Making gender identity disorder of childhood: Historical lessons for contemporary debates

Abstract

Gender Identity Disorder of Childhood (GIDC)—a psychiatric diagnosis given to gendervariant children—has been controversial since its creation. Critics inside and outside of the mental health professions have called for the removal or revision of GIDC, arguing that it has served to pathologize homosexuality, to enforce normative notions of masculinity and femininity, and to recast a social problem as individual pathology. Drawing on published clinical and research papers, archival materials, and interviews with clinicians, researchers, and advocates, this article analyzes early studies of gendervariant boys from the 1960s and 1970s and describes the process through which the GIDC diagnosis was created. The article examines some of the limitations of current debates over GIDC and points out new trends that hold the most promise for providing support to gender-variant children.

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References

  1. American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders (2nd ed.). Washington, DC: Author.

    Google Scholar 

  2. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

    Google Scholar 

  3. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised). Washington, DC: Author.

    Google Scholar 

  4. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  5. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

    Google Scholar 

  6. Arksey, H. (1994). Expert and lay participation in the construction of medical knowledge. Sociology of Health & Illness, 16(4), 448–468.

    Article  Google Scholar 

  7. Armstrong, E. M. (1998). Diagnosing moral disorder: The discovery and evolution of fetal alcohol syndrome. Social Science & Medicine, 47(12), 2025–2042.

    Article  Google Scholar 

  8. Bartlett, N. H., Vasey, P. L., & Bukowski, W. M. (2000). Is gender identity disorder in children a mental disorder? Sex Roles, 43(11–12), 753–785.

    Article  Google Scholar 

  9. Bates, J. E., & Bentler, P. M. (1973). Play activities of normal and effeminate boys. Developmental Psychology, 9(1), 20–27.

    Article  Google Scholar 

  10. Bates, J. E., Bentler, P. M., & Thompson, S. K. (1973). Measurement of deviant gender development in boys. Child Development, 44(3), 591–598.

    PubMed  Article  Google Scholar 

  11. Bates, J. E., Bentler, P. M., & Thompson, S. K. (1979). Gender-deviant boys compared with normal and clinical control boys. Journal of Abnormal Child Psychology, 7(3), 243–259.

    PubMed  Article  Google Scholar 

  12. Bates, J. E., Skilbeck, W. M., Smith, K. V. R., & Bentler, P. M. (1974). Gender role abnormalities in boys: An analysis of clinical ratings. Journal of Abnormal Child Psychology, 2(1), 1–16.

    PubMed  Article  Google Scholar 

  13. Bayer, R. (1987). Homosexuality and American psychiatry: The politics of diagnosis. Princeton, NJ: Princeton University Press.

    Google Scholar 

  14. Bem, S. L. (1974). The measurement of psychological androgyny. Journal of Consulting and Clinical Psychology, 42, 155–162.

    PubMed  Article  Google Scholar 

  15. Bem, S. L. (1993). The lenses of gender: Transforming the debate on sexual inequality. New Haven, CT: Yale University Press.

    Google Scholar 

  16. Benjamin, H. (1954). Transsexualism and transvestism as psychosomatic and somato-psychic syndromes. American Journal of Psychotherapy, 8, 219–230.

    PubMed  Google Scholar 

  17. Bentler, P. M., Rekers, G. A., & Rosen, A. C. (1979). Congruence of childhood sex-role identity and behaviour disturbances. Child: Care, Health and Development, 5, 267–283.

    Article  Google Scholar 

  18. Bowker, G. C., & Star, S. L. (1999). Sorting things out: Classification and its consequences. Cambridge, MA: MIT Press.

    Google Scholar 

  19. Bryant, K. (2006a). The new homonormativity and the old homophobia. Unpublished manuscript.

  20. Bryant, K. (2006b, August). Queering childhood. Paper presented at the annual American Sociological Association Conference, Montréal, Canada.

  21. Burke, P. (1996). Gender shock: Exploding the myths of male and female. New York: Anchor Books.

    Google Scholar 

  22. Butler, J. (2004). Undoing gender. New York: Routledge.

    Google Scholar 

  23. Califia, P. (1997). Sex changes: The politics oftransgenderism. San Francisco: Cleis Press.

    Google Scholar 

  24. Children’s National Medical Center. (2003). If you are concerned about your child’s gender behavior: A guide for parents. Washington, DC: Author.

    Google Scholar 

  25. Cooksey, E., & Brown, P. (1998). Spinning on its axes: DSM and the social construction of psychiatric diagnoses. International Journal of Health Services, 28, 525–554.

    PubMed  Google Scholar 

  26. Corbett, K. (1997). It is time to distinguish gender from health: Reflections on Lothstein’s “Pantyhose fetishism and self cohesion: Aparaphilic solution?” Gender & Psychoanalysis, 2, 259–271.

    Google Scholar 

  27. Corbett, K. (1998). Cross-gendered identifications and homosexual boyhood: Toward a more complex theory of gender. American Journal of Orthopsychiatry, 68(3), 352–360.

    PubMed  Article  Google Scholar 

  28. Epstein, S. (1996). Impure science: AIDS, activism, and the politics of knowledge. Berkeley, CA: University of California Press.

    Google Scholar 

  29. Feder, E. K. (1997). Disciplining the family: The case of genderidentity disorder. Philosophical Studies, 85(2–3), 195–211.

    Article  Google Scholar 

  30. Feder, E. K. (1999). Regulating sexuality: Gender identity disorder, children’s rights, and the state. In U. Narayan & J. J. Bartowiak (Eds.), Having and raising children: Unconventional families, hard choices, and the social good (pp. 163–176). University Park, PA: The Pennsylvania State University Press.

    Google Scholar 

  31. Feldstein, R. (2000). Motherhood in black and white: Race and sex in American liberalism, 1930–1965. Ithaca, NY: Cornell University Press.

    Google Scholar 

  32. Figert, A. E. (1995). The three faces of PMS: The profes- sional, gendered, and scientific structuring of a psychiatric disorder. Social Problems, 42, 56–73.

    Article  Google Scholar 

  33. Green, R. (1967a). Sissies and tomboys: A guide to diagnosis and management. In C. W. Wahl (Ed.), Sexual problems: Diagnosis and treatment in medical practice (pp. 89–114). New York: The Free Press.

    Google Scholar 

  34. Green, R. (1967b). Physician emotionalism in the treatment of the transsexual. Transactions of the New York Academy of Sciences, 29(4), 440–443.

    PubMed  Google Scholar 

  35. Green, R. (1968). Childhood cross-gender identification. Journal of Nervous and Mental Disease, 147(5), 500–509.

    PubMed  Article  Google Scholar 

  36. Green, R. (1971). Diagnosis and treatment of gender iden- tity disorders during childhood. Archives of Sexual Behavior, 1(2), 167–173.

    Article  Google Scholar 

  37. Green, R. (1974). Sexual identity conflict in children and adults. New York: Basic Books.

    Google Scholar 

  38. Green, R. (1976). One-hundred ten feminine and masculine boys: Behavioral contrasts and demographic similarities. Archives of Sexual Behavior, 5(5), 425–446.

    PubMed  Article  Google Scholar 

  39. Green, R. (1979). Childhood cross-gender behavior and subsequent sexual preference. American Journal of Psychiatry, 136(1), 106–108.

    PubMed  Google Scholar 

  40. Green, R. (1987). The “sissy boy syndrome” and the devel- opment of homosexuality. New Haven, CT: Yale University Press.

    Google Scholar 

  41. Green, R., & Fuller, M. (1973a). Family doll play and female identity in pre-adolescent males. American Journal of Orthopsychiatry, 43(1), 123–127.

    PubMed  Google Scholar 

  42. Green, R., & Fuller, M. (1973b). Group therapy with feminine boys and their parents. International Journal of Group Psychotherapy, 23(1), 54–68.

    PubMed  Google Scholar 

  43. Green, R., Fuller, M., & Rutley, B. R. (1972). It-scale for children and draw-a-person test: 30 feminine vs. 25 masculine boys. Journal of Personality Assessment, 36(4), 349–352.

    PubMed  Google Scholar 

  44. Green, R., Fuller, M., Rutley, B. R., & Hendler, J. (1972). Playroom toy preference of fifteen masculine and fifteen feminine boys. Behavior Therapy, 3, 425–429.

    Article  Google Scholar 

  45. Green, R., & Money, J. (1960). Incongruous gender role: Nongenital manifestations in prepubertal boys. Journal of Nervous Disorders, 131(2), 160–168.

    Google Scholar 

  46. Green, R., & Money, J. (1961). Effeminacy in prepubertal boys: Summary of eleven cases and recommendations for case management. Pediatrics, 27, 286–291.

    PubMed  Google Scholar 

  47. Green, R., & Money, J. (1964). Prepubertal, morphologically normal boys demonstrating signs of crossgender identity: A five-year follow-up (abstracted). American Journal of Orthopsychiatry, 34 (2), 365–366.

    Google Scholar 

  48. Green, R., & Money, J. (1966). Stage-acting, role-taking, and effeminate impersonation during boyhood. Archives of General Psychiatry, 15, 535–538.

    PubMed  Google Scholar 

  49. Green, R., Newman, L. E., & Stoller, R. J. (1972). Treatment of boyhood “transsexualism”: An interim report of fouryears’ experience. Archives of General Psychiatry, 26, 213–217.

    PubMed  Google Scholar 

  50. Green, R., Stoller, R. J., & McAndrew, C. (1968). Attitudes toward sex transformation procedures. Archives of General Psychiatry, 15(2), 178–182.

    Google Scholar 

  51. Greenson, R. R. (1966). A transvestite boy and a hypothesis. International Journal of Psycho-Analysis, 47, 396–403.

    PubMed  Google Scholar 

  52. Halberstam, J. (1999). Oh bondage, up yours!: Female masculinity and the tomboy. In M. Rottneck (Ed.), Tomboys and sissies: Gender nonconformity and homosexual childhood (pp. 153–179). New York: New York University Press.

    Google Scholar 

  53. Haldeman, D. C. (2000). Gender atypical youth: Clinical and social issues. School Psychology Review, 29(2), 192–200.

    Google Scholar 

  54. Herman, E. (1995). The romance of American psychol- ogy: Political culture in the age of experts. Berkeley, CA: University of California Press.

    Google Scholar 

  55. Horwitz, A. V. (2002). Creating mental illness. Chicago: Chicago University Press.

    Google Scholar 

  56. Isay, R. A. (1997, November 21). Remove gender identity disorder from DSM. Psychiatric News, 32, 9, 13.

    Google Scholar 

  57. Kimmel, M. (1996). Manhood in America: A cultural history. New York: Free Press.

    Google Scholar 

  58. Kirk, S. A., & Kutchins, H. (1992). The selling of DSM: The rhetoric of science in psychiatry. New York: Aldine de Gruyter.

    Google Scholar 

  59. 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(1), 5–23.

    Article  Google Scholar 

  60. Lunbeck, E. (1994). The psychiatric persuasion: Knowledge, gender, and power in modern America. Princeton, NJ: Princeton University Press.

    Google Scholar 

  61. Mayes, R., & Horwitz, A. V. (2005). DSM-III and the rev- olution in the classification of mental illness. Journal of the History of the Behavioral Sciences, 41, 249–267.

    PubMed  Article  Google Scholar 

  62. McCarthy, L. (2003). Off that spectrum entirely: A study offemale-bodied transgender-identified individuals. Unpublished dissertation, University of Massachusetts, Amherst.

    Google Scholar 

  63. Menvielle, E. J., & Tuerk, C. (2002). A support group for parents of gender-nonconforming boys. Journal of the American Academy of Child & Adolescent Psychiatry, 41(8), 1010–1013.

    Article  Google Scholar 

  64. Meyerowitz, J. 2002. How sex changed: A history of transsexuality in the United States. Cambridge, MA: Harvard University Press.

    Google Scholar 

  65. Money, J., Hampson, J. G., & Hampson, J. L. (1955a). An examination of some basic sexual concepts: The evidence of human hermaphroditism. Bulletin of the Johns Hopkins Hospital, 97, 301–319.

    PubMed  Google Scholar 

  66. Money, J., Hampson, J. G., & Hampson, J. L. (1955b). Hermaphroditism: Recommendations concerning assignment of sex, change of sex, and psychologic management. Bulletin of the Johns Hopkins Hospital, 97, 284–300.

    PubMed  Google Scholar 

  67. Money, J., Hampson, J. G., & Hampson, J. L. (1956). Sexual incongruities and psychopathology: The evidence of human hermaphroditism. Bulletin of the Johns Hopkins Hospital, 98, 43–57.

    PubMed  Google Scholar 

  68. Money, J., Hampson, J. G., & Hampson, J. L. (1957). Imprinting and the establishment of gender role. Archives of Neurology and Psychiatry, 77, 333–336.

    Google Scholar 

  69. Money, J., & Russo, A. J. (1979). Homosexual outcome of discordant gender identity/role in childhood. In M. C. Roberts, G. P. Koocher, D. K. Routh, & D. J. Willis (Eds.), Readings inpediatric psychology (pp. 81–93). New York: Plenum Press.

    Google Scholar 

  70. Moore, S. M. (2002). Diagnosis for a straight planet: A critique of gender identity disorder for children and adolescents in the DSM-IV. Unpublished dissertation, Wright Institute, Berkeley, CA.

    Google Scholar 

  71. Morgan, N. L. (2001). Defining normal gender behavior: Therapeutic implications arising from psychologists’ sex-role expectations and attitudes toward lesbians and gays. Unpublished dissertation, American School of Professional Psychology, San Francisco, CA.

    Google Scholar 

  72. Morin, S. F., & Schultz, S. J. (1978). The gay movement and the rights of children. Journal of Social Issues, 34(2), 137–148.

    Article  Google Scholar 

  73. Neisen, J. (1992). Gender identity disorder of childhood: By whose standard and for what purpose? A response to Rekers and Morey. Journal of Psychology & Human Sexuality, 5(3), 65–67.

    Google Scholar 

  74. Nordyke, N. S., Baer, D. M., Etzel, B. C., & LeBlanc, J. M. (1977). Implications of the stereotyping and modification of sex role. Journal of Applied Behavior Analysis, 10(3), 553–557.

    PubMed  Article  Google Scholar 

  75. Pickstone-Taylor, S. D. (2003). Children with gender nonconformity [Letter to the editor]. Journal of the American Academy of Child & Adolescent Psychiatry, 42(3), 266.

    Article  Google Scholar 

  76. Rekers, G. A. (1972). Pathological sex-role development in boys: Behavioral treatment and assessment. Unpublished dissertation, University of California, Los Angeles.

    Google Scholar 

  77. Rekers, G. A. (1975). Stimulus control over sex-typed play in cross-gender identified boys. Journal of Experimental Child Psychology, 20, 136–148.

    PubMed  Article  Google Scholar 

  78. Rekers, G. A. (1977). Atypical gender development and psychosocial adjustment. Journal of Applied Behavior Analysis, 10(3), 559–571.

    PubMed  Article  Google Scholar 

  79. Rekers, G. A. (1979). Sex-role behavior change: Intrasubject studies of boyhood gender disturbance. Journal of Psychology, 103, 255–269.

    PubMed  Google Scholar 

  80. Rekers, G. A. (1982a). Growing up straight: What every family should know about homosexuality. Chicago: Moody Press.

    Google Scholar 

  81. Rekers, G. A. (1982b). Shaping your child’s sexual identity. Grand Rapids, MI: Baker Book House.

    Google Scholar 

  82. Rekers, G. A., Bentler, P. M., Rosen, A. C., & Lovaas, O. I. (1977). Child gender disturbances: A clinical rationale for intervention. Psychotherapy: Theory, Research and Practice, 14(1), 2–11.

    Article  Google Scholar 

  83. Rekers, G. A., & Lovaas, O. I. (1974). Behavioral treatment of deviant sex-role behaviors in a male child. Journal of Applied Behavior Analysis, 7(2), 173–190.

    PubMed  Article  Google Scholar 

  84. Rekers, G. A., Lovaas, O. I., & Low, B. (1974). The behavioral treatment of a “transsexual” preadolescent boy. Journal of Abnormal Child Psychology, 2(2), 99–116.

    PubMed  Article  Google Scholar 

  85. Rekers, G. A., & Mead, S. (1979). Early intervention for female sexual identity disturbance: Self-monitoring of play behavior. Journal of Abnormal Child Psychology, 7(4), 405–423.

    PubMed  Article  Google Scholar 

  86. Rekers, G. A., & Mead, S. (1980). Female sex-role deviance: Early identification and developmental intervention. Journal of Clinical Child Psychology, 9(3), 199–203.

    Article  Google Scholar 

  87. Rekers, G. A., Rosen, A. C., Lovaas, O. I., & Bentler, P. M. (1978). Sex-role stereotypy and professional intervention for childhood gender disturbance. Professional Psychology, 9(1), 127–136.

    Article  Google Scholar 

  88. Rekers, G. A., & Varni, J. W. (1977). Self-monitoring and self-reinforcement processes in a pre-transsexual boy. Behaviour, Research, and Therapy, 15, 177–180.

    Article  Google Scholar 

  89. Rekers, G. A., Willis, T. J., Yates, C. E., Rosen, A. C., & Low, B. P. (1977). Assessment of childhood gender behavior change. Journal of Child Psychology and Psychiatry and Allied Disciplines, 18, 53–65.

    Article  Google Scholar 

  90. Richardson, J. (1996). Setting limits on gender health. Harvard Review of Psychiatry, 4(1), 49–53.

    PubMed  Article  Google Scholar 

  91. Richardson, J. (1999). Response: Finding the disorder in gender identity disorder. Harvard Review of Psychiatry, 7(1), 43–50.

    PubMed  Article  Google Scholar 

  92. Riessman, C. K. (1983). Women and medicalization: A new perspective. Social Policy, 14(1), 3–18.

    PubMed  Google Scholar 

  93. Rittenhouse, C. A. (1991). The emergence of premenstrual syndrome as a social problem. Social Problems, 38, 412–425.

    Article  Google Scholar 

  94. Rorvik, D. M. (1975, October 9). The gender enforcers: Seeing to itthat boys will be boys. Rolling Stone, 53, 67, 86–88.

    Google Scholar 

  95. Rosen, A. C., Rekers, G. A., & Friar, L. R. (1977). Theoretical and diagnostic issues in child gender disturbances. The Journal of Sex Research, 13(2), 89–103.

    Article  Google Scholar 

  96. Scott, W. (1990). PTSD in DSM-III: A case in the politics of diagnosis and disease. Social Problems, 37, 294–310.

    Article  Google Scholar 

  97. Sedgwick, E. (1993). How to bring your kids up gay: The war on effeminate boys. In Tendencies (pp. 154–164). Durham, NC: Duke University Press.

    Google Scholar 

  98. Stoller, R. J. (1966). The mother’s contribution to infan- tile transvestic behaviour. International Journal of Psycho-Analysis, 47, 384–395.

    PubMed  Google Scholar 

  99. Stoller, R. J. (1967). Etiological factors in male transsex- ualism. Transactions of the New York Academy of Science, 29(4), 431–433.

    Google Scholar 

  100. Stoller, R. J. (1968). Sex and gender: On the develop- ment of masculinity and femininity. New York: Science House.

    Google Scholar 

  101. Stoller, R. J. (1975). Sex and gender, volume II: The trans- sexual experiment. New York: Jason Aronson.

    Google Scholar 

  102. Wilchins, R. A. (1997). The GID controversy: Gender identity disorder harms transsexuals. Transgender Tapestry, 79, 31–44.

    Google Scholar 

  103. Wilson, I., Griffin, C., & Wren, B. (2002). The validity of the diagnosis of gender identity disorder (child and adolescent criteria). Clinical Child Psychology & Psychiatry, 7(3), 335–351.

    Article  Google Scholar 

  104. Wilson, M. (1993). DSM-III and the transformation of American psychiatry: A history. American Journal of Psychiatry, 150, 399–410.

    PubMed  Google Scholar 

  105. Winkler, R. C. (1977). What types of sex-role behavior should behavior modifiers promote? Journal of Applied Behavior Analysis, 10(3), 549–552.

    PubMed  Article  Google Scholar 

  106. Wolfe, B. E. (1979). Behavioral treatment of childhood gender disorders: A conceptual and empirical critique. Behavior Modification, 3(4), 550–575.

    Article  Google Scholar 

  107. Zucker, K. J. (2000). Gender identity disorder. In A. J. Sameroff, M. Lewis, & S. M. Miller (Eds.), Handbook of developmental psychopathology (2nd ed., pp. 671–686). New York: Kluwer Academic/Plenum Publishers.

    Google Scholar 

  108. Zucker, K. J., & Bradley, S. J. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Press.

    Google Scholar 

  109. 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 & Marital Therapy, 31(1), 31–42.

    Article  Google Scholar 

  110. Zuger, B. (1966). Effeminate behavior in boys present from early childhood. I. The clinical syndrome and follow-up studies. Journal of Pediatrics, 69(6), 1098–1107.

    PubMed  Article  Google Scholar 

  111. Zuger, B. (1969). Effeminate behavior present in boys from early childhood. II. Comparison with similar symptoms in non-effeminate boys. Pediatrics, 44(3), 375–380.

    PubMed  Google Scholar 

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Bryant, K. Making gender identity disorder of childhood: Historical lessons for contemporary debates. Sex Res Soc Policy 3, 23–39 (2006). https://doi.org/10.1525/srsp.2006.3.3.23

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Key words

  • history of psychiatry
  • scientific controversy
  • transsexuality
  • homosexuality
  • psychiatric diagnosis