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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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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.
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."
The APA has roundly dismissed so-called conversion therapy (sometimes called "ex-gay" therapy) as unproductive and potentially harmful.
One version of conversion therapy, Gender Wholeness Therapy was designed by an ex-gay Licensed Professional Counselor, David Matheson. "The emphasis in Mr. Matheson's counselling is on helping men — all his clients are male — develop 'gender wholeness' by addressing emotional issues and building healthy connections with other men. He says he believes that helps reduce homosexual desires.
Another variation of conversion therapy, "gender-affirmative therapy" has been described by A. Dean Byrd as follows: "The basic premise of gender-affirmative therapy is that social and emotional variables affect gender identity which, in turn, determines sexual orientation. The work of the therapist is to help people understand their gender development. Subsequently, such individuals are able to make choices that are consistent with their value system. The focus of therapy is to help clients fully develop their masculine or feminine identity".
Several organizations have started retreats led by coaches aimed at helping participants diminish same-sex desires. These retreats tend to use a variety of techniques. Journey into Manhood, put on by People Can Change, uses "a wide variety of large-group, small-group and individual exercises, from journaling to visualizations (or guided imagery) to group sharing and intensive emotional-release work." Weekends put on by Adventure in Manhood support "healthy bonding with men, through masculine activity, teamwork, and socialization." Though not specific to gay men, several gay men attended the New Warrior Training Adventure, a weekend put on by ManKind Project, which is a "process of initiation and self-examination that is designed to catalyse the development of a healthy and mature masculine self." Joe Dallas, a prominent ex-gay, leads a monthly five-day men's retreat on sexual purity titled, Every Man's Battle.
Several reparative therapies have been established, including:
- Sexual identity therapy was designed by Warren Throckmorton and Mark Yarhouse, and was endorsed by Robert L. Spitzer, prior to Spitzer's backing away from this belief that he had proven reparative therapy at times successful. Its purpose is to help patients line up their sexual identity with their beliefs and values. Therapy involves four phases: (1) assessment, (2) advanced or expanded informed consent, (3) psychotherapy, and (4) social integration of a valued sexual identity.
- Group psychotherapy uses group sessions led by a single psychologist and focuses on conflict surrounding homosexual expression.
- Context Specific Therapy was designed by Jeffrey Robinson. It does not work with any one theory of homosexuality, but uses several theoretical backgrounds according to the client's need, and is based on phenomenological research. It does not seek to change the client's orientation, but instead focuses on diminishing homosexual thoughts and behaviours. It works within the client's own view of God, noting that "individuals who are successful at overcoming homosexual problems are motivated by strong religious values".
- MAP Therapy is designed for both the individual with ego-dystonic sexual orientation and their family members. There are four main paths that clients may choose to take: (1) they can affirm an LGB identity, (2) they can foster a lifestyle of celibacy, (3) they can work on developing heterosexual attractions, or (4) they can explore their options.
"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.
Transvestism is the practice of dressing and acting in a style or manner traditionally associated with the opposite sex. In some cultures, transvestism is practiced for religious, traditional or ceremonial reasons.
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.
The following are some of the partialisms commonly found among people:
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.
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.
A non-operative transsexual person, or non-op, is someone who has not had SRS, and does not intend to have it in the future. There can be various reasons for this, from the personal to the financial.
In May 2013, the American Psychiatric Association published the DSM-5 in which the GIDC diagnosis was removed and replaced with gender dysphoria, for the first time in its own distinct chapter. Lev states that gender dysphoria places the focus on distress with one's body rather than conformity with societal gender norms, and that this change was accompanied by changes to sexist language and a reduced reliance on binary gender categories. Gender dysphoria reframes the diagnosis as a time-limited distress of the body which is potentially rectified with access to gender transition procedures, rather than a lifetime disorder of the identity.
Partialism is sexual interest with an exclusive focus on a specific part of the body other than the genitals. Partialism is categorized as a fetishistic disorder in the DSM-5 of the American Psychiatric Association only if it causes significant psychosocial distress for the person or has detrimental effects on important areas of their life. In the DSM-IV, it was considered a separate paraphilia (not otherwise specified), but was merged into fetishistic disorder by the DSM-5. Individuals who exhibit partialism sometimes describe the anatomy of interest to them as having equal or greater erotic attraction for them as do the genitals.
Partialism occurs in heterosexual, bisexual, and homosexual individuals. The foot is considered one of the most common partialisms.
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.
Though coined as late as the 1910s, the phenomenon is not new. It was referred to in the Hebrew Bible. The word has undergone several changes of meaning since it was first coined and is still used in a variety of senses. Today, the term "transvestite" is commonly considered outdated and derogatory, with the term "cross-dresser" used as a more appropriate replacement. This is because the term "transvestite" was historically used to diagnose medical disorders, including mental health disorders, and transvestism was viewed as a disorder, but the term "cross-dresser" was coined by the transgender community. In some cases, however, the term "transvestite" is seen as more appropriate for use by members of the transgender community instead of by those outside of the transgender community, and some have reclaimed the word.
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
Some people experience sexual excitement from the look or feel of a women's bra. The attraction may be to the look or feel of the material, such as lace, or how it looks on a person. Some people get excitement from removing a bra.
Some people experience sexual excitement from the look or feel of articles made of silk or satin fabric. Such interest is usually directed towards the person wearing silk or satin, but it can also be directed towards the garment itself, or to the feel of the garment when worn.
The attraction can be to the physical properties of the garment, such as softness, smoothness, drape and shine, and to its association with elegance, glamour, romance and opulence.
The principal materials which are considered erotic are charmeuse silk (silk woven so that it has a sheen) and satins (such as acetate satin and rayon satin), but other materials with similar properties, such as spandex and polyester are also admired.
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.
"Biphobia" is a portmanteau word patterned on the term "homophobia". It derives from the English neo-classical prefix "bi-" (meaning "two") from "bisexual" and the root "-phobia" (from the , "phóbos", "fear") found in "homophobia". Along with "transphobia" and "homophobia", it is one of a family of terms used to describe intolerance and discrimination against LGBT people. The adjectival form "biphobic" describes things or qualities related to biphobia, and the less-common noun "biphobe" is a label for people thought to harbor biphobia.
"Biphobia" need not be a phobia as defined in clinical psychology (i.e., an anxiety disorder). Its meaning and use typically parallel those of "xenophobia".
Surgery is sometimes performed to alter the appearance of the genitals. However many surgeries performed on intersex people lack clear evidence of necessity, can be considered as mutilating, and are widely considered to be human rights violations when performed without the informed consent of the recipient.
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.
Homosexual panic disorder is a separate diagnosis from acute aggression panic disorder. Glick notes that the difference is explained by differing instinctual drives that motivate each disorder. Patients whose primary motivation is a sexual one are suffering from homosexual panic, whereas patients whose motivation is primarily aggression are suffering from acute aggression panic disorder. As stated above, both Glick and Kempf noted in their accounts of patients that those with homosexual panic disorder were not aggressive toward others. Also in concordance with this, Hart's study concluded that those individuals with homosexual panic who chose to satisfy homosexual urges experienced relief from their symptoms.
Spending copious amounts of time with members of the same sex in a confined or limited atmosphere was cited by Kempf as a possible reason for the onset of the disease. Environments where this might occur included but were not limited to army camps, ships, monasteries, schools, asylums, and prisons. Kempf asserted that individuals in these environments who had recently or were currently undergoing stress (due to fatigue, sickness, loss of a love interest, etc.) were more likely to have weak egos. According to the Freudian theory of psychoanalysis, the ego is the part of an individual's mind that mediates between the primitive unconscious and reality. When in such a position, sufferers would become "eccentric and irritable", tending to feel inferior and weak amongst his or her companions.
It is important to note that the onset of this condition was not attributed to unwanted homosexual advances. Rather, Kempf stated that it was caused by the individual's own "aroused homosexual cravings". The individual's homosexual feelings as a cause of his or her symptoms was what differentiated this diagnosis from any other stress-related disorder.
Cognitive-behavioural therapy (CBT) has primarily substituted the psychoanalytic and dynamic approach in the treatment of kleptomania. Numerous behavioural approaches have been recommended as helpful according to several cases stated in the literature. They include: hidden sensitisation by unpleasant images of nausea and vomiting, aversion therapy (for example, aversive holding of breath to achieve a slightly painful feeling every time a desire to steal or the act is imagined), and systematic desensitisation. In certain instances, the use of combining several methods such as hidden sensitisation along with exposure and response prevention were applied. Even though the approaches used in CBT need more research and investigation in kleptomania, success in combining these methods with medication was illustrated over the use of drug treatment as the single method of treatment.
The phenomenological similarity and the suggested common basic biological dynamics of kleptomania and OCD, pathological gambling and trichotillomania gave rise to the theory that the similar groups of medications could be used in all these conditions. Consequently, the primary use of selective serotonin reuptake inhibitor (SSRI) group, which is a form of antidepressant, has been used in kleptomania and other impulse control disorders such as binge eating and OCD. Electroconvulsive therapy (ECT), lithium and valproic acid (sodium valproate) have been used as well.
The SSRI's usage is due to the assumption that the biological dynamics of these conditions derives from low levels of serotonin in brain synapses, and that the efficacy of this type of therapy will be relevant to kleptomania and to other comorbid conditions.
Opioid receptor antagonists are regarded as practical in lessening urge-related symptoms, which is a central part of impulse control disorders; for this reason, they are used in treatment of substance abuse. This quality makes them helpful in treating kleptomania and impulse control disorders in general. The most frequently used drug is naltrexone, a long-acting competitive antagonist. Naltrexone acts mainly at μ-receptors, but also antagonises κ- and λ-receptors.
There have been no controlled studies of the psycho-pharmacological treatment of kleptomania. This could be as a consequence of kleptomania being a rare phenomenon and the difficulty in achieving a large enough sample. Facts about this issue come largely from case reports or from bits and pieces gathered from a comparatively small number of cases enclosed in a group series.