Case Study: Fatima Durrani

Fatima Durrani, a 20-year-old, comes to see you with her parents. Both parents look very worried and in a very low volume plead with you to help their daughter become normal. The family immigrated from Pakistan 15 years ago and are U.S. citizens. They have maintained many of their cultural practices and live in a close-knit Pakistani community.
Fatima explains her situation: “Ever since I was in the seventh grade, I kept on feeling that I should have been a boy. I realized that I preferred to wear pants and shirts and would play games like baseball, football, and Pokémon with boys. During my school years, I repeatedly fell in love with girls who were usually my classmates. I would write love letters to girls as if I was a boy and occasionally, I’d do some sexual activities like kissing and touching their breasts.
“About six months ago, my parents gave me in marriage to Abdul Aziz, who is the only son of Adil Aziz. My parents are… uh, that is they were not aware of my gender identity problem. My father-in-law and my husband were good to me. My father-in-law would often say that I reminded him of his dead wife. Though I tried to adjust in my new role, I soon discovered that I was not getting any sexual arousal with my new husband, and so I returned to my parents. Although my parents seemed to be genuinely worried and concerned about me, I know that they are very upset. We don’t discuss my situation openly at home. As for my husband, my father-in-law, and my larger family, my parents have told them that I am going through withdrawal symptoms because I was missing my parents too much. Some of my relatives think I am pregnant and want to be with my mother. My parents are very embarrassed and want to secretly see if anything will help me. I am interested in a behavior modification therapy program so that I can go back to my husband.”
Fatima’s physical and gynecological examination does not reveal any abnormalities. She understands the limitations of sex reassignment surgery.
Questions
From your perspective as Fatima’s psychiatric nurse practitioner, answer the following questions in your initial post.
1. What is the DSM-5 criteria for gender dysphoria? Would Fatima meet the criteria for this? Explain your rationale.
2. What resources are in your community for Fatima and her family?
3. What referrals would you make for Fatima?
4. Recommend a movie, TV show, or book about or by a transgender person.
5. Are you familiar with this or similar cultures? What would you need to do in your practice to be culturally sensitive?