Communication is the expression of a message by speaking, writing, or signing. When a message is not expressed clearly, it can be misinterpreted. Clear communication means that the receiver of the message understands exactly what the sender is intending. It is essential for being understood, building relationships, and communicating efficiently.

For many Spanish speakers, having clear communication when speaking English can be an important step when it comes to achieving their goals, whether that be in their careers, their social lives or just not having to repeat themselves and being understood. The purpose of accent training is to help you feel confident and to communicate as effectively as possible—not to sound like a native speaker or erase your individuality. This in-depth guide will go over what accent training is, how it works, and how one-on-one coaching can help with clarity, confidence-building, and successful communication in both professional and social settings.

Accent training is personalized coaching that helps individuals who want to address specific communication challenges. It focuses on pronunciations, appropriate intonation, rhythm, timing, and stress patterns. It helps speakers identify which habitual features they take from Spanish and use while speaking English. The goal of accent training is not to sound like a native speaker, it is to help individuals communicate clearly and confidently. Accent training is flexible and personalized to meet each individual’s needs.

Accents are made up of substitutions; the sounds, rhythms, and intonations from a person’s native language or region that he or she uses when speaking English. If these substitutions are not what the listener expects to hear in English, the listener hears an accent (The accent channel). Accents are a normal part of any language and reflect the cultural diversity of speakers. No accent is better than another; they are all valid forms of expression.

Accents only become noteworthy if they begin to interfere with someone’s communication at work or in social settings. They may cause confusion or prevent someone from achieving their goals. Some people may also feel that there are preconceived notions about their accent, which can lead to biases and stereotypes. The choice to change the way we speak is up to each individual. They may want to improve their communication and avoid embarrassing speech mistakes.

After accent training, most accents become difficult to associate with any specific location; they begin to sound very neutral and unidentifiable. Speakers become easily understood, which boosts their confidence and allows them to communicate clearly and as effectively as possible.

Personalized accent training provides many advantages over apps and videos. It offers immediate feedback and allows the opportunity to correct mistakes instantly. It also helps the individual to recognize their personal challenges when communicating; not every Spanish speaker has to work on the same objectives during accent training. Unlike apps and videos, personalized training is tailored to each individual’s needs. Working with a speech trainer also ensures you are accountable and practicing consistently, which is important for progress. Immediate feedback from a speech trainer is much more effective and leads to better results.

The process of accent training begins with a speech assessment in order to identify the sound substitutions, rhythms, stress patterns, and intonations that are currently being used and would need to be replaced with those of the goal accent (General American English for example). Once the substitutions are identified, appropriate objectives can be set. It is important to note that new objectives may appear after the initial assessment as the speech trainer is constantly assessing their client as they work together. Each session targets a single objective and consists of a variety of tasks that are practiced multiple times. During these tasks, immediate feedback is given to help the client identify any substitutions and make the necessary corrections. In addition to these in-session practices, at-home tasks are assigned; it is crucial that the client practices consistently outside of sessions in order to make notable progress. Repetition is necessary for making adjustments in the accent, and frequent practice is required for permanent improvement. The goal of accent training is for the client to internalize the correct speech patterns and produce them fluently in a way that is easily understood by their listeners.

Each goal takes approximately one session to be taught. It is recommended to have one session a week, and normally takes between 12-15 sessions to work through each objective (depending on the number of objectives of each student, could be more, could be less). It is important that the student is practicing at home at least 15 minutes a day to make notable progress. After the completion of their program, the client will have the option of maintenance sessions if they would like to continue practicing with a speech coach.

To communicate clearly and confidently, we will focus on several key areas tailored to each client’s needs. We will address high-value sounds specific to English that are uncommon in Spanish and can lead to pronunciation difficulties. We will also work on rhythm and stress; English features vary in syllable length, some syllables are stressed and longer, while Spanish syllables are generally given equal time. Additionally, we will focus on vocabulary, predominantly common words used in daily life that are often mispronounced. We will use targeted exercises and practice to improve pronunciation, rhythm, and vocabulary, which will enhance overall communication skills.

Taking action to overcome communication challenges is an important step towards personal and professional development. Accent training is a powerful tool that can help you achieve effective and clear communication. It can help boost your confidence and enhance your interactions in all areas of life. Working with a speech trainer provides you with personalized guidance and support, and ensures that you reach your goals more effectively than through self-study tools alone.

I am Jarrisvette Villarreal, originally from South Texas. I have been living in Spain for several years, where I have worked as an English teacher and have taught young Spanish speakers. Through my experience, I have become familiar with the common mispronunciations and typical mistakes Spanish speakers make when speaking English. In addition to teaching, I have experience as a Speech-Language Pathologist Assistant, working with children on articulation through speech therapy. I have also completed a specialized training in accent coaching through “The accent channel”, which has equipped me with the skills to provide personalized accent training. I have also worked diligently to achieve a neutral English accent; I understand the challenges and preconceived notions about having an accent. I am passionate about teaching pronunciation and excited to help others reach their communication goal.

What wouldn’t we do to protect our children, our most precious treasures? As parents, our instinct is to shield them from harm and negative experiences, fearing that difficult situations might cause pain or lasting trauma. We are driven by love and a deep desire to see our children happy and thriving. However, in our efforts to safeguard them, we might unintentionally prevent them from developing the resilience they need to navigate life’s inevitable challenges.

Resilience is the ability to bounce back from adversity and cope with setbacks. It is a crucial skill that helps children manage the complexities of life. Shielding them from every challenge can leave them unprepared for future difficulties. Without encountering adversity, they may struggle to handle setbacks when they arise, potentially leading to a lack of confidence and problem-solving abilities.

One of the most valuable lessons we can teach children is that emotions—both positive and negative—are a natural part of life. Everyone experiences anger, frustration, or sadness at times, and that’s okay. Emotions are natural responses to situations and are not something we can directly control, but we can control how we express and respond to them.

It’s essential for children to understand that feeling sad, frustrated, or angry is perfectly normal. These emotions aren’t to be feared or avoided; rather, they are signals that deserve attention. For example, fear can alert us to danger, such as encountering a wild animal (we do not want to meditate when a lion is approaching us), prompting us to take protective action. Anger, when managed properly, can help us stand up for ourselves and advocate for a just world (we do not want to be taken advantage of). By teaching children to accept their emotions, rather than suppress or ignore them, we help them develop an understanding of their emotional responses—a cornerstone of resilience.

While understanding emotions is crucial, it’s equally important for children to learn how to express them in healthy and constructive ways. We cannot always run away from what scares us, nor can we lash out when angry. It is okay to feel emotions, but how we express them matters. Children need to learn effective ways to manage their emotions so they do not create new problems, which could intensify their negative feelings.

First, remember that your child is a keen observer. One of the most powerful ways they learn is by watching your behavior. If you model healthy emotional expression, your child is likely to emulate it. Conversely, if you respond to anger by hitting or breaking things, it becomes difficult for the child to understand that these behaviors are unacceptable.

A helpful guideline is to focus on teaching your child what to do, rather than what not to do. Instead of saying “Don’t hit” or “Don’t scream,” guide them toward alternative behaviors. For example, you might say, “I see you’re angry because of what happened. It’s understandable—it’s not fun when things don’t go your way. When you’re angry, use your words to tell me what’s bothering you, and we can figure out how to make things better.” This approach is easier said than done, especially when parents are short on time and energy. Many of us weren’t taught how to manage our own emotions, so learning to do so may be necessary before we can effectively teach our children. Remember, just like on an airplane, you need to put on your own oxygen mask before helping others.

Building resilience in children doesn’t mean exposing them to unnecessary hardships; rather, it means equipping them with the tools they need to handle the challenges they will inevitably face. By teaching them to understand, manage, and express their emotions, we prepare them for the realities of life and help them build the resilience needed to thrive.

Resilient children are better equipped to cope with adversity, recover from setbacks, and continue moving forward. They understand that emotions are a natural part of life and that challenges, while difficult, can be managed. With these skills, they will be prepared to handle criticism at work or navigate conflicts in their personal relationships, confidently facing whatever life throws their way.

– I’ve been diagnosed with anxiety. Which is the best anxiolytic?

+ Let’s take it easy and start from the beginning.

– And what is the beginning?

+ Well, even from the Bible, the beginning is always the word: «anxiolytic» literally means something that calms anxiety. However, nowadays, we use many different medications from various pharmacological groups.

– Are there that many?

+ Yes, quite a few. Antidepressants like sertraline or escitalopram; antipsychotics, such as olanzapine or quetiapine; antihistamines (hydroxyzine); antiepileptics (pregabalin, gabapentin); beta-blockers (propranolol); and finally, what most people understand by anxiolytics without any qualifier, though they are also known as hypnotic-sedatives, are benzodiazepines (alprazolam, lorazepam, diazepam). For historical interest, although they are no longer used for anxiety but are still beloved by the media, let me mention the barbiturates.

– Wow, that’s a lot of names. You doctors must be something special to be able to remember all these terms.

+ And pronounce them without biting our tongues, yes

– Could you explain to me how medications are named, since we’re on the topic of words?

+ Very briefly. When a drug is in the development phase, and it’s not yet known whether it will be useful or not, it’s given a “code name,” consisting of letters and numbers, such as UK-92,480. Once its efficacy is confirmed, it receives a name related to its chemical structure and the family it belongs to (let’s imagine lormetazepam): this name is the “generic” or “international nonproprietary name,” by which it will be known worldwide, with slight variations depending on the language. Finally, when the company markets it, it assigns a brand name made up by the marketing department or based on some of its characteristics (e.g., Atarax – hydroxyzine – an antihistamine with anxiolytic properties, from the Greek ataraxia, meaning imperturbability, serenity). I should also point out that the brand names I’ll be using here are for educational purposes only and do not reflect any commercial interest (I have no ties to the pharmaceutical industry).

– I understand now. Back to my initial question, out of all those options, which is the best for anxiety?

+ That will depend on many factors.

– Such as…

+ The first and probably most important is the type of clinical presentation. I’d also like to remind you that psychotherapy is the most appropriate treatment for mild anxiety disorders and should be combined with pharmacological treatment for moderate cases.

– So, not everyone with anxiety should take medication, right?

+ Exactly. You might not even need to do anything at all—remember that anxiety is an innate emotion (we are born with it) and can even be adaptive. For instance, normal anxiety the first day at a new job pushes us to do better. However, when it’s so exaggerated that it paralyzes us or has very negative consequences on life, leading to unnecessary suffering, it obviously needs to be treated.

– So, which is the best medication? Antidepressants, despite their name?

+ Probably yes. Nowadays, most anxiety disorders are treated with antidepressants. Regarding specific diagnoses, panic disorder (with or without agoraphobia), social anxiety disorder, and generalized anxiety disorder, the most common ones, have antidepressants as their first line of treatment.

– Without being depressed at all? Isn’t it that most cases involve a mix of anxiety and depression?

+ There’s some truth to that. But even in pure anxiety, without any depressive component, antidepressants are the first-line treatment.

– Do all antidepressants work?

+ Almost all of them. The most notable exception is bupropion, which is not effective. The most commonly used nowadays are the well-known SSRIs (selective serotonin reuptake inhibitors), and among these, current guidelines recommend sertraline as the first option. Other widely used ones include escitalopram, fluoxetine, and paroxetine.

– So, I just take a pill, and my anxiety will go away forever?

+ Well, magic belongs to others, unfortunately. Antidepressants work differently: you need to take the treatment every day, and gradually, the anxiety will decrease. Also, it’s not uncommon for it to get worse at the beginning.

– How gradually? How long does it take for the antidepressant to work?

+ Here, I’m afraid, you need to be a “patient” patient. In all cases, we’re talking about weeks to achieve full remission, and although there is considerable interindividual variability, a minimum of about 2 weeks is required to see effects.

– But if I’m feeling really bad, how do I survive that time until the antidepressant kicks in?

+ That’s where the other groups I mentioned come into play. Let’s start with the main one, benzodiazepines—benzos for short. They are pure anxiolytics (meaning they are not antidepressants), but they also have other actions, the most well-known being that they are good muscle relaxants, hypnotics (sleep-inducing, making you sleep), and even antiepileptics. They take effect immediately, last for hours, and then are eliminated, but…

– If they’re so good, that “but” must be the size of a mammoth.

+ BUT, as I said, they make you sleepy (which is bad if we intend to take them during the day and lead a normal life), slow you down, decrease reflexes and balance, impair memory while under their effects, are lethal in overdose, have potential for abuse and addiction, and can be diverted for illicit purposes as well.

– So they’re terrible! How can they be among the best-selling medications?

+ Because they’re truly effective for their intended purpose, which is to eliminate anxiety, and when used properly, they are extremely useful. The most well-known include bromazepam (the famous Lexatin, as in the popular expression “Lexatin omelette”), lorazepam (Orfidal), and alprazolam (one of the strongest benzodiazepines, with a brand name in Spain that alludes to its action, Trankimazin -it’s known as Xanax in US, nice name anyway).

– How should they be taken?

+ Exactly as prescribed by the doctor… to avoid the risks we mentioned earlier. With this medication, it’s especially important to follow the prescribed regimen and inform your healthcare provider if you deviate from it. In panic disorder, for example, benzodiazepines are often used initially along with the antidepressant to cover the time it takes for the latter to start working, and then they are tapered off within weeks.

– What happens when they are prescribed “SOS”?

+ It’s also called “as needed,” “rescue,” “PRN” or “if necessary.” It’s a very useful way to take benzodiazepines. It means they are not scheduled, not taken daily or anything close to that, but only when the person feels they can’t control the anxiety or are in the middle of a crisis. Often, just carrying around the pill is enough to provide reassurance and avoid taking it, almost like a talisman. To draw an analogy, it’s similar to having paracetamol at home. Not every time we have a headache do we take it; we know that sometimes just sleeping or doing something entertaining will make it go away, but if we need it, it’s there, and that’s enough.

– Which one is the best then?

+ There isn’t really a best or worst. They differ in terms of the speed of action, strength (the amount needed to exert its effect), duration of effect, probability of “rebound” anxiety, metabolism… depending on what you’re looking for, you’ll choose the appropriate compound.

– And the other types of drugs you mentioned?

+ Some antihistamines (first generation, which cross into the brain) produce a non-specific “sedation” and a sense of calm: the most commonly used is hydroxyzine. Certain antipsychotics (mainly olanzapine and quetiapine) are also used for their sedative effects, as well as antiepileptics called gabapentinoids, pregabalin, and gabapentin, which share with benzodiazepines their action in favor of the calming neurotransmitter, gamma-aminobutyric acid (GABA). All of these are certainly useful, especially when, for some reason, we want to avoid using benzodiazepines. The most common reason being the risk of addiction.

– Without having a crystal ball, how do you know if someone is going to become addicted to benzos?

+ Indeed, we can’t know for sure, but remember that the best predictor of future behavior is past behavior: someone with a history of substance use is likely to have problems. This is especially true with alcohol: the combination of alcohol and benzodiazepines is one of the most dangerous in my field.

– Are the other drugs better and safer than benzodiazepines?

+ The other drugs also have their own side effects and issues; no medication is free of them. Even water itself is dangerous in excess. But they certainly offer several advantages, especially in terms of their zero potential for addiction and misuse.

– You haven’t mentioned that other drug with the difficult name, propranolol.

+ Propranolol, and a few others in its group, the beta-blockers, are indicated for a very specific form of anxiety, “performance anxiety.” In certain circles, it’s known as the “exam pill,” and it’s also very popular among those giving a lecture or, more modernly, a presentation.

– How does it work?

+ It’s the only one of all the medications we’ve discussed that doesn’t cross the blood-brain barrier, meaning it doesn’t reach the brain. Its action is to reduce all the “peripheral” anxiety symptoms, i.e., those related to the body rather than the mind: tachycardia, sweating, tremors, dry mouth… and in this way, we convince ourselves that we’re not anxious. It’s ideal for oral exams, theatre actors, and all those situations where the sedative effects of other drugs are not desirable. Obviously, antidepressants don’t sedate either, but as we said at the beginning, they’re not effective in the moment.

– We’ve really covered pharmacology. Any final message?

+ The usual: listen to your doctor and trust Sinews, we’re here to help.

– Wait, I almost forgot, what about herbal remedies? That trendy one with the difficult name?

+ Phytotherapy is probably better left for another day; it’s getting late today.

Alicia Fraile is a psychiatrist at SINEWS, Madrid, with more than 20 years of experience in general clinical psychiatry. She has worked in brain damage, Mental Health Centers, occupational psychiatry, work accidents and their repercussion in psychiatry (post-traumatic stress disorder, adaptive disorders), patients with chronic health problems and of course with the most frequent pictures of our field: anxiety, depression, insomnia, obsessive-compulsive disorder.

Accent training is a specialized form of language instruction designed to help individuals modify or refine their accent in a second language. It goes beyond working on your pronunciation and perfecting the sounds of individual words; it also involves the way we connect words, the rhythm, and the intonation that we use when speaking. Many speakers unknowingly carry over the speech patterns of their native langue when speaking English, this can sometimes change the meaning of what is being said and affect clarity. Personalized Accent training can pinpoint the specific aspects of speech a person may need to target, to ensure that they are conveying a clear message. This guide will explore how connection, rhythm, and intonation are essential to accent training and how they can help anyone who wants to sound more natural and confident when speaking English.

Mastering connection, rhythm, and intonation is crucial for achieving natural and fluent English speech. While pronunciation is foundational, these elements ensure that speech flows smoothly and conveys intended meanings accurately. Effective accent training emphasizes these aspects to help non-native speakers overcome the influence of their native language and sound more natural in English.

Connection in speech refers to the way we blend words and sounds to create fluent communication. Without these connections, speech can sound unnatural or choppy, making non-native speakers come across as robotic. English speakers often link words that start with consonant sounds or blend vowel sounds between words, such as in phrases like «turn off» (which can sound like «turnoff») or «see it» (which can sound like «seeyit»). Enhancing how you connect sounds can improve pronunciation, rhythm, timing, and overall intelligibility. When speaking English, it is important to connect words smoothly so that entire sentences flow together. Pausing is natural and appropriate at the end of a sentence, when taking a breath, or when emphasizing a particular point.

Rhythm in speech plays an important role in effective communication. It involves the patterns of stressed and unstressed syllables and influences how messages are perceived. People are accustomed to hearing a certain timing during speech to fully comprehend a message. When the rhythm is off, the message can be difficult to follow or can cause confusion. “English is a stress-timed language, meaning, we don’t give equal stress to every syllable, but we spend lots of time on some syllables and we rush through other syllables” (The accent Channel). In English, when stressing a syllable, the vowel becomes longer, louder, and goes up in pitch. This can make it challenging for Spanish speakers to adapt to uneven stress patterns and can affect the natural sound of their speech.

Intonation in speech refers to the variation in pitch that we use to convey different meanings in English. It helps distinguish between statements, questions, and commands. Intonation can also reveal emotions like sarcasm, uncertainty, or enthusiasm, and it highlights important aspects of a spoken message. When we vary in pitch, we can express a range of meanings and emotions.

Spanish speakers sometimes use repetitive intonation patterns when speaking English, this can make a person sound monotone and confusing. Without proper intonation, speech is flat and difficult to follow. Stressing different parts of a phrase can completely change its meaning, even when using the same words. Mastering intonation is crucial for clear and engaging communication.

English and Spanish differ significantly in their approach to connection, rhythm, and intonation. Spanish, being a syllable-timed language, maintains a steady rhythm by giving equal time to each syllable. In contrast, English’s stress-timed nature creates a more fluid and varied rhythm, with stressed syllables occurring at regular intervals. This difference can lead Spanish speakers to emphasize every syllable equally in English, disrupting the natural rhythm and clarity of their speech.

When it comes to connection, Spanish tends to maintain a more continuous flow between syllables, with each sound clearly articulated. English, however, often blends sounds together, making it sound smoother and more connected. Additionally, while Spanish vowels are precise and static, English vowels are longer and more dynamic, requiring greater mouth movement. Finally, when Spanish speakers speak English, they tend to use a repetitive intonation, and English requires varied intonation to convey different emotions and intentions. By focusing on these differences—strong syllables, elongated vowels, varied intonation, and fluid sound connections—Spanish speakers can significantly improve their clarity and fluency in English.

A speech coach is essential for mastering connection, rhythm, and intonation which are critical for natural English communication. Through tailored exercises and real-time feedback, a coach can address specific challenges in blending words, managing syllable timing, and varying pitch. Coaches use practical techniques, such as listening drills and rhythmic practice, to improve speech flow and intonation. Personalized training ensures that learners understand and apply these elements effectively, leading to more natural and confident speech.

Mastering connection, rhythm, and intonation is essential for anyone looking to improve their English accent and communicate more effectively. These elements are the building blocks of natural speech, influencing how we are understood and how our messages are received. While pronunciation is important, it is the fluidity of connected words, the rhythmic flow of stressed and unstressed syllables, and the dynamic use of pitch that makeup language.

For non-native speakers, especially those coming from languages with different speech patterns like Spanish, focusing on these areas can make a significant difference in how natural and confident their English sounds. With the help of personalized accent training and a speech coach, learners can develop these skills, leading to clearer, more engaging communication. Whether for personal growth, professional development, or social interaction, refining connection, rhythm, and intonation can unlock a new level of proficiency in English, helping speakers to be not only understood but also to connect more deeply with others through language.

I am Jarrisvette Villarreal, originally from South Texas. I have been living in Spain for several years, where I have worked as an English teacher and have taught young Spanish speakers. Through my experience, I have become familiar with the common mispronunciations and typical mistakes Spanish speakers make when speaking English. In addition to teaching, I have experience as a Speech-Language Pathologist Assistant, working with children on articulation through speech therapy. I have also completed a specialized training in accent coaching through “The accent channel”, which has equipped me with the skills to provide personalized accent training. I have also worked diligently to achieve a neutral English accent; I understand the challenges and preconceived notions about having an accent. I am passionate about teaching pronunciation and excited to help others reach their communication goal.

Speech therapy is the branch of science that focuses on the assessment, diagnosis, treatment and prevention of speech, language, communication and swallowing disorders. It is a discipline that serves people of all ages. Speech therapy is a profession that combines different areas, such as linguistics, psychology, biology and medicine.

In America, the Spanish Association of Speech Therapy, Phoniatrics and Audiology (AELFA-IF) is one of the main organisations of speech therapists in Spain. This association offers resources, ongoing training and support to professionals.

Speech therapists can work in a wide variety of settings, such as hospitals, private clinics, schools, nursing homes and early childhood centres, among others. Areas of intervention include:

As mentioned above, speech therapy also encompasses the area of assessment. This is a multi-stage process. Speech therapists use techniques and tools to assess speech, language, communication and swallowing. Assessment can be carried out through standardised or non-standardised tests.

The first step in an assessment is an initial interview, in which detailed information about the patient’s development is collected. It is important to know the patient’s medical history and family history. In addition, it is very important to know about possible speech and language difficulties.

After this first step, assessment takes place. This may be through standardised tests, with specific tests that compare the individual’s performance in a given area with the norms established for their age group, or through non-standardised tests, which include observation of the user in their daily life or in specific activities to assess specific aspects.

This assessment allows the identification of the strengths and weaknesses of individuals, which enables the setting of specific goals for therapeutic intervention.

With the information extracted from the assessment, the speech therapist establishes intervention objectives. These goals can be short, medium or long term and allow the user’s progress to be monitored.

As a general conclusion, speech therapy is a profession that treats disorders related to speech, language, communication and swallowing through individualised intervention. The goals of the intervention are established on the basis of an exhaustive assessment carried out by the professional. The speech therapist has a very important role in improving the quality of life of individuals in need and seeks to develop skills and tools that enable people to communicate effectively.

It is an area in which research plays an important role in incorporating new techniques into interventions, ensuring their effectiveness.

Some sites that provide up-to-date information on speech therapy are:

• American Speech-Language-Hearing Association
• National Institute on Deafness and Other Communication Disorders
• Speech-Language-Therapy.com
• Understood

Mariló Martínez

Parenting a teenager can sometimes feel like navigating a maze of complex emotions. As your child grows, their emotional landscape becomes more intricate, making it harder to connect and communicate. Luckily, movies like Inside Out 2 offer a unique opportunity to bridge that gap. This animated film, like its predecessor, dives deep into the world of emotions, making it an ideal tool for sparking conversations about feelings with your teen. Establishing healthy communication with your children from an early age can be a transformative experience, deeply influencing how they perceive themselves and the world around them.

Here are some ways you can use Inside Out 2 to engage your teenager in meaningful discussions about their emotional experiences.

As a child psychologist, I believe in the importance of connecting before correcting. Creating opportunities for quality time with our children is a key way to open the door to meaningful communication and understanding. Prepare a comfortable environment where emotions can naturally come to the surface. Plan a family movie night to watch Inside Out 2 together. Make it a relaxed and enjoyable experience with your teen’s favorite snacks, and ensure that everyone is present in the moment, without distractions like phones or other devices.

After the credits roll, resist the urge to jump straight into the heavy stuff. Instead, ask your teen open-ended questions about the movie. Some examples include:

«What did you think of the way emotions were portrayed in the movie?»
«Did any of the characters remind you of your own feelings?»
«Which emotion do you think was most important for the main character?»
“Did any scenes resonate with something in your life?”

These questions are non-threatening and invite your teen to share their thoughts without feeling pressured. Let them take the lead in the conversation, offering your insights only when appropriate.

Remember to share some of your own thoughts and experiences while and after watching the movie, making sure to do so in a way that’s appropriate for your child’s age. When our children hear about the emotions and challenges that adults face, it helps normalize these feelings and makes them more comfortable opening up about their own.

One of the strengths of Inside Out 2 is its ability to make abstract emotions tangible. Use this to your advantage by relating scenes from the movie to real-life situations. For example:

«Remember how [character] felt when they had to make that tough decision? Have you ever felt like that?»
«The way the characters showed [specific emotion] was interesting. How do you think you handle that emotion in your own life?

This helps your teenager draw connections between the fictional world of the movie and their personal experiences, making it easier for them to express their own feelings.

If your child (and you) are struggling to express yourselves verbally, consider using art and play as alternative channels for communication that feel more authentic and natural. For instance, you can use jars and colors to label different emotions and invite them to share examples of times they’ve felt each way. You can also guide them towards more specific topics, such as, ‘Can you think of a moment today when you felt anxious at school?’ This approach allows them to explore their feelings in a creative and less pressured environment.

One of the key themes in Inside Out 2 is that emotions are complex and often mixed. It’s crucial for teenagers to understand that it’s normal to feel conflicting emotions simultaneously, especially during their developmental years. Discuss moments in the movie where characters felt more than one emotion at a time, and share examples from your own life when you’ve experienced something similar.

For instance, you might say, «I noticed that [character] felt both happy and sad at the same time when they made that choice. I’ve felt like that before when I had to say goodbye to someone I care about. Have you ever felt like that?»

Another special approach Inside Out does an excellent job at, is highlighting that all emotions have value, even the ones we tend to shy away from, like sadness, fear, or anger. Use this as an opportunity to discuss the importance of these emotions in your teen’s life. Ask questions like:

«Why do you think [emotion] was important for the characters?»
«How do you feel when you experience [specific emotion]? Do you find it hard to talk about?»

By addressing these “unpopular” emotions, you help your teenager understand that it’s okay to feel them and that they have a purpose in their emotional well-being.

Inside Out 2 is more than just an entertaining film; it’s a powerful tool for helping your teenager understand and express their emotions. By using the movie as a starting point for conversations, you can create a safe space where your teen feels comfortable discussing their feelings, leading to a deeper emotional connection between you. Remember, the goal isn’t to solve all their problems but to let them know that you’re there to support them, no matter what emotions they’re experiencing.

Talking about emotions isn’t a one-time event. You can revisit the themes in future conversations with your teen. Use it as a reference point when discussing challenges they face, reminding them of how the characters navigated their emotional journeys. This not only reinforces the lessons from the movie but also keeps the lines of communication open.

Finally, remember that your own emotional awareness sets the tone for these discussions. Share your feelings openly and model healthy emotional expression. When your teen sees you handling your emotions with maturity and empathy, they’re more likely to feel comfortable doing the same.

Noa Zelman is a licensed child development psychologist with over 10 years of experience helping families navigate the complexities of emotional development. Passionate about fostering healthy communication between parents and children, Noa believes that movies like Inside Out 2 can be a valuable tool in bridging the gap between generations and bringing us closer to positive mental health development.

The Netflix series «Love on the Spectrum» offers a unique perspective on the experiences of people on the autism spectrum in the realm of both social and romantic relationships. Through various episodes, it explores how these individuals navigate the complex world of dating and relationships, highlighting both their challenges and triumphs. This analysis will focus on three main aspects: social and communicative difficulties, the importance of understanding and support, and the positive impact of media representation for the autistic community.

One of the most prominent aspects of the series is observing how individuals on the autism spectrum face social and communicative difficulties when trying to form romantic relationships. Communication is a fundamental tool in any relationship and can be especially challenging for people with autism due to differences in interpreting social and emotional cues.

People on the autism spectrum often find it difficult to interpret and use non-verbal communication, such as body language, eye contact, and facial expressions. The series shows how some participants may miss subtle cues of interest or disinterest from their partners, leading to misunderstandings and frustrations. This difficulty can make dating stressful and sometimes discouraging for the protagonists.

The tendency to interpret language literally is also a common characteristic within the autism spectrum. This style of communication is seen in the series when participants speak in a direct and honest manner, often without the nuances or filters that many neurotypicals use in dating. While this frankness can be refreshing, it can also create awkward moments or misunderstandings with their dates.

Social anxiety is another significant challenge depicted throughout the series. The anticipation of a date can generate considerable stress, often manifesting in repetitive behaviors or avoidance of social situations, such as fleeing from the date. The series captures moments when participants feel overwhelmed by the pressure of social interactions, highlighting the need for coping strategies and support during these times.

The series also emphasizes the importance of understanding and support from both loved ones and professionals in developing healthy relationships for people on the autism spectrum. This is crucial, as the protagonists might not venture to use the tools provided and communicate their needs and concerns without this support.

Families play a crucial role in providing emotional and practical support to autistic individuals. In «Love on the Spectrum,» many participants rely on their family members for advice, motivation, and companionship. This familial support is essential in helping them face the challenges of dating and build self-confidence.

The series also features specialized dating coaches, or professionals who work with people on the autism spectrum to improve their social and communication skills. These professionals provide practical techniques and personalized strategies to help participants navigate dates with greater confidence. Their intervention may include practicing eye contact to understanding the emotional signals of the other person.

Creating a community and fostering connection with others in similar situations is also a recurring theme. Support groups and specialized social networks can provide a safe and understanding environment where autistic individuals feel accepted and valued. These environments can help reduce feelings of isolation and provide opportunities to learn from others’ experiences.

Accurate and positive representation of people on the autism spectrum in media is crucial for combating stereotypes and fostering greater social understanding and acceptance. «Love on the Spectrum» makes a significant contribution in this regard.

The series aims to humanize people on the autism spectrum by showing their personalities, desires, and struggles authentically. In doing so, it promotes empathy and challenges negative stereotypes. The audience can see beyond the autism label and recognize the universal experiences of seeking love and connection with another person.

One of the strengths of the series is its focus on diversity within the autism spectrum. Each individual has a unique experience, and the series highlights this diversity, from high-functioning autistic individuals to those needing more support. This inclusive approach helps demystify autism and show that there is no «right way» to be autistic.

For autistic viewers and their families, the series offers a message of hope. Seeing others facing similar challenges and finding love can be inspiring and motivating. This type of representation can help reduce hopelessness and increase self-esteem by demonstrating that meaningful relationships are possible for everyone, regardless of neurological differences.

«Love on the Spectrum» offers a profound and enriching view of the experiences of autistic individuals in the realm of romantic relationships. By addressing social and communicative difficulties, the importance of support, and media representation, the series significantly contributes to understanding and accepting autism. This analysis highlights the need for an empathetic and supportive approach to help people on the autism spectrum navigate the world of relationships and find love. Lastly, it is not only an entertaining series but also educates and promotes greater inclusion and respect for the neurological diversity present in our world today.

Lidia Fernández

Migraine goes beyond being simply a headache; it is a complex neurological disease that frequently accompanies symptoms related to mental health. It affects more than 5 million people in Spain. Additionally, approximately 1.5 million Spaniards suffer from chronic migraine, characterized by occurring 15 or more days per month. Chronic migraine significantly reduces productivity, deteriorates quality of life, and leads to disability rates four to six times higher than those with episodic migraine. Despite its neurological origin, migraine often coexists with various psychiatric disorders such as depression, anxiety disorders, insomnia, bipolar disorder, etc., complicating its management and treatment. These mental health issues not only exacerbate the burden of migraine symptoms but also increase the risk of increased frequency and treatment resistance over time.

Many migraine patients face not only severe headaches but also persistent feelings of sadness and hopelessness. Depression affects a significant number of migraine individuals, impacting their quality of life and making pain management difficult. The relationship between depression and migraine is especially strong in cases of chronic migraine, where both conditions often worsen each other’s symptoms. Symptoms such as persistent sadness, loss of interest in activities, changes in appetite or weight, sleep disturbances, and difficulty concentrating can complicate migraine management. Treating depression with a combination of medication and psychotherapy can help improve overall mood and resilience, thus facilitating coping with the challenges posed by migraine. At Sinews MTI, a team of psychiatry and psychology professionals is available to offer assistance.

Anxiety disorders, such as generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder, are also common among migraine patients. Moreover, stress and uncertainty of living with migraines can intensify anxiety symptoms, creating a cycle where anxiety triggers migraines and, in turn, migraines increase anxiety. This cycle can make managing both migraine and anxiety challenging, perpetuating and worsening both conditions.

Symptoms such as excessive worry, restlessness, muscle tension, and sleep difficulties can significantly impact the migraine experience. Therapeutic approaches like cognitive-behavioral therapy (CBT) are effective in managing anxiety symptoms, thereby alleviating their impact on migraine frequency and severity.

Stress activates the hypothalamic-pituitary-adrenal (HPA) axis, a regulatory system that controls the body’s response to stress. When a person experiences stress, whether emotional, physical, or psychological, the hypothalamus releases the CRH hormone (corticotropin-releasing hormone), which stimulates the pituitary gland to release ACTH (adrenocorticotropic hormone). This in turn acts on the adrenal glands to produce cortisol, essential for regulating the stress response. Cortisol is crucial for various bodily functions, including pain response. However, elevated and chronic levels of cortisol due to prolonged stress can have long-term negative consequences on health and contribute to pain sensitization.

Stress significantly affects health and migraines. Studies indicate that patients with chronic migraines report more stressful events preceding the chronification of their migraines compared to those with episodic migraines. Chronic stress and recurrent migraines can trigger structural changes in the central nervous system, increasing sensitivity to pain. Pain sensitization involves an enhanced response of the nervous system to painful stimuli. Functional magnetic resonance imaging studies have shown increased brain activation in response to pain in individuals with chronic migraines. Paradoxically, sudden reduction in stress can also increase the risk of migraine the following day, due to the abrupt reversal of stress-induced anti-inflammatory effects that alleviate pain.

Stress also influences psychiatric disorders; stressful or traumatic events, especially in childhood, increase vulnerability to major depression and other mental disorders. Chronic stress can induce genetic/epigenetic changes that alter the response to future stressors, thereby increasing susceptibility to migraines and psychiatric disorders. In the context of migraines, chronic stress may not only trigger episodes of acute pain but also contribute to pain chronification and heightened sensitivity to migraine triggers. Activation of the HPA axis and the resulting increase in cortisol levels may perpetuate chronic migraines and amplify pain perception in patients. Effectively managing stress not only prevents migraines but also improves overall physical and mental health. Consult with our neuropsychiatrist for guidance on your case.

There is a bidirectional relationship between migraine and bipolar disorder, especially migraine with aura. Approximately one-third of patients with bipolar disorder have migraines, with a higher prevalence in bipolar disorder type II. Both conditions share an episodic nature, sensitivity to stress, and family history, potentially linked through dysfunctions in calcium channels. Bipolar disorder, characterized by alternating periods of depression and mania or hypomania, can complicate migraine management. Mood instability associated with bipolar disorder can exacerbate the frequency and severity of migraines. Effective management of bipolar disorder through mood stabilizers, antipsychotic medications, and psychotherapy can help reduce migraine episodes and improve overall stability.

Sleep disorders are frequently reported by patients with migraines and are both a trigger and a consequence of migraines. Conditions such as insomnia, sleep apnea, and restless leg syndrome are common among migraine patients. Poor sleep quality can increase the frequency and severity of migraines, creating a vicious cycle that is difficult to break. Managing sleep disorders can lead to significant improvements in migraine symptoms. Improving sleep hygiene through regular sleep schedules, creating a suitable rest environment, and avoiding stimulants before bedtime can help reduce migraine frequency. For conditions such as sleep apnea, medical interventions such as continuous positive airway pressure (CPAP) therapy may be necessary to improve both sleep quality and migraine management.

While previous studies suggested a relationship between migraines and substance abuse, recent research indicates that this association may be confounded by factors such as depression and other psychiatric disorders. For example, patients with migraines tend to consume less alcohol, possibly due to its potential to trigger headaches.

However, abuse of other substances such as medications used to treat migraines can be a concern. Excessive use of medications, particularly analgesics, can lead to medication overuse headache, which worsens the frequency and intensity of the headaches. Addressing substance abuse issues through proper medical guidance, counseling, and support groups is critical for effective migraine management. Get advice on substance abuse from our psychiatry team.

Chronic migraine often evolves from episodic migraine and is linked to various risk factors such as depression, anxiety, obesity, and excessive medication use. Depression is especially important and increases the risk of chronic migraine. Effectively treating these psychiatric conditions can prevent migraine from worsening. It is crucial to adopt treatment approaches that consider both neurological and psychiatric aspects to improve quality of life.

Several hypotheses attempt to explain the bidirectional relationship between migraine and psychiatric disorders. These include shared genetic factors, common environmental triggers, and dysfunctions in systems such as serotonin regulation and the hypothalamic-pituitary-adrenal axis. Chronic stress and central sensitization are proposed mechanisms linking migraines to conditions such as depression and anxiety. Understanding these mechanisms can guide the development of targeted therapies that address both migraine and its psychiatric comorbidities.

Neuroimaging studies highlight abnormal brain function and connectivity in areas involved in emotional processing among migraine patients. Regions such as the anterior cingulate cortex, insula, and prefrontal cortex show altered activity patterns during pain and sensory processing, potentially contributing to the emotional aspects of migraines and comorbid psychiatric symptoms. These insights from brain imaging research underscore the importance of a comprehensive approach in migraine treatment that considers both neurological and psychological factors. By addressing the brain’s role in both pain and emotion, more effective and holistic treatment plans can be developed.

Despite the challenges, there are effective treatment options that can help manage both migraines and associated mental health problems. Initially, primary care physicians are the first point of contact for patients with migraines and typically prescribe pain relief medication for acute episodes. When primary care physicians deem it necessary for specialist intervention, patients are referred to neurologists, who are responsible for evaluating and managing specific migraine treatments.

For acute migraine attacks, pain relievers such as ibuprofen and triptans are effective options for quick and efficient pain relief. Additionally, depending on the frequency and severity of migraines, neurologists may recommend preventive pharmacological treatments such as beta-blockers (e.g., propranolol), antidepressants (such as amitriptyline), and antiepileptics (like valproic acid and topiramate). In cases where these treatments are insufficient or poorly tolerated, newer pharmacological approaches have been developed, such as monoclonal antibodies targeting calcitonin gene-related peptide (CGRP), which have shown high effectiveness in migraine prevention by significantly reducing the frequency and severity of episodes.

Furthermore, when treatment response is unsatisfactory, a psychiatric evaluation is crucial. This allows for the detection of psychiatric comorbidities that may contribute to poor treatment response or migraine chronification. Psychiatrists can identify and treat conditions such as anxiety disorders, depression, or other emotional issues that might impact the frequency and severity of migraines, using medication when necessary. At Sinews MTI, we have psychiatrists who will help you address psychiatric comorbidities.

In addition, behavioral therapies play a crucial role in the comprehensive treatment of migraines and their associated complications. These interventions, guided by specialized psychologists, use techniques such as cognitive-behavioral therapy (CBT) and stress management strategies to develop effective coping skills. Seek help from our psychologists.

This combination of treatments not only addresses the physical aspects of migraines but also focuses on psychiatric and psychological aspects, thereby improving the quality of life for patients.

In conclusion, migraine is a neurological condition that profoundly impacts the productivity and quality of life of millions of individuals. Despite its neurological basis, migraine often coexists with a spectrum of psychiatric comorbidities including depression, bipolar disorder, anxiety disorders, stress, sleep disorders, and substance abuse. These conditions not only increase healthcare utilization but also elevate the risk of migraine chronification and worsen overall disability.

Effective management of these psychiatric comorbidities is crucial to optimize migraine treatment outcomes and enhance the quality of life for affected individuals. Psychiatrists play a pivotal role in this context, employing a biopsychosocial approach to address the biological, psychological, and social dimensions of migraine comorbidities.

Adapting treatment approaches that integrate pharmacological and behavioral therapies is imperative, especially for patients with psychiatric comorbidities, to ensure comprehensive and personalized care in migraine management.

María Isabel Zamora is a physician with a double specialty in Psychiatry and Neurology. She has experience in the care of patients in general psychiatry consultations, and in a more specialized way, in the care of patients who combine psychiatric and neurological symptoms. She has worked with psychogeriatric patients and patients with functional diversity. She has experience in cognitive impairment, psychological and behavioral symptoms of dementia, psychiatric symptoms related to neurological disorders or chronic pain, autism, ADHD, adaptive disorders, depression, anxiety, addictions, bipolar disorder, obsessive-compulsive disorder, sleep disorders, eating disorders, etc.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in communication and social interaction, as well as the presence of repetitive and restricted behaviors and interests, having a lifelong impact on the individual. Ideally, it should be identified during childhood to address any potential difficulties during the early stages of development. However, those who are not diagnosed until adulthood may experience other related mental health issues, such as anxiety disorders, due to the challenges they face in social adaptation.

In Europe, it is estimated that around 1% of the population has an ASD diagnosis. In Spain, 0.9% of people are diagnosed, a percentage similar to other European countries, which hover around 1 to 1.2%. It is estimated that for every four men diagnosed with autism, one woman receives a correct diagnosis, encompassing the entire spectrum of this disorder. However, it is concluded that the figures for women are not entirely accurate, and we do not have the real value in the Spanish population.

A study by Bonney et al. mentions that if autism is diagnosed in childhood in both boys and girls, girls would receive a diagnosis at least one year later than boys, as 80% of girls remain undiagnosed until the age of 18 (McCrossin, 2022). This may be due to girls and women on the spectrum masking or camouflaging their difficulties to the extent that even their close circles are unable to identify them and thus seek help.

According to 2018 data on the Spanish population, it is estimated that there are currently between 140,000 and 264,000 autistic girls and women in Spain, a significant minority too large to be ignored.

The characteristics found in girls with ASD include:

On the other hand, the diagnosis of autism in adult women can be made, and the signs differ from those in girls.

Women with ASD often receive incorrect diagnoses or no diagnosis of ASD despite seeking mental health services more frequently than men (Gesi, C., 2021). The diagnosis of a mental disorder may be the first and only one received by women with autism who use camouflage strategies, as diagnostic tools are based on the male profile and how ASD is described therein.

When time passes without an ASD diagnosis, we find a group of women who end up with psychiatric diagnoses and treatments that do not address the main symptoms of their problem but rather the manifestations of a prolonged imbalance. A study conducted in 2017 by the Women’s Board of the Association of Autism Professionals (AETAPI) indicated that 40% of the women surveyed had previous diagnoses of depression, more than 30% had anxiety, and approximately 20% had social phobia. They possibly manifested these symptoms, but they undoubtedly stemmed from their life difficulties and social rejection.

In many cases, not only do women with autism present the symptoms of this broad disorder, but it is often accompanied by symptoms of another disorder that may have developed until the diagnosis is obtained.

Diagnosing Autism Spectrum Disorder (ASD) in adult women can be a complex process due to gender differences in symptom presentation and the tendency of women to use camouflage strategies. To achieve this diagnosis, mental health professionals conduct a thorough evaluation to provide answers to the uncertainty and explanation that our adult patients need. To do this, we use the following tools:

The first step in diagnosis is conducting a thorough clinical interview covering personal and family history, childhood development, educational and work experiences, as well as interpersonal relationships. It is essential that the mental health professional is trained to ask specific questions that can reveal behaviors and experiences typical of ASD in women.

A detailed evaluation of current symptoms is crucial. This includes observing communication and social interaction, as well as identifying patterns of repetitive and restricted behavior. Women with ASD may present symptoms more subtly, such as having intense interests that are socially acceptable or using coping mechanisms that mask their difficulties.

Standard diagnostic tools, such as ADOS-2 (Autism Diagnostic Observation Schedule) and ADI-R (Autism Diagnostic Interview-Revised), should be used alongside questionnaires and scales that have proven useful in detecting ASD in women. It is important that these tools are applied by professionals who understand gender differences in the manifestation of autism.

Adult women with ASD often present comorbidities such as anxiety, depression, eating disorders, and obsessive-compulsive disorders. A comprehensive evaluation should include an analysis of these conditions, as they can influence the presentation of ASD and the interpretation of symptoms.

To obtain an accurate picture of the woman’s functioning, it is useful to observe her behavior in different contexts, such as at home, at work, or in social situations. This can help identify behavioral patterns that are not always evident in a clinical setting.

Testimonies from family, friends, and coworkers can provide valuable information about the woman’s behaviors and social skills at different stages of her life. These reports can complement the clinical evaluation and provide a broader perspective on her challenges and strengths.

It is important to consider the woman’s own perception of her experiences and challenges. Self-reports can reveal how she feels about her social interactions, her interests, and her ability to manage daily life. This subjective component is crucial to understanding how she perceives and handles her condition.

Mental health professionals must receive ongoing training on gender differences in ASD and stay updated with the latest research and diagnostic practices. Sensitivity to the ways women may mask their symptoms is essential to avoid incorrect or late diagnoses.

In conclusion, diagnosing ASD in adult women requires a multifaceted and gender-sensitive approach. By combining detailed clinical interviews, symptom evaluations, specific diagnostic tools, and considerations of comorbidities, as well as evaluating observations in various contexts and third-party testimonies, professionals can offer more accurate diagnoses and ultimately provide more effective support.

After the diagnosis, although it can initially be a shock, this relief is usually limited to the woman or girl’s immediate environment. For most adult women, discovering that the difference they have felt since childhood is not imaginary or a severe personal deficit, and that previous mental disorders treated over the years are actually manifestations of another problem, generally brings a great sense of relief.

But after this feeling of relief, girls and women may be subjected to what can be called the «ghosting effect»: «How can you be autistic if you are smart…», «If you have children…», «If you work…», or «If it doesn’t seem like you have autism…».

This effect continues with masking, fear of being different, and plunges women who thought the diagnosis would alleviate their burden into confusion and loss of self-esteem. It is already very challenging for adult women to get an accurate diagnosis, and if we add the normative society’s doubts about whether they belong to the spectrum or their special needs, which for them are basic needs to lead a functional life with the necessary supports.

Adult women with ASD can significantly benefit from a comprehensive and personalized support approach that addresses their unique needs. By providing accurate diagnoses, psychological support, social skills development, workplace accommodations, and community support networks, we can help these women lead fuller and more satisfying lives.

In conclusion, as a mental health professional, it saddens me that women face so many difficulties in accessing an answer to the feeling they have often carried since early stages of their lives. I also believe that it is the responsibility of professionals to continue updating ourselves on these issues to provide the best quality care to our patients and to be aware that in today’s society, there are many prejudices that cause many women on the spectrum to camouflage themselves and not obtain the help they need until adulthood, leading to other problems beyond Autism Spectrum Disorder. I faithfully hope that we will continue to advance in this area, and autism specialists will continue to provide the essential, basic supports for all individuals on the spectrum, enabling them to achieve the highest possible quality of life despite their difficulties.

– Mujeres y autismo. La identidad Camuflada. 2022
– Mujeres autistas: Dentro del espectro. Ed. CEPAMA. 2020
– Hervás, Amaia. (2022). Género femenino y autismo: infra detección y mis diagnósticos. Medicina (Buenos Aires), 82(Supl. 1), 37-42. Recuperado en 25 de junio de 2024, de http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0025-76802022000200037&lng=es&tlng=es.

Written by Lidia Fernández.

DISCLAIMER: This article contains obsolete language that stems from the pathologization of realities that in no case are considered disorders by any reputable Psychology or Psychiatry institution, both at a national and international level. The language used in this article reflects the evolution of academic and health institutions throughout history and it is included here to reflect how the approach of institutions to social demands influences the categorization of the realities studied.

As is often the case with ideas that seem to be my own, it is not clear to me whether the thoughts underlying this article – and the next one that I will publish as a continuation of it – are homegrown or the result of having read about them somewhere. Probably the latter, hence why I am very grateful to all those who write about human rights and the importance of ethical practices within institutions. It has long been clear to me that being original is wildly overrated. If someone has good ideas, it is better to listen to them, internalize them and elaborate on them so that you can expand them in a way that makes sense within your own worldview and, in my case, the scientific evidence available to me. I apologize for not citing authors in these articles, but it is difficult for me to point to anyone specific. However, I would like to briefly mention Devon Price, a social psychologist who does an incredible job at educating and advocating for human rights. It may seem unexpected that I, as a Psychologist doing therapy at a clinic, would mention a Social Psychologist as an author I resort to for relevant topics about my work. However, because of my eagerness to do evidence-based work, Behavior Analysis is central in my practice because this approach, even if heavily misunderstood, is focused on the interaction between a person and their environment. Therefore, Social Psychology is perfect if I want to broaden my understanding of how our context shapes our reality.

Since it dawned on me, I periodically catch myself thinking about how the evolution of the diagnostic labels attributed to the realities of trans people is strikingly similar to that of the labels attributed to people with non-normative sexual orientations. The depathologization of non-heterosexual people is widely accepted by all institutions of psychology and medicine, but although the depathologization of trans people follows the same path, we have not yet reached the completion of that process in part due to, I believe, the fact that society has not yet finished understanding and accepting the existence of people who identify with a gender other than the one assigned at birth based on their genitalia.

The diagnoses included in the DSM (Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association) and other classifications are a product of their time, as they reflect the interests of society and the paradigms most accepted by psychiatrists at the time of their publication. Thus, I have decided to show the evolution of both diagnoses assigned to homosexuality (and other non-heterosexual sexual orientations) and those assigned to trans people.

Different editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have classified homosexuality differently, reflecting changes in the social perception of homosexuality over time.

“Sociopathic Personality Disorder – Sexual Deviations”: In the first edition of the DSM, written in 1952, homosexual people are diagnosed with a “Sociopathic Personality Disorder”, within the subcategory of “Sexual Deviations”, reflecting a clear negative bias towards this population.

Homosexuality is still included under “Sexual Deviations”. However, this time there are a bunch of other subcategories classified as sexual deviations along with it. Thus, homosexuality appears in this edition along with other categories such as fetishism, tavestism, pedophilia and sadism, among others.

Strong criticism from society: During the 1960s and early 1970s, and due to a growing civil rights movement and pressure from LGBT activists, ordinary people and professionals begin to talk about the need for the elimination of homosexuality as a psychiatric diagnosis.

In 1973, the Board of Directors of the American Psychiatric Association (APA) makes the decision to remove homosexuality as a mental disorder after voting on it. In its place a new category is created: “Disorders of Sexual Orientation,”. This new label does not present homosexuality as a disorder in itself, but serves as a diagnosis for homosexual people who feel conflicted about their sexual orientation.

In the third edition of the DSM, the former category “Disturbance of Sexual Orientation” is replaced by the new label “Egodystonic Homosexuality,” assigned to those whose sexual orientation caused them distress and who had a desire to change it.

During the DSM-III revision, Egodystonic Homosexuality was eliminated as a diagnosis. However, it is still possible to assign a diagnosis to people who experience persistent discomfort caused by their sexual orientation. For this purpose, this reality is included within “Sexual Disorders Not Otherwise Specified”, a broader category.

As of the fourth edition of the manual, any allusion to homosexuality as a mental disorder is completely eliminated because sexual diversity is seen as part of normal human variation. Suffering related to one’s sexual condition no longer has a specific category, as it is understood that a specific label for people with non-normative sexual orientations can be stigmatizing and that a person can suffer for many different reasons, so it is not necessary to create so many subcategories.

Although the chronology presented above summarizes the technical changes seen in the different editions of the manual published by the American Psychiatric Association, it must be said that these changes were clearly influenced by the harsh criticisms that the above-mentioned diagnoses received. The professionals who created these diagnostic categories were questioned, among other things, due to the poor scientific evidence provided by the theories on which they justified them.

I consider it is very important to recognize the work of those who, both inside and outside Psychology and Psychiatry institutions, helped facilitate these changes.

Thank you to those who maintain a critical attitude towards institutions and those who understand that science and its practical applications are influenced by the social realities of their time.

Jorge Jiménez Castillo is a psychologist at SINEWS, where he practices in English and Spanish. He works daily with local and international populations and has a long history of studying the reality of the LGTBIQ+ community in and out of the clinic. He works from a cognitive-behavioral approach with evidence-based interventions and believes that in order to provide quality psychological care one must be aware of the inequalities that intersect with users and explore how they intersect with each other.