Meeting abstract

https://doi.org/10.24869/spsih.2026.282

Transgender Identity or Adolescent Crisis: A Case Report

Ana Čikara ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia *
Julija Erceg ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
Tonći Mastelić ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; Department of Psychiatry, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia; Department of Psychological Medicine, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
Karlo Glavičić ; Health Centre of Split-Dalmatia County, Kavanjinova 2, 21000 Split, Croatia
Davor Lasić ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; Department of Psychiatry, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
Trpimir Glavina ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; Department of Psychiatry, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia

* Corresponding author.

Abstract

Transgender identity has for some time been a
topic of interest in both psychiatric and lay circles.
Our aim is to present the complexity of this phenomenon
and the importance of a cautious approach
in clinical practice. A patient in their early
twenties presents to a psychiatric outpatient clinic
due to anxiety–depressive difficulties. During the
examination, tension, avoidance of eye contact,
wariness, and reduced clarity of speech are observed,
and the patient reports suicidal thoughts
occurring several months earlier. It is learned that
there has been social withdrawal, termination of
employment, increased alcohol consumption, and
excessive playing of video games, through which the patient meets and establishes a long‑distance
romantic relationship with a girl reported to have
an autism spectrum disorder. In this context, the
patient expresses suspicion of having a neurodevelopmental
disorder themself and plans to move
abroad with the girl, where they would undergo
transition to the female gender. Personal history
reveals a complex family dynamic marked by the
mother’s verbal and physical aggressiveness and
the onset of symptoms after her death. Following
psychiatric assessment, treatment with vortioxetine
and alprazolam was initiated. After one
month, stabilization of mood is observed, along
with reduced anxiety and alcohol consumption;
the patient joins a therapeutic community, and
the vortioxetine dose is increased to 15 mg daily.
At a follow‑up visit five months later, the patient
reports abstinence from alcohol and video games,
remission of anxiety–depressive symptoms, significantly
improved social functioning, and complete
absence of thoughts related to gender identity.
The presented case points to the complex interplay
of affective disturbances, developmental
processes, life circumstances, and identity issues,
and illustrates the importance of the differential
diagnosis between primary gender dysphoria and
gender‑related distress as a manifestation of complex
psychological difficulties such as trauma, depression,
and addiction. In young individuals who
develop doubts related to gender identity, it is
important to conduct comprehensive psychiatric
assessment and follow‑up, with an individualized
and cautious clinical approach.

Keywords

gender identity; adolescent crisis; depression; anxiety; vortioxetine

Hrčak ID:

352966

URI

https://hrcak.srce.hr/352966

Publication date:

15.6.2026.

Article data in other languages: croatian

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