Each month at Ability Partners, our hard working Occupational Therapists gather to present, analyse and discuss different journal articles.

They recently covered the following journal:

Murphy, Melanie; Tinsley Schaefer, Julie; and Washington, Enjoli, “Gender Dysphoria and the Role of Occupational Therapy” (2017). School of Occupational Master’s Capstone Projects. 14.

Summary of Journal Article

This journal article was sourced to support clinical practice when addressing the impacts of Gender Dysphoria. Details of the article are as follows;

• Review of 29 articles from qualitative and quantitative research, systematic reviews and additional evidence.
• While Gender Dysphoria is emerging in mainstream culture, and numbers of youth and their families seeking gender affirming care rises, there is a lag in the delivery of tertiary level education regarding Gender Dysphoria among healthcare disciplines. This causes barriers to accessing appropriate care for these individuals and their families.

What is Gender Dysphoria?

The DSM VI defines GD as:

A marked incongruence between one’s experienced/expressed gender and natal gender of at least 6 months in duration, as manifested by at least two of the following:

• A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)

• A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)

• A strong desire for the primary and/or secondary sex characteristics of the other gender

• A strong desire to be of the other gender (or some alternative gender different from one’s designated gender)

• A strong desire to be treated as the other gender (or some alternative gender different from one’s designated gender)

• A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s designated gender)

Why is this an important topic for health professionals to consider?

• How common is GD in Australia? In 2022 the Royal Children’s Hospital reported that around 1.2% or about 45,000 children are thought to identify as transgender or gender diverse.  
• These 45,000 young people who identify as transgender are more likely than their cisgender peers to have concurrent mental health and neurodiverse conditions including depression, anxiety, attention deficit disorders, and autism 
• Transgender /non binary / gender diverse children and youth are more likely than their peers to experience bullying and social deprivation
• A trans, non-binary or gender diverse person is more likely to experience unemployment at a rate of about 19% in Australia – or about 3 times the national average and are more likely to experience poverty.
• They are more likely to experience discrimination
• They are more likely to have attempted self-harm or suicide at a rate of around 63%.
• This community is also more likely to have been physically assaulted in their lifetime.
• Trans, non-binary and gender diverse persons are more likely to engage in substance abuse at the rate of double that of the general population.

An Australian Community Survey of 928 trans people found the largest challenges faced in healthcare was barriers to access and limited education provided to health professionals regarding GD. 

With all that information, it is important to flag that not all trans persons have gender dysphoria. Many trans people know and understand that their gender identity does not match the sex assigned to them at birth yet do not experience dysphoria. Not every trans man, trans woman, or non-binary person experiences emotional pain, discomfort, or other negative feelings deriving from the body in which they live.

Methodology review

• Researchers set the following question ““What evidence supports the use of occupational therapy (OT) interventions in improving the psychosocial health of children and youth between the ages of 0 to 25 experiencing gender dysphoria (GD)?”
• 29 Articles from both qualitative and quantitative research were reviewed, systematic reviews and additional evidence

How was the research question answered?

Researchers employed the following search terms:

• “gender dysphoria,”
• “gender identity disorder,”
• “children,”
• “adolescents,”
• “treatment,” and
• “occupational therapy.”

Inclusion criteria

The researchers used articles from the following disciplines: education, nursing, OT, physical therapy, physiotherapy, psychiatry, psychology, pediatrics, and social work. Articles with participants between the ages of 0 to 25 and interventions focused on addressing GD were included.   

Exclusion Criteria     

Articles published prior to 2000 were excluded.

Additional articles were excluded if they included interventions that fell exclusively outside the scope of OT practice, the participants’ GD was not the primary focus, or if they were previously referenced in literature reviews or meta-analyses that appeared in the critical appraisal of topic.

Findings

The Transgender community is currently underserved, and those experiences gender dysphoria have difficulty accessing appropriate healthcare.

• Lack of knowledge of available services for individuals and their families/support persons
• Hurdles to accessing gender affirming care such as Gender Affirming Clinics needing to demonstrate a zero percent regret rate to deliver a procedure, or patients needing to demonstrate they have socially transitioned to access gender affirming interventions
• Lack of peer support or sense of belonging in a community
• Limited education regarding this population and diagnosis is delivered to OT’s / healthcare professionals

Evidence suggests the transgender population is growing

Education needs to be increased to healthcare professionals to reduce stigma and assist them to advocate for their patients

OT’s are well placed to work with trans individuals and their families

The researchers discovered that OT practitioners can play a vital role in supporting transgender clients. However, there are currently no OT-specific, published guidelines regarding this community. As such, the process of providing interventions for this population will necessitate consistent reflection upon the long-term implications associated with differing approaches. In spite of this hurdle, the field of OT is well-aligned with other health professionals’ formal recommendations for addressing patients with GD. Practice suggestions found in the literature reinforce core OT ideals such as clientcentered care, validation of clients’ concerns, and client advocacy, and the focus on occupational performance

Note the researchers stated that it was crucial to explore any biases or preconceived ideas regarding this population prior to delivering therapeutic supports. Knowing that you were comfortable to work with this population is key to delivering meaningful and effective therapy.

Recommendations:

• Due to the shortage of current empirical literature further research is needed to determine best interventions, approaches and supports for individuals with GD.

The researchers noted that universal agreement of terminology will aid in consolidating practice informing knowledge and to support development of therapeutic interventions.

If you or someone you know is experiencing Gender Dysphoria and would like support from an Occupational Therapist, please contact us.