Gender dysphoric individuals are a growing number in society and like other minority groups they are at risk of falling victim to discrimination. In an attempt to understand how attitudes affect discriminatory behaviour in a recruitment situation, future recruiters’ implicit and explicit attitudes toward gender dysphoric individuals were measured in relation to a résumé choice task. Implicit attitudes were measured with an Implicit Association Test and explicit attitudes with a transphobia scale. An independent sample t-test was conducted (N = 42), to measure if implicit attitudes differed between participants who chose a résumé of a gender dysphoric individual and participants that chose a résumé of a non-gender dysphoric individual. Although no significant differences in attitudes between the two groups were found, the results indicate other noteworthy differences in that a vast majority of participants had negative implicit attitudes toward gender dysphoric individuals in contrast to their positive explicit attitudes.

This qualitative study examines the healthcare provision for gender dysphoria patients by the National Health Service (NHS) in England. The thesis takes as its starting point the experiences of those providing and receiving care following the A, D & G vs North West Lancashire Health Authority court decision in 1999. The aims of the research are threefold: To examine what trans narratives tell us about individual understandings of gender, to explore what practitioner narratives tell us about the understandings of gender utilised in NHS treatment, and to determine what issues are important to consider when providing gender services. It undertakes an empirical thematic analysis through a triangulation of data sources - a literature review, qualitative interviews with specialists and focus groups with trans patients. The research is underpinned by three central questions: Do differences exist between the ways in which trans people and their doctors understand gender identity? Can the ways in which trans people formulate and express their gender identity map onto the notions of gender that practitioners employ? What are the wider implications for healthcare policymaking? The research questions were intended to investigate how trans people formulate and express their gender, whether and how those understandings differ from those that practitioners employ, whether trans narratives can map onto medicalised notions, and the implications for healthcare policymaking.

The purpose of this research was to gain a better understanding of transgender people and allow participants to have a voice in describing the experience of those in the transgender community. This study was conducted utilizing qualitative analysis through individual interviews with six participants. One of the major key findings of this study was the prevalence of depression among all participants. Another key finding of this study found safety among peers to be an issue for those transitioning from male to female. From the findings, it is imperative for social work practitioners to understand this marginalized community and be sensitive to the issues they face, such as: higher rates of mortality, suicide, substance abuse, and mental health issues.

The overarching aim of this thesis was to explore psychological wellbeing among a treatment seeking population of trans individuals. Specifically, psychopathology and quality of life were studied as key dimensions of psychological wellbeing. The thesis begins with a proposed model of predictors of psychological wellbeing derived from a review of the literature, which includes social support, interpersonal problems, body dissatisfaction, self-esteem, experiences of transphobia, non-suicidal self-injury (NSSI), age and gender. Study 1 proceeds then to focus specifically on levels of perceived social support and its relationship to psychological wellbeing. Study 2 assesses interpersonal problems. Study 3 investigates prevalence rates of NSSI. Drawing on the findings from the previous three studies, Study 4 subsequently tests an amended model of predictors. In terms of the methodology employed across the studies, a cross-sectional questionnaire survey was conducted using standardised measures, a large sample of trans individuals recruited from a national gender identity clinic (GIC), and a matched control group of non-trans (hereafter referred to as cisgender) individuals. Throughout, consideration was given to differences between trans women and trans men as well as how trans individuals compare to cisgender individuals, with regards to each of the variables tested. The thesis concludes with a revised model of predictors, in addition to recommendations for preventing the development of poor psychological wellbeing and interventions for improving poor psychological wellbeing among the trans population.

Purpose: There are no large controlled studies of health disparities in transgender (TG) or gender dysphoric patients. The Veterans Health Administration (VHA) is the largest healthcare system in the United States and was an early adopter of electronic health records. We sought to determine whether medical and/or mental health disparities exist in VHA for clinically diagnosed TG veterans compared to matched veterans without a clinical diagnosis consistent with TG status. Methods: Using four ICD-9-CM codes consistent with TG identification, a cohort of 5135 TG veterans treated in VHA between 1996 and 2013 was identified. Veterans without one of these diagnoses were matched 1:3 in a case-control design to determine if medical and/or mental health disparities exist in the TG veteran population. Results: In 2013, the prevalence of TG veterans with a qualifying clinical diagnosis was 58/100,000 patients. Statistically significant disparities were present in the TG cohort for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. TG Veterans were more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. Significant disparities in the prevalence of medical diagnoses for TG veterans were also detected for 16/17 diagnoses examined, with HIV disease representing the largest disparity between groups. Conclusion: This is the first study to examine a large cohort of clinically diagnosed TG patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group. TG veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-TG veterans. These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems.

All known cases of breast cancer in patients with a diagnosis consistent with transgender identification were identified in the Veterans Health Administration (1996-2013). Ten cases were confirmed: seven birth sex females and three birth sex males. Of the three birth sex males, two identified as gender dysphoric male-to-female and one identified as transgender with transvestic fetishism. The birth sex males all presented with late-stage disease that proved fatal, whereas most of the birth sex female transgender veterans presented with earlier stage disease that could be treated. These cases support the importance of screening for breast cancer using standard guidelines in birth sex males and females. Family history of breast cancer should be obtained from transgender people as part of routine care. This report expands the known cases of breast cancer in transgender persons from 5 to 12 (female-to-male) and from 10 to 13 (male-to-female).

Researchers continually identify gender dysphoria as a significant mental health concern for many transgender individuals. Physical and mental health providers use the existing medical model to conceptualize and design treatment for gender dysphoria. This means that gender dysphoria is currently viewed and treated as an internal concern isolated to the individual. Researchers have also identified that external factors, such as discrimination and societal prejudice, have a significantly negative impact on the health of transgender individuals. Given that current conceptualizations of gender dysphoria focus on internal contributors to distress, external factors that also potentially contribute to gender dysphoria have not yet been explored. To address this gap in the literature, I conducted a study to identify and assess the severity of various external factors that may contribute to self-reported levels of gender dysphoria in transgender individuals. I recruited 195 participants who identify as transgender and who report experiencing gender dysphoria. Participants completed a survey that included the Transgender Congruence Scale, the Gender Preoccupation and Stability Scale, the Multidimensional Scale of Perceived Social Support, Gender Minority Stress and Resilience subscales, and the Gender Dysphoria from External Contributors Measure, a series of Likert-type scales developed for the present study that measure frequency of gender dysphoria experienced in a variety of external contexts. I conducted hierarchical multiple regression analyses to evaluate predictors for gender dysphoria from external contributors and gender dysphoria from internal contributors. Gender dysphoria from internal contributors was significantly associated with gender dysphoria from external contributors (r = 0.51). Several predictors uniquely predicted external contributors (i.e. gender-related rejection and gender-related discrimination) while others uniquely predicted internal contributors (i.e. internalized transphobia). Findings indicate that focusing solely on internal contributors generates an incomplete conceptualization of gender dysphoria. The results from this study allow for a more comprehensive understanding of gender dysphoria and the ways in which it impacts many transgender individuals. These results will be helpful in developing more accurate measures of gender dysphoria, which will lead to more effective, inclusive, and affirmative treatments for gender dysphoria and for transgender individuals in general.

The Institute of Medicine report of 2011 defined Transgender Specific Health Needs as one of four priority research areas. While there is research asserting that health care providers (HCPs) do not have adequate training in providing competent care to transgender patients, there are no studies to date assessing HCPs' gender identity attitudes and their willingness to learn the Standards of Care (SOC) developed for this patient population. According to the Agency for Health Care Research and Quality, as of 2010, 52% of Nurse Practitioners (NPs) were practicing in primary care settings. As more than half of NPs practice in primary care and transgender patients often initially present their gender concerns to their primary care provider, this study focuses on the NP population. This study describes a sample of NPs' attitudes towards gender variance, as well as their perceived need and interest in learning the SOC as published by the World Professional Association for Transgender Health. Multi-state purposive sampling of NP professional organizations was conducted. Two conservative and two progressive states' professional organizations were included in the sample. The states were randomly assigned within both geopolitical groups to intervention or control with the use of a random numbers table. Comparisons between geopolitical groups and between control and intervention groups cannot be made due to low response rates of all states. The majority of this small sample of NPs agreed that they needed and wanted additional training in transgender health care. Future research with representative sample sizes is needed to better understand provider-sided barriers to caring for this marginalized patient population.

This study examines the psychology of fictional and real-life serial killers and the behavioral similarities between them. Three fictional murderers, mainly Macbeth (William Shakespeare’s Macbeth), Buffalo Bill (The Silence of the Lambs), and the Creature (Frankenstein),as well as real life killers such as Charles Manson, Ed Gein, and Edmund Kemper were researched in depth. The data for this study was gathered from a variety of sources such as biographies, television interviews, published novels, articles, and documentaries. This study also focuses on predispositional factors and personality traits that led these killers to a life of crime. While no single behavioral trait was found to be present in every murderer studied, some of the psychological factors that were found to have predictive value included: abusive upbringings, mother hate, adoption, pornography, and brain damage were also reliable predictors in the lives of fictional and nonfictional perpetrators.

Syftet med studien var att få en bild av hur föräldrar upplever situationen kring att ha ett barnvars kropp och upplevda kön inte harmonierar och utifrån det identifiera och lyfta fram relevanta aspekter som kan bidra till bättre förståelse och förbättringar inom området. Det har tidigare inte gjorts någon liknande undersökning i Sverige. Datamaterialet samlades in med hjälp av semistrukturerade intervjuer med åtta föräldrar till barn med könsdysfori. Datan analyserades genom induktiv tematisk analys. Analysen resulterade i tre huvudteman:Tillgänglighet, Kunskap och kompetens samt Resan. Slutsatserna var att föräldrarna fyller funktionen som informatörer, rådgivare och stödpersoner till andra – funktioner de själva efterfrågar, bör få och behöver - och att hälso- och sjukvården och skolan behöver utveckla sina kunskaper kring könsdysfori och trans för att bättre kunna möta barnens och föräldrarnas behov. / The purpose of this study was to explore how parents experience the situation of having a child whose body does not harmonize with their experienced gender, in order to identify and highlight relevant aspects for better understanding and improvements within the field. No such research has been carried out in Sweden previously. Data was collected by semi- structured interviews with eight parents of children with gender dysphoria. The data was analyzed by inductive thematic analysis. The outcome was three central themes: Availability, Knowledge and competence and The Journey. Conclusions were that the parents fill the function as informers, advisors and sustaining persons in relation to others – functions that they request, should get and need for themselves - and that health care and schools need to explicate their competence regarding gender dysphoria and trans to better meet the needs of both children and parents.