Wise T N
J Sex Marital Ther. 1979 Winter;5(4):368-73. doi: 10.1080/00926237908407081.
Proper categorization of individuals with gender dysphoria allows rational psychotherapy. The treatment of an aging transvestite who requested sexual reassignment is presented to demonstrate the clinical features of the disorder and the course of the illness. The initial task was to place the patient into the proper clinical category of individuals with gender dysphorias. The clinical details of this disorder include an episoidic course with individuals who have previously had clear masculine identities. In the past they have been labeled secondary or marginal transsexuals as well as fetishtic cross-dressers. The patient, who had a long-standing history of cross-dressing, reacted to specific life stresses by the symptomatic wish for sexual reassignment. The individual psychotherapy consisted of phases of symptomatic expression, emerging depression, interpersonal awareness, symptom resolution and disavowel of the wish for sexual reassignment. The genesis of this perversion appears to be identification with a phallic maternal figure. Discussion of the descriptive and dynamic literature is reported in relation to the reported case. Identification of important losses in this patient's recent life allowed proper diagnosis and appropriate ongoing therapy to prevent the patient from irreversible surgery for a condition that was a symptom not an ingrained belief of gender dysphoria.
对性别焦虑症患者进行恰当分类有助于开展合理的心理治疗。本文介绍了一位寻求性别重置的老年异装癖患者的治疗情况，以展示该疾病的临床特征和病程。首要任务是将患者归入性别焦虑症患者的恰当临床类别。该疾病的临床细节包括病程呈发作性，患者此前有明确的男性身份认同。过去，他们被归类为继发性或边缘性易性症患者以及恋物癖异装者。这位有长期异装史的患者，因特定生活压力而产生了进行性别重置的症状性愿望。个体心理治疗包括症状表达阶段、出现抑郁阶段、人际意识阶段、症状缓解阶段以及放弃性别重置愿望阶段。这种性变态的成因似乎是对阴茎型母亲形象的认同。结合所报告的病例，对描述性和动力学文献进行了讨论。识别该患者近期生活中的重大损失，有助于做出正确诊断并进行适当的持续治疗，从而防止患者因一种并非性别焦虑症固有信念而是症状的情况接受不可逆转的手术。
