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性別不一致

維基百科,自由的百科全書
性別不一致
同義詞性別不安、性別焦慮、性別認同障礙
症狀個人經驗性別與指定性別之間存在顯著且持續的不一致[1]
併發症飲食失調,自殺,抑鬱,焦慮,社會孤立[2]
類型性健康相關情況[1]
鑑別診斷性別認同性別表現方面不匹配,令人痛苦[3][4]
治療性別轉換心理治療[5][4]
藥物性別肯定激素治療(例如:雄激素抗雄激素雌激素孕激素促性腺素釋素
分類和外部資源
醫學專科心理學、​精神病學
ICD-11HA60、​HA61、​HA6Z
ICD-10F64
[編輯此條目的維基數據]

性別不一致[a](英語:gender incongruence)的特點是個人認同的性別與天生的性別之間存在顯著且持續的不一致[1]。其在DSM-5中對應為性別不安(英語:gender dysphoria[b][c]

「性別認同障礙」(或稱:易性症[7]、性身份障礙、性別識別障礙)在DSM-5(2013年出版)中被重新分類為「性別不安」,以消除與術語「障礙」相關的污名。[8]ICD-11(2022年生效)中,其被重新命名為「性別不一致」。

性別不安與非常規性別不同。[9]根據美國精神醫學學會的說法,性別不安的關鍵因素是「臨床上的顯著痛苦」。[3]一些跨性別和研究人員支持性別認同障礙的重新分類,因為他們說診斷會使非常規性別病理化,並強化了性別二元論的模型。[10][11][12]

有研究證據表明,性別不安存在遺傳原因。[13][14]性別不一致的治療可能涉及支持患者改變性別表現。透過性別肯定激素治療(GAHT)或性別肯定手術可以用來協助這種改變。[5][4]治療還可能包括心理諮詢或心理治療。[4]

概念

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許多性別不安者都有強烈的、持久的願望,希望過一種「符合」或實現其性別認同的生活。他們通過改變自己的外表和行為方式來實現這一願望。[15]

一些性別不安者,但不是所有的人,可能想使用激素,有時想通過手術來表達他們的性別認同。[15]

性別不安不是一種精神疾病,但有些人可能因為性別不安而產生心理健康問題。[15]

性別不安與性傾向無關。性別不安者可能會認為自己是異性戀、男同性戀、女同性戀或雙性戀。[15]

症狀

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一個人感覺到的性別與被分配的性別(通常在出生時)不一致而產生的困擾是性別不一致的主要症狀[16][17]

出生時被分配為男性的人的性別不一致(通常被稱為AMAB)傾向於遵循兩種廣泛的軌跡之一:早發或晚發。早發的性別不一致在童年時行為上就很明顯。有時,這一群體的性別不一致會停止一段時間,他們會在一段時間內認同為同性戀者,然後再復發性別不一致。這類人在成年後通常會被其出生時的性別所吸引,通常被認定為異性戀。遲發的性別不一致並不包括早期兒童時期的明顯跡象,但有些人報告說,他們在童年時曾有過成為異性的願望,但沒有向他人報告。[18]出生時被分配為男性的人,如果有遲發的性別不一致,通常會因性興奮而變裝。[19]出生時被分配為男性的跨性別者,如果經歷晚發的性別不一致,通常會被女性所吸引,並可能被認定為女同性戀或雙性戀者,而早發的通常會被男性所吸引。[18]類似的模式也發生在出生時被分配為女性的人(AFAB)身上,經歷早發的性別不一致的人最有可能被女性吸引,而晚發的人最有可能被男性吸引並被認定為同性戀。[18]在AFABs中,早發的性別不一致是最常見的。[18][19]

性別不一致兒童通常有以下情況:喜歡異性典型的玩具、遊戲或活動;討厭自己的生殖器;以及非常喜歡異性玩伴。[20]一些兒童也可能經歷與與同齡層的社會隔離,焦慮,孤獨和抑鬱。[21]美國心理學會稱,跨性別兒童比其他兒童更容易在學校,寄養,住宿治療中心,無家可歸者中心和少年司法方案中遭受騷擾和暴力。[22]

在青少年和成年人中,症狀包括渴望成為另一性別並被當作另一性別對待。[20]成年性別不一致者面臨更大的壓力、孤獨、焦慮、抑鬱、自卑和自殺風險。[21]跨性別者還面臨飲食失調[23]和藥物濫用[24]的高風險。

在許多案例中性別不一致通常是在小時候就會出現,但也有在青春期或成人時才出現的可能,並且隨著年紀增長而越來越強烈[25]。由於許多文化並無法接受跨性別的行為,這種感覺往往為當事人以其家人、朋友帶來許多問題。在許多案例的報告中,也有人的不適感是覺得自己的身體「出了差錯」,或從一開始就不應該是如此。

原因

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當一個人因性別認同而感到不滿時,性別不一致就會存在,從而導致他們情緒低落。[26]研究人員對性別不一致者的痛苦和損傷的本質持不同意見。一些研究人員認為,性別不一致者受苦是因為他們受到羞辱和暴力。[27]而且,如果社會性別分化不那麼嚴格,跨性別就會遭受少一點的痛苦。[28]

性別不一致的確切成因尚未明確。[15]有研究證據表明,遺傳因素在性別不一致的發展中起主要作用[29][30],性別認同被認為可能反映了生物、環境和文化因素的複雜相互作用。[31]

診斷

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ICD-10

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根據《國際疾病與相關健康問題統計分類》第十版(1993),列出與性別認同有關的幾種疾病:[32][33]

  • 易性症(F64.0):渴望成為及被接受為相反性別的成員,通常伴隨著性別重置手術和激素治療的慾望。
  • 兒童性別認同障礙(F64.2):一個人對於自身的指定性別而持續強烈的痛苦,並且在青春期之前表現出來。
  • 其他性別認同障礙(F64.8)
  • 性別認同障礙,不明確(F64.9)
  • 性成熟障礙(F66.0):關於一個人的性別認同性取向的不確定性,導致焦慮或痛苦。[34]

DSM-IV

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根據《精神疾病診斷與統計手冊》第四版(1994),要被診斷判定為「性別認同障礙」前,須達到五項條件: [35]

  • 必須要有證據顯示有強烈且持續的跨性別認同感。
  • 跨性別認同感不可以是因為認為另一種性別在文化上有更多優勢而產生的。
  • 同時也必須要有證據顯示對於天生的性別有持續性的不適應感,或是無法適應自己所屬性別的性別角色
  • 當事人不可同時擁有身體上的雙性人狀態(例如睪脂酮不敏症候族英語Androgen Insensitivity Syndrome先天性腎上腺增生症)。
  • 必須要有臨床上的證據能顯示當事人在社交、工作或其他重要領域上遭遇顯著的挫折或傷害。

DSM-5

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根據《精神疾病診斷與統計手冊》第五版(2013),要被診斷判定為「性別不安」前,青少年成人須至少符合兩個標準以及持續至少六個月:[36]

兒童性別不安診斷需要表現為下列至少六項且持續至少六個月:[37]

  • 強烈抵抗指定性別的裝扮,強烈偏好指定性別以外性別裝扮。
  • 在假扮或幻想遊戲中強烈希望扮演指定性別以外性別角色
  • 強烈希望成為或堅持自身就是指定性別以外的性別。
  • 強烈偏好另一種性別通常使用的玩具或參與的活動
  • 強烈希望第一或第二性徵與自己體驗的性別相匹配
  • 強烈偏好另一種性別玩伴
  • 強烈厭惡自身性生理特徵

此外,該病症必須與臨床上顯著的痛苦或損害相關。[36]

DSM-5將性別不安從性偏離中移除,並將其納入其他的類別。[36]在性別認同障礙被批評為污名後,該診斷被重新命名為性別不安,[38]並刪除了子類別中的性取向兒童的診斷與成人的診斷被分開,如「兒童性別不安」。為兒童建立一種特定的診斷反映了兒童較少有能力洞察他們正在經歷的事情,或者讓他們表達自身正在經歷的事情。[39]如果一個人不符合性別不安的標準但仍有臨床上顯著的痛苦或損傷,則可以診斷出「其他性別不安」或「性別不安,不明確」。[36]

ICD-11

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根據《國際疾病與相關健康問題統計分類》第十一版(2019),對性別認同相關疾病的分類進行重大修訂,[40]將「性別認同障礙」從精神障礙的分類中移除,更名為「性別不一致」,並重新歸入「性健康」一欄。[41]截至2018年8月 (2018-08),ICD-11這種情況列為「性別不一致」。[42]

  • 青春期或成年期性別不一致(HA60):取代 F64.0
  • 童年期性別不一致(HA61):取代 F64.2
  • 未特指的性別不一致(HA6Z):取代 F64.9

在ICD-11中,由於缺乏公共衛生或臨床意義,雙重角色異裝癖被移除。[43]此外,已經移除了性成熟障礙[44]

在ICD-11中,其解釋類似於DSM-V的定義,但不需要明顯的痛苦或損害。[42]

在ICD-10中,按照當時的慣例,性別認同障礙被列入精神障礙一章。在整個20世紀,ICD和DSM都從精神病理學的角度探討了跨性別,因為跨性別呈現出某人的性別指定和他們的性別認同之間的差異。由於這可能導致精神痛苦,因此被認為是一種精神障礙,痛苦或不適是核心診斷特徵。[45][46][47]在2000年代和2010年代,這種觀念受到了越來越多的挑戰,因為一些人認為將跨性別視為一種精神障礙是一種恥辱。有人認為,跨性別者的痛苦和功能障礙應被視為社會對具有性別差異外表和行為的個人的排斥、歧視和(性)暴力的結果,這樣做更為恰當。[48]研究表明,跨性別者比其他人群更有可能出現心理健康問題,但針對跨性別者的健康服務往往不足或不存在。由於通常需要一個正式的ICD代碼來獲得治療和報銷,世界衛生組織認為將跨性別從ICD-11中全部刪除是不明智的。因此,決定將這一概念從精神障礙章節移至新的性健康章節。[43]

治療

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診斷為性別不一致的治療可能包括心理諮詢、支持患者的性別表達、激素治療或手術。這可能涉及到醫療干預(如激素治療、生殖器手術、電解或雷射脫毛、胸部/乳房手術或其他重建手術)導致的身體過渡。[15]治療的目標可能僅僅是減少患者跨性別狀態引起的問題,例如:為患者提供諮詢,以減少與變裝相關的內疚感。[49]

已有機構制定了指導方針來幫助臨床醫生。世界跨性別人士健康專業協會(WPATH)的護理標準被一些臨床醫生用作治療指南。治療指南通常遵循「減少傷害」模式。[50][51][52]

注釋

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  1. ^ 世界衛生組織官方中文譯名
  2. ^ 也譯作性別煩躁[6]性別焦慮
  3. ^ 性別不一致和不安並非完全對應的關係,不需要造成不安的情緒,更接近於跨性別的總體概念。參見§ ICD-11

參考文獻

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  29. ^ Heylens G, De Cuypere G, Zucker KJ, Schelfaut C, Elaut E, Vanden Bossche H, De Baere E, T'Sjoen G. Gender identity disorder in twins: a review of the case report literature. The Journal of Sexual Medicine. March 2012, 9 (3): 751–7. PMID 22146048. doi:10.1111/j.1743-6109.2011.02567.x. Of 23 monozygotic female and male twins, nine (39.1%) were concordant for GID; in contrast, none of the 21 same‐sex dizygotic female and male twins were concordant for GID, a statistically significant difference (P = 0.005)... These findings suggest a role for genetic factors in the development of GID. 
  30. ^ Diamond, Milton. Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation. International Journal of Transgenderism. 2013, 14 (1): 24–38. S2CID 144330783. doi:10.1080/15532739.2013.750222. Combining data from the present survey with those from past-published reports, 20% of all male and female monozygotic twin pairs were found concordant for transsexual identity... The responses of our twins relative to their rearing, along with our findings regarding some of their experiences during childhood and adolescence show their identity was much more influenced by their genetics than their rearing. 
  31. ^ Rosenthal, Stephen M. Approach to the Patient: Transgender Youth: Endocrine Considerations. The Journal of Clinical Endocrinology & Metabolism. 2014-12-01, 99 (12): 4379–4389. ISSN 0021-972X. PMID 25140398. doi:10.1210/jc.2014-1919可免費查閱 (英語). 
  32. ^ International Classification of Diseases (ICD) F64 Gender identity disorders. World Health Organization. [9 August 2018]. (原始內容存檔於2017-02-08). 
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  35. ^ Diagnostic criteria for Gender Identity Disorder 網際網路檔案館存檔,存檔日期2007-06-21. - DSM-IV & DSM-IV (TR)
  36. ^ 36.0 36.1 36.2 36.3 American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 5th. Washington, DC and London: American Psychiatric Publishing. 2013: 451–460. ISBN 0-89042-555-8. 
  37. ^ 美國精神醫學學會. 精神障碍诊断与统计手册(第五版). 由張道龍翻譯. 北京大學出版社. 2015: 444. ISBN 978-7-301-25812-5. 
  38. ^ Gender Dysphoria in Children. American Psychiatric Association. May 4, 2011 [July 3, 2011]. (原始內容存檔於2012-03-14). 
  39. ^ P 00 Gender Dysphoria in Children. American Psychiatric Association. [April 2, 2012]. (原始內容存檔於2012-03-14). 
  40. ^ International Classification of Diseases. World Health Organization. [August 11, 2018]. (原始內容存檔於2018-09-02). 
  41. ^ 世卫组织将性别认同障碍从精神疾患分类中移除. 聯合國新聞. 2019-05-30 [2024-08-15]. (原始內容存檔於2024-08-15) (中文). 
  42. ^ 42.0 42.1 Gender incongruence (ICD-11). icd.who.int. WHO. [August 28, 2018]. (原始內容存檔於2018-08-01). 
  43. ^ 43.0 43.1 Reed GM, Drescher J, Krueger RB, Atalla E, Cochran SD, First MB, et al. Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations. World Psychiatry. October 2016, 15 (3): 205–221. PMC 5032510可免費查閱. PMID 27717275. doi:10.1002/wps.20354. The ICD‐10 classification of Sexual dysfunctions (F52) is based on a Cartesian separation of 「organic」 and 「non‐organic」 conditions. 
  44. ^ Reed GM, Drescher J, Krueger RB, Atalla E, Cochran SD, First MB, Cohen-Kettenis PT, Arango-de Montis I, Parish SJ, Cottler S, Briken P, Saxena S. Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations. World Psychiatry. October 2016, 15 (3): 205–221. PMC 5032510可免費查閱. PMID 27717275. doi:10.1002/wps.20354. 
  45. ^ Drescher J, Cohen-Kettenis P, Winter S. Minding the body: situating gender identity diagnoses in the ICD-11. International Review of Psychiatry. December 2012, 24 (6): 568–77 [2022-01-08]. PMID 23244612. S2CID 12805083. doi:10.3109/09540261.2012.741575. (原始內容存檔於2022-01-08). Until the middle of the 20th century, with rare exceptions, transgender presentations were usually classified as psychopathological. 
  46. ^ Cohen-Kettenis PT, Pfäfflin F. The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Archives of Sexual Behavior. April 2010, 39 (2): 499–513. PMID 19838784. S2CID 16336939. doi:10.1007/s10508-009-9562-y. The DSM has consistently approached gender problems from the position that a divergence between the assigned sex or 「the」 physical sex (assuming that 「physical sex」 is a one-dimensional construct) and 「the」 psychological sex (gender) per se signals a psychiatric disorder. Although the terminology and place of the gender identity disorders in the DSM have varied in the different versions, the distress about one’s assigned sex has remained, since DSM-III, the core feature of the diagnosis. 
  47. ^ Lawrence AA. Gender Dysphoria. Beidel DC, Frueh BC (編). Adult Psychopathology and Diagnosis 8th. John Wiley & Sons. 2018: 634 [2022-01-08]. ISBN 978-1-119-38360-4. (原始內容存檔於2022-01-08). The World Professional Association for Transgender Health (WPATH), for example, defined GD as 「discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics)」 
  48. ^ Robles R, Fresán A, Vega-Ramírez H, Cruz-Islas J, Rodríguez-Pérez V, Domínguez-Martínez T, Reed GM. Removing transgender identity from the classification of mental disorders: a Mexican field study for ICD-11. The Lancet. Psychiatry. September 2016, 3 (9): 850–9 [2022-01-08]. PMID 27474250. doi:10.1016/S2215-0366(16)30165-1. (原始內容存檔於2021-07-05). 
  49. ^ Leiblum, Sandra. Principles and Practice of Sex Therapy, Fourth Edition. The Guilford Press. 2006: 488–9. ISBN 978-1-59385-349-5. 
  50. ^ Committee On Adolescence. Office-based care for lesbian, gay, bisexual, transgender, and questioning youth. Pediatrics. July 2013, 132 (1): 198–203. PMID 23796746. doi:10.1542/peds.2013-1282可免費查閱. However, adolescents with multiple or anonymous partners, having unprotected intercourse, or having substance abuse issues should be tested at shorter intervals. 
  51. ^ www.glma.org Compendium of Health Profession Association LGBT Policy & Position Statements (PDF). GLMA. 2013 [August 27, 2013]. (原始內容存檔 (PDF)於2020-11-09). 
  52. ^ APA Policy Statements on Lesbian, Gay, Bisexual, & Transgender Concerns (PDF). American Psychological Association. 2011 [August 27, 2013]. (原始內容存檔 (PDF)於2022-01-21). BE IT FURTHER RESOLVED that APA recognizes the efficacy, benefit, and necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments; 

外部連結

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