Gender Identity Disorder (GID) and Trangender

One of the most fascinating disorder related to sexuality is gender identity disorder (GID), a disorder in which a person persistently feels extremely uncomfortable about his or her assigned sex and strongly wishes to be a member of the opposite sex. Also known as transexualism or gender dysphoria.  Based on DSM IV-TR, the diagnostic criterion are as following:

1. Characterized by a strong, persistent cross gender identification and discomfort with one’s biological sex.
2. Persistent discomfort with one’s sex or a sense of inappropriateness in the gender role of that sex (preoccupation with getting rid of primary and secondary sex characteristic or belief one was born the wrong sex
3. Significant distress and impairment

However, we should distinguish GID from transvestic fetishism(transvestism) and sexual orientation. Transvestism is a form of paraphilia in which heterosexual man dresses in the clothing of the other gender in order to become sexually aroused.  In contrast, GID individuals dress in opposite sex clothing as an expression of gender identity, and they are not sexually aroused by cross-dressing.

Furthermore, the relation between gender identity disorder and sexual orientation has been controversial. Some clinicians suggested that transexuals are homosexuals who claim to be member of the other gender as a way to avoid criticism and stigmatization from the  community that discourage sexual relationship with members of their own sex. However, this proposal doesn't make sense for two reasons.

First, lesbian, gay and bisexual are not uncomfortable with their own identity.

Second, laboratory studies suggest that transsexual and homosexual subjects exhibit different patterns of sexual arousal in response to erotic stimuli.

For the first reason, this issue is rather complex to discuss. The research on relation of GID and LGB group is rather scarce. From my opinion, self-identified transgender individuals are most likely related to  GID.  Reason being transgender individuals are uncomfortable with their own gender identity (they might or might not want to go through the sex reassignment surgery (SRS)), whereas most LGB individuals are comfortable with their identity.

Let me share two real life examples  with you and I hope that through this two examples you could better appreciate the complexity of transgender identity.

1) One of my gay couple friends informed me that they are going to get married next year and invited me to their wedding celebration.  One of my heterosexual friends *David was invited to their wedding as well. David and I had a discussion one time regards this good news. However, I was surprised with a question asked by David and I found the question really hilarious. He asked me "Will either one of them wear gown in their wedding day?". People always assume a female and male relationship in LGB couple and either one of the parties would like to change their gender identity,  but it is definitely not true for all LGB couples. This gay couple friends of mine are comfortable with their identity and sexual orientation, and they would dress in their best suit (maybe tuxedo as what he told me) in their wedding day.

2) A lesbian couple, *Janet and *Crystal  came for couple therapy and counselling. Their relationship was doomed for months due to the fact that Janet has gone for SRS [female-to-male (FTM)] , and Crystal was struggling with how to continue and sustain their relationship with Janet's new gender identity. Crystal explained that she was extremely uncomfortable with Janet's male identity and she feel disgusted with the new "male" body. Moreover, Janet was glad that she finally could get her sex reassigned but she was upset that Crystal was not happy of her new identity. From this example, we could understand that Crystal only would like to have a relationship with female, NOT a male. Janet's new male identity has placed their relationship at risk. Thus, we could see that not all lesbian relationship has femme and butch dynamics as what the stereotype suggested. From my opinion, I would agree that Janet had GID and she was relieved from the distress by being a male. However, Crystal did not has issue with her female identity and sexual orientation as a lesbian, and most importantly she has no desire to be the member of opposite sex.

*not their real name for confidentiality purpose

I hope that this two examples could illustrate and support my view that not all LGB individuals are related to GID. However, there could be co-occurrence between GID and homosexuality but we shouldn't  generalize that all LGBT individuals have GID.

According to Browne & Lim (2008), transpeople felt strongly that their mental health problems were not caused by their gender identity, but by the lack of social support, isolation and transphobic responses in everyday life. We have to note that society (or heterosexual authority figure I guess) might medicalising or pathologizing trans identities with diagnosis of GID for social control. Labelling them as mentally ill could effectively reduce their autonomy and human /legal rights.

Transgender identity is rather more complex than LGB group, the table below show the details of how transgender identify themselves regards of  their sexual orientation and gender identity.

Sexual Preferences		Sexual Orientation
		Homosexual	Heterosexual	Bisexual
Gender Identity	MTF (Male to Female)	Women (lesbian)	Men	Men and Women
	FTM (Female to Male)	Man (Gay)	Women	Men and Women

 For example, a MTF transwoman would identify her as heterosexual when she has a relationship with man, whereas she would identify herself as lesbian if she is in love with women.
 

Is being transgender a mental disorder?

Though I mentioned that transgender individual could be more related GID, but I have to emphasize that NOT all transgender individuals experience their transgender feelings and traits to be distressing or disabling( a very important criteria in DSM IV) If some transgender individual do find their transgender feelings to be distressing and impair their social functioning, and they also meet other DSM diagnostic criterion as mentioned above as well as they have reached puberty, a GID diagnosis might be given. However, this diagnosis is again highly controversial among mental health professionals and transgender people. Some contend that the diagnosis inappropriately pathologies gender variance and should be eliminated. Some LGBT activist also argue that GID is used as a stigmatizing and pathologizing diagnosis by the authority to control and dictate the live of gender-different person. On the other hand, because the health care system in the United States requires a diagnosis to justify medical or psychological treatment (for example, transgender people will only be allowed to do SRS if they are diagnosed GID),it is essential to retain the diagnosis to ensure access to care.  So what is your stand on this?

What kind of mental health problems do transgender people face?
In general, LGBT group has increased risk for certain mental health problems such as substance abuse, mood disorder and suicidal attempts and etc. However, the stigma, discrimination, and internal conflict that many transgender people experience could be  more intense than other LGB people. For example, many transgender people are the targets of hate crimes, and many of them can be denied employment due to their "uncommon" gender identity or gender expression. One of my previous transgender clients has been unemployed for the last 5 years because the employer could not accept her MTF appearance while most of my LGB friends and clients could still be employed and hold  high job position in the organization. So transgender is the "minority within the minority group", the discrimination and lack of social support can exacerbate mental health problems in transgender people

I also attached two videos that illustrate transgender employment discrimination in US for your reference. A lawsuit might be filed if you discriminate transgender people, beware if you are employer!

Transgender Employment Discrimination 1

Transgender Employment Discrimination 2

I will continue with the causes, prevalence and treatment for Gender Identity Disorder tomorrow.

References

APA (American Psychiatric Association). (1994). Diagnostic and statistical manual of mental disorders (4th ed). Washington, DC:  Author.

 

APA (American Psychiatric Association). (2006). Answers to your questions about transgender individuals and gender identity. Washington, DC: Author.

Browne, K & Lim, J. (2008a). Count me in Too: Mental Health. Brighton: Spectrum.

Choong B. (2011). Handling sexuality issues. Singapore: Oogachaga.