Yesterday night, I stumbled upon this article.
I know for a long time I've had issues with the term "gender dysphoria," because really all it means is a feeling of being unwell with one's gender. And it really doesn't do much to explain where it comes from, what it is, or how to treat it. This article rectifies these things by arguing for a new term, "Gender Expression Deprivation Anxiety Disorder." In other words, the experience of dysphoria isn't just a feeling of being unwell with one's gender, it's coming from a lack of ability to express oneself's internal gender identity.
I know for me this has been a helpful definition, because just using the term "dysphoria" when I'm feeling bad about myself, it really doesn't say anything, just that I'm feeling bad. And when people talk of being a man or a woman trapped in the wrong body, I didn't know that this really applied to me, because I didn't really feel that strongly about it. I didn't feel "trapped" per se, just a lingering feeling of unhappiness about who I was. The definition as proposed, though, says everything about the problem. That it comes not from just a general feeling of unwellness, but from a lack of self-expression, a lack of being oneself in regards to gender.
This article really helped me to clarify in my mind what I was feeling, and what I have been feeling my whole life. So I highly recommend it. And even if you don't agree with the definition part, this article contains some very profound stories of how gender dysphoria manifests itself through different stages of life. Reading this, SO many of the experiences resonated with me. The experiences from childhood to early adulthood felt like they were hitting me right in the gut in terms of self-application. And some of the experiences from those later in life than me really served as a cautionary tale, as though saying "this is your future if you don't deal with this."
I hope it helps someone else as much as it helped me.
http://www.avitale.com/developmentalreview.htm
The basic summary of this article is as follows:
Living in conflict with one of the basic tenets of existence (Am I male or am I female?) is understandably anxiety provoking. This fact leads me to suggest that Gender Identity Disorder as this conflict is described in the DSM IV, is not an appropriate descriptor. I suggest here as I have elsewhere (Vitale, 1997, 2001) that instead the condition be termed Gender Expression Deprivation Anxiety Disorder (GEDAD). After explaining my thinking on gender expression deprivation anxiety, I will describe how this anxiety, if left untreated, is manifested in each of the five developmental stages of life: confusion and rebellion in childhood, false hopes and disappointment in adolescence, hesitant compliance in early adulthood, feelings of self induced entrapment in middle age, and if still untreated, depression and resignation in old age.
Thanks for posting this Carrie Liz. It certainly a wake up call to people like me who are older and haven't transitioned. It definitely sounds like the only way to go is to get on hormones because the GD is never going away. The Middle Age section really hit home, and I can really understand the bitterness that could develop as you get even older.
Dr. Vitale's article is definitely something that everyone should read. I especially think it would be an eye opener for my wife.
Nice article, the adolescence and early adulthood sections covered my experience to a tee. I think I will send my parents an link to that article to help them understand some of the things that they are confused about right now.
I remember reading this a bit back, and it shed lots of light on my life experiences to date. A real,.Whait you mean I am not alone? sort of thing.
The way I tended to deal with things, though, was denying gender differences existed, period. Had a heck of a time doing that... but it worked for about thirty years.
The article seems pretty definitive that hormones are the only thing that really help with our situation. I've never read anything to the point as this. I wonder how many in the medical community would agree with this paper.
Thank you, Carrie, for sharing this.
Reading this, it seems I fall squarely into Group 3. The descriptions of childhood and adolescent experiences match my own to a T.
I think I may need to show this to my mother. Especially given some of the questions she asked me the other night.
Loved it.
This will probably help a lot of people, thank you for posting it Carrie :)
That's one of the most damnedest things I have ever read! :o It's like seeing my life story written by someone else word for word, situation for situation. It's actually tough to get through. Much appreciated for finding and posting it!
Quote from: Paige on October 18, 2013, 10:13:23 AM
The article seems pretty definitive that hormones are the only thing that really help with our situation. I've never read anything to the point as this. I wonder how many in the medical community would agree with this paper.
Haven't had a chance to read the article but it's interesting you bring that up. I could possibly answer that from a medical-legal point of view as I've studied medical law (at least UK medical law). In medical negligence there is the Bolam test. This test says that so long as there is one reasonable body of medical opinion then it is perfectly reasonable to be carried out. So this would mean so long as the person who wrote this is a reasonable form of medical opinion and someone was to follow that, in theory, through the Bolam test, it could be applied.
Wow. Just wow. I think she nailed it.
Others have said it, but "Wow" this was perfect. Thanks for sharing!
I remember reading this some time back, what's weird is I kinda feel like a cross between group1 and group3 but I think I have more in common with group1. I think were I can relate to group3 is because I was kinda shamed into acting more like a boy but the truth was I never tried to actually be a boy and I never developed my own male personality I just copied it from those around me.
QuoteAs a psychotherapist I have found female identified males (G1) to be clinically similar to male-identified females (G2). That is, individuals in both groups have little or no compunction against openly presenting themselves as the other sex. Further, they make little or no effort to engage in what they feel for them would be wrong gendered social practices (i.e., the gender role assigned at birth as the basis of authority). Although I have seen some notable exceptions, especially in male-identified females, these individuals--at the time of presentation for treatment--are rarely married or have children, are rarely involved in the corporate or academic culture and are typically involved in the service industry at a blue- or pink-collar level. With little investment in trying to live as their assigned birth sex and with a lot of practice in living as closely as possible to their desired sex, these individuals report relatively low levels of anxiety about their dilemma. For those who decide transition is in their best interest, they accomplish the change with relatively little difficulty, particularly compared to G3, female-identified males.
I think this quote pretty much sums up my life so far I never invested in trying to be a male at all. In fact after I went back in the closet when I was 17 I lost total interest in living at all and just went through the motions of living. But I do wish I would have been fully in group3 though it seems like they are the overachievers who make a lot of money and have pretty successful lives. :P
Awesome article- mind you having to type gedad (gee dad) would be a bitch but I agree wholeheartedly with the description of gender expression deprivation anxiety... that pretty much sums it up.
Whats everyone thinj of gedad?
https://www.susans.org/forums/index.php?topic=36243.0
Old thread on what I think is the same article.
As for GEDAD, it might depend on how you interpret it. The article seems to define it as not being able to live in your desired gender, but the words "deprivation anxiety" almost make it sound like occasional cross dressing would work as a therapy. For some, maybe, but even as the article indicates, many require hormones to reach balance.
I'm worried about the phrasing because there are people out there still who believe if gender differences in society were abolished, there would be no GID, which isn't true. Saying all people would need to do is be allowed to dress up now and again to "cure" them doesn't describe the experience of many trans folks.
Getting back to what the article does say, I totally agree that my anxiety has only increased as I have aged, and I am now at the breaking point. I see women my age or even older who seem fulfilled in their lives, and I feel a gaping whole in mine because I feel like I have been denied so much. I am very thankful in many ways for what I have been blessed with, but I have always had trouble appreciating it due to constant anxiety and feelings of displacement.
Yeah, that is an old thread on the same article. But since it's 5 years old at this point, and the conversation didn't really go anywhere, and I felt like that old one was more a discussion topic on whether the "new" wording was appropriate or not rather than bringing it up as kind of a personal-confirmation thing, I thought it was worth re-posting and looking at it with a different context.
I found the article very interesting, but I don't really fit in either of the two categories for male-assigned individuals. There are certainly bits and pieces that I relate to, but it's inconsistent. I fit the G3 model as a child almost perfectly. But I was closer to G1 as an adolescent as I consistently failed to behave as an appropriate guy--yet I still refused to actually admit anything, so everyone thought I was just gay... though I didn't do any dating at all and I actually like girls. I transitioned at 26.
I do think it's important to remember that any model is going to be a best-fit and will invariably have to leave some people out. Basically, it's awesome if you recognize yourself in that article and it helps you to better understand your situation/needs. That's really great! But it's also totally cool if you don't relate to the article; it doesn't make you any lesser or anything. You do you.
I guess I just worry sometimes that people might end up reading things like this, and not being able to relate and end up feeling even more alone and lonely. So if that's you, don't be sad; you are awesome too, promise! ;)
Very interesting, but it still pretty expressly leaves out nonbinary identities. With this paper in mind, it seems like GID actually leaves more wiggle room for us than the proposed GEDAD. One step forward, one step back...
Even though this article focused more on the G3 group, I still saw some insight of what the future might be for a young person who identifies with G2. There is much common ground to be shared between the groups. Recently, I've really been struggling with the denial of GID/GEDAD and fear of transitioning. Logically, I knew I would probably be happier if I transitioned, however, there is still a big emotional road bump of fear (family/friend rejection), anxiety (what if I regret it?), and the sheer amount of will that is needed to get through it all. Just being able to back it up with some hard science and evidence has forced me to look at it clearly and examine future prospects. Looking at what is down the road, and seeing that it really never goes away. Most importantly, what will make me happier?
The downfall of this view, however, is that it seems to present a fairly narrow view of the treatment, where only hormones seems like the only way. I would love to see more research on this subject.
Really liked it, thanks for sharing.
Hey Carrie, thanks very much for posting this.
It's funny, for the most part my brain just collapses when faced with reading anything written in a relatively scholarly/academic/research-oriented way. My partner often laughs at this; how my eyes at a certain point glaze over and the article's storyline evaporates for me!
Things are so different with trans/gender/binary/nonbinary stuff. Again and again I have found the precision of such pieces incredibly helpful. Terms are carefully defined. Parameters clearly noted. I have spent most of my life to date in a kind of 'gender fog' - Am I this? Am I that? What do these words really mean: 'this' and 'that'?!? - so the exactitude offers welcome insight!
As for this article in particular, I personally am in the midst of an ongoing struggle to wholly embrace my transgender reality. Things are in a kind of 'step in / step out' phase. I feel a very complete acceptance for an hour or a day, perhaps, then the whole situation drifts into a bit of unreality, uncertainty, and denial. The barely conscious mantra of such times seems to be, 'Oh I can fix this, make it go away.' This piece reaffirms the fact that these feelings do not go away and are, as a result, best accepted and worked with in some sort of appropriate way.
The author does, of course, have a sense of what 'appropriate' looks like. I continue to wonder, 'Can there be other responses?"
Again, thanks for putting this up! Would love to see more.
Quote from: TanyaW on November 02, 2013, 04:43:30 PM
The author does, of course, have a sense of what 'appropriate' looks like. I continue to wonder, 'Can there be other responses?"
That's the million dollar question isn't it? I'm the exact same way, some days I'm certain, other days I'm completely confused. Thanks for posting your comment Tanya.
This article really helps me in my doubts as to whether I am really transsexual. Reading the description of Group 3 fits me to a T. I'm going to share this article with my GT this week. Thanks for sharing it!
Quote from: Sarah7 on October 21, 2013, 07:19:05 PM
II do think it's important to remember that any model is going to be a best-fit and will invariably have to leave some people out. Basically, it's awesome if you recognize yourself in that article and it helps you to better understand your situation/needs. That's really great! But it's also totally cool if you don't relate to the article; it doesn't make you any lesser or anything. You do you.
I guess I just worry sometimes that people might end up reading things like this, and not being able to relate and end up feeling even more alone and lonely. So if that's you, don't be sad; you are awesome too, promise! ;)
Thank you for saying this. I guess I kind of fit into the G3 category but not well. I'm definitely not a 1. There were so many little parts that don't fit. Just a little tired of being the exception that proves the rule.
However, it still helped. Thank you for the article.
Quote from: Carrie Liz on October 17, 2013, 12:15:35 PM
http://www.avitale.com/developmentalreview.htm
Ann suggests GID can be classified into groups based on
inappropriate androgenization of the brain at a critical stage of embryonic development.
This would not only confront religious belief that people are born male or female, also this could be seen as reducing humans down to be the same as every other animal on this planet. This would bring into question the fundamental premise of religion that humans are the "chosen ones" made in God's image with an after-live awaiting us, unlike all the other creatures of the Earth.
There will be furious opposition to any science that tries to prove GID is pre-birth.
Quote from: genderhell on November 04, 2013, 07:21:43 PM
There will be furious opposition to any science that tries to prove GID is pre-birth.
I hate to tell you this - but that ship has sailed over 20 years ago. There is already solid medical evidence (I might even say proof) that the underlying causes of this condition pre date birth in a lot of people. This is being widely taught in medical schools as fact already! It's only the "head in the sand" mob in the USA, whose minds are so made up, that they are trying to deal with it by completely ignoring/suppressing any facts, and what is now well known!
I could seriously cite you at least 10 or 15 reputable European and Australian studies in this area, including one done right here in the UK by someone at my medical school, whom I see every day. There are even a few from America.
The only thing that is really under debate is the precise mechanism by which people move from a hidden and unexpressed condition, to one which is actively expressed, pressing, and life changing.
Quote from: Doctorwho? on November 06, 2013, 08:41:44 AM
I could seriously cite you at least 10 or 15 reputable European and Australian studies in this area, including one done right here in the UK by someone at my medical school, whom I see every day. There are even a few from America.
Would you know if there's a website that's a central source for all these studies? Perhaps a good wiki idea for Susan's if there isn't one. I would guess most of these studies are published in journals that you need to pay to read. I would really like to read them or at least the summaries.
Thank you so much for posting this Doctorwho. :)
I'm glad to see people are getting something out of this article.
I read it and my first thought was, great, another psychologist trying to come up with a Ben & Jerry's ice cream flavor of a "disorder". However, I realize that it does help people to have some name to put with the particular way they feel.
For me, it's just more unnecessary diagnosis. It's just more trying to narrow people down into tidy little boxes. It's also just someone else's "theory" and parts of it I read were, frankly, way off for me personally (such as, "These individuals rarely marry, preferring instead to partner with women who may or may not identify as lesbian." I guess I'm "rare".). It's applying majority rule to individuals. Which is why I have a personal distaste for much of psychology.
On another note, I am a firm believer that being "gender variant" can be linked to events in utero in some cases (like mine). But I also believe that these types of things do naturally occur. Meaning, they're valid on the gender spectrum ... that there isn't just 100% male and 100% female. Just look at some of the stats for intersex conditions, such as 1 in 100 people born do not have a "standard" male or female body. And so I believe that's how it is when your brain chemistry has been effected in the womb. You may have a fully functioning body, but you're not the typical male or female. And I don't think that's abnormal, it's psychologists and a lot of society who do.
Psychologists were the ones that originally theorized that gender is a learned "identity". I don't believe that. I believe you pop out into the world with that identity hardwired into you – whether it be male, or female, or anywhere in between the two. Even in cases where people may "decide" they're trans* at a certain point, it's only because they've found a definition for how they've been feeling for chunks of their lives. So I can agree with the generalization that most "gender variant" people have felt something is "not right" for some time or in some instances of their lives. I can agree that the social constructs of gender are learned. You learn from your earliest examples what society thinks men and women should be and do and look like (because in the good old US of A that pretty much is your only options for "socially acceptable"). If you're not distinctly playing for one team or the other, you're an outcast and you can just plan on those "not right" feelings being intensified through these social expectations that you were never cut out to meet in the first place.
Quote from: Carrie Liz on October 17, 2013, 12:15:35 PM
Yesterday night, I stumbled upon this article.
I know for a long time I've had issues with the term "gender dysphoria," because really all it means is a feeling of being unwell with one's gender. And it really doesn't do much to explain where it comes from, what it is, or how to treat it. This article rectifies these things by arguing for a new term, "Gender Expression Deprivation Anxiety Disorder." In other words, the experience of dysphoria isn't just a feeling of being unwell with one's gender, it's coming from a lack of ability to express oneself's internal gender identity.
I know for me this has been a helpful definition, because just using the term "dysphoria" when I'm feeling bad about myself, it really doesn't say anything, just that I'm feeling bad. And when people talk of being a man or a woman trapped in the wrong body, I didn't know that this really applied to me, because I didn't really feel that strongly about it. I didn't feel "trapped" per se, just a lingering feeling of unhappiness about who I was. The definition as proposed, though, says everything about the problem. That it comes not from just a general feeling of unwellness, but from a lack of self-expression, a lack of being oneself in regards to gender.
This article really helped me to clarify in my mind what I was feeling, and what I have been feeling my whole life. So I highly recommend it. And even if you don't agree with the definition part, this article contains some very profound stories of how gender dysphoria manifests itself through different stages of life. Reading this, SO many of the experiences resonated with me. The experiences from childhood to early adulthood felt like they were hitting me right in the gut in terms of self-application. And some of the experiences from those later in life than me really served as a cautionary tale, as though saying "this is your future if you don't deal with this."
I hope it helps someone else as much as it helped me.
http://www.avitale.com/developmentalreview.htm
The basic summary of this article is as follows:
Living in conflict with one of the basic tenets of existence (Am I male or am I female?) is understandably anxiety provoking. This fact leads me to suggest that Gender Identity Disorder as this conflict is described in the DSM IV, is not an appropriate descriptor. I suggest here as I have elsewhere (Vitale, 1997, 2001) that instead the condition be termed Gender Expression Deprivation Anxiety Disorder (GEDAD). After explaining my thinking on gender expression deprivation anxiety, I will describe how this anxiety, if left untreated, is manifested in each of the five developmental stages of life: confusion and rebellion in childhood, false hopes and disappointment in adolescence, hesitant compliance in early adulthood, feelings of self induced entrapment in middle age, and if still untreated, depression and resignation in old age.
you mean DSM 5 ?
Thanks for sharing, it was definitely an interesting article and I enjoyed reading it.
The only thing I was wondering about is the absence of a group 4, meaning female assigned but male identifying with similar characteristics to group 3.
The article seems to suggest that all ftm individuals acted masculine since childhood and never attempted overcompensation, like typical female activities or outfits and so on due to society being more accepting of them. But from my little experience I know (either personally or for having heard their stories on the web) of many ftms who lived a relatively typical female childhood and adolescence) and always felt distress over their assigned sex but never showing it openly ( just like group 3 mtf's). Let's just think about all the late transitioners who married and had children before accepting who they were. Not all of them were masculine females to begin with.
Me too, I lived extremely girly phases trying to deny what I felt. I was never able to express myself the way I felt right for fear of other people's opinion.
I think this hypothetic group 4 exists, but I am sure there are reasons for not including it. Anyone else thinking so?
( I still liked the article, it made me think about a lot of subjects and gave me new keys of interpretation for many feelings)
Quote from: Sacha on November 13, 2013, 10:15:19 AM
you mean DSM 5 ?
Now, yes, but this article is a few years old, so it was technically written in regards to the definition as presented in DSM-IV.
Awww... this article... In the beginning of this year, when slowly but steadily all things started to collapse around and inside of me, I was desperately searching and reading all articles I could find. This one looked quite "scientific" and as I was reading through it, how it described different stages in one's life, how precisely it had described my life... The message it sent me was - I was totally screwed, all my life-long efforts had been in vain and this... feeling is never ever going to go away. What scared the hell out of me was that apparently I would not be able to deal with this alone and I would have to tell my shameful story to someone else. I am pretty sure, if I had a gun back then... well, but I had not :P. About an hour later, having read this article, I finally accepted myself and decided to proceed with something (I had no idea what at that time) to avoid the bleak scenario of living remainder of my life with an untreated GID.
I still see that day when I read this article as my second birthday :).
Thank you for sharing this :-)
The G3 parts have resonated so much in me, it has helped me pave a large portion of my yellow brick road toward acceptance of who I really am, and how denial and suppression of the truth never helps..
I was reading the whole thing with tears running down my face ...which made reading quite tricky
Lots of food for thought...
Thanks again xx
I actually used this article in my most recent therapy session. My therapist was already familiar with Anne Vitale's work, so I didn't need to explain it what it was about, though in retrospect, I should have reread it immediately beforehand so that I wouldn't have had to waste time looking up the relevant passages. Oh well. I had brought it up near the end of the previous session, but didn't have time to go into it, so these things happen.
Anyway, I talked about how the experiences of Group 3 really seemed to mirror my own, especially during the first two stages. I was the gentle, if weird, kid that never quite fit in; that knew that they were different early on; that had little interest in sports or rough-and-tumble play, and tended to play by themselves. While I didn't play with the girls that often, nor was I opposed to it the way many boys were. With adolescence, I never dated; I experimented with my mother's clothes; I spent a colossal amount of time engaged in fantasy, where I could pretend I was female. I often wished I would go to bed a boy and wake up a girl. And of course, there was that constant anxiety that I could never express how I really felt, lest I be castigated by my peers. Despite this, I never took on the defensive, hyper-masculine persona that many do, because I knew it wasn't me; my own sense of self-integrity would not allow me to embrace what I knew was a lie. I think this may have a had a lot to do with why I was picked on so much, but it also explains why I don't match the description of Group 3 in Early Adulthood quite as well as the first two stages. That being said, I can easily see how if things had been different, I might have turned out the way that many in Group 3 did. That's especially scary in regards to the sexism, as I've always found misogyny to be particularly odious. Regardless, I still have that sense of embarrassment that I feel the way that I do.
Interestingly enough, I find a lot of this mirrors what my own introspection over the past year has told me. This is real. This has been going on my entire life. I haven't seen it because I didn't want to accept it.
So again, thanks. This is proving to be quite useful.