Mental disorder and transsexual behavior relationship has long history. This association has been described in Greek mythology as well as in Hinduism. It was during nineteenth century that ‘sexual identity disorder’ started to be discussed as a new concept. French and German psychiatrists used transsexual phenomenon as part of sexual perversions. But it was in the middle of the twentieth century (1949) that the name transsexualism was fixed for this disorder for the first time by Cauldwell and after a few years Benjamin in the US and then Delay in France described it as an exclusively separate group of psychiatric problems distinct from others. It has been described in the Diagnostic and Statistical Manual of Mental Disorders –IV (DSM-IV) as perturbation should exist continuously for at least two years without other mental disorder and International Classification of Disorders – 10 (ICD –10) mentions diagnostic criteria for transsexualism as exclusion of other disorders, especially schizophrenia, along with its presence. This is because sexual delusions are frequent phenomena of schizophrenia. According to DSM-IV, schizophrenia is far more frequent psyciatrist problem as compared to Gender Identity Disorde (GID). Based on this rarity, it becomes even more infrequent that these two disorders exist together. Because of rare coexistence, literature also does not support in this regard. Only two case reports have been published on schizophrenia and transsexualism.
Sexual behavior problems are usually exhibited by schizophrenic patients. Unmarried male individuals are more prone to delusions of sex change. It is important that other sociodemographic factors do not show this much strong predilection for these disorders. ‘Pseudosexxual’ delusions have got four categories; one of these, delusions of belonging to the opposite sex has received more attention for its association between transsexualism and schizophrenia.
These delusions of sex change at times have been found to be associated with genital sensory hallucinations also. Patients can also state the feeling that someone has got an intention to have intercourse with her or him. Acute psychotic exacerbations are the time when these sex change delusions or hallucinations are present and can be observed. Because of an intense desire for changing physical appearance especially in schizophrenic patients, and they may go upto self-castration.
Patents with transsexual disorders may have desire for sex change and this happens when psychotic patients with such desire have got such demands. This sex change has been given very little space in the literature.
A case report of a male of 40 years of age who has got a history of paranoid schizophrenia is presented. He was diagnosed with infantile psychosis as he used to be lonely, paranoid and aggressive. His father died of myocardial infarction when he was in his early 20s, other important history in the family was related to alcohol and drug abuse. Shortly after his father’s death he had started psychotic symptoms along with gender identity preoccupation. By this time he had not started with antipsyhotic drugs rather he was desirous of surgery for sex change. His demand did not fulfill until he was of 32 years when one of his physicians agreed to sex change demands. He was started on hormonal preparations for eight months followed by classical reassignment surgery. His aggressiveness improved after change of sex.
After sex reassignment, his desire changed and he wanted for sex change from female to male. Rather he started stating about conversion to hermaphrodite. Delusional grandiosity kept him resistant to any treatment. After that, although, his follow up did not remain regular but his symptoms decreased in severity. He used to get suicidal ideation especially when he had resistance to another surgery for change of sex.
Critique
- Title: Title of this article provides some information which should be contained in a title. There is information on some of the items/variables of the research with little message contained about participants of the symptoms, which is apparent from schizophrenia.
- Abstract: Author has been able to describe what is there in the main article along with some description on the methodology of the research study. As the research design is not as stronger therefore, methodology does not convey a required message. Abstract does contain results of the study which author wanted to share.
- Literature reviews: The start of the article has been relevant with discussion and review on the history of the topic along with description and definition of the terms used. Whatever current research h is available, the author tried to incorporate that work.
- Research design: A case study has been utilized to carry out this descriptive research activity. As there was only one case study was used so as such data collection was not there in the study but author did search literature through medline to review the existing level of research on this topic. So there was not a questionnaire which was used for interview purposes so no statistical test was applied or any other analysis was carried out. As no sample was used but a case study was shared where a description of only one patient was provided. This description could address the characteristics of the individual.
- Instrumentation: No specific instrument was used so there were no questions but a comprehensive account about the patient has been provided.
- Experimental Procedures: As it was a case study and not an experimental research study so no experimental procedure was carried out.
So there was no random assignment of groups
There was no treatment assignment to control or experimental groups.
There were no treatment or control groups.
The researcher did not use any ethical or politically acceptable procedure rather author did not require these procedures because of the study design utilized.
- Results: Results have been narrated in a smooth flow with connection between the two consecutive sections.
Although, there were no hypotheses, or formal research questions but in the introduction author did mention about the purpose of the article in a narrative way.
There were no tables, but the results whichever are present in the study have been laid out in an understandable way.
- Discussion: Author tried to summarize the results because of the nature of the design he may not have been successful in conveying a message as he would have been for an observational or other study with some what stronger design.
Author tried to discuss the main points and implications of the results of this study.
Author could not guide towards more research in the future.
Putting all together: Topic is important in a variety of ways, like: dearth of available information on the topic; practical importance of the topic.
It supports the existing information.
This research study may not inspire in the direction of more research in the future.