Therapy of a case of psychotic personality organization manifesting gender identity disorder.

The author relates his experience with a case of psychotic personality organization manifesting transsexualism spanning about 10 years. This paper presents the case and discusses the psychodynamics together with the course of therapy. The patient was a case of primary transsexualism who fell into hallucinatory-delusional states each time he seriously tried to become a woman. His transsexual wish was identification with his idealized grandmother image, for defense of his helpless and vulnerable self, and an attempt to reestablish his self which was facing a crisis of disintegration due to disorganization of his ego. Over about 4 years of psychoanalytic psychotherapy, the conflict between "becoming a woman" and "taking over as head of the house" was an integral issue. The psychotherapy was brought to a tentative conclusion by the patient giving up the idea of "becoming a woman" and deciding to "take over as head of the house".