Gender identity disorder (GID), or what is also called gender dysphoria, is identified as a strong and persistent feelings of identification with the opposite gender and a discomfort with one’s own gender. Those with GID often believe that they are victims of a biological accident and are imprisoned in a body that is incompatible with their gender identity. An example of this might be a boy who feels and acts like a girl.
Those with GID live with an overwhelming desire to live as members of the opposite sex, often dressing and using the mannerisms normally associated with the other gender. They often even go so far as to submit to sexual reassignment surgery. Persons who have this extreme form of GID and submit to surgery are called transexuals. In the past, mental health professionals have called GID a “disorder”, since the subjects do not match the person’s psychological (felt) gender. However, the medical attitude to GID have now generally softened; the condition is now more commonly referred to as gender dysphoria.
It is important to understand, however, that this condition is not the same as homosexuality. Homosexuals almost always identify with their own gender, and they have a strong attraction to those of their own gender.
Gender Identity and GID
Gender identity is a subjective sense of knowing to which gender a person belongs. It is more than just saying “I am male” or “I am female.” Gender identity is a deep seated sense of masculinity or femininity, the point of which is the public expression of being male, female, or androgynous. As a result, for most people, there is a congruity between their genitalia, their identity, and their role. For those with GID, these identifiers are not quite so clear. Some of those with GID have identity issues that manifest themselves in a variety of different ways. For example, some people with normal genitalia and secondary sexual characteristics of one gender privately identify more with the other gender. Some may even dress more like the opposite sex, and some may even seek and receive sexual reassignment surgery. Others who are born with more ambiguous genitalia can raise even greater identity issues.
Associated Features of GID
Many individuals with GID become socially isolated, whether by choice or as a result of ostracization, which can often contribute to low self-esteem and can lead to school aversion or even dropping out. Peer ostracism and harassment are especially common consequences for boys with GID.
Disturbances in the lives of those with GID cause some to isolate their lives to activities that lessen gender distress. They are often overtly preoccupied with their appearance, especially when they are early in the gender transition phase. Those with GID often experience difficulties in their relationships with their parents, often even experiencing abandonment of those relationships.
Some males with GID resort to self-administration of hormones and a rare few might even perform their own castration or penectomy. Some males with GID, especially those in urban centers, often engage in prostitution, which places them at high risk of contracting HIV. Many of those with GID attempt suicide and/or endure substance abuse.
Children and GID
Gender identity struggles may begin as early as age two to four years, when children begin to exhibit interest in cross-gender activities. Most will outgrow symptoms of gender identity disorder before adolescence. By late adolescence or adulthood, about three quarters of boys with symptoms of GID report homosexual or bisexual orientations. Most of the remaining 25 percent live as heterosexuals. A small percentage of adolescents and adults will go on to identify as transsexuals.
Symptoms of Child Gender Identity Disorder
- The desire to be a member of the opposite sex, including passing themselves as a member of the opposite sex, and even wishing to be known by a name identified as belonging to the opposite sex.
- A disgust with their own genitalia. Boys often pretend that they do not have a penis and may sit while urinating. Girls may grow increasingly uncomfortable with the development of their breasts and of menstruating. They may also refuse to sit while urinating. Girls may also bind their breasts in an attempt to make their growth less noticeable.
- A belief that they will grow up to become a member of the opposite sex.
- Ostracism by their peer groups as well as harassment by others.
- Dressing and exhibiting behavior which is typical of the opposite sex (i.e., a female who wears boy’s underwear).
- Withdrawal from social interactions and activities.
- Feelings of isolation, depression, and anxiety.
Adolescents with GID are particularly at risk for depression and suicide attempts.
What Causes GID?
The exact cause of GID is unknown, but professionals have many theories. These theories include genetic abnormalities, hormonal imbalances in the course of development, even prior to birth, defective human bonding and child rearing, or a combination of all these factors and more.
Adults with GID often display anxiety and symptoms of depression. Some adult males with GID have a history of transvestic fetishism and other paraphilias.
Although most of those who eventually become transsexuals began having gender identity issues in early childhood, some do not attempt to publicly present until adulthood. Male-to-female transsexuals often cross-dress first and only later in life accept their cross-gender identity. Marriage and military service are common among transsexual men who seek to run from their cross-gender feelings. Once they accept their cross-gender feelings, many transsexuals adopt a convincing public feminine gender role. Some are satisfied with mastering a more feminine appearance and obtaining an identity card (i.e., a driver’s license) as a female to help them work and live in society as women. Others experience more severe psycho-social problems, which may include depression and suicidal behavior.
How Common is GID?
GID is a rare condition and affects both children and adults. It often appears initially in early childhood. Further, most of those with GID recognize that they have the identity issue before they reach their adolescence. GID occurs far more frequently in males than in females.
How is GID Diagnosed?
GID is most often diagnosed by a trained mental health professional, either a psychiatrist or a psychologist. In diagnosis a professional will conduct a thorough medical history and psychological examination in order to rule out other possible causes. These might include depression, anxiety or psychosis. GID is diagnosed after the complete evaluation confirms that the person exhibits a persistent desire to be a member of the opposite sex.
Treatment of the Disorder
For children with GID, individual and family counseling, along with social and physical interventions are recommended. Children with gender identity disorder may develop symptoms of depression, generalized anxiety and separation anxiety disorder. Adolescents may be at risk for depression, suicidal thoughts or suicide attempts. Counseling should focus on improving self-esteem and treating associated complications.
Parents are encouraged to allow their child to explore fantasies about being a member of the opposite gender in a safe and tolerant environment. Additionally, parents are offered suggestions such as using gender-neutral language, making gay-friendly media available, and encouraging the child to participate in any activities she or he is interested in without judgment.
When GID is diagnosed in an adult, a multifaceted therapeutic approach begins. Moreover, patients may choose hormone therapy, undertake a Real-Life Experience (living full time in their desired gender for a year or longer) and sexual reassignment surgery. Patients desiring gender reassignment surgery undergo extensive evaluation, therapy and a transition period before they can be approved for surgery.
According to the American Psychological Association, the transgendered suffer from a higher than average rate of depression, anxiety, suicide and self-mutilation, yet rarely seek treatment. Untreated gender identity disorders may manifest in associated disorders and emotional distress that can interfere with the individual’s ability to function socially at school, at work, or in relationships. Treatment helps a patient achieve and maintain a healthy and stable life.
Cross-gender behavior, such as cross-dressing, may not require treatment if it occurs without concurrent psychological distress or functional impairment. Also, no treatment is necessary if a person has a physical intersex condition (eg, congenital adrenal hyperplasia, ambiguous genitals, androgen insensitivity syndrome).
Most transsexuals who request treatment are natal males who claim a feminine gender identity and regard their genitals and masculine features with repugnance. However, as treatments improve, female-to-male transsexualism is increasingly seen in medical and psychiatric practice. Transsexuals’ primary objective in seeking medical help is not to obtain psychological treatment but to obtain hormones and genital surgery that will make their physical appearance approximate their gender identity. The combination of psychotherapy, hormonal reassignment, and sex reassignment surgery is often curative when the disorder is appropriately diagnosed. Clinicians follow the internationally accepted standards of care for the treatment of gender identity disorders, available from the World Professional Association for Transgender Health.