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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For several decades, little attention was paid in the literature to "pathologies" related to gender role, until Christine Jorgensen's widely-publicized sex-change operation in 1952. By the late 1960s and early 1970s, such operations were a sought-after and popular treatment for what was then known as transsexualism (and would later be termed GID). In an effort to try to prevent this condition, a number of psychiatrists in the 1970s designed programs to identify, study, and treat children "at risk" for developing adult transsexualism. The targeted children were those who displayed unusual amounts of cross-gender behavior (Bem, 1993). The treatments, as well as the very notion that children's cross-gender identification and behaviors warranted treatment, were renounced by several authors, including those from gay rights groups, as unethical (Morin & Schultz, 1978; Nordyke et al., 1977; Winkler, 1977). GID in children was first officially recognized by the APA as a disorder with the 1980 publication of DSM-III. Recently, there has been a resurgence of concern about its status as a disorder, both in published literature on the topic and among members of feminist and gay and lesbian organizations, who are calling for the depathologization of "gender-variant" youth (Bem, 1993; Burke, 1996; Conaty & Lobel, 1998; Neisen, 1992; Wilson & Hammond, 1996).

CONCEPT OF MENTAL DISORDERS IN DSM-IV

The definition of mental disorder used by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders has remained essentially unchanged since the publication of DSM-III (APA, 1980). This definition is basically a simplified derivative (Wakefield, 1993) of a definition proposed by the editor of DSM-III and DSM-III-R, Robert Spitzer, and his colleagues, who were involved with the American Psychiatric Association's Task Force on Nomenclature and Statistics (Spitzer & Endicott, 1978). Remarkably, the DSM-III was the first edition of the DSM for which there was an official definition of mental disorder. The initial impetus for defining mental disorder, according to Spitzer and Endicott, was the controversy surrounding the removal of homosexuality from the psychiatric nomenclature. The associated debate apparently highlighted the need for the boundaries of the concept of mental disorder to be delineated, to make explicit a set of guiding principles for determining which conditions should be included in or excluded from the nomenclature, as well as how conditions should be defined.

The current DSM-IV definition of mental disorder is as follows (each sentence is numbered to facilitate later reference to the definition):

[1] In DSM-IV, each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. [2] In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. [3] Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. [4] Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as described above" (DSM-IV, pp. xxi, xxii).