Gender Identity Disorder
George A. Rekers, Ph.D.
The past three decades have witnessed a well-
Paradoxically, during these same recent decades, two developments emerged
in the mental health and behavioral science disciplines. First, a mass of research
data accumulated which led to a recognition of the often detrimental effects of father
absence on several critical aspects of child development, including normal sex role
development and sexual adjustment (see reviews by Biller, 1974; Hamilton, 1977; Hetherington,
Cox & Cox, 1979; Lamb, 1976; Mead and Rekers, 1979; and Rekers, 1986b, 1992, for
example). Secondly, clinical and research data accumulated to a sufficient degree
to enable the mental health professions to officially identify a newly recognized
form of psycopathology-
Recent years witnessed the swing of the pendulum of public attention
to the social advocates of "eliminating all distinctions based on sex." However,
an objective consideration of the whole scope of findings in human development research
and clinical studies yields an appreciation and recognition of appropriate sex roles
in the family and their critical importance to the normal gender identity development
of children.
Normal Versus Abnormal Sex Role Development
As part of the process of normal gender identity in the family, young children will
often try out a variety of sex role behaviors as they learn to make the fine distinctions
between masculine and feminine roles. Some young boys occasionally perform behaviors
that our culture traditionally has recognized as feminine, such as wearing a dress,
using cosmetics or play acting the roles of bearing and nursing infants. Similarly,
many young girls will occasionally assume a masculine role-
In pathological cases, however,
children deviate from the normal pattern of exploring masculine and feminine behaviors
and develop an inflexible, compulsive, persistent and rigidly stereotyped pattern
(Zucker, 1985). On one extreme is the distorted supermasculinity of boys who are
belligerent, destructive, interpersonally violent, and uncontrolled and simultaneously
lacking gentle and socially sensitive behaviors (Harrington, 1970). Professional
intervention is required for these exaggeratedly "hypermasculine" boys who actually
have adopted a maladaptive caricature of masculinity. The opposite extreme is observed
in effeminate boys who reject their masculinity to the extent of rigidly insisting
that they are a girl or that they want to become a mother and bear children (Rekers,
1981; Rekers & Milner, 1978; Rekers & Kilgus, 1997). Such a boy frequently avoids
play with boys, dresses in girls' clothing, plays predominantly with girls, tries
on cosmetics and wigs, and displays stereotypically feminine arm movements, gait,
and body gestures. This boyhood femininity goes beyond normal transitory, curiosity
induced exploration of feminine behavior to constitute a serious clinical problem
(Rekers, 1985d, 1985e) Although little research exists on female childhood gender
disorders, it is possible to identify the parallel conditions of maladaptive hyperfemininity
and hypermasculinity in girls (Rekers & Mead, 1979, 1980).
One of the clinician's
tasks is to differentiate normal adjustment phases in psychosexual development from
gender disturbances that require specific treatment intervention (Rekers & Kilgus,
1995; Rekers, 1995a). To illustrate this task, let me describe a boy to you.
Carl
(a pseudonym) was referred to me for treatment at the age of 8 years, 8 months (Rekers,
Lovaas & Low, 1974). The referring physician had found Carl to be physically normal
in terms of currently available methods of biomedical testing. Prior to referral
to me, Carl had been evaluated by two separate psychiatric agencies as having a severe
cross gender identity problem. In one clinic, Carl had been treated in family therapy
for a period of 8 months in a largely unsuccessful attempt to alleviate his personal
problems and his major difficulties in peer and family relationships.
He came from
a broken family in which his mother had had four marriages in Carl's lifetime. Carl
had a brother seven years old and a sister six years old.
Since the age of our years,
Carl had pronounced feminine voice inflection and feminine speech content. He was
extremely verbal, and his conversations were dominated by topics such as dresses,
cosmetics, maternal roles, female impersonators, delivering babies, and female underclothing.
He had several recurring exclamatory feminine sounding remarks, such as "goodness
gracious," and "oh, dear me."
His feminine gestures were exaggerations of an effeminate, swishy gait and arm movements.
He would typically sit with his legs crossed very effeminately and his arms folded
like a female model. At home, he would frequently use towels after a bath to simulate
female garments and long hair.
In his peer relationships, Carl passively allowed
boys to lease him without asserting himself in return. He preferred girls in play,
assuming the female role himself with great....played house with his sister frequently.
Carl was ostracized by his male peers who labeled him "sissy" and "queer." He harbored
a strong fear of "getting hurt" and feigned illnesses and injuries to avoid play
with boys. Not only was Carl labeled by his peers as effeminate, but also he referred
to himself as a "sissy" and "fag," and his speech regularly implied that he preferred
to be considered a girl.
Carl's feminine behavior was increasingly leading him to
social isolation, ridicule, and chronic unhappiness. His mother, who had found his
feminine gestures to be amusing before he was age four, was very alarmed when they
persisted to the age of eight years. She strongly wanted him to receive professional
help, and she requested help herself to solve the related problems in her family.
Disorder Created by Incongruity Across Dimensions
Physically, Carl's physician had determined that his sexual status was normal prepubertal
male with a normal 46XY male karyotype. His sex of assignment had been male, and
his mother had raised him as a boy.
His gender identity was that of a girl. In other words, he had a cross gender identity.
He called himself a "sissy" and a "fag," and this constituted an aspect of his sex
role identity. His gender role behavior was predominantly feminine.
Because of his
age, his sexual object orientation and genital interpersonal behavior were not assessed
at the time of his initial evaluation. He was not involved in sexual behavior.
Carl's
case illustrates how any incongruity across any two of these psychosexual dimensions
can create psychological conflict and associated maladjustment problems (Rekers,
1981b; Rosen & Rekers, 1980). This brings us to a distinction between Gender Role
Behavior Disturbance and Cross Gender Identification in boys.
Gender Role Behavior Disturbance
A Gender Role Behavior Disturbance may be present in a boy as young as three years
old who has normal male physical sex status. Typically, the sex assignment has been
male, although cases have been reported where family members have given incongruent
or ambiguous messages to a young child regarding his physical sex status. Gender
identity is typically male and not female, although sex role identity may range from
male gender role, to self-
The distinguishing features
of Gender Role Behavior Disturbance exist at the interpersonal dimension where any
of the following behavior are observed over an extended period of time; Cross dressing;
play with cosmetic articles; "feminine" appearing gestures; avoidance of masculine
sex-
Of course,
Gender Role Behavior Disturbance may occur in either boys or girls, although it is
detected more frequently in boys. And there are two major extremes that can be manifested
in terms of role inflexibility in either the masculine or feminine direction, in
either boys or girls. The two possible chromic patterns in boys are (1) excessive
feminine behavioral rigidity, and (2) pathological hypermasculinity. The two possible
chronic patterns in girls are (1) excessive masculine behavioral rigidity, and (2)
pathological hyperfemininity.
Gender Identity Disorder of Childhood
In addition to the behavioral manifestations of a Gender Role Behavior Disturbance,
a boy with a Gender Identity Disorder also manifests one or more of these features:
(1) And expressed desire to be a girl or a woman, (2) expressed fantasies of bearing
children and breast-
Carl illustrates the potentially more serious disorder
of Cross Gender Identification. This condition in boys involves gender identification
as a female, including requests to change one's physical sex status.
I have observed and reported in the literature (Rosen & Rekers, 1980) this distinction
between the Gender Role Behavior Disturbance and the Cross Gender Identification
Disturbance. Theoretically, Gender Role Behavior Disturbance in child development
may parallel the adulthood conditions of transvestism, while the problem of Cross
Gender Identification in children may parallel the adulthood condition of transsexualism.
But this remains a question for empirical research into the life span development
of these individuals.
Cross Gender Identification in boys is only one potential type
of Gender Identity Disorder because a parallel condition can be found in some girls.
Prognosis for Child Gender Disorders
In terms of atypical gender development in children, the literature deals almost
exclusively with the cases of deficit masculine development in boys, including cross
gender identity disturbance, gender role behavior disturbance and homosexual behavior
development. This state of the research literature is, in part, a function of the
frequently replicated finding that problems of sexual dysphoria and deviation occur
more frequently in males than females and may be a function of the relatively greater
concern by American parents over feminine sex role behavior in their sons.
The feminine
sex-
There are no base rate data
on the occurrence of these various types of sex role disturbance.
Medical Examination for Research Subjects
Over the past 12 years, over 100 boys have been referred to my N.I.M.H. supported
Gender Research Project for evaluation and potential treatment for a gender disturbance.
My research team completed comprehensive psychological evaluations of approximately
70 of these children, and we required a complete physical examination and medical
history report from the child's pediatrician. In addition, a pediatric geneticist
joined us to conduct a more complete medical examination for a subset of consecutive
referrals to our project. According to our geneticist, baseline endocrinological
studies were considered unnecessary unless abnormalities were detected in the physical
examination. The following medical examination was given to the subset of research
subject referrals: Medical history; physical examination, including external genitalia;
chromosome analysis, including two cells karyotyped and 15 counted; and sex chromatin
studies.
All 70 of the gender disturbed boys were found to be normal physically and
the more completely evaluated boys were found to be normal physically, with the single
exception of one boy with one undescended testicle (Rekers, Crandall, Rosen & Bentler,
1979). No evidence was found for maternal hormone treatment during pregnancy nor
were there any histories of hormonal imbalance in the mothers. Our findings were
consistent with the literature on adulthood gender disturbances such as transsexualism
and transvestism-
The Importance of Family Variables
In these cases, therefore, the social environment of child-
Why should the families of gender disturbed children be studied?
I believe that much has been learned about normal life span development by investigations
of deviant cases which shed light upon critical processes relevant to normal social
development.
My first step in the analysis for the families of these boys was to
focus upon the fathers, the father substitutes, and the male models available to
these boys with inadequate masculine role development. The research literature of
the psychosexual development of normal children has revealed that the father is the
parent whose role behaviors are most likely to generate sex appropriate behaviors
in the children in a family unit (Mead & Rekers, 1979). The characteristics that
have been reported to foster the establishment of normal gender identity in children
include the father's nurturance and dominance. In contrast, literature on the effects
of paternal deprivation indicates that the sex role learning process is adversely
affected when fathers are either physically or psychologically absent from the home
(Biller, 1974; Hamilton, 1977).
The impact of paternal deprivation on psychosexual
development is most conspicuous in the retrospective clinical studies of homosexual
and transsexual men. But direct studies of the families of gender disturbed children
have been few.
Family Problems Associated with Gender Disturbance
My own study of the family variables associated with childhood gender disturbance
was based upon a subset of the boys we evaluated for gender disturbance, for whom
we completed three independent psychological evaluations, each of which took into
account these factors: Identity statements, cross dressing history and frequency,
cross gender role play behavior, parent-
Two other clinical psychologists,
in addition to myself, completed independent diagnostic evaluations of each subject,
and rated each subject on two scales one scale for gender role behavior and another
for gender identity. Each of these scales constituted a five-
One of the most striking findings in
the families of these boys I studied was the incidence of psychiatric problems. Eighty
percent of the mothers and 45% of the fathers had a history of mental health problems
and/or psychiatric treatment. It may be possible that these figures are somewhat
inflated compared to the larger population of gender disturbed boys in that parents
who have sought treatment for themselves may be more likely to seek treatment for
their children. However, these findings suggest that the parents of gender disturbed
boys have an unusual degree of psychological maladjustment.
Our findings with regard
to paternal deprivation in these boys parallels much of the literature on the detrimental
effects of father absence on normal psychosexual development.
In the boys who were
classified as the most profoundly disturbed, father absence was observed for all
cases. In the remaining less disturbed cases, father absence was found in 54% of
the cases. Using the nonparametric Fisher's exact probability test, this difference
was found to be statistically significant.
For the entire group of 46 subjects, 37% had no adult male role model (either biological
father or father substitute) present in the home. According to the 1977 U.S. Census
figures (which are comparable to this sample) only 12% of all white children lived
with their mother only, therefore without the benefit of a father or a father surrogate.
Of the 36 boys in this study who received a diagnostic rating, 75% of the most severely
disturbed boys and 21% of the less severely disturbed had neither the biological
father nor a father substitute living in the home-
Eighty percent of the boys whose fathers left their family were five years or under
at the time of that separation-
For all the gender disturbed boys, if the biological father or a father
substitute were present, he was described in 60% of the cases as being psychologically
distant or remote by the other family members.
A consistent picture is beginning to emerge from these findings and from other small
sample studies. The young males with the most pronounced gender disturbances tend
to be less likely to have a male role model in the home, as compared to less severely
gender disturbed boys (Rekers, Mead, Rosen & Brigham, 1983; Rekers & Swihart, 1989).
In general, the picture of the fathers of gender disturbed children found in these
data is in sharp contrast to the image of the idealized father who promotes masculinity
in his sons through his psychological and physical presence, his active involvement
with his children and with the family decision making, his leadership, his dominance
and his nurturance (Mead & Rekers, 1979).
In a large number of instances, no male
role model existed during early childhood developmental years in the home, whether
it be father, father substitute or older male sibling. This absence of male role
models with whom to identify was even more characteristic of the most severely disturbed
effeminate boys. In cases where the father or a father surrogate was present in the
home, he was typically described as psychologically remote from the family.
These
various sources of clinical evidence suggest that fathering variables are correlated
with male sex role disturbance, even though the direction of causality between these
variables is inferred, not established, by scientific observation. An ideal future
study in this area would be a longitudinal investigation of a large enough sample
of boys selected at random at birth that would contain a sufficient number of male
role disturbed boys to provide definite causal evidence. Two comparison groups would
be in order-
Child and Family Treatment Interventions
There are numerous interrelated reasons for intervening in the life of a boy diagnosed
with a gender disturbance. The first reason for treatment is the psychological maladjustment
of gender disturbed children. The second reason for intervention is to prevent severe
sexual problems of adulthood such as transsexualism and homosexuality (Rekers, 1985b;
Rekers & Kilgus, 1995) that are highly resistant to treatment in later phases of
development. The third reason is to prevent the serious emotional, social and economic
maladjustments secondary to severe adulthood sexual problems. And the fourth main
reason is to cooperate with appropriate parental concern over gender deviance. I
have published several detailed articles developing this rationale with reference
to the clinical data (Rekers, 1977, 1984; Rekers, Bentler, Rosen & Lovaas, 1977;
Rekers & Mead, 1980; Rekers, Rosen, Lovaas & Bentler, 1978; Rosen, Rekers & Bentler,
1978).
I have developed and validated several child and family treatment interventions
with intrasubject research studies on gender disturbed children (Rekers, 1995b).
The mother-
Let me illustrate this program of treatment strategies by returning
to the case of the young boy, Carl, whom I described earlier. With a multiple baseline
intrasubject design across stimulus environments and across behaviors, Carl was treated
in one setting at a time in order to assess the generalization of behavioral treatment
effects.
Both before and during the brief treatment in the clinic, Carl's gender
role behaviors were recorded in the home by the mother and a research assistant using
time sampling procedures. The major portion of Carl's treatment took place in the
home and school settings because Carl felt overly self-
Because
Carl enjoyed telling elaborate fantasized stories while drawing pictures on a chalkboard,
the brief clinic intervention procedure was designed to demonstrate simple reinforcement
control over the sex-
You will
recall that Carl's conversations at the initial evaluation were dominated by topics
such as dresses, cosmetics, maternal roles, female impersonators and female underwear.
After obtaining a baseline measure of masculine and feminine speech content, a psychology
intern introduced a differential social reinforcement contingency in which Carl's
questions regarding masculine or neutral topics were answered by giving short, nonleading,
direct answers, expressing positive interest. When Carl referred to a feminine topic,
the psychology intern immediately withdrew social attention by looking away and by
reading a magazine. If Carl persisted with direct questions regarding feminine topics,
the intern expressed disinterest.
An ABA reversal design demonstrated reinforcement
control over sex-
Then Carl's mother
was trained to administer a token and point economy reinforcement procedure in the
home which successively increased Carl's masculine play with brother and decreased
his feminine gestures, feminine speech content, feminine voice inflection and predominant
play with his sister.
Because Carl's treatment in the clinic had not generalized to the home or to the
school setting, his teacher was trained to apply a response cost procedure to what
she called his "brat behaviors" and to his feminine/gesture mannerisms. The "brat
behaviors" included: Creating a class disturbance, bossing another child, behaving
rudely to teacher and teasing another child.
When the contingency was applied to
the brat behaviors, they decreased immediately. The contingency for feminine gestures
resulted in a gradual suppression of both gestures and feminine speech. These effects
were found to be stimulus-
After a 15 month period, this treatment program in the clinic, home and school setting
was completed. The social learning interventions for the boy had been combined with
individual counseling for the mother and her marital problems and family relationship
difficulties.
Carl and his mother were then referred for an independent evaluation
by two clinical psychologists who administered tests, interviews and unobtrusive
observations of the boy at school. They found no evidence of any feminine behavior
or cross-
However, Carl remained inept at most games and
sports played by his male peers at school and in his home neighborhood. We, therefore,
provided an additional 15 month program of behavior shaping procedures to overcome
his deficits in throwing the ball, socking a playground ball, and in playing kickball.
This training was combined with what are called "companionship therapy" in which
a relationship was established between Carl and a male psychology student who modeled
appropriate masculine behaviors and took Carl on numerous trips to the park, beach,
and for tumbling lessons.
Twelve months after this additional program, another clinical evaluation was made
of Carl's adjustment. Once again, no evidence of feminine behavior or cross gender
identification were found. He was found to be normal in emotional and social adjustment.
Six years after the completion of therapy, we arranged another followup evaluation
by an independent clinical psychologist. Carl was then 16 years and ten months of
age. A comprehensive set of interviews, personality tests and observations were completed.
This independent psychologist concluded: "This young man appears to be a normal gender
appropriate adolescent boy with no salient evidences of difficulty in gender role
or gender identity. He has some difficulty in feeling unsure of himself in social
interactions and is generally, however, emotionally within the normal adolescent
range."
Similar positive outcomes have been obtained with the other previously treated
gender-
If the psychopathology of "Gender Identity Disorder of Childhood"
is one of the major etiological precursors to adulthood homosexual orientation disturbance
(as the research indicates at present), it would now appear logical that homosexuality
per se be re-
In the introduction to his political
analysis of the psychiatric battle over homosexuality, Ronald Bayer described the
subject of his book:
In 1973, after several years of bitter dispute, the Board of Trustees of the American
Psychiatric Association decided to remove homosexuality from the Diagnostic and Statistical
Manual... Instead of being engaged in a sober consideration of data, psychiatrists
were swept up in a political controversy. The American Psychiatric Association had
fallen victim to the disorder of a tumultuous era, when disruptive conflicts threatened
to politicize every aspect of American social life. A furious egalitarianism that
challenged every instance of authority had compelled psychiatric experts to negotiate
the pathological status of homosexuality with homosexuals themselves. The result
was not a conclusion based on an approximation of the scientific truth as dictated
by reason, but was instead an action demanded by the ideological temper of the times...
(Bayer, 1981, pages 3-
It remains to be seen if the mental health professions will be able to readdress
the issue of homosexuality from a logical and scientific perspective in the near
future (Lundy & Rekers, 1995b, 1995c). The use (or abuse) of research may continue
to be influenced by ideological factors in American culture (Lundy & Rekers, 1995a).
Suggestions for Future Research Study
1) Prior to my own series of studies, no treatment procedures for Gender Identity
Disorder in Childhood had been experimentally demonstrated to be effective. We, therefore,
intervened with labor intensive, multiple methods to achieve a positive therapeutic
outcome. Future clinical research should investigate the most efficient set of treatment
variables, for economically feasible treatment applied on a larger scale in routine
clinical practice.
2) Preliminary findings have been published in the literature
which report on the positive therapeutic effects of religious conversion for curing
transsexualism (Barlow, Abel & Blanchard, 1977) and on the positive therapeutic effect
of a church ministry to repentant homosexuals (Pattison & Pattison, 1980). Further
research should be addressed to the relationship of spiritual conversion and spiritual
well-
3) Research is needed to further understand the etiology and treatment of the other
type of inadequate male role development in boys namely, those boys who are interpersonally
violent, destructive and sexually promiscuous with girls sometimes to the extent
of aggressive rape (Harrington, 1970; Rekers & Jurich, 1983; Rekers, 1992, 1996).
This pattern, too, has been associated with father absence; but the paternal deprivation
typically occurs after the age of six years (Mead & Rekers, 1979).
It is possible that our society has not yet fully reaped the full consequences of
widespread breakdown of family units caused by divorce. Too often divorce of the
parents results in a divorce of the father from the children. If research on the
effects of divorce and separation on children can be better communicated to the general
population of our culture, perhaps the American public will make greater efforts
to achieve stable marriage and family life and be more highly motivated to seek genuine
problem solving solutions to marital conflict rather than so quickly considering
divorce, as though it were the only alternative (Rekers, 1985a).
4) As a matter of
public policy, it appears now to be necessary for federal and local governments to
direct funding not only to the remediation of categorical problems associated with
family dysfunction (such as gender identity disorder of childhood, run away youth,
or teenage pregnancy) but also toward evaluation research of community level demonstration
projects using preventative educational approaches to teach fathers the value and
importance of their active, warm emotional involvement with their children. Baseline
measures of paternal involvement with children might be recorded before and after
an intensive educational effort. Data should be gathered regarding the maintenance
of the hoped for increase in paternal involvement over time.
5) Finally, in a generation
confused by radical ideologies on male and female roles, we need solid research on
men and women who are well adjusted examples of a secure male identity and a secure
female identity. Such research could demonstrate what adaptive masculinity and femininity
bring about for family life and the larger culture (Rekers, 1986a, 1991). Children
with poor parental models need substitute male role and female role models. Such
research could serve this need.
Figure 2
Family Correlates to Male Gender Disturbance
Gender Distributed Boy Sample
46 boys with diagnoses by 3 independent clinicians aged 3 to 13 years, mean age 7
years.
Psychiatric History of Family Available on 30 of 46 Boys
80% of mothers with mental health problems/history>
45% of fathers with mental health
problems/history
Male Role Model Deprivation
67% of biological fathers physically absent from the home for all cases; 100%* fathers
absent for most severely disturbed boys; 54%* fathers absent for less severely disturbed
boys; * Significant at .02 level (Fisher's Exact Test)
3.55 Years = Mean Age of Boys
at Time of Father's Separation
(80% of boys were aged 5 years or under at separation)
Reason for Separation from Father
82% due to marital separation or divorce
10% due to death of the father
8% due to
birth out of wedlock
Presence of Stepfather or Surrogate Father Figure in
25% of most severely disturbed boys
60% of less severely disturbed boys
Presence of Older Male Sibling in
25% of most severely disturbed boys
48% of less severely disturbed boys
[This paper was presented at the First Annual Meeting of the North American Social
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Rekers, G.A. Early detection
and treatment of sexual problems: An introductory overview. Chapter 1 in G.A. Rekers
(Ed.), Handbook of Child and Adolescent Sexual Problems. New York, NY: Lexington
Books of Macmillan/Simon & Schuster, 1995, pages 3-
Rekers, G.A. Assessment
and treatment methods for gender identity disorder and transvestism. Chapter 13 in
G.A. Rekers (Ed.), Handbook of Child and Adolescent Sexual Problems. New York, NY:
Lexington Books of Macmillan/Simon & Schuster, 1995, pages 272-
Rekers, G.A.,
Amaro-
Rekers, G.A., Bentler,
P.M., Rosen, A.C., & Lovaas, O.I. Child gender disturbances: A clinical rationale
for intervention. Psychotherapy: Theory, Research and Practice, 1977, 14, 2-
Rekers,
G.A., Crandall, B.F., Rosen, A.C. & Bentler, P.M. Genetic and physical studies of
male children with psychological gender disturbances. Psychological Medicine, 1979,
9, 373-
Rekers, G.A., & Hohn, R. Sex education. In J. Sears & J. Carper (Eds.),
Public Education and Religion: Conversations for Enlarging the Public Square. New
York: Teachers College Press, 1996, in press.
Rekers, G.A. & Jurich, A.P. Development
of problems of puberty and sex-
Rekers, G.A., Kilgus, M. & Rosen, A.C. Long-
Rekers, G.A., & Kilgus, M.D. Differential diagnosis
and rationale for treatment of gender identity disorders and transvestism. Chapter
12 in G.A. Rekers (Ed.), Handbook of Child and Adolescent Sexual Problems. New York,
NY: Lexington Books of Macmillan/Simon & Schuster, 1995, pages 255-
Rekers, G.A.,
& Kilgus, M.D. Cross-
Rekers, G.A., & Lovaas,
O.I. Behavioral treatment of deviant sex-
Rekers, G.A., Lovaas, O.I., & Low,
B.P. The behavioral treatment of a "transsexual" preadolescent boy. Journal of Abnormal
Child Psychology, 1974, 2, 99-
Rekers, G.A. & Mead, S. Early intervention for
female sexual identity disturbance: Self-
Rekers, G.A. & Mead, S. Human sex
differences in carrying behaviors: A replication and extension. Perceptual and Motor
Skills, 1979, 48, 625-
Rekers, G.A. & Mead, S. Female sex-
Rekers, G.A., Mead, S.L., Rosen A.C. & Brigham, S.L. Family
correlates of male childhood gender disturbance. Journal of Genetic Psychology, 1983,
142, 31-
Rekers, G.A. & Milner, G.C. Sexual identity disorders in childhood and
adolescence. Journal of the Florida Medical Association, 1978, 65, 962-
Rekers,
G.A. & Milner, G.C. How to diagnose and manage childhood sexual disorders. Behavioral
Medicine, 1979, 6(4), 18-
Rekers, G.A. & Milner, G.C. Early detection of sexual
identity disorders. Medical Aspects of Human Sexuality, 1981, 15(11) 32EE-
Rekers,
G.A. & Moray, S.M. Relationship of maternal report of feminine behavior and extraversion
to the severity of gender disturbance. Perceptual and Motor Skills, 1989, pages 387-
Rekers, G.A. & Moray, S.M. Sex-
Rekers, G.A. & Moray, S.M. Personality problems associated with childhood
gender disturbance. Italian Journal of Clinical and Cultural Psychology, 1989, 1,
85-
Rekers, G.A. & Moray, S.M. The relationship of sex-
Rekers, G.A., Rosen A.C., Lovaas, O.I. & Bentler, P.M. Sex-
Rekers, G.A. & Rudy, J.P. Differentiation of childhood body gestures.
Perceptual and Motor Skills, 1978, 46, 839-
Rekers, G.A., Sanders, J.A., Strauss,
C.C., Rasbury, W.C. & Mead, S.L. Differentiation of adolescent activity participation.
Journal of Genetic Psychology, 1989, 150(3), pages 323-
Rekers, G.A., Swihart,
J.J. The association of parental separation with gender disturbance in male children.
Psychological Reports, 1989, 65, 1272-
Rekers, G.A. & Varni, J.W. Self-
Rekers, G. A. & Varni, J.W. Self-
Rekers, G.A., Willis, T.J., Yates, C.E., Rosen, A.C., & Low, B.P.
Assessment of childhood gender behavior change. Journal of Child Psychology and Psychiatry,
1977, 18, 53-
Rekers, G.A. & Yates, C.E. Sex-
Rekers, G.A.,
Yates, C.E., Willis, T.J., Rosen, A.C., & Taubman, M. Childhood gender identity change:
Operant control over sex-
Rosen, A. C. & Rekers, G.A. Toward a taxonomic
framework for variables of sex and gender. Genetic Psychology Monographs, 1980, 102,
191-
Rosen, A.C. & Rekers, G.A. & Bentler, P.M. Ethical issues in the treatment
of children. Journal of Social Issues, 1978, 34(2), 122-
Rosen, A. C., Rekers,
G.A. & Brigham, S.L. Gender stereotypy in gender-
Rosen, A.C. & Rekers, G.A. & Friar, L.R. Theoretical
and diagnostic issues in child gender disturbances. Journal of Sex Research, 1977,
13(2), 89-
Rosen, A.C. & Rekers, G.A. & Moray, S.M. Projective test findings
for boys with gender disturbance. Perceptual and Motor Skills, 1990, 71, 771-
Serbin, L.A. Sex-
Zucker, K.J. Cross-
Zuger, B. Effeminate behavior
present in boys from early childhood. I. The clinical syndrome and follow-
Zuger, B. Effeminate behavior present
in boys from childhood: Ten additional years of follow-
Zuger, B. Early effeminate behavior in boys: Outcome and significance
for homosexuality. Journal of Nervous and Mental Disease, 1984, 172, 90-
George
A. Rekers, Ph.D., is Professor of Neuropsychiatry and Behavioral Science, Research
Director for Child and Adolescent Psychiatry, and Chairman of Faculty in Psychology
at the University of South Carolina School of Medicine in Columbia, S.C. He has authored
nine books, over 120 academic journal articles, and numerous book chapters. He is
the editor of the Handbook of Child and Adolescent Sexual Problems (Lexington/Jossey-
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