177 Gender Identity Disorder in Adolescents or Adults (302.85)
177 Gender Identity Disorder in Adolescents or Adults (302.85)
DSM-IV-TR criteria
- In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the opposite sex, frequent dressing as the opposite sex, desire to live or be treated as the opposite sex, or the conviction that he or she has the typical feelings and reactions of the opposite sex.
- Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of their sex. In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.
- The disturbance is not concurrent with a physical intersex condition.
- The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Specify if (for sexually mature individuals): Sexually attracted to males, Sexually attracted to females, Sexually attracted to both, Sexually attracted to neither
Associated features
- Differentiation of sex vs. gender – The terms sex and gender are commonly, mistakenly, considered interchangeable. Stoller (1968) defines sex as the sum of overt anatomical and physiological differences between male and female. Gender, separate from sex, refers to the sum of behavioral or psychological differences between the sexes.
- General descriptive features – Individuals with GID experience strong, persistent desires to live as the opposite sex. These desires lead to pervasive distress over their assigned sex. Adults, often independent of immediate familial pressures, may seek hormonal treatment or gender reassignment surgery in order to pass as the opposite sex. This appearance is further enhanced by cross-dressing. Tension may exist between individuals with GID and their families; tension is typically greater when the subject is male, though generally neither males nor females are supported by their families in matters relating to their dissatisfaction with their assigned sex. In extreme cases, individuals with GID may resort to mutilation of, or self-removal of, their genitalia.
- Physical examination findings – individuals with GID generally have normal, rather than ambiguous, genitalia, which debunks the notion that GID onset may be related to ambiguous genitalia. Hormonal treatments may result in noticeable increases in breast size in males. Individuals with GID may also resort to plastic surgery or surgical reduction of the Adam’s apple in order to complete their desired appearances.
Adolescent vs adult presentation
- Adolescent presentation – Adolescents with GID are at a greater risk for depression, thoughts relating to suicide, and suicide attempts. In adolescents, GID presentation may resemble child or adult presentation depending on th