Clinical Management of Gender Dysphoria in Adolescents

SUMMARY

This paper aims to provide professionals working with adolescents with gender-dysphoric feelings practical clinical guidelines for diagnosis and treatment. The different phases of the assessment procedure and treatment process are described. Differential diagnostic considerations and possible psychotherapeutic treatment options are given. Physical interventions, including GnRH analogues to inhibit puberty and cross-sex hormones, are described with consideration of eligibility and readiness issues. We end with discussion of post-treatment evaluation.     

What Makes a Lengthy Article Brief?

ABSTRACT

Evidence continues to accumulate supporting an innate basis of human sexual identity as male or female. Selective mustering of these particles of data can congeal into a compelling argument.

Plyers of the law trade present one side of an argument in their legal brief. The reader is overwhelmed by its forceful logic and inevitable conclusions. The reader is dumbfounded that there is an opposition. Until reading the opponent's brief.

That is law. This is science. A peer-reviewed journal is a vehicle for balanced presentation of data with conclusions not outstripping the evidence.

This lengthy article on gender identity is a brief cross-dressed as science. It set out to “pass” but it was “read.”     

Face gender recognition in developmental prosopagnosia: Evidence for holistic processing and use of configural information

Face identification deficits in developmental prosopagnosics (DPs) have been thought to be due to general difficulties with processing configural face information and integrating configural and parts information into a coherent whole (holistic processing). Gender recognition provides a further opportunity to more fully examine this issue as this ability may be intact in DPs and it has been shown to depend on processing configural information and holistic processing in neurotypical individuals. In the present study we first determined that, indeed, gender discrimination performance was similar in DPs and controls. Second, we found that inversion and scrambling (which we propose measures holistic processing and sensitivity to configural information, respectively) produced comparable deficits in DPs and controls, suggesting that both groups use holistic processing and configural information to recognize gender. This indicates that holistic processing and using configural face information are not general impairments in DP and may be more specific to face identity.     

Integrating visual images and visual percepts across time and space

Recent studies suggest that visual information can be integrated over a relatively long delay (> 1500 ms) to form a more complete representation (image-percept integration). The current studies investigated whether this process can occur between stimuli that differ in their spatial properties. Participants viewed two dot arrays that filled all but one space in a square or rectangular grid when combined, and reported the missing space. The arrays differed either in size or orientation. Performance reached a comparable level as when spatial properties were matched. However, such performance depends on at least two processes. We suggest an early encoding process and a later image formation/spatial attention reallocation process are required. The flexibility of the image-percept integration process suggests a strong mechanism to form more complete or detailed representations over time, even when the retinal size and orientation of the scene may change between successive views.     

Angels and the Dragon King's Daughter: Gender,Sexuality in Western Buddhist New Religious Movements

Abstract

Through colonialism and globalization, Buddhism has developed an increasing profile in the West. This can be observed within popular culture as well as the presence of Buddhist practitioners from a range of ethnicities of whom a significant number are converts. This presence has led to the development of Buddhist new religious movements (NRMs). We first outline interpretations of gender and sexuality that have arisen within Buddhist traditions. Then, using Linda Woodhead's (2007) model that theorises religion's positioning with respect to gender, we discuss gender norms that have developed for two of the largest Buddhist NRMs in the UK: the Triratna Buddhist Community (TBC, formerly the Friends of the Western Buddhist Order, FWBO) and the Nichiren group Sōka-Gakkai International-UK (SGI-UK). Through examining new empirical data, we explore how their gender norms are negotiated by members. We note that within these movements, women, queer people and people of colour are creating provisional spaces that challenge attempts to hegemonize hetero-patriarchal perspectives.     

Counselling asylum seekers and refugees: a study of Kurds in early and later stages of exile

This study explores the experience of asylum seekers and refugees in early and later phases of exile. Twenty-five Kurds (mainly asylum seekers) were interviewed in Greece in early phases of exile and twenty Kurds (mainly refugees) in later phases of exile in the UK. Refugee camps in Greece and community centres in London were the main locations for these interviews. Representatives from eight support organizations were also interviewed in each country. The multidimensional aspects of being a refugee are discussed, including models of formulating the experience, PTSD and the cross-cultural context. Key findings of the study include the desperate need among the asylum seekers and refugees, in the early phases, to have the story of their traumatic journey to Greece witnessed and validated by an outsider; the differing experiences of men and women; a change in identity over time; and considerable fear, which was evident in early and later phases. Moreover, all the support organizations expressed pronounced frustration but responded to it in different ways. Those organizations with supervision and support groups in place demonstrated more insight into their interactions with asylum seekers and refugees. Counselling approaches are evaluated with reference to the asylum seekers' and refugees' needs, and the desirability of adequate support for those with a counselling role is highlighted.     

The association of relational and physical victimization with hostile attribution bias,emotional distress,and depressive symptoms: A cross‐cultural study

The purpose of the present study was to examine the association between relational victimization and socio‐cognitive patterns (i.e. hostile attribution biases and emotional distress) or social–psychological adjustment problems (i.e. depressive symptoms) in Japanese and European American children (N = 272; ages 9–10). Results showed that relational victimization, which was conceptually different from physical victimization, was associated with a greater level of emotional distress for an overall sample; however, the links between relational victimization and hostile attribution biases and depressive symptoms were evidenced only for Japanese children. A follow‐up analysis revealed that hostile attribution biases had a direct effect on depressive symptoms for European American children; however, these biases mediated the link between relational victimization and depressive symptoms for Japanese children. These findings are discussed from normative and cross‐cultural perspectives.     

Ambivalence over emotional expression and symptom attribution are associated with self‐reported somatic symptoms in Singaporean school adolescents

Although somatization is common across cultures, its meanings may differ as culture shapes emotional experience. Thus, instead of treating somatization as a form of psychopathology, it is more useful to conceptualize it as an idiom of distress, and how complaints of somatic symptoms are related to social relationships, patterns of emotional expression and symptom attribution in a cultural context. This study seeks to explore whether ambivalence over emotional expression and causal attribution would shed light on the meanings of somatization among Asian adolescents. Three hundred secondary school adolescents in Singapore participated in this study. The main results show that emotional ambivalence, biomedical and Traditional Chinese Medicinal causal beliefs, and magical attribution contributed to additional variance in somatic symptoms over and above the variance explained by emotional distress. These findings are discussed from both psychological and cultural perspectives.     

Instituting impairment: Extended cognition and the construction of Female Sexual Dysfunction

I further the argument for a socially extended mind by examining gender and the role it plays in cognition. My first claim is that gender is a social institution that often if not always subtends our cognitive processes, especially those that are maximally embodied. The social institution of gender often serves to inhibit female embodied cognitive processing, as a quick glance at the myriad of oppressive forces at play in gender dynamics illustrates. To combat the potential objection that gender is not a vehicle for extending cognitive processes, but rather plays a shaping role in embodied practice, I propose looking at the history of Female Sexual Dysfunction and its construction by the social institutions of the pharmaceutical companies and media. By doing so, I claim a case can be made that these institutions have actually invaded the minds of many women to the point that cognition pertaining to sex, sexual functioning, and health are wholly dependent upon and constituted by the interplay of these social systems.     

Understanding of moral emotions and social exclusion in pre-schoolers and third graders

Abstract

This study examined whether children use information about moral emotions when judging peer exclusion. Japanese pre-schoolers and third graders (N = 110) listened to stories featuring characters who felt happy or sad after engaging in immoral behaviour or avoiding immoral behaviour (pushing a child off a swing and stealing another child’s doughnuts). In study 1, participants judged the extent to which characters who felt happiness, guilt, and pride would be socially excluded. In study 2, participants judged whether characters who felt guilt, no guilt, pride, and no pride would be socially excluded. Participants believed that characters would be socially excluded based on moral emotions. Characters who did not feel guilt or pride were excluded more frequently relative to those who did; however, children found it easier to judge exclusion based on guilt rather than pride, especially in the case of pre-schoolers. Moreover, pre-schoolers had difficulty explaining their reasoning.