Childhood Trauma Survivor Misdiagnosed as Transsexual with Gender Dysphoria

[Virginia]

You are not seeing the point, Lucca. SoupSarah's DID was NEVER "detected." It took their unwavering resistance to their physiologist's insistence that they were transgender to get their doctor to revise his misdiagnosis.

SoupSarah writes:
"The really scary fact is had I not been in a position to challenge, to say his initial theory of me was wrong in the first instance I would now be transitioning."

This scenario is exactly why it is vital for people with a need to express themself as another gender to understand there are other reasons for this besides being transgender.

[Dena]

I think I am starting to see a pattern here. When you get a diagnosis of "transsexual in denial" it's an indication that something more might be going on. The non binary often come here without being sure where they fit in but they are fully aware of the conflict from both sides and they aren't denying the fact that they are transgender.

I attempted to search for "transsexual in denial" and I really couldn't find a good definition for it. It's almost as if it's something the doctors made up when they didn't have a good explanation for what they were seeing in a patient. It would be helpful if we had a few more terms like this that would flag us that things may not be all they seem to be.

[Virginia]

Brilliant observation, Dena!

[Lucca]

You're still being unclear on what exactly it is that qualifies someone for DID diagnosis over a transgender diagnosis, and also haven't provided any evidence as to what the rate of misdiagnosis is, even though you've insinuated it must be high because there are more people with gender dysphoric DID than there are transgender people, which suggests that the majority of people who go to a therapist and report gender dysphoria aren't transgender, and therefore should not transition, which goes against the established fact that transition has a very high success rate of relieving gender dysphoric symptoms. Those are very important things to clarify if you want therapists to revise their diagnostic crieteria, and I'm not sure why you keep avoiding them. Frankly, I don't want anyone delaying my transition because they think I might have DID just because I have gender dysphoria.

[Virginia]

I am ending my conversation with you, Lucca.

[Lucca]

Seriously, what did I miss? Because while I don't think you're doing it on purpose, you haven't actually answered most of my questions and have acted like I'm just trying to be difficult. If you don't want to keep talking to me, I'll accept an explanation from a moderator.

All I want is some sort of explanation of how this isn't something that a bad therapist would use against me, and a clear explanation of diagnostic differences from ->-bleeped-<- would solve that. I want to be properly treated too, and it's not like it's a cakewalk to find a therapist who will diagnose and treat ->-bleeped-<- properly. Or anything properly if you're even slightly out of the ordinary, for that matter. I've had therapists laugh my problems off because I'm an atheist and they didn't believe that religion could cause someone to be depressed, for example. I'm only concerned about this because the mental health community has put roadblock after roadblock in front of properly recognizing me, not to mention all the unflattering pseudo-scientific explanations my conservative community has tossed at me for my behavior. All I want is the smallest explanation of how this isn't another misdiagnosis someone could throw at my face. You claim to understand that, so I'm not sure why you're refusing to talk or answer my questions.

[SoupSarah]

Hi Lucca,
I think you make some valid points and ask some important questions. They are not easy to answer quickly but if you don't mind I will try to answer some of your questions and concerns. Please understand I am no expert, just my take on the whole thing. I will try and be as precise as I can with my wording but forgive me if I err.

As for "how is it something a bad therapist could use against someone who is genuinely transsexual?"
To obtain a diagnosis of DID is very difficult, most people spend around 8 years in mental health care before getting such a diagnosis. A portion of therapist even refute its existence. That cannot be said about transsexualism, it is a widely accepted state of being enshrined in law in a lot of countries. Of the dozen or so DID individuals I have had the pleasure to talk to, and the hundreds of trans* people, I have heard of 6 cases (including my own) of misdiagnosis of transsexualism and none of the other way round. Of the dozen people with DID I have talked to all but one had alternate gendered parts.
So, this is not something that would affect you. In the UK there is now legislation in place to protect trans* individuals, to give them rights to therapy where as half the psychologist disregard DID as even being a thing.

What qualifies a DID diagnosis over a transgender diagnosis?
And there in you answer your own question. If I am correct, the "diagnosis" criteria for being trans* is believing yourself to be trans? There is no test, no psychological rigour to conform to, your the gender your brain tells you. As a female part in a male body there is no difference between me and a transwoman. I fully believe myself to be female and want nothing more than to live an authentic life in an authentic body. It is only because I realised quickly that I actually share this body, that I know I would hurt my other part in trying to achieve this. Being multiple is not as overt as the media makes out. We don't all of a sudden start using different voices or live in a vacuum from our other parts. When the psychologist was offering us gender therapy, hormones and eventual surgeries I wanted to say "Yes please". A few months earlier and I would of, it was only due to our own research, our own findings, our own perseverance that I was informed enough to understand "that was not me".
So what qualifies? nothing qualifies and it cant be qualified. The only way is to go through therapy, with a therapist who is aware of the issues. I was lucky, my male side is persistent and questioning. He would freely admit to being a obsessive compulsive nerd - not everyone is like that. Some sort of protection needs to be in place. Not so much "I don't want anyone delaying my transition because they think I might have DID" as "I am glad all the checks and balances were in place, it would be horrendous if someone had made a mistake".

Of the five DID people I know of that had an trans-gender diagnosis originally, the length of time was 2-5 years before the gender therapy became derailed. That is a big chunk of someones life and some big changes they accommodated in their life from a mis-diagnosis. All of them were over the age of 30 and all had questions over their true gender identity. By contrast I am very good friends with a bi-gendered individual, they live their life as two separate binary genders. They are resolute in understanding and knowing who they are and how much they need to transition. They know they are two genders. I. on the other hand, went for a long period of time just believing I was the only one in this body. There is no simple test, no one-shot lets anyone decide yes or no. People are not as black and white as that, and DID is a mechanism to allow parts to hide completely within the subconscious. As I said, I did not know I was any different to any other transwoman out there except by talking to people who are trans I started to realise that I did not quite fit. That is a bit of a small hunch to work on and probably not too different from just normal reasonable doubt.

I am not sure but 3% of the population to be DID seems a bit high - I could quite believe 3% of people experience some form of dissociation on a clinical scale, but full multiple personality is not common. My psychiatrist said I was a "Once in a career patient" and has never seen or treated anyone with DID before. Now, that could be because he has never believed it existed and hundreds of DID people have passed before him. We are misdiagnosed with a lot more than just transsexualism. Schizophrenia, BPD, Bipolar and depressives are just a few of the more common ones.

The real point is that DID needs to be better educated amongst all mental health professionals. It needs to be seen and recognised as a probable cause for some other symptoms that are easily misdiagnosed. It is certainly not a call to arms to debase anyone else who is transsexual. But to put it into context, if you were facing major surgery and there was a slight chance that taking a pill for a few months could actually negate the need for surgery, would it not be ethical for your doctors to at least try the pill first?

"What it is that seperates transgender people from those suffering from DID "
As I explained, on the surface there could be nothing - dig a little deeper and you will find they are as different as ham and eggs. The fact is it is not simple. People are not that simple. Trained therapist are the only answer, people that understand the many reasons (not just DID) why someone may express another gender to the one they are born as.

I hope that helps clarify - if you need anything else, then just ask. xx Sarah

Dena, good call about the "Transgender in denial". But if you take it on face value, I am a 47 year old male, with a wife and family. The disruption to all of our lives would be huge to admit to being trans-gendered. It could be that I had lived my whole life as a lie, and it just got too much for me and the only way forward was to make up my multiple parts to justify it to the rest of the world. I am sure it happens. That is why the question the psychiatrist asked "How do you feel when you dress in women's clothes" was so pertinent. Not being able to answer showed us both clearly (me and the psychiatrist) that denial was not the reason. Anyone but a multiple would be able to answer that.

[Lucca]

Thank you, that makes it all much more clear .

But to put it into context, if you were facing major surgery and there was a slight chance that taking a pill for a few months could actually negate the need for surgery, would it not be ethical for your doctors to at least try the pill first?

Depends on the context... has my doctor noticed other symptoms that make him believe that the pill will not only work, but that the surgery wouldn't actually help at all? Or is he just making me take the pill because he requires everyone to take the pill first?

What I want to avoid is having my therapist treat my gender dysphoria with treatments for DID by default, simply on the basis that I have gender dysphoria, or have started to take an active interest in feminine things. That just sounds like the therapist is pathologizing my habit of buying women's clothing to try on, which is the kind of thing that conversion therapy advocates do; slapping people in the face for harmless cross-gender activities and discouraging them from doing them. If the therapist is instead looking for additional symptoms of DID besides just gender dysphoria, and has found them, then yes, treating someone for DID instead of assuming that transition is the best solution would be the way to go. It certainly sounds like you fit the bill yourself, and have an assortment of symptoms that aren't common to ->-bleeped-<- alone.

As for how easy it is to receive recognition and treatment for being transgender... well, I'm sure it's easier than being diagnosed with DID, but I've personally had the hardest time getting mental health help for even the simplest, most obvious mental illnesses or conditions, and for the silliest, most easily avoidable reasons. Like I said, I had two different therapists refuse to treat my depression just because my stressors were religion-based. I had another one tell me I probably had an autism-spectrum disorder, even though she said in the same breath that she was not qualified to give such a diagnosis, and had not ran me through any official tests to detect such a thing, but that I didn't need one because her personal assessment was good enough. I had a different one who dumped me after two sessions and canceled our next scheduled session saying she wasn't able to help me, but didn't say why, and didn't offer me a referral. I had another one who strongly believed I was transgender based on what I told her (which I now believe I am), but was so pushy about it at a time when I was suffering from extreme anxiety that I got fed up with it and refused to further consider that I was transgender at the time, which set me back months of personal development while I was actively trying to explore my issues and get treatment for them. If she hadn't been so hell-bent on suggesting that gender dysphoria was the cause of all my problems and I needed to transition as the first line of defense against all of them, instead of letting me figure things out for myself, I would've had an easier time accepting everything. Additionally, I know plenty of anti-LGBT religious people who would love to have an excuse to label all transgender people as mentally ill and remove their access to transitional care, which is why it is very important that distinctions are clearly made between the small number of cases where gender dysphoria is a symptom of mental illness which can be solved through non-transitional means and transition might be detrimental to the patient, and the majority of cases where it is best solved through transition. If this is not made clear, we get people like Walt Heyer ruining things for everybody.


So just to make it clear, making vague claims about how gender dysphoria can be caused by a mental illness and be treated without transition is the sort of badgering that transgender people get all the time, and they are naturally going to be disinclined to be receptive to it. Making even a small amount of clarification goes a long way toward eliminating that, which you have done and Virginia has not. I'm not trying to be antagonistic and I certainly did not start this discussion with anything other than simple curiosity, but I've gotten frustrated with the lack of simple answers to my simple questions, and getting vaguely insulting replies that don't address my concerns instead, combined with statistics that don't actually support the writer's point.

[Virginia]

For reference, The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides the following criteria to diagnose Dissociative Identity Disorder:
1.   Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
2.   Amnesia must occur, defined as gaps in the recall of everyday events, important personal information, and/or traumatic events.
3.   The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
4.   The disturbance is not part of normal cultural or religious practices.
5.   The symptoms can not be due to the direct physiological effects of a substance (such as blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (such as complex partial seizures).
https://www.webmd.com/mental-health/dissociative-identity-disorder-multiple-personality-disorder#1

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides for one overarching diagnosis of gender dysphoria with separate specific criteria for children and for adolescents and adults.
In adolescents and adults gender dysphoria diagnosis involves a difference between one's experienced/expressed gender and assigned gender, and significant distress or problems functioning. It lasts at least six months and is shown by at least two of the following:
1.   A marked incongruence between one's experienced/expressed gender and primary and/or secondary sex characteristics
2.   A strong desire to be rid of one's primary and/or secondary sex characteristics
3.   A strong desire for the primary and/or secondary sex characteristics of the other gender
4.   A strong desire to be of the other gender
5.   A strong desire to be treated as the other gender
6.   A strong conviction that one has the typical feelings and reactions of the other gender
https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria

[SoupSarah]

Lucca

I'm not trying to be antagonistic and I certainly did not start this discussion with anything other than simple curiosity, but I've gotten frustrated with the lack of simple answers to my simple questions, and getting vaguely insulting replies that don't address my concerns

Your simple questions are not "simple" questions. The simple answers you ask for do not exist. This is not a simple topic and not one best conducted through a limited medium such as a forum in the detail you seem to require.
Your concerns about being misdiagnosed as DID are absurd. I have explained in numerous ways the issue is people with DID being misdiagnosed not the other way round. The fear and intolerance you show about misdiagnosis is held in just the same way by DID individuals being incorrectly labelled. An individual regardless what "slings and arrows of outrageous fortune" they have to contend with should have the basic human right to a correct path for treatment.

I want to avoid having my therapist treat my gender dysphoria with treatments for DID by default

That  is quite simply never going to be an issue - That is the exact issue the nice people on here have been trying to explain. IF you are DID you are highly likely to be diagnosed as trans. No one is saying IF you are trans your more likely to be diagnosed DID.

If (as I said) DID was better understood and accepted in the mental health community and society at large then your fear about all trans* people being labelled as mentally ill would fall by the wayside. To be able to clearly state that within the mental assessment for confirming trans status that all "mental illness" has been ruled out would leave the community at large free from such persecution - that is why it baffles me that such hatred and scorn is fired at individuals for suggesting it. The essence is it is not the trans* community that suffers but the few? individuals who are DID and enter this community as their first point of understanding. By weedling out the mentally ill, you and your fellow trans* members can clearly demonstrate not only due dilligence in the care of others, but that the people on the pathway to correct their birth defects are sane, whole and completely justified in demanding their care and place in society. In one swoop it stops the extremist views about mental illness being a cause of any gender incongruity. It may also save a few lives.

I am far from anti-trans*. Having been there at the gateway to transition, having made those "coming out" speeches to my closest family - I have felt it, understood the pain and difficulty society places on this community. I do not think "I have dodged a bullet", far from it, I thought I was just naturally female and in a male body. My GD is crippling, I cry for days on end in emotional agony. However, it now turns out that I do not have a clear path forward, that I am mentally ill. It turns out that my issues stem from repeated sexual abuse that happened to me before the age of 3. I am looking at years and years of therapy, painful traumatic therapy. My happy ever after is decades in the future, not a few years of hormone therapy and maybe some confirming surgery. It is also a future of darkness and pain as me and my family cope with me dealing with my years of abuse. This is not required because it is something I am, something I feel - this is required because someone else abused me and used me when I was little more than an infant.

In all of my communication with you I have tried to show you compassion and understanding. I believe for you to move on with this you need to do the same. Trans* people face difficulties, huge major difficulties in health care and society. Being diagnosed as DID is not one of those difficulties as that never happens. There in is the whole point your missing, DID survivors are not diagnosed and instead left to continue along a track that is in most cases harmful to them. The simple raising of awareness of this issue helps everyone involved. Attacking and criticising the issue is just detrimental and fuels the extremist views.

I wish you luck with your transition and  truly pray you get the correct help you need to live a long and fruitful life.

Can we all be friends now?

Sarah xx

nb: in the hour it has taken me to write just this reply, I noticed there has been another post, I have so far not read it so cannot comment on anything about it yet.

[Lucca]

What, are you holding me in contempt just because I asked for an explanation? How are you going to gain acceptance by doing that?

I'd been satisfied with your answers up to this point, as I've tried to make clear. What I've not been satisfied with are Virginia's evasive responses as well as his quote-mining, nor your new insinuation that I'm being "absurd" and filled with "hatred and scorn" just for asking for clarification on a topic that I'm not already knowledgeable about, and that I can only learn about by asking questions. I don't like how I'm being treated here, I'd like a moderator to review this thread and if they think I'm out of line, I'll defer to them.

All I wanted was an explanation of what differentiates DID from ->-bleeped-<-, and how a psychiatrist would distinguish one from the other in a diagnosis. I initially was not given such a thing, was then derided for asking for it, and am now being derided for having received it. Great. I've learned nothing except to avoid the topic at all costs.

[Dena]

Lucca, Virginia is offering the best possible explanation one can offer from the position of having DID. The transgender diagnosis was forced incorrectly by the therapist and it became a matter of digging out the truth. Virginia is here to watch for others who might fall into this trap. It has happened to another member of the site who was able to receive surgery only to discover the mistaken diagnosis. Remember that the opening post isn't so much about being transgender but is about having DID and being misdiagnosed with transsexualism.

All I wanted was an explanation of what differentiates DID from ->-bleeped-<-, and how a psychiatrist would distinguish one from the other in a diagnosis. I initially was not given such a thing, was then derided for asking for it, and am now being derided for having received it. Great. I've learned nothing except to avoid the topic at all costs.

If you have a skilled therapist, you state your transgender and you exhibit the symptoms of being transgender, the therapist will have few options other than to diagnosis you as transgender. ->-bleeped-<- is a self diagnosed condition so the therapist's purpose is to verify what your saying and determine that there are no other conditions that would interfere with your judgement. The therapist isn't there to diagnosis you though they might make suggestions for you to consider.

DID is another matter because often people who suffer from it aren't aware that they have it. They have gaps in their memory much like you do when you sleep or they might remember the actions of their alter as a dream. The reason they don't realize this is abnormal is because it's all they have ever known so they are unaware of what everybody else experiences. There is an element of self denial when somebody describes an action they took that they lack the memory of.

A good therapist is unlikely to diagnosis you as DID unless a symptom indicates the possibility. This is a relatively rare condition and even when a therapist suspects it, they will have to do a good deal more digging for supporting evidence. The therapist is looking for anything that might affect your judgement and bipolar or schizophrenia are more likely possibilities than DID.

If you should ever disagree with a diagnosis you receive from your therapist, demand the reasons for the diagnosis. If you feel the therapist is wrong, you have the option of discussing it here or seeing another therapist for a second opinion. If a therapist isn't a good fit, there is no reason why you should stay with them.

Also remember that I am watching this thread and the inability to answer a question isn't a reason to be upset. Try waiting for somebody else to answer the question or try to rephrase the question. Sometimes there isn't an answer to a question so forcing the issue isn't going to provide an answer.   

[Lucca]

Ah... ok, well, sorry for derailing the thread I was just curious initially, I didn't want there to be any fighting  . I probably just shouldn't have said anything in the first place.

[V M]

This is an interesting topic, think I may follow along as well

[Virginia]

Related thread specifically addressing ->-bleeped-<- and dissociation:
"Dissociation as a coping mechanism"
https://www.susans.org/forums/index.php/topic,239653.0.html

[angelats]

Hello Virginia,

thank you very much for sharing your story and information about DID/MPD.

I had gender therapy many years ago and i was very fast diagnosed by my gender therapist as mtf transsexual.
When she asked me about sexual abuse i had no memory about sexual abuse then. When i asked my brother whether there was any abuse, he was quite astonished and he asked me whether i have forgotten everything? 

Then i had memory flashes, bad dreams and a very hard time and stopped then therapy because everything was too much.

Now, years later i try to get gender therapy again and to continue transition. Your Information helped me to consider the abuse that happened as a possible cause or influence for my gender dysphoria. I will consider this in my therapy. Thank you!

Angelats

[Virginia]

THANK YOU for sharing this with me, angelats.
I feel like a fifth wheel on the forum, the voice in the wind no one wants to hear. To know my story relates with you...means more to me than you can know.

Regardless of where therapy takes you, it is vital to find your peace with the trauma you experienced as a child. ->-bleeped-<- is a biological condition not a mental disorder. But sexual fantasies about becoming women, a need to dress as women, extreme guilt related to masturbation, gender confusion, sexual confusion, and/or dysphoria about their genitals are all quite common in cisgender males who were sexually abused as children. One in Six men are sexually abused so it is much more common reason for these symptoms than ->-bleeped-<-. The mind's ability to protect us from things too painful to remember makes it extremely difficult to determine the underlying cause- particularly for a transgender person child with a history of child abuse. Therapy is vital to determine the underlying reason.

[Allison S]

My mom just asked me if I was sexually abused as a child because I'm transitioning male to female. This caught me off guard though it had crossed my mind. But to my knowledge I never was abused in anyway, and I was in therapy for a year or two before transitioning. I was in therapy before even crossdressing... The depression and anxiety was only getting worse over time. So my mom asking this makes me realize I'm in this by myself and as we talk more and more, it's pretty clear.

I can understand that your experience of sexual abuse and trauma has influenced your gender questioning. I'd being dishonest if I didn't acknowledge that it does make things more complicated in my situation. Sometimes I think I'd truly be better of dead than having to be constantly questioned and maybe ridiculed. My mom said she wishes she was dead and never saw me transitioning. She's questioning her parenting I guess right now. This is why I haven't been open about things. It's a tough place to be in right now

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[SailorMars1994]

My mom just asked me if I was sexually abused as a child because I'm transitioning male to female. This caught me off guard though it had crossed my mind. But to my knowledge I never was abused in anyway, and I was in therapy for a year or two before transitioning. I was in therapy before even crossdressing... The depression and anxiety was only getting worse over time. So my mom asking this makes me realize I'm in this by myself and as we talk more and more, it's pretty clear.

I can understand that your experience of sexual abuse and trauma has influenced your gender questioning. I'd being dishonest if I didn't acknowledge that it does make things more complicated in my situation. Sometimes I think I'd truly be better of dead than having to be constantly questioned and maybe ridiculed. My mom said she wishes she was dead and never saw me transitioning. She's questioning her parenting I guess right now. This is why I haven't been open about things. It's a tough place to be in right now

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It is very important to weigh out everything no doubt. But truth be told it seems like your mom is making your transition about her. Litterly all about her.

[Allison S]

It is very important to weigh out everything no doubt. But truth be told it seems like your mom is making your transition about her. Litterly all about her.

I'm used to her antics. I just listen and then do what I want. My sisters and brother would agree with you too. She's hard to get along with.

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