"Psychology Works" Fact Sheet: Gender Dysphoria in Children
Note that our understanding of gender and gender dypshoria continues to evolve. What is presented below is a summary of current thinking and research. This fact sheet will be periodically revised to include new theories and evidence.
What is gender dysphoria?
Most people experience little doubt about their gender, seeing themselves as either male or female. However, others experience an inconsistency between their internal sense of gender (their gender identity) and their physical sex (which generally matches the sex they were assigned at birth). Gender dysphoria refers to the unhappiness that some people feel with their physical sex and/or gender role. For children, this generally means that they think of themselves as or desire to be of the opposite sex.
It is important to note, however, that many people question the idea that male and female are fixed opposites. Theorists have suggested that it may be more appropriate to think of gender as lying on a continuum or having multiple categories. Others have proposed a position of gender transcendence, arguing that traits, behaviours, and roles should be divorced from gender.
Regardless, a desire to be of the opposite to their physical/assigned sex is a common experience for both girls and boys (Bailey & Zucker, 1995; Dunne, Bailey, Kirk, & Martin, 2000). Moreover, studies suggest that this is a frequent reason children are referred to school counsellors (Haldeman, 2000).
Gender dysphoria in children
Gender dysphoria is much more common in children than in adults. However, the majority of children with gender dysphoria do not grow up to be adults with gender dysphoria: They seem to outgrow it. Studies that have followed children with a strong desire to be of the opposite sex have found that only a very small proportion of these children continue to have gender dysphoria when they grow up (Zucker & Bradley, 1995). Indeed, some researchers argue that since cross-gender behaviour in childhood is so common, it represents a normal part of development.
Nonetheless, gender dysphoria may cause problems or distress for affected children and their families. In such cases, a psychologist may help the child cope with any difficulties resulting from expressing their gender differently from their peers. Psychologists may also provide support to parents in terms of helping them figure out how best to manage their child’s gender expression and live with the uncertainty of its course.
Children with gender dysphoria may be more likely than other children to have problems with anxiety and depressed mood. It is not clear if these problems cause, are the result of, or are unrelated to the gender dysphoria. Regardless, children and the families of children with gender dysphoria may benefit from psychological treatments aimed at helping them with any mood- and anxiety-related problems.
What is gender identity disorder?
Gender dysphoria is not a diagnosis. It is one of the symptoms of gender identity disorder, however. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR; American Psychiatric Association, 2000) outlines the criteria for childhood gender identity disorder as follows: (a) a continuing and strong identification with the opposite gender; (b) a continuing discomfort with one’s current gender or gender role; (c) the gender dysphoria is not due to an intersex condition;[1] and (d) the gender dysphoria causes a high degree of distress or impairment in the child’s life.
The final criterion is very important: A diagnosis of gender identity disorder requires evidence that the gender dysphoria leads to significant distress and/or life problems. The majority of children who display stereotypically masculine and feminine behaviours are comfortable with their gender identity and do not seek or need treatment. There is nothing wrong or harmful about having traits and behaving in ways that have commonly been associated with the other gender. Indeed, individuals who possess high levels of both “male” and “female” traits have been shown to be especially well-adjusted (Bem, 1975).
While some psychologists provide diagnoses to children with significant gender dysphoria, others do not. Either way, psychologists can help children and their families cope with distress related to gender dysphoria, associated problems, and situations where others are less understanding of the child’s self-expression and behaviour.
Although gender dysphoria has been viewed as a mental health issue in recent history, it was not always this way. Recorded history includes many descriptions of people, from a range of cultures, who did not fit into the simple categories of male or female. In some cases these people were highly regarded and viewed as holy by virtue of their insight into both female and male worlds. It is important to remember that the idea of two opposite sexes may be a recent, Western idea.
REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.
Bailey, J. M., & Zucker, K. J. (1995). Childhood sex-typed behavior and sexual orientation: A conceptual analysis and quantitative review. Developmental Psychology, 31, 43-55.
Bem, S. L. (1975). Sex-role adaptability: One consequence of psychological androgyny. Journal of Personality and Social Psychology, 31, 634-643.
Dunne, M. P., Bailey, J. M., Kirk, K. M., & Martin, N. G. (2000). The subtlety of sex-atypicality. Archives of Sexual Behavior, 29, 549-565.
Haldeman, D. (2000). Gender atypical youth: Clinical and social issues. The School Psychology Review, 29, 216-222.
Zucker, K. J., & Bradley, S. J. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford.
RESOURCES
Canadian Professional Association for Transgender Health (CPATH). CPATH is an interdisciplinary professional organization devoted to the health care of individuals with gender variant identities. www.cpath.ca
Gender Identity Clinic at the Centre for Addiction and Mental Health. This Toronto-based clinic provides consultation and counselling services to individuals who wish to explore issues related to cross-dressing or transgendered expression. www.camh.net/Care_Treatment/Program_Descriptions/Mental_Health_Programs/Gender_Identity_Clinic/
Intersex Society of North America (ISNA). ISNA provides resources for clinicians, parents, and affected individuals regarding disorders of sex development (previously known as intersex conditions; this refers to individuals whose sex development differs from that of the average boy or girl). www.isna.org
Sherbourne Health Centre. A Toronto-based health care centre that provides programs and health care services for the transgender community. www.sherbourne.on.ca/programs/transhealth.html
Trans Programming at the 519. The 519 is a Toronto-based community centre that provides programs specific to the sexual-minority (lesbian, gay, bisexual, queer) and transgender communities. The trans programs provide a range of services for lower income, marginalized, and street active people. www.the519.org/programsservices/transprograms
Vancouver Coastal Health Transgender Health Program. This Vancouver-based program helps transgender individuals find trans-positive health and social services. http://transhealth.vch.ca
World Professional Association for Transgender Health (WPATH; formerly known as the Harry Benjamin International Gender Dysphoria Association). WPATH is an international multidisciplinary professional association devoted to promoting evidence-based care for transgender health. WPATH provides ethical guidelines concerning the care of individuals with gender dysphoria as well as a membership directory and resource lists. www.wpath.org