Gender Dysphoria and Co-Existing Psychosis: Review and Four Case Examples of Successful Gender Affirmative Treatment

Meijer, Julia H.; Eeckhout, Guus M; Vlerken, Roy H. T. van; Vries, Annelou L.C. de

doi:10.1089/lgbt.2016.0133

Cited by 30 publications

(37 citation statements)

References 36 publications

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“…Controversy exists as to if, and when, gender affirmative treatment should be offered to TW and co-existing psychosis. Concerns exist regarding regret afterward due to impulsive decision making, and deterioration of psychotic symptoms, but a recent study shows that gender affirmative treatment is possible and safe in this vulnerable population [15].…”

Section: Discussionmentioning

confidence: 99%

Transgender Women with Severe Mental Illness and Homelessness: A Retrospective Case Series

García-Andrade¹,

Rendón-Luna²,

Martínez³

et al. 2019

JSS

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Transgender women (TW) with Severe Mental Illness (SMI) are one of the most vulnerable and most difficult to engage in order to receive medical attention population, raising major challenges in their treatment of adverse health conditions. A retrospective chart review was carried out to identify TW with SMI attended by the "Programme for the Psychiatric Care of the Homeless Mentally Ill" in Spain from June 2015 to June 2018. During the study period, 235 patients with SMI received psychiatric care, of which only 3 (1.3%) were TW. Sociodemographic and clinical variables of these patients are described. We conclude that TW with SMI suffer significant levels of discrimination, stigma, and physical violence. This stigma plays an important role in limiting the opportunities and access to resources in a number of critical domains (e.g., medical care, disability certificate, accommodation in shelters) while continuously having a detrimental effect on their mental health. Forced migration in TW with SMI, must be specially considered. In addition homelessness and social exclusion are structural risk factors for HIV in TW with SMI. Social, health and psychiatric care may moderate the effect of stressors on mental health, reduce social isolation, and build social networks.

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Section: Discussionmentioning

confidence: 99%

Transgender Women with Severe Mental Illness and Homelessness: A Retrospective Case Series

García-Andrade¹,

Rendón-Luna²,

Martínez³

et al. 2019

JSS

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“…Assessment of patients who are seeking transition services, but do not clearly meet criteria for GD, may require more time and exploratory therapy 9 (e.g., a patient desiring hormonal or surgical treatment to transition to another gender, who does not clearly experience incongruence between their experienced gender and their gender assigned at birth). The same is true for those with the onset of gender dysphoria in the context of a psychiatric disturbance (e.g., psychosis, dissociative disorder, and autism spectrum disorder) or recent trauma 9 , 98 , 99 ; those who are ambivalent about their gender identity or desired sex characteristics; and those who exhibit marked exacerbations and remissions of dysphoria over time.…”

Section: Mental Health Assessment and Treatmentmentioning

confidence: 93%

“…If not, coexisting mental illness is not a contraindication to supporting transition if it is sufficiently controlled to not interfere with the patient's capacity for decision-making or ability to safely adhere to the demands of the desired treatment. 7 , 9 , 98 …”

Section: Mental Health Assessment and Treatmentmentioning

confidence: 99%

“… 100 Such delusions can usually be easily differentiated from GD by their content (i.e., if they do not entail the belief that one's gender differs from that assigned at birth), as well as by their presence only during psychotic phases of illness, and the absence of other DSM criteria required for the diagnosis of GD. 98 Importantly, GD and psychotic disorders may coexist and patients with both diagnoses can benefit from gender-affirmative treatment and appropriate hormonal and/or surgical gender interventions. 98 Timely diagnosis of GD may be impeded when it is first overtly expressed in adolescence or early adulthood coincident with, or shortly following, the first psychotic episode.…”

Section: Mental Health Assessment and Treatmentmentioning

confidence: 99%

“… 98 Importantly, GD and psychotic disorders may coexist and patients with both diagnoses can benefit from gender-affirmative treatment and appropriate hormonal and/or surgical gender interventions. 98 Timely diagnosis of GD may be impeded when it is first overtly expressed in adolescence or early adulthood coincident with, or shortly following, the first psychotic episode. 98 …”

Section: Mental Health Assessment and Treatmentmentioning

confidence: 99%

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Gender Dysphoria in Adults: An Overview and Primer for Psychiatrists

et al. 2018

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Regardless of their area of specialization, adult psychiatrists are likely to encounter gender-variant patients; however, medical school curricula and psychiatric residency training programs devote little attention to their care. This article aims to assist adult psychiatrists who are not gender specialists in the delivery of respectful, clinically competent, and culturally attuned care to gender-variant patients, including those who identify as transgender or transsexual or meet criteria for the diagnosis of Gender Dysphoria (GD) as defined by The Diagnostic and Statistical Manual of Mental Disorders (5th edition). The article will also be helpful for other mental health professionals. The following areas are addressed: evolution of diagnostic nosology, epidemiology, gender development, and mental health assessment, differential diagnosis, treatment, and referral for gender-affirming somatic treatments of adults with GD.

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Increasing Criminalization of Gender-Affirming Care for Transgender Youths—A Politically Motivated Crisis

2021

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Arkansas passed Act 626, to be known as the "Arkansas Save Adolescents From Experimentation (SAFE) Act," 1 thus becoming the first state to outlaw gender-affirming care (GAC) for transgender youth. Many other states are considering similar bills, some of which include provisions that impose criminal penalties on health care professionals.Although Act 626 is among the more severe examples of antitransgender legislation, the United States has a history of similar legislation. Since 2015, coordinated attacks against lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights have escalated in an unprecedented fashion. The targets of these attacks have shifted from marriage equality, bathroom access, and sports participation to the most recent attacks on transgender youths and their bodies. Act 626 is a part of recent nationwide efforts to limit access to GAC for transgender youths. This year represents a critical time for transgender young people, with new bills targeting their access to health care in at least 21 states.Approximately 1.4 million adults (0.6% of adults in the United States) and 150 000 youths (0.7% of youths aged 13-17 years in the US) identify as transgender. 2 A large body of research dedicated to transgender health indicates that GAC, including prescribing or using puberty blockers such as gonadotropin-releasing hormone agonists, (GnRHa), hormone therapy (eg, testosterone or estrogen therapy), and gender-affirming surgery, is medically necessary for patients experiencing gender dysphoria. 3 The discordant effects of societal gender roles and gendered activities on transgender youths are exacerbated during puberty, when masculinizing and feminizing anatomical changes take place. Transgender youths may find that pubertal changes worsen the dissonance between their anatomy and their gender identity, contributing to gender dysphoria and increasing the risk for negative health outcomes. Consider the case of a transgender woman who was assigned male at birth. 4 At the age of 7 years, this individual started showing an interest in playing with dolls and dressing in her sister's clothes, activities that her parents discouraged. Fearing disapproval from those around her, she began to withdraw socially. At the onset of puberty, she developed a hatred for her male physical features, leading to 2 suicide attempts by 16 years of age. As her gender dysphoria progressed, she experienced suicidal behavior, self-mutilation, depression, and poor mental health. Gender-affirming care is medically necessary and, in this case, lifesaving for transgender youth with gender dysphoria. 3 In addition, sexual and gender minority adolescents are more likely to delay care and avoid health screenings, for fear of discrimination. Legislation that

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Gender Dysphoria and Co-Existing Psychosis: Review and Four Case Examples of Successful Gender Affirmative Treatment

Abstract: These case examples show that GA treatment is possible and safe in this vulnerable population.

Cited by 30 publications

References 36 publications

Transgender Women with Severe Mental Illness and Homelessness: A Retrospective Case Series

Transgender Women with Severe Mental Illness and Homelessness: A Retrospective Case Series

Gender Dysphoria in Adults: An Overview and Primer for Psychiatrists

Increasing Criminalization of Gender-Affirming Care for Transgender Youths—A Politically Motivated Crisis

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