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PubMed2002

Relational theory and cultural enhancement interventions for African American adolescent girls.

OBJECTIVE: This study tested the effectiveness of two culturally appropriate substance abuse prevention intervention programs for African American girls. METHODS: Project Naja recruited 210 girls ages 10-12 from schools in a low-income ward in Washington, D.C., to participate in a 2.5- year, three-phase intervention to develop strong ethnic and gender identity. The Cultural Enhancement Project recruited sixth grade girls in Richmond, Virginia, for a 15-week curriculum. The author collected pre- and post-test data on cultural, drug, and sex measures. RESULTS: Project Naja participants in the intervention group scored significantly higher on Africentric values and racial identity than comparison group participants. They also had more positive concepts of their physical appearance. In the Cultural Enhancement Project, girls in the intervention group scored higher on the global African American identity scale. There was a trend toward significance in increased percentage of androgyny for girls in the intervention group. CONCLUSIONS: Prevention programs should include a component directed at strengthening ethnic identity and other protective factors (self-esteem, positive peer support, and skill-enhancement).

Adolescent↗
PubMed1983

Issues in diagnosis and treatment of transsexualism.

Transsexualism involves incongruity between anatomy and gender identity in biological normal persons. The literature in this area indicates controversy in diagnosis and treatment. Current guidelines for assessment and treatment selection are critically reviewed. Outcome data suggest that sex reassignment surgery is variably effective and potentially deleterious. Child and adult interventions may be more viable than previously assumed. Recommendations for research include systematic follow-up, longitudinal studies of gender-deviant children, and studies of psychopathology. Until rigorous outcome data are available, return to a conservative position on sex reassignment, using highly exclusive diagnostic guidelines and restrictive selection criteria, is advocated.

Adolescent↗
PubMed1999

[Expert phoniatric assessment of voice adaptation in male to female transsexualism].

Sex change surgery for patients with gender identity disorders has been performed successfully during the last decade, especially for males becoming females. A troublesome problem for some of these individuals is the retention of a male voice. Castration and estrogen therapy may produce only minor changes in pitch, with patients requiring further surgical treatment. Techniques used include glottoplasty, crico thyroid approximation and/or anterior commissure advancement. Although the voice is highly gender-specific, the standards of care for transsexuals do not cover guidelines for a diagnostic approach and surgical therapy. For medical jurisprudence, questions concerning specific aspects of German social law are answered in a representative case of a male-to-female transsexual. A review of the literature shows that there is no common thought about whether and when a specific surgical procedure should be performed in a gender-transforming process and which method should be used for long-term results and patient satisfaction. Although worldwide experience with these operations and overall good results are assumed, further reports by phonosurgeons performing these operations are required concerning actual results. We propose that medical scientific societies should offer phonosurgery as an optional treatment for male-to-female transsexuals in their guidelines and standards of care.

Adult↗
PubMed1990

Essay on the diagnosis and nature of paraphilia.

Increasing clinical experience has allowed the formulation of three psychodynamic viewpoints about the nature of the paraphilic disorder. Paraphilia is a disorder of sexual identity development, often solely of the intention component, that has three characteristics: a long-standing, highly arousing, unusual erotic preoccupation; a pressure to act upon the erotic fantasy; sexual dysfunction with a partner during conventional sexual behavior. Paraphilia is also a disorder of self-regulation characterized by a considerable gap between personal aspirations and behaviors. Finally, paraphilia is a dramatic impairment in the capacity to love. Two rarely recognized issues complicate the nosology of paraphilia: Many related sexual problems are often confused with paraphilia, and some paraphilias manifest themselves as variations in gender identity and object choice. The defensive functions of paraphilia are discussed and common terms used in conjunction with paraphilia are redefined.

Adult↗
PubMed1990

The relationship of measures of sex-typed play with clinician ratings on degree of gender disturbance.

Forty-nine boys, aged 3 to 11 years, who were referred for an evaluation of a potential gender identity disorder of childhood, were assessed with a standardized in vivo behavioral observation of sex-typed play in an alone condition and with the parent-report Bates-Bentler Games Inventory. Without access to these measures of sex-typed play, an independent clinical psychologist rated each of the subjects on a 9-point scale that indicated the degree of severity of a gender disturbance, based upon child and parent interviews and a complete psychological test battery. The percentage of feminine play in the behavioral observation procedure was found to be correlated significantly with the clinician rating of degree of gender disturbance (r = .55). The Games Inventory was found to differentiate significantly the gender-disturbed boys from the nonclinical reference group on its feminine/preschool games, masculine nonathletic games, and athletic games subscales and on its composite index of feminine play preference; however, only the composite index (and none of the 3 subscales) was correlated significantly (r = .34) with degree of severity of gender disturbance.

Child↗
PubMed1992

To be or not be a woman: anorexia nervosa, normative gender roles, and feminism.

This paper reviews the characteristics of anorexia nervosa described in the DSM-III-R, relates them to normative gender roles and adolescent development, and critiques those roles on feminist grounds. Two apparently contradictory explanations for the irrational pursuit of thinness are considered: a) the anorexic thus attempts to conform to a socially defined feminine ideal; b) the anorexic thus attempts to avoid the appearance and consequences of mature womanhood. I propose that both explanations are applicable, together emplifying the ambiguity that Simone de Beauvoir considers characteristic of female experience. Because both explanations suggest a gender identity disorder, I question the fact that the DSM-III-R fails to indicate this linkage. I argue further that therapeutic considerations require efforts to alter the socialization factors that are implicative in anorexia nervosa.

Anorexia Nervosa↗
PubMed2001

Temperament and character in italian men with anorexia nervosa: a controlled study with the temperament and character inventory.

This study compares personality traits of men and women with anorexia nervosa and matched controls. The Temperament and Character Inventory was used to assess personality traits of 15 male and 50 female anorectics and 28 male and 58 female controls matched for age and education. Male anorectic patients displayed overall lower reward dependence and cooperativeness. Male and female anorectics displayed higher persistence and lower self-directedness than controls. Anorectic men had lower harm avoidance than anorectic women. Discriminating analysis revealed the anorectic male group as the most clearly defined. Anorectic men shared more traits with anorectic women than with male controls. Temperament and character of anorectic men reflect features partly similar to those of women with anorexia. Personal history and discriminating analysis led to interesting inferences about the gender identity of anorectic men. These results should be helpful in directing pharmacologic and psychotherapeutic approaches that consider the specific personality traits of these patients.

Adolescent↗
PubMedDate not supplied

[Transsexual wish and and cis-sexual defense].

The desire of trans-sexual patients to appropriate the physical attributes of the opposite sex via hormone treatment or surgery confronts psychoanalysis and sex research with problems that are not only psychological in nature. Sigusch uses the term "defence" here not only in a technical sense but also in an epistemological, discourse-analytic and disposition-analytic register. The general dispositions determining the reality of gender and gender difference are "cis-sexual" in nature. The polarity they display extends to the physical and manifests itself in the form of sexual binarism. The author coins the consciously neologistic term "cis-sexual" to describe individuals where physical gender and gender identity are completely and "naturally" co-extensive. Only the realization that "second-nature" is in reality primary can trigger the detotalization of so-called trans-sexuality that Sigusch is concerned to call into question.

Combined Modality Therapy↗
PubMed2004

The androgen insensitive micropenis: long-term follow-up into adulthood.

AIM: To assess the adult stretched penile length (SPL) and sexuality in patients with micropenis who exhibited an inadequate response to exogenous testosterone therapy and were raised as males. PATIENTS AND METHODS: Patients with micropenis who had an equivocal response to exogenous testosterone therapy and were raised as males were evaluated at adulthood (>17 yr). RESULTS AND CONCLUSIONS: Twenty patients with micropenis, initial median SPL -3.3 SD below the mean (range -5.5 to -2.6) had a suboptimal response to initial testosterone therapy, median SPL post-treatment -2.7 SD (-3.3 to -2.2), and were raised as males. At adulthood, 90% (18/20) had a micropenis, median SPL -3.4 (-5.9 to -2.2). All have a male gender identity, five are undergoing psychiatric counseling (fear of sexual rejection--five patients, one of whom also has suicidal ideation). Eight have not pursued a sexual relationship; 12 are sexually active, one of whom is bisexual.

Adolescent↗
PubMed2000

Genetic and environmental influences on sexual orientation and its correlates in an Australian twin sample.

We recruited twins systematically from the Australian Twin Registry and assessed their sexual orientation and 2 related traits: childhood gender nonconformity and continuous gender identity. Men and women differed in their distributions of sexual orientation, with women more likely to have slight-to-moderate degrees of homosexual attraction, and men more likely to have high degrees of homosexual attraction. Twin concordances for nonheterosexual orientation were lower than in prior studies. Univariate analyses showed that familial factors were important for all traits, but were less successful in distinguishing genetic from shared environmental influences. Only childhood gender nonconformity was significantly heritable for both men and women. Multivariate analyses suggested that the causal architecture differed between men and women, and, for women, provided significant evidence for the importance of genetic factors to the traits' covariation.

Adolescent↗
PubMed1996

The concept of penis envy revisited. A child analyst listens to adult women.

Current psychoanalytic scholarship concerning gender development rejects recognition of the genital difference, or "penis envy," as central to the construction of "femininity," substituting the concept of "primary femininity." This shift in the paradigm of gender construction has occurred in part because of contributions from child-observational research showing that "gender identity" is acquired by age three. It has also been stimulated by the observations of adult analysts that interpretations organized around the concept of penis envy appear to have little mutative value in contrast to the communications in play and action from the analyses of preschool girls, which seem to reflect intense intrapsychic conflict stimulated by the girls' recognition of the genital difference. Using clinical material, this paper contrasts fantasies of gender found in oedipal girls with those presented in the analyses of adult women. The differences reflect not only the vicissitudes of gender construction and developmental changes in the mind's capacity to adapt to the demands of reality but also the fate of aggressive and narcissistic derivatives as they become entangled in conflict created by recognition of the inherent limitations of the body. The fantasies referred to by the concept "penis envy" are not constitutive of femininity; however, they reflect one approach to a defensive solution to intrapsychic dilemmas stemming from awareness of bodily and generational limits.

Adult↗
PubMedDate not supplied

Psychosexual development: an examination of the role of prenatal hormones.

Naturally occurring endocrine syndromes and the offspring from steroid-treated pregnancies are the major sources of evidence for a role of prenatal hormones in psychosexual development in man. Effects of prenatal androgens have been established for the sex-dimorphic behaviour clusters of energy expenditure (increased), parenting rehearsal (decreased), peer associations (shifted to male), and grooming-related behaviour (decreased); most of the information was obtained on the syndrome of congenital adrenal hyperplasia and in progestin-induced female hermaphroditism. Studies of children and adults exposed prenatally to exogenous oestrogens and/or progestagens suggest slight demasculinizing effects but cannot yet be considered conclusive. Gender identity is largely dependent on the sex of rearing; a direct role of prenatal hormones in its formation has not been shown. The evidence for the role of prenatal hormones in the development of sexual orientation is inconclusive.

Female↗
PubMed1998

Changes in the sexual orientation of six heterosexual male-to-female transsexuals.

Researchers traditionally have assumed that sex reassignment procedures do not change sexual orientation. Of 20 transsexuals of various types that were interviewed, 6 heterosexual male-to-female transsexual respondents reported that their sexual orientation had changed since transitioning from male to female. These respondents stated that before transitioning they had been sexually orientated towards females. After transitioning, these same respondents reported that they were sexually orientated towards males. Five of the six respondents reported having various sexual encounters with males since transitioning. The respondents explained the changes in their sexual orientation as part of their emerging female gender identities. Three of the respondents claimed that the use of female hormones played a role in changing their sexual orientation. It did not appear that the respondents' post-transitional sexual attractions towards males were similar to autogynephilic images and fantasies described by Blanchard (1991).

Female↗
PubMed1996

Case study: sex reassignment in a teenage girl.

The etiology of gender identity is explored through the case history of a teenager with intersex raised without stigmatization as a girl but who declared himself male at age 14 years. Psychological ramifications of such complex medical anomalies as ambiguous genitalia demand a role for child psychiatry.

Adolescent↗
PubMed1980

On the genesis of narcissistic and phobic character formation in an adult patient: a developmental view.

A case has been presented in which early maternal failures reconstructed from separation-individuation subphase developments revealed a narcissistic alliance between the child and her parents. This alliance stood in the way of separation and individuation processes and blocked the expression of hostility. Identifications with the phobic mother prevented the ego from developing a signal function for anxiety. A maternal father, who in many ways counteracted the deficiencies of the mother, could only partially become the principal love object during the phallic and oedipal phases. A strong bisexual orientation prevented the full emergence of a feminine gender identity. Only after the narcissistic alliance emerged in transference and was given no gratification did phobic symptoms appear. The transference recapitulated a segment of the infantile neurosis in which phobia-proneness was held in check by the 'narcissistic alliance' between mother and daughter.

Adult↗
PubMed1977

The discrete syndromes of transvestism and transsexualism.

The literature concerning the relationship between transvestism and transsexualism is briefly reviewed. Some workers consider the two conditions to be on a continuum, whereas others feel that they are independent clinical entities. To clarify the relationship between the two syndromes, biographical data were collected and penile volume changes recorded in 29 subjects who identified themselves as transsexuals and 35 who identified themselves as transvestites. In comparison to the transvestite subjects, significantly more transsexuals were younger, were single, cross-dressed fully, and reported homosexual interest, a feminine gender identity, and a desire for a sex-change surgery. In comparison to the transsexual subjects, significantly more transvestites reported heterosexual interest, cross-dressed partially, and had shown fetishistic arousal. It is concluded that transvestism and transsexualism are separate clinical entities.

Adult↗
PubMed1999

Assignment of sex in neonates with ambiguous genitalia.

Sex assignment in the newborn with ambiguous genitalia has been based on the adequacy of the phallus in the male, potential fertility in the female, and cosmetic appearance of the reconstructed genitalia. Recent data from both the neurosciences and from clinical research, however, casts doubt on the validity of such criteria for clinical decision making. Current knowledge suggests a need to shift away from the current clinical approach and to incorporate these new data into decisions based on a broader understanding of the etiology of gender identity. Recognition of the primacy of psychosocial and psychosexual developmental outcomes for children with ambiguous genitalia is lending direction to longitudinal outcomes research. New approaches to sex assignment have been suggested, and the paradigm for sex assignment in the newborn period is in transition.

Decision Making↗
PubMed2003

Constructions of femininity and experiences of menstrual distress.

The purpose of this article is to explore the relationship between constructions of feminine gender identity and experiences of menstrual distress. Both quantitative and qualitative methods were used to assess the relationship between femininity and PMS. Statistically significant correlations were found between T-scores for femininity on the Bem Sex Role Inventory (Bem, 1978) and total distress scores on the Menstrual Distress Questionnaire (Moos, 1991). Analysis of the qualitative data suggests that women engage in intense premenstrual bodily surveillance, and the data support Ussher, Hunter, and Browne's (2000) findings that the 'PMS self' becomes lived as an identity position in contrast to a 'real' or 'non-PMS sell.' The authors conclude that our biopsychiatric discourse about PMS functions to legitimize traditional constructions of femininity and that future research should conceptualize menstrual distress as both lived experience and social construction.

Adult↗