Set aside your special, personal definition of "derangement," which apparently requires a person to be loudly hysterical and incoherent at all times.
It is a mental disorder not to be able to perceive reality correctly, especially regarding simple, obvious issues. McBride has testicles, but McBride thinks they were somehow wrongly attached and don't belong there, and even though McBride is a biological male, McBride doesn't perceive that fact. That is a mental disorder.
There are similar disorders for other body parts. But, you can't yet use those disorders to obtain political power, so you disregard them for now. You are about political power for your party more than anything else.
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