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Gender Identity Disorder A condition in which a male or female feels a strong identification with the opposite sex.

it is a formal diagnosis used by psychologists and physicians to describe persons who experience significant gender dysphoria (discontent with the biological sex they were born with). A person with this disorder often experiences great discomfort regarding his or her actual anatomic gender. People with gender identity disorder may act and present themselves as members of the opposite sex and may express a desire to alter their bodies. The disorder affects an individual's self-image, and can impact the person's mannerisms, behavior, and dress. Individuals who are committed to altering their physical appearance through cosmetics, hormones and, in some cases, surgery are known as transsexuals. Cause: The exact cause of gender identity disorder is not known, but several theories exist. These theories suggest that the disorder may be caused by Genetic (chromosomal) abnormalities, hormone imbalances during fetal childhood development, defects in normal human bonding child rearing, or a combination of these factors.

How common is gender Idenity disorder? Gender identity disorder is a rare disorder that affects children and adults. It can be evident in early childhood. In fact, most people recognize that they have a gender identity problem before they reach adolescence. The disorder occurs more often in males than in females. Children with gender identity disorder often display the following symptoms:

Expressed desire to be the opposite sex (including passing oneself off as the opposite sex and calling oneself by an opposite sex name). Disgust with their own genitals (Boys may pretend not to have a penis. Girls may fear growing breasts and menstruating and may refuse to sit when urinating. They also may bind their breasts to make them less noticeable.) Belief that they will grow up to become the opposite sex. Rejection by their peer groups. Dressing and behaving in a manner typical of the opposite sex (for example, a female wearing boy's underwear). Withdrawal from social interaction and activity. Feelings of isolation, depression, and anxiety.

Adults with gender identity disorder often display the following symptoms:

Desire to live as a person of the opposite sex. Desire to be rid of their own genitals. Dressing and behaving in a manner typical of the opposite sex. Withdrawal from social interaction and activity. Feelings of isolation, depression, and anxiety.

How Is Gender Identity Disorder Diagnosed? Gender identity disorder typically is diagnosed by a trained mental health professional (psychiatrist or psychologist). A thorough medical history and psychological exam are performed to rule out other possible causes for the symptoms, such as depression, anxiety, or psychosis. Gender identity disorder is diagnosed when the evaluation confirms the persistent desire to be the opposite sex. How Is Gender Identity Disorder Treated? Individual and family counseling usually is recommended to treat children with gender identity disorder. Counseling focuses on treating the associated problems of depression and anxiety and on improving self-esteem. Therapy also aims at helping the individual function as well as possible within his or her biological gender. Counseling is recommended for adults, as is involvement in a support group. Some transsexual adults request hormone and surgical treatments to suppress their biological sex characteristics and to achieve those of the opposite sex. The surgical alteration of a person's sex is called gender reassignment surgery (sometimes referred to as a "sex change" operation). Because this surgery is major and irreversible, candidates for surgery must undergo an extensive evaluation and transition period. What Are the Complications of Gender Identity Disorder? If not addressed, the disorder can cause a poor self-image, social isolation, and emotional distress. Untreated, the disorder can also cause severe depression and anxiety, and can interfere with an individual's ability to function, leading to problems in school or work, or with developing relationships. Paraphilia
Paraphilias are sexual behaviors in which unusual objects or scenarios are necessary to achieve sexual excitement.1 Eight paraphilias are recognized which are grouped into 3 broad catergories. Paraphilias are

problems with controlling impulses that are characterized by recurrent and intense sexual fantasies, urges, and behaviors involving unusual objects, activities, or situations not considered sexually arousing to others. In addition, these objects, activities or situations often are necessary for the person's sexual functioning. With a paraphilia, the individual's urges and behaviors cause significant distress and/or personal, social or occupational dysfunction.

Preferences for Nonhuman Objects There are two types of preferences for nonhuman objects: fetishism and transvestism. Fetishism A fetish exists when a person is sexually aroused by a nonliving object. It can manifest in two ways, one more extreme than the other. One form associates coitus with some object (most frequently women's panties or other undergarments1 ). It is relatively harmless if the action is taken playfully and is acceptable to the person's partner. A related disorder, called partialism, involves becoming sexually aroused by a body

part, such as the feet, breasts or buttocks.

The more extreme form of fetishism is when a nonliving object completely substitutes for a human partner, such as underwear, boots, and shoes or such textured objects as velvet or silk. Here, orgasm is achieved when the person is alone, fondling the object. Transvestism This paraphilia exists when the person achieves sexual excitement by cross-dressing. This is very rarely found in females so the male side of this paraphilia will be used as the example. Two different purposes seem to be associated with this act in different individuals. In one aspect the person seeks to intensify sexual excitement in intercourse with a partner by only partially dressing as a woman. In the other form, the male moves about in full female regailia, which suggests some type of gender identity problem but not necessarily homosexuality. Transvestitism

Transvestitism, or transvestic fetishism, refers to the practice by heterosexual males of dressing in female clothes to produce or enhance sexual arousal. The sexual arousal usually does not involve a real partner, but includes the fantasy that the individual is the female partner, as well. Some men wear only one special piece of female clothing, such as underwear, while others fully dress as female, including hair style and make-up. Crossdressing itself is not a problem, unless it is necessary for the individual to become sexually aroused or experience sexual climax.
Preferences for Situations Causing Suffering Sadism and Masochism The term sadist is derived from the reported violent sexual exploits of the Marquis de Sade. "Sadist" is applied to those who derive sexual excitement from the pain of others. The term masochist was derived from the writing of Leopold von Sacher-Masoch whose characters sought out women who would beat them. "Masochist" is applied to those who derive sexual excitement through their own pain. Hence, sadists and masochists go hand in hand, one depending on the need of the other. The danger of these needs is that each may need succesively more brutal treatment to satisfy their sexual needs. Preference for Nonconsenting Partners The three types of this catergory of paraphilia are exhibitionism, voyeurism, and pedophilia. All three are considered crimes in this country and are almost entirely male crimes. Exhibitionism Exhibitionism is the exposure of one's genitals in a public place. It is the most prominent sexual offense leading to arrest and makes up one third of all sexual crimes. 1 From the psychological point of view, there are three characteristic features of the exhibition. First, it is always performed for unknown women; second, it always takes place where sexual intercourse is impossible, for example in a crowded shopping mall; and third, it must be shocking for the unknown woman or it seems to lose its power to produce sexual arousal in the individual. Exhibitionists are not assaultive and are considered more of a nuisance than an actual danger.

Voyeurism Looking at sexually arousing pictures or situations is a relatively common, apparently normal activity. The difference between this and voyeurism is that in normal watching, the viewing is a prelude to normal sexual activity. In the voyeur or "Peeping Tom" the experience replaces normal sexual activity. Nevertheless, voyeurism may exist in a person who also engages in normal heterosexual activity.1 Pedophilia Pedophilia is the act of deriving sexual excitement through the physical contact of children. This paraphilia is radically different from exhibitionism and voyeurism in its severely damaging impact on the nonconsenting partner, a child. Ordinarily, the pedophiliac is someone who has ready access to the child. The child or parent would have no reason to suspect that the individual has a pedophilic orientation. CAUSE:

It is not know for certain what causes paraphilia. Some experts believe it is caused by a childhood trauma, such as sexual abuse. Others suggest that objects or situations can become sexually arousing if they are frequently and repeatedly associated with a pleasurable sexual activity. In most cases, the individual with a paraphilia has difficulty developing personal and sexual relationships with others. Many paraphilias begin during adolescence and continue into adulthood. The intensity and occurrence of the fantasies associated with paraphilia vary with the individual, but usually decrease as the person ages.


Psychotherapy - Long-term individual or group psychotherapy is usually necessary and may be especially helpful when it is part of multimodal treatment that includes social skills training, treatment of comorbid physical and psychiatric disorders (eg, seizure disorders, attention deficit disorder, depression), and hormonal treatment. Antiandrogen Drugs - In the USA, IM medroxyprogesterone acetate is the treatment of choice; cyproterone acetate is used in Europe. Typically, a male with a moderate to severe paraphilia is given medroxyprogesterone. Treatment is usually long-term, because deviant sexual arousal patterns usually reoccur shortly after testosterone levels return to normal. SSRIs ( selective serotonin reuptake inhibitors) - eg, fluoxetine or fluvoxamine may be useful.