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.     

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.     

Factors and processes in children's transitive deductions

Transitive tasks are important for understanding how children develop socio-cognitively. However, developmental research has been restricted largely to questions surrounding maturation. We asked 6-, 7- and 8-year-olds (N?=?117) to solve a composite of five different transitive tasks. Tasks included conditions asking about item-C (associated with the marked relation) in addition to the usual case of asking only about item-A (associated with the unmarked relation). Here, children found resolving item-C much easier than resolving item-A, a finding running counter to long-standing assumptions about transitive reasoning. Considering gender perhaps for the first time, boys exhibited higher transitive scores than girls overall. Finally, analysing in the context of one recent and well-specified theory of spatial transitive reasoning, we generated the prediction that reporting the full series should be easier than deducing any one item from that series. This prediction was not upheld. We discuss amendments necessary to accommodate all our earlier findings.     

Adolescent mental health in Japan and Russia: The role of body image,bullying victimisation and school environment

This study examined associations between self-reported mental health problems, body image, bullying victimisation and school safety in large adolescent samples in Japan and Russia, considering the effects of gender, culture and their interactions. In both Japan and Russia, girls reported a greater number of mental health problems, less bullying victimisation and much higher body dissatisfaction than boys did. Japanese adolescents rated themselves higher on total difficulties, reported less body dissatisfaction and bullying victimisation, and rated their school safety lower than that of Russian youths. Cross-cultural differences in total difficulties and body image were qualified by gender. Body dissatisfaction, bullying victimisation and school safety all independently contributed to adolescent mental health problems. The protective effect of school safety on total difficulties was larger for girls than for boys; the strength of the association between bullying victimisation and adolescent mental health problems differed across genders and cultures. The findings indicate a need for a cross-cultural approach and provide a strong basis for targeted interventions that seek to improve adolescent mental health.