Examining the validity of the assessment of gender identity disorder: Diagnostic, self-reported psychological distress and strategy adjustment

Muirne Caitlin Shonagh Paap

Research output: ThesisPhD Thesis - Research external, graduation external

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Transsexualism is characterised by a discrepancy between biological sex and gender identification, in spite of hormonal levels that are normal with respect to the biological sex. Generally, having the diagnosis ‘transsexualism’ or ‘Gender Identity Disorder’ (GID) is a prerequisite for hormonal and surgical treatment. Since transsexualism is such a rare phenomenon, and a so-called ‘gold standard’ against which the diagnosis could be evaluated is lacking, it is of utmost importance that reliable information be published by as many clinics as possible.

One of the main aims of this thesis in psychiatry was to investigate potential differences in diagnostic ‘habits’ or interpretation of the classification rules as provided by DSM-IV and ICD-10 among four European GID clinics (Belgium, Germany, the Netherlands and Norway). Secondly, it was investigated whether a widely used self-report inventory, the SCL-90-R, is suitable to be used in this patient group as well as two other patient groups. Finally, it was investigated whether cross-sex hormone therapy in GID patients has an effect on the answering strategy they employ on a math test that is known to show sex differences.

The diagnostic criteria were interpreted in a similar manner in the four clinics. However, a distinction was made in Amsterdam between onset/duration on the one hand and severity/persistence on the other hand. This may lead to differences in diagnostic decisions among the clinics. It is recommended that severity and duration be taken into account in the next version of the DSM. The findings of two of the papers suggest that the dimensionality of the SCL-90-R is not stable. Subscale scores be used with care in patient groups reporting little distress, such as GID patients. Finally, it is concluded that even though cross-sex hormone treatment has been shown to not influence cognitive performance as such, it may still influence other cognitive factors, such as answering strategy and adjustment.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • University of Oslo
  • Haraldsen, Ira, Supervisor, External person
  • Malt, Ulrik, Supervisor, External person
Award date4 Feb 2011
Place of PublicationOslo
Print ISBNs978-82-8264-014-5
Publication statusPublished - 4 Feb 2011
Externally publishedYes


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