Gender Identity Disorder

[Guest Rayne]

Notes on Gender Identity Disorder

By Anne Vitale Ph.D.

Gender Identity Disorder:

A Brief Description of the Problem

June 10, 1996 -Revised April 2, 1997

[email protected]

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Abstract: This essay briefly discusses the psychological consequences to individuals who, through differential gender development, do not fit the usual male - female model of gender identity. Several possible theories for the early onset and persistent nature of the disorder are also discussed.

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Gender may well be the most basic thing in the elements that make up human personality. In fact, gender is so basic to our identity, most people mistakenly assume our sense of being male or female is defined with absolute certainty by our anatomical sex. Contrary to popular belief, one's sense of gender and one's anatomical sex are two distinct elements: each developing at different times in different parts of the body.

John Money has coined a useful term to describe this phenomenon. The term is Gendermaps. Money defines a gendermap as the entity, template, or schema within the mind and brain that codes masculinity and femininity and androgyny. This map or coding imprint is established very early in life through an interaction of nature and nurture. Because gendermap development is highly influenced by hormones emanating from the developing fetus, sex and gender identification are generally closely matched. But like most aspects of being human, there are no guarantees. As a result an individual may, as early as the age of four, find themselves aware of being caught between having the anatomy of one sex but being equipped with a gendermap much more typical of an individual of the opposite sex. It is also apparently possible for an individual to have no clear sense of gender whatsoever.

Although there has been a recent increase in the mentioning of cross-gender behavior issues in the popular media, Gender Identity Disorder, as it is referred to in the American Psychological Association's Diagnostic and Statistical Manual IV, is not a new thing. Indeed, it may be as old as humankind itself. Reports of cultural anthropologists and others interested in human nature have many accounts of cross-gender behaviors that span classical and Hindu mythology, Western and Asian classical history, the Renaissance, and late nineteenth and early twentieth century studies of pre-literate cultures. This consistent record across cultures and time adds to the notion that the disorder may be, at least in part, of biological origin.

There is no clearly understood cause for Gender Identity Disorder. However, we have enough information about fetal and childhood development to implicate a complex interaction of events.

Nature starts out the human developmental process by using the female schema as a base. For a male embryo to develop, something must be added. That something must be a Y chromosome inherited from the father. Furthermore, that Y chromosome must contain a gene known as the Testes Determining Factor (TDF), telling the embryo to differentiate and develop male genitalia. Embryos without the factor continue to develop undifferentiated as female.

Nature takes male differentiation further by having the newly formed male testes flood the brain with male hormones at around the third month of pregnancy. This sudden surge of brain masculinizing hormones -- the creation of the male gendermap -- occurs again in males somewhere between the second and twelfth week after birth. Importantly, there is no corresponding feminizing hormonal surge sequence observed in females.

This leads one to consider the possibility that male hormonal surges must occur not only in sufficient amounts, but also during a short window of time to cause masculinization of the gendermap. If there is insufficient androgen(male hormone), or the surge comes too early or too late, the gendermap may be only partially imprinted as male. These disruptions of hormonal surges may come from a variety of sources. A partial list would include a disorder in the mother's endocrine system such as a hormone secreting tumor, common maternal stress, maternal medications or some other toxic substances yet to be identified.

Recent post-mortem studies done on male-to-female transsexuals, non-transsexual men, and non-transsexual women show a significant difference in the volume of a portion of the hypothalamus that is essential for sexual behavior. While further studies are necessary, these studies seem to confirm that one's sense of gender resides in the brain and that it is physically determined.

Gender appears to be a continuum with most people gathered at either end, the rest being somewhere in between. Feelings of discomfort or complete inappropriateness about one's assigned sex does not mean the individual is wrong or ill. It simply means that the original assignment was made based on an absolutism that is inconsistent with the possibilities of human development.

Beyond congenital biological determinants, there are at least three well-published theories on gender development in children. The biological theory is based on evidence that high levels of the male hormone testosterone are associated with high levels of aggression in boys and tomboyishness in girls. Social learning theory proposes that gender typing is the result of a combination of observational learning and differential reinforcement. A third, Cognitive-Developmental theory, states that gender understanding follows a prescribed time line. The pattern put forth is that children recognize that they are either boys or girls by the age of two or three, followed shortly by recognition that gender is stable over time. By the age of six or seven children understand that gender is also stable across situations.

No matter what theory one adopts, for most children, whose sex and gendermap are congruent, this insight typically goes unnoticed. However, if there is a sex/gendermap incongruency, the child is left perplexed about his or her gender status and begins a lifelong, often compulsive search for resolution of the discrepancy.

All children naturally comply with the demands of their internal sense of gender. Boys generally express male behavior and girls generally express female behavior even when raised in closely monitored gender-neutral conditions. If there is any confusion in the child, he or she quickly learns from adults and peers that certain gender-expression behaviors are inappropriate for that individual. This is true even of gender dysphoric children. Some gender dysphoric children internalize their dilemma and make heroic efforts to display the gender behavior expected of them, while expressing their internal sense of gender through secret play, cross-dressing, and cross-gender fantasies. Others may continue to struggle by insisting that they be allowed to openly express maleness or femaleness irrespective of their assigned sex. Either way, the problem becomes subsumed into the child's personality.

The arrival of adolescence increases the difficulties for people who are gender dysphoric. Without fail, the subsequent development of secondary sex characteristics counter to the individual's desires increases anxiety. Often, frustration sets in, and determination to finally resolve the problem becomes the individual's driving force in life. This is especially true for gender dysphoric males. Since the obvious first effort is to accept the physical evidence of their genitalia as reality, it is very common to see many of these people push through these early years of adulthood by engaging in stereotypical, even supermale activities. Since outward behavior has no permanent influence on internal gender understanding, these activities serve only to complicate the individual's social involvement, resulting in anxiety about expressing his true felt gender.

This anxiety state is characterized by feelings of confusion, shame, guilt, and fear. These individuals are confused over an inability to handle their gender identity problem in the same way they readily handle other problems in life. They feel shame over an inability to control what they believe society considers to be sexually perverse activities. Even though cross-dressing and cross-gender fantasies provide much-needed temporary relief, these activities often leave the individual profoundly ashamed of what she or he has done. Closely associated with shame is guilt over being dishonest by hiding secret needs and desires from family, friends, and society. For example, people commonly get married and have children without telling their spouse of their gender dysphoria before making the commitment. Typically it is kept secret because they have the mistaken conviction that participation in marriage and parenting will in itself erase their gender dysphoria. All of this then leads to fear of being discovered. With some justification, gender dysphoric people fear being called sick, uncaring, selfish and even being left aloneby the people they love the most.

To sum things up, Gender Identity Disorder is a real and serious problem. Although we don't know all of what may be the cause or causes of the problem that these individuals feel toward their assigned sex, we can be reasonably certain that it is connected with either a congenital irregularity, an irregularity that occurs in the first few years of childhood or some combination of the two. We also know that every individual's sense of gender, once established, is unchangeable over the individual's life time. Men do not suddenly think they are women and women do not suddenly think they are men. This is true for transsexuals as well as those whose sense of gender does correspond to their genitalia. Most transsexuals report being aware of their condition from the age of four to seven. The only variable is the individual's ability to tolerate the anxiety of feeling missexed. If the individual's gender dysphoria is a relatively minor one, cross-gender lifestyle changes in periodic dressing and behaviors may be all that is necessary to ease the anxiety. However, if the individual's dysphoria is profound, a life style change may be insufficient. In this latter case, gender expression moves from a lifestyle problem to a life-threatening imperative.

General References:

Diagnostic and Statistical Manual of Mental Disorders IV. 4th ed. Washington, D.C. : American Psychiatric Association (1994)

Bulliet, C., Venus Castina, Famous Female Impersonators Celestial and Human. New York: Covici, Friede (1928)

De Savitsch, E. Homosexuality, Transvestism, and Changes of Sex, London: Wm. Heinemann Medical Books (1958)

Gifford, E. (1933) The Cocopa. University of California Publications in American Archaeology and Ethnology, 31 (whole issue)

Gilbert, O. Men in Women's Guise. London: John Lane (1926)

Green R. Sex-dimorphic behavioral development in the human: prenatal hormone administration and postnatal socialization. Sex, Hormones and Behavior, CIBA Foundation Symposium 62, Excerpta Medica, 59-80, Amsterdam (1979)

Kohlberg, L. A Cognitive-Developmental Analysis of Children's Sex-Role Concepts and Attitudes. In E. E. Maccoby (ed.). The Development of Differences. Stanford, CA: Stanford University Press (1966)

Leach, M. (Ed.). Standard Dictionary of Folklore, Mythology and Legend. New York: Funk and Wagnall (1950)

Money, J., Gendermaps: Social Constructionism, Feminism, and Sexophical History. New York, The Continuum Publishing Company (1995).

Money, J. & Ehrhardt, A. A. Man and Woman, Boy and Girl: The Differentiation and Dimorphism of Gender Identity from Concept to Maturity. Baltimore: Johns Hopkins Press (1972)

Stein,S., Girls and Boys: The Limits of Non-Sexist Rearing, London, Chatto and Windus (1984)

Ward I.L. Sexual Behavior: The Product of Parinatal Hormonal and Prepubertal Social Factors. In Handbook of Behavioral Neurobiology, Vol. 11 Sexual Differentation, ed. A. A. Gerall, H. Moltz, and I.L. Ward. New York: Plenum Press, (1992)

Ward, O.B., Fetal Drug Exposure and Sexual Differentiation of Males. In Handbook of Behavioral Neurobiology, Vol. 11 Sexual Differentiation, ed. A. A. Gerall, H. Moltz, and I.L. Ward. New York: Plenum Press, (1992)

Zhou, J.-N., Hofman, M.A., Gooren, L. G. & Swabb, D.F., A Sex Difference in the Brain and its Relation to Transsexuality, Nature, 378, 68-70 (1995)