Talking to Children About Death

Mental Health Problems Plague Transgender Kids []

by Stephanie Pappas /

Kids who are distressed because they feel their physical body doesn’t match their gender suffer from high rates of psychiatric symptoms, such as depression and suicide attempts, a new study finds.

In a sample of children and adolescents treated at the Endocrine Division at Children’s Hospital Boston, young people who experienced distress about the “mismatch” between their body’s sex and their mental gender had high rates of psychiatric complications (before any gender treatment). Kids who don’t get treatment, whether for financial reasons or because their parents aren’t supportive, likely have higher rates of psychiatric problems, said study researcher Scott Leibowitz, a psychiatrist at Children’s Hospital Boston.

“Individuals who are not transgender take for granted what life must be like when our minds and bodies are incongruent with one another,” Leibowitz told LiveScience. “Personally, I’ve seen so many kids who experience such high levels of distress with their changing bodies that it impairs their emotional and social functioning,” he said.

Mind-body mismatch

Transgender people — people who feel that their biological sex does not reflect their true gender — have astonishingly high rates of mental health problems: A 2010 survey found that 41 percent of transgender people in the U.S. have attempted suicide.

Researchers attributed those rates to discrimination and stigma, as well as a lack of laws protecting transgender people from employment discrimination. Poor insurance coverage of hormones and other treatments to help a transgender person transition to their desired gender also account for the rates, the researchers found. [5 Myths About Gay People]

But the mismatch between mind and body alone can be a major source of psychological pain, Leibowitz said. Of 97 patients who came to the Endocrine Division for hormones and other treatments related to gender identity disorder between January 1998 and February 2010, 44.3 percent had significant mental health histories. Twenty percent had self-mutilated, and 9.3 percent had attempted suicide at least once. About 37 percent were taking psychiatric medication.

Treating gender identity

Growing up, many children experiment with cross-gender behaviors, but very few of them will grow up to experience distress about their biological sex. Persistent gender identity disorder is rare: In the Netherlands, where gender-treatment programs are well- established, only about 1 in every 10,000 to 30,000 people seeks treatment.

When young people start puberty and experience serious distress about their bodies developing into a gender they don’t identify with, there are solutions, Leibowitz said. The medical standard established by the Endocrine Society and the World Professional Organization for Transgender Health call for treatment with hormones that suppress puberty in teens who have not yet undergone major physical changes. These treatments “buy time,” Leibowitz said, preventing the development of secondary sex characteristics such as breasts or an Adam’s apple while kids mature mentally enough to make decisions about whether they’d like to transition to a new gender. These treatments are reversible.

Older teens, ages 16 or 17, can begin to make decisions about taking estrogen or testosterone to promote the sexual characteristics of the gender they feel they are. Puberty-suppressing treatments are also used at this stage to lessen the doses — and thus side effects — of these hormones. The effects of cross-sex hormone therapy are partially reversible.

At every step of the way, Leibowitz said, families and children are counseled and evaluated to be sure they’re ready for treatment. Doctors counsel young children and their families, but do not treat them with drugs or hormones unless their gender identity distress persists at puberty.

The cost of not treating can be high, as the new study, published today (Feb. 21) in the journal Pediatrics, highlights.

“Without treatment, a lot of these kids are prone to psychiatric disorders, including depression, suicide, self-mutilation, anxiety,” Leibowitz said.


Are Your Annoying Friends Making You Physically Ill? []

by Cassie Murdoch /

We all have those friends who are competitive or are constantly causing drama for one reason or another. It’s tempting to just put up with them, but a new study has found that conflicts with those kinds of people could actually be irritating you physically—as in causing your immune system to fire up. This leads to your body to become inflamed, a state which has been associated with things like cancer and diabetes.

The study investigated whether stress from personal conflicts or sports competitions would cause the body to release cytokines, which are molecules linked to inflammation. The researchers saw cytokine levels rise after negative interactions like arguments, but people’s cytokine levels did not rise when they were playing a competitive sport. Co-author psychology professor Shelley Taylor explains the consequences of her findings, “What this tells me is that people should be investing in socially supportive relationships, and they should not court relationships that lead to a great deal of conflict.”

It’s probably a lot more complicated than that, but let’s just take this for what it’s worth: a good excuse to break up with your obnoxious friends and suspend contact with irritating workmates. No one will be able to argue with your scientific reasoning.

As luck would have it, the New York Times has also just offered up a hideously detailed explanation of how to dump your friends when the need arises. It takes them a remarkable three pages to conclude what we all already know: The easiest way to put a friendship out of its misery is to just let it slowly fade away with a series of declined invitations, severed social network ties, and unreturned texts. But if you really need to do a direct, in-person execution, theTimes points you to the advice of psychologist Erika Holiday, who is totally legit because she’s been on Dr. Phil:

Schedule a time where you can sit down with them. It’s not about putting the other person down, but telling them, “You don’t fit into my life, you’re not on same path as me.”

But the great thing is that now you don’t even need to do the bit about fitting into your life, you can just say, “I’m sorry we can’t hang out anymore, but studies have shown you make me sick.” And with those magic words your toxic friendship will most certainly be dead, and you can live healthily ever after.

Study shows how stress triggers immune system [USA Today]
It’s Not Me, It’s You [New York Times]

Do you reside somewhere on the autism spectrum? In the near future, you may not. []

by Robert T. Gonzalez /

For the first time in seventeen years, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (D.S.M.) is undergoing a significant revision. One of the mental conditions facing major emendations in its D.S.M. definition is autism. If the changes go through, a recent analysis suggests that the rate of official diagnosis for autism, and related disorders like Asperger syndrome, could plummet. And that, some people worry, could be bad news for those marginalized by the new diagnostic criteria.

The revision of the D.S.M. puts the APA in the unenviable position of having to draw what the New York Times calls “the line between unusual and abnormal” in relation to mental disorders; in the case of autism, the fact that symptoms are widely believed to manifest themselves along a “spectrum” of class and severity makes the situation even more difficult to navigate. According to the Times:

At least a million children and adults have a diagnosis of autism or a related disorder, like Asperger syndrome or “pervasive developmental disorder, not otherwise specified,” also known as P.D.D.-N.O.S. People with Asperger’s or P.D.D.-N.O.S. endure some of the same social struggles as those with autism but do not meet the definition for the full-blown version. The proposed change would consolidate all three diagnoses under one category, autism spectrum disorder, eliminating Asperger syndrome and P.D.D.-N.O.S. from the manual. Under the current criteria, a person can qualify for the diagnosis by exhibiting 6 or more of 12 behaviors; under the proposed definition, the person would have to exhibit 3 deficits in social interaction and communication and at least 2 repetitive behaviors, a much narrower menu.

If the proposed changes come into effect, an analysis conducted by Yale researchers Fred Volkmar, Brian Reichow and James McPartland indicates they could have a dramatic impact on everything from diagnosis rates (some estimates indicate that autism diagnoses have mushroomed to one child in 100 in recent years), to the ability for many people — people who presently reside somewhere on the autism spectrum of disorders — to access health, educational and social services.

“Our fear is that we are going to take a big step backward,” said Lori Shery, president of the Asperger Syndrome Education Network. “If clinicians say, ‘These kids don’t fit the criteria for an autism spectrum diagnosis,’ they are not going to get the supports and services they need, and they’re going to experience failure.”

Read more over on The New York Times.

National Institutes of Health Statistics on Mental Illness []

Understanding the scope of mental health problems and treatment in the United States is central to NIMH’s mission. Much of what we understand in this area comes from research in the field of epidemiology; the scientific study of patterns of health and illness within a population. Research on psychiatric epidemiology shows that mental disorders are common throughout the United States, affecting tens of millions of people each year, and that only a fraction of those affected receive treatment.

The resource below represents an extensive collection of our best statistics on the prevalence, treatment, and costs of mental disorders. Equally important are sections that have been included on mental health-related disability and on suicide.

This resource is a continuing work in progress, and will be updated regularly as new statistics are released. As it continues to develop, NIMH seeks users’ comments and suggestions on its content, as well as its usability. Comments may be sent

Click on image to go to statistics selections at NIH…

US Affordable Care Act to Collect Health Data/Disparities on LGBT Populations

From the US Department of Health and Human Services:

June 29, 2011
Contact: HHS Press Office
(202) 690-6343

Affordable Care Act to improve data collection, reduce health disparities

HHS announces new draft standards to improve the monitoring of health data by race, ethnicity, sex, primary language, and disability status, and begins planning for the collection of LGBT health data 

HHS Secretary Kathleen Sebelius today announced new draft standards for collecting and reporting data on race, ethnicity, sex, primary language and disability status, and announced the administration’s plans to begin collecting health data on lesbian, gay, bisexual and transgender (LGBT) populations. Both efforts aim to help researchers, policy makers, health providers and advocates to identify and address health disparities afflicting these communities.

“Health disparities have persistent and costly affects for minority communities, and the whole country,” Secretary Sebelius said.  “Today we are taking critical steps toward ensuring the collection of useful national data on minority groups, including for the first time, LGBT populations.  The data we will eventually collect in these efforts will serve as powerful tools and help us in our fight to end health disparities.”

Under the plan announced today, HHS will integrate questions on sexual orientation into national data collection efforts by 2013 and begin a process to collect information on gender identity.  This plan includes the testing of questions on sexual orientation to potentially be incorporated into the National Health Interview Survey.  The department also intends to convene a series of research roundtables with national experts to determine the best way to help the department collect data specific to gender identity.

“The first step is to make sure we are asking the right questions,” Secretary Sebelius said.  “Sound data collection takes careful planning to ensure that accurate and actionable data is being recorded.”

The proposed standards for collection and reporting of data on race, ethnicity, sex, primary language and disability status in population health surveys are intended to help federal agencies refine their population health surveys in ways that will help researchers better understand health disparities and zero in on effective strategies for eliminating them.

The race and ethnicity standards, for example, will provide additional categories from which racial and ethnic differences in health care and outcomes can be examined in more detail, particularly among Asian, Hispanic/Latino and Pacific Islander populations.  The disability standards would consist of six items that are already being used successfully in the Census Bureau’s American Community Survey.  It is intended to improve researchers’ ability to monitor health disparities.

“These new data standards, once finalized, will help us target our research and tailor stronger solutions for underserved and minority communities,” added HHS Director of the Office of Minority Health, Dr. Garth Graham.  “To fully understand and meet the needs of our communities, we must first thoroughly understand who we are serving.”

In anticipation of these efforts, HHS, over the past year, has consulted with federal agencies, requested recommendations from the HHS Data Council, and held listening sessions with relevant community stakeholders.  The public may submit comments for the draft minority data collection standards at under docket number HHS-OMH-2011-0013.  Public comments will be accepted until August 1.  Information is also available

Under Section 4302 of the Affordable Care Act, the Secretary is required to ensure that any federally conducted or supported health care or public health program, activity or survey collects and reports data, to the extent practicable, on race, ethnicity, sex, primary language and disability status, as well as other demographic data on health disparities as deemed appropriate by the Secretary.

For more information on improving data collection to reduce health disparities please visit

For more information on improving data collection within the LGBT community visit

Study: Big City Life Will Make You Mean!!!

In a new study just released it appears that living in a Big City has the effect of making people be less tolerant of others.  In other words, people get on each other’s nerves faster!!!!

In the AP article, “Big City Got You Down? Stress Study May Show Why?” by Malcolm Ritter, he reports that

Imaging scans show that in city dwellers or people who grew up in urban areas, certain areas of the brain react more vigorously to stress. That may help explain how city life can boost the risks of schizophrenia and other mental disorders, researchers said.

The study, sponsored by the Central Institute of Mental Health in Mannheim, Germany, looked at people from urban settings and was published in the latest issue of “Nature.”

For more on the study:

AP: Big city got you down? Stress study may show why

Nature: City living and urban upbringing affect neural social stress processing in humans

View Helen’s Presentation to SRO Housing on LA’s Skid Row concerning Transgender Diversity and Treatment

On June 22nd I had the privilege to present to a combination of public agencies who work with the homeless population in downtown Los Angele’s Skid Row.  These are incredible people who work very hard with all kinds of unique homeless individuals, including Transgendered populations.

I was invited to present on the topic of how to work with homeless transgendered populations, including treatment issues, sensitivity training, legal issues, and cultural understandings between people.  It was a great event and I was very pleased by the turnout (5o or more providers, counselors, service workers, and others) as well as their questions and thoughts!

The picture below is also a LINK to the presentation.  (WordPress does NOT allow me to embed my own Flash presentation!!)  You will be taken to the presentation on my website (  I want to share the information in hopes that it will be helpful to agencies and transgendered populations and individuals.

Click to view presentation

10 Psychological States You’ve Never Heard Of — And When You Experienced Them []

Annalee Newitz – Everybody knows what you mean when you say you’re happy or sad. But what about all those emotional states you don’t have words for? Here are ten feelings you may have had, but never knew how to explain.

1. Dysphoria
Often used to describe depression in psychological disorders, dysphoria is general state of sadness that includes restlessness, lack of energy, anxiety, and vague irritation. It is the opposite of euphoria, and is different from typical sadness because it often includes a kind of jumpiness and some anger. You have probably experienced it when coming down from a stimulant like chocolate, coffee, or something stronger. Or you may have felt it in response to a distressing situation, extreme boredom, or depression.

2. Enthrallment
Psychology professor W. Gerrod Parrott has broken down human emotions into subcategories, which themselves have their own subcategories. Most of the emotions he identifies, like joy and anger, are pretty recognizable. But one subset of joy, “enthrallment,” you may not have heard of before. Unlike the perkier subcategories of joy like cheerfulness, zest, and relief, enthrallment is a state of intense rapture. It is not the same as love or lust. You might experience it when you see an incredible spectacle — a concert, a movie, a rocket taking off — that captures all your attention and elevates your mood to tremendous heights.

3. Normopathy
Psychiatric theorist Christopher Bollas invented the idea of normopathy to describe people who are so focused on blending in and conforming to social norms that it becomes a kind of mania. A person who is normotic is often unhealthily fixated on having no personality at all, and only doing exactly what is expected by society. Extreme normopathy is punctuated by breaks from the norm, where normotic person cracks under the pressure of conforming and becomes violent or does something very dangerous. Many people experience mild normopathy at different times in their lives, especially when trying to fit into a new social situation, or when trying to hide behaviors they believe other people would condemn.

4. Abjection
There are a few ways to define abjection, but French philosopher Julia Kristeva (literally) wrote the book on what it means to experience abjection. She suggests that every human goes through a period of abjection as tiny children when we first realize that our bodies are separate from our parents’ bodies — this sense of separation causes a feeling of extreme horror we carry with us throughout our lives. That feeling of abjection gets re-activated when we experience events that, however briefly, cause us to question the boundaries of our sense of self. Often, abjection is what you are feeling when you witness or experience something so horrific that it causes you to throw up. A classic example is seeing a corpse, but abjection can also be caused by seeing shit or open wounds. These visions all remind us, at some level, that our selfhood is contained in what Star Trek aliens would call “ugly bags of mostly water.” The only thing separating you from being a dead body is . . . almost nothing. When you feel the full weight of that sentence, or are confronted by its reality in the form of a corpse, your nausea is abjection.

Click to Read the Rest of the Article on IO9…–and-when-you-experienced-them

Psychiatrists Wrestle With Defining Disorders (Again) []

Psychiatrists are in the thick of a years-long effort to produce the latest edition of the essential textbook for diagnosing mental illnesses, the DSM. They’re dogged by controversies over ‘new’ conditions.

By Shari Roan, Los Angeles Times - May 22, 2011

“Where are we going to put the narcissists?”

It was a question asked urgently by one of the hundreds of psychiatrists gathered here last week for their professional society’s annual meeting. With doctors in the thick of a years-long effort to rewrite the essential textbook for diagnosing mental illnesses, questions like these came up time and again in meeting rooms, over drinks sipped from coconut shells, and in other venues during the five-day conference.

Among the myriad proposals now on the table: reducing the number of specific personality disorders from 10 to five, a move that would eliminate the diagnosis of narcissistic disorder.

“Of course there are narcissists!” the psychiatrist insisted in the convention’s vast exhibit hall, where new research papers were displayed next to pharmaceutical-industry booths. “We see them all the time!”

Don’t let the cheery Hawaiian shirts fool you — the nation’s psychiatrists aren’t feeling all that ku’u aku (relaxed) as the deadline nears for the next edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5.The first revision in almost 20 years will roll off the presses in 2013. Since the 1994 edition, research has exposed pieces of the biological framework underlying disorders likeschizophreniaanorexia and depression. But molecular tests and brain scans based on those discoveries aren’t yet ready for diagnostic use, and that leaves the authors of the upcoming book with the same problem that vexed their predecessors: how to distinguish a mental illness from the rainbow of normal human behavior.

Much of the discussion at the American Psychiatric Assn. meeting centered on fears that, without solid scientific evidence, additions or deletions in their new bible of mental health could do more harm than good.

“The brain is so darn complicated,” said Dr. David Axelson, director of the Child and Adolescent Bipolar Services program at the Western Psychiatric Institute in Pittsburgh.

As with each edition, the controversies dogging DSM-5 center on the proposed “new” conditions. Among the questions:

• Is there a distinct mood disorder that occurs in some women prior to their periods?

• Is hoarding a brain-based illness?

• Can the sorrow accompanying bereavement swell into a certifiable mental disorder?

Even when concepts are not at issue, nomenclature sometimes is. Suggestions include replacing the word “anxiety” with “worry,” and scrapping the terms “addiction,” “dependence” and “substance abuse” in favor of “substance-use disorder.”

“We have to be very careful about our choice of language and precise criteria,” said Dr. David J. Kupfer, the DSM-5 task force chairman and director of research at Western Psychiatric Institute and Clinic. Slight word changes could translate into making a disorder much more prevalent — or much more rare, he said.

Click to read the rest of the article…

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