Abnormal Psychology

Gender and Sexual Disorders 481

full-time as the other sex, the clinician helps them discover whether doing so feels

more consistent with how they feel and how they see themselves. Moreover, the

clinician helps the patient with problem solving related to living as the other sex—

identifying and developing possible solutions to issues that might arise regarding

other people’s responses.

Targeting Social Factors: Family Support

Family members of those with gender identity disorder may not understand the

disorder or know how to be supportive. Educating the family about gender iden-

tity disorder and standard family therapy techniques that focus on communication

(see Chapter 4) can help family members develop more effective ways to discuss

problems.

In addition, groups for people with gender identity disorder can provide sup-

port and information. Group therapy may also focus on relationship diffi culties or

problems that may arise as a result of living as the other sex, such as experiencing

sexual harassment for those newly living as a woman, or being taunted by other

men for those newly living as a man (Di Ceglie, 2000).

In sum, treatment for gender identity disorder fi rst targets psychological fac-

tors—helping individuals determine whether they want to live as the other sex. If

they decide to do so, then treatment targeting social factors comes into play, to ad-

dress problems with family members and interactions with other people in general.

Finally, treatment targeting neurological and other biological factors is provided

when individuals wish to have medical or surgical procedures.

Key Concepts and Facts About Gender Identity Disorder

• Gender identity disorder is characterized by a persistent cross-
  gender identification that leads to chronic discomfort with
  one’s biological sex. Symptoms of gender identity disorder of-
  ten emerge in childhood, but most children diagnosed with the
  disorder no longer have the disorder by the time they become
  adults. However, most adults with gender identity disorder re-
  port that their symptoms began in childhood.


• In children, symptoms of gender identity disorder include
  cross-dressing and otherwise behaving in ways typical of the
  other sex, such as engaging in other-sex types of play, choosing
  other-sex playmates, and even claiming to be the other sex.
  In adults, symptoms include persistent and extreme discom-
  fort from living publicly as their biological sex, which leads
  many to live (at least some of the time) as someone of the
  other sex.


• Criticisms of the diagnostic criteria in DSM-IV-TR for this disorder
  point to the overly narrow concept of gender and appropriate
  behavior (particularly for males) and the ambiguous require-
  ment about distress. With gender identity disorder, the person’s
  distress often arises because of other people’s reactions to the
  cross-gender behaviors.


• Some brain areas in adults with gender identity disorder are
  more similar to the corresponding brain areas of members of
  their desired sex than they are to those of their biological sex.
  Results from animal studies suggest that one explanation for

this disorder is that prenatal exposure to hormones causes the

brain to develop in ways more similar to the other sex, although

the sexual characteristics of the body are unchanged. Beyond

symptoms that are part of the diagnostic criteria for the disor-

der, no psychological or social factors are clearly associated

with the disorder.

• Treatments may target neurological (and other biological), psy-
  chological, or social factors:
  
  
  • Treatments that target neurological (and other biological)
    factors include hormone treatments and sex reassignment
    surgery.
  
  
  • Treatments that target psychological factors include psycho-
    education, helping the patient choose among gender- related
    lifestyle options, and problem solving about potential
    diffi culties.
  
  
  • Treatments that target social factors include family education,
    support groups, and group therapy.
  
  
  
  

Making a Diagnosis

• Reread Case 11.1 about Jenny Boylan, and determine whether or
  not her symptoms meet the criteria for gender identity disorder.
  Specifically, list which criteria apply and which do not. If you
  would like more information to determine whether the diagno-
  sis fi ts, what information—specifi cally—would you want, and in
  what ways would the information infl uence your decision?

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