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Gender Identity Disorders

Sexual disorders that involve gender identity produce persistent feelings of gender discomfort and dissatisfaction. Defined as the intimate personal feeling one has about being male or female, gender identity includes three components: self-concept, perception of an ideal partner, and external presentation of masculinity and femininity through behavior, dress, and mannerisms.

Patients with these disorders typically behave and present themselves as people of the opposite sex, which they intensely desire to become. The disorder affects more men than women and usually begins in childhood. Rare in both children and adults, gender identity disorders shouldn't be confused with the far more common phenomenon of feelivg inadequate in fulfilling the expectations normally associated with a particular sex.


Current theories about the causes of gender identity disorders suggest a combination of predisposing factors: chromosomal anomaly, hormonal imbalance (particularly in utero during brain formation), and pathologic defects in early parent-child bonding and child-rearing practices. For example, parents who deliberately treat their child as a member of the opposite sex significantly contribute to gender identity disorder.


A strong and persistent identification with the opposite gender. There is a sense of discomfort in their own gender and may feel they were 'born the wrong sex.' This has been confused with cross-dressing or Transvestic Fetishism, but all are distinct diagnoses.


Gender identity disorder is typically diagnosed by a psychiatrist or psychologist, who conducts an interview with the patient and takes a detailed social history. Family members may also be interviewed during the assessment process. This evaluation usually takes place in an outpatient setting.


Individual and family therapy are indicated for treatment of childhood gender identity disorders. Ideally, a therapist of the same sex may be useful for role modeling purposes. The earlier this problem is diagnosed and treatment begins, the more hopeful the prognosis for the child.

In an adult, individual and couples therapy may help the patient to cope with the decision to live as, the opposite sex or to cope with the knowledge that he or she won't be able to live as the opposite sex.

Sex reassignment through hormonal and surgical treatment may be an option; however, surgical sex reassignment hasn't been as beneficial as first hoped. Severe psychological problems may persist after sex reassignment and sometimes lead to suicide. Furthermore, these patients may have gender disorders as part of a larger pattern of depression and personality disorders such as a borderline personality disorder.

With or without treatment, female transsexuals have shown stabler patterns of adjustment than male transsexuals have demonstrated.

Appropriate psychiatric management, including hospitalization, may be necessary if the patient displays evidence of the potential for violent behavior, such as suicidal ideation and fantasies of self-mutilation.


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