Gender Dysphoria• Occasionally, boys and girls and men

and women feel that there is a mismatch between their anatomy and gender identity so much so they identify more with the opposite sex.

• The feeling of mismatch of anatomy and identity, wanting to be the opposite sex and psychological discomfort is referred to as gender dysphoria.

• It is still considered to be a disorder and is categorised in the DSM as “gender identity disorder.”

Biosocial view including Gender Dysphoria 1

DEFINITION OF GENDER DYSPHORIA (“GENDER IDENTITY DISORDER”)

o A strong and persistent cross-gender identification. o Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.o The disturbance is not concurrent with a physical intersex condition.o The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

In children, 4 or more of the following: Repeatedly stating a desire to be, or insistence that he or she is, the other sex. In boys: preference for cross-dressing or simulating female attire; in girls: insistence on wearing only stereotypical masculine clothing. Strong and persistent preferences for cross-sex roles in make believe play or persistent fantasies of being the other sex. Intense desire to participate in the stereotypical games and pastimes of the other sex. Strong preference for playmates of the other sex.

Zach Avery• Zach Avery has insisted on wearing girls’ clothes

since the age of three. He is now five and was assessed as having Gender Identity Disorder (GID) after worried parents Theresa 32, and Darren, 41, sought medical help.

• Mrs Avery explained her son was a ‘normal’ little boy who liked Thomas the Tank Engine but became obsessed with Dora the Explorer, a television programme aimed at young girls.

• She said: ‘He just turned round to me one day when he was three and said, “Mummy I’m a girl”. I assumed he was just going through a phase and left it at that. ‘But then it got serious and he would be upset if anyone referred to him as a boy. He used to cry and try to cut his willy off out of frustration.’

• Initially, Zach’s parents believed he was autistic but, after several months, a child psychologist diagnosed him with GID when he was four.

• Zach now attends his local primary school where the toilets have been turned gender neutral to support him.

To distinguish Psychological and Biological Explanations of Gender Dysphoria 3

ThePsychological Explanations

Exam Practice •“Discuss explanations of gender dysphoria.” (5+10 marks)

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Psychoanalytic 1

FreudConditioning

Psychoanalytic 2: Separation

anxiety

Gender dysphoria can be explained from a biological and psychological perspective

Psychological

• Psychoanalytic 1: state that problems can result from difficulties with establishing gender identity.

• Psychoanalytic 2: GID could be a result of an attachment disorder.

• Conditioning – Behaviourism and SLT

Biological

• Visual differences in the brain structures of men and women thought to cause transsexualism.

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Freud“Psychoanalytic

1”• Freudian concepts state

that gender dysphoria can result from difficulties establishing gender identity in toddlerhood.

• Gender identity is established through resolution of the Oedipal and Electra complexes in the Phallic stage of development from identification with the same-sex parent.

• Gender dysphoria may result from identification with an inappropriate role model.

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Lothstein (1979), for example, claimed that some female-to-male transsexuals had mothers who lacked a cohesive self with which it was difficult for girls to identify.

A02 Gender identification problems• There is little evidence to suggest that some boys identify

with their mothers and girls identify with their fathers and so go on to experience gender dysphonia.

• As psychoanalytic concepts rely on the unconscious mind and repressed childhood traumas which affect adult personality it is an impossible theory to test in any sort of scientific way.

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Psychoanalytic 2: Attachment problems/separation anxiety

• One approach that may be useful is to look at male children with GD’s attachment to their mother.

• Boys may be ‘trying to restore a fantasy tie to a physically or emotionally absent mother’ (by wearing her clothes!)

• A02 Support -Coates & Person (1985) and Lowry & Zucker (1991) have found a high incidence of separation anxiety in samples of boys with GD (60%). In other words, there is a correlation.

• AO2 Support – Stoller found that individuals with GID had overly close mother-son relationships.

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Evaluation• Cole et al studied 435 individuals experiencing gender

dysphoria and reported that the range of psychiatric conditions experienced were no greater than that found in the normal population. Therefore GID is generally unrelated to trauma or pathological families.

• How is ‘separation anxiety’ measured?• What samples are used?• What inferences can we draw from a correlation?

Conditioning

• Parents of gender dysphorics often report that they gave attention to and encouraged their children when they cross dressed, particularly boys.

• Social learning could also play a part , with an absence of or inappropriate role models to imitate.

• This could lead to conditioning that is incompatible to the individual’s sex and difficulties relating to the opposite sex such as gender dysphoria may follow.

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AO2 support - ConditioningA02 Support:

Rekers reported that out of 70 gender dysphoric boys none had any evidence of biological causes but they had experienced a common lack of a stereotypical male role model – suggesting that social learning theory played a role in the condition.

But ignores role of BIOLOGY

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Ruth’s Story

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http://www.nhs.uk/Conditions/Gender-dysphoria/Pages/Introduction.aspx

Quick Questions

1. According to the Freudian assumption, gender dysphoria children have not passed through which stage?

2. Therefore, according to Freud children are unable to?

3. What is separation anxiety?

4. How can separation anxiety lead to gender dysphoria?

5. How can behaviourist psychology explain gender dysphoria?

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The Biological Explanations

Exam Practice •“Discuss explanations of gender dysphoria.” (5+10 marks)

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Genetics andHormone levels

Environmental pollution

Biological explanation 1:Genetics and hormone levels• Genetic conditions may affect pre-natal hormone levels

which may lead to a mismatch between genetic sex and hormones. It is possible that the hormones have caused parts of the brain to develop in a way that is not consistent with the genitalia and usually with the chromosomes. The brain has not developed in the way that corresponds to the sex/gender assigned to the child at birth.

• Conditions such as AIS and CAH

• Brain sex theory is based on the difference in size of certain brain structures in men and women.

• There has been particular interest in those that are sexually dimorphic i.e. taking a different form in males and females.

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In 1995, Zhou, Hofman and Gooren studied an area of the brain, which

is also located in the hypothalamus, and is known as

the bed nucleus of the stria terminalis central division.

Brain differences• The stria terminalis is believed to be fully developed by

five years and influences sexual behaviour. • In post-mortems of six male-to-female transsexuals who

had received feminising hormones, it was found to be the same size as a heterosexual woman!!

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HOWEVER:Additional post-mortem comparisons, this time with non-transsexual clients with abnormal hormone levels, concluded that the size of BSTc in male-female transsexuals could not be wholly accounted for by their sex hormone exposure in adulthood.

Evaluation• Several brain studies of transsexuals have supported this

view e.g. Zhou et al part of the brain usually larger in males was found to be smaller in six male to female transsexuals. (Zhou et al)

• However, some studies have shown no evidence of atypical biological brain development on people with the condition.

Evaluation• A problem with this theory is that Chung (2002) found that

these brain differences only emerge in adulthood (transsexual feelings usually begin in childhood) suggesting brain differences might be the effect of transsexualism rather than the cause.

• Transgender hormone therapy could have caused any changes identified because brains are examined during adulthood or after death.

• Recent research has suggested the hormones given to help a person become their new gender do affect brain structure – suggesting brains were not different before they started therapy.

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Environmental effects – bio exp 2• One possibility is that environmental pollution may be

causing problems. For example the insecticide DDT contains oestrogens which may affect males prenatally.

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Evaluation of environmental effects – bio exp 2• A number of studies have produced supporting evidence

- for example showing boys exposed to high levels of these chemicals displayed more feminine play.

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Conclusion

What does seem clear is that:• Individuals show gender-inappropriate behaviour for a

variety of reasons.• Any complete explanation of an individual’s gender

behaviour is likely to involve complex interactions of different factors, particularly biological (e.g. genetic and hormonal); social (e.g. parenting, media role models, cultural factors, labelling) and environmental (e.g. learning/ conditioning).

IDA (Issues, Debates and Application)

The complex interaction of nature and nurture•The human brain undergoes considerable development pre-natally and continues to develop after birth.•By the time it is fully developed, the child has also been subjected to numerous environmental influences, including gender socialisation.•It then becomes impossible to detangle the effects of nature and nurture on both the brain and gender development.•It appears that whilst researchers are prepared to accept a biological dysphoria, can we be certain it can be explained in this way alone?

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IDA (Issues, Debates and Application)

• It is generally difficult to tease out any behavioural effects influence by nature and nurture by this becomes even more so in the sensitive area of gender dysphoria where strictly a biological reductionist explanation could be inadequate.

• If the researchers resort to reductionist measures, the fMRI scan is the most informative as it shows the brain in action.

• However, the brain develops pre-natally and continues to develop post-natally when exposed to the environment.

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IDA– cultural issues

• As a culture, we seem to be particularly obsessed with gender roles.

• Perhaps “gender identity disorder” (gender dysphoria) would simply disappear from the psychiatrist’s manuals if we were more relaxed about it!

• Individuals born biologically “intersex” could then decide whether to adopt a male or female role, or stay ‘in-between’.

• Agree or disagree?

Exam question

• Discuss biological and psychological (or biosocial) explanations for gender dysphoria (24 marks)