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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Is GID Simply Deviant Behavior or a Conflict Between the Individual and Society (Sentence [4])?

Deviant Behavior

A limitation of an evaluation of GID as a deviant behavior is that there exists no agreed-upon definition of "deviance." The latter is defined in the Penguin Dictionary of Psychology (Reber, 1985) as, "Generally, any pattern of behavior that is markedly different from the accepted standards within a society. The connotation is always that moral or ethical issues are involved and, in use, the term is typically qualified to note the specific form, such as sexual deviance (p. 196)." Relevant to an examination of whether GID in children simply represents deviant behavior is a review of the literature on the later psychosexual outcome of children with GID, that is, to what extent is their behavior simply a precursor to later sexual "deviance?" The link between cross-gender identification and behaviors in childhood with postpubertal sexual orientation or cross-gender/cross-sex identification or both has been examined using both retrospective and prospective studies. Extensive follow-up psychosexual information on cross-gender identified children is available from a number of sources. Taken together, the results suggest that between 61% and 100% of boys who had GID are homosexual or bisexual in adulthood, whereas only a very few (from 0% to 7%) have adult outcomes of GID. Heterosexual outcomes have been observed in up to 31% of the cases reported (Green, 1985, 1987; Money & Russo, 1979; Zuger, 1984; see Zucker, 1985, for a review).

Retrospective data show that homosexual men and women remember higher rates of childhood cross-gender behavior than do their heterosexual counterparts (see Bailey & Zucker, 1995, for a review). Data from retrospective studies of gay men and lesbians tend to indicate similar childhood gender nonconforming experiences as do prospective studies (cf. Phillips & Over, 1992). Compared to their heterosexual counterparts, for example, more gay men and lesbians recall having enjoyed "cross-gender" activities, dressing like the other sex, and pretending to be the other sex (Bell, Weinberg, & Hammersmith, 1981). Harry (1982) reported that between 36% and 58% of his sample of 1,500 gay men recalled playing primarily with girls and some cross-dressing behavior, rates significantly higher than those for heterosexual men. With respect to cross-sex wishes or discomfort with their biological sex, between 22% and 34% of the gay men in Harry's study recalled wanting to be girls, compared to 5% of heterosexual men, a significant difference. Importantly, though, the difference in cross-sex wishes among the gay and heterosexual respondents was reduced to a trend in adolescence and was nonsignificant in adulthood. One may wonder whether some of these gay men could have received diagnoses of GID as children for having wished to be girls, which was, for most, a transient desire. Regarding individuals with GID in adolescence and adulthood, there appears to be a strong link with re called cross-gender behavior. Bradley and Zucker (1990) reported that most of the adolescents they saw clinically who requested sex reassignment had a history of early cross-gender behavior, and would have met DSM-III-R criteria for childhood GID. It is not clear how many of these adolescents had cross-sex wishes in childhood.