I see this mostly as a result of individualism and our preoccupation with personal identity. We all get so caught up in the process of defining ourselves that we forget to just be as we are, from time to time. This looks like a pretty extreme case.
To wildly (also uselessly) speculate, it could be that this person grew up repressing their sexuality or gender issues and is now holding onto those things for dear life. But who knows. Sometimes it seems like a lot of trans* people suffer from very serious personality disorders, and honestly that shouldn't come as a surprise. To live your life knowing that somehow you're not
yourself (or something) is hard. We should be grateful for what little sanity we have. There but for the grace of god go we...