Tag Archives: Gender

Gender Identification Disorder (GID)

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?

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“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)

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Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.

Schizophrenia, Downward Social Drift, and Interpersonal Adjustment

Everyday social encounters present people with schizophrenia a considerable amount of difficulty.  They show significant impairment in both “instrumental relationships” and social-emotional relationships.  This impairment is demonstrated by “downward social drift” and, perhaps more importantly, the fact that the majority of people with schizophrenia never marry.  Of note is that interpersonal adjustment issues are much more prevalent in the male portion of the schizophrenia population that in the female portion.

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Social competence is a global or “macro” measurement of social role performance.  Global social competence issues continue to be a marker not only for people who have schizophrenia, but for people who are considered “high risk.”  I still don’t quite understand the etiology of these social deficits however… which came first, the social deficits or the disorder?

Social skills are less global and more molecular, thereby representing skills that enable a person to competently perform a social task.  They include “specific verbal, non-verbal and paralinguistic (e.g., voice tone) behavioral components that together form the basis for effective communication.”  (Blaney & Millon, 2009, p. 335)  To my own personal delight, I really enjoy any opportunity to utilize role-play… and this is one of them.  Typically, people with schizophrenia will show weaker verbal and nonverbal skill development, they tend to be less assertive, and they tend to deny making errors or lie as opposed to apologize or explain.  I am really looking forward to utilizing role-play with this population, I believe it to be one of my strong suits (and one of the pieces I really enjoy).

People with schizophrenia can have remarkably impaired ability to solve social problems.  This might manifest in difficulty recognizing interpersonal problems, formulating solutions to that problem, or perhaps most importantly implementing a solution that has a probably degree of success.  They are generally less able to recognize poor problem solutions (e.g., solutions that are unlikely to work).

Gender is an often neglected variable when studying schizophrenia.  Female patients typically have later onset, shorter and less frequent psychotic episodes, and show better response to treatment when compared to make counterparts.  They are more likely to be marked, to live independently, and to be employed (despite having similar symptoms to men).  Women often require less antipsychotic medication to stabilize them.  This leads some authors to speculate about the neuroprotective properties of estrogen… interesting concept to say the least.  This might be off-base, but could this possibly explain the late life crisis that women often experience around menopause?

Positive and negative symptoms should not be viewed in the context of “good and bad.”  Positive symptoms are “added,” like delusions or hallucinations for example.  Negative symptoms are typically features that are removed, reduced, or blunted.  This typically manifests as emotional withdrawal or anhedonia.  Negative effects have been shown to predict both unemployment and reduced social network size.  In total, positive symptoms, negative symptoms, and “disorders of relating” represent three distinct dimensions of schizophrenia.  (Blaney & Millon, 2009, p. 340)

Of particular interest to me is the discussion on interpersonal stress, relapse, and the apparent foundation of the above in family systems theory.  Specifically, “the social environment into which schizophrenia patients were discharged after they left the hospital was significantly associated with how well patients fared psychiatrically over the next several months.”  (Blaney & Millon, 2009, p. 349)  Expressed emotion (EE) reflects the extent to which the relatives of a psychiatric patient talk about that patient in a critical, hostile, or emotionally over-involved way.  EE has been found to be a reliable predictor of relapse, and as a result, family therapy focused on dealing with living with a schizophrenic patient is definitely in order.  This can assist family members in overcoming their apparent difficulty in accepting, and understanding, the disorder.

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Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.