ABSTRAKLatar Belakang: Disorder of Sexual Development (DSD) atau ambiguous genitalia adalah ketidakjelasan dalam menentukan jenis kelamin luar yang tidak secara jelas menunjukan jenis kelamin laki-laki dan perempuan. Data di Indonesia belum banyak menentukan angka kejadian, sedangkan di dunia 1 dari 2000 bayi lahir hidup. Kesalahan dalam menentukan jenis kelamin dapat berdampak terhadap segala aspek kehidupan anak, orang tua, lingkungan dan hukum. Pendekatan terapi realitas dalam penanganan pasien DSD yang didapatkan psikopatologi karena adanya stressor biopsikososial. Penting juga pada penerimaan identitas gender pada pasien DSD.Tujuan : Menghasilkan pedoman dan mampu melakukan pendekatan terapi realitas dalam mempersiapkan pasien Disorder of Sexual Development (DSD) selama dilakukan terapi. Pendekatan skrining dan penanganan psikopatologi pada penderita Disorder of Sexual Development (DSD)dan keluarga.Metode : Penelitian ini merupakan studi kualitatif berbentuk studi kasus bertujuan untuk mempersiapkan pasien Disorder of Sexual Development (DSD) selama dilakukan terapi.  Terjadi pendekatan psikoterapi realitas pada penanganan  psikopatoligi  pasien DSD.Hasil : Tersusun pedoman pendekatan teapi realitas pada pasien Disorder of Sexual Development (DSD). Pendekatan psikoterapi realitas efektif terhadap penderita DSD tergantung pada jenis diagnosa yaitu berdasarkan genotif, kadar hormon, fenotif, faktor pendukung baik keluarga dan sosial, serta fungsi peran personal dan masyarakatKesimpulan : Pendekatan psikoterapi realitas efektif terhadap penderita DSD tergantung pada jenis diagnosa yaitu berdasarkan  pemeriksaan  genotif, kadar hormone, fenotif, faktor pendukung baik keluarga dan sosial, serta fungsi peran personal dan masyarakatKata kunci : terapi realitas, Disorder of Sexual Development (DSD).ABSTRACTBackground : Disorder of Sexual Development (DSD) or ambiguous genitalia is a ambiguity in determining the sex beyond which is not clearly show the gender male and female. Data in Indonesia has not been define the the incidence, whereas in the world 1 in 2000 babies born alive. Mistake in determining the sex can an impact on all aspects of life of children, the elderly, the environment and law. Reality therapy approach in the treatment of patients with DSD is obtained psychopathology because of the biopsychosocial stressors. Also important to the acceptance of gender identity in patients with DSDObjective : Generate guidelines and were able to approach reality therapy in patients prepare for Disorder of Sexual Development (DSD) as long therapy. Approach to screening and treatment of psychopathology in patients Disorder of Sexual Development (DSD) and the family.Methods : This study is a qualitative study in the form a case study aims to prepare patients Disorder of Sexual Development (DSD) as long as therapy. Psychotherapeutic approaches reality occur in the handling of patients psikopatoligi DSD.Results : Structured guidelines reality therapy approach for patients Disorder of Sexual Development (DSD). Effective approach to psychotherapy reality DSD patients depending on the type of diagnosis that is based on genotype, hormone levels, phenotypes, both factors supporting the family and social, as well as the functions of personal and role of community.Conclusion : Effective psychotherapeutic approaches reality of DSD patients depends on the type of diagnosis is based on examination of genotype, hormone levels, phenotypes, both factors supporting the family and social, as well as the functions of personal and community rolesKeywords : reality therapy, Disorder of Sexual Development (DSD).