Gender Dysphoria

In the decade-and-a-half since I coedited Transsexualism and Sex Reassignment (Green & Money, 1969), remarkable changes have occurred with Harry Ben jamin's "transsexual phenomenon" (1966). Formerly, when writing about this condition in scientific journals, it was necessary to define the term transsex ualism. Now the lay public recognizes it. Even the American Psychiatric Asso ciation acknowledges it as a "disorder," with its inclusion in the Third Edition of its Diagnostic and Statistical Manual (1980). Although this "elevation" to the status of mental illness may seem a Pyrrhic victory, it is a recognition of the legitimacy of transsexual ism as a source of human suffering. The controversy that surrounded the decisions in the early patient cases to perform sex-change surgery has largely dissipated. The cries of "collusion with delusion," principally from psychoanalysts, have quieted. The dire predictions of psychosis and/or suicide following surgery as the "last psychic defenses are cut away" have almost never been realized. By contrast, many postoperative patients consider the surgery to have been life-saving. Medical centers worldwide have incorporated programs for evaluating and treating persons requesting sex reas signment. Elaborate guidelines for patient management have been developed by an international organization of health care professionals (Harry Benjamin Inter national Gender Dysphoria Association, 1981). Harry Benjamin's child has come of age.

Contenu
1 Introduction.- Terminology.- Overview.- 2 The Origin of Gender Identity.- Terminology.- Animal Studies.- Human Studies.- Conclusions.- 3 Etiology of Transsexualism.- Essential Characteristics of the Syndrome.- Psychosocial Etiology.- Biological Etiology.- Conclusions.- 4 Cross-Gender-Identified Children.- Phenomenology and Diagnosis.- Epidemiology.- Adaptive Functioning.- Treatment.- Long-Term Follow-Up.- Etiology.- Conclusions.- 5 Gender Disorders in Childhood: A Formulation.- General Observations.- The Child.- The Parents.- Theoretical Formulation.- Sexual Object Choice.- Discussion.- Future Needs.- 6 The Spectrum of Gender Identity Disturbances: An Intrapsychic Model.- Derivation of the Model.- Case Presentation.- Discussion.- Summary.- 7 The Meanings of Cross-Dressing.- Gender Roles and Clothes.- Transsexualism and Gender Identity.- Fetishism.- Sadomasochism and Violence.- Narcissism and Egocentrism.- Conclusions.- 8 Research Methods for the Typological Study of Gender Disorders in Males.- Stability of Gender Identity.- Erotic Partner Preference.- Cross-Gender Fetishism.- Descriptive Classification of Transsexual Males.- Early Cross-Gender History.- Limitations of Self-Report Methods.- 9 Cross-Gender Identity in a Broader Context.- Cross Gender Identity and Heterosexuality versus Homosexuality.- Gender Identity and Intersexes.- The Animal Model.- 10 The Management of Patients with Gender Disorders.- The Establishment of Gender Identity Clinics.- Diagnosis of Transsexualism.- Method of Patient Evaluation.- Establishment of Gross-Gender Identity and Role.- Surgical Management of Transsexuals.- Nonsurgical Management of Patients.- Unusual Gases.- 11 Transsexuals, Transvestites, and their Partners.- Homosexual Transsexuals.- Heterosexual Transsexuals and Transvestites.- Unusual Cases.- 12 Gender Dysphoria and Gender Reorientation.- Presurgical Gender Reorientation.- Love and Work.- Sex Reassignment Surgery.- Conclusions.- 13 Medical-Legal Issues.- Medical and Legal Aspects to the Concept of Sex.- Change of Name.- Birth Certificates.- Changing Other Documents.- Matrimonial Issues.- Child Custody.- Criminal-Legal Aspects.- Wills and Inheritances.- The Legality of Sex Reassignment Surgery.- The Right to Treatment of Transsexuals.- Discrimination.- Recent Legal Developments outside North America.- 14 Transsexualism in the Arts.- 15 A Personal Perspective.