obsolete gender identity disorder in children

Obsolete Gender Identity Disorder in Children

The concept of "gender identity disorder" (GID) in children was a formal diagnosis used to describe distress caused by incongruence between assigned sex and gender identity in pre-pubescent transgender and gender diverse children. However, this term is now considered outdated and has been replaced with more accurate and sensitive language.

Diagnostic Criteria

The diagnostic criteria for GID in children were defined in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The diagnosis involved a difference between one's experienced/expressed gender and assigned gender, and significant distress or problems in everyday functioning [13].

Characteristics

Children with GID might experience discomfort or distress due to the incongruence between their biological sex and gender identity. This condition was characterized by a marked incongruence between an individual's experienced/expressed gender and assigned gender [3]. The diagnosis of GID now includes intersex people comparably with trans people if their clinically assigned gender at birth causes them “distress” for at least 6 months [7].

Evolution of Terminology

The term "gender identity disorder" was introduced in the DSM-III in 1980. However, it has been widely criticized for being stigmatizing and pathologizing. The current understanding is that gender dysphoria is a condition characterized by significant distress due to discordance between biological sex and gender identity [2]. The idea that gender dysphoria is the "defining characteristic that makes someone trans" is very outdated despite it still being the prevailing view [5].

References

• [1] Gender dysphoria in children (GD), also known as gender incongruence of childhood, is a formal diagnosis for distress (gender dysphoria) caused by incongruence between assigned sex and gender identity in some pre-pubescent transgender and gender diverse children.
• [2] Gender dysphoria (GD) is a condition characterized by significant distress due to discordance between biological sex and gender identity.
• [3] Gender incongruence of childhood : Gender incongruence of childhood is characterised by a marked incongruence between an individual's experienced/expressed ...
• [5] The idea that gender dysphoria is the "defining characteristic that makes someone trans" is very outdated despite it still being the prevailing view.
• [7] The diagnosis of GD now includes intersex people comparably with trans people if their clinically assigned gender at birth causes them “distress” for at least 6 months.

Understanding Signs and Symptoms of Obsolete Gender Identity Disorder in Children

Gender dysphoria, previously known as gender identity disorder, can manifest differently in children compared to adolescents and adults. While it's essential to note that the term "gender identity disorder" is no longer used in modern psychiatry, understanding its historical context can provide valuable insights into the signs and symptoms exhibited by children.

Historical Context

In the past, a diagnosis of gender identity disorder was considered for children who displayed significant distress or discomfort with their assigned sex. This condition was characterized by a marked difference between the child's expressed gender and their biological sex (1).

Signs and Symptoms in Children

Children who may have been considered for a diagnosis of gender identity disorder in the past often exhibited the following signs and symptoms:

• Prefer cross-dressing: Some children might express a strong desire to wear clothes typically associated with the opposite sex (2, 4).
• Insist they are of the other sex: Children may insistently claim that they identify as the opposite sex, which can be distressing for them and their caregivers (3).
• Say they wish they would wake up as the other sex: This statement can indicate a child's discomfort with their assigned sex and a desire to be different (3).

Important Considerations

It's crucial to note that these signs and symptoms do not necessarily mean a child has gender dysphoria. Many children, especially young ones, engage in role-playing or explore different identities without experiencing significant distress (12). A diagnosis of gender dysph

Diagnostic Criteria for Obsolete Gender Identity Disorder (GID) in Children

The Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III), published in 1980, introduced the concept of Gender Identity Disorder (GID) in children. This diagnosis was later revised in the DSM-III-R and DSM-IV.

Diagnostic Criteria for GID in Children:

• The DSM-III criteria for GID in children included a persistent identification with the opposite sex, a desire to live and be accepted as a member of the opposite sex, and a strong preference for cross-dressing or other behaviors typical of the opposite sex.
• The DSM-III-R added a criterion of significant distress or impairment in social, occupational, or other areas of functioning due to the gender identity disorder.
• The DSM-IV retained the same criteria as the DSM-III-R but also emphasized the importance of considering cultural and individual differences in evaluating the diagnosis.

Diagnostic Tools for GID:

Several diagnostic tools were used to assess children with suspected GID, including:

• The Gender Identity/Gender Dysphoria Questionnaire for Children (GIGD-QC)
• The Child Behavior Checklist (CBCL)
• The Conners' Parent and Teacher Rating Scales (CPTRS)

These tools were designed to help clinicians evaluate the presence of GID in children, but their clinical validity, strengths, and limitations have not been systematically reviewed.

Relevance of Obsolete Diagnostic Criteria:

The diagnostic criteria for GID in children as outlined in the DSM-III, DSM-III-R, and DSM-IV are no longer considered relevant or valid. The current diagnosis of Gender Dysphoria (GD) in children is based on a different set of criteria, which emphasizes the importance of considering individual differences and cultural context.

References:

• [1] Bloom et al., 2021
• [2] Cohen-Kettenis et al., 2006
• [3] DSM-III, 1980
• [4] DSM-III-R, 1987
• [5] DSM-IV, 1994

Treatment Options for Gender Dysphoria in Children

The treatment options for gender dysphoria in children have evolved over the years, and the current approach focuses on supportive environments and knowledge about treatment to reduce the difference between an individual's inner gender identity and sex assigned at birth.

• Puberty blockers: Hormone-blocker drugs given to adolescents over several months or years that prevent the development of secondary sex characteristics. This treatment is used to give children time to explore their gender identity before making any permanent changes.
  • [7]
  • [8]
• Hormone therapy: The goal of pharmacotherapy is to inhibit or promote the expression of secondary sex characteristics in males and females. However, the data lacks an established standard regiment for hormone combinations used in the treatment of gender dysphoria.
  • [13]

Important Considerations

It's essential to note that the approach to treating gender identity disorder (GID) in childhood and adolescence has been rapidly evolving and is in a state of flux. The Endocrine Society published clinical practice guidelines in 2009, which provide recommendations for managing GID in children.

• Clinical guidelines: The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no established standard regiment exists.
  • [9]

References

• [1]
• [3]
• [7]
• [8]
• [13]

The differential diagnosis for obsolete gender identity disorders in children, as mentioned in the context, involves distinguishing between conditions that may present with similar symptoms to Gender Identity Disorder (GID) or Transsexualism.

According to [4] and [6], differential diagnosis is carried out with disorders and conditions in which violations of gender identity and gender-role behaviour can also be observed. Such conditions include:

• Disorders of sex development, such as intersex conditions
• Psychiatric conditions that may present with symptoms of GID, such as:
  • Mood disorders (e.g., depression)
  • Anxiety disorders
  • Personality disorders
• Neurodevelopmental disorders, such as autism spectrum disorder

It's essential to note that the ICD-11 has redefined gender identity-related health, replacing outdated diagnostic categories like ICD-10's “transsexualism” and “gender identity disorder of childhood” with more nuanced and inclusive terminology [3].

In the context of differential diagnosis, it's crucial to consider the child's overall presentation, including their psychological and emotional well-being, as well as any underlying medical conditions that may be contributing to their symptoms.

The diagnostic criteria for GID in children, as outlined in the DSM-III, DSM-III-R, and DSM-IV, emphasize the importance of a persistent cross-gender identification and a strong desire to live and be accepted as the opposite sex [14]. However, these criteria have been updated in recent years to reflect a more nuanced understanding of gender identity and expression.

In summary, differential diagnosis for obsolete gender identity disorders in children involves considering a range of conditions that may present with similar symptoms, including psychiatric and neurodevelopmental disorders. A comprehensive evaluation, taking into account the child's overall presentation and any underlying medical conditions, is essential to ensure accurate diagnosis and treatment.