Transgenderism and Comorbidity

Transgenderism and Comorbidity

Most psychologists and psychiatrists would agree that, per both DSM-IV and DSM-5, transgenderism (Gender Dysphoria / Gender Identity Disorder) is an actual, undeniable, mental/psychiatric disorder. Please note that I am speaking specifically of those with Gender Dysphoria/Identity Disorder, and not of those experiencing true hermaphroditism (a group compromising an exceedingly small percentage of those within, or that some would deem to be within, the transsexual community).

Many are upset with President Trump’s announced military ban on transsexuals; however, we must ask, why is his decision controversial? Why would we even consider advocating in favour of allowing those to serve who have an untreated and significant psychological problem (again, see DSM-IV and DSM-5), especially in times of war, and especially in combat (or near to combat) scenarios. Given the greater psychological stress associated with military, versus civilian, life, how is this even remotely prudent? In addition, given the strong evidence that Axis I psychological comorbidity accompanies Gender Dysphoria / Gender Identity Disorder, why would you want to place those suffering from these things under greater stress and risk? Why would you want to jeopardise their lives, the lives of those around them, and the overall tactical/strategic mission in light of these heightened risks?

There are those who will argue, perhaps even vehemently, that the debate on comorbidity remains open. Fine, let them have their say. There are indeed studies that deny comorbidity (or any significant presence of comorbidity); however, these studies are in the minority; are sometimes published in less prestigious journals; and have lower sample cases (they also often have more female-to-male cases than male-to female cases in their studies, despite the fact that male-to-female cases show higher incidents of comorbidity than their female-to-male counterparts). To me, common sense tells us that those with gender dysphoria also have elevated comorbidity rates (ever have to work in, or travel through, certain parts of New York City and Atlanta?)… The drug and alcohol use/abuse correlation also appears to be greater. Yet, do not take my word for this, nor anyone else’s; instead, do your own (reasonably) in-depth research, and discern for yourselves.

To assist in your research, the following will hopefully give you an idea of the nature of the discussion. I provided a further (Google Scholar) link to help you go beyond what I have given you. Please note that the following pertains almost exclusively to adults, and not to children, given that (1) children do not usually join the US Military and (2) children remit more often than adults (which is why they should not be receiving surgery/hormonal treatments for gender dysphoria, seeing that they often grow out of (overcome) this disorder; see, for instances, https://www.acpeds.org/the-college-speaks/position-statements/gender-ideology-harms-children).

I. STUDIES SHOWING SIGNIFICANTLY HIGHER AXIS I COMORBIDITY RATES AMONGST U.S. MILITARY VETERANS:

A. “Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case–Control Study” [Brown, Jones / LGBT Health. April 2016, 3(2): 122-131.] / http://online.liebertpub.com/doi/abs/10.1089/lgbt.2015.0058

  • Conclusion “In 2013, the prevalence of TG veterans with a qualifying clinical diagnosis was 58/100,000 patients. Statistically significant disparities were present in the TG cohort for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. TG Veterans were more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. Significant disparities in the prevalence of medical diagnoses for TG veterans were also detected for 16/17 diagnoses examined, with HIV disease representing the largest disparity between groups… This is the first study to examine a large cohort of clinically diagnosed TG patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group. TG veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-TG veterans. These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems.”

B. “70 U.S. Veterans with Gender Identity Disturbances: A Descriptive Study” / [McDuffie, Brown / International Journal of Transgenderism / Vol. 12, 2010 – Issue 1] / http://www.tandfonline.com/doi/abs/10.1080/15532731003688962

  • Conclusion: “Veterans often reported that they joined the military in an attempt to purge their transgender feelings, believing the military environment would “make men” of them. Most were discharged before completing a 20-year career. More than half received health care at veterans affairs medical centers, often due to medical or psychiatric disabilities incurred during service. Comorbid Axis I diagnoses were common, as were suicidal thoughts and behaviors.”

C. “Mortality Among Veterans with Transgender-Related Diagnoses in the Veterans Health Administration, FY2000–2009” [Blosnich, Brown, Wojcio, Jones, and Bossarte / LGBT Health. December 2014] / https://doi.org/10.1089/lgbt.2014.0050

  • Conclusion: “Approximately 9.3% (n=309) veterans with transgender-related ICD-9-CM diagnoses died across the study period. Although diseases of the circulatory system and neoplasms were the first and second leading causes of death, respectively, the other ranked causes of mortality differed somewhat from patterns for the US during the same time span. The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses across the 10-year period was approximately 82/100,000 person-years, which approximated the crude suicide death rates for other serious mental illness in VHA (e.g., depression, schizophrenia). The average age of suicide decedents was 49.4 years…. The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses is higher than in the general population, and they may be dying by suicide at younger ages than their veteran peers without transgender-related ICD-9-CM diagnoses. Future research, such as age-adjusted rates or accounting for psychiatric co-morbidities, will help to better clarify if the all-cause and suicide mortality rates are elevated for veterans with transgender-related ICD-9-CM diagnoses.”

D. “Factors Associated with Suicidality Among a National Sample of Transgender Veterans” [Lehavot, Simpson, and Shipherd / Suicide and Life Threatening Behaviour (Journal), 46: 507–524. doi:10.1111/sltb.12233] / http://onlinelibrary.wiley.com/doi/10.1111/sltb.12233/full

  • Conclusion: “Correlates of past-year suicidal ideation and lifetime suicide risk among a national sample of transgender veterans were examined. An online, convenience sample of 212 U.S. transgender veterans participated in a cross-sectional survey in February–May 2014. We evaluated associations between sociodemographic characteristics, stigma, mental health, and psychosocial resources with past-year suicidal ideation and lifetime suicide plans and attempts. Participants reported high rates of past-year suicidal ideation (57%) as well as history of suicide plan or attempt (66%). Transgender-related felt stigma during military service and current post traumatic stress disorder and depressive symptoms were associated with suicide outcomes as were economic and demographic factors.”

E. “Psychiatric and Metabolic Comorbidities Associated with Veterans with Gender Dysphoria” [Vasco, Pinkson, Bess, Koops, Esparza, hansis-Diarte, and Tripathy / Endocrine Society’s 98th Annual Meeting and Expo, April 1–4, 2016 – Boston] / http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2016.RE.15.FRI-143

  • Conclusion: “The prevalence of major depressive disorder and GAD was higher in patients with GD though there was no difference in prevalence of hypertension, T2DM, hyperlipidemia between patients with and without GID.”

II. STUDIES SHOWING SIGNIFICANT/HIGHER AXIS I COMORBIDITY RATES IN THE GENERAL (CIVILIAN) POPULATION:

A. “Gender Dysphoria in Adults” [Zucker, Lawrence, Kreukels / Annual Review of Clinical Psychology / Vol. 12:217-247 / March 2016] / http://www.annualreviews.org/doi/abs/10.1146/annurev-clinpsy-021815-093034

  • Conclusion “Prevalence studies conclude that fewer than 1 in 10,000 adult natal males and 1 in 30,000 adult natal females experience GD, but such estimates vary widely. GD in adults is associated with an elevated prevalence of comorbid psychopathology, especially mood disorders, anxiety disorders, and suicidality. Causal mechanisms in GD are incompletely understood, but genetic, neurodevelopmental, and psychosocial factors probably all contribute.”

B. “Psychiatric comorbidity of gender identity disorders: a survey among Dutch psychiatrists” [Campo; Nijman; Merckelbach; Evers / The American Journal of Psychiatry / vol. 160, Issue 7, July 2003, pp. 1332-1336] / https://www.ncbi.nlm.nih.gov/pubmed/12832250

  • Conclusion: “These respondents reported on 584 patients with cross-gender identification. In 225 patients (39%), gender identity disorder was regarded as the primary diagnosis. For the remaining 359 patients (61%), cross-gender identification was comorbid with other psychiatric disorders. In 270 (75%) of these 359 patients, cross-gender identification was interpreted as an epiphenomenon of other psychiatric illnesses, notably personality, mood, dissociative, and psychotic disorders.”

C. “Psychiatric Axis I Comorbidities among Patients with Gender Dysphoria” [Meybodi, Hajebi, Jolfaei / Psychiatry Journal / doi: 10.1155/2014/971814. Epub 2014 Aug 11.] / https://www.ncbi.nlm.nih.gov/pubmed/25180172?log$=activity

  • Conclusion: “Fifty-seven (62.7%) patients had at least one psychiatric comorbidity. Major depressive disorder (33.7%), specific phobia (20.5%), and adjustment disorder (15.7%) were the three most prevalent disorders. Conclusion. Consistent with most earlier researches, the majority of patients with gender dysphoria had psychiatric Axis I comorbidity.”

D. “Psychiatric comorbidity in gender identity disorder” [Hepp/Kraemer/Schnyder/Miller/Delsignore/ Journal of Psychosomatic Research/ vol. 58, Issue 3, March 2005, Pages 259-261] / http://www.sciencedirect.com/science/article/pii/S0022399904005951

  • Conclusion: “Lifetime psychiatric comorbidity in GID patients is high, and this should be taken into account in the assessment and treatment planning of GID patients.” / “Twenty-nine percent of the patients had no current or lifetime Axis I disorder; 39% fulfilled the criteria for current and 71% for current and/or lifetime Axis I diagnosis. Forty-two percent of the patients were diagnosed with one or more personality disorders.”

E. “Mental health and gender dysphoria: A review of the literature.” [Dhejne, van Vlerken, Heylens, and Arcelus/ International Review of Psychiatry Journal / Vol 28 / 2016 – Issue 1] / https://www.ncbi.nlm.nih.gov/pubmed/26835611

  • Conclusion: “Although many studies were methodologically weak, and included people at different stages of transition within the same cohort of patients, overall this review indicates that trans people attending transgender health-care services appear to have a higher risk of psychiatric morbidity (that improves following treatment), and thus confirms the vulnerability of this population.”

F. “Transsexualism: Clinical Guide To Gender Identity Disorder” [Martin / Current Psychiatry, Vol. 6, No. 2 / February 20] / http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.510.6911&rep=rep1&type=pdf

  • Conclusion: “Research, mainly on biologic boys, indicates that GIDs are usually associated with behavioral difficulties, relationship problems with peers and parents, and—most notably—separation anxiety disorder. An audit of the files of 124 children and adolescents with GID showed that 42% experienced loss of one or both parents, mainly through separation. Psychiatric comorbidity. Studies using standardized diagnostic instruments to assess psychiatric comorbidity in GID are rare. A study of 31 patients with GID found that many met diagnostic criteria for lifetime psychiatric comorbidity, including:

* 71% for Axis I disorders (primarily mood and anxiety disorders)
* 42% for comorbid personality disorders, primarily a cluster B diagnosis
* 45% for substance-related disorders
* 6.5% for psychotic disorders
* 3.2% for eating disorders.”

G. “Psychological burdens are associated with young male transsexuals in Korea” / [Kim, Cheon, Pae, Kim, Lee, et al. / Psychiatry and Clinical Neurosciences / 15 March 2006] / http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1819.2006.01525.x/full

  • Conclusion: “…the present study found young male transsexuals may be potentially vulnerable to develop psychiatric and familial problems in comparison with non-transsexuals at least in Korea, despite the existing methodological limitations. Further studies should include female transsexuals in Korea and evaluate the changes of psychological factors along with a longitudinal course of transsexualism in accordance with surgical transformations.”

H. “Gender Identity Disorder and Mental Comorbidities” [Radke / Rare Disease Report (published online) / April 5, 2016] / http://www.raredr.com/conferences/ENDO2016/gid-mental-comorbidities

  • Conclusion: “the rate of GID in patients in the Veterans Affairs Health Care is 22.9/100,000 persons compared to 4.3/100,000 persons in the general population… One study by Blosnich et al2 estimated the rates of suicide-related events among GID veterans are 20 times higher than the general veterans’ population… The Researchers concluded that most [US military veteran] GID patients—approximately 90%— have mental health co-morbidities and nearly 50% required intervention for suicide attempt/ideation.”

I. “Suicide risk among transgender individuals” [Maguen and Shipherd / Psychology & Sexuality (Journal) / Pages 34-43 / Published online: 25 Mar 2010] / http://www.tandfonline.com/doi/abs/10.1080/19419891003634430

  • Conclusion: “We examined the frequency and predictors of suicide attempts among gender minority individuals (N = 153) who were recruited at a transgender conference. Eighteen percent of the participants reported a past suicide attempt, with trans men reporting the highest rate of suicide attempts (41%), followed by trans women (20%)…”

III. STUDIES SHOWING INSIGNIFICANT/LOWER AXIS I COMORBIDITY RATES IN THE GENERAL (CIVILIAN) POPULATION

When reviewing this section, note (1) the journal at issue); (2) how the samples tend to include more ‘female to male’ than ‘male to female’ cases; and (3) whether it distinguishes field studies from clinical. Also note that there are more studies arguing higher comorbidity (above) than low comorbidity (below) because there are simply more studies showing higher comorbidity than lower:

A. “Comorbidity of Gender Dysphoria and Other Major Psychiatric Diagnoses” / [Cole; O’Boyle; Emory; Meyer III / Archives of Secual Behaviour / Feb. 1997, Vol. 26, Issue 1, pp 13–26] / https://link.springer.com/article/10.1023%2FA%3A1024517302481?LI=true

  • Note the caveat: “Those completing the MMPI (93 female and 44 male) demonstrated profiles that were notably free of psychopathology (e.g., Axis I or Axis II criteria). The one scale where significant differences were observed was the Mf scale, and this held true only for the male-to-female group.”

B. “Psychiatric comorbidity among patients with gender identity disorder” / [Hoshiai; Matsumoto; Sato; Oshnishi; et al / Psychiatru and Clinical Neurosciences Journal] / http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1819.2010.02118.x/full

  • Note the caveat: “Some limitations of this study have to be considered. First, this study is a clinic-based study rather than a field study. Therefore, the sample is large, but not necessarily representative of all GID individuals. In our study, 60.3% were FTM GID patients, and 39.7% were the MTF type.”

C. “Symptom profiles of gender dysphoric patients…” / [Haraldsen; Dahl / Acta Psychiatrica Scandinavica / October 2000]/ https://www.ncbi.nlm.nih.gov/pubmed/11089727

  • Note: Look at the numbers in the methodology “TS patients (n=86), patients with personality disorder (PD, n=98) and adult healthy controls (HC, n=1068) were compared”

IV. GOOGLE SCHOLAR RESULT LIST TO AID FURTHER RESEARCH:

V.REFERENCE TO A STUDY ON REMISSION IN ADULTS

VI. COMMON COUNTER-ARGUMENT:

“WHY RESEARCH THIS STUFF? CAN’T WE JUST LET PEOPLE LIVE HOW THEY WANT TO LIVE? WHAT IS YOUR POSSIBLE MOTIVATION FOR PROVIDING KIND OF INFORMATION BESIDES HATE, BIGOTRY, PREJUDICE, HOMOPHOBIA (or would it be transphobia), ETC.”

My response is simple… people striving to (1) be informed and to (2) make informed judgments and decisions, will strive to listen objectively, research thoroughly, and ponder carefully before reacting. They are not readily followers of the crowd (via some group think-mentality) nor are they easily intimidated by the loudest voices or the powers that be. They are not apt to embrace the propaganda delivered by the mainstream news and entertainment media and they do not readily accept the “facts” (more often pseudo-science) coming forth from modern academia — the very same academia that has institutionalized a bias in favor of conformity, and political correctness, and against true higher learning and objective reasoning and truth.

So though some will feel better, wiser, or even more progressive, if they stick their proverbial heads in the sand; and just get along; going with the flow; not standing up for truth; not engaging in the kind of honest discernment and discourse that can bring about personal persecution; not rocking the boat; not willing to risk not being liked by everyone; etc., many of us cannot operate under such a slavish mindset. If others wish to so operate, that is their business; it is between them and God. All we ask is that those so acting, refrain from judging those of us who take truth, honesty, objectivity, reason, research, analysis, contemplation, discernment, free discourse, the open exchange of ideas, personal freedom, moral responsibility, true love, and both God and His word ‘a bit’ more seriously than they do.

Finally, if I am incorrect concerning any argument or offered supporting data; if my facts are wrong; if the studies I linked to are in error, please… feel free to say so. All that I ask is that you offer your counters with proof-texts / citations, and do so in a manner designed to inform and edify, as opposed to merely opining, ridiculing, or scoffing. These are issues that directly relate to God, his Christ, His people, His creation, His law; His morality; His truth; and His justice. God created mankind; He created them male and female; the male/female creation of humanity is a direct type of Christ and His Bride/Body; and God’s word has much to say about both the type and the spiritual reality concerning these matters. May we take all such things very, very, seriously.

To God be the glory,

Curt Wildy

 

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