As a diagnostic category, gender identity disorder remains problematic with ongoing debates concerning aetiology, definition and ethics of treatment. Inherent in the current DSM definition is a Western model of the relationship between sex and gender which epitomizes the tension existing between essentialist and constructivist accounts of gender development. This model determines that gender-aberrant behaviour and gender variation are, by definition, pathological, and reinforces a binary gender model. Studies of non-Western cultures reveal variations in models of gender and in the understanding of gender deviance. Cultures vary in their definition of gender roles and show varying degrees of tolerance for atypical gender behaviours and gender change. An understanding of cultural context is important in the clinical assessment of a typical gender development and challenges current models of sex and gender.
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