Clarke Patrick, J Amos Andrew
Faculty of Health and Medical Science, Adelaide Health and Medical Sciences building, University of Adelaide, North Adelaide, SA, Australia.
Division of Tropical Health and Medicine, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
Australas Psychiatry. 2025 Apr;33(2):282-288. doi: 10.1177/10398562241276978. Epub 2024 Aug 29.
ObjectiveTo describe the increasing number and changing demographics of patients presenting with gender dysphoria and provide an account of patient- and clinician-related factors which may have contributed to these changes. The concept of abnormal illness behaviours introduced by Pilowsky, and its extension to the concept of abnormal treatment behaviours by Singh, provides a framework for understanding healthy and pathological interactions between gender dysphoria patients and their doctors.ConclusionsAbnormal illness behaviours driven by the reinforcing contingencies of gender-affirming care may explain, in part, the increasing number and changing demographics of gender dysphoria, as well as the increasing incidence of desistance and detransition. The under-diagnosis and under-treatment of mental health disorders by clinicians treating these patients are examples of abnormal treatment behaviours. Uncritical affirmation of patient reported gender identity appears likely to conceal unconscious motivations of some patients and clinicians, increasing the risks of harm to both.
目的
描述出现性别焦虑症的患者数量增加及人口统计学变化情况，并阐述可能导致这些变化的患者及临床医生相关因素。皮洛斯基提出的异常疾病行为概念，以及辛格将其扩展至异常治疗行为概念，为理解性别焦虑症患者与其医生之间的健康及病理互动提供了一个框架。
结论
由性别肯定治疗的强化意外事件驱动的异常疾病行为，可能部分解释了性别焦虑症患者数量增加、人口统计学变化，以及停止治疗和转变治疗的发生率上升的原因。治疗这些患者的临床医生对心理健康障碍的诊断不足和治疗不足是异常治疗行为的例子。对患者报告的性别认同不加批判地肯定，似乎可能掩盖一些患者和临床医生的无意识动机，增加对双方造成伤害的风险。
