by Joseph Nicolosi, Ph.D.

transgender children

On Tuesday, January 13th, I was a guest on the "Dr. Phil Show" when a segment was aired on children who want to be the opposite sex.

Also appearing on the show was the mother of a transgendered boy who is living life as a girl, and several psychotherapists who believe that transgenderism is normal, natural and healthy for some people.

I took the position that children should not, however, be encouraged to think of themselves--and live as--as the opposite sex. All of the other psychotherapists disagreed with me.

"Imitative Attachment" in the Gender-Disturbed Boy

"Gender-identity disorder is primarily an attachment problem." These words, spoken by me during the TV interview, were edited out, but they are critical to the understanding of gender-disturbed children. No one on the show discussed this issue.

GID children do not necessarily suffer from a lack of parental love. But to begin to understand the GID child, we must understand that in early infancy, the child's sense of self is very fragile, and is formed in relationship to the mother. The mother is the source and symbol of the child's very existence. It is a simple, biological reality that infants cannot survive without a nurturing caregiver.

Experts in the area of childhood gender-identity disorder (GID) have found certain patterns in the backgrounds of GID children. A common scenario is an over-involved mother with an intense, yet insecure attachment between mother and child. Mothers of GID children usually report high levels of stress during the child's earliest years.

We often see severe maternal clinical depression during the critical attachment period (birth to age 3) when the child is individuating as a separate person, and when his gender identity is being formed. The mother's behavior was often highly volatile during this time, which could have been due to a life crisis (such as a marital disruption), or from a deeper psychological problem in the mother herself -i.e., borderline personality disorder, narcissism, or a hysterical personality type.

When the mother is alternately deeply involved in the boy's life, and then unexpectedly disengaged, the infant child experiences an attachment loss--what we call "abandonment-annihilation trauma." Some children's response is an "imitative identification"-- the unconscious idea that "If I become Mommy (i.e., become female), then I take Mommy into me and I will never lose her."

This is the same dynamic that we see in the fetish, where the boy is "taking in a piece of Mommy" (her shoes, her scarf) and developing an intense (and later sexualized) attachment to an object associated with her.

The infantile dynamic of "imitative attachment" is such that "keeping Mommy inside" becomes truly a life-or-death issue - "Either I become Mommy, or I cease to exist." This explains why gender-disturbed boys are willing to tolerate social rejection for their opposite-sex role-playing--it feels like death to abandon this perception of themselves as a female.

The phenomenon of "imitative attachment" explains why gender-disturbed boys do not display femininity in a natural, biologically based way, as do girls; but rather, demonstrate a one-dimensional caricature of femininity--exaggerated interest in girls' clothes, makeup, purse-collecting, etc. and a mimicry of a feminine manner of speaking.

As one mother explained to me, "My GID boy is more 'feminine' than his sisters."

"Born that Way?"

Although I believe gender disturbances always involve some kind of attachment problem, there may also be biological influences that lead some children in that direction.

One psychiatrist on the show discussed a recent, credible biological theory. For at least some boys who want to be girls, there may have been an unusual biological developmental problem, during the time when the then-unborn child was being formed in the uterus. This resulted in the incomplete masculinization of the boy's brains. These boys' brains are more feminine than other boys'; in extreme cases, they may grow up feeling like girls trapped in a male body.

This biological theory has some credible support--in fact, it may well explain some cases of gender disturbance. But science has, as yet, no biological test that can confirm that this brain event has actually occurred. Furthermore, we know that human emotional attachment changes the structure of the infant's brain after birth. So if we encourage the gender-disturbed boy to act like a girl, we will never know to what extent he could have become more comfortable with his biological sex if his parents were committed to actively reinforcing his normal, biologically appropriate gender identity and working to address the psychological problem of imitative attachment with the mother.

In our clinical work with GID boys, we see genuine, positive changes occur. We never shame the child for acting like a girl; we reinforce him for biologically appropriate behaviors and encourage him to grow more comfortable as a boy, thus helping him to sense that being a boy (and internalizing a masculine identity) is safe, and that being a boy is good.

No one on the Dr. Phil Show mentioned the implications of taking the opposite approach--actively preparing a boy for future sex-change surgery. Surgery can never truly change a person's sex. Doctors can remove the male genitals and form an imitation of the sex female sex organs, but they cannot make the simulated organs reproductively functional. The DNA in a boy's body cells cannot be changed with surgery. Thus, after sex reassignment surgery, there will still be a typically male genotype present.

We believe that every effort should be made to help a gender-disturbed boy accept his biological maleness, and be comfortable in life with the intact (not surgically mutilated) body with which he was born.