L'étude clinique et psychodynamique du transsexualisme revêt un intérêt croissant à la lumière des récentes interventions de réassignation chirurgicale. Nous avons exploré le fonctionnement psychologique de 28 sujets transsexuels à l'aide d'un test projectif (Psychodiagnostic de Rorschach) et comparé les données obtenues avec celles d'un groupe témoin. Nos résultats suggèrent l'existence d'un mode de pensée opératoire analogue à celui observé chez certains patients psychosomatiques.

The authors studied the outcome of Rorschach tests on 28 transsexuals who had applied for sex reassignment surgery. The results were analysed on a 63-item grid. The transsexuals and the control group were matched by biological sex, age and education level. For the interpretation of the results, the authors refer to: a)- psychodynamic theory (C. Chabert); b)- L. Cassier's symbol elaboration index (SEI); c)- some aspects of the Exner method. The various indexes produce significant figures: - Subject's very low SEI levels suggests a defect in symbolization capacity bringing their mental processes close to those of operatory thought: i)- a deficit in emotional control (CF+C>FC); ii)- the passive movements count (Kau+K) is higher than the active movements count (Snow White index confirmed), signifying a tendency to look to others to resolve problems in reality. What are the applications of this new approach to transsexualism? We find the elements of operatory thought dear to P. Marty to be characteristic of the mental functioning of transsexuals: difficulty in feeling and expressing emotional states, life of the imagination reduced to the factual, and concretely-oriented thought processes. Operatory thought can be constituent of the development of the ego and be rooted in the essentiel depression of the infant. It may also represent an "extreme» defence mechanism against an "extreme» threat endangering the ego. In this case it may be only transitory and open to evolution. This psychosomatic model directly influences the accompaniment of patients who would benefit, in psychotherapy, from help in gaining better access to symbolization.