ABSTRACT
Introduction: Gender incongruence (GI) is characterized by a marked and persistent incongruence between an individual's experienced gender and assigned sex, which often leads to a desire to "transition" and a demand for medical treatments. Dissociative identity disorder and partial dissociative identity disorder (PDID) are poorly known mental disorders whose clinical presentation can be confused with GI. Aims: To provide a case report of a patient with PDID and GI who required treatment for GI. Methods: A case report and follow-up were described. Results: The case report describes a person suffering from PDID and GI and asked for hormonal treatment for GI. In view of the complexity of the case, it was decided to start a follow-up to investigate the gender experience of the different personalities. After 4 months of follow-up, the symptomatology changed, and the patient waived treatment for GI and continued psychotherapeutic treatment for PDID. Conclusion: Our case report shows the complexity of providing treatment for patient with PDID and GI.
ABSTRACT
BACKGROUND: World Professional Association for Transgender Health guidelines support the importance of a mental health assessment before providing medical treatment for Gender Dysphoria (GD). During this assessment, patients without GD but with mental health disorder and who request treatment for GD should be excluded. Dissociative Identity Disorder (DID) is a poorly known mental disorder which can be confused for GD. AIM: To provide a case report of a patient suffering for DID but asking for treatment for GD and to provide a review of the literature on GD and DID. METHOD: A case report assessment and follow-up was described and a systematic review of the literature was performed in Pubmed, PsychInfo, and Embase databases. OUTCOME: To provide all cases with assessment and follow-up of DID and GD. RESULTS: The case report describes a man suffering from DID and asking for hormonal treatment for GD. After assessment the patient was able to let go of his wish for treatment for GD and begin psychotherapy for DID. During the literature review 11 articles were included. 3 articles showed a prevalence of DID of 0%, 0.8% and 1,5% in GD samples. 5 articles were case reports of patients with both diagnoses of GD and DID which showed the complexity of the care of these patients. 2 articles were case reports, where a GD diagnosis was done first, and then counseling for GD was proposed. After a second session, the diagnosis was changed for DID. In 1 other case report and our case report there was a description of 2 persons suffering from DID and asking for treatment for GD. CLINICAL IMPLICATIONS: Our review shows the complexity of providing care to patients with a comorbidity of GD and DID, as well as the complexity of making the differential diagnosis between GD and DID. STRENGTHS AND LIMITATIONS: A systematic review was performed on these rare cases. Our study presents the results for a small group of patients. CONCLUSIONS: This article provides the first systematic review on GD and DID and shows that DID in a GD sample does not seem to be higher than in the general population. In addition, it allow clinicians to gain better knowledge about patients suffering from both DID and GD and patients suffering from DID who ask for GD treatment. Soldati L, Hasler R, Recordon N, et al. Gender Dysphoria and Dissociative Identity Disorder: A Case Report and Review of Literature. Sex Med 2022;10:100553.
ABSTRACT
Subjects with ADHD suffer from inattention, hyperactivity, and impulsivity. Clinicians often assume that specific symptoms of ADHD are bound to affect sexual desire by increasing the frequency of hypersexuality. There is a lack of knowledge about the comorbidity between ADHD, hypersexuality, and paraphilias. The aim of this article was to provide a review of the literature on the association of ADHD and hypersexuality and paraphilias and to discuss the screening and the management of these syndromes when associated with ADHD. A systematic review of the literature was performed in PubMed, PsychInfo, and Embase databases. The studies reviewed show that some individuals who suffer from ADHD report hypersexuality and paraphilias, but no clear data emerged supporting the idea that hypersexuality and paraphilias are more frequent in an ADHD population. On the other hand, some studies showed a high prevalence of ADHD in hypersexual and paraphilic subjects. This is the first systematic review of hypersexuality and paraphilias in individuals with ADHD. However, the results are limited by differences in the methodology and measurement instruments for hypersexuality and paraphilias as well as by the small number of studies and the small sample sizes of many studies.
Subject(s)
Attention Deficit Disorder with Hyperactivity/epidemiology , Attention Deficit Disorder with Hyperactivity/psychology , Paraphilic Disorders/epidemiology , Paraphilic Disorders/psychology , Adolescent , Adult , Attention Deficit Disorder with Hyperactivity/diagnosis , Clinical Trials as Topic/methods , Comorbidity , Compulsive Behavior/diagnosis , Compulsive Behavior/epidemiology , Compulsive Behavior/psychology , Female , Humans , Impulsive Behavior/physiology , Male , Paraphilic Disorders/diagnosis , PrevalenceABSTRACT
This article is the result of the joint work of psychiatrists-psychotherapists working with patients with gender dysphoria (children, adolescents and adults) in Lausanne and Geneva university hospitals. It emphasizes the importance of their clinical interventions when hormone therapy and sex reassignment surgery are requested.
Cet article est issu d'une collaboration entre les psychiatres-psychothérapeutes et les pédopsychiatres-psychothérapeutes intervenant dans les deux consultations universitaires spécialisées pour la dysphorie de genre en Suisse romande et illustre l'importance de leur intervention dans la prise en charge des personnes qui sollicitent des traitements médicochirurgicaux de réassignation sexuelle.
Subject(s)
Gender Dysphoria/diagnosis , Gender Dysphoria/therapy , Physician's Role , Psychiatry , Psychotherapy , Gender Dysphoria/psychology , Gender Identity , Humans , Sex Reassignment SurgeryABSTRACT
BACKGROUND: The scientific literature on sexuality among mentally ill patients clearly shows a higher prevalence of sexual disorders for many mental disorders, but little is known about sexuality in individuals suffering from ADHD. Clinicians will often assume that specific difficulties of ADHD are bound to affect sexual functioning. AIM: The aim of this study was to provide a review of the literature to gain better knowledge about sexuality in subjects with ADHD and to discuss screening and management of their potential sexual problems. METHODS: A systematic review of the literature was performed in Pubmed, PsychInfo, and Embase databases. MAIN OUTCOME MEASURES: The main outcome measures were sexual function and sexual dysfunctions. RESULTS: The studies indicated that subjects with ADHD report more sexual desire, more masturbation frequency, less sexual satisfaction, and more sexual dysfunctions than the general population. CLINICAL IMPLICATIONS: Clinicians working with subjects with ADHD should explore the quality of their sexual life. STRENGTHS & LIMITATIONS: This is the first systematic review of the sexuality of individuals with ADHD. However, the results are limited by the small number of studies, by the small sample size of many studies, and the potential for bias. CONCLUSIONS: ADHD is a mental disorder affecting sexual health. Further studies are warranted to learn more about sexuality in subjects with ADHD. Soldati L, Bianchi-Demicheli F, Schockaert P, et al. Sexual Function, Sexual Dysfunctions, and ADHD: A Systematic Literature Review. J Sex Med 2020;17:1653-1664.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Sexual Dysfunction, Physiological , Sexual Dysfunctions, Psychological , Attention Deficit Disorder with Hyperactivity/epidemiology , Humans , Sexual Behavior , Sexual Dysfunction, Physiological/epidemiology , Sexual Dysfunctions, Psychological/epidemiology , SexualityABSTRACT
Although there is a substantial literature concerning the sexuality of people suffering from a psychiatric disorder, such as depression, anxiety disorder, schizophrenia, eating disorders or personality disorders, few studies have investigated the sexuality of attention deficit/hyperactivity disorder (ADHD) patients. The purpose of this article is therefore to show current knowledge about sexuality in people suffering from ADHD. The latter seem to have less sexual satisfaction, more sexual desire, more sexual dysfunction and more risky sexual behavior than the general population.
Bien qu'il existe une littérature conséquente concernant la sexualité des personnes atteintes d'un trouble psychiatrique tel que la dépression, le trouble anxieux, la schizophrénie, les troubles alimentaires ou les troubles de la personnalité, peu d'études ont investigué à ce jour la sexualité des patients souffrant d'un trouble du déficit de l'attention avec ou sans hyperactivité (TDAH). Le but de cet article est donc de se focaliser sur les connaissances actuelles en matière de sexualité chez des personnes souffrant du TDAH. Ces derniers semblent avoir moins de satisfaction sexuelle, plus de désir sexuel, plus de dysfonctions sexuelles et plus de comportements sexuels à risque que la population générale.
Subject(s)
Attention Deficit Disorder with Hyperactivity/psychology , Sexual Behavior , Sexuality , Attention Deficit Disorder with Hyperactivity/epidemiology , Humans , Unsafe Sex/statistics & numerical dataABSTRACT
The term « cybersex ¼ refers to the use of the Internet for sexual purposes (pornography, webcams, dating). While moderate use of cybersex could have a positive effect on sexual life, a small fraction of these cyber-users could have difficulties to control their consumption with negative consequences. This phenomenon, whose understanding of the mechanisms still raises debates, seems to be influenced by various psychological factors, including avoidant attachment (avoidance of close emotional relationship) and depressed mood. Sexual desire, different types of motivations for using cybersex, and impulsivity could contribute, to some extent, to this phenomenon. Despite of their preliminary character, current available data lead us to recommend an integrated approach of the treatment of the persons facing these difficulties.
Le terme de « cybersexe ¼ fait référence à l'utilisation d'internet pour des motifs sexuels (pornographie, webcams, rencontres). Alors qu'un usage modéré du cybersexe pourrait avoir des effets positifs sur la vie sexuelle, une petite fraction de ses utilisateurs pourrait en avoir une consommation peu contrôlée avec des conséquences négatives. Ce phénomène dont la compréhension est encore sujette à débats semble influencé par différents facteurs psychologiques, notamment l'attachement évitant (fuite des relations trop intimes) et l'humeur dépressive. Le désir sexuel, le type de motivations à l'usage du cybersexe et l'impulsivité pourraient dans une certaine mesure y contribuer. Malgré leur caractère préliminaire, les données disponibles à ce jour invitent à une approche intégrée du traitement des personnes confrontées à ces difficultés.
Subject(s)
Behavior, Addictive , Sexual Behavior , Erotica , Internet , Surveys and QuestionnairesABSTRACT
Scientific literature shows that sexual dysfunction is more common in patients suffering from psychiatric illness as opposed to the general population. It also shows that the prevalence of sexual dysfunction is underestimated by professionals, partly because patients rarely talk spontaneously about their dysfunctions. However, sexual dysfunction has an impact on patients' mental health. Furthermore, some psychotropic medication, antidepressants and antipsychotics in particular, can hinder sexual functioning and induce sexual dysfunction. These harmful effects can, in turn, reduce patients' compliance with their medical treatments. It is therefore important that practitioners take into account their patients' sexual experience.
Subject(s)
Mental Disorders/epidemiology , Sexual Dysfunction, Physiological/epidemiology , Sexual Dysfunctions, Psychological/epidemiology , Feeding and Eating Disorders/complications , Feeding and Eating Disorders/epidemiology , Humans , Mental Disorders/complications , Mentally Ill Persons/psychology , Mentally Ill Persons/statistics & numerical data , Sexual Dysfunction, Physiological/complications , Sexual Dysfunctions, Psychological/etiologyABSTRACT
Gender dysphoria refers to the distress caused by the discrepancy between a person's gender identity and his or her sex assignment at birth. It can be alleviated by specialized multidisciplinary care, which is summarized in this article.Unfortunately, this disorder is still not widely known in the medical world and this can cause a discriminatory attitude on the part of caregivers and can lead to detrimental patient care.Faced with this finding and the complaints of some patients, we have decided to create a care network which includes healthcare professionals from various disciplines. The professionals in this network aim to improve the quality of care for patients with gender dysphoria and to create a leading care network in French-speaking Switzerland.
Par dysphorie de genre, on désigne la détresse due à la discordance entre l'identité de genre d'une personne et son sexe d'assignation à la naissance. La dysphorie de genre peut être atténuée par une prise en charge spécialisée et pluridisciplinaire, qui est résumée dans cet article.Malheureusement, ce trouble est encore peu connu du monde médical, ce qui amène parfois une attitude discriminante de la part des soignants et un effet plus nocif que positif de certaines prises en charge sur les patients.Face à cette constatation et aux plaintes de certains patients, nous avons décidé de créer un réseau de soins comprenant des soignants des diverses disciplines concernées. Les buts de ce réseau seront d'améliorer la qualité des soins offerts aux patients souffrant de dysphorie de genre et de devenir une référence pour la Suisse romande.
Subject(s)
Delivery of Health Care/organization & administration , Gender Dysphoria/therapy , Gender Identity , Delivery of Health Care/standards , Female , Gender Dysphoria/psychology , Humans , Male , Patient Care Team , Quality of Health Care , SwitzerlandABSTRACT
OBJECTIVE: Our first objective in this paper was to review the literature on psychodynamic rating scales of sexual disorders. Our second objective, based on the findings from our review, was to develop a psychodynamic rating scale for people with sexual disorders: the KAPP-SD. METHOD: We developed the KAPP-SD by modifying an existing psychodynamic rating scale, which assesses stable modes of mental functioning and character traits, the Karolinska Psychodynamic Profile (KAPP). We removed items 13 and 14 of the KAPP and replaced them with three other items-sexual fantasies, conceptions and role of gender identity, and conceptions and role of sexual orientation. These items are part of the assessment of an individual's sexuality and are used to evaluate a person with a sexual disorder psychodynamically. RESULTS: The KAPP-SD, a modified version of the KAPP, can be found in the Appendix. CONCLUSION: We developed the KAPP-SD in order to help sex therapists make a rigorous psychodynamic evaluation of persons with sexual disorders, which would give information on the prognosis and on the type of treatment to offer.
Subject(s)
Psychiatric Status Rating Scales , Sexual Dysfunctions, Psychological/diagnosis , Female , Gender Identity , Humans , Male , Prognosis , Sexual BehaviorABSTRACT
Psychoanalysis and sexology are both int-rested in human sexuality but they do not share the same approach. Sexual medicine and sexotherapy aim to o-jectify sexuality and to treat sexual disorders whereas psychoanalysis is more interested in the discovery and the understanding of the subjective experienceoof sexuality. In psych-analysis, change arises rather from acceptance than modification. Evidence based medicine shows that the efficacy of sex therapy is limited and recommends the use of integrative approaches. Psychoanalysis is a necessary complement to sexology because of the links it forges between functional sexuality and psychosexuality, a sexuality with a psychological and emotional dimension, related to an individual's personal history and his identity.
