Psychological distress, self-harming behavior, and suicidal tendencies in adults with disorders of sex development

Arch Sex Behav. 2009 Feb;38(1):16-33. doi: 10.1007/s10508-007-9241-9. Epub 2007 Oct 18.


Evaluation of psychological distress has received relatively little attention in research on persons with disorders of sex development (DSD). Results of previous studies varied considerably, but most studies did not find increased levels of psychological distress. We conducted a pilot study based on a sample of 37 persons with diverse forms of DSD recruited via various strategies. The Brief Symptom Inventory (BSI) was used to assess self-reported psychological distress. Psychological distress varied broadly across all diagnostic subgroups. Overall, the BSI Global Severity Index indicated higher distress in the sample of persons with DSD compared to a non-clinical norm population of women, with an effect size of d = 0.67. According to predefined BSI criteria, 59% of participants were classified as a clinical case. Self-harming behavior and suicidal tendencies were also assessed and compared to a community based sample of women, including subgroups of traumatized women with a history of physical or sexual abuse. The prevalence rates of self-harming behavior and suicidal tendencies in the DSD sample exceeded the rates of the non-traumatized comparison subgroup, with rates comparable to the traumatized comparison groups of women with physical or sexual abuse. As possible explanations for the higher distress found here compared to most previous studies, differences in measures and sample recruitment are discussed. Our results suggest that adults with DSD are markedly psychologically distressed with rates of suicidal tendencies and self-harming behavior on a level comparable to non-DSD women with a history of physical or sexual abuse, but sample recruitment procedures do not permit a firm generalization.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenal Hyperplasia, Congenital / psychology
  • Adult
  • Battered Women / psychology
  • Disorders of Sex Development / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Pilot Projects
  • Prevalence
  • Self-Injurious Behavior* / epidemiology
  • Sex Offenses
  • Stress, Psychological*
  • Young Adult