There are two
components of Gender Identity Disorder, both of which must be present
to make the diagnosis. There must be evidence of a strong and persistent
gross-gender identification, which is the desire to be, or the insistence
that one is of the other sex. This cross-gender identification must
not merely be a desire for any perceived cultural advantages of being
the other sex. there must also be evidence of persistent discomfort
about one’s assigned sex or a sense of inappropriateness in the
gender role of that sex. The diagnosis is not made if the individual
has a concurrent physical intersex condition (e.g., androgen insensitivity
syndrome or congenital adrenal hyperplasia). To make the diagnosis,
there must be evidence of clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
Diagnostic Criteria
for Gender Identity Disorder:
A strong 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:
Repeatedly stated
desire to be, or insistence that he or she is, the other sex.
In boys, preference
for cross-dressing or simulating female attire; In girls, insistence
on wearing only stereotypical masculine clothing.
Strong and persistent
preferences for cross-sex roles in make believe play or persistent
fantasies of being the other sex.
Intense desire
to participate in the stereotypical games and pastimes of the other
sex.
Strong preference
for playmates of the other sex.
In adolescents
and adults, the disturbance is manifested by symptoms such as a
stated desire to be the other sex, frequent passing as the other
sex, desire to live or be treated as the other sex, or the conviction
that he or she has the typical feelings and reactions of the other
sex.
Persistent discomfort with his or her sex or sense of inappropriateness
in the gender role of that sex. In children, the disturbance is manifested
by any of the following:
In boys, assertion
that his penis or testes are disgusting or will disappear or assertion
that it would be better not to have a penis, or aversion toward
rough-and-tumble play and rejection of male stereotypical toys,
games, and activities.
In girls, rejection of urinating in a sitting position, assertion
that she has or will grow a penis, or assertion that she does not
want to grow breasts or menstruate, or marked aversion toward normative
feminine clothing.
In adolescents
and adults, the disturbance is manifested by symptoms such as preoccupation
with getting rid of primary and secondary sex characteristics (e.g.,
request for hormones, surgery, or other procedures to physically
alter sexual characteristics to simulate the other sex) or belief
that he or she was born the wrong sex.
The disturbance is not concurrent with physical intersex condition.
The disturbance causes clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
The patient strongly and persistently identifies with the other sex.
This is not simply a desire for a perceived cultural advantage of
being the other sex. In adolescents and adults, this desire may be
manifested by any of::-
Stated wish
to be the other sex.
Often passing as the other sex.
Wish to live or be treated as the other sex.
Belief that the patient's feelings and reactions are typical of
the other sex.
There is strong discomfort with the patient's own sex or a feeling
that the gender role of that sex is inappropriate for the patient:-
Preoccupation
with hormones, surgery or other physical means to change one's sex
characteristics.
Patient's belief in having been born the wrong sex.
The patient does not have a physical intersex condition.
These symptoms cause clinically important distress or impair work,
social or personal functioning.
Associated Features:
Separation
Anxiety Disorder
Generalized Anxiety Disorder
Symptoms of Depression
Transvestic Fetishism
Other
Paraphilias.
Androgen Insensitivity Syndrome
Congenital Adrenal Hyperplasia.
Differential
Diagnosis:
Some disorders have similar or even the same symptoms. The clinician,
therefore, in his/her diagnostic attempt has to differentiate against
the following disorders which need to be ruled out to establish a
precise diagnosis. Children
with Gender Identity Disorder may manifest coexisting Associated Personality
Disorders are more common among males than among females being evaluated
at adult gender clinics.
Schizophrenia.
Delusions.
Cause:
The onset of cross-gender
interests and activities is usually between ages 2 and 4 years, and
some parents report that their child has always had cross-gender interests.
Only a very small number of children with Gender Identity Disorder
will continue to have symptoms that meet criteria for Gender Identity
Disorder in later adolescence or adulthood. Typically, children are
referred around the time of school entry because of parental concern
that what they regarded as a phase does not appear to be passing.
Most children with Gender Identity Disorder display less overt cross-gender
behaviors with time, parental intervention, or response from peers.
In adult males,
there are two different courses for the development of Gender Identity
Disorder. The first is a continuation of Gender Identity Disorder
that had an onset in childhood or early adolescence. These individuals
typically present in late adolescence or adulthood. In the other course,
the more overt signs of cross-gender identification appear later and
more gradually, with a clinical presentation in early to mid-adulthood
usually following, but sometimes concurrent with, Transvestic Fetishism.
The later-onset group may be more fluctuating in the degree of cross-gender
identification, more ambivalent about sex-reassignment surgery, more
likely to be sexually attracted to women, and less likely to be satisfied
after sex-reassignment surgery. Males with Gender Identity disorder
who are sexually attracted to males tend to present in adolescence
or early childhood with a lifelong history of gender dysphoria. In
contrast, those who are sexually attracted to females, to both males
and females, or to neither sex tend to present later and typically
have a history of Transvestic Fetishism. If Gender Identity Disorder
is present in adulthood, it tends to have a chronic course, but spontaneous
remission has been reported.
