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  1. The Muslim culture.

     

    Fatima Durrani, a 20-year-old married female, comes to see you with her parents. Both parents look very worried and in a very low volume plead with you to help their daughter become normal. The family immigrated from Pakistan fifteen years ago and are U.S. citizens. They have maintained many of their cultural practices and live in a close-knit Pakistani community.

    Fatima explains her situation, “Ever since I was in the seventh grade, I kept on feeling that I should have been a boy. I realized that I preferred to wear pants and shirts and would play games like baseball, football, and Pokémon with boys. During my school years, I repeatedly fell in love with girls who were usually my classmates. I would write love letters to girls as if I was a boy and occasionally, I’d do some sexual activities like kissing and touching their breasts.

    “About six months ago, my parents gave me in marriage to Abdul Aziz, who is the only son of Adil Aziz. My parents are… uh, that is they were not aware of my gender identity problem. My father-in-law and my husband were good to me. My father-in-law would often say that I reminded him of his dead wife. Though I tried to adjust in my new role, I soon discovered that I was not getting any sexual arousal with my new husband and so I returned to my parents. Although my parents seemed to be genuinely worried and concerned about me, I know that they are very upset. We don’t discuss my situation openly at home. As for my husband and my father-in-law and my larger family, my parents have told them that I am going through withdrawal symptoms because I was missing my parents too much. Some of my relatives think I am pregnant and want to be with my mother. My parents are very embarrassed and want to secretly see if anything will help me. I am interested in a behavior modification therapy program so that I can go back to my husband.”

    Fatima’s physical and gynecological examination does not reveal any abnormalities. She understands the limitations of sex reassignment surgery.

    Questions
    From your perspective as Fatima’s psychiatric nurse practitioner, answer the following questions in your initial post.

    What is the DSM-5 criteria for gender dysphoria? Would Fatima meet the criteria for this? Explain your rationale.
    What resources are in your community for Fatima and her family? (I LIVE IN TAMPA, FL)
    What referrals would you make for Fatima? DEFINITELY THERAPY, SUPPORT GROUPS
    Recommend a movie, TV show, or book about or by a transgender person. (the Danish Girl?)
    Are you familiar with this or similar cultures? What would you need to do in your practice to be culturally sensitive? I lived in Egypt for many years so I am familiar with the Muslim culture. The trans culture I would have to continue to educate myself etc

     

 

Subject Cultural Integration Pages 5 Style APA

Answer

Gender Dysphoria

Gender dysphoria is an individual’s state of unease due to the difference of his gender identity with his biological sex or the physical characteristics associated with his sex. Therefore, people experiencing gender dysphoria tend to be comfortable when assuming gender roles of their preferred gender identity (Turban, 2020). This case study evaluates the case of Fatima Durrani, who is suffering from gender dysphoria exacerbated by the fact that she is married.

According to Turban (2020), the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes gender dysphoria in adolescents and adults as incompatibility in one’s expressed gender and the gender attached to them. However, according to DSM-5, an individual can only be diagnosed with this condition if it lasts for at least 6 months while exhibiting specific characteristics. These characteristics include; a solid desire to be of the other preferable gender, adopting primary sex characteristics of the other gender, and inefficiency in other aspects of social life. Therefore, according to this case study, Fatima meets the DSM-5 criteria for having gender dysphoria. She explains how she ever wanted to be a boy since 7th grade, how she would fall in love with other girls, indulge in sexual activities like touching their breasts, and his failure to adjust to his new role as a wife, thereby leading to a lack of sexual arousal.

Resources in Tampa, Florida that will be of great use to Fatima and his family include; Mental health services provided at the Neuropsychiatric Institute, primary care providers such as the Diversity Health Center of Tampa Bay, and endocrinology centers such as the USF Health Diabetes and Endocrinology Center.

To curb traditional gender roles and stereotypes faced by Fatima, I would recommend behavior modification therapy and support groups. Behavior modification therapy involves changing an individuals’ undesirable behavior to achieve a quality of life (Dewitt, 2020). Behavior modification therapy will prove a great help in suppressing the other gender sex characteristics, which are viewed as ‘negative’ by Fatima’s family, who are described as being embarrassed, thus seeking her medication in secrecy. On the other hand, social groups will be beneficial to Fatima by helping her interact with other adults experiencing gender dysphoria, thus getting to learn more about trans-related topics and on the local resources available for transgender individuals (Lawlis, Butler & Middleman, 2020).

As a way of showing Fatima the hardships associated with going against the norm, the challenges experienced by the transgender in an ever-judging society, and how to embrace one’s true gender identity, I will recommend her the ‘Danish Girl’ movie. The Danish Girl is majorly based on the theme of transgender and sexism. The transgender theme is portrayed by a character known as Einar Wegener, who was the 1st person in history to undergo sexual reassignment surgery, thus transforming himself into Lili Elbe. In the movie, Einar Wegener embraces his feminine side when she is first asked to pose as a model in one of Gerda’s paintings, which later brings out his feminine identity that had been suppressed. Sexism is also portrayed when Einar’s wife Gerda is asked why she cannot be a good painter as her husband despite being a gifted artist (Ustoyev, 2016). Thus, these sexist comments on Gerda bring out the society’s view of women, which is only a supportive wife. This aspect of sexism will be well relatable to Fatima, who is regarded as nothing but a wife with his father-in-law who constantly says that she reminds him of his dead wife.

Having spent the most time in Egypt, I am familiar with Fatima’s Muslim culture. Therefore, to be culture-sensitive, I will create an inclusive environment whereby I will avoid microaggressions, assumptions, asking questions unrelated to the services I am providing just because of curiosity, getting to know the kind of topics my clients will be comfortable with alongside their preferable terminologies, issuing treatment that is within given acceptable cultural values, and also the inclusion of the clients’ relatives in decision making, for instance, incorporating Fatima’s parents in policy implementation.

In summary, gender dysphoria affects Fatima Durrani, which is even worse because she is married. Fatima meets the DSM-5 criteria of being diagnosed with gender dysphoria through exhibiting characteristics such as; a solid desire to be of the other preferable gender, adopting primary sex characteristics of the other gender, and inefficiency in other aspects of social life. Resources available in Tampa, Florida for Fatima’s exploitation include; Mental health services provided at the Neuropsychiatric Institute, primary care providers such as the Diversity Health Center of Tampa Bay, and endocrinology centers as the USF Health Diabetes and Endocrinology Center. In terms of referrals, I would recommend behavior modification therapy and support groups. In recommending a transgender movie, I commended the Danish Girl, which is based on transgender and sexism. To be culturally sensitive, I need to create an all-inclusive environment that respects diversity.

 

 

References

Dewitt, S. (2020). What Is Behavior Modification Therapy? Better help. https://www.betterhelp.com/advice/therapy/what-is-behavior-modification-therapy/?.

Lawlis, S., Butler, P., & Middleman, A., (2020). Evaluating transgender youth and parent interest and preferences regarding support groups. Global Pediatric Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488600/.

Turban, J. (2020). What Is Gender Dysphoria? American Psychiatric Association. https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria.

Ustoyev, S. (2016). Review: The Danish Girl. Seminar One: Arts in New York City. https://eportfolios.macaulay.cuny.edu/artsinnyc2016/2016/09/14/review-the-danish-girl/.

 

 

 

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