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Intersexuality and the diagnosis of gender identity disorder

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Abstract

Problems of gender identity development are the core concern in the psychosocial management of medical conditions involving ambiguous genitalia. This report discusses the difficulties encountered in applying the DSM category and criteria of Gender Identity Disorder (GID) to such patients. Data on prevalence, age of onset or presentation, sex ratio, and associated or predictive factors also suggest marked differences between intersex patients with gender identity problems and nonintersex patients with GID. Patients with intersexuality or similar medical conditions should be excluded from the GID diagnosis.

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References

  • American Psychiatric Association. (1980).Diagnostic and Statistical Manual of Mental Disorders 3rd ed., American Psychiatric Association, Washington, DC.

    Google Scholar 

  • American Psychiatric Association (1987).Diagnostic and Statistical Manual of Mental Disorders 3rd ed., rev., American Psychiatric Association, Washington, DC.

    Google Scholar 

  • Blanchard, R. (1989). The classification and labeling of nonhomosexual gender dysphorias.Arch. Sex. Behav. 18: 315–334.

    PubMed  Google Scholar 

  • Bradley, S. J., Blanchard, R., Coates, S., Green, R., Levine, S. B., Meyer-Bahlburg, H. F. L., Pauly, I. B., and Zucker, K. J. (1991). Interim report of the DSM-IV Subcommittee on Gender Identity Disorders.Arch. Sex. Behav. 20: 333–342.

    PubMed  Google Scholar 

  • Bräutigam, W. (1964). Körperliche, seelische und soziale Einflüsse auf die Geschlechtszugehörigkeit des Menschen.Internist (Berlin) 5: 171–182.

    Google Scholar 

  • Brown, J. B., and Fryer, M. P. (1964). Plastic surgical correction of hypospadias with mistaken sex identity and transvestism resulting in normal marriage and parenthood.Surg. Gynecol. Obstet. 118: 45–46.

    PubMed  Google Scholar 

  • Dewhurst, C. J., and Gordon, R. R. (1963). Change of sex.Lancet 2: 1213–1216.

    Google Scholar 

  • Dewhurst, C. J., and Gordon, R. R. (1969).The Intersexual Disorders. Baillière and Cassell, London.

    Google Scholar 

  • Ehrhardt, A. A. (1979). Psychosexual adjustment in adolescence in patients with congenital abnormalities of their sex organs. In Vallet, H. L., and Porter, I. H. (eds.),Genetic Mechanisms of Sexual Development (Birth Defects Institute Symposia) Academic Press, New York, pp. 473–484.

    Google Scholar 

  • Ellis, A. (1945). The sexual psychology of human hermaphrodites.Psychosom. Med. 7: 108–124.

    Google Scholar 

  • El-Hefnawi, H., Girgis, S. M., Ibrahim, A. A., Kahil, S., Rasheed, A., and Mattar, N. (1966). Sex reversal after puberty in a male pseudo-hermaphrodite (A case report).Egypt. Med. Assoc. J. 49: 70–77.

    Google Scholar 

  • Elsayed, S. M., Al-Maghraby, M., Hafeiz, H. B., and Taha, S. A. (1988). Psychological aspects of intersex in Saudi patients.Acta Psychiat. Scand. 77: 297–300.

    PubMed  Google Scholar 

  • Ghabrial, F., and Girgis, S. M. (1962). Reorientation of sex: Report of two cases.Int. J. Fertil. 7: 249–258.

    PubMed  Google Scholar 

  • Gooren, L., and Cohen-Kettenis, P. T. (1991). Development of male gender identity/role and a sexual orientation towards women in a 46,XY subject with an incomplete form of the androgen insensitivity syndrome.Arch. Sex. Behav. 20: 459–470.

    PubMed  Google Scholar 

  • Green, R. (1974).Sexual Identity Conflict in Children and Adults Basic Books, New York.

    Google Scholar 

  • Green, R. (1987).The “Sissy Boy Syndrome” and the Development of Homosexuality Yale University Press, New York.

    Google Scholar 

  • Harrison, S. I. (1970). Reared in the wrong sex.J. Am. Acad. Child Psychiat. 9: 44–102.

    Google Scholar 

  • Herdt, G.H., and Davidson, J. (1988). The Sambia “Turnim-Man”: Sociocultural and clinical aspects of gender formation in male pseudohermaphrodites with 5-alpha-reductase deficiency in Papua New Guinea.Arch. Sex. Behav. 17: 33–56.

    PubMed  Google Scholar 

  • Hiekkala, H., Takkunen, R.-L., Sulamaa, M., Aukee, M., and Miikkulainen, R. (1963). Change of sex in male pseudohermaphroditism.Ann. Paediat. Fenniae 9: 258–269.

    Google Scholar 

  • Imperato-McGinley, J., Guerrero, L., Gautier, T., and Peterson, R. E. (1974). Steroid 5α-reductase deficiency in man: An inherited form of male pseudohermaphroditism.Science 186: 1213–1215.

    PubMed  Google Scholar 

  • Imperato-McGinley, J., Peterson, R. E., Gautier, T., and Sturla, E. (1979). Androgens and the evolution of male-gender identity among male pseudohermaphrodites with 5α-reductase deficiency.New Engl. J. Med. 300: 1233–1237.

    PubMed  Google Scholar 

  • Imperato-McGinley, J., Peterson, R. E., Gautier, T., and Sturla, E. (1981). The impact of androgens on the evolution of male gender identity.Clin. Androl. 7: 99–108.

    Google Scholar 

  • Imperato-McGinley, J., Miller, M., Wilson, J. D., Peterson, R. E., Shackleton, C., and Gajdusek, D. C. (1991). A cluster of male pseudohermaphrodites with 5α-reductase deficiency in Papua New Guinea.Clin. Endocrinol. 34: 293–298.

    Google Scholar 

  • Keppel, W. H., and Osofsky, H. J. (1985). A patient with ambiguous genitalia and gender confusion.Bull. Menninger Clin. 49: 584–585.

    PubMed  Google Scholar 

  • Köbberling, J., König, A., and Meyer, J. E. (1972). “Transsexualismus” bei testiculärer Feminisierung.Klin. Wochenschr. 50: 696–701.

    PubMed  Google Scholar 

  • Kok, L. P., and Tsoi, W. F. (1982). A case of a hermaphrodite presenting as a transsexual.Ann. Acad. Med. Singapore 11: 297–299.

    PubMed  Google Scholar 

  • König, P. A. (1966). Sexual- und Sozialpsychologie bei Pseudohermaphroditismus masculinus und testikulärer Feminisierung.Geburtshilfe Frauenheilkd. 26: 1070–1078.

    PubMed  Google Scholar 

  • Kraus, A. (1972). Zum Verhältnis von Geschlechtsrolle und Geschlechtsleib. Mit der Fallbeschreibung einer Psychose nach Geschlechtsrollenwechsel bei kongenitalem Adrenogenitalsyndrom mit Pseudohermaphroditismus femininus.Nervenarzt 43: 78–88.

    PubMed  Google Scholar 

  • Launay, C., Meer, G., and Daymas, S. (1966). Problèmes psychologiques poses par le choix du sexe dans l'enfance et l'adolescence.Arch. Fr. Pediat. 23: 715–726.

    Google Scholar 

  • Lev-Ran, A. (1974). Gender role differentiation in hermaphrodites.Arch. Sex. Behav. 3: 391–424.

    PubMed  Google Scholar 

  • Marantz, S., and Coates, S. (1991). Mothers of boys with gender identity disorder: A comparison of matched controls.J. Am. Acad. Child Adolescent Psychiat. 30: 310–315.

    Google Scholar 

  • Mendonca, B. B., Bloise, Arnhold, I. J. P., Batista, M. C., de Almeida Toledo, S. P., Drummond, M. C. F., Nicolau, W., and Mattar, E. (1987). Male pseudohermaphroditism due to nonsalt-losing 3β-hydroxysteroid dehydrogenase deficiency: Gender role change and absence of gynecomastia at puberty.J. Steroid Biochem. 28: 669–675.

    PubMed  Google Scholar 

  • Meyer-Bahlburg, H. F. L. (1985). Gender identity disorder of childhood. Introduction.J. Am. Acad. Child Psychiat. 24: 681–683.

    Google Scholar 

  • Meyer-Bahlburg, H. F. L., Aceto, T., Jr., and Bannerman, R. M. (1977). Transsexual development in a hypopituitary short-stature male with sex-chromosome mosaicism and a seizure disorder. (Abstract). Eastern Association for Sex Therapy. Third Annual Meeting. New York.

  • Money, J. (1988).Gay, Straight, and In-Between. Oxford University Press, New York.

    Google Scholar 

  • Money, J. (1991a).Biographies of Gender and Hermaphroditism in Paired Comparisons. Elsevier, Amsterdam, The Netherlands.

    Google Scholar 

  • Money, J. (1991b). Bibliography.J. Psychol. Hum. Sex. 4: 83–198.

    Google Scholar 

  • Money, J., and Ehrhardt, A. A. (1972).Man & Woman. Boy & Girl: Differentiation and Dimorphism of Gender Identity from Conception to Maturity Johns Hopkins University Press, Baltimore, MD.

    Google Scholar 

  • Money, J., and Norman, B. F. (1987). Gender identity and gender transposition: Longitudinal outcome study of 24 male hermaphrodites assigned as boys.J. Sex Marital Ther. 13: 75–92.

    PubMed  Google Scholar 

  • Money, J., Devore, H., and Norman, B. F. (1986). Gender identity and gender transposition: Longitudinal outcome study of 32 male hermaphrodites assigned as girls.J. Sex Marital Ther. 12: 165–181.

    PubMed  Google Scholar 

  • Money, J., Hampson, J. G., and Hampson, J. L. (1955). An examination of some basic sexual concepts: The evidence of human hermaphroditism.Bull. Johns Hopkins Hosp. 97: 301–319.

    PubMed  Google Scholar 

  • Newman, L. E., and Stoller, R. J. (1968). Gender identity disturbances in intersexed patients.Am. J. Psychiat. 124: 1262–1266.

    PubMed  Google Scholar 

  • Norris, A. S., and Keettel, W. C. (1962). Change of sex role during adolescence. A case study.Am. J. Obstet. Gynecol. 84: 719–721.

    PubMed  Google Scholar 

  • Roeske, N. A., and Banet, A. G., Jr. (1972). Gender identity. The problem of a true hermaphrodite.J. Am. Acad. Child Psychiat. 11: 132–156.

    Google Scholar 

  • Roeske, N. A., and McAdoo, W. G. (1973). Gender Identity. The problem of a true hermaphrodite, II.J. Am. Acad. Child Psychiat. 12: 137–141.

    Google Scholar 

  • Rösler, A., and Kohn, G. (1983). Male pseudohermaphroditism due to 17β-hydroxysteroid dehydrogenase deficiency: Studies on the natural history of the defect and effect of androgens on gender role.J. Steroid Biochem. 19: 663–674.

    PubMed  Google Scholar 

  • Saez, J. M., de Peretti, E., Morera, A. M., and Bertrand, J. (1971). Familial male pseudohermaphroditism and gynecomastia due to a testicular 17-ketosteroid reductase defect. I. Studies in vivo.J. Clin. Endocrinol. Metab. 32: 604–610.

    PubMed  Google Scholar 

  • Sreenivasan, U. (1985). Effeminate boys in a child psychiatric clinic: Prevalence and associated factors.J. Am. Acad. Child Psychiat. 24: 689–694.

    Google Scholar 

  • Stoller, R. J. (1964). The hermaphroditic identity of hermaphrodites.J. Nerv. Ment. Dis. 139: 453–457.

    PubMed  Google Scholar 

  • Stoller, R. J. (1968).Sex and Gender, Vol. 1, Science House, New York.

    Google Scholar 

  • Stoller, R. J. (1975).Sex and Gender, Vol. 2, Hogarth, London.

    Google Scholar 

  • Stoller, R.J. (1979). A contribution to the study of gender identity: Follow-up.Int. J. Psychoanal. 60: 433–441.

    Google Scholar 

  • Stoller, R.J. (1985).Presentations of Gender. Yale University Press, New Haven, CT.

    Google Scholar 

  • Task Force on DSM-IV. (1991).DSM-IV Options Book: Work in Progress American Psychiatric Association, Washington, DC.

    Google Scholar 

  • Teter, J., and Boczkowski, K. (1965). Errors in management and assignment of sex in patients with abnormal sexual differentiation.Am. J. Obstet. Gynecol. 93: 1084–1087.

    PubMed  Google Scholar 

  • Wolf, T. P. (1968). Geschlechtswechsel bei Hermaphroditen. Unpublished inaugural dissertation, Ruprecht-Karl-Universitat, Heidelberg, Germany.

    Google Scholar 

  • Wolfe, S., and Coates, S. (1991). Psychiatric disorders in fathers of boys with a gender identity disorder of childhood (Abstract). International Academy of Sex Research, 17th Annual Meeting, Barrie, Ontario. Canada.

  • Zucker, K. J., Bradley, S. J., and Hughes, H. E. (1987). Gender dysphoria in a child with true hermaphroditism.Can. J. Psychiat. 32: 602–609.

    Google Scholar 

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  1. Program of Developmental Psychoendocrinology, New York State Psychiatric Institute, and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 722 West 168 Street, Unit 10, 10032, New York, New York, USA

    Heino F. L. Meyer-Bahlburg Dr. rer. nat.

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Meyer-Bahlburg, H.F.L. Intersexuality and the diagnosis of gender identity disorder. Arch Sex Behav 23, 21–40 (1994). https://doi.org/10.1007/BF01541616

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