Gender Identity Disorder - University of Florida

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Gender Identity Disorder

What is gender identity disorder?

A person with a gender identity disorder is a person who strongly identifies with the other sex. The individual may identify with the opposite sex to the point of believing that he/she is, in fact, a member of the other sex who is trapped in the wrong body. This causes that person to experience serious discomfort with his/her own biological sex orientation. The gender identity disorder causes problems for this person in school, work or social settings. This disorder is different from transvestism or transvestic fetishism where cross-dressing occurs for sexual pleasure, but the transvestite does not identify with the other sex.

What characteristics occur with gender identity disorder?

Boys with gender identity disorder tend to prefer to dress in girls' clothes. They often avoid competitive sports and have little interest in rough and tumble games. They frequently prefer to play games with girls, and they enjoy girls as playmates. They usually enjoy acting as a female figure, such as a mother or a princess, in the games they play. Boys with gender identity problems pretend not to have a penis; they want it removed, and they wish they had a vagina.

Girls with gender identity disorder prefer to wear boys' clothes and want to look like a boy. They prefer boys as playmates and often enjoy competitive contact and rough play. Girls with gender identity disorder wish they could grow a penis, and do not look forward to growing breasts or menstruating. They would like to be a man when they grow up.

Adults with gender identity disorder sometimes live their lives as members of the opposite sex. They tend to be uncomfortable living in the world as a member of their own biologic or genetic sex. They often cross-dress and prefer to be seen in public as a member of the other sex. Some people with the disorder request sex-change surgery.

Does gender identity disorder affect males, females, or both?

Gender identity disorder is more prevalent in males than in females.

At what age does gender identity disorder appear?

This disorder can be evident in early childhood. Most people know whether they have a gender identity problem by the time they reach adolescence.

How is gender identity disorder diagnosed?

A mental health professional makes a diagnosis of gender identity disorder by taking a careful personal history from the client/patient. No laboratory tests are required to make a diagnosis of gender identity disorder. However, it is very important not to overlook a physical illness that might mimic or contribute to a psychological disorder. If there is any question that the individual might have a physical problem, the mental health professional should recommend a complete physical examination by a medical doctor. Laboratory tests might be necessary as a part of the physical workup.

Frequently, people with gender identity disorder complain that they were "born the wrong sex." They describe their sexual organs as "ugly" and may refrain from touching their genitalia. Although the genitalia of people with gender identity disorder is normal, those with the disorder may show signs of trying to hide their secondary sex characteristics. For instance, males may try to shave off or pluck their body hair, or they may take female hormones in an effort to enlarge their breasts. Females may try to hide their breasts by binding them close to their chest walls.

How is gender identity disorder treated?

Psychological therapy can alter the course of gender identity disorder. Early intervention can lead to less transsexual behavior later in life. The initial focus of the treatment is to help the individual function in his/her biologic sex role as well as possible.

Adults who have severe gender identity disorder which has persisted for many years sometimes request reassignment of their sex, or sex-change surgery. Prior to this kind of surgery they usually go through a long period of hormone therapy which attempts to suppress same sex characteristics and accentuate other sex characteristics. For instance, males that have gender identity disorder will be given the female hormone, estrogen. The estrogen causes the male breasts to enlarge, testes to become smaller, and body hair to diminish. Females with gender identity disorder will be given the male hormone, testosterone, to help them develop a lower voice and possibly a full beard. Following the hormone treatment, the adult will be asked to live in a cross-gender role before surgery to alter their genitalia or breasts is performed.

What happens to someone with gender identity disorder?

If the disorder persists into adolescence, it tends to be chronic in nature. There may, however, be periods of remission.

What can people do if they need help?

If you, a friend, or a family member would like more information and you have a therapist or a physician, please discuss your concerns with that person.



GENDER IDENTITY DISORDER What is Gender Identity Disorder? The term "gender identity" refers to a person's inner sense of self as male or female. For most people, their anatomical sex at birth corresponds to their gender identity. People with GID, however, experience a persistent and recurrent discordance between their anatomical birth sex and psychological gender.

How well-known is GID among mainstream medical professionals? GID is a well known and established mental disorder, recognized under DSM-IV Section 302.85. (The Diagnostic Statistical Manual of Mental Disorders) DSM is the generally recognized authoritative handbook on the diagnosis of mental disorders relied upon by mental health professionals, and GID (then called transsexualism) was first included in the DSM in 1980.

Besides the DSM, what other medical authorities recognize GID? Standard texts such as the American Medical Association Encyclopedia, the Merck Manual, the World Health Organization's International Classification of Diseases all include Gender Identity Disorder. GID is discussed in standard psychiatric texts including Psychiatry, The Treatment of Psychiatric Disorders, Kaplan & Sadock's Comprehensive Textbook of Psychiatry, and the New Oxford Textbook of Psychiatry.

How is it diagnosed? A mental health professional makes the diagnosis, using the four diagnostic criteria identified by medical texts. First, a person must have a strong and persistent cross-gender identification; second, the disturbance causes persistent, intense discomfort with one's sex or sense of inappropriateness in the gender role of that sex; third, the person in question

was not born with a physical intersex condition; and fourth, the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

How many people have GID? There are currently no reliable estimates for the prevalence of GID in the United States. However, its occurrence is frequent enough that it has been identified, documented, and studied, and standards of care developed for its treatment.

How is GID treated? The medical treatment of a person diagnosed with GID is based on an individualized plan involving one or more of three major components: 1) hormones of the desired gender; 2) living full-time in the new gender, known as the "real life experience"; and 3) surgery to change the genitalia and other sex characteristics. Treatment plans are based on standards of care developed by the World Professional Association of Transgender Health (formerly the Harry Benjamin International Gender Dysphoria Association).

Why is the "real life experience" of living full time in the desired gender part of the treatment? The real-life experience allows a person to confront the tremendous personal and social consequences of crossing over to the desired gender. The experience helps identify any ambivalence about proceeding with transitioning. It also helps the person address issues of external appearance and learn how to present successfully in the new gender.

When is surgery recommended for someone with GID? A patient must meet minimum criteria before getting surgery, demonstrating both eligibility and readiness. To be considered "eligible", a person must receive 12 months of hormone therapy; have 12 months of real life experience; demonstrate awareness of surgery's cost, length of hospitalization, possible complications, and required rehabilitation; engage a competent surgeon; and be of age. To be considered "ready", a person must demonstrate progress in consolidating his or her gender identity, and demonstrate progress in dealing with any work, family, or interpersonal issues.



Gender Identity

It is a matter of professional responsibility to correct certain statements made by Lawrence Newman, M.D., in the December 5 article, "Children With Gender-Identity Disorder Benefit From Early Psychiatric Intervention."

To his credit, Dr. Newman urges compassion and kindliness toward children with a disturbance in gender-defined sexual identity. He accurately states that such a condition leads to a lifelong disturbance in an individual's relationship with himself and with others, as well as producing isolation, depression, and anxiety in a prehomosexual child as he grows from childhood into adolescence and later adulthood. He announces correctly, but with apparent unconcern over this dire development, that such children, of course, will "develop a homosexual orientation in later life." But he makes no reference to the possibility of the reversal of this condition, while, in actuality, there are multiple case reports now appearing in the literature attesting to its reversibility.

He bases this assertion on a mysterious "landmark long-term study"-without citing it-that there is "no known therapy which could change this probability." This is completely erroneous and misleading, both to parents and to the child, as well as to the multitude of readers of Psychiatric News worldwide.

We cite, for example, Edward Glover's report (1960 Portman Clinic Survey), a factgathering committee report of the American Psychoanalytic Association (1956), the Bieber et al. report (1962), and the findings of Socarides (1978, 1997). He has completely disregarded the MacIntosh report (1994) published in the Journal of the American Psychoanalytic Association (1995) that in a responsive survey of 285 psychoanalysts who reported having analyzed 1,250 homosexual patients, 23 percent changed to heterosexuality from homosexuality and that 85 percent had significantly benefited from therapy. The National Association for Research and Therapy of Homosexuality report of 1997 confirms MacIntosh's study.

We take exception to Dr. Newman's attitude that parents disturbed over this development are "homophobic"-an erroneous term (for it does not meet the criteria of phobia) coined by the gay movement to stigmatize all parents who disapprove of this condition, for no parent ever raises a child to be a homosexual.

Tolerance, compassion, and understanding of both child and parents, along with a recommendation for psychoanalytic therapy, should be the position of dedicated and responsible psychiatrists.

One's compassion for the plight of the prehomosexual child and his parents, the child's own responsiveness as a patient, and his value as a human being lead to a mutuality of

gratitude and satisfaction between child, parent, and therapist that well justifies the commitment to the alleviation of this important and serious disorder.

It is no kindness to children with a gender-identity disorder disturbance in gender-defined self--identity-a precursor to adult homosexuality and other sexual deviations-to suggest that this condition should be not only accepted but embraced by both the patient and his family.

Charles W. Socarides, M.D. New York, N.Y.

For: Abraham Freedman, M.D. Philadelphia, Pa.

Harold Voth, M.D. Topeka, Kan.

C. Downing Tait, M.D. Atlanta, Ga.

Benjamin Kaufman, M.D. Sacramento, Calif.

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