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Gender Identity Disorder

Disorders of Psychosexual Identity


Presentation

The presentation of individuals with gender identity disorder sometimes differs depending upon his or her age and/or stage of physical development. In children, symptoms may include feeling rejected by their peers, being repulsed by their own genitals, believing that they may grow up to become the opposite sex, or saying that they would rather be the opposite sex.

In adults, symptoms may include desiring to live as the opposite sex, wanting to remove their own genitals, or wanting a sex change operation. In either children or adults, symptoms may include cross-dressing, withdrawal from social situations, depression and anxiety, and feelings of loneliness and isolation.

Pathologist
  • Psycho-pathologists with an interest in science seem, to me, to share a similar view. When they treat clients they primarily use their intuition even when they have knowledge about the research.[genderpsychology.org]
Intravenous Drugs
  • Four cases of male-to-female transsexuals with HIV infection are described, showing that individuals with gender identity disorder are vulnerable to HIV infection through unsafe sexual behaviour and intravenous drug use.[ncbi.nlm.nih.gov]
Anemia
  • (apparently not to be confused with the existing "Benjamin Syndrome," which is a form of anemia).[hemingways.org]
Vomiting
  • Transgender students were also twice as likely to report using diet pills and more than twice as likely to report vomiting or using laxatives during the previous month.[reuters.com]
Osteoporosis
  • In addition, we studied the effects of treatment on those who had osteoporosis.[ncbi.nlm.nih.gov]
  • After surgery, hormone treatment needs to be continued to prevent the complications of not having sex hormone production such as brittle bones ( osteoporosis ) or early heart disease.[yourhormones.info]
  • The question arises whether patients participating in this protocol may achieve a normal development of bone density, or will end with a decreased bone density, which is associated with a high risk of osteoporosis.[eje.bioscientifica.com]
Self-Mutilation
  • GID patients with a low level education might be at high risk of self-mutilation and should be watched with special attention to self-mutilation. Copyright 2011 Elsevier Ireland Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • Forty-three patients (44.3%) presented with significant psychiatric history, including 20 reporting self-mutilation (20.6%) and suicide attempts (9.3%).[ncbi.nlm.nih.gov]
  • The lifetime positive history of suicidal ideation and self mutilation was 76.1% and 31.7% among MTF patients, and 71.9% and 32.7% among FTM patients.[ncbi.nlm.nih.gov]
Psychiatric Symptoms
  • CONCLUSIONS: There is no evidence of elevated levels of psychiatric symptoms in GID, but potential predisposing factors, particularly in MF transsexuals, are present; these may originate from the more intense rejection they experience.[ncbi.nlm.nih.gov]
  • Abstract Childhood maltreatment (CM) is quite common and constitutes a nonspecific risk factor for a range of different psychiatric symptoms during lifespan.[ncbi.nlm.nih.gov]
  • Our observations reflect the Dutch finding that psychological functioning improves with medical intervention and suggests that the patients’ psychiatric symptoms might be secondary to a medical incongruence between mind and body, not primarily psychiatric[pediatrics.aappublications.org]
  • symptoms, social isolation, school drop‐out, loss of employment, homelessness, disrupted interpersonal relationships, physical injuries, social rejection, stigmatization, victimization, and violence.[ncbi.nlm.nih.gov]
Self Mutilation
  • GID patients with a low level education might be at high risk of self-mutilation and should be watched with special attention to self-mutilation. Copyright 2011 Elsevier Ireland Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • Forty-three patients (44.3%) presented with significant psychiatric history, including 20 reporting self-mutilation (20.6%) and suicide attempts (9.3%).[ncbi.nlm.nih.gov]
  • The lifetime positive history of suicidal ideation and self mutilation was 76.1% and 31.7% among MTF patients, and 71.9% and 32.7% among FTM patients.[ncbi.nlm.nih.gov]
Compulsive Disorder
  • A 4-year remission in a case of gender identity disorder (GID in DSM-IV, previously termed transsexualism) plus obsessive-compulsive disorder (OCD) prompted a search for further similar cases.[ncbi.nlm.nih.gov]
  • disorder ( F42- ) sleep disorders not due to a substance or known physiological condition ( F51.- ) Crisis psychosexual identity F64.2 Disorder (of) - see also Disease gender-identity or -role F64.9 ICD-10-CM Diagnosis Code F64.9 Gender identity disorder[icd10data.com]
Paranoid Ideation
  • The data were statistically analyzed by using SPSS 19.0, with significance levels set at P MAIN OUTCOME MEASURES: The psychopathological parameters include overall psychoneurotic distress, anxiety, agoraphobia, depression, somatization, paranoid ideation[ncbi.nlm.nih.gov]
Neglect
  • Parenting experiences of transsexual subjects were characterised by increased maternal dominance, emotional abuse and neglect compared to controls, with males being exposed to a disengaged maternal style and more paternal emotional neglect and criticism[ncbi.nlm.nih.gov]
  • They neglect to provide informed consent about treatment (ignoring the work of Drs. Zucker and Bradley), and the risks of sexual reassignment surgery.[lifesitenews.com]
  • LIMITATION: sample Paraphilias PEDOPHILIA con d Long-term Effects of Childhood Sexual Experiences Rind et al. (1998) cont d Adjustment o 1% of adult adjustment predicted by childhood sexual experiences o Family environment (verbal and physical abuse, neglect[www2.hawaii.edu]
Cognitive Deficit
  • In it he refers to this study as revealing a possible cognitive deficit/deficiency in children with GID.[genderpsychology.org]
Pelvic Pain
  • .• In DSM‐5, that category would similarly be classified as Genital‐pelvic pain/penetration disorder or under Specific phobia.[ncbi.nlm.nih.gov]

Workup

Although there are no laboratory tests used to diagnose gender identity disorder, health professionals generally utilize the following tools to aid in a definitive diagnosis: A complete review of an individual’s social history, a comprehensive psychiatric assessment, and a thorough physical examination.

Dyslipidemia
  • Complications Some physical complications that may occur include: hormone-related obesity, hormone-related thromboembolic disease, hormone-related dyslipidemia, and bone loss.[symptoma.com]

Treatment

For children, individual and family psychotherapy seems to be the most effective way to treat this disorder. Individual, group, and/or couples therapy are suggested for adults [8]. Other, more radical options include surgery [9] and hormonal therapy [10]. However, there is no guarantee that gender identity issues won’t linger even after these treatments.

Prognosis

Current case studies show that psychotherapy may not generate a comprehensive or permanent turnaround in those suffering from gender identity disorder. These individuals are not a homogenous group. They may include a spectrum of individuals ranging from transsexuals to cross-dressers [5].

Although some individuals are able to overcome gender identity disorder, the majority often continues to exhibit characteristics of the disorder for their entire lives, regardless of what form of treatment is sought [6]. Patients exhibiting other psychiatric comorbidity and mental instability worsens the prognosis [7].

Complications

Some physical complications that may occur include: hormone-related obesity, hormone-related thromboembolic disease, hormone-related dyslipidemia, and bone loss. Other difficulties that individuals may face include loneliness, anxiety or depression, poor self-esteem, general emotional upheaval and suicidal ideation.

Etiology

Although there is no known definitive cause for gender identity disorder, some factors that might influence the development may include such things as hormonal changes in the womb [2], genetic influences, and environmental considerations (such as parenting style or childhood experiences) [3]. Studies in developmental pediatrics have also identified the role of social and psychological play a role in gender identity disorder [4].

Epidemiology

Gender identity disorder is a fairly rare condition, affecting approximately only 0.005-0.014% of adult males and only about 0.002-0.003% of adult females, according to the DSM-4. The percentage of children and adolescents who suffer from this condition is much more difficult to gauge, due to the fact that they often experiment with various gender-identified roles.

Of interest, however, is the fact that among children, it is 2-5 times more likely for boys to identify with the female gender than it is for girls to associate themselves with the male gender. As adolescence approaches, this gap diminishes, and it is equally likely for either sex to associate itself with the opposite gender identity.

Sex distribution
Age distribution

Pathophysiology

Although previously considered a primarily psychological disorder, recent research studies of the brains of males suffering from gender identity disorder have shown that the sexual differentiation of one area of the brain, the bed nucleus of the stria terminalis, displays a more female configuration.

Since this locale of the brain has been supposed to be significant for gender identification, this research may indicate a biological basis for gender identity disorder. In general, however, there does not appear to be any significant difference between the physiological or neurological makeup of individuals with the disorder and those without it.

Prevention

It may be helpful to ensure that children have adequate access to gender-appropriate books and playthings during infancy and early childhood. Praising children for gender-appropriate behavior may encourage them as they work through their gender identity development. Providing appropriate information and support as a child grows older can foster a sense of security and comfortability with his or her gender identity.

Making critical statements about a child’s appearance or choices of activities should be avoided at all costs. Furthermore, if signs of gender confusion appear, the earlier psychotherapy is begun, the better the chance that such confusion end up being just a normal phase of developmental discovery.

Summary

Gender identity disorder (GID), is a psychological condition in which there is an incongruity between the physical gender identity that a person is born with and the gender identity that he or she feels the most at ease relating to himself or herself as. Such incongruity must continue to exist for at least 6 months [1].

Patient Information

Definition

Gender identity disorder (GID) occurs when someone does not feel comfortable living as his or her anatomical gender. For example, a boy may wish to be a girl, or vice versa. 

Cause

Scientists aren’t sure what causes gender identity disorder, but there is some evidence that there could be some genetic cause or it could be caused by someone’s life experiences or environment. 

Symptoms

Gender identity disorder is often first noticed as an individual approaches puberty. Signs to look for include: saying over and over again that they wish they were a member of the opposite sex, insisting on activities that are normally stereotypically associated with the opposite sex, preferring to play with friends of the opposite sex, cross-dressing, shame, guilt, or embarrassment about their sex organs, isolating themselves from others, and feelings of depression and/or anxiety.

Diagnosis

Only a qualified mental health professional can make a proper diagnosis of gender identity disorder. There aren’t any laboratory tests that are necessary to make the diagnosis. It is vital, however, to make sure that there aren’t any physical problems that could be contributing to the psychological problems. Generally, a mental health professional will take a complete social history and conduct a thorough interview of the patient and family members to make a final diagnosis. 

Treatment

The most common way to treat gender identity disorder is with talk therapy. The sooner the therapy is begun, the better the chance it will be successful. Some adults also choose hormone therapy or sex change operations, but these can have drastic consequences and may still not lead to a feeling of comfortability within one’s gender role. 

References

Article

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th. Arlington, VA: American Psychiatric Association; 2013:451-9.
  2. Dörner G, Rohde W, Schott G, Schnabl C. On the LH response to oestrogen and LH-RH in transsexual men. Exp Clin Endocrinol. Nov 1983; 82(3):257-67.
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th. Arlington, VA: American Psychiatric Association; 2013:451-9.
  4. de Vries AL, Doreleijers TA, Cohen-Kettenis PT. Disorders of sex development and gender identity outcome in adolescence and adulthood: understanding gender identity development and its clinical implications. Pediatr Endocrinol Rev. 2007; 4(4):343-51 (ISSN: 1565-4753).
  5. Person E, Ovesey L. The transsexual syndrome in males. I. Primary transsexualism. Am J Psychother. Jan 1974; 28(1):4-20.
  6. A.D.A.M. Medical Encyclopedia. Atlanta, Ga: A.D.A.M./PubMed Health; 2013.
  7. Hoshiai M, Matsumoto Y, Sato T, Ohnishi M, Okabe N. Psychiatric comorbidity among patients with gender identity disorder. Psychiatry Clin Neurosci. 2010; 64(5):514-9 (ISSN: 1440-1819)
  8. Mattila AK, Fagerholm R, Santtila P, Miettinen PJ, Taskinen S. Gender identity and gender role orientation in female assigned patients with disorders of sex development.J Urol. 2012; 188(5):1930-4 (ISSN: 1527-3792)
  9. Nakatsuka M. Adolescents with gender identity disorder: reconsideration of the age limits for endocrine treatment and surgery.Seishin Shinkeigaku Zasshi. 2012; 114(6):647-53 (ISSN: 0033-2658)
  10. Michel A, Mormont C, Legros JJ. A psycho-endocrinological overview of transsexualism. Eur J Endocrinol. Oct 2001; 145(4):365-76. 

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Last updated: 2019-07-11 20:38