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消除性别焦虑症诊断中的社会污名的最佳方法是什么?

What is the Best Approach to Removing the Social Stigma from the Diagnosis of Gender Dysphoria?

作者信息

Milionis Charalampos

机构信息

Department of Endocrinology, Diabetes, and Metabolism, 'Elena Venizelou' General Hospital, Elena Venizelou Square 2, Athens, 11521, Greece.

出版信息

Health Care Anal. 2025 Mar;33(1):52-62. doi: 10.1007/s10728-024-00509-8. Epub 2025 Jan 9.

DOI:10.1007/s10728-024-00509-8
PMID:39786479
Abstract

Historically, the transgender population has faced prejudice and discrimination within society. The purpose of diagnostic terms is to direct clinical care and facilitate insurance coverage. However, the existence of a medical diagnosis for gender nonconformity can exacerbate the stigmatization of transgender people with adverse consequences on their emotional health and social life. Whether transgenderism and gender dysphoria are indeed a psychopathological condition or even any kind of nosological entity is a contested issue. Many advocates of human rights, trans activists, social scientists, and clinicians support either the removal of gender incongruence from the list of mental disorders or at least its transfer to a separate category. Reforming the classification is an intermediate step toward depathologization and permits access to transgender-related care. Nonetheless, it partly preserves the stigma associated with abnormality and puts the availability of psychiatric care at risk. A more radical approach dictates that the classification of diseases serves exclusively medical purposes and must be dissociated from the respect for the legitimacy of one's autonomy and dignity. In the long term, only a swing in societal values can detach stigma from mental and physical illnesses. Enhancing collective respect for life, human rights, and diversity is the best way to achieve cohesion and well-being among members of society. Health professionals can be pioneers of social change in this field.

摘要

从历史上看,跨性别群体在社会中一直面临偏见和歧视。诊断术语的目的是指导临床护理并促进保险覆盖。然而,针对性别不一致的医学诊断的存在可能会加剧对跨性别者的污名化,对他们的情绪健康和社会生活产生不良影响。跨性别主义和性别焦虑症是否确实是一种精神病理状况,甚至是否属于任何一种疾病分类实体,是一个有争议的问题。许多人权倡导者、跨性别活动家、社会科学家和临床医生支持要么将性别不一致从精神障碍列表中删除,要么至少将其转移到一个单独的类别。改革分类是迈向去病理化的中间步骤,并允许获得与跨性别相关的护理。尽管如此,它部分保留了与异常相关的污名,并使精神科护理的可及性面临风险。一种更激进的方法认为,疾病分类仅服务于医学目的,必须与对一个人的自主权和尊严的合法性的尊重脱钩。从长远来看,只有社会价值观的转变才能消除对精神疾病和身体疾病的污名。增强对生命、人权和多样性的集体尊重是实现社会成员之间凝聚力和福祉的最佳方式。卫生专业人员可以成为该领域社会变革的先驱。

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本文引用的文献

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Preparing for the International Classification of Diseases, 11th Revision (ICD-11) in the US Health Care System.为美国医疗保健系统中的《国际疾病分类》第11次修订版(ICD-11)做准备。
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How gender dysphoria and incongruence became medical diagnoses - a historical review.性别焦虑和不和谐如何成为医学诊断-历史回顾。
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The Body I Live in. Perceptions and Meanings of Body Dissatisfaction in Young Transgender Adults: A Qualitative Study.我所生活的身体。年轻跨性别成年人身体不满的认知与意义:一项定性研究。
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Sex, gender and gender identity: a re-evaluation of the evidence.性别、社会性别与性别认同:证据的重新评估
BJPsych Bull. 2021 Oct;45(5):291-299. doi: 10.1192/bjb.2020.73.
10
The phenomenology of gender dysphoria in adults: A systematic review and meta-synthesis.成人性别焦虑症的现象学:系统综述和荟萃分析。
Clin Psychol Rev. 2020 Aug;80:101875. doi: 10.1016/j.cpr.2020.101875. Epub 2020 Jun 11.