Gender Identity Disorder: A Literature Review from a Developmental Perspective

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ABSTRACT

The present paper reviews the theoretical and empirical literature on children and adolescents with gender variant behaviors. The organizational framework underlying this review is one that presents gender behavior in children and adolescents as a continuum rather than as a dichotomy of normal versus abnormal categories. Seven domains are reviewed in relation to gendervariantbehavioringeneral.andtoGenderldentity Disorder (Gl D) in particular: theories of normative gender development, phenomenology, prevalence, assessment, developmental trajectories, comorbidity and treatment.

INTRODUCTION

Gender identity disorder (GID) is one of the most controversial diagnoses of the DSM-IV (1) and almost incomparable in the complexity of its social, ethical and political considerations to any other diagnosis. Because not many children meet complete diagnostic criteria for GID, the clinical experience of mental health professionals working with GID children and adolescents is limited. What is far more common, however, are parents seeking counseling about their children's gender variant behaviors, and therefore it is important to distinguish between these two conditions. The aim of the present paper is to review the available research data and clinical literature on gender variant behaviors in general, and on GID in particular, in children and adolescents.

TERMINOLOGY

In this section, a brief review of key terms in the field of gender development is presented.

* Sex - The genetic, hormonal and anatomical characteristics that determine if one is a biological male or a biological female.

* Gender - The psychological and cultural characteristics associated with biological sex.

* Gender role - Attitudes, behaviors and personality traits that a society, in a given cultural and historical context, associates with the male or female social role. Masculinity and femininity, the main concepts in gender role, pertain to the presence of qualities and behaviors in an individual that are consistent with those expected from males and females.

* Gender identity - Perception of one's self as male or female. In children, gender identity is related to the ability to reliably answer the question: "Are you a boy or a girl?" The individual's comfort with the sex and gender categories assigned at birth is a major element of gender identity.

* Sexual orientation - The sex of the person or persons to whom the individual's sexual fantasies, sexual arousal and sexual activities are predominantly directed. Sexual orientation ranges along a continuum from exclusive heterosexuality to exclusive homosexuality and includes various forms of bisexuality. A less common sexual orientation is asexuality, or the absence of sexual attraction to either sex.

THEORIES OF GENDER DEVELOPMENT

Gender is one of the most salient social categories, and it plays a major role in the way people define themselves and experience their social world. Extensive theoretical and empirical work has been invested in understanding the mechanisms underlying the trajectories of gender development. In this section, a brief description of theories of normative gender development is presented as the basis for the discussion of gender nonconformity which follows. (For a comprehensive review of gender development theories, see 2, 3.)

Theories of gender development may be divided into four types: psychoanalytic theories, gender essentialism, environmental theories and cognitive theories.

Psychoanalytic theories of sex differentiation are rooted in Freud's early work. Freud (4) claimed that a child's gender role is determined during the phallic stage. Fear of castration motivates the child to identify with the same-sex parent, thereby incorporating that parent's gender roles and attitudes. These concepts were later expanded by Horney (5), Chodorow (6) and others. Psychoanalytic theories are not amenable to empirical study and have therefore not received much empirical support (3). …