I’ve been sitting with your question for a couple of days, and, sorry, I’ve only just had the chance to sit down and compose a reply. This question seems to reflect your desire to do right by the people you come into contact with, and I respect and applaud that.
I would be curious to know what others think, but, to me, this question, does not have a simple answer because, chances are, the issue will most likely not be as either-or as you frame it. That is, with any of us – as humans – none of us can claim to either be completely insane nor can we claim to be completely in control of our faculties and able to understand with 100% accuracy what is going on in a given situation.
A lot of times, we in the church are quick to determine that someone else in a morally/ethically questionable situation knows exactly what they are doing. They know that what they are doing is “evil” but they do it anyway. And, while that can be the case, there will also be an element of them being driven by “forces” (for lack of a better word) that they are rather unaware of. So, on another level, they do not “know what they are doing”.
You mention two “psychological conditions” in your post – kleptomania and gender dysphoria. These are in two different categories, so perhaps looking at each one individually would be helpful.
First, kleptomania is related to impulse-control. It is a condition defined by a specific action, namely stealing. More specifically, it is where a person has the impulse to steal little, inconsequential things that they don’t necessarily need. So, if they take something that isn’t theirs, are they guilty of stealing? Well, yes. (“Thou shalt not steal.”) But, if one wants to actually help this person not steal again (that is, control their impulses), then one needs to focus not on the surface issue (the symptom, the stealing), but on what is below it…what is behind the often unconscious, uncontrollable impulse to take. In this case, we work from the symptom down.
Gender dysphoria is a different ballgame altogether; if we’re dealing with it, we’re already “down” into into psychological things. For, it is not about impulses, but about internal distress specifically regarding one’s body. It’s about working from the internal distress outward rather than the other way round. With this being the case, the outward “sin” that gender dysphoria can lead to is less obvious, because it doesn’t always lead to the same action. I find the guilt part of the question much more difficult to engage with here because it is unclear what there is to be guilty of.
Overall though, I would say that, as much as we like to do so, compartmentalizing conditions – whether biologically, psychologically, spiritually or socially – is incredibly unhelpful. Because it’s all intertwined. That’s why it’s complex. That’s why we’re complex. The system in which we exist is complex. So let’s not just merely pray; nor just merely write someone off as insane. Let us walk with each other, giving each of us room for our own complexity.