Leibowitz Scott, de Vries Annelou L C
a Ann & Robert H. Lurie Children's Hospital of Chicago , Department of Psychiatry and Behavioral Science, Northwestern Feinberg School of Medicine , Chicago , Illinois ;
b Departments of Pediatrics, Pediatric Psychology, and Child and Adolescent Psychiatry, Centre of Expertise on Gender Dysphoria , VU University Medical Centre , Amsterdam , Netherlands.
Int Rev Psychiatry. 2016;28(1):21-35. doi: 10.3109/09540261.2015.1124844. Epub 2016 Feb 1.
Adolescents presenting with gender-related concerns are increasingly seeking support from providers from a variety of disciplines within health care settings across the world. For those treating young people who meet the criteria for the DSM 5 diagnosis of gender dysphoria (GD), complex decisions in clinical care are common. Defining best practice with this population with respect to interventions that span mental health, physical, and surgical domains can be challenging, given a relative dearth of empirical data available; yet practice guidelines have emerged from different professional organizations which can aid with this. For this review paper, a broad literature search was performed to identify relevant studies pertaining to the care of adolescents with GD. In addition, an overview of trends in clinical practice, including shifts in conceptualization of how clinicians and patients define care that is considered affirming when working with this population, is described. This paper explores the characteristics of referral patterns to specialized clinics, provides a brief overview of gender identity development in adolescence, and then describes the phenomenology of known aetiological factors and co-occurring psychiatric issues in adolescents with GD. Additionally, clinical management considerations that detail assessment aims and common treatment interventions across disciplines will be explored.
世界各地医疗机构中,越来越多存在性别相关问题的青少年寻求来自不同学科医疗服务提供者的支持。对于那些治疗符合《精神疾病诊断与统计手册》第5版(DSM-5)性别焦虑症(GD)诊断标准的年轻人来说,临床护理中常见复杂的决策。鉴于可用的实证数据相对匮乏,确定针对这一人群在跨越心理健康、身体和手术领域的干预措施方面的最佳实践具有挑战性;然而,不同专业组织已经出台了实践指南,可对此提供帮助。在这篇综述论文中,我们进行了广泛的文献检索,以确定与GD青少年护理相关的研究。此外,还描述了临床实践的趋势概述,包括临床医生和患者在与这一人群合作时如何定义被认为是肯定性护理的概念化转变。本文探讨了转诊至专科诊所的模式特点,简要概述了青少年性别认同发展,然后描述了GD青少年已知病因因素和共病精神问题的现象学。此外,还将探讨详细说明评估目标和各学科常见治疗干预措施的临床管理考量。