The term gender identity, as used in the diagnosis of Gender Identification Disorder (GID), generally refers to issues surrounding the basic knowledge of understanding that he is a male or that she is a female. These individuals have a persistent cross-gender identification that frequently manifests in a stated desire to be (or insistence that he or she is) the other sex. Furthermore, individuals present with persistent discomfort with gender roles (Criterion B), although this particular criterion is quite ambiguous as it would seem that anyone who self-refers themselves to a therapist for diagnosis or treatment of GID is under some form of duress?
“Children who met the complete criteria for GID were significantly younger, of a higher social-class background, and more likely to come from an intact, two-parent family than the children who did not meet the complete criteria.” (Netherton, Holmes, & Walker, 1999, p. 370) Despite this apparent correlation, very little is known about the etiology of GID or the antecedents that would or could contribute to its onset or maintenance. What is known, is that the wish to change sex is negatively related to age, thereby making older children less likely to verbalize wishes to proceed with sex change procedures (hormonal treatment, surgical procedures, etc). It has been suggested that this may be because of social desirability factors, but I suspect it is also due to the permanency of the procedures themselves. What if they proceed and they change their minds? What a quandry?
I was puzzled by the statement “unlike adult females with GID, who are invariably attracted sexually to biological females, adult males with GID are about equally likely to be attracted to biological males or females.” (Netherton et al., 1999, p. 372) What could possibly account for such a difference? This leads me to believe that the male and female versions of this disorder are qualitatively different.
I am unsurprised that boys are referred more often than girls for concerns regarding GID. I think this is likely driven by fathers who innately have different expectations for their sons than they do their daughters. “Adults are less tolerant of cross-gender behavior in boys than girls…” (Netherton et al., 1999, p. 375) As a result, it has been suggested that girls would be required to display more extreme cross-gender behavior than boys before parents sought out a clinical assessment. When someone refers to a girl as a “tom-boy” I think… “cute.” When someone refers to a boy as a “sissy,” there is a distinctly negative connotation. There is no culturally neutral term for a boy who sexually identifies with the female gender… so, despite the fact that girls are more likely to display masculine behavior compared to boys who display feminine behavior… the latter not the former are referred more often. Seems backwards to me, but hey, that’s culture.
I was suitably surprised that the typical age of onset is so early! Pre-school years (or even earlier) is when GID traits typically begin to appear… with nearly 90% of kids who intend to cross-dress “coming out” by their 5th birthday. Differences have appeared as early as a child’s 2nd birthday… which may suggest some genetic/biological or prenatal influence on the phenomenon. (Something other than environmental, in any event)
Transvestic Fetishism (TF) typically manifests during adolescence or adulthood, unlike GID which typically manifests in early childhood. It is perceived to occur almost exclusively in biological males, although a few cases of adult females demonstrating cross-dressing sexual arousal have been reported. (Netherton et al., 1999, p. 384) Unlike GID, childhood gender development of adolescents with GF is typically heterosexual (masculine). TF would appear to serve some typify of self serving function, and as a result, the nature of cross-dressing in TF and in GID is qualitatively different. (Netherton et al., 1999, p. 386) Some have suggested that TF develops as a reaction to “petticoat punishment” (forced cross-dressing during childhood) although this is a very rare occurrence. (Netherton et al., 1999, p. 388)
Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.