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Block 4 Unit 3 Gender Identity Disorder

1. What is intersex condition?

An intersex condition refers to a situation where an individual's physical sex characteristics are ambiguous or not clearly defined as either male or female. This may include variations in genitalia, chromosomes, or hormone levels. The source specifically mentions examples like androgen insensitivity syndrome or congenital adrenal hyperplasia.

2. What is meant by cross-gender identification?

Cross-gender identification is a key component of gender identity disorder, referring to a strong and persistent desire to be, or the insistence that one is, the opposite gender. It goes beyond simply wanting the perceived cultural advantages of the other gender. The desire is so strong that the individual may believe they are "trapped in the wrong body".

3. Describe the symptoms of Gender Identity Disorder.

Symptoms of Gender Identity Disorder (GID) include:

• Strong and persistent cross-gender identification: This is not simply a desire for perceived cultural advantages of the other sex.
• Persistent discomfort with one's assigned sex: This includes a sense of inappropriateness in the gender role of that sex.
• In children, this may manifest as:
  • A stated desire to be the other sex or insistence that they are the other sex.
  • Preference for cross-dressing or opposite-sex roles in play.
  • Rejection of typical toys and games of their assigned sex.
  • Aversion towards their own genitals.
  • A strong preference for playmates of the opposite sex.
• In adolescents and adults, this may manifest as:
  • A stated desire to be the other sex, to live or be treated as the other sex.
  • Frequent "passing" as the other sex.
  • A desire to get rid of primary and secondary sex characteristics or belief that they were born the wrong sex.
  • A conviction that they have typical feelings and reactions of the other sex.
  • Social isolation, depression and/ or anxiety
• The individual may also:
  • Believe they will grow up to be the opposite sex.
  • Experience low self-esteem.
  • Drop out of school.

• The disturbance is not concurrent with a physical intersex condition
• The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

4. What are the causes of GID?

The causes of Gender Identity Disorder (GID) are complex and not fully understood, involving a combination of biological, psychological, and social factors.

• Biological theories suggest hormonal influences on the developing fetus may play a role, where the individual develops a "gender map" more typical of the opposite sex. Evidence suggests that higher levels of testosterone may cause tomboyishness in girls, or high aggression levels in boys.
• Social learning theory suggests that gender roles are learned through observation and reinforcement.
• Cognitive-developmental theory proposes that children develop an understanding of gender over time, recognizing that they are either male or female and that gender is consistent over time and across situations. The source notes that for most children, there is no issue, but when there is a sex/gender incongruence, they become perplexed.
• Regardless of the theory, the individual's internal sense of gender drives their behaviour and, that even in gender dysphoric children, confusion can be a source of internal conflict and distress.

5. What theories are associated with GID?

• Biological Theory: High levels of testosterone are associated with high levels of aggression in boys and tomboyishness in girls.
• Social Learning Theory: Gender is a result of a combination of observational learning and differential reinforcement.
• Cognitive-Developmental Theory: Gender understanding follows a prescribed timeline. Children recognise their gender by the age of two or three, recognise that it is stable over time, and, finally, by age six or seven, understand that it is stable across situations.
• Psychoanalyst Robert Stoller and behavioural psychologist John Money were instrumental in early theories of gender identity. Stoller introduced the term gender identity, and Money popularized an interactionist theory of gender identity, suggesting that it is fluid up to a certain age and subject to negotiation.
• John Money coined the term "gender maps" to describe the internal coding of masculinity, femininity and androgyny which is established early in life through the interaction of nature and nurture.

6. Define and describe Gender Identity Disorder.

Gender Identity Disorder (GID) is a condition where an individual experiences a strong and persistent identification with the opposite gender, and feels significant discomfort with their assigned sex. It's characterized by the belief that one is "trapped in the wrong body," and is not simply a desire to have the perceived cultural advantages of the opposite sex. GID can manifest in childhood, adolescence, or adulthood. It is considered a psychiatric term for what is widely known as transsexuality, transgender, transvestism, or cross-dressing.

7. Discuss the origin of gender identity disorder.

• During the 1950s and 60s, psychologists began to study gender development in young children, partly to understand the origins of homosexuality, which was then considered a mental disorder. Psychoanalyst Robert Stoller introduced the term "gender identity," and behavioral psychologist John Money was instrumental in the development of early theories. His work popularized an interactionist theory of gender identity, suggesting that gender identity is relatively fluid and subject to negotiation up to a certain age.
• The notion of gender identity was added to the Diagnostic and Statistical Manual of Mental Disorders in the 3rd edition, in the form of two diagnoses: gender identity disorder of childhood (GIDC) and transsexualism. Later versions added and removed other diagnoses, and the term was eventually changed to "gender identity disorder".

8. Describe the component factors in GID.

Two main components of GID that must be present to make a diagnosis:

• Evidence of a strong and persistent cross-gender identification: The desire to be, or the insistence that one is, the other sex. This is not just about wanting the cultural benefits of the opposite sex.
• Evidence of persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender role of that sex.

9. Explain the symptoms of gender identity disorder.

Symptoms of gender identity disorder include:

• A strong and persistent cross-gender identification, not simply a desire for cultural advantages. This may be exhibited through preferences for clothing, games, and roles of the opposite sex.
• Persistent discomfort with one's assigned sex or gender role. This may present as an aversion to one's own genitals, a desire to get rid of them, or a desire to have the genitalia of the opposite sex.

• In children, this is manifested by a stated desire to be the other sex, a rejection of typical toys, and an aversion to one’s genitals.
• In adolescents and adults, this presents as a desire to live as a member of the opposite sex, to be treated as the opposite sex, or to obtain hormone therapy or surgery to alter their physical characteristics.

10. How would you diagnose the existence of gender identity disorder?

The diagnosis of Gender Identity Disorder involves meeting specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV):

• Evidence of strong and persistent cross-gender identification: This is not a desire for perceived cultural advantages of the other sex.
• Evidence of persistent discomfort about one's assigned sex or inappropriateness in the gender role of that sex.
• Absence of a concurrent physical intersex condition.
• Evidence of clinically significant distress or impairment in social, occupational, or other areas of functioning.

• Different criteria are used for diagnoses of gender identity disorder in children, adolescents, and adults, with differences in the way the symptoms present at the different stages of development.

11. Explain the various treatments for gender identity disorder.

Various treatment options for Gender Identity Disorder (GID):

• For children, treatment often focuses on secondary issues such as depression and anxiety, improving self-esteem, and exploring positive identifications with their biological gender. Treatment may also involve psychosocial therapy for the child, and family therapy for the parents.
• For adults, treatment typically follows a multi-faceted therapeutic approach:
  • Support groups and counseling (both individual and couples counselling).
  • Hormone therapy, to induce physical characteristics of the desired gender.
  • Real-Life Experience (living full time in their desired gender for a year or longer).
  • Gender reassignment surgery after a period of evaluation and therapy.
• Psychological techniques aimed at altering gender identity to match the assigned sex are not typically effective. However, psychological therapy can help patients adjust and live successful, productive lives.
• Counselling should include educating both the individual and their families on the complexities of GID, including behaviours, dysphoria, and homosexuality.

12. Describe the features of gender identity disorder.

Features of Gender Identity Disorder

• Early Onset: GID is often reported as "having always been there," with many individuals recalling experiencing feelings that they were the opposite sex from an early age. While the condition can become apparent in adulthood, it often presents in childhood or adolescence.
• Stability: Once established, an individual’s sense of gender is unchangeable over their lifetime.
• Pervasive: GID affects various areas of a person’s life, causing discomfort and distress in social, occupational, and other significant areas of functioning.
• Clinically Significant Maladaptation: The persistent discomfort and distress stemming from GID can lead to a variety of problems and impairments in social, occupational, and other key areas of life.
• Cross-Gender Identification: A strong and persistent identification with the opposite gender is a primary feature. This is not simply a desire for perceived cultural advantages of the other sex, but a deep-seated feeling of being the other gender.
• Discomfort with Assigned Sex: Individuals experience persistent discomfort with their assigned sex or a sense of inappropriateness in the gender role of that sex. They may believe that they are trapped in the wrong body.

13. What is transgender? Explain

• The term "transgender" encompasses a broad range of identities and expressions related to gender. It includes individuals whose gender identity does not align with their sex assigned at birth.
• Those who consider themselves transgendered may include:
  • Transsexuals: Individuals who may or may not have undergone sex reassignment surgery.
  • Transvestites: Individuals who wear clothing and adopt behaviours of the opposite sex.
  • People with ambiguous genitalia.
  • People who have chosen to perform either an ambiguous gender role or no gender role at all.
• There are differing points of view on transgender issues:
  • Essentialist/Naturalist: This viewpoint believes that there is no difference between sex and gender, and that there are only two genders that cannot be changed.
  • Social Constructivist: This viewpoint believes that sex and gender are social constructs assigned by society.
  • Performance: This viewpoint understands gender through performance studies such as body position, gesture and facial expressions.
  • Memory and Language Generation: This viewpoint looks at the body as the expression of the symbols of words, gestures and cultural language. It sees the body as having deeper knowledge not registered by the mind.
• The study of transgender is a growing field influencing multiple disciplines like anthropology, psychology, and gender studies.

14. Describe the GID symptoms of children.

GID Symptoms in Children

• Children with GID often exhibit a strong and persistent cross-gender identification. This is demonstrated through:
  • Repeatedly stating a desire to be or insisting they are the other sex.
  • Preference for cross-dressing or simulating the attire of the opposite sex.
  • Strong preference for cross-sex roles in play or persistent fantasies of being the other sex.
  • Intense desire to participate in the games and pastimes of the opposite sex.
  • A strong preference for playmates of the opposite sex.
• They also experience persistent discomfort with their assigned sex:
  • Boys may assert that their penis or testes are disgusting or will disappear, or that it would be better not to have them.
  • Girls may reject urinating in a sitting position, assert they have or will grow a penis, or that they do not want to grow breasts or menstruate.
• They may also show:
  • Rejection of typical toys and games of their assigned sex.
  • Aversion towards their own genitals.
• These children may become isolated, develop anxiety and low self-esteem.

15. Elucidate the symptoms of GID in adolescents and adults.

GID Symptoms in Adolescents and Adults

• Adolescents and adults with GID exhibit symptoms including:
  • A stated desire to be the other sex.
  • Frequent "passing" as the other sex.
  • A desire to live or be treated as the other sex.
  • A conviction that they have the typical feelings and reactions of the other sex.
  • A desire to get rid of primary and secondary sex characteristics.
• They may also:
  • Be preoccupied with getting rid of primary and secondary sex characteristics.
  • Request hormone therapy or surgery to simulate the other sex.
  • Dress and act in a way indicative of the opposite sex.
  • Become socially isolated or ostracised.
  • Develop moderate to severe depression and anxiety.

16. What are hormonal and surgical treatments for GID?

Hormonal and Surgical Treatments for GID

• Hormone Therapy:
  • For male-to-female transitions, hormones are used to suppress male characteristics and develop female ones such as breasts and a more feminine body shape.
  • For female-to-male transitions, hormones are used to promote male characteristics like facial hair and a lower voice.
• Surgical Treatments:
  • Male-to-female surgery involves a vaginoplasty to create a neo-vagina, removal of the penis and testes, and corrective plastic surgery.
  • Female-to-male surgery may involve a phalloplasty to create a neo-phallus, removal of breasts, uterus and ovaries.
• These treatments are considered medically necessary interventions.
• Candidates for surgery are evaluated extensively and are required to live for a time in their desired gender before the procedure.
• These treatments are usually not offered to individuals under 18 years of age.

17. Describe the psychological treatments for GID.

Psychological Treatments for GID

• Psychotherapy:
  • Aims to help people bring their true feelings to the surface so they can experience and understand them better.
  • Helps alter the course of GID problems and assists with adjustment to life, often by helping the person live out their daily lives as the gender which matches their internal sense of self.
• Counselling:
  • Provides support and guidance for individuals and families.
• Helps patients and families understand the complexities of GID.
• Educates on issues of GID, gender dysphoria, and homosexuality.
• Can include individual and couples counselling.
• Support Groups: Provide peer support and a sense of community.
• Cognitive Behavioural Therapy (CBT) can also be a treatment option.
• Psychological techniques that attempt to alter gender identity are typically ineffective.

18. What are the Action Steps in the treatment of GID?

Action Steps in the Treatment of GID

The following action steps for treating gender identity disorder:

• Step 1: Identify and Challenge Negative Thoughts:
  • Recognise and challenge negative thoughts related to one's biological sex.
  • Identify any "lies" or half-truths in these negative statements.
• Step 2: Find Ways to Identify with One's Biological Sex:
  • Assess what aspects of one's life correspond with their biological sex.
  • Identify similarities with others of the same biological sex.
• Step 3: Neutralise Physical Issues:
  • Consider one's genetic sex, whether XX or XY chromosomes.
  • Reframe thoughts about gender identity, recognising that outward appearance is secondary to genetics.
• For children with GID, the focus is on treatment of secondary problems such as depression and anxiety, and instilling positive identifications with the child's biological gender.
• For adults, treatment includes counselling, hormone therapy, a real-life experience and gender reassignment surgery.
• Early diagnosis and treatment are associated with better recovery outcomes.