Gender Identity Disorder (GID) is a passive phenomenon which is found globally including in the Arab countries, despite the fact that this phenomenon contradicts Arab social, religious, and moral values.

Research on factors that may cause GID has been flourishing in recent decades. In 1966, Kohlberg focused on moral development. In the same area, Green (1987), Zucker, Bradley, and Sanikhani (1997), and Zucker, Bradley, and Sullivan (1996), investigated gender identity formation and disorders among children and adolescents. Zucker and Bradley (1999) scrutinized GID in relation to variables such as different developmental stages. Orlofsky and Stake (1981) examined academic and career achievement and interpersonal concerns in males and females. Results indicated that psychological masculinity and femininity are better predictors of strivings and self-concepts in the achievement and interpersonal domains than is gender.

Marsh (1987) tested the generality of the Marsh/Shavelson conclusions in a study of the relations between multiple dimensions of self-concept and masculinity/femininity (MF) measures. The relationships between four Australian Sex-Role Scale (M+, M-, F+, F-) items and two facets of self-concept (SDQ II) were examined. Results showed that the social desirability of MF items, whether positive or negative, were more highly correlated with self-concept responses than whether the items were M or F. Signorella and Jamison (2001) studied the influence of gender stereotyping on sex differences in spatial performance. Results showed that adolescent girls whose masculine self-concept scores exceeded their feminine self-concept scores, performed better on spatial tasks than did girls whose F scores were higher than their M scores. No significant associations were found for boys.

GID is characterized by strong and persistent cross-gender identification and by persistent discomfort with one’s sex. Results (Marsh, 1987) indicated that extreme caution must be taken when treating adolescents with GID. Sex reassignment must not be started before patients have reached eighteen years of age (Meyenburg, 1999).

The DSM-IV (DSM - American Psychiatric Association, 1994) diagnosis of Gender Identity Disorder as a mental disorder has attracted controversy for its diagnostic criteria as a target for therapeutic intervention, and for its relationship to a homosexual sexual orientation. Another controversy is the claim that the diagnosis of GIDC was introduced into the DSM-III to replace homosexuality. In this article it is argued that GIDC was included as a psychiatric diagnosis because it met the generally accepted criteria used by the framers of the DSM-III for inclusion. Therefore, the entry of GIDC was guided by research clinicians using the same mechanism that led to the introduction of other new psychiatric diagnoses (Zucker & Spitzer, 2005).

According to social learning theory (Cohen, Derend, & Arrindell, 1994), a child acquires gender identity characteristics by observing the conduct of a certain model, and then adapts such a model of conduct to be replicated in his/her own behavior.

Green (1987) and Coates (1992) suggest that an unstable relationship with the father and strong identification with the mother are among the most important reasons for a male child’s GID. An unstable father-child relationship could be due to the father’s death or to divorce, or to the unavailability of the father for psychological interaction with the children. This could lead boys to strongly identify with their mothers and to become feminine in their attitudes towards their sex role. Green pointed out that gender identity disorders may start at the age of three or four, as a result of factors which include body image, hormone deficiency, identification with the mother and the absence of the father. According to Green, disorder at an early age represents a risk factor which paves the way for the disorder to continue in later years.

Bodlund and Armelius (1995) focused on self-image and personality trait among GID and normal individuals. Results showed that individuals with GID have negative self-concept, a lack of social skills, and that they suffer from various personality disorders.

Coates and Wolfe (1995) examined the relationship between attachment bond and GID among a group of young adults. Children of unidentified sex who suffered from worry, were unable to resolve the Oedipus complex, and identified with the parent of the same sex were more susceptible to GID. Dobb (1997) studied self-concept in young adults who were being treated for GID and who had developed positive attitudes towards the same sex. Subjects were found to have self-concept disorder and conflict between their biological formation and desire to transform into the other sex.

In Kuwait, Mikhamer and Al-Thafairi (2003) investigated the relationship between childhood experiences of abuse and GID. Results revealed significant differences among subjects with GID, in relation to their exposure to physical and psychological abuse from parents. A father’s abuse was more harmful than that of a mother. Also, a significant relationship was found between a father’s physical and psychological abuse and the sexual abuse of others.

This study was designed to answer the following three questions:

1. Is there significant difference between normal male individuals and those with Gender Identity Disorder in relation to social self-concept dimensions, that is, social, family, moral, physical, and personal?
2. Is there significant difference between normal individuals and males with Gender Identity Disorder in relation to the clinical subscales of self-concept: neurosis, general maladjustment, personality disorder, defensive positive and personality integration?
3. Is there significant difference between normal males and male individuals with Gender Identity Disorder on the Masculinity/Femininity scale?

Tennessee Self-Concept Scale (2nd edition) The scale was developed by W. H. Fitts and adapted for an Arab milieu by Farag and Al-Qurashi (1999). It is used to measure the self-concept dimensions – physical, social, family, moral, and personal – in addition to the other clinical scales: neurosis, psychosis, disharmony, personality disorder, defensive mechanisms, and personality harmony. The validity and reliability of the scale have been calculated on a sample of Kuwaiti students. The alpha reliability factors of the study subscales for both normal individuals and those with GID were calculated and are shown in Table 2.

Table 2 shows that the self-concepts subscales indicate acceptable alpha reliability levels for both groups, apart from the physical subscale for the GID group which shows a low alpha reliability of 0.48.

Masculinity/Femininity Scale (MMPI) (translated into Arabic by Hana, Ismail, & Milaika, 1986) The scale consists of 60 statements. The participants are asked to provide a yes or no response for each statement. A high score on the scale indicates high masculinity. The scale also has a proven high level of validity and reliability. Moreover, the researcher has calculated the Cronbach alpha reliability and found that it reached an acceptable level (0.82).

Table 3 shows that there are significant differences between the normal males and the GID males.

As a consequence of the harmony between his personality traits and his psychological characteristics on the one hand, and his biological sex on the other, the normal individual feels that he has realized his sex identity, and therefore, feels satisfied, self-confident, and psychologically secure. On the other hand, disharmony between the psychological traits and biological sex leads to a negative self-concept, a feeling of depression, anxiety and detachment. This might lead to a deviant passive identity, which acts against the self and society. Such an individual demonstrates his deviation through homosexuality, addiction, crimes, or any other forms of deviation to realize himself passively (Zahran, 1994).

The family self subscale relates to the individual’s relationship with his family members. Scores here reflect the individual’s feelings of worthiness in social interaction with others. High scores generally indicate a state of satisfaction with family self, whereas a low score indicates disorder in that area. The study findings revealed a disorder in the family self among GID individuals. Cohen et al. (1994) suggest that self-concept disorder and GID may relate to some family variables, in particular variables of disorder in the family environment: divorce, separation, argument, or addiction of one parent. The absence of the father by death or lack of interaction is another variable that affects a boy’s self-concept. The personal self is related to the individual’s feeling of adequacy and his evaluation of his personality regardless of his body image or relationships with others. The high scores on that subscale indicate personal-self satisfaction and vice versa. The study findings point out increased personality disorder among GID individuals compared to normal individuals.

To test the first hypothesis, t-test analysis was used to elicit the differences between normal individuals and those with Gender Identity Disorder on the clinical scales as demonstrated in the following table.

Table 4 shows statistically significant differences between the mean scores of normal males and those with Gender Identity Disorder in the dimensions related to neurosis, psychosis, general maladjustment, and personality disorder. There is a higher occurrence within the Gender Identity Disorder group. However, on the subscales of defensive positive, and personality integration, the normal individual group scored higher than those with GID.

The high scores on the neurosis scale reflect neurotic symptoms which characterize the behaviors of neurotic individuals. The high score on the maladjustment scale is considered an indication of the individual’s maladjustment to his society, family, and self. At the same time, high scores on the personality disorder scale indicate that such individuals suffer from weakness of personality. It is clear from the above table that the statistical averages on the neurosis, maladjustment, and personality disorder subscales incline towards the GID group.

In their study, David and Signer (1993) pointed out that a weak, or unstable family relationship is related to a child’s feeling of lower self-security and inadequacy of personal competence. This may pave the way to psychosis, personality and mental disorders, and, consequently, the inability to define personal and sexual identity.

To test the hypothesis that normal individuals would score higher on the masculinity scale than would individuals with GID, t-test analysis was used to elicit the significance of the differences between the average scores of both groups in relation to masculinity. The results are shown in Table 5.

Bodlund, Q., & Armelius, R. (1995). Self-image and personality traits in gender identity disorders: An empirical study. Journal of Sex and Marital Therapy, 20, 303-317.

Coates, S. (1992). The etiology of Boyhood Gender Disorder: An integrative model. In J. W. Barron, M. N. Eagle, & D. Wolitzky (Eds.), Interface of Psychoanalysis and Psychology, (pp. 245-265). Washington, DC: American Psychiatric Association.

Coates, S., & Wolfe, S. (1995). Gender identity disorder in boys: The interface of constitution and early experience. Psychoanalytic Inquiry, 15, 6-38.

Cohen, P., Derend, S., & Arrindell, S. (1994). Parental factors and transsexualism. In C. Perris, W. Arrindell, & M. Eisemanns (Eds.), Parenting and Psychopathology (pp. 267-279). New York: John Wiley & Sons.

David, H., & Signer, M. (1993). Psychological distress, problem behavior and family functioning of sexually abused adolescent inpatients. Journal of American Academy of Child and Adolescent Psychiatry, 32, 954-961.

Dobb, L. (1997). Relationships among gay men’s self-concept, their attitudes towards homosexuality, and their degree of disclosure to others about being gay. Dissertation Abstract International, 57, 10B, 6567.

DSM-American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed). (DSM). Washington, DC: American Psychiatric Association.

Farag, S. E., & Al-Qurashi, A. (1999). Psychometric characteristics: An abbreviated form of Tennessee Self-Concept Scale (in Arabic). Egyptian Journal of Psychological Studies (Egypt), 23, 22-47.

Fitts, W. H., & Warren, W. L. (1965). Tennessee Self-Concept Scale, TSCS-2, CA, USA: Western Psychological Services.

Green, R. (1987). Sexual identity conflicts in children and adults. New York: Basic Books.

Hana, A., Ismail, M. E., & Milaika, L. K. (1986). Multi-facet personality test. Kuwait: Dar Al-Qalam (in Arabic).

Kohlberg, L. (1966). A cognitive developmental analysis of children’s sex-role concepts and attitudes. In E. E. Maccoby (Ed.), The development of sex differences. Stanford, CA: Stanford University Press.

Maden, Y. (1995). Sexual upbringing for children and adults. Dar Al-Mahaba. Beirut, Lebanon. (in Arabic).

Marsh, H. W. (1987). Masculinity, femininity and androgyny: Their relations with multiple dimensions of self-concept. Multivariate Behavioral Research, 22, 91-118.

Mcdermid, S., Zucker, K., Bradley, S., & Maing, D. (1998). Effects of physical appearance masculine trait ratings of boys and girls with Gender Identity Disorder. Archives of Sexual Behavior, 27, 237-267.

Meyenburg, B. (1999). Gender Identity Disorder in adolescence: Outcomes of psychotherapy. Adolescence, 34, 134.

Michael, L. (1997). The father’s role in the child’s life: A multi-dimensional perspective, part two. Translated by Adel Abdulla. Cairo: United Company for Publication and Distribution.

Mikhaimer, E., & Al-Thafairi, A. (2003). Child abuse experiences and Gender Identity Disorder. Psychological Studies (Egypt), 13(30), 447- 486 (in Arabic).

Orlofsky, J. L., & Stake, J. E. (1981). Psychological masculinity and femininity: Relationship to striving and self-concept in the achievement and interpersonal domains. Psychology of Women Quarterly, 6 (2), 218-231.

Rogers, C. (1959). Theory, therapy, personality as developed in the client centered framework. In S. Koch (Ed.), A study of science, 3, (pp. 184-256). New York: McGraw-Hill.

Shu’aib, A. (2001). Body language, morality studies (in Arabic). Kuwait: Allya, Printing & Distribution.

Signorella, M. L., & Jamison, W. (2001). Relations of masculinity and femininity self-concept to spatial performance in adolescents. Journal of Genetic Psychology, 148(2), 249-251.

Zahran, H. A. (1994). Social Psychology (in Arabic). Cairo, Egypt: Book World.

Zucker, K., & Bradley, S. (1999). Gender Identity Disorder and transvestic fetishism. In S. Netherton, D. Holmes, & C. Walker (Eds.), Child and Adolescent Psychological Disorder. New York: Oxford University Press.

Zucker, K. J., Bradley, S. J., & Sanikhani, M. (1997). Sex differences in referral rates of children with gender identity disorder: Some hypotheses. Journal of Abnormal Child Psychology, 25, 217-227.

Zucker, K. J., Bradley, S. J., & Sullivan, C. B. L. (1996). Traits of separation anxiety in boys with Gender Identity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 791-798.

Zucker, K. J., & Spitzer, R. L. (2005). Was the Gender Identity Disorder of childhood diagnosis introduced into DMS-III as a backdoor maneuver to replace homosexuality? A historical note. Journal of Sex & Marital Therapy, 31, 31-42.

Bodlund, Q., & Armelius, R. (1995). Self-image and personality traits in gender identity disorders: An empirical study. Journal of Sex and Marital Therapy, 20, 303-317.

Coates, S. (1992). The etiology of Boyhood Gender Disorder: An integrative model. In J. W. Barron, M. N. Eagle, & D. Wolitzky (Eds.), Interface of Psychoanalysis and Psychology, (pp. 245-265). Washington, DC: American Psychiatric Association.

Coates, S., & Wolfe, S. (1995). Gender identity disorder in boys: The interface of constitution and early experience. Psychoanalytic Inquiry, 15, 6-38.

Cohen, P., Derend, S., & Arrindell, S. (1994). Parental factors and transsexualism. In C. Perris, W. Arrindell, & M. Eisemanns (Eds.), Parenting and Psychopathology (pp. 267-279). New York: John Wiley & Sons.

David, H., & Signer, M. (1993). Psychological distress, problem behavior and family functioning of sexually abused adolescent inpatients. Journal of American Academy of Child and Adolescent Psychiatry, 32, 954-961.

Dobb, L. (1997). Relationships among gay men’s self-concept, their attitudes towards homosexuality, and their degree of disclosure to others about being gay. Dissertation Abstract International, 57, 10B, 6567.

DSM-American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed). (DSM). Washington, DC: American Psychiatric Association.

Farag, S. E., & Al-Qurashi, A. (1999). Psychometric characteristics: An abbreviated form of Tennessee Self-Concept Scale (in Arabic). Egyptian Journal of Psychological Studies (Egypt), 23, 22-47.

Fitts, W. H., & Warren, W. L. (1965). Tennessee Self-Concept Scale, TSCS-2, CA, USA: Western Psychological Services.

Green, R. (1987). Sexual identity conflicts in children and adults. New York: Basic Books.

Hana, A., Ismail, M. E., & Milaika, L. K. (1986). Multi-facet personality test. Kuwait: Dar Al-Qalam (in Arabic).

Kohlberg, L. (1966). A cognitive developmental analysis of children’s sex-role concepts and attitudes. In E. E. Maccoby (Ed.), The development of sex differences. Stanford, CA: Stanford University Press.

Maden, Y. (1995). Sexual upbringing for children and adults. Dar Al-Mahaba. Beirut, Lebanon. (in Arabic).

Marsh, H. W. (1987). Masculinity, femininity and androgyny: Their relations with multiple dimensions of self-concept. Multivariate Behavioral Research, 22, 91-118.

Mcdermid, S., Zucker, K., Bradley, S., & Maing, D. (1998). Effects of physical appearance masculine trait ratings of boys and girls with Gender Identity Disorder. Archives of Sexual Behavior, 27, 237-267.

Meyenburg, B. (1999). Gender Identity Disorder in adolescence: Outcomes of psychotherapy. Adolescence, 34, 134.

Michael, L. (1997). The father’s role in the child’s life: A multi-dimensional perspective, part two. Translated by Adel Abdulla. Cairo: United Company for Publication and Distribution.

Mikhaimer, E., & Al-Thafairi, A. (2003). Child abuse experiences and Gender Identity Disorder. Psychological Studies (Egypt), 13(30), 447- 486 (in Arabic).

Orlofsky, J. L., & Stake, J. E. (1981). Psychological masculinity and femininity: Relationship to striving and self-concept in the achievement and interpersonal domains. Psychology of Women Quarterly, 6 (2), 218-231.

Rogers, C. (1959). Theory, therapy, personality as developed in the client centered framework. In S. Koch (Ed.), A study of science, 3, (pp. 184-256). New York: McGraw-Hill.

Shu’aib, A. (2001). Body language, morality studies (in Arabic). Kuwait: Allya, Printing & Distribution.

Signorella, M. L., & Jamison, W. (2001). Relations of masculinity and femininity self-concept to spatial performance in adolescents. Journal of Genetic Psychology, 148(2), 249-251.

Zahran, H. A. (1994). Social Psychology (in Arabic). Cairo, Egypt: Book World.

Zucker, K., & Bradley, S. (1999). Gender Identity Disorder and transvestic fetishism. In S. Netherton, D. Holmes, & C. Walker (Eds.), Child and Adolescent Psychological Disorder. New York: Oxford University Press.

Zucker, K. J., Bradley, S. J., & Sanikhani, M. (1997). Sex differences in referral rates of children with gender identity disorder: Some hypotheses. Journal of Abnormal Child Psychology, 25, 217-227.

Zucker, K. J., Bradley, S. J., & Sullivan, C. B. L. (1996). Traits of separation anxiety in boys with Gender Identity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 791-798.

Zucker, K. J., & Spitzer, R. L. (2005). Was the Gender Identity Disorder of childhood diagnosis introduced into DMS-III as a backdoor maneuver to replace homosexuality? A historical note. Journal of Sex & Marital Therapy, 31, 31-42.