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Gender Identity Disorder

What is Gender Identity Disorder?

GenderOne of the most controversial diagnoses in the DSM-IV is gender identity disorder (GID), as its complex social, ethical, and political considerations are incomparable to any other diagnosis.[1] While it is uncommon for children to meet the entire list of diagnostic criteria for GID, it is common for parents to seek counseling regarding their child’s gender variant behaviors.[2]  It is important to distinguish between these two conditions, and Psychologist at the Department of Psychology at Tel Aviv University in Israel, Tomer Shechner, Ph.D. discusses information from available literature regarding gender variant behaviors in children and adolescents in the article “Gender Identity Disorder: A Literature Review from a Developmental Perspective.”2

Gender is one of the most important social categories to all individuals, as it plays an important role in the way one defines themselves and experiences the world around them. Research has begun to understand the underlying course of gender development and four types of theories have been developed regarding such: psychoanalytic theories, gender essentialism, environmental theories, and cognitive theories. First, rooted in the works of Freud, are psychoanalytic theories of sex differentiation.[3] According to Freud, a child’s gender role is determined within the phallic stage of their development, which occurs between the ages of three and six. Freud stated that the fear of castration motivates the child to identify with the same-sex parent, connecting with that parent’s gender roles and attitudes.3 While Horney,[4] Chodorow,[5] and others have expanded upon this theory, it has not received much empirical support.[6]

Gender and Biological Factors

Second, gender essentialism states that gender differentiation is attributed to biological differences, focusing on genetics, hormones, and neurological factors.2 For example, research states that the evolutionary perspective explains human sex differences due to the survival value of certain traits and characteristics that were adopted by men and women during early times.[7] Other research suggests that different biological factors of sex-typing attitudes and behaviors have causal effects of development.[8]

Gender and Environmental Factors

Third, the environmental theories explain gender development in keeping with learning theory.2 According to Shechner, there are three elements that are required for one to learn: the stimulus, the response to the stimulus, and the resulting behavior.2 Reinforcement of the behavior increases the chances for the same behavior to recur, while, on the other hand, punishment will decrease the chances.2 The learning theory states that people are passive, allowing the environment to shape their behavior.2 For example, children learn their gender expectations through the reactions of their behavior by social agents (parents, teachers, etc.). [9]

Gender and Personal Characteristics

Lastly, cognitive theories state that gender development is shaped by a child’s cognitive abilities, interests, knowledge, and other personal characteristics.2 Liben divided the cognitive theories into two approaches: cognitive-environmental and developmental-constructivist.[10] The cognitive-environmental approach stresses the interaction of the environment and the individual’s personal characteristics.2 Bussey and Bandura state that gender development involves learning through modeling and imitation, which require the child to acquire certain skills.[11] Also, under this approach, gender-typed behaviors are thought to result from a child’s interaction with environmental events, personal factors, and behavioral patterns.2 According to the developmental-constructivist approach, individuals are active participants who seek out and organize information regarding social contexts.2 This includes a few theories, including cognitive-developmental stage theory and gender schema theory.2 Derived from Piaget’s studies of cognitive development, the cognitive-developmental stage theory states that cognition is the result of self-driven processes—not just environmental experiences.[12] Gender schema theory states that an individual’s attitude about gender is used as a “cognitive prism,” through which information is filtered and manifested as behavior.[13]

Diagnosing and Treating Gender Identity Disorder

In order to diagnose GID, a systematic clinical interview must be conducted by a psychiatrist.2 The evaluation should include the child, their parents, and perhaps other important figures in their life.2 The intake evaluation may be difficult to get through in one visit, as emotions are strong and embarrassment and subject matter may hold individuals back from stating their full feelings.2 The clinician may use several instruments to gather information about sex-typing behavior.2 The Occupational, Activity, and Trait Personal Interest and Attitude Measure Scales for Children (COAT-PM/AM) and Preschoolers (POAT-PM/AM) are common instruments used in the United States.[14] Of these instruments, the Activities and Traits portions are recommended to asses sex-typing behaviors and preferences.2

Treatment of GID brings out the ethical and social aspects of the disorder’s controversies.2 An issue associated with GID is the relationship between gender nonconformity in childhood and later homosexuality.2 Parents may express concern regarding this issue; however, homosexuality is not a mental disorder and there is no justification for any treatment regarding. If the child feels disgusted or alienated by their body organs, distress may present itself, leading to impairment of function.2 Therefore, in some situations, hormone and surgical treatment are a good fit, but if not, physical interventions and therapy are another.2 It is important to assess the child’s and parents’ difficulties when formulating a treatment plan.2



[1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed., text revision. Washington, D.C.: American Psychiatric Association, 2000.

[2] Shechner, T. (2010). Gender Identity Disorder: A Literature Review from a Developmental Perspective. Isr J Psychiatry Relat Sci 47(2): 132-138.

[3] Freud S. Three essays on the theory of sexuality. 1905: standard Edition. London: Hogarth, 1953.

[4] Horney K. The dread of women. Int J Psychoanalysis 1922;13,348-360.

[5] Chodorow N. Mothering, object-relations, and the female oedipal configuration. Feminist Studies 1978;4:137-158.

[6] Ruble DN, Martin CL, Berenbaum SA. Gender development. In: Eisenberg N, Damon W, Lerner RM, editors. Handbook of child psychology, Vol. 3. Social, emotional, and personality development (6th ed.) Hoboken, N.J.: Wiley, 2006: pp. 858-932.

[7] Cosmides L, Tooby J. Origins of domain specificity: The evolution of functional organization. In: Hirschfeld LA, Gelman SA, editors. Mapping the mind: Domain specificity in cognition and culture. New York: Cambridge University, 1994: pp. 85-116.

[8] Liben LS, Susman EJ, Finkelstein JW, Chinchilli VM, Kunselman S, Schwab J, Dubas JS, Demers LM, Lookingbill G, D’Arcangelo MR, Krough HR, Kulin HE. The effects of sex steroids on spatial performance: A review and an experimental clinical investigation. Dev Psychol 2002;38:236-253.

[9] Mischel W. Sex typing and socialization. In: Mussen PH, editor. Carmichael’s handbook of child psychology, Vol. 2. New York: Wiley, 1970: pp. 3-72.

[10] Liben LS. Cognitive approaches to gender development. In: Blakemore JEO, Berenbaum SA, Liben LS, editors. Gender development. New York: Taylor & Francis, 2008: pp. 197-226.

[11] Bussey K, Bandura A. Social cognitive theory of gender development and differentiation. Psychol Rev 1999;106:676-713.

[12] Kohlberg LA. A cognitive-developmental analysis of children’s sex role concepts and attitudes. In: Maccoby EE, editor. The development of sex differences. Stanford, Cal.: Stanford University, 1966: pp. 82-173.

[13] Martin CL, Halverson CF. A schematic processing model of sex typing and stereotyping in children. Child Dev 1981;52:1119-1134.

[14] Zucker KJ, Cohen-Kettenis PT. Gender identity disorder in children and adolescents. In: Rowland DL, Incrocci L, editors. Handbook of sexual and gender identity disorders. Hoboken, N.J.: Wiley, 2008: pp. 376-422. Gender.

One Comment

  • Albert

    April 25, 2014, 7:29 am

    I totally agree that this is not a disorder, however, I for one would like to see it stay classed as a disorder There have been several people that I have talked to in just my small circle that if it were not for insurance paying for hormones to treat this disorder , they would never have been able to take that first step because of the financial burden. We have all heard stories of someone that has taken their life because they felt there was no way that they could even begin the journey To have being Transgen classed as a disorder, in my book at least, is a good thing if it helps even one person begin their journey or saves even one life from suicide.That’s my take.

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