Is crossdressing a mental disorder

What transsexuality has to do with mental health

"One day, when I grow up, I'll be a beautiful woman. But today I'm still a child, today I'm still a boy." The New York artist Anohni sang that back then under the name Antony on her album "I Am a Bird Now" in 2005. She never made a secret of the fact that she is transgender, she once said in an interview. And: Although she always saw herself as a woman, she did not have the courage to ask others to address her as a woman. It wasn't until 2015 when she officially changed her name at the age of 45. The singer became a singer.

Everyday hurdles

If the gender identity and the physical gender do not match, one speaks of trans identity or transsexuality. Getting into one's own gender is a long process for transsexuals. Until then, they have to overcome many hurdles - social and medical. The path runs from psychotherapy to diagnosis and hormone treatment to gender reassignment surgery, but not everyone opts for this last step.

Social misunderstanding and a widespread transphobic attitude create enormous levels of suffering in those affected. This manifests itself, among other things, in countless everyday obstacles: For example, when you have to show your ID, which is in a man's name, but you look feminine. Sitting in the waiting room can also be an obstacle if you are called by a woman's name but are outwardly male. Or everyday things like going to public toilets and filling out a form, if only the two options "male" and "female" are available.

Pathologizing and incapacitating

And then there are the legal foundations of gender change: those affected experience anything but self-determined in the psychological and psychiatric diagnoses that are required in Austria, for example, in order to change the first name and the gender entry. In a position paper written in 2016, transgender groups describe the handling as "pathologizing and incapacitating harassment".

The Viennese association Trans X, founded in 1995, shares this view. Transgender people are often assessed as pathological and not taken seriously, says Eva Fels. She is a transgender activist and has been the chairwoman of the Austrian association Trans X since 2000. "When the topic of trans identity comes up, therapists often cannot react adequately. Due to their own ignorance, depression, anxiety disorders or autistic traits are diagnosed, but these usually resolve. as soon as you have found the right therapeutic accompaniment, "says Fels.

Transsexuality is considered a mental illness

The classification of transsexuality as a mental illness is perceived as particularly degrading. A diagnostic manual for mental disorders, currently the ICD-10, serves to diagnose mental illnesses. The World Health Organization (WHO) still lists transsexualism as a mental disorder. A new version is currently being worked on, the ICD-11 is expected to appear in 2018, but it is still unclear whether the assignment of transsexuality as a mental illness will be deleted in the revised version. Back in 1974, when homosexuality dropped out of the international catalog of diagnoses of mental disorders, millions of homosexuals were healed in one go.

Parallel to the ICD-10 there is the DSM-5, the US psychiatric classification system. Here at least the medical diagnosis "gender identity disorder" was replaced in 2013 by the diagnosis "gender dysphoria", which means a rejection of one's own gender.

"Transsexuality is not a mental disorder or illness. Transsexual people are healthy people who suffer from constitutional gender incongruence," says Cornelia Kunert. She is a psychotherapist, supervisor and member of the expert team for transsexuality / trans identities of the Austrian Federal Association for Psychotherapy. At most, the compulsion to live in what is perceived to be the wrong gender is what makes you sick, emphasizes the Trans X association.

When depression goes away

"Transsexuals do not experience themselves as mentally ill and feel more comfortable in the long term and become more functional when they go through a process of gender reassignment," says therapist Kunert. She advocates removing hurdles and ensuring free access to medically supervised hormone therapy. Because the positive psychological effect of the hormone administration is remarkable. Kunert: "Depression and anxiety disorders, which otherwise often occur in transsexual people, are melting away." This "congruence dynamic" is a sign of the increasing correspondence between self-experience and physical constitution.

A Vienna study recently confirmed that gender identity is not a psychological phenomenon, but rather biologically verifiable. The neurologist Georg Kranz and the psychologist Rupert Lanzenberger suggest that gender identity is irreversibly "programmed" into our brain.

Influence of gender reassignment treatment

A current study from the Netherlands also assumes this - but it goes a step further and examines rare cases in which transsexuality and psychosis are present at the same time. Not only can anxiety disorders and depression be cured through gender reassignment measures, but psychotic disorders are also reduced, the study suggests. The results were published in April 2017 in the journal "LGBT Health".

In their report "Gender Dysphoria and Co-Existing Psychosis: Review and Four Case Examples of Successful Gender Affirmative Treatment", the Dutch research team led by Julia Meijer from the University of Amsterdam describes four case studies. Subjects were two trans men and two trans women aged 29 to 57 years. The result: Transgender people diagnosed with a psychotic disorder were successfully treated with the help of gender reassignment measures, i.e. with psychological, endocrine and surgical treatment. Meijer and her team admit, however, that psychotic developments with simultaneous transsexuality affect a very small number of cases. (Christine Tragler, May 10, 2017)