Although the critical analysis of the DSM-IV classification of the gender identity disorder has shown the manual to be adequate, it nevertheless has shortcomings which may impede exact diagnosis.

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A psychiatric syndrome following overwhelming stress after an interval of more than thirty years is described in holocaust survivors who had claimed compensation for persecution between 1939 and 1945. Five nuclear symptom complexes emerge: depressive reactions; anxiety states; somatic complaints; subjective intellectual impairment; and contact abnormalities. Subjects who had experienced persecution during their childhood exhibited contact abnormalities of an aggressive type three times as often as survivors who had suffered an identical trauma as adults.

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