Gender identity disorder

Causes

People with gender identity disorder may act and present themselves as members of the opposite sex. The disorder may affect:

• Choice of sexual partners
• Mannerisms, behavior, and dress
• Self-concept

Gender identity disorder is not the same as homosexuality.

Identity conflicts need to continue over time to be a gender identity disorder. How the gender conflict occurs is different in each person. For example, some people may cross-dress while others want sex-change surgery. Some people of one gender privately identify more with the other gender.

People who are born with ambiguous genitalia, which can raise questions about their gender, may develop a gender identity disorder.

The cause is unknown, but hormones in the womb, genes, social and environmental factors (such as parenting) may be involved. This rare disorder may occur in children or adults.

Symptoms

Symptoms can vary by age, and are affected by the person's social environment. They may include the following:

Children:

• Are disgusted by their own genitals
• Are rejected by their peers, feel alone
• Believe that they will grow up to become the opposite sex
• Have depression or anxiety
• Say that they want to be the opposite sex

Adults:

• Dress like the opposite sex
• Feel alone
• Have depression or anxiety
• Want to live as a person of the opposite sex
• Wish to be rid of their own genitals

Either adults or children:

• Cross-dress, show habits typical of the opposite sex
• Withdraw from social interaction

Exams and Tests

The feeling of being in the body of the "wrong" gender must last for at least 2 years for this diagnosis to be made. A history and psychiatric evaluation can confirm the person's constant desire to be the opposite sex. The person's partner choices may be same sex or opposite sex.

Treatment

Individual and family therapy is recommended for children to create a supportive environment at home and in school. Individual and, if appropriate, couples therapy is recommended for adults. Sex reassignment through surgery and hormonal therapy is an option, but identity problems may continue after this treatment.

Outlook (Prognosis)

Diagnosing and treating this disorder early can reduce the chances of depression, emotional distress, and suicide.

Possible Complications

• Depression or anxiety
• Emotional distress
• Feeling alone
• Poor self-concept
• Suicide

When to Contact a Medical Professional

Make an appointment with your health care provider if you have symptoms of this disorder and want help, especially with anxiety and depression.

Alternative Names

Transsexualism; Transgender

References

Shafer LC. Sexual disorders and sexual dysfunction. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 36.

Bockting W. Sexual identity development. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 104.2.

Moller B, Schreier H, Li A, Romer G. Gender identity disorder in children and adolescents. Curr Probl Pediatr Adolesc Health Care. 2009;39:117-143.

Update Date: 2/13/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Mediicne, UW Medicine, School of Medicine, University of Washington; and Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.