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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Treatment for a person diagnosed with GID may include psychotherapy or to support the individual's preferred gender through hormone therapy, gender expression and role, or surgery. This may include psychological counseling, resulting in lifestyle changes, or physical changes, resulting from medical interventions such as hormonal treatment, genital surgery, electrolysis or laser hair removal, chest/breast surgery, or other reconstructive surgeries. The goal of treatment may simply be to reduce problems resulting from the person's transgender status, for example, counseling the patient in order to reduce guilt associated with cross-dressing, or counseling a spouse to help them adjust to the patient's situation.
Hormone treatment or surgery for gender dysphoria is somewhat controversial because of the irreversibility of physical changes. Guidelines have been established to aid clinicians. The World Professional Association for Transgender Health (WPATH) Standards of Care are used by some clinicians as treatment guidelines. Others use guidelines outlined in Gianna Israel and Donald Tarver's "Transgender Care". Guidelines for treatment generally follow a "harm reduction" model.
The question of whether to counsel young children to be happy with their assigned sex, or to encourage them to continue to exhibit behaviors that do not match their assigned sex—or to explore a transsexual transition—is controversial. Some clinicians report that a significant proportion of young children diagnosed with gender dysphoria later do not exhibit any dysphoria.
Professionals who treat gender identity disorder in children have begun to refer and prescribe hormones, known as a puberty blocker, to delay the onset of puberty until a child is believed to be old enough to make an informed decision on whether hormonal gender reassignment leading to surgical gender reassignment will be in that person's best interest.
Psychosexual disorders can vary greatly in severity and treatability. Medical professionals and licensed therapists are necessary in diagnosis and treatment plans. Treatment can vary from therapy to prescription medication. Sex therapy, behavioral therapy, and group therapy may be helpful to those suffering distress from sexual dysfunction. More serious sexual perversions may be treated with androgen blockers or selective serotonin reuptake inhibitors (SSRIs) to help restore hormonal and neurochemical balances.
Selective serotonin reuptake inhibitors (SSRIs) are used, especially with exhibitionists, non-offending pedophiles, and compulsive masturbators. They are proposed to work by reducing sexual arousal, compulsivity, and depressive symptoms. However, supporting evidence for SSRIs is limited.
There are many ways a person may go about receiving therapy for ego-dystonic sexual orientation associated with homosexuality. There is no known therapy for other types of ego-dystonic sexual orientations. Therapy can be aimed at changing sexual orientation, sexual behaviour, or helping a client become more comfortable with their sexual orientation and behaviours. Human rights groups have accused some countries of performing these treatments on egosyntonic homosexuals. One survey suggested that viewing the same-sex activities as compulsive facilitated commitment to a mixed-orientation marriage and to monogamy. Treatment may include sexual orientation change efforts or treatment to alleviate the stress. In addition, some people seek non-professional methods, such as religious counselling or attendance in an ex-gay group.
Pharmacological treatments can help people control their sexual behaviors, but do not change the content of the paraphilia. They are typically combined with cognitive behavioral therapy for best effect.
Therapeutic approaches for GIDC differ from those used on adults and have included behavior therapy, psychodynamic therapy, group therapy, and parent counseling. Proponents of this intervention seek to reduce gender dysphoria, make children more comfortable with their bodies, lessen ostracism, and reduce the child's psychiatric comorbidity. The majority of therapists currently employ these techniques. "Two short term goals have been discussed in the literature: the reduction or elimination of social ostracism and conflict, and the alleviation of underlying or associated psychopathology. Longer term goals have focused on the prevention of transsexualism and/or homosexuality."
Individual therapy with the child seeks to identify and resolve underlying factors, including familial factors; encourage identification by sex assigned at birth; and encourage same-sex friendships. Parent counseling involves setting limits on the child's cross-gender behavior; encouraging gender-neutral or sex-typical activities; examining familial factors; and examining parental factors such as psychopathology. Longtime researchers of gender identity disorder, Kenneth Zucker and Susan Bradley, state that it has been found that boys with gender identity disorder often have mothers who to an extent reinforced behavior more stereotypical of young girls. They also note that children with gender identity disorder tend to come from families where cross-gender role behavior was not explicitly discouraged. However, they also acknowledge that one could view these findings as merely indicative of the fact that parents who were more accepting of their child's cross-gender role behavior are also more likely to bring their children to a clinical psychiatrist as opposed to parents who are less accepting of cross-gender role behavior in their children (Bradley, Zucker, 1997). " Proponents acknowledge limited data on GIDC: "apart from a series of intrasubject behaviour therapy case reports from the 1970s, one will find not a single randomized controlled treatment trial in the literature" (Zucker 2001). Psychiatrist Domenico Di Ceglie opines that for therapeutic intervention, "efficacy is unclear," and psychologist Bernadette Wren says, "There is little evidence, however, that any psychological treatments have much effect in changing gender identity although some treatment centres continue to promote this as an aim (e.g. Zucker, & Bradley, 1995)." Zucker has stated that "the therapist must rely on the 'clinical wisdom' that has accumulated and to utilize largely untested case formulation conceptual models to inform treatment approaches and decisions."
Gender dysphoria in children or gender identity disorder in children (GIDC) is a formal diagnosis used by psychologists and physicians to describe children who experience significant discontent (gender dysphoria) with their biological sex, assigned gender, or both.
GIDC was formalized in the third revision of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-III) in 1980 and primarily referenced gender non-conforming behaviors. GIDC remained in the DSM from 1980 to 2013, when it was replaced with the diagnosis of "gender dysphoria" in the fifth revision (DSM-5), in an effort to diminish the stigma attached to gender variance while maintaining a diagnostic route to gender affirming medical interventions such as hormone therapy and surgery.
Controversy surrounding the pathologization and treatment of cross-gender identity and behaviors, particularly in children, has been evident in the literature since the 1980s. Proponents of more widespread GIDC diagnoses argue that therapeutic intervention helps children be more comfortable in their bodies and can prevent adult gender identity disorder. Opponents say that the equivalent therapeutic interventions with gays and lesbians (titled conversion or reparative therapy) have been strongly questioned or declared unethical by the American Psychological Association, American Psychiatric Association, American Association of Social Workers and American Academy of Pediatrics. The World Professional Association for Transgender Health (WPATH) states that treatment aimed at trying to change a person's gender identity and expression to become more congruent with sex assigned at birth "is no longer considered ethical." Critics also argue that the GIDC diagnosis and associated therapeutic interventions rely on the assumption that an adult transsexual identity is undesirable, challenging this assumption along with the lack of clinical data to support outcomes and efficacy.
Gender identity disorder in children is more heavily linked with adult homosexuality than adult transsexualism. According to limited studies, the majority of children diagnosed with GID cease to desire to be the other sex by puberty, with most growing up to identify as gay or lesbian with or without therapeutic intervention.
Ego-dystonic sexual orientation is an ego-dystonic mental disorder characterized by having a sexual orientation or an attraction that is at odds with one's idealized self-image, causing anxiety and a desire to change one's orientation or become more comfortable with one's sexual orientation. It describes not innate sexual orientation itself, but a conflict between the sexual orientation one wishes to have and the sexual orientation one actually possesses.
Psychosexual disorder is a term which may simply refer to a sexual problem that is psychological, rather than physiological in origin. "Psychosexual disorder" was a term used in . The term of psychosexual disorder (Turkish: "Psikoseksüel bozukluk") used by the TAF for homosexuality as a reason to ban the LGBT people from military service.
Sexual maturation disorder is a disorder of anxiety or depression related to an uncertainty about one's gender identity or sexual orientation. The World Health Organization (WHO) lists sexual maturation disorder in the ICD-10, under "Psychological and behavioural disorders associated with sexual development and orientation".
Sexual orientation, by itself, is not a disorder and is not classified under this heading. It differs from ego-dystonic sexual orientation where the sexual orientation or gender identity is repressed or denied.
Biphobia is aversion toward bisexuality and toward bisexual people as a social group or as individuals. It can take the form of denial that bisexuality is a genuine sexual orientation, or of negative stereotypes about people who are bisexual (such as the beliefs that they are promiscuous or dishonest). People of any sexual orientation can experience or perpetuate biphobia, and it is a source of social discrimination against bisexual people.
Transsexual people experience a gender identity that is inconsistent with, or not culturally associated with, their assigned sex, and desire to permanently transition to the gender with which they identify, usually seeking medical assistance (including hormone replacement therapy and other sex reassignment therapies) to help them align their body with their identified sex or gender.
"Transsexual" is generally considered a subset of "transgender", but some transsexual people reject the label of "transgender". A medical diagnosis of gender dysphoria can be made if a person expresses a desire to live and be accepted as a member of their identified sex, and if a person experiences impaired functioning or distress as a result of their gender identity.
"Sex reassignment therapy" (SRT) is an umbrella term for all medical treatments related to sex reassignment of both transgender and intersex people.
Individuals make different choices regarding sex reassignment therapy, which may include female-to-male or male-to-female hormone replacement therapy (HRT) to modify secondary sex characteristics, sex reassignment surgery (such as orchiectomy) to alter primary sex characteristics, chest surgery such as top surgery or breast augmentation, or, in the case of trans women, a trachea shave, facial feminization surgery or permanent hair removal.
To obtain sex reassignment therapy, transsexual people are generally required to undergo a psychological evaluation and receive a diagnosis of gender identity disorder in accordance with the Standards of Care (SOC) as published by the World Professional Association for Transgender Health. This assessment is usually accompanied by counseling on issues of adjustment to the desired gender role, effects and risks of medical treatments, and sometimes also by psychological therapy. The SOC are intended as guidelines, not inflexible rules, and are intended to ensure that clients are properly informed and in sound psychological health, and to discourage people from transitioning based on unrealistic expectations.
Transmisogyny (sometimes trans-misogyny) is the intersection of transphobia and misogyny. Transphobia is defined as "the irrational fear of, aversion to, or discrimination against transgender or transsexual people". Misogyny is defined as "a hatred of women". Therefore, transmisogyny includes negative attitudes, hate, and discrimination of transgender or transsexual individuals who fall on the feminine side of the gender spectrum, particularly transgender women. The term was coined by Julia Serano in her 2007 book "Whipping Girl" and used to describe the unique discrimination faced by trans women because of "the assumption that femaleness and femininity are inferior to, and exist primarily for the benefit of, maleness and masculinity", and the way that transphobia intensifies the misogyny faced by trans women (and vice versa). It is said many trans women experience an additional layer of misogyny in the form of fetishization; Serano talks about how society views trans women in certain ways that sexualize them, such as them transitioning for sexual reasons, or ways where they’re seen as sexually promiscuous.Transmisogyny is a central concept in transfeminism and is commonly referenced in intersectional feminist theory. That trans women's femaleness (rather than only their femininity) is a source of transmisogyny is denied by certain radical feminists, who claim that trans women are not female.
Until the 1990s, it tended to be described mostly as acrotomophilia, at the expense of other disabilities, or of the wish by some to pretend or acquire disability. Bruno (1997) systematised the attraction as factitious disability disorder. A decade on, others argue that erotic target location error is at play, classifying the attraction as an identity disorder. In the standard psychiatric reference "Diagnostic and Statistical Manual of Mental Disorders", text revision (DSM-IV-tr), the fetish falls under the general category of "Sexual and Gender Identity Disorders" and the more specific category of paraphilia, or sexual fetishes; this classification is preserved in DSM-5.
Lesbophobia (sometimes lesbiphobia) comprises various forms of negativity towards lesbians as individuals, as couples, or as a social group. Based on the categories of sex, sexual orientation, lesbian identity, and gender expression, this negativity encompasses prejudice, discrimination, and abuse, in addition to attitudes and feelings ranging from disdain to hostility. As such, lesbophobia is sexism against women that intersects with homophobia and vice versa.
Transphobia is a range of negative attitudes, feelings or actions toward transgender or transsexual people, or toward transsexuality. Transphobia can be emotional disgust, fear, violence, anger or discomfort felt or expressed towards people who do not conform to society's gender expectations. It is often expressed alongside homophobic views and hence is often considered an aspect of homophobia. Transphobia is a type of prejudice and discrimination similar to racism and sexism, and transgender people of color are often subjected to all three forms of discrimination at once.
Child victims of transphobia experience harassment, school bullying, and violence in school, foster care, and social programs. Adult victims experience public ridicule, harassment including misgendering, taunts, threats of violence, robbery, and false arrest; many feel unsafe in public. A high percentage report being victims of sexual violence. Some are refused healthcare or suffer workplace discrimination, including being fired for being transgender, or feel under siege by conservative political or religious groups who oppose laws to protect them. There is even discrimination from some people within the movement for the rights of gender and sexual minorities.
Besides the increased risk of violence and other threats, the stress created by transphobia can cause negative emotional consequences which may lead to substance abuse, running away from home (in minors), and a higher rate of suicide.
In the Western world, there have been gradual changes towards the establishment of policies of non-discrimination and equal opportunity. The trend is also taking shape in developing nations. In addition, campaigns regarding the LGBT community are being spread around the world to improve acceptance; the "Stop the Stigma" campaign by the UN is one such development.
Attraction to disability or devotism is a sexualised interest in the appearance, sensation and experience of disability. It may extend from normal human sexuality into a type of sexual fetishism. Sexologically, the pathological end of the attraction tends to be classified as a paraphilia. (Note, however, that the very concept "paraphilia" continues to elude satisfactory definition and remains a subject of ongoing debate in both professional and lay communities) Other researchers have approached it as a form of identity disorder. The most common interests are towards amputations, prosthesis, and crutches.
Transmisogyny is generally understood to be caused by the social belief that men are superior to women. In "Whipping Girl", Julia Serano writes that the existence of trans women is seen as a threat to a "male-centered gender hierarchy, where it is assumed that men are better than women and that masculinity is superior to femininity". Gender theorist Judith Butler echoes this assumption, stating that the murder of transgender women is "an act of power, a way of re-asserting domination... killing establishes the killer as sovereign in the moment that he kills".
Trans women are also viewed as threatening the heterosexuality of cisgender men. In media, "deceivers" such as Dil, a transgender woman from the 1992 film "The Crying Game", have been observed to invoke outrage and male homophobia in an audience when their "true" maleness is unveiled.
Homophobia encompasses a range of negative attitudes and feelings toward homosexuality or people who are identified or perceived as being lesbian, gay, bisexual or transgender (LGBT). It has been defined as contempt, prejudice, aversion, hatred or antipathy, may be based on irrational fear, and is often related to religious beliefs.
Homophobia is observable in critical and hostile behavior such as discrimination and violence on the basis of sexual orientations that are non-heterosexual. Recognized types of homophobia include "institutionalized" homophobia, e.g. religious homophobia and state-sponsored homophobia, and "internalized" homophobia, experienced by people who have same-sex attractions, regardless of how they identify.
Negative attitudes toward identifiable LGBT groups have similar yet specific names: lesbophobia is the intersection of homophobia and sexism directed against lesbians, biphobia targets bisexuality and bisexual people, and transphobia targets transgender and transsexual people and gender variance or gender role nonconformity. According to 2010 Hate Crimes Statistics released by the FBI National Press Office, 19.3 percent of hate crimes across the United States "were motivated by a sexual orientation bias." Moreover, in a Southern Poverty Law Center 2010 "Intelligence Report" extrapolating data from fourteen years (1995–2008), which had complete data available at the time, of the FBI's national hate crime statistics found that LGBT people were "far more likely than any other minority group in the United States to be victimized by violent hate crime."
The term "homophobia" and its usage have been criticized by several sources as unwarrantedly pejorative
As the disorder progresses in life, it can increase in severity, and cause other behaviors or actions in late adolescence and adulthood. “A strong and persistent cross-gender identification in adolescents and adults [can cause a] disturbance manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex” (APA, 2000). This can cause severe conflict for the individual living in a society which endorses and enforces adherence to strict gender roles. In a more persistent disassociation with one’s own body or gender, someone can go to more extreme lengths to feel as though they are fulfilled or satisfied with themselves. This can lead these individuals to engage in behavior that displaces their emotions. These individuals may also seek to undergo sex reassignment surgery. “Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex in adolescents and adults [can cause a] disturbance manifested by symptoms such as preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex” (APA, 2000).
Many people with sexual obsessions are alarmed that they seem to lose their sex drive. People with OCD may see this as evidence that they no longer have normal sexual attractions and are in fact deviant in some way. Some may wonder if medication is the answer to the problem. Medication is a double-edged sword. Drugs specifically for erectile dysfunction (i.e. Viagra, Cialis) are not the answer for people with untreated OCD. The sexual organs are working properly, but it is the anxiety disorder that interferes with normal libido.
Medications specifically for OCD (typically SSRI medications) will help alleviate the anxiety but will also cause some sexual dysfunction in about a third of patients. For many the relief from the anxiety is enough to overcome the sexual problems caused by the medication. For others, the medication itself makes sex truly impossible. This may be a temporary problem, but if it persists a competent psychiatrist can often adjust the medications to overcome this side-effect.
People with sexual obsessions can devote an excessive amount of time and energy attempting to understand the obsessions. They usually decide they are having these problems because they are defective in some way, and they are often too ashamed to seek help. Because sexual obsessions are not as well-described in the research literature, many therapists may fail to properly diagnose OCD in a client with primary sexual obsessions. Mental health professionals unfamiliar with OCD may even attribute the symptoms to an unconscious wish (typically in the case of psychoanalysts or psychodynamic therapists), sexual identity crisis, or hidden paraphilia. Such a misdiagnosis only panics an already distressed individual. Fortunately, sexual obsessions respond to the same type of effective treatments available for other forms of OCD: cognitive-behavioral therapy and serotonergic antidepressant medications (SSRIs). People with sexual obsessions may, however, need a longer and more aggressive course of treatment.
While some people use only the more general term "homophobia" to describe this sort of prejudice or behavior, others believe that the terms "homosexual" and "homophobia" do not adequately reflect the specific concerns of lesbians, because they experience the double discrimination of both homophobia and sexism. Similarly, bisexual women may prefer to use the term biphobia to refer to prejudice or abuse that they encounter which is based on their bisexual identity or behaviour, and people who identify as transgender often prefer to use the word transphobia.