Primary transsexuals are schizoid obsessive, socially withdrawn, asexual, unassertive, and out of touch with anger. Underlying this personality, they have a typical borderline syndrome characterized by separation anxiety, empty depression, sense of void, oral dependency, defective selfidentity, and impaired object relations with absence of trust and fear of intimacy. The authors' opinion, they most resemble a subgroup of the borderline syndrome which Grinker calls 'the adaptive, affectless, defended, 'as if' persons'. Unlike other borderline patients, however, primary transsexuals are distinguished by severe impairment of both core gender identity and of gender role identity from earliest childhood.