Clinical Management of Gender Dysphoria in Adolescents

SUMMARY

This paper aims to provide professionals working with adolescents with gender-dysphoric feelings practical clinical guidelines for diagnosis and treatment. The different phases of the assessment procedure and treatment process are described. Differential diagnostic considerations and possible psychotherapeutic treatment options are given. Physical interventions, including GnRH analogues to inhibit puberty and cross-sex hormones, are described with consideration of eligibility and readiness issues. We end with discussion of post-treatment evaluation.     

“I knew that I wasn’t cis,I knew that,but I didn’t know exactly”: Gender identity development,expression and affirmation in youth who access gender affirming medical care

Abstract

Background: Research about gender identity development is still in its infancy, especially among youth who experience gender dysphoria and are accessing gender-affirming medical care.

Aims: This article contributes to the literature on how gender identity and gender dysphoria is experienced, expressed and addressed by youth who have started, or are just about to start, a gender-affirming medical intervention.

Methods: The project draws from qualitative interviews with 36 trans children and youth of different ages and stages of puberty. The data were collected in three specialized Canadian clinics that offer gender-affirming care and they were analyzed through inductive thematic analysis.

Results: Two interlinked dimensions of the youth’s lives allow meaning-making of their gender identity: 1) internal or personal and 2) interactional or social processes. Careful analysis reveals three gender identity development pathways that may be taken by youth, from early questioning to the affirmation of their gender identity. A discussion of current models of gender identity development and their limitations concludes the article.     

The Gender Identity Reflection and Rumination Scale: Development and Psychometric Evaluation

The authors describe the development of the Gender Identity Reflection and Rumination Scale (GRRS), which measures rumination in the context of gender identity among transgender persons. GRRS items were formulated taking into account previous research on rumination, stigma stress, and identity processing. Two national U.S. samples were collected to investigate the psychometric properties of the GRRS, resulting in 3 factors of gender identity rumination: Reflection, Rumination, and Preoccupation With Others’ Perceptions.     

The Development of Gender Identity,Gender Roles,and Gender Relations in Gifted Students

This article describes the interaction of giftedness with gender identity, gender role, and gender relations. The authors explored ways in which many gifted educational practices are gendered, a model for the development of talent in the context of gender and gender relations, and ways of reducing gender inequities in the realization of potential for both male and female students. Issues that are unique to gifted individuals are aligned with suggestions for counseling interventions.     

Gender is what you look like: Emerging gender identities in young children and preoccupation with appearance

Abstract

Our work examining young children’s strong desire to wear gender-stereotypical clothing suggests that physical appearance may be early reflections of developing gender identities. We test implications of this association between gender and appearance with two studies examining young children’s preoccupation with looking pretty or handsome. Findings revealed that being more attuned to gender information was linked to greater appearance preoccupation. Girls were more preoccupied with their appearances compared to boys. Age was associated with greater appearance preoccupation in two of our three measures. These studies suggest that appearances may reflect developing gender identities, and that gender identity development can influence children’s appearance preoccupation. We suggest that future research examine the stability and generalizability of appearance preoccupation.     

The use of metaphors in understanding atypical gender identity development and its psychosocial impact

Abstract

Over the years I have found a number of metaphors which have helped me to deal with particular dynamics in therapeutic work or with group and institutional conflicts involving the Gender Identity Development Service at the Tavistock Centre. This nationwide service, which is for young people with atypical gender identity development and their families, was established in 1989. In this paper I describe some of these metaphors in relation to the particular problems or conflicts which had stimulated their appearance in my mind. The emergence of these metaphors links the vicissitudes of atypical gender identity development to issues regarding symbolisation or symbolic thinking. Metaphors such as ‘working at the edge’ or ‘navigating between Scylla and Charybdis’ allow the professional to hold on to multiple perspectives and to maintain a certain degree of ambiguity in situations in which the interpersonal dynamics can be experienced as rigid and deterministic. The emergence of metaphors can then be perceived by the professional with a sense of relief and freedom of thinking. In this paper, metaphors are linked to: the model of care developed; the therapeutic stance; and the aims, risks and pressures experienced by the professional in this area of work. The association between gender dysphoria in some young people and autistic spectrum features is explored. The paper emphasises the importance of responding flexibly to individual differences and of recognising complexity.     

青少年身体自我的发展特点和性别差异研究

对1699名青少年学生用自编具有较好信度和效度指标的身体自我量表进行测试。结果表明：青少年学生对身体的满意度从“最满意”到“最不满意”依次是负面特征、相貌特征、性特征、运动特征和身材特征,随年龄的增长其发展呈现波动性,青春期早期和中期呈明显下降趋势,青春期后期有缓慢上升;身体自我在相貌特护、身材特征、性特征、负面特征方面都存在显著的性别差异,男生比女生对身体更满意;城市学生比农村学生对自己的身体更满意。     

学前儿童性别恒常性的发展

采用改进的访谈方法,考察了3、4、5、6岁儿童的性别恒常性的发展。结果表明：3、4岁儿童已获得性别认同的能力,4、5岁儿童逐步获得性别稳定性的能力,5、6岁是性别一致性发展的快速期,大多数的6岁被试儿童已获得性别恒常性。研究还发现,在提示条件下,各年龄获得性别恒常性的被试人数大大增加;儿童对自己的性别恒常性的认知发展早于对他人,但这一差异仅表现在3岁儿童身上     

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.     

性别同一性的形成及研究角度发展

性别的同一性是自我同一性的一部分,是人格和社会化发展的重要内容。性别的同一性概念已经从性同一性转移到性别同一性。对性别同一性的研究角度经过了概念认知、图式认知和社会认知的探索,目前开始进入人际关系角度的研究。最后,提出了对性别同一性未来的研究展望。     

Managing the interactions between multiple identities in inter-organizational collaborations: an identity work perspective

Inter-organizational collaboration (IOC) research considers the achievement of a collaborative identity as a key enabler of a successful collaboration. As a result, little has been said about the interactions between collaborative and non-collaborative identities. We build on narrative identity work and positioning theory, to explore how collaboration partners engage in identity work positioning to manage the interactions of the multiple identities emerging through the process of collaboration as they try to accomplish collaborative work. We illustrate this process through a qualitative longitudinal study of an educational partnership in Greece. Our analysis shows how IOC partners manage the interactions between collaborative and non-collaborative identities by positioning themselves, and others, in narratives of collaboration as part of their daily identity work when responding to emerging collaborative needs. Our research extends our current understanding of identity work processes in IOCs by demonstrating the paradoxical nature of the collaboration, which requires relying on both collaborative and non-collaborative identities for the successful achievement of aims. We therefore suggest that identity tensions should not be resolved but rather managed, since they enable partners to respond creatively to contextual organizational changes and make sense of the collaboration as it happens.     

Racial Identity as Mediator of the Relationship Between Gender Role Conflict and Severity of Psychological Symptoms in Black, Latino, and Asian Men

The purpose of this investigation was to examine the extent to which racial identity attitudes mediate the relationship between gender role conflict and psychological symptoms in Men of Color. The mediating role of racial identity was tested in Study 1 with a sample of Black men and in Study 2 with a sample of Asian and Latino men. The results of Study 1 provided support for full mediation, whereas in Study 2 evidence was found for partial mediation. The combination of the studies' findings underscores the importance of considering the extent to which Men of Color identify with their own racial group when examining the relationship between gender role conflict and psychological symptoms.     

The Role of Racial Discrimination in the Economic Value of Education Among Urban,Low-Income Latina/o Youth: Ethnic Identity and Gender as Moderators

The present study used resilience theory to explore relationships among perceived racial discrimination, ethnic identity, gender, and economic value of education (EVE) among urban, low‐income, Latina/o youth. It was expected that racial discrimination would predict poorer perceptions of the EVE among Latina/o adolescents. Ethnic identity was hypothesized to buffer the negative effect of racial discrimination on Latina/o students’ EVE. The participants in this study were 396 urban, low‐income Latina/o high school students from a large, Midwestern city who completed surveys in both 9th‐ and 10th‐grade. Structural equation modeling was used to test the relationships among racial discrimination, ethnic identity, and EVE. Results supported a protective model of resilience. Specifically, ethnic identity served as a protective factor by buffering the negative effect of perceived racial discrimination on EVE for male participants. The present study is the first to examine ethnic identity as a buffer of racial discrimination on EVE among Latina/o high school students. Future directions and implications are discussed.     

Halloween Costume Choices: Reflections of Gender Development in Early Childhood

The author examined whether preschoolers’ Halloween costume choices reflect their gender development. The sample consisted of 110 (53 boys, 57 girls) infant through preschool-aged participants, and 1 parent of each child. Both observational methodologies and parent-report surveys were used to assess the gender-typed nature of children's Halloween costumes, information about the Halloween costume choice process, and about the children's gender development. Boys’ costumes were more masculine and girls’ costumes were more feminine. Younger children's costumes were consistently less gender typed than the older children's costumes were. Children whose parents chose their Halloween costumes for them had Halloween costumes that were less gender typed than did children who were involved in the Halloween costume decision-making process. Moreover, children's gender-typed play and desire to wear gender-stereotyped clothes were related to the gender stereotyped nature of their Halloween costume. Unexpectedly, gender typicality, a dimension of gender identity, was not related to children's Halloween costume choices. Overall, the findings support that children's Halloween costume choice is an indicator of children's gender development processes.     

Gender as an Obstacle in HIV/AIDS Prevention: Considerations for the Development of HIV/AIDS Prevention Efforts for Male-to-Female Transgenders

SUMMARY

Social discourses regarding gender are responsible for molding people's cognitions, perceptions, behaviors, and interactions with others. Approaching and understanding gender socialization is an important strategy that must be included in the development of HIV/AIDS prevention intervention efforts targeting male-to-female (MTF) transgender people.

This paper represents an effort to identify the influence of gender construction among a group of MTF transgenders in Puerto Rico. Using combined methodology, authors examined results from a questionnaire and in-depth interviews with a convenience sample of MTF transgenders living in the San Juan metropolitan area.

Quantitative analysis demonstrated that this sample is composed of young, unemployed, and undereducated population. Many participated in the sex industry. Participants reported need for basic health and social services and alienation from social networks. Qualitative analysis confirmed their traditional social construction of the “feminine.” Their discourse underlines their need to reinforce their identity by the construction of a female self which undermines their possibilities for negotiating safer sex, as happens to most females in Latino societies.

Social vulnerability, institutional exclusion, and gender construction issues are obstacles for the HIV prevention efforts among these communities.     

Ego Development at the Crossroads: Identity and Intimacy Among Black Men and White Women in Cross-Racial Relationships

This study addressed the ego development of White women and Black men who were in cross-racial relationships. Twenty-one participants completed in-depth, individual interviews, focus group inquiries, and the Sentence Completion Test (SCT). The results indicate that a majority of the participants scored at the higher levels of ego development: 50% of the Black males and 67% of the White females were at the conscientious stage of ego development, 25% of the Black males and 22% of the White females were at the individuated stage. The results from the interviews and the focus groups substantiated the participants' scores on the SCT, exemplifying the complexity in which Black men and White women perceive themselves as individuals and others in relationships. Loevinger (1976, Ego development: Conceptions and theories. San Francisco: Jossey-Bass.) contends that these higher stages represent a complex means of understanding oneself and of interacting in intimate relationships. The terms of African American heritage, African American, and Black are used synonymously and interchangeably, as are the terms of European American heritage, European American, and White.     

The place of once-weekly treatment in the work of an analytically trained child psychotherapist

In this paper, I explore how we might link ideas about clinical facts to current issues in child psychotherapy research. I consider what our understanding of clinical facts might contribute to our research methods and how our research methods might better represent the clinical facts. The paper introduces a selection of psychoanalytic writers' formulations of the concept and describes some of the debates about the shortcomings of the traditional style of case reporting. The importance of keeping emotional experience central in our research is discussed. I describe a research method that I believe has the potential to capture and describe some of the complicated processes of change in psychotherapy. This is the concept of the ‘turning point’ session. Introducing the paradigm of complexity theory, I briefly explore how we might think about and understand the relationship between processes revealed through detailed analysis of a single session and change over a longer period of therapy.     

Identity styles and causality orientations: in search of the motivational underpinnings of the identity exploration process

This study examines relationships between constructs based on two perspectives on the development of self‐governance, namely Self‐Determination Theory (SDT; Deci & Ryan, 2000) and Berzonsky's (1990) identity style model. Theoretically predictable relationships are found between the three causality orientations defined by SDT (autonomous, controlled, and impersonal) and the three identity styles proposed by Berzonsky (informational, normative, diffuse–avoidant) in a sample of Belgian late adolescents. An autonomous causality orientation is positively related to an informational identity style and negatively related to a diffuse–avoidant style. A controlled orientation is positively associated with a normative identity style, and an impersonal orientation is positively related to a diffuse–avoidant identity style. Participants' gender does not moderate these relationships. The findings suggest that the causality orientations late adolescents employ may play an important role in how actively and thoroughly they explore identity‐relevant issues. Copyright © 2005 John Wiley & Sons, Ltd.