Psychodynamic psychotherapy in the diagnosis and treatment of gender dysphoria

Relevance. In this article, we consider the possibilities of a psychodynamic psychotherapeutic approach in the diagnosis and treatment of gender dysphoria on the example of a clinical case. Gender dysphoria refers to the distress that may accompany a mismatch with the patient's biological sex and assigned gender. In the past few years, there has been an increase in the number of patients requesting the restoration of congenital anatomical sex characteristics due to regret after genderaffirmation surgery (GAS). Recent studies have shown that one of the key regrets after GAS is inadequate psychological and psychiatric evaluation in determining whether GAS is an indication.

Case study. In this article, we explored how psychodynamic psychotherapy can be used to diagnose and treat disorders associated with gender dysphoria in the case of a 21-year-old man who presented with symptoms that met the diagnostic criteria for two conditions: unspecified gender dysphoria 302.85 (F64.1) and transvestic disorder with autogynephy 302.3 (F65.1) according to DSM-5. The main symptom appeared when the patient was at pre-school age and has been a constant concern ever since. The symptoms disappeared after psychodynamic psychotherapy, which lasted 11 months. Evaluation of psychotherapeutic effects 2 years after the completion of psychotherapy showed the stability of the results achieved.

Conclusion. Based on our analysis, we concluded that the use of psychodynamic psychotherapy for patients with gender dysphoria helps recognize neurotic conflicts that may underlie transgender symptoms, and thereby reduce the likelihood of a diagnostic error in determining the presence of indications for GAS. Looking at cases of gender dysphoria in Balint groups can also be of great help in understanding the etiology of gender dysphoria symptoms.

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