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PubMed1995

The debate over recovered memory of sexual abuse: a feminist-psychoanalytic perspective.

This paper presents a feminist-psychoanalytic analysis of the contemporary debate over the veracity of memories of sexual abuse recovered in treatment. Clinical discourse is currently divided between those who argue that recovered memories are veridical accounts of sexual trauma and those who claim that many therapists are creating memories of abuse in their patients. I present here an analysis of the debate on recovered memory and of the social dynamics underlying it, and discuss how these dynamics have shaped clinical practice. In exploring the clinical issues raised by the debate, I reassess Freud's abandonment of seduction theory and explore some of the problematic issues in separating fantasy and memory in female psychosexual development. Conflictual aspects of female development are situated in an analysis of patriarchal social relationships that continue to mediate feminine experience. I argue that the jettisoning of the concept of fantasy in much of the clinical literature on sexual abuse has contributed to a reification of memory-that is, as "true" or "false"- and a sacrifice of complexity in the clinical elaboration of women's abuse experiences. In reclaiming the concept of fantasy, I explore a range of meanings located between the imaginary and the "real" suggested by female narratives of sexual abuse.

Adult↗
PubMed1986

Sexual dysfunction within an adult developmental perspective.

The focus of this paper is on the adult who has adequately mastered the oedipal stage of psychosexual development and who presents with a sexual dysfunction. Drawing on the developmental sequence of Erik Erikson, the authors suggest that failure to address adequately an adult psychosocial crisis may result in sexual dysfunction. There may be both adult developmental deficits and regression to adolescent and adult stages previously negotiated. Both may be symptomatically represented by sexual dysfunction. The authors urge that the sexual and marital problems be evaluated within an adult developmental framework and that the therapy address the psychosocial issues which are appropriate to the developmental stage of the patient.

Adolescent↗
PubMed1975

[New views on the significance and treatment of undescended testis (author's transl)].

Undescended testis is of clinical importance because there are increased risks of milignancy and torsion and disturbances of fertility and psychosexual development. New quantitative morphologic investigations show that human prepubertal testicular maturation does not occur in phases but is continuous. This made it necessary to investigate afresh the causes of disturbance of fertility and the treatment of indescended testis. Our own investigations show that damage to the germ epithelium need not be congenital but may develop because of its ectopy. If, in dogs, a testis is placed into the abdomen, not only this but also the normally placed testis in the scrotum is damaged. The diameter of the tubules and their surfaces as well as the numbers of pachtenous primary spermatocytes are significantly reduced both in the displaced and the normally placed testis. Nuclear surfaces and density of the cells involved in spermatogenesis differ from those in the controls. The findings support the plea for early hormonal or surgical treatment in order to prevent later disturbances of fertility.

Age Factors↗
PubMedDate not supplied

[Brief psychoanalytic point of view on assisted reproduction].

Some psychological mechanisms, regarding the new techniques of ART are reported in this work. A short overview of Freudian theory of psychosexual development of the child is given. The narcissistic wound induced by the diagnosis of sterility is quite important but quite different for men and women. It seems that oocyte donation may "cure" fantasmatically some female sterilities, given that this technique allows some women to get pregnant and to deliver a child, which was until then out of their biological "fate". Whether the anonymity of gamete donation is adapted to the psychic structure of recipients, donors, and medical teams is a question that should be considered. Very few works have been reported about the fantasies of the medical teams on this topic. The importance of infantile sexual theries is stressed again.

Confidentiality↗
PubMed1979

Negative attitudes toward masturbation in sex therapy.

The incidence of masturbation in males and females as reported by Kinsey was cited as basic data to support Gagnon and Simon's theoretical conceptions of differences in the psychosexual development of males and females. The use of masturbation as treatment in sex therapy was reviewed. An inventory to measure negative attitudes toward masturbation was described, and four research studies supporting its construct validity was summarized. The affective-cognitive structure of masturbation-guilt was posited to inhibit masturbatory behavior and to elicit negative affects such as guilt and disgust as a consequence of masturbation. The use of the inventory measuring negative attitudes toward masturbation was illustrated using the P-LI-SS-IT model. Intensive therapy from a gestalt sex therapy perspective was illustrated as integrating the negative masturbatory schema into self-regulating awareness-expression cycles. A caution to sex therapists alerted them to the importance of awareness of emotions, fantasy, and sociosexual meanings in sex therapy rather than using masturbation as a packaged technique.

Affect↗
PubMed1987

The psychological facet of psychosomatic disturbances.

The first part of this paper deals with the psychological background to the most common difficulties in the relation between doctors and patients, particularly when the two parties disagree about the diagnostic and therapeutic approach to a psychosomatic affection. The following causes for discord are discussed: Alexithymia--a mental deficiency that obstructs the insight into the connection between emotional and physical reactions to all types of life experiences; Anal object relationships--a disturbance of the psychosexual development in early childhood, involving in particular the risk of a destructive struggle for power between the patient and the doctor; Regression--the return to a more infantile stage of behaviour in a person who had once passed that stage, involving the risk of mistrust and hatred from the patient towards a doctor whom he conceives as coldhearted and repudiating; Gain of illness--unconscious psychic defence mechanisms that are often misunderstood and may lead the unwise and unsuspecting doctor to fateful errors of treatment and management. The second part describes the tactics for a fruitful cooperation between doctor and patient in regard to the investigation and management of gastrointestinal complaints, possibly originating from psychosomatic reactions to stress and other psychological and social strains. Before the diagnosis is made, it is essential to pursue in parallel two lines of investigation--the somatic and the psychosocial--to avoid one line impeding advances along the other. When a thorough somatic examination has made it clear that the patient's complaints are not caused by an organic disease and the patient's search for a psychosomatic connection has not yet been successful, the so-called redirectional work remains.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1982

Narcissism and female gender identity: a reformulation.

The theory of narcissism and the study of the psychological development of the female child have both been subjects of considerable controversy within psychoanalysis. Some issues central to these controversies have been discussed and evaluated with attention to the contributions made by advances in each area upon the other. From a historical perspective, Freud's illuminating introduction of the concept of narcissism opened the door toward explaining a variety of puzzling clinical phenomena. Deutsch then elaborated upon Freud's contribution as well as upon his specific bias in her description of the psychology of women. Later, Jacobson addressed herself to a reformulation of then existing views of female psychological development. Kohut's innovative clinical observations and Stolorow's functional definition of narcissism provided a unique vantage point from which to offer a critical restatement of narcissistic factors in the development of the female child. Specifically, narcissism was freed from its singular relationship to female development (the emphasis on castration shock and penis envy as rock bottom factors in female character formation) and related to structuralization of the representational world--self- and object-representations. Sexual differences can then be understood as most relevant for the content of these structures. In this context, the work of Stoller was cited. Finally, three topics that grew out of these considerations and elaborations were considered: the role of the little girl's attachment to and separation from her mother, the role of the psychosexual phases and an evaluation of penis envy, and the role of the father as an ideal. The reciprocal relationship between psychosexual development and the differentiation, integration and consolidation of self and object images has specific relevance for the manner in which femininity as the content of the self-representation of the developing girl enhances and is enhanced by the structuralization of the representations. The unfolding of the psychosexual phases with their associated imagery can be viewed as the gradual unfolding of more complex, differentiated and articulated self and object representations. Conversely, the gradual separation, integration and consolidation of self- and object-representations makes possible the development of increasingly more advanced forms of psychosexual experiences. Thus, the original question of the relationship between narcissism and female development has led to much broader issues. Narcissism concerns the structuralization and maintenance of the self. However, while narcissistic activities may promote structuralization, they may also serve to shore up a precarious sense of gender identity.

Adolescent↗
PubMed1986

The superego: a revised developmental model.

The superego is not, as psychoanalytic theory asserts, primarily heir to the oedipus complex. Freud proposed two theories of identification and superego formation, only one of which is widely known and accepted. The first, which he abandoned, argues for the genesis of conscience as compensation for lost narcissism. The second explains superego formation as a response to object loss and fear of castration. The latter view faces a number of anomalies, including the occurrence of preoedipal and postoedipal identifications unrelated to the castration complex, and the difficulty in providing a cause for female superego development. An alternative theory is proposed that returns to Freud's first theory of identification, arguing that gender-specific explanations are inappropriate for a phenomenon such as conscience, which occurs in both sexes. Prototypical male and female cases are presented alongside a general model of the development of ego processes and object relations. Case material is briefly examined, and the argument is made for conceptualizing psychosexual development as a developmental line rather than as the core of character formation.

Adult↗
PubMed1996

Issues related to the sexual decision-making of inner-city adolescent girls.

To be effective in reducing the risks of sexual activity in adolescent girls, the context of adolescent sexuality needs to be understood. Two focus groups of high-risk inner-city African-American and Caucasian adolescent girls (15 to 16 years of age) were organized to explore issues related to sexual decision-making. The transcripts of the groups were reviewed for recurrent themes the girls discussed in regard to sexual decision-making, and their views of relationships and images of males. Verbatim examples are presented to exemplify each category. These adolescents experienced multiple pressures to engage in intercourse at young ages, but utilizing the presence of others was described as a helpful means to avoid engaging in sexual activities. The lack of mutual trusting relationships also was an important aspect for the these girls. Interventions which reduce the pressures to engage in sexual behaviours, develop methods for coping with these pressures, and facilitate the ability to establish mutual relationships will aid the healthy psychosexual development of adolescent girls.

Adolescent↗
PubMed1997

Psychological and psychosexual aspects of vulvar vestibulitis.

AIMS: To objectively assess the psychological and psychosexual morbidity of patients with vulvar vestibulitis. METHODS: 30 patients with variable degrees of vulvar vestibulitis were recruited from a vulval clinic. Each patient underwent a detailed history and clinical examination. Friedrich's criteria were used for the diagnosis of vulvar vestibulitis. Standardised questionnaires to assess psychological and psychosexual function were completed by the patient before review. These questionnaires were the STAI and a modified psychosexual questionnaire introduced by Campion. RESULTS: Patients experienced considerable psychological dysfunction compared with controls. All aspects of psychosexual dysfunction were affected. CONCLUSIONS: When managing patients, psychosexual and psychological issues must be considered in addition to other conventional types of therapy. Vulvar vestibulitis may be a risk factor for developing psychosexual complications including vaginismus, low libido, and orgasmic dysfunction. Consideration of these factors must be an integral part of the management of patients with all chronic vulval conditions.

Adolescent↗
PubMed1987

Preventing and diagnosing sexual abuse in children.

Childhood sexual-abuse occurrences are life-altering events. Children are remarkably successful at keeping the facts of sustained abuse hidden. This results in delayed therapeutic intervention, or none at all. Traditionally, evaluating the symptoms of physical and emotional trauma has been the basis of screening for sexual abuse. This article presents an alternative method. The evaluation of some basic components of psychosexual development will make more evident a child's vulnerability to and/or experience with sexual abuse. A guide to parent-child education based on these same components of psychosexual maturity is also presented as a means of prevention. Screening and education are recognized as interdependent activities within this model of care.

Child↗
PubMed1997

Outcome of congenital adrenal hyperplasia.

In congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, affected girls are born with ambiguous genitalia due to increased secretion of androgens in utero by the defective adrenal gland. Even though it is generally accepted that there are differences between male and female brain development, determining factors have been difficult to identify. Girls with CAH have frequently been studied to evaluate the impact of prenatal androgen exposure on psychological, psychosocial, and psychosexual development, and impairments in various areas have been identified. However, there is no comprehensive study available regarding the outcome of this chronic disorder in adult life. We studied the quality of life in women with CAH, with particular emphasis on how they cope with genital malformations, genital operations, and chronic disease as well as lifelong medication. The patients filled out questionnaires covering their physical state, psychological well-being, social relationships, and functional capacity, as well as questionnaires on psychosexual identification and psychosocial integration. The results were evaluated using a computerized statistical program for social studies. Out of a total of 94 patients above 18 years of age, 45 agreed to participate and were compared to 46 healthy, age-matched controls. Age at diagnosis was 2. 31 +/- 1.55 years and 38% suffered from the simple-virilizing, 45% from the salt-wasting, and 17.0% from the late-onset form of CAH. About one-third of patients had Prader stage 3 or 4 genital virilization. While the overall quality of life did not differ significantly, CAH patients were more often single (47.8% vs. 66.7%) and fewer of them had children (22.2% vs. 38.6%) compared to controls. Significant impairments were found in regard to body image and attitudes toward sexuality, but there was no increased homosexual preference. The women were successful in adjusting to illness and receiving social support. It is speculated that improved psychosocial adaptation is part of a coping mechanism that helps to maintain a high level of well-being despite impairment. Coping mechanisms should be identified and strengthened in order to help patients cope with their chronic illness.

Adaptation, Psychological↗
PubMed1997

[Psychosexual and psychosocial development of patients with hypospadias].

Recently results were published concerning the long-term effects of surgical correction of hypospadias on psychosexual and psychosocial development and on genital perception. Hypospadias patients (9-38 years) were compared with age-matched males operated for inguinal hernia. A semi-structured interview and standardised psychological questionnaires were used. Hypospadias patients did not show a disturbed psychosexual adjustment, but they reported significantly more inhibitions with seeking sexual contacts as a result of embarrassment about their penile appearance. Also, hypospadias patients were significantly less satisfied with their penile appearance, mostly because of the circumcised appearance and a smaller length. No differences were found between psychosocial functioning of hypospadias patients and the control males. Following the investigations 8% of the patients were reoperated because of a poor functional or cosmetic operative result. It is recommended that all hypospadias patients be seen at least once during adolescence as a standard therapeutic procedure, to give optimal care to the small group of patients with psychosexual or psychosocial problems.

Adolescent↗
PubMed1986

A developmental approach to pregnancy prevention with early adolescent females.

Traditional pregnancy prevention strategies employed with adults and older teens do not recognize significant developmental differences between early adolescents and other age groups. Methods that compliment, reflect, and are consistent with developmental needs of the young teen provide cogent approaches to teen pregnancy prevention. Particular emphasis should be placed on interpersonal relationships and their importance in the young woman's life, especially the relationship between the young teen and her parents. Developing and improving all relationships instrumental in positively affecting teen decision-making represent potent approaches to pregnancy prevention. The axioms of Piaget, Erikson, and Mercer are examined in regard to cognitive, social, emotional, and psychosexual development in the 12-14 year old. Young teens' responses to sex education as well as their use of contraception are reviewed in relation to developmental theory.

Adolescent↗
PubMed1999

Psychoanalytic contributions to the study of gender issues.

OBJECTIVE: To explore the issue of gender development and its applications and implications with respect to dynamic psychiatry. METHOD: Gender study is approached in this paper as a continually evolving process of thinking about male and female attributes, similarities, and differences. The paper reviews a specific thematic area of the extensive literature on the subject. RESULTS: Gendered psychosexual development and identity construction are intertwined and determined by multibiopsychosocial factors. Freud's theory on femininity is briefly reviewed from the perspective of new theoretical developments. CONCLUSIONS: The paper highlights the fact that gender is becoming a useful conceptual tool in clinical practice, teaching, and neurosciences.

Female↗
PubMed1990

[Sex determination in ambiguous genitalia].

Choice of sex in children with ambiguous genitalia requires morphological evaluation of external and internal genitalia together with prevision of the kind of pubertal and psychosexual development. Female features in female pseudohermaphroditism, ambiguous in true hermaphroditism and mixed gonadal dysgenesis, male, ambiguous or female in male pseudohermaphroditism, are usually awaited. Increased risk of malignancy in poorly differentiated male gonads should be considered. In neonates diagnostic procedures should be urgently undertaken in order to choose correct sex as soon as possible. Parents must be convinced from the beginning in order to remove any possible doubt. There should be no change in sex, as a rule, after the second year of life, unless a strong psychosexuality arises in definite opposition to the sex so far assumed. In our experience, in 4 out of 23 cases with ambiguous genitalia, neonatal choice of female sex was refused by parents.

Disorders of Sex Development↗
PubMed1997

Overall maturity of object relations as assessed by the McGill Object Relations Scale.

The McGill Object Relations Scale (MORS) is an instrument for assessing levels of drive-based object relations along a continuum of positions representative of psychosexual development. Its theoretical foundations as well as empirical antecedents are presented, and its rating procedure is demonstrated through a case application. The MORS was applied, by five experienced psychiatrists, to 67 adult patients seeking psychoanalytic psychotherapy, in order to assess interrater reliability, internal structure, and construct validity. Results indicate that overall maturity of object relations stems from structural indices of self-object differentiation determined by a particular configuration of many positions, rather than from the thematic aspects included in the individual psychosexual positions.

Adult↗