Troubling Gender or Engendering Trouble? The Problem With Gender Dysphoria in Psychoanalysis

Ayelet R. Barkai, MD

Abstract

This paper reviews existing case reports in the psychoanalytic literature of children diagnosed with gender identity disorder (GID), now called gender dysphoria. It concentrates on a review of problems and psychoanalytic dilemmas inherent in the use of the term GID and elucidates the concurrent quandaries this term both signifies and is symptomatic of. The focus is on reports of child psychoanalyses published during or after 1991, when the American Psychoanalytic Association formally adopted a nondiscrimination policy against homosexuality. These cases reflect common problematic themes in these treatments, for example, the lack of neutrality in specifying the treatment goal of same-gender identification. This paper explores the effects of these problems on the treatments, raises questions regarding the emphasis on gender in the treatments, and discusses an alternative psychoanalytic approach to children with gender variation.

About the Author:

Ayelet R. Barkai, MD, is a Lecturer in Psychiatry, Harvard Medical School, and a member of the teaching faculty of the Cambridge Health Alliance Division of Adult and Child and Adolescent Psychiatry. She is a member and on the teaching faculty of the Boston Psychoanalytic Society and Institute, where she serves on the Committee on Gender and Sexualities, and a corresponding member of the PINE Psychoanalytic Center.

The Psychoanalytic Review. 104/1: 1-32, 2017.

Link to Online Publication (can be requested from, or downloaded in, the library).

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