Gender identity disorder in children

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Gender identity disorder in children (GIDC) is the formal diagnosis used by psychologists and physicians to describe children who experience significant gender dysphoria. (discontent with their biological sex).

Contents

Diagnostic classification

Children suspected of having Gender Identity Disorder (GID) face numerous issues in therapy. The first is simply knowing if he or she is suffering with an issue of gender identity. As many as 80 to 95 percent of pre-pubescent children with GID will no longer experience a GID in adolescence, often due to the original complaints being caused by the desire to have the privileges, perceived or otherwise, of the opposite sex. On the flip side to this, is the possibility of unnecessary dismissal of complaints by parents or health care providers. Unfortunately this is due to the general lack of understanding of how gender identity is formed. GID can be distinguished from gender behaviour nonconformity by the extent and pervasiveness of the cross-gender wishes, interests, and activities. Children should not be given the diagnosis unless the full set of symptoms are present, including marked distress or impairment. The criteria of knowing if a child has GID vary by the prevailing psychological instruments used to test him or her with, as well as the methodology to assess. The two most popular indexes of diagnosing patients suspected of having psychological disorders include, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in the United States, and the International Classification of Diseases (ICD-10) used by most of the rest of the world.

In the DSM-IV, there are no criteria written specifically for children or adolescents, the criteria for adults however are:

  • There must be evidence of a strong and persistent cross-gender identification.
  • This cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex.
  • There must also be evidence of persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender role of that sex.
  • The individual must not have a concurrent physical intersex condition.
  • There must be evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning.

It should be noted that the DSM-IV contains a diagnosis coding based on the current age of the patient.

In the ICD-10, Gender Identity Disorder of Childhood has essentially four criteria, which may be summarised as:

  • The individual is persistently and intensely distressed about being a girl/boy, and desires (or claims) to be of the opposite gender.
  • The individual is preoccupied with the clothing, roles or anatomy of the opposite sex/gender, or rejects the clothing, roles, or anatomy of his/her birth sex/gender.
  • The individual has not yet reached puberty.
  • The disorder must have been present for at least 6 months.

Therapeutic intervention

After an official diagnosis of GID, the next issue is how to treat it, or in least, provide psychological assistance to the child. There are currently three methods of thought, when it comes to the medical treatment of children with GID.

The first and most common is simply no medical treatment. This is the default course of action of most psychologists practising today. The belief stems from the thought that any crises in gender identity are passing thoughts, which with the assistance of psychotherapy, be managed without medical intervention, or at least, have delayed until adulthood. Proponents of early medical intervention claim that halting puberty allows for immediate relief of perceived suffering due to body image issues allowing time to explore their gender identity without having to deal with the development of “wrong” secondary sex characteristics.

The second and increasingly popular way of treatment, is for the recommendation of a GnRH antagonist, a drug designed to prevent puberty, or halt it, if it is in progress. Early hormonal interventions should not be considered as sex reassignment per se. Their effects are reversible. At no point before the child reaches the legal age where he or she may make medical decisions independently, are cross-sex hormones administered to the patient. A fringe benefit of this treatment is a much reduced chance of the seeking of grey or black market sources of hormones. Those against this form of therapy claim it is not possible to make a definitive diagnosis because gender identity may be still fluctuating. Another potential risk of blocking pubertal development relates to the development of bone mass and growth.

And finally, there is a minority whom administer reparative therapy. Reparative therapy, also known as Conversion therapy, is where by using behaviour modification, aversion therapy, and psychoanalysis, a person can be “cured” of behaviour considered undesirable by some in society. The chief proponent for reparative therapy in the treatment of children with GID, psychologist Kenneth J. Zucker of the Canadian Centre for Addiction and Mental Health, alleges that by encouraging the child to accept their birth sex, (and associated gender) will result in the reduction of social ostracism by their peers, and prevention of the chance of adult GID. Opponents to this form of therapy claim that attempts to reverse sexual orientation or gender identification is an "extreme example" of bias that may hamper effectiveness of care, which may lead to increased self hatred and psychological and/or social issues later in life.

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