Gender identity dysphoria
Charlie was sixteen when she was referred for psychotherapy because of extreme distress about being a girl. She would cry inconsolably at the time of her monthly periods and it would take her some days to overcome her feelings of horror at her body's reasserted femaleness, so at odds with her own sense of male identity. She had felt she was a boy since she could remember and when she ®rst heard about the existence of `sex-change operations' she clung to that as the only solution to her predicament. Her con¯ict had come to a head during the pubertal changes accompanying adolescence. With the onset of the menarche she had started having suicidal feelings which caused extreme concern in her parents and was affecting her otherwise good school life. By the time the therapist met Charlie, she was extremely distrustful of anyone who tried to explore her feelings of identity and her conceptions of femaleness and maleness, and their meanings for her. From this description of Charlie's feelings we get a vivid illustration of gender identity dysphoria.