Kk&s Ch.22 Gid

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GID key feature?

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preference for living as other sex

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The affective component of gender identity disorders is , discontent with one's designated birth sex and a desire to have the body of the other sex, and to be regarded socially as a person of the other sex.

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gender dysphoria

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Gender identity crystallizes in most persons by age

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2 or 3 years

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GID > in boys or girls?

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The sex ratio of referred children is 4 to 5 boys for each girl.
Most clinical centers report a sex ratio of three to five male patients for each female patient.

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Children usually develop a gender identity consonant with their sex of rearing (also known as

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assigned sex

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Sigmund Freud believed that gender identity problems resulted from conflicts experienced by children within the

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oedipal triangle
Whatever interferes with a child's loving the opposite-sex parent and identifying with the same-sex parent interferes with normal gender identity

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Criterion A for GID

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strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex).
In children, the disturbance is manifested by four (or more) of the following:

1. repeatedly stated desire to be, or insistence that he or she is, the other sex
2. in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
3. strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex
4. intense desire to participate in the stereotypical games and pastimes of the other sex
5. strong preference for playmates of the other sex

In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex.

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Criterion B for GID

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Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.
In children, the disturbance is manifested by any of the following: in boys, assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities; in girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing.
In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.

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GID coding, Specifiers?

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Code based on current age:
Gender identity disorder in children
Gender identity disorder in adolescents or adults
Specify if (for sexually mature individuals):
Sexually attracted to males
Sexually attracted to females
Sexually attracted to both
Sexually attracted to neither

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DDX of GID in Children

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1. Gender Atypical Children
2. Hermaphrodism

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DDX of GID in teens/adults

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Psychosis
Axis II: BPD

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Approximately ? of adult men with gender identity disorder are sexually attracted to men only

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2/3

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The treatment of gender identity disorder in children is directed largely at

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developing social skills and comfort in the sex role expected by birth anatomy.

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Teen Tx of GID?

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dolescents whose gender identity disorder has persisted beyond puberty present unique treatment problems. One is how to manage the rapid emergence of unwanted secondary sex characteristics. Thus, a new area of treatment management has evolved with respect to slowing down or stopping pubertal changes expected by anatomical birth sex and then implementing cross-sex body changes with cross-sex hormones.

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Tx of Adult GID

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Adult patients coming to a gender identity clinic usually present with straightforward requests for hormonal and surgical sex reassignment. No drug treatment has been shown to be effective in reducing cross-gender desires per se. When patient gender dysphoria is severe and intractable, sex reassignment may be the best solution.

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Smoking is a contraindication of endocrine treatment, because it

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increases the risk of deep vein thrombosis and pulmonary embolism.

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Biological women are treated with monthly or three weekly injections of testosterone. Because the effects of exogenous testosterone are more profound than those of estrogen, clinicians should be more cautious about commencing female patients on hormone treatment.
complications?

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The pitch of the voice drops permanently into the male range as the vocal cords thicken. The clitoris enlarges to two or three times its pretreatment length and is often accompanied by increased libido. Hair growth changes to the male pattern, and a full complement of facial hair may grow. Menses cease. Male pattern baldness may develop, and acne may be a complication.

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An enzymatic defect in the production of adrenal cortisol, beginning prenatally, leads to overproduction of adrenal androgens and virilization of the female fetus.Postnatally, excessive adrenal androgen can be controlled by steroid administration.

Dx?

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COngenital virilizing adrenal hyperplasia was formerly called the adrenogenital syndrome.

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GID NOS eg's

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Examples include

1. Intersex conditions (e.g., partial androgen insensitivity syndrome or congenital adrenal hyperplasia) and accompanying gender dysphoria
2. Transient, stress-related cross-dressing behavior
3. Persistent preoccupation with castration or penectomy without a desire to acquire the sex characteristics of the other sex

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In these persons with the XY karyotype, tissue cells are unable to use testosterone or other androgens. Therefore, the person appears to be a normal female at birth and is raised as a girl. She is later found to have cryptorchid testes, which produce the testosterone to which the tissues do not respond, and minimal or absent internal sexual organs.

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Androgen insensitivity syndrome was formerly called testicular feminization.

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Children have female genitalia, are short, and, possibly, anomalies such as a shield-shaped chest and a webbed neck. As a consequence of dysfunctional ovaries, they require exogenous estrogen to develop female secondary sex characteristics. Gender identity is female

Dx?

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In Turner's syndrome, one sex chromosome is missing, such that the sex karyotype is simply X

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An extra X chromosome is present in ? syndrome, such that the karyotype is XXY. At birth, patients appear to be normal males. Excessive gynecomastia may occur in adolescence. Testes are small, usually without sperm production. They are tall, and body habitus is eunuchoid. Reports suggest a higher rate of gender identity disorder.

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Klinefelter's Syndrome

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In ?, an enzymatic defect prevents the conversion of testosterone to dihydrotestosterone, which is required for prenatal virilization of the genitalia. At birth, the affected person appears to be female, although some anomaly is visible. In earlier generations, before childhood identification of the disorder was common, these persons, raised as girls, virilized at puberty and changed their gender identity to male.

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5-α-reductase deficiency

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Infants born with ambiguous genitals are

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pseudohermaphrodites.

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True ? is characterized by the presence of both testes and ovaries in the same person.

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hermaphroditism

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The DSM-IV-TR lists cross-dressing—dressing in clothes of the opposite sex—as a if it is transient and related to stress. If the disorder is not stress related, persons who cross-dress are classified as having , which is described as a paraphilia in DSM-IV-TR

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The DSM-IV-TR lists cross-dressing—dressing in clothes of the opposite sex—as a gender identity disorder if it is transient and related to stress. If the disorder is not stress related, persons who cross-dress are classified as having transvestic fetishism, which is described as a paraphilia in DSM-IV-TR.