Commentary on Langer and Martin’s (2004) “How Dresses Can Make You Mentally Ill: Examining Gender Identity Disorder in Children”

Abstract

Langer and Martin's (2004) essay on the diagnosis of Gender Identity Disorder in Children (GIDC) is the most recent addition to a literature of critics. Although many of Langer and Martin's criticisms have been raised by others, elements of their essay are novel. In this commentary, I attempt to counter some of their criticisms with a more detailed explication of the theoretical, research, and clinical literature on GID in children.

The Needs of Gender-Variant Children and Their Parents: A Parent Survey

“…Though transpositive approaches to working with gender-variant children and their families have been strongly advocated during the last decade (Brill & Pepper, 2008;Cohen-Kettenis & Pfafflin, 2003;Hill, Menvielle, Sica, & Johnson, 2010;Lev, 2004), there is still controversy among clinicians regarding the most suitable approach for working with gendervariant children (Cohen-Kettenis, Delemarrevan de Waal, & Gooren, 2008;Hill et al, 2007;Langer & Martin, 2004;Zucker, 2006). Also, the issues faced by prepubertal gender-variant children are different to those faced by adolescents (de Vries, Cohen-Kettenis, & Delemarre-van de Waal, 2007;Olsen, Forbes, & Belzer, 2011), who are much more likely to persist into adulthood (Wallien & Cohen-Kettenis, 2008).…”

From Mental Disorder to Iatrogenic Hypogonadism: Dilemmas in Conceptualizing Gender Identity Variants as Psychiatric Conditions

“…There also seems to be considerable intraindividual variability in gender-related distress over time. I am, therefore, not convinced that--in the absence of systematic documentation of distress--it is appropriate to routinely attribute “inherent distress” to all who want to change gender (Zucker, 2006). If one postulates “inherent distress,” would one not also have to attribute something like “body dysphoria” to patients with somatic diseases or disorders who decide for surgery (say, of a facial wart) or radiation treatment (of cancer) and thereby label them as having a “mental disorder”?…”

The DSM Diagnostic Criteria for Gender Identity Disorder in Children

“…As a member of the DSM-III-R Subcommittee on Gender Identity Disorders, I have reviewed my own correspondence file and could find no indication that this distinction was either noted or commented upon by the Subcommittee at large. My conclusion, as stated in Zucker (2006a), was that ''the committee just goofed.'' It is also conceivable that the distinctions in phraseology were overlooked in the context of the added proviso of ''persistent and intense distress.…”

“…As I have noted elsewhere (Zucker, 2006a), it is not clear why the DSM-III-R wound up changing the criteria for boys to ''an intense desire'' to be a girl from a ''strongly and persistently stated desire.'' The original was clearly more stringent.…”