A 15-year-old boy is brought to the office by his parents due to concern about his development. The patient has had a long-standing interest in fashion and a preference for having girls as friends, and his parents noticed that he recently bought women's underwear and shoes and went out to meet friends wearing makeup. They worry that he is being bullied since moving to a new high school last year. When interviewed privately the patient says, "I have always wanted to be a girl." He is distressed that his voice is deepening and that he is developing facial and pubic hair, which he shaves regularly. Which of the following is the most likely explanation of this patient's behavior?

Question

A 15-year-old boy is brought to the office by his parents due to concern about his development.  The patient has had a long-standing interest in fashion and a preference for having girls as friends, and his parents noticed that he recently bought women's underwear and shoes and went out to meet friends wearing makeup.  They worry that he is being bullied since moving to a new high school last year.  When interviewed privately the patient says, "I have always wanted to be a girl."  He is distressed that his voice is deepening and that he is developing facial and pubic hair, which he shaves regularly.  Which of the following is the most likely explanation of this patient's behavior?

Quizplus · Accepted Answer

This patient's persistent desire to be female and significant distress at developing male secondary sexual characteristics are most consistent with gender dysphoria (GD). Individuals with GD experience discomfort from the incongruence between their gender identity (eg, an internal sense of what one's gender is) and their assigned gender at birth (either boy or girl based on external sexual anatomy). They often have a strong desire to live and be treated as another gender and become preoccupied with changing primary and secondary sexual characteristics. Preferences for playmates or friends of another gender and for the attire and typical interests and activities of another gender are characteristic. Individuals with GD typically describe identifying with another gender since childhood or adolescence and frequently encounter bullying and discrimination. Gender-diverse adolescents struggling with these issues benefit from early identification and support to promote positive outcomes. (Choice A) Bisexuality is a form of sexual orientation defined as being attracted (sexually, romantically, and/or emotionally) to more than one gender. Gender identity and expression (eg, behavior, clothing, hairstyle, makeup) are independent of an individual's sexual orientation. (Choice B) Body dysmorphic disorder is characterized by preoccupation with slight to nonexistent defects in physical appearance. It is not diagnosed in patients who are preoccupied with changing only their primary and secondary sexual characteristics and who meet other diagnostic criteria for GD. (Choice C) Fetishistic disorder involves sexual urges, fantasies, or behaviors that are focused on a nongenital body part or inanimate object, not including articles of clothing used in cross-dressing. (Choice E) Transvestic disorder involves sexual arousal from cross-dressing. Unlike in GD, individuals with transvestic disorder do not typically report a desire to be another gender. Educational objective: Gender dysphoria is characterized by a strong and persistent desire to live and be treated as another gender, which causes distress or impairment. It is often accompanied by a desire to change one's primary or secondary sexual characteristics.

A 15-Year-Old Boy Is Brought to the Office by His