This Clinical Perspectives presentation describes an anonymised case of an adult patient with complex PTSD following prolonged interpersonal trauma, complicated by substance use and problematic benzodiazepine intake. The patient presented with persistent affect dysregulation, hyperarousal, intrusive symptoms, dissociation, sleep disturbance and severe functional impairment, alongside escalating use of alcohol/cannabis and intermittent high-dose benzodiazepine self-medication to manage anxiety and insomnia. The case highlights key clinical dilemmas frequently encountered in trauma-related care: differential diagnosis (complex PTSD vs borderline personality disorder vs major depression), risk assessment including self-harm, and treatment sequencing when trauma symptoms coexist with addiction-related behaviours. Management is discussed using a phased, recovery-oriented approach, integrating stabilisation and psychoeducation, careful psychopharmacological planning (including benzodiazepine harm reduction and tapering strategy), and referral to evidence-based psychotherapy (trauma-focused therapy when clinically safe), combined with addiction-focused interventions and relapse prevention. The presentation emphasises multidisciplinary collaboration and practical decision-making applicable to outpatient psychiatry, particularly when ongoing stressors and limited resources affect continuity of care.

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Trauma-related disorders are common in psychiatric practice and often present with heterogeneous symptom profiles, high comorbidity, and significant functional impairment. Beyond canonical post-traumatic stress presentations, complex, dissociative, and somatic manifestations are increasingly encountered, frequently shaped by developmental trauma, repeated interpersonal exposure, and ongoing psychosocial stressors. These features may complicate recognition, risk assessment, and treatment planning across diverse clinical settings.

A pragmatic, clinically oriented framework is presented for (i) identifying trauma-related disorders and relevant specifiers, (ii) differentiating them from overlapping conditions (e.g., mood, anxiety, psychotic, personality, and functional disorders), and (iii) implementing stepped, evidence-based interventions tailored to symptom clusters, comorbidity, and patient preferences.

Current diagnostic frameworks and guideline-concordant treatment evidence are synthesized, and clinical decision points applicable to routine care are integrated. Particular attention is given to structured assessment of trauma exposure and symptom profiles, dissociation, sleep, and substance use, alongside formulation-based case conceptualization and risk management for self-harm, suicidality, and re-traumatization. Emphasis is placed on transdiagnostic mechanisms, including threat processing, avoidance, and emotion dysregulation, and on trauma-informed communication to enhance engagement and retention.

A phased, personalized care pathway is proposed. Initial stabilization focuses on safety, psychoeducation, sleep and arousal regulation, and management of comorbid depression, anxiety, and substance use. Readiness for trauma-focused therapy is addressed through selection and sequencing of first-line psychotherapies, including trauma-focused CBT, EMDR, prolonged exposure, and cognitive processing therapy, with adaptations for dissociation, complex presentations, and ongoing stress. Pharmacological strategies are discussed as adjuncts targeting specific symptoms such as hyperarousal, nightmares, and comorbid mood and anxiety disorders, with caution regarding polypharmacy and agents with dependence potential. Special considerations are outlined for developmental trauma, perinatal contexts, migration-related trauma, and culturally sensitive assessment.

A structured yet flexible clinical approach is required for trauma-related disorders, balancing diagnostic precision with formulation, prioritizing safety and engagement, and applying stepped, evidence-based interventions. Trauma-informed, mechanism-focused pathways may improve outcomes, reduce chronicity, and support integrated care across psychiatric services.

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Trauma-related disorders affect a significant portion of the population. Among others, they include post-traumatic stress disorder (PTSD), acute stress disorder and adjustment disorders. Some exposed to trauma will develop PTSD and other conditions such as anxiety, depression and substance use disorder. Those conditions are seen in everyday clinical practice and are expected to increase due to ongoing social issues and conflicts. We will present a case study of a patient that reflects current challenges and possibilities in trauma-related disorders.

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While increased awareness in today’s socioeconomic conditions has led to some positive progress in areas related to gender equality, we are still far from the ideal. Achieving gender equality, ensuring equal representation and rights for women in all settings and systems, should occur naturally; however, this is only partially possible through various regulations and their monitoring. Although professional organizations generally have a high level of awareness on these issues, internalized patriarchal codes can prevent our female colleagues from achieving adequate representation and having a voice in the process. Developing awareness and planning sustainable practices in this area is our responsibility and duty. I would like to introduce you to a series of initiatives we have implemented within the Psychiatric Association of Türkiye. In 2018, a policy document was prepared by a task force composed of knowledgeable colleagues in the field. A unit was established under the same name as this document on preventing sexual violence and supporting gender equality. In addition to its primary task of evaluating and supporting complainants in sexual abuse investigations where one of the parties is a psychiatrist, this unit also develops activities to support gender equality. Coordinating with other working units and task groups operating under our association, this unit recently prepared a Guide to Using Discrimination-Sensitive Language and Creating Content. We are working to promote the widespread use of this guide, which also includes gender equality issues, in all the association’s scientific activities. Through informational texts placed in congress’ bag, group work, and workshops at our association’s twice-yearly congresses, we aim to keep the theme of gender equality on the agenda in the theory and practice of our members. This year, during the week of March 8th, International Women’s Day, we are preparing a webinar where we will discuss the representation rates of women in all units and elected boards of our association, listen to suggestions and experiences from senior female colleagues in active roles, and discuss the expectations and challenges of young female colleagues. With the awareness of being part of and transforming the bigger picture, we need to discuss together the importance and impact of professional organizations taking an active role in the field of gender equality, starting from their own internal structures.

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More women than men enter psychiatry in the meantime, but the proportion of female leaders is still very low

In this interactive session you will get to know

• - some data on gender and career in medicine and psychiatry,

• - on career obstacles for women including their structural, but also psychological reasons, esp. the influence of traditional gender roles,

• - on the negative consequences for both female and male psychiatrists and their patients, and

• - on alternative solutions.

overview and discussion

In order to promote careers and work-life balance for both genders in psychiatry we need

• - structural reforms

• - Mentoring with early start and ongoing coaching

• - Questioning of traditional gender roles and promoting role models

Especially in psychiatry we should aim at integration of living and working for both genders.

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Gender equality in the workplace is increasingly recognised as a key determinant of mental health, yet it is still often framed as a structural or policy issue rather than a core clinical concern. In psychiatry, where work-related stress, role overload and social expectations directly shape symptom presentation, diagnostic pathways and treatment outcomes, this separation is particularly problematic. Early career psychiatrists—both residents and young consultants—occupy a unique position: they deliver frontline clinical care while simultaneously navigating hierarchical, gendered work environments themselves.

This talk provides a concise, evidence-informed overview of where we currently stand regarding gender equality and women’s health at work, with a focus on its relevance for everyday psychiatric practice. Drawing on epidemiological data, occupational mental health research and clinical experience, it highlights how gendered workplace exposures—such as unequal caregiving burdens, reduced autonomy, discrimination and “invisible work”—translate into well-established psychiatric risk factors, including chronic stress, burnout, depression and anxiety.

The presentation moves beyond theory to focus on practical implications. It explores common gender-related biases in assessment and diagnosis, the importance of routinely integrating women’s health and life-course factors into psychiatric evaluations, and the clinical value of validation-focused communication. In addition, it addresses the workplace as a determinant of mental health for both patients and psychiatrists, linking concepts such as double standards, token roles and leaky pipelines to early career vulnerability and professional sustainability.

Finally, the talk offers concrete, low-threshold strategies that early career psychiatrists can apply immediately in clinical encounters and team settings—micro-level actions that promote equity without requiring formal leadership roles. The central message is that championing gender equality at work is not an ideological stance, but a component of clinically accurate, ethically sound and sustainable psychiatric practice.

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Psychiatry sees itself as progressive, yet gender inequality persists within our training systems — subtle, structural, and rarely challenged. Women enter the field in equal or greater numbers, but senior leadership remains disproportionately male. This is not just a pipeline problem; it is a training problem.

Training transmits not only knowledge but norms. What we teach — and omit — shapes who advance and which work is sidelined.

First, the content of training itself often renders gender peripheral. Sex- and gender-sensitive psychiatry is frequently confined to optional modules or niche subspecialties such as perinatal mental health. Core curricula still prioritise “neutral” diagnostic frameworks that implicitly centre male presentations of illness. Gender-based violence, reproductive transitions, caregiving burdens, and intersectional discrimination are treated as contextual add-ons rather than central determinants of mental health. When gender is framed as a “special interest,” those who champion it risk being labelled advocates rather than scientists — a subtle but powerful professional devaluation.

Second, training reinforces unexamined professional norms. Trainees quickly learn which research topics are considered prestigious and career-enhancing or invisible labour. Teaching, mentoring, pastoral support, and diversity work — disproportionately undertaken by women — are rarely rewarded in promotion criteria. Meanwhile, assertiveness in leadership is praised in men and problematised in women. These double standards are not written into curricula, but they are learned experientially.

Third, academic training structures often clash with reproductive timelines. Fellowship schemes and publication metrics assume uninterrupted productivity during years when many trainees take on parental or caring responsibilities. Flexibility is framed as accommodation rather than entitlement, reinforcing the idea that caregiving deviates from the professional norm — and in some countries, is barely supported at all.

If psychiatry is serious about gender equality, training reform must be structural, not symbolic. This means embedding sex- and gender-based science across curricula, integrating intersectionality into core teaching, valuing educational and equity work in assessments, ensuring transparent authorship and sponsorship, and publishing gender-disaggregated data on research, training, and promotion outcomes.

Early-career psychiatrists are uniquely positioned to challenge entrenched norms because they experience them most acutely. But change cannot depend on individual resilience; it requires institutional accountability. Gender equality will not arise from demographic shifts alone. Without redesigning training, evaluation, and culture, we will reproduce the hierarchies we critique. Reforming psychiatric training is not a diversity add-on — it is a scientific, ethical, and professional necessity.

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Suicide is often conceptualized as the tragic endpoint of psychiatric illness. However, accumulating evidence suggests that suicidal behavior emerges not merely from diagnostic categories, but from the dynamic convergence of emotional dysregulation and cumulative illness burden. This lecture proposes a crossroad model in which suicide risk reflects the interaction between proximal failures in affect regulation and distal biological and clinical load.

Emotion dysregulation constitutes a central proximal mechanism of suicidal crises. Heightened affective reactivity, impaired prefrontal control, cognitive constriction, and anhedonia converge to reduce the capacity to tolerate distress. Neurobiologically, alterations in fronto-limbic circuitry, stress-axis dysregulation, and impaired reward processing contribute to this vulnerability. Yet these mechanisms unfold within a broader context of illness burden.

Psychiatric comorbidity, chronic somatic disease, pain syndromes, and systemic low-grade inflammation progressively erode resilience. Biological stressors such as inflammatory activation, hypothalamic–pituitary–adrenal axis alterations, and potential blood–brain barrier dysfunction may lower the threshold at which emotional dysregulation translates into suicidal behavior. Illness burden may therefore act as an amplifier, transforming transient distress into existential crisis.

Integrating these dimensions allows a shift toward precision suicidology. Rather than treating suicide risk solely through categorical diagnoses, this framework emphasizes the identification of dominant vulnerability pathways—such as inflammatory profiles, reward-processing deficits, stress-sensitivity phenotypes, or severe emotion regulation impairments. Stratifying patients according to these interacting biological and psychological mechanisms may inform personalized preventive strategies and targeted interventions.

Suicide should not be viewed as a dead end, but as a systemic tipping point—where emotional collapse meets accumulated biological and clinical load. Advancing prevention requires bridging psychiatry, neuroscience, and somatic medicine to develop mechanism-based, individualized models of care.

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The King’s Maudsley Partnership at the Pears Maudsley Centre is the UK’s first fully integrated clinical and research facility dedicated to children and young people’s mental health. The partnership brings together clinical services (South London and Maudsley NHS Trust), academics (Child Psychiatry Department at the Institute of Psychiatry, Psychology and Neuroscience) and the Maudsley Charity. This session will explore how the KMP team aim to integrate research and practice, transforming discovery science, accelerating early clinical translation and delivering impactful implementation.

In this first talk, I will review some of the barriers to progress in child and adolescent psychiatry, highlighting how many stem from a lack of joint working between key partners. I will then consider ways forward: how the Partnership and its new home at the Pears Maudsley Centre might overcome some barriers. This could help clinicians accelerate the early translation of new findings, and academics conducting research that is embedded in clinically vital questions.

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The presentation will go further into needs-based interventions representing interdisciplinary collaboration, and how an academic knowledge network of a University Hospital and 18 long term care organizations provides the context for developing, evaluating and implementing these. It will elaborate on the Act in case of Depression intervention, a cyclic intervention developed for detecting and treating depression in nursing homes. This intervention was tested in a stepped-wedge cluster randomized trial which showed that it increased Quality of life in nursing home residents, lowered depression prevalence in residents living in nursing home units for somatically frail residents and lowered apathy in residents of specialized dementia units. Further, the development of the Shared Action for Breaking through Apathy intervention for people with dementia in nursing homes will be illustrated.

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In 2023, the new project NETPHARM was granted in the Czech Republic, developing during the scientific works on WP4 „Geriatric clinical pharmacy and new technologies for the individualization of drug schemes in older patients” international research collaboration in highly individualized geriatric pharmacotherapy among clinical pharmacists, geriatricians and other medical specialities, including psychiatrists.

This project builds upon previous findings of the EU projects describing problems of irrational geriatric pharmacotherapy and importance of the implementation of clinical pharmacy services in different settings of care, e.g. the EUROAGEISM H2020 and I-CARE4OLD H2020 projects, EU COST Action IS1402 ESR7 program, INOMED, EU SHELTER 7th FP EC project and the START/MED/093 project. Using results of secondary analyses from available EU datasets utilized in the NETPHARM research, this lecture describes the situation in inappropriate geriatric prescribing of psychotropics in Central and Eastern Europe.

Results from regionally different nursing home facilities in 4 Central and Eastern EU countries - the Czech Republic (CZ), Bulgaria (BUL), Croatia (CRO), Slovakia (SLO), where in total 876 NH residents were assessed in 2020-2022 by the interRAI-LTCF international tool for comprehensive geriatric assessment (CGA), confirm the high rates of polypharmacy (49.6%, 5+ meds), hyperpolypharmacy (25.7%, 10+, meds), frequent use of psychotropic multicombinations (3+ psychotropics in 36.7% older patients) and overprescribing of benzodiazepines (BZDs), in some countries with the prevalence up to 30 % (CRO, SLO). BZDs were usually prescribed for 5+ years, in non-geriatric dosing (28%) and in risky drug multicombinations (52%). The odds of being prescribed hyperpolypharmacy was significantly higher in patients with moderate to severe frailty (CFS ≥5; proportional OR = 4.3), signalling the need for deprescribing initiatives and for optimizing pharmacotherapy in this multimorbid cohort of older patients.

This lecture documents core problems of irrational use of psychotropics in older adults in nursing homes in Central and Eastern Europe and increases awareness to important role of clinical pharmacists in multidisciplinary clinical teams in optimizing pharmacotherapy in older NH residents.

Grant support: NETPHARM project CZ.02.01.01/00/22_008/0004607, co-financed by the European Union, Cooperatio research program of the Faculty of Pharmacy, Charles University (Research Unit KSKF-1, Chair: Assoc. Prof. Fialová) and SVV260665.

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In the beginning of 2026 the Superior Health Council published an advice on the psychosocial well-being in residential care centers. The ‘usual suspects’ on this subject as education, medicalization, innovation and internal organization are evaluated and given new incentives. It soon became clear that the existential is not just another box that needs ticking. On the contrary, it permeates the whole project of living well and well being in general. In residential care centers moreover people are confronted with frailty but also with (renewed) resilience. The importance and implementation of the existential dimension in the centers will be presented and discussed.

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As a young doctor, it is challenging to decide when coercion or forceful measures are necessary, as well as when the use of force follows the principle of “less harm”. This is because there are a wide spectrum of opinions, criteria,ethical questions, moral values, and laws which one must consider, and which can be difficult to understand and balance without a great amount of prior experience.

Every medicine has primary effects and side effects, and every intervention has potentially positive benefits and negative implications. As psychiatric doctors we have the obligation to not do harm, a moral duty to help others, and a lawful compulsion to use the minimum harmful measure when needed. The decision to use coercion is complicated to navigate as a young doctor in training with potentially limited experience in making such morally and legally complex decisions. We are forced to make fast decisions when an acute situation arises, where we must grapple with many considerations, including: external input and pressure, internal ethical questions about what is right and wrong, utilitarian questions about what is the best and least harmful measure to take to help our patients, unintended consequences of our decisions for the patients recovery and wellbeing and the safety of ourselves and colleagues, and the possible lawful implications of the actions and measures taken.

Furthermore, young doctors face pressure from colleagues and care personnel. Thus, when making treatment decisions, one must consider not only their own opinion, but that of potentially more senior colleagues whose ideas, methods, and approaches to the concept of “less harm” may be different. The path of educating ourselves and finding our own criteria and methods of work is long and complicated, which can lead young doctors to feel as though they are ”walking in a jungle” of uncertainty, confusion, frustration, fear and contradiction. This especially challenging when deciding on cases involving coercion and force.

This talk is based largely on personal experiences as well as screening among young doctors both within and outside of psychiatry using both personal and group interviews and surveys. Results will be contextualized with existing academic studies on the topic of coercion in psychiatry.

The aim of this talk is to present the different challenges a young doctor faces while working in a psychiatric institution, opening a debate about the concept of “less harm” in the context of an acute situation, exploring the uncertainties and ethical values that a young doctor faces on a daily basis whilst performing their job and discuss different proposals about how to reduce the amount of coercive messures.

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Treatment-resistant schizophrenia (TRS) is a common clinical problem, up to 30% of patients show little or no response to treatment. The most comprehensive definition of TRS was coined by the Treatment Response and Resistance in Psychosis (TRRIP) working group. First step in the management of TRS is to rule out pseudoresistance, i.e., failure to respond from different reasons (non-adherence, poor metabolizers, incorrect diagnosis, comorbidity, insufficient dosage or duration of trial, masking side effects). There is a general agreement among various treatment guidelines, the drug of choice for TRS is clozapine. Recent meta-analyses, systematic reviews, and individual meta-analyses cast doubts on clozapine superiority, suggesting that other antipsychotics (e.g., olanzapine, clozapine) may as effective as clozapine. However, it should be noted that in many RCTs clozapine was underdosed; numerous studies where clozapine arm was not blinded were excluded from analyses, severely resistant patients were not included, and finally, clozapine was significantly superior to comparator drugs when disregarding RCTs sponsored by the manufacturer of the comparator. Patients who do not respond or do not tolerate clozapine (“ultra-resistant schizophrenia”) may benefit from clozapine augmentation. Data indicate that clozapine can be effectively combined with ECT, mirtazapine, or memantine for overall symptoms, with ECT for positive symptoms, memantine, duloxetine, or mirtazapine for negative symptoms. Real-world data from Finnish and Swedish national registers showed that the dose of an augmenting agent is important (standard doses of SSRIs and SNRIs, medium doses of aripiprazole). Non-pharmacological therapeutic options for TRS, in monotherapy or as clozapine augmentation, include neurostimulatory methods (ECT, rTMS, tDCS), psychotherapy for specific symptoms (CBT), physical activity for negative symptoms, or more experimental (DBS, virtual reality).

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Based on the 2023 Ambassador study on schizophrenia, conducted among 454 psychiatrists and trainees from 35 European countries using six clinical vignettes (cases A–F), we aimed to explore therapeutic approaches across different phases and clinical situations, while assessing adherence to guidelines.

Our findings showed moderate to high agreement among European psychiatrists on pharmacological treatment for first-episode psychosis, cognitive and negative symptoms, prodromal symptoms, and pregnancy, with only moderate adherence to guidelines. Treatment preferences were similar for antipsychotic-induced metabolic side effects and treatment resistance, but guideline adherence in these areas was partial. Non-pharmacological interventions—such as psychotherapy, recovery-oriented care, cognitive remediation, and physical exercise—were generally underused, with exceptions for psychoeducation, lifestyle recommendations, and cognitive behavioral therapy in the prodromal phase.

These results highlight a gap between research evidence, guidelines, and real-world practice. Clinicians’ expertise and experience are key to shaping future guidelines in form of clinical consensus, particularly where practice diverges from recommendations.

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The postpartum period represents one of the highest-risk phases for relapse in women with bipolar disorder, with a markedly increased vulnerability to depressive episodes, mania, mixed states, and postpartum psychosis. Rapid biological changes after childbirth, combined with sleep deprivation, stress, and psychosocial demands, can destabilize even previously well-controlled patients. Effective postpartum management therefore requires proactive, individualized planning that integrates pharmacological relapse prevention with psychosocial interventions and family-centred care.

This presentation provides practical, evidence-based guidance for everyday clinical practice in postpartum bipolar disorder. Pharmacotherapy remains a cornerstone of relapse prevention. Lithium is among the most effective options, particularly for preventing severe postpartum mood episodes; however, careful monitoring is essential due to postpartum physiological changes affecting fluid balance and renal clearance. Other mood-stabilizing strategies may include lamotrigine and second-generation antipsychotics, selected according to prior response, symptom profile, and tolerability. Treatment decisions must also address breastfeeding-related concerns. Shared decision-making is crucial, balancing the benefits of breastfeeding with maternal stability, infant safety, and the risk associated with sleep loss. In acute episodes with psychotic symptoms or severe agitation, rapid stabilization and safety planning—including consideration of hospitalization and, when indicated, electroconvulsive therapy—may be lifesaving.

Alongside medication, psychosocial interventions are essential and should not be considered optional. Psychoeducation focused on relapse signatures, early warning signs, and adherence support improves insight and timely help-seeking. Sleep protection is a key preventive strategy, requiring structured plans for night-time support and realistic expectations around infant care. Interpersonal and social rhythm approaches may help restore daily routines and reduce mood instability, while cognitive-behavioural techniques can support coping with anxiety, guilt, and intrusive thoughts. Partner and family involvement is often critical for monitoring symptoms, reducing burden, and strengthening protective factors. Special attention should be given to the parent–infant relationship, as mood episodes may impair bonding and parenting confidence; supportive interventions can promote recovery and healthier developmental outcomes.

Overall, integrated postpartum care combining pharmacotherapy with psychosocial and family-based strategies can reduce relapse risk, improve maternal functioning, and support safe, meaningful early motherhood for women living with bipolar disorder.

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Very little research to date has been conducted to investigate mother-infant relationship and infant development in women with a history of bipolar disorder or affective psychosis.

Objectives: The current study (Biaggi et al. J Affect Disord 2021; Biaggi et al. Psychol Med 2023; Biaggi et al. J Affect Disord 2024) aimed to investigate the quality of the mother-infant relationship and the development of the infants born to women with a history of bipolar disorder, schizoaffective disorder or previous postpartum psychosis (PP). Potential predictors of mother-infant interaction quality were also investigated.

103 women (and their offspring) were included in the study, 43 with a history of bipolar disorder, schizoaffective disorder or previous postpartum psychosis, and 60 with no current/previous mental illness or family history of PP. Women were recruited during pregnancy and followed up with their offspring until 12 months postpartum.

Mother–infant relationship was assessed using the MAAS in pregnancy, the MPAS and the CARE-Index at 8 weeks and 12 months postpartum. Infant development was investigated using the Bayley-III at 12 months postpartum.

Compared to healthy controls, women with a history of bipolar disorder or affective psychosis had less synchronous mother–infant interactions, a more negative affective experience towards their infants at both 8 weeks and 12 months postpartum and had infants with less optimal cognitive, language, motor and socio-emotional development at 12 months postpartum. Maternal ability to recognize emotions, particularly fear and infant social-interactive behaviour were significant predictors for mother-infant interaction quality.

These results suggest that a history of bipolar disorder or affective psychosis could represent a risk factor for the mother-infant relationship and the infant development during the perinatal period, suggesting the need of early monitoring and the development of interventions, where necessary. Preventive interventions aimed at improving maternal ability to recognize emotions and infant social-interactive behaviour may be helpful to support the quality of the mother-infant interaction and potentially also the infant long-term development.

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Access to parenthood for patients suffering from bipolar disorder is a public health issue that must be addressed through prevention.

The preconception period is the most appropriate time to define shared prevention plans that address both the adjustment of psychotropic treatments and the most appropriate obstetric, pediatric, and psychiatric care pathways for the mother and baby.

When a patient consults while already pregnant, time constraints mean that strategies must be adapted, particularly in terms of in terms of obstetric and pediatric care.

This presentation will address the main approaches to the use of psychotropic drugs during the perinatal period, as well as the organization of coordinated and graduated integrated care pathways for mothers and newborns during the perinatal period.

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The relationship between neurodivergence and gender diversity is an actively growing research interest, where many research findings suggest a stronger association than that is observed in the general population. The issue has been more extensively studied with regard to the autism spectrum features, compared to attention deficit and hyperactivity. Yet, there are some prevalence studies suggesting a higher rates of ADHD in trans and gender diverse individuals. Recent research in the mental health and clinical implication of the presence of autistic features in trans and gender diverse people indicate a major contribution of the level of executive functions in the excessive mental health burden they experience, compared to other trans and gender diverse individuals, both with respect to their experience with the minority stress and their progress in gender-affirmation. Trans and gender diverse individuals with ADHD may share a similar difficulty, though with varying severity. Furthermore, ADHD may complicate the access to the potential sources of resilience, including social support, especially if it is not recognized and managed early in life. Finally, the clinical presentation of ADHD may render the access to and execution gender-affirming health services for the individual. This may be related to the failure of the individual to follow the requirements of the assessment in the clinic; but also, sometimes more importantly, the clinician’s and social relation’s failure to confide in the authenticity of expressed identity. Mental health care professional should be familiar with the increased burden of this intersection for the individual and have the means to assist the individual in both domains concurrently.

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Sexual health in neurodevelopmental disorders remains understudied. Women and transgender/gender diverse (TGD) adults with ADHD may face elevated risks of sexual dysfunction and interpersonal violence, alongside gender-specific barriers to care. Evidence also suggests higher ADHD symptom burden in TGD populations, yet little is known about sexuality and relationship safety in these groups.

Using preliminary findings from the International Survey on Experiences, Health, and Barriers in Women with ADHD, the objectives are to:

1. (1) Describe gender identity, sexual orientation, and relationship characteristics in women/TGD respondents with ADHD.

2. (2) Estimate self-reported sexual problems and interpersonal conflict (including intimate partner violence, IPV), and explore associations with ADHD context.

Cross-sectional, descriptive analysis of an international online survey (Dutch/English) targeting women ≥18 years with self-reported ADHD symptoms or a formal ADHD diagnosis. Recruitment: social media, patient organisations, newsletters, research networks. Outcomes included demographics, sexual/romantic orientation (multi-select), relationship status, partner ADHD, and conflict tactics/IPV items. Analyses summarised distributions using valid-percent denominators, with explicit reporting of missing data due to optional items.

Nearly 6,000 respondents completed the survey (N=5,893). Most were assigned female at birth (n=4,114). Respondents reported diverse sexual and romantic orientations, with around two-thirds identifying as straight and over one-third as bisexual, pansexual, queer, asexual, or other minority orientations. Two in five were married, and a notable proportion reported partners with ADHD.

Although only 1% reported a diagnosed sexual disorder, this was likely underestimated due to nonresponse. Reports of relationship conflict were concerning: 15% disclosed partners insisting on sex without force, and 2.6% reported forced sex at some point. Very few endorsed perpetration themselves.

These preliminary findings highlight substantial diversity in sexual orientation, frequent partnerships where ADHD is present, and notable rates of sexual coercion and forced sex among women/TGD adults with ADHD. The low rate of diagnosed sexual disorders likely reflects underreporting. Findings underscore the need for clinicians to integrate sexuality and relationship safety into ADHD assessment and care.

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