Transcript Gender Identity Disorder: Am I Male or Female?”

Gender Identity Disorder:
Am I Male or Female?”
By Robert Brennan, M.A. MFTI
Apokata. Psychological Services
220 Montgomery Street, Suite 1098
San Francisco, CA 94103
www.ChristianMentalHealth.com
1
Objectives for Today
1. Understand healthy gender identity
2. Undeveloped gender identity patterns
3. Develop compassion for those with
gender identity problems
4. Recovery from gender identity disorder
5. Church response to GID persons
February 2003
Exodus Asia Conference 2003 Teipei
2
Characteristics and Symptoms in
Gender Identity Disorder
Definition of Gender Identity Disorder
 Disturbance in sexual desire
– Cause distress
– Interpersonal difficulties
February 2003
Exodus Asia Conference 2003 Teipei
3
Definitions
 Gender Identity: Subjective awareness of
maleness or femaleness
 Gender Role or Behavior: Pattern of
outward behavior – most culturally
determined
 Sexual Orientation: Preferred sexual
attraction and object choice
 Cross-dresser: one who wears clothes
designed for the opposite sex.
February 2003
Exodus Asia Conference 2003 Teipei
4
Definitions
 Eroticism: Arousal patterns and the
particular stimuli that causes arousal
 Homosexual: of, relating to, or characterized
by a tendency to direct sexual desire toward
another of the same sex.
 Intersexual: intermediate sexual characters
between a typical male and a typical female.
February 2003
Exodus Asia Conference 2003 Teipei
5
Definitions
 Transgender: “Cross-dressing”- exhibiting
the appearance and behavioral
characteristics of the opposite sex. This is
often used in describing a transsexual.
 Transsexual: a person with a urge to belong
to the opposite sex that may be carried to the
point of undergoing surgery to modify the sex
organs to mimic the opposite sex.
February 2003
Exodus Asia Conference 2003 Teipei
6
Definitions
 Transvestite: a person who adopts the
dress and often the behavior typical of
the opposite sex especially for purposes
of emotional or sexual gratification.
February 2003
Exodus Asia Conference 2003 Teipei
7
DSM IV – Definitions
Diagnostic S Manual
Gender Identity Disorder
 A. Strong and persistent cross-gender
identification
February 2003
Exodus Asia Conference 2003 Teipei
8
DSM IV
In Children – 4 or More:
 Repeated stated desire to be, or
insistence of being other sex
 In boys, preference for cross-dressing
or simulating female attire
 In girls, insistence on wearing only male
clothing
February 2003
Exodus Asia Conference 2003 Teipei
9
DSM IV
 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 or pastimes of the
other sex
February 2003
Exodus Asia Conference 2003 Teipei
10
DSM IV
 Strong preference for playmates of the
other sex
February 2003
Exodus Asia Conference 2003 Teipei
11
DSM IV
In Girls:
 Rejection of urinating in sitting position
 Assertion that she will grow male
genitals
 Assertion that she does not want to
grow breasts or menstruate
 Marked aversion toward normative
feminine clothing
February 2003
Exodus Asia Conference 2003 Teipei
12
DSM IV
In Boys:
 Assertions that his male genitals are
disgusting or will disappear or:
– that it would be better to not have male
genitals
 Aversion toward rough and tumble play
 Rejection of male stereotypical toys,
games, activities
February 2003
Exodus Asia Conference 2003 Teipei
13
DSM IV
In Adolescents and Adults
 Stated desire to be the other sex
 Frequent passing as the other sex
February 2003
Exodus Asia Conference 2003 Teipei
14
DSM IV
 Desire to live or be treated as the other
sex
 Conviction that he or she has the typical
feelings and reactions of the other sex
February 2003
Exodus Asia Conference 2003 Teipei
15
DSM IV
 Persistent discomfort with his or her
sex or sense of inappropriateness in
the gender role of that sex
 Preoccupation with getting rid of
primary and secondary sex
characteristics
February 2003
Exodus Asia Conference 2003 Teipei
16
DSM IV
 Request for hormones, surgery or
other procedures to physically alter
sexual characteristics to simulate the
other sex
 Belief that he or she was born the
wrong sex
February 2003
Exodus Asia Conference 2003 Teipei
17
DSM IV
 Disturbance is not concurrent with a
physical intersex condition
 Clinically significant distress or
impairment in social, occupational, or
other important areas of functioning.
February 2003
Exodus Asia Conference 2003 Teipei
18
Note
 Photographs of individuals used to
illustrate Gender Identity Disorder
characteristics have been removed from the
next 5 slides to protect the identity of the
individuals.
February 2003
Exodus Asia Conference 2003 Teipei
19
Prevalence
 Prevalence of Gender Identity Disorder
 M→F = 1 in 10,000
 F→M = 1 in 30,000
February 2003
Exodus Asia Conference 2003 Teipei
20
Gender Identity Formation
Stages
Stage 1 (Birth to Four years old)
– Parental Same-Gender Attachment
Stage 2 (Kindergarten to Elementary
School)
– Social Same-Gender Attachment
February 2003
Exodus Asia Conference 2003 Teipei
21
Gender Identity Formation Stages
Stage 3 (Elementary to Middle School)
– Social Opposite-Gender Attachment
Stage 4 (Middle to High School)
Social Same-Gender Attachment
Stage 5 (High School to College)
– Social Opposite-Gender Attachment
February 2003
Exodus Asia Conference 2003 Teipei
22
Gender Identity Formation Stages
 Stage 6 (Beyond College & Marriage)
– Navigate a mutually nurturing committed
relationship through Marriage & Parenting
February 2003
Exodus Asia Conference 2003 Teipei
23
Gender-Identity-Imprinting
Stage
 Imprinting: An Opportune-Window of time
for Gender Identity to take place
– Successful attainment: Secure Gender Identity
– Attainment failure: Incomplete Gender Identity
 When Imprinting period is passed, child
becomes more vulnerable in Gender Identity
Copyright © Melvin W. Wong, Ph.D.1999
February 2003
Exodus Asia Conference 2003 Teipei
24
Interruptions in Gender
Development
1.
2.
3.
4.
5.
Childhood Traumatic Experience
Sexual Violation and Verbal Abuse
Opposite-Sex Peer Friendship
Same-Sex Peer Friendships
Breakdown of Family System
(Source: Melvin W. Wong, PhD)
February 2003
Exodus Asia Conference 2003 Teipei
25
Family Tree Diagram
Father
Mother
Daughter
February 2003
Son-1
Son-2
Exodus Asia Conference 2003 Teipei
26
Healthy Relationship
Father
Mother
Daughter
Son-1
Son-2
Son separates from mom
for psychological
individuation successfully
February 2003
Exodus Asia Conference 2003 Teipei
27
Healthy Relationship
Father
Mother
Daughter
Son-1
Son-2
Son attempts to attach
to father for GenderIdentity formation
February 2003
Exodus Asia Conference 2003 Teipei
28
Unhealthy Relationship Begins
Father
Mother
Daughter
Son-1
Son-2
Son’s attempts to attach
to father was rebuffed
and he experiences
rejection and hurt
February 2003
Exodus Asia Conference 2003 Teipei
29
Unhealthy Relationship
Defensive Detachment Begins
Father
Mother
Daughter
Son-1
Son-2
Son’s attempts to defend
against more pain from
rejection by defensively
detaching from father’s
relationship emotionally
February 2003
Exodus Asia Conference 2003 Teipei
30
Unhealthy Relationship
Defensive Attachment Begins
Father
Mother
Daughter
Son-1
Son-2
Son has no choice but
to re-attach with mom
for emotional security
February 2003
Exodus Asia Conference 2003 Teipei
31
Unhealthy Relationship
Defensive Attachment Continues
Father
Mother
Daughter
February 2003
Son-1
Son-2
Son has no choice but
to re-attach with mom
for emotional security
Forming Defensive
Attachment
Exodus Asia Conference 2003 Teipei
32
Unhealthy Relationship
Defensive Attachment Intensifies
Father
Mother
Daughter
February 2003
Son-1
Son-2
Son generalizes
defensive detachment
to defensively attach to
girls and women: Nonaggressive & softer
Exodus Asia Conference 2003 Teipei
33
Unhealthy Relationship
Defensive Attachment Intensifies
Father
Mother
Daughter
Girl 1
Girl 2
February 2003
Son-1
Son-2
Generalization
intensifies. Father
becomes a stranger
Exodus Asia Conference 2003 Teipei
34
Unhealthy Relationship
Defensive Attachment Intensifies
Father
Mother
Daughter
Girl 1
Girl 2
February 2003
Son-1
Son-2
Generalization
intensifies. Men are
unfamiliar
Girlfriend
Exodus Asia Conference 2003 Teipei
35
Unhealthy Relationship
Defensive Attachment Solidifies
Grandma
Father
Mother
Daughter
Men are objectifiedcurious-sexualized
Girl 1
Girl 2
February 2003
Son-2
Son-1
Girlfriend
Exodus Asia Conference 2003 Teipei
36
Unhealthy Relationship
Defensive Attachment Solidifies
Aunt 1
Grandma
Father
Mother
Daughter
Men are objectifiedcurious-sexualized
Girl 1
Girl 2
February 2003
Son-2
Son-1
Girlfriend
Exodus Asia Conference 2003 Teipei
37
Fathers of Gender Confused
Alcoholic
Mentally Abusive
Absent, remote, uninvolved
18%
28%
72%
Unaffirming
93%
(Source: Focus on The Family)
February 2003
Exodus Asia Conference 2003 Teipei
38
Mothers of Gender Confused
Mentally Abusive
Unaffirming
28%
93%
(Source: Focus on The Family)
February 2003
Exodus Asia Conference 2003 Teipei
39
Treatment
Therapeutic Approaches to Treatment of GID
• Gender Identity Disorder is an Identity
problem and not a sexual disorder per se
• While sexual issues are symptoms; the key
to treatment is to resolve developmental
issues
• The focus is in the area of Gender security
development
February 2003
Exodus Asia Conference 2003 Teipei
40
Treatment
Therapeutic Approaches to Treatment of GID
 Different for each age group
 Younger the child, the easier & more effective
is the treatment
 Diagnose early
 Average referral is three and a half year-old
 Remember: Most are victims of sexual abuse
February 2003
Exodus Asia Conference 2003 Teipei
41
Church Response to GID
 Reconcile personal gender phobia
 Create a safe environment for GID persons
to receive healing
 Share personal brokenness and gender
difficulties
 Include GID persons in Church life
 Seek to understand GID persons life
 Rejection / abuse is basis for GID
February 2003
Exodus Asia Conference 2003 Teipei
42
Resources
 Exodus Int. web site:
http://www.exodusnorthamerica.org
February 2003
Exodus Asia Conference 2003 Teipei
43