XVI Harry Benjamin International Gender Dysphoria Association Symposium
17 - 21 August 1999, London

Reflections on "Transsexualism and Sex Reassignment" 1969 -1999

Psychological Functioning of 92 Prepubertal Children with Gender Identity Disorder

Dillen, C.M.G. and Cohen-Kettenis, P.T.

Department of Child and Adolescent Psychiatry, Utrecht University Hospital, the Netherlands

In various studies, high percentages (up to 84%) of prepubertal children with gender identity disorder (GID) have been found to show behavioral and emotional problems. Some of the studies reported behavioral problems in general, whereas in other studies specific problem behaviors were found, such as fearfulness and inhibition, separation anxiety, social incompetence and feelings of inadequacy and depression. It has been suggested that part of the observed psychopathology, anxiety in particular, contributes to or even determines the development of GID. Other types of psychopathology, such as depression, are supposed to be the result of social ostracism. The studies thus far were conducted at clinics in North America. No large samples of GID kids from other countries have been described.

We will report on a sample of 92 children, aged 4-12, seen at the Gender Clinic of the Child and Adolescent Psychiatry Department of the Utrecht University Hospital in the Netherlands.

The following instruments were used: the Dutch Child Behavior Check List and Teacher Report Form (instruments measuring problem behaviors at home and in the school, developed by Achenbach and Edelbrock), to measure psychopathology; a gender identity interview (developed by Zucker), a parent questionnaire (Elisabeth & Green), a free play test, the Draw-a-Person test to measure gender knowledge, gender identity and gender role behavior; and Wechsler Intelligence Scales to measure intelligence. Also, various demographic data were collected.

The high scoring (clinical group, which consisted of 30% of the total group, appeared to differ from the low scorers in several factors such as intelligence, father’s educational level, and marital relationship of the parents. They did not show more or less gender disturbance than the low scoring group. Our results are partially consistent with the literature. Reasons for the differences and implications for treatment will be discussed.

Some of the children have, in adolescence, returned to our clinic applying for sex reassignment. Characteristics of this group will be presented in detail.