Sexual prejudice and discrimination towards LGBT youth

For LGBT youth, the impact of discrimination, harassment and violence can be worse. The emotional and physical turmoil many adolescents face as part of the maturation process can be further complicated in LGBT youth who struggle to construct their self-identity and role at this developmental stage (Identity crisis). 

1) Two million US teenagers were reported in 2001 as having serious problems in school because they were taunted with antigay slurs (Stepp, 2001, A1).

2) 84.3% of LGBT students reported hearing homophobic remarks using words such as faggot or dyke.

3) 90% reported frequently hearing the expression "that's so gay" or "you're so gay".

4) 86% of LGBT students were verbally harassed at school in the past year because of their sexual orientation; 67% were harassed because of their gender expression (acting “too masculine” or “too feminine”).

5) 68.6% of LGBTQ students reported feeling unsafe in school because of their sexual orientation

6) 80.6% of students reported there were no positive portrayals of LGBTQ people, history or events in classes.

 (Gay, Lesbian and Straight education network (GLSEN), 2003; GLSEN, 2009).

Seriously, an allies program that aim to facilitate LGBT youth building up their sexual identity and recognizing their sexual orientation need  to be developed in school especially in Asia countries. I have spent 17 years in school but I couldn't remember there was such program being established in school. Only till recent year I heard that there is school counselor in school (my friend who is the school counselor, and she is the only one that provide counseling services to the students and staff (approximately 700 students in her school). Can you believe that one counselor can handle all 700 students? 

References

Stepp, L. (2001). A lesson in cruelty: Anti-gay slurs common in school. The Washington Post, pp. A1, A7

GLSEN (2009). GLSEN Safe Space Kit: Guide to being an ally with LGBT students. Retrieved  Oct 16, 2012 from http://www.glsen.org/binary-data/GLSEN_ATTACHMENTS/file/000/000/294-10.pdf, pp. 1-48.

GLSEN (2003). GLSEN Safe Space: A how-to guide for starting an allies program, pp. 1-38. New York: Author

LGBT Risk to Mood Disoders and Anxiety Disoders

Many LGBT people suffer from symptoms of depression and anxiety due to a lifetime of discrimination and ridicule. It might be hard for us to imagine how discrimination and prejudice could engenders depression and anxiety, however, we should appreciate and understand the social stress that LGBT people face on top of the common stress we have in your workplace, school and family. There are many findings report that the vulnerability of  LGBT people of having mood disorder and anxiety disorder is much higher than heterosexual people.

1) A study done in 2011 by University of Michigan revealed that  discrimination, harassment and  internalized homonegativity are the main factor that explain depression and anxiety among black sexual minority men. 30% of the sample had a scale scores indicating likelihood of depression and anxiety (Graham et al., 2001).

2) Homosexual seniors who have not come out or come to terms with their sexual orientation may experience depression and isolation from the years of internalized homophobia (Altman, 2000).

3) Chronic low-grade depression is often the reason gay men seek therapeutic assistance. These symptoms can arise out of societal oppression and difficulties they face in the coming-out process. Long term symptoms of depression are masked by substance abuse and only emerge after the individual begins recovery from chemical dependency (Gonsiorek, 1982; Smith, 1988).

4) A research in U.S. based on 912 men who self-identified as both Latino and non-heterosexual showed high prevalence rates of psychological symptoms of distress in the population of gay Latino men during the 6 months before the interview, including suicidal ideation (17% prevalence), anxiety (44%), and depressed mood (80%). Experiences of social discrimination were strong predictors of psychological symptoms (Diaz et al., 2001).

5) In Conhran and Mays' study in 2000, lesbian women are more likely to experience generalized anxiety disorder (GAD) than their heterosexual female counterparts.

6) Homosexual and bisexual individuals are more frequently than heterosexual persons reported both lifetime and day-to-day experiences with discrimination. Approximately 42% attributed this to their sexual orientation, in whole or part. Perceived discrimination was positively associated with both harmful effects on quality of life and indicators of psychiatric morbidity (depression, anxiety disorder, substance abuse, panic disorder) in the total sample(Mays & Cochran, 2001).

7) People with GID often experience anxiety or depression and may have thoughts of suicide (Doctor & Neff, 2001; Bradley. 1995). Anxiety and depression might be the reactions that related to the confusion and pain brought on by the disorder itself, but they may also be tied to the prejudice typically experienced by individuals in daily basis.

I found this interesting picture and I would like to share with you :0

 

Picture link: http://25.media.tumblr.com/tumblr_mbg31rCqsb1qk1b4io1_1280.jpg

 

 

References

Altman, C. (2000). Gay and lesbian seniors: Unique challenges of coming out in later life. SIECUS Report, 4, 14.

Bradley, S. J. (1995).Psychosexual disorders in adolescence. In J. M. Oldham & M. B. Riba (Eds.), American Psychiatric Press review of psychiatry, (Vol. 14). Washington, DC: American Psychiatric Press.

Cochran, S.D, & Mays, V. M. (2000). Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the US population. American Journal of Epidemiology , 151(5), 516-523.

Mays, V. M. & Cochran, S. D (2001). Mental Health Correlates of Perceived Discrimination Among Lesbian, Gay, and Bisexual Adults in the United States. American Journal of Public Health, 91(11), 1869–1876.

 

Díaz RM, Ayala G, Bein E, Henne J & Marin BV. (2001). The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. American Journal of Public Health, 91(6), 927-32.

Doctor, R.M., Neff, B. (2001). Sexual Disorders. In H. S. Friedman (Ed.), Specialty articles from the encyclopedia of mental health. San Diego: Academic Press.

Graham LF, Aronson RE, Nichols T, Stephens CF, Rhodes SD. (2011). Factors Influencing Depression and Anxiety among Black sexual Minority Men. Retrieved October 12, 2012 from http://www.ncbi.nlm.nih.gov/pubmed/21941644

Gonsiorek, J. (1982). The use of diagnostic concepts in working with gay and lesbian populations. Journal of Homosexuality, 7, 9-20.

LGBT Risk to Suicide

Sadly, most of my LGBT friends did think of or attempt suicide when they were facing stress with disclosure or during the coming out process.  It might be rather easy for  heterosexual people to share their love relationship conflict with their significant others and seek advice from them. However,  for LGBT people, due to the sexual stigmatization, majority of them keep their relationship conflict or problem within themselves and hardly express their emotional pain. The hopelessness and helplessness might be the key elucidation of suicidal thoughts and attempt. Here are some research about the LGBT risk to suicidal ideation:

1) A large-scale UK study which compared the mental health of 1,093 heterosexual with 1,284 LGBT people, almost a third of the LGBT people had attempted suicide (King et al., 2003).

2) Research suggest that lesbian are at greater risk for attempting and completing suicide than heterosexual woman. One study of adults found that lesbians were significantly more likely to have considered suicide in the past than heterosexual women, with over half of the lesbians having contemplated suicide (51%), compared to 38% of heterosexual women (Hughes et al., 2000).

3) National lesbian health Care survey (NLHCS) found that over half their lesbian sample had thought about suicide, with 18 % having attempted suicide (Bradford et al., 1997).

4) The  Boston Lesbian health Project II showed that 20% of their sample had made a suicide attempt (Roberts et al., 2004).

5) Between 48% and 76% of homosexual and bisexual youth have thoughts of committing suicide, and 29% to 42% have attempted it, compared with estimated rates of 7% to 13% among high school students in general (Armesto, 2001; Cochran & Mays, 2000; Russell & Joner, 2001).

 

There is always hope, please do not keep this suicidal feelings to yourself, share with someone you trust (at least make a call), it could your friends, parents, family members or counsellor, and let them know how bad things are. Don’t let fear, shame, or embarrassment prevent you from seeking help. Just talking about how you got to this point in your life can release a lot of the pressure that’s building up and help you find a way to cope.

There a few hotlines or organization you could seek help or make call for: Let someone know your pain.

1) Samaritans organization worldwide:

Hong Kong : http://www.samaritans.org.hk - 24/7 hotline: 2896 0000

United States : http://www.samaritansusa.org

Samaritans of Singapore (SOS) : 24/7 hotline: 1800-221 4444

United Kingdom : http://www.samaritansusa.org : 24/7 hotline: 08457 90 90 90

2) USA national suicide hotline http://www.suicidehotlines.com/ 1800-SUICIDE :1-800-784-2433

References

Armesto, J.C. (2001). Attributions and emotional reactions to the identity disclosure of a homosexual child. Family Process, 40(2), 145-162.

Bradford, J., Ryan, C., & Rothblum, E. (1997). National lesbian health care surveys. Implications for mental health care. Journal of Lesbian Studies, I(2), 217-249.

Bradley, S. J. (1995).Psychosexual disorders in adolescence. In J. M. Oldham & M. B. Riba (Eds.), American Psychiatric Press review of psychiatry, (Vol. 14). Washington, DC: American Psychiatric Press.

Cochran, S.D, & Mays, V. M. (2000). Lifetime prevalence of suicide symptom and affective disorder among men reporting samesex sexual partners: Results from NHANES III. American Journal of Public Health, (90)4, 573-578.

Hoare, J. and Moon, D. (Ed.) (2010) Drug Misuse Declared: Findings from the 2009/10 British Crime Survey. Home Office Statistical Bulletin 13/10. Retrieved October 17, from  http://www.homeoffice.gov.uk/rds/pdfs10/hosb1310.pdf

 

Hughes, T.L., Haas, A., Razzano, L., Matthews, A.K., & Cassidy, R.(2000). Comparing lesbians' and heterosexual women's mental health: Findings from a multi-site study. Journal of Gay & Lesbian Social Services, 11, 57-76.

King, M., McKeown, E., Warner, J., Ramsay, A., Johson, K. & Cort, C. (2003). Mental health and quality of life of gay men and lesbian in England and Wales: controlled, cross sectional study. British Journal of Psychiatry, 183, 552-8.

Roberts, S., Grindel, C., Patsdaughter, C. Reardon K., & Tarmina, M. (2004). Mental health problems and use of services of lesbian: Results of the Boston Lesbian Health Project II. Journal of Gay & Lesbian Social Services, 17(4), 1-16.

Russell, S. T., & Jorner, K (2001). Adolescent sexual orientation and suicide risk: Evidence from a natural study. American Journal of Public Health, 91(8), 1276-1282.

LGBT Risk to Substance abuse

Concern have been expressed about the nature and extent of substance misuse or abuse in LGBT communities over the past 20 years. Studies have suggested that the rates of use are higher in comparison to the general population. The possible explanations  for substance abuse have included discrimination, minority stress and living in urban environments or no children in the household. (McCabe et al., 2010; Baiocco et al., 2010; Hoare et al.,2010). However, I believe there are various reasons that caused LGBT people to be vulnerable to substance abuse other than the aforementioned explanations.

1.      Stall and Wiley (1988) report that gay men not only use drugs more often but use a greater variety of drugs than heterosexual men. Explanation for this phenomenon include internalization of society's homophobia, nonacceptance of self, fear of coming-out, low self-esteem and lead a double life (Finnegan & McNally, 2002).

2.      Recent research also suggested that mental disorders are more common in LGBT people which they are more likely to experience psychological distress, to have thoughts of suicide and self harm (Warner et al., 2004).

3.      A UK study of gay and bisexual men identified factors associated with drug and alcohol use such as individual's sense connectedness to LGBT communities (peer pressure), mitigating social unease, alleviating loneliness or unhappiness and enabling sexual encounters (Keogh et al., 2009).

4.      Use of illicit drugs was found to be fairly common in gay and bisexual men, with half having used at least one drug in the last year. The three most common used drugs were alcohol, amyl nitrite and cannabis (Keogh et al., 2009).

5.      LGBT youth Higher rates of substance abuse and alcohol-related problems (Rivers & Noret, 2008), along with more widespread use of marijuana and cocaine than heterosexual youth and adults (Rosario et al., 2004; Ryan & Futterman, 2001). Overall, compared with heterosexual and homosexual men and women, bisexual have been found to be at higher risk for substance abuse (S. T. Russell et al., 2002).

 

References

Baiocco, R., D'Alessio, M. & Laghi, F. (2010). Binge drinking among gay and lesbian youths: the role of internalized sexual stigma, self-disclosure, and individual's sense of connectedness to the gay community. Addictive Behaviors, 35, 896-9.

Finnegan, D., & McNally, E. (2002). Counseling lesbian, gay, bisexual and transgender substance abusers: Dual identities. Binghamton, NY: The Haworth Press.

Hoare, J. and Moon, D. (Ed.) (2010) Drug Misuse Declared: Findings from the 2009/10 British Crime Survey. Home Office Statistical Bulletin 13/10. Retrieved October 17, from  http://www.homeoffice.gov.uk/rds/pdfs10/hosb1310.pdf

Keogh. P., Reid, D., Bourne, A., Weatherburn, P. Hickson, F. Jessup, K. and Hammond, G. (2009). Wasted opportunities: Problematic Alcohol and Drug Use among Gay men and Bisexual Men. London: Sigma Research.

McCabe, S.E., Bostwick, W. B., Hughes, T. L., West, B. T. and Boyd, C. J. (2010). The relationship between discrimination and substance use disorders among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 100, 1946-52. 

Rivers, I., & Noret, N. (2008). Well-being among same-sex and opposite-sex-attracted youth at school. School Psychology Review, 37, 174-187.

Rosario, M., Schrimshaw, E., & Hunter, J. (2004). Predictors of substance use over time among gay, lesbian, and bisexual youths. An examination of three hypotheses. Addictive Behaviors, 29(8), 1623-1631.

Russell, S.T., Driscoll, A.K., & Truong, N. (2002). Adolescent same-sex romantic attractions and relationships: Implications for substance use and abuse. American Journal of Public Health, 92, 198-202.

Ryan, C., & Futterman, D. (2001). Social and developmental challenges for lesbian, gay, bisexual youth. SIECUS Report, 29(4), 5-18.

Stall, R., & Wiley, J. (1988). A comparison of alcohol and drug use patterns of homosexual and heterosexual men. Drug & Alcohol Dependence, 22, 63-73.

LGBT Risk to Mental Disorders

 

It is no doubt that LGBT individuals encounter many steep challenges in their lives. Social stigma, prejudice, discrimination, violence and abuse against LGBT in the mainstream society is the primary challenge they face in their daily life. Furthermore, secondary challenges like rejection of friends and family, being deemed unwelcome by their faith community, bullying and harassment at school and workplace, inequitable legal rights and the risk for harm is enormous (Goldman, 2008). Ryan et al. (2009) report that family and community rejection of LGBT youth, including bullying, can have profound and long-term impacts (e.g., depression, use of illegal drugs, and suicidal behavior).

The removal of homosexuality as mental disorder from DSM II in 1973  did not significantly reduce the stigmazation, prejudice and discrimination towards LGBT, this problem we could probably contribute to the weak public education on LGBT issues. People continue to be homophobic and misunderstand LGBT  as sexually immoral and inappropriate behavior.  

LGBT studies also showed  that LGB people have higher risk, higher prevalence of mental disorders than heterosexual people with the enormous pressures of living in a society that discriminates against them, historical antigay stance and the stigmatization of LGB persons (Bailey, 1999). Some studies suggest that mood, anxiety and substance abuse disorder are likely to be influenced by the effects of oppression and stigma (Dohrenwend, 2000; Markowitz, 1998). Vulnerable and stigmatized groups in general has higher rates of mental illness often result from coping with stigma-related stress. Furthermore, homosexuals and bisexuals are particularly vulnerable to harassment and other forms of risk, further compounding their stress (Mishna et al., 2008). For person who is as both LGBT individual and mental patient, they will be considered  as "the minority within sexual minority" and this "double stigmazation" will further exacerbate his or her mental health condition.

Furthermore, several studies have been published to explain how stigma, prejudice, and discrimination create a hostile and stressful social environment for that causes mental health problems in LGBT group (Meyer, 2003).

You could refer to this link http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2072932/ for more details.

In this blog, I will share findings on the prevalence and risk of mental illness in LGBT people and hope that with these findings and sharing, mainstream public could be aware of the serious consequences they have created by imposing social stress, discrimination and prejudice on LGBT individuals.

If we could embrace the diversity in human regardless of their race, ethnicity, sex and country;why couldn't we embrace the diversity of sexuality in human as well?

References

Bailey JM (1999). Homosexuality and Mental Illness. Arch Gen Psychiatry, 56(10): 883-4.

Dohrenwend, B. P. (2000). The role of adversity and stress in psychopathology: Some evidence and its implications for theory and research. Journal of Health and Social Behavior, 41(1, 1-19.

Goldman L. (2008). Coming Out, Coming In: Nurturing the Well-being and Inclusion of Gay Youth in Mainstream Society. New York: Routledge.

Markowitz, F. E. (1998). The effects of stigma on the psychological well-being and life satisfaction of persons with mental illness. Journal of Health and Social Behavior, 39(4), 335-347.

Meyer, IIan. H (2003) Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. Retrieved October 12, 2012 from http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2072932.

Mishna, F., Newman, P.A., Daley, A. & Solomon, S. (2008). Bullying of lesbian and gay youth: a qualitative investigation. British Journal of Social Work, 39, 1578-1614.

Ryan C, Huebner D, Diaz RM, & Sanchez J. (2009). Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults. Pediatrics, 123, 346–352.

Treament of Gender Identity Disoder (GID)

Hormone therapy and psychotherapy have been used to help some people with this disorder to adopt the gender role they believe represents their true identity. For others, however, this is not enough, they might choose to undergo one of the most controversial practices in medicine : Sex Reassignment Surgery (SRS), in which the person' genitals are changed to match the gender identity.  This surgery is preceded by one to two years of hormone therapy. The operation itself involves, for men, amputation of the penis, creation of an artificial vagina, and face-changing plastic surgery. For women, surgery may include bilateral mastectomy, hysterectomy and phalloplasty. Clinicians have heatedly debated whether surgery is an appropriate treatment for GID. Some consider it a humane solution, perhaps the most satisfying one to people with the disorder (Cohen-Kettenis &Gooren, 1999). Others argue that transsexual surgery is a "drastic nonsolution" for a largely psychological problem. The long term psychological outcome of surgical sex reassignment is not clear. Some people seem to function well for years after such treatment, but others experience psychological difficulties (Lewins, 2002; Michel et al., 2002)

 

My experience with LGBT

In term of my personal experience, I have a few transman friends who have gone SRS, they  function well in their social and occupational life, some even hold managerial position in the organization.  They did admit that this was a difficult journey, however, the satisfaction  they gain from being in their true identity is indeed worth living for them.

James and Jan - Feeling like a woman trapped in a man's body, the British writer James Morris (top) underwent Sex Reassignment Surgery, described in his 1974 autobiography, Conundrum. Today Jan Morris (bottom) is a successful author and seems comfortable with her change of gender

References

Cohen-Kettenis, P. T., & Gooren, L. J. (1999). Transsexualism: A review of etiology, diagnosis and treatment. J. Psychosom. Res., 46(4), 315-333

Comer, R.J. (2007). Fundamentals of Abnormal Psychology (5th ed). New York: Worth Publisher

Lewins, F (2002). Explaining stable partnerships among FTMs and MTFs: A significant difference? J. Sociol, 38(1), 76-88

Michel, A., Ansseau, M., Legros, J.-J., Pitchot, W., & Mormont, C. (2002). The transsexual: What about the future. Eur. Psychiat., 176(6), 353-362

Gender Identity Disorder Etiology

Prevalence of Gender Identity Disorder (GID)

We discussed previously that GID is 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.

These disorder are rare in comparison to most of the other mental disorders. Male-to-female transexuals are more common than female-to-male transexuals. Men with GID outnumber women by around 2 to 1. Some studies estimate the prevalence to be approximately 1:12,000 in males and 1:30,000 in females (Olsson & Moller, 2003. Overall, the prevalence of GID ranges from 0.003% to 3% in boys and 0.001% to 1.5% in girls (Bartlett, et al., 2000).

Gender Identity Disorder Etiology

 Very little is known about their etiology of GID. Cause is largely unknown, however, various theories have been proposed to explain this disorder, but research to test the ideas has been limited and generally weak. For instance, theorist have suggested that GID is the result of an absent father (Stoller, 1979), a mother being enmeshed with her son ( Loeb and Shane, 1982), the parents wishing they had had a child of the opposite sex (Green, 1974), or transsexuals had more feminised 2D:4D ratios finger length(Schneider et al. 2006). After reading several research regarding the etiology of GID, I found that the biological factors play a crucial role in this disorder. Here are some research that support the biological proposal:

1)Hormonal influences

There are some research pointed out that gender identity is strongly influenced by sex hormones , especially during the prenatal period (Diamond, 2009). Early reports suggested that plasma testosterone was lower in MtF transsexuals when compared to heterosexual men (Starká et al., 1975) and higher in FtM transsexual when compared to heterosexual women (Spiová and Starká, 1977). In addition, there is an interesting set of data comes from studies of people with a condition called pseudohermaphroditism. Individuals with this condition are genetically male, but they are unable to produce hormone that is responsible for shaping the male genital in the fetus. Therefore, the child is born with external genitalia that are ambiguous in appearance. Many of these children are raised as girls by their families , when they reach puberty, a sudden increase in testosterone leads to dramatic changes in the primary sexual characteristic of the adolescent's such as clitoris become enlarged and turns into penis, deeper voice, increasing muscle mass and etc. The child quickly begins to consider himself to be a man. The speed and apparent ease that these children adopt a masculine gender identity suggest that their brains had been prenatally programmed for this alternative (Hines, 2004)

2) Brain correlational studies

One biological has received considerable attention (Zhou et al., 1995). This research was to examine the sex difference in the human brain and its relation to transsexuality. Dutch investigators autopsied the brains of six people who had changed their sex  from male to female (MtF). They found that the transsexuals' bed nucleus of stria terminalis of the hypothalamus (BST) was only half as large in these subjects as it was in a control group of normal men (generally, woman's BST is much smaller than a man's). Scientist do not know the function of BST in humans but they know that it helps control sexual behaviour in male rats. This research proposed that men who develop GID have a key biological difference that leaves them very uncomfortable with their assigned sex characteristics.

3) Bruce/Brenda and David Reimer  (A case of a Boy being raised as a Girl)

In 1967, a Canadian couple brought their two identical twin boy (8 months old) to the hospital for routine circumcisions. A surgical mistake during one of the twin's circumcisions resulted in the destruction of his penis. The couple met with Dr.John Money, a well-known medical psychologist who believed that gender was learned and could be changed through child rearing. After meeting with Dr.Money and discussing their options, the couple decided to have their son, Bruce, undergo castration and have surgery to transform his genitals into those of an anatomically correct female. Bruce became Brenda and was raised as a girl. She was put on hormone treatment beginning in adolescence to maintain her feminine appearance.

For many years, this Brenda/Bruce case stood as "proof" that children were psychosexually "neutral" at birth and that gender could be assigned , no matter what the genetic or biology indicated. However, no one paid much attention to the fact that Brenda was struggling against her girlhood and  gender identity from the beginning. Once Brenda reached puberty, despite her hormone treatments, her misery increased. She became depressed and suicidal. She never felt that she was a girl, and she was relentlessly teased by peers. Her parents finally told her the truth, and at 15 years old, she stopped hormonal treatment and changed her name to David.

Soon afterward, David went public with this medical story in hopes of discouraging similar sex assignment (especially nonconsenting minors) and published his real-life story in a book called As nature Made Him: The Boy Who Raised as a Girl. This book, in conjunction with interview with David, influenced medical understanding about the biology of gender.

Although David eventually married and adopted children, his struggles with depression continued. In 2004, at age 38, David committed suicide.

These are the links of YouTube video where you could watch the interview with David Reimer (Part 1 to Part 5)

1) http://www.youtube.com/watch?v=3GhbVFjIaN0

2)http://www.youtube.com/watch?v=noqRhuE8_XA&feature=related

3) http://www.youtube.com/watch?v=5ctg3poxT9g&feature=relmfu

4) http://www.youtube.com/watch?v=Fnb3EwJtsDs&feature=relmfu

5) http://www.youtube.com/watch?v=2OeITsQgKns&feature=relmfu

I always feel downhearted whenever I read through David's story. His life became a tragedy because of our poor medical understanding about the biology of gender and gender identity. From his case, we might conclude that gender is innate and cannot be overridden by nurture or social learning. Indeed, more research should be done to find out the biology of gender as well as etiology of GID  to prevent another tragedy from happening. Research could also benefit psychology clinical practice in terms of the diagnostic assessment and treatment plan.

References

Carroll JL. (2010). Sexuality Now: Embracing diversity (3rd ed). Belmont: Wadsworth Cengage Learning.

Bartlett, N.H., Vasey, P.L., Bukowski, W. (2000). Is gender identity disorder in children a mental disorder. Sex Roles, 43(11-12), 753-785.

Diamond, M. (2009). Clinical implications of the organizational and activational effects of hormones. Hormones and Behavior, 55, 621-632

Green R (1974). Sexual Identity Conflict in Children and Adults. New York: Basic Books.

Hines, M. (2004). Psychosexual development in individuals who have female pseudohermaphroditism. Child and Adolescent Psychiatric Clinics of North America, 13, 641-656

Loeb L and Shane M (1982). The resolution of a transsexual wish in a five-year-old boy. Journal of the American Psychoanalytic Association 30: 419-434.

Olsson, S., & Moller, A. R. (2003). On the incidence and sex ratio of transsexualism in Sweden, 1972-2002. Archives of sexual behaviour, 32, 381-386.

Schneider HJ, Pickel J, & Stalla GK (2006). Typical female 2nd-4th finger length (2D:4D) ratios in male-to-female transsexuals - possible implications for prenatal androgen exposure. Psychoneuroendocrinology 31: 265-269.

Spiová L,  Starká L (1977). Plasma testosterone values in transsexual women. Archieves of Sexual Behaviour 6:477-481.

Starká L, Spiová L, & Hynie J (1975). Plasma testosterone in male transsexuals and homosexuals. Journal of Sex Research 11: 134-138.
Stoller RJ (1979). Fathers of transsexual children. Journal of the American Psychoanalytic Association 27: 837-866.

Zhou JH, Hofman MA, Gooren LJ, and Swaab DF (1995). A sex difference in the human brain and its relation to transsexuality. Nature 378: 68-70