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.
American Psychiatric Association (1987).Diagnostic and Statistical Manual of Mental Disorders 3rd ed., rev., American Psychiatric Association, Washington, DC.
Blanchard, R. (1989). The classification and labeling of nonhomosexual gender dysphorias.Arch. Sex. Behav. 18: 315–334.
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.
Bräutigam, W. (1964). Körperliche, seelische und soziale Einflüsse auf die Geschlechtszugehörigkeit des Menschen.Internist (Berlin) 5: 171–182.
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.
Dewhurst, C. J., and Gordon, R. R. (1963). Change of sex.Lancet 2: 1213–1216.
Dewhurst, C. J., and Gordon, R. R. (1969).The Intersexual Disorders. Baillière and Cassell, London.
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.
Ellis, A. (1945). The sexual psychology of human hermaphrodites.Psychosom. Med. 7: 108–124.
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.
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.
Ghabrial, F., and Girgis, S. M. (1962). Reorientation of sex: Report of two cases.Int. J. Fertil. 7: 249–258.
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.
Green, R. (1974).Sexual Identity Conflict in Children and Adults Basic Books, New York.
Green, R. (1987).The “Sissy Boy Syndrome” and the Development of Homosexuality Yale University Press, New York.
Harrison, S. I. (1970). Reared in the wrong sex.J. Am. Acad. Child Psychiat. 9: 44–102.
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.
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.
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.
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.
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.
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.
Keppel, W. H., and Osofsky, H. J. (1985). A patient with ambiguous genitalia and gender confusion.Bull. Menninger Clin. 49: 584–585.
Köbberling, J., König, A., and Meyer, J. E. (1972). “Transsexualismus” bei testiculärer Feminisierung.Klin. Wochenschr. 50: 696–701.
Kok, L. P., and Tsoi, W. F. (1982). A case of a hermaphrodite presenting as a transsexual.Ann. Acad. Med. Singapore 11: 297–299.
König, P. A. (1966). Sexual- und Sozialpsychologie bei Pseudohermaphroditismus masculinus und testikulärer Feminisierung.Geburtshilfe Frauenheilkd. 26: 1070–1078.
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.
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.
Lev-Ran, A. (1974). Gender role differentiation in hermaphrodites.Arch. Sex. Behav. 3: 391–424.
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.
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.
Meyer-Bahlburg, H. F. L. (1985). Gender identity disorder of childhood. Introduction.J. Am. Acad. Child Psychiat. 24: 681–683.
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.
Money, J. (1991a).Biographies of Gender and Hermaphroditism in Paired Comparisons. Elsevier, Amsterdam, The Netherlands.
Money, J. (1991b). Bibliography.J. Psychol. Hum. Sex. 4: 83–198.
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.
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.
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.
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.
Newman, L. E., and Stoller, R. J. (1968). Gender identity disturbances in intersexed patients.Am. J. Psychiat. 124: 1262–1266.
Norris, A. S., and Keettel, W. C. (1962). Change of sex role during adolescence. A case study.Am. J. Obstet. Gynecol. 84: 719–721.
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.
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.
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.
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.
Sreenivasan, U. (1985). Effeminate boys in a child psychiatric clinic: Prevalence and associated factors.J. Am. Acad. Child Psychiat. 24: 689–694.
Stoller, R. J. (1964). The hermaphroditic identity of hermaphrodites.J. Nerv. Ment. Dis. 139: 453–457.
Stoller, R. J. (1968).Sex and Gender, Vol. 1, Science House, New York.
Stoller, R. J. (1975).Sex and Gender, Vol. 2, Hogarth, London.
Stoller, R.J. (1979). A contribution to the study of gender identity: Follow-up.Int. J. Psychoanal. 60: 433–441.
Stoller, R.J. (1985).Presentations of Gender. Yale University Press, New Haven, CT.
Task Force on DSM-IV. (1991).DSM-IV Options Book: Work in Progress American Psychiatric Association, Washington, DC.
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.
Wolf, T. P. (1968). Geschlechtswechsel bei Hermaphroditen. Unpublished inaugural dissertation, Ruprecht-Karl-Universitat, Heidelberg, Germany.
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.
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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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DOI: https://doi.org/10.1007/BF01541616