| Walter Bockting, Eli Coleman, "A comprehensive Approach to the Treatment of Gender Dysphoria", J of Psychology & Human Sexuality, 5:4 1992, pp. 131-153 |
| | We have found a high incidence of childhood physical abuse, ridicule and emotional neglect among our clients. Early childhood trauma, dysfunctional family systems and dysfunctional family attitudes about sex and intimacy can create a number of psychological disorders (most commonly anxiety and personality disorders) which disrupt psychosocial and psychosexual development. |
| | Sometimes the desire for sex reassignment is a cry for help, an expression of psychological pain stemming from a long history of anxious attachments, generalized anxiety, social phobia, intimacy dysfunction, depression, loneliness and despair. |
| | In reviewing the clients biography, evidence of family of origin intimacy dysfunction or childhood abuse may be encountered. In such cases, the effect on the client's identity development and ability to form intimate relationships is addressed. A number of relationships between an individual's abuse history and his or her gender dysphoria are possible. |
| | For some gender dysphoric clients, their cross dressing and cross gender feelings are the focus of their obsessive/compulsive behavior and a means of coping with anxiety. |
| | Identity development is often hampered by primary co morbid psychopathology, usually stemming from early childhood. |
| | In clients whose gender dysphoria has increased after a history of fetishistic transvestism or sexual orientation dysphoria, we find that the cross dressing and gender dysphoria exhibit obsessive/compulsive features and serve as a way to cope with psychological pain originating from childhood abuse and family intimacy dysfunction. By obsessively ruminating about a desired gender, the individual avoids the pain of childhood memories. |
| Michael Ross, William Walters, "Transsexualism and Sex Reassignment", Oxford University Press, 1986 p25 |
| p25: | Present evidence strongly suggests that the great majority of gender dysphorics, results from varying disorders of parental rearing practices, psychopathology, and psychological disturbances or lack of ego development, social and environmental factors, object losses or separations, general stressors, lack of core identity. |
| p21: | The fact that a large number (up to 70 per cent) of individuals who present for gender reassignment may be able to give up their request for surgical procedures and come to terms with their gender dysphoria, strongly suggests the disorder is not biologically determined and that psychodynamic considerations in many cases may determine the request for surgery. Familial data are not consistent, although they do suggest that the psychodynamics of gender dysphorias are related to parental rearing practices in childhood. This does suggest that attention should be paid to the very early psychodynamics of upbringing. |
| p55: | Many, such as Stafford-Clark, see transsexualism as a delusion of psychotic proportions requiring psychiatric treatment. Sex reassignment surgery is seen by this group as complicity with the psychosis and therefore both inappropriate and ineffective. |
| p53: | In a more sex-role rigid society, more individuals would be likely not to fit into the more stereotyped roles and thus assume that, if they did not fit the role of one sex, they must belong to the other; similarly, in a more anti-homosexual society, more homosexuals would be likely to attempt to legitimize their same-sex object preference by attempting to change sex. |
| p1: | Gender dysphoria is commonly regarded as being primary (present constantly from childhood and to a considerable degree) or secondary (being intermittent or of low strength and exacerbated by some problem later in life). In many cases of secondary dysphoria there has been some degree of gender disturbance or dissatisfaction throughout life, but problems such as the break up of relationships, aging, or inability to function in the appropriate masculine or feminine role, have brought it to the fore. |
| p4: | it is not uncommon for individuals who are homosexual to request gender reassignment. Such individuals usually have disturbances of social sex role also and are unable to accept their homosexuality, reasoning that their same-sex partner choice will become acceptable to society only if they themselves change sex and legitimize such a relationship as 'heterosexual.' |
| p5: | Psychological components of sexual identity are frequently independent of one another, and disturbances of some or all may lead to individuals presenting as transsexuals (that is, with the symptom of wishing to change their sex) without necessarily being primarily gender dysphoric. In such cases, gender dysphoria may be secondary to other disorders of sexual identity. |
| p20: | The familial pattern noted by Buhrich and McConaghy included the fact that mothers of male transsexuals and transvestites wanted a daughter more often than did other mothers, and while there was no evidence of an abnormal relationship with the mother, there was a trend for fathers to lack interest in their children. |
| p21: | Familial data are not consistent, although they do suggest that the psychodynamics of gender dysphorias are related to parental rearing practices in childhood. |
| p23: | Gender dysphoria may be an attempt to ward off decompensation and psychological breakdown which occurs from a lack of core gender identity and defective self-identity: opposite-sex gender identity thus serves as a protective shield. Levine notes in a case history that, in some instances, the frantic search for meaningful identities may encompass gender identity if there have been early disturbances in significant relationships. It can thus be seen that there are a number of possible psychodynamic routes to gender dysphoria and that they need not necessarily occur in childhood. |
| L. Lothstein, Howard Roback, "Black Female Transsexuals and Schizophrenia: A Seredipitous Finding?", Archives of Sexual Behavior, 13:4 1984, p. 371 |
| | Four of the patients reported having incestual relationships and stated that these experiences had a disorganizing effect on their psychological state and an organizing effect on their sexual orientation. |
| Laura Roberto, "Issues in Diagnosis and Treatment of Transsexualism", Archives of Sexual Behavior, 12:5 1983, p. 445 |
| | The desire to alter gender role and body outline can represent a maladaptive solution to other, more acute types of emotional distress. |
| Michael Ross, "Societal Relationships and Gender Role in Homosexuals: A cross-Cultural Comparison", The Journal of Sex Research, 19:3 August 1983, pp. 273-288 |
| | in anti-homosexual societies with rigid gender roles, opposite-sex gender identity in homosexuals will be , to some degree, a function of believing that heterosexual relationships are the only appropriate ones, and that individuals who are homosexual will thus validate same-sex preference by opposite-sex identification. |
| Anke Ehrhardt, Heino Myer-Bahlburg, "Effects of Parental Sex Hormones on Gender-Related Behavior", Science, 20 March 1981 |
| | The development of gender identity seems to depend largely on the sex of rearing. |
| Ellen Halle, Jon Meyer, Chester Schmidt, "The Role of Grandmothers in Transsexualism", Am J Psychiatry, 137:4 April 1980 |
| | Most studies of aetiology emphasize disturbances in early child-parent relationships and point to a variety of dynamic conflicts. |
| | Inasmuch as all these patients experienced loss of one or both parents through illness, death, separation-divorce, or desertion, the involvement of the grandparent in child -rearing cannot be viewed as an etiologic factor in the development of transsexualism. The presence of the grandmothers per se does not lead to the development of transsexualism; however, the data suggest that the behavior and attitudes of these particular grandmothers (eg encouraging cross-dressing) played a role in the development of the disorder. |
| | Over the course of 6 years of evaluating patients who had complaints of gender dysphoria, we were impressed by the number who spontaneously reported that their maternal grandmothers had played a significant role in rasing them during their early childhood. |
| Nils Uddenberg, Jan Walinder, "Parental contact in male and female transsexuals", Acta psychat. Scand., 1979, pp. 113-120 |
| p113: | Our findings suggest that disturbed emotional relations to the parents may be one contributory cause in the development of transsexualism. |
| L. Lothstein, "Psychodynamics and Sociodynamics of Gender Dysphoric States", American Journal of Psychotherapy, 33:2 April 1979 |
| | The wish to undergo sexual surgery was intensified by the patient's inability to establish enduring social and sexual relations. |
| | Our work with gender-dysphoric patients suggests that mother's contribution to the child's gender identity disturbance is profound. Whether the mother was too close or too distant, too engulfing or too aggressive, almost all the male patients either yearned to reunite with mother or felt ambivalently fused to her. |
| | The stigmatised homosexual is an individual whose sexual object choice is homosexual but who cannot tolerate the explicit and implicit stigma of being homosexual (and the social sanctions and punishment that go with it) in a society that is vehemently antihomosexual. Rather than relinquish their object choice, some homosexuals adopt a transsexual role. By assuming an opposite gender role they wish to characterize their sexual behavior as "heterosexual". This not only reduces the patient's tension and cognitive dissonance, but is more acceptable to society as well. |
| | Conflict and defence are basic to the establishment of a transsexual gender identity. |
| | For the female child there is a deflection of the attachment to mother onto father. However, the role of the mother is equally as strong for female transsexuals. |
| | In order to protect the 'true' self from annihilation and allow conflict free spheres of the ego to develop, the transsexual internalizes the 'true' self as a secret self. For the transsexual, the maintaining of a secret identity, that is, a secret male or female self, helps to establish his or her separateness and independence from mother, thereby preventing a total loss of self via fusion with the mother. The relationship between secrecy and secrets for boundary formatio, ego development, and self-identity and impostering are well established. |
| | The mother-child relationship and the quality of parenting are the bedrock on which gender disturbances rest. |
| | For some patients the adoption of a transsexual role was an alternative to personality decompensation. Lacking a core gender identity and experiencing a defective self-identity, the patient's opposite sex identification provided them with a protective shield against an empty structure less self-identity. |
| | For most aging patients, the request for sex reassignment surgery often concealed a desperate attempt to be rescued from a life of isolation and alienation. |
| | (female transsexual) patients were extremely fearful of the female role as it implied passivity, helplessness, vulnerability, lack of control, and the susceptibility for being dominated. Only by adopting a male role (identifying with the aggressor) could these patients feel safe from their feared vulnerability. |
| | All major theorists on transsexualism acknowledge the important and sometimes crucial role of mothering in the formation of core gender identity. |
| Neil Buhrich, Neil McConaghy, "Parental Relationships During Childhood in Homosexuality, Transvestism and Transsexualism", Australian and New Zeland Journal of Psychiatry, 12:103 1978 |
| | Significantly more mothers of transvestite and transsexual subjects hoped for a girl prior to the subject's birth. During childhood there was a trend for homosexual, transvestite and transsexual subjects to report that their fathers lacked interest in them or were absent from home. |
| Leonard Derogatis, Jon Meyer, "A Psychological Profile of the Transsexual 1. The male", The Journal of Nervous and Mental Disease, 166:4 1978 |
| | Psychological theories concerning transsexualism essentially fall into two groups, pivoting on the issue of whether the transsexualism is a symptomatic expression of underlying conflict or an actual gender identity in its own right of nonconflictual origins. |
| Claude Friedmann, Martha Kirkpatrick, "Treatment of Requests for Sex-Change Surgery with Psychotherapy", Am J Psychiatry, 133:10 October 1976 |
| | The symptom (of transsexualism) is usually associated with an attempt to avoid the pain of a loss that is experienced as gender-related. A change to the idealized or invulnerable opposite sex is seen as a protection from loss. The therapist can identify the loss and support the patient facing it. |
| | In the three individuals we have described, the transsexual ideation is a defence against anxiety, not a core gender identity disturbance. The first two patients had conflict about their homosexual orientation that was exacerbated by new stresses in their lives. The surgical solution was sought to minimize this conflict rather than to treat a gender disorder. |
| Lawrence Newman, Robert Stoller, "Nontranssexual Men Who Seek Sex Reassignment", Am J Psychiatry, 131:4 April 1974 |
| | Transsexualism belongs in the area of psychopathology as a personality disorder. If we again look at it in terms of a developmental process, we certainly can expect better results from psychotherapy if it is instituted at an early age. For the late adolescent and adult patients there is some promise contained in a recent report for the University of Mississippi Medical center on the use of behavior modification in changing gender identity in a transsexual. |
| Lionel Oversey, Ethel Person, "The Transsexual Syndrome in Males I. Primary Transsexualism", American Journal of Psychotherapy, 28:4 1974 |
| | In male transsexualism, to counter separation anxiety, the child resorts to a reparative fantasy of symbiotic fusion with the mother. In this way, mother and child become one and the anxiety is allayed, but the cost is an ambiguity of core gender identity (sense of maleness). We infer that this fantasy is laid down before the child is three years old; otherwise, core gender identity would be firmly established by that age. The ambiguous core gender identity, of necessity, interferes with normal development of gender role identity (sense of masculinity). It also impedes sexual development in most transsexuals leads to relative asexuality. |
| Ira Pauly, "Female Transsexualism Part II", Archives of Sexual Behavior, 3:6 1974, p. 509 |
| | One is impressed by certain interfamily dynamics in the development of female transsexualism, just as one is aware of a different set of family patterns in the development of male transsexualism. There is an identification with a masculine but abusive father. The mother is perceived as weak, less admirable, emotionally unavailable, and in need of protection from the father. A protective attitude toward the mother develops in these young girls, which has all the dynamics of the oedipal relationship between the father and son. |
| | Parents ought to be made more aware of the need to positively reinforce all infants for those gender characteristics which are consistent with their biological sex. |
| | I can think of very few worse fates than to be the life-long victim of the kind of family discord or ignorance which breeds gender identity problems. |
| Phil Lebovitz, "Feminine Behavior in Boys: Aspects of It's outcome", Am J Psychiatry, 128:1 April 1972 |
| | The stereotyped negative view the subjects had of their fathers suggests that their fathers played a critical role in the development of their gender identity. |