Personality Disorders and Psychiatric Comorbidity among Persons with Gender Identity Disorder

The term gender identity, meaning a person's relative sense of his/her own masculine or feminine identity was first used by John Money in 1965 to refer to the subjective experience of gender (Mijolla, 2005). Later on Robert Stoller introduced it into psychoanalytic literature. He used gender to refer to ideas and experiences of masculinity, femininity and gender identity to general sense of masculinity and femininity. According to him, failure to interrupt the maternal symbiosis with boys may result in transsexualism (Stoller, 1968). The psychoanalytic theories explain this disorder differently. The developmental model of Mahler, Pearson and Ovesey (1974) emphasized that transsexualism in males originates from unresolved separation anxiety during the separation-individuation phase. We should bear in mind that traditionally in explaining the femininity in men, classical psychoanalytic theorists have emphasized the decisive role of fear of castration and of powerful identification with mother (Fenichel, 1972).The Term Transsexualism in its current usage refers to those individuals who have persistent desire for living in the social role of the opposite sex, and wish to undergo sex reassignment surgery (Cohen-Kettenis & Pfafflin, 2003). As a psychiatric diagnosis, Transsexualism was named as a disorder for the first time in DSM-III in 1980. Then in DSM-IV, it was substituted by Gender Identity Disorder (Heath, 2006), that often corresponds with behavioral and anxiety problems in addition to higher rate of comorbid psychiatric disorders (Korte et al., 2008). DSM5 has renamed the problem and calls it Gender Dysphoria (American Psychological Association, 2013).The rate of gender identity disorder is, however, low : 1:30,000 per males and 1:100,000 per females (Kring, Davison, Neale, & Johnson, 2007). The referral cases of GID disorder among boys are greater than GID among girls (Bradley & Zucker, 1997). This disorder causes inconvenience and psychological pain in the person and his/her friends and family, and inflicts serious damage to occupational, educational, social, marital performances and interpersonal relationships (Westheimer & Lopater, 2005). Teenagers, with GID disorder, may often feel lonely and rejected and due to the low possibility of having satisfactory sexual relationship; they feel dissatisfied in their relationship with their peers. Most of the teens with GID disorder have a belief that they are actually of the opposite sex or are susceptible to be the opposite gender (Zucker & Bradley, 1995). Many patients with GID are socially isolated, and this may lead to weakness of self-esteem, hatred of school and seclusion from their coevals (American Psychiatric Association, 2000).GID disorders may be accompanied by other disorders. Although, some of these patients have a record of a major psychiatric disorders such as schizophrenia and/or major mood disorders, most of them lack such background. In these patients, some types of Axis II Personality Disorder are seen, particularly Borderline Personality Disorder (BPD); however, no personality disorder seems to be specific to GID. Personality disorder is a factor that provides ground for other psychiatric disorders and it interferes with therapeutic results of Axis I Syndromes (Sadock, Kaplan, & Sadock, 2007). Comorbidity of personality disorders are related to more severe syndromes and more adverse therapeutic results for Axis I disorders (Kring et al., 2007). When dealing with Axis I disorders, clinical specialists should consider personality backgrounds. Often an interaction can be observed between interpersonal conflicts and psychiatric disorders. Psychological disorder may revive interpersonal conflicts or intensify them or create new conflicts. On the other hand, the existing conflicts may stimulate or intensify the course of a psychiatric disorder (Othmer & Othmer, 2001). The synchronous occurrence of Gender Identity Disorder with other psychological traumas may result from social consequences (like seclusion by coevals, isolation and low self-esteem) during performing sexual behavior incongruent with their body (Money & Russo, 1979). …