Treatment strategies for clients with gender identity disorder

GID

Gender Identity disorder has received a great deal of attention in recent years. The purpose of this discussion is to emphasize current treatment strategies for clients affected by Gender Identity Disorder. The discussion will include a review of the literature and recommendations for practitioners. Let us begin our discussion by defining Gender Identity Disorder.

Definition of Gender Identity Disorder

According to the National Institutes of Health Gender Identity disorder is a condition in which there is a cionflict between an individuals physical or obvious gender and the individual's self-identification. For examply an individual that is a female may feel and display the characteristics of a male. The NIH points out that Gender Identity disorder is wholly different from homosexuality because homosexuals almost always identfy with their actual gender (Gender Identity Disorder).

The NIH also explains that these gender Identity issues can manifest themselves in a myriad of ways. For instance, some people with this disorder that have normal genitals but secondary sex characteristics of one gender, may sometimes identify more with the other gender (Gender Identity Disorder). In addition, some individuals may cross-dress, and in some cases people with this some may request and receive reassignment surgery (Gender Identity Disorder). Still others with GID are born with ambiguous genitals, which can cause identity issues (Gender Identity Disorder). The NIH also explains that People with gender identity disorder may act and present themselves as members of the opposite sex. The disorder may affect self-concept, choice of sexual partners, and the display of femininity or masculinity through mannerisms, behavior, and dress. The feeling of being in the body of the "wrong" gender must persist for at least 2 years for this diagnosis to be made. The cause is unknown, but hormonal influences in the womb, genetics, and environmental factors (such as parenting) are suspected to be involved. The disorder may occur in children or adults, and is rare (Gender Identity Disorder)."

The Natioanl Institutes of Health explains that the symptoms of GID in children include a disdain for their own genetalia, a desire to be the opposite sex, depression, rejection, isolation and anxiety. The symptoms of adult with GID include wanting to destory their genitals, dressing as the opposite sex, the desire to live their life as the opposite sex, rejection, depression and anxiety (Gender Identity Disorder). Now that we have garnered a greater understanding of GID, let us focus on the impact of GID on both children and adults and the treatments that are available for both children and adults.

Children with GID

According to Menvielle & Tuerk (2002) a GID diagnosis in children uassually involves a child that sufferes from severe gender dysphoria. The authors explain that there is still no consensus on whether childhood gender dysphoria leads to a diagnosis of GID in adulthood, or whether this dysphoria seen in childhood is just an indication of homsexuality or bisexuality at a later stage of life (Menvielle & Tuerk 2002).

The authors assert that children with GID or gender noncomformity are often stigmatized and isolated. Such stigma can come from parents and society when a child's behavior or characteristics are not congruent with their apparent sex (Menvielle & Tuerk 2002). The authors pouint out that boys in particualr are ridiculed when they are viewed as feminine. Such stigma often increases throughout middle school and high school (Menvielle & Tuerk 2002). In fact many children that are homosexual, bisexual or transgender have a very difficult time in school This diffficulty is due to rejection from peers which creates feelings of isolation, depression and anxiety (Menvielle & Tuerk 2002).

Adults with GID

Just as children with GID often feel isolated, so do the adults that have this disorder. In addition, many of the symptoms such as anxiety and depression that are seen in children are also seen in adults.

Treatments for Adults with GID

The treatment of adults with gender identity disorder is also problematic because there is not a general consensus on how it should be treated. In fact, many practitioners argue the GID is actually a form of homophobia; some practitioners have asserted that those that have GID are simply afraid to identify themselves as gay or lesbian because of the stigma that is attached to homosexuality (Carroll & Gilroy, 2002; Fagan Schmidt & Wise, 1994).

Adults with GID can also be involved in individual and group counseling to assist them in dealing with the disorder. However adults also have an option that children do not and this option is known as reassignment surgery (Griggs, 1998). Reassignment Surgery -- formerly referred to as a sex change operation -- allows an individual to be surgically altered to reflect the gender that they identify with (Lief & Hubschman, 1993). This surgery has now been available for quite some time and presents many people with GID with the possibiltiy of living a life that is more "normal."

According to Cuypere et al. (2005) hormonal therapy and sex reassignment surgery are the treatment of choice for persons with GID. As a result Cuypere et al. conducted a study which evaluated the physical and sexual health of individuals that received reassignment surgery. The participants were 107 Dutch speaking participants that had the surgery between 1986 and 2001 (Cuypere et al. 2005).

The results demonstrate that those participants going form Female-to-males had more problems establishing a secure relationship following the transition (Cuypere et al. 2005). In fact the study found that a third of the female-to-males did not have a sexual partner following the surgery even though their sexual drives were intact (Cuypere et al. 2005). The results also found that in spite of the fact that participants had masculine presentations and sex organs, many of them steered clear of a relationship with a potential partner. This avoidance was present because he participants were not yet confident in their maleness (Cuypere et al. 2005). The study also found that when transsexual participants were able to establish a stable relationship, they were sexually satisfied. This finding is in contradiction with the findings of prior research (Bodlund & Kullgren, 1996), "who reported that male-to-females have, after transition, more frequently a new partner whereas the female-to-males tend to remain with the same partner, we observed no significant difference between the two groups (Cuypere et al. 2005, pg 679)."

Indeed, the results of treatment via reassignment surgery in adults can vary greatly. In his study of Male to Female sex reassignment surgery Lawrence (2005) explains that the sexual behaviors and attitudes of male-to-female (MtF) transsexuals before and after sex reassignment surgery (SRS) have long been of interest to sex researchers, clinicians, and MtF transsexuals themselves. One of the most important reasons MtF transsexuals undergo SRS is to acquire genitalia that will allow them to engage in sexual activity, specifically penile-vaginal intercourse, as women (Schroder & Carroll, 1999). Consequently, clinicians have sought to understand the sexological outcomes of SRS in order to inform and counsel their transsexual patients. Sexual orientation and sexual activity before SRS have often been regarded as important predictors of the success of sex reassignment (Lawrence 2005)."

The current study involved Male to Female transsexuals who had SRS between May 1994 and March 2000. All of the participants were patients of Toby Meltzer, M.D., who practices in Portland, Oregon. In addition all participants had undergone the surgery using a similar technique, which involved penile-inversion vaginoplasty and clitoroplasty using a fraction of the glans penis on a dorsal neurovascular pedicle (Lawrence 2005). The article explains that a total of 232 valid questionnaires were returned, this represented 32% of the patients that were believed to of had the surgery. In addition this number was representative of 65% of the patients that received the questionnaire. The mean age of the SRS patient when they underwent surgery was 44 years and their mean age at the time the survey was carried out was 47 (Lawrence 2005).

The article explains that is was hypothesized that this study would reflect other studies that found that Male to Female participants would change in sexual attraction and behavior and prefer male partners following the surgery (Lawrence 2005). This hypothesis was correct; however the study found that the median changes were small as it related to both sexual attraction and sexual behavior. However, there were some participants who reported a significant change in their sexual orientation. These participants were completely or nearly completely sexually oriented toward women prior to the surgery and completely or nearly completely sexually oriented toward men following the surgery (Lawrence 2005). The study also found that "these participants were virtually indistinguishable from participants who were exclusively or almost exclusively sexually oriented toward women both before and after SRS, based on the preoperative characteristics examined in this study (Lawrence 2005)."

The study also found that participants that experienced a significant change in sexual orientation were nearly impossible to differentiate from participants who were completely or nearly completely sexually oriented toward men prior to and following the surgery (Lawrence 2005). In addition, as it related to postoperative characteristics evaluated in the study; number of male partners following surgery was the most significant exception (Lawrence 2005).

The participants that noticed a significant change in the sexual orientation may have chosen a male partner following the surgery for the purposes of experimentation as opposed to a commitment (Lawrence 2005). Approximately 50% of the participants that reported having only female partners prior to the surgery and only male partners following the surgery asserted that they only had one male partner following the surgery (Lawrence 2005). If this assumption is not the case, the variable that were evaluated in the study do not provide a hypothesis to explicate why some Male to Female transsexuals experienced significant changes in sexual orientation following surgery and others do not experience such changes (Lawrence 2005).

In addition to the above hypothesis it was also hypothesized that the amount of sexual partners reported by participants prior to surgery would be consistent with population norms for women (Lawrence 2005). This hypothesis was also correct. The study found that the distribution of the amount of sexual partners reported by survey participants prior to surgery was closely correlated to the distribution of the amount of partners the participants had since the age of 18 reported by the NHSLS men (Laumann et al., 1994). This amount was markedly higher than the number reported by the NHSLS women. Even though the participant in the current survey were older than those in the NHSLS study and as such giving them more opportunity to accumulate partners -- this age difference was not consistent with the observed distribution of the amount of partners, since younger survey participants tended to report have more partners than the older individuals that took part in the survey (Lawrence 2005).

Recommendations for Practitioners

Debates concerning the treatment of GID are likely to continue well into the future, as there is still a great deal that is unknown about GID. A great deal of the research that currently exists on this topic is focused on treatment for children. The treatments that are available to children seemed to be geared toward assisting them in the area of self acceptance and some research indicates that these children are able to function well as homosexual adults. However, there is not a great deal of research available for individual that are diagnosed with GID as an adult. It seems the only treatment offered to adults is reassignment surgery which can be extremely problematic on both a physical and emotional level.

Because the research is scarce and somewhat difficult to determine, practitioners must attempt the different approaches that do seem to have some positive outcomes. It is recommended that practitioners seek out others in the field that has treated people with GID successfully. Beyond this, there must be more comprehensive studies that are conducted and that gradually improve practitioners' understanding of individuals with GID.

Conclusion

The purpose of this discussion was to examine the current treatment strategies for clients affected by Gender Identity Disorder. The discussion also includes a review of the literature and recommendations for practitioners. The research indicates that GID treatment for children is inclusive of individual and group therapy and also separate individual and group therapy for parents. The research also found that GID treatment for adults is also inclusive of therapy in addition to hormone therapy and reassignment surgery. The research indicates that there is still a great deal that is unknown about GID and as such practitioners must attempt treatments that have realized some positive outcomes.