We examined a variety of male patients with gender identity disorder on the basis of a style of “conviction” of gender identity disorder. From the point of view of the clinic, we took the variety as framework of “the core group” and “the periphery group”. The core group consists of those who have, already since childhood, manifested a special longing for feminine clothes and behaviors. The periphery group consists of those with an uncomfortable feeling about their own sex that did not begin until adolescence. The present study is based on the author's clinical experience with 27 subjects, among which 14 patients belonged to the core group and 13 to the periphery group.

In the patients of the core group, their subject was formed by a self-referential statement “I am a woman.” It can be considered that since their early childhood, their “ideal ego” led them to experience this longing and that “I” situating its own body in an “ideal ego”, brought them gradually to express “I am a woman.” This had the structure of a “first-person conviction.”

In the periphery group, on the contrary, a consistent insufficiency and avoidance of masculinity could to be pointed out. We recognized homosexuality, transvestism, adolescent paranoia, and certain neuroses in the background of the periphery group. In the periphery group it may be required to engage in the psychotherapeutic task of investigating what this “disgust with being male” derives from.