Gender Identity Disorder in Children and Adolescents

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Introduction

In 1980, the third edition of DSM included, for the first time, two diagnoses pertaining to gender identity disorder: gender identity disorder of childhood and transsexualism. In 1987, DSM-III-R (American Psychiatric Association 1987) added a third diagnosis, gender identity disorder of adolescence and adulthood, nontranssexual type. In 1994, the fourth edition of DSM (DSM-IV; American Psychiatric Association 1994) collapsed these three diagnoses into one overarching diagnosis, gender identity disorder, with distinct criteria sets for children versus adolescents and adults.

Over the past 20 years, the study of gender identity disorder (GID) in children has advanced on several fronts: 1) its phenomenology has been well described (Coates 1985; Green 1974; Stoller 1968); 2) the reliability and validity of the diagnosis have been established with reasonable success (Zucker 1992; Zucker and Bradley 1995; Zucker et al. 1984, 1998a); 3) associated features have been identified (Blanchard et al. 1995; Coates and Person 1985; McDermid et al. 1998; Zucker and Bradley 1998; Zucker et al. 1993c, 1996, 1997b, 1998b, 1999); 4) follow-up studies have tracked its “natural history” (Green 1987; Zuger 1984); and 5) various etiological hypotheses have been examined (Coates and Person 1985; Green 1987; Marantz and Coates 1991; Zucker and Bradley 1995). In contrast to these advances, research on the treatment of GID in children has lagged considerably. In both the first and second editions of this textbook (Green 1995; Zucker and Green 1989), one will find not a single randomized controlled treatment trial. Such a trial has still not been conducted. There have, however, been some treatment-effectiveness studies, although much is lacking in these investigations. In general, the treating clinician must rely largely on the “clinical wisdom” that has accumulated in the case report literature and the conceptual underpinnings that inform the various approaches to intervention.