The diagnosis of transsexualism puts a psychiatrist. A doctor of any other specialty can only suspect his existence and send the patient to a psychiatrist to confirm or exclude transsexualism.
1) inversion of gender identity;
2) inversion of the sexual socialization of the individual; 3) inversion of psychosexual orientation.
The diagnosis of transsexualism is based on the following criteria:
a stable and unchanging feeling of belonging to the opposite sex, discomfort and a feeling of inconsistency with their biological sex;
constant concern and desire to get rid of the primary and secondary sexual characteristics and acquire the opposite, through surgical and hormonal treatment;
completion of sexual development.
Additional diagnostic indications are the development of these disorders from early childhood, the absence of symptoms of another mental illness and congenital malformations of the genital organs.
The main symptoms are: full identification of sexual self-awareness and sexual role with the opposite sex, homosexual orientation, persistent dominant ideas of rejecting their biological and social gender with dysmorphophobia-like disorders and changing it to the opposite.
Accompanying symptoms are represented by various forms of psychosocial maladjustment, manifested by psychogenic disorders and various types of deviant behavior, destructive tendencies and suicidal activity.
A person with transsexualism feels like a man imprisoned in a woman’s body, or vice versa. In a harmoniously organized body of a certain sex, a “non-sexual” soul lives, and this soul not only lives, it feels, thinks, suffers, experiences desires and impulses that it cannot realize, and therefore A. A. Bukhanovsky (1985) and LJ S. Goran (1984) believes that it is actually a question of chronic stress, which makes it possible to reveal suicidal behavior in most transsexual patients.
Thus, the final stage of the unfolded picture of transsexualism includes all the above basic and derivative symptoms. The final formation of transsexualism is completed, as a rule, by the age of 20.
One of the most important and still unresolved aspects of the problem of transsexualism is the question of the origin and validity of the requirement to change sex. Personality disharmony in transsexualism naturally gives rise to numerous specific transsexual conflicts. They are always complex and manifest themselves as a kind of individual combination of internal and external conflicts. The peculiarity of the course of transsexualism in our country is the high burden of suicidal behavior. Its various manifestations were noted in 86.4% of patients. To a certain extent, according to A. O. Bukhanovsky (1994), this is associated with repressive sexual morality and public aggression against persons with sexual deviations. The author also notes that, in fact, it is possible to talk about social discrimination of people suffering from transsexualism, since meeting with an unknown and incomprehensible phenomenon, Russian society is not civilized enough, which is manifested by the set of public sanctions that had been faced by all to patients:
● misunderstanding up to the negation of this phenomenon – 87.6%
● Condemnation up to contempt – 78.1%;
● surprise up to curiosity – 75.1%;
● legislative coercion and suppression up to administrative and
physical impact and beatings – 27.9%;
● tabuing up to prohibitions and expulsion (from employment or educational collective, informal group, hotels, airplanes, etc.) – 37.2%.
Suicidal behavior in transsexualism reflects the intractable nature of the contradictions that have arisen in connection with the personality disharmony. The patients themselves are not willing to accept the ways of resolving the situation, and the methods that they know are reduced to zero. Believe that, in connection with the above reaction of society, suicidal behavior becomes a form of conflict resolution through self-elimination and self-destruction, which once again underlines the extreme nature of transsexualism.
The only acceptable way for patients to resolve transsexual conflicts, end painful suffering and find inner harmony can be to bring the biological sex into conformity with the mental floor. Neither the doctors’ explanation about the crippling essence of the required operations, nor the awareness of the impossibility of a significant change in the biological sex with the creation of a full-fledged organism, does not change the patient’s attitude. It is the appearance of this conviction that marks the apogee of the formation of transsexualism and the maximum degree of manifestation of the symptom of rejecting sex – “the emergence of a transsexual attitude towards its change” [Laube D.R. et al., 1974].
Patients are willing to accept any sacrifices, operations and physical oh inner unity. They are not afraid of the possibility of injury, or even death, because the only competing form of resolving these conflicts is death itself self-destruction.
When studying the prevalence of transsexualism in several countries, noted that it is found in many, if not all, ethnic groups, despite significant cultural differences, which can serve as indirect evidence of the biological basis of this pathology.