Assessment is crucial and includes a detailed gender history with attention to such issues as type of childhood play, desire motor dress, feelings about one’s body and reactions to puberty, any history of cross-dressing, sexual fantasies, and early in life sexual experiences. Typically gender dysphoria takes one of three different forms: female – to – male gender dysphoria, male – to – female gender dysphoria (androphilic type) and male – to – female gender dysphoria (autogynephilic). The problem most likely to be presented by transgender individuals is gender dysphoria, which is defined as unhappiness with one’s given gender. DSM-V defines the criteria for gender identity disorder as
- “a strong and persistent cross – gender identification,”
- “persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex”
- The problem is “not congruent with a physical intersex condition,” and
- “Clinically significant distress or impairment” (American Psychiatric Association, 2013).
It is important here to note that this diagnosis requires evidence that the gender dysphoria leads to psychological distress or other forms of impairment in functioning. Zucker and Bradley (1995) conclude “a sizable number of children and their families achieve a great deal of change in these cases, the generally identity disorder resolve fully, and nothing in the children’s behavior of fantasy suggest that gender identity issues remain problematic” (P. 282). The Harry Benjamin International Gender Dysphoria Association standard of care (2001) stated that hormonal or surgical interventions should not be done for children in order to effect a gender reassignment, but rather psychological treatment should be offered to assist the child’s in the family’s adjustment. Zucker and Bradley (1995) also found children from ages 6 to 11 with gender identity disorder are more likely to demonstrate mental health problems in our matched controls primarily in the area of internalizing symptomology (for example anxiety or depression). It remains unclear if this associated symptomology is the result of, the cause of, or is unrelated to the gender identity disturbance. However, these children will need and could benefit from psychological services that focus on the gender dysphoria.