|
|
Editors: Managing Editor: Editorial Assistant: Contents Info Published by |
Volume 2, Number 4, October - December 1998
German Standards for the Treatment and Diagnostic Assessment
of Transsexuals
In interpreting a patient’s assertions, it is
important to keep in mind that aspirations towards a "sex-change" can be a
template for solving various identity and/or gender identity problems. If the diagnostic
process shows that a diagnosis of transsexuality (as defined by the Standards) is not
appropriate, then the "Standards for the Treatment and Diagnostic Assessment of
Transsexuals" are inapplicable.
A diagnosis of transsexuality requires the fulfillment of the following criteria:
- a permanent and profound identification with the opposite sex
- a persistent feeling of discomfort with regarding one’s biological sex, or feelings of inadequacy in the gender role of that sex.
- clinically relevant distress and/or impaired ability to function in social, work-related, and other situations
These criteria generally conform with those described in the International Classification of Diseases (DSM-IV, ICD-10). Unlike the Classification, however, an intersexed condition is not automatically viewed as a ground for rejection. Cases of this nature should, however, be examined in light of law § 47 in the Code of Legal Status ("Mistaken Sexual Identification at time of Birth") to determine if it should be applied in place of the Code of Transsexuality.
The aforementioned criteria require the following diagnostic measures:
- a scrupulous case history focusing on the development of gender-identity, psychosexual development (including sexual orientation), and current life-situation;
- a physical examination, including the gynecological or andrological/urological and endocrinological status;
- a clinical psychiatric/pscychological evaluation, due to the fact that many patients with gender identity problems demonstrate conspicuous psychopathological characteristics . These can either precede the gender identity disorder, denote a reaction to it, or arise with it concurrently.
The clinical psychiatric/psychological diagnostic should have a broad conception, with inquiry and evaluation in the following areas:
- the deficits and the structural level of personality
- the level of psychosocial functioning
- neurotic dispositions or conflicts
- dependencies / addictions
- suicidal tendencies and self-destructive behavior
- paraphilias / perversions
- psychotic illnesses
- organic mental disorders
- mental retardation
Differential Diagnostic Standards
In the field of gender identity disorders, a pronounced diversity in the course which the disorder takes, personality structures, associated psychosocial characteristics, and sexual-partner preferences demands precise differential diagnosis.
The following forms of differential diagnosis should be kept in mind:
- Unease, difficulties, or non-conformity with present expectations involving gender-roles which have not reached the point of a lasting or profound disorder of gender identity
- partial or temporary disorders of the gender identity, as in adolescent crises
- Transvestitism and fetishistic transvestitism, which in times of crisis can lead to a desire for sex reassignment
- Difficulties with gender identity which result from the refusal to acknowledge a homosexual orientation
- Psychotic misjudgements of gender identity
- Severe personality disorders affecting the gender identity.
 |
 |
