In the DSM, the presence of a disorder, by definition, assumes that there is associated distress and/or impairment. Although the assessment of distress in child psychiatric disorders, including GID, is a complex task with little in the way of systematic empirical research, many child clinicians argue that the distress that is often observed in children with GID is a compelling rationale for intervention. Children with GID can be observed to manifest such distress in various ways: behavioral and ideational preoccupation with gender, verbal comments that reflect unhappiness about gender, verbal and behavioral disparagement of sexual anatomy, and so on.

Case Example 7
Nathan was a 5-year-old boy with an IQ of 110. He lived with his middle-class parents and an older sibling. Since the age of 2, he had shown the various behavioral signs of GID. He repeatedly told his parents that he hated being a boy and that he wanted a vagina. He described other boys as “ugly and mean.” For Christmas, he asked Santa Claus for only one present: “to turn me into a girl.”