Short communicationPsychiatric comorbidity in gender identity disorder
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
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