Epidemiology

No epidemiological studies exist of GID in children. Prevalence can be estimated only roughly from indirect sources. Two items on the Child Behavior Checklist {!) are consistent with components of the diagnosis. They are 'behaves like opposite sex' and 'wishes to be of opposite sex'. Among 4- to 5-year old boys, not clinically referred for behavioural problems, about 1 per cent of parents answer in the affirmative that their child 'wishes to be the opposite sex'. For ages 6 to 7 it drops to near zero, but rises to 2 per cent at age 11. For girls, the highest rate was 5 per cent at ages 4 to 5, but less than 3 per cent for other ages. With respect to 'behaves like opposite sex', among the boys the rate was about 5 per cent and among girls about 11 per cent for all ages. However, these data do not indicate any longitudinal aspect of the reported behaviour, and do not detail the behaviour. (2)

An alternative source of estimation looks to the percentage of adults believed to be homosexually orientated. From this population the percentage of homosexual men and women who typically report childhood cross-gender behaviour is used for the estimate. If the rate of exclusive homosexuality is 3 to 4 per cent for men and 1.5 to 2 per cent for women,(3) with perhaps half to two-thirds of homosexual men and one-half of homosexual women recalling childhood cross-gender behaviour, (!,5) the estimate of childhood cross-gender behaviour is about 3 per cent for boys and under 1 per cent for girls. However, this estimate suffers from problems of retrospective recall and poor comparability between surveys of adults. Further, the recalled behaviour may not have constituted GID.

A disparate sex ratio is evident in referral rates with GID. Approximately five boys to one girl are referred. One reason may be greater parental concern over cross-gender behaviour in boys and the greater stigmatizing peer group response to 'sissiness' than to 'tomboyism'. An alternative explanation is that, as with most disorders of sexuality, there is a higher ratio of males to females reflecting a common intrinsic predisposition to all these disorders amongst males.

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