[Gender identification disorders from the clinical perspective. A contribution from psychiatric practice].

Referring to the recent debate on how to describe and classify "transsexual phenomena" according to psychopathological and diagnostic criteria and the necessary definition of standards of care, this investigation is intended as a clinically oriented contribution to the study of gender identity disorders. Beside a literature review to outline the different theoretical positions, several case reports are presented to illustrate and analyze the variety and complexity of conditions which are underlying or concomitant to the desire for a sex change. This study focuses on the need for more careful diagnostic considerations and scrupulous follow-up of patients presenting with the conviction of wrong sex assignment. Although it seems reasonable to "detotalize" transsexualism, the authors plead for the adherence to a clinically oriented approach to this issue. They disagree with arguments to abandon a "nosomorphic view" or with notions that regard transsexualism as a "minority which has been pathologized". In order to match demands properly and to give adequate advice it appears necessary to improve general knowledge and specific therapeutic competence in the field of gender identity disorders.