| Stanistaw Dulko, Anna Grabowska, Anna Herman-Jeglinska, "Masculinity, Femininity and Transsexualism", Archives of Sexual Behavior, 31:6 December 2002, pp. 527-534 |
| | Transsexualism does not imply a simple inversion of sex-role patterns: transsexuals differ not only from nontranssexual individuals of the same anatomical sex but also from those of the opposite sex. Moreover, MF transsexualism is not a mirror image of FM transsexualism: it constitutes a more extreme condition in the identification with feminine versus masculine personality traits. These differences seem to be universal for different countries and regions. |
| Lynne Carroll, Paula Gilroy, Jo Ryan, "Counselling Transgendered, Transsexual, and Gender-Variant Clients", Journal of Counseling & Development, 2002, p. 131 |
| | The term transgender was coined in the late 1980s by men who did not find the label transvestite adequate enough to describe their desire to live as a woman. Alternately, the term transsexual was deemed inappropriate because many non-traditionally gender-identified persons did not necessarily want to reconfigure their bodies surgically and hormonally and did not share the desire to pass or to fit into normative gender categories of male and female. |
| "Standards Of Care For Gender Identity Disorders, Sixth Version", The Harry Benjamin Gender Dysphoria Association, February 2001 |
| | The diagnosis of Transsexualism was introduced in the DSM-III in 1980 for gender dysphoric individuals who demonstrated at least two years of continuous interest in transforming the sex of their bodies and their social gender status. Others with gender dysphoria could be diagnosed as Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual Type; or Gender Identity Disorder Not Otherwise Specified (GIDNOS). These diagnostic terms were usually ignored by the media, which used the term transsexual for any person who wanted to change his/her sex and gender. |
| | Between the publication of DSM-III and DSM-IV, the term "transgender" began to be used in various ways. Some employed it to refer to those with unusual gender identities in a value-free manner -- that is, without a connotation of psychopathology. Some people informally used the term to refer to any person with any type of gender identity issues. Transgender is not a formal diagnosis, but many professionals and members of the public found it easier to use informally than GIDNOS, which is a formal diagnosis. |
| | The ICD-10 now provides five diagnoses for the gender identity disorders (F64): Transsexualism (F64.0) has three criteria: 1. The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment; 2. The transsexual identity has been present persistently for at least two years; 3. The disorder is not a symptom of another mental disorder or a chromosomal abnormality. |
| | The term transsexual emerged into professional and public usage in the 1950s as a means of designating a person who aspired to or actually lived in the anatomically contrary gender role, whether or not hormones had been administered or surgery had been performed. |
| | In 1994, the DSM-IV committee replaced the diagnosis of Transsexualism with Gender Identity Disorder. Depending on their age, those with a strong and persistent cross gender identification and a persistent discomfort with their sex or a sense of inappropriateness in the gender role of that sex were to be diagnosed as Gender Identity Disorder of Childhood (302.6), Adolescence, or Adulthood (302.85). For persons who did not meet these criteria, Gender Identity Disorder Not Otherwise Specified (GIDNOS)(302.6) was to be used. This category included a variety of individuals, including those who desired only castration or penectomy without a desire to develop breasts, those who wished hormone therapy and mastectomy without genital reconstruction, those with a congenital intersex condition, those with transient stress-related cross-dressing, and those with considerable ambivalence about giving up their gender status. Patients diagnosed with GID and GIDNOS were to be sub classified according to the sexual orientation: attracted to males; attracted to females; attracted to both; or attracted to neither. |
| | During the 1960s and 1970s, clinicians used the term true transsexual. The true transsexual was thought to be a person with a characteristic path of atypical gender identity development that predicted an improved life from a treatment sequence that culminated in genital surgery. True transsexuals were thought to have: 1) cross-gender identifications that were consistently expressed behaviourally in childhood, adolescence, and adulthood; 2) minimal or no sexual arousal to cross dressing; and 3) no heterosexual interest, relative to their anatomic sex. True transsexuals could be of either sex. True transsexual males were distinguished from males who arrived at the desire to change sex and gender via a reasonably masculine Behavioral developmental pathway. Belief in the true transsexual concept for males dissipated when it was realized that such patients were rarely encountered, and that some of the original true transsexuals had falsified their histories to make their stories match the earliest theories about the disorder. |
| Walter Bockting, Eli Coleman, "A comprehensive Approach to the Treatment of Gender Dysphoria", J of Psychology & Human Sexuality, 5:4 1992, pp. 131-153 |
| | Gender/sexual identity is only one aspect of overall identity. |
| L. Lothstein, "Psychological Testing with Transsexuals: A 30-year Review", Journal of Personality Assessment, 48:5 1984 |
| | The conceptualisation that transsexuals really suffer from a borderline disorder may also provide a possible explanation for the discrepancy between transsexuals clinical material and their psychological test results. For example, transsexuals have been noted to be free of significant psychopathology both on clinical interview and on objective test measures but exhibiting severe psychopathology on projective tests. These patters of behavior and test results are identical to those reported for borderlines. |
| | By viewing the transsexuals psychological test patters in terms of borderline psychopathology, clinicians will no longer need to use psychological testing only to make predictions whether a given transsexual is a good candidate for surgery or determine whether a transsexual is really female or male. Indeed the psychological testing of transsexuals could then be used to assess the patients overall ego strengths and weaknesses and his/her potential for engaging in psychotherapy. |
| | Over the last decade a number of clinicians have suggested that transsexualism may be a variant, or subtype of the spectrum of borderline disturbances, a range of disorders whose aetiology is traceable to a developmental arrest occurring during the rapprochement phase of separation-individualisation (between the ages of 1 to 3). These disorders as seen as involving structural defects and weaknesses of the ego and profound narcissistic and self pathology. |
| L. Lothstein, "Psychodynamics and Sociodynamics of Gender Dysphoric States", American Journal of Psychotherapy, 33:2 April 1979 |
| | In spite of the different labels attributed to gender-dysphoric patients, researchers have isolated core features suggesting a similar clinical phenomenon. These core features included a compulsive belief or wish of the patients to be members of the opposite sex (which was not seen to be delusional) and an insistent request for sex reassignment surgery to ameliorate their condition. The patients often presented with the chief complaint "I am a man/woman trapped in a woman/man's body" a statement which served as the final common pathway for the patients reports of their disorder. |
| | Because clinicians have been pressured to evaluate transsexuals on the basis of extrinsic factors (suitability for surgery) the issues of evaluation, diagnosis and treatment have been sorely neglected. |
| Neil Buhrich, Neil McConaghy, "Parental Relationships During Childhood in Homosexuality, Transvestism and Transsexualism", Australian and New Zeland Journal of Psychiatry, 12:103 1978 |
| | Homosexuality, transvestism and transsexualism appear to be separate diagnostic entities. |
| Bengt Lundstrom, Jan Walinder, "Prognostic Factors in the Assessment of Male Transsexuals for Sex Reassignment", Brit. J. Psychiat., 132 1978, pp. 16-20 |
| p17: | Unstable personality: This factor is difficult to define. Our characterization of unstable personality incudes those who show striking immaturity, low tolerance of frustration, increased suggestibility or pronounced emotional instability. These personality traits are often combined with a poor grasp of reality, and such patients usually entertain unrealistic expectations of what sex reassignment has to offer. |
| P18: | Inadequate support from the family: This means that the patient either entirely lacks family or close friends or that the relatives take an expressly negative attitude to his wish for sex reassignment. |
| L. Lothstein, "Psychotherapy with patients with Gender Dysphoria Syndromes", Bulletin of the Menninger Clinic, 41:6 1977 |
| | Attempts to define the term transsexualism have led to either widespread clinical disagreement or abandonment of the concept. Meyer has suggested that the term transsexualism be restricted to only those individuals who have received sex reassignment surgery, while Fisk has suggested that Gender Dysphoria Syndrome replace the term transsexualism. |
| | Although some clinicians still maintain the idea that a group of pure transsexuals exists for whom SRS ought to be prescribed, the fact is that patients requesting such surgery constitute a diverse group of individuals suffering from a broad range of gender disorders. |
| Linda Friar, George Rekers, Alexander Rosen, "Theoretical and Diagnostic Issues in Child Gender Disturbances", The Journal of Sex Research, 13:2 May 1977, pp. 89-103 |
| | A distinction is made between two different but closely related syndromes, cross gender identification and gender behavior disturbance in male children. |
| | Relationship to other Psychopathology: Cross-gender identification and gender role disturbances may be observed in otherwise well adjusted boys. The behavior of gender disturbed boys frequently causes them to be socially rejected by their peers, resulting in secondary adjustment problems when the boy begins school. The majority of the boys we have evaluated in our clinical experience have suffered from an abnormal amount of depression and social conflict resulting from peer rejection, isolation, and ridicule of their feminine behavior. |
| | Parental Attitude Toward Cross-Gender Role Behaviors: parents of cross gender identified boys fail to perceive anything abnormal until some outside person points it out to them. Once the parents become aware that their boy is behaving in a atypical fashion, they are able to recall many earlier instances of effeminate behavior such as cross-dressing and cross-gender play. |
| | Cross-Dressing: Dressing in feminine clothing or improvising feminine-like dress is an extremely common behavior in cross-gender identified boys. |
| | Cross-Gender Role Play Behavior: Both cross-gender identified boys and gender behavior disturbed boys prefer games and toys which are labelled feminine in our society. An actual dislike for masculine toys and rough and tumble play may be verbalized. Boys with cross-gender identity problems also prefer female playmates over male playmates. |
| | Parent-Child Relationships: An extremely intimate physical and psychological contact with the mother is seen in many boys who are cross-gender identified. In contrast to mothers, fathers of cross-gender identified boys tend to be either psychologically or physically distant in the majority of cases. Frequently they spend little time with their children. In short, the mothers provide the major model of behavior, while the fathers are distant and ineffective as parents. |
| | Physical Appearance: Cross-gender identified boys tend to be attractive in appearance. The mothers often report that the boy was frequently mistaken for a girl in early childhood. The boy's appearance seems to elicit affectionate responses from adults. |
| Jon Meyer, "Training and Accreditaiton for the Treatment of Sexual Disorders", Am J Psychiatry, 133:4 April 1976 |
| | Borderline or narcissistically based sexual disorders: These are sexual disorders having their basis in the relatively stable borderline or narcissistic personality disturbances. Many deviations have their basis in these personality modifications. In particular the gender dysphoria syndromes are most often seen in severely borderline individuals. |
| Claude Friedmann, Martha Kirkpatrick, "Treatment of Requests for Sex-Change Surgery with Psychotherapy", Am J Psychiatry, 133:10 October 1976 |
| | It is important to distinguish between the transsexual syndrome for which sex-reassignment surgery may be the only useful therapy and the transsexual symptom that can benefit from psychotherapy. |
| Lawrence Newman, Robert Stoller, "Nontranssexual Men Who Seek Sex Reassignment", Am J Psychiatry, 131:4 April 1974 |
| | We should not use the diagnostic term "male transsexual" unless the patient presents evidence of lifelong femininity, inability to live according to his assigned gender role, and the capacity to pass in society as a member of the desired cross-gender. |
| Lionel Oversey, Ethel Person, "The Transsexual Syndrome in Males I. Primary Transsexualism", American Journal of Psychotherapy, 28:4 1974 |
| | The differentiation of these patients, one from the other, is not just of academic interest; it is of crucial importance for the psychiatrist who must evaluate applicants for sex reassignment. |
| | Transsexuals fall into two groups: primary and secondary. The former are transsexuals throughout the course of their development; the latter are effeminate homosexuals and transvestites who become transsexuals under stress. |
| Lionel Oversey, Ethel Person, "The Transsexual Syndrome in Males II. Secondary Transsexualism", American Journal of Psychotherapy, 1974 |
| | Secondary transsexualism is defined as a transsexualism developing in homosexuals and transvestites regressively under conditions of stress. |
| | We have defined transsexualism as the wish in biologically normal persons for hormonal and surgical sex reassignment. |
| J Hoenig, J. Kenna, "The Nosological Position of Transsexualism", Archives of Sexual Behavior, 3:3 1974, p. 273 |
| | Just as the patient who is afflicted with this disorder does not fit into any of our social categories and is outside and alone, so also is the condition itself, for we have not made provision in our classification to accommodate it. Just as the loneliness of these patients appeals to our compassion, so do the unusual aspects of this strange syndrome, which make it difficult to fit into diagnostic categories , challenge our scientific interest. |
| | The view has often been put forward that transsexualism is a particular content of a personality disorder, particularly the obsessional or anaclastic type. The coexistence of these personality disorders may well color the transsexual syndrome or receive coloring from it, but are not and cannot be regarded as identical with it. |
| | No standard psychiatric category of mental disorder comfortably embraces the syndrome of transsexualism. It's nosological uniqueness characterizes our dilemma over aetiology, diagnosis and treatment. |
| Jon Meyer, "Clinical Variants Among Applicants for Sex Reassignment", Archives of Sexual Behavior, 3:6 1974, p. 527 |
| | In current lose usage, "transsexual" means a patient who has requested sex conversion. Greater specificity in patient categorization can be achieved by using the general term "gender dysphoria syndrome" with secondary modifying terms describing the primary features of the clinical presentation. |
| | Loose usage of the term "transsexualism" and limitations of the diagnostic categories "transvestism" and "homosexuality" as applied to applicants for sex reassignment have created difficulties in evaluation, disposition, and follow-up. Patients falling into the grey areas between diagnostic categories are more common than those fitting existing typologies. |
| Ray Blanchard, "Typology of Male-to-Female Transsexualism", Archives of Sexual Behavior, 14:3, p. 1985247 |
| | These finding support the view that male transsexuals may be divided into two basic types: heterosexual and homosexual. |