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Development of psychosexual concepts in relation to expressive language performance.

Cognitive-developmental theory suggests that the learning of gender identity concepts is a sequential process, beginning with the learning of one's own gender, and moving to recognition of the invariance of gender as a human characteristic. Neither clinical nor theoretical literature can fully explain the steps involved. In this study, retarded and nonretarded children were asked to respond to tasks requiring knowledge of core gender identity and gender constancy. When both the retarded and nonretarded children were pooled, a significant interaction was found across all ages between expressive language performance and the development of the psychosexual concepts of core gender identity and gender constancy.

Age Factors

Gender dysphoria in a child with true hermaphroditism.

This case report describes the psychosexual development of a child with true hermaphroditism who was assigned to the male sex at birth, but reassigned to the female sex at age two months. Given this child's excessive exposure to male sex hormone in utero, relative to physically normal females, one would predict a biological predisposition to behave in a masculine manner. This has occurred since two years of age. In addition, this child has had periodic episodes of gender disturbance, dysphoria, and ambivalence. In contrast, a physically normal fraternal twin sister has been conventionally feminine. A number of psychosocial factors appeared to have exacerbated the biologic predisposition to behave in a masculine manner, and thus may have been responsible for "pushing" this child into varying degrees of gender identity conflict. These included a closer father-daughter than mother-daughter relationship, parental tolerance of cross-gender behavior, and a mother who has been psychologically disturbed since the birth of her children. The heuristic value of this case will be discussed in relation to contemporary models of psychosexual development which emphasize the interaction of biological and psychosocial factors.

Child, Preschool

Penis envy: from childhood wish to developmental metaphor.

Two phases of penis envy are considered. The first regularly occurs early in development and is registered as a narcissistic injury which can be resolved under optimal conditions and can contribute to female psychosexual development. If, however, it is not favorably resolved or, even more significantly, if the basic character disorder is of a narcissistic type, the awareness of the genital difference becomes one of many narcissistic traumas. A later phase of penis envy usually represents a regressive effort to resolve oedipal conflicts. In the past, these two phase-oriented forms of penis envy have not been adequately distinguished. Two clinical examples are presented in which the envy of men was only part of a tendency to envy in a narcissistic character disorder. In the analysis, the interpretation of the penis envy offered a metaphor around which all of the "free-floating" envy could coalesce. The cases illustrate the necessity to consider penis envy as the manifest content of a symptom that needs analysis, rather than as "bedrock" or ultimate conflict.

Adult

Gender-related behavior development in females exposed to diethylstilbestrol (DES) in utero: an attempted replication.

This report concerns the role of prenatal hormones in normal and abnormal psychosexual differentiation. Several studies indicate that perinatal treatment of infrahuman female mammals with diethylstilbestrol (DES) masculinizes certain features of their brain and behavior. Accordingly, the authors have hypothesized that prenatal exposure to DES may also masculinize the gender-role behavior of girls and women. A previous study suggested that prenatally DES-exposed women show decreased interest in parenting. The authors failed to replicate these findings in a different sample despite the use of similar methodology. Post-hoc analysis shows that the assessment devices would have detected masculinization if it were present. The implications of these findings for an understanding of psychosexual development are discussed.

Adolescent

Separation-individuation and reconstruction in psychoanalysis.

The development constructs of Mahler and her coworkers are seen as clinically based theory which enrich practice. Freud discovered the importance of the infantile past and psychosexual development in particular, he related these findings to the psychodynamics of neurotic structures, and devised a successful therapeutic model based on his findings. Mahler has uncovered and detailed other aspects of infantile mental life, related genetically not to neurotic byt also to other mental structures, thereby broadening the range of applicability of Freud's therapeutic model. Clinical vignettes are offered depicting unresolved residua from the infantile developmental phases described by Mahler. The issue of the analyst's and the patient's conviction concerning reconstructions that attempt to reach across the "primal repression barrier" is discussed. Finally, it is suggested that working through involves, among other things, completion of developmental process that had been interrupted in the childhood of the patient.

Anxiety, Castration

Irony in psychoanalysis.

Irony is a more important element of analysis than we generally recognize. First, verbal irony characterizes the discourse of certain patients who employ it as a defense, both adaptively and as a resistance, especially against the expression of intense affect associated with the transference. The frequent employment of irony reflects a significant character trait, an habitual mode of dealing with conflict. It is also a frequent manifestation of a particularly active self-critical faculty. Ironic employment of a "double audience" is also relevant to analytic technique. Second, situational irony is inherent in many aspects of psychoanalysis, as a process and a point of view. It implies the acceptance of the inevitability of conflict, ambiguity and paradox, never quite capable of perfect resolution. It emphasizes critical examination of mixtures of motives of both analysand and analyst, and it requires perpetual questioning of what might otherwise be taken as accepted doctrine, including the principles of psychoanalysis per se. An ironic stance requires some degree of detachment in conjunction with deep commitment, itself an ironic circumstance. Third, the capacity to understand and employ irony can be traced to childhood, relatively early in the course of development of speech and sphincter control; some of its early determinants are to be found in the anal phase of psychosexual development; it reflects as well the capacity to use certain early defenses and mechanisms originally described as characteristic of the dream work. Its later fate as a prominent feature of character is very much a matter of ego and superego development, including such components as intelligence, verbal skills, the capacity for joking and for play, i.e., controlled regression. Sources of identification in the family and the culture are of obvious importance. Finally, an understanding of irony has an important place in the theory of technique, especially with regard to transference and resistance. An ironic stance and understanding on the part of the analyst are valuable, even essential; but irony may become a questionable defense for him as well as for his patient.

Aggression

Bamboo phobia in an eighteen-month-old boy.

We have presented a developmental history and an account of the treatment of an eighteen-month-old boy who had a bamboo phobia. Conceptual problems concerning drive organization, the expression of drive derivatives, and object relations have been explored. The correlation of these with Mahler's separation-individuation theory has been considered. Analysis of the bamboo phobia revealed two castration themes. One related to projections onto the father, and another onto the mother and sister. Our case illustration highlights the important role of object-relations development in determining the level of psychosexual organization. It also demonstrates the difficulty in correlating level of psychosexual development with capacity for symptom formation. The importance of sexual and aggressive impulses in separation-individuation is emphasized. The bamboo phobia is seen as a symptom formed to deal with psychosexual conflicts that played a part in the rapprochement crisis. Tth role of fantasies and internal representations of objects, as well as the parents' actual behavior, is stressed--again, in relation to the influence of the drives.

Child Behavior Disorders

Visual inhibitions of automobile driving.

Three patients in psychotherapy who were symptomatically unable to drive automobiles also gave histories of having been afflicted with oculomotor disorders in childhood. This calls attention to the previously undiscussed visual dimension of automobile driving, which is considered in general terms. The specific question of an inhibition of visual function resulting in avoidance of automobile driving is then raised, and a case illustration given in which the attachment of sexual and aggressive meanings to the act of looking was important in the formation of an automobile driving symptom. The particular impact of ocular deviation on early psychosexual development is explored, using the clinical material as a point of departure.

Aggression

Sex differences in psychoanalytic treatment.

Sex sterotypes, clinical observations, and psychoanalytic theory of sex differences are presented. Stereotypes show differences in areas of inhibition and clinical observations, differences related to the phallic and genital phases in psychosexual development. Divergent analytical views on the sexual development of boys and girls are discussed.

Female

Dependence and psychotherapy--developmental considerations.

This article illustrates how the assessment of the level and degree of dependency in psychotherapy can be used as a diagnostic and therapeutic tool. Dependency varies with the stage of psychosexual development, with the degree and state of illness, and with the stage of treatment. Appropriate monitoring of this factor promotes optimal growth potential in the patient.

Affective Symptoms

[Hysterical personality and sexuality of the female].

The investigation involved 30 hysterical women, who were interviewed and who completed four questionnaires relating to: psychosexual development; attitude towards sexuality; sexual activity; and reactivity. Dysharmonic sexual development, and low levels of activity and reactivity in their sexual life was revealed. Contrasted with other groupings of female psychiatric patients, from a sexual point of view the female hysterical personality presents a special psychological case.

Adult

Sleep-related penile tumescence as a function of age.

The authors conducted a study of nocturnal penile tumescence (NPT) in 125 healthy males aged 3 to 79 by means of EEG recordings to provide normative data on how general the phenomenon is, its range of charateristics, and how it is related to man's sexual function. The results indicate that NPT occurs consistently in a healthy male population, that its expression is significantly affected by age, that it is related to stage of psychosexual development, and that it is worthy of further investigation. Clinical experience indicates that it is a useful, objective method of discriminating among various types of biogenic and psychogenic impotence.

Adolescent

Idiopathic precocious puberty in girls: long-term effects on adolescent behavior.

Precocious puberty in girls has endocrinological as well as behavioral implications. We present data from a first systematic controlled follow-up study of 16 adolescent girls with a history of idiopathic precocious puberty (IPP) compared to closely pair-matched adolescent control subjects of comparable pubertal status and normal pubertal history. Findings in four areas of behavior are reported: Psychiatric sequelae: the IPP sample showed an increase in minor psychopathological symptoms. Psychosexual development: The IPP sample was advanced in sociosexual milestones, albeit mostly within the normal range for adolescents. Intelligence: IQ was not different from controls. However, school achievement was accelerated during childhood. Cognitive pattern: The IPP sample had lower spatial perception scores than controls.

Adolescent

[Sexologic forensic expert evaluation of sex offenders].

The authors differentiate between deviant and nondeviant sexual delinquents and focus attention in particular on the forensic evaluation of deviantly conditioned delinquents. They describe some differences in the psychosexual development of deviant delinquents and some anamnestic facts which signalize a deviant structure of the sexual motivation system. They emphasize the necessity of a comprehensive examination of the delinquent, incl. thorough sex diagnosis, psychological diagnosis of the personality, a detailed analysis of controlling and recognizing ability of the time of the crime and they submit suggestions for health measures.

Humans

Gender identity conflicts in adolescents as motivation for suicide.

One of the motivational factors for suicide in adolescents is examined in light of gender identity issues and conflicts. It is proposed that difficulties in the formation of a cohesive gender identity are related to the adolescent's motivation to attempt suicide. This paper makes use of Fast's (1984) distinction between "event-centered" and "self-centered" experiences in order to explore problems in the formation of gender identity with reference to regression to earlier stages of psychosexual development. Physiological changes and regressive pull may lead the adolescent to the "event-centered" mode of experience. Thus one minor event may become the focus of the adolescent's gender and self identities. The adolescent may then have regressive omnipotent fantasies of being able to change gender identity through suicidal acts.

Adaptation, Psychological

Sexual behavior in adolescent and adult females with congenital adrenal hyperplasia.

As part of a comprehensive interview study, 34 female patients with congenital adrenal hyperplasia (CAH) plus 14 control sisters (ages 11-41 yr.) reported on their psychosexual development and sexual orientation (90 items). Fewer patients than sisters had ever experienced love relationships and sexual activities with male partners (p < 0.05 to 0.001). Twenty percent of the patients and none of the sisters wished for and/or had had homosexual relationships; in the patients > 21 yr 44% expressed this interest (p < 0.07). For most items, patients with the salt-wasting variant of CAH (SW) differed more clearly from the sisters than the simple-virilizing patients (SV). For two scales "indicating" homosexual (HOM) and heterosexual orientation (HET) and for two indices of HOM/HET differences), the patients also revealed relatively stronger homosexual and/or weaker heterosexual interests than the sisters (p < 0.05 to 0.001). Here, too, the SW/sister differences were more clear-cut. These results corroborate earlier reports on both delays in reaching psychosexual milestones and increased rates of bisexual/homosexual fantasies and experiences in CAH women.

Adolescent

Psychosexual aspects of the panic-fear personality types in asthma.

Numerous earlier studies have demonstrated the close relationship between MMPI Panic-Fear categories and various medical outcome measures in asthma. The present study relates MMPI Panic-Fear categories to psychosexual development. Specifically, High Panic-Fear patients demonstrate oral preoccupations, Low Panic-Fear patients demonstrate anal preoccupations, while Moderate Panic-Fear patients do not demonstrate pre-Oedipal preoccupations. Thus, MMPI Panic-Fear categories, useful in predicting medical outcome measures, have now been related to developmental levels, with the explanatory power of developmental concepts as well as their implications for psychological treatment.

Adolescent

Developmental profile of 200 male and 100 female transsexuals in Singapore.

Two hundred male and 100 female transsexuals compared with 100 male and 80 female heterosexuals were studied in Singapore. Transsexuals started their psychosexual development earlier than controls. Transsexual feelings started in childhood. Male transsexuals went through a homosexual phase followed by a transvestite phase, before they became transsexual. Female transsexuals did not go through distinct phases. Cross-dressing was one of the early signs of transsexualism and started earlier in females. None of the transsexuals were married, in contrast to reports showing that up to 50% of Caucasian transsexuals had been married. Cultural differences may explain the contrasts between Singapore transsexuals and patients from Western countries.

Adolescent