Adolescents who are eligible for sex reassignment surgery: Parental reports of emotional and behavioural problems

One important reason why clinicians abstain from medical intervention in transsexual adolescents is that they assume that transsexualism and psychopathology are necessarily associated. However, several studies among transsexual adolescents considered eligible for sex reassignment, employing self-report questionnaires and the Rorschach according to Exner's Comprehensive System, did not find the high levels of psychopathology encountered in psychiatric populations. Thus far, no data have been gathered from sources other than the patients themselves. It has been argued that the method used may create a bias, as the sources of information were persons who have a stake in the outcome. In this study we therefore assessed the number and type of psychological problems among transsexual adolescents using Child Behavior Checklist and DISC data gathered from parents or other caretakers, at the time of application. In about one quarter of the patients DSM criteria were fulfilled (one specific phobia, one tic disorder, one oppositional disorder and one anxiety disorder), and in about one third of the patients, parents reported high levels of behavioural or emotional problems on the Child Behavior Checklist (CBCL). A post hoc qualitative inspection of the clinical CBCL group's situation revealed that in all patients important unfavourable family circumstances could be observed, such as having major conflicts with parents. This might have led to an over-reporting of problems by parents or may be indicative of a real elevation of emotional or behavioural disturbance, perhaps as a reaction of family problems that already existed or were a consequence of the child's gender dysphoria. However, in line with previous data, transsexual adolescents as a group did not score in the clinical range at the time of application.