Gender Dysphoria and Dissociative Identity Disorder: A Case Report and Review of Literature

Abstract

Abstract Background World Professional Association for Transgender Health guidelines support the importance of a mental health assessment before providing medical treatment for Gender Dysphoria (GD). During this assessment, patients without GD but with mental health disorder and who request treatment for GD should be excluded. Dissociative Identity Disorder (DID) is a poorly known mental disorder which can be confused for GD. Aim To provide a case report of a patient suffering for DID but asking for treatment for GD and to provide a review of the literature on GD and DID. Method A case report assessment and follow-up was described and a systematic review of the literature was performed in Pubmed, PsychInfo, and Embase databases. Outcome To provide all cases with assessment and follow-up of DID and GD. Results The case report describes a man suffering from DID and asking for hormonal treatment for GD. After assessment the patient was able to let go of his wish for treatment for GD and begin psychotherapy for DID. During the literature review 11 articles were included. 3 articles showed a prevalence of DID of 0%, 0.8% and 1,5% in GD samples. 5 articles were case reports of patients with both diagnoses of GD and DID which showed the complexity of the care of these patients. 2 articles were case reports, where a GD diagnosis was done first, and then counseling for GD was proposed. After a second session, the diagnosis was changed for DID. In 1 other case report and our case report there was a description of 2 persons suffering from DID and asking for treatment for GD. Clinical implications Our review shows the complexity of providing care to patients with a comorbidity of GD and DID, as well as the complexity of making the differential diagnosis between GD and DID. Strengths and Limitations A systematic review was performed on these rare cases. Our study presents the results for a small group of patients. Conclusions This article provides the first systematic review on GD and DID and shows that DID in a GD sample does not seem to be higher than in the general population. In addition, it allow clinicians to gain better knowledge about patients suffering from both DID and GD and patients suffering from DID who ask for GD treatment.