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The concept of gender and core-gender identity has developed in recent decades as a result of the work of many authors, especially Stoller. His research clearly indicates that core-gender identity develops in the first two to three years of life. He has also clearly demonstrated that early intervention is absolutely necessary in the working-through of maladaptive gender identity situations. The longer one waits to treat this type of psychopathologic condition, the more one is faced with behavior which becomes either ego-syntonic or ego-dystonic but unavailable to change because of its chronicity.
As psychiatrists we must also be aware of the fact that our culture frequently determines what is psychopathology and what is not. Psychopathology and gender disturbance are significant areas being reviewed by psychiatrists, sociologists, and anthropologists. Whether or not a situation is considered psychopathologic is somewhat related to whether the potential patient identifies his sexuality as a problem and whether he sees a psychiatrist who also views his difficulty as a psychopathological state which needs treatment. If we can assume that both the patient and the psychiatrist are in accord, then we can proceed with the concept of therapy problems in male youth. An understanding of the psychodynamic development of the young man, including his sexual behavior, and an attempt to understand the specific conflicts centering around adolescent sexuality and dysfunction are necessary in order to treat the adolescent growth period in males.
As a psychoanalyst, I concur with the early developmental pathology that Stoller has described in his clinical observation of the individual with gender-identity disturbance. I would suggest that specificity in sexual psychopathology, if we view it from a medical model, is closely related to traumatic experience early in life as related to the parenting object of the same sex and/or the opposite sex. In this situation the child has an inability