Physical attractiveness of girls with gender identity ... - Springer Link

Archives of Sexual Behavior, Vol. 25, No. L 1996

Physical Attractiveness of Girls with Gender Identity Disorder Sari R. Fridell, M.A., 1 Kenneth J. Zucker, Ph.D., 2,4 Susan J. Bradley, M.D., 2 and Dianne M. Maing, Ph.D. 3

University students, masked to group status, judged the physical attractiveness of girls with gender identity disorder and clinical and normal control girls, whose photographs were taken at the time of assessment (~ age, 6.6 years). Each student made ratings for all girls for five traits: attractive, beautiful, cute, pretty, and ugly. A multivariate analysis of variance showed a significant group effect. Multiple comparisons of the significant univariate effects showed that the girls with gender identity disorder had significantly less attractive ratings than the normal control girls for the traits attractive, beautiful, and pretty who, in turn, had less attractive ratings than the clinical control girls. Girls with gender identity disorder and the normal controls also had less attractive ratings than the clinical controls for the trait cute. Correlational analyses showed that age was substantially negatively related to the attractiveness ratings in the group of girls with gender identity disorder, but was considerably less so in the two control groups. The extent to which the group differences in attractiveness were due to objective, structural differences in facial attractiveness vs. socially created, or subjective, processes is discussed. KEY WORDS: physical attractiveness; gender identity disorder of childhood; girls.

A version of this article was presented at the meeting of the International Academy of Sex Research, Edinburgh, Scotland, June 1994. 1Child and Family Studies Centre, Clarke Institute of Psychiatry, Toronto, Ontario, Canada, and Centre for Applied Cognitive Science, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario. 2Child and Adolescent Gender Identity Clinic, Child and Family Studies Centre, Clarke Institute of Psychiatry, 250 College Street, Toronto, Ontario M5T 1R8 Canada. 3Department of Psychology, University of Windsor, Windsor, Ontario. Now at Kinark Child and Family Services, Barrie, Ontario. ~1"o whom correspondence should be addressed. 17 0004-0002/96/0200-0017509.50/0 9 1996 Plenum Publishing Corporation

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Fridell, Zucker, Bradley, and Maing

INTRODUCTION A long line of research has shown that a person's physical attractiveness influences the social perceptions of others (see, e.g., Berscheid and Walster, 1974; Dion, 1986; Feingold, 1992; Jackson, 1992). From a developmental perspective, Langlois (1986) conceptualized physical attractiveness as a child characteristic that might affect social interaction and self-perception and appraisal. Several studies have established that the facial attractiveness of infants and children can be rated reliably by both other children and adults, It has also been shown that children retain their relative rank of physical attractiveness over time. Among infants, structural or objective features of the face reliably elicit judgments of cuteness or attractiveness. Hildebrandt and Fitzgerald (1979a), for example, concluded that a "cute" infant is likely to have "short and narrow features, large eyes and pupils, and a large forehead" (p. 329). Such variations in physical attractiveness affect the social perceptions of adult raters--infants and young children preselected as cute or attractive receive more favorable judgments regarding personality traits than do infants and children preselected as not cute or unattractive (for overviews of the normative physical attractiveness literature on infants and children, see Adams, 1981; Alley, 1993; Hildebrandt, 1982; Langlois, 1986; Langlois and Stephan, 1981; Patzer and Burke, 1988). In a previous article (Zucker et al., 1993), we noted that physical attractiveness was implicated by Stoller (1968, 1975) as a risk factor for maternal feminization of several boys who later developed behavioral characteristics consistent with the DSM-III diagnosis of gender identity disorder of childhood (now simply termed "gender identity disorder" in the DSM-IV) (American Psychiatric Association [APA], 1994). Green (1987; see also Green et al., 1985; Roberts et al., 1987) studied physical attractiveness in a more systematic sample of behaviorally feminine boys and a behaviorally unselected group of control boys. At the time of assessment (~ age, 7.1 years), the parents of both groups of boys were asked to describe the faces of their sons when they were infants. Masked ratings of parental responses showed that the feminine boys were more often described during infancy as "beautiful" and "feminine" than were the control boys. There was also a trend for the parents of the feminine boys to recall that strangers commented, "He would make a beautiful girl." Although Green's (1987) data supported Stoller's (1968, 1975) clinical observations, it was not clear if the results implicated objective properties of the feminine boy as infant or parental retrospective distortion. For example, it could be argued that parental recall of earlier attractiveness was affected by the son's current femininity. Recollection of the boy as femi-

Physical Attractiveness and Gender Identity

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nine-like in appearance would provide a certain continuity to, or perhaps even an explanation for, the current behavioral pattern. Given what has been learned about the objective properties of infant cuteness, it is conceivable that prefeminine infant boys have morphological facial features that distinguish them from premasculine infant boys. Moreover, the normative literature on the continuity of attractiveness suggests that such differences would persist into childhood. To test the latter idea, Zucker et al. (1993) had university students provide attractiveness ratings for 17 boys referred for gender identity problems and 17 clinical control boys, whose photographs were taken at the time of clinical assessment (~ age, 8.1 years). Five traits were rated on a 5-point scale: attractive, beautiful, cute, handsome, and pretty. Several of these descriptors (e.g., beautiful and pretty) were intentionally selected for their female-valenced stereotype. Results showed a significant multivariate effect and subsequent univariate analyses showed that the boys with gender identity problems were judged to be significantly more attractive, beautiful, handsome, and pretty than were the clinical control boys. Zucker et al. (1993) also found that age correlated differently with the attractiveness ratings in the two groups of boys. For the boys with gender identity problems, age was unrelated to the attractiveness ratings, with the exception of the trait cute, which was negatively related to age. In contrast, for the clinical controls, age was strongly negatively related to all five attractiveness ratings. It appeared, therefore, that the boys with gender identity problems retained, with age, the features that elicited the partially female-valenced attractiveness ratings. Physical attractiveness in girls with gender identity disorder has also received some clinical attention. Stoller (1972) noted that the mothers of some of these girls perceived them as relatively unattractive in infancy. For example, one mother described her infant daughter as "the ugliest thing in the world . . . . I was disappointed more that she was so ugly more than I was disappointed that she was not a boy. And then after a couple of days, naturally, these things went away" (Stoller, 1972, p. 54). However, Stoller (1972) described the "physiognomy and build" of such girls as "finefeatured and girlish. T h e . . . unpretty quality of the first months does not grow into a masculine look in bone structure or muscle distribution" (p. 60). Later, Stoller (1975) remarked that the premasculine infant daughter did not "strike the parents . . . . as beautiful, graceful, or 'feminine' (whatever that would be to the parents of a newborn)" (p. 226, our emphasis). Thus, it appears that Stoller was more inclined to view such parental recollections as some type of retrospective distortion. Green et al. (1982) studied a group of behaviorally masculine ("tomboy") and feminine girls, who were recruited by means of advertisement.


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Regarding physical attractiveness, the mothers of the masculine girls indicated that other adults more frequently commented that their daughters "would make a handsome boy" than did the mothers of feminine girls. However, actual assessment of the girls' physical attractiveness was not made. The present study was designed to assess the physical attractiveness of girls with gender identity disorder and clinical and normal control girls using the procedure employed by Zucker et al. (1993).

METHOD Subjects There were 12 girls with a DSM-III-R diagnosis of Gender Identity Disorder of Childhood (n = 11) or Gender Identity Disorder Not Otherwise Specified (n = 1) (APA, 1987). These girls had been referred by either their parents or a professional to a clinic specializing in gender identity problems in children and adolescents; the clinic is housed within the child psychiatry service of a psychiatric research institute. The clinical control girls (n = 12) were obtained from two sources. One girl had participated as a control for one of the girls with gender identity disorder in a previous study concerned primarily with the assessment of sex-typed behavior and general psychosocial functioning in children with gender identity disorder. The remaining 11 were taken from a pool of girls referred to a child protection agency because they had been either sexually abused (n = 2) or had experienced physical abuse or emotional neglect (n = 9) and who participated in a study by Maing (1991). 5 The normal control girls (n = 10) were also obtained from two sources. Two girls were taken from a pool of female siblings of boys with gender identity disorder. The remaining 8 were taken from a pool of normal control girls also studied by Maing (1991). Pair matching with the gender-referred group was guided by the following criteria: matching for age (+12 months) was mandatory; where possible, pair matching was also attempted for IQ (+15 points), and parent's social class and marital status; however, these were not mandatory matching criteria. Using this procedure, all 12 girls with gender identity disorder 5Because sexually abused girls sometimes show developmentally atypical sexualized behavior (Beitchman et al., 1991), we reasoned that this might affect their physical appearance. Although we are unaware of any study that has documented this empirically, we decided to first search for clinical controls from Maing's (1991) pool of physically or emotionally abused subjects. This is why the majority of the clinical controls were not from the sexually abused group.


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could be pair-matched with a clinical control girl and 10 could be pairmatched with a normal control girl. Thirteen other girls referred for gender identity problems were not included in the study. For 8 girls, photographs had not been taken; the 5 others were excluded on a priori grounds because they had some form of physical hermaphroditism (true hermaphroditism, congenital adrenal hyperplasia, or partial androgen-insensitivity syndrome). Table I shows the demographic characteristics of the three groups of girls. There were no significant differences for age, IQ, and ethnicity. There were, however, differences for parent's social class, F(2, 31) = 3.5, p = 0.042, and marital status, Z2(2) = 9.2, p = 0.01. The gender-referred girls came from a higher social class background than did the normal control girls (p < 0.05), but they did not differ significantly from the clinical control girls. More of the gender-referred girls lived with both of their parents than did the clinical control girls (p = 0.012), but they did not differ significantly from the normal control girls. Table I also shows maternal report data for the Child Behavior Checklist (CBCL, Achenbach and Edelbrock, 1981), a measure of general psychopathology, for the three groups of girls. Although both the gender-referred and clinical control girls had higher scores than the normal control girls, one-way analysis of variance (ANOVA) with social class and marital status covaried revealed no significant between-groups differences. The 12 gender-referred girls who participated in the study were also compared with the 8 gender-referred girls whose photographs had not been taken. The participants were significantly younger than were the nonparticipants (p = 0.037), but there were no differences with regard to IQ, parent's social class and marital status, and CBCL scores. Procedure

With parental consent at the time of assessment, a colored photograph was taken of each girl, usually from the chest up. The girls were instructed to smile. Subsequent inspection of the photographs showed that only three girls did not smile. The relative surface area of the photograph occupied by the girl was determined by measuring the distance from the girl's left to right shoulder and multiplying this value by the distance from the top of the girl's head to the part of her body that was at the bottom edge of the photograph. This value was then divided by the product of the length and width of the total photograph. A one-way ANOVA showed that the proportion of the photograph occupied by the girls with gender identity


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Table I. Sample Characteristics Group Gender identity disorder SD

Age (years) IQ Social classa

Normal controls 9

SD

Clinical controls ~

6.3

2.6

6.7

2.5

6.8

2.3

116.8

21.0

104.9

14.6

105.6

12.9

40.3

16.0

26.3

10.3

29.3

12.2

Marital status (n) Both parents Mother only/reconstituted

9 3

3 7

2 10

Ethnicity (n) Nonwhite White

3 9

0 10

4 8

Child Behavior Checklist Sum of items Internalizing T Externalizing T

SD

38.9 60.0 55.9

19.5 9.7 11.4

30.7 54.7 51.5

24.6 13.4 11.2

39.2 54.7 57.5

36.0 16.3 15.0

aHollingshead's (1975) Four-Factor Index of Social Status (absolute range, 8-66).

disorder did not differ from the proportion occupied by the clinical and normal controls (respective ~ = .39, .37, .37), F(2, 31) < 1. The photographs were made into standard 2-inch x 2-inch (5.1 x 5.1 cm) slides. The raters were 15 men and 25 women (~ age, 21.6 years), of whom all but 2 were in introductory psychology classes at the University of Toronto, and who participated in the study for course credit. Two other raters were employees at our Institute. Each rater was seen individually in a test room located in our department. The raters were unaware of the clinical status of the girls. They were informed only that they would be viewing slides of "school-age girls" and that they were to make attractiveness ratings of each youngster. Each of five traits was rated on a 5-point scale: attractive, beautiful, cute, pretty, and ugly. These traits were culled from the previous clinical and research literature (Green, 1987; Stoller, 1972, 1975; see also Rubin et al., 1974). The slides of the three groups of girls were presented in one of two quasi-random orders, one the reverse of the other. The order of rating the five traits was randomly determined across the 34 slides. The test room was dark except for a small light that


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allowed the raters to see their coding sheet. The distance from the rater to a screen was about 9 feet (2.7 m).

RESULTS

Table II presents the trait ratings. A 2 (Sex of Rater) x 3 (Group) multivariate analysis of variance (MANOVA) yielded a main effect for group, F(10, 144) = 6.43, p < 0.001. Univariate ANOVAS showed significant main effects for four of the five traits: attractive, beautiful, cute, and pretty (see Table II). Newman-Keuls tests were then performed to decompose the significant univariate effects. These comparisons are also shown in Table II. For the traits attractive, beautiful, and pretty, the gender-referred girls were rated as significantly less attractive than the normal control gifts who, in turn, were rated as significantly less attractive than the clinical control gifts. For the trait cute, both the gender-referred and the normal control gifts were rated as significantly less attractive than the clinical control gifts. A factor analysis of the five trait ratings revealed one strong factor, accounting for 52.4% of the variance. The factor loadings for the five traits

Table H. Attractiveness Ratings Group b Gender identity disorder

Normal controls

Clinical controls

Variablea

.~

SD

9

SD

9

SD

pC

Attractive

2.55a

0.74

2.69b

0.72

2.81c

0.79

0.001

Beautiful

2.30a

0.87

2.52b

0.85

2.64e

0.86

0.000

Cute

3.46 a

0.76

3.40a

0.77

3.60b

0.72

0.005

Pretty

2.62a

0.77

2.9%

0.73

3.13e

0.69

0.000

Ugly

1.59

0.56

1.70

0.69

1.57

0.56

ns

Composited

2.73a

0.66

2.89b

0.66

3.05r

0.67

0.000

aResponse scale ranged from 1 (not at all descriptive) to 5 (highly descriptive). bCommon subscripts adjacent to the means indicate that the groups were not significantly different on Newman-Keuls tests. CMultivariate main effect for group, F(5, 30) = 12.7, p < 0.000; p values are from univariate F tests. dF(2, 37) = 14.2, p < 0.000. Composite excluded the ratings for ugly.

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were .89 (pretty), .82 (beautiful), .73 (attractive), .64 (cute), and -.45 (ugly), respectively. Because the univariate test for the trait ugly was not significant and because it had the lowest factor loading, it was excluded from the composite, which is also shown in Table II. Effect sizes, as calculated by d (Glass et al., 1981), for the five traits and the composite are shown in Table III. F o r b o t h the gender-referred/clinical control and gender-referred/normal control comparisons, the largest effect sizes were for the traits attractive, beautiful, and pretty. These effect sizes were all larger than those observed for the clinical control/normal control comparisons. Table IV shows the correlations between the attractiveness ratings and the four demographic variables: age, IQ, and parent's social class and marital status. For the girls with gender identity disorder, age was strongly correlated with all five traits. Older girls were rated as less attractive, beautiful, cute, and pretty, but more ugly. For the control girls, age was negatively correlated with the rating for cute, but not with the other four traits. It can be seen that the parent's social class and marital status were unrelated to the attractiveness ratings for both the gender-referred girls and the controis. The absence of significant correlations between these demographic variables and the attractiveness ratings was important, given that there were some group differences on these two demographic variables. IQ was also unrelated to the attractiveness ratings.

Table IlL Effect Sizesa

GID vs. NC

GID vs. CC

CC vs. NC

Attractive

.20

.33

.16

Beautiful

.26

.40

.14

Cute

-.08

.18

.26

Pretty

.44

.74

.27

Ugly

-.16

.03

-.21

.23

.47

.24

Composite

aGID = gender identity disorder; CC = clinical controls; NC -- normal controls. For the GID-NC and GID-CC comparisons, the SD of the control group was used. For the CC-NC comparison, the pooled SD was used.


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Table IV. Correlations Between Attractiveness Ratings and Demographic Variables

Group Gender identity disorder (n = 12)

Controls (n = 22)

Variable

Age

IQ

SCa

MSb

Age

Attractive

-.45f

-.17

.36

-.46

Beautiful

-.59e

-.20

.39

Cute

-.82`/

.29

Pretty

-.64e

Ugly Compositec

IQ

SCa

MSb

.20

.09

-.22

.17

-.33

-.02

-.00

-.22

.21

.35

-.49

-.44e

.01

-.23

.14

-.30

.45

-.17

.09

.04

-.18

.24

.56e

.17

-.23

.40

.04

-.02

.25

-.24

-.72d

-.11

.44

-.39

-.02

.04

-.23

.21

aSocial class. /'Marital status (dummy variable where 1 = both parents and 2 = mother only/reconstituted). cComposite excluded the ratings for ugly. dp< 0.01, one-tailed. < 0.05, one-tailed. < 0.10, one-tailed.

~p

Table V shows the correlations between the composite attractiveness rating and the three C B C L measures of behavioral psychopathology. F o r the girls with g e n d e r identity disorder, a m o r e favorable attractiveness rating was associated with lower behavior p r o b l e m scores, even with age partialled out. F o r the controls, there were similar associations although of lower magnitude.

DISCUSSION The purpose o f the present study was to assess the physical attractiveness of girls with g e n d e r identity disorder and age-matched clinical and n o r m a l control girls. Unlike previous clinical and research w o r k ( G r e e n et a/., 1982; Stoller, 1972, 1975), which relied on either c o n c u r r e n t or retrospective parental appraisals, our study examined physical attractiveness objectively. T h e results show that university student raters, m a s k e d to g r o u p status, perceived girls with g e n d e r identity disorder to be significantly less attractive than both the clinical and normal control girls.

Fridell, Zueker, Bradley, and Maing

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Table V. Correlations Between Composite Attractiveness Rating and Child Behavior Checklist Scores Group Gender identity disorder (n = 12) Variable

Controls (n = 22)

r

pa

r

pa

Sum

-.518

.051

-.282

.108

Internalizing T

-.482

.066

-.247

ns

Externalizing T

-.488

.064

-.113

ns

aOne-tailed with age partialled out. For all subjects, respective rs were -.295 (p = .048),-.297 (t7 = .047), and -.174 (ns).

It should be noted that two of the five adjectives (pretty and beautiful) were intended to be at least somewhat stereotyped in a feminine direction.6 The effect sizes were the greatest for these two adjectives. Nevertheless, significant between-groups effects were also observed for the traits attractive and cute. It would be useful to test whether the girls with gender identity disorder would have more favorable attractiveness ratings if stereotypical masculine adjectives are employed (e.g., handsome, rugged). Although the normative literature implicates objective facial features in attractiveness ratings (cf. Hildebrandt and Fitzgerald, 1979a), our data do not allow us to determine the extent to which the between-groups difference was due to objective factors, subjective factors, or some proportional combination of both. It is conceivable that a structural analysis of the girls' faces would yield differences along the lines suggested by Hildebrandt and Fitzgerald (1979b) to be associated with cuteness during infancy. It appears warranted to analyze infant photographs of girls with gender identity disorder to see if similar properties could be identified. This would be particularly intriguing from a psychosexual perspective, since some studies have implicated objective properties of infant faces, even newborns, that are correlated with accurate predictions of biological sex (e.g., Gewirtz and Hernandez, 1984, 1985, Gewirtz et aL, 1990; for studies of the sex-correlated features of adult faces, see Brown and Perrett, 1993; Bruce et al., 1993; Burton et al., 1993). Hildebrandt and Fitzgerald (1977, 1979b) found that perceived facial "cuteness" predicted college students' judg6Most physical attractiveness studies instruct the rater to judge the attractiveness of the stimulus with the simple anchor points of "attractive" and "unattractive" or "very cute" and "not very cute." One would presume that there are gender-specific notions associated with the perception of attractiveness in males and females. In the present study, we relied on the clinical and normative literature to include some adjectives that were hypothesized to be associated more commonly with girls.


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ments that infants were female. Perhaps premasculine infant girls have facial properties more commonly associated with infant boys. In many studies of physical attractiveness, social cues likely affect rater impressions. In studies of children, including the present one, hairstyle and clothing style are probably particularly salient. Clinically, it has been observed that girls with gender identity disorder often show a strong aversion toward wearing culturally normative feminine clothing (e.g., dresses or "frilly" tops), prefer clothing more typically worn by boys, and insist on having very short hair (Green, 1974; Stoller, 1975; Zucker, 1982). These social cues often result in these girls being misidentified as boys. Based on our clinical notes, 6 of the 12 gender-referred girls in the present study were systematically misidentified by peers or strangers as boys at the time of the assessment. For example, one girl (age 12 years) registered herself at a new school as a boy without difficulty. Another girl (age 6) began spelling her name as "Tony" instead of "Toni." Coupled with her gender-ambiguous physical appearance, she quickly lost her previous popularity among the female peer group, and her friends began to query the teacher if Toni was really a boy. A third girl (age 4), upon entry into junior kindergarten, was thought to be a boy, and her teacher was convinced, based on her appearance, that her parents had erred in identifying her on the school registration form as a girl. Because this girl came from a nonWestern culture, her teacher was unable to determine her actual sex based on her given name. She was unable to ask the girl about her sex because she did not speak English. The teacher reported that she took this little girl to the washroom and pulled down her blue jeans "to check." Another girl (age 6) who, for her fifth birthday, had only one request for a present--a penis--was unequivocally assumed to be a boy by the peer group and her teachers. The socially masculine physical appearance of some girls with gender identity disorder can be viewed, therefore, simply as a sign of the underlying cross-gender identification. The extent to which their physical appearance "drives" the cross-gender identification is unclear. From a transactional perspective, however, one could argue that the masculine appearance of at least some of these girls would have a marked effect on their social interactions and self-representations and thus contribute to the consolidation of a masculine gender identity. As noted earlier, our correlational analyses show that older girls with gender identity disorder are perceived to be substantially less attractive. Clinically, it has been our impression that the parents of these older girls eventually chose to allow their daughters to adopt a more masculine appearance vis-a-vis clothing and hairstyle. Their daughters' marked insistence on shaping their appearance in this way was often experienced by their

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parents as extremely stressful. Parents often reported that their daughters would have severe temper tantrums if not allowed to wear masculine clothing or to have their hair cut short. It is likely that with some of the younger girls their parents felt that they still had some degree of influence regarding their daughter's appearance. It would be interesting, therefore, to monitor over time the younger girls with gender identity disorder whose physical appearance was more conventional to see if it was maintained or shifted to a more masculine style. Alternatively, it is possible that the younger girls were less gender-dysphoric than were the older girls and that this was reflected, in part, by the apparent differences in physical attractiveness. With a larger sample, it would be possible to examine whether there is an association between physical appearance and measures of actual sex-typed behavior. The correlational analyses also showed a negative relation between attractiveness and maternal report of behavioral problems, which was observed in both the girls with gender identity disorder and the controls, even with age partialled out. In adults, links between attractiveness and clinical symptomatology have been demonstrated (e.g., Archer and Cash, 1985; Farina et al., 1977) and similar findings have been observed for children (e.g., Barocas and Black, 1974; Cavior and Howard, 1973; Johnstone et al., 1992; Kennedy, 1990; Salvia et al., 1975). The nature of this relation is, however, unclear. On the one hand, relative attractiveness may elicit more favorable responses from significant others, which protects against the development of behavioral problems. On the other hand, it is possible that a youngster with behavioral problems may pay less attention to her physical appearance or receive less attention from caregivers, which may also have an impact on one's attractiveness. Whatever the explanation, the relation between attractiveness and behavior problems in the present study shows a similar pattern in the gender-referred girls and the controls. Retrospective studies have clearly documented that childhood masculinity is strongly associated in adult females with gender identity disorder (transsexualism) or a homosexual sexual orientation (Bailey and Zucker, 1995; Blanchard and Freund, 1983). A socially phenotypic masculine appearance is extremely common among adult females with gender identity disorder (Stoller, 1972) and is characteristic of some homosexual women (Rothblum, 1994; see also Dew, 1985; Dunkle and Francis, 1990; Laner and Laner, 1980; Unger et al., 1982). To date, the number of girls with gender identity disorder who have been followed prospectively into their adolescence or adulthood is too small to verify the retrospective data. However, the results of the present study suggest that a socially phenotypic masculine appearance characteristic of adult females with gender identity disorder and some homosexual women likely has its origin in childhood.


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ACKNOWLEDGMENT Cathy Spegg assisted in statistical analyses.

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