Gender disforia in children or gender disorder in children (GIDC) is a formal diagnosis used by psychologists and physicians to describe children who experience significant dissatisfaction (gender dysphoria) with their biological gender, assigned gender, or both.
The GIDC was inaugurated in the third revision of the Diagnostic and Statistical Manual of Mental Disorder (DSM-III) in 1980 and mainly refers to gender-inappropriate behavior. GIDC remained at DSM from 1980 to 2013, when it was replaced with the diagnosis of "gender density" in the fifth revision (DSM-5), in an attempt to reduce the stigma attached to the gender variant while maintaining a diagnostic route for gender. confirming medical interventions such as hormone therapy and surgery.
Controversy surrounding the pathology and treatment of gender identity and behavior, especially in children, has been evident in the literature since the 1980s. Advocates of the wider GIDC diagnosis argue that therapeutic interventions help children become more comfortable in their bodies and can prevent the disruption of adult gender identity. Opponents say therapeutic interventions equivalent to gays and lesbians (conversion or reparative therapy) have been questioned or declared unethical by the American Psychiatric Association, the American Association of Social Workers and the American Academy of Pediatrics. The World Professional Association for Transgender Health (WPATH) states that treatments aimed at trying to change one's gender identity and expression become more aligned with the gender defined at birth "are no longer considered ethical." Critics also argue that GIDC diagnosis and related therapeutic interventions depend on the assumption that adult transsexual identity is undesirable, challenging this assumption along with lack of clinical data to support outcomes and efficacy.
Gender dysphoria in children is more closely related to adult homosexuality than adult transsexualism. According to limited research, the majority of children diagnosed with gender dysphoria cease desiring to be of another gender at puberty, with most becoming gay or lesbian with or without therapeutic interventions.
Video Gender dysphoria in children
Classification
Children with persistent gender dysphoria are characterized by more extreme sex dysphoria in childhood than children with stopping gender dysphoria. Some (but not all) diverse gender/gender independent/gendered youth fluids will want or need transition, which may involve a social transition (changing clothing, names, pronouns), and, for older adolescents and adolescents, medical transitions hormonal and surgical intervention). Treatment may be a pubertal blockade such as Lupron Depot or Leuprolide Acetate, or cross-sex hormones (eg, estrogen administration to a man who is assigned at birth or testosterone to a woman who is determined at birth), or surgery (ie, mastectomy, salphingo-Hactifectectomy/hysterectomy, the creation of neophallus in transsexual women, orchiektomi, breast augmentation, facial feminization surgery, neovaginal creation in male-to-female transsexuals), with the aim of bringing one's physical body in line with the gender they perceive. The ability to transition (socially and medically) is sometimes necessary in the treatment of gender dysphoria.
The Endocrine Society does not recommend endocrine treatment in prepubertal children because clinical experience suggests that GID can be reliably assessed only after the first signs of puberty. It recommends treating transsexual adolescents by pressing puberty with puberty inhibitors until age 16, after which cross-sex hormones can be given.
The University of Washington leads the largest study of transgendered adolescents ever conducted. The study, known as the Transgender Youth Project, looked at 300 transgender children between the ages of 3 and 12. Researchers hope to follow children for 20 years.
DSM-IV TR (2000)
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV (TR)) makes the coding of differential diagnoses based on the current age:
- 302.6 Gender Identity Disorder in Children
- 302.85 Gender Identity Disorder in Adolescents or Adults
The latest edition of the International Statistical Classification of Diseases and Health Problems Related (ICD-10) has five different diagnoses for gender identity disorder, including one for manifest moments during childhood. It is important to note that the diagnosis of gender identity disorder is not given to intersex individuals (those born with "ambiguous" genitals). In addition, it is important to note that, as with all psychological disorders, these symptoms should lead to direct distress and impaired function of the individuals who exhibit symptoms (Bradley, Zucker, 1997).
F64.2 Childhood gender identity disturbance: Distractions, usually first manifested during childhood (and always well before puberty), marked by persistent and intense interruptions of assigned sex , along with a desire to be (or pressure one) of the other sex . There is an ongoing preoccupation with clothing and the opposite sex activity and individual sexual denial . Diagnosis requires a deep disruption of a normal gender identity; only tomboyishness in girls or flirty behavior in boys is not enough. Gender identity disorders in individuals who have reached or entered puberty should not be classified here but in F66.0.
In DSM mental disorders used by psychologists in the United States, gender identity disorder is given two sets of criteria. Criterion A shows that a child identifies as a member of the opposite sex. The child needs to point out four of the following five symptoms: dressing as a member of the opposite sex, especially making friends with the opposite sex, indicating a desire to engage in play activities that are characteristic of the opposite sex, and actively declaring that they want to be the opposite sex. Criterion B, on the other hand, shows that the child does not identify with the gender they were born with. It can manifest itself as an aversion to the style of dress that characterizes the sexes they bear, the avoidance of association with the sex members they bear, and the distress of their physiological aspects of the sexes they express (Bradley, Zucker, 1997). DSM-5_ (2013) _diagnosis_of_gender_dysphoria "> DSM-5 (2013) diagnosis of sex dysphoria
In May 2013, the American Psychiatric Association published DSM-5 in which GIDC diagnosis was removed and replaced with sex dysphoria, for the first time in its own chapter. Lev stated that gender dysphoria puts the focus on distress with one's body rather than conformity with the social norms of society, and that this change is accompanied by changes in the sexist language and reduced dependence on the binary gender category. Gender dysphoria repeats the diagnosis as a time-limited disruption of potentially reversible body with access to gender transition procedures, rather than lifelong disruption of identity.
Maps Gender dysphoria in children
Management
Support
The therapeutic approach to GIDC differs from that used in adults and includes behavioral therapy, psychodynamic therapy, group therapy, and parental counseling. Advocates of this intervention seek to reduce gender dysphoria, make children more comfortable with their bodies, reduce exclusion, and reduce child psychiatric comorbidities. The majority of therapists currently use this technique. "Two short-term goals have been addressed in the literature: the reduction or abolition of social isolation and conflict, and the underlying or related psychopathological eradication The long-term goal has been focused on preventing transsexualism and/or homosexuality."
Individual therapy with the child seeks to identify and resolve the underlying factors, including family factors; encourage identification based on sex determined at birth; and encourage same-sex friendships. Parental counseling involves setting limits on the child's cross-gender behavior; encourage activities that are gender-neutral or gender; examine family factors; and check for parental factors such as psychopathology. Older researchers on gender identity disorder, Kenneth Zucker and Susan Bradley, stated that it has been found that boys with gender identity disorder often have mothers who to some extent reinforced more stereotypical behavior than young girls. They also note that children with gender identity disorder tend to come from families where cross-gender role behaviors are not explicitly impeded. However, they also recognize that people can see these findings only as an indication of the fact that parents who are more accepting of their child's cross-gender role behaviors are also more likely to take their children to a clinical psychiatrist than those who are less accepting cross role behaviors -genders on their children (Bradley, Zucker, 1997). "Advocates acknowledge limited data on GIDC:" apart from a series of cases of intrasubject behavioral therapy from the 1970s, one will not find any randomized controlled treatment trials in the literature. "(Zucker 2001) Psychiatrist Domenico Di Ceglie believes that "There is little evidence, however, that any psychological treatment has much influence in changing gender identity even though some treatment centers continue to promote this as a goal (eg Zucker, , 1995). "Zucker has stated that" the therapist must rely on accumulated 'clinical wisdom' and to utilize conceptual models of untested formulation to inform approaches and care decisions. "
Opponent
The Consensus of the World Professional Association for Transgender Health is that treatment aimed at trying to change the identity and expression of a person's gender to be more in line with gender defined at birth "is no longer considered ethical." Doctors call Zucker and Bradley's therapy interventions "something very disturbing reparative therapy for homosexuals" and have noted that the goal is to prevent transsexualism: "Reparative therapy is believed to reduce the likelihood that adult (ie, transsexualism) GIDs characterized by Zucker and Bradley is undesirable. "Author Phyllis Burke wrote," The GID diagnosis in children, as supported by Zucker and Bradley, is child abuse. " Zucker dismisses Burke's book as "simple" and "not too flashy;" journalist Stephanie Wilkinson says Zucker characterizes Burke's book as "the work of a journalist whose views should not be put in the same camp as scientists like Richard Green or himself." However, a strong critique of Dr. Zucker does not come from lay activists and journalists, but also from psychiatrists and psychologists in his own field. Edgardo Menvielle, a child psychiatrist at the National Children's Medical Center in Washington stated, "Therapists advocating changes in gender behavior should be avoided." Developmental and clinical psychologist Diane Ehrensaft told the Psychiatric Times: "Mental health professions have consistently endangered children who are not 'normal gender,' and they need to retrain,"
Critics argue that GIDC is a backdoor maneuver to replace homosexuality at DSM, and Zucker and Robert Spitzer point out that GIDC inclusion is based on "expert consensus," which is "the same mechanism that led to the introduction of many new psychiatric diagnoses, including where systematic field trials not available when DSM-III is published. "Katherine Wilson of the GID Advocate Renewal states:
In the case of inappropriate gender of children and adolescents, the GID criterion is significantly broader within the scope of DSM-IV (APA, 1994, page 537) than in previous revisions, to the attention of many libertarian civilians. A child can be diagnosed with Gender Identity Disorder without ever expressing a desire to be, or an insistence of being, another gender. Boys are mysteriously held with a much tighter conformity standard than girls. Most psychologists who specialize in gender identity disorder in children note a higher rate of male patients being brought to them, rather than female patients. A possible explanation is that cross-sex behavior is less acceptable and therefore more visible and more likely to be seen by troubled child parents (Bradley, Zucker, 1997). preferences for cross-dressing or simulating women's clothing meet the diagnostic criteria for boys but not for girls, who must insist on wearing only men's clothing to get a diagnosis. References to "stereotypical" clothes, toys and other sex activities are inappropriate in American culture where the clothing of many children is unisex and the corresponding sex role is the subject of political debate. Equally perplexing are the criteria that include "strong preference for playmates of the other sex" as a symptom, and seem to equate mental health with discrimination and sexual segregation.
Doctors argue that GIDC "has served to suppress boys to fit traditional gender and heterosexual roles." Feder notes that the diagnosis is based on the reaction of others to the child, not the behavior itself. Langer et al. states "Gender impartiality is a social construction that varies over time in accordance with culture and social class and therefore should not be pathological." Zucker refuted their claim in response. Critics "argue that it is a precursor of homosexuality, that parents should just accept it, and that the diagnosis is strongly based on sexist assumptions."
Controversy DSM-5
Therapeutic interventions for GIDC came under renewed scrutiny in May 2008, when Kenneth Zucker was appointed to the DSM-5 committee at GIDC. According to MSNBC, "The petition accused Zucker of being involved in 'junk science' and promoting 'painful theories' during his career." Zucker is accused by LGBT activists of promoting "gender-appropriate therapy in children" and "caring for children with GID with the aim of preventing homosexuality or adult transcendence." Zucker "rejects junk-science content, saying that 'there has to be an empirical basis for changing anything' at DSM.Like to hurt people," in my own career, my primary motivation in working with children, youth and families is to help those with the distress and suffering they endured, whatever their reason for experiencing this struggle. I want to help people feel better about themselves, not to hurt them. '"However, opponents continue to argue that the diagnosis" very harmful to children is meant to help ".
The DSM-5 transformation into "gender dysphoria" is supported by transgender and allied activists as a way to reduce stigma but maintain a diagnostic route for trans-specific medical care. However, Lev stated that the diagnosis of gender dysphoria continues to pathologize the transgender experience.
Alternate approach
The existence of people with two spirits (understood to be related to masculine and feminine spirit) has been documented in over 130 pre-colonial Indigenous nations in North America including Zuni lhamana and Lakota wattes. In some of these countries, the identification of the two spirit children is considered a blessing for the family and society. While the role of two spirits in their community varies greatly from country to country, in some cases they are respected, for example We'wha who was the cultural ambassador for the Zuni people during the late nineteenth century. The historical and contemporary existence of alternative gender roles has also been documented throughout the world, for example: kathoey in Thailand and Laos, Indian migrants, muxe Zapotec people in Mexico, mukhannathun from what is now Saudi Arabia,? h? in Hawaii, fakaleiti in Tonga and fa'afafine in Samoa. Although the historical significance of these roles is often debated, their existence is not.
Referring to the contemporary Western outlook on gender diversity, psychologist Diane Ehrensaft states: "I witnessed shocks in the mental health community as training sessions, workshops and conferences multiply throughout the country and around the world, demanding that we reevaluate the binary gender system, that gender incompatibility is a nuisance, and create new guidelines to facilitate the healthy development of gender-conscious children. "Teenage psychiatrist Edgardo Menvielle and psychotherapist Catherine Tuerck offer support groups for parents of children who are not gender-compliant at Children's National Medical Center in Washington DC, which aims to "not change the behavior of children but help parents to support". Other publications are beginning to call for a similar approach, to support parents to help their children become who they really are. Community organizations established to support this family have begun to evolve, such as the Gender Spectrum, Trans Youth Family Allies, Gender Creative Kids Canada and Trans Kids Purple Rainbow, as well as conferences such as the Gender Odyssey Family Conference and summer camps such as Camp Aranu 'tiq, all with the aim of supporting healthy families with inappropriate gender or transgender children. The popular media accounts of parents who helped their children to live in their recently perceived gender roles began to emerge. These stories show that children and their parents face a substantial stigma; However, Menvielle argues that "the therapist should focus on helping children and families cope with social intolerance and prejudice, not on children's behavior, interests or a playmate's choice." A number of new terms applied to these children (such as gender variants), gender, gender-creative and gender-independent discrepancies) suggest that many are beginning to reject the Gender Identity Disorder label in Children.
History
The introduction of GIDC diagnosis into DSM-III in 1980 was preceded by many studies and treatments in the US in feminine boys beginning as early as the 1950s and 1960s, most notably by John Money and Richard Green at Johns Hopkins Hospital and University of California, Los Angeles (UCLA). The prevention of transsexuality and/or homosexuality is explicitly stated as the goal of many of these studies: "My focus is what we might consider preventing transsexualism." Bryant notes that feminine boys are not a recent phenomenon; However, the emergence of public transsexual adult women (male to female) in the 1950s was new and created a number of problems for psychologists, motivating some to make an effort to prevent further appearances. Meyerowitz recounts the profound disagreement that erupted between psychologists and physicians after the public gender transition Christine Jorgensen, whether transsexuals should be allowed to align their bodies with their inner identities or whether their inner identity should be in line with their bodies. At that time, transsexual women began publishing the first person narratives that highlighted their awareness of their femininity at a young age and Bryant noted that some doctors and researchers thus turned their attention to feminine boys, building up the sections as "new patients and populations research. "
One of the earliest researchers was George Alan Rekers, who focused his 1972 doctoral research on the care of female boys. In this work, Rekers describes the litany of feminine behavior he catalogs including: feminine posture, gait movements, hands and hands, feminine movements in speech, as well as an interest in feminine clothing, games, and topics. Using his classic behavior modification technique and his team of research assistants set about feminine 'problem' behaviors that fade in three boys in particular, asking for help from parents and sometimes teachers to reward and punish appropriate behavior identified as desired or undesirable. Dissertation writing explains in detail, the case of Kraig (a pseudonym for Kirk Andrew Murphy) whose mother was taught through earphones to glamorize or ignore them interchangeably depending on whether he played with a feminine (usually stuffed) or masculine toy (usually a weapon) toy table. She is also trained to monitor her behavior at home, with research assistants visiting each week to ensure she is properly completing her four-day-daily observations of Kraig's gender behavior. The physical punishment of Kraig's father is referred to as one of the main consequences for feminine behavior at home. Throughout the work of the Rekers of the future, he cites his treatment with Kraig as successful, claiming that "Kraig's feminine behavior seems to have stopped completely [...]."
In contrast to this, a number of facts about Kraig have become public information, including: that he is a gay man; that according to his family, he never recovered from this treatment; and that in 2003, at the age of 38, he committed suicide. Even without confirmed knowledge about the outcome, in the mid-1970s, Rekers' publication of treatment modalities had drawn harsh criticism from popular and scientific media sources and Bryant speculated that this was one possible explanation for why many physicians did not publish on techniques their treatment. , focusing on the less controversial aspects of GIDC, such as diagnostic criteria. Currently, the nature of care currently being given to children diagnosed with poor GIDC is described in the work of leading physicians such as Kenneth Zucker; However, first-person treatment accounts in popular media sources seem to indicate that feminine behavior in boys continues to be identified and selected for elimination, the more contrary to this practice.
Sexual orientation
Hepp, Milos and Braun-Scharm states in their study of gender identity disorder and anorexia nervosa in monozygotic twin males that the correlation between childhood gender identity disturbance and adult homosexuality is stronger than the correlation between gendered identity disorder of childhood and transsexualism adult. Cohen-Kettenis and Gooren notes in their review of the literature on transsexualism that children with gender identity disorder are more likely to identify as gay or lesbian at a later date, as opposed to identifying as transgender. In addition, gay and lesbian adults reported having shown gender role behaviors that were more different from heterosexual adults.
See also
- Child gender incompatibility
- Transgender youth
- List of transgender related topics
References
External links
- Gender Identity Disorder and Transsexualism via Merck Manual
- Unsuitable Gender Diagnostic Problems for Gender Youth through GIDreform.org
- More Kids Seek Help for Dysphoria Gender through WebMD.com
- Health Effects Of Transition In The Years Unknown by NPR
- When Transgender Kids Transition, Known Medical Risk and Unknown via Frontline PBS
- Parents of transgender children are faced with difficult decisions via NYMag.com
- Boys who raised a girl through the BBC
- Led by a child who only knows The twins are identical in everything but one. via Boston.com
- Nonprofit programs that serve transgender and sex teenagers and their families. via Camp Aranutiq
- As Growing Concerns, Transgender Kids Numbers Become Elusive through The New York Times
- First First Transgender Youth Study funded by NIH through University of California, San Francisco
- Reddit forum for transgender support and information via Reddit.com
Source of the article : Wikipedia
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