Comorbidity of Gender Identity Disorders

To the Editor: Many psychiatrists go through their entire clinical career seeing only a few cases of gender identity disorder, as illustrated by Dr. à Campo et al. When a disorder is this unusual, appropriate practice should be to seek the opinion and experience of physicians and psychologists who have evaluated and cared for many of these patients. The article by Dr. à Campo et al. collected the opinions of nonexperienced individuals.

The Harry Benjamin International Gender Dysphoria Association endorses a thorough psychiatric and psychological evaluation of patients who are seen with gender identity concerns. Comorbid psychiatric conditions are common (1), but they rarely explain the underlying gender identity disorder; also, treatment of these conditions rarely alleviates the symptoms of gender identity disorder. In fact, my colleagues and I (1) found that after the gender disorder is treated, the comorbid mood and anxiety disorders usually do not return.

Furthermore, psychosis (schizophrenia) is rare unless the clinician interprets the statement by the gender-dysphoric person that he is a woman trapped in a male body as a psychotic symptom (1). Also gender identity disorder in persons with schizophrenia is extremely rare (2). Regardless, a thorough psychological/psychiatric evaluation is called for in the Harry Benjamin International Gender Dysphoria Association’s standards of care (3).

These standards of care also outline procedures for dealing with the endocrine management of teenagers seen with gender identity disorder. That procedure combines psychological treatment with a conservative, safe approach to maintaining the adolescent’s treatment options by delaying gender-dysphoric pubertal development until he or she is old enough to make a legal and informed decision. Dr. à Campo et al. should have included information concerning the survey respondents’ experiences in adolescent psychiatry since they were voicing opinions about adolescent conditions and how they should be handled. The article by Dr. à Campo et al. is an unhelpful list of opinions concerning gender identity disorder expressed by psychiatrists who have evaluated few individuals with gender dysphoria. The article appears to this reader to be a political attack on the Dutch gender clinics. So long as physicians and psychologists adhere to an internationally accepted standard of care, the patients should be protected.