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.
