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PubMed1998

Conflict and compromise in gender identity formation. A longitudinal study.

The aims of this paper are twofold. The first aim is to show the complexity of the determinants leading to gender identity formation via the longitudinal study of one female research subject over 33 years. Focus is on the origins, meanings and functions of masculine character traits accrued at each phase of development. The second aim is to show that character formation begins early in the second year of life and that early patterns have a certain continuity with adult character despite reorganizations of the oedipal phase and subsequent contributions from each phase of development. Discussion focuses on the complicated nature of female gender identity formation.

Adolescent↗
PubMed2006

The playmate and play style preferences structured interview: a comparison of children with gender identity disorder and controls.

The present study compared the sex-typed preferences for playmates and play styles in children referred for concerns about their gender identity development (199 boys, 43 girls) with that of controls (96 boys, 38 girls). Each child was administered the Playmate and Play Style Preferences Structured Interview (PPPSI) developed by Alexander and Hines (Alexander, G. M., & Hines, M. (1994). Child Development, 65, 869-879). In the two single dimension conditions (playmates and play styles), the controls significantly preferred same-sex playmates and same-sex play styles whereas the gender-referred children significantly preferred cross-sex playmates and cross-sex play styles. Effect sizes ranged from 1.56-2.78. In the conflict condition (which required a choice between same-sex playmates and cross-sex play styles vs. cross-sex playmates and same-sex play styles), there was a general indication of a hierarchical preference for the preferred play style in the single dimension condition as opposed to the preferred playmate except for the gender-referred boys, who showed an inverted pattern. For the gender-referred group, the PPPSI data were significantly correlated with other measures of sex-typed behavior, providing evidence of predictive validity. The PPPSI also discriminated between probands threshold and subthreshold for the diagnosis of gender identity disorder. The results were discussed in relation to both basic and applied issues in the assessment of sex-typed behavior in children.

Child↗
PubMed2005

Gender identity and sport: is the playing field level?

This review examines gender identity issues in competitive sports, focusing on the evolution of policies relating to female gender verification and transsexual participation in sport. The issues are complex and continue to challenge sport governing bodies, including the International Olympic Committee, as they strive to provide a safe environment in which female athletes may compete fairly and equitably.

Female↗
PubMed2003

Demographic characteristics, social competence, and behavior problems in children with gender identity disorder: a cross-national, cross-clinic comparative analysis.

This study examined demographic characteristics, social competence, and behavior problems in clinic-referred children with gender identity problems in Toronto, Canada (N = 358), and Utrecht, The Netherlands (N = 130). The Toronto sample was, on average, about a year younger than the Utrecht sample at referral, had a higher percentage of boys, had a higher mean IQ, and was less likely to be living with both parents. On the Child Behavior Checklist (CBCL), both groups showed, on average, clinical range scores in both social competence and behavior problems. A CBCL-derived measure of poor peer relations showed that boys in both clinics had worse ratings than did the girls. A multiple regression analysis showed that poor peer relations were the strongest predictor of behavior problems in both samples. This study-the first cross-national, cross-clinic comparative analysis of children with gender identity disorder-found far more similarities than differences in both social competence and behavior problems. The most salient demographic difference was age at referral. Cross-national differences in factors that might influence referral patterns are discussed.

Child↗
PubMed1981

TAT measures of gender identity (castration anxiety) in father-absent males.

DAT stories of 28 father-absent (FA) and 103 father-present (FP) college males were coded for castration anxiety. Relying on Stoller's (1974) use of castration anxiety (CA) as an index of core male gender identity, it was predicted that FA males would have less secure gender identity and higher CA than FP males. The FP subjects were grouped into three subgroups according to ratings of the quality of father-son interaction (positive, neutral and negative). Social class, age, SAT scores and story-length did not discriminate between FAs and FPs. FAs were significantly higher in CA, but there were no significant differences between the three FP subgroups. Age at father-loss did not affect CA, although father-absence through death rather than divorce, separation or desertion was associated with higher CA. Presence of a stepfather, other significant older male, sibling sex or birth-order did not affect CA level of FAs.

Adolescent↗
PubMed2000

[Sexual development of the child and the onset of gender identity].

In view of the numerous questions raised by the recently disclosed pedophilia, sexual abuses and prostitution of children, it appeared worthwhile to review the recent studies dealing with the child sexual development and the onset of the gender identity. These studies consist partly in retrospective analysis of pathological situations and partly in the analysis of normal development. It appears that the social and emotional surroundings of the child, provided that they were continuous and devoid of ambiguity, play a prominent role in this process. At present, numerous authors consider that gender identity is achieved at about 2 years of age when the child has a harmonious general development. The family physician and the paediatrician are on the first line to detect potential problems provided that they were aware of the main determinants and symptoms involved.

Child↗
PubMed1976

Iatrogenic homosexuality: gender identity in seven 46,XX chromosomal females with hyperadrenocortical hermaphroditism born with a penis, three reared as boys, four reared as girls.

This paper describes seven chromosomal and gonadal females with the adrenogenital syndrome who were born with a penis as a result of extreme fetal androgenization. Four of them were reared as girls and differentiated a female gender identity with tomboyism. The other three were reared as boys, differentiated a male gender identity, and performed sexually as men with women partners. Even though these men are by no means homosexual in the everyday meaning of the term, the sexual relation is homosexual on the criteria of chromosomal and gonadal sex. The prenatal hormonal environment as well as the social experience of the rearing have thus demonstrated a formula for creating the perfect female homosexual.

Achievement↗
PubMed1999

Gender identity: affected by social change?

To determine whether social changes in attitudes toward the role of men and women have influenced gender identity measures, 60 male and female college students were assessed using both a Thematic Apperception Test measure (May's, 1966, Deprivation/Enhancement measure) and a self-report measure (Bem's, 1974, Sex Role Identity [BSRI]), both of which were developed more than 20 years ago. Although some recent research has found the BSRI to no longer differentiate between men and women (Twenge, 1997; Wilcox & Francis, 1997), this study found significant gender differences for both gender identity measures.1

Journal Article↗
PubMed1983

An MMPI subscale (Gd): to identify males with gender identity conflicts.

This study reported on the development and cross-validation of a 31-item MMPI Gender Dysphoria subscale (Gd) which accurately discriminates between gender identity patients and matched controls, and identifies males with gender dysphoria syndrome. Both the validity and reliability of the Gd scale has been demonstrated and there is every expectation that the scale has excellent potential for clinical usage. In the construction of the Gd scale, we have addressed the major methodological problems of previous studies which have used psychological tests to assess gender role and identity disturbances: small criterion groups, a lack of an appropriate control group, and prediction of too many false positives.

Adult↗
PubMed2004

Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation.

Male sexual differentiation of the brain and behavior are thought, on the basis of experiments in rodents, to be caused by androgens, following conversion to estrogens. However, observations in human subjects with genetic and other disorders show that direct effects of testosterone on the developing fetal brain are of major importance for the development of male gender identity and male heterosexual orientation. Solid evidence for the importance of postnatal social factors is lacking. In the human brain, structural diferences have been described that seem to be related to gender identity and sexual orientation.

Animals↗
PubMedDate not supplied

Adult gender identity disorder can remit.

A 4-year remission in a case of gender identity disorder (GID in DSM-IV, previously termed transsexualism) plus obsessive-compulsive disorder (OCD) prompted a search for further similar cases. Reports were reviewed for apparent remissions in adult GID. GID and paraphilias may wax and wane. This fluctuation can be in tandem with that of comorbid psychopathology or in response to sexual and other life events. Remission has been documented at up to 10 years. If evaluated over many years, GIDs and paraphilias can be less fixed than is often thought. The frequency of permanent remission may be underestimated, as such subjects may not consult clinicians. Implications for the clinician are that such subjects require a long trial period of cross-gender living prior to any surgical interventions.

Adult↗
PubMed2001

The gender identity disorder in the DSM-IV classification: a critical evaluation.

OBJECTIVE: The DSM-IV classification in its definition and description of the gender identity disorder omits a number of diagnostically significant features. This paper attempts to correct the deficiencies. METHOD: The text under the headings: 'Diagnostic features', 'Specifiers', 'Associated disorders', 'Laboratory findings', 'Prevalence', 'Course' and 'Differential diagnosis' is subjected to a detailed scrutiny, using the author's experience as consultant psychiatrist to the Monash University Gender Dysphoria Clinic over a period of 25 years as source and background. Results of two studies of male-to-female and female-to-male transsexuals are given in the Table. RESULTS: DSM-IV criteria are augmented and the symptomatology focused. The existing gaps in the delineation of specifiers and associated features are closed by providing additional clinical material. The description of the course and the differential diagnosis are enriched. CONCLUSIONS: Although the critical analysis of the DSM-IV classification of the gender identity disorder has shown the manual to be adequate, it nevertheless has shortcomings which may impede exact diagnosis.

Diagnosis, Differential↗
PubMed2026

Quality of life and gender identity in females with congenital adrenal hyperplasia after genital restoration surgery: A single-center experience.

BACKGROUND: Legislation restricting surgical interventions in children with differences of sex development (DSD) has intensified debate about female genital restoration surgery (FGRS) in patients with congenital adrenal hyperplasia (CAH). Long-term patient-reported outcomes are needed regarding the optimal timing of surgery. OBJECTIVE: We aimed to assess health-related quality of life (HRQoL), gender identity, and family satisfaction regarding surgical timing and outcome in females with CAH following genital restoration surgery. STUDY DESIGN: Cross-sectional survey of CAH patients who underwent surgery between January 2007 to December 2016 at our institution. Validated instruments (KINDL questionnaire for HRQoL, Utrecht Gender Dysphoria Scale, UGDS) and structured telephone interviews were employed. RESULTS: Data on HRQoL was available for 25 patients (self- and/or parent-reported) out of 56 eligible patients (45% response rate). Median age at first surgery was 6 months (range: 3-137 months). Patients' age at time of participation ranged from 2 to 28 years. All had 21-hydroxylase deficiency (92% salt-wasting form) with Prader grades ranging from II-V. Wound dehiscence requiring secondary suturing occurred in 15% of patients with primary surgery at our center, while only one (4%) patient developed vaginal stenosis after early primary vaginoplasty. Two additional patients (8%) with prior outside surgery required vaginal revision after FGRS at age 12. HRQoL scores were comparable to healthy reference populations across most age groups. Children aged 3-6 and adolescents and young adults showed no significant difference from reference values, while children aged 7-13 showed a slight elevation. None of five patients &#x2265;14 years demonstrated gender dysphoria (all UGDS scores <40, threshold &#x2265;40). 14 patients and families were also interviewed by telephone. All preferred early surgical timing. No family expressed regret about the decision or preferred delayed surgery. DISCUSSION: This study provides validated intermediate-term patient- and parent-reported outcomes after FGRS in CAH. Key limitations include the small sample size, single-center design, and young age of most patients. Selection bias may exist, though participating families included those who underwent revision surgery. The absence of a non-operated comparison group reflects current clinical reality, as nearly all CAH patients with urogenital sinus underwent surgical correction. CONCLUSIONS: Females with CAH reported normal HRQoL and a comfortable female gender identity after early FGRS. The patients and their families expressed a preference for early surgery. However, there is need for longer-term follow-up to assess sexual function and reproductive outcomes as well comparison of outcomes with a non-operated group.

Humans↗
PubMedDate not supplied

Gender identity reversal in an adolescent with mixed gonadal dysgenesis.

We describe a patient who was assigned female at birth because of genital ambiguity without performing further diagnostic procedures and presented at the age of 13-1/2 years because of her strong desire to change her legal sex. Karyotype was 46,XY; clinical, endocrinological, radiological and surgical work-up revealed hypergonadotropic hypogonadism and mixed gonadal dysgenesis. Gender identity reversal was performed after extensive psychological testing and adaptation of living circumstances resulting in a successful integration as a male with normal psychological and social functioning. In several surgical procedures, the streak gonad, the nonfunctional testis, and the rudimentary uterus were removed, and a penis was reconstructed from a penisoid with chorda and hypospadias. Our patient supports the idea that gender identity is imprinted prenatally by hitherto poorly understood mechanisms and that sex assignment in infants with ambiguous genitalia needs careful consideration of not solely endocrinological and anatomical data.

Adolescent↗
PubMed1995

The phallic castration complex and primary femininity: paired developmental lines toward female gender identity.

I suggest that two developmental lines contribute to the achievement of female gender identity. One is rooted in the phallic castration complex, and the other in primary femininity. Far from being mutually exclusive, the two comprise necessary aspects of every girl's progress toward becoming a woman. To that extent, every woman's analysis will include the analysis of compromise formations that emerge from both. In distinguishing clinical manifestations of each developmental line, I suggest that it may be useful to conceptualize primary femininity and the phallic castration complex as affect-defense configurations which incorporate two fundamentally different ideas about danger. In conflicts of primary femininity, danger is anticipated: anxiety is the signal for compromise formation, since what is actually possessed (the female genital) is valued and is therefore imagined as subject to danger. In the phallic castration complex, danger is imagined already to have occurred. Depressive affect becomes the primary motive for defense, based on a fantasy that what is valued (the male genital) has already been lost. This distinction may facilitate our efforts to specify exactly how recent revisions in theories of female development have explicit implications for practice.

Adult↗
PubMed1995

Pseudologia fantastica and gender identity disturbance in a Chinese male.

A Chinese patient with pathological lying (pseudologia fantastica) and gender identity disturbance is described. The stories "save face" and lack a truly self-aggrandising quality. The importance of keeping "face" and maintaining modest behaviour in the Chinese culture is central to the psychopathology.

Adult↗
PubMedDate not supplied

Split gender identity: problem or solution? Proposed parameters for addressing the gender dysphoric patient.

Working with the gender dysphoric patient is complex because of the various clinical issues that arise. One issue that has not been addressed in the psychiatric literature is whether to address the patient with the biologically congruent pronoun or name or with the patient's preferred-gender pronoun or cross-gender name. This article presents clinical examples that allow a template to be developed for pronoun use in working with such patients. Whether the clinician uses biologically congruent names and pronouns may depend upon the patient's progress in adopting the cross gender role as well whether family or friends either know or accept such changes. In certain situations, such as meetings with family members, the therapist may address the patient with gender congruent names; whereas on other occasions use cross-gender pronouns or names.

Adult↗