Colleagues Response week 11



Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you selected to the diagnostic features of the disorder your colleagues were assigned.

Note: Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. 

Colleagues Respond # 1

Gender Dysphoria

Transgender is the term used to mean that individual sex assigned during birth based on the external genital does not fit their gender identity. These kinds of people usually experience gender dysphoria, which is one of the psychological distresses associated with the incongruence between one’s gender identity and the sex they were assigned during birth. Gender dysphoria usually starts at the beginning of childhood, but in some cases, individuals may not experience it until after puberty and even much later in their stages of life. People with transgender may pursue different domains of gender affirmation, which includes: surgical affirmation, medical affirmation, legal affirmation, and social affirmation (Lindley, 2020). Not all people with transgender issues will desire to have all these domains of gender affirmation as these are highly individual and personal decisions.

Medical treatment for gender dysphoria

Medical treatments for this condition may include hormone therapy, such as masculinizing hormone therapy or feminizing hormone therapy. Surgery includes masculinizing surgery or feminizing surgery, which intends to change chest or breasts, internal genitalia, external genital, body contouring, and facial features.

Some people used hormone therapy to seek maximum masculinization or feminization. Other people find relief from gender dysphoria by using hormones to maximize secondary sex characteristics such as facial hair and breasts. These kinds of treatments are based on individuals’ goals and the evaluation of the benefits and risks of the medication use, presence of any other conditions, and consideration of individual’s economic and social issues (Zucker, 2018). Most of these gender dysphoria individuals find surgery the most effective and necessary procedure that relieves their condition.

The World Professional Association for Transgender Health gives the following procedure for the surgical or hormonal treatment for people with gender dysphoria.

1. Persistent and a well-documented gender dysphoria

2. The capacity to make consent and an informed decision for the treatment

3. The aged majority of a given country and when the patient is young need to follow the standard of care for the adolescents and children.

Behavioral health treatment

This treatment aims to improve the individual’s psychological well-being, self-fulfillment, and quality of life. This kind of treatment does not aim to alter an individual’s gender identity, but it aims to explore gender concerns and find ways to reduce gender dysphoria. The main goal here is to help the gender-nonconforming and transgender individuals become more comfortable with the situation as gender identity expressions enable success in their education, work, and relationships. This therapy can also address any other mental health concerns (Kaltiala-Heino, 2018).

The therapy can be individual, family, group, or couple, which will help the individual explore and integrate on their gender identity and accept themselves. It will address the emotional and mental impact of the minority stress and build on a support network. To achieve these entire, one needs to develop a plan to address legal and social concerns related to the transition and coming out to the loved ones, close contacts, colleagues, and friends. This will make one more comfortable by expressing their gender identity. It will also explore healthy sexuality and make the right decision on medical treatment options and ensure an increased quality of life and well-being.

Therapy might be needful and helpful during many stages in everyone’s life. The pre-treatment of behavioral health evaluation is done by a doctor who is an expert and has experience in intersex and transgender health when needed for surgical and hormonal treatment of gender dysphoria.

Colleagues Respond # 2

Diagnostic Criteria for Gender Dysphoria

           According to the DSM V, Gender Dysphoria occurs when an individual believes that their gender identity does not correspond to the biological sex (APA, 2013).  These individuals prefer to be identified as the gender they personally identify with, not with the gender assigned at birth. Within their family and socially, they wish to be identified as either male or female depending upon their self-identification.  They experience personal distressed when they are viewed as the gender they were born with and they have a desire to have the body of the opposite sex (Sadock, Sadock & Ruiz, 2014).   Those with gender dysphoria often opt to have gender reassignment surgery and receive hormonal treatments (Kaltiala-Heino, 2018). At around age 2 or 3 gender identity is established (Sadock et. al., 2014). The criterion for Gender Dysphoria includes  two of the  following for at least 6 months: an incongruence between experienced gender and assigned gender, a desire to get rid of or prevent the development of primary and/or sex characteristics, a strong desire to have the sex characteristics of the other gender, a strong desire to be the other gender, a strong desire to be treated like the other gender, and a belief that one has the feelings and beliefs of the other gender and secondly,  distress or impairment in school, social settings and daily functioning (APA, 2013). Gender dysphoria may occur in children, adolescents and adults.

         Psychotherapy and Psychopharmacologic Treatment for Gender Dysphoria

For this disorder treatment options include psychotherapy, hormone therapy and gender reassignment surgery.  For children and adults, individual, group and family therapy is beneficial. With adults, hormonal and surgical options can be explored.  Since physicians who perform gender reassignment surgery require a letter from a mental health provider, individuals would participate in treatment so that they could get a psychiatric clearance for surgery. Nguyen et. al., (2018) suggest that prescribing gender affirming hormone therapy helps alleviate the mental distress related to gender dysphoria by reducing the symptoms of anxiety and depression Otherwise, these individuals would avoid mental health treatment. There is now an informed consent model in some clinics so that they could receive hormone therapy without a mental health professional’s involvement.  This is unfortunate since many adults and children with gender dysphoria have underlying psychiatric diagnoses such as anxiety , social anxiety , depression, risk of suicide, substance abuse and other self-harm behaviors (Sadock, 2014). Mental health professionals do have an essential role in promoting the wellness of patients with gender dysphoria. Johnson, Shipherd and Walton (2020) emphasize the many services such as advocacy, coordination of care, and referrals for medical care and surgery.  Because of stigma and social anxiety, patients with this diagnosis may not seek help. Gabbard (2014) emphasized the importance of psychoeducation for spouses, parents and family members. A psychotherapist knowledgeable about gender dysphoria can be an invaluable resource.

Those who offer conversion therapy are not abiding by the position statements by the American Psychiatric Association or the guidelines established by the American Academy of Child and Adolescent Psychiatry (Sadock et. al., 2014).  Additionally, cognitive behavioral therapy (CBT) can be helpful for transgender or gender non-conforming (TGNC) patients by targeting social anxiety.

      Differential Diagnosis for Gender Dysphoria

 The patient must experience distress with their gender identity.  Those with psychosis who have delusional thoughts that they are the opposite gender may experience distress, however, once the psychosis is treated, the distress regarding gender diminishes.  Body dysmorphic disorder is a differential diagnosis in that some people may want to change gender body parts but they believe it is abnormal but they do not question their assigned birth gender.. Another differential diagnosis is transvestic disorder in which the individual identifies with their birth gender but is aroused by wearing the opposite gender’s clothing.

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