Disordered eating and gender identity disorder: a qualitative study

The association between disordered eating and gender identity was examined in a sample of 20 (11 female-to-male, 9 male-to-female) transgender Finnish adults, aged 21-62 years. Using semi-structured interviews, participants' own understanding of the underlying causes of their disordered eating was analyzed, as well as the effect of gender reassignment on eating behaviors and cognitions. A majority of the participants reported current or past disordered eating. Participants most frequently described strive for thinness as an attempt to suppress features of one's biological gender, or accentuate features of one's desired gender. Gender reassignment was primarily perceived as alleviating symptoms of disordered eating.     

Association study of gender identity disorder and sex hormone-related genes

To investigate the biological mechanism of gender identity disorder (GID), five candidate sex hormone-related genes, encoding androgen receptor (AR), estrogen receptors α (ERα) and β (ERβ), aromatase (CYP19), and progesterone receptor (PGR) were analyzed by a case–control association study. Subjects were 242 transsexuals (74 male-to-female patients (MTF) and 168 female-to-male patients (FTM)), and 275 healthy age- and geographical origin-matched controls (106 males and 169 females). The distributions of CAG repeat numbers in exon 1 of AR, TA repeat numbers in the promoter region of ERα, CA repeat numbers in intron 5 of ERβ, TTTA repeat numbers in intron 4 of CYP19, and six polymorphisms (rs2008112, rs508653, V660L, H770H, rs572698 and PROGINS) of PGR were analyzed. No significant difference in allelic or genotypic distribution of any gene examined was found between MTFs and control males or between FTMs and control females. The present findings do not provide any evidence that genetic variants of sex hormone-related genes confer individual susceptibility to MTF or FTM transsexualism.     

Identity and intimacy during adolescence: Connections among identity styles,romantic attachment and identity commitment

Integration of adult attachment and psychosocial development theories suggests that adolescence is a time when capacities for romantic intimacy and identity formation are co-evolving. The current study addressed direct, indirect and moderated associations among identity and romantic attachment constructs with a diverse sample of 2178 middle adolescents. Identity styles were found to have unique and direct associations with identity commitment. Attachment anxiety showed only indirect associations and attachment avoidance had both direct and indirect associations with identity commitment. Tests of moderation revealed that gender, race and relationship status had no influence on the direct associations of identity styles or romantic attachment with identity commitment. Few differences in association strength among identity styles and romantic attachment emerged for gender or race. However, the differences found for relationship status suggested that relationship experiences adolescents bring to their exploration of identity and intimacy matter for how these two areas of development articulate.     

The day hospital in search of its identity

After more than fifty years of existence, the day hospital remains a little known tool. Submerged in the new psychiatric landscape, between part time therapeutic care centres, home hospital care and mutual support groups, this institution, which offers appropriate care, finds itself being questioned with regard to its place, its development and its future.     

Comorbidity of Asperger syndrome and gender identity disorder

Abstract The case of a 35-yearold biological woman with Asperger syndrome (AS) and gender identity disorder (GID) fulfilling DSM-IV criteria is reported. Against the background of recently emerging theories of cognitive male pattern underlying autism we present additional psychological assessments in order to discuss any possible interaction or discrimination between AS and GID. Whilst we explain GID as a secondary feature of AS, we examine the assumption of the necessity of treating GID in AS as a primary GID in accordance with international standards. We consider the treatment of GID as compelling, particularly because curative therapy for AS is lacking and with GID treatment in this vein, the patient gains psychosocial improvement.     

Dynamics of perceived parenting and identity formation in late adolescence

Identity formation is a dynamic process of person-context interactions, and part of this context are parents, even in late adolescence. Several theories on parent-adolescent relationships share the idea that parents influence the process of identity formation. However, up to now, empirical evidence, particularly longitudinal evidence for this link is limited. Therefore, this study aims to examine short-term changes in parenting and identity formation during late adolescence and to test the transactional process involved. Moreover, we focused on gender differences. Late adolescents were measured twice with a 1-year interval. Analyses using latent change models largely showed that parenting predicted the explorative phases of identity formation (i.e., exploration in breadth and commitment making), while evaluative phases of identity formation (i.e., exploration in depth and commitment identification) predicted more supportive parenting. Gender differences emerged, with respect to both parents' and adolescents' gender. These results clearly show that parenting and identity formation are dynamically interlinked, and underscore that parents keep being an important source of socialization for their developing children, even in late adolescence.     

Adolescents with gender identity disorder: reconsideration of the age limits for endocrine treatment and surgery

The third versions of the guideline for treatment of people with gender identity disorder (GID) of the Japanese Society of Psychiatry and Neurology does not include puberty-delaying hormone therapy. It is recommended that feminizing/masculinizing hormone therapy and genital surgery should not be carried out until 18 year old and 20 year old, respectively. On the other hand, the sixth (2001) and the seventh (2011) versions of the standards of care for the health of transsexual, transgender, and gender nonconforming people of World Professional Association for Transgender Health (WPATH) recommend that transsexual adolescents (Tanner stage 2, [mainly 12-13 years of age]) are treated by the endocrinologists to suppress puberty with gonadotropin-releasing hormone (GnRH) agonists until age 16 years old, after which cross-sex hormones may be given. A questionnairing on 181 people with GID diagnosed in the Okayama University Hospital (Japan) showed that female to male (FTM) transsexuals hoped to begin masculinizing hormone therapy at age of 15.6 +/- 4.0 (mean +/- S.D.) whereas male to female (MTF) transsexuals hoped to begin feminizing hormone therapy as early as age 12.5 +/- 4.0, before presenting secondary sex characters. After confirmation of strong and persistent cross-gender identification, adolescents with GID should be treated with cross-gender hormone or puberty-delaying hormone to prevent developing undesired sex characters. These treatments may prevent transsexual adolescents from attempting suicide, being depressive, and refusing to attend school. Subsequent early breast and genital surgery may help being employed in desired sexuality.     

Diagnosis and differential diagnostic features of gender identity disorder

Gender identity disorder, or transsexualism as it is more commonly known, is a highly complex clinical entity. It is an identifiable and incapacitating disease which can be diagnosed and successfully treated by reassignment surgery. The diagnosis of gender identity disorder can be a difficult process. Transsexual patients will have to undergo extensive psychiatric assessment. The authors review the development of nosology of transsexualism. The current classification systems, symptoms and diagnostic features of gender identity disorders are discussed. The article also discusses differential diagnostic features, like intersex states, psychosis, transvestitism, autogynephilia, gynandromorphophilia, and self-amputation. The authors also discuss the problem of comorbidity, as well.     

Inpatient and day hospital treatment of the borderline: an integrated approach

An integrated treatment approach to the severely ill borderline patient is outlined. Treatment is conceptualized as a process of progression along a continuum of decreasing levels of care. This involves an inpatient, day hospital, and outpatient phase of treatment. During the treatment process, there are many progressions and regressions. The overall goal is to give the patient an increasing sense of separateness, autonomy, and self-reliance.     

Cross-sex hormone treatment does not change sex-sensitive cognitive performance in gender identity disorder patients

Cognitive performance in untreated early onset gender identity disorder (GID) patients might correspond to their born sex and not to their perceived gender. As a current mode of intervention, cross-sex hormone treatment causes considerable physical changes in GID patients. We asked, as has been suggested, whether this treatment skews cognitive performance towards that of the acquired sex. Somatically healthy male and female early onset GID patients were neuropsychologically tested before, 3 and 12 months after initiating cross-sex hormone treatment, whereas untreated healthy subjects without GID served as controls (C). Performance was assessed by testing six cognitive abilities (perception, arithmetic, rotation, visualization, logic, and verbalization), and controlled for age, education, born sex, endocrine differences and treatment by means of repeated measures analysis of variance. GID patients and controls showed an identical time-dependent improvement in cognitive performance. The slopes were essentially parallel for males and females. There was no significant three-way interaction of born sex by group by time for the six investigated cognitive abilities. Only education and age significantly influenced this improvement. Despite the substantial somatic cross-sex changes in GID patients, no differential effect on cognition over time was found between C and GID participants. The cognitive performance of cross-sex hormone-treated GID patients was virtually identical to that of the control group. The documented test–retest effect should be taken into consideration when evaluating treatment effects generally in psychiatry.     

Conduct disorder in childhood and adolescence: an update

Conduct disorder is a diagnostic entity that has elicited controversy throughout the years. Classified as a psychiatric disorder of childhood and adolescence, the syndrome of conduct disorder recently was revised from four to three categories in the DSM-III-R (Revised). This article presents an overview of conduct disorders, including diagnostic criteria, epidemiology, etiology, treatment approaches and implications for nursing practice.     

Physiological correlates of anxiety in children with gender identity disorder

Background Internalizing psychopathology, anxiety in particular, is assumed to contribute to the development of gender Identity disorder (GID). Until now, anxiety has only been reported in studies using parent-report questionnaires; physiological correlates of anxiety have not been studied. In this study we assessed anxiety and stress in children with GID by measuring their cortisol, heart rate (HR) and skin conductance levels (SCL) and asking them to repeat their moods and experience of control. Methods By using an established psychological challenge, involving provocation and frustration, we investigated whether children with GID as compared to healthy controls react in a more anxious way under these experimental circumstances. We assessed anxiety levels in 25 children with GID and 25 matched controls by measuring cortisol, HR and skin conductance and examined whether a pattern of increased physiological activity corresponded with the feeling of being less in control and having more intense negative emotions. Results The results showed that children with GID had more negative emotions and a tonically elevated SCL. There were no differences between the groups in cortisol and HR. Conclusion This is the first study that shows that children with GID have a more anxious nature as compared to their normal counterparts.