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Abstract Background The number of people seeking gender reassignment (GR) has increased everywhere and these increases particularly concern adolescents and emerging adults with female sex. It is not known whether the psychiatric needs of this population have changed alongside the demographic changes. Methods A register-based follow-up study of individuals who contacted the nationally centralized gender identity services (GIS) in Finland in 1996–2019 (gender dysphoria [GD] group, n = 3665), and 8:1 age and sex-matched population controls (n = 29,292). The year of contacting the GIS was categorized to 5-year intervals (index periods). Psychiatric needs were assessed by specialist-level psychiatric treatment contacts in the Finnish Care Register for Hospital Care in 1994–2019. Results The GD group had received many times more specialist-level psychiatric treatment both before and after contacting specialized GIS than had their matched controls. A marked increase over time in psychiatric needs was observed. Among the GD group, relative risk for psychiatric needs after contacting GIS increased from 3.3 among those with the first appointment in GIS during 1996–2000 to 4.6 when the first appointment in GIS was in 2016–2019. When index period and psychiatric treatment before contacting GIS were accounted for, GR patients who had and who had not proceeded to medical GR had an equal risk compared to controls of needing subsequent psychiatric treatment. Conclusion Contacting specialized GIS is on the increase and occurs at ever younger ages and with more psychiatric needs. Manifold psychiatric needs persist regardless of medical GR.

Introduction Gender dysphoria is characterized by a mismatch between the biological sex and gender identity of a person, frequently associated to distress or discomfort. Many transgender people will seek professional help to obtain a congruence between the gender identity and the body. Objectives Brief review of the literature in the field of mental health and gender dysphoria. Methods Review of the literature, through research in the PubMed database, using the following keywords: “gender dysphoria”, “mental health”, “psychiatric disorders”. Results Although the true prevalence of gender dysphoria (GD) is unknown, several studies indicated that the prevalence of psychiatric disorders in this population is elevated. In comparison with the general population, persons with GD have higher rates of depressive symptoms (64.5%), suicidality (42.9%), substance use disorders (40.2%), general distress (33.8%), anxiety (25.9%), discrimination, and stigma, that contribute to mental health problems. Even though, we cannot reach firm conclusions due to the lack of controlled studies exploring psychiatric disorders on GD people versus controls. An interdisciplinary approach to the health and well-being of this population is highly recommended. Social support, community connectedness, and effective coping strategies appear beneficial. Conclusions Individuals with GD have higher rates of psychiatric disorders and social stressors. Healthcare professionals should have a basic understanding on GD. Management should be individualized and may involve a multidisciplinary team. It would be important to have access to more controlled studies in order to achieve a better characterization of the prevalence of mental health disorders in this population. Disclosure No significant relationships.

Introduction We present the clinical case of a patient where the psychotic clinic coexists with gender dysphoria. This scenario can be the result of a change in gender identity derived from the psychotic process or appear independently of it. Objectives We want to explain the importance of knowing how to act with a patient in whom these two processes coexist. Methods 20-year-old woman, with no history of mental health. She comes to the emergency department for behavioral alteration. The family observes strange behaviors, unmotivated laughter, soliloquies and aggressive episodes. Abandonment of studies, hobbies and radical physical change. Delusions of prejudice and self-referential delusions. Possible phenomena of echo and diffusion of the thought. Auditory hallucinations talking to her in male gender, since then she presents doubts about her sexual identity and manifests her desire to change sex. Altered judgment of reality. Results During admission, we started treatment with an antipsychotic with good tolerance and she was referred to mental health team, where psychopharmacological treatment was adjusted with good response. In the following medical appointments the psychotic clinic disappeared at the same time that sexual identification was completely restored and made a critique of the behavior and experiences. Conclusions This case highlights the importance of assessing the chronology of symptoms, the patient’s criticality, the response to antipsychotic treatment and the need to exclude the psychotic background of the desire for gender reassignment before making a therapeutic decision. Disclosure No significant relationships.

Introduction Eating disorders (ED) and gender dysphoria (GD) are associated with a change in body perception. Therefore, body dissatisfaction plays a common and central role in these disorders. In GD, body image concerns are related to the features of the biological sex. In ED, body dissatisfaction comes from a distorted perception of weight and body shape and plays an important role in the development and maintenance of the psychopathology. Objectives To present and discuss the clinical case of a patient with a previous diagnosis of GD who presented with a clinical condition suggesting a restrictive anorexia nervosa (AN). Methods Patient´s clinical files consultation and literature review using Pubmed and the keywords: eating disorders and gender dysphoria. Results We present the case of a 25-year-old patient who was living in a shelter for victims of domestic violence and was admitted for severe restrictive AN. The patient was discharged after 40 days and medicated with sertraline, diazepam and olanzapine, as well as her previous medication (hormonal therapy): cyproterone, finasteride, estradiol, oxybutynin. Conclusions Although studies on this subject are still scarce, there has been some progress and the literature recognizes the coexistence of these conditions. However ED symptoms in patients with GD could have a different meaning: they may represent a dysfunctional coping strategy adopted to block features of the biological sex. Therefore health professionals may take a more holistic approach to body image. Additional studies will be necessary, allowing the establishment of cause-consequence interactions between weight loss and psychopathology related to GD. Disclosure No significant relationships.

Introduction Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized with difficulties in social interaction/communication, restricted interests, and repetitive behaviors. Sexual issues such as paraphilic behaviors in ASD have gained attention in recent years, however there is still a great paucity of research regarding this issue. Objectives The aim of this presentation is to draw attention to a crucial dimension through a case of ASD with paraphilic disorder (pedophilic tendencies) and gender dysphoria. Methods One case from an inpatient unit of a psychiatric clinic in Lower Saxony, Germany will be reported. Results Case: An 18-year-old male was referred to our acute psychiatric ward due to suicidal thoughts and other depressive symptoms. In further examination, he stated that he had pedophilic phantasies which he was trying to satisfy by using child pornography in the darknet. He had never been involved in any sexual relationship with a child and described this behavior as an addiction that he wanted to get rid of. Detailed psychiatric examination and developmental history yielded the diagnosis of high-functioning ASD. The compulsory paraphilic engagement is classified as a restrictive-repetitive interest in terms of ASD. In addition, the patient presented gender incongruence with moderate gender dysphoria, dressed in a skirt and wanted to be perceived and named rather gender-neutral, which was supported through the whole course. Conclusions Through systemic understanding of the high-functioning ASD structure and complex symptomatology, socio- and psychotherapeutic approaches were implemented which yielded an apparent stabilization. The detailed therapeutic process in the light of the present literature will be discussed. Disclosure No significant relationships.

Introduction Mental health remains key comorbidity in the transgender population. There are more grave consequences on mental health if there is long-term incarceration history of a transgender person. 21% of transgender women are incarcerated in their lifetime, compared to

Introduction As the incidence of gender incongruence (GI)/gender dysphoria (GD) rises yearly, public understanding of transgender is also increasing, whereas this improvement cannot be achieved without extensive transgender-related surveys. However, most of the surveys were only issued to people who identify themselves as transgender with the absence of medical confirmations in most situations. These result in a gap between transgender survey and diagnosed GI/GD. Objectives This study aims to discover the gap between self-reported and diagnostically confirmed transgender and GI/GD individuals among students in China. Methods We chose two middle schools and one college from Changsha (a city in China) at random with a total of 2047 students. Among them, 1661 students gave us certain gender identify responses in which we categorized them into two types (cisgender and gender minorities). Professional psychiatrists then used ICD-11 and DSM-5 criteria to confirm whether the self-reported gender minorities could be diagnosed with GI/GD via phone or in person. Results In total, 7.5% of the college students and 5.8% of the middle school students reported themselves as gender minorities. Although 29% of college students and 43.8% of middle school students did not cooperate with the subsequent psychiatric interviews, none of the self-reported gender minority students meet the GI/GD criteria of ICD-11/DSM-5. Conclusions The epidemiological investigation of transgender is heavily affected by the definition and the data sources. There is a huge heterogeneity between self-reported transgender and diagnosed GI/GD. Future transgender studies should strictly control inclusion criteria. Disclosure No significant relationships.

Introduction Development of gender identity is a complicated process. During this process it is thought that many factors play a role. Gender dysphoria is a condition where there is a mismatch between the assigned gender at birth and gender identity. Although scarce, literature shows that compared to cisgender individuals, transgender and gender-diverse individuals have higher rates of autism, other neurodevelopmental and psychiatric diagnoses. Objectives To describe posible relations and overlap between gender dysphoria and neurodevelopmental disorders. Methods Literature search in Pubmed and other similar platforms. Articles considered relevant under this theme were included. Results Autism spectrum disorders (ASD) and attention-deficit hyperactivity disorder (ADHD) can compromise health and may be more prevalent amongst individuals with gender dysphoria (GD). Symptoms such as attention difficulties, deficits in communication and social skills, obsessional interests, and stereotyped behaviour can significantly impact assessment of GD and the appropriate clinical care. With some overlapping symptoms, the potential for misdiagnosis is possible. Data about prevalence of this conditions in transgender community is of low quality, but ASD is more prevalent, ranging from 6-26%. Conclusions Studies demosntrate that neurodevelopmental disorders and other psychiatric conditions are more common in transgender and gender-diverse individuals. It is important that future studies focus on exploring the mental health outcomes of neurodevelopmental-trans individuals. Disclosure No significant relationships.

Introduction APA describes Gender dysphoria (GD) as the conflict between a person’s physical or assigned gender and the gender with which he/she/they identify. Recently DSM-V renamed gender identity disorder as “gender dysphoria”. This change in terminology removes the ‘pathology’ from being transgender, which is not a mental health condition. Objectives To systematically summarise available evidence in this important but less researched field. Methods A comprehensive review was carried using the PubMed/ Medline database. Results Formal epidemiological studies of gender dysphoria in children and adolescents have not been conducted. The true prevalence os gender dysphoria is unknown around the world because of the varying definitions, different cultural norms and lack of data. Individuals who identify as transgender are vulnerable, and have higher rates of psychiatric comorbility compared with the general population. Gender dysphoria, gender identity disorder or transsexualism is a psychological condition that requires care and multiple health professionals. Conclusions The natural history of gender identity for children who express gender nonconforming or transgender identities is an area of active research. In addition, there is a lack of guidelines to approach these patients.

Introduction Gender identity is each person’s internal and individual experience of gender. Gender expression is how a person publicly expresses their gender. Gender incongruence (GI) is defined as a condition in which a person has a marked incongruence between the expressed or experienced gender and the biological sex at birth. Adolescence is a crucial period for the persistence or development of GI, due hormonal changes, peer relations and first romantic experiences. Objectives To make a revision of the literature about GI along childhood throughout adolescence. Methods Research in the literature with the words “gender identity”, “gender incongruence”, “gender dysphoria”, “childhood” and “adolescence” in scientific databases. Results GI is present in a small percentage of children, often provoking psychopathological distress. There is a high prevalence of autism spectrum disorders in these children, compared with the general population. In most cases the dysphoria does not persist until adolescence. There has been an increasing number of adolescents seeking for treatment at gender identity services. The studies show that after the onset of puberty, the probability of persistent GI is high and that adolescents submitted to hormonal suppression tend to continue the medical treatment. Conclusions Epidemiological formal studies about gender incongruence in children and adolescents are very few. Studies of prevalence in these populations are community studies and don’t reflect the true prevalence of GI, so it would be necessary to investigate its prevalence and persistence in different world populations. It’s also necessary to make more prospective studies about the long-term effects of the medical treatment of GI. Disclosure No significant relationships.

Introduction A person who has gender dysphoria can experience some difficulties in his/her/their life (as we can see even in language). These difficulties are mostly because of the binary gender system. Especially in countries like Turkey, homophobia is very common. Because of that, a homosexual person can think that he/she/they is a transgender. Objectives At this point, group psychotherapies are worthwhile, especially for differantial diagnosis. These individuals can share their experiences about the process. On this way, they can also explore themselves. Methods We have a monthly group psychotherapy for transgender and gender nonconforming adults in our clinic. We accept the individuals who have problems about gender identity. All trans adults who apply to us and are considered to be suitable are directed to the support group. Results An individual, aged 20, who defines herself as a FtM trans has joined to the group for 4-5 months. She was in hurry and had decided to go under surgery for gender transition. She was referred to surgery by another clinic which didn’t have a group psychotherapy. So she applied to our clinic. During the group psychotherapy, she realized that she was homosexual and gived up gender transition. Conclusions Group psychotherapy is helpful for trans individuals to reduce psychological distress and manage their process. This study shows that it is not the only benefit of group support psychotherapy. It also helps the individuals to explore themselves, like our case. Its benefit can be as major as saving themselves from an irreversible step and its consequences.

Introduction: Interest in the co-occurrence of gender dysphoria and autism spectrum disorder has gained prominence in recent years. Gender dysphoria refers to the distress experienced when there is an incongruence between gender identity and sex assigned at birth. On the other hand, autism spectrum disorder is characterized by difficulties in communication and social interaction, as well as restrictive and repetitive patterns of behavior. Objectives: The aim of this paper is to review the current available literature in order to expand our knowledge about gender identity and dysphoria in the population with autism spectrum disorder. Methods: A qualitative review was conducted over the last 20 years, using the Medline database through PubMed. Combinations of MeSH terms related to gender identity and people with autism spectrum disorder were used, selecting those studies in English, French or Spanish that met the objectives of the review, excluding references in other languages. The scientific evidence obtained was analyzed and synthesized. Results: The development of gender identity of people with autism spectrum disorder can be a complex process. Comparing the general population with the population with autism spectrum disorder, a higher prevalence of gender dysphoria has been evidenced in the population with autism spectrum disorder, and within this group when segmented by gender, greater in women than in men. Conclusions: This review highlights the importance of increasing knowledge about sexuality and gender dysphoria in people with autism spectrum disorder in order to facilitate the development, understanding and acceptance of their gender identity and sexual orientation of these people. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

AbstractBackground.To assess the prevalence of autism traits in individuals accessing gender affirming treatments, we conducted a cross-sectional survey in the regional specialist gender services in Northern Ireland.Methods.One hundred and twenty-three individuals (38 adolescents and 69 adults) currently attending or who previously attended specialist gender services in Northern Ireland were recruited. Fifty-six individuals assigned male at birth (AMAB) and 66 individuals assigned female at birth (AFAB) took part in the study. Main outcome measures: Autism Quotient (AQ), Cambridge Behavior Scale (EQ), and RAADS-14.Results.Autism trait prevalence rates of 19.5% (AQ); 25.4% (RAADS-14); and 35.8% (poor empathy traits). A combined measure comprising all three provided a prevalence of 17.2%. There were no mean differences in the scores between AMAB (assigned male at birth) individuals and AFAB (assigned female at birth) individuals.Conclusions.Autism traits present additional challenges during the assessment and treatment of individuals with gender dysphoria. Autism screening tools can aid in the identification of individual with additional needs.

Background. To assess the prevalence of autism traits in individuals accessing gender affirming treatments, we conducted a cross-sectional survey in the regional specialist gender services in Northern Ireland. Methods. One hundred and twenty-three individuals (38 adolescents and 69 adults) currently attending or who previously attended specialist gender services in Northern Ireland were recruited. Fifty-six individuals assigned male at birth (AMAB) and 66 individuals assigned female at birth (AFAB) took part in the study. Main outcome measures: Autism Quotient (AQ), Cambridge Behavior Scale (EQ), and RAADS-14. Results. Autism trait prevalence rates of 19.5% (AQ); 25.4% (RAADS-14); and 35.8% (poor empathy traits). A combined measure comprising all three provided a prevalence of 17.2%. There were no mean differences in the scores between AMAB (assigned male at birth) individuals and AFAB (assigned female at birth) individuals. Conclusions. Autism traits present additional challenges during the assessment and treatment of individuals with gender dysphoria. Autism screening tools can aid in the identification of individual with additional needs. [ABSTRACT FROM AUTHOR]

For the 11th version of the International Classification of Diseases, the WHO recommended to rename transgender transidentity as "gender incongruence", to remove it from the chapter of mental and behavioral disorders, and to put it in a new category titled "Conditions related to sexual health". This should contribute to reduce stigmatisation while maintaining access to medical care. One argument in favor of depsychiatrisation is to demonstrate that essential features of gender identity disorders, namely psychological distress and functional impairment, are not necessarily reported by every transgender person, and may result from social rejection and violence rather than dysphoria itself. Initially confirmed in Mexico, these hypotheses were tested in a specific French medical context, where access to care does not require any prior mental health evaluation or diagnosis. In 2017, 72 transgender persons completed retrospective interviews which focused on the period when they became aware that they might be transgender and perhaps would need to do something about it. Results showed that psychological distress and functional impairment were not reported by every participant, that they may result from rejection and violence, and especially from rejection and violence coming from coworkers and schoolmates. Additional data showed that the use of health services for body transformation did not depend on distress and dysfunction. Finally, participants preferred ICD 11 to employ "transgender" or "transidentity" rather than "gender incongruence". Results support depsychiatrisation. They are discussed in terms of medical, ethical, legal, and social, added values and implications of depsychiatrisation. [ABSTRACT FROM AUTHOR]

Background Over the last 50 years, several studies have provided estimates of the prevalence of transsexualism. The variation in reported prevalence is considerable and may be explained by factors such as the methodology and diagnostic classification used and the year and country in which the studies took place. Taking these into consideration, this study aimed to critically and systematically review the available literature measuring the prevalence of transsexualism as well as performing a meta-analysis using the available data. Methods Databases were systematically searched and 1473 possible studies were identified. After initial scrutiny of the article titles and removal of those not relevant, 250 studies were selected for further appraisal. Of these, 211 were excluded after reading the abstracts and a further 18 after reading the full article. This resulted in 21 studies on which to perform a systematic review, with only 12 having sufficient data for meta-analysis. The primary data of the epidemiological studies were extracted as raw numbers. An aggregate effect size, weighted by sample size, was computed to provide an overall effect size across the studies. Risk ratios and 95% confidence intervals (CIs) were calculated. The relative weighted contribution of each study was also assessed. Results The overall meta-analytical prevalence for transsexualism was 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men. Time analysis found an increase in reported prevalence over the last 50 years. Conclusions The overall prevalence of transsexualism reported in the literature is increasing. However, it is still very low and is mainly based on individuals attending clinical services and so does not provide an overall picture of prevalence in the general population. However, this study should be considered as a starting point and the field would benefit from more rigorous epidemiological studies acknowledging current changes in the classification system and including different locations worldwide. [ABSTRACT FROM AUTHOR]

Abstract: Studies on diagnostic subtypes of gender identity disorder (GID) or gender incongruence (GI), comorbidity and treatment outcome show considerable variability in results. Clinic/country specific factors may account for the contradictory results, but these factors have never been studied. This article is the first of a series reporting on a unique collaborative study of four European gender identity clinics (the European network for the investigation of gender incongruence [ENIGI]). Here, we present the diagnostic procedures of the four clinics (Amsterdam, Ghent, Hamburg, and Oslo), the standard battery of instruments, and the first results regarding applicants with GI who seek treatment. Applicants in the four clinics did not differ in living situation, employment status, sexual orientation, and age of onset of GI feelings. However, the Amsterdam and Ghent clinic were visited by a majority of natal males, whereas Hamburg and Oslo see more natal females. Male applicants were older than female applicants within each country, but female applicants in one country were sometimes older than male applicants in another country. Also, educational level differed between applicants of the four clinics. These data indicate that certain sociodemographic and/or cultural characteristics of applicants have to be taken into account in future studies. [Copyright &y& Elsevier]

Introduction: Ovotesticular Disorder of Sexual Development (DSD) refers to an extremely rare form of DSD, where adult gender identity is unpredictable and variable at birth and may evolve as the child grows. Objectives: To review the literature regarding Ovotesticular DSD, gender atribution and gender dysphoria and reflect in how medical attitudes can impact patient's life's. To present a clinical case about an individual with 46 XX karyotype and with Ovotesticular DSD, which was surgically interventioned twice, so her phenotype could match with her genotype. Afterwards presenting symptoms of gender dysphoria. Methods: Review of the literature, using Google Scholar and Pubmed with the keywords: ovotesticular, DSD, gender dyshoria, medical intervention. Results: Data from small case series suggests that patients reared in either sex can be satisfied with their sex assignment, but gender dysphoria also may occur. The clinical case is about a 16 years old adolescent with 46XX karyotype and born with bilateral female and male gonads. It was decided by the medical team and her parents for the removal of dysgenetic gonads in early chilhood and for a vaginoplasty when she was 14 years old. From two years now, she has described what seem to be a case of Gender Dysphoria. Conclusions: Adult gender identity is difficult to predict in Ovotesticular DSD and therefore consensus andDSD advocacy groups have recommended that genital surgery be deferred until the child is old enough to confirm his or her gender identity. Medical intervention should be weighed very careful, unless it can be warmful. [ABSTRACT FROM AUTHOR]

Introduction: Gender identity is each person's internal and individual experience of gender. Gender expression is how a person publicly expresses their gender. Gender incongruence (GI) is defined as a condition in which a person has a marked incongruence between the expressed or experienced gender and the biological sex at birth. Adolescence is a crucial period for the persistence or development of GI, due hormonal changes, peer relations and first romantic experiences. Objectives: To make a revision of the literature about GI along childhood throughout adolescence. Methods: Research in the literature with the words "gender identity", "gender incongruence", "gender dysphoria", "childhood" and "adolescence" in scientific databases. Results: GI is present in a small percentage of children, often provoking psychopathological distress. There is a high prevalence of autism spectrum disorders in these children, compared with the general population. In most cases the dysphoria does not persist until adolescence. There has been an increasing number of adolescents seeking for treatment at gender identity services. The studies show that after the onset of puberty, the probability of persistent GI is high and that adolescents submitted to hormonal suppression tend to continue the medical treatment. Conclusions: Epidemiological formal studies about gender incongruence in children and adolescents are very few. Studies of prevalence in these populations are community studies and don't reflect the true prevalence of GI, so it would be necessary to investigate its prevalence and persistence in different world populations. It's also necessary to make more prospective studies about the long-term effects of the medical treatment of GI. [ABSTRACT FROM AUTHOR]

Introduction: A person who has gender dysphoria can experience some difficulties in his/her/their life (as we can see even in language). These difficulties are mostly because of the binary gender system. Especially in countries like Turkey, homophobia is very common. Because of that, a homosexual person can think that he/she/they is a transgender. Objectives: At this point, group psychotherapies are worthwhile, especially for differantial diagnosis. These individuals can share their experiences about the process. On this way, they can also explore themselves. Methods:Wehave a monthly group psychotherapy for transgender and gender nonconforming adults in our clinic. We accept the individuals who have problems about gender identity. All trans adults who apply to us and are considered to be suitable are directed to the support group. Results: An individual, aged 20, who defines herself as a FtM trans has joined to the group for 4-5 months. She was in hurry and had decided to go under surgery for gender transition. Shewas referred to surgery by another clinic which didn't have a group psychotherapy. So she applied to our clinic. During the group psychotherapy, she realized that she was homosexual and gived up gender transition. Conclusions: Group psychotherapy is helpful for trans individuals to reduce psychological distress and manage their process. This study shows that it is not the only benefit of group support psychotherapy. It also helps the individuals to explore themselves, like our case. Its benefit can be as major as saving themselves from an irreversible step and its consequences. [ABSTRACT FROM AUTHOR]

Introduction: APA describes Gender dysphoria (GD) as the conflict between a person's physical or assigned gender and the gender with which he/she/they identify. Recently DSM-V renamed gender identity disorder as "gender dysphoria". This change in terminology removes the 'pathology' from being transgender, which is not a mental health condition. Objectives: To systematically summarise available evidence in this important but less researched field. Methods: A comprehensive review was carried using the PubMed/Medline database. Results: Formal epidemiological studies of gender dysphoria in children and adolescents have not been conducted. The true prevalence os gender dysphoria is unknown around the world because of the varying definitions, different cultural norms and lack of data. Individuals who identify as transgender are vulnerable, and have higher rates of psychiatric comorbility compared with the general population. Gender dysphoria, gender identity disorder or transsexualism is a psychological condition that requires care and multiple health professionals. Conclusions: The natural history of gender identity for children who express gender nonconforming or transgender identities is an area of active research. In addition, there is a lack of guidelines to approach these patients. [ABSTRACT FROM AUTHOR]

Introduction: Recent literature has addressed the association between Autistic Spectrum Disorder (ASD) and Gender Dysphoria (GD) and or "gender diverse", a term used to describe those who identify as "non-binary", meaning somewhere on a continuum between male and female. Some studies have shown that 5-7% of those with ASD have GD, compared to 1% in the general population, but others have wondered if those with ASD do not have GD but are simply "gender diverse". Objectives: There are many unanswered questions pertaining to the association between the diagnoses of Autistic Spectrum Disorder (ASD) and Gender Dysphoria and/or Gender Diversity. This Oral Communication aims to shed light upon this topic offering clinical materials including a case vignette, to stimulate participant's questions, and provide sufficient time for a robust discussion. Methods: This presentationwill provide a developmental perspective of ASD and illustrate the association of ASD and gender dysphoria/gender diversity with a clinical case of a 23-year-old young adult. Results: The presenter will give a broad overview of Autism through a developmental lens, focusing on the difficulty assessing the affirmed gender of the patient. He will describe a 23-year-old patient with a history of trauma, ASD, ADHD, and intellectual disability who stated he was a "girl because his mother dressed him that way". Conclusions: Psychiatrists are encouraged to use their developmental expertise to treat complex ASD patients and contemplate their patient's current cognitive state, social skill level, and cultural environment when making the diagnosis of Gender Dysphoria. [ABSTRACT FROM AUTHOR]

Introduction: Not only gender identity disorder is often accompanied by mental illnesses, but vice versa: there are higher rates of homosexuality and cross-sexual behavior in people with mental illnesses compared to general population. Understudied is the question how gender identity depends on certain diseases and pathological features? Objectives: This study seeks to address how gender identity is affected in patients with mental illnesses. Methods: The sample consisted of 80 patients, 44 women and 36 men with aged 16-29 with schizotypal disorder, histrionic personality disorder and schizoid personality disorder. Their gender self-identity matched biological sex. The structure of gender identity was measured by adapted version of Bem Sex-Role Inventory, projective drawings. Results: Almost half (46,1%) of schizotypic patients demonstrated opposite gender identity according to projective drawings. That highly correlated with results of Bem inventory (r=0,658; sig=,001). They had higher anxiety (X2=8,234; df=2; p=,004) and more sexual problems (X2=5,733; df=2; p=,033), than such patients whose projected gender identity matched their biological sex. In addition, an undifferentiated type of identity associated with extreme disadaptation was detected in 23% of these patients. Inverted gender identity was rarely met among patients with personality disorders. Most of them (65,7%) had accordingly masculine and feminine types. Although androgenic gender identity was found only in 15,5% cases whereas in general population it rates circa 80% and is connected to higher adaptation potential. Conclusions: This study demonstrates how gender identity is transformed in mental illnesses and is connected to general psychological problems, such as anxiety, sexual problems, disadaptation. [ABSTRACT FROM AUTHOR]

Introduction: Dissociation as a psychological defence again traumatic experiences, acute or longer term stressful events, entails fragmentation of conscious experience. Dissociation can affect self-concept, identity, memory, or perception of the external world. Lack of capacity to integrate traumatic or adverse experiences can result with maladaptive functioning. Contemporary medical understanding of dissociation concept has shifted from Janet, although the research of its neurobiological underpinning is still elusive. There is emerging evidence linking trauma and dissociation to different psychiatric disorders other than trauma related disorders and dissociative disorders as such. Objectives: The goal of presented case studies is to recognize the importance of trauma history and dissociative symptoms in the process of differential diagnosis of mental health issues, and in choosing the appropriate treatment for them. Methods: Three case studies of psychotherapeutic treatment that addressed dissociative symptoms in psychosis, depressive disorder and gender dysphoria will be presented. Multidisciplinary team of mental health professionals were included in diagnostic procedures and in treatment. Results: Recognizing and treating dissociative symptoms in gender dysphoria, psychosis and depressive disorder, results in better clinical outcomes, improved quality of life and better functioning. Conclusions: Trauma entails psychological, biological and social component. Traumatic experiences can result in adaptive insufficiencies or chronic mental issues. Probing for childhood or adult trauma history and consequent dissociative symptoms should be included in differential diagnostic procedures with people suffering from mental health issues regardless of the severity of their symptoms or diagnostic categories. [ABSTRACT FROM AUTHOR]

Introduction: Gender identity disorder (GID) is found in patients with schizophrenia, autistic spectrum disorders, personality disorders significantly more often, then in general population. That emphasizes necessity of differentiation between normal and abnormal transsexualism. Dissatisfaction with one's body is the most common symptom of such states. Therefore we suggest using body self-perception as the most direct way of investigating GID. Objectives: The purpose of this study is to detect features of body self-perception in patients with mental illnesses accompanied by GID. Methods: The sample consisted of 46 women and 17 men aged 16-29 with schizotypic disorder and personality disorders, who demonstrated GID symptoms. Body self-perception was measured by neuropsychological tests for somatognosis, M. Feldenkrais method of bodymeasurements, projective test "Figure Pose Clothes". Results: Two patterns of self-perception were revealed. Patientswith personality disorders perceived their bodies as more content with desired sexual role, though their competence in body perception was intact. When defining sex of a person in picture they based their judgements mostly on formal features (clothes, pose), not the figure of the person. Schizotypic patients on contrary didn't modify their body perception according to gender identity. Body image played little role in self-perception. They poorly identified sex of persons in pictures, ignoring socially determinated features and stereotypes. Conclusions: This study showed differences between GID symptoms in patients with schizotypic disorder and personality disorders. The first are due to low differentiation of sex roles and lack of reliance on social experience. The latter identify with desired gender on cognitive and perceptual, but not emotional level. [ABSTRACT FROM AUTHOR]

Introduction: Adolescence is a critical period characterized by deep alterations in one's identity, conditioned by the experiences and life adversities such as childhood sexual assault (CSA). Objectives: Describe the impacts of CSA and study its correlations with PTSD, bipolar disorder (BD) and gender dysphoria (GD). Methods: The case of a 17-year-old adolescent, followed-up at the adolescent and child psychiatry department (Mongi Slim Hospital, Tunisia), is reported. A literature review using the following key words was done on Pubmed and Google Scholar: PTSD, avoidance, homosexuality, BD, sexual identity, CSA. Results: Case description: GR is a 17-year-old female who's been followed-up since 2018 for PTSD and depression following a sexual assault. The treatment was based on psychotherapy and medication. The antidepressant was substituted with mood stabilizers following an induced hypomania. During follow-up, considerable changes in physical appearance were noted. GR had her hair cut short and she began to dress like a boy. She also admitted a recent attraction to females, and that she entertained an intimate relationship with a girl, with whom she had a sexual intercourse. This event caused great distress, guilt, perpetual questioning about her sexual identity, and additional PTSD symptoms regarding the homosexual experience. Conclusions: CSA is a deleterious type of trauma with severe effects on developmental processes, psychopathology and identity, especially during adolescence. Correlations between CSA, sexual orientation, gender identity and mood disorders remain blurred and require further investigations. [ABSTRACT FROM AUTHOR]

Traditionally, gender identity disorder (GID) is associated with high level of psychiatric comorbidity, particularly psychotic and affective disorders. The aim of this study is to evaluate clinical aspect of GID in a sample of patients in charge of the Operative Unit for Diagnosis and Therapy of GID, Psychiatric Clinic and the Department of Endocrinology, University of Cagliari. Assessment was made by SCID-I, for Axis I comorbidity, GAF, for global functioning, BUT for body discomfort (BUT-A measures different aspects of body image, BUT-B looks at worries about particular body parts). The sample comprised 14 MtF (56%) and 11 FtM (44%), of age between 17–49 years; a diagnosed psychiatric disorder was reported in 32%: 16% mood disorders, 12% anxiety disorders, 4% psychotic disorders. Among subject with GAF < 85, 58.3% were identify to have a Axis I disorder compare to 7,7% patients with GAF ≥ 85 ( P = .011), especially for mood disorders ( P = .039). Main score of Global Severity Index (GSI) for BUT-A was 2.45 ± 883; all subjects had a score GSI > 1.2 (clinically relevant discomfort index). Regarding BUT-B, MtF have higher scores in PSDI global scale (3.37 ± .577; P = 0.019) and subscale VI (4.38 ± 1.496 vs. .81 ± 1.864; P = 0.006): there are not significant gender differences in the others subscales, although discomfort regards different aspects of both sexes. According to literature, we observed a slightly higher prevalence of Axis I psychiatric disorders compare to general population, with functioning level statistically significant. Generally, GID was not associated with higher level of psychopathology, appearing as specific diagnostic aspect, where the main origin of discomfort is dissatisfaction toward self-body imagine. [ABSTRACT FROM AUTHOR]

Introduction Gender dysphoria and its treatment have been legalized in Iran since 1976. Study on transgender people in Iran is very difficult. Perhaps, one of the most problems is stigma. Negative attitudes and discrimination in society make them and their partners to be socially isolated. No extensive research has been done entirely on their sexual partners in the field of stigma. Aim The aim of this study is to evaluate the attitude toward stigma of sexual partners of transgender people. If there are problems, what are they? What is the impact of stigma on their life? Method Because there is little information about the research subject, grounded theory methodology was used. This methodology can be used to build a theory. Participants were partners of transgenders who referred from the Forensic Medicine Center to Tehran Institute of Psychiatry and met these inclusion criteria: 1 – being in the relationship for at least 6 months and meet at least one of these criterias: A: they are cohabiting, B: they have regular sexual relationship, C: they recognize each other as their steady partners. 2 – at least 18 years of age. Five males and 6 females participated. All of them had given a written consent. In depth face-to-face and semi-structured interview were used to collect information. Participants were asked to attend to second interview after coding and analyzing the first session. The codes were classified and categories, using the constant comparative method. Conclusion It seems that transgender's sexual partners suffer from the stigma. According to the codes, they suffer from multiple problems in their personal and social life. [ABSTRACT FROM AUTHOR]

Introduction Attachment has been defined as a deep and enduring emotional bond that connects one person to another across time and space. Subjects with gender dysphoria (GD) are sometimes accompanied by psychiatric problems because they face potential parent and peer rejection. Objectives The present study aims to investigate the parental attachment in subjects with female-to-male (FtM) GD. Methods Sixty-six subjects with FtM GD (DSM-5 criteria) and 67 female controls were assessed using: short version of the Inventory of Parent and Peer Attachment (IPPA). Results Main findings highlighted that female controls were significantly more attached to their parents than subjects with FtM GD. The scores of specific dimensions of attachment such as trust, communication and alienation were significantly higher in control females than subjects with FtM GD. Conclusions The results of this study indicate that subjects with FtM GD have significantly poor parental attachment compared to female controls, measured by IPPA. These findings may suggest that psychological basis underlying the development of psychiatric disorders, which was seen in subjects with FtM GD. [ABSTRACT FROM AUTHOR]

Introduction According to DSM-5, gender dysphoria (GD) is the “distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender” (p. 451). Research showed that it may be associated with different social, psychological and psychiatric difficulties. It is clear how body is central in GD. Eating Disorders (ED) are strongly related too with the body, and, although they may co-occur with GD, a systematic review of the studies about this association is not available. Objectives and aims To carry out a review of the published studies about co-occurrence of GD and ED. Methods Literature research in 12 databases was performed, and the papers analyzed. Results Nine papers about case studies and four empirical studies are available. Results of the clinical reports suggest a link between GD and ED may be the strong body uneasiness perceived by these people. The empirical studies support this hypothesis, outlining that usually adolescence, when secondary sexual characteristics develop, is a crucial phase for the onset of ED. Restrictive eating behaviors may function as a way of modifying the body shape and the hormone system. Differences between Female-to Male and Male-to-Female transsexuals are outlined, as well as persistence of ED symptomatology after sex reassignment surgery. Conclusions Body becomes an expression of the inner conflicts linked to gender incongruence, shifting the focus of the suffering from mind to body. In the light of these results, specific indications for the clinical practice with transgender people and for future directions in research are outlined. [ABSTRACT FROM AUTHOR]

Introduction Gender dysphoria is a new diagnostic class in DSM-5 that reflects a new conceptualization of the disorder emphasizing the phenomenon of 'gender incongruence”. It refers to the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender. Hormone and/or surgery are treatment options available. There is some clinical evidence that patients under gonadotropin-releasing hormone (GnRH) agonists may develop symptoms consistent with various psychiatric disorders with and without psychotic features. Objectives and Aims To review new DSM-5 conceptualization of gender dysphoria and psychiatric side-effects of ovocyte stimulation drugs. Also to report one selected clinical case of psychosis after FSH and LH stimulation in a patient under female to male sex reassignment process. Methods The authors have conducted an online search on PubMed on psychosis after ovocytes stimulation and gender dysphoria and systematically reviewed a case report. Results There is little evidence of psychiatric side-effects of GnRH agonist. Case report: 22 years old male with diagnosis of gender dysphoria under female to male sex reassignment process with FSH and LH stimulation to ovocyte preservation that acutely developed psychiatry symptoms of bizarre behaviour, irritability, flight of ideas, soliloquies and erotomaniac delusions that remit on antipsychotic drugs. Conclusions Gender dysphoria is a new diagnostic class in DSM-5. There are multiple hormone and/or surgery treatments options. There is little evidence hormone treatments are associated with psychiatric side-effects, namely psychosis. To conduct a well-designed clinical trial on psychiatric symptoms related with hormone treatment in gender dysphoria patients is needed. [ABSTRACT FROM AUTHOR]