Comparison of self-harm and defense mechanisms in individuals with Gender Identity Disorder before and after sex reassignment surgery

Document Type : Original Article


1 Clinical psychology, Islamic Azad University, Zanjan Branch

2 Research and education Unite, Qazvin office of education


Introduction:Individuals with gender identity disorder (GID) experienceseries of adjustment problems in society before and after sex reassignment surgery. The aim of this study was to compare self-harm and defense mechanisms before and after sex reassignment surgery in these persons.
Method: We used a case- control design, in quantitative stage 30 people with GID before surgery and 30 people with GID after surgery and normal people were investigated.
Results:Data analysis by a Multivariate analysis of variance were showndecreasedtrend of directly self-harm behaviors after surgery, whereas there were not any differences in indirect self-harm behaviors  before and after surgery. No differences was found in neurotic and mature defense mechanisms between groups.
Conclusion: It seemthat the sex reassignment surgery could effectivelydecreasethe directly self-harm and immature defense mechanisms, while it has no effect in changing indirect self-harm, neurotic and mature defense mechanisms. It could be concluded that indirect self-harm sustains even after sex reassignment surgery that need to be targeted with psychological and social interventions. Changing in the immature defense mechanisms could be considered as a valid indicator of physical and psychological treatments.


Main Subjects

1- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 2013;Washington, DC.
2- Bouman WP, Claes L, Brewin N, Crawford JR, Millet N, Fernandez-Aranda F, et al. Transgender and anxiety: A comparative study between transgender people and the general population. International Journal of Transgenderism. 2017; 18(1): 16-26.
3- Kuhn A, Bodmer C, Stadlmayr W, Kuhn P, Mueller MD, Birkhauser M. Quality of life 15 years
 after sex reassignment surgery for transsexualism. Fertil Steril. 2009; 92(5): 1685-89.
4- Murad MH, Elamin MB, Garcia MZ, Mullan RJ, Murad A, Erwin PJ, et al. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol (Oxf). 2010; 72(2): 214-31.
5- Sansone RA, Wiederman MW, Sansone LA. The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. J Clin Psychol. 1998; 54(7): 973-83.
6- Germain SA, Hooley JM. Direct and indirect forms of non-suicidal self-injury: evidence for a distinction. Psychiatry research. 2012; 197(1-2): 78-84.
7- Claes L, Bouman WP, Witcomb G, Thurston M, Fernandez-Aranda F, Arcelus J. Non-suicidal self-injury in trans people: associations with psychological symptoms, victimization, interpersonal functioning, and perceived social support. J Sex Med. 2015; 12(1): 168-79
8- Marshall E, Claes L, Bouman WP, Witcomb GL, Arcelus J. Non-suicidal self-injury and suicidality in trans people: A systematic review of the literature. International review of psychiatry (Abingdon, England). 2016; 28(1): 58-69.
9- Nock MK, Joiner TE, Jr., Gordon KH, Lloyd-Richardson E, Prinstein MJ. Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry research. 2006; 144(1): 65-72.
10- Klonsky ED. The functions of deliberate self-injury: a review of the evidence. Clinical psychology review. 2007; 27(2): 226-39.
11- Khanipour H, Borjali A, Falsafinejad MR. Non-suicidal Self-injury in delinquent adolescents and adolescents with history of childhood maltreatment: motivation and suicide probability. Psychology of Exceptional Individuals. 2016; 6(21): 59-79 [Persian].
12- Banifield D. Psychodynamic theory for therapist. (D Arab-ghahestani, F Vadaye-kheiri, S Aryan, Trans). Roshd publication. 2010. [Persian].
13- Vaillant GE, Bond M, Vaillant CO. An empirically validated hierarchy of defense mechanisms. Archives of general psychiatry. 1986; 43(8): 786-94.
14- Hepp U, Kraemer B, Schnyder U, Miller N, Delsignore A. Psychiatric comorbidity in gender identity disorder. Journal of psychosomatic research. 2005; 58(3): 259-61.
15- Prunas A, Vitelli R, Agnello F, Curti E, Fazzari P, Giannini F, et al. Defensive functioning in MtF and FtM transsexuals. Comprehensive psychiatry. 2014; 55(4): 966-71.
16- Andrews G, Singh M, Bond M. The Defense Style Questionnaire. The Journal of nervous and mental disease. 1993; 181(4): 246-56.
17- Heidarinasab L, Mansour M, Azadfalah P; Shoeiri M.. Validity and reliability of defense style mechanisems in Iranian populations. Daneshavere rafter. 2008; 14(22): 1-16. [Persian].
18- Gilbert P, McEwan K, Irons C, Bhundia R, Christie R, Broomhead C, et al. Self‐harm in a mixed clinical population: The roles of self‐criticism, shame, and social rank. British Journal of Clinical Psychology. 2010; 49(4): 563-76
19- Khanipour H, Borjali A, Hashemi Azar J, HossainKhanzadeh A. Comparison of Emotion Regulation Skills and Suicide Probability in Adolescents with Self-Harm. Practice in Clinical Psychology. 2014; 2(1): 9-15 [Persian].
20- Gratz KL. Risk Factors for and Functions of Deliberate Self-Harm: An Empirical and Conceptual Review. Clinical Psychology: Science and Practice. 2003; 10(2): 192-205.
21- Nock MK, Banaji MR. Assessment of self-injurious thoughts using a behavioral test. American Journal of Psychiatry. 2007; 164(5): 820-823.
22- Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical psychology review. 2010; 30(2): 217-37.
23- Lobato MI, Koff WJ, Crestana T, Chaves C, Salvador J, Petry AR, et al. Using the Defensive Style Questionnaire to evaluate the impact of sex reassignment surgery on defensive mechanisms in transsexual patients. Revista Brasileira de Psiquiatria. 2009; 31(4): 303-6.
24- Bond M, Perry JC. Long-term changes in defense styles with psychodynamic psychotherapy for depressive, anxiety, and personality disorders. Focus. 2005; 161: 1665–71.
25- Kipper L, Blaya C, Teruchkin B, Heldt E, Isolan L, Mezzomo K, et al. Evaluation of defense mechanisms in adult patients with panic disorder: before and after treatment. The Journal of nervous and mental disease. 2005; 193(9): 619-24.
26- Besharat MA, Tavalaeyan F. Comparisons of interpersonal difficulties of individuals among gender identity disorder after and before sex reassignment surgery and control group. J Health psychology. 2014; 13(2): 1-14. [Persian].
27- Hejazi A, Edalati Shateri Z, Saadat Mostafavi S, Sadat Hosseini Z, Razaghian M, Mogaddam MA. preliminary analysis of the 12 transsexual patients with regards to their adaptation in means of role and gender identity after a sexual reassignment surgery. Scientific Journal of Kurdistan University of Medical Sciences. 2009; 13(4): 78-87. [Persian].
28- Anzabdashti, S.I., Asgharnejadfarid, A.A, Rayisi Z. Comparison of Early Maladaptive Schemas and Parental Origins in Patients With Gender Identity Disorder and Normal Individuals. Journal of Clinical Psychology. 2015; 7(2): 49-60. [Persian].
29- Sarraj-Khorrami A, Karami J, Momeni KM. Comparing Thinking Rumination and Defense Mechanisms in Patients Suffering from Major Depression and Obsessive-Compulsive Disorders with Normal Individuals. Journal of Clinical Psychology. 2014; 6(2): 53-63. [Persian].
30- Akkerman K, Carr V, Lewin T. Changes in ego defenses with recovery from depression. The Journal of nervous and mental disease. 1992; 180(10): 634-8.
31- Prunas A, Preti E, Huemer J, Shaw RJ, Steiner H. Defensive functioning and psychopathology: a study with the REM-71. Comprehensive psychiatry. 2014; 55(7): 1696-702.