Archives of Sexual Behavior

, Volume 39, Issue 2, pp 461–476 | Cite as

From Mental Disorder to Iatrogenic Hypogonadism: Dilemmas in Conceptualizing Gender Identity Variants as Psychiatric Conditions

Original Paper

Abstract

The categorization of gender identity variants (GIVs) as “mental disorders” in the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association is highly controversial among professionals as well as among persons with GIV. After providing a brief history of GIV categorizations in the DSM, this paper presents some of the major issues of the ongoing debate: GIV as psychopathology versus natural variation; definition of “impairment” and “distress” for GID; associated psychopathology and its relation to stigma; the stigma impact of the mental-disorder label itself; the unusual character of “sex reassignment surgery” as a psychiatric treatment; and the consequences for health and mental-health services if the disorder label is removed. Finally, several categorization options are examined: Retaining the GID category, but possibly modifying its grouping with other syndromes; narrowing the definition to dysphoria and taking “disorder” out of the label; categorizing GID as a neurological or medical rather than a psychiatric disorder; removing GID from both the DSM and the International Classification of Diseases (ICD); and creating a special category for GIV in the DSM. I conclude that—as also evident in other DSM categories—the decision on the categorization of GIVs cannot be achieved on a purely scientific basis, and that a consensus for a pragmatic compromise needs to be arrived at that accommodates both scientific considerations and the service needs of persons with GIVs.

Keywords

Gender identity disorder Transsexualism Transgenderism DSM-V Mental illness 

References

  1. Alanko, K., Santtila, P., Witting, K., Varjonen, M., Jern, P., Johansson, A., et al. (2009). Psychiatric symptoms and same-sex sexual attraction and behavior in light of childhood gender atypical behavior and parental relationships. Journal of Sex Research, doi:10.1080/00224490902846487.
  2. American Medical Association. (2008, June). Resolution 122 on removing financial barriers to care for transgender patients. Retrieved December 6, 2008, from http://www.gires.org.uk/assets/AMA122.html
  3. American Psychiatric Association. (1952). Diagnostic and statistical manual: Mental disorders. Washington, DC: Author.Google Scholar
  4. American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders (2nd ed.). Washington, DC: Author.Google Scholar
  5. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
  6. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised). Washington, DC: Author.Google Scholar
  7. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  8. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.Google Scholar
  9. American Psychological Association. (2008a, August). Resolution on transgender, gender identity, and gender expression non-discrimination. Retrieved December 6, 2008, from http://www.apa.org/pi/lgbc/policy/transgender.html
  10. American Psychological Association Task Force on Gender Identity and Gender Variance. (2008b). Report of the task force on gender identity and gender variance. Washington, DC: American Psychological Association.Google Scholar
  11. Ault, A., & Brzuzy, S. (2009). Removing gender identity disorder from the Diagnostic and Statistical Manual of Mental Disorders: A call for action. Social Work, 54, 187–189.PubMedGoogle Scholar
  12. Bailey, J. M., & Zucker, K. J. (1995). Childhood sex-typed behavior and sexual orientation: A conceptual analysis and quantitative review. Developmental Psychology, 31, 43–55.Google Scholar
  13. Bartlett, N. B., & Vasey, P. L. (2006). A retrospective study of childhood gender-atypical behavior in Samoan fa’afafine. Archives of Sexual Behavior, 35, 559–566.Google Scholar
  14. Bartlett, N. B., Vasey, P. L., & Bukowski, W. M. (2000). Is gender identity disorder in children a mental disorder? Sex Roles, 43, 753–785.Google Scholar
  15. Bayer, R. (1981). Homosexuality and American psychiatry: The politics of diagnosis. New York: Basic Books.Google Scholar
  16. Benjamin, H. (1954). Transsexualism and transvestism as psychosomatic somato-psychic syndromes. American Journal of Psychotherapy, 8, 219–230.PubMedGoogle Scholar
  17. Benjamin, H. (1966). The transsexual phenomenon. New York: Julian Press.Google Scholar
  18. Bentz, E.-K., Hefler, L. A., Kaufmann, U., Huber, J. C., Kolbus, A., & Tempfer, C. B. (2008). The polymorphism of the CYP17 gene related to sex steroid metabolism is associated with female-to-male but not male-to-female transsexualism. Fertility and Sterility, 90, 56–59.PubMedGoogle Scholar
  19. Berglund, H., Lindström, P., Dhejne-Helmy, C., & Savic, I. (2008). Male-to-female transsexuals show sex-atypical hypothalamus activation when smelling odorous steroids. Cerebral Cortex, 18, 1900–1908.PubMedGoogle Scholar
  20. Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria. Journal of Mental and Nervous Disease, 177, 616–623.CrossRefGoogle Scholar
  21. Blanchard, R. (2008). Deconstructing the feminine essence narrative. Archives of Sexual Behavior, 37, 434–438.PubMedGoogle Scholar
  22. Bockting, W. O. (2009a, April). The theory of gender and stigma. Transgender-affirmative typology, treatment, and research. Paper presented at the meeting of the Society for Sex Therapy and Research, Arlington, VA.Google Scholar
  23. Bockting, W. O. (2009b). Are gender identity disorders mental disorders? Recommendations for the revision of the World Professional Association for Transgender Health’s Standards of Care. International Journal of Transgenderism, 11(1), 53–62.Google Scholar
  24. Bockting, W. O., Brenner, A., & Coleman, C. (2009). Gay and bisexual identity development among female-to-male transsexuals in North America: Emergence of a transgender sexuality. Archives of Sexual Behavior, doi:10.1007/s10508-009-9489-3.
  25. Bockting, W. O., & Ehrbar, R. (2005). Commentary: Gender variance, dissonance, or identity disorder. Journal of Psychology and Human Sexuality, 17(3/4), 125–134.Google Scholar
  26. Borras, L., Huguenet, P., & Eytan, A. (2007). Delusional “pseudotranssexualism” in schizophrenia. Psychiatry, 70, 175–179.PubMedGoogle Scholar
  27. Bosinski, H. A., Peter, M., Bonatz, G., Arndt, R., Heidenreich, M., Sippell, W. G., et al. (1997). A higher rate of hyperandrogenic disorders in female-to-male transsexuals. Psychoneuroendocrinology, 22, 361–380.PubMedGoogle Scholar
  28. Bradford, N. J. (1983). Transgenderism and the cult of Yellamma: Heat, sex, and sickness in South Indian ritual. Journal of Anthropological Research, 39, 307–322.Google Scholar
  29. Brett, M. A., Roberts, L. F., Johnson, T. W., & Wassersug, R. J. (2007). Eunuchs in contemporary society: Expectations, consequences and adjustments to castration. Journal of Sexual Medicine, 4, 946–955.PubMedGoogle Scholar
  30. Brill, S., & Pepper, R. (2008). The transgender child: A handbook for families and professionals. San Francisco, CA: Cleis Press.Google Scholar
  31. Bryant, K. (2008). In defense of gay children? “Progay” homophobia and the production of homonormativity. Sexualities, 11, 455–475.Google Scholar
  32. Bullough, V. L., & Bullough, B. (1993). Cross dressing, sex, and gender. Philadelphia, PA: University of Pennsylvania Press.Google Scholar
  33. Burke, P. (1996). Gender shock: Exploding the myths of male and female. New York: Anchor Books.Google Scholar
  34. Cardoso, F. L. (2005). Cultural universals and differences in male homosexuality: The case of a Brazilian fishing village. Archives of Sexual Behavior, 34, 103–109.PubMedGoogle Scholar
  35. Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of Homosexuality, 51, 53–69.PubMedGoogle Scholar
  36. Cloud, J. (2000, September 25). His name is Aurora. Time, pp. 90–91.Google Scholar
  37. Coates, S. (1990). Ontogenesis of boyhood gender identity disorder. Journal of the American Academy of Psychoanalysis, 18, 414–438.PubMedGoogle Scholar
  38. Coates, S., & Wolfe, S. (1995). Gender identity disorder in boys: The interface of constitution and early experience. Psychoanalytic Inquiry, 15, 6–38.Google Scholar
  39. Cohen-Kettenis, P. T. (2001). Gender identity disorder in DSM? [Letter to the editor]. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 391.Google Scholar
  40. Cohen-Kettenis, P. T., & Pfäfflin, F. (2009). The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Archives of Sexual Behavior, doi:10.1007/s10508-009-9562-y.
  41. Cohen-Kettenis, P. T., & van Goozen, S. H. (1997). Sex reassignment of adolescent transsexuals: A follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 263–271.PubMedGoogle Scholar
  42. Coleman, E., Colgan, P., & Gooren, L. (1992). Male cross-gender behavior in Myanmar (Burma): A description of the acault. Archives of Sexual Behavior, 21, 313–321.PubMedGoogle Scholar
  43. Coolidge, F. L., Thede, L. L., & Young, S. E. (2002). The heritability of gender identity disorder in a child and adolescent twin sample. Behavior Genetics, 32, 251–257.PubMedGoogle Scholar
  44. Costa, L., & Matzner, A. (2007). Male bodies, women’s souls: Personal narratives of Thailand’s transgendered youth. Binghampton, NY: The Haworth Press.Google Scholar
  45. Currah, P., Green, J., & Stryker, S. (2009). The state of transgender rights in the United States of America. Retrieved March 18, 2009, from http://nsrc.sfsu.edu
  46. Currah, P., Juang, R. M., & Minter, S. P. (Eds.). (2006). Transgender rights. Minneapolis, MN: University of Minnesota Press.Google Scholar
  47. de Cuypere, G., Knudson, G., & Bockting, W. O. (Chairs). (2009). WPATH’s Consensus Statement on Gender Dysphoria and the DSM-V. Symposium presented at The World Professional Association for Transgender Health (WPATH) the 2009 XXI Biennial Symposium, Oslo, Norway, June 17–20, 2009.Google Scholar
  48. DeLoache, J. S., Simcock, G., & Macari, S. (2007). Planes, trains, automobiles—and tea sets: Extremely intense interests in very young children. Developmental Psychology, 43, 1579–1586.PubMedGoogle Scholar
  49. Dessens, A. B., Slijper, F. M. E., & Drop, S. L. S. (2005). Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia. Archives of Sexual Behavior, 34, 389–397.PubMedGoogle Scholar
  50. Devor, H. (1997). FTM: Female-to-male transsexuals in society. Bloomington, IN: Indiana University Press.Google Scholar
  51. de Vries, G. J., & Södersten, P. (2009). Sex differences in the brain: The relation between structure and function. Hormones and Behavior, 55, 589–596.PubMedGoogle Scholar
  52. Di Ceglie, D. (1998). Reflections on the nature of the “atypical gender identity organization”. In D. Di Ceglie & D. Freedman (Eds.), A stranger in my own body: Atypical gender identity development and mental health (pp. 9–25). London: Karnac Books.Google Scholar
  53. Docter, R. F. (1988). Transvestites and transsexuals: Towards a theory of cross-gender behavior. New York: Plenum.Google Scholar
  54. Docter, R. F. (2007). Becoming a woman: A biography of Christine Jorgensen. Kirkwood, NY: Harrington Park Press.Google Scholar
  55. Doorn, C. D., Poortinga, J., & Verschoor, A. M. (1994). Cross-gender identity in transvestites and male transsexuals. Archives of Sexual Behavior, 23, 185–201.PubMedGoogle Scholar
  56. Drescher, J. (2009). Queer diagnoses: Parallels and contrasts in the history of homosexuality, gender variance, and the Diagnostic and Statistical Manual. Archives of Sexual Behavior, doi:10.1007/s10508-009-9531-5
  57. Egan, S. K., & Perry, D. G. (2001). Gender identity: A multidimensional analysis with implications for psychosocial adjustment. Developmental Psychology, 37, 451–463.PubMedGoogle Scholar
  58. Fausto-Sterling, A. (2000). Sexing the body: Gender politics and the construction of sexuality. New York: Basic Books.Google Scholar
  59. Federoff, J. P. (2000). The case against publicly funded transsexual surgery. Psychiatry Rounds, 4, 1–3.Google Scholar
  60. Feinberg, L. (1996). Transgender warriors: Making history from Joan of Arc to RuPaul. Boston: Beacon Press.Google Scholar
  61. First, M. B. (2005). Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 35, 919–928.PubMedGoogle Scholar
  62. Freund, K., & Blanchard, R. (1993). Erotic target location errors in male gender dysphorics, paedophiles, and fetishists. British Journal of Psychiatry, 162, 558–563.PubMedGoogle Scholar
  63. Garcia-Falgueras, A., & Swaab, D. F. (2008). A sex difference in the hypothalamic uncinate nucleus: Relationship to gender identity. Brain, 131, 3132–3146.PubMedGoogle Scholar
  64. Gender Identity Research and Education Society (GIRES). (2006). Atypical gender development: A review. International Journal of Transgenderism, 9(1), 29–44.Google Scholar
  65. Gender Spectrum Family. Retrieved November 16, 2008, from http://www.genderspectrumfamily.org
  66. GID Reform Advocates. Retrieved October 8, 2008, from http://www.gidreform.org
  67. Gizewski, E. R., Krause, E., Schlamann, M., Happich, F., Ladd, M. E., Forsting, M., et al. (2009). Specific cerebral activation due to visual erotic stimuli in male-to-female transsexuals compared with male and female controls: An fMRI study. Journal of Sexual Medicine, 6, 440–448.PubMedGoogle Scholar
  68. Goy, R. W., Bercovitch, F. B., & McBrair, M. C. (1988). Behavioral masculinization is independent of genital masculinization in prenatally androgenized female rhesus macaques. Hormones and Behavior, 22, 552–571.PubMedGoogle Scholar
  69. Green, R., & Money, J. (1960). Incongruous gender role: Nongenital manifestations in prepubertal boys. Journal of Nervous and Mental Disease, 131, 160–168.PubMedGoogle Scholar
  70. Green, R., & Money, J. (Eds.). (1969). Transsexualism and sex reassignment. Baltimore: The Johns Hopkins Press.Google Scholar
  71. Hamburger, C., Stürup, G. K., & Dahl-Iversen, E. (1953). Transvestism: Hormonal, psychiatric, and surgical treatment. Journal of the American Medical Association, 152, 391–396.PubMedGoogle Scholar
  72. Hare, L., Bernard, P., Sánchez, F. J., Baird, P. N., Vilain, E., Kennedy, T., et al. (2009). Androgen receptor repeat length polymorphism associated with male-to-female transsexualism. Biological Psychiatry, 65, 93–96.PubMedGoogle Scholar
  73. Hembree, W. C., Cohen-Kettenis, P., Delemarre-van de Waal, H. A., Gooren, L. J., Meyer, W. J., Spack, N. P., et al. (2009). Endocrine treatment of transsexual persons: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism, 94, 3132–3154.PubMedGoogle Scholar
  74. Henningsson, S., Westberg, L., Nilsson, S., Lundström, B., Ekselius, L., Bodlund, O., et al. (2005). Sex steroid-related genes and male-to-female transsexualism. Psychoneuroendocrinology, 30, 657–664.PubMedGoogle Scholar
  75. Herbert, J. (2008). Who do we think we are? The brain and gender identity. Brain, 131, 3115–3117.PubMedGoogle Scholar
  76. Herdt, G. (Ed.). (1996). Third sex, third gender: Beyond sexual dimorphism in culture and history. New York: Zone Books.Google Scholar
  77. Hill, D. B., Rozanski, C., Carfagnini, J., & Willoughby, B. (2007). Gender identity disorders in childhood and adolescence: A critical inquiry. International Journal of Sexual Health, 19(1), 57–74.Google Scholar
  78. Holterhus, P.-M., Bebermeier, J.-H., Werner, R., Demeter, J., Richter-Unruh, A., Cario, G., et al. (2009). Disorders of sex development expose transcriptional autonomy of genetic sex and androgen-programmed hormonal sex in human blood leukocytes. BMC Genomics, 10.Google Scholar
  79. Iervolino, A. C., Hines, M., Golombok, S. E., Rust, J., & Plomin, R. (2005). Genetic and environmental influences on sex-typed behavior during the preschool years. Child Development, 76, 826–840.PubMedGoogle Scholar
  80. Inciardi, J. A., Surratt, H. L., Telles, P. R., & Pok, B. H. (1999). Sex, drugs, and the culture of travestismo in Rio de Janeiro. International Journal of Transgenderism, 3(1/4). Retrieved January 15, 2007, from http://www.symposion.com/ijt/hiv_risk/inciardi.htm
  81. International Foundation for Gender Education. (2008). Sweden removes transvestism from list of disorders. Retrieved November 24, 2008, from http://www.ifge.org/Article380.phtml
  82. Isay, R. A. (1997). Remove gender identity disorder from DSM. Psychiatric News, 32(1), 13.Google Scholar
  83. Jackson, P. A. (1997). Kathoey < > gay < > man. The historical emergence of gay male identity in Thailand. In L. Manderson & M. Jolly (Eds.), Sites of desire/economies of pleasure: Sexualities in Asia and the Pacific (pp. 166–190). Chicago: University of Chicago Press.Google Scholar
  84. Johnson, T. W., Brett, M. A., Roberts, L. F., & Wassersug, R. J. (2007). Eunuchs in contemporary society: Characterizing men who are voluntary castrated. Journal of Sexual Medicine, 4, 930–945.PubMedGoogle Scholar
  85. Kessler, S. J. (1990). The medical construction of gender: Case management of intersexed infants. Signs, 16, 3–26.Google Scholar
  86. Knafo, A., Iervolino, A. C., & Plomin, R. (2005). Masculine girls and feminine boys: Genetic and environmental contributions to atypical gender development in early childhood. Journal of Personality and Social Psychology, 88, 400–412.PubMedGoogle Scholar
  87. Kolla, N. J., & Zucker, K. J. (2009). Desire for non-mutilative disability in a nonhomosexual, male-to-female transsexual. Archives of Sexual Behavior, doi:10.1007/s10508-009-9501-y.
  88. Kruijver, F. P., Zhou, J., Pool, C., Hofman, M. A., Gooren, L. J. G., & Swaab, D. F. (2000). Male-to-female transsexuals have female neuron numbers in a limbic nucleus. Journal of Clinical Endocrinology and Metabolism, 85, 2034–2041.PubMedGoogle Scholar
  89. Kulick, D. (1998). Travesti: Gender and culture among Brazilian transgendered prostitutes. Chicago: University of Chicago Press.Google Scholar
  90. Langer, S. J., & Martin, J. I. (2004). How dresses can make you mentally ill: Examining gender identity disorder in children. Child and Adolescent Social Work Journal, 21, 5–23.Google Scholar
  91. Lawrence, A. A. (2005). Sexuality before and after male-to-female sex reassignment surgery. Archives of Sexual Behavior, 34, 147–166.PubMedGoogle Scholar
  92. Lawrence, A. A. (2006). Clinical and theoretical parallels between desire for limb amputation and gender identity disorder. Archives of Sexual Behavior, 35, 263–278.PubMedGoogle Scholar
  93. Lawrence, A. A. (2007). Becoming what we love. Autogynephilic transsexualism conceptualized as an expression of romantic love. Perspectives of Biology and Medicine, 50, 506–520.Google Scholar
  94. Lawrence, A. A. (2009). Erotic target location errors: An underappreciated paraphilic dimension. Journal of Sex Research, 46, 194–215.PubMedGoogle Scholar
  95. Lev, A. I. (2005). Disordering gender identity: Gender identity disorder in the DSM-IV-TR. Journal of Psychology and Human Sexuality, 17, 35–69.Google Scholar
  96. Levine, S. B., & Solomon, A. (2009). Meanings and political implications of “psychopathology” in a gender identity clinic: A report of 10 cases. Journal of Sex and Marital Therapy, 35, 40–57.PubMedGoogle Scholar
  97. Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385.Google Scholar
  98. Lombardi, E. L., Wilchins, R. A., Priesing, D., & Malouf, D. (2001). Gender violence: Transgender experiences with violence and discrimination. Journal of Homosexuality, 42, 89–101.PubMedGoogle Scholar
  99. Luders, E., Sánchez, F. J., Gaser, C., Toga, A. W., Narr, K. L., Hamilton, L. S., et al. (2009). Regional gray matter variation in male-to-female transsexualism. NeuroImage, 46, 904–907.PubMedGoogle Scholar
  100. Marks, I., Green, R., & Mataix-Cols, D. (2000). Adult gender identity disorder can remit. Comprehensive Psychiatry, 41, 273–275.PubMedGoogle Scholar
  101. Mathy, R. M., & Drescher, J. (Eds.). (2008). Childhood gender nonconformity and the development of adult homosexuality. Journal of Gay & Lesbian Mental Health, 12(1–2), xxi–165.Google Scholar
  102. McHugh, P. (2004). Surgical sex. First Things: The Journal of Religion, Culture and Public Life, 147, 34–38.Google Scholar
  103. Meyer, I. H., & Northridge, M. E. (Eds.). (2007). The health of sexual minorities: Public health perspectives on lesbian, gay, bisexual, and transgender populations. New York: Springer.Google Scholar
  104. Meyer-Bahlburg, H. F. L. (2002). Gender identity disorder in young boys: A parent- and peer-based treatment protocol. Clinical Child Psychology and Psychiatry, 7, 360–376.Google Scholar
  105. Meyer-Bahlburg, H. F. L. (2005). Gender identity outcome in female-raised 46,XY persons with penile agenesis, cloacal exstrophy of the bladder, or penile ablation. Archives of Sexual Behavior, 34, 423–438.PubMedGoogle Scholar
  106. Meyer-Bahlburg, H. F. L. (2008). Treatment guidelines for children with disorders of sex development. Neuropsychiatrie del’Enfance et de l’Adolescence, 56, 345–349.Google Scholar
  107. Meyer-Bahlburg, H. F. L., Dolezal, C., Baker, S. W., Carlson, A. D., Obeid, J. S., & New, M. I. (2004). Prenatal androgenization affects gender-related behavior but not gender identity in 5–12-year-old girls with congenital adrenal hyperplasia. Archives of Sexual Behavior, 33, 97–104.PubMedGoogle Scholar
  108. Meyer-Bahlburg, H. F. L., Dolezal, C., Baker, S. W., Ehrhardt, A. A., & New, M. I. (2006). Gender development in women with congenital adrenal hyperplasia as a function of disorder severity. Archives of Sexual Behavior, 35, 667–684.PubMedGoogle Scholar
  109. Meyer-Bahlburg, H. F. L., Dolezal, C., Baker, S. W., & New, M. I. (2008). Sexual orientation in women with classical or non-classical congenital adrenal hyperplasia as a function of degree of prenatal androgen excess. Archives of Sexual Behavior, 37, 85–99.PubMedGoogle Scholar
  110. Meyer-Bahlburg, H. F. L., Gruen, R. S., New, M. I., Bell, J. J., Morishima, A., Shimshi, M., et al. (1996). Gender change from female to male in classical congenital adrenal hyperplasia. Hormones and Behavior, 30, 319–332.PubMedGoogle Scholar
  111. Money, J., Jobaris, R., & Furth, G. (1977). Apotemnophilia: Two cases of self-demand amputation as a paraphilia. Journal of Sex Research, 13, 115–125.Google Scholar
  112. Moser, C. (2009). Autogynephilia in women. Journal of Homosexuality, 56, 539–547.PubMedGoogle Scholar
  113. Moser, C., & Kleinplatz, P. J. (2005). DSM-IV-TR and the paraphilias: An argument for removal. Journal of Psychology & Human Sexuality, 17(3/4), 91–109.Google Scholar
  114. Murad, M. H., Elamin, M. B., Garcia, M. Z., Mullan, R. J., Murad, A., Erwin, P. J., et al. (2009). Hormonal therapy and sex reassignment: A systematic review and meta-analysis of quality of life and psychosocial outcomes. Clinical Endocrinology, doi:10.1111/j.1365-2265.2009.03625.x.
  115. Nanda, S. (1999). The Hijras of India: Neither man nor woman (2nd ed.). Belmont, CA: Wadsworth.Google Scholar
  116. National Alliance on Mental Illness. Retrieved January 25, 2009, from http://www.nami.org
  117. Nuttbrock, L., Bockting, W., Mason, M., Hwahng, S., Rosenblum, A., Macri, M., et al. (2009a). Sexual orientation and transvestic fetishism among male-to-female transgender persons in New York City: A further assessment of Blanchard’s findings. Manuscript submitted for publication.Google Scholar
  118. Nuttbrock, L., Hwahng, S., Bockting, W., Rosenblum, A., Mason, M., Macri, M., et al. (2009b). Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. Journal of Sex Research, doi:10.1080/00224-490903062258.
  119. Olsson, S.-E., & Möller, A. (2006). Regret after sex reassignment surgery in a male-to-female transsexual: A long-term follow-up. Archives of Sexual Behavior, 35, 501–506.PubMedGoogle Scholar
  120. Pauly, I. B. (1965). Male psychosexual inversion: Transsexualism. A review of 100 cases. Archives of General Psychiatry, 13, 172–181.PubMedGoogle Scholar
  121. Perrin, E. C. (2002). Sexual orientation in child and adolescent health care. New York: Springer.Google Scholar
  122. Perry, M. E. (1987). The manly woman. A historical case study. American Behavioral Scientist, 31, 86–100.Google Scholar
  123. Pfäfflin, F., & Junge, A. (1998). Sex reassignment thirty years of international follow-up studies SRS: A comprehensive review, 1961–1991. Düsseldorf, Germany: Symposium Publishing.Google Scholar
  124. Pickstone-Taylor, S. D. (2003) Children with gender nonconformity [Letter to the editor]. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 3.Google Scholar
  125. Plöderl, M., & Fartacek, R. (2009). Childhood gender nonconformity and harassment as predictors of suicidality among gay, lesbian, bisexual, and heterosexual Austrians. Archives of Sexual Behavior, 38, 400–410.PubMedGoogle Scholar
  126. Professionals Concerned with Gender Diagnoses in the DSM. Retrieved October 7, 2008, from http://professionals.gidreform.org/index.html
  127. Ramachandran, V. S., & McGeoch, P. D. (2007). Occurrence of phantom genitalia after gender reassignment surgery. Medical Hypotheses, 69, 1001–1003.PubMedGoogle Scholar
  128. Richardson, J. (1999). Response: Finding the disorder in gender identity disorder. Harvard Review of Psychiatry, 7, 43–50.PubMedGoogle Scholar
  129. Romeo, F. (2008, September 19). Overview of transgender legal strategies and implications for DSM-V. Lecture presented at the Work Group on Gender, Department of Psychiatry, Columbia University, New York, NY.Google Scholar
  130. Roscoe, W. (1990). The Zuni man-woman. Albuquerque, NM: University of New Mexico Press.Google Scholar
  131. Rowsen, E. K. (1991). The effeminates of early Medina. Journal of the American Oriental Society, 111, 671–693.Google Scholar
  132. Ruble, D. N., Martin, C. L., & Berenbaum, S. A. (2006). Gender development. In W. Damon & R. M. Lerner (Series Eds.) & N. Eisenberg, W. Damon, & R. M. Lerner (Vol. Eds.), Handbook of child psychology: Vol. 3. Social, emotional, and personality development (6th ed., pp. 858–932). New York: Wiley.Google Scholar
  133. Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123, 346–352.PubMedGoogle Scholar
  134. Schützmann, K., Brinkmann, L., Schacht, M., & Richter-Appelt, H. (2009). Psychological distress, self-harming behavior, and suicidal tendencies in adults with disorders of sex development. Archives of Sexual Behavior, 38, 16–33.PubMedGoogle Scholar
  135. Sedgwick, E. K. (1991). How to bring your kids up gay. Social Text, 9, 18–27.Google Scholar
  136. Siomopoulos, V. (1974). Transsexualism: Disorder of gender identity, thought disorder, or both? Journal of the American Academy of Psychoanalysis, 2, 201–213.Google Scholar
  137. Smith, Y. L., van Goozen, S. H., & Cohen-Kettenis, P. T. (2001). Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: A prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 472–481.PubMedGoogle Scholar
  138. Smith, Y. L., van Goozen, S. H., Kuiper, A. J., & Cohen-Kettenis, P. T. (2005). Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals. Psychological Medicine, 35, 89–99.PubMedGoogle Scholar
  139. Stedman’s Medical Dictionary, 26th ed. (1995). Baltimore: Williams & Wilkins.Google Scholar
  140. Stephen, L. (2002). Sexualities and genders in Zapotec, Oaxaca. Latin American Perspectives, 29(2), 41–59.Google Scholar
  141. Stevenson, I. (1974). Twenty cases suggestive of reincarnation (2nd ed., revised and enlarged). Charlottesville, VA: University Press of Virginia.Google Scholar
  142. Stoller, R. J. (1964). A contribution to the study of gender identity. International Journal of Psycho-Analysis, 45, 220–226.PubMedGoogle Scholar
  143. Sylvia Rivera Law Project. Retrieved January 25, 2009, from http://srlp.org
  144. Thagard, P. (2008). Mental illness from the perspective of theoretical neuroscience. Perspectives in Biology and Medicine, 51, 335–352.PubMedGoogle Scholar
  145. Trans Youth Family Allies. Retrieved November 15, 2008, from http://www.imatvfa.org
  146. Ujike, H., Otani, K., Nakatsuka, M., Ishii, K., Sasaki, A., Oishi, T., et al. (2009). Association study of gender identity disorder and sex hormone-related genes. Progress in Neuropsychopharmacology and Biological Psychiatry.Google Scholar
  147. van Beijsterveldt, C. E. M., Hudziak, J. J., & Boomsma, D. I. (2006). Genetic and environmental influences on cross-gender behavior and relation to behavior problems: A study of Dutch twins at ages 7 and 10 years. Archives of Sexual Behavior, 35, 647–658.PubMedGoogle Scholar
  148. Vance, S., Cohen-Kettenis, P. T., Drescher, J., Meyer-Bahlburg, H. F. L., Pfäfflin, F., & Zucker, K. J. (2009). Transgender advocacy groups’ opinions on the current DSM gender identity disorder diagnosis: Results from an international survey. Manuscript submitted for publication.Google Scholar
  149. Vasey, P. L., & Bartlett, N. H. (2007). What can the Samoan Fa’afafine teach us about the Western concept of gender identity disorder in childhood? Perspectives in Biology and Medicine, 50, 481–490.PubMedGoogle Scholar
  150. Wakefield, J. C., & First, M. B. (2003). Clarifying the distinction between disorder and nondisorder: Confronting the overdiagnosis (false positives) problem in DSM-V. In K. A. Phillips, M. B. First, & H. A. Pincus (Eds.), Advancing DSM dilemmas in psychiatric diagnosis (pp. 23–55). Arlington, VA: American Psychiatric Association.Google Scholar
  151. Wallien, M. S. C., & Cohen-Kettenis, P. T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child and Adolescent Pychiatry, 47, 1413–1423.CrossRefGoogle Scholar
  152. Wallien, M. S. C., van den Langenberg, S., Knol, D. L., Kreukels, B. P. C., & Cohen-Kettenis, P. T. (in press). Parental functioning and parent-child interaction style of children with gender dysphoria. European Child & Adolescent Psychiatry.Google Scholar
  153. Wallien, M. S. C., Veenstra, R., Kreukels, B. P. C., & Cohen-Kettenis, P. T. (2009). Peer-group status of gender-dysphoric children. Archives of Sexual Behavior, doi:10.1007/s10508-009-9517-3.
  154. Washington Psychiatric Society. (2009). Task Force on GID Report Draft. (Available from P. H. Troy, Washington Psychiatric Society, 550M Ritchie Highway, #271, Severna Park, MD 21146).Google Scholar
  155. Wassersug, R. J., & Johnson, T. W. (2007). Modern day eunuchs: Motivations for and consequences of contemporary castration. Perspectives in Biology and Medicine, 50, 544–546.PubMedGoogle Scholar
  156. Whitam, F. L. (1997). Culturally universal aspects of male homosexual transvestites and transsexuals. In B. Bullough, V. L. Bullough, & J. Elias (Eds.), Gender blending (pp. 189–203). Amherst, NY: Prometheus Books.Google Scholar
  157. Wiesner-Hanks, M. (2001). Gender in history: New perspectives on the past. Malden, MA: Wiley-Blackwell.Google Scholar
  158. Wikan, U. (1977). Man becomes woman: Transsexualism in Oman as a key to gender roles. Man, 12, 304–319.Google Scholar
  159. Wilkinson-Ryan, T., & Westen, D. (2000). Identity disturbance in borderline personality disorder: An empirical investigation. American Journal of Psychiatry, 157, 528–541.PubMedGoogle Scholar
  160. Winter, S. (2009). Cultural considerations for the World Professional Association for Transgender Health’s Standards of Care: The Asian perspective. International Journal of Transgenderism, 11, 19–41.Google Scholar
  161. Winter, S., Chalungsooth, P., Teh, Y. K., Rojanalert, N., Maneerat, K., Wong, Y. W., et al. (2009). Transpeople, transprejudice and pathologization: A seven-country factor analytic study. International Journal of Sexual Health, 21, 96–118.Google Scholar
  162. Winters, K. (2005). Gender dissonance: Diagnostic reform of gender identity disorder for adults. Journal of Psychology & Human Sexuality, 17(3/4), 71–89.Google Scholar
  163. Yogyakarta Principles. (2007). Principles on the application of international human rights law in relation to sexual orientation and gender identity. Retrieved September 22, 2008, from http://www.yogyakartaprinciples.org/principles_en_home.htm
  164. Zhou, J.-N., Hofman, M. A., Gooren, L. J. G., & Swaab, D. F. (1995). A sex difference in the human brain and its relation to transsexuality. Nature, 378, 68–70.PubMedGoogle Scholar
  165. Zucker, K. J. (2006). Commentary on Langer and Martin’s (2004) “How dresses can make you mentally ill: Examining gender identity disorder in children”. Child and Adolescent Social Work Journal, 23, 533–555.Google Scholar
  166. Zucker, K. J. (2009). The DSM diagnostic criteria for gender identity disorder in children. Archives of Sexual Behavior, doi:10.1007/s10508-009-9540-4
  167. Zucker, K. J., & Bradley, S. J. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Press.Google Scholar
  168. Zucker, K. J., & Spitzer, R. L. (2005). Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note. Journal of Sex and Marital Therapy, 31, 31–42.PubMedGoogle Scholar

Copyright information

© American Psychiatric Association 2009

Authors and Affiliations

  1. 1.New York State Psychiatric Institute and Department of PsychiatryColumbia UniversityNew YorkUSA

Personalised recommendations