Throughout Barbara's childhood, mother had a series of tandem relationships which exposed Barbara to confusing sexual and aggressive experiences. Mother virtually abandoned Barbara to the stepfather and was either out partying with men, engaged in alcoholic binges, or at work (where she was employed as a salesperson). Barbara recalled feeling constantly abandoned by mother, but also feeling the need to cling to her.

Barbara remembered very little of her early childhood. She was told that her father; of Italian ancestry, had abandoned the family prior to her birth (but there are no records that mother ever married the man). Mother, an impulsive, paranoid, disorganized woman, told Barbara that during her pregnancy with her she prayed for a boy and was depressed and disappointed when she delivered another girl baby.

It was hard to believe that the cocky, self assured "male" sitting in the waiting room was really a biological female. Introducing herself as Brian, she demanded hormones and surgery and stated: "I'm a man trapped inside a woman's body. I'm in desperate need to match my body with my mind, the real me inside.

Of the fifty three women, full psychiatric diagnoses were obtained for forty six. The other seven patients had MMPI diagnoses, but they had not remained in treatment long enough for a thoroughgoing diagnosis to be established. Most of the diagnoses resulted from a consensus opinion of our clinic staff.

Almost half of the patients reported early childhood histories in which child abuse, including violence and neglect, was common and losses, separations, and abandonments the norm. Four patients reported being physically abused by both parents, while at least twelve women (23 per cent) reported incestuous experiences, including two who gave birth to their own fathers' babies.

Over an eight year period fifty three female transsexuals were evaluated for sex change surgery. This group comprised forty eight whites and five blacks (9 per cent of the total). The data reported below came from numerous sources, including clinical interview material, psychological testing, and the patient's written material.

The gender clinic consisted of approximately fen interdisciplinary clinicians, including psychiatrists, clinical psychologists, a social worker, a nurse sociologist, and trainees from various disciplines, who met weekly for 1t hours to present new cases and evaluate and treat, in long term individual and group therapy (using various theoretical and treatment strategies), patients who were self labeled transsexuals.

Clinical psychiatric diagnosis must be viewed as an ongoing process involving the interplay of many factors over a long period of time. While no one factor should have ultimate ascendancy, neither should one omit data crucial to the diagnostic process (such as the results of psychological testing).

The diagnosis of transsexual ism has also been influenced by behavior therapists, who have played a pivotal role in most gender identity clinics. While behaviorists have successfully treated some transsexual patients, they have also promised more than they could deliver, at the same time avoiding some of the moral issues around treatment itself by ignoring the wider issues about society's role in transsexualism.

The prevalence and incidence of childhood gender identity disturbances are unknown. Some practitioners, however, have estimated an incidence of one case in every 100,000 children or similar to that reported for adult gender identity disorders.

The DSM III diagnostic criteria for childhood gender identity disturbances separated the male and female components. The criteria for female childhood gender identity disturbances were reported to be as follows: