Lesson 1: Clinical Disorders – Part E

Description

The parents of Charlie, a six year-old boy, sought treatment regarding his desire to be a girl. While the parents tried to encourage friendships between Charlie and other boys, he preferred to play with his sister, other girls, or to be with his mother or female babysitter. Although Charlie was above average in height, well-built for his age, and co-ordinated, he disliked physical play and aggressive behaviour. He preferred to pretend-play with his sister – assuming the roles of mother or big sister. He also imitated female characters from television shows and books; in essence, he preferred to idolize Wonder Woman over Superman.

Toy cars and trains held no interest for Charlie - he liked to play wedding, pregnancy, or lady doctor instead. He liked to draw female figures and cross-dress (he used towels for skirts, long t-shirts for dresses, and veils for long hair.) He also liked to have bows in his hair and was fascinated with jewelry and make-up. Although his parents tried to restrict this modeling behaviour, Charlie persisted in acting like a girl and stated that he wanted to be a girl, that he did not want to be a boy, and that he did not want to play army or other boy games.

Medical examination determined that Charlie was a healthy and robust child with normal intellectual development. The pregnancy and birth were uneventful, and neither parent showed any obvious mental illness. When Charlie was two years-old,

his sister was born and, shortly after this, Charlie’s desire to be a girl (and the accompanying behaviours) became more pronounced. When Charlie was four years-old, his sister went to their grandparents for a holiday. When they returned, Charlie complained that his sister received more attention than he did. He asked, “Why can’t I be a girl? Why didn’t God make me a girl?”

When Charlie was three, he attended nursery school where the teacher noted that he was more sensitive than the other children, that he dressed up frequently, and that he avoided rough play. These behaviours continued through first and second grade - his teacher even had to restrict access to the doll corner because of his fascination with doll play. The teacher noted that he was very good at imitating girls (their inflection and walk) and that he often commented that he wanted to be a mother when he grew up.

Diagnosis

Charlie repeatedly stated that he desired to become a “she”. He preferred female company, drew female figures, imitated female roles, and preferred to dress and act like a girl instead of a boy. He preferred stereotypical female toys and rejected toys that other boys liked. He wanted to be a girl – not just act like a girl. Charlie’s symptoms indicate that he has strong features of gender dysphoria and as such, his DSM-5 diagnosis for Axis I is gender dysphoria.