Acute symbiotic psychosis in a postoperative transsexual

An unexpected complication of sex-reassignment surgery in a 23-year-old male-to-female transsexual is presented. Having been periodically depressed but never psychotic before surgery, the patient experienced an acute decompensation 3 days after operation. Symptoms of this time-limited illness included hallucinations and wish-fulfilling delusions, but most prominent was the demand to be in continuous contact with other people. Historical data revealed a symbiotic relationship with the grandmother ending precipitously with her death when the patient was 6. It is hypothesized that the unresolved grief reappeared after the surgery, owing to the unconscious linkage between becoming "female" and regaining the lost symbiotic object. Recompensation, possibly through the use of another person as a transitional object, was noted during the illness. This was felt to be a repetition of the pattern of reaction to previous losses.