An Evaluation of the Validity of Rorschach Popular Responses as Differentiae of Ambulatory Schizophrenia

We compared MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, &; Kaemmer, 1989) profiles of 2 groups of adult biological men requesting sex reassignment surgery; 1 group was diagnosed with Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) transsexualism and the other with gender identity disorder of adolescence and adulthood, nontranssexual type (GIDAANT). Although the mean profiles for the transsexual group did not demonstrate any psychopathology, the GIDAANT group showed moderate psychopathology. A cluster analysis indicated that 85% of the transsexual group showed low psychopathology and 47% of the GIDAANT group showed severe psychopathology. Neither the MMPI-2 results nor the DSM-III-R clinical evaluation support the conclusion of many authors that transsexualism is associated with severe personality disorder; rather, the data indicate that transsexualism and other gender identity disorders without persistent wish for sex reassignment differ significantly in degree of psychopathology.     

β2-糖蛋白Ⅰ依赖性自身抗体与自然流产的关系

为探讨β2-糖蛋白Ⅰ依赖性自身免疫抗体对自然流产病因诊断价值.将59名自然流产患者作为研究组,同时选择29名正常妊娠的产妇作为对照组.结论显示检测抗磷脂抗体能提高对自然流产患者病因诊断,β2-糖蛋白Ⅰ依赖性抗心磷脂抗体的特异性较单纯抗心磷脂抗体的特异性高,诊断妊娠丢失的病因更准确.     

Comparisons of two groups of sex-change applicants based on the MMPI

Out of 29 men asking for a sex-change, 16 reported clinical anamnesis criteria for transsexualism according to the DSM-III-R, a more restrictive diagnosis than the DSM-IV gender dysphoria diagnosis. In addition, all the subjects had taken an MMPI which, of course, did not contribute to the transsexualism diagnosis but which served to describe their personalities. The 16 subjects diagnosed as transsexual and the 13 who did not qualify for this diagnosis were compared on the basis of personality variables measured by the MMPI. Certain differences became evident. The transsexuals systematically complied to cultural stereotypes of femininity without any uneasiness, whereas the nontranssexuals could be subdivided into two groups, those with a vague sense of ill-being linked to a pronounced feminine identity or those with only a slight feminine identity and who showed no particular difficulties.     

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.     

Sex Differences in Referral Rates of Children with Gender Identity Disorder: Some Hypotheses

From 1978 through 1995, a sex ratio of 6.6:1 of boys to girls (N = 275) was observed for children referred to a specialty clinic for gender identity disorder. This article attempts to evaluate several hypotheses regarding the marked sex disparity in referral rates. The sexes did not differ on four demographic variables (age at referral, IQ, and parent's social class and marital status) and on five indices of general behavior problems on the Child Behavior Checklist; in addition, there was only equivocal evidence that boys with gender identity disorder had significantly poorer peer relations than girls with gender identity disorder. Although the percentage of boys and girls who met the complete DSM-III-R criteria for gender identity disorder was comparable, other measures of sex-typed behavior showed that the girls had more extreme cross-gender behavior than the boys. Coupled with external evidence that cross-gender behavior is less tolerated in boys than in girls by both peers and adults, it is concluded that social factors partly account for the sex difference in referral rates. Girls appear to require a higher threshold than boys for cross-gender behavior before they are referred for clinical assessment.     

MMPI-2 characteristics of transsexuals requesting sex reassignment: comparison of patients in prehormonal and presurgical phases

To assess psychopathology in transsexuals at different phases of sex reassignment, we administered the Spanish adaptation of the MMPI-2 (Avila-Espada & Jiménez-Gómez, 1999) to 107 male-to-female and 56 female-to-male transsexuals. Except for the Mf scale, mean T scores from the Clinical scales were within the normal range and did not differ between sexes. Male-to-female transsexuals seeking sex-reassignment hormonal therapy, but not female-to-male patients, scored significantly higher on the Depression, Hysteria, Psychopathic Deviate, Schizophrenia, and Social Introversion scales than patients seeking sex-reassignment surgery. The results show that the majority of patients were free of psychopathology. Transsexuals in the initial phases of sex reassignment may experience more distress than in later phases; however, these results are unlikely to reflect clinically relevant differences.     

Psycho-Social Functioning in an Individual with Gender Identity Disorder

An adult transsexual male with presenting complaints of substance dependence was taken up for the study at the All India Institute of Medical Sciences. Past history covering substance use and transsexualism was followed by psychological assessment comprising of Verbal Adult Intelligence Scale, Draw-A-Person Test, Sentence Completion Test, The Adjustment Inventory and Rorschach Psychodiagnostics. The patient presented with interpersonal difficulties and distress owing to substance use. He reported being personally comfortable with his transsexual status and sought help for sex reassignment surgery. The study directs attention towards the fact that individuals with GID are at a risk for healthy adjustment with respect to their socio- cultural set up and in coping with situations. Hence, detailed assessment of distress related to GID, the social milieu leading to acceptance/isolation of the person and co-morbid conditions (if any) is productive.     

The seventh penis: towards effective psychoanalytic work with pre‐surgical transsexuals

The author reflects on his contrasting analytic work with two transsexual patients. He uses three previous psychoanalytic studies (Stoller, Morel and Lemma) to explore whether effective analytic work with the issues driving a person's determined wish for sex reassignment surgery (SRS) is possible. Particular consideration is given to how such work might navigate a path between traumatizing and pathologizing the patient on the one hand and avoiding important analytic material out of fear of so doing on the other. The author proceeds to ask whether it is possible to tell in advance, with any degree of reliability, who is and who is not likely to benefit from surgery. He considers certain diagnostic issues in relation to these questions. Illustrations are given of how, in practice, countertransference anxieties about psychopathologizing transsexual patients can contribute to significant difficulties in working clinically with them. It is argued that the understanding and containment of such anxieties could eventually lead to more effective analytic work, and that such work might be further facilitated by considering the contribution of mind‐body dissociation to transsexualism.     

Homosexuality,Transvestism and Transsexuality: Reflections on Their Etiology and Differentiation

SUMMARY

This article was first published in The American Journal of Psychotherapy, vol. 11, 1957, pp. 80–85. Prince distinguishes three types of male who may share “the desire to wear feminine attire.” She argues that although Havelock Ellis and Magnus Hirschfeld had distinguished transvestism from homosexuality almost 50 years earlier there was still a tendency to confuse the two. Arguing that the “discovery” of transsexualism and the possibility of sex reassignment surgery had further complicated the picture, she distinguishes the homosexual and the transsexual from what she calls the “true transvestite.” True transvestites are exclusively heterosexual. They value their male organs, enjoy using them and do not want them removed.     

MMPI-2 profiles of women with eating disorders in a Dutch day treatment sample

In this study, we examined the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles of 324 Dutch patients with eating disorders at an eating disorder day treatment program. We studied the MMPI-2 profiles in 5 diagnostic eating disorder groups. All diagnostic subgroups showed high mean elevations of the T scores on the same 6 or 7 scales. Remarkable similarities existed between the mean profile configurations. The MMPI-2 distinguished especially in that patients with restricting anorexia nervosa scored lower on one Validity scale (F), two Clinical scales (1 and 2) and several Supplementary and Content scales of the MMPI-2 compared to the other groups. Only on the validity Scale L did they score higher. The MMPI-2 also distinguished patients with the bulimia nervosa purging type who scored higher on Scale 9 and different on several Content and Supplementary scales. We discuss results with regard to other studies of MMPI (Hathaway & McKinley, 1983) and MMPI-2 profiles of women with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified in inpatient and outpatient settings.     

Psychosocial Adjustment in Male-to-Female Transsexuals: An Overview of the Research Evidence

Transsexualism has been defined as an extreme gender dysphoria; it refers to unhappiness with one's biological sex and the desire to have the body of the opposite sex and to be regarded by others as a member of that other sex. Transsexualism is not a common condition, but its prevalence is not yet known. A large number of transsexuals receive hormonal treatment and sex reassignment surgery (SRS). In spite of years of poor quality research, due in part to methodological problems, recent research on surgical outcomes has provided important information. However, psychological research into transsexualism has ignored the cognitive style and psychological functioning of transsexuals, and very little effort has been made to incorporate research findings into the development of psychological treatments to improve the quality of life for transsexuals.     

MMPI results of male candidates for transsexual surgery.

The MMPI was administered to a group of 27 male transsexual candidates for sex change surgery, and their test results were compared with those of 24 male kidney transplant surgical candidates and 26 males suspected of having a psychophysiological disorder. The data revealed a notable absence of psychopathology among the transsexuals as well as the kidney patients, while the psychophysiological patients showed the expected elevations in the Hypochondriasis, Depression, and Hysteria scales. The results were in keeping with previous research of male-to-female sex change candidates that reject the notion that transsexuals invariably suffer major emotional disturbance.     

Comparative accuracy of the MMPI-2 and the MMPI-A in the diagnosis of psychopathology in 18-year-olds

Both the Minnesota Multiphasic Personality Inventory--2 (MMPI-2) and the Minnesota Multiphasic Personality Inventory--Adolescent (MMPI-A) may be administered to 18-year-olds. Each test was administered to 18-year-old participants classified as psychopathology present (PP) or psychopathology absent (PA) to assess (a) the degree of correspondence between the 2 test versions in yielding clinically elevated or nonclinically elevated profiles and (b) the relative accuracy of the 2 test versions in identifying the presence of psychopathology. The 2 tests produced profiles that were inconsistent in clinical elevation status in 70 of 152 participants (46%). All 70 participants with incongruent profiles had clinically elevated MMPI-2 scores and normal-range MMPI-A scores. Analyses of incongruent profiles obtained by PP and PA participants indicated that 18-year-olds were overpathologized by the MMPI-2 and underpathologized by the MMPI-A.     

Can sex offenders who minimize on the MMPI conceal psychopathology on the Rorschach?

Rorschach sensitivity to minimization is important in forensic evaluations of sex offenders because these individuals frequently deny psychological problems. To study Rorschach minimization, we divided alleged sex offenders according to whether they minimized on the MMPI (Hathaway & McKinley, 1943) or MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and compared their Rorschachs on indexes of distress, faulty judgment, interpersonal dysfunction, and cognitive distortions. We predicted there would be no differences between MMPI minimizers and nonminimizers on these indexes and that sex offenders of both groups would show greater psychopathology than normative adult samples. Results indicate that mini- mizers produce normal MMPI clinical profiles but still show evidence of psychopathology on the Rorschach. As predicted, sex offenders showed more Rorschach psychopathology than normative samples. Sex offenders' protocols that contained sexual content also showed perceptual distortions. These findings indicate that the Rorschach is resilient to attempts at faking good and may therefore provide valuable information in forensic settings where intentional distortion is common.     

Similarities and differences between MMPI and MMPI-2 applications to the assessment of posttraumatic stress disorder

The purpose of this study was to address the question: Is the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) comparable to the original MMPI in its applicability to the assessment of posttraumatic stress disorder (PTSD) among Vietnam combat veterans? The question was addressed by administering both the original MMPI and MMPI-2 to 29 subjects classified as meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) criteria for PTSD and comparing MMPI and MMPI-2 scores in terms of: degree of association, code-type congruence, diagnostic hit rates (when compared to two other clinical samples, and one normal sample), and congruence of the Keane PTSD Scale (PK). Results reveal highly significant correlations between MMPI and MMPI-2 basic scales for the PTSD sample as well as congruence in 2-point codes comparable to previous studies. The MMPI-2 was found to identify effectively PTSD subjects from the other groups. Results also showed a high degree of association between the MMPI and MMPI-2 in regard to PK scores, although minor differences were found in PK raw scores between the two tests. Overall, the findings suggest a high degree of comparability between the MMPI and MMPI-2 in the assessment of PTSD.     

Disinhibitory trait profile and its relation to Cluster B personality disorder features and substance use problems

Certain personality and motivational traits may present vulnerability towards disinhibitory psychopathology (e.g. antisocial personality disorder, substance abuse). Cluster analysis was used to separately group 306 women and 274 men on impulsivity, Constraint, Negative Emotionality, behavioural activation system (BAS), and behavioural inhibition system (BIS) scores. As expected, a ‘disinhibited’ group with low Constraint, high impulsivity, weak BIS, and strong BAS emerged that showed elevated drug use problems, and histrionic and antisocial personality disorder features across gender. A ‘high affectivity’ group with high Negative Emotionality and strong BIS also showed elevated drug use problems and personality disorder features. Results suggested that two different trait profiles are associated with disinhibitory psychopathology and both may present vulnerability toward the development of such disorders. Copyright © 2006 John Wiley & Sons, Ltd.     

Similarities in becoming: transsexuals and adolescents

The Gender Identity Service (located in Boston, Massachusetts) is an evaluative and counseling unit designed to provide full services including sexual reassignment to transsexuals. In that capacity, since the spring of 1972, we have seen over 120 transsexuals. During this time we have been impressed with behavioral similarities between our population of transsexuals and adolescents. This emerging observation provided impetus for the present paper. After carefully reviewing our caseload material it is our contention that indeed psychological, biological and sociological similarities do exist. Through a comparison of these, we hope not only to make transsexual behaviors more comprehensible but also to underscore the importance of the adolescent years for the development of adult gender identity. Using primarily an ego psychoanalytic approach, the paper attempts to demystify the diagnosis of transsexual by pointing to its dynamic similarities with adolescence.     

Gender identity disorder in adolescence: outcomes of psychotherapy.

Gender identity disorder (GID) is characterized by strong and persistent cross-gender identification and by persistent discomfort with one's sex. This paper reviews reports of GID in which adolescent psychotherapy patients initially desired sex reassignment. In addition, four case studies of adolescents with GID, demonstrating different outcomes of psychotherapy, are presented. It is concluded that great caution must be exercised when treating adolescents with GID, and that sex reassignment must not be started before patients have reached eighteen years of age.     

An evaluation of the usefulness of the MMPI-2 F(p) scale

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F(p) scale was developed by Arbisi and Ben-Porath (1995) by identification of 27 items endorsed by fewer than 20% of individuals in both normal and psychiatric samples. The F(p) scale was designed for applications in settings characterized by high base rates of serious psychopathology, such as psychiatric inpatient units, and is proposed as a useful scale in discriminating overreported protocols from those produced by patients with serious psychopathology. In this study we investigated the characteristics of this scale in a sample of 617 psychiatric inpatients who responded to the MMPI-2 under standard conditions, and 203 overreported protocols derived in research studies conducted with normal adult participants instructed to simulate various forms of serious psychopathology. Results of this study are consistent with prior reports of a relatively low frequency of item endorsement for F(p) scale items in psychiatric samples, and intercorrelations between the F(p) scale and the MMPI-2 basic clinical scales in clinical samples that are generally lower than those produced between either F or Fb and the basic clinical scales. However, this intercorrelational pattern between F(p) and the MMPI-2 basic scales was not as consistent for the overreported sample. Additionally, the F(p) scale appears to be effective in discriminating overreported from accurate MMPI-2 protocols, with some evidence that the optimal cutting scores for this and other MMPI-2 infrequency scales may differ as a function of gender. Finally, these findings do not show clear evidence of improved group prediction derived from the use of the F(p) scale in contrast to results obtainable through the use of the MMPI-2 F scale.