 |
 |
|
|
Children who dislike their sexual identity and yearn to be members of the opposite sex are often rejected by their peers and even family members.
If untreated, they become increasingly unhappy with their sexual identity, leading to further isolation and depression.
So said Lawrence Newman, M.D., a child and adolescent psychiatrist in private practice in Los Angeles who treats numerous children and adults with gender identity disorder. Boys are four times more likely than girls to have the disorder, he noted.
Newman, who is also an assistant clinical professor in the division of child psychiatry, University of California at Los Angeles, spoke at the annual meeting of the American Academy of Child and Adolescent Psychiatry in Toronto in October.
Boys between the ages of 4 and 6 who cross-dress, say they wish to be a girl, and play girls’ roles in games may be initially tolerated by a young female playmate. When boys and girls turn 8 or 9, however, they form groups and consolidate their own sense of identity. That is when they often reject these feminine boys as strange, said Newman.
"Boys with gender identity disorder become increasingly isolated as they get older and often develop comorbid states such as depression, anxiety, and school problems due to withdrawal," said Newman.
Difficulty with social adjustment and relationships with peers can have devastating consequences as the child becomes an adolescent, observed Newman. Without treatment in childhood, persistent gender identity disorder dysphoria and distress can develop.
"It is possible to reverse this pattern and make the child happy with him- or herself. The child will retain a lot of creative and artistic abilities, which are desirable qualities associated with this syndrome," said Newman.
Parents usually seek psychiatric consultation when their child’s behavior persists and they see that the child is increasingly isolated and unhappy, Newman added.
Once he diagnoses gender identity disorder based on the criteria listed in DSM-IV, Newman explains to the parents that there is no known specific etiology or cause and that no one is to blame. He also cautions them that the disorder can have lifelong implications and is not merely a passing phase.
"I believe parents can make an enormous difference in the outcome of this disorder, especially when the child is young, because the problems are easier to treat," said Newman.
Because some parents hope that treatment will prevent the child from becoming homosexual, Newman explains to them that no known therapy would change the probability of that outcome.
"The evidence is fairly clear from a landmark long-term study published in the late 1980’s that a majority of boys diagnosed with gender identity disorder will develop a homosexual orientation later in life."
However, regardless of the parents’ position on homosexuality, most want their child to be happy. "That appeal is a very strong motivator," said Newman.
He meets regularly with the parents to work on issues such as homophobic attitudes to lessen the child’s distress and unhappiness. He meets separately with the child for psychotherapy over an extended period.
"It is amazing to see the child’s increased happiness with his or her sexual identity and improvements in social adjustment and acceptance by peers in just one or two years of therapy and parental involvement," said Newman.
A case in point was a severely depressed 10-year-old boy who had low-self-esteem, dressed oddly, and performed poorly in school.
He had no friends and was hated and teased by his two brothers. His father ignored and rejected him, complaining that he had nothing in common with his son, said Newman.
"That boy was headed for trouble," he commented.
"During my conversation with his parents, I challenged the father about his homophobic attitudes, which were the basis for his rejection, and he agreed to enter treatment to overcome them.
"I told him that ‘regardless of whether or not your son becomes a homosexual, your rejection is harming him now and will permanently damage your relationship with him.’"
Newman said, with his encouragement, the boy dressed in jeans to look like the other boys in school and interacted more assertively with other children. His father also encouraged him to be more outgoing and became more actively involved with him, noted Newman.
"It is very important to involve the fathers in treatment," Newman stated.
With parental support, the boy also became involved in sports and went on to become a champion swimmer and tennis player in high school in addition to class president, said Newman.
"The boy, whose orientation will probably be homosexual, now appears self-confident, happy, and secure in himself," said Newman.