Abstract
Gender identity refers to a person’s concept related to their sense of themselves as a boy, girl, or other nonbinary identities. There is a paradigm shift occurring in today’s society in which an increasing number of youth are identifying as transgender, gender nonconforming, or intersex. Psychologists consulting in medical clinics or inpatient settings are likely to encounter youth who experience gender identity in a variety of ways. Youth who are gender nonconforming are at higher biomedical and psychosocial risk; these risks can be exacerbated by negative experiences in the health-care setting. This chapter provides an overview of foundational knowledge needed to understand gender identity (distinct from related concepts) and gender dysphoria. Two populations in which gender identity plays a primary role are highlighted, namely, transgender/gender nonconforming youth and people affected by a disorder/difference of sex development. For both of these populations, current research on psychosocial functioning is reviewed. The role of the psychologist in working with these populations is described, with particular emphasis on potential treatment targets and possible intervention strategies within the consultation setting.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Press.
American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70, 832–864.
Becerra-Culqui, T. A., Liu, Y., Nash, R., Cromwell, L., Flanders, W. D., Getahun, D., … Millman, A. (2018). Mental health of transgender and gender nonconforming youth compared with their peers. Pediatrics, 141, e20173845. https://doi.org/10.1542/peds.2017-3845
Berenbaum, S. A. (2018). Evidence needed to understand gender identity: Commentary on Turban & Ehrensaft (2018). Journal of Child Psychology and Psychiatry, 59, 1244-1247. https://doi.org/10.1111/jcpp.12997.
Chodzen, G., Hidalgo, M. A., Chen, D., & Garofalo, R. (2018). Minority stress factors associated with depression and anxiety among transgender and gender-nonconforming youth. Journal of Adolescent Health, 64, 467. https://doi.org/10.1016/j.jadohealth.2018.07.006
Clarke, A., Thompson, A. R., Jenkinson, E., Rumsey, N., & Newell, R. (2013). CBT for appearance anxiety: Psychosocial interventions for anxiety due to visible difference. West Sussex, UK: John Wiley & Sons.
Cohen-Kettenis, P. T., & Klink, D. (2015). Adolescents with gender dysphoria. Best Practice & Research Clinical Endocrinology & Metabolism, 29, 485–495. https://doi.org/10.1016/j.beem.2015.01.004
Cools, M., Nordenström, A., Robeva, R., Hall, J., Westerveld, P., Flück, C., … Schweizer, K. (2018). Caring for individuals with a difference of sex development (DSD): A consensus statement. Nature Reviews Endocrinology, 14, 415–429. https://doi.org/10.1038/s41574-018-0010-8
Day, J. K., Fish, J. N., Perez-Brumer, A., Hatzenbuehler, M. L., & Russell, S. T. (2017). Transgender youth substance use disparities: Results from a population-based sample. Journal of Adolescent Health, 61, 729–735. https://doi.org/10.1016/j.jadohealth.2017.06.024
de Vries, A. L., Kreukels, B. P., Steensma, T. D., & McGuire, J. K. (2014). Gender identity development: A biopsychosocial perspective. In B. Kreukels, T. Steensma, & A. de Vries (Eds.), Gender dysphoria and disorders of sex development (pp. 53–80). Boston, MA: Springer.
de Vries, A. L., Noens, I. L., Cohen-Kettenis, P. T., van Berckelaer-Onnes, I. A., & Doreleijers, T. A. (2010). Autism spectrum disorders in gender dysphoric children and adolescents. Journal of Autism and Developmental Disorders, 40, 930–936. https://doi.org/10.1007/s10803-010-0935-9
Durwood, L., McLaughlin, K. A., & Olson, K. R. (2017). Mental health and self-worth in socially transitioned transgender youth. Journal of the American Academy of Child & Adolescent Psychiatry, 56, 116–123. https://doi.org/10.1016/j.jaac.2016.10.016
Eccleston, C., Palermo, T. M., Fisher, E., & Law, E. (2012). Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database Systematic Reviews (Online), 8, CD009660. https://doi.org/10.1002/14651858.CD009660.pub2
Edwards-Leeper, L., Leibowitz, S., & Sangganjanavanich, V. F. (2016). Affirmative practice with transgender and gender nonconforming youth: Expanding the model. Psychology of Sexual Orientation and Gender Diversity, 3, 165–172. https://doi.org/10.1037/sgd0000167
Egan, S. K., & Perry, D. G. (2001). Gender identity: A multidimensional analysis with implications for psychosocial adjustment. Developmental Psychology, 37, 451–463.
Engberg, H., Strandqvist, A., Nordenstrom, A., Butwicka, A., Nordenskjold, A., Hirschberg, A. L., & Frisen, L. (2017). Increased psychiatric morbidity in women with complete androgen insensitivity syndrome or complete gonadal dysgenesis. Journal of Psychosomatic Research, 101, 122–127. https://doi.org/10.1016/j.jpsychores.2017.08.009
Flores, A., Herman, J., Gates, G., & Brown, T. (2016). How many adults identify as transgender in the United States? Los Angeles, CA: Williams Institute.
Glidden, D., Bouman, W. P., Jones, B. A., & Arcelus, J. (2016). Gender dysphoria and autism spectrum disorder: A systematic review of the literature. Sexual Medicine Reviews, 4, 3–14. https://doi.org/10.1016/j.sxmr.2015.10.003
Hatzenbuehler, M. L., & Pachankis, J. E. (2016). Stigma and minority stress as social determinants of health among lesbian, gay, bisexual, and transgender youth research evidence and clinical implications. Pediatric Clinics of North America, 63, 985–997. https://doi.org/10.1016/j.pcl.2016.07.003
Human Rights Watch. (2017). “I Want to Be Like Nature Made Me”: Medically unnecessary surgeries on intersex children in the US. Retrieved from https://www.hrw.org/report/2017/07/25/i-want-be-nature-made-me/medically-unnecessary-surgeries-intersex-children-us
Hyde, J. S., Bigler, R. S., Joel, D., Tate, C. C., & van Anders, S. M. (2018). The future of sex and gender in psychology: Five challenges to the gender binary. American Psychologist, 74, 171. https://doi.org/10.1037/amp0000307
Johns, M. M., Beltran, O., Armstrong, H. L., Jayne, P. E., & Barrios, L. C. (2018). Protective factors among transgender and gender variant youth: A systematic review by socioecological level. The Journal of Primary Prevention, 39, 263–301. https://doi.org/10.1007/s10935-018-0508-9
Johnson, E. K., Rosoklija, I., Finlayso, C., Chen, D., Yerkes, E. B., Madonna, M. B., … Cheng, E. Y. (2017). Attitudes towards “disorders of sex development” nomenclature among affected individuals. Journal of Pediatric Urology, 13, 608.e601–608.e608. https://doi.org/10.1016/j.jpurol.2017.03.035
Johnson, L. L., Bradley, S. J., Birkenfeld-Adams, A. S., Kuksis, M. A. R., Maing, D. M., Mitchell, J. N., & Zucker, K. J. (2004). A parent-report gender identity questionnaire for children. Archives of Sexual Behavior, 33, 105–116.
Jones, B. A., Bouman, W. P., Haycraft, E., & Arcelus, J. (2018). The gender congruence and life satisfaction scale (GCLS): Development and validation of a scale to measure outcomes from transgender health services. International Journal of Transgenderism, 20, 1–18. https://doi.org/10.1080/15532739.2018.1453425
Kellogg, T. A., Clements-Nolle, K., Dilley, J., Katz, M. H., & McFarland, W. (2001). Incidence of human immunodeficiency virus among male-to-female transgendered persons in San Francisco. Journal of Acquired Immune Deficiency Syndromes (1999), 28, 380–384. https://doi.org/10.1097/00126334-200112010-00012
Klein, A., & Golub, S. A. (2016). Family rejection as a predictor of suicide attempts and substance misuse among transgender and gender nonconforming adults. LGBT Health, 3, 193–199. https://doi.org/10.1089/lgbt.2015.0111
Kreukels, B. P., Köhler, B., Nordenström, A., Roehle, R., Thyen, U., Bouvattier, C., … de Vries, A. (2018). Gender dysphoria and gender change in disorders of sex development/intersex conditions: Results from the dsd-LIFE study. The Journal of Sexual Medicine, 15, 777–785. https://doi.org/10.1016/j.jsxm.2018.02.021
Lee, P. A., Houk, C. P., Ahmed, S. F., & Hughes, I. A. (2006). Consensus statement on management of intersex disorders. Pediatrics, 118, e488–e500. https://doi.org/10.1542/peds.2006-0738
Liao, L. M., & Simmonds, M. (2013). Communicating with clients affected by diverse sex development. In J. Wiggins & A. Middleton (Eds.), Getting the message across: Communication with diverse populations in clinical genetics (pp. 42–60). New York: Oxford University Press.
Lindgren, T. W., & Pauly, I. B. (1975). A body image scale for evaluating transsexuals. Archives of Sexual Behavior, 4, 639–656.
Martin, C. L., Andrews, N. C., England, D. E., Zosuls, K., & Ruble, D. N. (2017). A dual identity approach for conceptualizing and measuring children’s gender identity. Child Development, 88, 167–182. https://doi.org/10.1111/cdev.12568
Mendelson, T., Cluxton-Keller, F., Vullo, G. C., Tandon, S. D., & Noazin, S. (2017). NICU-based interventions to reduce maternal depressive and anxiety symptoms: A meta-analysis. Pediatrics, 139, e20161870. https://doi.org/10.1542/peds.2016-1870
Meyer-Bahlburg, H. F., Khuri, J., Reyes-Portillo, J., & New, M. I. (2016). Stigma in medical settings as reported retrospectively by women with congenital adrenal hyperplasia (CAH) for their childhood and adolescence. Journal of Pediatric Psychology, 42, 496–503. https://doi.org/10.1093/jpepsy/jsw034
Nordenström, A. (2015). Psychosocial factors in disorders of sex development in a long-term perspective: What clinical opportunities are there to intervene? Hormone and Metabolic Research, 47, 351–356. https://doi.org/10.1055/s-0034-1398562
Pasterski, V., Mastroyannopoulou, K., Wright, D., Zucker, K. J., & Hughes, I. A. (2014). Predictors of posttraumatic stress in parents of children diagnosed with a disorder of sex development. Archives of Sexual Behavior, 43, 369–375. https://doi.org/10.1007/s10508-013-0196-8
Rider, G. N., McMorris, B. J., Gower, A. L., Coleman, E., & Eisenberg, M. E. (2018). Health and care utilization of transgender and gender nonconforming youth: A population-based study. Pediatrics, 141, e20171683. https://doi.org/10.1542/peds.2017-1683
Ristori, J., & Steensma, T. D. (2016). Gender dysphoria in childhood. International Review of Psychiatry, 28, 13–20. https://doi.org/10.3109/09540261.2015.1115754
Ruble, D. N., Martin, C. L., & Berenbaum, S. A. (2006). Gender Development. In W. Damon, R. Lerner, & N. Eisenberg (Eds.), Handbook of child psychology: Social, emotional, and personality (Vol. 3, pp. 858–932). New York: John Wiley & Sons.
Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health, 63, 503–505. https://doi.org/10.1016/j.jadohealth.2018.02.003
Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, 23, 205–213. https://doi.org/10.1111/j.1744-6171.2010.00246.x
Ryan, C., Toomey, R. B., Diaz, R. M., & Russell, S. T. (2018). Parent-initiated sexual orientation change efforts with LGBT adolescents: Implications for young adult mental health and adjustment. Journal of Homosexuality, 1–15. https://doi.org/10.1080/00918369.2018.1538407
Sahler, O. J. Z., Fairclough, D. L., Phipps, S., Mulhern, R. K., Dolgin, M. J., Noll, R. B., … Butler, R. W. (2005). Using problem-solving skills training to reduce negative affectivity in mothers of children with newly diagnosed cancer: Report of a multisite randomized trial. Journal of Consulting and Clinical Psychology, 73, 272–283. https://doi.org/10.1037/0022-006x.73.2.272
Sandberg, D. E., Gardner, M., & Cohen-Kettenis, P. T. (2012). Psychological aspects of the treatment of patients with disorders of sex development. Seminars in Reproductive Medicine, 30, 443–452. https://doi.org/10.1055/s-0032-1324729
Sax, L. (2002). How common is intersex? A response to Anne Fausto-Sterling. Journal of Sex Research, 39, 174–178. https://doi.org/10.1080/00224490209552139
Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53, 791–793. https://doi.org/10.1016/j.jadohealth.2013.07.019
Smith, D. S., & Juvonen, J. (2017). Do I fit in? Psychosocial ramifications of low gender typicality in early adolescence. Journal of Adolescence, 60, 161–170. https://doi.org/10.1016/j.adolescence.2017.07.014
Steensma, T. D., McGuire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 52, 582–590. https://doi.org/10.1016/j.jaac.2013.03.016
Tamar-Mattis, A., Baratz, A., Baratz Dalke, K., & Karkazis, K. (2014). Emotionally and cognitively informed consent for clinical care for differences of sex development. Psychology & Sexuality, 5, 44–55. https://doi.org/10.1080/19419899.2013.831215
Tishelman, A. C., Shumer, D. E., & Nahata, L. (2017). Disorders of sex development: Pediatric psychology and the genital exam. Journal of Pediatric Psychology, 42, 530–543. https://doi.org/10.1093/jpepsy/jsw015
Toomey, R. B., Syvertsen, A. K., & Shramko, M. (2018). Transgender adolescent suicide behavior. Pediatrics, 142, e20174218. https://doi.org/10.1542/peds.2017-4218
Trotta, D. (2018, October 9). New York City creates gender-neutral ‘X’ option for birth certificates. Retrieved from https://www.reuters.com/article/us-usa-lgbt-new-york/new-york-city-creates-gender-neutral-x-option-for-birth-certificates-idUSKCN1MJ2OP
Yunger, J. L., Carver, P. R., & Perry, D. G. (2004). Does gender identity influence children’s psychological well-being? Developmental Psychology, 40, 572–582. https://doi.org/10.1037/0012-1649.40.4.572
Zucker, K. J. (2005). Measurement of psychosexual differentiation. Archives of Sexual Behavior, 34, 375–388. https://doi.org/10.1007/s10508-005-4336-7
Zucker, K. J., Bradley, S. J., Sullivan, C. B. L., Kuksis, M., Birkenfeld-Adams, A., & Mitchell, J. N. (1993). A gender identity interview for children. Journal of Personality Assessment, 61, 443–456. https://doi.org/10.1207/s15327752jpa6103_2
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Brady, C.E., Ernst, M.M. (2020). Pediatric Gender Identity: Consultation on Matters of Identity, Transgender Concerns, and Disorders/Differences of Sex Development. In: Carter, B.D., Kullgren, K.A. (eds) Clinical Handbook of Psychological Consultation in Pediatric Medical Settings. Issues in Clinical Child Psychology. Springer, Cham. https://doi.org/10.1007/978-3-030-35598-2_33
Download citation
DOI: https://doi.org/10.1007/978-3-030-35598-2_33
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-35597-5
Online ISBN: 978-3-030-35598-2
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)