Collaborative Group Post

Within this post the group members will look at how Gender Identity Disorder (GID) treatments affect children immediately as well as in the long term.  To start off, GID must be defined in terms of the Diagnostic and Statistical Manual of Mental Disorders, specifically the Fourth Edition Test Revision.

Diagnostic criteria for Gender Identity Disorder

"A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex).

In children, the disturbance is manifested by four (or more) of the following:

(1) repeatedly stated desire to be, or insistence that he or she is, the other sex
(2) in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing
(3) strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex
(4) intense desire to participate in the stereotypical games and pastimes of the other sex
(5) strong preference for playmates of the other sex

In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex.

B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.

In children, the disturbance is manifested by any of the following: in boys, assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games, and activities; in girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing.

In adolescents and adults, the disturbance is manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.

C. The disturbance is no concurrent with a physical intersex condition.
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Coded based on current age:

302.6 Gender Identity Disorder in Children
302.85 Gender Identity Disorder in Adolescents and Adults

Specify if (for sexually mature individuals):

Sexually Attracted to Males
Sexually Attracted to Females
Sexually Attracted to Both
Sexually Attracted to Neither

302.6 Gender Identity Disorder Not Otherwise Specified

This category is included for coding disorders in gender identity that are not classifiable as a specific Gender Identity Disorder. Examples include

1. Intersex conditions (e.g., partial androgen insensitivity syndrome or congenital adrenal hyperplasia) and accompanying gender dysphoria.
2. Transient, stress-related cross-dressing behavior
3. Persistent preoccupation with castration or penectomy without a desire to acquire the sex characteristics of the other sex"

The reason why I give the current conditions for diagnosing children with this "disorder" is because they are just that, current.  Yes, the conditions are going to change, but like we went over in class, it doesn't seem that they will be changing much for children which is a huge problem.  Children are always growing and changing their minds constantly, so it seems to me that it is impossible for a child to be considered disordered on choices they are consciously making without negative effects on themselves or those around them.  Yes, it may make some people uncomfortable but unless they are putting themselves in eminent danger there is no problem with a child wanting to dress as the opposite gender of what they are or play "stereotypical" games of the opposite gender.

-Emily

Throughout the semester we all have made posts and learned more in depth about the DSM and Gender Identity Disorder. Generally GID is a decision based on the individual, and with some criticism to the DSM not delusional as seen in  mental illnesses. There are so many aspects to touch on with the topic. A couple that we found were GID in adolescents, how it "correlates" to other diseases, acceptance, treatments, and rights.  We all really learned a lot this semester through personal exploration and research and  how the justice for transgendered people needs to come forward, and be faced head on. What we also have realized is that people would rather criticize and fix someone who is different rather than to accept them and give them the respect that is right. Someone with Gender Identity Disorder will be picked at, questioned, and pushed to their limits by their hetronormative peers instead of just letting them live their lives.  Through our posts of stories, research, psychological history of Gender Identity Disorder in the DSM we want to inspire you take a opportunity to be open minded to everything that is going on around you, and the privileges that many of us take for granted that we have. Based on a few classifications in the DSM and a decision to be who some wants to be their whole life can be turned upside down, children and adults.
-Brittani

There is no clear cause of GID but here’s what some think: “Many contemporary clinicians have argued that GID in children is the result, at least in part, of psychodynamic and psychosocial mechanisms, which lead to an analogous fantasy solution: that becoming a member of the other sex would somehow resolve internalized distress.” (Zucker) Psychodynamics refers to the relation between conscious and unconscious mental processes, and psychosocial refers to a relation between social and psychological behaviors. The author uses this perspective to argue that when treating children with GID, the primary goal should be to make children comfortable with their biological gender identity. It is apparent that the author places higher validity on the child’s gender over the child’s desired sexuality.

Understandably, there is a lot of controversy surrounding the treatment of GID in children. Professionals Langer and Martin reject hormonal and psychiatric treatment and favor a therapeutic approach arguing that “attempting to change children's gender identity [for the purpose of reducing social ostracism] seems as ethically repellant as bleaching black children's skin in order to improve their social life among white children” (p. 14).

According to Zucker, “the prospects for therapeutic change with regard to GID become considerably less malleable over the life course.” In other words, the successfulness of GID decreases with age.  GID diagnosed adults are rarely interested in psychotherapeutic techniques, usually turning to hormones and surgery, and the ones who do have little success. Adolescents rarely respond to therapeutic treatment as well. Hormones and surgery may be the best remedies for adolescents seeking treatment as well. Zucker believes that there is strong evidence that therapeutics may work in the case of children with GID although, “there is a large empirical black hole in the treatment literature for children with GID. As a result, the therapist must rely largely on the “clinical wisdom” that has accumulated in the case report literature and the conceptual underpinnings that inform the various approaches to intervention.”

-Amanda Ranusch

       GID has two basic models of thought as far as treatment goes. The first is the therapeutic model. This has both the individual child diagnosed with the disorder and their entire family go under psychological therapy. According to the typical therapeutic perspective, the child has a family that is not psychologically and emotionally functioning as it should. His mother could be depressed or clingy; his father could be physically or emotionally absent. These things, according to this perspective, are what causes gender role confusion.
       The second model of thought, called the accommodation model, says the child would be better off as the opposite gender. The downside of this is that if the child changes over time and no longer feels they should be the other gender, it is too late as the changes have already been put in place to change their gender. Also, this model tends to ignore the fact that life is often very stressful as a transgender individual.
-Zack


In "Gender Identity Disorders in Childhood and Adolescence: A Critical Inquiry" the authors touch on what can result if a child is diagnosed with GID. One main short-term thing that they repeatedly going back to was that if a child was diagnosed with GID then they would likely have other pathological disorders; Internalizing or externalizing disorders. Male bodied kids usually showed internalizing disorders(disturbances in emotion i.e. depression) while femal bodied kids expressed externalizing disorders (behavior). They also said that these kids may be expressing some type of distress through gender. As Amanda will touch on soon, they state that these symptoms are not the same in the long-run of these kids' lives.
-Derek


Sources:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author. 2000. web. 25 April 2012

Alice Dreger, "Gender Identity Disorder in Childhood: Inconclusive Advice to Parents," Hastings Center 
       Report 39, no 1 (2009): 26-29. 

Zucker, KJ. “Children with gender identity disorder: Is there a best practice?” Neuropsychiatrie de l'enfance et de l'adolescence [0222-9617]

According to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR), major depressive disorder (MDD), also known as clinical depression or major depression, is characterized by a recurrent low mood along with low self-esteem and loss of interest or pleasure in every day activities.  Many disorders have related symptoms to and are usually comorbid (or paired) with MDD.

According to Branny and White (2008), the prevalence rate for this disorder is much higher for women than it is for men, making men a minority in this area.  This means that more women than men are self-diagnosing themselves and entering themselves into treatment.  For this reason, effective interventions are lower for men than for women.  This makes sense because there won’t be a high push for treating men with depression effectively (and differently than women) if there isn’t a high rate of them seeking treatment.  There may also be an overdiagnosis of women with depression because women are known to be more in tune with how they feel and more open with expressing their emotions.  They may enter themselves into therapy, displaying signs of depression when the cause of their low mood could be temporary, thus relieving their symptoms and them returning to a "normal" state of mind.

According to Branny and White (2008), as far as symptoms in the DSM go for diagnosing depression, they are usually aimed towards women.  Depressed women show symptoms of worry, crying spells, helplessness, loneliness, suicidal idea, augmented appetite and weight gain, which are all recorded in the DSM as symptoms of depression.  Some symptoms that are not common to diagnostic criteria for (adult) depression are slow movements, scarcity of gestures and slow speech, non-verbal hostility, trait hostility, and alcohol dependence in difficult times.  These are all symptoms shown by men but are not under the criteria for being diagnosed with depression.  Here is an outlined list found in “Big boys don’t cry: depression in men” of non-diagnostic symptoms of depression:

Diagnostic criteria and non-diagnostic symptoms for depression

ICD–10 F32 Depressive episode (World Health Organization, 1992)

·       Depressed mood

·       Loss of interest or enjoyment

·       Reduced energy, leading to increased fatiguability and diminished activity

·       Marked tiredness after slight effort

·       Reduced concentration and attention

·       Reduced self-esteem and self-confidence¹

·       Ideas of guilt and unworthiness

·       Bleak and pessimistic views of the future

·       Ideas or acts of self-harm or suicide¹

·       Disturbed sleep

·       Diminished appetite¹

DSM–IV Major depressive episode (American Psychiatric Association, 1994)

·       Depressed mood

·       Loss of interest or enjoyment

·       Weight loss

·       Insomnia or hypersomnia

·       Psychomotor agitation

·       Fatigue

·       Feelings of unworthiness¹

·       Reduced concentration

·       Slow movements²

·       Slow speech²

Non-diagnostic symptoms

·       Alcohol dependence during difficult times²

·       Bodily pains¹

·       Hostility (non-verbal)²

·       Hostility (trait)²

·       Scarcity of guestures²

·       Stooping posture¹

            According to Li, Guiseppe, and Froh (2006), “in gender role theory, the feminine style of coping is to deal with the emotion associated with the stressor (emotion focused), whereas the masculine style is to deal directly with the stressor (problem focused).”  According to Branny and White (2008), this causes some to question whether or not we are addressing depression in the right way.  Some have suggested that ‘male depressive syndrome’ (characterized by periodic irritability, anger attacks, and aggressive behavior) needs to be addressed as a symptom or branch of depression so that men can be diagnosed correctly instead of overlooked based on the non-feminine symptoms they may exhibit.

So as you can see, this disorder is typically seen in females rather than males.  I believe, however, that this is because of the pressure society puts on men to be strong and unemotional in a sense as well as the stigma that is put on women that they are weak and emotional.  There is also no real reason for men to think there is something wrong with them because they do not display the written symptoms of depression, which are targeted towards females.  For this reason, men are likely underreported because they do not want to seem weak in the eyes of others for feeling the way that they do, or because they are exhibiting symptoms that are not classified in the DSM.

-Emily

References:

American Psychiatric Association.. Diagnostic and statistical
manual of mental disorders (4th ed., text rev.). 2000. web. 25 April 2012
doi:10.1176/appi.books.9780890423349.

Li, C., DiGiuseppe, R. and Froh, J. "The roles of sex, gender, and coping in adolescent depression." Adolescence. 2006. web. 25 April 2012 409–415.
 

Peter Branney and Alan White. "Big boys don't cry: depression and men." Advances in PsychiatricTreatment. 2008. web. 25 April 2012. 256-252. 

Eating Disorders and Gender Identity Disorder

    In an article titled Gender Identity Disorder and Eating Disorders, by Hepp, Urs and Milos, Gabriella there was a case study on three adult patients who were seeking out GID treatment who had also been diagnosed to have eating disorders.  Through studying these patients in the out patient program they tried to loosely link GID to cause higher risk factors for eating disorders. In psychology however, it is very hard to prove that one thing causes another because everyone is different.


     There was an interesting quote used in the article that said:

"Homosexual men are more likely to desire an underweight ideal.." (Hepp and Milos 2002)

This statement i'm sure was based on the idea that society pushes our women to be super skinny and model like, and ideally homosexual men want to fit into society's idea of a perfect woman. This is bold to say because not every homosexual man is pushing to be transgender or possess woman like qualities, so how do push this mainly on homosexual men.

     It was also really hard for me to go with what this article was saying because it pushes the on the idea that people with GID will push themselves to eating disorders because of the fact they are so unhappy with their bodies only. From prior knowledge there is plenty of information on how most transgender people have to go to sex work and alcohol abuse (one disorder mentioned in the article), so it may have come to them trying to make their body look good to make a living or it may be because of messed up living situations that causes depression that leads to abuse of their bodies.

     To simply link a disorder based on skeptic belief that everyone wants to fit in to this perfect woman, is absurd, to me at least. While I am sure yes there are situations in which such reasons create a backdrop for disorders, its hard to put a label that transgender people are at risk because of an ideal body shape. It does not make sense really, because a lot of people with eating disorders transgender, homosexual, heterosexual, or asexual for that matter can develop an issue with their body image on the basis of societal pressures, equally.

References

Hepp, Urs, and Gabriella Milos. "Gender Identity Disorder and Eating Disorders."International Journal of Eating Disorders. Wiley Periodicals Inc, 2002. Web. 25 Apr. 2012. <http://onlinelibrary.wiley.com.ezproxy.emich.edu/doi/10.1002/eat.10090/abstract>.

-Brittani Moorer

The Ethics of Gender Identity Disorder

     I am like most people educated about equal rights and GID. I have a strong belief that it should be removed from the DSM V scheduled to come out very soon. It only makes sense that people making the decision that they are knowingly the wrong sex biologically does not make them mentally ill at all. The idea of GID is that someone decides that their assigned sex does not match who they feel they are inside. I do not see this as any different, from realizing that you are not an athlete or an actress, its just some things that we know about  our selves that make us all uniquely different.

     With the information I have learned over the course of the semester about GID I realized that it is unfair to not give transgendered people the right to everything that heteronormative society seems to be entitled to in some way. I think more in a since of equality for all people, black, white, orange, or purple it doesn't matter, whats right is whats right. Transgendered people have not broken any legal laws nor have they physically hurt anyone in the process so I think that it is a no brainer to allow a simpler process when it comes to making decisions about their lives and especially how they choose to live it (i.e. social security cards, licenses, etc.).

     Reading the article "Ethics of Gender Identity Disorder" written by Colin Ross brought up some sticky points. He first mentions how we can rule out GID as not a mental disorder. Through all the explanation, he came to the conclusion that people who decide to transition do just that,  decide. If they were to speak to a professional they could identify their biological sex, but also can say that they do not fit that outer appearance inside. This brings up the fact that they are not delusional, however a bit unhappy about the mismatch of body vs mind in a physical sense. So on the basis of Ross's description, we could easily rule out GID  as a mental disorder as we did homosexuality in the DSM in the 70s.

     There are cons to removing the disorder from the DSM though and this where it gets tough feeling through all the fine print. He brings up an argument comparing women who get breast augmentation vs transition surgery. Similarly in both cases there are two people who are unhappy with their bodies and decide to change their physical appearance to alter the negative feelings associated with it. The interesting point brought up was the fact that women always pay for the augmentation procedures, but in some cases with GID there are insurance companies to help with the costs on the grounds of it being a disorder.

     So now we are left to ponder the fact is it even ethical to leave GID in the DSM on the basis that there is no disorder for women who dislike the size or shape of their breasts. As silly as it may sound there is a point here, two adults with different situations but the bottom line is the same they so not like the body they were born in. With GID there is sometimes assistance from health insurance institutions, but with breast augmentation there is never any help. Should we pathologize one issue over another based on what society accepts, or should we do whats logical and remove GID all together from the DSM. It sounds a bit harsh because the procedures are pricey and these people need help. Looking at the situation technically however it seems politically correct to remove it all together.

     It sounds a little bittersweet to remove GID and not receive help because the condition does not qualify as a disorder. We can look at the brighter side for transgender people getting the respect they deserve as well. Its a tough cookie to take in, but as a country built on equality, we all have to sit back and come to a middle ground as to what is fair. If necessary we can try and scale back prices to make these procedures more affordable, but we cannot ignore the fact of the diagnosis because we want to help some people and not others.

Sticky Right.!?!

VS.

References

Ross, C.. (2009). Ethics of Gender Identity Disorder. Ethical Human Psychology and Psychiatry, 11(3), 165-170.  Retrieved April 25, 2012, from ProQuest Psychology Journals. (Document ID: 1923231181).

-Brittani Moorer

Borderline Personality Disorder (BPD), according to the Diagnostic and Statistical Manual for Mental Disorders (DSM), belongs to Cluster B of the personality disorders, which can be seen as dramatic, emotional, and erratic behaviors.  According to the most current DSM there are nine ways to tell if someone is suffering from BPD (a minimum of five being required to have the diagnosis):

(a) frantic efforts to avoid abandonment; (b) a history of unstable and intense relationships with others; (c) identity disturbance; (d) impulsivity in at least two functional areas such as spending, sex, substance use, eating, or driving; (e) recurrent suicidal threats or behaviors as well as self mutilation; (f) affective instability with marked reactivity of mood; (g) chronic feelings of emptiness; (h) inappropriate and intense anger or difficulty controlling anger; and (i) transient stress-induced paranoid ideation or severe dissociative symptoms. (Wiederman and Sansone 277)

            One thing that caught my eye while looking at this disorder was the third way to see if someone is suffering from BPD, which is “identity disturbance.”  I began to ask myself, “What exactly is meant by ‘identity disturbance’ and can it be used to be a deciding factor in whether someone has BPD or not?”  Well I began to look deeper and found an article by Michael W. Wiederman and Randy A. Sansone.  Within the article it stated that more than 20 years ago, researchers found a high rate of homosexuality within the diagnosis of BPD.  Knowing that most disorders are comorbid, or have another disorder accompanying them, I put two and two together and realized that by “identity disturbance” they were directly involving homosexuality as a determining factor in BPD.  I just imagined psychologists or psychiatrists asking patients whether or not they were gay or lesbian and then checking that requirement off the checklist, making it that much more easy for homosexuals to be considered disordered. 

Another fact that is thrown at readers is that “at some point” over a 10-year study period, one third of either the men or women in that study reported having engaged in some sort of a homosexual relationship, thus checking them off the list again.  According to Robert O. Friedal, the age of onset for BPD is usually in the teenage years or early twenties, a.k.a the end of high school/early college years.  Now I don’t know about anyone else out there, but I’m pretty sure many teenagers are just starting to figure themselves out at that age and will most certainly do some experimenting.  To have been in that study and said “yes, I did have sexual relations that would be considered homosexual at some point through the past ten years, but it doesn’t define my sexuality,” I doubt they would have been listened to and would have just been considered to have had that disorder because it’s just another check mark on a list which should not relate to sexuality in the first place.  Although this study focuses more so on homosexuality, I couldn’t help but think about how Gender Identity Disorder (GID) can also play into this.  I mean, one of the criteria is “identity disturbance” and people who do consider themselves another gender, or no gender at all, will most certainly be the first people to be diagnosed with this disorder for displaying that certain criteria.

            Being homosexual or having GID is definitely not the end-all be-all determining factor in BPD, in fact sexuality in general is a big part of it.  If you look back at the criteria for diagnosing BPD one of the criteria listed is “unstable and intense relationships with others.”  Another criteria is “impulsivity in at least two functional areas such as spending, sex, substance abuse, eating, or driving.”  Within the article that I read, BPD usually stems from childhood abuse, most of it being sexual.  Knowing that cycles often repeat when experiencing abuse it can only be assumed that those sexually abused children will one day become promiscuous (as seen in cases of BPD) or the sexual abusers themselves. 

It is also suggested that unstable and abusive relationships at such a young age can cause poor attachment systems between the parent and child which can later result in poor ways of handling adult relationships or even post-traumatic anxiety in dealing with sexual relationships.  This can lead to either sexual avoidance or promiscuity with partners barely known.  It was also said in the article that sexual promiscuity was mostly seen in heterosexual women as well as gay men as they may have an easier time finding men interested in casual, no strings attached sex.  The article then connected this to “impulsivity and a relatively unstable sense of personal identity being an explanation for the higher rates of homosexual behavior in individuals with BPD.”  It’s funny that they relate “unstable sense of personal identity” and homosexual behavior since homosexuality has been out of the DSM for quite some time now.  It just shows that some people are still under the impression that homosexuality is dysfunctional and an abnormal way to live.
Another point made in this article was that way more women than men are diagnosed with this disorder.  Because it talks about sexual promiscuity being one of the main traits of this disorder, it's easy to recognize that it is still viewed as way more "abnormal" for women to be sexually promiscuous than men.  Because men have the stigma that they should be sexual beings, I assume that they are less likely than women to fit the criteria for this disorder.  According to Wiederman and Sansone, BPD manifests itself differently in each sex.  Women display it more in a histrionic fashion (self-harming, eating disorders, post-traumatic stress, etc.) while men display more antisocial features (fighting, reckless behavior, substance abuse, etc.  This being said along with the fact that it is abnormal for women to be sexually promiscuous, BPD sounds much more similar to the way women display it rather than how men display it resulting in men being diagnosed/misdiagnosed with antisocial personality disorder.  The way society views women and men can have a huge impact on the way they are perceived even when dealing with a diagnosis of a mental disorder.

-Emily

Recources:

Michael W. Wiederman, and Randy A. Sansone. "Borderline Personality Disorder and Sexuality." The Family Journal. July 2009. Web. 25 April 2012

Robert O. Friedel. "Borderline Personality Disorder Demystified: Knowledge is the edge." 2012. Web. 25 April 2012. http://www.bpddemystified.com/index.asp?id=2

The Diagnostic and Statistical Manual for Mental Disorders (DSM) has had many successes and many critiques over the years as far as diagnosing people with certain disorders goes.  It has definitely come a long way since it's first edition, which came out in 1952.  Even before that time (as far back as 5000 BCE according to studentpulse.com) people were diagnosing people with being either mentally disturbed or mentally stable.  For example, if anything seemed off about you, you were automatically assumed to be possessed by demons and the treatment for that was trephining, or more simply put, drilling holes in one's head to release said demons.  This resulted in the person reverting to a vegetative-state or, more often than not, death.  These classifications of who was sane and insane were also socially bound.  If we jump back to when the first DSM came out, homosexuality was in there, not because it was scientifically proven to be a disease but because many people did not approve of homosexuality at the time and did not see it as normal behavior.

Now, if you're like me you figure that after the elimination of homosexuality from the DSM, psychologists and psychiatrists have come a long way and rely on research and science more-so than popular opinion to diagnose clients as abnormal or normal.  This much is true, psychologists and psychiatrists have come a long way in deciphering between what is opinion and what is fact, but there is still much to do in defining what exactly should be considered disordered behavior.  In these nest couple of posts I will look at the DSM and disorders surrounding sexuality and gender or the ways in which sexuality and gender play a role in certain disorders.

-Emily

Psychological Damage to Adolescents with GID

     In an article I read published in Yahoo! News there is apparent a strong tie with psychiatric risk with children with Gender Identity Disorder. A couple of months back in February there was a study within the Children's Hospital of Boston, that showed:

"Of these patients, who first came to Children's Hospital Boston at an average age of 14.8 years, 44 percent had a history of psychiatric symptoms, 37 percent were taking psychotropic medications, 21 percent had a history of self-mutilation and 9 percent had attempted suicide." (PRNewswire 2012)

Though these facts can prove to be a little disturbing, it is a little light at the end of the tunnel I believe. With this new information we can teach our parents to our children ways to often avoid escalated issues in the future. 

     I believe that a good piece that tied into this somewhat was the article we read in class by Alice Dreger, "Gender Identity Disorder in Childhood: Inconclusive Advice to Parents". There is some helpful advice in this article on how to handle your child's situation without being biased or cold. The one method that I found particularly helpful in light of these facts of the Yahoo! article was the idea to accommodate the child, supporting them, and going with their feelings, beliefs, and what felt right to them.
     I think that knowing this information based on factual studies is a good thing, because it shows that medical doctors and psychiatrists are moving away from unbiased opinions and shelling out information that is viable and worth people knowing and using. It is hard to be a parent of a child with GID I'm sure, however there is always room to improve and change tactics to handling situations for the greater good.

References

"Children with Gender Identity Disorder Are at Serious Psychiatric Risk." Yahoo! News. PRNews, 20 Feb. 2012. Web. 24 Apr. 2012. <http://news.yahoo.com/children-gender-identity-disorder-serious-psychiatric-risk-050219755.html>. 

Dreger, Alice. "Gender Identity Disorder in Childhood: Inconclusive Advice to Parents." 

The Hastings Center Report, Jan.-Feb. 2009. Web. 19 Mar. 2012. <http://corwin.emich.edu.ezproxy.emich.edu/sfx_local/?genre=article&sid=ProQ:&atitle=Gender%20Identity%20Disorder%20in%20Childhood%3A%20Inconclusive%20Advice%20to%20Parents&title=The%20Hastings%20Center%20Report&issn=00930334&date=2009-01-01&volume=39&issue=1&spage=26&au=Alice%20Dreger>.

 -Brittani Moorer