Trans people’s attitudes and beliefs regarding the diagnosis of “gender dysphoria”: Research in the Italian context.

Abstract

In many countries, the psychological pathway is an important practice in gender transition, especially where a diagnosis is needed in order to access medical treatments and legal recognition. This filter function is a source of debate for both professionals and trans people, particularly because of its potential for equating gender variances with mental illness. Despite recent changes in health communities' attitudes toward diagnosis for gender transition, this issue must be handled carefully, as it can also affect the dynamics of the clinical interaction. This study explores beliefs and attitudes toward diagnosis by addressing the subjective perspectives of 25 people in transition. Through a nonstructured interview, we sought to shed light on how a diagnosis of gender dysphoria is perceived and used, what position trans people take in relation to mental health practitioners, and the possible implications. Interpretative repertoires analysis showed that the diagnosis was experienced as a "constraint," described in terms of convergence toward or divergence from the individual's own identity. Positioning analysis found that the mental health practitioner was seen as either contributing to the denial of participants' identity and hindering their progress along the path to transition, or as supporting this process. The practitioner is also seen as an evaluator rather than an expert, because trans people know themselves best. The findings indicate that the diagnostic process may obscure or interfere with the most important function of the psychological pathway, namely, the creation of an affirmative space and shared objectives. Public Significance StatementsThis study focuses on one of major issues in the field of gender transition, that is, the diagnosis. We collected narratives about beliefs and attitudes toward gender dysphoria by addressing the subjective perspectives of 25 people in transition. Our findings shed light on positionings and meanings associated with diagnosis and the psychological path which can enable mental health practitioners to rethink the implications of the diagnostic process in construing the clinical relationship.

What does transgender mean to you? Transgender definitions and attitudes toward trans people.

“…According to Reed et al (2015), one of the reasons that the American Psychiatric Association changed “gender identity disorder” to “gender dysphoria” in the DSM–5 was “to reduce mental illness stigmatization” (p. 463) of trans people. Nevertheless, this change was controversial, with some arguing that the “gender dysphoria” label still stigmatizes trans people as having a psychological disorder (Gorton, 2013; Neri et al, 2020). Some research supports this stigmatization.…”

Mental health practitioners’ narratives about gender transition and the role of diagnosis: A qualitative study in the Italian context

“…The risk is that the practitioner will be perceived as the expert to whom one must adapt, in a hierarchical relationship (Foucault, 1963). These critical implications also become visible in the face of other studies in the Italian context that emphasise the narratives of trans people regarding their relationship with the practitioners (Neri et al., 2020). For the practitioner, instead, taking the role of the expert may make it difficult to help create a space for sharing trans people's needs, despite the desire to promote their health and accompany them along the path to life changes.…”

“…On the one hand, the reference to an affirmative approach is found to be in line with the international literature and guidelines; on the other hand, specific discourses about diagnosis and its use are found. These are partly shared by trans people in the same Italian context, although some disparities are also noted (Neri et al., 2020; Vitelli & Riccardi, 2010).…”

“…These actions could help promote a new image of the mental health practitioner dealing with gender transition: A practitioner who is able to fulfil a function other than the classification and decision‐making involved in the medicalisation process (Bryant, 2006). Such a practitioner would be a promoter of change and recognition of the identity the trans person desires to affirm, capable of recognising and empowering others as experts in their own history and biography, and able to accept with confidence the value of professional and personal responsibility (ACA, 2010; Faccio et al., 2020; Iudici et al., 2017; Lev, 2004; Neri et al., 2020; Salpietro et al., 2019; Vitelli & Riccardi, 2010).…”

“…In Italy, there is little research around these themes, largely in the fields of sociology (Arfini, 2007; Garosi, 2012; Rinaldi, 2006) and clinical psychology (Cipolletta et al., 2017; Faccio et al., 2013; Neri et al., 2020; Vitelli & Riccardi, 2010). Previous sociological papers highlight the organisation of the Italian context with respect to gender transition and the critical implications related to the foundation and use of the diagnostic category and the more general legislative matter.…”