Behavior Problems and Psychiatric Diagnoses in Girls with Gender Identity Disorder: A Follow-Up Study.

This study evaluated the presence of clinical range behavior problems and psychiatric diagnoses in 25 girls referred for gender identity disorder (GID) in childhood (mean age: 8.88 years) at the time of follow-up in adolescence or adulthood (mean age: 23.2 years). At follow-up, three (12%) of the girls were judged to have persistent GID based on DSM-IV criteria. With regard to behavior problems at follow-up, 39.1% of the girls had a clinical range score on either the Child Behavior Checklist or Adult Behavior Checklist as rated by their mothers, and 33.3% had a clinical range score on either the Youth Self-Report or the Adult Self-Report. On either the Diagnostic Interview for Children and Adolescents or the Diagnostic Interview Schedule, the girls had, on average, 2.67 diagnoses (range: 0-10); 46% met criteria for three or more diagnoses. From the childhood assessment, five variables were significantly associated with a composite Psychopathology Index (PI) at follow-up: a lower IQ, living in a non-two-parent or reconstituted family, a composite behavior problem index, and poor peer relations. At follow-up, degree of concurrent homoeroticism and a composite index of gender dysphoria were both associated with the composite PI. Girls with GID show a psychiatric vulnerability at the time of follow-up in late adolescence or adulthood, although there was considerable variation in their general well-being.

"I am not a friend to men": Embodiment and desire in Magnus Hirschfeld's Transvestites case studies.

This article reads sexological case studies of the fin-de siècle that contain accounts of trans women's lives in the period. It argues that these sources contradict the diagnostic criteria that doctors determine as the factors that define trans feminine identity in the period: desire for men, social isolation, and tortured bodily dissatisfaction. Chief among these contradictions is the prevalence of the expression of trans women's desire for women and easy participation in women's social and kinship networks. Therefore, this article considers these narratives to be a crucial and overlooked resource for considering the breadth of lesbian identity and sociality in the late nineteenth and early twentieth century.

Sexual Arousal Patterns of Autogynephilic Male Cross-Dressers.

Men's sexual arousal patterns have been an important window into the nature of their erotic interests. Autogynephilia is a natal male's paraphilic tendency to be sexually aroused by the thought or image of being a woman. Autogynephilic arousal per se is difficult to assess objectively, because it is inwardly focused. However, assessing sexual arousal patterns of autogynephilic males in response to external stimuli is also potentially useful. For example, there is substantial association between autogynephilia and gynandromorphophilia (GAMP), or sexual attraction to gynandromorphs (GAMs), colloquially "she-males." GAMP men's sexual arousal patterns in response to GAM, female, and male stimuli have recently been characterized. In the present study, we extended this understanding by comparing the sexual arousal patterns of autogynephilic male cross-dressers, GAMP men, heterosexual men, and homosexual men. Erotic stimuli included sexually explicit videos of men, women, and GAMs. Autogynephilic men were much more similar in their arousal patterns to heterosexual and GAMP men than to homosexual men. However, similar to GAMP men, autogynephilic men showed increased arousal by GAM stimuli relative to female stimuli compared with heterosexual men.

Cases of violence involving transvestites and transsexuals in a northeastern Brazilian city. / Situações de violência contra travestis e transexuais em um município do nordeste brasileiro.

Objective To analyze cases of violence against transvestites and transsexuals based on their sociodemographic profile. Method Cross-sectional, descriptive research performed in Cajazeiras / Paraíba, consisting of 16 transvestites and transsexuals. Data collection took place in April 2014 and was analyzed descriptively. Results The typology of violence that victimized transvestites and transsexuals were: verbal (91.96%), psychological (58.33%) and physical (33.33%), often between 24 hours and six months preceding the survey. Regarding the spatiality: the street, school and health services were all scenarios of aggression. With respect to the offending agent, the findings point towards neighbors, family members and health professionals. All forms of violence happened between agents and spaces of aggression. Conclusions Violence among this population, silence around the situations of abuse became more pronounced as did its invisibility in the social and institutional context, reflecting the inhibition of human rights and concealment of reality.

The Psychometric Structure of Items Assessing Autogynephilia.

Autogynephilia, or paraphilic sexual arousal in a man to the thought or image of himself as a woman, manifests in a variety of different behaviors and fantasies. We examined the psychometric structure of 22 items assessing five known types of autogynephilia by subjecting them to exploratory factor analysis in a sample of 149 autogynephilic men. Results of oblique factor analyses supported the ability to distinguish five group factors with suitable items. Results of hierarchical factor analyses suggest that the five group factors were strongly underlain by a general factor of autogynephilia. Because the general factor accounted for a much greater amount of the total variance of the 22 items than did the group factors, the types of autogynephilia that a man has seem less important than the degree to which he has autogynephilia. However, the five types of autogynephilia remain conceptually useful because meaningful distinctions were found among them, including differential rates of endorsement and differential ability to predict other relevant variables like gender dysphoria. Factor-derived scales and subscales demonstrated good internal consistency reliabilities, and validity, with large differences found between autogynephilic men and heterosexual male controls. Future research should attempt to replicate our findings, which were mostly exploratory.

Men's sexual interest in children: one-year incidence and correlates in a population-based sample of Finnish male twins.

In a study of 1,310 Finnish adult male twins we found that sexual interest in children aged 12 or younger was reported by 0.2% of the sample. Sexual interest in children aged 15 or younger was reported by 3.3%. Participants reporting sexual interest in children aged 15 or younger were younger, reported stronger sexual desire, and had experienced more childhood sexual and nonsexual abuse. The present study is the first to give a population-based estimate of the incidence of sexual interest in children among adult men. The 12-month incidence of sexual interest in children below the age of 16 years is roughly comparable to the one-year incidence of major depression or the lifetime prevalence of transvestitic fetishism.

Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism.

This study provided a descriptive and quantitative comparative analysis of data from an assessment protocol for adolescents referred clinically for gender identity disorder (n = 192; 105 boys, 87 girls) or transvestic fetishism (n = 137, all boys). The protocol included information on demographics, behavior problems, and psychosexual measures. Gender identity disorder and transvestic fetishism youth had high rates of general behavior problems and poor peer relations. On the psychosexual measures, gender identity disorder patients had considerably greater cross-gender behavior and gender dysphoria than did transvestic fetishism youth and other control youth. Male gender identity disorder patients classified as having a nonhomosexual sexual orientation (in relation to birth sex) reported more indicators of transvestic fetishism than did male gender identity disorder patients classified as having a homosexual sexual orientation (in relation to birth sex). The percentage of transvestic fetishism youth and male gender identity disorder patients with a nonhomosexual sexual orientation self-reported similar degrees of behaviors pertaining to transvestic fetishism. Last, male and female gender identity disorder patients with a homosexual sexual orientation had more recalled cross-gender behavior during childhood and more concurrent cross-gender behavior and gender dysphoria than did patients with a nonhomosexual sexual orientation. The authors discuss the clinical utility of their assessment protocol.

A further assessment of Blanchard's typology of homosexual versus non-homosexual or autogynephilic gender dysphoria.

In a series of important but now highly controversial articles, Blanchard examined associations of sexual orientation and transvestic fetishism among male-to-female (MTF) transgender persons in Toronto, Canada. Transvestic fetishism was rare among the homosexuals but prevalent among the non-homosexuals. Subtypes of non-homosexual MTFs (heterosexual, bisexual, and asexual) were consistently high with regard to transvestic fetishism. Non-linear associations of a continuous measurement of sexual attraction to women (gynephilia) and transvestic fetishism were interpreted in terms of an etiological hypothesis in which transvestic fetishism interferes with the early development of heterosexuality. Blanchard concluded that homosexual versus non-homosexual sexual orientation is a dominant and etiologically significant axis for evaluating and understanding this population. We further assessed these findings among 571 MTFs from the New York City metropolitan area. Using the Life Chart Interview, multiple measurements of transvestic fetishism were obtained and classified as lifetime, lifecourse persistent, adolescent limited, and adult onset. Large (but not deterministic) differences in lifetime, lifecourse persistent, and adolescent limited transvestic fetishism were found between the homosexuals and non-homosexuals. Contrary to Blanchard, differences in transvestic fetishism were observed across subtypes of the non-homosexuals, and linear (not curvilinear) associations were found along a continuous measurement of gynephilia and transvestic fetishism. Age and ethnicity, in addition to sexual orientation, were found to be statistically significant predictors of transvestic fetishism. The clinical, etiological, and sociopolitical implications of these findings are discussed.

Autogynephilia: an underappreciated paraphilia.

Autogynephilia is defined as a male's propensity to be sexually aroused by the thought of himself as a female. It is the paraphilia that is theorized to underlie transvestism and some forms of male-to-female (MtF) transsexualism. Autogynephilia encompasses sexual arousal with cross-dressing and cross-gender expression that does not involve women's clothing per se. The concept of autogynephilia defines a typology of MtF transsexualism and offers a theory of motivation for one type of MtF transsexualism. Autogynephilia resembles a sexual orientation in that it involves elements of idealization and attachment as well as erotic desire. Nearly 3% of men in Western countries may experience autogynephilia; its most severe manifestation, MtF transsexualism, is rare but increasing in prevalence. Some theorists and clinicians reject the transsexual typology and theory of motivation derived from autogynephilia; their objections suggest a need for additional research. The concept of autogynephilia can assist clinicians in understanding some otherwise puzzling manifestations of nonhomosexual MtF transsexualism. Autogynephilia exemplifies an unusual paraphilic category called 'erotic target identity inversions', in which men desire to impersonate or turn their bodies into facsimiles of the persons or things to which they are sexually attracted.

"Health does not discuss trans bodies": Oral History of transsexuals and transvestites.

OBJECTIVES: to understand the life stories and itineraries of transvestites and transsexuals in health services. METHODS: study with a qualitative approach, anchored in the methodological framework of Oral History. Interviews were conducted and thematically analyzed. RESULTS: two themes emerged: 1) gender and sexuality in life stories; and 2) the trajectories in health services. These revealed the challenges in the process of recognizing gender identity before the family and society. The reports show the dilemmas that transsexuals and transvestites face in health care, which ends up generating the removal of this population from services. FINAL CONSIDERATIONS: it has been demonstrated that Oral History can increase knowledge, especially about life histories and trajectories in the health services of transvestites and transsexuals; in addition, information was offered that can assist managers and health professionals in making decisions or caring for these people.

Identity as a 'patchwork': aspects of identity among low-income Brazilian travestis.

This paper is based on findings from a qualitative study that took place within the context of a four-year healthcare programme directed towards low-income travestis in the central area of Sao Paulo, Brazil. Throughout the study the formation of social identity among travestis was investigated through a focus on four axes: gender, body, work and violence. This paper subjects the identity of the travestis to a critical analysis and proposes a view of their sense of self as a 'patchwork' assembled through the assimilation of various fragments of identity common in Brazilian society. The primary identities assimilated by the travestis under study were, in the area of femininity, the submissive woman, the puta ['whore'] and the super-seductive woman and, in the area of masculinity, the viado ['queer'], the malandro ['rascal'] and the bandido ['bandit']. The resulting travesti identity exhibited not only gender ambiguity, but also contradictions among the feminine identities described, as well as among the masculine ones.

Religion in the psychoanalytic relationship-some aspects of transference and countertransference.

This case poses the problem of the nature of transference and counter-transference dynamics in analytic relationships in which analyst and analysand share a communality of religious background, training, belief, and commitment. In this analysis, both analyst and analysand were professionally trained and committed Catholic priests. The analysis revealed the preoedipal and oedipal determinants of the analysand's intrapsychic perspective on religious matters and his engagement in religious activities. Countertransference difficulties arose in relation to empathic resonances potentially leading to excessive empathic attunement and concordant identification on one hand and a contrary pull to possible complementary identification and role responsiveness.

Case report of autogynophilia--family, ethical and surgical implications.

Through the case presentation of a diagnostically and therapeutically interesting gender dysphoric individual, the authors wish to address diagnostic problems associated with this controversial category, illustrate dilemmas and emphasize the importance of diagnostic procedures in differentiating between primary transsexualism and other transgender states. Many questions have been triggered by this case, mainly about whether this patient should be classified as a paraphilia (transvestite, transvestite with transsexual trend), primary transsexualism or autogynephilia and about the most adequate treatment (e.g., sex-reassignment surgery, hormone therapy as a way of partial feminisation or exclusively psychotherapy). The issue of reconstructive surgery, i.e. its justification in the case of this particular condition is specifically discussed. Before any decision is made, both medical but also ethical consequences of the treatment choice need to be considered (e.g., the client is the father of two underage children).

Accidental death due to complete autoerotic asphyxia associated with transvestic fetishism and anal self-stimulation - case report.

A case is reported of a 36-year-old male, found dead in his locked room, lying on a bed, dressed in his mother's clothes, with a plastic bag over his head, hands tied and with a barrel wooden cork in his rectum. Two pornographic magazines were found on a chair near the bed, so that the deceased could see them well. Asphyxia was controlled with a complex apparatus which consisted of two elastic luggage rack straps, the first surrounding his waist, perineum, and buttocks, and the second the back of his body, and neck. According to the psychological autopsy based on a structured interview (SCID-I, SCID-II) with his father, the deceased was single, unemployed and with a part college education. He had grown up in a poor family with a reserved father and dominant mother, and was indicative of fulfilling DSM-IV diagnostic criteria for alcohol dependence, paraphilia involving hypoxyphilia with transvestic fetishism and anal masturbation and a borderline personality disorder. There was no evidence of previous psychiatric treatment. The Circumstances subscale of Beck's Suicidal Intent Scale (SIS-CS) pointed at the lack of final acts (thoughts or plans) in anticipation of death, and absence of a suicide note or overt communication of suicidal intent before death. Integration of the crime scene data with those of the forensic medicine and psychological autopsy enabled identification of the event as an accidental death, caused by neck strangulation, suffocation by a plastic bag, and vagal stimulation due to a foreign body in the rectum.

[Psychological well-being among transvestites and trans women in the state of São Paulo, Brazil]. / Bem-estar psicológico entre travestis e mulheres transexuais no Estado de São Paulo, Brasil.

This article sought to estimate factors associated with the psychological well-being of transvestites and trans women. It is a cross-sectional study with 602 transvestites and trans individuals in seven cities in the state of São Paulo, Brazil from 2014 to 2015. We carried out a sample selection through a consecutive approach and using the snowball technique. The dependent variable was psychological well-being (WHOQOL-BREF) and the independent variables were: sociodemographic characteristics, body modifications, health conditions, violence and incarceration. We used a multiple variance analysis to identify associated factors. Most were black or brown and were aged between 25 and 39 years, had up to complete secondary education, individual income of up to two times the minimum wage and worked, and 42.3% were sex workers. Around one-quarter had been incarcerated. Around one-quarter were in treatment for HIV. Mean psychological well-being score was 63.2 (95%CI: 61.8-64.6). In the multiple analysis, the factors associated with lower psychological well-being were: not having a fixed address, having lower educational levels, being dissatisfied with personal relationships, friend support or the gender-affirming procedures they had undergone and having suffered verbal or sexual violence. While worse living conditions and exposure to violence harm the psychological well-being of transvestites and trans women, the possibility of undergoing desired body transformations and having their social name respected interfere positively in their evaluations of their lives.

O objetivo do trabalho foi estimar fatores associados ao bem-estar psicológico de travestis e mulheres transexuais. Estudo transversal com 602 travestis e pessoas transexuais em sete municípios do Estado de São Paulo, Brasil entre 2014 e 2015. Foi realizada seleção amostral com abordagem consecutiva e técnica bola de neve. A variável dependente foi bem-estar psicológico (WHOQOL-BREF) e as independentes foram: características sociodemográficas, modificações corporais, condições de saúde, violência e encarceramento. A análise de variância múltipla foi usada para identificar os fatores associados. A maioria tinha cor da pele preta ou parda e entre 25 e 39 anos de idade, até o Ensino Médio completo, renda individual de até dois salários mínimos e trabalhava, sendo 42,3% profissionais do sexo. Cerca de um quarto já foi presa. Em torno de um quarto fazia tratamento para HIV. O escore médio observado foi de 63,2 (IC95%: 61,8-64,6). Na análise múltipla, estiveram associados ao menor bem-estar psicológico: não ter endereço fixo, ter menor escolaridade, estar insatisfeita com as relações pessoais, suporte de amigos ou procedimentos transexualizadores realizados e ter sofrido violência verbal ou sexual. Enquanto piores condições de vida e de exposição à violência prejudicam o bem-estar psicológico de travestis e mulheres transexuais, a possibilidade de realizar transformações corporais desejadas e o respeito ao nome social interferem positivamente na avaliação que fazem de suas vidas.

El objetivo fue estimar factores asociados al bienestar psicológico de travestis y mujeres transexuales. Se trata de un estudio transversal con 602 travestis y personas transexuales en siete municipios del estado de São Paulo, Brasil, entre 2014 y 2015. Se realizó una selección de muestras con un enfoque consecutivo y técnica bola de nieve. La variable dependiente fue bienestar sicológico (WHOQOL-BREF) y las independientes fueron: características sociodemográficas, modificaciones corporales, condiciones de salud, violencia y encarcelamiento. Se usó un análisis multivariante de variancia para identificar los factores asociados. La mayoría tenía el color de piel negro o eran mulatos, y entre 25 y 39 años de edad, con hasta la enseñanza media completa, renta individual de hasta dos salarios mínimos y trabajaba, siendo un 42,3% profesionales del sexo. Cerca de un cuarto ya estuvo presa. También cerca de un cuarto estaba con tratamiento para el VIH. Las puntuaciones medias de bienestar sicológico fue 63,2 (IC95%: 61,8-64,6). En el análisis múltiple, estuvieron asociados a un menor bienestar sicológico: no tener dirección fija, tener menor escolaridad, estar insatisfecha con las relaciones personales, apoyo de amigos o procedimientos transexualizadores realizados, y haber sufrido violencia verbal o sexual. Mientras que unas peores condiciones de vida y de exposición a la violencia perjudican el bienestar sicológico de travestis y mujeres transexuales, la posibilidad de realizar las transformaciones corporales deseadas y el respeto al nombre social interfieren positivamente en la evaluación que hacen de sus vidas.

Clinical encounters with internet pornography.

Abstract Pornography, if understood to involve the depiction of sexual activity, organs, and experiences, is perhaps as old as human civilization itself. Historically linked to various technological innovations, pornography viewing in the Internet age has reached epic proportions, with large numbers of individuals taking advantage of ease of access, affordability, and presumed anonymity to explore sexual material online. Within the mental health professions substantial research exists on the effects of viewing general pornography; however, the distinctive effects of the marriage of pornography and cyberspace is only beginning to be examined. In addition to reviewing some historical and statistical material about pornography and the relevant psychiatric and psychoanalytic literature, four detailed clinical vignettes are presented to illustrate the types of problems related to Internet pornography use that are being presented to practicing psychotherapists.

Boyish Mannerisms and Womanly Coquetry: Patients with the Diagnosis of Transvestitismus in the Helsinki Psychiatric Clinic in Finland, 1954-68.

This article examines the case files of patients diagnosed with Transvestitismus [transvestism] in the Psychiatric Clinic of the Helsinki University Central Hospital in the years 1954-68. These individuals did not only want to cross-dress, but also had a strong feeling of being of a different sex from their assigned one. The scientific concept of transsexuality had begun to take form, and this knowledge reached Finland in phases. The case files of the transvestism patients show that they were highly aware of their condition and were very capable of describing it, even if they had no medical name for it. Psychiatrists were willing to engage in dialogue with the patients, and did not treat them as passive objects of study. Although some patients felt that they had been helped, many left the institution as frustrated, angered or desperate as before. They had sought medical help in the hope of having their bodies altered to correspond to their identity, but the Clinic psychiatrists insisted on seeing the problem in psychiatric terms and did not recommend surgical or hormonal treatments in most cases. This attitude would gradually change over the course of the 1970s and 1980s.

[Stigma and resistance among travestis and transsexual women in Salvador, Bahia State, Brazil]. / Estigma e resistência entre travestis e mulheres transexuais em Salvador, Bahia, Brasil.

This was a qualitative study based on an analysis of narratives produced by travestis and transsexual women in Salvador, Bahia State, Brazil, with the aim of analyzing their experiences with stigmatization by describing events, actors, and contexts that have marked their life stories, as well as elucidating the relationship between stigma and their female performances. The narratives came from 19 in-depth interviews during an epidemiological survey, based on a prior script that explored the production of narratives on lifestyles and experiences of travestis and transsexual women in the city of Salvador. The life stories that emerged in the field were transcribed and analyzed from a theoretical and narrative perspective. The narratives of many travestis and transsexual women described an "effeminate" gender performance that had been identified since their childhood by family and community members. This performance was presented as insubordination to the power established by heteronormative society's legal system. The process of stigmatization begins to operate when social expectations concerning the coherence between "biological sex" and "gender performance" are frustrated in social interactions, submitting the individuals to discrimination and violence. Thus, stigmatization is operated through the power exercised over bodies by the laws of compulsory heterosexuality. However, during the life stories of travestis and transsexual women, strategies of resistance to stigma are produced, with the potential to transform this situation.

Travestis e Transexuais no Brasil: Memórias de Luta e Resistência / Travestis and Transexuals in Brazil: Memories of Fight and Resistance

As reflexões do artigo são resultado de uma pesquisa de mestrado realizada no Brasil, nos anos 2015-2018, abordando a luta histórica de travestis e transexuais femininas no espaço do ativis-mo. Desvendamos as práticas sociais, táticas e estratégias, tendo como foco as conquistas de espaço social e político, como a luta pela visibilidade das principais pautas do movimento trans organizado. Percorremos um caminho que abrange temporalidades diferentes. Resgatamos a importância das precursoras que contribuíram com a visibilidade da luta desde 1970. Na se-quência, abordamos um breve recorte histórico do movimento LGBT brasileiro, com a partici-pação ativista de travestis e transexuais, no marco referencial de 1990 até 2016. Por fim, cole-tamos no período de 2014 até 2016, narrativas de travestis e transexuais da cidade do Recife, nordeste do Brasil, viabilizada através de entrevistas que demonstram a continuação do legado da resistência a toda forma de violação de direitos. (AU)

The reflections of the article are the result of a master's research conducted in Brazil, in the years 2015-2018, addressing the historical struggle of female transvestites and transsexuals in the space of activism in the years 2015-2018, addressing the historical struggle of female transvestites and transsexuals in the space of activism. We unveil the social practices, tactics and strategies, focusing on the conquests of social and political space, such as the struggle for visibility of the main agendas of the organized trans movement. We follow a path that covers different temporalities. We rescue the importance of the precursors who contributed to the visibility of the struggle since 1970. Next, we address a brief historical cut of the Brazilian LGBT movement, with the activist participation of transvestites and transsexuals, in the frame of reference from 1990 to 2016. Finally, in the period from 2014 to 2016, we collected narratives of transvestites and transsexuals from the city of Recife, northeastern Brazil, made possible through interviews that demonstrate the continuation of the legacy of resistance to all forms of rights violation. (AU)

Psychiatric comorbidity among children with gender identity disorder.

OBJECTIVE: To investigate the prevalence and type of comorbidity in children with gender identity disorder (GID). METHOD: The Diagnostic Interview Schedule for Children-Parent version was used to assess psychopathology according to the DSM in two groups of children. The first group consisted of 120 Dutch children (age range 4-11 years) who were referred to a gender identity clinic between 1998 and 2004 (GID group) and the second group consisted of 47 Dutch children who were referred to an attention-deficit/hyperactivity disorder (ADHD) clinic between 1998 and 2004 (ADHD group; 100% response rate for both groups). RESULTS: Fifty-two percent of the children diagnosed with GID had one or more diagnoses other than GID. As expected, more internalizing (37%) than externalizing (23%) psychopathology was present in both boys and girls. Furthermore, the odds ratios of having internalizing or externalizing comorbidity were 1.28 and 1.39 times higher, respectively, in the clinical comparison group (ADHD group) than in the GID group. Finally, 31% of the children with GID suffered from an anxiety disorder. CONCLUSIONS: The results of this categorical diagnostic study show that children with GID are at risk for developing co-occurring problems. Because 69% of the children do not have an anxiety disorder, a full-blown anxiety disorder does not seem to be a necessary condition for the development of GID. Clinicians working with children with GID should be aware of the risk for co-occurring psychiatric problems and must realize that externalizing comorbidity, if present, can make a child with GID more vulnerable to social ostracism.