Investigations in the field of gender dysphoria (GD) have been mostly related to psychiatric comorbidity and severe psychiatric disorders, but have focused less on personality traits and personality disorders (PDs).

We aimed to assess personality and the presence of PDs in a sample of 25 persons with GD attending the Psychiatric Clinic or the Department of Endocrinology of the University of Cagliari requesting sex reassignment therapy. They were assessed through the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Structured Clinical Interview for DSM-IV Axis II (SCID-II).

The sample consisted of 14 MtF and 11 FtM, with a mean age of 29.6 ± 9.5. Overall, 39.1% of the sample met the criteria for at least one PD, more frequently cluster-B PD (21.7%). MtF met a higher number of SCID-II criteria than FtM, especially regarding histrionic personality traits (P = 0.001). A total of 20 persons (9 MtF and 11 FtM) completed the MMPI-2. Mean T scores did not differ from the general population, except for the Psychopathic Deviate (Pd) scale (mean T = 66.2 ± 11.2). The Masculinity-Femininity (Mf) scale was slightly increased, and its score reduced after correction for perceived sex (P = 0.037). MtF scored significantly higher at the Family Problems (FAM) scale (P = 0.052) and lower at the Social Discomfort (SOD) scale (P = 0.005) compared to FtM.

The high prevalence of PDs confirms that this kind of assessment in GD is of great importance, as a key part of personalized treatment plan tailoring. The high scores on the Pd scale suggest misidentification with societal standards.