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PubMed1993

Gender identity disorder and courtship disorder.

A hypothetical connection between gender identity disorder and courtship disorder was investigated in 274 heterosexual male patients of the following types: nontransvestic fetishists for female attire; transvestic fetishists; patients with gender identity disorder of adolescence and adulthood, nontranssexual type; and transsexuals. Of these patients, 53 had also demonstrated one or more of the putative expressions of courtship disorder. The proportion each of these types contributed to this group of 53 patients with a courtship disorder was compared with the same type's proportional contribution to the group of 221 gender identity patients without a courtship disorder. The transvestic fetishists contributed a significantly larger percentage and the transsexuals a significantly smaller percentage of individuals to the group with a courtship disorder than to that without a courtship disorder. Theoretical implications of this asymmetry are discussed.

Adult↗
PubMed2003

Psychiatric comorbidity of gender identity disorders: a survey among Dutch psychiatrists.

OBJECTIVE: In the Netherlands, it is considered good medical practice to offer patients with gender identity disorder the option to undergo hormonal and surgical sex reassignment therapy. A liberalization of treatment guidelines now allows for such treatment to be started at puberty or prepuberty. The question arises as to what extent gender identity disorder can be reliably distinguished from a cross-gender identification that is secondary to other psychiatric disorders. METHOD: The authors sent survey questionnaires to 382 board-certified Dutch psychiatrists regarding their experiences with diagnosing and treating patients with gender identity disorder. RESULTS: One hundred eighty-six psychiatrists responded to the survey. These respondents reported on 584 patients with cross-gender identification. In 225 patients (39%), gender identity disorder was regarded as the primary diagnosis. For the remaining 359 patients (61%), cross-gender identification was comorbid with other psychiatric disorders. In 270 (75%) of these 359 patients, cross-gender identification was interpreted as an epiphenomenon of other psychiatric illnesses, notably personality, mood, dissociative, and psychotic disorders. CONCLUSIONS: These data suggest that there is little consensus, at least among Dutch psychiatrists, about diagnostic features of gender identity disorder or about the minimum age at which sex reassignment therapy is a safe option. Therapy options proposed to patients with gender identity disorder appear to depend on personal preferences of psychiatrists. These results underline the need for more specific diagnostic rules in this area.

Adolescent↗
PubMed1977

Gender identity change in a transsexual: an exorcism.

Gender identity change in a conservatively diagnosed 21-year-old transexual after faith healing was fortuitously observed, was objectively and independently measured, and is reported. This case, and other recent developments, suggests a reexamination of the possibilities of psychosocial intervention to modify atypical gender identity.

Adult↗
PubMedDate not supplied

A clinical and psycho-sociological case study on gender identity disorder in Japan.

Gender identity disorder (GID) has been attracting increasing attention in recent years in Japan as well as in the rest of the world. This report presents a GID case followed by a discussion on GID patients in Japanese culture, social pressures upon diagnosis and treatment of GID, and social changes that have brought about the possibility for GID diagnosis and treatment.

Adult↗
PubMed2003

Sex-sensitive cognitive performance in untreated patients with early onset gender identity disorder.

BACKGROUND: We explored whether the cognitive performance of gender identity disorder patients (GID) was comparable to that of their biological sex or skewed towards that of their gender identity. METHOD: We tested four potentially sex-sensitive cognitive factors (rotation, visualization, perception, and verbalization) as well as two neutral factors (logic and arithmetic) in GID patients from Norway (GID-N, n = 33) or the USA (GID-US, n = 19) and in a control group (C, n = 29). The testing was undertaken prior to cross sex hormone treatment. Four-way ANOVA was applied in the final analysis of the cognitive performance and its dependency on different predictors (age, biological sex, education, group). RESULTS: In both GID groups as well as in the control group (C) males excelled in visualization and rotation, also when controlling for potential confounders (biological sex, group, age and education). No female advantage was detected. Furthermore, no interaction between biological sex and group assignment was revealed in the samples. CONCLUSION: In this study the cognitive pattern of GID patients is consistent with that of their biological sex and not that of their gender identity.

Adult↗
PubMed1977

Extension of the Gender Identity Scale for Males.

Our earlier Femine Gender Identity Scale for males appear to measure a strong single factor which was reliable and displayed substantial discriminant validity. However, the number of items was small and there was substantial overlap between items with respect to their meaning. In an attempt to overcome these limitations, in the present study the scale was extended and validated. Each item of the new scale differentiated among the groups in an experimental sample and, subsequently, in a cross-validation sample. A secondary finding was the significantly higher femine gender identity scores of homosexual patients over homosexual nonpatients.

Adolescent↗
PubMed1994

Cross-gender identity in transvestites and male transsexuals.

A self-theory of transvestism and secondary transsexuality in which gender identity is a major self subsystem has been advanced in previous research. Within this framework transsexuals and transvestites were compared on a number of developmental characteristics. While early-onset transsexuals (n = 103) were dominantly female, both late-onset transsexuals (n = 52) and transvestites (n = 36) showed much more feminine behavior than expected. This was interpreted as a sign that they were already developing a feminine gender identity in their early years. Implications for this theory were discussed: (i) The assumption of two gender identity subsystems (a masculine and a feminine) in any human being, which can have any relative strength; (ii) the incorporation of the concept of expression of an identity subsystem, which can be unconditional or conditional (i.e., expression of aspects of the self only if certain conditions are fulfilled) and which has the function of self-seeking. Two continua are proposed. One ranges from a strong feminine gender identity subsystem that is unconditionally expressed to weak unexpressed femininity. The second ranges from a strong and unconditionally expressed masculinity to a weak masculinity. Male-to-female transsexuals (and "normal" females) are characterized by a strong unconditionally expressed feminine gender identity in combination with a weak unexpressed masculinity. Transvestism is a position in between in which both masculinity and femininity are conditionally expressed.

Adolescent↗
PubMed1985

Exploring the relationship between gender identity and sexual functioning.

This study examined the hypotheses that individuals who are sexually functional and/or highly satisfied with their sexual relations exhibit an androgynous gender identity as well as high levels of congruence among their gender identity, sex-role expectations, and sex-role performance. Conversely, it was hypothesized that sexually dysfunctional and/or dissatisfied people display a polarized gender identity and low levels of congruence among their gender identity, sex-role expectations, and sex-role performance. A total of 61 married or intimate heterosexual couples served as subjects. Each subject completed a Bem Sex-Role Inventory three times, the instructions differing each time in order to provide measures of gender identity, sex-role expectations, and sex-role performance. Subjects also completed specially designed questionnaires which gauged their sexual functioning and sexual satisfaction. The results did not support the hypotheses. Instead, the evidence suggested that sexual functioning and satisfaction for both men and women are associated with the perception that the actor possesses significantly more masculine traits than the typical same-sex person, whereas dysfunctioning and lower levels of satisfaction are associated with the perception that the actor exhibits more feminine traits than the typical member of one's sex group. The implications of these findings are discussed.

Adolescent↗
PubMed1998

Adoptee overrepresentation among clinic-referred boys with gender identity disorder.

OBJECTIVES: To test the hypothesis that adoptees are overrepresented among a sample of clinic-referred boys with gender identity problems (N = 238). To compare the adoptees and nonadoptees on demographic, behaviour problem, and gender-typed measures. METHOD: The percentage of clinic-referred boys with gender identity problems adopted in the first 2 years of life ("early adoptees") was compared to the base rate of boys adopted in Ontario. Parent-report and behavioural measures were used to compare the early adoptees with "late adoptees" (adopted after the second year of life) and nonadoptees. RESULTS: The percentage of boys with gender identity problems who were early adoptees (7.6%) was significantly higher than the base rate of males adopted in Ontario in the first 2 years of life (1.5%). Both the early and late adoptees were significantly less intelligent than the nonadoptees. The early adoptees also had significantly higher externalizing T scores on the Child Behavior Checklist than did the late adoptees and the nonadoptees. The 3 groups did not differ in the percentage who met the complete Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for gender identity disorder and on 4 other measures of gender-typed behaviour. CONCLUSION: Adoptees are overrepresented among clinic-referred boys with gender identity problems. The reasons for this finding are not clear but may be accounted for by general risk factors that increase the likelihood of clinical referral or by psychosocial and biological factors associated with adoption.

Adoption↗
PubMed2003

The relationship of gender, gender identity, and coping strategies in late adolescents.

The relationships among gender, gender identity, and coping in late adolescents were examined. One hundred sixty-nine late adolescents completed measures assessing their masculinity and femininity, as well as their use of coping strategies. Females endorsed greater use of emotion-focused coping strategies than males. Late adolescents who were high in masculinity endorsed higher levels of problem-focused coping strategies than those who were low in masculinity. In contrast, late adolescents who were high in femininity endorsed higher levels of emotion-focused coping strategies than those who were low in femininity. Neither the gender nor the masculinity and femininity of late adolescents were predictive of the use of avoidant coping strategies. Overall, gender identity made an important and independent contribution to the endorsement of coping strategy use. These results emphasize the importance of assessing both gender and gender identity with regard to coping in late adolescents.

Adaptation, Psychological↗
PubMed1982

Patterns of intellectual functioning and spatial ability in boys and gender identity disorder.

Preadolescent boys with Gender Identity Disorder (N = 13), their brothers (N = 8) and boys referred for psychiatric assessment (N = 10) were administered age-appropriate Wechsler intelligence scales. Four hypotheses regarding patterns of intellectual functioning and spatial ability were tested. A previous suggestion that the development of boyhood femininity is associated with higher than average IQ was not supported, since the IQs of the feminine boys and their brothers did not differ. A report of enhanced verbal ability as compared with perceptual organization also was not replicated in these feminine boys. On Kaufman's "Freedom from Distractibility" factor, the feminine boys and their brothers obtained scores as low as the psychiatric controls; that is, all three groups were equally distractible. It was suggested that anxiety contributed to poor performance on this factor. Unlike the control groups, the feminine boys obtained low scores on a test of spatial ability (Block Design) as compared to their scores on a verbal task (Vocabulary). The association between a feminine gender role and relatively poor spatial ability was discussed.

Child↗
PubMed2003

Effects on gender identity of prenatal androgens and genital appearance: evidence from girls with congenital adrenal hyperplasia.

To address questions about sex assignment in children with ambiguous genitalia, we studied gender identity in girls with congenital adrenal hyperplasia (CAH) in relation to characteristics of the disease and treatment, particularly genital appearance and surgery. A 9-item gender identity interview was administered to 43 girls with classical CAH ranging in age from 3-18 yr, 7 tomboys, and 29 sister control girls. Groups were compared on total score and on individual items. Results showed that, on the total gender identity score, 88% of girls with CAH had scores overlapping those of control girls, but the average score was intermediate between control girls and tomboys. On individual items of gender identity (discomfort as a girl, wish to be a boy), girls with CAH were similar to control girls. Gender identity in girls with CAH was not related to degree of genital virilization or age at which genital reconstructive surgery was done. Thus, moderate androgen excess early in development appears to produce a small increase in the risk of atypical gender identity, but this risk cannot be predicted from genital virilization.

Adolescent↗
PubMed1986

The gender identity movement: a growing surgical-psychiatric liaison.

The evaluation and treatment of individuals with gender identity problems has resulted in an interesting and productive collaboration between several specialties of medicine. In particular, the psychiatrist and surgeon have joined hands in the management of these fascinating patients who feel they are trapped in the wrong body and insist upon correcting this cruel mistake of nature by undergoing sex reassignment surgery. Over the last two decades, some 40 centers have emerged in which interdisciplinary teams cooperate in the evaluation and treatment of these gender dysphoric patients. The model for this collaboration began at The Johns Hopkins Hospital, where the Gender Identity Clinic began its operation in 1965 (Edgerton, 1983; Pauly, 1983). This "gender identity movement" has brought together such unlikely collaborators as surgeons, endocrinologists, psychologists, psychiatrists, gynecologists, and research specialists into a mutually rewarding arena. This paper deals with the background and modern era of research into gender identity disorders and their evaluation and treatment. Finally, some data are presented on the outcome of sex reassignment surgery. This interdisciplinary collaboration has resulted in the birth of a new medical subspecialty, which deals with the study of gender identification and its disorders.

Consumer Behavior↗
PubMed2004

Anorexia nervosa and gender identity disorder in biologic males: a report of two cases.

UNLABELLED: Gender identity disorder is a rare disorder of uncertain etiology. The emphasis on body shape in this disorder suggests that there may be an association with anorexia nervosa. METHOD: We report two cases of anorexia nervosa and gender identity disorder in biologic males who presented to an eating disorders service. RESULTS: One was treated successfully as an outpatient and subsequently underwent gender reassignment surgery. The other patient required admission and prolonged psychotherapy. DISCUSSION: Differences between the two cases are discussed. Issues of gender identity should be considered in the assessment of male patients presenting with anorexia nervosa.

Adult↗
PubMed2004

A parent-report gender identity questionnaire for children.

This paper reports on the psychometric properties of a 16-item parent-report Gender Identity Questionnaire, originally developed by P. H. Elizabeth and R. Green (1984), to aid in the assessment of children with potential problems in their gender identity development. The questionnaire, which covered aspects of the core phenomenology of gender identity disorder (GID), was completed by parents of gender-referred children (N = 325) and controls (siblings, clinic-referred, and nonreferred; N = 504), who ranged in age from 2.5-12 years (mean age, 7.6 years). Factor-analysis indicated that a one-factor solution, containing 14 of the 16 items with factor loadings > or =.30, best fit the data, accounting for 43.7% of the variance. The gender-referred children had a significantly more deviant total score than did the controls, with a large effect size of 3.70. The GIQ total score had negligible age effects, indicating that the questionnaire has utility for assessing change over time. The gender-referred children who met the complete DSM criteria for GID had a significantly more deviant total score than did the children who were subthreshold for GID, although the latter group had a mean score that was closer to the threshold cases than to the controls. With a specificity rate set at 95% for the controls, the sensitivity rate for the probands was 86.8%. It is concluded that this parent-report gender identity questionnaire has excellent psychometric properties and can serve as a useful screening device for front-line clinicians, for whom more extensive, expensive, and time-consuming assessment procedures may be precluded.

Analysis of Variance↗
PubMed1993

Physical attractiveness of boys with gender identity disorder.

University students blind to group status rated boys with gender identity disorder and clinical control boys regarding their physical attractiveness. Ratings were made of the face and upper torso from photographs taken at the time of clinical assessment (mean age, 8.1 years). On all five adjectives (attractive, beautiful, cute, handsome, and pretty), boys with gender identity disorder were judged to be more attractive than were the clinical control boys. Attractiveness correlated with extent of behavioral femininity in the clinical control group, but not in the group of boys with gender identity disorder. The extent to which the group differences in attractiveness were due to objective, structural differences in facial attractiveness vs. socially created, or subjective, processes is discussed.

Beauty↗
PubMed1998

We all need our tails to lean on. An analysis of a latency-age girl with a gender identity disorder.

This essay reviews current theories of gender identity disorders, with particular reference to the etiology of the problem in girls. The analysis of a latency-age girl with a serious cross-gender identity disorder is presented in detail. The case material illustrates the complex relationships among this girl's fantasies about her adoption, her ambivalent attachments to her adoptive parents and brother, her pet rats, and about herself as a boy. In the analytic work, the real and transferential connections to the analysts were explored, which enabled the patient to reenact the traumatic derailments in her early attachments, to begin to mourn her losses, and to move to a more feminine identification.

Adoption↗
PubMed2005

The gender identity of pedophiles: what does the outcome data tell us?.

The aim of this study was to determine whether pedophiles have a different gender identity profile compared with non-sexual offenders. Participants were 87 male adult subjects, divided into three groups: (a) 27 pedophiles who abused male victims, (b) 30 pedophiles who abused female victims, and (c) 30 non-sexual offenders. The gender identity factor was measured with the Mf scale of the MMPI and the Bem Sex Role Inventory (BSRI). Results indicated no significant inter-group differences in terms of gender identity. However, the order of the three groups regarding scores on the Bem-Masculinity and the Mf scale was as predicted. Conceptual and empirical elements related to gender identity are addressed in order to shed light on potential disturbances in the gender identity of pedophiles.

Adult↗