Persistent discomfort about one's sex or sense of inappropriateness is a diagnostic criterion for transsexualism (ICD-10), though mechanisms and psychopathological characteristics of these conditions are not clear enough. This investigation concerns phenomenological peculiarities of non-acceptance of one's own sex characteristics (SC).

241 persons (136 male and 105 female), who sought change of sex split into four groups. Group 1 were diagnosed as transsexuals (N=83), Group 2 as schizophrenia-spectrum disorder (N=77), Group 3 as organic mental disorder (N=22) and Group 4 as personality disorder (N=59). Average age: 24,3 years.

Clinical-psychopathological, sexological, statistical

Persons in Group 1 would not accept their primary (59%) and secondary (92,8%) SC, which expressed in discomfort, irritability and shame but no psychopathology involved. For Group 2, was more common non-acceptance of secondary SC (68,8%) with ideas of reference, depressive mood and dysmorphomanic delusions (21%). In Group 3, non-acceptance of one's SC (63,6%) combined with background asthenia (57%) and hypochondric fixation (40,1%). In Group 4 (76,3%), it was accompanied by psychopathic reactions dependent on the personality profile. Severity varied from feeling uncomfortable and distressed and trying to suppress sex-related external manifestations to ignoring or refusal to use them in sexual contacts and desire to get rid of them (including castration) and acquire the SC of the other sex.

Subjects in all groups would not accept their primary and secondary SC. This non-acceptance differed in intensity and psychopathological structure, and their qualification could be important for diagnosis of variants of gender-identity disorders.