Gender identity disorder
Gender identity disorder as identified by psychologists and medical doctors is a condition where a person who has been assigned one gender (usually at birth on the basis of their sex, but compare intersexual) but identifies as belonging to another gender, or does not conform with the gender role their respective society prescribes to them.
This feeling usually is reported as "having always been there", although in many cases it seems to appear in adolescence or even in adulthood, and has been reported by some as intensifying over time. Since many cultures strongly disapprove of cross-gender behaviour, it often results in significant problems, for example a severe identity crisis. Also, social problems are likely to occur if a society does not accept cross-gender behaviour. In many cases discomfort is also reported as stemming from feeling like one's body is "wrong" or meant to be different.
Diagnostic criteria (DSM-IV)
The current edition of the Diagnostic and Statistical Manual of Mental Disorders has five criteria that must be met before a diagnosis of Gender Identity Disorder can be given:
1. There must be evidence of a strong and persistent cross-gender identification.
2. This cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex.
3. There must also be evidence of persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender role of that sex.
4. The individual must not have a concurrent physical intersex condition (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia).
5. There must be evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The DSM-IV also provides a code for gender disorders that did not fall into these criteria. This diagnosis of Gender Identity Disorder Not Otherwise Specified (GIDNOS) is similar to other "NOS" diagnoses, and can be given for, for example:
1. Intersex conditions (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia) and accompanying gender dysphoria
2. Transient, stress-related cross-dressing behavior
3. Persistent preoccupation with castration or penectomy without a desire to acquire the sex characteristics of the other sex, which is known as skoptic syndrome
For some people GID in the DSM-IV is comparable to transsexuality, whereas GIDNOS to them is more comparable to other transgender behaviour that may be seen as disordered. On the other hand, many transgender people themselves feel quite accurately described by the DSM-IV, and many have none of the symptoms listed above under NOS.
Transvestic fetishism has its own code, as a paraphilia rather than a gender identity disorder.
Diagnostic criteria (ICD-10)
The current edition of the International Statistical Classification of Diseases and Related Health Problems has five different diagnoses for gender identity disorder: transsexualism, Dual-role Transvestism, Gender Identity Disorder of Childhood, Other Gender Identity Disorders, and Gender Identity Disorder, Unspecified.
Transsexualism has the following criteria:
* The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment.
* The transsexual identity has been present persistently for at least two years.
* The disorder is not a symptom of another mental disorder or a chromosomal abnormality.
Dual-role transvestism has the following criteria:
* The individual wears clothes of the opposite sex in order to experience temporary membership in the opposite sex.
* There is no sexual motivation for the cross-dressing.
* The individual has no desire for a permanent change to the opposite sex.
Gender Identity Disorder of Childhood has essentially four criteria, which may be summarised as:
* The individual is persistently and intensely distressed about being a girl/boy, and desires (or claims) to be of the opposite gender.
* The individual is preoccupied with the clothing, roles or anatomy of the opposite sex/gender, or rejects the clothing, roles, or anatomy of his/her birth sex/gender.
* The individual has not yet reached puberty.
* The disorder must have been present for at least 6 months.
The remaining two classifications have no specific criteria and may be used as catch-all classifications in a similar way to GIDNOS.
Since very often many people (including doctors, judges etc.) assume that for adults only the classifications "transsexual" and "transvestite" can apply, the F64 section of the ICD-10 is often criticised, especially since the "usually" in "usually accompanied by the wish to make his or her body as congruent as possible " is often ignored as well, and wish for sexual reassignment surgery (SRS) is seen as a requirement for the diagnosis of "transsexualism".
Many transgender people do however not fit into either of these two categories, for example transgender people who wish to change their social gender completely, but who do not bother with SRS. This can lead to significant problems in procuring medical treatment or a legal change of name or gender or make them completely impossible.
A lot of transgender people do not regard their cross-gender feelings and behaviours as a disorder. They question what a "normal" gender identity or a "normal" gender role is supposed to be; and sometimes even the very existence of a "normal" gender identity or gender role is examined and occasionally rejected by parts of modern gender studies.
Some people see "transgendering" as a means for deconstructing gender. However, not all transgender people do wish to or feel that they are deconstructing gender.
Other transgender people object to the classification of GID as a mental disorder on the grounds that there may be a physical cause, as suggested by recent studies about the brains of transsexuals, also pointing out that the treatment for this disorder consists primarily of physical modifications to bring the body into harmony with one's perception of mental (psychological, emotional) gender identity.
Even though the preponderance of evidence suggests that transgender behaviour has a neurological etiology, there is not yet clear and convincing evidence as to whether the etiology of transgender is mental or physical. Thus the psychiatric diagnoses will continue to carry authority and to be useful for medical billing purposes and potentially for the classification of research results unless those diagnoses are debunked. However, little or no research into transgender or transsexualism is actually being conducted, especially not in North America. The mental illness diagnoses are also enshrined in the HBIGDA-SOCs, persist because no other medical diagnoses are available.
However, it should be noted that there are numerous diagnoses included in the DSM for which there is strong evidence of a genetic and neurobiological etiology such as schizophrenia and bipolar disorder. Dividing conditions into 'biological' versus 'psychological' is not a scientifically supported dichotomy. Thus, the medical community recognizes that psychiatric illnesses have their origins in disorders of chemistry, not of character. Psychiatric conditions are not separate from biological disorders, but rather a subset of biological disorders.
In a landmark publication in December 2002 the British Lord Chancellor's office published a Government Policy concerning Transsexual People document that categorically states "What transsexualism is not...It is not a mental illness." It would appear to be likely that other countries will follow this lead. Nonetheless existing psychiatric diagnoses of Gender Identity Disorder or the now obsolete categories of Homosexuality Disorder, Gender Dysphoria Syndrome, True Transsexual etc. continue to be accepted as formal evidence of transsexuality.
The official politics in many countries interprets transgender in terms of an undesireable thing that has to be prohibited or a psychiatric disorder, which has to be cured.
Medicine and psychology have tried to cure gender identity disorder or transgender behaviour or feelings ever since it came to their attention in the middle of the 19th century. Only occasionally reports about "cures" can be found, and almost all of them lack a follow-up. Also, all of those reports can be matched with the stories of transgender people who at one point left a treatment as cured. (Some transgender people were in fact "cured" several times.) It never worked, unless the reason for transgender behaviour could clearly be identified as laying outside of the person showing this behaviour.
Medical treatment for changing a person's sexual characteristics is not a cure for transsexual or transgender feeling or behaviour, but can help transsexual persons to live in a gender role that is more appropriate to their gender identity. But while there will most likely always be transgender people who will need this kind of medical treatment, the best help transgender people can get is social acceptance in a gender role that fits their identity, regardless of their individual perception of their appropriate gender role or their individual need for medical treatment.
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