| Michael Ross, William Walters, "Transsexualism and Sex Reassignment", Oxford University Press, 1986 p47 |
| p47: | When taking a case history of a patient applying for sex reassignment surgery, one must be aware of the extensive knowledge which some transsexuals have acquired through contact with fellow sufferers and the reading of magazines and books (even special texts on transsexualism). Consequently, statements in the history must be treated with some circumspection. |
| L. Lothstein, Howard Roback, "Black Female Transsexuals and Schizophrenia: A Seredipitous Finding?", Archives of Sexual Behavior, 13:4 1984, p. 371 |
| | The fathers were generally unavailable (either physically or emotionally). |
| Steven Brigham, Shasta Mead, George Rekers, Alexander Rosen, "Family Correlates of Male Childhood Gender Disturbance", The Journal of Genetic Psychology, 142 1983, pp. 31-42 |
| | Significantly fewer male role models were found in the family backgrounds of the severely gender-disturbed boys as compared to the mild-to-moderately gender-disturbed boys. Male childhood gender disturbance was also found to be correlated with a high incidence of psychiatric problems in both the mothers and fathers and with atypical patters of the boys' involvement with their mothers and fathers. |
| L. Lothstein, "Psychodynamics and Sociodynamics of Gender Dysphoric States", American Journal of Psychotherapy, 33:2 April 1979 |
| | Although most women who sought sex reassignment surgery wished to rid themselves of their breasts, those patients who dreaded their femaleness and vagina experienced and expressed more severe psychopathology, were more difficult to manage, and enacted a pathologically rigid and stereotyped male role. These women were usually self-mutilative as they attempted to ward of fusion fantasies with the dreaded "engulfing" mother. |
| | The early histories were replete with losses, deaths and separations which left the patients feeling empty. |
| | During early childhood there was a conspicuous lack of socialization experiences and failure to establish usual patters of friendship. |
| | Several women believed that the women's only role was to serve men and they hoped that by becoming men, they would have their dependency needs gratified, and would become more assertive sexually. |
| | During periods of stress, the magical idea of attaining satisfying object relations through sex change was entertained. The patients conceptualized this as "if only I were a girl/boy then I would be attractive to someone and have a satisfying relationship". |
| | Involvement in the gay community offered some degree of socialisation but, unable to adopt a homosexual orientation, the transsexual was soon outcast even in the homosexual community. |
| | During the adolescent and young adult years the patients incapability to establish meaningful relationships heightened their estrangement. |
| | Though many patients had opposite sex playmates, these relationships were shallow, empty and superficial. |
| | The more open the patients were with their immediate family, the less likely they were to experience dysphoria about their gender role. Those patients who did not talk with their family often experienced heightened insecurity and fear of the truth being discovered. |
| | Most of our patients had chronic histories of inadequate mothering and impaired object relations. |
| | The social histories of our patients were replete with losses, separations, family chaos, abandonment or deaths which may have mobilized intense separation anxiety and dread of abandonment, weakening their developing ego structures. |
| | All of the white females went through a homosexual phase before announcing their transsexualism. |
| | Many of the mothers of female transsexuals were also psychotic and either emotionally absent, physically unavailable, or engaged in a primitive struggle with their daughters (which often took on bizarre proportions). |
| | At least one father of a female transsexual, however, reportedly abused her and hated her. The patient's identification with the father (identification with the aggressor) while warding off feelings of helplessness and vulnerability, may have related to her feelings of abandonment by mother who did not protect the patient from father's aggression (that is, let her husband act out her aggression toward her daughter). |
| P Bentler, George Rekers, Alexander Rosen, "Genetic and physical studies of male children with psychological gender disterbances", Psychological Medicine, 1979 |
| | All gender disturbed boys were found to be normal genetically and physically with the exception of one subject with one undescended testicle. |
| Lionel Oversey, Ethel Person, "The Transsexual Syndrome in Males I. Primary Transsexualism", American Journal of Psychotherapy, 28:4 1974 |
| | The primary transsexual in childhood has no major defence against separation anxiety other than this fantasy, which markedly inhibits masculine behavior; hence, the primary transsexual has undiluted gender discomfort which becomes progressively more severe as he grows older. Not until late adolescence or early adulthood, when he learns of the existence of transsexualism, does he get any relief. Only then does he resolve the ambiguity through a transsexual identity and sex reassignment. |
| | The secondary transsexuals are more successful in alleviating gender discomfort (than primary transsexuals). They usually resolve the ambiguity somewhat earlier by dealing with the separation anxiety either as transvestites or as homosexuals. The defences in these disorders tip the ambiguity toward a male core gender identity, and as long as these defences work, the patients maintain some semblance of emotional balance. However, under conditions of severe stress, where either tenuous masculinity is threatened, they may regress to transsexualism and seek a reversal of core gender identity. |
| Phil Lebovitz, "Feminine Behavior in Boys: Aspects of It's outcome", Am J Psychiatry, 128:1 April 1972 |
| | Those with the earlier age of onset are more likely to develop severe gender identity disturbances. |
| Robert Stoller, "Etiological Factors in Female Transsexualism: A First Approximation", Archives of Sexual Behavior, 2:1 1972 |
| | The common mechanism appears to be that each of the female transsexuals reports that as far back as she can remember she has felt very protective toward her mother and has conscious thoughts of taking care of her as a husband would and that her mother has reciprocated, openly encouraging the transsexual-to-be to serve in this protective way. These mothers have been tired, long-suffering, sad or angry women, left too much alone by their husbands. In these familles just noted, the little girl moved into the vacuum created by her mother's sadness that was unfilled by the husband. |