Gender‐affirming care in the assessment and treatment of psychosis risk: Considering minority stress in current practice and future research

Abstract

IntroductionAlthough research has documented the marked disparities in rates of psychosis‐spectrum diagnoses in various socially marginalized populations, there is limited research addressing the needs of gender expansive individuals in the context of psychosis‐spectrum illnesses using a minority stress lens. As clinical high‐risk for psychosis (CHR‐p) assessment and treatment becomes accessible to increasingly diverse populations, there is a need for clinicians to demonstrate greater clinical competency working with individuals across diverse social backgrounds and identities.MethodsWe examined rates of gender expansive (GE) patients seeking evaluation at an urban‐based CHR‐p clinic and compared the diagnostic profile of GE individuals to cisgender patients. Post‐hoc analyses were conducted on clinical variables with significant differences between the cisgender and GE groups.ResultsThe proportion of GE patients seeking evaluation increased from 2017 (9.3%) to 2021 (16.7%). Compared to cisgender youth, GE patients had significantly higher depressive, social anxiety, borderline personality disorder symptoms, higher levels of suicidality and non‐suicidal self‐injurious behaviour, and lower role functioning. Gender identity was predictive of suicidality controlling for social anxiety, borderline symptoms, and role functioning.ConclusionsWe review implications for CHR‐p treatment and discuss ways to integrate minority stress theory and gender‐affirming practices into coordinated specialty care for CHR‐p patients.

Harmonizing early intervention strategies: scoping review of clinical high risk for psychosis and borderline personality disorder

“…20 studies ( Schultze-Lutter et al, 2012 ; Thompson et al, 2012 ; Byars, 2013 ; Nelson et al, 2013 ; Barrantes-Vidal et al, 2014 ; Rutigliano et al, 2016 ; Fusar-Poli et al, 2017 ; Ryan et al, 2017 ; Kotlicka-Antczak et al, 2018 ; Madsen et al, 2018 ; Sevilla-Llewellyn-Jones et al, 2018 ; O’Connor et al, 2019 ; Paust et al, 2019 ; Hadar et al, 2020 ; Boldrini et al, 2020b ; DaBreo-Otero, 2021 ; West et al, 2022 ; Ceccolini et al, 2023 ; Pelizza et al, 2023 ; Tronick et al, 2023 ) focused on early detection and intervention within the framework of the CHR-P paradigm. Overall, the clinical population comprised CHR-P patients and, in some studies, control patients, accessing CHR-P clinics or mental health services.…”