The treatment of fetishism in an adolescent with attention deficit hyperactivity disorder.

Fetishism is characterized by recurrent, intense sexual fantasy or behavior involving the use of nonliving objects, such as women's undergarments, over a period of at least six months. This disorder occurs mostly in males and usually begins in adolescence. The neurobiological etiologies of fetishism remain unclear, and studies on treatment were limited. We present a 14- year-old boy with attention deficit hyperactivity disorder with fetishistic behavior who was treated successfully with 36 mg extended-release methylphenidate daily and 4 months of cognitive-rational emotive psychotherapy.

Travestismo de duplo papel ou bivalente: considerações gerais / Dual role transvestism or bivalent: general considerations

A Classificação Internacional de Doenças, 10a edição (CID-10), inclui, na seção Transtornos de Identidade Sexual, o transexualismo, o travestismo de duplo papel ou bivalente e o transtorno de identidade sexual na infância. Este artigo se pauta na apresentação daqueles que se percebem ambivalentes quanto ao gênero (masculino ou feminino), os quais podem ou não vestir e utilizar adornos do sexo oposto e/ou fazer uso de próteses e hormônios, mas não têm desejo de se submeter à cirurgia de redesignação sexual. Essa condição se aproxima do travestismo de duplo papel ou bivalente pela CID-10. Não há excitação sexual nessa experiência.A origem dos transtornos de identidade sexual bivalente permanece pouco esclarecida.Consumo abusivo de álcool e drogas e maior exposição a situações de risco para doenças sexualmente transmissíveis (DST) são mais elevados na população com transtorno de identidade sexual (entre eles os bivalentes), quando comparada à população geral. A frequência de comorbidades psiquiátricas e, entre elas, a ideação suicida, é alta nessa população.Um número expressivo de artigos se volta para a questão das políticas públicas para a população de transgêneros. Embora partam de investigações sobre aspectos clínicos, o maior interesse parece ser a vulnerabilidade psicossocial desses indivíduos e a importância da implementação de intervenções voltadas para as reais necessidades deles. Apontam, tais artigos, para a fragilidade e a escassez dessas políticas e para o compromisso ético com a diversidade sexual.

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).

Transgender health.

Transgender persons represent an underserved community in need of sensitive, comprehensive health care. This article presents a literature-based review of the health needs of the transgender patient. Physicians, whether or not they choose to provide hormone therapy, will likely encounter patients with gender identity issues at some point in their practice. A transgender health assessment should involve recognition of possible gender identity disorder, history-taking with respect to prior and current use of hormones or surgical interventions, as well as general physical, mental, and sexual health histories. Physical exam and screening tests need to be based on the organ systems present rather than the perceived gender of the patient. Physicians should be aware of common hormone regimens and their associated risks. Finally, patients best explore transgender issues in a setting of respect and trust in which confidentiality concerns are addressed, and clinic staff are educated about transgender issues.

Clinical notes on a case of transvestism in a child.

This clinical presentation describes the therapeutic process of a 5-year-old male child presenting as a main symptom quasi-delusional feminine enactments starting at an early age, which persisted for most of his five-year treatment. This symptom was understood in terms of an attempt at restitution, itself the result of being confronted with an autistic structure stemming from a series of traumatic incidents during the oral phase: his mother's pregnancy, abortion, depression and subsequent three-month absence at the end of his first year of life. The clinical material, drawings included, illustrates the interplay of oral, anal and phallic levels, with enactment predominant in sessions. The oral traumatic situation initially led to anal-manic play, then to quasi-delusional female personifications in sessions, later surfacing as an annihilating 'black hole'. All the above issued into a broad enacted phallic-genital unfolding that dramatised an oral-genital primal scene, in the course of which he managed to structure his male identity. Near the end of the analytic process the analysand reworked the 'stages' of the link to the analyst. To end, based on the clinical material, the respective participation of the early and the late Oedipus complex is examined.

Treatment of a transvestic fetishist with cognitive-behavioral therapy and supportive psychotherapy: case report.

Transvestic fetishism is a paraphilia marked by recurrent, intense sexually arousing fantasies, sexual urges, or behavior involving cross-dressing, in a heterosexual male. There are many explanations of the pathogenesis, but none are conclusive. Different treatments have been applied, but they generally remain obscure and disappointing. Transvestic fetishists rarely seek psychotherapy, because of their dynamic balance between perversion and intrapsychic disintegration. There are few studies, either qualitative or quantitative, associated with transvestic fetishism in Taiwan. This case report describes an adolescent transvestic fetishist who underwent a brief course of psychotherapy in the outpatient department of a psychiatric center in Taipei. After consultation for one year, he still maintained his deviant sexual behavior but also developed more severe moral anxiety. He was then referred for psychotherapy. Cognitive-behavioral and psychodynamic theories associated with transvestic fetishism were reviewed and applied in both understanding and treating this client. Some temporal effectiveness was achieved with combined cognitive-behavioral and dynamic-oriented supportive psychotherapy. After 18 sessions of psychotherapy over more than 4 months, the client was able to stop his perverse behavior and have fewer sexually arousing fantasies. The prognosis of transvestic fetishism is generally supposed to be pessimistic and have a high rate of recurrence. Some propose that adolescents have a better outcome after treatment. This case report reveals the possibility of change for a transvestic fetishist. However, the long-term effects of the brief course of psychotherapy require further evaluation in the future.

Harry Benjamin's first ten cases (1938-1953): a clinical historical note.

The value in studying Dr. Harry Benjamin's first gender dysphoria patients is in learning how they described themselves--without any books to read, without any other source of information, assuming that he or she was alone and unlike anyone else in the world--and before hardly any literature on the subject had been published. Just as today, Benjamin's earliest patients came to him self-diagnosed. Even without the terminology currently available, their early descriptions of this unique phenomenon are identical with cross-gender identity patients who present themselves today: a recognition of the condition very early in their lives; the attempts at cross-dressing; the secrecy; the guilt; the unsuccessful attempts at suppressing desires and feelings; the episodic and continuous purging. These early individuals who suffered from gender conflicts had discovered Benjamin who would try to understand their unusual dilemma and be a barometer and a guide for the changes they would make. Their early individualistic perceptions provided insights that led to the birth of a new discipline. These 10 people must be lauded for their courage in seeking a description and a solution for a phenomenon that had no description and no treatment.

A clinical approach to childhood gender identity disorder.

A review of gender identity disorder is presented along with a case of a four-year-old boy. An overview of some of the theories of gender identity disorder directs our attention via the clinical material to conflict/defense as the most useful. The youngster's cross-gender behavior, possible contributions to it, treatment issues, parental input, boundaries, and transitional objects are considered. The necessity of close communication, cooperation, and guidance to parents, as well as involving them in individual and family therapy, is stressed.

Psychoanalysis as a lifeline: a clinical study of a transference perversion.

Case material from the analysis of a fetishistic cross-dresser is reported. The evolution of a transference perversion and treatment impasse, in the form of the recalcitrant symptom of anal flatulence, is described. The patient's contrasting needs to cling perversely and addictively to the analyst, on the one hand, and to provoke an acting out of the countertransference, on the other, are placed in the context of his dread of rejection and potentially suicidal reaction. The author argues in favour of offering psychoanalysis as a lifeline, but with the condition that the psychoanalytic setting and boundaries are maintained and that gratifications are denied. Limited but precise interpretive psychoanalytic work in the transference was maintained. The relatively good outcome is explained in terms of the provision of safety, survival of the analyst and avoidance of countertransference acting out, which, in the author's view, represents an implicit and mutative transference interpretation, the specific factor in bringing about psychic change. This enabled the patient to recognise and accept the analyst as a 'new' object and, as a consequence, to question and reject his idealisation of the anal universe that he inhabited.

Identity formation in adolescence: case study of gender identity disorder and treatment through an intermediate-care day hospital.

A review of the literature on gender identity disorders is integrated with a case study presentation of a psychiatrically disturbed nineteen-year-old transvestite youth. Accommodations and interventions made both with this patient and in the day care program for psychiatrically disturbed youths that allowed him to live at home and be maintained despite severe pathology are discussed.

Gender-disturbed males.

Adolescent and adult cross-dressing or "transvestism" is the most common antecedent behavioral pattern among those who request sex reassignment surgery. Transvestites are actually a diverse group of men who differ in their gender identities, orientation, and intention. They do, however, have in common a soothing image of themselves as women. Because of this, whether cross-dressing occurs among masculine or feminine males or heterosexuals, homosexuals, bisexuals, or asexuals, or among those with paraphilia, the behavior should be considered the expression of their consciously felt femininity. The confusing differences among cross-dressing males may be explained by their diversity along three dimensions: 1) the ambition for heterosexual intercourse; 2) the natural history of their sexual arousal to female clothing; 3) their current capacity to integrate their masculine and feminine strivings into separate compartments. When cross-dressers give up all vestiges of male gender role behaviors and successfully live and work full time as women, the appropriate descriptive term for them becomes "transsexual."

Paradoxical psychotherapy in a case of transvestism.

Paradoxical psychotherapy succeeded in removing the compulsive element and reducing the guilt attached to transvestism in a male transvestite patient. Cross-dressing at home became acceptable to him and the temptation to cross-dress in public ended. Data suggested three independent motivational systems in this patient.

Gender-disordered children: does inpatient treatment help?

Treatment guide-lines for gender-disturbed children currently are unclear. This clinical report describes eight children with cross-gender behaviour who were treated in an inpatient unit for children. The short-term outcome and long-term clinical observations are provided, which indicate a generally good outcome. The findings may have both practical and theoretical significance because they suggest that some gender disorders may be determined by intrafamilial interactions which are correctable.