Conclusion
At this stage, the provisional status of our data only permits some few conclusions. The central findings of this questionnaire analysis support the view of a great heterogeneity of gender disordered males which not only extends to the already well known gender and sexuality variables but also to general personality pathology and especially the different modes of self-regulation. We could identify a significant narcissistic pathology in most of our patients, but the regulation-modes afflicted by this pathology differ widely. The cluster analysis has yielded an interesting and clinically reasonable subtyping of our patients with two larger subgroups of which one is marked by severe narcissistic and personality pathology where the gender dysphoria appears as only one facet in this profound pathology, as a rather desperate attempt at stabilizing a fragmented self. In the other larger cluster there is no substantial personality pathology, but one might speculate that the gender dysphoria is part of a deeper problem in object-relations, for which the transsexual wish probably serves as an imagined solution. The data analysis has indicated that the sexual orientation does account for some variance in our sample, but in a multivariate view it does not seem to be a significant predictor. Thus, by our preliminary analysis the notion that gynephilics have more substantial personality and gender pathology could not be confirmed. However, the complete analysis of our data including the developmental and biographic variables as well as the results of the structured interview appears to be promising and may change this impression.
In closing, the cumulative evidence of our study so far is consistent with the view that gender dysphoria is a disorder of the sense of self as has been proposed by Beitel (1985) or Pf?fflin (1993). The central problem in our patients is about identity and the self in general and the transsexual wish seems to be an attempt at reassuring and stabilizing the self-coherence which in turn can lead to a further destabilization if the self is already too fragile. In this view the body is instrumentalized to create a sense of identity and the splitting symbolized in the hiatus between the rejected body-self and other parts of the self is more between good and bad objects than between masculine and feminine. The results obtained so far confirm the conviction that we have to maintain a clinical perspective in the field of gender dysphoria and must continue to improve our understanding of this enigmatic and fascinating problems.
