DOCSLIB.ORG

Trans Mental Health and Social Work Resources, Harry Dixon, M.A., Katrina Hale, MSW, & Kelly Serafini, Ph.D

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Trans Mental Health and Social Work Resources, Harry Dixon, M.A., Katrina Hale, MSW, & Kelly Serafini, Ph.D Trans Mental Health and Social Work Resources, Harry Dixon, M.A., Katrina Hale, MSW, & Kelly Serafini, Ph.D. 1 Agenda • Gender Dysphoria Criteria • Prevalence of Mental Health Disorders • Safety (Suicide/Homicide) • Treatment Outcomes & Mental Health • Psychotherapeutic Considerations • Patient Resources 2 BACKGROUND Kelly Serafini, Ph.D. 3 Being Transgender is Not a Mental Disorder • Although Gender Dysphoria is a mental illness, being transgender itself is not a disorder and it is not pathological • The dysphoria that is caused by the incongruence between physical anatomy and gender identity is distressing and it is treatable 4 Gender Dysphoria Disorder (Adults & Adolescents) • Difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning • Lasts at least 6 months • And 2 of the following criteria are met: A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics A strong desire to be rid of one’s primary and/or secondary sex characteristics A strong desire for the primary and/or secondary sex characteristics of the other gender A strong desire to be of the other gender A strong desire to be treated as the other gender A strong conviction that one has the typical feelings and reactions of the other gender 5 Gender Dysphoria Disorder (Children) • Lasts at least 6 months • And 6 of the following criteria are met: A strong desire to be of the other gender or an insistence that one is the other gender A strong preference for wearing clothes typical of the opposite gender A strong preference for cross-gender roles in make-believe play or fantasy play A strong preference for the toys, games or activities stereotypically used or engaged in by the other gender A strong preference for playmates of the other gender A strong rejection of toys, games and activities typical of one’s assigned gender A strong dislike of one’s sexual anatomy A strong desire for the physical sex characteristics that match one’s experienced gender 6 Among Children: Is it just a phase? • Gender ‘atypical behavior’ is common among children, and likely developmentally appropriate • The predictors that are most associated with Gender Dysphoria persisting into adulthood are: More intense symptoms and distress More persistence in gender identity Insistent and consistent in cross-gender statements and behaviors Use of more declarative statements (“I am a boy or girl” vs. “I want to be a boy or girl”) • Estimated that between 12-50% of children diagnosed with Gender Dysphoria Disorder may identify as transgender as an adolescent or young adult (Drummond et al., 2008) 7 Gender Dysphoria is Not Body Dysmorphic Disorder • Body Dysmorphic Disorder is based on the premise that one holds a distorted belief about the body, and treatment focuses on altering the beliefs. • Gender Dysphoria, on the other hand, operates from the premise that the beliefs causing distress are valid. Instead of focusing on changing beliefs, treatment addresses altering the body in order to be in alignment with gender identity. 8 Being Transgender is not the same as Transvestic Disorder • Transvestic Disorder is characterized by cross-dressing for sexual arousal • Causes clinically significant distress and impairment • Not centered on gender identity 9 Being Transgender is not the same as Drag • Drag tends to center on performance and entertainment • Most commonly associated with gay male (the community is also evolving to include trans individuals and female) • Drag can vary substantially by background, gender identity, and reasons for participating in drag performances 10 Mental Health & The Scientific Data • Growing body of research • Historically a neglected area in the scientific literature • 85% of trans identified persons have sought some form of mental health care 11 Prevalence of Mental Health Disorders (2015 US Transgender Survey Report) • 39% of respondents were currently experiencing serious psychological distress, nearly eight times the rate in the U.S. population (5%). • 29% of respondents reported illicit drug use, marijuana consumption, and/or nonmedical prescription drug use in the past month, nearly three times the rate in the U.S. population (10%). • 40% of respondents have attempted suicide in their lifetime— nearly nine times the attempted suicide rate in the U.S. population (4.6%). • Many also report elevated levels of trauma 12 13 14 15 Mental Health Concerns May or May Not Be Related to Gender Identity • Directly Related: Gender dysphoria Mood changes as a result of treatment with hormones • Indirectly Related: Minority stress Oppression/discrimination/hostility Sexual Objectification Secondary to other disorders (Ex: Eating disorder for the purposes of amenorrhea) • Unrelated: Life stressors, substance use, psychiatric illness, etc. 16 Safety: Suicide • Forty percent (40%) have attempted suicide in their lifetime, nearly nine times the rate in the U.S. population (4.6%). • Seven percent (7%) attempted suicide in the past year—nearly twelve times the rate in the U.S. population (0.6%). • Suicide is the leading cause of death in LGBTQ+ individuals aged 10-24, 4x’s more likely • 38%-65% trans individuals will exp suicidal ideation • If there’s a family rejection, the individual is 8xs more likely to attempted suicide • Assess for suicidal ideation and have a pro-active safety plan in place 17 Safety: Homicide/Interpersonal Violence • Overall homicide rate estimated to be lower than cis-gender individuals. (Dinno, 2017) • Exception: Black and Latin@ transgender females are at a higher risk. (Dinno, 2017) • Human Rights Campaign estimates 25 deaths in 2017 for transgender women of color • Assess for perceived safety and have a plan in place (e.g., romantic partners; family members; etc.) 18 Social Support (2015 US Transgender Survey Report) • 10% reported a family member was violent towards them • 8% were kicked out of their homes • 10% ran away from home • 19% were rejected by spiritual communities 19 Social Support (2015 US Transgender Survey Report) 20 Treatment Outcomes • Research supports positive treatment outcomes when patients receive trans-affirmative care, whether the treatment modality is psychotherapy, hormones, or surgery (Byne et al., 2012; Cohen- Kettenis et al., 2008; Davis & Meier, 2014) • A meta-analysis found increased psychological wellbeing across 28 studies when participants received gender-affirming treatments (hormonal + surgery) (Murad et al., 2009). 21 Youth Treatment Outcomes • N = 55 • Longitudinal • Treatments: puberty suppression, hormonal replacement therapy, gender affirmation surgery • After surgery in young adulthood, gender dysphoria was alleviated and the psychological functioning was comparable or better in comparison to the general population (de Vries et al., 2014) 22 Hormonal Treatment Outcomes • Transgender males receiving hormonal treatment (testosterone) had lower levels of depression, anxiety, and stress in comparison to transgender males not receiving hormonal treatment (Colton Meier et al., 2011) • Transgender females reported an increase in positive emotions following treatment (Slabbekoorn et al., 2001) • Psychological relief reported following hormonal treatment (Slabbekoorn et al., 2001) 23 Surgical Treatment Outcomes • Transgender females receiving hormonal treatment and had undergone genital reconstruction reported increased well-being (Kuiper & Cohen-Kettenis, 1988) • In a sample of 232 transgender females, none reported outright regret with surgery. Only a few expressed occasional regret, which was due to unsatisfactory physical results of the surgery (Lawrence, 2003) • Another sample of 107 transgender individuals reported no regret (De Cuypere et al., 2006) • Even after surgery and with alleviated gender dysphoria, this population is at greater risk for suicide attempts and psychiatric inpatient care than the general population (Dhejne et al., 2011) 24 Family Outcomes • A small body of research has found that the children of transgender parents do not suffer long-term negative impacts directly related to parental gender change (White & Ettner, 2004) Two primary factors associated with children's outcomes: Younger age at time of transition Good relationship between both parents during transition Only 4% had academic decline at the time of transition (which was confounded with parental divorce) 25 COURAGE • Being one’s authentic self is an act of courage & vulnerability • Recognize, respect, and affirm this with your patients 26 PSYCHOTHERAPEUTIC CONSIDERATIONS HARRY DIXON, M.A., L.M.H.C. 27 Current Status • Respondents also reported the following problem areas that were present within the past 5 years • Did not know how to help me with my sexual orientation and/or gender identity/expression concerns • My sexual orientation and/or gender identity/expression became the sole focus of my mental health care despite not being the primary complaint • Provider made negative comments about my sexual orientation and/or gender identity/expression • Provider did not know how to help same-sex couples or mixed orientation couples 28 LGBTQ+ Specific Barriers 1. I do not know how to find a mental health provider that is LGBTQ+ competent 2. I cannot find a provider I am comfortable with who is also LGBTQ+ knowledgeable 3. I am concerned that my provider would not be supportive of my identity or behavior 4. There are no LGBTQ knowledgeable mental health services in my neighborhood/geographic
Load more

Recommended publications
  • Practical Tips for Working with Transgender Survivors of Sexual Violence
    Practical Tips: working with trans survivors michael munson Practical Tips for Working With Transgender Survivors of Sexual Violence Who Are Transgender People? Transgender is an umbrella term which encompasses the whole “gender community,” including transsexuals, cross‐dressers, intersexed individuals, androgynes, bigendered persons, genderqueers, SOFFAs (Significant Others, Friends, Family and Allies) and others. Transgender may also refer to people who do not fit neatly into either the “male” or “female” categories, instead crossing or blurring gender lines. The term can also refer to butch lesbians and effeminate gay men. In some communities, “transgender” refers only to cross‐dressers. By definition, transgender individuals piece together a self‐identity that is different from or in opposition to what everyone tells them they are. Although the rise of the Internet and growing public visibility of transgender people and issues are making it easier for individuals to tap into preexisting identity models, the transgender experience is still largely an isolated, individual one. This might be the primary reason why the nomenclature for the trans experience is both unsettled and, among trans people themselves, very hotly contested. There are literally hundreds of words used to describe a trans identity or experience (See last page). Therefore, definitions and examples should be used gingerly and in a way that makes it possible for each trans individual hirself to use the term(s) s/hei considers most reflective of hir self‐conception and experience. Key Concepts Our culture strongly promotes the idea of an immutable gender binary in which people are supposed to fit into only one of just two gender boxes, and stay there from birth to death.
    [Show full text]
  • Outline Introduction, Background, and Terminology
    SUMMARY OF CLINICAL EVIDENCE FOR GENDER REASSIGNMENT SURGERIES Outline Introduction, Background, and Terminology ................................................................................................ 2 Categories of Gender Reassignment Surgery ........................................................................................... 3 Summaries of Clinical Evidence for Gender Reassignment Surgeries ......................................................... 4 Surgeries for Female-to-Male (FTM) individuals..................................................................................... 4 Breast/Chest Surgery ........................................................................................................................ 4 Genital Surgeries ............................................................................................................................... 4 Other Surgeries ................................................................................................................................. 4 Surgeries for Male-to-Female (MTF) individuals..................................................................................... 5 Breast/Chest Surgery ........................................................................................................................ 5 Genital Surgeries ............................................................................................................................... 5 Other Surgeries ................................................................................................................................
    [Show full text]
  • Caring for Transgender People with Severe Mental Illness
    Caring for Transgender People with Severe Mental Illness MAY 2018 Transgender people, like the general population, can suffer from a variety of common and rare severe mental health illnesses (SMI). Severe mental illness (SMI) refers to psychiatric disorders that are relatively persistent and result in comparatively severe impairment in major areas of function, disruption of normal developmental processes, and reduced vocational capacity and social relationships.1 People with SMI experience unique vulner- abilities within society, which include a longstanding history of being institu- tionalized, marginalized, victimized, and subjected to experimental psychiatric interventions.2 There is strong evidence that people with SMI are woefully underserved and rarely receive evidence-based treatments even when they are able to access care.2 In turn, transgender people are more likely than the general population to expe- rience discrimination in housing, employment, and healthcare.3 Many are verbal- ly and physically victimized starting at a young age.3 Abuse related to gender minority status has a dose-response relationship with major depressive disorder and suicidality among transgender adolescents.4 Daily experiences of anti-trans- gender stigma, prejudice, and discrimination become internalized and ultimately affect psychological health.5,6 An estimated 40% of all transgender people have attempted suicide in their lifetimes.3 Though research on transgender behavioral health is limited, studies have found a higher risk for mood disorders, posttrau- matic stress disorder (PTSD), and substance use disorders, but not psychotic disorders compared to the rest of the population.7,8 When risk profiles based on transgender status and SMI intersect, patients are liable to experience a particu- larly dangerous array of vulnerabilities that require attentive, specialized care.
    [Show full text]
  • Trans People, Transitioning, Mental Health, Life and Job Satisfaction
    DISCUSSION PAPER SERIES IZA DP No. 12695 Trans People, Transitioning, Mental Health, Life and Job Satisfaction Nick Drydakis OCTOBER 2019 DISCUSSION PAPER SERIES IZA DP No. 12695 Trans People, Transitioning, Mental Health, Life and Job Satisfaction Nick Drydakis Anglia Ruskin University, University of Cambridge and IZA OCTOBER 2019 Any opinions expressed in this paper are those of the author(s) and not those of IZA. Research published in this series may include views on policy, but IZA takes no institutional policy positions. The IZA research network is committed to the IZA Guiding Principles of Research Integrity. The IZA Institute of Labor Economics is an independent economic research institute that conducts research in labor economics and offers evidence-based policy advice on labor market issues. Supported by the Deutsche Post Foundation, IZA runs the world’s largest network of economists, whose research aims to provide answers to the global labor market challenges of our time. Our key objective is to build bridges between academic research, policymakers and society. IZA Discussion Papers often represent preliminary work and are circulated to encourage discussion. Citation of such a paper should account for its provisional character. A revised version may be available directly from the author. ISSN: 2365-9793 IZA – Institute of Labor Economics Schaumburg-Lippe-Straße 5–9 Phone: +49-228-3894-0 53113 Bonn, Germany Email: [email protected] www.iza.org IZA DP No. 12695 OCTOBER 2019 ABSTRACT Trans People, Transitioning, Mental Health, Life and Job Satisfaction For trans people (i.e. people whose gender is not the same as the sex they were assigned at birth) evidence suggests that transitioning (i.e.
    [Show full text]
  • Trransition-Related Health Care
    31 CHAPTER VIII Trransition-Related Health Care The kinds of health care associated with gender transition needs associated with transition than for treating someone have too often been misunderstood as cosmetic, experimental with diabetes who needs vital care. In both cases, a doctor or simply unnecessary. Yet there is medical consensus that makes an individualized assessment to determine if treatment is hormone therapy and gender-affirming surgery are medically warranted—if it is, both patients should get the recommended necessary for many transgender people. It’s quite clear now that care. a person’s gender identity—one’s inner sense of being male or This fact sheet explains the medical community’s current female—is deep-seated and cannot be changed. Therefore, this framework for understanding transition-related care as transition-related health care can be crucial. medically necessary and how Lambda Legal and other The courts have come a long way on this issue in recent advocates are applying this in the legal domain to challenge years, citing decades of medical data to find in more and more denial of such care as discrimination. Also highlighted are ways cases that not providing transition-related health care as readily that private industry and municipal government have begun to as other medically necessary treatment is discrimination. follow the medical mainstream by dropping barriers to health The problem is that most public and private insurance care for transgender people and setting standards for a more companies are still behind the times. Many cite cost, even equitable future. though that hasn’t turned out to be an issue at all for the growing number of employers now providing coverage.
    [Show full text]
  • A Little Shiny Gender Breakthrough": Community Understandings of Gender Euphoria
    ”A little shiny gender breakthrough": Community understandings of gender euphoria Presenter: Will Beischel (Brit Ellis, pinterest.com) Co-authors: Stephanie Gauvin and Dr. Sari van Anders : @WillBeischel : [email protected] 15 minute talk, questions at end of session I’m coming to you from Chicago, which is located on the traditional unceded homelands of the Council of the Three Fires: the Ojibwe, Odawa, and Potawatomi Nations. I’m a PhD student in psychology and I’ll be presenting some empirical qualitative work today on gender euphoria that I've done with Stephanie Gauvin and Sari van Anders What is Gender Dysphoria? ● The distress arising from conflicts between a person’s gender identity or expression and their assigned gender/sex (American Psychiatric Association, 2016) ● Physical body (Pulice-Farrow, Cusack, Galupo, 2019) ● Social gendered experiences (Galupo, Pulice-Farrow, Lindley, 2019) ● Often seen as a diagnostic term 2 I’ll start with a term that is probably familiar to many if not all of you, gender dysphoria, which is the distress arising from conflicts between a person’s gender identity or expression and their assigned gender/sex. Just a note that I use gender/sex as an umbrella term to indicate the entanglement of people’s social genders with their physical, bodily sexes, though not everyone experiences it this way. Research has demonstrated that gender dysphoria can be about sex or the physical body, as with feelings of discord between a person’s sex characteristics and their gender/sex identity, and it can also arise from social gendered experiences, such as people using the wrong pronouns or name for someone.
    [Show full text]
  • A Primary Care Toolkit Contents
    August 2021 Gender-affirming Care for Trans, Two-Spirit, and Gender Diverse Patients in BC: A Primary Care Toolkit Contents Table of Contents ................................................................................................................................................................... w Indigenous people and Two-Spirit considerations ....................................................................................................... iii Acknowledgment and Disclaimer ...................................................................................................................................... iv Introduction ................................................................................................................................................................................1 Gender-affirming health care options ............................................................................................................................... 2 Social options ..................................................................................................................................................................... 2 Medical options ................................................................................................................................................................. 2 Surgical options ................................................................................................................................................................. 2 Role of the primary care provider
    [Show full text]
  • Khwaja Sira: Culture, Identity Politics, and "Transgender" Activism in Pakistan
    Syracuse University SURFACE Dissertations - ALL SURFACE June 2014 Khwaja Sira: Culture, Identity Politics, and "Transgender" Activism in Pakistan Faris Ahmed Khan Syracuse University Follow this and additional works at: https://surface.syr.edu/etd Part of the Social and Behavioral Sciences Commons Recommended Citation Khan, Faris Ahmed, "Khwaja Sira: Culture, Identity Politics, and "Transgender" Activism in Pakistan" (2014). Dissertations - ALL. 56. https://surface.syr.edu/etd/56 This Dissertation is brought to you for free and open access by the SURFACE at SURFACE. It has been accepted for inclusion in Dissertations - ALL by an authorized administrator of SURFACE. For more information, please contact [email protected]. Abstract In 2009, the Pakistani Supreme Court began granting rights to gender ambiguous people who are locally known as khwaja siras. The Court organized this population into taxonomic groups and ordered the government to ‘mainstream’ them. These actions were based on certain cultural assumptions and occurred amid uncertainties about who khwaja siras really were. Meanwhile, khwaja siras began to mobilize in an effort to control their public image. Based on fourteen months of ethnographic fieldwork on the identity politics of khwaja siras in Karachi, this dissertation seeks to understand the ways in which gender ambiguous people constructed, negotiated and represented themselves both within their social networks and in the wider society, as well as the factors underpinning their public portrayals. I conceive khwaja sira politics as a ‘game’, that is, as the art of manipulation and concealment. I argue that the games of secrecy and deception in which this minority population engaged were responses to the stigma they experienced in everyday life.
    [Show full text]
  • Autogynephilia and the Typology of Male-To-Female Transsexualism
    Special Issue: Controversial Issues in Human Sexuality Research: The State of the Science Original Articles and Reviews Autogynephilia and the Typology of Male-to-Female Transsexualism Concepts and Controversies Anne A. Lawrence Department of Psychology, University of Lethbridge, AB, Canada Abstract: Sexual scientists have recognized for over a century that biologic males who seek sex reassignment – male-to-female (MtF) transsexuals – are not a homogeneous clinical population but comprise two or more distinct subtypes with different symptoms and developmental trajectories. The most widely used typologies of MtF transsexualism have been based on sexual orientation and have distinguished between persons who are androphilic (exclusively sexually attracted to males) and those who are nonandrophilic (sexually attracted to females, both males and females, or neither gender). In 1989, psychologist Ray Blanchard proposed that most nonandrophilic MtF transsexuals display a paraphilic sexual orientation called autogynephilia, defined as the propensity to be sexually aroused by the thought or image of oneself as a woman. Studies conducted by Blanchard and colleagues provided empirical support for this proposal, leading to the hypothesis that almost all nonandrophilic MtF transsexuals are autogynephilic, whereas almost all androphilic MtF transsexuals are not. Blanchard’s ideas received increased attention in 2003 after they were discussed in a book by psychologist J. Michael Bailey. The concept of autogynephilia subsequently became intensely controversial
    [Show full text]
  • Gender Dysphoria Treatment – Commercial Medical Policy
    UnitedHealthcare® Commercial Medical Policy Gender Dysphoria Treatment Policy Number: 2021T0580J Effective Date: April 1, 2021 Instructions for Use Table of Contents Page Related Commercial Policies Coverage Rationale ....................................................................... 1 • Blepharoplasty, Blepharoptosis and Brow Ptosis Documentation Requirements ...................................................... 3 Repair Definitions ...................................................................................... 4 • Botulinum Toxins A and B Applicable Codes .......................................................................... 5 • Cosmetic and Reconstructive Procedures Description of Services ................................................................. 9 • Gonadotropin Releasing Hormone Analogs Benefit Considerations .................................................................. 9 Clinical Evidence ......................................................................... 10 • Habilitative Services and Outpatient Rehabilitation U.S. Food and Drug Administration ........................................... 15 Therapy References ................................................................................... 15 • Panniculectomy and Body Contouring Procedures Policy History/Revision Information ........................................... 16 • Rhinoplasty and Other Nasal Surgeries Instructions for Use ..................................................................... 17 Community Plan Policy • Gender Dysphoria
    [Show full text]
  • Transgender Terminology
    Transgender Terminology Agender Individuals: People who identify as genderless or gender-neutral. Cisgender Individuals: People who identify with the gender that was assigned to them at birth (i.e., people who are not transgender). Cisgender Privilege: The set of conscious and unconscious advantages and/or immunities that people who are or who are perceived as gender conforming benefit from on a daily basis. Crossdressers: Individuals who, regardless of motivation, wear clothing, makeup, etc. that are considered by the culture to be appropriate for another gender but not one’s own (preferred term to “transvestites”). Drag or In Drag: Wearing clothing considered appropriate for someone of another gender. Drag Kings and Drag Queens: Female-bodied crossdressers (typically lesbians) and male-bodied crossdressers (typically gay men), respectively, who present in public, often for entertainment purposes. FTM Individuals: Female-to-male transsexual people, transsexual men, transmen, or transguys— individuals assigned female at birth who identify as male. Some transmen reject being seen as “FTM,” arguing that they have always been male and are only making this identity visible to other people (instead, they may call themselves “MTM”). Gender: The beliefs, feelings, and behaviors that a specific culture attributes to individuals based on their perceived sex. It involves gender assignment (the gender designation of someone at birth), gender roles (the expectations imposed on someone based on their gender), gender attribution (how others perceive someone’s gender), and gender identity (how someone defines their own gender). Gender Affirming Surgery: Surgical procedures that change one’s body to conform to one’s gender identity. These procedures may include “top surgery” (breast augmentation or removal) and “bottom surgery” (altering genitals).
    [Show full text]
  • Mainstreaming Third-Gender Healers: the Changing Percep- Tions of South Asian Hijras Pooja S
    HUMANITIES AND SOCIAL SCIENCES Mainstreaming Third-Gender Healers: The Changing Percep- tions of South Asian Hijras Pooja S. Jagadish College of Arts and Science, Vanderbilt University Mainstreaming is the act of bringing public light to a population or issue, but it can have a deleterious impact on the individuals being discussed. Hijras comprise a third-gender group that has long had cultural and religious significance within South Asian societies. Described as being neither male nor female, hijras were once called upon for their religious powers to bless and curse. However, after the British rule and in the wake of more-recent media attention, the hijra identity has been scrutinized under a harsh Western gaze. It forces non-Western popula- tions to be viewed in terms of binaries, such as either male or female, and it classifies them by inapplicable Western terms. For example, categorizing a hijra as transgendered obfuscates the cultural significance that the term hijra conveys within their societies. Furthermore, media rep- resentations of hijras cause consumers to view themselves as more natural, while hijras become objectified as occupying a false identity. This has caused them to be pigeonholed within the very societies that once legitimated their existence and respected them for their powers. With their cultural practices being seen as outmoded, and their differences from Western people be- ing pointed out in the news and on television, hijras have faced significant discrimination and ridicule. After providing a discussion of relevant Western and non-Western concepts, I seek to describe hijras and the effects of mainstreaming on their lives.
    [Show full text]