A Most Stigmatized Population: Clinicians Must Carefully Navigate Numerous Issues Facing Transgender Clients

By Shelton, Michael | Addiction Professional, November-December 2013 | Go to article overview

A Most Stigmatized Population: Clinicians Must Carefully Navigate Numerous Issues Facing Transgender Clients


Shelton, Michael, Addiction Professional


A ddiction professionals are well aware of the controversy surround-ing diagnostic changes for addictive disorders in the DSM-5. Some are not aware, however, of an equally vociferous controversy regarding the diagnosis of gender identity disorder (GID), which was changed to gender dysphoria in the DSM's most recent edition.

[ILLUSTRATION OMITTED]

This change harkens back to the 1973 removal of homosexuality from the field's diagnostic manual. According to Robin Rosenberg, a clinical psychologist and co-author of the psychology textbook Abnormal Psychology, "The concept underlying eliminating homosexuality from the DSM was recognizing that you can be homosexual and psychologically healthy or be homosexual and psychologically screwed up. Being homosexual didn't have to be the issue." (1)

In the same way, the new DSM recognizes that there are many transgender individuals who are living healthy and productive lives. For those who aren't, it is not necessarily because of their transgender identity but possibly a result of living in a culture that stigmatizes those who do not conform to traditional norms.

Currently, gay, lesbian and bisexual adults are roughly twice as likely as the general population to lack health insurance, but rates of being uninsured are even higher for transgender individuals. (2) Since the Affordable Care Act (ACA) mandates substance use and mental health services among the essential benefits that all qualified insurance plans must offer, behavioral healthcare systems soon might be dealing with an influx of more LGBT individuals and their families than at any other point in their history.

All sexual minorities have faced discrimination and hurdles in accessing supportive, safe and knowledgeable behavioral health treatment, but the transgender population has indeed fared the worst.

[ILLUSTRATION OMITTED]

Defining transgender

The 2011 Institute of Medicine report The Health of Lesbian, Gay, Bisexual and Transgender People: Building a Foundation for Better Understanding defined transgender as "an umbrella term that encompasses a diverse group of individuals who depart from traditional gender norms." The American Psychological Association (APA), in comparison, offered a more detailed definition: Transgender refers to "a variety of people who are gender variant in relation to cultural norms in significant ways. While the descriptor transgender typically brings to mind someone who wants to transition to the other sex/gender both socially and physically through surgical procedures, it can also refer to people who express gender atypicality along a continuum, including, for example, cross-dressers, those who present as gender ambiguous, or those who live in the role of the other gender without surgical or hormonal intervention." (3)

A 2013 literature review published in Contemporary Sexuality determined that 2 to 27% of adults who received a GID diagnosis as children continue to meet criteria for GID in adulthood, but the review acknowledged that research on the gender identity of adults identified as gender nonconforming in childhood is scarce. The 2011 Institute of Medicine report summarized that the current generation of gender nonconforming individuals typically comes out in childhood or shortly after the onset of puberty. In contrast, transgender persons who are not visibly gender role nonconforming in childhood typically do not come out until much later in life, during midlife or beyond.

Earlier theories postulated parenting styles or trauma as the cause of gender nonconformity, but current research--built upon a conflux of biology, sociology, psychology, gender studies and queer theory--has dispelled these theories. For example, the Children's National Medical Center in Washington, D.C., which runs an outreach program for children with gender variant behaviors and their families, counsels against the notion that there is a "cause" of gender nonconformity and instead presents "the concept of gender identity as something that begins with a genetic propensity, hard-wired in the brain before or soon after birth, and is then influenced by the gender roles that are learned and specific to each time and place," as stated in the Contemporary Sexuality article. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

A Most Stigmatized Population: Clinicians Must Carefully Navigate Numerous Issues Facing Transgender Clients
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.