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  #1  
Old 05-16-2011
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Question Sexual Identity Reassignment

37 year old man is referred to a psychiatrist for evaluation for sexual reassignment, he states that from as early as he can remember, he has been sexually attracted only to other men. however, he always feels enormous guilt after a sexual liaison with a man. while he has functioned adequately with women, he has no emotional or physical affinity for them. he is requesting sexual reassignment because he wants to have a husband and a normal heterosexual life; which of the following is the most likely diagnosis

a : ego-dystonic gender identity disorder
b : ego-dystonic homosexuality
c : ego-syntonic gender identity disorder
d : ego-syntonic homosexuality
e : paraphilia



ps: question from kaplan book
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  #2  
Old 05-16-2011
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Question ego dystonic homosexuality?

feeling guilty after a liaison = Ego Dystonic
Attracted to men as long as i remember = homosexuality
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Old 05-16-2011
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b : ego-dystonic homosexuality
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Old 05-16-2011
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Quote:
Originally Posted by nevillenic View Post
feeling guilty after a liaison = Ego Dystonic
Attracted to men as long as i remember = homosexuality
correct the correct answer in the kaplan book is Ego-Dystonic Homosexuality


but this sentence made me doubt "he has no emotional or physical affinity for them (women). he is requesting sexual reassignment because he wants to have a husband and a normal heterosexual life"

he want's a husband and heterosexual life, and sexual reassignment (is a request to change sex; isn't" . why not ego-dystonic gender identity disorder?
what made you guys (and kaplan book as well) take the homosexual option and not gender identity disorder option?
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Old 05-16-2011
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Well, "gender identity disorder" is a conflict between a person's actual physical gender and the gender that person identifies himself or herself as.
This person has been sexually attracted only to other men, but he does not think/act/identifies as a women. That´s way I chose homosexuality.
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Old 05-16-2011
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Quote:
Originally Posted by bebix View Post
Well, "gender identity disorder" is a conflict between a person's actual physical gender and the gender that person identifies himself or herself as.
This person has been sexually attracted only to other men, but he does not think/act/identifies as a women. That´s way I chose homosexuality.
but he is willing to become a women, because the main request is a sexual reassignment, and he want an heterosexual relationship with a man.
I'm really confused
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Quote:
Originally Posted by tinhi View Post
but he is willing to become a women, because the main request is a sexual reassignment, and he want an heterosexual relationship with a man.
I'm really confused
I think that's the ego-dystonic part = he just want to have a "normal heterosexual life"
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Quote:
Originally Posted by bebix View Post
I think that's the ego-dystonic part = he just want to have a "normal heterosexual life"
a man with a man is not an heterosexual relationship! so why this man want to change his gender?
it's the part I didn't get, if he has not a gender identity crisis, so why does he want to change sex?
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Old 05-16-2011
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I know this question is so close...

Gender Identity would always have one important criteria-- The man thinks that he is a women psychologically- dresses like one, etc.. I mean no where in the question they say that he thinks he is in the wrong body.

Homosexuality = Only attracted to men as long as they remember-which is given in the question..
Can have a relationship with a women but not satisfied--- given in the question

Although he does want a sex change and wants to have a normal heterosexual life -- we usually do this for transexual or people with gender identity disorders.. Howver that is something he is requesting not the physician ..
I think the point is, we have to go with the patients symptoms rather than what he requests for... they gave that to us to confuse us but we need to make sure we are answering the question --"what is the diagnosis(based on the symptoms, not based on what the man wants)"

I agree though this question is really confusing.
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  #10  
Old 05-17-2011
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Exactly. For gender identity disorder, the man would have said something like: I think I'm a woman on the inside. Or words to this effect. Since he didn't, it should be egodystonic homosexuality.
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Old 05-17-2011
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Quote:
Originally Posted by step1saga View Post
I know this question is so close...
...
I agree though this question is really confusing.
I think this question is absolutely clear.
One of keyphrase: "... he has no emotional or physical affinity for them" (ie women). In the other hands that man has affinity only to another men (not women).
+ We should remember that homosexuality is not means only sex (only intercourse) with same sex - it is prefer of a partner for life.
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Instead of saying “we don’t know why,” though, say “idiopathic.” It sounds so much smarter.
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  #12  
Old 05-17-2011
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Quote:
Originally Posted by deyneko View Post
I think this question is absolutely clear.
One of keyphrase: "... he has no emotional or physical affinity for them" (ie women). In the other hands that man has affinity only to another men (not women).
+ We should remember that homosexuality is not means only sex (only intercourse) with same sex - it is prefer of a partner for life.

Thanks for this post again tinhi!

In my opinion, this question is just asking for the most likely diagnosis! The fact that he is still a man who has sex with men (homosexual) makes the answer choice B : ego-dystonic homosexuality correct. But if the question states that he had already performed a surgery to change his sex preference to become an heterosexual individual (sexual reassignment to become a woman in order to have a husband), then I would choose option A: ego-dystonic gender identity disorder.
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Old 05-17-2011
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Quote:
Originally Posted by TenderLovingDoc View Post
But if the question states that he had already performed a surgery to change his sex preference to become an heterosexual individual
That man didn't say or shown any things that he thinks that he is woman absolutely. This make this question more difficult. If this question had continue I would not sure that he very need the operation (reassignment) - may be only some kind of psychological treatment first etc... And the question does not ask us to make conclusion about the reassignment. There is only one leading problem - the patient feels guilty. So he thinks that after the reassignment he will appear close to "woman". And this will make "green light" in the society to have man as life partner. So he things that the operation will remove that enormous guilty problem and he will feel himself more comfortable even he things that he is not woman "inside".
So, again the question deals with choosing a partner for the life.
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Instead of saying “we don’t know why,” though, say “idiopathic.” It sounds so much smarter.
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  #14  
Old 05-17-2011
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Quote:
Originally Posted by deyneko View Post
That man didn't say or shown any things that he thinks that he is woman absolutely. This make this question more difficult. If this question had continue I would not sure that he very need the operation (reassignment) - may be only some kind of psychological treatment first etc... And the question does not ask us to make conclusion about the reassignment. There is only one leading problem - the patient feels guilty. So he thinks that after the reassignment he will appear close to "woman". And this will make "green light" in the society to have man as life partner. So he things that the operation will remove that enormous guilty problem and he will feel himself more comfortable even he things that he is not woman "inside".
So, again the question deals with choosing a partner for the life.
I like this explanation it helps to understand the choice of the answer

thank you all for the great explanations
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