In contemporary developmental psychology and sexology, gender identity is usually described in a binary manner (i.e., a male vs. a female gender identity). In clinical practice, this has been translated into a dichotomous conceptualization of gender dysphoria or gender identity disorder (GID), and is reflected in nosological systems, such as the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000), in that a person either does or does not meet criteria for GID. Thus, given this constraint of a binary approach, there has been increasing interest in measuring gender dysphoria as a dimensional construct.
There are various reasons why a dimensional approach to the measurement of gender identity and gender dysphoria may have both conceptual and clinical merit. In post-modern Western culture, it has been claimed that more and more individuals are rejecting the traditional binary of male versus female, suggestive of greater evidence of normative gender fluidity (Diamond & Butterworth, 2008). Among clinical populations (see below), including patients who present to specialized gender identity clinics, it has been argued that there is currently more heterogeneity in clinical presentation, which may not be fully captured by a dichotomous diagnostic system, such as the DSM-IV-TR (American Psychiatric Association, 2000; e.g., Feldman & Bockting, 2003). Accordingly, a dimensional measure of gender identity and gender dysphoria may be able to better capture such putative variability.
Deogracias et al. (2007) reported on the development of a dimensional measure of gender identity and gender dysphoria that could be used in the assessment of both adolescents and adults. They constructed a 27-item gender identity and gender dysphoria questionnaire called the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA), with each item rated on a five-point response scale for the previous 12 months. In the development of this measure, gender identity and gender dysphoria were conceptualized as existing on a bipolar continuum with a male pole, a female pole, and varying degrees of gender dysphoria existing between them. Parallel versions were constructed for males and females. Factor analysis identified a one-factor solution containing all 27 items (see below for details). The mean factor score significantly discriminated both adolescents and adults with GID (n = 39) from a non-clinical comparison group of both heterosexual and non-heterosexual university students (N=389), with excellent specificity (90.4%) and sensitivity (99.7%) rates. As acknowledged by Deogracias et al. (2007), perhaps the most prominent limitation of their study was the lack of a clinical control (CC) comparison group. The acquisition of CC data would help to clarify the extent to which gender dysphoria is a characteristic of clinical populations in general or is quite specific to patients referred because of concerns about their gender identity.
This study aimed to replicate and extend the findings of Deogracias et al. (2007). In Study 1, a new sample of adolescents with GID was utilized and compared to adolescents referred for a variety of other clinical concerns and adolescent males with transvestic fetishism (TF). This enabled us to examine the comparability of GIDYQ-AA scores for two samples of GID adolescents and to provide a further test of discriminant validity. In Study 2, adults with GID were compared to adults referred for other clinical concerns. In both studies, we also examined the relation between current self-reported gender dysphoria and a dimensional measure of recalled cross-gender behavior in childhood as a test of convergent validity.
Participants. A total of 44 adolescents (19 males, 25 females) referred consecutively to the Gender Identity Service, Child, Youth, and Family Program (CYFP) at the Centre …