476 CHAPTER 11
The fi nal two DSM-IV-TR criteria require that the symptoms do not arise be-
cause the person is an intersex individual (someone who was born with both male
and female sexual characteristics) and that the symptoms cause signifi cant distress
or impair functioning. However, the distress experienced by someone with gender
identity disorder often arises because of other people’s responses to the cross-gender
behaviors. For instance, a biological male child with gender identity disorder may
be ostracized or made fun of by children or even teachers for consistently “playing
girl games”—and thus the child feels distress because of the reactions of others. In
contrast, for most disorders in DSM-IV-TR, the distress the individual feels arises
directly from the symptoms themselves (e.g., distress that is caused by feeling hope-
less, or being afraid in social situations).
Most adolescents and adults with gender identity disorder report having
had symptoms of the disorder in childhood (even though most people who had
gender identity disorder in childhood do not have it later in life), like the person in
Case 11.1. And like Mike’s friend Sam, some people with gender identity disorder seek
to change their sexual anatomy to match their gender identity; such surgery is called
sex reassignment surgery (discussed later in the chapter, in the section on treatment).Most commonly, individuals with gender identity disorder
are heterosexual relative to their gender identifi cation. For in-
stance, biological men who see themselves as women tend to
be attracted to men, and thus feel as if they are heterosexual
(Blanchard, 1989, 1990; Zucker & Bradley, 1995). Others are
homosexual relative to their gender identifi cation; a biological
woman who sees herself as a man may be sexually attracted to
men. However, some people with gender identity disorder are
asexual—they have little or no interest in any type of sex.
As noted in Table 11.2 (along with other facts about gender
identity disorder), gender identity disorder is about three times
more common among biological males as biological females.
One explanation for this difference is that in Western cultures,
females have a wider range of acceptable “masculine” behavior
and dress than males do of acceptable “feminine” behavior and
dress. A woman dressed in “men’s” clothes might not even get a
second look, but a man dressed in “women’s” clothes will likely
be subjected to ridicule.CASE 11.1 • FROM THE INSIDE: Gender Identity Disorder
In her memoir, She’s Not There: A Life in Two Genders (2003), novelist and English pro-
fessor Jenny Finney Boylan (who was born male) describes her experiences feeling,
since the age of 3, as if she were a female in a male body:
Since then, the awareness that I was in the wrong body, living the wrong life, was never out of
my conscious mind—never, although my understanding of what it meant to be a boy, or a girl,
was something that changed over time. Still, this conviction was present during my piano
lesson with Mr. Hockenberry, and it was there when my father and I shot off model rockets,
and it was there years later when I took the SAT, and it was there in the middle of the night
when I woke in my dormitory at Wesleyan. And at every moment I lived my life, I countered
this awareness with an exasperated companion thought, namely, Don’t be an idiot. You’re not
a girl. Get over it.
But I never got over it.
[... ] By intuition I was certain that the thing I knew to be true was something others would
fi nd both impossible and hilarious. My conviction, by the way, had nothing to do with a desire
to be feminine, but it had everything to do with being female. Which is an odd belief for a
person born male.
(pp. 19–21)Teena Brandon was born female, yet felt like a
male on the inside and came to live as a man,
though without having sex reassignment surgery.
As an adult, Brandon was raped and later killed
by young men after they discovered that Brandon
was biologically female. Brandon’s life was the
subject of the documentary fi lm The Brandon
Teena Story and the feature fi lm Boys Don’t Cry.Bless Bless Productions 1998
Females have a wider range of acceptable
“masculine” behavior and dress than males have
of acceptable “feminine” behavior and dress.
Women can wear men’s clothes without risk of
being labeled as deviant, whereas men who wear
women’s clothes (when not as part of a perfor-
mance) are often considered to have something
wrong with them.United Artists/Photofest Bob Barkany/Getty Images