The purposes of this paper are to look back on arguments whether DSM (Diagnostic and statistical manual of mental disorders) should include Gender Identity Disorder (GID) in children and adolescents or not, and to review the research outcomes on how treatments and interventions have been implemented and have produced effect.
First, this paper discusses whether gender nonconforming children should be diagnosed as having a mental disorder or not and where an underlying problem of the disorder lies; in a society, a family, or child oneself. Depending upon where clinicians stand, treatments and interventions differ. Approaches to therapy can be placed into 4 categories: 1) therapy for aiming at changing cross-gender identity, 2) therapy that exhibits a nonjudgmental attitude to cross-gender identity, 3) therapy that affrmatively accepts cross-gender identity, 4) physical interventions for sex reassignment. Because no controlled comparison study has been conducted, we do not have any evidence for different outcomes by selected approaches.
Finally, referring to researches in Western countries, the paper discusses support for children and adolescents with GID in Japan. For children, because of the possibility of gender identity change, we should provide a family a choice of the approaches 1), 2), or 3) as previously indicated. On the other hands, for adolescents, a family should be presented a choice of the approaches 2), 3), or 4). However, in Japan, as use of pubertal delaying hormones in GID treatment has never been discussed, we can not present the approach 4). Further discussion on physical interventions for adolescents is necessary.
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