Chapter 36. Gender Identity and Sexual Orientation

Kenneth J. Zucker, Ph.D.
DOI: 10.1176/appi.books.9781585623921.465192



Gender identity refers to a person's basic sense of self as a male, a female, or some other "third" type of gendered subjectivity. By the age of 3, most children demonstrate the rudimentary capacity to self-label their gender identity. Thus, most preschoolers can answer "correctly" the basic question "Are you a boy or a girl?" However, most preschoolers do not appreciate that gender is an invariant aspect of the self. Thus, 3-year-olds may not understand that they will grow up to be a man or a woman, or they may believe that if they engage in cross-gender surface behaviors this will alter their gender. It is not until a few years later that children appear to master the concept of gender constancy (Zucker et al. 1999). Children also attach affective meaning to being a boy or a girl. There is, for example, a tendency among young children to "overvalue" their own gender and "devalue" the other gender, a phenomenon that developmental and social psychologists have studied under the rubric of "in-group" and "out-group" biases (Susskind and Hodges 2007).

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Table Reference Number
TABLE 36–1. Interview transcript of the Gender Identity Interview for Children


Achenbach TM, Edelbrock C: Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington, University of Vermont, Department of Psychiatry, 1983
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition. Washington, DC, American Psychiatric Association, 1980
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, American Psychiatric Association, 1994
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
Bakker A, van Kesteren PJM, Gooren LJG, et al: The prevalence of transsexualism in the Netherlands. Acta Psychiatr Scand 87:237–238, 1993
Blanchard R, Klassen P: H-Y antigen and homosexuality in men. J Theor Biol 185:373–378, 1997
Blanchard R, Zucker KJ, Bradley SJ, et al: Birth order and sibling sex ratio in homosexual male adolescents and probably prehomosexual feminine boys. Dev Psychol 31:22–30, 1995
Bockting W: Are gender identity disorders mental disorders? Recommendations for revision of the World Professional Association for Transgender Health's Standards of Care. International Journal of Transgenderism 11:53–62, 2009
Cochran SD: Emerging issues in research on lesbians' and gay men's mental health: does sexual orientation really matter? Am Psychol 56:931–947, 2001
Cohen-Kettenis PT, Pfäfflin F: Transgenderism and Intersexuality in Childhood and Adolescence: Making Choices. Thousand Oaks, CA, Sage Publications, 2003
Cohen-Kettenis PT, van Goozen SHM: Sex reassignment of adolescent transsexuals: a follow-up study. J Am Acad Child Adolesc Psychiatry 36:263–271, 1997
Cohen-Kettenis PT, Owen A, Kaijser VG, et al: Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: a cross-national, cross-clinic comparative analysis. J Abnorm Child Psychol 31:41–53, 2003
Deogracias JJ, Johnson LL, Meyer-Bahlburg HFL, et al: The gender identity/gender dysphoria questionnaire for adolescents and adults. J Sex Res 44:370–379, 2007
Diamond LM: A new view of lesbian subtypes: stable versus fluid identity trajectories over an 8-year period. Psychol Women Q 29:119–128, 2005
Diamond LM: Sexual Fluidity: Understanding Women's Love and Desire. Cambridge, MA, Harvard University Press, 2008
Drescher J, Zucker KJ (eds): Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics, and Culture. New York, Harrington Park Press, 2006
Drummond KD, Bradley SJ, Badali-Peterson M, et al: A follow-up study of girls with gender identity disorder. Dev Psychol 44:34–45, 2008
Ehrensaft D: Raising girlyboys: a parent's perspective. Studies in Gender and Sexuality 8:269–302, 2007
Goodenow C, Netherland J, Szalacha L: AIDS-related risk among adolescent males who have sex with males, females, or both: evidence from a statewide survey. Am J Public Health 92:203–210, 2002
Green R: The "Sissy Boy Syndrome" and the Development of Homosexuality. New Haven, CT, Yale University Press, 1987
Hill DB, Rozanski C, Carfagnini J, et al: Gender identity disorders in childhood and adolescence: a critical inquiry. International Journal of Sexual Health 19:57–75, 2007
Johnson LL, Bradley SJ, Birkenfeld-Adams AS, et al: A parent-report Gender Identity Questionnaire for Children. Arch Sex Behav 33:105–116, 2004
Lock J, Kleis BN: A primer on homophobia for the child and adolescent psychiatrist. J Am Acad Child Adolesc Psychiatry 37:671–673, 1998
Menvielle EJ, Tuerk C, Perrin EC: To the beat of a different drummer: the gender-variant child. Contemp Pediatr 22:38–39, 41, 43, 45–46, 2005
Meyer IH: Prejudice, social stress, and mental health issues in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 129:674–697, 2003
Meyer-Bahlburg HFL: Gender identity disorder in young boys: a parent- and peer-based treatment protocol. Clin Child Psychol Psychiatry 7:360–377, 2002
Meyer-Bahlburg HFL: Introduction: gender dysphoria and gender change in persons with intersexuality. Arch Sex Behav 34:371–373, 2005
Ruble DN, Martin CL, Berenbaum SA: Gender development, in Handbook of Child Psychology, 6th Edition, Vol 3: Social, Emotional, and Personality Development. Edited by Damon W, Lerner RM (series eds), Eisenberg N (vol ed). New York, Wiley, 2006, pp 858–932
Savin-Williams RC: Who's gay? Does it matter? Curr Dir Psychol Sci 15:40–44, 2006
Savin-Williams RC, Cohen KM: Homoerotic development during childhood and adolescence. Child Adolesc Psychiatr Clin N Am 13:529–549, 2004
Savin-Williams RC, Ream GL: Suicide attempts among sexual-minority male youth. J Clin Child Adolesc Psychol 32:509–522, 2004
Segal NL: Two monozygotic twin pairs discordant for female-to-male transsexualism. Arch Sex Behav 35:347–358, 2006
Silenzio VMB, Pena JB, Duberstein PR, et al: Sexual orientation and risk factors for suicidal ideation and suicide attempts among adolescents and young adults. Am J Public Health 97:2017–2019, 2007
Smith YLS, van Goozen SHM, Cohen-Kettenis PT: Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: a prospective follow-up study. J Am Acad Child Adolesc Psychiatry 40:472–481, 2001
Smith YLS, van Goozen SHM, Kuiper AJ, et al: Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals. Psychol Med 35:89–99, 2005
Susskind J, Hodges C: Decoupling children's gender-based in-group positivity from out-group negativity. Sex Roles 56:707–716, 2007
Townsend MH, Wallick MM, Pleak RR, et al: Gay and lesbian issues in child and adolescent psychiatry training as reported by training directors. J Am Acad Child Adolesc Psychiatry 36:764–768, 1997
Wallien MS, Cohen-Kettenis PT: Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 47:1413–1423, 2008
Wallien MS, Swaab H, Cohen-Kettenis PT: Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adolesc Psychiatry 46:1307–1314, 2007
Wallien MS, Zucker KJ, Steensma TD, et al: 2D:4D finger-length ratios in children and adults with gender identity disorder. Horm Behav 54:450–454, 2008
Wichstrøm L, Hegna K: Sexual orientation and suicide attempt: a longitudinal study of the general Norwegian adolescent population. J Abnorm Psychol 112:144–151, 2003
Zucker KJ: Gender identity disorder in children and adolescents. Annu Rev Clin Psychol 1:467–492, 2005a
Zucker KJ: Measurement of psychosexual differentiation. Arch Sex Behav 34:375–388, 2005b
Zucker KJ: Gender identity disorder in children, adolescents, and adults, in Gabbard's Treatments of Psychiatric Disorders, 4th Edition. Edited by Gabbard GO. Washington, DC, American Psychiatric Publishing, 2007, pp 683–701
Zucker KJ: Children with gender identity disorder: is there a best practice? [Enfants avec troubles de l'identité sexuée: y-a-t-il une pratique la meilleure?] Neuropsychiatr Enfance Adolesc 56:358–364, 2008
Zucker KJ, Bradley SJ: Gender Identity Disorder and Psychosexual Problems in Children and Adolescents. New York, Guilford, 1995
Zucker KJ, Lawrence AA: Epidemiology of gender identity disorder: recommendations for the Standards of Care of the World Professional Association for Transgender Health. International Journal of Transgenderism 11:8–18, 2009
Zucker KJ, Spitzer RL: Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? An historical note. J Sex Marital Ther 31:31–42, 2005
Zucker KJ, Bradley SJ, Lowry Sullivan CB, et al: A Gender Identity Interview for Children. J Pers Assess 61:443–456, 1993
Zucker KJ, Bradley SJ, Kuksis M, et al: Gender constancy judgments in children with gender identity disorder: evidence for a developmental lag. Arch Sex Behav 28:475–502, 1999
Zucker KJ, Beaulieu N, Bradley SJ, et al: Handedness in boys with gender identity disorder. J Child Psychol Psychiatry 42:767–776, 2001
Zucker KJ, Owen A, Bradley SJ, et al: Gender-dysphoric children and adolescents: a comparative analysis of demographic characteristics and behavioral problems. Clin Child Psychol Psychiatry 7:398–411, 2002
Zucker KJ, Bradley SJ, Owen-Anderson A, et al: Is gender identity disorder in adolescents coming out of the closet? (Letter to the editor). J Sex Marital Ther 34:287–290, 2008

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