39 - Gender identity disorders

Gender identity disorders

© SPMM Course Habit and impulse disorders Impulse control disorders (DSM-IV) or habit and impulse disorders (ICD 10 –chapter F 63) include the following: Kleptomania, Pyromania, Trichotillomania, Intermittent explosive disorder (not in ICD-10, but present in DSM-IV) & Pathological gambling. These disorders are typified by recurrent behaviours that appear irrational and result in harming the patient's own and others interests. This definition excludes the habitual excessive use of alcohol or drugs or sexual (F65.-) or eating (F52.-) related compulsive acts. A repeated failure  to  resist  impulses  (to  set  fire,  steal,  pull  one’s  own  hair  etc.)  is  a  common  theme. Gender identity disorders ICD-10 recognises three disorders: transsexualism, dual role transvestism and gender identity disorders of childhood. Gender identity is established  by  3  years;  it  is  an  individual’s  self  perception  of  being  male  or  female  and   depends on reared sex more than biological sex. It is resistant to change once established firmly. Gender dysphoria refers  to  feeling  of  incongruence  between  one’s  gender  identity  (I’m  a  man, or  I’m  a   woman)  and  one’s  phenotypic  appearance  (I  appear  like  a  man  or  woman). Various degrees of gender dysphoria exist. One mild form is recognized in ICD and DSM as dual role transvestism. Individuals with dual role transvestism wear clothes of the opposite sex in order to experience temporary membership in the opposite sex. The individual experiences a sense of appropriateness by wearing clothes of the other gender. There is no sexual motivation for the cross-dressing. The individual has no desire for a permanent change to the opposite sex. Dual role transvestism must be differentiated from fetishistic transvestism where cross-dressing results in sexual arousal often associated with masturbation or sexual activity. This is classified as a paraphilia (see below). A severe form of gender dysphoria is recognised as transsexualism in ICD and DSM. Transsexualism has the following criteria: x Persistent discomfort with his/her sex or sense of inappropriateness in the gender role of the sex x Strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). This may be associated with the wish to  make  one’s  body  as  congruent   as possible with the preferred sex through surgery and hormone treatment. x The disturbance is not concurrent with a physical intersex condition and not due to other functional psychiatric disorders x The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning x The transsexual identity has been present persistently for at least two years.