Gender identity disorder in children
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{{Infobox_Disease |
Name = Gender Identity Disorder of Childhood|
Image = |
Caption = "Childhood GID"|
ICD10 = {{ICD10|F|64.2||f|60}} |
ICD9 = {{ICD9|302.6}} |
ICDO = |
OMIM = 600952 |
MedlinePlus = 001527 |
eMedicineSubj = |
eMedicineTopic = |
MeshName = Transsexualism |
MeshNumber = F03.800.800.800 |
}}
'''Gender identity disorder in children (GIDC)''' is the formal diagnosis used by [[psychologist]]s and [[physician]]s to describe [[child]]ren who experience significant [[gender identity disorder|gender dysphoria]] (discontent with their biological [[sex]]).
The [[differential diagnosis]] for children was formalized in the third revision of the [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM-III) in 1980.<ref name="Bartlett">Bartlett NH, Vasey PL, Bukowski WM (2000). [http://findarticles.com/p/articles/mi_m2294/is_2000_Dec/ai_75959827 Is Gender Identity Disorder in Children a Mental Disorder?] ''Sex Roles: A Journal of Research'' 43:11/12 pp. 753-785, December 2000</ref> Children assigned as males are diagnosed with GIDC 5 to 30 times more often than children assigned as females.<ref name=”coates1992”>Coates S, Zucker KJ (1992). Gender Identity Disorders in Children. In Kestenbaum CJ, Williams DT (Eds.) ‘’Handbook of clinical assessment of children and adolescents’’ NYU Press. ISBN 0814746284</ref> The majority of children diagnosed with GID in childhood cease to desire to be the other sex by [[puberty]] and instead grow up to identify as [[homosexual]] with or without therapeutic intervention.<ref>Green, R. (1987). ''The sissy boy syndrome.'' New Haven, CT: Yale University Press.</ref>
Controversy surrounding the [[pathologization]] and treatment of cross-gender identity and behaviors, particularly in children, has been evident in the literature since the 1980s.<ref name="Bartlett"/> Proponents argue that [[intervention (counseling)|therapeutic intervention]] helps children be more comfortable in their bodies and can prevent adult [[gender identity disorder]]. Critics of treatment cite limited [[outcome data]] and questionable [[efficacy]], and some liken it to [[conversion therapy]].
==Diagnostic classification==
The current edition of the [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM-IV (TR)) makes a differential diagnosis coding based on current age:
*302.6 Gender Identity Disorder in Children
*302.85 Gender Identity Disorder in Adolescents or Adults
The current edition of the [[ICD|International Statistical Classification of Diseases and Related Health Problems]] (ICD-10) has five different diagnoses for gender identity disorder, including one for children.
<blockquote>F64.2 Gender identity disorder of childhood<br>
A disorder, usually first manifest during early childhood (and always well before puberty), characterized by a persistent and intense distress about assigned sex, together with a desire to be (or insistence that one is) of the other sex. There is a persistent preoccupation with the dress and activities of the opposite sex and repudiation of the individual's own sex. The diagnosis requires a profound disturbance of the normal gender identity; mere tomboyishness in girls or girlish behaviour in boys is not sufficient. Gender identity disorders in individuals who have reached or are entering puberty should not be classified here but in F66.-.</blockquote>
==Therapeutic intervention==
===Proponents===
Therapeutic approaches for GIDC differ from those used on adults and have included [[behavior therapy]], [[psychodynamic therapy]], [[group therapy]], and parent counseling. Proponents of this [[intervention (counseling)|intervention]] seek to reduce [[gender dysphoria]], make children more comfortable with their bodies, lessen [[ostracism]], and reduce the child's psychiatric [[comorbidity]]. The majority of therapists currently employ these techniques. <ref name="spiegel2008">Spiegel Alix (May 7, 2008). [http://www.npr.org/templates/story/story.php?storyId=90247842 Two families grapple with sons' gender preferences]. ''[[All Things Considered]]'', [[National Public Radio]]</ref> "Two short term goals have been discussed in the literature: the reduction or elimination of social ostracism and conflict, and the alleviation of underlying or associated psychopathology. Longer term goals have focused on the prevention of transsexualism and/or homosexuality."<ref name="bradley1990">Bradley SJ, Zucker KJ (1990). Gender Identity Disorder and psychosexual problems in children and adolescents. ''Canadian Journal of Psychiatry''. 35:477-86.</ref>
Individual therapy with the child seeks to identify and resolve underlying factors, including familial factors; encourage identification by sex assigned at birth; and encourage same-sex friendships. Parent counseling involves setting limits on the child's cross-gender behavior; encouraging gender-neutral or sex-typical activities; examining familial factors; and examining parental factors such as [[psychopathology]]. [[Kenneth Zucker]] and [[Susan Bradley]], the most prominent proponents of therapeutic intervention for GIDC, note patterns in family dynamics such as "a mother who is hostile toward men and a physically or emotionally absent father."<ref name="goleman1994">Goleman, Daniel (March 22, 1994). [http://query.nytimes.com/gst/fullpage.html?res=9901E0DA153CF931A15750C0A962958260 The 'Wrong' Sex: A New Definition Of Childhood Pain]. ''[[New York Times]]''</ref> Zucker notes, "If parents allow their child to continue to engage in cross-gender behaviour, the GID is, in effect, being tolerated, if not reinforced." <ref name="zucker2002">Kucker, Ken J. (2002). Gender Identity Disorder. In Michael Rutter, Eric A. Taylor (Eds). Child and adolescent psychiatry: modern approaches. Blackwell Publishing. ISBN 0865428808</ref> Proponents acknowledge limited data on GIDC: "apart from a series of intrasubject behaviour therapy case reports from the 1970s, one will find not a single randomized controlled treatment trial in the literature" (Zucker 2001). <ref name="zucker2002"/> Psychiatrist Domenico Di Ceglie notes that for therapeutic intervention, "[[efficacy]] is unclear,"<ref name="diceglie1995">di Ceglie D (1995). Gender Identity Disorders in Children and Adolescents. ''British Journal of Hospial Medicine'', 1995, Vol. 53, no. 6)</ref> and psychologist Bernadette Wren notes, "There is little evidence, however, that any psychological treatments have much effect in changing gender identity although some treatment centres continue to promote this as an aim (e.g. Zucker, & Bradley, 1995)." <ref name="wren2000">Early Physical Intervention for Young People with Atypical Gender Identity Development. ''Clinical Child Psychology and Psychiatry'', Vol. 5, No. 2, 220-231 (2000)</ref>
===Opponents===
Clinicians have called Zucker and Bradley's therapeutic intervention "something disturbingly close to [[Conversion therapy|reparative therapy]] for [[homosexuals]]" <ref name="pickstone2003">Pickstone-Taylor, Simon D. (2003). Children with gender nonconformity. ''Journal of the American Academy of Child and Adolescent Psychiatry'', 42, 266.</ref> and have noted that the goal is preventing [[transsexualism]]: "Reparative therapy is believed to reduce the chances of adult GID (i.e., transsexualism) which Zucker and Bradley characterize as undesirable."<ref name="hill2006">Hill DB, Rozanski C, Carfagnini J, Willoughby B (2006). Gender Identity Disorders in Childhood and Adolescence: A Critical Inquiry. pp. 7-34. In Karasic D, Drescher J (Eds.) ''Sexual and Gender Diagnoses of the Diagnostic and Statistical Manual (DSM): A Reevaluation.'' Haworth Press ISBN 0789032147</ref> Author Phyllis Burke wrote, "The diagnosis of GID in children, as supported by Zucker and Bradley, is simply [[child abuse]]." <ref name="burke1996">Burke, Phyllis (1996). ''Gender Shock''. Anchor. ISBN 978-0385477185</ref> Zucker dismisses Burke's book as "simplistic" and "not particularly illuminating;" journalist Stephanie Wilkinson said Zucker characterized Burke's book as "the work of a journalist whose views shouldn't be put into the same camp as those of scientists like [[Richard Green (sexologist)|Richard Green]] or himself."<ref name="wilkinson2001">Wilkinson, Stephanie (2001). [http://www.brainchildmag.com/essays/fall2001_wilkinson.htm Drop the Barbie!] ''Brain, Child''</ref> Critics argue GIDC was a backdoor maneuver to replace homosexuality in the DSM, and Zucker and [[Robert Spitzer (psychiatrist)|Robert Spitzer]] counter that GIDC inclusion was based on "expert consensus," which is "the same mechanism that led to the introduction of many new psychiatric diagnoses, including those for which systematic field trials were not available when the DSM-III was published."<ref name="zuckerspitzer2005">Zucker KJ, Spitzer R (2005). Was the Gender Identity Disorder of Childhood Diagnosis Introduced into DSM-III as a Backdoor Maneuver to Replace Homosexuality? A Historical Note. ''Journal of Sex and Marital Therapy'', Volume 31, Number 1, January-February 2005 , pp. 31-42(12)</ref> Katherine Wilson of GID Reform Advocates notes:
<blockquote>In the case of gender non-conforming children and adolescents, the GID criteria are significantly broader in scope in the DSM-IV (APA, 1994, p. 537) than in earlier revisions, to the concern of many civil libertarians. A child may be diagnosed with Gender Identity Disorder without ever having stated any desire to be, or insistence of being, the other sex. Boys are inexplicably held to a much stricter standard of conformity than girls. A preference for cross-dressing or simulating female attire meets the diagnostic criterion for boys but not for girls, who must insist on wearing only male clothing to merit diagnosis. References to "stereotypical " clothing, toys and activities of the other sex are imprecise in an American culture where much children's' clothing is unisex and appropriate sex role is the subject of political debate. Equally puzzling is a criterion which lists a "strong preference for playmates of the other sex" as symptomatic, and seems to equate mental health with sexual discrimination and segregation. <ref name="wilson1998">Wilson K (1998). [http://www.gidreform.org/kwapa98.html The Disparate Classification of Gender and Sexual Orientation in American Psychiatry] 1998 annual meeting of the American Psychiatric Association, Workshop IW57, Transgender Issues, Toronto Canada, June.</ref></blockquote>
Clinicians argue that GIDC "has served to pressurize boys to conform to traditional gender and heterosexual roles." <ref name="wilson2002">Wilson I, Griffith C, Wren B (2002). The Validity of the Diagnosis of Gender Identity Disorder (Child and Adolescent Criteria). ''Clinical Child Psychology and Psychiatry'', Vol. 7, No. 3, 335-351 (2002)</ref> Feder notes that the diagnosis is based on the reactions of others to the child, not the behavior itself.<ref name="feder1997">Feder EK (1997). Disciplining the family: The case of gender identity disorder. ''Philosophical Studies'', Volume 85, Numbers 2-3 / March, 1997.</ref> Langer ''et al.'' state "Gender atypicality is a [[social construction]] that varies over time according to culture and social class and therefore should not be pathologized."<ref name="langer">Langer SJ, Martin JI (2004). [http://www.springerlink.com/content/j560672n6101525k/ How Dresses Can Make You Mentally Ill: Examining Gender Identity Disorder in Children.] ''Child and Adolescent Social Work Journal'' 21:1 pp. 5-23 (February 2004)</ref> Zucker refuted their claims in a response.<ref name="zucker2006">Zucker KJ (2006). Commentary on Langer and Martin’s (2004) "How Dresses Can Make You Mentally Ill: Examining Gender Identity Disorder in Children." ''Child and Adolescent Social Work Journal'' 23:5/6, pp. 533-555.</ref> Critics "contend that it is a precursor of homosexuality, that parents should simply accept it, and that the very diagnosis is based on [[sexist]] assumptions."<ref name="goleman1994"/><ref name="bem1993">Bem, S. L. (1993). The lenses of gender: Transforming the debate on sexual inequality. New Haven: Yale University Press.</ref>
===DSM-V controversy===
Therapeutic intervention for GIDC came under renewed scrutiny in May 2008, when Kenneth Zucker was appointed to the [[DSM-V]] committee on GIDC.<ref>{{cite news | title = Activists alarmed over APA: Head of psychiatry panel favors 'change' therapy for some trans teens | author = Lou Chibbaro Jr. | date = 2008-05-30 | work = Washington Blade}}</ref> According to [[MSNBC]], "The petition accuses Zucker of having engaged in '[[junk science]]' and promoting 'hurtful theories' during his career."<ref name=msnbc>{{cite news |first=Brian |last=Alexander |title=What's 'normal' sex? Shrinks seek definition: Controversy erupts over creation of psychiatric rule book's new edition |url=http://www.msnbc.msn.com/id/24664654/ |work=MSNBC |publisher= |date=2008-05-22 |accessdate=2008-06-14 }}</ref> Zucker is accused by activists of promoting "gender-conforming therapies in children"<ref name="szymanski2008">Szymanski, Zak (July 3, 2008). [http://www.ebar.com/news/article.php?sec=news&article=3128 Trans March rallies around inclusion.] ''Bay Area Reporter''</ref> and "treating children with GID with an eye toward preventing adult homosexuality or transsexuality."<ref name=GayCity>{{cite news |first=Duncan |last=Osborne |title=Flap Flares Over Gender Diagnosis |url=http://www.gaycitynews.com/site/news.cfm?newsid=19693908&BRD=2729&PAG=461&dept_id=568864&rfi=6 |work=Gay City News |publisher= |date=2008-05-15 |accessdate=2008-06-14 }}</ref> Zucker "rejects the junk-science charge, saying that there 'has to be an empirical basis to modify anything' in the DSM. As for hurting people, 'in my own career, my primary motivation in working with children, adolescents and families is to help them with the distress and suffering they are experiencing, whatever the reasons they are having these struggles. I want to help people feel better about themselves, not hurt them.'"<ref name=msnbc/>
==See also==
*[[Gender identity disorder]]
*[[List of transgender-related topics]]
==References==
{{reflist}}
==External links==
*[http://www.merck.com/mmpe/sec15/ch203/ch203b.html Gender Identity Disorder and Transsexualism] via Merck Manual
*[http://www.gidreform.org/gid3026.html Issues of Psychiatric Diagnosis for Gender Nonconforming Youth] via GIDreform.org
{{Sexual Identities}}
[[Category:Gender]]
[[Category:Sexual and gender identity disorders]]
[[Category:Transgender and medicine]]