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Gender identity disorder

Definition

Gender identity disorder is a conflict between a person's actual physical gender and the gender that person identifies himself or herself as. For example, a person identified as a boy may actually feel and act like a girl. The person experiences significant discomfort with the biological sex they were born.

See also: Intersex

Alternative Names

Transsexualism

Causes, incidence, and risk factors

People with gender identity disorder may act and present themselves as members of the opposite sex. The disorder may affect:

• Choice of sexual partners
• Display of feminine or masculine mannerisms, behavior, and dress
• Self-concept

Gender identity disorder is not the same as homosexuality.

Identity conflicts can occur in many situations and appear in different ways. For example, some people with normal genitalia and sexual characteristics (such as breasts) of one gender privately identify more with the other gender.

Some people may cross-dress, and some may seek sex-change surgery. Others are born with ambiguous genitalia, which can raise questions about their gender.

The cause is unknown, but hormones in the womb, genes, and environmental factors (such as parenting) may be involved. This rare disorder may occur in children or adults.

Symptoms

Symptoms can vary by age, and are affected by the person's social environment. They may include the following:

Children:

• Are disgusted by their own genitals
• Are rejected by their peers, feel alone
• Believe that they will grow up to become the opposite sex
• Have depression or anxiety
• Say that they want to be the opposite sex

Adults:

• Dress like the opposite sex
• Feel alone
• Have depression or anxiety
• Want to live as a person of the opposite sex
• Wish to be rid of their own genitals

Either adults or children:

• Cross-dress, show habits typical of the opposite sex
• Withdraw from social interaction

Signs and tests

The feeling of being in the body of the "wrong" gender must last for at least 2 years for this diagnosis to be made. A history and psychiatric evaluation can confirm the person's constant desire to be the opposite sex. The person's partner choices may be same sex or opposite sex.

Treatment

Individual and family therapy is recommended for children. Individual and, if appropriate, couples therapy is recommended for adults. Sex reassignment through surgery and hormonal therapy is an option, but identity problems may continue after this treatment.

Support Groups

Expectations (prognosis)

Diagnosing and treating this disorder early can lead to a better outcome.

Complications

• Depression or anxiety
• Emotional distress
• Feeling alone
• Poor self-concept

Calling your health care provider

Make an appointment with your health care provider if you have symptoms of this disorder and want help, especially with anxiety and depression.

Prevention

References

Shafer LC. Sexual disorders and sexual dysfunction. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 36.

Peralta L. Gender identity disorder. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 13.2.

Möller B, Schreier H, Li A, Romer G. Gender identity disorder in children and adolescents. Curr Probl Pediatr Adolesc Health Care. 2009;39:117-143.