Gender Identity Disorder

When a person has a discrepancy between their personal belief and their biological sex, it is known as gender identity disorder (GID). A person may feel they were born a woman but want to live their life as a man or vice versa. Sometimes a person with this disorder believes they are in the wrong body. People with this disorder usually present by requesting “gender reassignment”. This involves changing one’s appearance through hormonal and surgical means. Not all of these individuals are transsexuals. Transvestites and some homosexuals may suffer from this disorder, so it is important to do a thorough evaluation before recommending sexual reassignment.

GID is a rare with estimates in the range of 30,000 worldwide. About three times as many men as women seek sexual reassignment, however, approximately equal numbers of men and women are reassigned. Women generally have sexual attraction towards men, but approximately 75% of men have homosexual attraction. Often both male and female patients have some level of homophobia and remain asexual after reassignment rather than concede their homosexual orientation.

Co-morbid conditions include psychosis and severe personality disorders. Psychotic individuals may have delusions related to genitalia. The delusions often dissipate as the patient is treated for the psychosis. Some personality disordered individuals have significant identity confusion that results in a rather diffuse sense of self. Under severe stress, some of these individuals suffer a transient desire for gender reassignment. It is important for the clinician to evaluate if this is a transient wish or if it is continuous over time. It is often important to contact family members to verify life-long and continuous desire for sex change.

Theoretical approach associated with disorder are behavioral, psychodynamic (interpersonal), and psychoeducational.

Some treatment techniques can be group, family, or individual therapy or a combination of all three. Other important techniques are role-playing, reflecting, nurturing and teaching client to live with who they are.

In the early stage of gender identity disorder, the goals would be to assess the problems and establish a working relationship with the patient and the family. A full clinical history including a psychosocial will be the first step in the intervention. You will want to determine whether the symptoms are ego-syntonic or ego-dystonic. Next, you should determine the reasons the person chooses a cross-gender identity and why they are uncomfortable with their own gender. You will use this information to develop a treatment plan.

Finally, you should refer to a physician to rule out any other medical conditions. Since patient usually come to treatment requesting gender reassignment, it is likely that this will be the patient’s goal, rather than eliminating the gender identity confusion. This makes assessment and treatment problematic, as the patient will undoubtedly be less than forthcoming. Identifying those individuals who are denying their homosexual attraction is important. Helping resolve issues of homophobia and living a homosexual lifestyle may be more important than changing one’s sex. If the individual is desperately seeking a sex change, engaging them in treatment will be difficult at best. However, gender reassignment has been highly studied and is often the best treatment for the disorder if the individual has a “life long” desire for gender reassignment.