Is Gender Identity Disorder in Children a Mental Disorder?

Sex Roles: A Journal of Research,  Dec, 2000  by Nancy H. Bartlett,  Paul L. Vasey,  William M. Bukowski

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It should be noted that not all authors agree that psychopathology, or internalizing symptomatology in particular, is specifically related to gender "prolems." Pleak and his colleagues (Pleak, Meyer-Bahlburg, O'Brien, Bowen, & Morganstein, 1989) reported no relation between higher feminine scores in their male sample (boys referred for problems unrelated to gender) and psychopathology in general or internalizing scores, as measured by the CBCL. It is also important to note that Zucker and Bradley (1995) reported that, in their sample, there was "tremendous range in the extent of the CBCL pathology" (p. 88), with some children exhibiting little behavioral disturbance and others a great deal (see also Zucker & Green, 1991, 1993). This suggests that blanket statements regarding associated psychopathology in children with GID cannot be made based on the available empirical evidence. It is also important to acknowledge a limitation in the literature regarding disability among children with GID, namely, the heavy reliance on the CBCL. One problem is that it provides only a rough measure of child psychological functioning, thus caution should be taken in using it to infer pathology (Richardson, 1999). A second problem is that the CBCL data are based primarily on parent-reports of competence and impairment. Research has shown that correlations between parent and child self-reports of behavioral and emotional problems tend to be low, and that, in clinical samples, parent-reports commonly imply a greater magnitiude of disturbance than do child self-reports (Achenbach, McConaughy, & Howell, 1987; Epkins, 1996; Handwerk, Larzelere, Soper, & Friman, 1999; Huddleston & Rust, 1994; Kazdin, Colbus, & Rodgers, 1986). With respect to peer relations, children have been found to report experiencing fewer difficulties than that reported by their parents. Taken together, research would suggest that caution must be taken in making definitive statements about the mental health of children with GID, when the preponderance of information is based on parent-report and rarely takes into account the child's subjective experience, which may paint a less disturbed picture.

Is GID Associated With a Significantly Increased Risk of Suffering Death, Pain, Disability, or an Important Loss of Freedom (Sentence [1])?

A condition that is associated with an increased risk for poor outcomes meets the criterion in Sentence [1] for mental disorder. Relevant to this criterion are the likely psychosexual outcomes of children with GID and the mental health correlates of those outcomes. As will be discussed, the most likely psychosexual outcome for children with GID is homosexuality in adolescence or adulthood (Green, 1985,1987,1994; Money & Russo, 1979; Zuger, 1984; see Zucker, 1985, for a review). Asking whether children who will go on to be homosexual are at increased risk for suffering death, pain, disability, or an important loss of freedom, should be an irrelevant issue, as it has been formally accepted in the mental health professions that homosexual individuals are intrinsically as mentally healthy as are heterosexuals (see Gonsiorek, 1991; Hart et al., 1978). Regardless of the fact that homosexuality is not officially considered a disordered outcome, the prevention of homosexuality remains a significant reason for referral of children with GID. It would be naive to believe that prevention of homosexuality is not a motivating factor for at least some of the clinicians who work with children referred for gender-a typicality. Indeed, some researchers and clinicians in the area of GID in children are quite open about such a goal, writing books (e.g., Rekers, 1982, 1991) or belonging to organizations devoted to the prevention of homosexuality (e.g., L. Loeb: see www.narth.com/menus/advisors.html). Thus, although the issue of the risk associated with a homosexual outcome should be moot, it is not. It is crucial that researchers and clinicians in the area of GID in children recognize that the most likely outcome for children with GID, with or without treatment (Green, 1987), is homosexuality, and that homosexuality is a nondisordered outcome.