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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As data from across cultures and time indicate, the notion of cross-gender identification or behaviors or both as disordered is highly dependent on the cultural and historical context in which they occur. It is unlikely, however, that conflict between the individual and society characterizes children whose discomfort lies with their biological sex. A sense of discomfort with one's biological sex is not consistent with conflict between the individual and society, as it represents the individual's experience of his or her biological status, which may transcend cultural and historical contexts.

CONCLUSIONS

The comparisons presented in this paper fail to support a conclusion that GID in children, as it appears in DSM-IV, meets the criteria of mental disorder. Children who do and do not present with discomfort with their biological sex may represent different populations. In this paper, sufficient evidence has been presented to conclude that children whose discomfort lies only with the gender role of their sex should not be considered to have a gender-related disorder. Those who experience discomfort with their biological sex may meet some of the DSM-IV criteria for mental disorder. Shortcomings in the current definition of mental disorder, and the fact that studies published to date have not separated these two groups of children make it impossible to thoroughly evaluate the extent to which children with discomfort with their biological sex meet all the criteria for mental disorder. Longitudinal studies of children with discomfort with their sex are needed to clarify this issue. It is thus recommended that the category of GID in children in its current form should not appear in future editions of the DSM. With further study, perhaps sufficient data will be gathered to determine whether children who experience discomfort with their biological sex should be considered to have a mental disorder.

Agreeing that children with discomfort with the culturally prescribed gender role of their sex do not have GID does not preclude clinical attention to children with cross-gender identification. The reality of life in North American society is such that individuals who manifest gender identity and behaviors typical of the "opposite sex" face ridicule and ostracism. The resulting emotional difficulties, such as anxiety or depressive symptomatology, must be dealt with if the child is in sufficient distress. In consideration of the child as part of a family system, the value of family therapy should not be overlooked, as has been specified in The Standards of Care for Gender Identity Disorders (Harry Benjamin International Gender Dysphoria Association, 1998).

The previous notion of sexual inversion, and more recently, of homosexuality as mental disorders should be a reminder to mental health professionals about psychiatry's power to pathologize those who do not fit the social norm (Bem, 1993). With homosexuality as the most likely psychosexual outcome for a child with GID, APA's Position Statement on Homosexuality is relevant. In 1993, the American Psychiatric Association's Committee on Gay, Lesbian, and Bisexual Issues of the Council on National Affairs called on organizations and individuals to "do all that is possible to decrease the stigma related to homosexuality wherever and whenever it may occur" (p. 686). It seems as though the inclusion of GID in children as it appears in the DSM-IV does little in responding to this appeal. Although the focus of this paper was on GID in children, it raises a larger question about the concept of "pathology" in general. To what extent do other "disorders" represent conditions that simply violate societal norms? In this paper, we have provided a simple means of assessing whether a condition meets DSM criteria for mental disorder (i.e., a comparision between the definitional criteria and the extant literature). This kind of analysis could prove useful in the clarification of other forms of behavior that might constitute psychopathologies.