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Gender Identity Disorder

Overview

Gender identity disorder is characterized by a feeling of being uncomfortable in one’s own gender and anatomy. The person presents himself/herself as a member of the opposite sex. Problems regarding identity begin at an early age when the person starts behaving and dressing like the opposite sex, what they want to be like. Some people identify with particular characteristics of a gender and try to change themselves. Some people may cross dress or get a sex change surgery. Some are born with an ambiguous genitalia, which leaves them and others confused.

The disorder affects the self-concept of the person, his/her choice of sexual partners, the show of feminine or masculine behaviors, manners and dress. It is very distressing for people who have the condition. It becomes difficult for them to adapt and they often feel rejected. Cases of suicides and drug abuse are common among such people.

Gender identity disorder is different from homosexuality and transvestitism or transvestic fetishism, where the person cross-dresses for sexual pleasure and does not identify with the opposite sex.

There are two different ways of development of this condition in adult males. First is onset of the disorder in childhood or early adolescence. The second is when overt signs of cross-gender identification appear more gradually later, with clinical signs in early to mid-adulthood like transvestic fetishism. This group can be more ambivalent about sex identity and getting sex change surgery; they may also get attracted to women. Males with this condition, who are sexually attracted to males show a past of gender dysphoria; and those sexually attracted to females, or even to both males and females, or not at all, show a history of transvestic fetishism.

This gender identity crises and behaviours are usually learned. They learn some behaviours at home and then later outside home. They learn to define gender specific behaviours, and adapt to the one they identify with. Girls may act like boys, called tomboys and boys may play with dolls and dress like girls in play.

In pathological cases, the person may become excessively feminine or masculine, like males may reject their masculine features and may want to bear children like women.

The condition is more prevalent in males than in females. This disorder may occur in children as well as adults.


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Causes

Specific cause of this condition is not known, but genetic factors and environmental may lead to it. The chromosome content in the baby determines the sex of the child. For males, it is an X and a Y chromosome, and for females, there are two X chromosomes. The Y chromosome has a gene called testes determining factor, which develops male genitals. If this is not present, the embryo develops as female. Further male differentiation is enhanced with more release of male hormones; a similar enhancement is done for females also. The hormonal release should occur in sufficient quantity and at a particular time. Problems in this can occur due to mother’s endocrine system, maternal stress or medications or intake of some toxic substances.

 

Recent studies reveal that non-transsexual men, male-to-female transsexuals and non-transsexual women display a marked difference in the volume of a part of the hypothalamus, which is important for sexual behavior. These studies show gender identity disorder due to chemical changes in the brain.

 

Besides these, environmental factors like socialization also can cause the gender identity disorder. According to the social learning theory a combination of observational learning, instrumental learning in the form of various kinds of reinforcement given by parents, friends and family, can affect the child’s sense of gender. This develops what the gender-appropriate and gender inappropriate behavior.


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Signs & Symptoms

The symptoms can vary with age; the social environment can also affect the development of these symptoms. The symptoms seen in children are:

 

  • They repeatedly show their desire to be of the opposite sex.
  • Boys prefer to dress up like girls, whereas girls want to wear masculine clothes.
  • Showing a preference for the opposite gender’s manner and play, fantasize oneself as being of the opposite sex – boys reject their stereotypical toys and activities, girls reject sitting position for urination.
  • Wanting to play games of the opposite gender.
  • Strong preference for playmates of the opposite sex.
  • Dislike their own genitals, have feelings of disgust for them, girls believe they will grow a penis, and does not want breasts to grow or menstruate. 
  • Usually are rejected by their peers and feel lonely.
  • They hold a belief that they will become the opposite sex one day. 
  • Suffer from depression or anxiety.
  • Express their need to become like the opposite sex.

 

The following symptoms are seen in adults and adolescents:

  • Like to dress like the opposite gender.
  • They feel lonely.
  • Suffer from depression or anxiety.
  • Express the desire to live as the opposite sex.
  • Want their genitals to be removed.

In the case of adolescents and adults, there is a repeated desire to get rid of primary and secondary characteristics of their sex, like they want a sex change or hormones given to get characteristics of the opposite sex, or they believe they are born in the wrong sex.

This abnormality causes difficulties in the social and occupational areas of functioning. An adult or an adolescent expresses his/her desire to change by stating their wish to be like the opposite sex, they may sometimes even pass off as the other sex, they want to be treated like the opposite gender and they believe that their feelings and reactions are those of the opposite sex.

 

As soon as puberty begins and the secondary sex characteristics begin to develop, the anxiety and frustrations of the person increases. Some men make become more masculine by trying to get rid of such feelings, like a man may play football or wrestle to feel more macho. All this increases their anxiety. They feel confused, are ashamed, have feelings of guilt and fear. They do not know how to handle or control their problem. The society’s reactions to their behavior and activities leave them feeling shameful.

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Prevention

The condition can be prevented in early childhood by giving children gender appropriate clothes to wear and things to do. Children should be criticized from playing their gender roles and games. Many people need that support and appreciation from other sources, which prevents the condition from developing. The support of family and other social groups can be beneficial in preventing as well treating the condition.


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Treatments
Counseling Psychotherapy

Counseling and psychotherapy are the best means of treatment for this condition. The establishment of a good support system is also used to treat the disorder. Usually, for children, individual and family counseling is used, and for adults individual or couples therapy is given. The therapy aims at helping individuals adapt into their biological sex roles, as much as possible. By reinforcing and encouraging gender appropriate behavior, the therapy helps to change the patient’s belief.

Early intervention through psychotherapy gives best results, increasing the chances of a positive change. It can reduce the level of any transsexual behavior in the later years.

Medical surgery Psychotherapy

Many adults resort to a sex reassignment or sex change through surgery. Before this, they need to get a hormonal therapy done, which curbs their present sex specific characteristics and increase the characteristics of the sex desired for, like female hormone estrogen is administered to males to reduce facial hair, widen hips and make breasts grow. The male hormone testosterone is given to females to make the voice deeper, increase body hair and curb menstruation. But, this can worsen the condition causing identity problems.

After the hormonal treatment, the patients have to live the cross gender role for about a year before the final sex change surgery is conducted

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