Tateno Masaru, Ikeda Hiroshi, Saito Toshikazu
Department of Neuropsychiatry, Sapporo Medical University, School of Medicine.
Seishin Shinkeigaku Zasshi. 2011;113(12):1173-83.
Pervasive developmental disorders (PDD) are characterized by two essential symptoms: impairment in social interaction, and restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. PDD include autistic disorder, Asperger's disorder, and PDD-Not Otherwise Specified (PDD-NOS). These three disorders are sometimes termed autism spectrum disorders. A recent epidemiological survey demonstrated that the rate of PDD may be almost 1% and that many PDD cases might not be diagnosed properly in childhood. Erik Erikson described eight stages of psychosocial development through which a normally developing human should pass from infancy to adulthood. In the theory, an adolescent shows 'Identity vs. Role Confusion'. It has been reported that individuals with PDD often have identity crises which sometimes include gender dysphoria. This phenomenon might be related to the so-called identity diffusion in youth. When they reach their young youth, it has been said that subjects with PDD realize their uniqueness and differences compared to others, and, as a result, they may develop confusion of identity which could be exhibited as gender identity disorder. A recent study demonstrated that, amongst 204 children and adolescents who visited a GID clinic in the Netherlands, 7.8% were diagnosed with autism spectrum disorders after a careful diagnostic procedure by a multi-disciplinary team. Taken together, PDD and GID seem closely related to each other. In this paper, we present four PDD cases with gender dysphoria and related symptoms: 1) a girl with PDD who repeatedly asserted gender identity disorder (GID) symptoms in response to social isolation at school, 2) a junior high school boy with PDD and transvestism, 3) a boy diagnosed with Asperger's disorder who developed a disturbance of sexual orientation, and 4) a boy with Asperger's disorder and comorbid childhood GID. Many of the clinical symptoms related to gender dysphoria might be explained by the cognitive characteristics and psychopathology of PDD. The Japanese Society of Psychiatry and Neurology published guidelines for the assessment and treatment of GID in 1997, and revised them in 2006. As a result, GID has become well known as a clinical entity in Japan, and there have been an increasing number of Japanese patients complaining of gender dysphoria. It is important to consider an underlying diagnosis of PDD when encountering patients with gender dysphoria.
广泛性发育障碍（PDD）的特征有两个基本症状：社交互动障碍，以及行为、兴趣和活动的受限、重复和刻板模式。PDD包括孤独症、阿斯伯格综合征和未特定的广泛性发育障碍（PDD-NOS）。这三种障碍有时被称为孤独症谱系障碍。最近的一项流行病学调查表明，PDD的发病率可能接近1%，而且许多PDD病例在儿童期可能未得到正确诊断。埃里克·埃里克森描述了正常发育的人从婴儿期到成年期应经历的八个心理社会发展阶段。在该理论中，青少年表现出“同一性对角色混乱”。据报道，患有PDD的个体经常会出现身份危机，有时还包括性别焦虑。这种现象可能与青少年中所谓的身份扩散有关。据说，当患有PDD的个体进入青少年早期时，他们会意识到自己与他人相比的独特性和差异，结果可能会出现身份困惑，表现为性别认同障碍。最近一项研究表明，在荷兰一家性别认同障碍诊所就诊的204名儿童和青少年中，经过多学科团队仔细的诊断程序后，7.8%被诊断患有孤独症谱系障碍。综上所述，PDD和性别认同障碍似乎密切相关。在本文中，我们介绍了4例伴有性别焦虑及相关症状的PDD病例：1）一名患有PDD的女孩，因在学校遭受社交孤立而反复表现出性别认同障碍（GID）症状；2）一名患有PDD和异装癖的初中男孩；3）一名被诊断患有阿斯伯格综合征的男孩，出现了性取向障碍；4）一名患有阿斯伯格综合征且合并儿童期GID的男孩。许多与性别焦虑相关的临床症状可能可以用PDD的认知特征和精神病理学来解释。日本精神神经学会在1997年发布了性别认同障碍的评估和治疗指南，并于2006年进行了修订。结果在日本，性别认同障碍已成为一个广为人知的临床实体，抱怨性别焦虑的日本患者数量也在不断增加。在遇到患有性别焦虑的患者时，考虑潜在的PDD诊断很重要。
