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Psychiatric comorbidity in gender identity disorder

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Abstract

Objective

Despite being recognized as an important prognostic factor for the outcome in gender identity disorder (GID), psychiatric comorbidity has rarely been assessed by means of standardized diagnostic instruments. The aim of this study was to assess current and lifetime psychiatric comorbidity in patients with GID.

Methods

A cross-sectional sample of 31 patients who were treated for GID was assessed by the structured clinical interview for Axis I and II (SCID-I/II) and the Hospital Anxiety and Depression Scale (HADS).

Results

Twenty-nine percent of the patients had no current or lifetime Axis I disorder; 39% fulfilled the criteria for current and 71% for current and/or lifetime Axis I diagnosis. Forty-two percent of the patients were diagnosed with one or more personality disorders.

Conclusions

Lifetime psychiatric comorbidity in GID patients is high, and this should be taken into account in the assessment and treatment planning of GID patients.

Introduction

Gender identity disorder (GID) is considered by some authors to be part of an underlying psychiatric morbidity, namely, borderline personality [1], [2] or psychotic disorder [3], which, in the past, led to the recommendation to abandon sex reassignment altogether in patients with profound psychological dysfunction [2]. Other authors regard GID as a nosological entity and assume that psychiatric comorbidity is a consequence of the persistent gender dysphoria and the concomitant psychosocial distress [4], [5], [6], [7]. Furthermore, psychiatric comorbidity and mental instability seem to be important unfavorable prognostic factors for long-term psychosocial adjustment [8], [9], [10].

Despite clinical relevance, studies using standardized diagnostic instruments to assess psychiatric comorbidity in GID are scarce. Bodlund et al. diagnosed a personality disorder, mainly Cluster B, in 5 of 19 GID patients using SCID screen for DSM-III Axis II. Subthreshold personality disorder was more frequent than in a control sample, and a clinical diagnosis of an Axis I disorder was found in 10 of 19 patients [11]. Haraldsen and Dahl [5], using SCID I and II found current Axis I disorders in 33% of 86 GID patients (predominantly mood and anxiety disorders) and Axis II disorders (most frequently Cluster B) in 20%.

The aim of this study was to assess current and lifetime psychiatric comorbidity on a categorical and on a dimensional level in a cross-sectional sample of 31 GID patients.

Section snippets

Participants

Inclusion criteria were a diagnosis of GID according to DSM-IV [12] and current psychiatric outpatient treatment for sex reassignment. The study was approved by the research review board of the canton of Zurich.

Twenty (64.5%) out of 31 patients were biological males, 11 (35.5%) were biological females. The mean age was 33.2 years (S.D.=±10.3 years). The mean duration of treatment at the Department of Psychiatry of the University Hospital of Zurich was 2.7 years (S.D.=2.7 years; range: 2 months

Results

Current and lifetime Axis I diagnoses are shown in Table 1, Table 2.

One or more personality disorders were identified in 13 patients (41.9%). An Axis II Cluster A personality disorder was found in five patients (16.1%), a Cluster B diagnosis in seven patients (22.6%), a Cluster C diagnosis in six patients (19.4%), and a personality disorder not otherwise specified in two patients (6.5%).

Group comparisons of Axis I and/or II comorbidity showed no significant differences with regard to biological

Discussion

Some limitations have to be addressed. First of all, the sample is not representative for all GID individuals. An unknown percentage of GID patients do not undergo professional assessment and SRS. In some countries, even SRS is available without prior psychiatric assessment. However, most of the GID patients replying for SRS and living in our region are probably treated at the University Hospital of Zurich. The sample may therefore be regarded as representative for GID patients seeking

References (20)

  • A Michel et al.

    The transsexual: what about the future?

    Eur Psychiatry

    (2002)
  • C Herrmann

    International experiences with the Hospital Anxiety and Depression Scale—a review of validation data and clinical results

    J Psychosom Res

    (1997)
  • LM Lothstein

    Psychological testing with transsexuals: a 30-year review

    J Pers Assess

    (1984)
  • J Beatrice

    A psychological comparison of heterosexuals, transvestites, preoperative transsexuals, and postoperative transsexuals

    J Nerv Ment Dis

    (1985)
  • JA Meerloo

    Change of sex and collaboration with the psychosis

    Am J Psychiatry

    (1967)
  • YL Smith et al.

    Postoperative psychological functioning of adolescent transsexuals: a Rorschach study

    Arch Sex Behav

    (2002)
  • IR Haraldsen et al.

    Symptom profiles of gender dysphoric patients of transsexual type compared to patients with personality disorders and healthy adults

    Acta Psychiatr Scand

    (2000)
  • CM Cole et al.

    Comorbidity of gender dysphoria and other major psychiatric diagnoses

    Arch Sex Behav

    (1997)
  • GR Brown et al.

    Personality characteristics and sexual functioning of 188 cross-dressing men

    J Nerv Ment Dis

    (1996)
  • O Bodlund et al.

    Transsexualism—general outcome and prognostic factors: a five-year follow-up study of nineteen transsexuals in the process of changing sex

    Arch Sex Behav

    (1996)
There are more references available in the full text version of this article.

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