Gender identity disorder (GID) is a distressing condition in which the patient has a strong and persistent desire to belong to a gender other than the one he or she is in, as well as a strong desire for sex reassignment surgery. The patient is typically unhappy with his or her biological sex and seeks aid from a psychiatric consultation to obtain formal consent for sex reassignment surgery to make them appear to be the opposite sex.
When patients seek sex reassignment surgery, GID is frequently referred to a psychiatrist. Comorbid psychopathology, anxiety, a lack of parental and familial support, and acute psychological suffering are all common among these people. When taken to the psychiatrist by family members, some of them may present themselves. Individuals with GID have been assessed using a range of psychological tests, rating scales, sex role inventories, projective tests, neuropsychological exams, and psychopathology scales. Many researchers have used the Minnesota Multiphasic Personality Inventory (MMPI) to better characterise psychopathology in GID patients, with mixed findings.
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The study included 56 consecutive patients with GID who satisfied the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria on clinical assessment. Between January 2015 and January 2017, data from these patients was collected throughout a three-year period. The control group consisted of 54 people who had no psychiatric issues. There were 36 males and 20 females in the sick group, and 46 males and 8 females in the control group.
The MMPI is a 566-item personality test that asks people to answer true or false questions based on how the statement applies to them. It has been proven to be valid and trustworthy. The inventory includes three validity measures – Lie (L), Infrequency (F), and Correction (K) – as well as eight clinical scales – Hypochondriasis (Hy), Depression (D), Hysteria (Hs), Psychopathic Deviate (Pd), Masculinity-Femininity (Mf), Paranoia (Pa), Psychasthenia (Ps), Schizophrenia (Sc), Mania ( (Si). This questionnaire is currently the most extensively used for psychopathology assessment.
Other measures such as paranoia, Schizophrenia and Psychopathic Deviate were also increased in many patients, in addition to the masculinity-femininity (Mf) scale. Male patients who wanted to change their gender had higher Pa and Sc ratings than female patients. After a thorough investigation, it was discovered that there was no clinical evidence of psychosis and that their paranoia was founded on reality. In the majority of scales, such as Pd, Mf, Pa, Pt, Sc, and Ma, there was a substantial difference between the case and control groups.
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In GID cases, the patient’s biological sex was used to compare the differences in scores across several measures. Male-to-female patients were shown to have more paranoid traits than female-to-male patients, a statistically significant difference. On the Pa, Pd, and Sc measures, male patients who had sex reassignment surgery to females scored higher. The percentage of patients with high Mf, Pa, Sc, Pd, and Ma scores. When compared to the control group, more GID patients exhibited elevated scales.
Only the MF scale, which has been found to be suggestive of their illness, was expected to be raised in the GID group. Other scales were found to be increased in a large number of participants in our study. Pa scale was increased in 39% of them, while Sc scale was elevated in 37.5%. These data show that the patients may have displayed symptoms of psychosis. This was incorrect because they had no symptoms suggestive of the same on clinical history or mental status examination. When the scales’ content was examined, it was discovered that they contained reality-based doubts.
According to several studies, the prevalence of psychotic symptoms in patients with GID ranges between 15% and 60%. Depression, anxiety disorder, specific phobia, and adjustment disorder are all common among them.
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It’s worth noting that many GID patients have high scores on at least one MMPI subscale other than the Mf scale. Within intimate family circles, patients with GID are frequently mocked, stigmatised, and rejected. They lose faith in their ability to confide in, trust, and share their concerns. Even non-psychiatrist clinicians may not always be responsive to their requirements.
This causes apprehension and caution when conversing with medical experts, and it may result in a misleading elevation of Pa and Sc scores, which is unrelated to an underlying psychotic condition. The majority of the profiles evaluated in the study were valid, indicating that the patients were honest in their responses because they were genuinely distressed and seeking help for their difficulties.
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