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Received: July 15, 2002
Accepted: February 4, 2003
Abstract
A case of bipolar disorder and transsexualism is reported and discussed. The case report shows the problematic nature of the distinction between transsexualism and psychosis-induced transsexual desires. If there is a true comorbidity of these disorders, a subtly differentiated process to guide medical expert opinion and therapy is necessary.
Key Words
Transsexualism [middot] Gender identity disorder [middot] Bipolar disorder [middot] Gender identity [middot] Gender dysphoria
Copyright (C) 2003 S. Karger AG, Basel
Introduction
Transsexualism is a rare psychiatric disorder with a prevalence of 1 in 30,000 males and 1 in 100,000 females [1]. The disorder is defined in ICD-10 [2] as part of the gender identity disorders with the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make the body as congruent as possible with the preferred sex through surgery and hormone treatment. The transsexual identity should be present persistently for at least 2 years and should not be a symptom of another mental disorder or a chromosomal abnormality. In the DSM-III-R, the diagnosis of transsexualism also appears designed for gender-dysphoric individuals who have decided upon surgical sex reassignment as the solution to their inner distress. This concept of transsexualism is questionable because it couples gender dysphoria with severe and irreversible therapeutic consequences. Even though the ICD-10 diagnosis of transsexualism has the highest interrater reliability in the group of adult personality and behaviour disorders (F6) [3], there is a necessity to separate the clinical diagnosis of gender dysphoria from criteria approving patients for surgical treatment. This has led to a distinct and broader diagnostic category for disturbances of gender identity in DSM-IV [4]: the term transsexualism has been dropped, persistent distress about the assigned sex and the desire to be of the other sex is now conceptualised under the diagnosis of gender identity disorder [1]. The exclusion criterion for this disorder is a physical intersex condition, but there are no explicit criteria according to the exclusion of other mental - especially psychotic - disorders.
Possible psychogenic or biological aetiologic factors of transsexualism are still discussed: Zhou [5] reports that male-to-female transsexuals show a smaller volume of the central subdivision of the bed nucleus...