Allison Owen-Anderson

Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism.

This study provided a descriptive and quantitative comparative analysis of data from an assessment protocol for adolescents referred clinically for gender identity disorder (n = 192; 105 boys, 87 girls) or transvestic fetishism (n = 137, all boys). The protocol included information on demographics, behavior problems, and psychosexual measures. Gender identity disorder and transvestic fetishism youth had high rates of general behavior problems and poor peer relations. On the psychosexual measures, gender identity disorder patients had considerably greater cross-gender behavior and gender dysphoria than did transvestic fetishism youth and other control youth. Male gender identity disorder patients classified as having a nonhomosexual sexual orientation (in relation to birth sex) reported more indicators of transvestic fetishism than did male gender identity disorder patients classified as having a homosexual sexual orientation (in relation to birth sex). The percentage of transvestic fetishism youth and male gender identity disorder patients with a nonhomosexual sexual orientation self-reported similar degrees of behaviors pertaining to transvestic fetishism. Last, male and female gender identity disorder patients with a homosexual sexual orientation had more recalled cross-gender behavior during childhood and more concurrent cross-gender behavior and gender dysphoria than did patients with a nonhomosexual sexual orientation. The authors discuss the clinical utility of their assessment protocol.

Patterns of Referral to a Gender Identity Service for Children and Adolescents (1976–2011): Age, Sex Ratio, and Sexual Orientation

In a previous Letter to the Editor (Zucker, Bradley, Owen-Anderson, Kibblewhite, & Cantor, 2008), we provided data on the number of referred children and adolescents to a specialized gender identity service between the years 1976–2007 (grouped by 4-year intervals). In that Letter, we noted three key observations: (a) the number of children assessed on an annual basis substantially exceeded the number of adolescents assessed; (b) the number of referred children increased sharply for the 1988–1991 cohort and had remained stable since that time; and (c) in the last cohort of adolescents (2004–2007), there was a sharp increase in the number of cases. Regarding the last point, we queried whether gender identity disorder in adolescents was “coming out of the closet” and suggested a number of reasons why this might be the case. In this Letter, we provide information on a new cohort (2008–2011) and, in addition, consider more carefully some other demographic factors, including the sex ratio, the sex ratio by age intervals, and the sexual orientation of the adolescent patients.

The Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults: Further Validity Evidence

This study aimed to provide further validity evidence for the dimensional measurement of gender identity and gender dysphoria in both adolescents and adults. Adolescents and adults with gender identity disorder (GID) were compared to clinical control (CC) adolescents and adults on the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ–AA), a 27-item scale originally developed by Deogracias et al. (2007). In Study 1, adolescents with GID (n = 44) were compared to CC adolescents (n = 98); and in Study 2, adults with GID (n = 41) were compared to CC adults (n = 94). In both studies, clients with GID self-reported significantly more gender dysphoria than did the CCs, with excellent sensitivity and specificity rates. In both studies, degree of self-reported gender dysphoria was significantly correlated with recall of cross-gender behavior in childhood—a test of convergent validity. The research and clinical utility of the GIDYQ–AA is discussed, including directions for further research in distinct clinical populations.

Is gender identity disorder in adolescents coming out of the closet

Over the past several years, many media articles, television programs, and films have paid attention to gender identity issues in both children and adolescents. In the film Boys Don’t Cry in 1999, for example, the actress Hilary Swank won an Academy Award for her role as Brandon Teena. Teena (born Teena Brandon), a female-to-male transsexual from Nebraska, was raped and subsequently murdered in 1993 at the age of 21 after two of his male friends discovered that he was a biological female (Sloop, 2000; Willox, 2003). The print media has also given attention to gender identity disorder (GID), including articles in Time (Cloud, 2000), Saturday Night (Bauer, 2002), and the New York Times (Brown, 2006). On May 12, 2004 the Oprah Winfrey Show, which attracts at least 20 million daily viewers in the United States alone, featured several “transgendered” children and their parents and, on April 27, 2007, ABC’s 20/20 had a similar show. Over the years, we have noted that there really are no good epidemiological prevalence studies of GID. Accordingly, we have been limited in our research, which now spans 30 years, to the study of clinic-referred children (Zucker, 2007; Zucker & Bradley, 1995). Figure 1 shows the number of children and adolescents with gender identity disorder (GID) referred to, and then assessed in, our clinic, grouped by four-year intervals. We excluded children referred for fetishistic crossdressing and we excluded referred adolescents who were diagnosed with transvestic fetishism (without co-occurring gender dysphoria), gay youth, and youth who were “undifferentiated” (see Zucker & Bradley, 1995).

Cross-National Replication of the Gender Identity Interview for Children

We administered the Gender Identity Interview for Children, a 12-item child-informant measure, to children referred clinically for gender identity problems in Toronto, Ontario, Canada (N = 329) and Amsterdam, The Netherlands (N = 228) and 173 control children. Confirmatory factor analysis identified a Cognitive Gender Confusion factor (4 items) and an Affective Gender Confusion factor (8 items). Patients from both clinics had a significantly higher deviant total score than the controls, and the Dutch patients had a significantly higher deviant score than the Toronto patients. In this cross-national study, we are the first to report on the validity of this measure to discriminate children with gender identity disorder from controls outside of North America.

A Parent-report Gender Identity Questionnaire for Children: A Cross-national, Cross-clinic Comparative Analysis:

A one-factor, 14-item parent-report Gender Identity Questionnaire for Children (GIQC) was developed in a sample of 325 clinic-referred children with gender identity problems and 504 controls from Toronto, Canada (Johnson et al., 2004). In this study, we report a cross-national, cross-clinic comparative analysis of the GIQC on gender-referred children (N = 338) from Toronto and gender-referred children (N = 175) from Utrecht, The Netherlands. Across clinics, the results showed both similarities and differences. Gender-referred boys from Utrecht had a significantly higher total score (indicating more cross-gender behavior) than did gender-referred boys from Toronto, but there was no significant difference for girls. In the Toronto sample, the gender-referred girls had a significantly higher total score than the gender-referred boys, but there was no significant sex difference in the Utrecht sample. Across both clinics, gender-referred children who met the complete DSM criteria for gender identity disorder (GID) had a significantly higher cross-gender score than the gender-referred children who were subthreshold for GID (Cohensd = 1.11). The results of this study provide the first empirical evidence of relative similarity in cross-gender behavior in a sample of gender-referred children from western Europe when compared to North American children. The results also provide some support for cross-clinic consistency in clinician-based diagnosis of GID.

Puberty-Blocking Hormonal Therapy for Adolescents with Gender Identity Disorder: A Descriptive Clinical Study

The use of puberty-delaying or blocking hormonal treatment of adolescents with gender identity disorder (GID) has become increasingly common. In the present study, we examined demographic, behavior problem, and psychosexual measures to see if any of them correlated with the clinical decision to recommend, or not recommend, puberty-blocking hormonal therapy in a consecutive series of 109 adolescents (55 females, 54 males) with GID evaluated between 2000 and 2009. Of the 109 adolescents, 66 (60.6%) were recommended for puberty-blocking hormonal therapy and 43 (39.4%) were not. A combination of five (of 15) demographic, behavior problem, and psychosexual measures were identified in a logistic regression analysis to significantly predict this clinical recommendation. The quantitative data were complemented by clinical case descriptions and some follow-up information. We discuss our data in relation to the Dutch model of early biomedical treatment for youth with GID and consider areas that require further clinical and empirical examination.

Expressed Emotion in Mothers of Boys with Gender Identity Disorder

The authors examined the construct of expressed emotion in mothers of 20 boys with gender identity disorder (GID), 20 clinical control boys with externalizing disorders (ECC), 20 community control boys (NCB), and 20 community control girls (NCG). The mean age of the children was 6.86 years (SD = 1.46, range = 4–8 years). The authors predicted that the mothers of boys with GID would demonstrate (a) higher percentages of expressed emotion, criticism, and emotional overinvolvement compared with normal controls; and (b) higher percentages of only emotional overinvolvement compared with mothers of boys with externalizing difficulties. They used the Five-Minute Speech Sample (Magaña-Amato, A., 1986) to assess maternal expressed emotion. A significantly greater percentage of mothers in both clinical groups were classified as high expressed emotion than mothers in the NCB group. When the authors compared the GID group with all other groups combined, they found that the mothers of boys with GID were classified as having higher levels of a combination of both high or borderline emotional overinvolvement and low criticism than were mothers in the other 3 groups. The authors discuss expressed emotion as a maternal characteristic in the genesis and perpetuation of GID in boys.