Sukupuoli-identiteetti ja vanhemmuus

Vertaisarvioitu.JOHDANTO : Suomessa edellytetään lisääntymiskyvyttömyyttä juridisen sukupuolen korjauksen edellytyksenä. Sukupuolenkorjaushoidot vaikuttavat lisääntymiskykyyn estävästi tai heikentävästi. Sukupuolivähemmistöjen halusta vanhemmuuteen tiedetään vähän. AINEISTO JA MENETELMÄT : Sukupuoli-identiteetin tutkimuspoliklinikassa Hyksissä tai Taysissa 1.4.2016-31.10.2017 käyneiden täysi-ikäisten henkilöiden toiveita vanhemmuudesta tutkittiin kyselytutkimuksella. TULOKSET : Vastanneiden 103 henkilön keski-ikä oli 26 vuotta, ja heistä 8 %:lla oli lapsia. Suurin osa oli saanut hormonihoitoja ja 9 %:n sukusoluja oli talletettu. Valtaosa kertoi, että ei enää voi tai ei tiedä, voiko tulla biologisesti vanhemmaksi. Haluttomuus vanhemmuuteen liittyi noin puolella koettuun ristiriitaan oman sukupuoli-identiteetin ja raskauden välillä, mutta osan halukkuus vanhemmuuteen oli lisääntynyt hoitojen myötä. PÄÄTELMÄT : Sukupuolenkorjaushoitojen toteuttaminen ajoittuu ikään, jolloin vanhemmuus ei välttämättä ole ajankohtaista. Identiteetin liittäminen lisääntymiskykyyn ilman oikeutta tallettaa sukusoluja osana julkista terveydenhuoltoa on ongelmallista. Vaikutukset hedelmällisyyteen tulee huomioida osana korjaushoitoja.Peer reviewe

Sukupuoli-identiteetti ja vanhemmuus

Vertaisarvioitu.JOHDANTO : Suomessa edellytetään lisääntymiskyvyttömyyttä juridisen sukupuolen korjauksen edellytyksenä. Sukupuolenkorjaushoidot vaikuttavat lisääntymiskykyyn estävästi tai heikentävästi. Sukupuolivähemmistöjen halusta vanhemmuuteen tiedetään vähän. AINEISTO JA MENETELMÄT : Sukupuoli-identiteetin tutkimuspoliklinikassa Hyksissä tai Taysissa 1.4.2016-31.10.2017 käyneiden täysi-ikäisten henkilöiden toiveita vanhemmuudesta tutkittiin kyselytutkimuksella. TULOKSET : Vastanneiden 103 henkilön keski-ikä oli 26 vuotta, ja heistä 8 %:lla oli lapsia. Suurin osa oli saanut hormonihoitoja ja 9 %:n sukusoluja oli talletettu. Valtaosa kertoi, että ei enää voi tai ei tiedä, voiko tulla biologisesti vanhemmaksi. Haluttomuus vanhemmuuteen liittyi noin puolella koettuun ristiriitaan oman sukupuoli-identiteetin ja raskauden välillä, mutta osan halukkuus vanhemmuuteen oli lisääntynyt hoitojen myötä. PÄÄTELMÄT : Sukupuolenkorjaushoitojen toteuttaminen ajoittuu ikään, jolloin vanhemmuus ei välttämättä ole ajankohtaista. Identiteetin liittäminen lisääntymiskykyyn ilman oikeutta tallettaa sukusoluja osana julkista terveydenhuoltoa on ongelmallista. Vaikutukset hedelmällisyyteen tulee huomioida osana korjaushoitoja.Peer reviewe

Binge eating and menstrual dysfunction

The relation between eating disorders and menstrual function has been widely studied, but it is unknown whether the behavior of binge eating itself is related to menstrual dysfunction

NURTURE: Development and pilot testing of a novel parenting intervention for mothers with histories of an eating disorder: Nurture Pilot Testing

To describe the treatment development and pilot testing of a group parenting intervention, NURTURE (Networking, Uniting, and Reaching out To Upgrade Relationships and Eating), for mothers with histories of eating disorders

Shapes and sizes : body image, body dissatisfaction and disordered eating in relation to gender and gender identity

Syftet med denna avhandling var att empiriskt undersöka kroppsbild, kroppsmissnöje och ätstörningssymptom hos vuxna i relation till kön och könsidentitet. Även sexuell kroppsbild studerades. Data samlades in via en populationsbaserad frågeformulärsstudie (11,468 deltagare) samt en intervjustudie med 20 transpersoner. Kvinnor rapporterade mer kroppsmissnöje och ätstörningssymptom än män. Till exempel uppgav mer än hälften av kvinnorna och en tredjedel av männen att de uppfattade sig som mindre attraktiva än de önskade att de var. Mer än hälften av kvinnorna och en tredjedel av männen uppgav sig banta, och självframkallade kräkningar rapporterades av var tionde kvinna och var hundrade man. Könsidentitetskonflikt var associerat med högre nivåer av kroppsnöje och ätstörningssymptom. Majoriteten av de intervjuade transpersonerna rapporterade omfattande missnöje med sina kroppar, särskilt gällande sexuell kroppsbild, samt ätstörningssymptom. Könskorrigering uppgavs i huvudsak lindra kroppsmissnöje och ätstörningssymptom. Vårdpersonal bör vara medveten om att kroppsmissnöje och ätstörningssymptom berör både vuxna kvinnor och män. Missnöje med de sexuella delarna av kroppen förefaller vara relativt vanligt bland vuxna och bör inte förbises. Vårdpersonal som arbetar med transpersoner bör vara medvetna om hur djupt och omfattande dessa personers kroppsmissnöje kan vara, samt uppmärksamma en eventuellt förhöjd risk för ätstörningssymptom. Det är även värt att notera att könskorrigering kan lindra kroppsmissnöje och ätstörningssymptom hos transpersoner.Väitöskirjassa tutkittiin aikuisten kehonkuvaa, tyytymättömyyttä omaan kehoon ja häiriintynyttä syömistä suhteessa sukupuoleen ja sukupuoli-identiteettiin. Myös seksuaalista kehonkuvaa tutkittiin. Aineisto kerättiin väestöpohjaisen kyselylomaketutkimuksen (11,468 osallistujaa) sekä 20 transihmisten haastattelututkimuksen kautta. Naiset ilmoittivat enemmän tyytymättömyyttä omaan kehoonsa ja häiriintynyttä syömistä kuin miehet. Esimerkiksi yli puolet naisista ja kolmasosa miehistä kokivat olevansa vähemmän puoleensavetäviä kuin tahtoisivat olla. Yli puolet naisista ja kolmasosa miehistä ilmoittivat laihduttavansa, ja joka kymmenes nainen sekä joka sadas mies ilmoittivat yrittävänsä oksentaa syötyään. Osallistujat, joilla oli ristiriitainen sukupuoli-identiteetti, ilmoittivat enemmän tyytymättömyyttä omaan kehoonsa sekä häiriintynyttä syömistä kuin kontrollihenkilöt. Enemmistö haastatelluista transihmisistä ilmoittivat voimakasta tyytymättömyyttä omaan kehoonsa, erityisesti koskien seksuaalista kehonkuvaa, sekä häiriintynyttä syömistä. Sukupuolen korjaushoito koettiin pääosin asiana, mikä lievensi sekä tyytymättömyyttä kehoon että häiriintynyttä syömistä. Hoitohenkilökunnan tulee tiedostaa, että tyytymättömyys omaan kehoonsa ja häiriintynyt syöminen koskevat sekä aikuisia miehiä että naisia. Tyytymättömyys kehon seksuaalisiin osiin näyttää olevan suhteellisen tavallista eikä tätä tule jättää huomioimatta. Transihmisten kanssa työskentelevän hoitohenkilökunnan tulee huomioida se, miten laaja ja voimakas näiden ihmisten tyytymättömyys omaan kehoonsa voi olla. Lisäksi hoitohenkilökunnan tulee tiedostaa transihmisten mahdollisesti kohonnut riski häiriintyneelle syömiselle. On myös huomion arvoista, että sukupuolen korjaushoito voi mahdollisesti lieventää näitä ongelmia

Cognitive Behavioral and Cognitive Remediation Strategies for Managing Co-Occurring Anorexia Nervosa and Elevated Autism Spectrum Traits

Anorexia nervosa (AN) is a potentially severe eating disorder whose core characteristics include energy intake restriction leading to low body weight. Autism spectrum disorder (ASD) is a developmental disorder characterized by deficits in social interaction and communication as well as repetitive, stereotyped behavior and interests. Both high ASD traits and diagnosed ASD are over-represented among individuals with AN, and AN and ASD appear to share certain neurocognitive features. These features are associated with the severity of eating disorder symptoms and prolongation of AN. Thus, individuals with AN and high ASD traits or ASD may benefit less from traditional treatment when compared to those with low ASD traits. No previous reviews have summarized what is known about treatment adaptations for individuals with AN and high ASD traits or ASD. The purpose of this narrative review was to investigate the feasibility of cognitive remediation therapy (CRT), cognitive remediation and emotional skill training (CREST), and cognitive behavioral therapy (CBT), and give an overview of treatment modifications for individuals with AN and co-occurring ASD or high ASD traits. We found nine studies that fulfilled our inclusion criteria. The combined results suggest that individuals with AN and high ASD traits or ASD benefit less from CRT, CREST, and CBT than those with AN and low ASD traits. However, CRT and CREST administered in individual format may be associated with improved cognitive flexibility, motivation for change, and decreased alexithymia among adults with AN and high ASD traits or ASD. Individuals with comorbid AN and ASD themselves highlight the importance of treatment adaptations that take the characteristics of ASD into account. In the future, controlled studies of the treatment strategies for individuals with AN and ASD/high ASD traits are needed in order to improve the outcome of individuals with this challenging comorbidity.Peer reviewe

A novel outpatient treatment model for patients with severe and enduring anorexia nervosa: an observational study of patient characteristics, treatment goals, and treatment course

Abstract Background Approximately 20–30% of people with anorexia nervosa develop an enduring form of the disorder. In the present study a newly developed outpatient treatment unit for patients with severe and enduring anorexia nervosa was described. The treatment model is flexible, patient-centered, and aims at enhancing quality of life, maintaining medical stability, and minimizing harm. Treatment contents, patient characteristics, treatment goals, and course of treatment from the first five years of operation were described and analyzed. Methods The participants (N = 22) consisted of all referrals resulting in an assessment or treatment period at the unit between May 2017 and May 2022. All participants were women. The study was a registry study. Information regarding patient characteristics, treatment goals, and the course of treatment was gathered from medical records. Results On average, the participants had had a diagnosed eating disorder for 12.80 years, and self-reported eating disorder symptoms for 19 years. Their symptomatology included severe eating disorder symptoms, psychiatric comorbidities, extreme underweight, and co-occurring medical conditions. Their treatment goals commonly concerned improving physical health, reducing eating disorder symptoms, improving psychological well-being, and improving quality of life. The majority of participants for whom this information was available benefited from the treatment (60%) and their treatment goals were met or partly met (66.6%), as measured by evaluations made by the patient or the treatment team. More than two thirds (69.2%) of the participants for whom this information was available remained weight stable or showed an increase in BMI. Conclusions This observational study suggests that many individuals with severe and enduring anorexia nervosa may benefit from flexible treatment, aiming at supporting quality of life. The results highlight the importance of coordinating and integrating the treatment of severe and enduring anorexia nervosa and co-occurring psychiatric disorders as well as medical complications. Further research and international dialogue about the how treatment for this vulnerable patient group should best be organized is called for. Trial registration Trial registration number: NCT05708404. Date of registration: 01/23/2023 (retrospectively registered)

A novel outpatient treatment model for patients with severe and enduring anorexia nervosa : an observational study of patient characteristics, treatment goals, and treatment course

BackgroundApproximately 20-30% of people with anorexia nervosa develop an enduring form of the disorder. In the present study a newly developed outpatient treatment unit for patients with severe and enduring anorexia nervosa was described. The treatment model is flexible, patient-centered, and aims at enhancing quality of life, maintaining medical stability, and minimizing harm. Treatment contents, patient characteristics, treatment goals, and course of treatment from the first five years of operation were described and analyzed.MethodsThe participants (N = 22) consisted of all referrals resulting in an assessment or treatment period at the unit between May 2017 and May 2022. All participants were women. The study was a registry study. Information regarding patient characteristics, treatment goals, and the course of treatment was gathered from medical records.ResultsOn average, the participants had had a diagnosed eating disorder for 12.80 years, and self-reported eating disorder symptoms for 19 years. Their symptomatology included severe eating disorder symptoms, psychiatric comorbidities, extreme underweight, and co-occurring medical conditions. Their treatment goals commonly concerned improving physical health, reducing eating disorder symptoms, improving psychological well-being, and improving quality of life. The majority of participants for whom this information was available benefited from the treatment (60%) and their treatment goals were met or partly met (66.6%), as measured by evaluations made by the patient or the treatment team. More than two thirds (69.2%) of the participants for whom this information was available remained weight stable or showed an increase in BMI.ConclusionsThis observational study suggests that many individuals with severe and enduring anorexia nervosa may benefit from flexible treatment, aiming at supporting quality of life. The results highlight the importance of coordinating and integrating the treatment of severe and enduring anorexia nervosa and co-occurring psychiatric disorders as well as medical complications. Further research and international dialogue about the how treatment for this vulnerable patient group should best be organized is called for.Trial registration Trial registration number: NCT05708404. Date of registration: 01/23/2023 (retrospectively registered).ConclusionsThis observational study suggests that many individuals with severe and enduring anorexia nervosa may benefit from flexible treatment, aiming at supporting quality of life. The results highlight the importance of coordinating and integrating the treatment of severe and enduring anorexia nervosa and co-occurring psychiatric disorders as well as medical complications. Further research and international dialogue about the how treatment for this vulnerable patient group should best be organized is called for.Trial registration Trial registration number: NCT05708404. Date of registration: 01/23/2023 (retrospectively registered).Approximately 20-30% of individuals with the eating disorder anorexia nervosa develop an enduring form of the illness. In this study a newly developed treatment unit for patients with severe and enduring anorexia nervosa was described. The treatment is flexible and aims at enhancing quality of life. Patient characteristics, treatment goals, and course of treatment from the first five years of operation were analyzed. The participants were patients treated at the new treatment unit. All participants were women. The study was based on patient records. On average, the participants had had a diagnosed eating disorder for more than 12 years, and self-reported eating disorder symptoms for 19 years. Many participants had severe eating disorder symptoms, other psychiatric illnesses, extreme underweight, and other medical conditions. Their own treatment goals concerned improving physical health, reducing eating disorder symptoms, improving psychological well-being, and improving quality of life. Many participants benefited from the treatment. This study shows that individuals with severe and enduring anorexia can benefit from flexible treatment that supports quality of life.Peer reviewe

Effects of family-based treatment on adolescent outpatients treated for anorexia nervosa in the Eating Disorder Unit of Helsinki University Hospital

Abstract Background Family therapy for adolescent anorexia nervosa (AN) has stronger evidence of efficacy in comparison with individual therapy, and family-based treatment (FBT) is the most evaluated in numerous randomized clinical trials. However, few studies have focused on how FBT performs outside of research settings. The current study is the first to assess clinical outcomes of FBT for adolescent AN in Finland, in a specialized outpatient clinic. Aim The naturalistic outcome of outpatient FBT for adolescent AN was investigated. Methods Fifty-two female patients and their families who received FBT at a tertiary eating disorders unit participated in the study. Data on their pre-treatment parameters, treatment details, and condition at the end of treatment (EOT) was collected from their medical records. Results At EOT, a majority (61.5%) had achieved a full weight restoration [percentage of expected body weight (%EBW) ≥ 95%]. Participants with an %EBW ≥ 95 at EOT had a significantly higher pre-treatment %EBW than those with an EBW < 95% at EOT. Participants with an EBW ≥ 95% at EOT showed significantly higher total weight gain during the treatment period, a higher rate of regular menstrual periods at EOT, significantly lower rates of dietary restrictions, and less cognitive or behavioral symptoms of the eating disorder overall, compared to participants who did not achieve a normal body weight. In 22 cases (42.3%), there was no need for further treatment at the end of FBT. Participants who needed further treatment after FBT, compared to those who did not, showed significantly higher rates of psychiatric comorbidity, history of mental health treatment, and need for psychopharmacological treatment. Conclusions In this naturalistic study, and in line with previous studies, FBT for AN appeared to be an effective and sometimes sufficient intervention, especially for patients with milder weight deficit and less severe psychiatric comorbidities. The results show that FBT can be successfully implemented in Finland and suggest that training more ED clinicians in FBT would be beneficial. Trial registration: The study was retrospectively registered on February 8th, 2023, in ClinicalTrials.gov Protocol Registration and Results System, identifier: NCT05734573