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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↗
PubMed2002

Vaginal reconstruction utilizing sigmoid colon: Complications and long-term results.

BACKGROUND/PURPOSE: The use of sigmoid colon segments to repair congenital deformities of the vagina is well established. There are little data, however, on complications or functional results in these patients. The purpose of this study was to evaluate complication rates and long-term patient outcomes in the use of sigmoid segments in vaginal reconstruction for congenital anomalies. METHODS: The authors identified 28 patients who underwent vaginal reconstruction with sigmoid colon segments between 1985 and 2000 at their institution. Patient charts were reviewed for surgical technique, complication rates, cosmetic results, functional results, and psychosocial development. Patients were recalled for physical examinations and personal interviews to assess current status. RESULTS: Of the 28 patients, 13 had male pseudohermaphroditism, 6 had Mayer-Rokitansky-Kuster-Hauser syndrome, 2 had true hermaphroditism, 2 had mixed gonadal dysgenesis, 2 had common urogenital sinus syndrome, 2 had adrenogenital syndrome, and 1 had penile agenesis. Mean patient age was 16 years (range, 6 to 21 years). Mean follow-up was 6.2 years (range, 2 months to 15 years). Postoperative complications included introital stenosis (4 patients), mucosal prolapse (4), partial small bowel obstruction (2), perineal wound hematoma (2), superficial wound infection (2), and vaginal prolapse (1). None of the complications have affected long-term patency or cosmesis of the neovagina, nor has mucous production significantly affected quality of life. Fourteen of 16 (88%) adult patients are heterosexually active, 1 is homosexually active, and 1 is asexual. Of the 14 heterosexually active patients, 11 (79%) are "very satisfied" with their psychosexual development and 3 are "comfortable." Four patients are married, and 1 has carried a child to term. All adult patients felt that the appropriate time to undergo surgery was in adolescence. CONCLUSIONS: Reconstruction with sigmoid segments is an effective approach for many congenital conditions requiring vaginal reconstruction. Although surgical outcomes are not perfect, appropriately timed reconstructive vaginal surgery can provide most patients with an improved quality of life. For the best long-term results, a multidisciplinary team must be available from infancy to supply comprehensive support.

Adolescent↗
PubMed2000

Differential environmental factors in anorexia nervosa: a sibling pair study.

OBJECTIVES: Previous studies have explored differences in psychosocial and familial factors between women who develop anorexia nervosa and those who do not. However, these studies have generally used between-group comparisons. This study looks at the environmental factors which may be antecedents of anorexia nervosa looking at sister pairs where one had anorexia nervosa and the other did not. DESIGN: A paired design was used to compare anorexic women with an unaffected sister on a number of background variables, including sibling interaction, parental care, peer group characteristics and other events unique to the individual. METHODS: The Sibling Inventory of Differential Experience (SIDE) was used to determine non-shared environment. Out of an initial sample of 148 women with past or current anorexia nervosa, 28 were identified who had sisters with no reported history of eating disorders and who also consented to complete the questionnaire. RESULTS: Anorexic sisters perceived more maternal control and reported more antagonism towards and jealousy of their sisters than did unaffected sisters. In addition, anorexic women reported having had fewer friends and boyfriends than their sisters. CONCLUSIONS: These results confirm the perceived differences in background environment between women with and women without anorexia nervosa. These issues are discussed in relation to behavioural genetics, family dynamics and psychosexual development.

Adolescent↗
PubMed1999

Estrogen: consequences and implications of human mutations in synthesis and action.

Recent developments have advanced our knowledge of the role of estrogen in the male. Studies of the mutations in CYP19, the gene encoding aromatase, in six females and two males and a mutant estrogen receptor alpha in a man are described. These observations provide illuminating new insights into the critical role of estrogen in the male (as well as female) in the pubertal growth spurt and skeletal maturation, and in the importance of estrogen sufficiency in the accrual and maintenance of bone mass. The weight of evidence supports an effect of androgens on the latter processes, but this effect has not been quantitated. There is a discordance in the estrogen-deficient male between skeletal growth and skeletal maturation and the accrual of bone mass and density. Estrogen synthesis by the testis is limited before puberty, and estrogen deficiency does not affect the age of pubertal onset. Estrogen deficiency in men leads to hypergonadotropism, macroorchidism, and increased testosterone levels. Estrogen lack has a significant effect on carbohydrate and lipid metabolism, and estrogen resistance was associated with evidence of premature coronary atherosclerosis in a man. These observations have highlighted the role of extraglandular estrogen synthesis and intracrine and paracrine actions. In the human, in contrast to nonprimate vertebrates, aromatase deficiency and estrogen resistance (alpha) does not seem to affect gender identity or psychosexual development. The clinical repercussions of mutations in CYP19 on the fetal-placental unit have highlighted the major role of placental aromatase in the protection of the female fetus from androgen excess, thus preventing androgen-induced pseudohermaphrodism and virilization of the mother. These features are compared with the virilization that occurs in utero in the female spotted hyena. The novel features of the aromatase deficiency syndrome in the affected female--in the fetus, during childhood, and at puberty--are discussed, including virilization at puberty and development of polycystic ovaries. The severity of the syndrome correlates with the severity of impairment of aromatase formation in expression systems. Finally, the structural consequences of missense mutations in CYP19 are described in accordance with a model of the structure of human aromatase.

Aromatase↗
PubMed1977

Clinical assessment of a profession: Roman Catholic clergymen.

The present study investigated the personality of the American Catholic priest by means of clinical procedures. It is based on a national, randomly selected, representative sample. Recorded 2-hour clinical interview plus a battery of standardized as well as specially designed psychological tests were administered to 271 Ss. A clinical report was written for each priest based on all the interview data. Four categories or types of classification were devised to describe and to distinguish the priests along a continuum of soci-psychological development: maldeveloped (8%), underdeveloped (57%), developing (29%), and developed (6%).

Adult↗
PubMed1995

Women, alcohol, and sexuality.

Alcohol consumption increases subjective sexual desire, arousal, and pleasure for many women, although it lowers physiological arousal. Despite the general belief that alcohol disinhibits female sexual behaviors, alcohol leads to changes in sexual behavior only for a minority of women. Expectancies about the effects of alcohol on sexual behavior may be important mediators of the alcohol-sexual behavior linkage. There also is a relationship between overall alcohol consumption and risky sexual behavior for women, but when alcohol use at or preceding individual instances of sexual activity is examined, there is no association in the majority of studies. Alcohol use by both perpetrators and victims has been implicated in instances of sexual victimization. Heavy alcohol consumption and alcohol problems in women are associated with heightened risk of childhood incest, sexual assault, and sexual dysfunction.

Adolescent↗
PubMed1990

Anorexia nervosa in adolescent males: a review and case study.

The clinical presentation of anorexia nervosa among males is quite rare. This paper examines the personality and developmental issues of anorexia nervosa in adolescent males through a comprehensive review of the literature and a case presentation. In addition, this paper will demonstrate the application of the empirical literature in the development of a conceptual model to identify critical diagnostic and psychotherapeutic issues within the assessment of a clinically rare case, a male adolescent with anorexia nervosa.

Adolescent↗