Gut interpretations: how difficulties in emotion regulation may help explain the relation of visceral sensitivity with depression and anxiety among young adults with gastrointestinal symptoms

It is widely recognized that abdominal pain and discomfort are common problems in the United States and are often associated with negative quality of life. The prevalence of anxiety/depression elevations and disorders among persons with gastrointestinal disturbances (GI) is estimated to be at least two to three times the rate in the general population. Visceral sensitivity reflects anxiety about GI sensations and its accompanying contexts and often leads to worsening of sensations (e.g. bloating, upset stomach, diarrhea). Among individuals with GI symptoms, visceral sensitivity may be associated with interpreting common sensations as catastrophic which may be related to greater difficulties with emotion dysregulation (e.g. severe anxiety and depression). The current study evaluated the indirect association of visceral sensitivity via emotion dysregulation in relation to depression, anxious arousal, and social anxiety symptoms among 344 young adults with a current history of GI symptoms and problems. Results indicated an indirect effect of visceral sensitivity via emotion dysregulation. These findings provide novel empirical support for the association of visceral sensitivity with emotional distress symptoms among young adults with GI symptoms. Based on the results, targeting emotion dysregulation may be a promising health promotion tactic among young adults with GI symptoms and disorders.     

“Now there are diversities of gifts,but the same spirit.” (1Cor 12:4): images of the self and concepts of office of LGBTQ* pastors in Germany

ABSTRACT

After providing background information on the legal status and admission of LGBTIAQ* pastors in Germany, the paper focusses on experiences of LGBTQ* Protestant pastors in the major German Protestant church (Evangelische Kirche in Deutschland) to explore how they include their sexual orientation and/or gender in their pastoral work. LGBTIAQ* pastors face the challenge of managing visibility and discretion, in relation to a heteronormative setting, as well as the specific expectations of LGBTIAQ* Christians. The presumption of shared experiences and knowledge by similarly marginalized people plays a part in their ministry. The paper argues that embracing those experiences and community knowledge as part of pastoral theology can strengthen their reflection on pastoral work.     

Same-sex unions in Islam

The objective of this paper was to streamline the case for Muslim same-sex unions that was comprehensively made in Jahangir and Abdullatif (2016). Additionally, we try to address same-sex unions on the basis of non-binary gender, gender expression and sexual orientation. Based on our work, we argue that the case for Muslim same-sex unions can be made on the basis of broad principles of human dignity and affection and therefore through marriage or through the specific arguments of repelling harm and legal authority. In this regard, going beyond the overarching Islamic value of human dignity, we specifically argue that the case for same-sex unions can be anchored on verse 4:28 on facilitating a legal outlet for sexual expression.     

Women’s breast-feeding meanings in the context of mother-to-child transmission of HIV

This study explored infant feeding practice meanings of HIV-positive mothers. Informants were eight black South African mothers (age range 18–29 years) enrolled in a mother-to-child transmission (MTCT) prevention programme. In-depth interviews on factors that influence exclusive breast-feeding were conducted with the mothers. Thematic analysis of the data yielded meanings around practices of knowledge contestation with health care providers and family, work demands, and personal preferences. Moreover, successful breast-feeding by mothers with HIV status may depend on addressing contradictory messages by health workers on infant feeding and community and family pressure to mix-feed the infant children.     

In Defense of “Denial”: Difficulty Knowing When Beliefs Are Unrealistic and Whether Unrealistic Beliefs Are Bad

Bioethicists often draw sharp distinctions between hope and states like denial, self-deception, and unrealistic optimism. But what, exactly, is the difference between hope and its more suspect cousins? One common way of drawing the distinction focuses on accuracy of belief about the desired outcome: Hope, though perhaps sometimes misplaced, does not involve inaccuracy in the way that these other states do. Because inaccurate beliefs are thought to compromise informed decision making, bioethicists have considered these states to be ones where intervention is needed either to correct the person’s mental state or to persuade the person to behave differently, or even to deny the person certain options (e.g., another round of chemotherapy). In this article, we argue that it is difficult to determine whether a patient is really in denial, self-deceived, or unrealistically optimistic. Moreover, even when we are confident that beliefs are unrealistic, they are not always as harmful as critics contend. As a result, we need to be more permissive in our approach to patients who we believe are unrealistically optimistic, in denial, or self-deceived—that is, unless patients significantly misunderstand their situation and thus make decisions that are clearly bad for them (especially in light of their own values and goals), we should not intervene by trying to change their mental states or persuade them to behave differently, or by paternalistically denying them certain options (e.g., a risky procedure).     

Learning to listen to trans and gender diverse children: A Response to Zucker (2018) and Steensma and Cohen-Kettenis (2018)

ABSTRACT

The authors answer recent responses by Steensma & Cohen-Kettenis (2018 Steensma, T. D., & Cohen-Kettenis, P. T. (2018). A critical commentary on “A critical commentary on follow-up studies and “desistence” theories about transgender and gender non-conforming children”. International Journal of Transgenderism. Advance online publication. doi:10.1080/15532739.2018.1468292[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) and Zucker (2018 Zucker, K. (2018). The myth of persistence: Response to AA critical commentary on follow-up studies and “Desistance” theories about transgender and gender non-conforming children. International Journal of Transgenderism. Advance online publication. doi:10.1080/15532739.2018.1468293[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) to our critical commentary on “desistance” stereotypes and their underlying research on trans and gender diverse children (Temple Newhook et al., 2018 Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., … Pickett, S. (2018). A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children. International Journal of Transgenderism. Advance online publication. doi:10.1080/15532739.2018.1456390[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). We provide clarification in the following areas: (1) the scope of our paper; (2) our support of longitudinal studies; (3) consequences of harm to trans and gender diverse children; (4) clinical practice implications; (5) concerns about validity of research methodology; and (6) the importance of learning to listen to trans and gender diverse children.     

Differentiating crisis incidents: A replication study using the action systems model

Crisis incidents are volatile situations that can pose significant risk to those involved and to law enforcement. The idiosyncratic conditions that lead to such incidents, as well as their volatility, often militate against consistent explanatory models. However, the application of overarching paradigms, such as the action systems model, has shown some promise in imposing order in the domain. Recent research has successfully differentiated crisis incidents into the four distinct modes of the action systems model: conservative, adaptive, integrative, and expressive. The purpose of this paper is to attempt to replicate this recent study using 242 cases from the United States, Ireland, Canada, and Sweden. Data analysis involves smallest space analyses and constrained multidimensional scaling. Although the results supported the underlying structure of original proposed behavioural model, there are a few deviances. These differences along with the potential influence of cultural variations, offence variable selection, the type of incident, and the sample under scrutiny are discussed. It is evident that there remain several challenges, and further research is required, prior to developing a unified framework.     

The transgender parent: Experiences and constructions of pregnancy and parenthood for transgender men in Australia

Background: Transgender (trans) men are commonly born with the reproductive anatomy that allows them to become pregnant and give birth and many wish to do so. However, little is known about Australian trans men's experiences of desiring parenthood and gestational pregnancy.

Aims: The present study aims to address this gap in the literature through addressing the following research questions: how do Australian trans men construct and experience their desire for parenthood? And, how do Australian trans men construct and experience gestational pregnancy?

Methods: This study aimed to explore these experiences, through a mixed-methods research design using online survey data and one-on-one interviews, with 25 trans men, aged 25–46 years old, who had experienced a gestational pregnancy. Data were analyzed using thematic analysis.

Results: For our participants, parenthood was initially described as alienating and complex, however transitioning enabled participants to negotiate and construct their own parenting identity. Pregnancy was positioned as a problematic but “functional sacrifice,” however formal assisted fertility experiences were rife with exclusion. At the same time dysphoria associated with withdrawing from testosterone and the growing fecund body were significantly troubling. Changes to the chest were of particular concern for participants. Exclusion, isolation, and loneliness were the predominant features of trans men's experiences of gestational pregnancies. Healthcare systems are not generally supportive of trans bodies and identities and trans men encounter significant issues when interacting with healthcare providers. As such, the results reinforce the importance of inclusive and specialized health services to support trans men through pregnancy.     

Effectiveness of testosterone therapy for masculinizing voice in transgender patients: A meta-analytic review

Background: Testosterone therapy is the predominant treatment for voice masculinization in transgender patients. Although lowering of voice fundamental frequency (f₀) occurs with testosterone therapy, evidence suggests voice and gender identity may not fully align—i.e., voice-gender congruence may not be achieved—with its use.

Aim: This meta-analytic review evaluates the effectiveness of testosterone therapy to masculinize voice in transgender patients.

Methods: Multiple electronic databases were queried (inclusion dates: from database inception up to October 27, 2017) to identify original research on voice masculinization using testosterone therapy. Nineteen articles were included in this meta-analytic review, which followed PRISMA guidelines. In addition to qualitative analyses, random effects proportion meta-analyses were performed on data related to f₀, voice-gender congruence, voice problems, and satisfaction with voice.

Results: A meta-analysis on f₀ data showed after 1 year of testosterone therapy a combined estimate of 21% of participants (95% confidence interval [CI]: 5%–43%; I²: 59.9%) did not achieve cisgender male normative frequencies (f₀ ≤ 131 Hz). Meta-analyses on incomplete voice-gender congruence and voice problems indicated combined estimates of 21% (95% CI: 10%–34%; I²: 0.0%) and 46% (95% CI: 14%–79%; I²: 90.2%), respectively. Regarding incomplete satisfaction with voice, a meta-analysis showed a combined estimate of 16% (95% CI: 7%–28%; I²: 0.0%).

Discussion: We found that not all transgender patients using testosterone therapy to masculinize voice should expect f₀ lowering to cisgender male normative frequencies after 1 year. The vocal transition may involve voice problems for many patients, and some might not achieve voice-gender congruence without additional, voice-specific intervention. Given these findings, a voice evaluation should occur prior to initiating testosterone therapy and involve counseling on expectations for voice. Transgender patients who pursue voice masculinization may need management from laryngology and speech and language therapy to improve voice-gender congruence, mitigate voice problems, and increase satisfaction with voice.     

Bullies,blades, and barricades: Practical considerations for working with adolescents expressing concerns regarding gender and identity

ABSTRACT

Background: Adolescents, by their very nature and need for maturity, struggle with issues of the self and identity, while challenging the very systems that are there to support them. However, gender diverse adolescents may become detached and overwhelmed as a trans identity solidifies during this time. Bullies, blades and barricades describes the challenges, hardship and dispossession that some gender diverse adolescents face from interpersonal and intrapersonal conflicts, societal pressure and hostility.

Method: This paper utilizes the current research on safety and risks affecting trans youth, the authors clinical experience of trans and gender diverse adolescents, and recommendations in the literature for professional care and support of gender diverse adolescents to identify the various ways gender diverse adolescents are negatively affected by their experiences.

Results: Bullying is not limited to school or peer environments and may be present in adolescents' homes, in local communities, in professional services or from sources of information such as the media. The physical dangers gender diverse adolescents face may arise from victimization, violence or rejection, or self-harming behaviors due to negative beliefs, fear or frustration. Barriers preventing disclosure and expression of gender and/or identity may stem from negative experiences, rejection, pubertal changes, imposed limitations, dependence upon school, home or legal environments, or other spheres of influence.

Discussion: Affirmative approaches, individual focus, recognition of family dynamics, inclusion of significant others, advocacy in school and local community environments as well as professional training are the most commonly recommended interventions. This paper provides an inclusive review of the myriad of challenges confronting gender diverse adolescents including often unrecognized forms of pressure, oppression and restrictions. This paper aims to support clinicians by contextualizing the adversity that gender diverse adolescents face and offers strategies for engagement and intervention.