Chapter 45. Gender Identity Disorder in Children, Adolescents, and Adults

Kenneth J. Zucker, Ph.D.
DOI: 10.1176/appi.books.9781585622986.261477



Since its introduction to the psychiatric nomenclature in DSM-III (American Psychiatric Association 1980), the study of gender identity disorder (GID) in children, adolescents, and adults has advanced on several fronts: 1) its phenomenology has been well described; 2) the reliability and validity of the diagnosis have been established with reasonable success; 3) associated features have been identified; 4) follow-up studies have tracked its natural history; and 5) various etiological hypotheses have been examined (for reviews, see Cohen-Kettenis and Gooren 1999; Cohen-Kettenis and Pfäfflin 2003; Zucker 2004, 2005a, 2005b, 2006a; Zucker and Bradley 1995).

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American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition. Washington, DC, American Psychiatric Association, 1980
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, American Psychiatric Association, 1994
Bailey JM, Zucker KJ: Childhood sex-typed behavior and sexual orientation: a conceptual analysis and quantitative review. Dev Psychol 31:43–55, 1995
Bates JE, Skilbeck WM, Smith KVR, et al: Intervention with families of gender-disturbed boys. Am J Orthopsychiatry 45:150–157, 1975
Beh H, Diamond M: Ethical concerns related to treating gender nonconformity in childhood and adolescence: lessons from the Family Court of Australia. Health Matrix: Journal of Law-Medicine 15:239–283, 2005
Bem DJ: Exotic becomes erotic: a developmental theory of sexual orientation. Psychol Rev 103:320–335, 1996
Blanchard R, Sheridan PM: Gender reorientation and psychosocial adjustment, in Clinical Management of Gender Identity Disorders in Children and Adults. Edited by Blanchard R, Steiner BW. Washington, DC, American Psychiatric Press, 1990, pp 159–189
Blanchard R, Steiner BW, Clemmensen LH, et al: Prediction of regrets in postoperative transsexuals. Can J Psychiatry 34:43–45, 1989
Bleiberg E, Jackson L, Ross JL: Gender identity disorder and object loss. J Am Acad Child Psychiatry 25:58–67, 1986
Blount EL, Stokes TF: Self-reinforcement by children, in Progress in Behavior Modification, Vol 18. Edited by Hersen M, Eisler RM, Miller PM. New York, Academic Press, 1984, pp 195–225
Bradley SJ, Zucker KJ: [Reply to Pickstone-Taylor]. J Am Acad Child Adolesc Psychiatry 42:266–267, 2003
Burke P: Gender Shock: Exploding the Myths of Male and Female. New York, Anchor Books, 1996
Chiland C: The psychoanalyst and the transsexual patient. Int J Psychoanal 81:21–35, 2000
Clifford MD: "I'd get another job if I were you": the self psychologically informed treatment of an atypically gender identity disordered boy. Psychoanalysis & Psychotherapy 14:289–315, 1997
Coates S: Extreme boyhood femininity: overview and new research findings, in Sexuality: New Perspectives. Edited by DeFries Z, Friedman RC, Corn R. Westport, CT, Greenwood, 1985, pp 101–124
Coates S: Ontogenesis of boyhood gender identity disorder. J Am Acad Psychoanal 18:414–438, 1990
Coates S, Person ES: Extreme boyhood femininity: isolated behavior or pervasive disorder? J Am Acad Child Psychiatry 24:702–709, 1985
Coates S, Wolfe S: Gender identity disorder in boys: the interface of constitution and early experience. Psychoanalytic Inquiry 15:6–38, 1995
Coates S, Wolfe S: Gender identity disorders of childhood, in Handbook of Child and Adolescent Psychiatry, Vol 1: Infants and Preschoolers: Development and Syndromes. Edited by Noshpitz JD, Greenspan S, Wieder S, et al. New York, Wiley, 1997, pp 452–473
Coates S, Friedman RC, Wolfe S: The etiology of boyhood gender identity disorder: a model for integrating temperament, development, and psychodynamics. Psychoanalytic Dialogues 1:341–383, 1991
Cohen-Kettenis PT, Gooren LJ: Transsexualism: a review of etiology, diagnosis and treatment. J Psychosom Res 46:315–333, 1999
Cohen-Kettenis PT, Pfäfflin F: Transgenderism and Intersexuality in Childhood and Adolescence: Making Choices. Thousand Oaks, CA, Sage, 2003
Cohen-Kettenis PT, van Goozen SHM: Sex reassignment of adolescent transsexuals: a follow-up study. J Am Acad Child Adolesc Psychiatry 36:263–271, 1997
Cohen-Kettenis PT, van Goozen SHM: Pubertal delay as an aid in diagnosis and treatment of a transsexual adolescent. Eur Child Adolesc Psychiatry 7:246–248, 1998
Cohen-Kettenis PT, Walinder J: Sex reassignment surgery in Europe: a survey. Acta Psychiatr Scand 75:176–182, 1987
Cohen-Kettenis PT, Owen A, Kaijser VG, et al: Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: a cross-national, cross-clinic comparative analysis. J Abnorm Child Psychol 31:41–53, 2003
Corbett K: Homosexual boyhood: notes on girlyboys. Gender & Psychoanalysis 1:429–461, 1996
Corbett K: Cross-gendered identifications and homosexual boyhood: toward a more complex theory of gender. Am J Orthopsychiatry 68:352–360, 1998
de Ahumada LCB: Clinical notes on a case of transvestism in a child. Int J Psychoanal 83:291–313, 2003
Di Ceglie D: Management and therapeutic aims in working with children and adolescents with gender identity disorders, and their families, in A Stranger in My Own Body: Atypical Gender Identity Development and Mental Health. Edited by Di Ceglie D. London, Karnac, 1998, pp 185–197
Drescher J, Zucker KJ (eds): Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics, and Culture. New York, Haworth Press, 2006
Drummond KD: A follow-up study of girls with gender identity disorder. Unpublished master's thesis, University of Toronto, Toronto, ON, Canada, 2006
Feder EK: Disciplining the family: the case of gender identity disorder. Philosophical Studies 85:195–211, 1997
Fischhoff J: Preoedipal influences in a boy's determination to be "feminine" during the oedipal period. J Am Acad Child Psychiatry 3:273–286, 1964
Gilpin DC, Raza S, Gilpin D: Transsexual symptoms in a male child treated by a female therapist. Am J Psychother 33:453–463, 1979
Gooren L, Delemarre–van de Waal H: The feasibility of endocrine interventions in juvenile transsexuals. J Psychol Human Sex 8(4):69–84, 1996
Green R: The "Sissy Boy Syndrome" and the Development of Homosexuality. New Haven, CT, Yale University Press, 1987
Green R: Gender identity disorder in children, in Treatments of Psychiatric Disorders, 2nd Edition, Vol 2. Edited by Gabbard GO. Washington, DC, American Psychiatric Press, 1995, pp 2001–2014
Green R, Fleming D: Transsexual surgery follow-up: status in the 1990s. Ann Rev Sex Res 1:163–174, 1990
Green R, Fuller M: Group therapy with feminine boys and their parents. Int J Group Psychother 23:54–68, 1973
Green R, Newman LE, Stoller RJ: Treatment of boyhood "transsexualism": an interim report of four years' experience. Arch Gen Psychiatry 26:213–217, 1972
Greenson RR: A transvestite boy and a hypothesis. Int J Psychoanal 47:396–403, 1966
Haber CH: The psychoanalytic treatment of a preschool boy with a gender identity disorder. J Am Psychoanal Assoc 39:107–129, 1991
Harper GW, Schneider M: Oppression and discrimination among lesbian, gay, bisexual, and transgendered people and communities: a challenge for community psychology. Am J Community Psychol 31:243–252, 2003
Herdt G: Introduction: third sexes and third genders, in Third Sex, Third Gender: Beyond Sexual Dimorphism in Culture and History. Edited by Herdt G. New York, Zone Books, 1994, pp 21–81
Isay RA: Remove gender identity disorder in DSM. Psychiatric News 32:9, 13, 1997
Isay RA: Gender in homosexual boys: some developmental and clinical considerations. Psychiatry 62:187–194, 1999
Kline TJ: Alain Berliner's Ma Vie en Rose (1997): crossing dress, crossing boundaries. Gender & Psychoanalysis 3:435–449, 1998
Knight R: Margo and me: gender as a cause and solution to unmet needs. Psychoanal Study Child 58:35–59, 2003a
Knight R: Margo and me II: the role of narrative building in child analytic technique. Psychoanal Study Child 58:133–164, 2003b
Lawrence AA: Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Arch Sex Behav 32:299–315, 2003
Loeb LR: Analysis of the transference neurosis in a child with transsexual symptoms. J Am Psychoanal Assoc 40:587–605, 1992
Lothstein LM: Clinical management of gender dysphoria in young boys: genital mutilation and DSM IV implications. J Psychol Human Sex 5(4):87–106, 1992
Maccoby EE: The Two Sexes: Growing Up Apart, Coming Together. Cambridge, MA, Harvard University Press, 1998
Marantz S, Coates S: Mothers of boys with gender identity disorder: a comparison of matched controls. J Am Acad Child Adolesc Psychiatry 30:310–315, 1991
Marks I, Green R, Mataix-Cols D: Adult gender identity disorder can remit. Compr Psychiatry 41:273–275, 2000
Martin CL, Ruble DN, Szkrybalo J: Cognitive theories of early gender development. Psychol Bull 128:903–933, 2002
Mate-Kole C, Freschi A, Robin A: A controlled study of psychological and social change after surgical gender reassignment in selected male transsexuals. Br J Psychiatry 157:261–264, 1990
McCarthy L: Off that spectrum entirely: a study of female-bodied transgender-identified individuals. Unpublished doctoral dissertation, University of Massachusetts, Amherst, 2003
Mehta P: Transvestite behavior in a preschool boy: reflections on analytic treatment, in Objects of Desire: The Sexual Deviations. Edited by Socarides CW, Freedman A. Westport, CT, International Universities Press, 2002, pp 287–304
Menvielle EJ, Tuerk C: A support group for parents of gender non-conforming boys. J Am Acad Child Adolesc Psychiatry 41:1010–1013, 2002
Menvielle EJ, Tuerk C, Perrin EC: To the beat of a different drummer: the gender-variant child. Contemporary Pediatrics 22:38–39, 41, 43, 45–46, 2005
Meyer W, Bockting WO, Cohen-Kettenis P, et al: The Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders, Sixth Version. J Psychol Human Sex 13:1–30, 2001
Meyer-Bahlburg HFL: Review of "The Last Time I Wore a Dress: A Memoir." Arch Sex Behav 28:431–434, 1999
Meyer-Bahlburg HFL: Gender identity disorder in young boys: a parent- and peer-based treatment protocol. Clinical Child Psychology and Psychiatry 7:360–377, 2002
Minter S: Diagnosis and treatment of gender identity disorder in children, in Sissies and Tomboys: Gender Nonconformity and Homosexual Childhood. Edited by Rottnek M. New York, New York University Press, 1999, pp 9–33
Money J, Hampson JG, Hampson JL: Imprinting and the establishment of gender role. Arch Neurol Psychiatry 77:333–336, 1957
Newman LE: Treatment for the parents of feminine boys. Am J Psychiatry 133:683–687, 1976
Newman LK: Sex, gender and culture: issues in the definition, assessment and treatment of gender identity disorder. Clinical Child Psychology and Psychiatry 7:352–359, 2002
Nordyke NS, Baer DM, Etzel BC, et al: Implications of the stereotyping and modification of sex role. J Appl Behav Anal 10:553–557, 1977
Oppenheimer A: The wish for a sex change: a challenge to psychoanalysis? Int J Psychoanal 72:221–231, 1991
Pauly IB: Outcome of sex reassignment surgery for transsexuals. Aust NZ J Psychiatry 15:45–51, 1981
Petersen ME, Dickey R: Surgical sex reassignment: a comparative survey of international centers. Arch Sex Behav 24:135–156, 1995
Pfäfflin F, Junge A: Sex reassignment: thirty years of international follow-up studies. A comprehensive review, 1961–1991. Symposion Publishing, 1998. Available at: http://www.symposion.com/ijt/pfaefflin/1000.htm. Accessed November 2006.
Pleak RR: Ethical issues in diagnosing and treating gender-dysphoric children and adolescents, in Sissies and Tomboys: Gender Nonconformity and Homosexual Childhood. Edited by Rottnek M. New York, New York University Press, 1999, pp 34–51
Pickstone-Taylor SD: Children with gender nonconformity [letter to the editor]. J Am Acad Child Adolesc Psychiatry 42:266, 2003
Pruett KD, Dahl EK: Psychotherapy of gender identity conflict in young boys. J Am Acad Child Psychiatry 21:65–70, 1982
Quindoz D: A fe/male transsexual patient in psychoanalysis. Int J Psychoanal 79:95–111, 1998
Rekers GA: Stimulus control over sex-typed play in cross-gender identified boys. J Exp Child Psychol 20:136–148, 1975
Rekers GA: Gender identity problems, in Handbook of Clinical Behavior Therapy with Children. Edited by Bornstein PA, Kazdin AE. Homewood, IL, Dorsey, 1985, pp 658–699
Rekers GA: Inadequate sex role differentiation in childhood: the family and gender identity disorders. J Fam Cult 2:8–37, 1986
Rekers GA, Lovaas OI: Behavioral treatment of deviant sex-role behaviors in a male child. J Appl Behav Anal 7:173–190, 1974
Rekers GA, Mead S: Early intervention for female sexual identity disturbance: self-monitoring of play behavior. J Abnorm Child Psychol 7:405–423, 1979
Rekers GA, Varni JW: Self-monitoring and self-reinforcement in a pre-transsexual boy. Behav Res Ther 15:177–180, 1977a
Rekers GA, Varni JW: Self-regulation of gender-role behaviors: a case study. J Behav Ther Exp Psychiatry 8:427–432, 1977b
Rekers GA, Kilgus M, Rosen AC: Long-term effects of treatment for gender identity disorder of childhood. Journal of Psychology and Human Sexuality 3(2):121–153, 1990
Richardson J: Setting limits on gender health. Harv Rev Psychiatry 4:49–53, 1996
Richardson J: Response: finding the disorder in gender identity disorder. Harv Rev Psychiatry 7:43–50, 1999
Rosenberg M: Children with gender identity issues and their parents in individual and group treatment. J Am Acad Child Adolesc Psychiatry 41:619–621, 2002
Schaefer LC, Wheeler CC, Futterweit W: Gender identity disorder (transsexualism), in Treatments of Psychiatric Disorders, 2nd Edition, Vol 2. Edited by Gabbard GO. Washington, DC, American Psychiatric Press, 1995, pp 2015–2048
Scholinski D: After-wards. Hastings Law Journal 48:1195–1999, 1997a
Scholinski D: The Last Time I Wore A Dress: A Memoir. New York, Riverhead Books, 1997b
Schultz NM: Severe Gender Identity Confusion in an Eight-Year-Old Boy. Unpublished doctoral dissertation, Yeshiva University, New York, 1979
Sedgwick EK: How to bring your kids up gay. Social Text 9:18–27, 1991
Sloop JM: Disciplining the transgendered: Brandon Teena, public representation, and normativity. Western Journal of Communication 64:165–189, 2000
Smith YL, van Goozen SH, Cohen-Kettenis PT: Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: a prospective follow-up study. J Am Acad Child Adolesc Psychiatry 40:472–481, 2001
Soutter A: A longitudinal study of three cases of gender identity disorder of childhood successfully resolved in the school setting. School Psychology International 17:49–57, 1996
Spitzer RL: Can some gay men and lesbians change their sexual orientation? 200 participants reporting a change from homosexual to heterosexual orientation. Arch Sex Behav 32:403–417, 2003
Spriggs MP: Ethics and the proposed treatment for a 13-year-old with atypical gender identity. Med J Aust 181:319–321, 2004
Stoller RJ: The mother's contribution to infantile transvestic behavior. Int J Psychoanal 47:384–395, 1966
Stoller RJ: Male childhood transsexualism. J Am Acad Child Psychiatry 7:193–209, 1968
Stoller RJ: Boyhood gender aberrations: treatment issues. J Am Psychoanal Assoc 26:541–558, 1978
Stoller RJ: Fathers of transsexual children. J Am Psychoanal Assoc 27:837–866, 1979
Wallach HD: Termination of treatment as a loss. Psychoanal Study Child 16:538–548, 1961
Walters E, Whitehead L: Anorexia nervosa in a young boy with gender identity disorder of childhood: a case report. Clin Child Psychol Psychiatry 2:463–467, 1997
Willox A: Branding Teena: (mis)representations in the media. Sexualities 6:407–425, 2003
Wilson I, Griffin C, Wren B: The interaction between young people with atypical gender identity organization and their peers. J Health Psychol 10:307–315, 2005
Wren B: "I can accept my child is transsexual but if I ever see him in a dress I'll hit him": dilemmas in parenting a transgendered adolescent. Clin Child Psychol Psychiatry 7:377–397, 2002
Yanof JA: Barbie and the tree of life: the multiple functions of gender in development. J Am Psychoanal Assoc 48:1439–1465, 2000
Zients AB: A boy who thought he needed to be a girl. Psychoanal Study Child 58:19–34, 2003
Zucker KJ: Cross-gender-identified children, in Gender Dysphoria: Development, Research, Management. Edited by Steiner BW. New York, Plenum, 1985, pp 75–174
Zucker KJ: Commentary on Richardson's (1996) "Setting Limits on Gender Health." Harv Rev Psychiatry 7:37–42, 1999a
Zucker KJ: Gender identity disorder in the DSM-IV [letter to the editor]. J Sex Marital Ther 25:5–9, 1999b
Zucker KJ: Commentary on Walters and Whitehead's (1997) "Anorexia Nervosa in a Young Boy with Gender Identity Disorder of Childhood: A Case Report." Clin Child Psychol Psychiatry 5:233–239, 2000a
Zucker KJ: Gender identity disorder, in Handbook of Developmental Psychopathology, 2nd Edition. Edited by Sameroff AJ, Lewis M, Miller SM. New York, Plenum, 2000b, pp 671–686
Zucker KJ: Gender identity disorder in children and adolescents, in Treatments of Psychiatric Disorders, 3rd Edition, Vol 2. Edited by Gabbard GO. Washington, DC, American Psychiatric Press, 2001, pp 2069–2094
Zucker KJ: Gender identity development and issues. Child Adolesc Psychiatr Clin N Am 13:551–568, 2004
Zucker KJ: Gender identity disorder in children and adolescents. Annu Rev Clin Psychol 1:467–492, 2005a
Zucker KJ: Measurement of psychosexual differentiation. Arch Sex Behav 34:385–388, 2005b
Zucker KJ: Gender identity disorder, in Behavioral and Emotional Disorders in Adolescence: Nature, Assessment, and Treatment. Edited by Wolfe DA, Mash EJ. New York, Guilford, 2006a, pp 535–562
Zucker KJ: "I'm half-boy, half-girl": play psychotherapy and parent counseling for gender identity disorder, in Treatment Companion to the DSM-IV-TR Casebook. Edited by Spitzer RL, First MB, Williams JBW, et al. Washington, DC, American Psychiatric Publishing, 2006b, pp 321–334
Zucker KJ, Blanchard R: Transvestic fetishism: psychopathology and theory, in Sexual Deviance: Theory, Assessment, and Treatment. Edited by Laws DR, O'Donohue W. New York, Guilford, 1997, pp 253–279
Zucker KJ, Bradley SJ: Gender Identity Disorder and Psychosexual Problems in Children and Adolescents. New York, Guilford, 1995
Zucker KJ, Bradley SJ: Gender identity disorder, in Handbook of Infant Mental Health, 2nd Edition. Edited by Zeanah CH. New York, Guilford, 2000, pp 412–424
Zucker KJ, Green R: Gender identity disorder of childhood, in Treatments of Psychiatric Disorders, Vol 1. Edited by Karasu TB. Washington, DC, American Psychiatric Association, 1989, pp 661–670
Zucker KJ, Bradley SJ, Doering RW, et al: Sex-typed behavior in cross-gender-identified children: stability and change at a 1-year follow-up. J Am Acad Child Psychiatry 24:710–719, 1985
Zucker KJ, Bradley SJ, Ipp M: Delayed naming of a newborn boy: relationship to the mother's wish for a girl and subsequent cross-gender identity in the child by the age of two. J Psychol Human Sex 6:57–68, 1993a
Zucker KJ, Bradley SJ, Lowry Sullivan CB, et al: A gender identity interview for children. J Pers Assess 61:443–456, 1993b
Zucker KJ, Green R, Garofano C, et al: Prenatal gender preference of mothers of feminine and masculine boys: relation to sibling sex composition and birth order. J Abnorm Child Psychol 22:1–13, 1994
Zucker KJ, Bradley SJ, Sanikhani M: Sex differences in referral rates of children with gender identity disorder: some hypotheses. J Abnorm Child Psychol 25:217–227, 1997
Zucker KJ, Owen A, Bradley SJ, et al: Gender-dysphoric children and adolescents: a comparative analysis of demographic characteristics and behavioral problems. Clin Child Psychol Psychiatry 7:398–411, 2002
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