Gender Identity Disorder the Objective

Gender Identity Disorder The objective of this work is to research and report the diagnostic criteria and typical course of gender identity disorder including the theories of this disorder and the etiology and prevalence of this disorder. Evidence-based treatments found to be most effective will be reported as well as a consensus and controversies of the disorder in this field of study.

Gender identity disorder (GID) is defined as "strong, persistent feelings of identification with the opposite gender and discomfort with one's own assigned sex." (Psychology Today, 2007) the individual who has GID has a strong desire to be the opposite sex and holds a belief that they will change into the opposite sex as they grow up. These individuals are isolated from their peers and suffer from anxiety and depression.

According to Zucker (1985) in pathological cases...children deviate from the normal pattern of exploring masculine and feminine behaviors and develop an inflexible, compulsive, persistent and rigidly stereotyped pattern. I. CLINICAL DIAGNOSIS Clinical diagnosis of GID begins with the individual having persistent and strong feelings of identifying with the gender opposite of their own gender with manifestation of these feelings being in the following ways: 1) Repeatedly stated desire to be, or insistence that he or she is the other sex; 2) in boys, preference for cross-dressing or simulating female attire.

In girls, insistence on wearing only stereotypical masculine clothing; 3) Strong and persistent preferences for cross-sex roles in make believe play or persistent fantasies of being the other sex; 4) Intense desire to participate in the stereotypical games and pastimes of the other sex; and 5) Strong preference for playmates of the other sex." (Psychology Today, 2007) II.

CAUSE and PREVALENCE of GID The work of Mouaffak, Gallarda, Baup, Olie, and Krebs (2007) entitled: "Gender Identity Disorders and Bipolar Disorder Associated with the Ring Y Chromosome" states that gender identity is: "...a rare condition of atypical gender development in which there is a subjective perception of self in opposition to an individual's gender. The lifetime prevalence of mood disorders comorbidity with a gender identity is approximately 45%.

(as cited in Hepp, Schnyder, Miller, and Delsignore, 2005) Mouaffak, Gallarda, Baup, Olie, and Krebs go on to relate that the case reported this article is one which: "...shows a possible interaction between transsexalism and bipolar disorder, where both depression and mania exacerbate the demands for sex change..." (as cited in Habermeyer E, Kamps I, Kawohl, 2003) Reported is that the "ring Y chromosome is usually associated with deletions in telomeric regions." (Mouaffak, Gallarda, Baup, Olie, and Krebs, 2007) III.

CONTROVERSIES in the FIELD Controversies within the counseling profession related to gender identity disorder are reported by the National Association for Research and Therapy of Homosexuality in the work entitled: "Childhood Gender-Identity Disorder Under Attack" which reports that: "The a.P.A.

Monitor recently ran a story describing the growing conflict over the diagnosis of Childhood Gender-Identity Disorder." (2007) This work reports the fact that in the article "Researcher Probe Factors Behind Gender Disorders" should be "...of consideration interest to NARTH psychotherapists." (2007) the instance of GID is stated by clinical estimates to be "about one child in 1,000." (Childhood Gender-Identity Disorder under Attack, 2007) Research states findings that as these children mature "...their ambivalent gender status sometimes translates into sexual preference for the same gender, or into less sexual interest in the opposite sex." (Monitor, 1997; as cited in Childhood Gender-Identity Disorder Under Attack, 2007) The work of Duncan Osborne entitled: "Voices- Identity Crisis" relates the condition and the controversies very well in a story that tells of a five-year-old boy whom he treated.

Later the child was treated as an adult. Osborne relates that generally these children who have been diagnosed with gender identity disorder grow up to be homosexual. Osborne reports a study conducted in the early 1980's by Green who finds that, among 44 such boys with gender identity disorder that: "...75% were either gay or bisexual and one wanted sex reassignment." (Osborne, 2003) According to Osborne, Psychologist Kenneth J.

Zucker, head of Toronto's Child and Adolescent Gender Identity Service at the Centre for Addiction and Mental Health, is a "leading GID expert who has seen roughly 625 children or adolescents since 1978." (2003) According to Osborne, Zucker states that: "The majority of kids will have resolved their gender dysphoria and identify themselves as gay. We're also going to find that around 15% have a significant gender dysphoria that has persisted into adolescence and young adulthood to the point where they are wanting sex reassignment.

If we add on to that a small minority of kids who report being heterosexual, we're seeing a real range of outcomes." (Osborne, 2003) It is also reported by Osborne the National Association for Research and Therapy of Homosexuality (NARTH)..."promotes therapies that claim to convert homosexuals to heterosexuality..." (2003) However, Green and other experts assert that the work of NARTH is not supported by evidence.

Osborne additionally relates that Richard Isay, clinical professor of psychiatry at Weill Medical College of Cornell University in Manhattan and the author of "Becoming Gay: The Journey to Self-Acceptance" "published an article in 'Psychiatric News in 1997 urging that gender identity disorder (GID) be removed from the DSM..." (Osborne, 2007) based on the argument that the diagnosis "...implicitly labels homosexual boys are mentally disordered..." (Osborne, 2003) IV.

EVIDENCE-BASED THERAPIES After assessment which usually lasts between three to six months the care is chosen for the individual which includes diagnostic assessment, supportive psychotherapy, the 'real-life experience, hormone therapy and surgical interventions." (Davies, 2007) the work entitled: "Diagnosing and Treating Gender Identity Disorder in Women" stats that: "Patients are usually in their twenties when they first present to clinics with dissatisfaction of gender characteristics. More severely affected individuals present in childhood or early teens, after being referred by parents or teachers for cross-gendered behavior.

Later-presenting individuals as a group have had, in our experience more difficulties with ambivalence related to actual gender reassignment." (Medscape Journal, 1997) Much debate surrounds whether psychotherapy should precede sex reassignment or if it is necessary at all.

There is no evidence existing to support that "gender identity disorder or transsexualism is amenable to therapeutic change..." (Medscape Journal, 1997) Secondly, "this disorder does not appear to necessarily be directly related to other personality pathology or psychiatric difficulties." (Medscape Journal, 1997) In the case of treating women with this disorder it is stated that following a period of 'Real-life Experience' participation formal approval is given for patients to receive hormone treatment. Following two-year of documented 'Real-life Experience' adaptation the patient "undergoes psychiatric review and is then referred for surgical treatment.

Treatments involve construction of a male chest contour, which usually requires breast amputation." (Medscape Journal, 1997) Six months prior to the chest-wall survey a hysterectomy is advised.

It is stated that even with the more advanced and newer surgical techniques "phalloplasty (the surgical construction of a penile prototype) has been fraught with difficulties relating to operating and recovery time with a "high incidence of postoperative difficulty including stenosis, fistulas, problems and the urethra/neuorethral junction, and intrusion and extrusion of the testicular implant." (Medscape Journal, 1997) Other interventions may include: voice skills therapy support and advice on style to assist patients in 'passing' as a.