Psychosis and hermaphroditism: a case report

Background

A gender identity disorder has as its main symptom a persistent preference for the role of the opposite sex and the feeling that one was born into the wrong sex. People with disordered gender identity try to live as or pass as members of the opposite sex. Gender identity disorder may be a symptom in the context of a psychotic disorder.

Materials and methods

Patient, 52 years old, underwent sex- reassignment surgery in the age of 22. She was adopted in her infancy and she had masculine and feminine looking genitals. During her childhood she had preference for cross- dressing and simulating female attire, strong and persistent preferences for cross- sex roles in make- believe play, intense desire to participate in the stereotypical games and pastimes of the other sex, strong preference for playmates of the other sex, persistent discomfort with her sex and sense of inappropriateness in the gender role of being a boy.

Results

Since the age of 31 she has numerous hospitalizations, under the diagnosis of schizoaffective disorder. She suffers from delusions of persecution and reference; there are deficits in transpersonal communication and social skills, feelings of worthlessness and psychomotor retardation.

Conclusions

Psychopathology should be scrutinized in subjects with hermaphroditism. In the differential diagnosis, gender identity disorder, intersex disorders (andrenogenital syndrome, Turner's syndrome, Klinefelter's syndrome, testicular- feminizing syndrome, enzymatic defects in XY genotype, pseudohermaphroditism) and psychotic disorders, with delusions of being other sex, should be taken into account. It needs further investigation whether hermaphroditism is likely to trigger psychotic decompensation in a patient.