From the Department of Experimental Clinical and Health Psychology, Ghent University; and the Department of Endocrinology and the Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium.
Am J Psychiatry. 2017 Dec 1;174(12):1155-1162. doi: 10.1176/appi.ajp.2017.17060626. Epub 2017 Oct 20.
Gender dysphoria describes the psychological distress caused by identifying with the sex opposite to the one assigned at birth. In recent years, much progress has been made in characterizing the needs of transgender persons wishing to transition to their preferred gender, thus helping to optimize care. This critical review of the literature examines their common mental health issues, several individual risk factors for psychiatric comorbidity, and current research on the underlying neurobiology. Prevalence rates of persons identifying as transgender and seeking help with transition have been rising steeply since 2000 across Western countries; the current U.S. estimate is 0.6%. Anxiety and depression are frequently observed both before and after transition, although there is some decrease afterward. Recent research has identified autistic traits in some transgender persons. Forty percent of transgender persons endorse suicidality, and the rate of self-injurious behavior and suicide are markedly higher than in the general population. Individual factors contributing to mental health in transgender persons include community attitudes, societal acceptance, and posttransition physical attractiveness. Neurobiologically, whereas structural MRI data are thus far inconsistent, functional MRI evidence in trans persons suggests changes in some brain areas concerned with olfaction and voice perception consistent with sexual identification, but here too, a definitive picture has yet to emerge. Mental health clinicians, together with other health specialists, have an increasing role in the assessment and treatment of gender dysphoria in transgender individuals.
性别焦虑症是指个体对自己出生时被指定的性别感到心理不适，而认同与出生时被指定的性别相反的性别。近年来，人们在描述希望过渡到自己偏好性别的跨性别者的需求方面取得了很大进展，从而有助于优化护理。这篇文献综述批判性地研究了他们常见的心理健康问题、几种精神共病的个体风险因素，以及目前对潜在神经生物学的研究。自 2000 年以来，西方国家寻求过渡帮助的跨性别者的比例急剧上升；目前美国的估计为 0.6%。在过渡前后，焦虑和抑郁都经常出现，尽管之后有所减少。最近的研究在一些跨性别者中发现了自闭症特征。40%的跨性别者表示有自杀倾向，自残行为和自杀率明显高于一般人群。影响跨性别者心理健康的个体因素包括社区态度、社会接纳和过渡后的身体吸引力。神经生物学方面，尽管结构磁共振成像数据目前不一致，但跨性别者的功能磁共振成像证据表明，一些与嗅觉和声音感知有关的大脑区域发生了变化，这些变化与性认同一致，但在这里，也还没有明确的结论。心理健康临床医生与其他健康专家一起，在评估和治疗跨性别个体的性别焦虑症方面发挥着越来越重要的作用。
