At birth we are named and identified by our external sexual genital features; soon after, we develop sex-specific behaviors or gender roles based on our social experiences as males and females. Following two revisions that broadened its diagnostic scope, Gender Identity Disorder GID now identifies persons whose physical sex does not match their internal gender identity, and distinguishes between childhood gender nonconformity and gender conflict persisting into adulthood. Transsexual rites of passage. Lastly, since several pubertal changes are either irreversible or require surgery if the child is to "pass" as the preferred gender, parents may feel rushed to act without enough information. This framework is not limited by what is socially expected; instead, researchers may consider multiple interacting systems of biology and environment at home, in school, in a society, etc. Seth's work focuses on the conceptualizations, meanings, and expressions of transgender identities in late adolescence and adulthood. Parental rejection leads to low self-esteem and negative self-image Bolin, Selected findings of eight population-based studies. Schools and other community institutions lack information and resist parents' requests for accommodations for their children. Gender as Disorder Despite research demonstrating a range of gender identities and expressions Denny, ; Pardo, , the medical approach recognizes sex within a binary construct of male or female, and gender within a linear binary: The authentic model also discusses gender nonconformity as a natural human variability and not a mental disorder Denny, Today, researchers and advocates support an ecodevelopmental approach for exploring transgender identity development. Diagnostic and statistical manual of mental disorders. Transgender youth are marginalized both in mainstream society and in lesbian, gay, bisexual LGB social groups, compounding their risk.