Gender dysphoria, serious mental illness, and genital self-mutilation: A case report

Transgender individuals have consistently been shown to have higher rates of many psychiatric conditions, likely due to societal discrimination and trauma. While psychotic disorders are not of known higher prevalence among transgender patients, other etiologies of serious mental illness (SMI), including posttraumatic stress disorder, personality disorders, and mood disorders, are more common. Genital self-mutilation is sensationalized, but uncommon, in transgender people. It is poorly understood how SMI affects propensity for genital self-mutilation in this population. The following is a case of a 43-year-old transgender woman with SMI, presenting with genital self-mutilation in the setting of an acute mood episode with psychosis. She identified a lack of access to care, including an inability to receive medical assistance in obtaining sex reassignment treatment, as a major stressor contributing to her self-injury. Previous cases and analyses of genital self-mutilation among transgender patients have generally focused on patients with gender dysphoria without concomitant SMI. Further investigation into the effects of restrictions on sex-reassignment treatment of transgender patients with SMI is necessary to better understand the effects of these restrictions on their symptoms.