Gender and Sexual Disorders 477
Criticisms of the DSM-IV-TR Defi nition
Some critics of the DSM-IV-TR diagnosis of gender identity disorder point out that
the criteria don’t specify the nature of the “distress” that the disorder causes. As
mentioned earlier, with gender identity disorder, distress usually arises because of
other people’s reactions to the cross-gender behaviors associated with the symp-
toms (Langer & Martin, 2004). For instance, suppose family members respond
negatively—perhaps with anger—to an individual’s cross-gender behaviors, even
disowning him or her. Understandably, the person might then experience distress
or impaired functioning. In this case, the distress or impaired functioning doesn’t
arise from the symptoms of gender identity disorder; it arises as a (often reasonable)
response to the negative reactions of others.
In addition, some critics claim that the concept of gender in DSM-IV-TR is toonarrow. Critics also argue that the concept of “appropriate” behavior (especially for
males) is too constrained.
Understanding Gender Identity Disorder
We now know that the brains of adults with gender identity disorder are different
in some respects from the brains of people who do not have the disorder. Moreover,
various psychological and social factors are associated with gender identity disorder.
But research so far has not determined whether these factors contribute to the disorder
Table 11.2 • Gender Identity Disorder Facts at a Glancey
Prevalence- The prevalence of gender identity disorder is unknown, but believed to be low.
Comorbidity- In one survey of 31 patients who were diagnosed with gender identity disorder and had not yet
begun the process of sex reassignment surgery, almost 75% had another psychiatric disorder
at some point in their lives, most often either a mood disorder or a substance-related disorder
(Hepp et al., 2005). However, only 39% had comorbid Axis I disorders after they began the sex
reassignment process; this fi nding suggests that the previous high comorbidity was at least
partly related to living as a gender that did not correspond to a person’s gender identity.
Onset- Symptoms of cross-gender identity almost always begin in childhood.
- During adolescence, relationships with parents and peers often become particularly strained,
and teenagers with gender identity disorder may become depressed (Di Ceglie et al., 2002).
Course- If symptoms persist into adulthood, they are likely to remain stable, leading many individuals
to seek sex reassignment surgery.
Gender Differences- The incidence of those seeking sex reassignment surgery in some European countries is
1 of every 30,000 males and 1 of every 100,000 females, which suggests that gender identity
disorder may be three times more common among males. - Biological males with this disorder may be rejected by family and peers, may experience physical
abuse, substance abuse, prostitution, AIDS, or poverty, and may drop out of school (Seil, 1996).
Cultural Differences- Cross-gender identifi cation is not considered pathological in all cultures; in some Native
American and traditional African cultures, such people have high status and are seen as espe-
cially spiritual (Jacobs, Thomas, & Lang, 1997; Langer & Martin, 2004; Roscoe, 1993).
Source: Unless otherwise noted, information is from American Psychiatric Association, 2000.