Scigglez

I understand that psychotic disorders aren't your main focus, but I've always wondered how to professionally differentiate between transgenderism and a psychotic belief structure? If that sounds ignorant and inflammatory, allow me to elaborate: For example, a man who was born a man, is biologically, anatomically and physiologically a man claims he is actually a woman, has always felt more like a woman and identifies as a woman. This guy is a transgender. Another man claims he is the second coming of Christ, or hell, he claims he's really a horse, has always felt more like a horse and identifies as a horse. This guy is psychotic. Why is the first man not psychotic and the second man transspecies? I know this sounds like an absurd question, but I'm a current medical student planning on entering psychiatry, I've spent several years working in some of the more prestigious psychiatric hospitals in Boston and Philadelphia and have never had the proper platform to ask this question. Thank you.

It's obviously a comlex issue, for example I could imagine a scenario where a man who is attracted to other men and could just as easily be classified as homosexual finds some cognitive dissonance in this notion and feels more comfortable identifying himself as a women such that he now views himself as a straight female rather than a homosexual male. In this case he allows his sexual preference to determine his gender identity. My curiosity stemmed from having a patient who had a rather complex, delusional belief structure (believing he was a different ethnicity, from a different era, and of a different gender, among other things) and started me thinking why his other symptoms taken alone would qualify him as psychotic but the gender issue seems to get a pass and is classified as something else altogether when, at its core, its a claim based on internal stimuli with no external corroboration, which in most other circumstances, makes up the basis for a delusion or psychotic belief.