Gender dysphoria in children

Gender dysphoria in children, also known as gender identity disorder in children or gender incongruence of childhood, is a formal diagnosis used by psychologists and physicians to describe children who experience significant discontent (gender dysphoria) with their biological sex, assigned gender, or both.F64.2 Gender identity disorder of childhood: A disorder, usually first manifest during early childhood (and always well before puberty), characterized by a persistent and intense distress about assigned sex, together with a desire to be (or insistence that one is) of the other sex. There is a persistent preoccupation with the dress and activities of the opposite sex and repudiation of the individual's own sex. The diagnosis requires a profound disturbance of the normal gender identity; mere tomboyishness in girls or girlish behavior in boys is not sufficient. Gender identity disorders in individuals who have reached or are entering puberty should not be classified here but in F66.0.In the case of gender non-conforming children and adolescents, the GID criteria are significantly broader in scope in the DSM-IV (APA, 1994, p. 537) than in earlier revisions, to the concern of many civil libertarians. A child may be diagnosed with Gender Identity Disorder without ever having stated any desire to be, or insistence of being, the other sex. Boys are inexplicably held to a much stricter standard of conformity than girls. Most psychologists who specialize in gender identity disorder in children note a higher level of male patients brought to them, rather than female patients. A possible explanation would be that cross-sex behavior is less acceptable and therefore more noticeable and more likely to be viewed by problematic by the child’s parents (Bradley, Zucker, 1997). preference for cross-dressing or simulating female attire meets the diagnostic criterion for boys but not for girls, who must insist on wearing only male clothing to merit diagnosis. References to 'stereotypical' clothing, toys and activities of the other sex are imprecise in an American culture where much children's' clothing is unisex and appropriate sex role is the subject of political debate. Equally puzzling is a criterion which lists a 'strong preference for playmates of the other sex' as symptomatic, and seems to equate mental health with sexual discrimination and segregation. Gender dysphoria in children, also known as gender identity disorder in children or gender incongruence of childhood, is a formal diagnosis used by psychologists and physicians to describe children who experience significant discontent (gender dysphoria) with their biological sex, assigned gender, or both. GIDC was formalized in the third revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 and primarily referenced gender non-conforming behaviors. GIDC remained in the DSM from 1980 to 2013, when it was replaced with the diagnosis of 'gender dysphoria' in the fifth revision (DSM-5), in an effort to diminish the stigma attached to gender variance while maintaining a diagnostic route to gender affirming medical interventions such as hormone therapy and surgery. Controversy surrounding the pathologization and treatment of cross-gender identity and behaviors, particularly in children, has been evident in the literature since the 1980s. Proponents of more widespread GIDC diagnoses argue that therapeutic intervention helps children be more comfortable in their bodies and can prevent adult gender identity disorder. Opponents say that the equivalent therapeutic interventions with gays and lesbians (titled conversion or reparative therapy) have been strongly questioned or declared unethical by the American Psychological Association, American Psychiatric Association, American Association of Social Workers and American Academy of Pediatrics. The World Professional Association for Transgender Health (WPATH) states that treatment aimed at trying to change a person's gender identity and expression to become more congruent with sex assigned at birth 'is no longer considered ethical.' Critics also argue that the GIDC diagnosis and associated therapeutic interventions rely on the assumption that an adult transsexual identity is undesirable, challenging this assumption along with the lack of clinical data to support outcomes and efficacy. Gender dysphoria in children is more heavily linked with adult homosexuality than adult transsexualism. According to limited studies, the majority of children diagnosed with gender dysphoria cease to desire to be the other sex by puberty, with most growing up to identify as gay or lesbian with or without therapeutic intervention. Children with persistent gender dysphoria are characterized by more extreme gender dysphoria in childhood than children with desisting gender dysphoria. Some (but not all) gender diverse / gender independent / gender fluid youth will want or need to transition, which may involve social transition (changing dress, name, pronoun), and, for older youth and adolescents, medical transition (hormonal and surgical intervention). Treatment may take the form of puberty blockers such as leuprorelin, or cross-sex hormones (i.e., administering estrogen to an assigned male at birth or testosterone to an assigned female at birth), or surgery (i.e., mastectomies, salphingo-oophorectomies/hysterectomy, the creation of a neophallus in female-to-male transsexuals, orchiectomies, breast augmentation, facial feminization surgery, the creation of a neovagina in male-to-female transsexuals), with the aim of bringing one’s physical body in line with their felt gender. The ability to transition (socially and medically) are sometimes needed in the treatment of gender dysphoria. The Endocrine Society does not recommend endocrine treatment of 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 suppressing puberty with puberty blockers until age 16 years old, after which cross-sex hormones may be given. The University of Washington is leading the largest study of transgender youth ever conducted. The study, known as the Transgender Youth Project, looks at 300 transgender children between the ages of 3 and 12. Researchers hope to follow the children for 20 years. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV (TR)) makes a differential diagnosis coding based on current age: The current edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) has five different diagnoses for gender identity disorder, including one for when it manifests during childhood. It is important to note that the diagnoses of gender identity disorder is not given to intersex individuals (those born with 'ambiguous' genitalia). Additionally, it is important to note that, as with all psychological disorders, these symptoms must cause direct distress and an impairment of functioning of the individual exhibiting the symptoms (Bradley, Zucker, 1997).