One may be legally classified as a women, however feel as though they identify with a masculine personality. There are many steps involved to diagnose and treat gender identity disorder.On the contrary, others may disagree with it classification. Today, it has become more socially acceptable to tailor one's appearance to fit a stereotypical gender.
Recently, inclusion of GID in the upcoming DSM-V has been a subject of debate. As the DSM currently stands, GID is considered an illness that can be “treated,” and many psychologists argue that considering only one form of gender identity development to be “healthy” may define gender in a heteronormative way (Zucker, 2006). The lack of understanding about the true causes and considerations involved in GID only leaves room for discriminatory, stereotyped classification of individuals developing gender identities. Society passes judgment in the face of uncertainty and the mystery of sex and gender is no exception. However, a neurological understanding of gender identity as it relates to sexual identity may allow both clinicians and the public increased exposure to constructs related to sex and gender. By increasing public knowledge about gender identity development beyond the hetero-normative tradition, we may be able to improve social acceptance for both children and adults diagnosed with GID, who do not fall in the traditional gender paradigm.
A review of sex reassignment surgery outcome studies suggests that in most cases, surgery resolves the gender identity disorder. Depending on the study, between 71% and 97% of subjects were successfully treated with surgery and less than 1% later took steps to reverse the sex reassignment. Factors that predict a poor outcome include: misdiagnosed transvestism, poor surgery outcome, poor social or work functioning, suicidal tendencies, and sex reassignment surgery late in life. This suggests that the current procedure for determining appropriateness of sex reassignment surgery is effective, when applied strictly (Cohen-Kettenis & Gooren, 1999). Male to female transsexuals who are attracted to men (MF homosexuals) seem to have a better post-surgery outcome compared to MF transsexuals who are attracted to women (MF heterosexuals). MF heterosexuals may have a poorer post-surgery outcome because of the added stigma of becoming homosexual after surgery, and because they typically present for surgery much later in life than MF homosexuals and thus are likely to have more male-role investments (e.g., husband, father). FM transsexuals in general have better post-surgery outcome than MF transsexuals (Cohen-Kettenis & Gooren, 1999)
Social, parental, or familial factors have been associated with mild gender disturbance. MF transsexuals often report over controlling, rejecting fathers. FM transsexuals often report mothers and fathers who were rejecting and mothers who were over protective. It feasible, however, that these differences may have been the result of abnormal gender development, rather than the cause (Cohen-Kettenis & Gooren, 1999).
Other combinations are possible, however. A child whose biological sex is that of a typical female can have a gender identity and role of a boy. As an adult, this person may self-identify as transgender or transsexual and live as a man, who, like any other person, can be of any sexual orientation. On the other hand, a biological male can have a gender identity of a boy/man, be attracted to other men, and identify as gay. Contrary to what our society tends to believe, it is not necessary for people who feel attracted to others of the same gender to express any gender nonconformity. Gay men can be comfortable in their male body and exhibit no gender-variant behaviors, just as lesbian women can be comfortable with their sex and gender roles (Diamond, 2002).
The sex of a patient always is a significant factor in the management of GID. Clinicians need to separately consider the biological, social, psychological, and economic dilemmas of each sex. For example, when first requesting professional assistance, the typical biological female seems to be further along in consolidating a male gender identity than does the typical biological male in his quest for a comfortable female gender identity. This often enables the sequences of therapy to proceed more rapidly for male-identified persons.
In the United States, the American Psychiatric Association permits a diagnosis of gender identity disorder if the four diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4thEdition, Text-Revised (DSM-IV-TR) are met. The criteria are:
Long-standing and strong identification with another gender
Long-standing disquiet about the sex assigned or a sense of incongruity in the gender-assigned role of that sex
The diagnosis is not made if the individual also has physical intersex characteristics.
Significant clinical discomfort or impairment at work, social situations, or other important life areas.
If the four criteria are met under the DSM-IV-TR, a diagnosis is made under ICD-9 code 302.85. See the classification and external resources sidebar at right for other diagnostic codes for gender identity disorder.
A clinical threshold is passed when concerns, uncertainties, and questions about gender identity persist in development, become so intense as to seem to be the most important aspect of a person's life, or prevent the establishment of a relatively unconflicted gender identity. The person's struggles are then variously informally referred to as a gender identity problem, gender dysphoria, a gender problem, a gender concern, gender distress, or transsexualism. Such struggles are known to be manifested from the preschool years to old age and have many alternate forms. These forms come about by various degrees of personal dissatisfaction with sexual anatomy, gender demarcating body characteristics, gender roles, gender identity, and perceptions of others. When dissatisfied individuals meet specified criteria in one of two official nomenclatures--the International Classification of Diseases-10 (ICD-10) or the Diagnostic and Statistical Manual of Mental Disorders--Fourth Edition (DSM-IV)--they are formally designated as suffering from a gender identity disorder (GID). Some persons with GID exceed another threshold--they persistently possess a wish for surgical transformation of their bodies.
Although it has recently been declassified as a mental illness, gender dysphoria, a term encompassing both transgender and transsexual persons, is still extremely stigmatized in the public eye. Gender dysphoria is currently included in the most current DSM as a “disorder” – just one step down from the mental illness status.
To understand the plight of transgendered people, some key vocabulary must be introduced. For example, two words that are commonly used interchangeably – gender and sex – actually have significantly different meanings. Someone’s gender is how they identify themselves – how they dress, how they act, how they feel, and what they truly believe they are on the inside. Sex, however, is the physical way someone’s body is constructed, which may or may not match up with a person’s gender. Birth sex is the physical sex someone was born with.
Our cultural beliefs dictate that there are only two biological sexes corresponding to two genders. Moreover, males are expected to have masculine gender identifications/roles and to be attracted to women. Females, in turn, are expected to have gender identifications/roles of women and to be attracted to men. These two models are thus considered the norm, and any other combination of biological sex, gender, and sexuality is commonly considered unnatural or pathological (Mintz, & O’Neil, 1990; Newman, 2002; Schilt & Westbrook, 2009).