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Yoga and Mental Health? (click to open)

Nowadays, many people have turned to yoga as their preferred exercise method – and the reason for that is pretty apparent! It is one of the best practices you can incorporate into your daily life. Once you start practicing yoga regularly, you will reap its benefits immediately!

 

Besides the physical benefits of being more active, slim, healthy, and happy, you will also start noticing a handful of psychological benefits! If you are thinking about starting your venture of practicing yoga and want to know how it can do wonders for your mental health, we have gathered some helpful information just for you.

 

Reduce stress and anxiety – first and foremost, if you are looking for a healthy outlet that can help you cope with the stress and anxiety of everyday life, doing yoga is a great starting point. Practicing this mindfulness exercise for 20 minutes, half an hour, or one hour can help you cope and eliminate all the negative energy that has passed through you during the day, helping you achieve inner peace. Developing a regular habit will also improve how you cope with stressful situations as they arise, and learn how to avoid them affecting your mood.

 

Keep depression at bay – another coping strategy for keeping your mental health in check is using yoga to keep the feeling of depression away. Yoga has proven to be a much better option than any other treatment or medication. It does not have any side effects that can harm you. You will notice the difference during your well-deserved self-care time.

 

Improve the quality of your sleep – if you feel like your mental health starts posing an issue to your overall sleep quality, then it’s time to involve some healthy habits in your day-to-day life. Long working hours, poor dietary plans, and the stress of daily responsibilities can disturb your slumber and make you feel weaker and less focused. Of course, yoga is here to get you back on track! You can use this practice as a coping strategy to improve your sleep quality so you can relax and enjoy your nights peacefully.

 

Promote healthy habits – but the incredible benefits of yoga are not limited to mental wellness only. Regular practice can lead you to make other lifestyle changes to improve your general well-being. Regular yoga practice can increase your likelihood of choosing healthier foods. It may also motivate you to start different types of physical activity, such as going to a gym or practicing sports.

 

Aside from these advantages, this ancient technique may also prove beneficial in people who are actively trying to lose weight, quit their unhealthy smoking habit, or who lack persistence in managing certain chronic diseases.

 

These are just a few ways how yoga positively affects your mental wellness. Start practicing yoga; it could improve overall mental health.

How Does Exercise Affect Your Mental Health? (click to open)

Regarding exercise, society often focuses only on the physical benefits it offers, overlooking the benefits it also provides your mental health. However, with the ability to improve both physical and mental health, exercise becomes a powerful tool for enhancing and supporting multiple aspects of your well-being.

The Benefits of Exercise for Mental Health

Since many factors affect mental health, it makes sense that there are also various ways to address these concerns, with exercise being one of them. Not only that, but exercise improves mental health through more than one modality, with some of these approaches include:  


Reducing Loneliness

Exercise can be quite a social event, which can help those experiencing loneliness. 

 

Loneliness significantly impacts mental health, with reports showing that loneliness is associated with higher rates of mental health conditions such as anxiety and depression. Loneliness is so detrimental to psychological and physical health that it is considered a significant health concern and can increase someone’s risk of severe medical conditions. 

 

Knowing this, the ability of exercise, especially group exercise classes, to allow like-minded people to gather together can help lessen loneliness and, thus, improve your health.

 

Releasing Chemicals

Chemicals are not always seen in a good light, but certain chemicals in the body called neurotransmitters are very important for your mental health, and the body releases them when exercising. These neurotransmitters include endorphins and endocannabinoids, which work together to give that mood boost that is common after exercising. 

 

Reducing Stress

Stress can significantly impact mental health, but exercise offers an outlet for relieving stress and tension, which makes it a powerful treatment for those with anxiety. Additionally, exercise offers those with anxiety something to focus on, which allows them to get out of their head for a little bit, interrupting the worries that might otherwise consume their thoughts.

 

Treating Mental Health Conditions

In some cases, exercise even has the potential to treat certain mental health conditions, with studies showing that exercise can treat mild to moderate depression as effectively as medication does. This is because, beyond the release of endorphins that exercise produces, it also promotes longer-term effects in the brain, such as reduced inflammation, neural growth, and new activity patterns that encourage calmness and well-being. These changes can alter how the brain works, which can help with mental health conditions.

 

In addition to treating mental health conditions, exercise can also help those who manage their mental health prevent relapse, allowing them to continue living their life with good mental health.

 

Find Help for Your Mental Health

Beyond offering a distraction from whatever concern is plaguing you and bringing down your mental health, exercise also provides the ability to increase mood-boosting chemicals in the brain, combat loneliness, and alter pathways in the brain. All of these actions combine to produce immense mental health benefits.

 

While exercise is a powerful tool for improving mental health, not all mental health issues can be entirely managed and dissipated through exercise. Exercise can go a long way in helping, but you may need a therapist, such as Troy Mickle at DIFY Wellness, to help bridge that final gap and, indeed, find relief from your mental health condition.

  

References


What is Attention Deficit Hyperactivity Disorder (ADHD)? (click to open)

The word ADHD gets thrown around often, especially on TikTok. The algorithm has everyone thinking that we all have ADHD or, at least, some symptoms of this disorder.

ADHD is a neurotypical disorder commonly diagnosed in school-aged children due mainly to classroom disruptions, but in recent years adults are getting diagnosed later in life. It’s estimated that 8.4% of children and 2.5% of adults have ADHD1. Data also shows that it is more commonly diagnosed in boys than girls, but more research shows that girls present ADHD differently.

ADHD stands for attention deficit hyperactivity disorder, and it typically presents in a pattern of inattention and/or hyperactivity/impulsivity that makes daily life difficult for those diagnosed.

You may ask yourself: What happened to attention deficit disorder (ADD)? Well, the Diagnostic Statistical Manual (DSM-5)—the diagnostic tool that most, if not all, mental health professionals use in their practices—removed the ADD diagnosis in 1994 and put everything under the umbrella of ADHD.

The DSM-5 now includes three subtypes of ADHD: predominantly inattentive, predominately hyperactive-impulsive, or combined type2.

Symptoms and Diagnosis

To be diagnosed with ADHD, an individual needs to be assessed by their pediatrician, family doctor, or mental health professional. There is no lab test to figure out if someone has ADHD. There are some self-report quizzes and tests online, but seeing a doctor is best for an actual diagnosis.

The DSM-5 breaks down ADHD symptoms into two categories: inattentive type and hyperactive/impulsive. To get an official diagnosis, symptoms and behavior must be present for over six months and persist in two settings (e.g., home or school).

If individuals are less than seventeen years old, six or more symptoms must be present; if individuals are over seventeen, then only five or more symptoms are needed for diagnosis3.

Here is some the criteria used when making an ADHD diagnosis:

Inattentive Type Symptoms


Hyperactive/Impulsive Type Symptoms

To be classed predominately inattentive, an individual will meet almost all inattentive criteria and no hyperactive/impulsive criterion. The opposite is true for the predominantly hyperactive/impulsive type, and individuals will present with more hyperactive/impulsive criteria than inattentive. To meet the requirements for the combined type, individuals will meet both inattentive and hyperactive/impulsive criteria3.

Adult ADHD

About 10 million adults have ADHD, but it usually shows up and is associated with depression and other mood disorders, and sometimes substance abuse. Often, adults with ADHD go underdiagnosed.

Here are some symptoms that can be seen in individuals with adult ADHD4:

Adults who discover they have ADHD later in life often were undiagnosed children or had such a mild case that parents and teachers overlooked it. A doctor or mental health professional may use standardized behavior rating scales or an ADHD checklist to make their diagnosis. These standardized tests will examine working memory, executive functioning, and visual, spatial, and reasoning skills.

Even with more adults discovering they have ADHD, many don’t know it. Some adults chalk it up to being disorganized or lazy or having a poor memory5.

ADHD in Girls and Women

Most ADHD research has focused on young boys and men, but a recent study has been coming out showing that girls and women present with ADHD very differently than their male counterparts. ADHD usually goes underdiagnosed or undiagnosed in females due to the inattentive type being more common.

Often girls with ADHD get diagnosed as adults. Research finds that girls internalize many symptoms that affect their sense of self and life management skills. Girls and women with ADHD often have chronic feelings of inadequacy and shame that are difficult to discuss.

This makes the outward expression of ADHD very subtle and can easily be misinterpreted as shy, introverted, and perfectionistic. Future research needs to explore why ADHD takes a more significant psychological toll on women and how it may be linked to internalized symptoms, hormone fluctuations, and the weight of societal pressures6.

Treatment & Medication

There are a few different approaches to treatment that can be effective for ADHD. These include one or more types of therapy and medication. If a parent is seeking treatment for their child, practitioners will often offer behavioral measures for them to use.

Medication is an essential component of treatment and is best discussed with a doctor. There are two types of classifications of ADHD medications: stimulant and non-stimulant medication.

Stimulant Medication

This class of medication is most prescribed to children and adults. They work by increasing the production of dopamine and norepinephrine—two important neurotransmitters affected by ADHD.

Where this type of medication would stimulate a neurotypical individual, they have a calming effect on people with ADHD. Stimulants help reduce hyperactivity and improve attention, concentration, and focus.

Common drug names are Adderall, Focalin, Concerta, and Ritalin.

Non-stimulant Medication

This class of medication is second in line when stimulant medication is ineffective or causes unwanted side effects. They work at increasing the availability of norepinephrine in the brain, which helps attention and memory.

In addition to medication, several types of therapy are beneficial in managing ADHD symptoms.

Psychotherapy, also known as talk therapy, is a way to manage symptoms by coping with feelings, finding a way to better approach relationships with friends and family, and exploring behavior patterns.

Cognitive Behavior Therapy (CBT) is another very effective modality of therapy that is goal oriented. It aims to facilitate behavior change and negative thinking patterns and replace them with skills to manage ADHD symptoms. CBT helps improve time management and procrastination while managing irrational thought patterns that keep individuals from staying on task7.  

  

References


What is Obsessive-Compulsive Disorder (OCD)? (click to open)

A notable role in mental health is played by syndromes (sets of symptoms) grouped under the obsessive-compulsive disorder (OCD), named after the Latin terms obsessio and compulsio. In a broad sense, the core of obsessive-compulsive disorder is a condition in which the clinical picture is dominated by thoughts that arise against the patient's wishes but with an awareness of their morbidity (Chamberlain et al., 2021). Despite understanding the unnaturalness and illogical nature of the obsessions and states, the clients are powerless in their attempts to overcome them. Obsessive urges or ideas are recognized as alien to the personality but as if coming from within. Compulsive behaviors may be the performance of rituals designed to alleviate anxiety. Attempts to push away uninvited thoughts or urges may lead to a severe internal struggle accompanied by intense fear. Such attempts only worsen the patient's condition and increase distress. Eventually, to alleviate the stress, the patient engages in increasingly compulsive behaviors. 

OCD is often focused on specific themes - for example, an excessive fear of being infected by germs. To alleviate the anxiety of infection, you may obsessively wash your hands until your skin chafes. There are several theories about the causes of OCD. First, the biological approach suggests that OCD may result from changes in your body's natural chemistry or brain functions. The genetic theory states that OCD may have a genetic component, but the specific genes responsible for causing the disorder have yet to be identified. Finally, the learning theory states that compulsive fears and compulsive behavior can be learned by observing family members or gradually developed over time (Chamberlain et al., 2021). OCD usually starts in adolescence or young adulthood but can also manifest in childhood. Symptoms typically begin slowly and tend to change in severity throughout life. The types of obsessions and experiences may change over time and intensify during times of stress. OCD is usually seen as a lifelong disorder, and over the years, can have symptoms ranging from mild to almost disabling. It includes both obsessive and compulsive manifestations, but only one condition may predominate. 

The client may not realize that their obsessions and compulsive behaviors are excessive or unreasonable, but they are time-consuming and interfere with daily life and social relationships. Obsessive symptoms include recurrent, persistent, and unwanted thoughts, urges, or compulsive images and cause anxiety or distress (Chamberlain et al., 2021). Usually, the patient either tries to ignore them or get rid of the ideas through compulsive ritualistic activities. The most common types of obsessive behavior are fear of getting dirty, persistent mistrust, insecurity about everything, rigid organization of one's space and objects, and an increased craving for order. 

Compulsivity in OCD manifests itself in pathological cyclical behaviors that supposedly help reduce anxiety, but they provide only temporary relief. The most common types of compulsive behavior are frantic washing, cleaning, checking and rechecking the same things, counting, recounting, and compulsive mathematical activities in mind. The problems resulting from obsessive-compulsive disorder are most often related to social life:

One of the main goals of treating OCD, is to assist the client in managing the symptoms, thus improving their daily quality of life. 

 

 References

Chamberlain, S. R., Solly, J. E., Hook, R. W., Vaghi, M. M., & Robbins, T.W. (2021). Cognitive Inflexibility in OCD and Related Disorders. In: Current Topics in Behavioral Neurosciences. Springer. https://doi.org/10.1007/7854_2020_198


Why Are Good Sleeping Habits Important for Your Mental and Physical Health? (click to open)

Life has become so busy that most of us don't have much time for sleep in our schedule. We work from day to night and then sleep the bare minimum, only to start the cycle again. In all this hustle, we have forgotten the importance of sleep and how good sleeping habits can affect our physical and mental health. Getting adequate downtime is of utmost importance for our health, and if you have a poor sleeping schedule, it will reflect in your performance.

Good sleeping habits mean sleeping the recommended duration every night and having a fixed morning and nighttime routine. It is advisable to sleep at least 8 hours every night and sleep at the same time every night, even on your day off. There are numerous benefits associated with a good sleeping routine, and you will see beneficial effects on your mental and physical health. Let’s have a look at some of them:

Heart Health

When we sleep at night, our blood pressure goes down, and our vessels relax, which reduces the workload on the heart. This way, a good night's sleep helps to reduce heart diseases and stroke, whereas a lack of sleep is actually associated with an increased risk of heart problems. Sleep is also crucial to keep cholesterol levels in check.

Increases Immunity

The midnight snooze is the perfect time for the body to repair and rejuvenate, and this extends to the immune system as well. Sleep is crucial to maintaining a healthy immune system, and research suggests that getting high-quality sleep increases the body’s immune response to foreign invaders like bacteria and viruses. In contrast, people who suffer from insomnia or sleep apnea are more likely to suffer from immunity problems.

Helps to Reduce Weight

Getting inadequate sleep at night is a significant risk factor for weight gain and obesity. Our appetite is controlled by leptin and ghrelin hormones, which are responsible for promoting satiety and regulating the appetite. A lack of sleep throws these hormones off-balance, resulting in weight problems. Sleeping for at least 8 hours every night is recommended if you're trying to lose weight, as it helps keep these hormones in check.

Improved Memory

When we sleep, our brain gets a chance to assimilate and connect all the information it absorbed through the day. This process is critical as it helps you recall and remember things. Getting a whole night's sleep is essential for brain functions, and your memory will improve with good sleeping habits.

Reduces Stress

Throughout the day, the body goes through multiple experiences that cause the release of stress hormones, including adrenaline and cortisol. These hormones cause you to feel stressed out and anxious during the day. It is vital to get adequate sleep as sleep reduces the production of stress hormones and relaxes your body. When you sleep for an entire night, you will wake up stress-free and relaxed, ready to face the next day!

How does depression affect you physically? (click to open)

Depression is a widespread mental health problem that affects up to 7% of the US population. Depression is most often associated with psychological symptoms, including low mood, feeling sad and hopeless, or a loss of interest in everyday activities. If the symptoms persist for a few weeks, it may be a sign of a major depressive disorder that requires treatment.

 

Common symptoms like sadness, irritability, or guilt are easy to recognize and may prompt an individual to seek help from a medical professional. However, most people don't know that depression can also manifest as physical symptoms that are not as easy to pick. Some people don't feel depressed, yet they often experience physical problems like difficulty sleeping or weight loss. This presentation of depression is more common in men who are less likely to present with the cognitive effects.

 

Let's have a look at how depression affects you physically.

 

Trouble sleeping

 

Difficulty falling asleep and staying asleep is a classic physical symptom of depression. You may experience increased sleep latency, which basically means you will be rolling on the bed for hours without falling asleep. If you finally succeed in falling asleep, you may wake up multiple times during the night due to poor sleep quality. On the other extreme is hypersomnia, which means that a person with depression will feel tired even after adequate sleep and will want to sleep more during the day, resulting in dozing off and daytime naps. Both these conditions can have a toll on your physical well-being, and you may feel tired and irritated throughout the day. 

 

Low energy

 

Fatigue is a common physical manifestation of depression, and it can affect the quality of life. While it's normal to experience the usual off-day where you feel sluggish and tired, having low energy levels throughout the week may be a sign of depression. Most people with depression will prefer to stay in bed and watch TV all day long rather than getting up and doing something productive. This low energy affects all aspects of life and reduces one's ability to concentrate on the important stuff. If you are experiencing fatigue with other symptoms of depression like hopelessness or guilt, it may be time to consult a doctor.

 

Reduced pain tolerance

 

If you are suffering from depression, your pain tolerance may be reduced from average. It is common for someone with depression to have body aches and joint pain without other cognitive symptoms. There is no concrete link between pain and depression, and scientists are still trying to understand the relation between these two, but there are some theories. Depression is caused by an imbalance of neurotransmitters, including serotonin and norepinephrine. The same hormones may cause a disturbance in pain pathways leading to the chronic body ache usually seen in depression.

 

Disturbed eating patterns

 

Depression disturbs the appetite significantly, and you may experience one of the two extremes, just like sleep. Either your appetite will reduce to the point that you aren't interested in food anymore, or you'll get food cravings throughout the day. Neither of these is good for your health and will cause a negative impact on your weight and general health. It is best to consult a doctor if you lose weight rapidly as it may cause heart and kidney problems.

 

Decreased Sexual Drive

 

It is fairly common for someone with depression to have a disturbed sexual life, and often it is due to the physical inability to get aroused. Depression may affect the sex drive, reduce sexual pleasure or reduce the ability to have orgasms altogether. This has a detrimental effect on relationships and may cause a rift between partners. Therefore, it is important to recognize this physical sign of depression. 

 

Reduced immunity

 

Depression is a state in which the brain neurotransmitters are messed up, which increases the inflammatory signals all over the body. This inflammatory response affects the immune system and reduces the body's ability to fight off harmful invaders, which may cause you to get sick more often. Another reason depression reduces immunity may be linked to a lack of self-care. Depressed people often stop eating healthy and ignore exercise and physical well-being, which affects the immune system.

 

Gut problems

 

Depression is often linked to a variety of gastrointestinal symptoms, and while most people may pass them off as something else, it is important to recognize if your gut problems are linked with depression. Abdominal cramps and pain are the most common, and if this pain gets worse with stress, it may be a sign of depression. Other problems like bloating, nausea, or reduced appetite may also be seen. These symptoms may be caused by the inflammatory signals which irritate the gut, and they are often mistaken as inflammatory bowel syndrome. The problems may also be caused by an imbalance of good and bad bacteria in the intestines, as these good bacteria are essential for a healthy gut.

 

Headaches

 

Headaches are a common occurrence for most people and having a headache once in a while is not an alarming sign. However, if you notice an increase in the frequency of headaches, or if you have one every day, it may be depression affecting you physically. While depression headaches aren't as excruciating as a migraine, they still hinder your daily activities. They usually manifest as a throbbing pain behind the eyes and are more common in men. You can take an over-the-counter medication to relieve the pain, but the headache usually comes back until you get the root cause treated.


Depression is a debilitating condition that may present in more than one way. Some people show apparent symptoms of depression, while others may be smiling and laughing yet battling the problem while alone. Not everyone exhibits the classic signs associated with depression, and recognizing the physical symptoms is just as important as the mental ones. If you or your loved one is experiencing such problems, it is a good idea to share the problem with family and friends so that everyone can get the help they need!

Depression and the Heart (click to open)

Depression is one of the most common mental health illnesses in the world. Globally it is prevalent in more than 26 percent of adults. Feeling sad, gloomy, down in the dumps, or anxious sometimes is a normal part of our lives. But when these feelings last for more than two weeks, then they could be the symptoms of depression. It's estimated that almost 17 million adults experience depression each year in America.

 

Although depression is a mental health condition, it affects our physical health and well-being. If depression is left untreated, then it can interrupt your day-to-day life and cause additional complications.

 

Despite affecting our brain, depression can significantly affect our hearts.

Depression and heart disease are the companions of each other. People with depression are four times more likely to suffer from heart disease than people with no history of depression. A study conducted by researchers in Montreal, Canada, found that heart patients who were depressed were four times more likely to die in the next six months than those who were not depressed.

 

People with depression face a heightened risk of heart disease. Depression and stress are closely related. Depression makes it harder for the person to take the medications to carry out the treatment. A person suffering from depression will have a high quantity of stress hormones in the body. Those hormones will speed the heart rate and make blood vessels narrower. Narrow blood vessels will increase blood pressure. This will put your body in a prolonged state of emergency. Over time, this will lead to heart disease.

 

The recurrence of cardiovascular problems is linked more closely to depression than other risk factors like smoking, diabetes, high blood pressure, and high cholesterol.

Some researchers even found that most heart patients with depression do not receive appropriate treatment. Primary care physicians and cardiologists often miss the diagnosis of depression, and even if they do, they often do not treat it adequately.

 

Multiple studies are indicating that depression can cause heart disease. Psychological distress can rapidly increase heart rate, blood pressure, and faster blood clotting, along with elevated insulin and cholesterol level.

 

Due to increased heart rate and blood pressure, the heart has to work more, and this can damage heart muscles, ultimately leading to heart failure.

 

Faster blood clotting and a high level of cholesterol will start the process of atherosclerosis. This could result in blockage of the arteries and reduced blood flow to the heart. This could also result in a heart attack and heart failure.

 

One thing is for sure depression can be severe and have adverse effects on our health. Not only can it affect our brain, but it can also affect our heart. If you ever feel you are depressed, seek your doctor's advice and set up a session with a mental health provider.

Gender Dysphoria in Adolescents (click to open)

For the past several decades, scholars in LGBT studies have made significant progress in understanding the interpersonal relationships of LGBT people with their gender. However, it is crucial to be aware that transgender and non-binary people often tend to experience some form of gender dysphoria. According to Zucker et al. (2016), gender dysphoria is a disorder that describes a person’s dissatisfaction with their biological sex. Gender dysphoria usually develops during puberty when a child begins to recognize their first and secondary sexual characteristics. During this stressful gender identity period, parents should seek out information and support for their children to learn how to support their children and help them better understand why they feel the way they do.

Not all transgender and non-binary people have gender dysphoria; however, the parent must communicate with their child if the latter experiences the symptoms. Kaltiala-Heino et al. (2018) report that 0.17% to 1.3% of adolescents are transgender. One way to support young adults that identify as non-binary or transgender is to give them mental health care and understand how to begin their transition correctly. Butler et al. (2018) advise that medical professionals who provide physical health care must consult with their psychosocial colleagues to understand how to deal with the distressed queer youth. It is a crucial step to estimate other stressful indicators non-related to gender dysphoria.

Gender dysphoric disorder causes extreme discomfort that severely affects a person’s relationship with self-image and might even lead to more serious mental health issues such as depression. De Vries et al. (2016) suggest that “fostering greater acceptance of a variation in gender expression” reduces the “co-occurring psychopathology in children and adolescents with gender dysphoria” (p. 586). In addition, the parent’s involvement and care significantly relieve the hardships of the child who might experience pressure from peers, which usually results in one’s alienation from others.

In conclusion, it is crucial to perform up-to-date care for children with gender dysphoria because it is a severe condition that can negatively affect daily life and the emotional stability of children. Gender questioning is a frequent and expected behavior for any child; therefore, it becomes difficult to estimate the exact prevalence of gender dysphoric disorder. However, supporting a child during puberty, combining both professional physical and mental healthcare, will make the transition easier for every party involved.

References

Butler, G., De Graaf, N., Wren, B., & Carmichael, P. (2018). Assessment and support of children and adolescents with gender dysphoria. Archives of Disease in Childhood, 103(7), 631-636. http://dx.doi.org/10.1136/archdischild-2018-314992

de Vries, A. L., Steensma, T. D., Cohen-Kettenis, P. T., VanderLaan, D. P., & Zucker, K. J. (2016). Poor peer relations predict parent-and self-reported behavioral and emotional problems of adolescents with gender dysphoria: A cross-national, cross-clinic comparative analysis. European Child & Adolescent Psychiatry, 25(6), 579-588. https://doi.org/10.1007/s00787-015-0764-7

Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: Current perspectives. Adolescent Health, Medicine and Therapeutics, 9, 31-41. https://doi.org/10.2147/AHMT.S135432

Zucker, K. J., Lawrence, A. A., & Kreukels, B. P. (2016). Gender dysphoria in adults. Annual Review of Clinical Psychology, 12, 217-247. https://doi.org/10.1146/annurev-clinpsy-021815-093034