Disforia de gênero e psicose: a importância do conceito de self-mínimo para diferenciação psicopatológica – Revisão da literatura

Abstract

Gender dysphoria (GD) is defined as the distress resulting from the incongruence between the sex assigned at birth and the experienced gender. Psychosis, in turn, involves alterations in lived reality, such as delusions, hallucinations, and disruptions of the self. When both conditions co-occur, the clinical challenge lies in distinguishing whether the gender experience reflects an authentic identity or emerges within a delusional framework. Phenomenology contributes to this differentiation by describing the structures of experience rather than relying solely on nosographic classifications.In GD, the body is experienced as misaligned, producing estrangement and a desire for affirmation. This represents a rupture between Körper (the body as object) and Leib (the body as lived first-person experience), translating into suffering that is intensified by social scrutiny. In contrast, psychosis is characterized by experiences of manipulation, somatic passivity, and a loss of agency. While GD expresses narrative and identity conflict, psychosis affects the minimal self, compromising ipseity. Clinically, listening should avoid epistemic injustice, recognizing the legitimacy of gender identity within psychosis without automatically equating it with delusionIt is essential to distinguish between authentic identity and psychotic symptoms, keeping in mind that both conditions may coexist. Intervention requires integration of gender-affirmative care with appropriate psychosis management. Phenomenology thus enables an ethical, person-centered clinical approach that seeks to understand and respect the singularity of lived experience, preventing both pathologizing reductionism and diagnostic neglect