Treatment of Underlying Psychopathology

Several theoretical perspectives suggest that GID in children originates within the context of family factors or psychopathology. Such factors include parental conflict and trauma related to gender identity issues in their own life histories, attachment issues during early development, and general parent-child relational characteristics. Let us consider several examples.

Some mothers of boys with GID experience what Zucker and Bradley (1995) characterized as "pathological gender mourning". During the pregnancy with the proband, there is a strong desire to have a daughter. After the son is born, these mothers have great difficulty in coping with the disappointment of not having had a child of the preferred sex, and this disappointment appears to be transmitted to the boy in complex ways.

Case Example 3
Mark was a 4-year-old boy with an IQ of 111. He lived with his middle-class parents and an older brother. During the pregnancy, his mother had desired a daughter and recalled being quite depressed after his birth. She reported a preoccupation with not having had a daughter; for example, she reported vivid night dreams in which she was pregnant with a girl. Upon awakening, she became depressed upon realizing that "it was just a dream." Such dreams had recurred throughout Mark's life. Mark was reported to have been a very difficult infant, and his parents recalled that he could be soothed only if his mother held him. He would cry frantically if held by his father. At the time of assessment, Mark's mother described him as very oppositional in his relationship with her, and she found parenting him to be extremely challenging. Although he was markedly noncompliant and prone to intense temper tantrums, Mark also appeared to be very attuned to his mother's feelings. For example, when, at age 2, she talked about the family getting a cat, Mark began to meow. Mother recalled that Mark began to cross-dress in her clothes shortly after she verbalized how "nice" it would be to have a girl in the family. During the mother's individual interview, she was asked to talk about what the desire for a girl meant to her. With a great deal of sadness, she said that "Boys grow up and leave their mothers...then I'll be alone." She talked about how this left her feeling "like there is a hole in my heart...it will never be filled."

Coates and Person (1985) posited that separation anxiety, activated by uneven maternal availability, plays a pivotal role in the development of GID in boys. According to this model, severe separation anxiety precedes the feminine behavior of the boys, which emerges in order "to restore a fantasy tie to the physically or emotionally absent mother. In imitating 'Mommy [the boy] confuse[s] 'being Mommy' with 'having Mommy.' [Cross-gender behavior] appears to allay, in part, the anxiety generated by the loss of the mother" (Coates and Person 1985, p. 708).

Case Example 4
Harvey was a 10-year-old boy with an IQ of 69. He lived with his mother. His father had died in a construction accident prior to his birth. When Harvey was 2 years old, his mother returned with him to her country of origin. He was left in the care of his maternal grandmother and his mother returned to Canada to work. He was reunited with his mother at the age of 5. At that time, she observed that he engaged in extensive cross-gender behaviors, including cross-dressing. Harvey's mother worked long hours and, after school, Harvey was looked after by a neighbor. Harvey complained bitterly, but with sadness as well, that he never got to see his mother: "She's always working and on the weekends she is too busy shopping." When home alone, Harvey often would take his mother's scarves, wrap them around his head, and give them female names, and he would then talk to them, in a manner akin to an imaginary friend.