Own Study

Other mental disorders

The life situation of transsexuals naturally makes them particularly liable to mental troubles, but it is not always possible to say which of their mental problems are primary and which are secondary. Actually it is not impossible that things are the other way round: that mental disorders associated with transsexualism are the cause of the faulty psychosexual development.

All the subjects in my series had some kind of difficulty in social adjustment because of their feeling that they belonged to the opposite sex. The difficulty varied in amount and nature from case to case. These difficulties naturally enhanced the depressive reactions in some cases.

To see whether transsexualism was characterized by other mental components than despondency and a feeling of persecution, I examined the series for other traits sometimes occurring in these cases: manic or hypomanic, anancastic, cerebrolesional, and schizophreniform. t based my opinion on the presence or absence of these traits both on what the patients said about themselves, what their relatives and other physicians said, and my own impressions. Before going on to the actual figures. these are the operational definitions I used: By manic traits I mean a combination of hyperactivity, elated mood and rapid thinking and associations, and an inflated opinion of oneself, generally combined with a lack of insight. When there was only a suggestion of these traits, I used the word hypomanic instead. As anancasms I classed all types of phobia, obsessions and compulsions (Skoog, 1959). Among cerebrolesional traits I included: easy fatigability, hyperirritability, hypersensitivity to light and noise and emotional instability, often combined with memory defects and difficulty in concentrating (Lindberg, 1957). Under schizophreniform disorders I included delusions, disorders in thought processes, and hallucinations, but not severe enough, or of long enough duration, or of such quality that they could be called schizophrenic (see Langfeldt, 1939, 1960).

The following are the figures for these disorders as well as for depressive reactions and feelings of persecution:

Depressive reactions were the most common of these disorders, occurring equally often in the men and the women. Next most common was a cerebrolesional syndrome, noted in about every third case, and also about equally common among the men and women. The other traits only occurred in occasional cases. In case 11, registered under schizophreniform reaction in the table, the patient had an attack suspiciously like schizophrenia when he was 16, but as he recovered completely and showed no signs of a defect when I examined him, the episode was called schizophreniform. In case 25 the patient had been admitted to a mental hospital several times for traits of schizophrenic nature, but the diagnosis schizophreniform or epileptic psychosis seemed better in this case, because of the epilepsy and because the disorders often developed after anticonvulsant therapy was stopped for a while, and sometimes after the patient had been drinking heavily; otherwise the patient showed no signs of psychosis.