Gender Identity Disorder: Counseling Facts, Stats, Info, How to Overcome: Sex Therapy Treatment
August 17, 2008 – 10:11 pmGender Identity Disorder
Portraits
Sam was named after her father, and has always been “Daddy’s favorite.” “That’s not to be confused with Daddy’s little girl,” she says. She also says, “I hate being a girl—I’m more boy than girl.”
Pat had a normal childhood, but around the age of 13 starting feeling that something was wrong. Now at 16 years of age, he isn’t developing physically like the other boys, and socially he’s being picked on more and more. One classmate commented about Pat, “What the heck is he? He walks, talks, and even looks like a girl.”
Once called Danny, Danielle has been taking hormone treatments for the last year to develop secondary sex traits common for women. “Hips and Breasts is a good first step,” Danielle says. “As soon as I can afford it, I’m getting the surgery to become a woman. I’ve been a woman my entire life on the inside. Now I will finally be a woman on the outside too.”
Definitions and Key Thoughts
Gender identity disorder is a diagnosis given to persons who meet a certain number of clinical criteria related to feelings of discontent regarding one’s biological sex, and identification with the opposite biological sex.
According to the American Psychiatric Association and the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) the following criteria must be met before a person can be give the official diagnosis of gender identity disorder:
- There must be evidence of a strong and persistent cross-gender identification.
- 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 individual must not have a concurrent physical intersex condition (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia).
- There must be evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The DSM-IV also provides diagnostic criteria for gender disorders that do not meet the criteria for the general gender identity disorder diagnosis. The following criteria are sufficient for a diagnosis of Gender Identity Disorder in Children as well as for Gender Identity Disorder Not Otherwise Specified (GIDNOS). For the former diagnosis, criteria must be identified before a person is 18 years of age.
- Intersex conditions (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia) and accompanying gender dysphoria
- Transient, stress-related cross-dressing behavior
- Persistent preoccupation with castration or penectomy without a desire to acquire the sex characteristics of the other sex, which is known as skoptic syndrome
Regarding origins of gender identity disorder, gender identity disorder in children is often reported as “having always been present,” and persons with the disorder do not remember a time when they were satisfied with their gender. Other persons with the disorder report that synptoms began in adolescence or adulthood, and seemed to grow in intensity over time.
Issues regarding gender identity can manifest in a variety of ways. For example, some people may cross-dress, while others may seek a sex-change surgery. Below is a list of other common “side effects” of gender identity disorder.
Children often:
- Express a desire to be the opposite sex
- Find their genitals or indicators of their gender gross
- Believe that they will grow up to become the opposite sex
- Are often rejected by their peers
- Become isolated and shy
- Develop moderate to severe anxiety
- Present low self-esteem
- Drop out of school
- Develop moderate to severe anxiety
Adults often:
- Desire to live as a person of the opposite sex
- Pursue a sex reassignment operation
- Both dress and act in a way that is indicative of the opposite sex
- Become socially isolated or ostracized
- Develop moderate to severe depression
- Develop moderate to severe anxiety
Some persons with gender identity disorder have genitalia and secondary sex characteristics in line with their biological sex. Others may have ambiguous genitalia, or are hermaphroditic (this can often lead to gender identity issues). Note: while a person may have an external ambiguous gender appearance, they are not both or of no biological sex. The chromosomes what designate sex (XX, XY) are still designate the person as male or female.
Not all transsexual persons (persons who dress or act as persons of the opposite gender) have gender identity disorder. Transvestic fetishism is another clinical condition (categorized as a paraphilia), and is described in another chapter in this book.
Homosexuals do not (generally speaking) have gender identity disorder. The majority of homosexuals identify strongly with their biological gender. Homosexuality involves only a sexual attraction to persons of the same gender.
Action Steps and Treatment Plan for Gender Identity Disorder
Treating gender identity disorder can be a slow and complicated process. Consider the following steps as places to begin. Note: With gender identity disorder, better recovery outcomes are associated with early diagnosis and treatment.
Step 1: Identify and Challenge Negative Thoughts about One’s Biological Sex
First, identify any negative thoughts that are being had in regards to one’s gender. For example, a male suffering from gender identity disorder may say, “Men are pigs. They are crude, crass, and uncaring. Unlike me, men are athletic and sportsmanlike. Men don’t enjoy art and fashion.”
Look at these negative statements and note if there are any “lies” or half-truths that are being said. For example, many men are not crass, are un-athletic, and enjoy art.
Step 2: Find Ways that One Can Identify with One’s Biological Sex
A person with gender identity disorder generally believes they cannot identify with their biological sex.
Assess what things are present in one’s life that do correspond with their biological sex. For example, a woman suffering from gender identity disorder may feel that she does not identify with cosmetics. However, she does identify with Grey’s Anatomy—a show watched by more females than males.
Note these similarities and continue to identify things that one does have in common with others of the same biological sex.
Step 3: Neutralize Physical Issues
Some persons with gender identity disorder have genitalia and secondary sex characteristics in line with their biological sex (meaning they have physically developed normally). However, others may be experiencing either ambiguous genitalia, or a hermaphroditic physical condition.
If the later is present, consider that even though one’s external appearance is different from the average person of a particular sex, genetically one is always fully male or fully female. This male or female designation does not occur in one’s phenotype (the way their body looks externally), it occurs in their genotype, whether they present XX or XY chromosomes.
Confirming one’s gender based on genetics, and considering outward biology as only secondary, may be an effective tool in reframing thoughts about gender identity.
