The psychoanalytic treatment of a preschool boy with a gender identity disorder

A three-year, nine-month-old boy began analysis by wishing he was a girl and pretending he was a superheroine. Over the course of almost five years, the cross-gender defense against fear of loss of the object, anal loss, and castration by the object reorganized in all libidinal phases through early latency. Developmental arrests seemed to occur during the anal rapprochement and oedipal phases that led to observable cross-gender strivings by two and a half years of age. The role of early childhood illness, narcissistic vulnerability, mother's childhood wish for a sister, the mother's adult wish for a daughter, a shared fantasy between mother and child, identification with the perceived power and beauty of mother and grandmother, pathological sibling rivalry that influenced identification with his sister, were demonstrated in his play during sessions. Interwoven in the background was the impact of an emotionally absent father, a dying grandfather, and an accident-prone uncle. This paternal matrix seemed to discourage budding masculinity and encourage feminine identifications. The analyst's approach and the child's responses to interpretation of the transference manifestations, cross-gender behavior, fantasies, and play are presented. Finally, the gradual resolution of the conflicted wish to be a girl was supplanted by the emergence of appropriate gender identification. A two-year followup appeared to confirm his postanalytic gender stance and continuing consolidation of stable gender development.     

Effects of neutral toys on sex-typed play in children with gender identity disorder

This study assessed the relative influences of approach and avoidance behaviors toward same-sex and cross-sex toys in the play of children with gender identity disorder and in normal boys, normal girls, and psychiatric controls. Three forced-choice situations with toys and three forced-choice situations with dress-up apparel were presented that paired same-sex and cross-sex stimuli, same-sex and neutral stimuli, and cross-sex and neutral stimuli. In the same-sex/cross-sex situation, the gender-disordered group played a significantly shorter time with the same-sex stimuli and a significantly longer time with the cross-sex stimuli than the normal boys and the psychiatric controls, whereas the play patterns of the normal girls fell in between that of the gender-disordered group and the other two control groups. Within-groups analyses showed that the normal boys and the psychiatric controls preferred the same-sex toys, whereas the gender-disordered group and the normal girls showed no preference. When the neutral toys were the alternative, avoidance of cross-sex toys appeared to be stronger than the attraction to same-sex toys in the normal boys and in the psychiatric controls. The relative influence of approach-avoidance tendencies was more equivocal in the gender-disordered group, though they appeared to have a weaker attraction to same-sex toys and less avoidance of cross-sex toys in comparison with the normal boys and the psychiatric controls. The approach-avoidance patterns of the normal girls fell in between that of the gender-disordered group and the other two control groups.     

Sex-typed responses in the Rorschach protocols of children with gender identity disorder.

A coding system was developed to measure sex-typed responses in the Rorschach protocols of children with gender identity disorder (n = 79). Their responses were compared to that of sibling (n = 25), psychiatric (n = 26), and normal (n = 28) controls. Results show that children with gender identity disorder gave significantly more cross-sex responses than same-sex responses, whereas the psychiatric and normal controls gave significantly more same-sex responses than cross-sex responses. The siblings did not differ in the number of same-sex and cross-sex responses. Results are discussed with regard to various assessment issues in the study of children with gender identity disorder.     

A twenty-five year follow-up study of ten exceptionally creative adolescent girls

A 25-yr. follow-up of 10 women identified as highly creative during adolescence indicated that most believed they had actualized their creative potential to a moderately high degree. However, only one woman stated that creative expression was a dominant life theme and primary commitment. Factors that facilitate and inhibit creativity over a lifetime are discussed.     

Assessing multiple facets of gender identity: the gender identity questionnaire.

314 men and 451 women participated in a study to assess the reliability and validity of the multifaceted Gender Identity Questionnaire. Reliability coefficients of the (sub)scales varied between .67 and .80; content, criterion, and construct validity were satisfactory.     

A follow-up study of cognitive bias in generalized anxiety disorder

Patients with generalized anxiety disorder (GAD) without concurrent depression (n = 11) and normal controls (n = 17) were tested twice, about 2 months apart, on a modified Stroop colour-naming task, which presented anxiety-related, depression-related and neutral words in masked and unmasked exposure conditions. GAD patients received cognitive behaviour therapy in the test-retest interval, and were also retested at follow-up, about 20 months after initial testing. GAD patients showed interference in colour-naming negative words across both masked and unmasked conditions before treatment, but not post-treatment, compared with controls. Reduced interference effects of masked threat words over time correlated with reduced ratings of anxious thoughts at post-treatment, and at follow-up, in GAD patients. Thus, the preconscious bias for threat information in GAD appears to vary over time in association with changes in anxious thoughts and worries.     

Psychologists' representations of gender identity between Spain and Greece: A qualitative cross-cultural study

Trans people's relationship with mental health providers carries historical tensions. Counseling services have been tied to standardized procedures or diagnostic certification of dysphoria and gender evaluations, while other psychosocial demands have been largely disregarded. Moreover, protocols and approaches focus disproportionately on Anglo-American frameworks, in terms of epistemic resources established to describe gender-diverse experiences. These issues affect both representations of gender identity and attitudes toward counseling. The present study aimed to address psychologists' accounts cross-culturally, by using qualitative data acquired through interviews with active practitioners from Spain and Greece. Eighteen qualitative semi-structured interviews were conducted in both countries in order to delve into the narratives related to trans mental health care provision. Thematic analysis using Atlas.ti was used to systematize the data. The accounts centered on gender identity representations and attributions, attitudes toward counseling, relationship with diagnoses, psychological approaches, and competent training. Findings point to the need for all-encompassing, obligatory training of psychologists on trans mental health, followed by situated considerations of the contextual factors that may contribute to experiencing gender diversity differently. More cross-cultural qualitative accounts are thus encouraged, to enrich and update the upcoming trans literature on the matter.     

Three years follow-up of panic disorder patients: A naturalistic study

Forty Danish panic disorder patients participating in a placebo controlled study of alprazolam and imipramine (The Cross National Collaborative Panic Study, Phase II) were followed up by a telephone interview three years later, with essentially the same battery of evaluation procedures applied at baseline, end of study, and follow-up. The main finding was that panic disorder is a chronic disorder, but fluctuating in form and severity in the course of time. Twenty-five percent of the patients no longer fulfilled the DSM-III criteria for panic disorder, but had substantial disability due to a variety of symptoms, including panic attacks at infrequent rate, generalized anxiety symptoms, affective symptoms, and phobic avoidance behavior. Nearly three fourths of the patients were under treatment at follow-up. Benzodiazepines were the drugs most often prescribed, usually in combination with supportive psychotherapy. It was concluded that the different types of treatment offered were insufficient. Variables predicting panic disorder or substantial disability at 3-years follow-up were few.     

The theory of gender identity disorders

Experience with more than 500 patients over the last decade has led to the conclusion that the quest for sex reassignment is a symptomatic compromise formation serving defensive and expressive functions. The symptoms are the outgrowth of developmental trauma affecting body ego and archaic sense of self and caused by peculiar symbiotic and separation-individuation phase relationships. The child exists in the pathogenic (and reparative) maternal fantasy in order to repair her body image and to demonstrate the interconvertability of the sexes. Gender identity exists not as a primary phenomenon, but in a sense as a tertiary one. There is, no doubt, a tendency to gender-differentiate in a way concordant with biological endowment. Nevertheless, gender formation is seriously compromised by earlier psychological difficulty. Gender identity is a fundamental acquisition in the developing personality, but it is part of a hierarchical series beginning with archaic body ego, early body image, and primitive selfness, representing their extension into sexual and reproductive spheres. Gender identity consolidates during separation-individuation and gender pathology bears common features with other preoedipal syndromes. Transsexualism is closely linked to perversions, and the clinical syndromes may shade from one into another. However, what is kept at the symbolic level in the perversions must be made concrete in transsexualism. In this regard there is a close relation to psychosis. The clinical complaint of the transsexual is a condensation of remarkable proportions. When the transsexual says that he is a girl trapped in a man's body, he sincerely means what he says. As with other symptoms, however, it takes a long time before he begins to say what he means.     

Fighting like a girl fighting like a guy: gender identity, ideology, and girls at early adolescence

In this chapter we explore the phenomenon of "girls fighting like guys" by listening to adolescent girls' justification for physical fighting with other girls. We argue that physical girlfighting is a particular kind of gendered performance--a performance of identity that expresses, at least in part, an answer to the question, "Who am I?"--that both perpetuates and challenges the usual notions of masculinity and femininity and the differential power associated with these discourses. We present a sociocultural approach to identity that we believe not only holds promise for helping us to understand girl-fighting behavior but also highlights the clear interrelationship between social identity and personal identity. We conclude by highlighting several implications of this analysis for those who work with girls (and boys) in educational and clinical settings.     

Long-term stability of cognitive behavioral therapy effects for panic disorder with agoraphobia: A two-year follow-up study

Objective

Cognitive-behavioral therapy (CBT) aims to help patients establish new behaviors that will be maintained and adapted to the demands of new situations. The long-term outcomes are therefore crucial in testing the durability of CBT.

Method

A two-year follow-up assessment was undertaken on a subsample of n = 146 PD/AG patients from a multicenter randomized controlled trial. Treatment consisted of two variations of CBT: exposure in situ in the presence of the therapist (T+) or on their own following therapist preparation (T−).

Results

Both variations of CBT had high response rates and, overall, maintained the level of symptomatology observed at post-treatment with high levels of clinical significance. Effect sizes 24 months following treatment were somewhat lower than at the 6-month follow up. Once patients reached responder status, they generally tended to remain responders at subsequent assessments. Differences were observed for patients that obtained additional treatment during the follow-up period. Expert opinion and subjective appraisal of treatment outcome differed. No robust baseline predictors of 2-year outcome were observed.

Conclusion

Most patients maintain clinically meaningful changes two years following treatment across multiple outcome measures. Approximately 1/3 of patients continued to experience meaningful residual problems.     

Emotion,gender, and gender typical identity in autobiographical memory

Gender differences in the emotional intensity and content of autobiographical memory (AM) are inconsistent across studies, and may be influenced as much by gender identity as by categorical gender. To explore this question, data were collected from 196 participants (age 18–40), split evenly between men and women. Participants narrated four memories, a neutral event, high point event, low point event, and self-defining memory, completed ratings of emotional intensity for each event, and completed four measures of gender typical identity. For self-reported emotional intensity, gender differences in AM were mediated by identification with stereotypical feminine gender norms. For narrative use of affect terms, both gender and gender typical identity predicted affective expression. The results confirm contextual models of gender identity (e.g., Diamond, 2012 Diamond, L. M. (2012). The desire disorder in research on sexual orientation in women: Contributions of dynamical systems theory. Archives of Sexual Behavior, 41, 73–83. doi: 10.1007/s10508-012-9909-7[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]. The desire disorder in research on sexual orientation in women: Contributions of dynamical systems theory. Archives of Sexual Behavior, 41, 73–83) and underscore the dynamic interplay between gender and gender identity in the emotional expression of autobiographical memories.