Transformation: From (Trans-)Gender Roles to Profiles.

Combining a philosophical approach with empirical psychology, this essay investigates the relationship between "profilicity," the formation of identity in orientation to profiles, and gender identity. We discuss empirical research that indicates a significant difference between transgender identity in traditional (collectivist) and modern (individualist) societies. We suggest that this difference is due to a shift in the formation of gender identity away from gender roles and toward gender profiles. To substantiate this claim, we first outline a basic theoretical terminology of identity and gender. Then, we critically analyze the representation of gender, including transgender, in contemporary popular culture. Finally-with a descriptive, but not therapeutic intention-we discuss several case studies of identity formation of transgender people. We conclude that theoretical problems arising from historical shifts in gender identity formation, including transgender identity formation, are best conceptualized in terms of profilicity rather than in the still prevailing semantics of authenticity.

[Body modifications and sexual health : Impact of tattoos, body piercing and esthetic genital plastic surgery on the sexual health of women and men]. / Körpermodifikation und sexuelle Gesundheit : Einfluss von Tattoo, Piercing und ästhetisch-plastischer Chirurgie im Genitalbereich auf die sexuelle Gesundheit von Frauen und Männern.

The present paper addresses the psychological impact of body modifications (e.g. tattoos, body piercing and esthetic genital plastic surgery) on the sexual health of individuals and refers to past and present research insights. Body modifications are understood as invasive interventions on the human body, especially interventions on the human skin which result in (semi-)permanent changes. Tattoos and body piercing (in particular genital piercing) positively affect the sexual satisfaction and the sexual appeal of men and women but there is a controversial association with high risk sexual behavior. Moreover, this article focuses on esthetic genital plastic surgery based on the increasing interest and insights of the impact on female genital self-perception and sexual behavior.

Modulation of the attentional response to baby schema by testosterone in pedohebephilic men and its relation to the nurturing system.

Previous fMRI research found increased brain responses in men with pedophilic interest to non-sexual pictures of child and animal faces. This raised the question of whether an aberrant nurturing system could be linked to pedophilia. To further explore this hypothesis, 20 pedohebephilic and 23 teleiophilic men performed a target detection task with adult versus infant human and animal faces, which measured selective attention towards the baby schema by comparing reaction times to infant versus adult targets that were presented amongst distractors of the other category. Since the response to baby schema can be influenced by steroid hormones, saliva samples were additionally collected to determine endogenous testosterone, progesterone, estradiol and cortisol. Contrary to expectations, all men did not react faster to infant than adult faces. Yet, pedohebephilic men were more distracted by infant's faces than teleiophilic men. Pedohebephilic men with higher testosterone were faster in orienting attention to infant targets in the context of adult distractors. This association was not observed in teleiophilic men. Our results support the idea of an overactive nurturing system in pedophilia, which may be influenced by the endogenous testosterone level.

Is Dating Behavior in Digital Contexts Driven by Evolutionary Programs? A Selective Review.

In recent years, millions of citizens all over the world have used digital dating services. It remains unknown to what extent human sexuality will be changed by this. Based on an evolutionary psychological perspective, we assume that sexual selection shaped behavioural tendencies in men and women that are designed to increase the reproductive fitness. These tendencies are referred to as sexual strategies. Males and females sexual strategies differ according to sex-dimorphic reproductive investments. We assume that this inheritance will affect human sexuality also in a digital future. To evaluate this assumption, we conducted a selective review of studies on digital dating services. Based on sexual selection theory, we derived a number of hypotheses regarding how men and women will use digital dating services typically and how the use of digital dating services might affect sexual wellbeing. Out of an initial data set of 2,568 records, we finally reviewed a set of 13 studies. These studies provided support for the notion that men and women act in the digital dating area according to sex-typical strategies. However, sometimes the circumstances of digital dating affect communication flow, e.g., in that men are even more active in establishing contacts than they are in real world conditions. Overall, women appear to accomplish their sexual goals in digital dating arenas more than men do given a surplus of male demand. Our results suggest that future human sexuality will be impacted by an interaction of both: sex-dimorphic ancient sexual strategies and new technologies.

Motivations for body piercings and tattoos - the role of sexual abuse and the frequency of body modifications.

Though the popularity of body modification increases, psychosocial data about practitioners of body piercing and tattooing are few and controversial. Most studies used semi-structured interviews and relatively small sample sizes. The aim of this study was to explore psychosocial background information (motivation, sexual abuse) for body modification practises based on a sufficiently large sample. A core group of 432 subjects with body piercings and/or tattoos (readers of a specialised magazine on body modification; mean age: 28 years) was investigated in this study using a 55-item questionnaire. The mean number of body modifications (piercings and tattoos) was nine. Participants with a history of sexual abuse and high users with more than 10 body modifications differed from those without these features with respect to several motivations and consequences of body modification. Participants with sexual abuse often stated that they wanted to overcome certain experiences, and high users were characterised by the feeling of an addiction to continue body modification. Clinicians should include questions on body modifications and their motives in anamnestic schedules.

Addressing Sexual Problems in German Primary Care: A Qualitative Study.

Although general practitioners (GPs) are often the first contact for patients' sexual issues, little is known about how German GPs approach, diagnose, and treat sexual problems and disorders. Therefore, the present qualitative study explores approaches and management of sexual health issues used by GPs. The sample included 16 GPs from Kiel and surroundings and Sachsen-Anhalt. The in-depth, semi-structured interviews were coded according to the qualitative content analysis by Mayring using MAXQDA. The results revealed 5 main themes, 2 of which are explored in more detail in relation to the study objective (2 and 4): (1) sexual issues that arise in general practice, (2) addressing sexuality, (3) influencing factors in doctor-patient communication about sexuality, (4) diagnosing and treating sexual dysfunctions, and (5) changes in the approach to sexuality over time. Most GPs did not routinely ask their patients about sexual problems. Common barriers included lack of time, suspected embarrassment on both sides, and fear of offending patients. Almost all GPs tended to diagnose sexual problems individually adapted to patients' issues, not following a standardized approach. Medication was offered as the main treatment for sexual problems. For complex disorders, most GPs lack sexual medicine knowledge, and they requested a better range of training courses in sexual medicine.

Distinct cortical networks for the detection and identification of human body.

In the human brain information about bodies and faces is processed in specialized cortical regions named EBA and FBA (extrastriate and fusiform body area) and OFA and FFA (occipital and fusiform face area), respectively. Here we investigate with functional magnetic resonance imaging (fMRI) the cortical areas responsible for the identification of individual bodies and the distinction between 'self' and 'others'. To this end we presented subjects with images of unfamiliar and familiar bodies and their own body. We identified separate coactivation networks for body-detection (processing body related information), body-identification (processing of information relating to individual bodies) and self-identification (distinction of self from others). Body detection involves the EBA in both hemispheres, and in the right hemisphere: the FBA and areas in the IPL (inferior parietal lobe). Body identification involves areas in the inferior frontal gyrus (IFG) of both hemispheres and in the right hemisphere areas in the medial frontal gyrus (MFG), in the cingulate gyrus (CG), in the central (CS) and the post-central sulcus (PCS), in the inferior parietal lobe (IPL) and the FBA. When the recognition of one's own body is contrasted to the identification of familiar bodies, differential activation is observed in areas of the inferior parietal lobe (IPL) and inferior parietal sulcus (IPS) of the right hemisphere, and in the posterior orbital gyrus (pOrbG) and in the lateral occipital gyrus (LOG) of the left hemisphere. Thus, identification of individual bodies and self-other distinction involve in addition to the classical occipito-parietal network a parieto-frontal network. Interestingly, the EBA shows no differential activation for distinctions between familiar or unfamiliar bodies or recognition of one's own body.

Cortical responses to self and others.

The extrastriate body area (EBA) is one among the multiple, functionally specialized regions of the human visual cortex exhibiting modulation by body-related stimuli. Here we investigate whether activation patterns differ for the perception of one's own body and the bodies of others. We used functional magnetic resonance imaging to identify body-related brain areas and to see how these areas differentiate between images of one's own body and those of others in the absence of facial or motion cues. Whole brain explorative group-level analysis identified body-related blood oxygen level dependent (BOLD) signal enhancement in five regions of the right and in one region of the left hemisphere (right: in the extrastriate visual and parietal cortex and in the precentral gyrus, left: in the extrastriate visual cortex). General linear model group-level random effects analysis of the self-other contrast revealed self-related responses in the extrastriate and parietal regions in the right hemisphere but also in the right middle frontal gyrus. These results suggest the existence of a cortical network for the extraction of body-related information and another cortical network for the extraction of self-related body information. The two networks partially overlap in the right superior and inferior parietal cortices, but are clearly segregated in the extrastriate visual cortex and in the middle frontal gyrus. In addition, we report that the classical EBA is only involved in the analysis of body-related information but not in the assignment of body identity. The latter appears to be accomplished by a network in right hemisphere comprising the fusiform body area, regions of the superior parietal lobe, the inferior parietal cortex, and the middle frontal gyrus.

Tattoos, body piercings, and self-injury: is there a connection? Investigations on a core group of participants practicing body modification.

Reliable psychosocial data about practitioners of body piercing and tattooing are few and controversial. The goal of this study was to reinvestigate the issue by studying a large sample of individuals with body modifications (BMs), focusing on the motives and relations to biographical events. A 55-item anonymous self-report questionnaire was distributed among volunteers of what is considered to be a core group of individuals wearing BMs (N=432). Results show that BMs changed the participants' attitude toward their body considerably, and 34% of all participants reported BM practices in conjunction with decisive biographical events. Twenty-seven percent of the participants admitted self-cutting during childhood. This group differed from the group without self-cutting with respect to several features before, during, and after BM. The rate of medical complications of BM was 16% in the total sample, with a remarkably higher rate (26%) among participants with a history of self-cutting. The data suggest that the significance of BMs ranges from simple peer group imitations to highly informative symptoms of possibly severe psychopathological conditions. In the latter case, BMs sometimes serve as therapeutic substitutes.

Brain activity elicited by viewing pictures of the own virtually amputated body predicts xenomelia.

BACKGROUND: Xenomelia is a rare condition characterized by the persistent desire for the amputation of physically healthy limbs. Prior studies highlighted the importance of superior and inferior parietal lobuli (SPL/IPL) and other sensorimotor regions as key brain structures associated with xenomelia. We expected activity differences in these areas in response to pictures showing the desired body state, i.e. that of an amputee in xenomelia. METHODS: Functional magnetic resonance images were acquired in 12 xenomelia individuals and 11 controls while they viewed pictures of their own real and virtually amputated body. Pictures were rated on several dimensions. Multivariate statistics using machine learning was performed on imaging data. RESULTS: Brain activity when viewing pictures of one's own virtually amputated body predicted group membership accurately with a balanced accuracy of 82.58% (p = 0.002), sensitivity of 83.33% (p = 0.018), specificity of 81.82% (p = 0.015) and an area under the ROC curve of 0.77. Among the highest predictive brain regions were bilateral SPL, IPL, and caudate nucleus, other limb representing areas, but also occipital regions. Pleasantness and attractiveness ratings were higher for amputated bodies in xenomelia. CONCLUSIONS: Findings show that neuronal processing in response to pictures of one's own desired body state is different in xenomelia compared with controls and might represent a neuronal substrate of the xenomelia complaints that become behaviourally relevant, at least when rating the pleasantness and attractiveness of one's own body. Our findings converge with structural peculiarities reported in xenomelia and partially overlap in task and results with that of anorexia and transgender research.

Sexual Responses Are Facilitated by High-Order Contextual Cues in Females but Not in Males.

Sexual responses are thought to be controlled by a brain module called the sexual module. Sexual strategies of males and females vary to a great extent, and sexual responses of males and females may be affected by their sexual strategies. However, the current view of the sexual module is that of a unisex module. This might be questionable since brain modules are defined as evolved cognitive mechanisms to solve adaptive problems which are different for males and females. We hypothesize that the sexual module responds differently in the presence of complex (high-order) contextual cues that are related to gender-dimorphic sexual strategies in males and females. We conducted a priming experiment in which stimuli related to sexual strategies were disentangled from their sexual meaning. Nonsexual priming pictures related to either economic resources or social interactions preceded a sexual-target picture in order to test whether the primes were able to modulate the subjective sexual response to the sexual target. In a control condition, priming pictures without relation to mating preferences but with similar emotional impact were presented. In males, sexual responses were similar in the experimental and control conditions. In females, however, primes related to economic resources or social interactions modulated sexual arousal significantly more than the control primes. Our findings suggest that brain modules dedicated to process the experimental primes were functionally connected with the sexual module in females more than in males, making females' sexual responses more prone to the impact of high-order cultural cues than males' sexual responses. A gender-dimorphic connectivity of the sexual module may be the way in which gender-dimorphic sexual strategies are implemented in the human mind.

An Overwhelming Desire to Be Blind: Similarities and Differences between Body Integrity Identity Disorder and the Wish for Blindness.

BACKGROUND: The urge to be permanently blind is an extremely rare mental health disturbance. The underlying cause of this desire has not been determined yet, and it is uncertain whether the wish for blindness is a condition that can be included in the context of body integrity identity disorder, a condition where people feel an overwhelming need to be disabled, in many cases by amputation of a limb or through paralysis. OBJECTIVE: The aim of this study is to test the hypothesis that people with a desire for blindness suffer from a greater degree of visual stress in daily activities than people in a healthy visual control group. METHOD: We created a Likert scale questionnaire to measure visual stress, covering a wide range of everyday situations. The wish for blindness is extremely rare and worldwide only 5 people with an urge to be blind were found to participate in the study (4 female, 1 male). In addition, a control group of 35 (28 female, 7 male) visually healthy people was investigated. Questions addressing issues that may be experienced by participants with a desire to be blind were integrated into the questionnaire. RESULTS: The hypothesis that people with a desire for blindness suffer from a significantly higher visual overload in activities of daily living than visually healthy subjects was confirmed; the significance of visual stress between these groups was p < 0.01. In addition, an interview with the 5 affected participants supported the causal role of visual overload. CONCLUSIONS: The desire for blindness seems to originate from visual overload caused by either ophthalmologic or organic brain disturbances. In addition, psychological reasons such as certain personal character traits may play an active role in developing, maintaining, and reinforcing one's desire to be blind.

Decoding Pedophilia: Increased Anterior Insula Response to Infant Animal Pictures.

Previous research found increased brain responses of men with sexual interest in children (i.e., pedophiles) not only to pictures of naked children but also to pictures of child faces. This opens the possibly that pedophilia is linked (in addition to or instead of an aberrant sexual system) to an over-active nurturing system. To test this hypothesis we exposed pedophiles and healthy controls to pictures of infant and adult animals during functional magnetic resonance imaging of the brain. By using pictures of infant animals (instead of human infants), we aimed to elicit nurturing processing without triggering sexual processing. We hypothesized that elevated brain responses to nurturing stimuli will be found - in addition to other brain areas - in the anterior insula of pedophiles because this area was repeatedly found to be activated when adults see pictures of babies. Behavioral ratings confirmed that pictures of infant or adult animals were not perceived as sexually arousing neither by the pedophilic participants nor by the heathy controls. Statistical analysis was applied to the whole brain as well as to the anterior insula as region of interest. Only in pedophiles did infants relative to adult animals increase brain activity in the anterior insula, supplementary motor cortex, and dorsolateral prefrontal areas. Within-group analysis revealed an increased brain response to infant animals in the left anterior insular cortex of the pedophilic participants. Currently, pedophilia is considered the consequence of disturbed sexual or executive brain processing, but details are far from known. The present findings raise the question whether there is also an over-responsive nurturing system in pedophilia.

Neuronal correlates of colour-graphemic synaesthesia: a fMRI study.

Synaesthesia is a perceptual phenomenon in which specific events in one sensory modality induce experiences in another. In colour-graphemic synaesthesia, subjects report colour experiences induced by written letters. Our subjects displayed this type of synaesthesia, as verified by a test of the consistency of the perceptual associations over time, and had no history of neurological or psychiatric disorders. We investigated the hypothesis that the synaesthetic colour experience is accompanied by an activation of the human colour area (V4/V8) using functional magnetic resonance imaging (fMRI). With retinotopic and colour mapping we could confirm that colour stimuli specifically activate area V4/V8. For the study of colour-graphemic synaesthesia we used an AB boxcar design with blocks of letters that elicited a synaesthetic colour experience (condition A) alternating with blocks of letters that did not (condition B). In both hemispheres condition A led to a significantly higher activation of V4/V8 than condition B. These findings support the hypothesis that the grapheme-induced colour perception in synaesthesia is caused by an activation of the colour areas of the human visual cortex.

Prevalence of tattooing and body piercing in Germany and perception of health, mental disorders, and sensation seeking among tattooed and body-pierced individuals.

OBJECTIVE: The objective of this study was to obtain data on the incidence and relationship of psychological factors to tattooing and body piercing from a large and representative sample of German citizens (N=2043). METHODOLOGY: Representative data (sample age range=14-93 years) were evaluated with respect to health-related quality of life (SF-36), mental health (General Health Questionnaire), mental disorders (Patient Health Questionnaire), and sensation seeking (Arnett Inventory of Sensation Seeking). RESULTS: The prevalence of tattooing and that of body piercing in the general German population are 8.5% and 6.5%, respectively. Individuals aged between 14 and 24 years display the highest rate of body piercings or tattoos (females, 41%; males, 27%). Within the group of individuals aged between 14 and 44 years, unemployment and nonaffiliation to a church are positively correlated, tattooing is significantly correlated with the perception of reduced mental health, and both tattooing and body piercing are correlated with significantly increased sensation-seeking behavior. CONCLUSIONS: Next to being motivated by fashion and the urge to fit in with one's peers, the major reasons for body modification practices in the German population appear to be negatively perceived conditions of life, reduced social integration, and increased sensation-seeking behavior.

Assessing paedophilia based on the haemodynamic brain response to face images.

OBJECTIVES: Objective assessment of sexual preferences may be of relevance in the treatment and prognosis of child sexual offenders. Previous research has indicated that this can be achieved by pattern classification of brain responses to sexual child and adult images. Our recent research showed that human face processing is tuned to sexual age preferences. This observation prompted us to test whether paedophilia can be inferred based on the haemodynamic brain responses to adult and child faces. METHODS: Twenty-four men sexually attracted to prepubescent boys or girls (paedophiles) and 32 men sexually attracted to men or women (teleiophiles) were exposed to images of child and adult, male and female faces during a functional magnetic resonance imaging (fMRI) session. RESULTS: A cross-validated, automatic pattern classification algorithm of brain responses to facial stimuli yielded four misclassified participants (three false positives), corresponding to a specificity of 91% and a sensitivity of 95%. CONCLUSIONS: These results indicate that the functional response to facial stimuli can be reliably used for fMRI-based classification of paedophilia, bypassing the problem of showing child sexual stimuli to paedophiles.

The (in)consistency of changes in brain macrostructure in male paedophiles: A combined T1-weighted and diffusion tensor imaging study.

Thus far, four studies have used magnetic resonance imaging (MRI) to test for differences in brain structure between paedophilic (i.e. sexually attracted to pre-pubescent children) and teleiophilic (i.e. sexually attracted to adults) men, revealing divergent results. To re-examine this issue, we acquired high resolution structural T1-weighted and diffusion MRI scans of the brain in 24 paedophilic and 32 teleiophilic men. We performed voxel-based morphometry (VBM) of the T1-weighted images and tract-based spatial statistics (TBSS) of the diffusion tensor imaging data to search for grey and white matter differences between groups. In contrast to previous studies, less than half of the individuals in our paedophilic group had a record of sexual offences against children, as subjects were partially recruited from two outpatient facilities of a child sexual abuse prevention project for self-acknowledged paedophiles. After adjustment for multiple comparisons and controlling for important confounding factors, we did not find any significant grey or white matter differences between the paedophilic and teleiophilic subjects. Together with the inconsistencies in the literature, these results argue against consistent structural differences at the macroanatomical scale between paedophiles and teleiophiles.

Maintenance cognitive-behavioral therapy and manualized psychoeducation in the treatment of recurrent depression: a multicenter prospective randomized controlled trial.

OBJECTIVE: This multicenter study compared the relapse and recurrence outcomes of two active treatments, maintenance cognitive-behavioral therapy (CBT) and manualized psychoeducation, both in addition to treatment as usual, in patients in remission from depression. METHOD: This was a multicenter prospective randomized observer-blinded study with two parallel groups. The authors assessed 180 patients with three or more previous major depressive episodes who met remission criteria over a 2-month baseline period and who were randomly assigned to 16 sessions of either maintenance CBT or manualized psychoeducation over 8 months and then followed up for 12 months. The main outcome measure was time to first relapse or recurrence of a major depression, based on DSM-IV criteria, as assessed by blinded observers with the Longitudinal Interval Follow-Up Evaluation. RESULTS: Cox regression analysis showed that time to relapse or recurrence of major depression did not differ significantly between treatment conditions, but a significant interaction was observed between treatment condition and number of previous episodes (<5 or ≥5). Within the subsample of patients with five or more previous episodes, maintenance CBT was significantly superior to manualized psychoeducation, whereas for patients with fewer than five previous episodes, no significant treatment differences were observed in time to relapse or recurrence. CONCLUSIONS: The results indicate that maintenance CBT has significant effects on the prevention of relapse or recurrence only in patients with a high risk of depression recurrence. For patients with a moderate risk of recurrence, nonspecific effects and structured patient education may be equally effective.

[Body integrity identity disorder--first success in long-term psychotherapy]. / Body Integrity Identity Disorder: Erste Erfolge in der Langzeitpsychotherapie.

OBJECTIVE: The Body Integrity Identity Disorder (BIID) is a fairly unknown and unexplored psychic illness. Very little cases underwent a psychotherapeutic treatment. METHODS: We report on the two-and-a-half year psychotherapy with a 37 years old man, who wants an amputation of his two legs. RESULTS: Origin and meaning of the amputation desire were uncovered in psychotherapy. CONCLUSIONS: The psychodynamic oriented therapy with cognitive-behavioral elements can be used to develop further treatment approaches.

[Prevalence, sociodemography, mental health and gender differences of tattooing and body piercing]. / Prävalenz, Soziodemografie, mentale Gesundheit und Geschlechtsunterschiede bei Piercing und Tattoo.

OBJECTIVE: To obtain representative data on incidence and psychological background of tattooing and body piercing. METHOD: Prevalence of tattooing and body piercing is derived from a representative survey (N = 2043, age 14-93 years). Data are evaluated with respect to mental health (GHQ), Beck Depression Inventory (BDI) and sensation-seeking (AISS). RESULTS: The total prevalence of tattoo and piercing is 8.5 % and 6.8 %, respectively. In the age 14-44 15 % are tattooed and 14 % are pierced. Unemployment and lack of partnership correlate positively with body modifications. Tattooing correlates with the perception of reduced mental health and both, tattooing and body piercing correlate highly with increased "Sensation-Seeking" behaviour. DISCUSSION: Gender specific investigations show a differentiated picture background for body modifications.