Disforia de género en niños y controversias en su tratamiento: dos concepciones distintas sobre la identidad de género
DOI:
https://doi.org/10.5294/pebi.2020.24.1.5Keywords:
Gender dysphoria, Gender Identity, child treatment, therapeutic model, watchful waiting, affirmative model, sex-gender relationship, anthropologyAbstract
Gender Dysphoria in Children and Controversies about its Treatment: Two Different Conceptions of Gender Identity
Disforia de gênero em crianças e controvérsias em seu tratamento: duas concepções diferentes sobre a identidade de gênero
Gender dysphoria is a marked mismatch between the sex felt or expressed by an individual and that assigned to them at birth. It is associated with clinically significant discomfort or social impairment and can occur in children, adolescents, and adults. The literature mainly describes three approaches for preadolescents: therapeutic model, watchful waiting, and gender affirmative model. However, there is currently no consensus on its treatment nor any evidence that favors one approach over another. This paper provides a brief review of the existing literature on gender dysphoria, explains various approaches for children, and discusses the anthropological views behind them. We argue that at least two ways of understanding gender identity have given rise to disagreements over the proposed treatments. It is quite important to comprehend the anthropological assumptions on which these models are based since they underlie different conceptions of the person’s sex-gender relationship and, therefore, the role of corporality and self-awareness in gender identity.
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Cox P, Carrasco MA. Disforia de género en niños y controversias en su tratamiento: dos concepciones distintas sobre la identidad de género. Pers bioet. 2020;24(1):57-76. DOI: https://doi.org/10.5294/pebi.2020.24.1.5
Recibido: 30/10/2019
Aceptado: 03/01/2020
Publicado: 07/05/2020
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References
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Press; 2013.
Mas Grau, J. Del transexualismo a la disforia de género en el DSM. Cambios terminológicos, misma esencia patologizante. Revista Internacional de Sociología. 2017;75(2):p.e059. DOI: https://doi.org/10.3989/ris.2017.75.2.15.63
American Psychological Association. Guidelines for psychological practice with transgender and gender nonconforming people. Am Psychol. 2015;70:832-64. DOI: https://doi.org/10.1037/a0039906
Adelson SL. Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2012;51:957-74. DOI: https://doi.org/10.1016/j.jaac.2012.07.004
Byne W, Bradley SJ, Coleman E, Eyler AE, Green R, Menvielle EJ, et al. Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder. Arch Sex Behav. 2012;41:759-96. DOI: https://doi.org/10.1007/s10508-012-9975-x
Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gender nonconforming people, 7th version. Int J Transgend. 2011;13:165-232. Available from: https://www.wpath.org/publications/soc
Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869-903. DOI: https://doi.org/10.1210/jc.2017-01658
Turban JL, De Vries AL, Zucker KJ, Shadianloo S. Transgender and gender non-conforming youth. En: Rey JM, editor. IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions; 2018. Disponible en: https://iacapap.org/content/uploads/H.3-GENDER-IDENTITY-Edition-2018-REVISED.pdf
Vrouenraets LJ, Fredriks AM, Hannema S, Cohen-Kettenis PT, De Vries M. Early medical treatment of children and adolescents with gender dysphoria: An empirical ethical study. J Adolesc Health. 2015;57(4):367-73. DOI: https://doi.org/10.1016/j.jadohealth.2015.04.004
Money, J. The conceptual neutering of gender and the criminalization of sex. Arch Sex Behav. 1985;14:279-90. DOI: https://doi.org/10.1007/bf01542110
Fisk N. Gender dysphoria syndrome (the how, what, and why of a disease). En: Laub D, Gandy P, editors. Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome. Palo Alto, CA: Stanford University Press; 1973. p. 7-14.
World Health Organization (WHO). Clasificación Internacional de Enfermedades. 9ª ed. Ginebra: WHO (trad. cast.: Madrid, Meditor); 1978.
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: Author; 1980.
Gatica G, Almonte C. Intervenciones terapéuticas en disforia de género de niños y adolescentes. Rev Chil Psiquiatr Neurol Infanc Adolesc. 2015;26:121-32.
Shields JP, Cohen R, Glassman JR, Whitaker K, Franks H, Bertolini I. Estimating population size and demographic characteristics of lesbian, gay, bisexual, and transgender youth in middle school. J Adolesc Health. 2013;52(2):248-50. DOI: https://doi.org/10.1016/j.jadohealth.2012.06.016
Clark TC, Lucassen MF, Bullen P, Denny SJ, Fleming TM, Robinson EM, et al. The health and well-being of transgender high school students: Results from the New Zealand adolescent health survey (Youth’12). J Adolesc Health. 2014;55(1):93-9. DOI: https://doi.org/10.1016/j.jadohealth.2013.11.008
Olson K. Prepubescent transgender children: What we do and do not know. J Am Acad Child Adolesc Psychiatry. 2016;55:155-56. DOI: https://doi.org/10.1016/j.jaac.2015.11.015
Ristori J, Steensma TD. Gender dysphoria in childhood. Int Rev Psychiatry. 2016;28:13-20.
Wallien MS, Cohen-Kettenis PT. Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry. 2008;47(12):1413-23. DOI: https://doi.org/10.1097/CHI.0b013e31818956b9
Steensma TD, Biemond R, de Boer F, Cohen-Kettenis PT. Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Clin Child Psychol Psychiatry. 2011;16(4):499-516. DOI: https://doi.org/10.1177/1359104510378303
Zucker KJ. On the ‘‘natural history’’ of gender identity disorder in children [Editorial]. J Am Acad Child Adolesc Psychiatry. 2008;47:1361-3. DOI: https://doi.org/10.1097/CHI.0b013e31818960cf
De Vries AL, Doreleijers TA, Steensma TD, Cohen-Kettenis PT. Psychiatric comorbidity in gender dysphoric adolescents. J Child Psychol Psychiatry. 2011;52(11):1195-202. DOI: https://doi.org/10.1111/j.1469-7610.2011.02426.x
Olson J, Schrager SM, Belzer M, Simons LK, Clark LF. Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. J Adolesc Health. 2015;57(4):374-80. DOI: https://doi.org/10.1016/j.jadohealth.2015.04.027
Holt V, Skagerberg E, Dunsford M. Young people with features of gender dysphoria: Demographics and associated difficulties. Clinical Child Psychology and Psychiatry. 2016;21(1):108-18. DOI: http://dx.doi.org/10.1177/1359104514558431
De Vries AL, Noens IL, Cohen-Kettenis PT, van Berckelaer-Onnes IA, Doreleijers TA. Autism spectrum disorders in gender dysphoric children and adolescents. J Autism Dev Disord. 2010; 40(8):930-6. DOI: https://doi.org/10.1007/s10803-010-0935-9
Drescher J, Byne W. Introduction to the special issue on “The Treatment of Gender Dysphoric/Gender Variant Children and Adolescents.” J Homosex. 2012;59(3):295-300. DOI: https://doi.org/10.1080/00918369.2012.653299
Dreger A. Gender identity disorder in childhood: Inconclusive advice to parents. The Hastings Center Report. 2009;39(1):26-9. DOI: https://doi.org/10.1353/hcr.0.0102
Meyer-Bahlburg H. Gender identity disorder in young boys: A parent-and peer-based treatment protocol. Clin Child Psychol Psych. 2002;7:360-76. DOI: https://doi.org/10.1177/1359104502007003005
Zucker KJ, Wood H, Singh D, Bradley S. A developmental, biopsychosocial model for the treatment of children with gender identity disorder. J Homosex. 2012;59(3):369-97. DOI: https://doi.org/10.1080/00918369.2012.653309
De Vries A, Cohen-Kettenis PT. Clinical management of gender dysphoria in children and adolescents: The Dutch approach. J Homosex. 2012;59(3):301-20. DOI: https://doi.org/10.1080/00918369.2012.653300
Ehrensaft D. From gender identity disorder to gender identity creativity: True gender self child therapy. J Homosex. 2012;59(3):337-56. DOI: https://doi.org/10.1080/00918369.2012.653303
Rafferty J. (2018). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Policy statement of American Academy of Pediatrics. Pediatrics. 2018;142(4):E20182162. DOI: https://doi.org/10.1542/peds.2018-2162
Edwards-Leeper L, Spack N. Psychological evaluation and medical treatment of transgender youth in an interdisciplinary “Gender Management Service” (GeMS) in a Major Pediatric Center. J Homosex. 2012;59(3):321-36. DOI: https://doi.org/10.1080/00918369.2012.653302
Menvielle E. A comprehensive program for children with gender variant behaviors and gender identity disorders. J Homosex. 2012; 59(3): 357-368. DOI: https://doi.org/10.1080/00918369.2012.653305
Drescher J, Byne W. Gender Dysphoric/Gender Variant (GD/GV) Children and Adolescents: Summarizing What We Know and What We Have Yet to Learn. J Homosex. 2012;59(3):501-10. DOI: http://doi.org/10.1080/00918369.2012.653317
Carrasco MA. Género y humanismo. Estudios Públicos. 2006;103:307-35.
Siles C, Delgado G. Teoría de género: ¿de qué estamos hablando? 5 claves para el debate. Documento online de Instituto de Estudios de la Sociedad. 2014. Disponible en: http://www.ieschile.cl/claves-para-el-debate-2/
Aparisi A. Modelos de relación sexo-género: de la “ideología de género” al modelo de la complementariedad varón-mujer. Díkaion. 2012;21(2):357-84. DOI: http://doi.org/10.5294/dika.2012.21.2.2
Burgos JM. Dos formas de afrontar la identidad sexual: personalismo e ideología de género. En Aparisi A, editora. Persona y género. Pamplona: Thomson Reuters-Aranzadi; 2011. p. 405-421.
Butler J. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge; 1999.
González AM. Introduction: Gender identities in a globalized world. En: González AM, Seidler VJ, editors. Gender Identities in a Globalized World. New York: Prometheus Books; 2008. p. 15-32.
Fausto-Sterling A. The Dynamic Development of Gender Variability. J Homosex. 2012;59(3):398-421. DOI: https://doi.org/10.1080/00918369.2012.653310
World Health Organization (WHO). Disponible en: http://www.who.int/es/temas-salud/cie-11
Stein E. Commentary on the treatment of gender variant and gender dysphoric children and adolescents: Common themes and ethical reflections. J Homosex. 2012;59(3):480-500. DOI: https://doi.org/10.1080/00918369.2012.653316
Steensma TD, McGuire JK, Kreukels BP, Beekman AJ, Cohen-Kettenis PT. Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. J Am Acad Child Adolesc Psychiatry. 2013;52(6):582-90. DOI: https://doi.org/10.1016/j.jaac.2013.03.016
Schwartz D. Listening to children imagining gender: Observing the inflation of an idea. J Homosex. 2012; 59(3): 460-479. DOI: https://doi.org/10.1080/00918369.2012.653314
Gómez-Lobo A. Fundamentaciones de la bioética. Acta Bioeth. 2009;15(1):42-5. DOI: http://dx.doi.org/10.4067/S1726-569X2009000100005
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