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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↗

The circumscribed focus in intensive brief dynamic psychotherapy.

The clinical proposition that an ideal focus for intensive brief dynamic psychotherapy is an intra-psychic conflict rooted in oedipal pathology with circumscribed effects on personality functioning has been widely accepted a priori, without empirical validation. In this study 4 clinical raters assessed the 'degree of circumscribed conflict' and 'hypothesized psychosexual development level' from a dynamic evaluation interview. The variables were only marginally associated with DSM-III diagnoses. Within a subsample of 22 patients treated with intensive psychoanalytic technique, patients with whom a highly circumscribed conflict could be identified had the most favourable dynamic change 4 years after therapy.

Adult↗

Paranoia and beating fantasy: an inquiry into the psychoanalytic theory of paranoia.

Psychoanalytic contributions to the theory of paranoia are reviewed. As a primary problem underlying paranoia, this paper emphasizes the importance of beating fantasy associated with a fragile personality structure rather than the theory of repressed homosexuality. Castration anxiety and homosexual conflict may precipitate paranoia, but all levels of psychosexual development and their corresponding danger situations contribute to the transformed fantasy of persecution and punishment; early infantile narcissism, aggression, and sadomasochism are especially important. Severe preoedipal disturbance has contributed to deficient ego development and oedipal resolution. The failure to negotiate separation-individuation is associated with narcissistic arrest and impaired object relations and testing of reality. Ego integration, identity and sexual identity are unstable. Attempts at undoing, repair, or revenge of traumata and narcissistic injury and the maintenance of ego stability and (narcissistic) object relationship are more fundamental than homosexual object choice or the negative Oedipus complex in the understanding of paranoid psychopathology.

Fantasy↗

Androgen imprinting of the brain in animal models and humans with intersex disorders: review and recommendations.

PURPOSE: Psychosexual development, gender assignment and surgical treatment in patients with intersex are controversial issues in the medical literature. Some groups are of the opinion that gender identity and sexual orientation are determined prenatally secondary to the fetal hormonal environment causing irreversible development of the nervous system. We reviewed the evidence in animal and human studies to determine the possible role of early postnatal androgen production in gender development. MATERIALS AND METHODS: An extensive literature review was performed of data from animal experiments and human studies. RESULTS Many animal studies show that adding or removing hormonal stimulus in early postnatal life can profoundly alter gender behavior of the adult animal. Human case studies show that late intervention is unable to reverse gender orientation from male to female. Most studies have not permitted testing of whether early gender assignment and treatment as female with suppression/ablation of postnatal androgen production leads to improved concordance of the gender identity and sex of rearing. CONCLUSIONS: Animal studies support a role for postnatal androgens in brain/behavior development with human studies neither completely supportive nor antagonistic. Therefore, gender assignment in infants with intersex should be made with the possibility in mind that postnatal testicular hormones at ages 1 to 6 months may affect gender identity. A case-control study is required to test the hypothesis that postnatal androgen exposure may convert ambisexual brain functions to committed male behavior patterns.

Androgens↗

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↗

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↗

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↗

[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↗

[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↗

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↗

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↗

Ambiguous genitalia with perineoscrotal hypospadias in 46,XY individuals: long-term medical, surgical, and psychosexual outcome.

OBJECTIVES: To identify and study adults (21 years or older) who have a 46,XY karyotype and presented as infants or children with genital ambiguity, including a small phallus and perineoscrotal hypospadias, reared male or female. METHODS: Participants were classified according to the cause underlying their intersex condition based on review of medical and surgical records. Long-term medical and surgical outcome was assessed with a written questionnaire and physical examination. Long-term psychosexual development was assessed with a written questionnaire and semistructured interview. RESULTS: Thirty-nine (72%) of 54 eligible patients participated. The cause underlying genital ambiguity of participants included partial androgen insensitivity syndrome (n = 14; 5 men and 9 women), partial gonadal dysgenesis (n = 11; 7 men and 4 women), and other intersex conditions. Men had significantly more genital surgeries (mean: 5.8) than women (mean: 2.1), and physician-rated cosmetic appearance of the genitalia was significantly worse for men than for women. The majority of participants were satisfied with their body image, and men and women did not differ on this measure. Most men (90%) and women (83%) had sexual experience with a partner. Men and women did not differ in their satisfaction with their sexual function. The majority of participants were exclusively heterosexual, and men considered themselves to be masculine and women considered themselves to be feminine. Finally, 23% of participants (5 men and 4 women) were dissatisfied with their sex of rearing determined by their parents and physicians. CONCLUSIONS: Either male or female sex of rearing can lead to successful long-term outcome for the majority of cases of severe genital ambiguity in 46,XY individuals. We discuss factors that should be considered by parents and physicians when deciding on a sex of rearing for such infants.

Adaptation, Psychological↗

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↗

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↗

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↗