Dysphoria Symptoms Research Articles

Refinements in Gender-Affirming Feminizing Chest Surgery.

Feminizing top surgery, or mammaplasty augmentation, has multiple variables that surgeons can adjust to work synergistically with patient anatomy including plane of implant placement, pocket size, and inframammary fold (IMF) location. In the gender diverse population receiving this procedure to reduce symptoms of gender dysphoria, surgeons should be aware of differing anatomy and surgical approaches for feminizing top surgery. A retrospective chart review was conducted using our institution's electronic health record between December 2019 and May 2023 with a minimum follow up period of 12 months. Inclusion criteria included transgender women, nonbinary patients, and all patients who did not identify as cis-gender women and who underwent feminizing top surgery. Demographic data including age, race, ethnicity, and gender were collected. Complication rates were recorded for hematoma, infection, seroma, wound dehiscence, hypertrophic scar, minor contour abnormalities, implant asymmetry, and revision surgery. Our surgeons' subfascial approach, which uses 2 equations to calculate dissection pocket dimensions and determine placement of pocket and incision based on desired implant base diameter and projection, was performed on 140 gender-diverse patients and resulted in a hematoma rate of 4.29%, an infection rate of 2.86%, and a seroma rate of 1.42% with good cosmetic outcomes, as evidenced by our low rates of minor contour abnormalities (5.71%) and implant asymmetry (1.43%). Only 5 patients (3.57%) required revision surgery. Bilateral breast augmentation with round implants in a subfascial plane using a concealed IMF incision following equations to determine the dissection pocket size and new IMF position and incision position is a reproducible technique that results in good aesthetic outcomes and minimizes complications.

Geriatric Pharmacotherapy Case Series: Clotting and Gender-Affirming Care.

Background A transfeminine patient is a 79-year-old with past medical history significant for type 2 diabetes mellitus, hypertension, gender dysphoria, chronic kidney disease, dyslipidemia, total left hip replacement, and recent provoked deep venous thromboembolism (DVT). She was seen by a pharmacist in a primary care clinic after her discharge from a skilled nursing facility. The patient was experiencing symptoms of gender dysphoria after discontinuation of her estradiol in setting of her DVT. Assessment Her renal function was calculated to ensure she was on appropriate dosing of her medications. Because her DVT was provoked, providers determined she would require only 3 months of anticoagulation. Her laboratory test results showed a subtherapeutic estradiol level and her estradiol was restarted. Additionally, aspirin was being prescribed for primary prevention of atherosclerotic cardiovascular disease and was discontinued. Outcome She has significant improvement in her gender dysphoria symptoms with resuming her estradiol and now has a therapeutic estradiol level. She is tolerating her direct oral coagulant well and reports good quality of life. Conclusion When reviewing medications for patients it is important to take several factors into account, including dose, appropriate indication, and patient preference. Pharmacists play a key role, through collaboration with providers, in assessing these medication-specific factors. Estradiol was stopped in this patient because of her DVT, but given her DVT was provoked after a recent surgery, it was unlikely that estradiol was the cause of her clot. Weighing the risks and benefits for any patient is important when determining what medications are appropriate to continue. Additionally, calculating renal function appropriately in a gender-non-conforming patients ensures appropriate and safe dosing.

Resting vagally-mediated heart rate variability in the laboratory is associated with momentary negative affect and emotion regulation in daily life.

Vagally-mediated heart rate variability (vmHRV) is a physiological index reflecting parasympathetic activity that has been linked to emotion regulation (ER) capacity. However, very limited research has examined associations of physiological indices of regulation such as vmHRV with emotional functioning in daily life. The few studies that exist have small samples sizes and typically focus on only a narrow aspect of ER or emotional functioning. In this study, we examined associations between vmHRV assessed in the laboratory and emotional/mental health functioning in daily life using a 7-day ecological momentary assessment design in 303 adult community participants. We hypothesized that higher resting vmHRV would be associated with higher positive affect (PA), lower negative affect (NA), less affective variability, greater well-being, fewer dysphoria symptoms, greater use of engagement ER strategies, and less use of avoidance ER strategies, as assessed in daily life. Results revealed that higher resting vmHRV in the laboratory (as indexed by both high frequency heart rate variability, HF-HRV, and the root mean of successive square deviations between heart beats, RMSSD) was significantly associated with less frequent use of avoidance ER strategies in daily life. Theoretical and clinical implications are discussed, including the association of vmHRV with negatively valenced, rather than positively valenced, daily life experiences.

Torture Exposure Modulates Cognitive Control and Attention Neural Network Connectivity During a Go/NoGo Task

BackgroundTorture trauma is characterized by intentional uncontrollable acts, but the long-term effects of torture exposure on cognitive control brain mechanisms are unknown. MethodsA final sample of 33 torture survivors (TSs) and 44 non-TSs, all with a refugee background, completed a Go/NoGo response inhibition task during functional magnetic resonance imaging scanning. Data-driven independent component analysis identified active networks across the task and on Go, NoGo, and error of commission trials. Groups were compared on within-/between-network connectivity while for demographic and psychological symptom covariates were controlled for. Secondary analyses investigated whether network connectivity moderated the associations between torture exposure and severity on fear (e.g., re-experiencing) and dysphoria (e.g., anhedonia) posttraumatic stress disorder symptoms. ResultsThe TS group exhibited decreased connectivity (compared with the non-TS control group) within the posterior default mode network (specifically the left precuneus) and auditory-motor network (specifically the right superior temporal gyrus) and reduced connectivity between the dorsomedial frontal network and dorsal attention network across the Go/NoGo task. The TS group also showed more negative ventral attention network connectivity during NoGo (i.e., inhibition) trials. No behavioral effects were observed. Secondary analyses revealed that the association between torture exposure and elevated posttraumatic stress disorder dysphoria (not fear) symptoms was moderated by reduced connectivity in the right superior temporal gyrus and between the dorsomedial frontal network and the dorsal attention network. ConclusionsResponse inhibition, attention, and motor networks appear to be less connected in TSs, which may be specifically linked to posttraumatic stress disorder dysphoria symptom profiles. The findings suggest that targeting cognitive control processes may hold promise for alleviating posttraumatic symptoms among survivors of torture.

Gender dysphoria in adolescence: examining the rapid-onset hypothesis.

The sharp rise in the number of predominantly natal female adolescents experiencing gender dysphoria and seeking treatment in specialized clinics has sparked acontentious and polarized debate among both the scientific community and the public sphere. Few explanations have been offered for these recent developments. One proposal that has generated considerable attention is the notion of "rapid-onset" gender dysphoria, which is assumed to apply to asubset of adolescents and young adults. First introduced by Lisa Littman in a2018 study of parental reports, it describes asubset of youth, primarily natal females, with no childhood indicators of gender dysphoria but with asudden emergence of gender dysphoria symptoms during puberty or after its completion. For them, identifying as transgender is assumed to serve as amaladaptive coping mechanism for underlying mental health issues and is linked to social influences from peer groups and through social media. The purpose of this article is to analyze this theory and its associated hypotheses against the existing evidence base and to discuss its potential implications for future research and the advancement of treatment paradigms.

The Need to Look at Transgender and Gender Diverse People's Health: A Preliminary Descriptive Report on Pain, Sexual Distress, and Health Profile of Five Transmasculine People and One Non-Binary Person with Endometriosis.

The sexual health of transgender and gender diverse (TGD) people with endometriosis has been overlooked, and important emotional experiences, such as sexual distress and its correlates, have been ignored. This has prevented a more comprehensive look at the health experiences of TGD individuals. This descriptive online survey study preliminarily explored the experiences of pain symptoms, sexual distress, and mental health of N = 6 TGD individuals diagnosed with endometriosis. Descriptive results showed a mean delay of 10 years from the onset of symptoms to the diagnosis. Endometriosis-related pain was a common symptom, although with low to moderate intensity. Results also showed higher mean levels of pain impact, powerlessness and lack of control, somatization, depression, anxiety, and sexual distress, and lower mean levels of emotional well-being, social support, and worse self-image compared to reports on cisgender women with endometriosis in the literature. These results suggested that sexual and mental health in the context of TGD people with endometriosis has specificities and may be associated with factors that need to be accounted for to provide comprehensive and socially just healthcare, such as the recognition of the impact of endometriosis treatment on symptoms of gender dysphoria. To achieve sexual health equity for TGD people, continuous and updated professional training and inclusive research with multiple informants are necessary.

Dysphoric Milk Ejection Reflex: Characteristics, Risk Factors, and Its Association with Depression Scores and Breastfeeding Self-Efficacy.

Background: Dysphoric milk ejection reflex (D-MER) is a phenomenon that occurs before milk letdown and is described as a wave of negative or devastating emotions, ranging from mild to severe and lasting for seconds to minutes. To date, there has been little research regarding this phenomenon. This study aims to determine the prevalence of D-MER in our population as well as its association with postnatal depression scores and breastfeeding self-efficacy. Methods: Lactating persons between 4 and 12 weeks postpartum at our institution were invited to complete an anonymous 59-question survey via an online platform. Questions asked included patient demographics, presence of symptoms of dysphoria (including timing, duration, and frequency), the Edinburgh Postnatal Depression Scale (EPDS), and the Breastfeeding Self-Efficacy Scale Short Form (BSES-sf). Results: In total, 201 women completed the survey. Twelve women were classified as likely having D-MER (6%). Symptom resolution primarily occurred within a minute to 5 minutes (58%). Mean EPDS scores differed significantly between those with likely D-MER and those without (12.2 vs. 5.4, p = 0.002). BSES-sf scores differed significantly between the two groups (43.1 vs. 52.5, p = 0.009). Preexisting depression or anxiety was not associated with D-MER (p = 0.133), other reported mood disorders differed significantly between those with D-MER and those without (p = 0.004). Demographic characteristics of women with and without D-MER were similar. Conclusion: D-MER prevalence may be lower than previously reported. Patients with likely D-MER appear to have lower breastfeeding self-efficacy and higher depression scores. Those with preexisting mood disorders may be at higher risk of experiencing D-MER.

Cognitive Reappraisal is Associated with Lower Dysphoria Symptoms During the COVID-19 Pandemic

The COVID-19 pandemic has created unprecedented mental health concerns generally, but particularly for young adults navigating an already fluctuating and uncertain period of their lives. While there are many factors related to mental health, it is well-documented that emotion regulation– the ability to modulate an emotion or set of emotions– and risk perception appear to be relevant to the development, maintenance, and treatment of psychopathology. The current study aimed to assess the relationship between emotion regulation processes, COVID-19 risk perception, and dysphoria symptoms during the early months of the pandemic. Between April - May 2020, 243 undergraduate participants completed the Emotion Regulation Questionnaire, the dysphoria subscale of the IDAS-II, and questions about their perceived risk of COVID-19. Two subfacets of emotion regulation known as cognitive reappraisal and expressive suppression were analyzed specifically. Results indicated, contrary to hypotheses, no significant interaction between cognitive reappraisal and risk perception on dysphoria, nor was there a significant interaction between expressive suppression and risk perception on dysphoria. However, there were significant main effects of cognitive reappraisal on dysphoria and expressive suppression on dysphoria indicating cognitive reappraisal may be a more beneficial emotion strategy for maintaining mental health.

Co-occurring trauma- and stressor-related and substance-related disorders in youth: A narrative review

Adolescence is characterized by ongoing neurodevelopment and psychosocial development, resulting in a unique window to the adverse effects of traumatic events and substance use. In addition, trauma- and stressor-related disorders and substance use disorders (SUDs) commonly co-occur in adolescents. Youth with interpersonal violence and who have experienced multiple past traumas, or poly-victimization, are at the highest risk of developing these co-occurring disorders. There is a strong bidirectional relationship between traumatic events and substance use that predisposes youth to developing post-traumatic stress symptoms (PTSS) and SUDs. PTSD and states of substance intoxication and withdrawal also exhibit overlap in symptomatology. High rates of comorbidity may be explained in part by the self-medication hypothesis, that posits that individuals use substances to temporarily alleviate trauma-related symptoms. However, this results in negative reinforcement, often with increasing patterns of substance use and worsening symptoms of hyperarousal, dysphoria, and anxiety. In addition, PTSS and substance use problems share common risk factors and neurobiologic etiology, conceptualized as the susceptibility hypothesis. Youth who experience traumatic events and/or have substance use problems access the healthcare system at multiple levels, including through acute care and crisis services. Notably, substance use in adolescence increases the likelihood of experiencing a traumatic event, and youth presenting to the emergency department for substance-related problems are at higher risk of having a PTSD. Youth presenting for mental health, behavioral, or substance-related problems should be screened for PTSS and substance use problems. Given the strong clinical overlap and bidirectional relationship, evidence-based treatment integrates management of both disorders. An interdisciplinary approach with psychotherapy, psychopharmacologic therapy, and case management is often vital to engaging and maintaining youth in treatment.

A Pilot Trial of Stepwise Implementation of Virtual Reality Mindfulness and Accelerated Transcranial Magnetic Stimulation Treatments for Dysphoria in Neuropsychiatric Disorders

Dysphoria is a transdiagnostic symptom that causes considerable suffering. Implementation of established self-care and clinical treatment options, such as mindfulness and transcranial magnetic stimulation (TMS), is typically disjointed for conditions involving dysphoria. There is a need for a rapid progression of accessible treatments that can be efficacious across multiple comorbidities. In a pilot stepwise implementation study to assess feasibility and effectiveness, adult participants with dysphoria (depression, anxiety, PTSD, and/or chronic pain) went through a treatment course of VR mindfulness, then accelerated TMS (accel-TMS) over the left dorsolateral prefrontal cortex (left dlPFC), then accel-TMS over the dorsomedial prefrontal cortex (dmPFC). Participants who did not benefit from one treatment phase progressed to the next until remission or study completion. Twenty-four participants were enrolled with 23 in VR mindfulness (phase 1), 19 in accel-TMS left dlPFC (phase 2A), and 13 in accel-TMS dmPFC (phase 2B). For our primary outcome measure of the short form-36 emotional well-being subscale (paired t -test), no significant change was found in phase 1 ( n = 19 , p = .226 ), significant improvement was found in phase 2A ( n = 19 , p = .038 ), and no significant change was found in the smaller sample of phase 2B ( n = 12 , p = .089 ). Symptom improvement was largely supported by clinician-administered scales, with more significant changes found in accel-TMS left dlPFC and dmPFC. The benefits of VR mindfulness were limited; however, both accel-TMS phases showed a significant impact on secondary measures of depression, anxiety, and PTSD. This stepwise protocol shows promise in providing an approach to rapidly improve symptoms of dysphoria in transdiagnostic populations. This trial is registered with NCT05061745.

Comorbidity Patterns of Posttraumatic Stress Disorder and Depression Symptoms: Cross-Validation in Two Postearthquake Child and Adolescent Samples

Background. Children and adolescents who have been exposed to a major natural disaster are more likely to suffer from posttraumatic stress disorder (PTSD) and depression. However, only a few studies have examined comorbidity patterns at the symptom level. Furthermore, researchers should validate their findings using multiple samples to address the psychological reproducibility challenge. Methods. The Child PTSD Symptom Scale (CPSS) and Center for Epidemiological Studies Depression Scale for Children (CES-DC) were administered to two postearthquake child and adolescent samples (Wenchuan earthquake, N = 1506 ; Ya’an earthquake, N = 720 ). Each sample was followed up twice. Comorbidity patterns were characterized by cross-lagged panel network analysis (CLPN), and communities were determined by bootstrap exploratory graphical analysis (bootEGA). Results. Except for having difficulty remembering important aspects of the trauma, the remaining dysphoria symptoms could be considered bridge symptoms between PTSD and depression. Most often, intrusive and avoidant symptoms clustered together, whereas dysphoria symptoms tended to cluster with depressive symptoms. The relationship between PTSD and depression was reciprocal; within PTSD, intrusive symptoms often triggered avoidance symptoms. The correlation coefficient between the two networks was 0.70, and the correlation coefficient of node centrality was 0.55. Findings. The association between dysphoria symptoms and depression was strong, and intrusive symptoms constituted the core symptoms of PTSD. Depression and PTSD were causally related, explaining the high comorbidity rates. Two sample networks had similar global characteristics but different local characteristics. The conclusions can be generalized to some extent.

Opponent intrinsic brain network connectivity profiles associated with posttraumatic fear and dysphoria symptoms in trauma-exposed refugees.

Resting-state functional magnetic resonance imaging (rsfMRI) studies report functional alterations in the connectivity between intrinsic brain networks in posttraumatic stress disorder (PTSD), but PTSD heterogeneity is rarely considered. Evidence points to fear (e.g., reexperiencing) and dysphoria (e.g., withdrawal) symptom factors as important in PTSD presentations, including relating to variable emotion dysregulation patterns. This study, therefore, tested how fear and dysphoria posttraumatic symptoms were differentially associated with core network connectivity and emotion dysregulation behaviors in a large group of trauma-exposed refugees. A final sample of 77 trauma-exposed participants completed a rsfMRI scan. Independent component analysis identified active networks and functional network connectivity (FNC) between networks was assessed. Fear and dysphoria posttraumatic symptoms were partially correlated with FNCs, and linear regression models examined relationships with self-reported difficulties in emotion regulation. Twenty-three active networks were identified, eight being in the networks of interest (p < .05 false discovery rate-corrected). Fear and dysphoria symptoms were specifically related to connectivity patterns between two subnetworks of the default mode network (DMN). Fear symptoms were negatively associated with anterior dorsomedial DMN (admDMN) and temporoparietal DMN (tpDMN) connectivity; whereas dysphoria symptoms were positively associated with admDMN-tpDMN connectivity. Additionally, admDMN-tpDMN connectivity was positively predicted by goal-directed emotion dysregulation but negatively predicted by poor emotional clarity. Fear and dysphoria posttraumatic symptoms showed opponent associations with admDMN and tpDMN connectivity, potentially reflecting patterns of under- and overemotion dysregulation associated with these symptom profiles respectively. Findings highlight the importance of considering posttraumatic heterogeneity when constructing neural models of PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supplemental Material for Opponent Intrinsic Brain Network Connectivity Profiles Associated with Posttraumatic Fear and Dysphoria Symptoms in Trauma-Exposed Refugees

Supplemental Material for Opponent Intrinsic Brain Network Connectivity Profiles Associated with Posttraumatic Fear and Dysphoria Symptoms in Trauma-Exposed Refugees

Capturing mood dynamics through adolescent smartphone social communication.

Most adolescents with depression remain undiagnosed and untreated-missed opportunities that are costly from both personal and public health perspectives. A promising approach to detecting adolescent depression in real-time and at a large scale is through their social communication on the smartphone (e.g., text messages, social media posts). Past research has shown that language from online social communication reliably indicates interindividual differences in depression. To move toward detecting the emergence of depression symptoms intraindividually, the present study tested whether sentiment (i.e., words connoting positive and negative affect) from smartphone social communication prospectively predicted daily mood fluctuations in 83 adolescents (Mage = 16.49, 73.5% female) with a wide range of depression severity. Participants completed daily mood ratings across a 90-day period, during which 354,278 messages were passively collected from social communication apps. Greater positive sentiment (i.e., more positive weighted composite valence score and a greater proportion of words expressing positive sentiment) predicted more positive next-day mood, controlling for previous-day mood. Moreover, greater proportions of positive and negative sentiment were, respectively, associated with lower anhedonia and greater dysphoria symptoms measured at baseline. Exploratory analyses of nonaffective linguistic features showed that greater use of social engagement words (e.g., friends and affiliation) and emojis (primarily consisting of hearts) predicted more positive changes in mood. Collectively, findings suggest that language from smartphone social communication can detect mood fluctuations in adolescents, laying the foundation for language-based tools to identify periods of heightened depression risk. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychodynamic psychotherapy in the diagnosis and treatment of gender dysphoria

Relevance. In this article, we consider the possibilities of a psychodynamic psychotherapeutic approach in the diagnosis and treatment of gender dysphoria on the example of a clinical case. Gender dysphoria refers to the distress that may accompany a mismatch with the patient's biological sex and assigned gender. In the past few years, there has been an increase in the number of patients requesting the restoration of congenital anatomical sex characteristics due to regret after genderaffirmation surgery (GAS). Recent studies have shown that one of the key regrets after GAS is inadequate psychological and psychiatric evaluation in determining whether GAS is an indication.Case study. In this article, we explored how psychodynamic psychotherapy can be used to diagnose and treat disorders associated with gender dysphoria in the case of a 21-year-old man who presented with symptoms that met the diagnostic criteria for two conditions: unspecified gender dysphoria 302.85 (F64.1) and transvestic disorder with autogynephy 302.3 (F65.1) according to DSM-5. The main symptom appeared when the patient was at pre-school age and has been a constant concern ever since. The symptoms disappeared after psychodynamic psychotherapy, which lasted 11 months. Evaluation of psychotherapeutic effects 2 years after the completion of psychotherapy showed the stability of the results achieved.Conclusion. Based on our analysis, we concluded that the use of psychodynamic psychotherapy for patients with gender dysphoria helps recognize neurotic conflicts that may underlie transgender symptoms, and thereby reduce the likelihood of a diagnostic error in determining the presence of indications for GAS. Looking at cases of gender dysphoria in Balint groups can also be of great help in understanding the etiology of gender dysphoria symptoms.

Case Series of Ischemic Stroke occurring in Male- to- Female Transgender population on Gender - Affirming Hormonal Therapy and Review of the Literature (P2-5.022)

<h3>Objective:</h3> To stress the importance of individualized vascular risk assessment and shared decision-making to continue Gender-Affirming Hormonal therapy (GAHT) in the Male to Female (MTF) transgender population following ischemic stroke with review of the literature. <h3>Background:</h3> Transgender individuals have higher mental health burden and suicide rates. GAHT is the standard of care for transgender individuals suffering from symptoms of gender dysphoria. Estrogen therapy has been associated with increased stroke risk, but its specific contribution is poorly characterized and appears to be impacted by the route of administration. <h3>Design/Methods:</h3> We include three self-identified MTF transgender patients who had taken GAHT and treated for ischemic stroke inpatient or were seen for stroke follow-up. Data was gathered from chart review including demographics, vascular risk factors, type of GAHT, clinical course, and outcomes. <h3>Results:</h3> Two MTF transgender patients on GAHT were treated inpatient for an acute stroke and one was seen in follow up. At the time of infarct, one MTF transgender patient was on combination hormonal therapy, one patient was on combination hormonal therapy and spironolactone, and one patient was on estrogen hormonal therapy of unknown type. Traditional vascular risk factors were present in the patient population prior to ischemic stroke including: hypertension, hyperlipidemia, type 2 diabetes mellitus, morbid obesity, prior ischemic stroke, tobacco use disorder, alcohol use disorder. <h3>Conclusions:</h3> Each patient in our small series had traditional vascular risk factors in addition to GAHT use prior to ischemic infarct. Identifying and treating comorbid vascular risk factors in MTF transgender patients prior to and during GAHT is essential to decrease ischemic stroke risk. Additional studies are needed to determine the relative impact of GAHT on stroke risk. Given mental health burden of gender dysphoria symptoms, shared decision-making is necessary to determine risks and benefits of continuing GAHT after ischemic stroke in MTF transgender patients. <b>Disclosure:</b> Ms. Giovannini has nothing to disclose. An immediate family member of Dr. Ivan has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Cellular and Molecular Medicine. An immediate family member of Dr. Ivan has received intellectual property interests from a discovery or technology relating to health care. Dr. Karel has nothing to disclose.

Decentering from Emotions in Daily Life: Dynamic Associations with Affect, Symptoms, and Wellbeing.

Decentering is thought to be protective against a range of psychological symptoms, but little is known about the outcomes of decentering as a momentary state in daily life. We used ecological momentary assessment (42 reports across one week) to examine the temporal ordering of the associations of decentering with affect, dysphoria, participant-specific idiographic symptoms, and wellbeing. We also hypothesized that greater decentering predicts less inertia (persistence) of each variable, and weakens the association of affect with dysphoria, idiographic symptoms, and wellbeing. Results in 345 community participants indicated that decentering and these variables were mutually reinforcing over time, and that greater decentering was associated with less inertia of negative affect and dysphoria. Decentering generally predicted reduced impact of positive and negative affect on dysphoria symptoms, but results were mixed when predicting idiographic symptoms or wellbeing. Clinical implications and refinements for theory on decentering are discussed.

Assessment and treatment of a gender-dysphoric person with a traumatic history

ABSTRACT This paper presents a composite case based on a group of female-to-male transitioners with a history of trauma due to early separation or family illness. These early traumas may interfere with the process of integrating the mind and body. Symptoms of gender dysphoria often arise from, or increase in response to, subsequent separations later in life, as individuals transition from childhood to adulthood. Increased referrals to gender clinics are noted at puberty or the point of separation from the family, as individuals face the prospect of leaving home to go to university. Affected by anxieties associated with the onset of puberty or separation anxieties, these individuals sometimes seek a medical transition to gain control over their bodies. Exploring underlying psychoanalytic issues can help clinicians assess various conscious and unconscious influences, and help patients make more informed decisions on whether to pursue a medical transition. A focus on defence mechanisms and forms of thinking can help clinicians find ways of working with individuals who may be highly defensive and concrete in their thinking and feel threatened by the functioning of their minds.

Qualitative Assessment of the Experiences of Transgender Individuals Assigned Female at Birth Undergoing Gender-Affirming Mastectomy for the Treatment of Gender Dysphoria.

Evaluation and comparison of outcomes following gender-affirming mastectomy have been hindered by the lack of a validated population- and surgery-specific patient-reported outcome measure (PROM). The purpose of this study was to explore the lived experiences of transgender individuals assigned female at birth (AFAB) from before-to-after gender-affirming mastectomy to identify key qualitative themes that might inform the creation of a quantitative PROM in the future. Identified candidates were transgender men AFAB, 18-65 years of age (mean±standard deviation: 30.3±12.2), who had undergone gender-affirming mastectomy from 2015 through 2017 (n=53). Twelve individuals participated in either focus groups (6) or phone interviews (6), carried out in a semistructured fashion. Verbatim transcriptions were anonymized. Conventional content analysis was used to code all transcripts. Content analysis identified six key themes experienced by transgender men undergoing gender-affirming mastectomy. In contrast to their experiences before surgery, participant reported that after surgery they experienced fewer symptoms of gender dysphoria, lower anxiety associated with gender dysphoria, less fear about physical safety, no need to hide a female chest shape, and that they passed as male. Also explored were themes about experiences with the health care team. This study presents the first qualitative data based on the lived experiences of transgender individuals AFAB who underwent gender-affirming mastectomy. These qualitative themes should be heavily considered when creating a quantitative PROM that will fully capture the changes transgender individuals AFAB experience from before-to-after gender-affirming mastectomy.

Individual differences among older adults with mild and moderate dementia in social and emotional loneliness and their associations with cognitive and psychological functioning

BackgroundLoneliness is a major health issue among older adults. The aim of this study was to assess the relationship between loneliness, in its social and emotional facets, and the cognitive (language), and behavioral/psychological functioning as well as quality of life (QoL) in people with mild and moderate dementia, i.e., considering dementia severity as an individual characteristic.MethodsThis cross-sectional study involved 58 people with mild dementia and 55 people with moderate dementia. Participants completed the Social and Emotional Loneliness scale, along with measures assessing their language skills, the frequency and severity of their behavioral and psychological symptoms, and their QoL.ResultsSocio-demographic characteristics and depression, but not loneliness or its social and emotional facets, contributed to explain participants’ behavioral and psychological symptoms, regardless of dementia severity. Loneliness explained, though to a small extent (8% of variance), language skills in people with moderate dementia, with social loneliness only accounting for language skills (18% of variance) in this group. Loneliness also modestly accounted for dysphoria symptoms in both the mildly and moderately impaired (6% and 5% of variance, respectively) individuals with social loneliness predicting dysphoric mood in the former group only (7% of variance). Loneliness also explained, to a larger extent, QoL in both the mildly impaired and moderately impaired individuals (27% and 20% of variance, respectively), its social facet predicting QoL in the mildly impaired (30% of variance), and its emotional facet in the moderately impaired (21% of variance) group.ConclusionThese findings suggest that loneliness and its facets have a clear impact on perceived QoL, and influence the language skills and dysphoria symptoms of people with dementia, to a degree that depends on dementia severity. The assessment of loneliness and its facets in people with dementia considering dementia severity, and the promotion of social inclusion to reduce it should be considered by professionals.