Gender Identity Disorder - American Academy of Clinical Sexologists

349 Pages·2011·2.06 MB·English

GENDER IDENTITY DISORDER

Pre and Post Surgery Changes - Personality Profile, Psychopathology
and Social Adjustment - a Comparative Study

by

Iris Monteiro, BSc, MSc

A dissertation submitted to the Faculty of The American Academy of
Clinical Sexologists (AACS) in partial fulfilment of the requirements of
the degree of Doctor of Philosophy

September 2010
DISSERTATION COMMITTEE

Pedro de Freitas, MD, PhD
Associate Clinical Professor - Clinical Sexology
Chairman

William A. Granzig, Ph.D., MPH
President and Professor - Clinical Sexology

James O. Walker, Ph.D.
Clinical Professor- Clinical Sexology

Approved by the Dissertation Committee

American Academy of Clinical Sexologists
September, 2010

________________________________________________
Pedro de Freitas, MD, PhD Date
Associate Clinical Professor – Clinical Sexology
The American Academy of Clinical Sexologists
Chairman

________________________________________________
William A. Granzig, Ph.D., MPH Date
President and Professor – Clinical Sexology
The American Academy of Clinical Sexologists

________________________________________________
James O. Walker, Ph.D. Date
Clinical Professor – Clinical Sexology
The American Academy of Clinical Sexologists

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ACKNOWLEDGEMENTS

To Dr. Pedro de Freitas, to whom I owe the conceptualization of this project since the very
first moment… an unconditional acknowledgement for his orientation throughout this path,
generously sharing his experience… for his trust in me and for the continuous support and
motivation… and also for the security and endless availability, it’s remarkable!
It’s a pleasure working with you…

I’d like to express the honor of having Dr. William Granzig as a Committee member of my
Dissertation. To him, and also to Dr. James Walker, my kindest gratitude for allowing the
achievement of this project.

To Dr. Catarina Soares, for her valuable contribution with the translation of this paper…
but also a special acknowledgment for having instilled a special interest for Clinical
Sexology since the early days of my professional career, for the prodigal sharing, and work
together.

To Dr. António Lopes, who kindly cooperated in this project… for his statistical support,
for being there, and for his unlimited availability. And to my patients… without their
cooperation this work would never be possible.

Some very special words with my deepest gratitude to my Father… unity and eternal
admiration… who encouraged me with his infinitive patience, unconditional support, and
also for his friendship and trust, and for having allowed me to put some common dreams on
hold…the plan of a lifetime…
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To my dearest brother Diogo, for his pure and sincere smile and affection, and for his
constant encouragement… I’m so proud of you!

To Alexandra Ariana and Tânia Gandaio, my special friends, always available… To
Carolina Câmara, for her dedication and availability, essential for this work achievement.

To my friends, who kindly supported me in spite of my unavailability, for their friendship,
understanding and encouragement!

To my dear Bran… my resistances force!

This paper is dedicated to a special friend… Pedro

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VITA

Iris Monteiro BSc, MSc, completed her University Degree in Clinical Psychology 9
years ago in Lisbon (Portugal) and is also a trained Cognitive-Behavioral Psychotherapist.
Her activity has been developed since 2001 at the Behavioral Psychotherapy
Department at Hospital de Júlio de Matos (Lisbon) and also at the Clinical Sexology Unit,
as a member of the GID multidisciplinary team. She has worked for several years, as a
Clinical Psychologist, in “Ninho” (Institution dedicated to the social integration of female
prostitutes) and also in TAP (Portuguese Airliner) leading the “Flight Phobia” program.
She has completed various training courses in the Clinical Sexology field,
cognitive-behavioral therapies, social aptitudes, and has also done a post-graduation course
in Sexual Medicine at Lisbon Medical School.
Private clinic since 2003, both as a Clinical Psychologist, and a Clinical Sexologist.
Iris Monteiro is a Diplomate of the American Board of Sexology and is completing
her PhD with The American Academy of Clinical Sexologists (AACS).
Vice-President of “ILAS – American-Portuguese Institute of Sexology”, member of
The Portuguese Association of Behavioural and Cognitive Therapies (APTCC) and
effective member of the Portuguese Society of Clinical Sexology (SPSC).
Iris Monteiro has also completed a second BSc degree in Health Sciences, and a
Master’s Degree at the Instituto Superior de Ciências da Saúde – Egas Moniz (Portugal).

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ABSTRACT

Introduction: Gender Identity Disorder (GID) is still a complex and poorly understood
condition. The perception that transsexuality doesn’t emerge as an isolated entity has been
discussed for the past few decades, and its experience remit us to an inherent co-morbidity.
Following Sexual Reassignment Surgery (SRS), changes at psychopathology clinical
symptoms and social adaptation level become evident, but regarding the personality profile
no solid evidence has ever been granted that could prove its modification. This gap in
scientific data on this important subject led the researcher to conduct the present study,
aiming that these orientations might contribute for a better acuity in this area of clinical
care.

Objectives: To identify the characteristics of the personality profile and structure, clinical
psychopathological symptoms, and the level of social adaptation at the Moment of Clinical
Evaluation for diagnosis confirmation. Following the analysis of the former results,
compare them, in a similar way, with those at a different Moment, following SRS,
providing evidence of changes at the Personality Profile level, Psychopathology and Social
Adaptation, in this group of Transsexuals, before and after SRS.

Material and Methods: Initially a prospective and descriptive study of a group of
transsexuals at the Moment of Clinical Evaluation, and a posterior comparative study, with
the same group of transsexuals, before and after SRS, using a non-randomized sample of
twenty two individuals with the diagnosis of Gender Identity Disorder. Besides a semi-
structured interview, other self-assessment instruments were used: Symptom-Check –List-
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90 Revised (SCL-90), Sociofamily Life Questionnaire, Millon Multiaxial Clinical
Inventory - II (MCMI-II), Minnesota Multiphasic Personality Inventory – 2 (MMPI-2).
The statistical procedures were done using the Statistical Package for Social Sciences –
PASW 18 software.

Results and Conclusions: At the Moment of Clinical Evaluation, Gender Identity Disorder
does not emerge as an isolated clinical entity. After SRS, we’ve observed clinically
significant changes at various levels: psychopathological symptoms, clinical and
personality disorders, and also in social adaptation, referring to a positive evolution, with an
equilibrium and stability in various dimensions. We’ve also found changes at the
personality profile level, in GID, after SRS. Therefore, significant changes are exhibited
when compared to the initial phase of the Sexual Reassignment Process, not only at a
psychopathological level, but also at the structure and basic personality pattern. Existence
of a better balance, at various levels, when these individuals are envisaged, and evaluated,
according to their gender identity; and, a total consistency of their gender role consistent
with their gender identity.

Key-Words: GID, pre and post surgery changes, personality profile, psychopathology,
social adjustment.

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TABLE OF CONTENTS

DISSERTATION APPROVAL ii
ACKNOWLEDGEMENTS iii
VITA v
ABSTRACT vi
TABLE OF CONTENTS viii

CHAPTER 1 – INTRODUCTION 3
CHAPTER 2 – REVIEW OF RELATED LITERATURE 11
Historical Antecedents 11
Concepts 17
Sex 17
Transexualism 25
Etiology 29
Biological Factors 29
Psychological Factors 35
Diagnostic Criteria 45
The American Psychiatric Association 46
The World Health Organization 50
The Harry Benjamin International Gender Dysphoria Association’s 51
Differencial Diagnoses 52
Other Behavioural States Confused with Transsexuality 55
Incidence and Prevalence 72
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The Phemenology of Transsexuality 77
Evolutionary Gender Characterization 77
The Classification of Transexualism 86
Sociological Aspects 92
Family Adaptation 95
Academic and Professional Adaptation 99
Religious Issues 102
Studies of Transexualism 107
CHAPTER 3 – RESEARCH METHODOLOGY 116
Study characterization 117
Ethical considerations 117
Sample 117
Study Objectives 119
Research Hypothesis 119
Definition of Study Variables 120
Procedures 137
Statistical Methodology 137
CHAPTER 4 – PRESENTATION OF RESULTS 139
CHAPTER 5 – DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS 199
Discussion 199
Conclusions 232
Recommendations 235
SELECTED BIBLIOGRAPHY 236

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APPENDIX A 248
The American Psychiatric Association (Portuguese Version)
APPENDIX B 252
The World Health Organization (Portuguese Version)
APPENDIX C 255
(Portuguese Version)
Appendix C-I – Informed Consent Form
Appendix C-II – Interview
Appendix C-III – Symptom-Check –List-90 Revised – SCL 90
Appendix C-VI – Beck Depression Inventory – BDI
Appendix C-V – Sociofamily Life Questionnaire
Appendix C-VI – Millon Multiaxial Clinical Inventory – MCMI-II
Appendix C-VII – Minnesota Multiphasic Personality Inventory – 2 – MMPI-2
APPENDIX D 296
Statistical Analysis – Tables

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