POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

“WRITTEN REPORT: GENDER DYSPHORIA”

A Project
Presented to Prof. Aimee Rose Arguelles-Manda
Graduate School – Masters in Psychology
Polytechnic University of the Philippines
Sta. Mesa, Manila

In Partial Fulfillment of the Requirements for the Subject of

Seminar in Abnormal Psychology
(1PSY658- Sun 8:00am-5:00pm)

by

Annie Jane P. Tagum

May 2019
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OVERVIEW ON GENDER DYSPHORIA

Gender Dysphoria

One of the changed named features of the DSM-5 is Gender Dysphoria. It

was known from DSM-IV-TR as the Gender Identity Disorder. To start off, as
children and adults, most people feel like and identify themselves as males or
females- a feeling and identity that is consistent with their assigned gender, the
gender to which they are born or their natal gender. Which correlates with significant
distress or impairment with this gender mismatch. People with Gender Dysphoria
typically would like to get rid of their primary and secondary sex characteristics that
many their own genitals repugnant and acquire the characteristics of another sex.
(APA, 2013). However, it just so happens that like adults, children feel
uncomfortable about their assigned gender and yearn to be members of another
gender. In some cases, the childhood pattern disappears by adolescent or
adulthood, but in some case it develops into adolescent and adulthood forms of
Gender Dysphoria. Many Clinicians try to explains that the suspect was that of
biological factors. Perhaps genetic or prenatal plays a key role in Gender Dysphoria.

Description

302.6 (F64.2) Gender Dysphoria in Children- The characteristics of GD in

children are similar to those in adults, but manifest themselves in age-
appropriate ways. So, in their powerful longing to be the opposite gender, kids
may insist that’s what they are; they prefer clothing, toys, games, playmate,
and fantasy roles of the other gender while rejecting their own; and they may
say that they hate their own genitalia and want that which they don’t have. In
children, the number of criteria at least 6 out of 8. American Psychiatric
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Association. (2013). Gender Dysphoria Page 452. In Diagnostic and

statistical manual of mental disorders (5th ed.).

302. 85 (F64.1) Gender Dysphoria in Adolescents and Adults- There is a

marked disparity between nominal (natal) gender and what the patient
experiences as a sense of self. This can be experienced/expressed as a
rejection or wish no to have one’s own sex characteristics or to have those of
other gender. The patient might also express the desire to belong to the other
gender and to be treated as though that were the case. American Psychiatric
Association. (2013). Gender Dysphoria Page 452. In Diagnostic and
statistical manual of mental disorders (5th ed.).

302.6(F64.8) Other Specified Gender- We could include a patient who has

met GD criteria for less than the 6-month minimum. American Psychiatric
Association. (2013). Gender Dysphoria Page 459. In Diagnostic and
statistical manual of mental disorders (5th ed.).

302.6 (F64.9) Unspecified Gender Dysphoria- Use unspecified GD for

cases of GD symptoms that do not meet full diagnostic criteria and about
which you do not wish to be more specific. American Psychiatric Association.
(2013). Gender Dysphoria Page 459. In Diagnostic and statistical manual of
mental disorders (5th ed.).
 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

Clients Patterns of Gender Dysphoria

Richard Carol (2007) who is a leading theorist on Gender Dysphoria

has described 3 patterns of Gender Dysphoria for which commonly seek of
treatment:

1. FEMALE TO MALE GENDER DYSPHORIA

People with this pattern are born female but appear or behave in a
stereotypically masculine manner from early on- often as young at the age of
3 years old or younger. As children they always play rough games or sports,
prefers the company of boys, hates “girlish clothes and state their wish to be
male. As adolescents they become disgusted by the physical changes of
puberty and are sexually attracted to females.

2. MALE TO FEMALE GENDER DYSPHORIA: ANDROPHILIC TYPE

People with androphilic type of male-to-female gender dysphoria are

born male but appear or behave in a stereotypically female manner from birth.
As children, they are viewed as effeminate, pretty, and gentle; avoid rough
games; and hate to dress in boys’ clothing. As adolescents, they become
sexually attracted to males, and they often come out as gay and develop gay
relationships (the term “androphilic” means attracted to males). But by
adulthood, it often becomes clear to them that such gay relationships do not
truly address their gender dysphoric feelings because they want to be with
heterosexual men who are attracted to them as women.
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3. MALE-TO-FEMALE GENDER DYSPHORIA: AUTOGYNEPHILIC TYPE

People with an autogynephilic type of male-to-female gender

dysphoria are not sexually attracted to males; rather, they are attracted to the
idea of themselves being female (the term “autogynephilic” means attracted
to oneself as a female). Like males with the paraphilic disorder transvestic
disorder (see pages 449–450), persons with this form of gender dysphoria
behave in a stereotypically masculine manner as children, start to enjoy
dressing in female clothing during childhood, and after puberty become
sexually aroused when they cross-dress. Also, like males with transvestic
disorder, they are attracted to females during and beyond adolescence.
However, unlike people with transvestic disorder, these persons have desires
of becoming female that become increasingly intense and overwhelming
during adulthood

ASSESSMENT TOOLS AND PROCEDURES

1. Gender Identity Reflection and Rumination Scale- The GRRS

(Bauerband & Galupo, 2014) assesses the extent to which a person thinks
about their gender identity, both positively (reflection) and negatively
(rumination), and how others perceive their gender. The GRRS has 15 items
and three factors: Reflection, Rumination, and Preoccupation with Other’s
Perceptions. Example items include “I think that I will never be able to present
my gender the way I want,” and “I wish I could stop thinking about my gender
identity.”
Procedure: 15 items, 4 point likert-type scale. Higher scores indicate
more frequent thinking about gender identity.
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2. Gender Minority Stress and Resilience Scale- Testa, Habarth, Peta,
Balsam, and Bockting (2015) developed the GMRS to measure the difficulties
associated with identifying as a gender minority and protective factors for
psychological well-being. The GMRS was developed using Meyer’s (2003)
minority stress model and the expanded model for TGNC people (Hendricks
& Testa, 2012). The 58 items were adapted from other measures and
compiled into the GMRS to measure nine different constructs. Seven scales
assess the stressors associated with transgender identity including Gender-
related Discrimination, Gender-related Rejection, Gender-related
Victimization, Non-affirmation of Gender Identity, Internalized Transphobia,
Negative Expectations for Future Events, and Nondisclosure. The two
resiliency scales are Community Connectedness and Pride
Procedure: Sub-scale scores only. Varied scoring between subscales.
Higher scores indicate more of the sub-scale.

3. Masculine Gender Identity in Female Scale- The Masculine Gender

Identity Scale for Females (MGIS; Blanchard & Freund, 1983) was developed
to measure "masculinity" occurring in homosexual females. Masculine gender
identity in females was conceived as a continuous variable, inferable from the
extent of an individual's departure from the usual female pattern of behavior
toward the pattern typical of female-to-male transsexuals.
Procedure: The MGIS is a self-administered, multiple-choice
questionnaire measure. It includes two subscales. The 20 items of Part A
mainly concern the examinee's childhood preference for female versus male
playmates, games, and toys; the predilection for stereotypically masculine
household chores; childhood fantasies of adult pursuits commonly associated
with the male or female sex; and the frequency of frank cross-gender wishes
at various ages. Part A may be administered to any female over the age of
17. Part B consists mostly of items concerning cross-dressing and erotic
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preferences presupposing homosexuality. This subscale, which includes nine
items, is only appropriate for homosexual females.

4. Questionnaire on young Children’s Sexual Learning- The

Questionnaire on Young Children’s Sexual Learning is composed of three
separate scales. The Knowledge About Young Children’s Sexual Learning
Scale consists of 21 true-or-false statements designed to assess knowledge
about young children’s sexual development and learning. The
Attitudes/Beliefs About Young Children’s Sexual Learning Scale contains 28
statements to which a respondent indicates on a 5-point Likert scale his or
her attitudes and beliefs about sexual development and how young children
should learn about various aspects of sexuality. The Comfort With Young
Children’s Sexual Learning Scale lists 10 topics that adults typically need to
discuss or deal with when interacting with young children. Respondents
indicate their comfort level with these topics on a 4-point Likert-type scale.
(Brick, P. & Koch, P.B., 1996)
Procedures: respondents choose the answer to each statement that
best reflects their level of knowledge from 1 = Definitely True, 2 = Probably
True, 3 = Probably False, 4 = Definitely False, 5 = Don’t Know. This scale
requires no more than 10 minutes to complete. Respondents choose the
response which best reflects their attitudes/beliefs toward each statement on
the Attitudes/ Beliefs About Young Children’s Sexual Learning Scale from 1 =
Strongly Agree, 2 = Agree, 3 = Uncertain, 4 = Disagree, 5 = Strongly
Disagree. This scale requires no more than 15 minutes to complete. On The
Comfort With Young Children’s Sexual Learning Scale, respondents indicate
their comfort level in interacting with young children about each sexual topic
from 1 = Very Comfortable, 2 = Somewhat Comfortable, 3 = Somewhat
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Uncomfortable, 4 = Very Uncomfortable. Respondents can complete this
scale in less than 5 minutes.

CURRENT EVIDENCE-BASED PRACTICE APPLIED IN TREATMENT FOR THE

DISORDER
“A Proposed Approach Treating Gender Dysphoria Through Body Image
Therapy”
By Yuchen Wang, College of William and Mary Williamsburg, VA December 17,
2018
Research or Evidence based Treatment for gender Dysphoria has been very
rare. Also, there is treatment that directly targets the body dissatisfaction aspect of
Gender Dysphoria. The researchers of this journal studied a proposed approach on
treating Gender Dysphoria through Body Image Therapy. The relationship of their
chosen subjects makes a significant sense. Because Gender Dysphoria is described
as individual’s affective and cognitive discontent with their body assigned gender.
The Body Image Therapy was used to treat eating disorders. There is a parallel
relationship between the 2 disorders. Clients diagnosed with Gender Dysphoria and
Eating Disorder both requires change in their current physical status. In researchers
address to Gender Dysphoria through Body Image Therapy proposed 10 session
Cognitive Behavioral Treatment to effectively address the negative body image issue
of Transgender population on the result of the research. There was a significant
advantage on the proposed approach model for treating body image in person
diagnosed with Gender Dysphoria. Through addressing identity change according to
the researcher can help clients feel more comfortable with their identity but not
necessarily their body. By including the Cognitive Behavioral association between
Body Image and Gender Dysphoria, transgender populations redirect them to focus
on positive side of their body and clients learn to accept their bodies that were not
masculine/feminine enough.
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TRENDS AND ISSUES

“Parent reports of adolescents and young adults perceived to show signs of a

rapid onset of gender dysphoria”
By Lisa Littman- Department of Behavioral and Social Sciences, Brown University
School of Public Health, Providence, Rhode Island, United States of America. (2019)
https://doi.org/10.1371/journal.pone.0214157 

Parents have reported that their children seemed to experience a rapid onset
of gender dysphoria in an on-line forum found by the researcher. Researchers
collected data about to study parent’s observations, experiences and perspective
about their adolescent and young adults. Children showing signs of an apparent
sudden onset of Gender Dysphoria which began during and after puberty and to
develop hypothesis about the factors that may contribute to the onset of Gender
Dysphoria in the chosen demographic group of the researcher. Their description and
exploratory study with recruitment information to link the 90 questions survey
consisting of multiple-choice Likert-scale and open-ended questions on the website
they set up. The criteria that they set may held them on the indication of their child’s
onset if it’s during or after puberty. 256 parents completed the survey. In their
findings, a potential new subcategory of Gender Dysphoria was possible, because of
the social influences and maladaptive coping mechanisms. Parent child conflict was
seen as explanation. However, further more researches are to encourage on the
researcher was suggested to be required and include data collection to further
explore the roles of social influence, maladaptive coping mechanisms, parental
approaches and family dynamics. That could be an early development and duration
of Gender Dysphoria in adolescents and children.
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References:

Bauerband LA, Galupo MP. The gender identity reflection and rumination scale:
development and psychometric evaluation. Journal of Counseling & Development.
2014; 92:219–231. DOI: 10.1002/j.1556-6676.2014.00151.x

Blanchard, R., & Freund, K. (1983). Measuring masculine gender identity in females.
Journal of Consulting and Clinical Psychology, 51, 205–214.

Brick, P., & Koch, P. B. (1996, November). Healthy Foundations: An early childhood
educators’ sexuality program and its effectiveness. Paper presented at the Annual
Meeting of the Society for the Scientific Study of Sexuality, Houston, TX.

Brick, P., Montfort, S., & Blume, N. (1993). Healthy Foundations: The teacher’s book
—Responding to young children’s questions and behaviors regarding sexuality.
Hackensack, NJ: Planned Parenthood of Greater Northern New Jersey.

Carroll, R. A. (2007). Gender dysphoria and transgender experiences. In S. R.

Leiblum (Ed.), Principles and practice of sex therapy (4th ed., pp. 477–508). New
York: Guilford Press

Davies, S. L., Glaser, D., & Kossoff, R. (2000). Children’s sexual play and behavior
in pre-school settings: Staff’s perceptions, reports, and responses. Child Abuse and
Neglect, 24, 1329–1343.

Early Childhood Sexuality Education Task Force. (1995). Right from the start:
Guidelines for sexuality issues (birth to five years). New York: Sexuality Information
and Education Council of the U.S.
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Freund, K., Langevin, R., Satterberg, J., & Steiner, B. W. (1977). Extension of the
Gender Identity Scale for Males. Archives of Sexual Behavior, 6, 507–519.

Freund, K., Nagler, E., Langevin, R., Zajac, A., & Steiner, B. W. (1974). Measuring
feminine
gender identity in homosexual males. Archives of Sexual Behavior, 3, 249–260

Testa, R. J., Habarth, J., Peta, J., Balsam, K., & Bockting, W. (2015). Development
of the Gender Minority Stress and Resilience Measure. Psychology of Sexual
Orientation and Gender Diversity, 2(1), 65-77.
http://dx.doi.org/10.1037/sgd0000081