Psychiatric Comorbidity in Adults with Gender Identity Problems
For many decades of the twentieth century, gender dysphoria was seen as an intrinsic symptom of another psychiatric disorder (e.g., schizophrenia) that should be resolved by addressing the “underlying” psychiatric disorder. DSM-III (American Psychiatric Association, 1980) broke with that view and classified the gender identity disorders as a separate category of psychopathology. In contrast, many argue today that gender nonconformity and even gender dysphoria are not (psycho)pathology per se and that sex reassignment therapies are the most effective therapies for gender dysphoria (e.g., World Professional Association for Transgender Health, 2011).
However, based on the prevalence rate of comorbidity, many are convinced that the diagnosis and treatment of psychiatric comorbidity is of paramount importance for a proper diagnosis and for a successful treatment of gender dysphoria.
This chapter reviews the prevalence rate of comorbid Axis I and II disorders in persons with gender dysphoria (GD), explores theoretical models to explain comorbidity, and describes clinical implications. The central message is that we should avoid two pitfalls: First, we should avoid the assumption that all patients with GD must have comorbid disorders, and second, we should not assume that patients with GD will not have comorbid disorders. However, to ensure the best possible outcome of sex reassignment therapy and to prevent regret, comorbidity should be diagnosed and treated properly.
KeywordsPersonality Disorder Gender Identity Psychiatric Comorbidity Borderline Personality Disorder Gender Dysphoria
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