Published: 2017-01-12

Gender dysphoria with homosexuality and comorbid depressive disorder: complexities in concept and management

M. S. Bhatia, Priyanka Gautam


Gender identity disorder (GID) and homosexuality are complex entities debated over decades, whether should be categorized as a disorder or not. There are a number of problems specifically related to the criteria of the GID diagnosis like differences in the terms trans-sexualism and GID, failure of the proposed criteria in conceptualizing the whole spectrum of gender variance phenomena, the potential risk of physically invasive examinations to rule out intersex conditions and the application of diagnosis even after hormonal and surgical treatment. We hereby report complexities faced in the case of a male to female transsexual with homosexuality and depressive disorder and its management.


Gender dysphoria, Gender identity disorder, Homosexuality, Nosology, Management

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Somasundaram O. Transgenderism: Facts and fictions. Indian J Psychiatry. 2009;51(1):73–5.

World Health Organization. International Classification of Diseases, Clinical Description and Diagnostic Guidelines. 10th ed. Geneva: World Health Organization; 1992.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington DC: APA; 2013.

Cohen-Kettenis PT, Pfafflin F. The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Arch Sex Behav. 2010;39(2):499-513.

Drescher J. Queer diagnoses: parallels and contrasts in the history of homosexuality, gender variance, and the diagnostic and statistical manual. Arch Sex Behav. 2010 Apr;39(2):427-60.

Green R, Roberts CW, Williams K, Goodman M, Mixon A. Specific cross-gender behaviour in boyhood and later homosexual orientation.Br J Psychiatry.1987;151:84-8.

Zucker KJ. Gender identity disorder in children and adolescents. Ann Rev Clin Psychol. 2005;1:467-92.

Drummond KD, Bradley SJ, Peterson-Badali M, Zucker KJ. A follow-up study of girls with gender identity disorder. Dev Psychol. 2008;44:34–45.

Campo J, Nijman H, Merckelbach H, Evers C. Psychiatric comorbidity of gender identity disorders: a survey among Dutch psychiatrists. Am J Psychiatry 2003;160:1332-6.

Hepp U, Kraemer B, Schnyder U, Miller N, Delsignore A. Psychiatric comorbidity in gender identity disorder. J Psychosom Res 2005;58:259-61.

Rathi A, Bhatia MS. Management challenges in a case of gender identity disorder. Ind Psychiatry J 2014;23:157-9.

Sandberg DE, Gardner M, Cohe- Kittens PT. Psychological Aspects of the Treatment of Patients with Disorders of Sex Development. Semin Reprod Med. 2012; 30(5):443–52.

Wallien MS, Swaab H, Cohen-Kettenis PT. Psychiatric comorbidity among children with gender identity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(10):1307-14.

Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. J Homosex. 2011;58(1):10-51.

Korte A, Goecker D, Krude H, Lehmkuhl U, Grüters-Kieslich A, Beier KM. Gender Identity Disorders in Childhood and Adolescence: currently Debated Concepts and Treatment Strategies. Dtsch Arztebl Int. 2008;105(48):834–41.