I'm not going to disclose if I have a mental disorder. But is it possible to suffer simultaneously from several mental disorders and have gender issues? Is this just so god damn rare as to be impossible? Post your thoughts, opinions, feelings, and experiences.
I'm sure I'm going to be impaled for using gender issues...I'm not too good with the proper terminology...
Maybe Nichole or someone with actual experience in psychology, therapy, or psychiatry can help?
I'm no expert but the literature says it's quite possible. There are disagreements as to how common comorbid mental illness is in the trans community, but it is indeed possible to have severe mental illness and gender issues simultaneously.
Yes, it's not even unusual. Certain mental illnesses appear to have biological/genetic etiologies (where they come from): in fact, the three major Thought Disorders: depressive, bi-polar and schizophrenia all appear to have those etiologies.
Personality Disorders are more environmental in origin. They tend to come abvout due to experience when one's brain finds a good method of coping with pain, discounting and other negative, sometimes even positive, influences.
Nichole
Quote from: polymorphic on June 06, 2008, 10:07:53 AM
But is it possible to suffer simultaneously from several mental disorders and have gender issues?
Sure! I suppose they can all arise independently, but keep in mind that GID tends to make a mess of one's emotional landscape too. Issues of self-acceptance, self-esteem, self-perception, trust issues, paranoia, being super self-conscious, etc.
Ya carry around this
Big Dark Secret all your life, terrified of anyone finding out and punishing you, terrified "they can tell!" somehow... and it really wreaks havoc in our minds over time, gnawing at it from the inside.
That's why I'm always going on and on about how you HAVE to deal with your old, unresolved internal problems when transitioning, because transitioning has this nasty way of stirring things up, and all these old issues you THOUGHT you'd conquered suddenly come to the surface again and DEMAND resolution.
~Kate~
QuoteSure! I suppose they can all arise independently, but keep in mind that GID tends to make a mess of one's emotional landscape too. Issues of self-acceptance, self-esteem, self-perception, trust issues, paranoia, being super self-conscious, etc.
Yea... I have all those lol... sad but true.
Quote
Ya carry around this Big Dark Secret all your life, terrified of anyone finding out and punishing you, terrified "they can tell!" somehow... and it really wreaks havoc in our minds over time, gnawing at it from the inside.
Very true Kate.
Quote
That's why I'm always going on and on about how you HAVE to deal with your old, unresolved internal problems when transitioning, because transitioning has this nasty way of stirring things up, and all these old issues you THOUGHT you'd conquered suddenly come to the surface again and DEMAND resolution.
~Kate~
Please keep going on and on about it. Maybe after I hear it a few more times it will sink in and I won't think it's the first time
I've ever heard that. lol... I totally thought SO many things were behind me and long resolved... nope... they were just left
dormant for many years.
You are so right about this Kate. But why... why do these issues that are so far in the past become SO important?
Amanda
Quote
That's why I'm always going on and on about how you HAVE to deal with your old, unresolved internal problems when transitioning, because transitioning has this nasty way of stirring things up, and all these old issues you THOUGHT you'd conquered suddenly come to the surface again and DEMAND resolution.
~Kate~
Yeah, I noticed that one once I decided to face all of this head on. All of the repressed emotions came flooding out and it was very intense at times. But, once I began to face these emotional issues things have improved in that respect. UNTIL hrt came along and threw me through some more emotional loops. But, even that is getting better a little at a time.
QuoteSure! I suppose they can all arise independently, but keep in mind that GID tends to make a mess of one's emotional landscape too. Issues of self-acceptance, self-esteem, self-perception, trust issues, paranoia, being super self-conscious, etc.
Ya carry around this Big Dark Secret all your life, terrified of anyone finding out and punishing you, terrified "they can tell!" somehow... and it really wreaks havoc in our minds over time, gnawing at it from the inside.
Hmm, now I'm beginning to doubt myself again...I'm not sure this is me. I tend to think I'm an androgyne. Whatever I am, I still enjoy this forum because for some reason it gives me comfort to be here. :)
Of course, I contradict myself all the time...I don't know anything for certain.
Quote from: polymorphic on June 06, 2008, 10:07:53 AM
I'm not going to disclose if I have a mental disorder. But is it possible to suffer simultaneously from several mental disorders and have gender issues? Is this just so god damn rare as to be impossible? Post your thoughts, opinions, feelings, and experiences.
Yes. That's called comorbidity, and therapists are required by the standards of care to check for it.
Quote from: polymorphic on June 06, 2008, 10:07:53 AM
Is it possible for someone to have a mental disorder with gender issues?
...is it possible to suffer simultaneously from several mental disorders and have gender issues?
Yes.
Borderline Personality Disorder is clinically associated with gender identity issues.
This does not mean Transsexualism is the same as BPD! It does mean that BPD patients have issues of self-identity and frequently have disturbances in their gender identity.
http://healthlink.mcw.edu/article/983214704.html
http://www.mayoclinic.com/health/borderline-personality-disorder/DS00442/DSECTION=2
Comorbid conditions in BPD patients are extremely common and may include other mood disorders, other personality disorders, clinical depression, anxiety disorders, eating disorders, substance abuse, etc., and may be indicative of Dissociative Identity Disorder (Multiple Personality Disorder).
Borderline Personality Disorder is believed to be caused, at least in part, by an upbringing in an emotionally invalidating environment.
http://bpd.about.com/od/environmentalcausesorbpd/a/Invalidate.htm
Some advocacy groups have pressed for changing the name of Borderline Personality Disorder to "Emotional Regulation Disorder" as a more accurate description of BPD.
-Emerald :icon_mrgreen:
Quote from: Emerald on June 06, 2008, 04:47:50 PM
Quote from: polymorphic on June 06, 2008, 10:07:53 AM
Is it possible for someone to have a mental disorder with gender issues?
...is it possible to suffer simultaneously from several mental disorders and have gender issues?
Yes.
Borderline Personality Disorder is clinically associated with gender identity issues.
I have sincere issues about whether BPD is a disorder at all. The short description of a borderline personality is someone who "acts out."
BPD is associated with gender issues by whom? That's a new one for me and I don't see it in the DSM-IV-TR either.
It's associated with attachment and trust, adjustment and with childhood sexual abuse. I do agree that "Emotion-Regulation D.O." is probably best, Borderline being a hold-over from the rather ancient psych days when the shrinks couldn't figure out if the behavior was 'psychotic' or 'neurotic' and these behaviors strode along the 'borderline.'
N~
Quote from: Lisbeth on June 06, 2008, 07:36:10 PM
I have sincere issues about whether BPD is a disorder at all. The short description of a borderline personality is someone who "acts out."
Quote from: Nichole on June 06, 2008, 08:39:51 PM
BPD is associated with gender issues by whom? That's a new one for me and I don't see it in the DSM-IV-TR either.
It's associated with attachment and trust, adjustment and with childhood sexual abuse. I do agree that "Emotion-Regulation D.O." is probably best, Borderline being a hold-over from the rather ancient psych days when the shrinks couldn't figure out if the behavior was 'psychotic' or 'neurotic' and these behaviors strode along the 'borderline.'
The latest major revision of the DSM-IV, was published in 1994, 14 years ago. A "text revision", the DSM-IV-TR, was published in 2000, eight years ago. Clinical research and understanding of mental disorders is constantly improving and will continue to do so with every passing year. (The DSM dropped "Homosexuality" as a category of disorder in 1974.) The next major revision of the DSM is tentatively scheduled to be published in 2012 - four years from now, 12 years since the text revision, fully 18 years since the last major revision. Substantial changes are expected for many of its listed entries, including GID and BPD... and the probable inclusion of brand new entries such as "Body Integrity Identity Disorder" (BIID), which has the potential to put GID in a new light for clinical diagnosis.
http://en.wikipedia.org/wiki/Body_Integrity_Identity_Disorder
The DSM is old news. A great deal of new information has come into being since the DSM's last publication. My interest is in the family dynamics of BPD and current research and studies, not simply what appears in the DSM.
BPD kills just as surely as GID kills. The suicide rate is astronomically high for BPD's. About 10% die by their own hand, and with a comorbid a diagnosis of Panic Disorder the death toll increases to 25%. Borderline Personality Disorder affects 2% of the adult population - one out of every 50 people. Young adults are at the greatest risk for BPD suicide and self-harm. Run, don't walk, to seek out a talk therapist who specializes in "Dialectical Behavioral Therapy" if you or a loved one is dealing with symptoms of BPD.
A quick FYI: Some BPD's (about 75%) have been physically or sexually abused, not all BPD's.
BPD's have a poorly defined identities and "erratic dramatic" mood swings. Indeed, uncertainty and disturbances of gender identity and sexual identity are very much associated with BPD.
Google "Borderline Personality Disorder" + "gender identity" yourself, over 40,000 hits. Lots of info!
-Emerald :icon_mrgreen:
Wow nice info Emerald...Makes me wonder about myself.
BPD sure sounds like something I might be suffering from. Of course, I'm not sure at the moment.
Comorbid mental issues seem to be very common and many people tend to be quiet about them to get treatment for GID.
Even off hormones I get mood swings based on the environment (of course... I've become amazing at handling the stress over the years by releasing just the right amount with venting.). My mom thinks I'm bipolar, but shes kind of blantantly insane in the membrane.
I have really bad chemical depression though. REALLY bad. I felt so hollow that I'd collapse and die like an old used star, and that my black hole gravity would even suck peoples light away. Its why I never hang out when I'm in an outwardly bad mood and try to keep a cynical sense of humor with friends...
Like eff my life, but not being serious about it. I'd never want an affair with life... She's a whorebag.
But after my friend died, I wasn't able to maintain my cool with my depression without chemical aid. Hormones too, yeah, but my risky theory on finding a new female homeostasis actually worked out. Like... I get sad now, but not depressed to the point of TOTAL apathy. Of course... Finding your muse is still hard with only chemical inspiration, but I'm not suicidal or anything destructive in a bad way (except caffeine... Crud). Not to mention I need to cry sometimes and the meds prevent me from doing so, even if life is curbing me til I bleed----- Even when I'm more estrogenic than the girl I know, and emotional like a pubescent girl. D: That I am, apparently. I cry for different reasons now I guess...
But yeah. Chemical imbalanceness...
Fun Fun. Doesn't make an underlying gender problem not legit...
Its an ouroboros to me.
In a word, yes. You can have a mental disorder that co-exists with GID.
When I was 20, in 1970, I was living part time male, part time female. I had been having serious issues from the age of 5 or so, was mostly raised as a female well into my teens, and was starting to lose track of things to the point of (almost) really believing that I was born genetically female. In other words, I was worried that I was, or was becoming delusional.
GID, is unfortunately, something that colors all aspects of your life, and invites confusion and difficulty all across the spectrum. The problem is enhanced by the difficulty in recognizing when to find help. People who have no REAL understanding, are of little help, and the attitude of "if I can't see it, it doesn't exist," is too prevalent.
GID is truly a potentially debilitating condition, and it can bring with it a host of associated problems that require a knowledgeable and skillful practitioner to sort it all out. That may be part of the thinking behind the requirement in the Standards of Care, that one of the letters recommending SRS is from a therapist specializing in gender related concerns who has a Phd., so that the client can be evaluated for comorbid problems prior to SRS.
Forgive me... I'm not inclined to use PM on a subject of interest to all.
No, Nichole, I can't point out a specific study on BPD patients and gender disturbances although several may exist in scholarly literature. Gender disturbances in BPD is commonly seen in clinical practice but it exists as side note of the greater issues of emotional regulation and personal identity. Gender disturbances are not present in all BPD patients. Is not a wise to subject a BPD patient to direct gender identity questions for study! If they didn't have gender issues before the inquiry, BPD's may develop gender issues afterwards! BPD's have a profound tendency to think in terms of black and white, right or wrong, good or bad... there is no middle ground, only revolving self-doubt.
----------
GID and BPD are two different things:
IF you have GID (TS type), other people will "invalidate" what you feel. People will tell you that you are wrong, tell you God doesn't make mistakes, tell you that you don't know what you are talking about, tell you that you are crazy, tell you all kinds of things horrible things other than accept the fact that you FEEL you are not in a correctly sexed body and that you FEEL you are a member of the opposite sex. "Invalidation" is discounting and dismissing how someone feels. Being in a constantly invalidating environment may cause a person to develop the mood swings and suicide attempt associated with the criteria of BPD, which are also commonly seen in Transsexuals.
IF a person has BPD, having been raised in a more generally invalidating environment where having ANY opinion, ANY feelings, or ANY sense of emotional autonomy is being consistently invalidated (such as a child with a severely neglecting, over-controlling, Obsessive-Compulsive, or Narcissistic parent/caregiver), the child may grow up to become a young adult who is unable to regulate or control their own feelings and emotions. BPD's feel 'empty' inside, as if they have no identity or aren't allowed to have their own identity. Self-hatred, deep depression, and daily episodes of wildly swinging emotions are rampant in BPDs. Doubts and confusion about their gender identity is not uncommon. Gender confusion is one of the many and varied manifestations of BPDs due to the lack of self-identity and emotional self-regulation. Gender disturbances are not an underlying cause of BPD, merely a symptom.
As previously noted, many types of mental illnesses or sexual issues may manifest as something which mimics Transsexuality. Gender therapists are trained to sort out other issues which may cause a patient to believe changing their sex will solve problems completely unrelated to GID. BPD is not necessarily related to GID, there are very important differences! Few TS people have BPD. Some BPD's have disturbances of gender identity due to their uncertainly of personal identity in general, and they may erroneously present themselves as TS in a clinical setting (consistent with BPD's black and white thinking). By the time they "come out" most TS people have already worked out any existing self-doubts and know EXACTLY what gender they are.
Due to the more encompassing and profound personal identity problem of Borderline Personality Disorder, BPDs are among the most common patients to clinically present with gender issues other than those with GID ("true Transsexuals"). Patients who present with gender issues may be not have GID at all, they may have another psychiatric disorder such as Schizophrenia, Dissociative Identity Disorder, Munchausen Syndrome, BPD, or issues related to sexual orientation, or issues concerning sexual arousal (Transvestic Fetishists, etc), or may simply be avid Crossdressers.
BPD can mimic Transsexuality. Transsexuality can mimic BPD.
It would be fairly rare for a patient to have both conditions, but not impossible.
All Transsexual have very real gender issues. Some BPD patients have very real gender disturbances.
Feeling are very real things! Gender identity is something you feel.
I hope this addresses a goodly number of questions and comments and the PMs asking for more information.
I am not an expert in this field but I have some working knowledge about BPD and how it can relate to one's gender identity. Sharing what I can.
-Emerald :icon_mrgreen:
Quote from: Emerald on June 08, 2008, 11:39:06 AM
Forgive me... I'm not inclined to use PM on a subject of interest to all.
-Emerald
No. I know you are not so inclined. My bad for thinking that you would be. Ya see, I asked the questions on a PM to avoid making any possible attempt to embarrass you in front of others.
I forget that, in general, that same consideration almost never seems to apply to your posts here. Why answer in private when you can answer in public? That's where the satisfaction always is, right, E? From here out I'll try to recall your preferences. Sorry about the PM.
Thanks for the answer. I'd still like to see papers clinicians have written. Most, when they discover or find something that doesn't fit the literature pass on the info. You seem unable to find any info that actually supports your conclusions.
Best,
Nichole
With reference to BPD, I want to point that in tests of the reliability of various diagnostic categories, the APA has found that all personality disorders, including BPD, have extemely low reliability. What this means is that any two therapists are not likely to agree on whether a client has BPD or not. Without reliability as a diagnostic category, claiming various clinical effects as being caused by BPD is problematic.
With relationship to other mental problems, there are lot of people with GID who have substance abuse problems that ought to be dealt with before anything else. Informed consent depends on being rational in the first place.
Quote from: tekla on June 08, 2008, 02:46:15 PM
With relationship to other mental problems, there are lot of people with GID who have substance abuse problems that ought to be dealt with before anything else. Informed consent depends on being rational in the first place.
Definitely!
Quote from: tekla on June 08, 2008, 02:46:15 PM
With relationship to other mental problems, there are lot of people with GID who have substance abuse problems that ought to be dealt with before anything else. Informed consent depends on being rational in the first place.
Actually, you can and DO work with dual-diagosed people on their psychiatric issues while they are still using. In fact, harm reduction is the official policy of the San Francisco Dept. of Public Health. As abstinence programs continue to show poor performance, AA for example has a 10% success rate at the 5 year mark, more localities are likely to move in that direction. It already is the policy throughout many EU countries. Can you name any instances where someone in the midst of a severe substance use problem had the surgery? You'll find very few addicts have the financial resources for gender related surgeries.
harm reduction is the official policy of the San Francisco Dept. of Public Health
Which of course is such a huge success, after all, few places are as drug free as SF.
Quote from: tekla on June 08, 2008, 04:49:31 PM
harm reduction is the official policy of the San Francisco Dept. of Public Health
Which of course is such a huge success, after all, few places are as drug free as SF.
Be that as it may, tekla. Again, what appears to work best for the most is what often becomes best-evidence-based practice. Drug addictions may be cause, effect or symbiotic with mental disorders. I'd personally plunk for problems arising pretty much simultaneously.
Treatment of the two in conjunction with one another tends to work quite well. Your problem of being oriented enough to give one's informed consent is certainly mandatory. But, Claire is right at base that co-morbid disorders seem to best be treated both at once.
Harm reduction is another best-evidence practice as is a technique called motivational-interviewing.
As Liz pointed out above, with some disorders it is 1) hard to diagnose consistently the disorder and 2) have methods of treatment that qualify as best-evidence.
BPD, for instance, is often attributed to people who simply piss-off the clinician. It, like the over-used and under-defined 'passive-aggressive' can be euphemisms for 'that person pushes all of my buttons' to an actual difficult personality disorder.
One does the best one can and tries to admit when she's taken a wrong turn or is misinformed, ignorant of or inexperienced in particular modalities and mental difficulties. Team-work tends to be efficacious as then a number of people are able to bring experience and thoughts together.
Psychoanalysts, who created many of the terms we use, seldom did or do that.
N~
All that stuff I don't know about, but I do know the history of The City, and going back to the days when it was called Yerba Buena (Good Herb in Spanish, perfect eh?) when the first opium dens were set up, through the 49ers whiskey soaked vacations, the Barbary Coast (in its day, proudly called "the wickedest place on earth" and many here miss it, a bunch of antique stores is not a substitute for open and wanton debaucheries) to the Roaring Twenties when it was known as "the wettest of the wets" for its open violation of Prohibition, to the War Years, the Sixties - when the Ellis D. Sox (yes, LSD) was Director of the Department of Public Health of the City and County of San Francisco tried to stop the use of acid (today we celebrate Jerry Garcia, Ellis D. Sox is all but unknown), to the present day when marijuana is openly sold in stores that advertise and openly smoked -- trying to control drugs here (and alcohol is just the most popular drug, not something in a different class, as in "drugs and alcohol") is just peeing in the ocean trying to stop the tide. After all, if all the tourists left The City, there are enough seats and stools at the bars so that all the adults in the entire City can go out for a drink at the same time.
I'm not going to join the fray on co-occurring BPD but based on my own experience as a mental health professional I haven't really seen it. Working at a clinic that did treatment programs for both GID and BPD I saw maybe 1 TG client that was a participant in a Dialectic Behavioral Therapy (DBT) group, the level of care treatment for BPD.
I think a better candidate for co-occurring psychiatric disorders is Post Traumatic Stress Disorder, PTSD. That was what I saw at my previous job. A friend who did her MSW thesis project on violence in the transgender community found that of 300 TGs she surveyed "one in four participants in this study met criteria for posttraumatic stress disorder (PTSD)." Many PTSD symptoms are similar to those of BPD.
A friend who did her MSW thesis project on violence in the transgender community found that of 300 TGs she surveyed "one in four participants in this study met criteria for posttraumatic stress disorder (PTSD)."
That, sadly, sounds close to the truth, and close the the stats that CUAV uses too.
Quote from: Claire de Lune on June 08, 2008, 04:42:08 PM
Quote from: tekla on June 08, 2008, 02:46:15 PM
With relationship to other mental problems, there are lot of people with GID who have substance abuse problems that ought to be dealt with before anything else. Informed consent depends on being rational in the first place.
Actually, you can and DO work with dual-diagosed people on their psychiatric issues while they are still using. In fact, harm reduction is the official policy of the San Francisco Dept. of Public Health. As abstinence programs continue to show poor performance, AA for example has a 10% success rate at the 5 year mark, more localities are likely to move in that direction. It already is the policy throughout many EU countries. Can you name any instances where someone in the midst of a severe substance use problem had the surgery? You'll find very few addicts have the financial resources for gender related surgeries.
Groups like AA want you to believe that
Abstinance Only is the only treatment method that works. It's not. It's not even the best. The goal of most treatment programs is to help the client manage their substance use so that it does not cause personal and social problems at which point it's no longer a substance abuse problem. Of course with illegal substances abstinance is the only legal outcome.
Quote from: Claire de Lune on June 08, 2008, 05:50:50 PM
I'm not going to join the fray on co-occurring BPD but based on my own experience as a mental health professional I haven't really seen it. Working at a clinic that did treatment programs for both GID and BPD I saw maybe 1 TG client that was a participant in a Dialectic Behavioral Therapy (DBT) group, the level of care treatment for BPD.
I think a better candidate for co-occurring psychiatric disorders is Post Traumatic Stress Disorder, PTSD. That was what I saw at my previous job. A friend who did her MSW thesis project on violence in the transgender community found that of 300 TGs she surveyed "one in four participants in this study met criteria for posttraumatic stress disorder (PTSD)." Many PTSD symptoms are similar to those of BPD.
Yes, and is consistent with the high incidence of physical and sexual abuse of transgendered children and youth.
Quote from: Always Amanda on June 06, 2008, 12:04:24 PM
But why... why do these issues that are so far in the past become SO important?
That's an important question. I used to think that the past didn't matter and could go on without ever confronting it. Sadly, it doesn't work that way. (ticked me off to no end, let me tell you)
I'd say the shortest answer is that a lot of who we are is a reaction to our environments when we are young. For example, if a child is told to 'shut up' a lot as a child, that person may grow up to be a very quiet person who can't say what they think or feel (wonder how I know that ;)). That's just one example. But as a child who was forced to be extremely quiet and stay out of the way, the only way I got over that at all (certainly not completely) was to go back and deal with it. I had to let myself feel the emotions that it caused and the hardest thing I had to do was to put myself out there and start saying what I wanted and making people notice me...not always with great outcomes. But I did it and I'm a much more assertive and self assured person than I was.
So maybe it wasn't the short answer... :laugh: