Is related to the degree of associated psychopathology and the reaction of
peers and family to the person's behavior.
Prevalence. The disorder is apparently uncommon.
Sex ratio. In clinic samples there are many more boys with this disorder than
girls. The sex ratio in the general population is unknown.
Familial pattern. No information.
Predisposing factors. Studies indicate that characteristics of the child, the
parents, or of other social agents, such as parental substitutes and siblings, may
be predisposing factors for the development of the disorder. in boys, the
characteristics may Include "feminine" physical features, an aversion to
rough-and-tumble play, separation anxiety, and a history of early hospitalization.
The relevant characteristics of parents and other influential people in the child's
environment may include weak reinforcement of normative gender-role behavior,
absence or unavailability of a father, and encouragement of extreme physical and
psychological closeness with her son by a mother. In girls, a strong interest in
rough-and-tumble play on the part of the child and weak reinforcement of
normative gender-role behavior by the parents may contribute to the development
of the disorder.
Differential diagnosis. Children whose behavior merely does not fit the cultural
stereotype of masculinity or femininity should not be given this diagnosis unless
the full syndrome is present. Physical abnormalities of the sex organs are rarely
associated with Gender identity Disorder of Childhood.
(Diagnostic Criteria for Gender Identity Disorder of Childhood)
For Females:
A. Persistent and intense distress about being a girl, and a stated desire to be
a boy (not merely a desire for any perceived cultural advantages from being
a boy), or insistence that she is a boy.
B. Either (1) or (2):
(1) persistent marked aversion to normative feminine clothing and
insistence on wearing stereotypical masculine clothing, e.g., boys'
underwear and other accessories
(2) persistent repudiation of female anatomic structures, as evidenced
by at least one of the following:
(a) an assertion that she has, or will grow, a penis
(b) rejection of urinating in a sitting position
(c) assertion that she does not want to grow breasts or menstruate
C. The girl has not yet reached puberty.
For Males:
A. Persistent and intense distress about being a boy and an intense desire to
be a girl or, more rarely, insistence that he is a girl.
B. Either (1) or (2);
(1) preoccupation with female stereotypical activities, as shown by a
preference for either cross-dressing or simulating female attire, or by an
intense desire to participate in the games and pastimes of girls and
rejection of male stereotypical toys, games, and activities
(2) persistent repudiation of male anatomic structures, as indicated by at
least one of the following repeated assertions:
(a) that he will grow up to become a woman (not merely in role)
(c) that it would be better not to have a penis or testes
C. The boy has not yet reached puberty.
Page 12
Adoption World Main Site
The essential feature of the disorders included in this subclass is an incongruence between assigned sex (i.e., the sex that is recorded on the birth certificate) and gender identity. Gender identity is the sense of knowing to which sex one belongs, that is, the awareness that "I am a male," or l am a female." Gender identity is the private experience of gender role, and gender role is the public expression of gender identity. Gender role can be defined as everything that one says and does to indicate to others or to oneself the degree to which one is male or female.
Some forms of gender identity disturbance are on a continuum, whereas others may be discrete. When gender identity disturbance is mild, the person is aware that he is a male or that she is a female, but discomfort and a sense of inappropriateness about the assigned sex are experienced. When severe, as in Transsexualism, the person not only is uncomfortable with the assigned sex but has the sense of belonging to the opposite sex.
Disturbance in gender identity is rare, and should not be contused with the far more common phenomena of feelings of inadequacy in fulfilling the expectations associated with one's gender role. An example of the latter would be a person who perceives himself or herself as being sexually unattractive yet experiences himself or herself unambiguously as a man or a woman in accordance with his or her assigned sex.
Although people who first present clinically with gender identity problems may be of any age, in the vast majority of cases the onset of the disorder can be traced back to childhood. In rare cases, however, an adult will present clinically for the first time with a gender identity problem and report that the first sign; of the disturbance were in adult life.
Gender Identity Disorder of Childhood
The essential features of this disorder are persistent and intense distress in a child about his or her assigned sex and the desire to be, or insistence that he or she is of the other sex. (This disorder is not merely a child's nonconformity to stereotypic sex-role behavior as, for example, in "tomboyishness" in girls or "sissyish" behavior in boys, but rather a profound disturbance of the normal sense of maleness or femaleness.) In addition, in a girl there is either persistent marked aversion to normative feminine clothing and insistence on wearing stereotypic masculine clothing, or persistent repudiation of her female anatomic characteristics. In a boy, there is either preoccupation with female stereotypic activities, or persistent repudiation of his male anatomic characteristics. this diagnosis is not given after the onset of puberty.
Girls with this disorder regularly have male companions and an avid interest in sports and rough-and-tumble play; they show no interest in dolls or playing "house" (unless they play the father or another male role). More rarely, a girl with this disorder refuses to urinate in a sitting position, claims that she has, or will grow, a penis, does not want to grow breasts or menstruate, or asserts that she will grow up to become a man (not merely in role).
Boys with this disorder usually are preoccupied with female stereotypic activities. They may have a preference for dressing in girls' or women's clothes, or may improvise such items from available material when genuine articles are unavailable. (The cross-dressing typically does not cause sexual excitement, as in Transvestic Fetishism.) They often have a compelling desire to participate in the games and pastimes of girls. Female dolls are often their favorite toy, and girls are regularly their preferred playmates. when playing "house," the role of a female is typically adopted. Rough-and-tumble play or sports are generally avoided. Gestures and actions are often judged against a cultural stereotype of femininity, and the boy is usually subjected to male peer group teasing and rejection, whereas the same rarely occurs among girls until adolescence. Boys with this disorder may assert that they will grow up to become women (not merely in role). In rare cases a boy with this disorder claims that his penis or testes are disgusting or will disappear, or that it would be better not to have a penis or testes.
Some children refuse to attend school because of teasing or pressure to dress in attire stereotypical of their assigned sex. Most children with this disorder deny being disturbed by it, except that it brings them into conflict with the expectations of their family or peers.
Associated features. Some of these children, particularly girls, show no other signs of psychopathology. Others may display serious signs of disturbance, such as social withdrawal, separation anxiety, or depression.
Age at onset and course. The majority of the boys with this disorder begin to develop it before their fourth birthday. Social ostracism increases during the early grades of school, and social conflict is significant at about age seven or eight. During the later grade-school years, grossly feminine behavior may lessen. Studies indicate that from one-third to two-thirds or more of boys with the disorder develop a homosexual orientation during adolescence.
For females the age at onset is also early, but most give up an exaggerated insistence on male activities and attire during late childhood or adolescence. A minority retain a masculine identification, and some of these develop a homosexual orientation.
Whereas most adult people with Transsexualism report having had a gender identity problem during childhood, prospective studies of children with Gender ldentity Disorder of Childhood indicate that very few develop Transsexualism in adolescence or adulthood.
Complications. In a small number of cases, the disorder becomes continuous with Transsexualism or Gender Identity Disorder of Adolescence or Adulthood, Nontrans-sexual Type.
Impairment. Positive peer relations with members of the same sex are absent or difficult to establish. The amount of impairment varies from none to extreme, and Is related to the degree of associated psychopathology and the reaction of peers and family to the person's behavior.
Prevalence. The disorder is apparently uncommon.
Sex ratio. In clinic samples there are many more boys with this disorder than girls. The sex ratio in the general population is unknown.
Familial pattern. No information.
Predisposing factors. Studies indicate that characteristics of the child, the parents, or of other social agents, such as parental substitutes and siblings, may be predisposing factors for the development of the disorder. in boys, the characteristics may Include "feminine" physical features, an aversion to rough-and-tumble play, separation anxiety, and a history of early hospitalization. The relevant characteristics of parents and other influential people in the child's environment may include weak reinforcement of normative gender-role behavior, absence or unavailability of a father, and encouragement of extreme physical and psychological closeness with her son by a mother. In girls, a strong interest in rough-and-tumble play on the part of the child and weak reinforcement of normative gender-role behavior by the parents may contribute to the development of the disorder.
Differential diagnosis. Children whose behavior merely does not fit the cultural stereotype of masculinity or femininity should not be given this diagnosis unless the full syndrome is present. Physical abnormalities of the sex organs are rarely associated with Gender identity Disorder of Childhood.
(Diagnostic Criteria for Gender Identity Disorder of Childhood)
For Females: A. Persistent and intense distress about being a girl, and a stated desire to be a boy (not merely a desire for any perceived cultural advantages from being a boy), or insistence that she is a boy.
B. Either (1) or (2):
(1) persistent marked aversion to normative feminine clothing and insistence on wearing stereotypical masculine clothing, e.g., boys' underwear and other accessories
(2) persistent repudiation of female anatomic structures, as evidenced by at least one of the following:
(a) an assertion that she has, or will grow, a penis
(b) rejection of urinating in a sitting position
(c) assertion that she does not want to grow breasts or menstruate
C. The girl has not yet reached puberty.
For Males:
A. Persistent and intense distress about being a boy and an intense desire to be a girl or, more rarely, insistence that he is a girl.
B. Either (1) or (2);
(1) preoccupation with female stereotypical activities, as shown by a preference for either cross-dressing or simulating female attire, or by an intense desire to participate in the games and pastimes of girls and rejection of male stereotypical toys, games, and activities
(2) persistent repudiation of male anatomic structures, as indicated by at least one of the following repeated assertions:
(a) that he will grow up to become a woman (not merely in role)
(c) that it would be better not to have a penis or testes
C. The boy has not yet reached puberty.