Psychological Tests: The Uninvited Guest

Talks with colleagues at other gender identity clinics revealed that complete psychological testing was rarely obtained because it was viewed as either too expensive or irrelevant to the diagnosis and treatment of transsexualism. In retrospect, both objections were really based on the fact that most gender clinics did not have any psychodynamically trained psychologists to administer or interpret such tests. In addition, one colleague stated that since the diagnosis of transsexualism could not be made on the basis of the Rorschach test there was no reason to administer that test. However, some clinicians have maintained that one can diagnose transsexualism from the "draw a person" test, the idea being that if the patient draws the opposite sex figure first s/he has a possible transsexual gender disorder. While such anecdotal arguments are common, and have even spawned research, the conclusions are, at best, specious. No single psychological test ought to be used to diagnose a specific disorder. Moreover, the use of psychological tests to diagnose transsexualism is of doubtful value, since the very possibility of a clinical diagnosis of transsexualism has been called into question. Psychological testing involving a wide range of clinical assessment instruments may, however, facilitate overall personality assessment and diagnosis by providing important clinical material from areas not generally tapped by clinical interview alone. For some disorders, like the borderline personality condition (which has often been viewed as the basic structure of the transsexual's personality) psychological testing is central to confirming the diagnosis.

On the Wechsler Adult Intelligence Scale (WAIS) the patient scored a verbal IQ of 119, a performance IQ of 116, and a full scale IQ of 119. Her scores suggested that she was functioning in the bright to normal range of intellectual abilities. There was considerable inter test scatter among all subtests, and a significant amount of intra test scatter on the verbal tests. This scatter suggested considerable variability and inefficiency in her thinking and the possibility of ego defects, especially in those ego functions related to attention, effortful concentration, and organization of thought. While not overtly psychotic, her thinking could become disorganized under stress. Her high intelligence, coupled with her high comprehension subtest score on the WAIS, also suggested her capability for utilizing knowledge of social mores and conventions in a manipulative manner. (see PROPOSITION 1: THE SO CALLED "STABLE" COURSE OF FEMALE TRANSSEXUALISM PART VI)