PERSONALITY AND PSYCHOPATHOLOGY IN GENDER IDENTITY DISORDER: A RORSCHACH STUDY Congresso WAS Goteborg 2009 Chiara CRESPI, Mariateresa MOLO Centro Interdipartimentale Disturbi dell’Identità di Genere Ospedale San Giovanni Battista , Turin –Italy University of Turin

SUMMARY Introduction and Aim Materials and Method Participants characteristics Results Conclusions

To compare MMPI and Rorschach test clinical data AIM To assess G.I.D. people personality To compare MMPI and Rorschach test clinical data AIM To compare G.I.D. population with normative sample

Material and Method The study is based on CLINICAL DATA RORSCHACH TEST (Exner Comprhensive System Method) M.M.P.I.-2 (MINNESOTA MULTIPHASIC PERSONALITY INVENTORY ) Design and method   We used (slide) 1) WHOQOL 100: a questionnaire developed by the OMS WHOQOL 100 is composed of 6 domains: -         Physical -         Psychological -         Freedom, physical safety and security -         Social relationship -         Environment -         Spirituality, religion and personal beliefs Each domain includes one or more subdomains (24 in total) The subject answers each item giving a score from 1 to 4 and from 1 to 5 on a Likert scale The order of importance of the domains is not cross culturally influenced. 2) A self -administered specific questionnaire for G.I.D. patients who underwent SRS realized by the authors. The questionnaire is composed by 32 items asking the subject to evaluate differences before and after SRS on psychosocial conditions and sexual life. . (slide)

Materials and Method: RORSCHACH VARIABLES: -     Response Style - Stress Control - AFFECT Area -     SELF Perception - INTERPERSONAL Perception -     Information Processing -     Mediation -     Ideation      PERSONALITY ORGANIZATION Design and method   We used (slide) 1) WHOQOL 100: a questionnaire developed by the OMS WHOQOL 100 is composed of 6 domains: -         Physical -         Psychological -         Freedom, physical safety and security -         Social relationship -         Environment -         Spirituality, religion and personal beliefs Each domain includes one or more subdomains (24 in total) The subject answers each item giving a score from 1 to 4 and from 1 to 5 on a Likert scale The order of importance of the domains is not cross culturally influenced. 2) A self -administered specific questionnaire for G.I.D. patients who underwent SRS realized by the authors. The questionnaire is composed by 32 items asking the subject to evaluate differences before and after SRS on psychosocial conditions and sexual life. . (slide) COGNITIVE AREA

Materials and Method: M.M.P.I.-2 CLINICAL SCALES Hypochondria Depression Hypomania Schizophrenia Paranoia Social Introversion Design and method   We used (slide) 1) WHOQOL 100: a questionnaire developed by the OMS WHOQOL 100 is composed of 6 domains: -         Physical -         Psychological -         Freedom, physical safety and security -         Social relationship -         Environment -         Spirituality, religion and personal beliefs Each domain includes one or more subdomains (24 in total) The subject answers each item giving a score from 1 to 4 and from 1 to 5 on a Likert scale The order of importance of the domains is not cross culturally influenced. 2) A self -administered specific questionnaire for G.I.D. patients who underwent SRS realized by the authors. The questionnaire is composed by 32 items asking the subject to evaluate differences before and after SRS on psychosocial conditions and sexual life. . (slide) Psychasthenia   Hysteria Masculinity/Femininity Psychopatic Deviation

Partecipants characteristics 26,7% (n=8)

Social and demographic caracteristics G.I.D. (N=30) Sex, N : MtF: 22 FtM: 8 Age, years ( DS) 32,10 (8,64) Marital Status, N (%): Single Married Cohabitation 20 (66,7%) 0 (0%) 10 (33,3%) Educational level (years) 11,73 (3,03)

To compare G.I.D. population with normative sample To assess G.I.D. people personality AIM 1 To compare G.I.D. population with normative sample

RORSCHACH RESPONSE STYLE Cautious and defensive approach to testing (expected result because of the setting and motivation dell'assessment ) cosa vuol dire? LAMBDA SCORE: Design and method   We used (slide) 1) WHOQOL 100: a questionnaire developed by the OMS WHOQOL 100 is composed of 6 domains: -         Physical -         Psychological -         Freedom, physical safety and security -         Social relationship -         Environment -         Spirituality, religion and personal beliefs Each domain includes one or more subdomains (24 in total) The subject answers each item giving a score from 1 to 4 and from 1 to 5 on a Likert scale The order of importance of the domains is not cross culturally influenced. 2) A self -administered specific questionnaire for G.I.D. patients who underwent SRS realized by the authors. The questionnaire is composed by 32 items asking the subject to evaluate differences before and after SRS on psychosocial conditions and sexual life. . (slide) High score: avoidant style

Response Style *

Stress Control D and Adj.D < 0 (Control value of stress) EA stress control is only fairly low due to a low activation of cognitive-affective responses to stress (LOW PERCEPTION OF STRESS) D and Adj.D < 0 (Control value of stress) EA (value of internal resources) Internal resources are very limited but these subjects are less severe(?) because of the low value of Adj.es.: GID patients have very limitated resources but also have a low perception of stresso (?) stress.

Stress Control

Affect Area The activation of the emotions remained low, consistent with the style avoided (avoidant style ?)(high L). Emerging defensive operations of avoidance of emotional involvement (?) The values are in the normal range, therefore there is no affective psychopathology

Affective Area

Self Perception 113 * * * * * * *

Self Perception 1 Average low score of SumH and Pure H Specific dysfunctions in the self-perception: low index (?) of mature identification The self-perception is based on their beliefs, judgments and values. These subjects keep low (mantengono basso) the value awarded to the judgments of others (?) Average high score of EGO INDEX

Average high score of Hx and anatomical contents Self Perception 2 HIGH INTELLECTUALIZATION OF SELF-PERCEPTION Not based on experiental aspects Average low score of M based on very abstract aspects Average high score of Hx and anatomical contents

Self Perception 3 Given the particular problem about gender identity, the mechanisms emerged from the tests carry a high adaptive function (as well as defensive): Subjects can feel better in their own gender identity and in their body if they avoid the weight of social opinion and if they build their own identity in an intellectual way

Interpersonal Perception

Interpersonal Perception The values are normal but it is possible that, according to the style of response given(low number of responses, high value of Lambda), interpersonal problems have been (were) underestimated in this test (and therefore we get false negative result) NON DA PROIETTARE MA DA DIRE A VOCE

RORSCHACH VARIABLES: - Response Style - Stress Control - AFFECT Area -     SELF Perception - INTERPERSONAL Perception -     Information Processing -     Mediation -     Ideation      Design and method   We used (slide) 1) WHOQOL 100: a questionnaire developed by the OMS WHOQOL 100 is composed of 6 domains: -         Physical -         Psychological -         Freedom, physical safety and security -         Social relationship -         Environment -         Spirituality, religion and personal beliefs Each domain includes one or more subdomains (24 in total) The subject answers each item giving a score from 1 to 4 and from 1 to 5 on a Likert scale The order of importance of the domains is not cross culturally influenced. 2) A self -administered specific questionnaire for G.I.D. patients who underwent SRS realized by the authors. The questionnaire is composed by 32 items asking the subject to evaluate differences before and after SRS on psychosocial conditions and sexual life. . (slide) COGNITIVE AREA

Information Processing * * *

Cognitive Area: Information Processing      The information processing is normal. It shows a tendency to (have) a low ability to integrate environmental stimuli DQ v elevato: vedere significato Design and method   We used (slide) 1) WHOQOL 100: a questionnaire developed by the OMS WHOQOL 100 is composed of 6 domains: -         Physical -         Psychological -         Freedom, physical safety and security -         Social relationship -         Environment -         Spirituality, religion and personal beliefs Each domain includes one or more subdomains (24 in total) The subject answers each item giving a score from 1 to 4 and from 1 to 5 on a Likert scale The order of importance of the domains is not cross culturally influenced. 2) A self -administered specific questionnaire for G.I.D. patients who underwent SRS realized by the authors. The questionnaire is composed by 32 items asking the subject to evaluate differences before and after SRS on psychosocial conditions and sexual life. . (slide)

Mediation

Cognitive Area Mediation: l’esame di realtà è nella norm      Mediation: l’esame di realtà è nella norm DA NON PROIETTARE. SOLO DA COMUNICARE Design and method   We used (slide) 1) WHOQOL 100: a questionnaire developed by the OMS WHOQOL 100 is composed of 6 domains: -         Physical -         Psychological -         Freedom, physical safety and security -         Social relationship -         Environment -         Spirituality, religion and personal beliefs Each domain includes one or more subdomains (24 in total) The subject answers each item giving a score from 1 to 4 and from 1 to 5 on a Likert scale The order of importance of the domains is not cross culturally influenced. 2) A self -administered specific questionnaire for G.I.D. patients who underwent SRS realized by the authors. The questionnaire is composed by 32 items asking the subject to evaluate differences before and after SRS on psychosocial conditions and sexual life. . (slide)

Ideation *

Cognitive Area      Ideation: non emergono alterazioni patologiche del corso del pensiero Si conferma anche la tendenza all’intellettualizzazione DA NON PROIETTARE. SOLO DA COMUNICARE Design and method   We used (slide) 1) WHOQOL 100: a questionnaire developed by the OMS WHOQOL 100 is composed of 6 domains: -         Physical -         Psychological -         Freedom, physical safety and security -         Social relationship -         Environment -         Spirituality, religion and personal beliefs Each domain includes one or more subdomains (24 in total) The subject answers each item giving a score from 1 to 4 and from 1 to 5 on a Likert scale The order of importance of the domains is not cross culturally influenced. 2) A self -administered specific questionnaire for G.I.D. patients who underwent SRS realized by the authors. The questionnaire is composed by 32 items asking the subject to evaluate differences before and after SRS on psychosocial conditions and sexual life. . (slide)

To compare MMPI and Rorschach test clinical data AIM 2 To compare MMPI and Rorschach test clinical data

MMPI-2 Clinical Scales *

Unica Scala Patologica MMPI-2 fare diapo Scala MF Unica Scala Patologica Elevata negli MtF ma la differenza con gli FtM non è statisticamente significativa. Potrebbe indicare una > carica di ribellione verso l’autorità, maggiori problemi familiari e maggior aggressività manifesta Scala PD Significativamente inferiore negli FtM ma in entrambi i gruppi i valori sono al di sotto di 65 punti T, quindi non clinicamente rilevanti Scala Pa

Conclusion (1) In agreement with the literature, the profiles of both tests indicate the absence of a specific psychopathology. In contrast, in the two tests, our sample showed some functional mechanisms for adaptation.

Conclusion (1) Atteggiamento al test ( E’ ripetizione) Al Rorschach i soggetti hanno manifestato un atteggiamento guardingo e difensivo simile a quello che si ritrova in un setting di tipo forense E’ possibile che tali soggetti manifestino uno stile evitativo che consenta loro un miglior adattamento . Evitare gli eccessivi coinvolgimenti sia emotivi che interpersonali può essere una difesa contro la paura del rifiuto e dell’abbandono come anche un fattore protettivo per il mantenimento della propria autostima (PIERO)

Conclusion (2): Affective Area, Interpersonal Area and Stress control “Less is better”: DA CONTROLLARE L’INGLESE mantenendo un basso coinvolgimento affettivo, ci si garantisce un miglior adattamento interpersonale ed una gestione più adeguata dei livelli di stress (maintaining a low affective involvement, you will secure a better interpersonal adjustment and a more suitable management of stress levels)

Conclusion (3):Cognitive Area Not significant clinical disorders concerning the connection with reality and the course of thought.

Conclusion (4):Self Perception Self perception is the only problematic area. Self-esteem is maintained while minimizing the weight of others' opinions and building a very intellectualized identity. Under the assumption that what counts is what I think about myself it is easier to retain an adequate self-esteem for the social adaptation.

Thanks for your attention…

Who are we? since 1992 since 1998 C.I.D.I.Ge.M. Centro Interdipartimentale Disturbi Identità di Genere   A.S.O. San Giovanni Battista di Torino - Sede Molinette Il C.I.D.I.Ge.M. è un centro di intervento clinico nel percorso di adeguamento per le persone che intendono chiedere la riassegnazione chirurgica del sesso, secondo la legge 164 del 1982. Si rivolge ai pazienti provenienti da tutte le regioni d’Italia Offre i seguenti servizi: Valutazione psicodiagnostica Inquadramento medico-internistico e trattamenti ormonali Psicoterapia individuale e di gruppo Gruppi di supporto Interventi chirurgici specifici Seminari informativi per operatori e familiari. since 1992 since 1998 Con il patrocinio di Università degli Studi di Torino Facoltà di Medicina e Chirurgia