Paranoia in Patients with Gender Dysphoria: A Clinical Exploration

By Karia, Sagar; Alure, Alpa et al. | Indian Journal of Psychiatry, September-October 2019 | Go to article overview

Paranoia in Patients with Gender Dysphoria: A Clinical Exploration


Karia, Sagar, Alure, Alpa, Dave, Tejesvi, Shah, Nilesh, De Sousa, Avinash, Indian Journal of Psychiatry


Byline: Sagar. Karia, Alpa. Alure, Tejesvi. Dave, Nilesh. Shah, Avinash. De Sousa

Background: Gender identity disorder (GID) is a distressing disorder characterized by a persistent unhappiness with one's own gender and a desire to be of the opposite gender as well as seeking sex reassignment surgery for the same. The aim of the study was to assess the Minnesota Multiphasic Personality Inventory (MMPI) profiles in patients with GID and compare with healthy normal population and also examine differences in the profiles based on original gender of the patients. Materials and Methods: A total of 56 patients with GID that fulfilled the Diagnostic and Statistical Manual of Mental Disorders 5 criteria for the same were participants of the study, and there were 54 control participants. They were administered the MMPI, and the scores across various scales were statistically analyzed. Results: It was seen that apart from masculinity feminity (Mf) scale, other scales such as Paranoia (Pa, P < 0.01), Schizophrenia (Sc, P = 0.01), and Psychopathic deviate (Pd, P < 0.01) were also elevated in many patients. Male patients seeking surgery to become female showed higher scores on Pa and Sc scales than female patients. On detailed inquiry, it was found that there was no evidence of psychosis clinically, and in fact, their paranoia was reality based. Conclusion: MMPI profiles in patients with GID needs to interpreted with caution and clinicians must keep in mind that elevated Pa and Sc scales on the MMPI in these patients need not indicate a psychotic profile.

Introduction

Gender identity disorder (GID) is a distressing condition where there is a strong and persistent desire of wanting to belong to a gender opposite to what the patient is in, and there is a persistent request toward sex reassignment surgery for the same.[1] The patient often has a discomfort with his/her biological sex and seeks help via a psychiatric consultation to get a formal approval for sex reassignment surgery to look like the opposite sex.[2] GID often presents to the psychiatrist when referred from the plastic surgeon whom these patients approach for sex reassignment surgery. These patients often have comorbid psychopathology, anxiety, lack of parental and family support, and extreme psychological distress.[3] Some of them may directly present to the psychiatrist when brought by family members. A variety of psychological tests, rating scales, sex role inventories, projective tests, neuropsychological assessments, and psychopathology scales have been used in the assessment of individual with GID.[4] The Minnesota Multiphasic Personality Inventory (MMPI) has been used in many studies to understand psychopathology in patients with GID with varying results.[5],[6]

The current study aims to study the MMPI profiles of patients suffering from GID and observe whether any particular patterns emerged when compared to normal controls and to elucidate any differences based on the original gender of the patient.

Materials and Methods

The sample for the study consisted of 56 consecutive patients with GID that on clinical assessment met the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5)[7] criteria for GID in adulthood and presented to the psychiatric outpatient department of our hospital with chief complaints of gender dysphoria and wanted to undergo sex reassignment surgery. All cases were assessed by two senior psychiatrists and one clinical psychologist to ensure that the DSM criteria were fulfilled and to confirm the diagnosis. The study involved an exploration of psychological testing reports from our department. The study did not involve any interview of live subjects. Keeping the same in mind, the study was discussed in a departmental review board meeting and clearance obtained for the same. The patients who underwent psychological testing had given informed written consent for use of their test records under anonymity for the purpose of this study which would be akin to a retrospective chart review. …

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