Gender identity disorders in schizophrenia

BACKGROUND: Aspects related to the clinical differentiation of gender identity disorders in patients with schizophrenia remain insufficiently studied. AIM: To examine the clinical and psychopathological characteristics of gender identity disorders in schizophrenia spectrum disorders in terms of their typology, dynamics, and treatment. MATERIALS AND METHODS: The study included 35 patients aged 18–65 years diagnosed with schizophrenia or schizotypal disorder according to the ICD-10, who reported dissatisfaction with their biological gender. Clinical-psychopathological, clinical-catamnestic, and statistical research methods were used. RESULTS: A typological differentiation of gender identity disorders was conducted, determined by the structure of mental disorders and the patterns of the endogenous process course. The studied conditions were classified into two types: in Type 1, gender identity disorders manifested within the framework of affective-delusional psychoses in episodic schizophrenia (n=13), while in Type 2, they were observed in schizotypal disorder (n=22). In Type 1, the manifestation of gender identity disorders predominantly (69.2% of cases) occurred between the ages of 21 and 24 years. As schizophrenia progressed, 38.5% of cases showed a complication of delusional themes, with the emergence of characteristic signs of Kandinsky–Clérambault syndrome. At the peak of depressive-delusional psychosis, patients "suddenly realized" that they "belonged to the opposite gender" and began to "recall" and exaggerate past events that allegedly confirmed their belief. The further dynamics of gender identity disorder unfolded in phases. As the affective-delusional psychosis resolved, ideas of gender transition faded. Over time, patients developed two stable symptom complexes — hypochondriacal or dissociative. In Type 2, gender identity disorders primarily occurred within the framework of schizotypal disorder. Their development was observed against the background of monopolar depressive disorders with features of "metaphysical intoxication." Further progression of Type 2 gender identity disorders was not distinctly linked to the dynamics of other psychopathological disorders, with gender transition ideas becoming overvalued or paranoid in nature. CONCLUSION: The study identified clinical-dynamic types of gender identity disorders based on the structure of mental disorders and the patterns of the endogenous process course.