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It is not uncommon in family practice for the family physician to encounter the female patient with a hysterical personality disorder. A case presentation and interview are provided to help the family physician recognize the problem. A formulation of this case stresses psychosexual development, which will provide the reader with insight that can be generalized to other patients. Major emphasis is given to practical guidelines for the clinician for management of this frequently difficult problem in a medical setting.
The present study examined the development of sex typing during middle childhood, using a sample of 558 children aged 5-12 years. The purpose of the study was to provide information about the developmental course and stability of various aspects of sex typing during this period and to examine the relative contributions of cognitive and environmental factors to sex-role development. Multiple measures of sex typing were obtained, including indices of personal preference, knowledge of stereotypes, and flexibility in the domains of activities, occupations, and traits. We also collected information about the child's cognitive maturity, exposure to sex-typed models at home, and socioeconomic status. Results supported the need for an integrative theory of sex-role development, incorporating factors emphasized by cognitive-developmental, schematic-processing, and social learning theories. Knowledge of stereotypes, flexibility, and sex-typed personal preferences all increased with age during middle childhood. There were also individual differences in sex typing that were stable over a 1-year period. Distinct "cognitive" and "affective" aspects of sex typing were identified using a principal components analysis. Cognitive elements (flexibility and knowledge of stereotypes) were largely a function of the child's cognitive maturity level, although social-environmental factors such as father's presence in the home also had some effect. Affective elements (sex-typed preferences for activities, occupations, and peers), on the other hand, were related more consistently to sex typing of the home environment. Children whose mothers frequently modeled "reversed" sex-role behaviors (i.e., traditionally "masculine" household and child-care tasks) were less sex typed in their own preferences. However, cognitive factors were also important, in that children who believed gender stereotypes to be flexible were less sex typed in their choices of activities, occupations, and peers. In sum, both cognitive maturation and socialization experiences contribute to the development of sex typing during middle childhood. Potential practical implications of these findings, as well as implications for stereotyping in other social domains such as race and ethnicity, are discussed.
Rather than focus on the girl's phallic identification as a compensatory reaction to her femininity, I offer a conceptual framework through which to examine how the girl symbolically masters and elaborates her biologically unfolding sexuality. Presumably, because her genital inner space can be defined and filled only through the playful retention and expulsion of an external object, the girl's phallic identification paradoxically affords her the first experience of her genital femininity. Borne out of her genital stimulation at the oedipal threshold, the genital dress-rehearsal turns on outside gestures becoming registered as sensations inside her body. As a result of her dual experience, the girl is both phallic and vaginal, giver and receiver, father and mother. Through the magic of play, the girl renegotiates her oath of fidelity to her internal, pre-oedipal mother, while laying claim to the kind of sexual vibrancy that her external, oedipal mother shares with her oedipal father.
The case of a 21-month-old girl with an atypical eating disorder helps illustrate the impact that a serious illness and subsequent hospitalization may have on a young child's psychosexual development. The consultant emphasizes how assessing the interaction between the child's development and her environment can help treaters understand the child's self-experience during the hospitalization that led her to develop an eating disorder. Participants in the presentation discuss implications for intervention in a pediatric-liaison setting.
In this paper, we review developmental models for understanding adolescence as they might be applied to emerging sexuality and the challenges and risks that may be associated with different sexual orientations and identities. Models have been identified as: cumulative events or simultaneous change, accentuation, or trajectory models. Inclusion of risk and protective factors and considering the extent of balance between these elements of an adolescent's life is also discussed in terms of predicting mental health outcomes. These models have been particularly useful in the study of the development of psychopathology and clearly relate to the broader issue of understanding suicide risk during adolescence.
Youths with a homosexual orientation face different developmental challenges during adolescence than those faced by heterosexual youths or individuals who recognize their homosexual orientation later in life. We discuss the impact of "coming out," or defining a homosexual orientation, on the development and identity formation of youths who come out during adolescence. The process of coming out is presented as entailing four broad dimensions: recognizing oneself as lesbian or gay; exploring one's sexual orientation through the gay and lesbian community; disclosing one's sexual orientation to others; and becoming more comfortable with one's sexual orientation. Some of the major challenges faced by these youths are described, and future directions for research efforts are discussed.
Adolescence is a time of significant opportunity and significant challenge. Challenges can be difficult for some adolescents, which may result in problems that are expressed as affective disturbances or by the adolescent's participation in risk-taking behaviors. This review emphasizes the changes in biopsychosocial development during adolescence. We specifically address aspects of individual change during the adolescent decade (e.g., biological, cognitive, psychosocial, and sexual development) as well as the effects of context on normal development and responses to challenges during this period. Predispositions or vulnerabilities present prior to a developmental transition may be exacerbated by the transition. Adolescents can become healthy adults with the encouragement to develop gradually by limiting the simultaneous changes they experience, where possible, and by supporting healthy development through developmentally appropriate activities and supportive relationships with adults and peers.
Themes of love and death in combination determine Heinrich Heines early lyrics. Heine's psychosexual development ist analyzed by emphasising the female influence. His fantasies during adolescence, masochistic tendencies and his inclination to duels are highlighted by referring to Freud's concept of eros and thanatos.
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Since sonographic evaluation of the fetus became routine, prenatally established diagnosis of multiple or severe malformations raises the question of whether a pregnancy should be terminated. To answer this question properly, all aspects concerning the life of a child born with a serious malformation, such as exstrophy of the bladder, must be considered. Therefore, more than ever an evaluation of the quality of life of these patients is necessary to be able to make a solid based decision. We studied the psychosexual and socioeconomic development of 22 adult exstrophy patients (11 men and 11 women) by a standardized personal interview, evaluation of a standard performance test SCL-90 (symptom checklist 1990) and an adapted personality score test. The latter 2 tests are well established and provide reproducible results. Based on several large scale investigations, standard scores are available. Nine women (82%) and 10 men (91%) scored better or in accordance with the standard scores. Exstrophy of the bladder does influence the psychosexual and socioeconomic development. The quality of life is hardly ever considered so poor that termination of pregnancy is a realistic alternative.
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The associations between giving a history of physical, emotional, and sexual abuse in children and a range of mental health, interpersonal, and sexual problems in adult life were examined in a community sample of women. Abuse was defined to establish groups giving histories of unequivocal victimization. A history of any form of abuse was associated with increased rates of psychopathology, sexual difficulties, decreased self-esteem, and interpersonal problems. The similarities between the three forms of abuse in terms of their association with negative adult outcomes was more apparent than any differences, though there was a trend for sexual abuse to be particularly associated to sexual problems, emotional abuse to low self-esteem, and physical abuse to marital breakdown. Abuse of all types was more frequent in those from disturbed and disrupted family backgrounds. The background factors associated with reports of abuse were themselves often associated to the same range of negative adult outcomes as for abuse. Logistic regressions indicated that some, though not all, of the apparent associations between abuse and adult problems was accounted for by this matrix of childhood disadvantage from which abuse so often emerged.
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