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PubMed1975

Homosexuality: some diagnostic perspectives and dynamic considerations.

Homosexuality as a diagnostic category has been of limited value since the sexual functioning, ego development, and object relations of patients are not always correlated. Considering homosexuality as a complex configuration resulting from the interplay of unconscious drives with defensive processes and adaptive implications offers a comprehensive dynamic approach. Illustrative case material is presented.

Adaptation, Psychological↗
PubMed2001

Oedipus or Orestes? Homosexual men, their mothers, and other women revisited.

The psychodynamic relationship between homosexual sons, their mothers, and other women in their lives is reexamined. The limitations of earlier writings on the topic are discussed, and a reconceptualized psychoanalytic model is presented for understanding some aspects of the relationships between these sons and their mothers during childhood. In particular, the oedipal stage of development is reformulated to coincide with the sexual orientation of the developing boy. This stage is then examined in the context of the discordant psychosocial environment in which it is often played out. The usefulness of this construct for understanding aspects of the psychosocial development of gay men throughout their lives, particularly their relationships with women, is explored through the examination of clinical data from a number of sources. Finally, the implications of this model for psychotherapeutic endeavors with homosexual men are considered.

Female↗
PubMed2001

Freud's struggle with misogyny: homosexuality and guilt in the dream of Irma's injection.

The highly condensed dream element trimethylamin is central to the dream of Irma's injection. After a brief review of the medical literature on timethylamine (TMA), it is suggested that two important meanings of this chemical and its properties lie in its disguised reference to disparaging views of women, as well as to Freud's homosexual connection to Wilhelm Fliess. Freud's misogynistic and homosexual impulses were stimulated by Fliess's recent surgical error committed while operating on Freud's patient Emma Eckstein. Evidence is presented that the collaboration between Freud and Fliess in performing an aggressive act toward a woman was for Freud an enactment of a childhood situation in which he and his nephew John had ganged up on John's sister Pauline. The later relationship between Freud, Jung, and Sabina Spielrein is seen as an additional reenactment of this childhood triangle. An examination of Freud's associations to and analysis of the Irma dream, as well as some of his later relationships with women, indicates that guilt and the wish to make reparation were also prominent themes in Freud's inner life.

Austria↗
PubMed1993

Psychoanalysis, psychobiology, and homosexuality.

The potential role of biological influences in human sexual orientation was considered more seriously during the early phases of psychoanalysis than in the years since World War II. Recently studies of homosexuality and heterosexuality in the neurosciences have attracted widespread attention both in the scientific and lay communities. The salience of these new data for psychoanalytic theory and practice is just beginning to be explored. In this article, we review research on sexual orientation in the following areas: genetics, crosscultural studies, studies of development in individuals with abnormal prenatal hormone exposure, childhood play patterns, and brain studies in both nonhumans and humans. Differences between male and female homosexuality are explored. We propose that psychoanalytic theory can grow and profit from a careful consideration of new findings in the psychobiology of sexuality, and that the interaction between mind and body is the appropriate purview of psychoanalysis.

Brain↗
PubMed2000

Rectal gonorrhoea in homosexual men: source of infection.

The objective of this retrospective study was to determine the possible source of infection in homosexual men with rectal gonorrhoea: the probable source of rectal gonorrhoea was identified in 46/155 cases. Although the urethra was the site of infection in 33 (72%) of these contacts, only pharyngeal gonorrhoea was identified in 9 (20%) men. In 25/26 cases, there was concordance in the auxo/serotypes of Neisseria gonorrhoeae between contacts with urethral gonorrhoea and the index men with rectal gonorrhoea. Eleven out of 12 pharyngeal isolates were of the same auxo/serotype as the index cases. This study supports the hypothesis that rectal gonorrhoea in homosexual men can be acquired from the oropharynx. Because infection at this site is an independent risk factor for acquisition of HIV, screening for rectal and pharyngeal gonorrhoea should be offered to men who have sex with men, even when there is no history of unprotected receptive anal intercourse.

Adolescent↗
PubMed1990

Psychological determinants of increased condom use and safer sex in homosexual men: a longitudinal study.

A 6-month longitudinal study of psychological variables predictive of condom use and safer sex in homosexually active men was carried out in Adelaide, a city of one million, in a low prevalence area for human immunodeficiency virus (HIV) infection. Return rate of follow-up questionnaires was 60%, with no significant differences between the returners and non-returners on age, sexual behaviour, condom use, or any of the subscales of the instruments used: Adjective Check List (ACL), Profile of Mood States (POMS), General Health Questionnaire (GHQ) and Attitudes toward Condoms scale. Variables associated with increased condom use included personality style, particularly a more assertive and forceful style, which may be important in raising the issue of condom use with partners and promoting condom use in sexual encounters. These data confirm the findings of previous cross-sectional research. Those items significantly associated with change in the Attitude toward Condoms scale are from the subscales measuring Protection from Infection, and Availability, suggesting that these attitudes are those most closely associated with increasing condom use. The variables associated with lack of change to safer sex are consistently those of dysphoric mood state and psychological maladjustment, suggesting that such individuals may need psychological support to assist them to make the change to safer sex. These data support the view that personality and psychological adjustment are important predictors of risk reduction for HIV infection in homosexually active men.

Adolescent↗
PubMed1990

Reasons for non-use of condoms by homosexually active men during anal intercourse.

Sixty-eight homosexually active men attending an STD clinic were questioned to ascertain the percentage of the time they did not use condoms during anal intercourse, and the reasons for this. Data indicated that the reasons most commonly given were being in a steady relationship (32.8%), being unprepared (19.4%), couldn't be bothered (19.4%), use of alcohol or drugs (7.5%), being bisexual (4.5%), attractiveness of partner or partner attitude toward sex, and knowing the partner (3% each). These data suggest that both trust and situational variables are barriers to consistent condom use in homosexually active men.

Adult↗
PubMedDate not supplied

Effects of nitrite use on lymphocyte mitogenesis in homosexual men.

Immune function in 97 homosexually active men (none of whom had HIV infection) was assessed. Data revealed that mitogenesis in those who used volatile nitrites compared to those who did not was higher at 72 h but that there was no difference between the groups at 96 h. In those who had high as compared to low nitrite use, mitogenesis was higher at 72 h but decreased significantly by 96 h. These data support previous suggestions that immunosuppressive effects of nitrites alone cannot account for the development of Kaposi's sarcoma in homosexual men with HIV infection.

Homosexuality↗
PubMedDate not supplied

Trends in sexual behaviour in a cohort of homosexual men: a 7 year prospective study.

A cohort of homosexual men at risk for human immunodeficiency virus (HIV) infection were studied prospectively over a 7-year period (1982/88) to assess trends in sexual behaviour and amyl nitrite intake. During the period, there were dramatic declines in the proportion of HIV seropositive and seronegative subjects reporting multiple casual partners for anal intercourse, unprotected anal intercourse and recreational use of amyl nitrite. Reported rates of orogenital intercourse remained the same during the period, whilst the total number of seroconversions fell from 17 for the period 1982-84 to 8 for 1985-88. High-risk sexual and related social behaviour among homosexual men, as assessed by patterns of anal intercourse behaviour and nitrite intake, changed over the 7-year period, with the greatest changes apparent before the widespread availability of HIV antibody testing and public education campaigns. This highlights the effectiveness of peer-group and community-based programmes in modifying the sexual behaviour of their members.

Adolescent↗
PubMed2005

Same-sex attraction, homosexual orientation, and gay identity: a three-tier distinction for counseling and pastoral care.

Given recent prevalence estimates most pastoral caregivers and counselors will work with persons who experience same-sex attraction (SSA). Many of the people who experience SSA will report such a consistency in the directionality and intensity of their attractions that they think of themselves as having a homosexual orientation. Others will integrate their experiences of SSA into a gay identity. What can facilitate pastoral care and counseling is an intentional use of this three-tier distinction: experiences of SSA, homosexual orientation, and gay identity. A discussion of this three-tier distinction is followed by specific suggestions for utilizing this conceptual framework as a resource in pastoral care and counseling.

Counseling↗
PubMed2005

Cognitive-behavioural stress management with HIV-positive homosexual men: mechanisms of sustained reductions in depressive symptoms.

BACKGROUND: We examined the sustained efficacy of a group-based cognitive-behavioural stress management (CBSM) intervention in comparison to a modified wait-list control condition on measures of mood, coping and social support in mildly symptomatic HIV-positive homosexual and bisexual men. Participants were recruited largely during the era prior to highly active antiretroviral therapy (HAART; 1992-1997). METHODS: Men were randomized to either a 10-week, group-based CBSM intervention (n = 83) or a psychoeducational seminar group (n = 46). All participants completed a battery of psychosocial questionnaires administered by a research assistant at baseline, immediately following the 10-week CBSM intervention period, and at a 6-month follow-up. RESULTS: Men in the CBSM group maintained previously observed effects on depressive symptoms and perceived social support. These sustained effects of CBSM on depressive symptoms were mediated by 10-week increases in cognitive coping (i.e. positive reframing). DISCUSSION: CBSM appears to be a potentially efficacious treatment that reduces and maintains lower levels of depressive symptoms and enhances social support in HIV-positive homosexual and bisexual men. In particular, changes in positive reframing during the 10-week intervention period remain a crucial factor contributing to sustained reductions in depressive symptoms.

Adult↗
PubMed1980

Homosexuality and parental guilt.

Homosexuality in the male is commonly held to be the product of a specific family constellation consisting of a dominant mother and an ineffectual or hostile father. Prospective studies however, on boys with early effeminate behaviour, the majority of whom subsequently become homosexual, show that their closeness to the mother and distance from the father spring from their own needs. The physician should feel free to relieve parents of guilt for this condition.

Adolescent↗
PubMed1987

Specific cross-gender behaviour in boyhood and later homosexual orientation.

Data from a group of males aged 13 to 23, who as children exhibited extensive cross-gender behaviour, was analysed. In boyhood they frequently played with dress-up dolls, role-played as females, dressed in girls' clothes, stated the wish to be girls, primarily had girls as friends, and avoided rough-and-tumble play. The majority of the group evolved a bisexual or homosexual orientation; two types of behaviour, boyhood doll play and female role-playing, were found to be associated with later homosexual orientation. The findings suggest developmental associations between specific types of boyhood cross-gender behaviour and the objects of later sexual arousal.

Child Behavior↗
PubMed2004

A role for 5alpha-reductase activity in the development of male homosexuality?

Higher body hair with lower mesmorphism ratings were observed in Caucasian homosexual men compared with the general male population, reflecting elevated 5alpha-reductase (5alphaR) activity, and higher dihydrotestosterone-to-testosterone (DHT-to-T) ratio, in sharp contrast to 46,XY 5alphaR 2 deficiency subjects, who are often born with ambiguous, or female genitalia, but tend to grow up to be muscular, heterosexual men with very little body hair, or beard. One study also showed them scoring around dull normal IQs. A greater prevalence of liberal body hair growth in men with higher IQs and/or educational levels was also observed in several samples. The exceptions to this statistical trend are too unsettling, however. Nevertheless, the results of a number of published studies, including one showing higher DHT-to-T ratio in homosexual men, done with different objectives over a span of 80 years, together strongly support these findings. Furthermore, in an animal model, "cognitive-enhancing effects" of "5alpha-reduced androgen [metabolites]" were recently demonstrated.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed1986

Results of initial lymph node biopsy in homosexual men with generalized lymphadenopathy.

Persistent, generalized lymphadenopathy (PGL) is considered part of the acquired immunodeficiency syndrome (AIDS)-related complex. The clinical course is usually benign, although some patients may evolve to AIDS. Characteristic features on lymph node biopsy have been described. Recently, large series of PGL have been reported in which many study patients have not undergone initial diagnostic biopsy. The value of such biopsy has been questioned. We report the clinical, pathologic, and laboratory findings in six homosexual men initially considered as potential candidates for study of the natural history of PGL. They were excluded by initial lymph node biopsy, which revealed small-cleaved lymphoma in two, focal Kaposi's sarcoma in two, disseminated mycobacterium tuberculosis in one, and histoplasma encapsulatum in one. The clinical and laboratory data from these six patients were compared with those from 34 patients with biopsy-proven PGL; no statistically significant difference in any prebiopsy clinical parameter was found. We conclude that initial lymph node biopsy may reveal changes other than reactive hyperplasia in homosexual men with generalized lymphadenopathy.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Incidence of human immunodeficiency virus-related and nonrelated malignancies in a large cohort of homosexual men.

PURPOSE: To determine if the rates of malignancies other than Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL) are increased in human immunodeficiency virus (HIV)-infected homosexual men. SUBJECTS AND METHODS: From 1984 through 1993, 1,199 homosexual men were studied in the Pittsburgh component of the Multicenter AIDS Cohort Study (MACS), an examination of the natural history of HIV infection. The cohort consisted of 769 HIV-seronegative (SN) participants and 430 seropositive (SP) members who were either seroprevalent at the time of enrollment or who seroconverted during the study. Cancer incidence data were collected through semiannual visits, phone interviews, medical records, and death certificates. Five thousand seven hundred eight person-years and 2,344 person-years were contributed to the study by the SN and SP men, respectively. RESULTS: In addition to 44 cases of KS, 13 NHLs, and 3 CNS lymphomas (CNSLs), 27 other malignancies occurred (three nonmelanoma skin cancers and eight other malignancies in the SP group, eight nonmelanoma skin cancers, and eight other malignancies in the SN group). Age-adjusted rates were calculated for both groups and compared with each other and with rates for the general male population in Pennsylvania. There were no differences between the SN group and the general population. Among the SP group, the combined frequency of all cancers other than KS, NHL, CNSL, and nonmelanoma skin cancers was statistically significantly increased in comparison to both the SN group and the general population. This increase was secondary to an unusually increased frequency of both seminoma and Hodgkin's disease. CONCLUSION: These findings support the hypothesis that the incidences of cancers other than KS and lymphoma are moderately increased in the setting of HIV infection and immunosuppression.

Adolescent↗
PubMed1984

Correlates of social anxiety in college students and homosexuals.

The relationship between social anxiety and measures of trait anxiety, self-concept, locus of control, repression-sensitization and depression was examined in volunteer college student (39 males and 53 females) and homosexual (51 males and 11 females) samples. Social anxiety was significantly related to all variables of interest, except depression. Within both samples, subjects high in social anxiety had an external locus of control, were low in positive self-concept, and were high in both sensitization and anxiety. The correlational patterns were remarkably similar in both samples, and sensitization emerged as the best single predictor of social anxiety for both college and homosexual groups. Results are discussed in terms of theoretical predictions, previous studies of social anxiety, and implications for personality assessment.

Adult↗
PubMed1983

Fatal CNS toxoplasmosis in a homosexual man.

A compromised cellular immunity associated with an increased frequency of tumors and fatal opportunistic infections has recently been reported in homosexual men. We studied a homosexual man with fatal CNS toxoplasmosis to emphasize the value of CT in CNS toxoplasmosis and to alert neurologists to potentially curable opportunistic infections.

Central Nervous System Diseases↗