Currently, gender identity disorder (GID) in boys is a syndrome in which young boys not only wish to be girls, but they also intensely dislike being boys. Boys with GID manifest an interest in activities that are typical for girls such as dressing up in girls' clothes and having an intense interest in cosmetics, in jewlery and in doll play. In most boys, the disorder consolidates between the ages of two and three.

In prospective studies, about two-thirds of boys with GID grow up to be homosexual. There are no biological markers which have been identified with GID. Temperamentally, almost all GID boys demonstrate an aversion to aggression and to rough-and-tumble activities. They are timid in new situations.

Over 20 case reports on GID have appeared in the literature. In all of the cases described, GID occurred in the context of disturbed family functioning. Many psychoanalysts understand gender identity disorder to be a result of an identification with the mother. In other words, the mother has neglected the child, so the child, in order to regain his maternal figure, becomes the maternal figure. These children could be thought of as having an attachment disorder.

Research on the development of gender categorization has demonstrated that children are able to discriminate between boy and girls by about age one. When boys and girls can categorize themselves to the correct gender, they also show a preference for activities that are sterotypically associated with their gender.

Minna Emch discusses "the need to know" as related to identification and acting out. She suggests "the tension belonging to the child's experience of the unknown and unexpected can be dealt with by conversion of the unknown into the known". So, a child who is curious about the opposite sex is going to pretend to be the opposite sex in order to try to understand what that feels like.

Boys who have a strong preference for opposite sex play are trying to discover their world as they see it. This is not psychopathology. We look for psychopathology when a child is not enjoying his/her world. If a child is depressed, anxious or impulsive, we need to intervene. Likewise, if a child is playful, imaginative and enjoying his family and friends, we need to monitor and observe his development. The fact that the child acts out his fantasy of becoming a girl is not, in and of itself, grounds for a psychiatric diagnosis.

In 1973 the American Psychiatric Association declassified homosexuality as a mental disorder. My hope is that in 2013, when the next diagnostic manual is published, gender identity disorder will also be historical.

About the Author

Shirah Vollmer, MD

Shirah Vollmer, MD, is an Associate Clinical Professor of Family Medicine and Psychiatry at the David Geffen School of Medicine at UCLA.

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