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Gender Identity Disorder

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.



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 approaches 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 for adults.

Medical & Other:

Sex reassignment through surgery and hormonal therapy is an option, but often severe problems persist after this form of treatment.


DSM Code

302.6 Gender Identity Disorder in Children

302.6 Gender Identity Disorder NOS

F64.2 Gender Identity Disorder

Disorder Sheets

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Recommended Book

Gender Identity Disorder and Psychosexual Problems in Children and Adolescents - Click Here to View


Gender Identity Disorder

Misc Information


Gender Identity Disorder's