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Non-Binary Or Genderqueer Genders International Review of Psychiatry ISSN: 0954-0261 (Print) 1369-1627 (Online) Journal homepage: http://www.tandfonline.com/loi/iirp20 Non-binary or genderqueer genders Christina Richards, Walter Pierre Bouman, Leighton Seal, Meg John Barker, Timo O. Nieder & Guy T’Sjoen To cite this article: Christina Richards, Walter Pierre Bouman, Leighton Seal, Meg John Barker, Timo O. Nieder & Guy T’Sjoen (2016) Non-binary or genderqueer genders, International Review of Psychiatry, 28:1, 95-102, DOI: 10.3109/09540261.2015.1106446 To link to this article: http://dx.doi.org/10.3109/09540261.2015.1106446 Published online: 12 Jan 2016. Submit your article to this journal Article views: 174 View related articles View Crossmark data Citing articles: 1 View citing articles Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=iirp20 Download by: [212.200.65.127] Date: 18 February 2016, At: 12:21 INTERNATIONAL REVIEW OF PSYCHIATRY, 2016 VOL. 28, NO. 1, 95–102 http://dx.doi.org/10.3109/09540261.2015.1106446 REVIEW ARTICLE Non-binary or genderqueer genders Christina Richardsa,b, Walter Pierre Boumana, Leighton Sealb, Meg John Barkerc, Timo O. Niederd and Guy T’Sjoene aNottingham Centre for Gender Dysphoria, Nottingham, UK; bCharing Cross Gender Identity Clinic, London, UK; cDepartment of Psychology in Social Sciences, Open University, Milton Keynes, UK; dInterdisciplinary Transgender Health Care Centre Hamburg, Department for Sex Research and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf (UKE), Germany; eCentre for Sexology and Gender, Department of Endocrinology, Ghent University, Belgium ABSTRACT ARTICLE HISTORY Some people have a gender which is neither male nor female and may identify as both male and Received 29 June 2015 female at one time, as different genders at different times, as no gender at all, or dispute the very Accepted 6 October 2015 idea of only two genders. The umbrella terms for such genders are ‘genderqueer’ or ‘non-binary’ Published online 8 January genders. Such gender identities outside of the binary of female and male are increasingly being 2016 recognized in legal, medical and psychological systems and diagnostic classifications in line with KEYWORDS the emerging presence and advocacy of these groups of people. Population-based studies show a Gender; Genderqueer; small percentage – but a sizable proportion in terms of raw numbers – of people who identify as Non-binary; Transgender; non-binary. While such genders have been extant historically and globally, they remain Transsexual marginalized, and as such – while not being disorders or pathological in themselves – people with such genders remain at risk of victimization and of minority or marginalization stress as a result of discrimination. This paper therefore reviews the limited literature on this field and considers ways in which (mental) health professionals may assist the people with genderqueer and non-binary gender identities and/or expressions they may see in their practice. Treatment options and associated risks are discussed. Introduction diversity/disorder of sexual development (DSD) condi- tion (APA, 2013a) will have physical sexual character- Gender is often considered to come in two forms – male istics which fall outside of this binary (Roen, 2015); (masculine) or female (feminine). Indeed, it is frequently although the majority of people with this range of elided with physical sex such that when a person is conditions do still identify their gender within the binary – assigned a female sex at birth – through visual inspection as men or as women (Harper, 2007; Richards & Barker, of their external genitals – it is assumed that their gender too will be female; that they will likely be feminine (their 2013). gender role); and that they will most likely be sexually In contrast to this, there are a significant number of attracted to men when they reach sexual maturity. Of people who do not have an (observable) intersex/DSD Downloaded by [212.200.65.127] at 12:21 18 February 2016 course, this series of inferences is correspondingly made condition, but who nonetheless identify outside of the with men - linking sex to gender, to gender role, to gender binary. Such non-binary gender identity or sexuality. It is a trivial assertion, however, to say that expression has been present over time and across these inferences are not invariably correct. For example, different global cultures (Herdt, 1996). male people may be attracted to other male people; In the current Western context, however, some people people assigned male at birth may have a female gender may identify as predominantly male, but with aspects of identity; and people assigned female may have a male the ‘other’ gender and use the identity term ‘male’ gender identity but, for pragmatic reasons, have a female generally; or may identify as predominantly female, but gender role (Richards & Barker, 2013, 2015). with aspects of the ‘other’ gender and use the identity All these acknowledged variations nonetheless still term ‘female’ generally – but both groups of people may presuppose a binary system of male and female, albeit define additionally as ‘genderqueer’ when necessary – for that ‘male’ and ‘female’ here may be expressed in example in accepting environments or when neither a different ways, e.g. as gender, sex, gender role. male nor female identity suits. Those people who Notwithstanding this, people with an intersex or incorporate aspects of both male and female, but who CONTACT Christina Richards [email protected] Nottingham Centre for Gender Dysphoria, Nottinghamshire Healthcare NHS Trust, 3 Oxford Street, Nottingham, NG1 5BH, UK ß 2016 Taylor & Francis 96 C. RICHARDS ET AL. have a fixed identity, may identify as ‘androgynous’, This paper then, consists of a necessarily extremely ‘mixed gender’ or sometimes ‘pangender’ as the latter is a brief overview of the current psychiatric literature flexible term. In contrast, people who move between pertaining to such non-binary or genderqueer identities genders in a fluid way may identify as ‘bigender’, ‘gender as these have formed the basis of the literature until now. fluid’ or sometimes ‘pangender’ again. Some people It then considers how (mental) health professionals move between more than two genders and so identify as might assist these groups of people within clinical ‘trigender’, and sometimes ‘pangender’ as it is a flexible practice in a non-pathologizing manner, which recog- term. Some people identify as a specific additional nizes the pressures and needs of this group of people at gender (either between female and male or otherwise this time in history. additional to those genders) and identify as ‘third gender’, ‘other gender’, and sometimes again as ‘pan- gender’. Then there are those people who disrupt the Prevalence of non-binary people gender dichotomy though challenging its very ontology Two population studies have aimed to estimate the and/or veracity and so identify as ‘genderqueer’ or prevalence of people who identify as non-binary. Kuyper ‘genderfuck’. And there are also people who have no & Wijsen (2014) examined self-reported gender identity gender and so identify as ‘agender’, ‘gender neutral’, and dysphoria in a large Dutch population sample ‘non-gendered’, ‘genderless’, ‘neuter’, or ‘neutrois’. (N ¼ 8064, aged 15–70 years old), and found that 4.6% of An example of this is present in Bockting (2008) who people assigned male at birth and 3.2% of people found in the course of a US online study a variety of assigned female at birth reported an ‘ambivalent gender identities amongst 1229 transgender individuals that identity’ (defined as equal identification with the other were not reconcilable with a binary understanding of sex. sex as with the sex assigned to them at birth) and 1.1% of These included ‘shemale, bigender, two-spirit, gender people assigned male at birth and 0.8% of people neutral, genderless, androgyne, ambiguous, intergen- assigned female at birth reported an ‘incongruent gender dered, third gender, pan-, poly- or omni-gendered, identity’ (defined as stronger identification with the dynamically gendered, gender fluid, nonbiological inter- other sex as with the sex assigned to them at birth). sexed, in-between and beyond’ (Bockting, 2008, p. 214). Recently, Van Caenegem et al. (2015) reported results In her qualitative study, Hines (2007) quotes such based on two population-based surveys, one of 1832 further non-binary identities as ‘gender terrorist, intersex Flemish individuals and one of 2472 sexual minority by design, intentional mutation, hermaphrodyke, queer individuals in Flanders, Belgium, examining the preva- trannie boy’ (Hines, 2007, p. 80). All of the above terms lence of ‘gender incongruence’ (defined as identifying are often subsumed within the umbrella terms of ‘non- stronger with the other sex than with the sex assigned at binary’ or ‘genderqueer’ identities. In this emerging field birth) and ‘gender ambivalence’ (defined as identifying terms are likely to change, however, and, as usual, we equally with the other sex as with the sex assigned at should attend to people’s own preferred terms when birth). Their findings showed that the prevalence of undertaking clinical work. Moreover, it is important to ‘gender ambivalence’ or non-binary gender was 1.8% in Downloaded by [212.200.65.127] at 12:21 18 February 2016 use people’s preferred pronouns (in addition to names natal men and 4.1% in natal women. and terms for gender). Some non-binary people use they/ In terms of trans populations more specifically, one their/them/themselves or an explicitly developed term UK study found that 5% of Lesbian, Gay, Bisexual, Trans such as xe/xyr/xem/xyrself rather than he/his/him/him- and Questioning (LGBTQ) youth identified as neither self or she/her/her/herself. With all these aspects, ‘ask’ male nor female (METRO Youth Chances, 2014); a US etiquette is appropriate (Richards & Barker, 2013) which study found that 13% of trans people surveyed were ‘a simply involves asking what terminology people prefer gender not listed here’ (Harrison et al., 2012, p.
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