Gender Dysphoria Comorbidity with Schizophrenia

Abstract

Background: Gender dysphoria is a rare condition characterized by an incongruity between gender identity and biological sex. Although gender dysphoria in patients with schizophrenia is a rare phenomenon, it is observed more often than in the general population. Clinical evidence suggests that both gender dysphoria and schizophrenia may share common causal mechanisms and risk factors. Objectives: To review and evaluate the relationship between gender dysphoria and schizophrenia. Methods: The articles used for this review were selected from PubMed database and the studies included were only the studies with schizophrenia related to gender dysphoria of the last 10 years, using the keywords “Schizophrenia”, “Gender Dysphoria” and “Transsexualism”. Results: The PubMed search returned 196 papers. After duplicate removal, titles and abstracts were screened for eligibility. The total of 7 papers were included in this review. Hospital and clinic-based studies showed that schizophrenia occurs in patients with gender dysphoria at rates higher than in the general population. Clinical evidence suggests that patients with gender dysphoria may have schizophrenia-like personality traits. Conversely, patients with schizophrenia may experience alterations in gender identity and gender role perception. There are distinguished 4 mechanisms which have an impact on gender identification problems caused by schizophrenia: (1) identity problems as a stressor which can cause schizophrenia symptoms to appear; (2) identity problems as a consequence of schizophrenia; (3) the common neurobiological background of schizophrenia and gender dysphoria; (4) the influence of schizophrenia-specific deficits of mental functions on gender identity. Gender dysphoria in individuals with schizophrenia may result from the delusionally changed gender identity or appear regardless of psychotic process. Clinical evidence suggests shows that different delusional beliefs regarding belonging to another gender, anatomy or changes within the genitals affect about one-fourth of patients with schizophrenia Neurobiological research, including brain imaging and studies of finger length ratio and handedness, suggests that both these disorders are associated with altered cerebral sexual dimorphism and changes in cerebral lateralization. Discussion & Conclusion: The presence of symptoms of gender dysphoria in schizophrenic patients generates many serious diagnostic and therapeutic problems. It is imperative for clinicians to approach each diagnosis with a holistic lens, given the overlapping symptoms and potential for misdiagnosis.