Gender dysphoria in adolescents with psychotic disorders – symptom or co-occurring phenomenon?

Abstract

The occurrence of gender dysphoria symptoms in adolescents presenting psychotic disorders generates great diagnostic and therapeutic difficulties. They are related not only to the question of what is the nature of the reported dissatisfaction with one’s biological sex, but also to the normative period of uncertainty and searching in the process of psychosexual development in a young person. In this context, reaching a decision on gender correction treatment requires a particularly thorough analysis, a precise differential diagnosis and, above all, stabilisation of the psychological state as well as prolonged observation and exclusion of the delusional basis of gender dysphoria. It strikes us as particularly important to provide such patients with appropriate care. Allowing for gender correction, in the absence of a confirmed causal relationship between the two disorders, seems to be an appropriate, although debatable, therapeutic approach. Refusing medical interventions in adolescents in a timely manner poses a significant risk of psychological deterioration, may exacerbate gender dysphoria and contribute to self-representation provoking persecution and stigmatisation, and thus may increase stress levels, which is an important factor in psychotic decompensation.