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Personality factors of critical care nurses.

Two hundred members of the American Association of Critical-Care Nurses responded to a mail-out survey done to determine the psychologic profile of critical care nurses in terms of self-esteem, gender identity, and selected personality characteristics. The instruments used were Cattell's 16 PR, the Personal Attributes Questionnaire (PAQ), and the Texas Social Behavior Inventory (TSBI). Their personality factors tended to be aggressive, assertive, competitive, persevering, moralistic, resourceful, and mechanical. The nurses who enjoyed the field most were of the androgynous or masculine type and had high levels of self-esteem. On the basis of these findings, the nurse recruiter or faculty member doing career counseling could assess the personality characteristics, gender identity, and self-esteem levels of interested nurses. The goal would be to identify nurses who would both enjoy the field and remain active in critical care nursing after orientation. The goal could also be to help nurses dissatisfied with critical care nursing to seek means of improving their self-esteem.

Adult↗

Similarities in becoming: transsexuals and adolescents.

The Gender Identity Service (located in Boston, Massachusetts) is an evaluative and counseling unit designed to provide full services including sexual reassignment to transsexuals. In that capacity, since the spring of 1972, we have seen over 120 transsexuals. During this time we have been impressed with behavioral similarities between our population of transsexuals and adolescents. This emerging observation provided impetus for the present paper. After carefully reviewing our caseload material it is our contention that indeed psychological, biological and sociological similarities do exist. Through a comparison of these, we hope not only to make transsexual behaviors more comprehensible but also to underscore the importance of the adolescent years for the development of adult gender identity. Using primarily an ego psychoanalytic approach, the paper attempts to demystify the diagnosis of transsexual by pointing to its dynamic similarities with adolescence.

Adaptation, Psychological↗

Psychological aspects of intersex in Saudi patients.

Four cases of male pseudo-hermaphrodism were seen post pubertal. All had been reared as females unambiguously since birth. Two cases developed male gender identity post pubertal, but failed to declare themselves to their families and society until a similar case had been publicized in the local newspaper. The third case did not reveal her problem to her family even after being informed by a doctor at the age of 15, and was discovered accidentally at the age of 22 on routine medical examination. The fourth was discovered accidentally at age 40 after having been married and divorced. The families of the four cases shared a strong desire for their children to be reassigned to the male sex including the third case, irrespective of being assured of her female gender identity by physicians. Psychiatric and social problems encountered pre- and post-operatively are discussed with particular emphasis on the role of culture and traditions.

Adaptation, Psychological↗

Two clinically discrete syndromes of transsexualism.

Transsexuals are defined as subjects who have a sustained feminine gender identity combined with a wish to alter their bodily appearance towards the feminine. The results of this study indicate that they can be differentiated into two clinically discrete groups. In an investigation of 29 transsexuals who sought a change of sex operation it was found that those who had experienced fetishistic arousal were significantly more likely to be older, to have experienced heterosexual intercourse, to be married and to show penile responses to pictures of men and women indicative of a more heterosexual orientation. They had less experience of homosexual contact to orgasm as compared transsexuals who had not experiennced fetishistic arousal , but this difference was not statistically significant. Frequency of cross-dressing, strenght of feminine gender identity and intensity of desire for a sex change operation did not discriminate the two groups. The fact that desire for a sex change operation may be associated with experience of fetishistic arousal could be one reason for the higher incidence transsexualism in men than in women.

Adult↗

Current views on evaluation, management, and gender assignment of the intersex infant.

In recent years, traditional views regarding the management of infants with intersex conditions have been challenged. Some of these patients have gender dysphoria and gender conversion, although most adults with intersex consider themselves to be either male or female. Hormonal and genetic factors may have a more important role in gender identity and sexual satisfaction than previously recognized, whereas the importance of phallus size to male gender identity and sexual satisfaction may have been overestimated. The impact of androgen imprinting on the developing brain is uncertain, but it is likely to be significant. The issue of genital surgery in infancy is controversial, although many adult patients concur that infancy is the best time for such procedures. Several reports indicate that the functional outcomes of genital surgery are poor, although more recently developed surgical techniques may achieve better results. Good communication between physicians, patients, and families regarding intersex conditions is paramount. We review current understanding of the evaluation and management of intersex conditions.

Disorders of Sex Development↗

Prenatal exposure to drugs of abuse: methodological considerations and effects on sexual differentiation.

The pattern of results from the studies reviewed above indicates that alcohol, morphine, nicotine, marijuana, and possibly cocaine can influence reproductive aspects of the neurobehavioral sexual differentiation process to varying degrees. However, with the exception of alcohol, little is currently known regarding the effects of these drugs on nonreproductive sex-related behaviors. Future studies are needed to define the extent of perinatal disruption induced by each drug on the nonreproductive aspect of the sexual differentiation process. It is increasingly clear that the neurobehavioral development of reproductive and nonreproductive behaviors is not influenced to the same degree by alterations in the perinatal hormonal or monoaminergic environment, probably reflecting a fundamental underlying difference in the relative contributions of different brain areas to each behavior (Meaney and McEwen 1986). This fact points to the necessity of greater inclusion of sex-related behaviors in animal models used to assess the teratogenic potential of a given drug on the sexual differentiation process. In light of recent demonstrations of regional structural sex differences in the human CNS (Allen et al. 1989, 1991; deLacoste-Utamsing and Holloway 1982; Hofman et al. 1988; Swaab and Hofman 1988) as well as reports of structural differences in male homosexuals (LeVay 1992; Swaab and Hofman 1990), there is an increasing interest in the contribution of prenatal drug exposure to homosexuality in humans. These findings appear to have led some investigators to interpret behavioral results from animal studies of prenatal drug exposure as being relevant to understanding the causes of homosexuality in humans (Dahlgren et al. 1991; Hard et al. 1984). However, while data from the animal models reviewed above can provide invaluable preclinical evidence to help understand the effects of perinatal drug exposure on brain development and the process of sexual differentiation, the authors believe that the results of these studies provide minimal useful information with respect the prenatal influence of these drugs on homosexual behavior in humans. Animal models of homosexuality are inherently inadequate for several reasons. No adequate model exists for homosexual behavior in the rodent in the absence of pharmacological administration of steroids. Normal male rats that show low levels of masculine sex behavior in the presence of estrous females do not exhibit increased tendencies to mount other males nor to lordosis when mounted by another male. In fact, male preference behavior for an estrous female rat does not appear to be influenced by perinatal androgen exposure (Merkx 1984). A second issue that cannot be addressed in an animal model is the fact that sexual orientation in human is determined by an interaction between hormonal, environmental, and cultural factors (Money 1987). This problem, and others, with a developmental animal model of human homosexuality have been considered by Sachs and Meisel (1988), to which the reader is referred for a more extensive discussion. Finally, in humans there is also the issue of gender identity, which refers to traits or conditions of maleness or femaleness. The degree to which gender identity in humans is causally linked to cultural or biological influences is an area of current debate (Gentile 1993; Unger and Crawford 1993), but such identity is clearly beyond the scope of animal modeling. Therefore, issues related to sexual orientation of humans and prenatal drug exposure likely await data from future human studies for further resolution.

Animals↗

Skoptic syndrome: the treatment of an obsessional gender dysphoria with lithium carbonate and psychotherapy.

Cases of body image pathology are often misdiagnosed. Recognition of the obsessional annoyance with body image, especially with primary and secondary sex characteristics (skoptic syndrome), is important in making a differential diagnosis with other psychiatric and gender identity disorders. We have reported the successful use of lithium carbonate in treating two cases of skoptic syndrome. The initial low dosage (600 mg./day) resulted in dramatic reversal of obsessional thoughts of self-mutilization and self-castration. Increased dosages (900 mg./day) are still well below those usually used for manic-depressive illness. Our choice of lithium carbonate was prompted by our experience in successfully treating other forms of sexually related dysphorias at low doses, its ability to act rapidly, and the minimal side effects. These changes have been dramatic and lasting. In addition, there was marked lessening of dysthymia and intense anhedonia manifested by severe isolation, listlessness, and apathy. We believe that these cases are important to report in order that psychotherapists make better differential diagnoses of psychiatric disorders related to body image pathology and gender identity disorders. We also feel it is important to report a medication which was found effective in reducing the threat of self-mutilating behavior and making patients more receptive to psychotherapy. These cases increase our understanding of sexually obsessive and compulsive drives and some methods which have been found efficacious in reducing these symptoms.

Body Image↗

Transgender health.

Transgender persons represent an underserved community in need of sensitive, comprehensive health care. This article presents a literature-based review of the health needs of the transgender patient. Physicians, whether or not they choose to provide hormone therapy, will likely encounter patients with gender identity issues at some point in their practice. A transgender health assessment should involve recognition of possible gender identity disorder, history-taking with respect to prior and current use of hormones or surgical interventions, as well as general physical, mental, and sexual health histories. Physical exam and screening tests need to be based on the organ systems present rather than the perceived gender of the patient. Physicians should be aware of common hormone regimens and their associated risks. Finally, patients best explore transgender issues in a setting of respect and trust in which confidentiality concerns are addressed, and clinic staff are educated about transgender issues.

Female↗

The dermatoglyphic characteristics of transsexuals: is there evidence for an organizing effect of sex hormones.

It has been proposed that gender identity and sexual orientation are influenced by the prenatal sex steroid milieu. Human dermatoglyphics and brain asymmetry have also been ascribed to prenatal hormone levels. This study investigated dermatoglyphics (total ridge count and finger ridge asymmetry) in 184 male-to-female transsexuals and 110 female-to-male transsexuals. In a subgroup, the relationship between dermatoglyphic asymmetry and spatial ability was tested. All investigations included controls. For all subjects hand preference and sexual orientation were noted. We hypothesized that the dermatoglyphics of male-to-female transsexuals would show similarities with control women and those of female-to-male transsexuals with control men. Our results showed a trend for a sex difference in total ridge count (P<.1) between genetic males and females, but no difference in directional asymmetry was found. Contrary to our expectations, the total ridge count and finger ridge asymmetry of transsexuals were similar to their genetic sex controls. Additionally, directional asymmetry was neither related to sexual orientation, nor to different aspects of spatial ability. In conclusion, we were unable to demonstrate that our chosen dermatoglyphic variables, total ridge count and finger ridge asymmetry are related to gender identity and sexual orientation in adult transsexuals. Hence, we found no support for a prenatal hormonal influence on these characteristics, at least insofar as dermatoglyphics may be regarded as a biological marker of organizing hormonal effects.

Adult↗

Comparison of transvestism in Australia and America.

Information concerning gender identity, sexual orientation, cross-dressing behavior, fetishism, and bondage was obtained from a questionnaire which was posted to members of two transvestite clubs, one in the United States and one in Australia. This study reports the responses of 136 American and 86 Australian self-designated transvestites who reported a period of fetishism to women's clothes at some stage of development. Characteristics of transvestism of subjects in both countries were remarkably similar; all were male, almost half the subjects first cross-dressed in prepuberty, and in the large majority cross-dressing was well established by late adolescence; intense fetishism was usually experienced during adolescence but waned in later years; in almost a quarter of subjects fetishism ceased, although the desire to cross-dress continued; in many subjects transvestism was associated with fantasies of bondage, usually of the subjects bound while cross-dressed; sexual orientation was predominantly or exclusively heterosexual in more than three-quarters of the subject. Subjects were categorized into two groups. One group, termed nuclear transvestites, were satisfied with cross-dressing. The second group, termed marginal transvestites, desired feminization by hormone ingestion or by surgical intervention. Marginal compared to nuclear transvesites reported significantly stronger feminine gender identity and tended to report a stronger interest in the homosexual direction. The differences appeared to be present from childhood. No significant differences were found between the nuclear and marginal transvestites with regard to characteristics of fetishism, bondage, and cross-dressing except that in the American group marginal transvestites currently cross-dressed more frequently than did nuclear transvestites.

Adult↗

[Femininity, masculinity, androgyny and eating behaviours].

BACKGROUND: There are marked gender differences in the attitudes towards eating behaviors. AIM: To compare gender identity traits among females with eating disorders and subjects of both sexes without eating disorders. MATERIAL AND METHODS: An structured clinical interview based on the DSM-IV diagnostic criteria for eating disorders, the Eating Attitudes Test (EAT-40), the Eating Disorders Inventory (EDI) and the Bem Sex Role Inventory (BSRI) were administered to 119 female patients that fulfilled the DSM-IV criteria for anorexia nervosa and/or bulimia nervosa and/or eating disorders not otherwise specified (FCT group), 89 males (MST group) and 63 females (FST group) without eating disorders. RESULTS: The FCT group ranked significantly higher than the FST group on the EAT-40 and EDI and all its items (p < 0.001). There were no significant differences between FST and MST groups. The FST group ranked significantly higher than the MST group on the Drive for thinness (p = 0.003) and Body dissatisfaction (p = 0.009). The MST group scored significantly higher than the FST group on Perfectionism (p = 0.020) and Interpersonal distrust (p = 0.008). The FCT group was significantly identified with Feminine and Masculine categories and the FST group with Androgynous and Undifferentiated categories on the BSRI (p = 0.001). Comparatively, the MST group was significantly identified with Masculine category and the FST group with Feminine category on the IBRS (p = < 0.001). All groups rejected and approved feminine, masculine and neutral qualities. The higher correlations were observed among feminine quality on the BSRI with the total score on the EAT-40 (r = 0.46). Drive for thinness (r = 0.51) and Body dissatisfaction (r = 0.41). DISCUSSION: Femininity emerged as the main trait of gender identity in patients with eating disorders, in contrast to androgyny showed by male and female subjects without eating disorders. Females without eating disorders were more motivated to achieve thinness and displayed more body dissatisfaction than males.

Adult↗

Making sense of symptoms: self-categorization and the meaning of illness and injury.

A central theme in both medical sociology and health psychology is how people make sense of their symptoms. Both literatures, despite their stress on different aspects of the health evaluation process, see illness in terms of matching present symptoms to an underlying understanding of illness. In this paper we argue that such accounts have difficulty in explaining the impact of contextual factors on how symptoms are evaluated. We therefore propose a model based on self-categorization theory (Turner, Hogg, Oakes, Reicher & Wetherell, 1987). It is proposed that symptoms are evaluated, not against pre-existing illness representations, but by reference to their impact on situationally salient identities. In support of this and experiment is described which involves students who are training to be physical education (PE) teachers. They are defined either in terms of a 'PE student' identity or in terms of a 'gender' identity and asked to evaluate a number of scenarios which describe different illnesses and injuries. Overall, the results provide clear evidence that the significance ascribed to scenarios depends on which identity is salient and hence indicate the viability of a self-categorization theory approach to symptom evaluation.

Adult↗

Transsexualism and sex-related differences in hemispheric asymmetry.

Sex differences in human brain lateralization are documented by studies on normal subjects, patients with the unilateral brain damage, and individuals with atypical level of hormones. However, there is no agreement as to the specific role of gender in the development of hemispheric asymmetry. This experiment was designed to examine whether gender identity plays an important role in the formation of brain lateralization, as some recent data seem to suggest. A group of subjects showing gender dysphoria (transsexuals) and two groups of control male and female subjects were presented with verbal and visual-spatial tasks. Results show that neither biological sex nor gender identity are sufficient factors to determine the pattern of hemispheric asymmetry.

Adolescent↗

Gender development in women with congenital adrenal hyperplasia as a function of disorder severity.

Prenatal-onset classical congenital adrenal hyperplasia (CAH) in 46,XX individuals is associated with variable masculinization/defeminization of the genitalia and of behavior, presumably both due to excess prenatal androgen production. The purpose of the current study was threefold: (1) to extend the gender-behavioral investigation to the mildest subtype of 46,XX CAH, the non-classical (NC) variant, (2) to replicate previous findings on moderate and severe variants of 46,XX CAH using a battery of diversely constructed assessment instruments, and (3) to evaluate the utility of the chosen assessment instruments for this area of work. We studied 63 women with classical CAH (42 with the salt wasting [SW] and 21 with the simple virilizing [SV] variant), 82 women with the NC variant, and 24 related non-CAH sisters and female cousins as controls (COS). NC women showed a few signs of gender shifts in the expected direction, SV women were intermediate, and SW women most severely affected. In terms of gender identity, two SW women were gender-dysphoric, and a third had changed to male in adulthood. All others identified as women. We conclude that behavioral masculinization/defeminization is pronounced in SW-CAH women, slight but still clearly demonstrable in SV women, and probable, but still in need of replication in NC women. There continues a need for improved instruments for gender assessment.

Adrenal Hyperplasia, Congenital↗

Should requests for donor insemination on social grounds be expanded to transsexuals?

Donor insemination may provide an answer to transsexuals with female partners who have a wish for a child. Although the follow-up on children born in the context of these families is non-existent and the follow-up on transsexuals after sex reassignment surgery (SRS) is limited, fertility centres might consider accepting the requests of transsexuals with a female partner. Between 1997 and 2001, nine couples presented themselves at the Centre for Reproductive Medicine of the Dutch-speaking Brussels Free University, of whom five couples were accepted. Nevertheless, some caution is called for because transsexualism is socially not accepted. Moreover, transsexualism is still considered to be psychiatric condition. The following recommendations should be taken in consideration. Treatment should be limited to female-to-male transsexuals with a female partner. A multidisciplinary team of specialists should carry out the diagnosis for gender identity. Developmental problems of the gender-disordered child might interfere with socio-economic, psychological and emotional stability in adulthood. The period of sex reassignment should be nearly completed.

Adaptation, Psychological↗

'Hirsutism': a psychological analysis.

Hirsutism, i.e. 'excess' body hair in the 'male' distribution, is a medical term applied only to women. Although associated with social and psychological difficulties including anxiety, social avoidance and a confusion of gender identity and although it raises important gender issues, there has been little systematic study. No prior research has focussed on the relationship between women's perceived degree of hirsutism and psychological distress. A survey of 53 women with polycystic ovary syndrome (PCOS), which often produces 'excess' hair growth, was carried out to assess any psychological consequences of perceived hirsutism. Results indicated raised levels of psychological distress overall, but no significant relationships between perceived hirsutism and distress. Four semi-structured interviews were then conducted to facilitate more in-depth exploration of hirsute women's experience. Analysis suggested idealized cultural norms for hair growth prevail and excess hair growth contributes to gender inconsistencies and feelings of deviance and stigma. Effective concealment of hair growth and 'passing' for normal appear to facilitate relatively high levels of functioning and allows idealized cultural norms to be maintained.

Adaptation, Psychological↗

Stigma, sex and society: a new look at gender differentiation and sexual variation.

This paper takes a critical look at the hormonal basis of sexual behavior and concludes that it plays no part in determination of sexual activity or sexual preference in any of its forms including homosexuality and transsexualism. The empirical evidence of psychosexual functioning does not support Money's schema which suggest that sexual variation (homosexuality), transsexualism, and transvestism are incongruities of gender identity. At alternative approach which places gender differentiation and sexual variation in a social context is presented.

Adult↗

Creation of a male chest in female transsexuals.

This paper describes the indications for operation, the choice of operation, and the results in 9 patients evaluated by a gender identity clinic and referred for breast removal and construction of a male chest. These patients have lived for an average of ten years in their cross-gender identity and were found to be stable, nondemanding, cooperative, and responsible in their life as males. A different operation is recommended for each of three types of breasts. None of the patients was suitable for a simple gynecomastia-type operation. Patients with excess skin should have a procedure that produces an inframammary crease scar not connected to the nipple. Patients with less skin require a procedure that results in a C-shaped scar curing downward and laterally from the nipple.

Adult↗