Abstract
Ninetten transsexuals, approved for sex reassignment, were followed-up after 5 years. Outcome was evaluated as changes in seven areas of social, psychological, and psychiatric functioning. At baseline the patients were evaluated according to axis I, II, V (DSM-III-R), SCID screen, SASB (Structural Analysis of Social Behavior), and DMT (Defense Mechanism Test). At follow-up all but 1 were treated with contrary sex hormones, 12 had completed sex reassignment surgery, and 3 females were waiting for phalloplasty. One male transsexual regretted the decision to change sex and had quit the process. Two transsexuals had still not had any surgery due to older age or ambivalence. Overall, 68% (n=13) had improved in at least two areas of functioning. In 3 cases (16%) outcome were judged as unsatisfactory and one of those regarded sex change as a failure. Another 3 patients were mainly unchanged after 5 years. Female transsexuals had a slightly better outcome, especially concerning establishing and maintaining partnerships and improvement in socioeconomic status compared to male transsexuals. Baseline factors associated with negative outcome (unchanged or worsened) were presence of a personality disorder and high number of fulfilled axis II criteria. SCID screen assessments had high prognostic power. Negative self-image, according to SASB, predicted a negative outcome, whereas DMT variables were not correlated to outcome.
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References
American Psychiatric Association. (1987).Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., rev., APA, Washington, DC.
American Psychiatric Association. (1994).Diagnostic and Statistical Manual of Mental Disorders, 4th ed., APA, Washington, DC.
Bakker, A., van Kesterer, P. J., Gooren, L. J., and Bezemer, P. D. (1993). The prevalence of transsexualism in The Netherlands.Acta Psychiat. Scand. 87:237–238.
Benjamin, L. (1993).Interpersonal Diagnosis and Treatment of Personality Disorder, Guiford, New York.
Blanchard, R., Steiner, B., Clemmensen H., and Dickey, R. (1989). Prediction of regrets in postoperative transsexuals.Can. J. Psychiat. 34:43–45.
Bodlund, O., and Armelius, K. (1994). Self-image and personality traits in gender identity disorders—An empirical study.J. Sex. Marital Ther. 20(4): 301–314.
Bodlund, O., Kullgren, G. Sundbom, E., and Hojerback, T (1993). Personality traits and disorders among transsexuals.Acta Psychiat. Scand. 88: 322–327.
Burns, A., Farrell, M., and Brown, J. C. (1990). Clinical features of patients attending a gender-identity clinic.Br. J. Psychiat. 157: 265–268.
Ekselius, L., Lindstrom, E., von Knorring, L., Bodlund, O., and Kullgren, G. (1994). SCID interviews and the SCID screen questionnaire as diagnostic tools for personality disorders in DSM-III-R.Acta Psychiat. Scand. 90: 120–123.
Fisk, N. (1974). Gender dysphoria syndrome. Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome, Stanford University Medical Center, Stanford, CA, pp. 7–14.
Green, R., and Fleming D. (1990). Sex reassignment surgery.Ann. Rev. Sex Res. 1.
Hunt, D., and Hampson, J. L. (1980). Follow-up of 17 biologic male transsexuals after sex-reassignment surgery.Am J. Psychiat. 137: 4: 432–438.
Kockott, G., and Fahrner, E.-M. (1988). Male-to-female and female-to-male transsexuals: A comparison.Arch. Sex. Behav. 6: 539–546.
Kragh, U. (1955).The actual-genetic model of perception-personality, Gleerup, Lund, Sweden
Kullgren, G., and Armelius, B. A. (1990). The concept of personality organization: A long-term comparative follow-up study with special reference to borderline personality organization.J. Pers. Dis. 4(2): 203–212.
Lundstrom, B., Pauly, I., and Walinder, J. (1984). Outcome of sex reassignment surgery.Acta Psychiat. Scand. 70: 289–294.
Mate-Kole, C., Fresci, M., and Robin, A. (1990). A controlled study of psychological and social change after surgical gender reassignment in selected male transsexuals.Br. J. Psychiat. 157: 261–264.
Ohman, K., and Armelius, K. (1990). Schizophrenic and borderline patients: introjection, relationship to mother and symptoms,Acta Psychiat., Scand. 81: 488–496.
Pauly, I. B. (1981) Outcome of sex reassignment surgery for transsexuals.Aust. N. Z. J. Psychiat. 15: 45–51.
Reich, J. H., and Vasile, G. V. (1993). Effect of personality disorders on treatment outcome of axis I conditions: An update.J. Nerv. Ment. Dis. 181: 475–484.
Ross, M. W., Walinder, J., Lundstrom, B., and Thuve, I. (1981). Cross cultural approaches of transsexualism. A comparison between Sweden and Australia.Acta Psychiat. Scand. 63: 75–82.
Smith, G., and Danielsson, A. (1982). Anxiety and defensive strategies in childhood and adolescence.Psychol. Issues: Monogr. 52.
Sorensen, T. (1981). A follow-up study of operated transsexual females.Acta Psychiat. Scand. 64: 50–64.
Spitzer, R. L., Williams, J. B. W., Gibbon, M., and First, M. B. (1992).The Structured Clinical Interview for DSM-III-R (SCID). 49: 624–629.
Standards of Care (1985). The hormonal and surgical sex reassignment of gender dysphoric persons. The Harry Benjamin International Gender Dysphoria Association.Arch. Sex. Behav. 14: 79–90.
Sundbom, E., and Kullgren, G. (1992). Multivariate modelling and the Defence Mechanism Test: A comparative study of defensive structures in borderline, other personality disorders and schizophrenic disorder.Acta Psychiat. Scand. 86: 379–385.
Sundbom, E., Bodlund, O., and Hojerback, T. (1995). Object relations and defensive operations in transsexuals and borderline patients as measured by the Defense Mechanism Test.Nordic J. Psychiat. 49: 379–388.
Sundbom, E., Kullgren, G., and Armelius, B. A. (1989). Psychodynamic features in borderline personality disorder identified by a subliminal test, the Defense Mechanism Test.Acta Psychiat. Scand. 80: 101–105.
Walinder, J. (1971). Incidence and sex ratio of transsexualism in Sweden.Br. J. Psychiat. 118: 16–20.
Walinder, J., and Thuwe, J. (1975). Socialpsychiatric follow-up study of 23 sex-reassigned transsexuals.Am. J. Psychiat. 144: 748–752.
Walinder, J., Lundström, B., and Thuwe, I. (1978). Prognostic factors in the assessments of male transsexuals for sex reassignment.Br. J. Psychiat. 132: 16–20.
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Supported by Swedish Medical Research Council Grant 3-21X-10411-01A, and a grant from the Joint Committee of Northern Health Regions.
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Bodlund, O., Kullgren, G. Transsexualism—General outcome and prognostic factors: A five-year follow-up study of nineteen transsexuals in the process of changing sex. Arch Sex Behav 25, 303–316 (1996). https://doi.org/10.1007/BF02438167
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DOI: https://doi.org/10.1007/BF02438167
Key Words
- transsexualism
- sex reassignment
- outcome
- prognostic factors