Meyer and Dupkin studied twelve children who engaged consistently in cross-gender behavior. These children had experienced sexual overstimulation, repeated and varied separation traumata, maternal psychosis, or the birth of a new sibling before the appearance of the disorder. The cross-gender behavior appeared clinically in association with evident psychopathology. There were no monolithic transsexual symptoms of the sort seen in adults. In treatment, the patients revealed generalized ego impairment, preoccupation with part objects, and pathological elaborations of issues of the phallic-narcissistic phase. Their important object relationships were dyadic in nature. In the vast majority of cases, the symptoms seemed related to preoedipal interference with sexual identity formation. The authors conclude that gender disturbance emerges in piecemeal form out of compromised object relations, developmental interferences, drive regression, and ego impairment. The article includes a long and well-integrated review of pertinent literature on gender disturbances in children and adults.