How Gender Identity Disorder Works

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Boys will be boys, or so the saying goes. But what happens when boys want to be girls? Or girls want to be boys? Some people feel that their body does not match who they are on the inside. Some choose to present themselves as the gender they identify with through clothing and cosmetics. Others change their physical appearance through hormones and surgery. This is called gender identity disorder, or GID, also known as gender identity confusion, gender dysphoria, transgenderism and transsexualism.

Mental health professionals believe there are three components that make up our gender identity: our sexual orientation, behavior and mannerism preferences, and core gender identity (that gut feeling we have about the gender we identify with). In most of us, these three components and our anatomy align as male or female. For some, however, these components don't all match up.

The cause of gender identity disorder is still being debated. Theories suggest it is caused by genetic abnormalities, endocrine problems like a testosterone or estrogen imbalance in the womb, social factors like parenting or some combination of issues [source: Merck].

Gender identity disorder may manifest in children, adolescents or adults, and appears more frequently in males than in females [source: WebMD]. While there are no recent statistics to show us how prevalent gender identity disorder is, we do know that an estimated 1 in 30,000 adult males and 1 in 100,000 adult females seek gender reassignment surgery, a treatment chosen by some people with GID [source: Merck].

At what age do parents begin to see symptoms of GID in children? Keep reading to learn about treatment and diagnosis.

Symptoms and Diagnosis of Gender Identity Disorders

Because gender identity disorder is currently considered a psychological disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a mental health professional such as a psychiatrist, psychologist or therapist must make the diagnosis.

The World Professional Association for Transgender Health (WPATH), formerly known as the Harry Benjamin International Gender Dysphoria Association, maintains and publishes the Standards of Care (SOC) -- guidelines for how to treat people with gender identity disorder. The Standards of Care are intended for professionals, individuals with gender identity disorder and their families, as well as institutions or anyone else seeking to understand current information about the psychological, medical and surgical treatments for GID.

In accordance with the Standards of Care, when an individual begins to question and feel persistent dissatisfaction with his or her gender identity, no matter at what age, therapy -- psychological, endocrine or surgical -- should begin. Treatment is intended to help the patient's well-being, not to sway or convince a person from his or her path.

Gender identity struggles may begin as early as age two to four years, when children begin to exhibit interest in cross-gender activities.

Most will outgrow symptoms of gender identity disorder before adolescence. By late adolescence or adulthood, about three quarters of boys with symptoms of gender identity disorder report homosexual or bisexual orientations. Most of the remaining 25 percent live as heterosexuals [source: Merck]. A small percentage of adolescents and adults will go on to identify as transsexuals.

Adult gender identity disorder typically manifests in late adolescence or in early to mid-adulthood, although there is no determinant age of onset. Adolescents questioning their gender identity usually report cross-gendered feelings since childhood. Later onset gender identity disorder usually appears gradually, with individuals seeking therapy in early to mid-adulthood.

Next we'll talk about the specifics -- what are the symptoms and criteria for diagnosis?

More Symptoms and Diagnoses of Gender Identity Disorders

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Gender identity disorder is currently listed as a psychological disorder in the DSM-IV under Section 302.85 (adults and adolescents) and 302.6 (children). Depending on the individual's age, diagnosis may be termed Gender Identity Disorder of Childhood, Gender Identity Disorder of Adolescence or Adulthood and on condition, Gender Identity Disorder Not Otherwise Specified. The DSM changed its terminology from transsexualism to gender identity disorder in 1994.

GID was first included in the DSM-IV in 1980. In addition to the DSM, other standard medical texts like the American Medical Association Encyclopedia, the Merck Manual, and the World Health Organization's International Classification of Diseases (ICD) all include the disorder.

The ICD also maintains a list of gender identity disorder diagnoses, including:

  • Transsexualism
  • Dual-role Transvestitism
  • Gender Identity Disorder of Childhood
  • Other Gender Identity Disorders
  • Gender Identity Disorder, Unspecified

There is no specific test that can be performed to indicate whether or not a person has gender identity disorder. Instead mental health professionals use certain criteria to make a diagnosis. These criteria include:

  • Persistent identification with the opposite gender, including cross-dressing and living as the opposite sex
  • Persistent feelings of being in the "wrong" body for at least two years
  • No presence of a DSD (Disorder of Sex Development) condition
  • Anxiety, unhappiness or other distress in every day social or occupational situations due to cross-gendered identification [source: Psychology Today]

In children, the diagnosis must include the presence of at least four of the following symptoms:

  • Repeated insistence that he or she is the opposite gender, or desires to be the opposite gender
  • Persistent preference for cross-gender roles during play or persistent fantasies of being the opposite gender
  • A strong desire to play stereotypically gendered games
  • A strong preference for friends and playmates of the opposite sex
  • In boys, an insistence on dressing in stereotypical female clothing
  • In girls, an insistence on dressing in stereotypical male clothing [source: Psychiatric News]

DSD (or intersex) conditions are generally classified as "Not Otherwise Specified" (DSM) or "Unspecified" (ICD).

Next we'll explore available treatment options, complications and diseases related to gender identity disorder.

Treatment of Gender Identity Disorders

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Treatment plans for gender identity disorder are based on the Standards of Care developed by WPATH.

Each plan is created on an individual basis and varies depending on the age of the patient and the degree to which he or she wants to adapt to his or her desired gender.

For children with GID, individual and family counseling, along with social and physical interventions are recommended. Children with gender identity disorder may develop symptoms of depression, generalized anxiety and separation anxiety disorder. Adolescents may be at risk for depression, suicidal thoughts or suicide attempts. Counseling should focus on improving self-esteem and treating associated complications.

Parents are encouraged to allow their child to explore fantasies about being a member of the opposite gender in a safe and tolerant environment. Additionally, parents are offered suggestions such as using gender-neutral language, making gay-friendly media available, and encouraging the child to participate in any activities she or he is interested in without judgment.

When GID is diagnosed in an adult, a multifaceted therapeutic approach begins. In addition to support groups and counseling (both individual and couples counseling), patients may choose hormone therapy, undertake a Real-Life Experience (living full time in their desired gender for a year or longer) and gender reassignment surgery. Patients desiring gender reassignment surgery undergo extensive evaluation, therapy and a transition period before they can be approved for surgery.

According to the American Psychological Association, the transgendered suffer from a higher than average rate of depression, anxiety, suicide and self-mutilation, yet rarely seek treatment. Untreated gender identity disorders may manifest in associated disorders and emotional distress that can interfere with the individual's ability to function socially at school and work or in relationships. Treatment helps a patient achieve and maintain a healthy and stable life.

To learn more about gender identity disorder, gender reassignment surgery and other related topics, take a look at our links page.

How Gender Identity Disorder Works: Author’s Note

When I was given this assignment, I wanted to focus on the facts -- what the disorder is, what its symptoms are, how it's diagnosed and how it's treated. Personally, I disagree with the decision to list GID as a psychological disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) -- the cause is unknown, but current theories suggest it could be a result of genetics, hormonal imbalances in the womb and/or social and environmental factors. I hoped to add truths to the conversation about how we identify with our personal sex role and gender roles in larger society. At the very most, I didn't want to disappoint those in the transsexual community.


  • "Answers to Your Questions about Individuals with Intersex Conditions." The APA Task Force on Gender Identity, Gender Variance, and Intersex Conditions. American Psychological Association. 2008.
  • "Gender Identity Disorder." Psychology Today. 2005.
  • "GENDER IDENTITY DISORDER: What is Gender Identity Disorder?"Gay & Lesbian Advocates & Defenders (GLAD).
  • "Gender Identity Disorder Reform." GID Reform Advocates. 2008.
  • Hausman, Ken. "Controversy Continues to Grow Over DSM's GID Diagnosis." Psychiatric News. Volume 38 Number 14. 2003.;38/14/25
  • "Mental Health: Gender Identity Disorder." WebMD. 2005.
  • "Sexual and Gender Identity Disorders." Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. American Psychiatric Publishing, Inc.
  • Vitale, Anne. "Rethinking the Gender Identity Disorder Terminology in the Diagnostic and Statistical Manual of Mental Disorders IV." 2005.
  • Wells, Ken R., Thomson Gale, Gale, Detroit. "Gender Identity." Gale Encyclopedia of Children's Health. Healthline Networks, Inc. 2006.
  • WPATH Standards of Care for Gender Identity Disorders, Version 6. 2001.

Gender Identity Disorder: Cheat Sheet

Stuff You Need to Know:

  • Mental health professionals offer three components that make up our gender identity: 1. our sexual orientation, 2. behavior and mannerism preferences and 3. core gender identity (that gut feeling you have that tells you what gender you are).
  • Gender identity disorders (GID) are currently considered psychological disorders, and must be diagnosed by a mental health professional. There is no test to determine whether or not a person has a gender identity disorder, and the cause remains unknown. Theories suggest it may lie in genetic abnormalities, hormone imbalances or other endocrine problems in the womb and social factors.
  • Transgendered individuals have been found to suffer from higher-than-average rates of depression, anxiety, suicide and self-mutilation. Left untreated, GID may disclose itself through associated disorders and emotional issues.
  • Adults diagnosed with GID may choose to undergo a series of treatment therapies. These include support groups and counseling, hormone therapy, real-life experience and gender reassignment surgery.

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