Adult homosexual men frequently recall feeling different from other boys during early childhood. Their childhood experiences differed significantly from those of heterosexual men. These differences can be divided into two distinct groups:
Cross dressing, using make-up, fascination with women's clothes and hair
Expressed desire to be a girl, attempts to hide penis
Fantasy play taking female roles, attraction to female characters in stories
Girls as playmates
More likely to draw pictures of females
2) Chronic, Persistent Unmasculinity
Fear of Injury
Fear of Rough-and-tumble play
Non-participation in group sports
Body Dissatisfaction - feels fragile, weak, vulnerable to injury
Almost without exception boys with exhibit behaviors in category one also exhibit those in category two. Effeminate boys do not drop their dolls and run off to play soccer with other little boys. However, a substantial portion of homosexual men who exhibited chronic, persistent unmasculinity in childhood showed no symptoms of effeminacy. Some of these boys were labeled as sissies by peers, others were able to avoid the label by various strategies, but still recall feeling unmasculine. These experiences stand in a sharp contrast to the childhood experiences of the vast majority of heterosexual males.
In Bieber's study of the 106 homosexual men and 100 heterosexual men, 34% of the homosexual men recalled a degree of effeminacy at some time during their lives as opposed to only 5% of heterosexual controls.(Bieber 1962, p.189) On the other hand Bieber found that 75% of homosexual men reported being excessively fearful of physical injury in childhood (vs. 46% of heterosexual controls); 89% avoided physical fights (vs. 55% of controls); only 16% enjoyed baseball (vs. 62% of the controls). (Bieber 1962, p.175)
GENDER IDENTITY DISORDER
The more extreme manifestation of a failure to identify with one's own sex in childhood is recognized by the American Psychological Association in its Diagnostic and Statistical Manual of Mental Disorders, IV (1994) as an identifiable disorder. The criteria for making this diagnosis are as follows:
Gender Identity Disorder
A. A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex.)
In children, the disturbance is manifested by four (or more) of the following:
1) repeatedly stated desire to be, or insistence that he or she is, the other sex;
2) in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing;
3) strong and persistent preferences for cross-sex roles in male-believe play or persistent fantasies of being the other sex;
4) intense desire to participate in the stereotypical games and pastimes of the other sex;
5) strong preference for playmates of the other sex.
B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex. In children, the disturbance is manifested by any of the following: in boys, assertion that his penis or testes are disgusting or will disappear or assertion that it would be better not to have a penis, or aversion toward rough-tumble play and rejection of male stereotypical toys, games, and activities; in girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing. . .
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Gender Identity Disorder can be distinguished from simple nonconformity to stereotypical sex role behavior by the extent and pervasiveness of cross-gender wishes, interests, and activities. This disorder is not meant to describe a child's nonconformity to stereotypical sex-role behavior as, for example, in "tomboyishness" in girls or "sissyish" behavior in boys. Rather, it represents a profound disturbance of the individual's sense of identity with regard to maleness or femaleness. Behavior in children that merely does not fit the cultural stereotype of masculinity or femininity should not be given the diagnosis unless the full syndrome is present, including marked distress or impairment. (DSMIV, p.537- 538)
The Gender Identity Disorder (GID) diagnosis is not made when the person suffers from a physical problems such as androgen insensitivity syndrome or congenital adrenal hyperplasia. The children who suffer from GID are physically normal boys and girls and will develop into physically normal men and women.
Gender Identity Disorder (GID) causes considerable distress and prevents the development of normal childhood relationships. While less than half of all adult homosexual men report symptoms of childhood GID, numerous studies have found that GID boys are likely to become homosexually attracted as adults. According to Bradley and Zucker 75% of boys who exhibit the symptoms of GID report homosexual fantasies as adolescents. The relationship between childhood GID and adult homosexuality in males may be as a close to a "fact" as this type of research allows. According to Dr. Richard Friedman, who worked on the committee of psychosexual disorders for the DSMIII and who is the author of Male Homosexuality: A Contemporary Psychoanalytic Perspective:
A history of gender identity pathology (including effeminacy and chronic, extreme unmasculinity) is much more common among men who are predominately or exclusively homosexual than among men who are predominately or exclusively heterosexual. This correlation between childhood gender identity disturbance and persistent, predominant homosexuality during adulthood has been noted by many investigators using diverse strategies and methods of research (e.g., Bell, Weinberg & Hammersmith 1978, 1981; Bieber et al, 1962; Green 1985, 1987; Harry 1983; Holeman & Winokur 1965; Money and Russo 1979; Saghir & Robins 1973; Whitam 1977, 1980; Whitam & Zent 1984; Zuger, 1976, 1984). The childhood finding seems to be associated with homosexuality per se, distributed both across all types of psychopathology and among men without significant psychopathology. At present, I believe this is the only correlation between psychopathology and homosexual that may be taken as an established fact. (Friedman 1988, p.35)
Dr. Richard Green, author of Sexual Identity Conflict in Children and Adults and The "Sissy" Boy Syndrome, conducted a longitudinal study of which compared 66 GID boys with 56 demographically matched controls and concluded that while "not all boys with extensive cross gender behavior evolved as bisexual or homosexual men. No boys in the comparison group evolved as bisexual or homosexual."(Green, 1985)
Parents of 55 effeminate boys, who were asked about the aspects of their sons behavior, responded as follows:
Feminine dressing, 50/55
Aversion to boys games. 50/55
Desire to be female, 43/55
Girl playmate preference 42/55
Doll playing, 41/55
Feminine gesturing, 40/55
Wearing lipstick or other makeup, 34/55
In addition, 36 of the mothers volunteered that their son was a loner. (Zuger, 1984)
According to Saghir and Robins' survey of homosexuals, "Among boys destined to become adult male homosexuals, the prevalence of polysymptomatic effeminacy is very high. About two-thirds (67%) of the male homosexuals, but only 3% of the male heterosexuals, described themselves as having been girl-like during childhood." (Saghir, p.18) Saghir and Robins' define a "sissy" boy as:
one who shows a persistent aversion to playing with other boys or to being involved in boys' games and activities. He prefers being with girls and enjoys doing housework and playing with "girly" dolls. He is often teased by other boys and by his siblings about his "girl-like" behavior. He frequently becomes an unhappy and isolated child unable to belong in the company of boys or to participate fully in the activities of girls. His yearnings are not those of the boy next door but of the girl on the other side of the street. He feels awkward playing ball but is at home jumping rope. He dreads the gym hour but feels at ease cleaning or helping mother with her cooking.
As described above, "sissiness" in boys is a syndrome made up of a constellation of cross-gender behavioral patterns. It is not monosymptomatic nor transient. Its onset is early in childhood and its manifestations are prominent throughout the preadolescent and often during the adolescent years. (Saghir, p.18)
It should be noted that while these symptoms are described as "girl-like," girls do not generally relish cleaning or helping their mothers and do enjoy playing outside with their friends. Saghir and Robins also point out that childhood sissiness is not the universal experience of homosexual men:
While it seems that the majority of adult male homosexuals report a cross-gender syndrome of effeminacy during childhood, a significant proportion of them (33%) do not report such a syndrome. Like boys in general they were usually involved with other boys, interested in sports and disinterested in dolls, housework or girl playmates. In looking back at their childhood, this group of adult male homosexuals could not see anything that differentiated it from the childhood of other boys in terms of their interests and behavioral patterns. (Saghir, p.20)
According to the Bell, Weinberg, and Hammersmith study, "Childhood Gender Nonconformity turned out to be a very strong predictor of adult sexual preference among males in our sample."(Bell, p.76) They concluded that:
the development of male homosexuality is closely linked to gender nonconformity. Even among noneffeminate homosexual men this Dislike of Boys' Activities is the strongest predictor of Adult Homosexual. While their nonconformity may not have been so obvious either when they were growing up or in adulthood, it would appear that where they thought they stood on a masculine-feminine continuum when they were young was predictive of their eventual sexual orientation. (Bell, p.200)
According to Friedman:
The combined results of numerous investigations lead to the conclusion that childhood gender identity/gender role disturbances are associated with predominant or exclusive homosexuality in adulthood. Absence of such disturbance diminishes the likelihood that a boy will become a man who is exclusively or predominantly homosexual. This does not mean that homosexuality invariable results from such disturbances or that predominant or exclusive homosexuality invariably begins with them. Behavioral variability is the rule in psychobiology, particularly aspects of behavior that involve human sexuality... But an association as powerful from the statistical and scientific point of view as that between childhood gender identity disturbance and adult homosexuality must command the attention of clinicians and the theoreticians alike. (Friedman 1988, p.47-48)
Cross-cultural studies show that the relationship between childhood experiences and adult homosexuality appears in different cultural settings. Whitam and Zent surveyed homosexuals in the United State, Guatemala, Brazil and the Philippines and found constant patterns of early cross-gender behavior. In all four countries, as children the homosexuals were more interested in dolls, more likely to cross-dress, more likely to be regarded as sissies, and preferred play with girls. Whitam and Zent concluded:
The data suggests that early cross-gender patterns occur in the childhood experiences of homosexuals in each of the four societies, strongly supporting earlier findings that cross-gender behavior is associated with the later sexual orientation. (Whitam, 1984)
Money and Russo conducted a longitudinal study of a small group of GID boys. They acknowledged that some may object to the labeling of certain behaviors in boys as "girlish" and then classifying them as "pathological. However, they admit that GID boys did not exhibit a healthy or desirable androgyny:
At the time they were first seen, these boys were unable to widen their repertory of behavior to encompass that which in our society is stereotypically coded as male as well as that which is coded as female. They had no option of moving back and forth between both sets of stereotypes, which is the true mark of sexual liberation and behavioral androgyny. They were trapped in one of the two stereotypes. (Money, 1979)
According to the DSMIV, boys "with Gender Identity Disorder often show marked feminine mannerism and speech patterns." Rekers offers an example:
Craig behaved in a way that was a caricature of femininity. He frequently displayed a weak, limp writs and he swayed his hips when he walked. The ways in which he held his arms and the delicate ways he carefully folded his legs were all an imitation of a hyperfeminine role. It was remarkable how he could mimic all these subtle feminine behaviors as though he were a woman. (Rekers 1982, p.132)
The GID boy's mannerisms are frequently described by observers as "girl-like" or "effeminate." However, the mannerism observed are not typical of normal little girls at play, who often exhibit a high degree of androgynous behavior, physical freedom and ease of movement. Bieber points out that "effeminate" behaviors--tightly held shoulders, elbows to the sides, arms not swinging naturally with footsteps, limp wrist, hand-on-hip--are not copies of the natural mannerism of either girls or adult women. According to Bieber, the function of effeminacy may be a declaration of nonaggressiveness, since the most effeminate gestures are confined and close to the body, in contrast to normal expansive male gestures. Arno Karlen commenting on Bieber writes:
effeminacy seems to be a misleadingly named body language that combines reversal of masculine signals, nonassertive signs and some elements of burlesqued femininity to announce, "I won't fight, I'm not dangerous--if necessary, not even a man.(Karlen, p.579)
Moberly holds that effeminacy in the male homosexual results from a "defensive detachment from the parent of the same sex" which blocks the normal identificatory process. According to Moberly this is not a "genuine identification with the opposite sex, but rather a disidentification with the same sex." (Moberly, p.8)
Dr. Joseph Nicolosi, a therapist with extensive experience in the treatment of GID boys and adult homosexual, points out that the gender non-conformity observed GID boys does not have a rich an expansive character. Boyhood effeminacy often appears unnatural, one dimensional, with a quality of sham or caricature. The child appears to be hiding behind a role. In some cases the behavior is clearly related to frustration. One mother reported, "I can tell what kind of day my son had at the YMCA by his behavior. If he is effeminate, I know he was frustrated. On the other hand if he is warm and verbal, I know he was good at soccer."
A father describes his 7-year-old GID son as follows:
He at times becomes very effeminate in his mannerisms and his voice, particularly when he's under stress... he's under stress typically because he's either shy or ... reacting to something, he gets very effeminate... It's short-lived... but it's a, it's a very effeminate reaction. (Zucker 1995, p.21)
In many cases the extreme forms of effeminate behavior often diminished as the boy matures.
According to the DSMIV (p. 533), GID boys "may have a preference for dressing in girls' or women's clothes or may improvise such items from available materials when genuine articles are unavailable. Towels, aprons, and scarves are often used to represent long hair or skirts."
Cross-dressing often begins early. According to Zuger, "One boy at about 2 years
of age, insisted on being dressed in girl's clothes before he would agree to go to nursery school. Similarly, another boy less than 4 years of age would not leave the house unless in dress and makeup like a girl." Both became homosexual as adults. (Zuger, 1984)
According to Green, all the boys in the group studied "began cross-dressing before their sixth birthday; three-fourths began by their fourth birthday. The most frequent age of onset of an enduring interest in wearing girls' clothes was between the second and third birthday." (Green 1974, p.143) Many of the boys were extremely attracted to high heeled shoes. In 8% of the cases the feminine boy had been dressed in girls' clothes by a sister, in 10% of the cases by a grandmother, and in 15% by the mother. (Green 1974, p.219) Other family members reinforced the behavior. In one case when the boy was "a year and a half and these two little girls took him and they dressed him up completely from a wig all the way down to shoes." According to the father, "Everybody thought it was cute and everything. Everyone laughed." (Green 1974, p.217)
In another case, Edward, a 5-year-old boy, "showed a very strong interest in dressing in his mother's clothes and female costumes at nursery schools. He took a feminine role in games, seldom played with boys, and had no interest in masculine games. Even for such a young child his gestures and speech inflections were often effeminate, particularly when excited. This pattern, present from at least age 3, seemed partially to stem from his play with a very dominant 7-year-old neighborhood girl who encouraged Edward in his effeminate ways." (Bates, 1971)
According to Zucker and Bradley:
In many boys, cross-dressing has an obligatory quality (e.g., insistence on cross-dressing outside the home) and is not restricted to play situations. A common precipitant for referral is extensive cross-dressing by a boy in preschool or kindergarten. The driven quality of the cross-dressing is sometimes manifested by the boy's need to sleep in female clothing or by his agitation when female clothing is unavailable. Some parents report that when their son comes home from school, he manifests a frantic need to change into women's clothing. Even among parents who have a generally ambivalent or supportive reaction to their sons' cross-gender identification, there is an emerging unease with the chronic display of cross-dressing... By late childhood, the interest in cross-dressing may be transformed into a preoccupation with the appearance of female move stars or other popular figures. (Zucker 1995, p.15)
Zucker and Bradley report a case in which, "At age 3, Jimmy had begun cross-dressing in his mother's nightgown, swimsuit, and underwear. He would wear these under his own clothes when he had to be away from his mother." (Zucker 1995, p. 50)
According to the DSMIV (p.533) GID boys favor "stereotypical female-type dolls, such as Barbie: and "girls are their preferred playmates" Zucker and Bradley noted that GID boys were "preoccupied with Barbie (or her variants) spend inordinate amounts of time brushing her hair and dressing and undressing her." However, Zucker and Bradley also noticed very little nurturant play, such as parenting baby dolls. (Zucker 1995, p.16) Observational studies (Rekers, 1976, Zucker, 1979, Green, 1972, 1973) provide evidence that GID boys play with toys normally chosen by girls for a longer time than do masculine boys.
One mother reported extensive doll play by her GID son, "The dolls never worried me for a while because I figured it was only natural. 'Cause I had heard a long time ago that if boys played with dolls when they were young, they made a better father... So, I said he would grow out of it. But now it bothers me more... and it's kind of embarrassing when he says, "I don't want to go there because they don't have any dolls." (Green 1974, p.161)
Desire to be a girl
The DSMIV(p.537) lists "repeated stated desire to be, or insistence that he or she is, the other sex" as one of the criteria for diagnosing GID. A mother of a 6-year-old GID boys reports, "The teacher told me he acted real feminine in school, that he won't get on the boys' line. He stays on the girls' line." (Green 1974, p.156)
According to Saghir and Robins, 27% of homosexual males reported a repetitive desire to become a girl or a woman before the adult years. Those interviewed recalled:
I wanted to be a girl since I was 7 years old. I had fantasies that I was a woman and would occasionally put on woman's cloths. Later in adolescence I would have the fantasies of being a woman penetrated by a man. All these fantasies disappeared around the age of 18.
When I was 9, I started thinking about how nice it was to be a girl, to stay home, cook and do housework. I had these thought all through high school. I would visualize myself as a blonde and picture myself falling in love with a boy. I was 16 at the time. A year or so later these thoughts disappeared.
I started having the idea of wanting to be a woman. It has persisted since then. I think about it a great deal. I day dream about it.
As a child, I played with paper dolls and dressed up in mother's clothes. I was not the type to go running around with kids. For many years I have had thoughts of sex change. Few months ago I consulted a doctor about sex change and he was against it. I think I would be happier as a woman. (Saghir, p.21-22)
According to the DSMIV (p. 533) GID boys may "insist on sitting to urinate and pretend not to have a penis by pushing it in between their legs. More rarely, boys with Gender Identity Disorder may state that they find their penis or testes disgusting, that they want to remove them, or that they have, or wish to have a vagina." Zucker notes that a number of GID say they hate their genitalia. One 5-year-old boys stated:
When my penis goes up, I get mad and angry. I hate it when it goes up. I want to shoot it off with a gun. I want to get rid of it. I want to shoot myself and die.(Zucker 1995, p.21)
According to the DSMIV (p. 533), "When playing 'house,' these boys role-play female figures, most commonly 'mother roles,' and often are quite preoccupied with female fantasy figures."
According to a mother of a GID boy:
He was very imaginative in general, very imaginative in his play, and has been since the time he was a little child... and he usually was the woman... He would wear my shoes, and take my purse, and he would say, "Mommy is going to the market."... Teachers have been telling him he has to be the father. He says, "I don't know what a daddy does." They said he has no idea what to do in that role. (Green 1974, p.164)
A stepmother reported that her stepson frequently engaged in make-believe and seemed "able to transform himself into the role he's playing" and that the other children resented the way this boy "hogged the stage." (Green 1974, p.164) In another case, a GID boy frequently pretended to be Dorothy or the Wicked Witch from The Wizard of Oz. The Wizard of Oz appears to resonate with homosexual men. In Ireland homosexual men frequently inquire "Are you a friend of Dorothy's?" as a way of determining another man's sexual orientation. Judy Garland, who played Dorothy, continues to be extremely popular among homosexual men.
Zucker and Bradley also noted preoccupation and identification with "evil" females, such as the Wicked Witch of the West from The Wizard of Oz.
The mother of a GID boys reports:
When he was two, you know how the other boys say, "What do you want to be when you grow up?" He will say he wants to grow up to be a mommy. We just kind of laughed at it at first... and he plays with little girls all the time. He likes to play house, and he's the mama when he plays house. One day they were over playing and I said, "Why don't you be the daddy?" and he said, "No, I'll be the little sister." (Green 1974, p.154)
Girls as playmates
The DSMIV (p.537) lists "strong preference for playmates of the other sex" as one of the elements that should be considered in making the diagnosis of GID. Homosexual men frequently recall having girl playmates:
I preferred to play with the girls, not because I necessarily liked girls better, but because I preferred cooperative rather than competitive games, nor did I like the anger and aggressiveness on the playground. I really didn't like team things. (Silverstein, p.62)
While some GID boys choose girls as playmates, several clinicians have described these boys as "bossy." (Bakwin, 1968, Zuger, 1984) The GID boy may insist on taking the female part in fantasy play. Coates, Friedman, and Wolfe (1991) have noted that some of these boys are extremely egocentric and "insist on their own rules in games" and have temper tantrums if they do not get their way. Rekers reported a similar case:
Not only did Craig avoid the rough-and-tumble games of other boys his age, but he also preferred to play only with girls. His favorite game was to play house. He would take the role of "mother" and insist that one of the girls play the part of "father."(Rekers 1982, p.132)
In another case a 5-year-old boy with GID, was described as preferring girls as playmates, but would shy away from them if they became too boisterous. (Zucker 1995, p.12)
Drawing pictures of women
According to the DSM IV, GID boys "particularly enjoy playing house, drawing pictures of beautiful girls and princesses, and watching television or videos of their favorite female characters."(DSMIV, p.533) According to Green:
When ask to draw a person normally girls draw females and boy draw males, however when "feminine" boys were asked to "a person the majority of the feminine boys drew a female. In addition, when they were asked to draw a picture of themselves, the feminine boys drew a girl. (Green 1974, p.162)
One mother reported that her son refused to draw pictures of boys, even though she had on numerous occasions shown him how. According to the mother, he would resist saying, "I don't know how to draw a boy . . .I can't do it! I can't do it!" (Green 1974, p.152)
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