GENDER IDENTITY DISORDER

Gender identity disorder (GID) is a condition in which a person experiences discomfort with the biological sex with which they were born to such an extent that it becomes clinically significant. Children with GID typically behave as children of the opposite sex do, choosing to dress like them, play their games, prefer their toys, and use their verbal and physical mannerisms. All of the child’s friends are usually of the opposite sex, and they may avoid playing with anything or anyone related to their own gender. Very young children may not verbalize the desire to be the other sex, but they usually do by mid-childhood. Boys tend to have a very effeminate manner, but it is harder to recognize in females, as tomboyish behaviour is relatively common

DIAGNOSTIC CRITERIA:

1. 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 four (or more) of the following:
2. repeatedly stated desire to be, or insistence that he or she is, the other sex;
3. in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing;
4. Strong and persistent preferences for cross-sex roles in make-believe play, or persistent fantasies of being the other sex;
5. intense desire to participate in the stereotypical games and pastimes of the other sex;
6. strong preference for playmates of the other sex.
7. B) Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.
8. C) The disturbance is not concurrent with a physical intersex condition.

 D)The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

AETIOLOGY

The cause of this disorder is unknown. A number of factors have been shown to influence psychosexual development, but their relationship to GID is currently unclear.

• Hormones. Female children with congenital adrenal hyperplasia produce an excess of androgens, leading to virilization. These children tend to engage in more masculine games and behaviors from a young age, and often have male friends. However, they do not have the psychological wish to be the other sex. There have been several cases of male children who have undergone penectomy secondary to trauma and were reassigned to female before 2 years of life. These children, although brought up as females, tend to revert to their original sex in early adulthood, or become homosexual in orientation. This suggests a prenatal influence on gender identity.
• Early differences in behavior. Children as young as 10 months are thought to be able to distinguish between those who are the same and opposite sex from themselves. By 12 months, children start to show a preference for toys associated with their sex, and start to prefer the company of the same-sex parent. Boys begin to be more assertive an physically aggressive at about 18 months, whilst girls are more passive. At about this age, children become aware of sex stereotypes, believing that boys like to play with trucks and build things, whereas girls cook and play with dolls.
• Parental influences. There is robust evidence that parents tend to buy toys for their child that are gender related—dolls for girls and soldiers for boys. When mothers are presented with a young child call John and dressed as a boy, they treat them as a boy, even if the child is actually a dressed-up girl.

MANAGEMENT

Assessment of a child with GID should include all of the elements of a basic assessment outlined in the previous chapter.

Psychoeducation- is a key part of treating GID. Educating the whole family about gender identity, normal and abnormal, is very important and helps to establish that it is not necessary for boys to behave in one specific way, and that variation is normal.

Behaviour modification techniques - can be used to help the child. Finding other children of their biological sex who are less stereotypical in their behaviours (e.g. sporty girls, nonphysical more home-orientated boys) can assist the child in widening their peer group and interests. Individual therapy can be used in slightly older children, to address abnormal thought paths and associated psychological issues.

Cross-gender living- A small number of families make the decision to allow the child to live as the opposite sex. This is not a decision to be made lightly, and involves considerable discussion with all concerned, including the child’s school. Once the child is a teenager, puberty can be a very distressing time. Physical changes are unwanted, and problems such as facial hair and menses are particularly difficult to contend with.