Identity issues may manifest in a variety of different ways. For example, some people with normal genitals and secondary sex characteristics of one gender privately identify more with the other gender. Some may cross-dress, and some may actually seek sex-change surgery. Others are born with ambiguous genitalia, which can raise identity issues.
Associated Features and Disorders of Gender Identity Disorder
Many individuals with gender identity disorder become socially isolated, whether by choice or through ostracization, which can contribute to low self-esteem and may lead to school aversion or even dropping out. Peer ostracism and teasing are especially common consequences for boys with the disorder.
Boys with gender identity disorder often show marked feminine mannerisms and speech patterns.
The disturbance can be so pervasive that the mental lives of some individuals revolve only around activities that lessen gender distress. They are often preoccupied with appearance, especially early in the transition to living in the opposite sex role. Relationships with parents also may be seriously impaired. Some males with gender identity disorder resort to self-treatment with hormones and may (very rarely) perform their own castration or penectomy. Especially in urban centers, some males with the disorder may engage in prostitution, placing them at a high risk for human immunodeficiency virus (HIV) infection. Suicide attempts and substance-related disorders are common.
Children with gender identity disorder may manifest coexisting separation anxiety disorder, generalized anxiety disorder and symptoms of depression.
Adolescents are particularly at risk for depression and suicidal ideation and suicide attempts.
Adults may display anxiety and depressive symptoms. Some adult males have a history of transvestic fetishism as well as other paraphilias. Associated personality disorders are more common among males than among females being evaluated at adult gender clinics.