According to the Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD-10) [
Previous research of transsexualism has been mainly focused on the assessment of psychiatric comorbidity with an emphasis on high risks for suicidal behavior and self-mutilation [
There is predominance of the assessment scales and personality inventory in TS research studies with the most commonly used Minnesota Multiphasic Personality Inventory (MMPI-2), Mini-International Neuropsychiatric Interview (MINI), Structured Clinical Interview for DSM-IV Axis I and Axis II Disorders (SCID-I and SCID-II), and so forth [
Rorschach inkblot test has been rarely used in studies on TSP due to its specificity, complexity, and difficulties in interpretation, although the opportunities it provides are of major importance for the clinical assessment, in particular with the appearance of Exner’s Comprehensive System [
Review of the literature and research related to the assessment of Self-Perception of transseuxual persons is relatively modest. In one of the few studies dealing with this issue, Cohen et al. [
Self-Perception is associated with Self-Image and Self-Involvement. Self-Image is made up of the impressions that the client has about his/her own characteristics. Many of these impressions are easily accessible to conscious thinking, but some are partially or completely out of reach of consciousness because they are unwanted or conflicting, so there is a tendency towards concealment or suppression.
Assessment of Self-Perception in Rorschach includes the assessment of the cluster Self-Esteem, Self-Regard, Self-Awareness, and Sense of Identity, and the resulting scores are interpreted by Exner’s Comprehensive System [
Transsexual persons are characterized by anatomic discomfort and accordingly a certain degree of subjective suffering due to gender, incongruence and dysphoria, while their stigmatization and minority stress (additive to general stressors experienced by all people) further emphasize the development of psychological symptoms, such as anxiety and depression [
In the assessment of Self-Perception of transsexual persons, besides the presence or absence of personality psychopathology, psychiatric comorbidity seems to be an important prognostic factor for long-term psychosocial adjustment [
Having in mind that studies in the field of Self-Perception with TSP are rare (except for the transsexual adolescents) and important in the process of personality assessment and prediction of adaptive capacity and outcomes during the transition and posttransition period, the goal of our research is based on the exploration of Self-Perception of adult transsexual persons. Even though there are a number of scales for Self-Perception assessment, we have decided to assess this concept by Rorschach method which provides an insight into various aspects of Self-Perception [
Fifteen patients who had been assessed and diagnosed with transsexualism according to the ICD-10 [
The average age of the 15 patients was 28.3 years (SD = 7, min 19, max 40). Eight patients were transmen (FtMs—transman is assigned female at birth, but identifies as male) and seven were transwomen (MtFs—transwoman is assigned male at birth, but identifies as woman). MtFs and FtMs did not differ significantly in terms of age and duration of the sex-hormone therapy (all patients examined in the study commenced an endocrine treatment in 2–6-month duration).
The Rorschach was administered to the patients in accordance with the procedures for the Comprehensive System and it is a standard diagnostic measure in TSP according to the Cabinet of Transgender States, Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade [
Through the use of Exner’s Comprehensive System in the analysis of Rorschach protocols, an overview of the seven clusters involving major domains of psychological functioning is obtained. Self-Perception cluster of variables provides information about how people view themselves, particularly with respect to their level of Self-Esteem, the extent of their Self-Awareness, and the nature of their Self-Image. The relevant Rorschach findings help to identify whether people feel satisfied and comfortable with themselves or are burdened by negative self-attitudes [
Data are expressed as mean values for each of the variables taken into consideration in this study. The data were analyzed by using SPSS-18 statistical package (SPSS Inc., Chicago, Illinois, USA).
The results of variables for the cluster examined which were obtained via Rorschach protocol are presented in Table
Means and standard deviations for variables included in cluster of Self-Perception.
Min | Max | M | SD | |
---|---|---|---|---|
HVI | 0 | 0 | 0 | 0 |
OBS | 0 | 0 | 0 | 0 |
Index of Egocentricity | 0.04 | 0.60 | 0.34 | 0.14 |
|
0 | 2 | 0.13 | 0.51 |
Sum |
0 | 2 | 0.86 | 0.63 |
FD | 0 | 5 | 1.73 | 1.33 |
|
0 | 7 | 1.80 | 1.93 |
MOR | 1 | 5 | 2.13 | 1.12 |
|
1 | 4 | 2.53 | 1.06 |
|
0 | 5 | 2.06 | 1.57 |
The analysis of the means and standard deviations for the variables of interest of the study shows no significant deviations from the average values for normal population compared to the Hypervigilance Index (HVI = 0) and Obsessive Style Index (OBS = 0) that are negative. The Egocentricity Index a measure of Self-Focusing which is about the average show no significant deviations, while 6 the values indicating negative Self-Regard (V = 0.866, MOR = 2.133) had a tendency to increase. The score related to the Enhancing Self-Awareness (FD = 1.73) indicates a tendency toward elevated Self-Inspection of transsexual persons. In addition, given that the average sum of
The obtained average values of the seven variables included in the cluster of Self-Perception indicate potential ways in which people see themselves. None of the 15 survey respondents showed positive indexes, Hypervigilance Index (HVI) and Obsessive Style Index (OBS), which indicates that such persons have no prevailing tendency toward perfectionism, nor general vulnerability which is a result of basic mistrust towards the environment.
The values obtained in
Values indicating the quality of Self-Regard (V = 0.866, MOR = 2.133) indicate that the Self-Inspection process comprised negative and painful emotional states, associated with chronic concerns of a negative Self-Image, which is often accompanied by negative emotions due to gender dysphoria. The average value of MOR responses suggests that negative features are included in the Self-Concept or that there is an experience of imperfection. This finding is consistent with the core psychological conflict between gender and sex underlying the transsexualism. Considering that the MOR responses represent materials of significant projective importance, there seems to be a trend showing that their Self-perception includes the subjective impression of a personal imperfection or inadequacy. Primarily negative Self-Regard contributes to adjustment problems associated with self-critical, self-denigrating, and self-loathing attitudes and also with depression and suicidality which is often observed as a trend in people with gender dysphoria.
Enhancing Self-Awareness (
Having in mind that the sum
Overall results of our study indicate that transsexual persons have Adequate Self-Esteem, while the Egocentricity Index is of average values as in normal adult population. They also indicate a trend toward elevated introspection, with increased attention to the physical aspects of the body; that is, in the process of Self-Inspection negative and painful emotional states are present. It means that the trend of increased number of MOR responses in relation to the studies on adolescents transsexual persons is probably the result of long-term suffering, having in mind that the people who are involved in our study had initiated the sex reassignment procedure during their mature adult age [
Analysis of the results obtained may indicate that delayed entering into the sex-reassignment procedure in transsexual persons may potentiate the negative image of themselves and cause exhaustion of adaptive resources and consequently development of comorbid disorders, particularly depression and suicidal behavior.
The pilot study conducted has several limitations which need to be acknowledged. One of the limitations is the size of the sample. The total number of subjects was small for statistical purposes so only descriptive statistics was performed. Another limitation is the absence of a control group. According to the results obtained, in further research it is necessary to conduct a study that would include the assessment of Self-Perception in transsexual persons of different age groups, aimed at confirming the assumption that the prolongation of entering into the desired changes affects some aspects of Self-Perception.
The authors declare that there is no conflict of interests regarding the publication of this paper.