Gender Identity Disorder
There are two components of Gender Identity Disorder, both
of which must be present to make the diagnosis. Thee 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 (Criteria A). 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 ones assigned sex or a sense of
inappropriateness in the gender role of that sex (Criteria B). The diagnosis is not made
if the individual has a concurrent physical intersex condition (e.g., androgen
insensitivity syndrome or congenital adrenal hyperplasia) (Criteria C). To make the
diagnosis, there must be evidence of clinically significant distress or impairment in
social, occupational, or other important areas of functioning (Criteria D).
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.
discomfort with his or her sex or sense of inappropriateness in the gender role of that
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.
is not concurrent with physical intersex condition.
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. This is shown by any
symptoms such as:**
* Preoccupation with hormones, surgery or other physical means to change one's sex
* 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.
Assign code number according to current age:
302.85 Gender Identity Disorder in
Adolescents or Adults
302.6 Gender Identity Disorder in Children
For patients who are sexually mature, specify whether:
Sexually Attracted to Males
Sexually Attracted to Females
Sexually Attracted to Both Males and Females
Sexually Attracted to Neither Males nor Females
Separation Anxiety Disorder
Generalized Anxiety Disorder
Symptoms of Depression
Androgen Insensitivity Syndrome
Congenital Adrenal Hyperplasia.
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.
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.
Counselling and supportive system establishment are thought
to be the best appraoches to treating this disorder
Counseling and Psychotherapy [ See Therapy Section
Individual and family
counseling is recommended for children, and individual or couples therapy is recommended
Medical & Other:
Sex reassignment through surgery and hormonal therapy is an
option, but often severe problems persist after this form of treatment.
*Children who are younger than adolescent age must have
4 or more of the following signs of identity with the other sex:
- Reiterated desire to be, or insistence that the patient is, the other sex
- Boys prefer cross-dressing or simulating female garb; girls insist on wearing only male
-The child persistently and strongly prefers cross-sex roles in fantasy play or has
repeatedly fantasizes about being the other sex.
- The child badly wants to participate in games and pastimes of the other sex.
-The child strongly prefers to play with children of the other sex.
**A boy's discomfort with his assigned sex may be shown
by any of:
- Disgust with his genitals
- Assertion that his genitals will disappear or that it would be better not to have a
- Rejection of rough-and-tumble play and male activities, games and toys
**A girl's discomfort with her assigned sex may be shown
by any of:
- Rejection of urinating in a seated position
- Desire not to develop breasts or menstruate
- Claims that she will have a penis
- Pronounced dislike for usual female clothing