Module 11 - Sex and Gender Identity Disorders

Question 1

What is Transgender-affirmative cognitive behavior therapy (TA-CBT)?

Answer 1

A version of CBT hat has been adapted to ensure
(1) an affirming stance toward gender diversity,
(2) recognition and awareness of transgender-specific sources of stress
(3) the delivery of CBT content within an affirming and trauma-informed framework.

Question 2

What is the the minority stress model?

Answer 2

Based on the notion that sexual and gender minorities encounter high levels of stress because of homophobic and transphobic social conditions. In turn, excess exposure to stress causes higher prevalence of psychological distress among sexual and gender minority individuals compared with cisgender/heterosexual individuals.

Question 3

TGNC individuals experience high levels of minority stressors, including :

Answer 3

verbal, physical, and sexual abuse; stigma; and internalized stigma.

Question 4

High levels of _________ and ________ contribute to disparate mental health outcomes among the TGNC community.

Answer 4

identity-based stigma

stress

Question 5

True or False?

TGNC individuals experience similar rates of psychological distress, such as suicidality, depression, and anxiety, compared with their cisgender counterparts.

Answer 5

False.

TGNC individuals experience disproportionate rates of psychological distress, such as suicidality, depression, and anxiety, compared with their cisgender counterparts. Growing research highlights particularly high rates of suicidality among TGNC individuals.

Question 6

The marginalization of transgender identities increases their vulnerability to stressful events, including those of a life-threatening nature. Therefore, understanding the effects of _____________ and other trauma-related disorders is critical for providing culturally informed mental health care to TGNC individuals.

Answer 6

Posttraumatic stress disorder (PTSD).

Question 7

Preliminary evidence indicates that transgender persons who have been exposed to violence and other traumatic events experience high levels of posttraumatic symptoms.

Answer 7

True.

Gender nonconformity in childhood is associated with greater exposure to potentially traumatic events and the subsequent development of PTSD.

Question 8

T/F

Many TGNC individuals show symptoms consistent with a PTSD diagnosis, but they are exposed to events that do not meet the definition of trauma in the DSM.

Answer 8

True.

Question 9

What is an example of an acute form of non–life-threatening transphobic discrimination?

Answer 9

Being fired from employment because of gender identity.

Question 10

What is an example of a chronic form of non–life-threatening transphobic discrimination?

Answer 10

Dealing with transphobic stigma, and macroaggressions.

Question 11

Frequent exposure to both acute and chronic forms of non-life threatening transphobic can be accompanied by a pervasive fear of victimization. This hypervigilance may in turn…….

Answer 11

become a fundamental aspect of the person’s transgender identity.

Question 12

What are some key features of gender-affirmative clinical approaches?

Answer 12

1) t is critical that clinicians adopt, and make known, an affirming clinical position that recognizes all experiences of gender as equally healthy and valuable.

2) Clinicians should attend to policies regarding access to services based on gender identity versus assigned sex at birth and the use of gender-neutral rest- rooms, the development of transgender-inclusive promotional materials (eg, pamphlets, Web pages), and the use of inclusive language on intake and other forms of documentation.

3) It is recommended that clinicians show gender inclusivity at the moment of first con- tact with their clients. For example, “Hello, my name is Beth and I use she, her, and hers pronouns; what is your name and preferred gender pronouns?”

Question 13

What is perhaps the most fundamental component of a transgender-affirmative (TA) clinical practice?

Answer 13

Unconditional positive regard for the diversity of transgender identities and expressions that is integrated throughout all interactions with transgender individuals.

(As such, clinicians must diligently engage in self-exploration regarding their personal gender- related attitudes, beliefs, and biases. In addition, interventions attending to the specific needs of transgender individuals should be implemented and practiced with competency, and this requires clinicians who are committed to developing transgender-specific knowledge and skills.)

Question 14

TA-CBT is a version of CBT that has been adapted to ensure:

Answer 14

1. An affirming stance toward gender diversity
2. Recognition and awareness of transgender-specific sources of stress (eg, transphobia, gender dysphoria, systematic oppression)
3. The delivery of CBT content within an affirming and trauma-informed framework

Question 15

Flip for a fact (because I am running out of ways to ask questions lol).

Answer 15

Children and adults are often shamed for being transgender or gender nonconforming and quickly learn to suppress and/or reject a transgender identity. These early experiences can be traumatic and contribute to core beliefs of being unlovable, worthless, or incompetent. Core beliefs are conceptualized as a set of deeply embedded ideas that are regarded as absolute truths. The core beliefs are reinforced by society.

Question 16

Flip for another fact

Answer 16

It is important to remember that not all gender-diverse clients want to transition or seek services related to transitioning.

Question 17

The exploration of past and current stressors within the clinical setting may trigger intense emotional reactions for some clients whose experiences of transphobia in the home, school, and/or community were particularly traumatic. How can clinicians prepare for this?

Answer 17

It is important that clinicians help clients achieve a relaxed body and mind before they begin to recount traumatic experiences.

Question 18

What are the 2 primary goals of primary goals of the psychoeducational component in TA-CBT?

Answer 18

1. To help clients develop a basic understanding of the theoretic underpinnings of cognitive behavioral approaches to promoting health and well-being through an introduction to the cognitive model; that is, the relationship between thoughts, emotions, and behaviors
2. To help clients to understand the potentially traumatic impact of transphobic discrimination and prejudice and its contribution to feelings of distress

Question 19

What is an intermediate belief?

Answer 19

Conditional rules, attitudes, and assumptions, often unspoken, that significantly affect the way in which individuals respond to life’s challenges and stressors.

Question 20

Negative core beliefs generally have one of the following 3 themes:

Answer 20

1) being worthless
2) being unlovable
3) being helpless or incompetent.

Question 21

How might negative core beliefs develop in TGNC individuals?

Answer 21

Beginning in childhood, TGNC individuals are exposed to many implicit and explicit messages that stigmatize and pathologize gender nonconformity and transgender identities. In many instances these messages are internalized, which can lead to the development of core beliefs of being worthless or unlovable (eg, “Being transgender is not valued, therefore I have no value”). These core beliefs yield intermediate beliefs in people that may include a rigid if/then style of thinking about themselves and their interactions with the world (eg, “If I am not perfect, no one will like me”).

For example, clients develop core beliefs of being worthless or unlovable after repeated early exposure to stigmatizing messages like “Stop being a sissy!”; “What’s wrong with you?”; and “Look at that he/she.”

Question 22

If the negative self- beliefs are deeply entrenched and the client is experiencing a great deal of distress, what might TA clinicians do? may need take an even more active role in treatment by explicitly challenging transphobia and cisgender privileg

Answer 22

They may need take an even more active role in treatment by explicitly challenging transphobia and cisgender privilege.

Question 23

Sexual dysfunctions-sexual issues that are associated with clinically significant distress and are experienced for more than ______ months.

Sexual dysfunctions are characterized by disturbances in a person’s ability to respond sexually or to experience sexual pleasure. Sexual dysfunctions consist of clinically significant issues with desire, interest, arousal, orgasm, and genito-pelvic pain and penetration.

Answer 23

6

Question 24

T/F

Sexual dysfunctions are highly comorbid, especially for women.

Answer 24

True

Question 25

What are the four main categories of sexual response?

Answer 25

1) desire/interest dysfunctions, which describe issues with sexual fantasies and the wish to engage in sexual activity. For men this is diagnosis HSDD & for women this is SIAD.

2) Arousal dysfunctions, which are characterized by concerns related to the subjective feelings of sexual pleasure and associated physiological changes. For men this diagnosis is ED, for women this is SIAD (again).

3) Orgasm dysfunctions, which are problems with the timing of the release of sexual tension. For men this diagnosis is DE and/or PE, for women this is OD.

4) Vaginal Penetration, which describes issues that prevent vaginal penetration (e.g., pain, severe anxiety about penetration). This is diagnosed as GPPD (women).

Question 26

True or false?

GPPPD is a sexual dysfunction that is currently restricted to females; there is no parallel diagnosis for males, despite the fact that research has established the existence of genito-pelvic pain in men.

Answer 26

True.

Question 27

True or False?

ED is a well-established predictor of cardiovascular disease.

Answer 27

True.