Abstract: Diagnostic criteria for intellectual disability, borderline personality disorder, and gender dysphoria all emphasize functional impairments over simple trait descriptions. Individuals with intellectual disability have functional deficits in conceptual, social, and practical domains. Social deficits include difficulty perceiving and interpreting social cues with peers, problems with emotional regulation, and limited understanding of risk in social situations. As in the case of Ms. A, these individuals are at risk for being manipulated by others, especially in romantic relationships. The deficits in borderline personality disorder are similarly characterized by a defining pattern of instability of self-image, personal goals, interpersonal relationships, and affect, as well as impairment in domains of identity, self-direction, empathy, and intimacy. Individuals with gender dysphoria also experience internal conflict, distress, and varied psychiatric symptoms, in part as a result of the personal and societal stressors they face in understanding their situation.
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The participant will identify barriers to effective clinical care for individuals with multiple conditions, including gender dysphoria, intellectual disability, and borderline personality disorder.
This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.
Estimated Time to Complete
Duration: 1 hour
Begin Date: November 1, 2018
End Date: October 31, 2020
How to Earn Credit
In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™). A score of 60% or higher is required to receive credit.
The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The APA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Faculty and Planner Disclosures
Title: A Transgender Woman With Intellectual Disability and Borderline Personality Disorder
Authors: William J. Newman, M.D., Amy V. Barnhorst, M.D., Jackie Landess, M.D., J.D.
Affiliations: From the Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, St. Louis (W.J.N., J.L.); and the Department of Psychiatry and Behavioral Neuroscience, University of California Davis, Sacramento (A.V.B.).
Disclosures: The authors report no financial relationships with commercial interests.
Discussion of unapproved or investigational use of products*: No.
*APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.
Robert Freedman, M.D. (Editor-in-Chief, AJP); Susan K. Schultz, M.D. (Deputy Editor, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals).
Dr. Schultz has received research support from the Alzheimer’s Disease Cooperative Study for projects conducted in partnership with Toyama Chemical Company and in partnership with Eli Lilly and Company. Dr. Freedman, Mr. Roy, and Mr. Pogachar report no financial relationships with commercial interests.
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