Gender Identity Disorder Involves discomfort with ones gender or the role of that gender In adults, this disorder

rder can include the desire to live as the other gender or can involve feelings and reactions of the other gender (APA, 2000) Is a preoccupation with getting rid of primary and secondary sexual characteristics Believes that they were born as the wrong gender, experience unhappiness with their own biologic gender, and might desire hormones and surgery to become the opposite gender Sexual reassignment surgery is not undertaken immediately on request The individual must be assessed for the presence of other psychiatric disorders The patient desiring sexual reassignment undergoes psychotherapy for 6 to 12 months Emotional, medical, surgical, financial and legal issues are explored, along with the risks involved. Sexual reassignment surgery is not the answer for everyone with gender dissatisfaction. Some gender identity programs require written second opinion from another physician or psychologist before proceeding with surgical reassignment. Hormonal treatment and living and relationship changes are slowly made over months while the individual is in therapy.

DSM-IV-TR Criteria for GID A. A strong and persistent cross-gender identification 1. In children: a. Stated desire or insistence that he or she if the other sex b. In boys, dressing in female attire, in girls wearing only masculine clothing c. Make believe play of fantasies of being the other sex d. Desire to participate in games and pastimes of the other sex e. Prefers playmates of the other sex 2. In adolescents and adults: a. Stated desire to be the other sex b. Frequently passes as the other sex c. Desires to be treated as the other sex d. Conviction that he or she has typical feelings and reactions of the other sex B. Feelings of discomfort with own sex or inappropriateness in gender role of own sex

Nurse- Patient Relationship The nurse must have an accepting, emphatic and nonjudgmental attitude if patients are to be comfortable enough to disclose problems with sexuality. This trust comes about only after the nurse has reconciled and accepted his or her own feelings related to sexuality. Patients might interpret the nurses discomfort with sexual issues and sexuality as disapproval of them and of their sexual issues and concerns. The nurse discusses options for dealing with sexual issues and problems. Clarification and education might be needed about sexual functioning, effective communication, and healthy relationships. The nurse might also need to intervene with self- esteem issues, anxiety and guilt. The nurse is involved in the planning of patients care regarding the specific issues and problems that are addresses during an inpatient stay versus those addressed in outpatient treatment. The nurse is legally obligated to report suspected and actual sexual abuse of children to police or appropriate agencies. The nurse discusses possible referrals with patients and family members and refers patients to sex therapists, if necessary. Referrals to outpatient treatment programs or therapy groups for specific disorders might be necessary. Individual, group, and family treatment for incest and support groups for perpetrators and victim might be appropriate.