This study examined the prevalence of undiagnosed dissociative disorders in a sample of 201 adult patients admitted to a private psychiatric hospital in a major metropolitan city in the south-central United States, over an eight-month period. A screening measure, two blind structured interviews, and a blind clinical interview were employed. The lifetime prevalence of dissociate disorders among the interviewed subjects was 40.8%. More specifically, 7.5% were diagnosed with dissociative identity disorder, 15.4% with dissociative disorder not otherwise specified, 13.4% with dissociative amnesia, and 4.5% with depersonalization disorder. Dissociative fugue was not found in this sample. Cohen's kappa reliability coefficients were computed between the three interview measures, resulting in significant findings for the presence of dissociative identity disorder and dissociative disorder not otherwise specified versus no dissociative disorder. The Cohen's kappa reliability coefficients were as follows: DDIS-DES-T = 0.81; SCID-D-DES-T = 0.76; Clinician-DES-T = 0.74, DDIS-SCID-D = 0.74; DDIS-Clinician = 0.71, and SCID-D-Clinician = 0.56. A meeting was conducted at the end of all subject interviews to discuss discrepant findings between measures. Four additional sub-analyses were performed between dissociative and non-dissociative subjects on DSM-IV variables. Patients diagnosed with a dissociative disorder had higher rates of comorbid major depressive disorder, borderline personality disorder, somatization disorder, and childhood history of physical and/or sexual abuse. Theoretical and methodological issues were discussed as they relate to these findings.

Few bodies consistently portray natural or unaltered forms. Instead, humans inhabit bodies imbued with sociocultural meanings about what is attractive, appropriate, functional, and presentable. As such, embodiment is always gendered. The social, extra-corporeal body is a central locus for expressing gender. Surgical body modifications represent inherently gendered technologies of the body. But psychomedical institutions subject people who seek gender-crossing surgeries to increased surveillance, managing and regulating cross-gender embodiment as disorderly. Using mixed research methods, this research systematically compared transgender and cisgender (non-transgender) people’s experiences before, during, and after surgical body modification. I conducted a content analysis of 445 threads on a message board for an online cisgender surgery community, an analysis of 15 international protocols for transgender-specific surgeries, and 40 in-depth interviews with cisgender and transgender people who had surgery. The content analysis of the online community revealed similar themes among cisgender and transgender surgery users. However, detailed protocols existed only for transgender consumers of surgery. Interview findings showed that transgender and cisgender people reported similar presurgical feelings toward their bodies, similar cosmetic and psychological motivations for surgery, and similar benefits of surgery. For both cisgender and transgender people, surgery enhanced the inner self through improving the outer gendered body. Despite these similar embodied experiences, having a cisgender gender status determined respondents’ abilities to pursue surgery autonomously and with institutional support. Ultimately, this research highlights inequalities that result from gender status and manifest in psychomedical institutions by identifying the psychosocial impacts of provider/consumer or doctor/patient interactions, relating gendered embodiment to regulatory systems of authority, and illuminating policy implications for clinical practice and legal classifications of sex and gender.

There is a paucity of research on the diagnosis of dissociative disorders in children. Most children are misdiagnosed with more common mental disorders with similar symptoms. Earlier recognition of dissociative disorders can save years of pain, suffering, and cost. This qualitative collective case study examined the process of diagnosing dissociation in two children under the ages of 12 at the beginning of treatment. A concurrent focus on the training and development of the therapist/researcher is included. Archival data including progress notes, psychotherapy notes, assessments, correspondence, legal documents, school records, and medical records were analyzed using within-case and cross-case analyses to identify individual and common themes that may expedite the diagnosis of dissociative disorders in children. The narrative presentation of a qualitative study with its thick, rich description may increase the understanding of clinicians with little or no experience and help them to differentiate these disorders from other disorders with overlapping symptoms. Factors that impeded and advanced the recognition of dissociative disorders were identified. Clinical findings underscore the role of knowledge and training, experience, and consultation in the diagnosis of dissociative disorders.

The author reports on a case series of four inmates who engaged in attempted or completed surgical self-treatment of their gender dysphoria via autocastration, autopenectomy, or a combination in the absence of concomitant psychosis, intoxication, or other comorbidities that could reasonably account for this rare behavior. These behaviors occurred in the context of persistent denials of access to transgender health care in prison settings. The literature on genital self-harm is also reviewed. Incarcerated persons with severe GID may resort to life-threatening surgical self-treatments when persistently denied access to psychiatric evaluation and cross-sex hormonal treatment. In all cases of surgical self-treatment (SST; i.e., autocastration with the primary intent to reduce circulating testosterone levels) the intensity of gender dysphoria decreased compared to reported baseline levels, although symptoms of GID were still present. Of the four inmates, two were able to obtain access to cross-sex hormones after successful litigation at the time of this writing; another was not. One case remains active. This case series expands the limited literature on surgical self-treatment in the form of autocastration and autopenectomy with a focus on the potential influence of incarceration with denial of access to transgender health care.

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No description available.

The DSM-IV-TR diagnosis Gender Identity Disorder Not Otherwise Specified (GID NOS) is used to describe individuals who have gender issues but do not meet the current criteria for GID. As part of a consensus process conducted by the World Professional Association for Transgender Health, the authors make the following recommendations for DSM 5: removal from the chapter on sexual disorders, more specific diagnostic criteria, retention of clinical significance criteria, and removal of exclusionary criteria of Intersex/Disorders of Sex Development. Changes to the existing clinical examples were also recommended, suggesting additional clinical examples that encompass a broader range of gender-variance and more commonly found transgender presentations. The diagnosis must reflect the severity of the clinical issues that represent legitimate identity experiences and possible need for gender-confirming treatments.

This study addresses the complex issues of etiology and conceptualization of gender variance in the modern West. By analyzing medical, psychological, and popular approaches to gender variance, I demonstrate the highly political nature of each of these paradigms and how gender variant individuals engage with these discourses in the elaboration of their own gender identities. I focus on the role of institutional authority in shaping popular ideas about gender variance and the relationship of gender variant individuals who seek medical intervention towards the systems that regulate their care. Also relevant are the tensions between those who view gender variance as an expression of an essential cross-sex gender (as in traditional transsexual narrative) and those who believe that gender is socially constructed and non-binary. I finally argue that the standards of treatment for gender variant individuals pertains more to the medical legitimization of their identities than with necessarily improving outcomes.

This thesis analyses the violence perpetrated against transgender people. It scrutinizes the concept of transgender and the important role of transitioning. It looks at the essentialist and social constructionist debate and its relation to transgender. In this thesis, I will advocate a theory of violence in which violence is understood as structural. I will advocate bringing the lived experience of transgender people to the foreground in theorizing about embodiment. Hereby, I will especially focus on discursive violence and the violation of human rights. I will relate transgender and the importance of transitioning to DSM’s understanding of Gender Identity Disorder. Consequently, I will uncover DSM’s subtle misogyny and transphobia and argue that it perpetrates discursive violence against transgender people. In addition, I will scrutinize the direct and indirect ways it violates the human rights of transgender people. Finally, the thesis will discuss the suggestions the Hammarberg report has made in order to improve the human rights situation of transgender persons.

Title from second page of PDF document. Includes bibliographical references (p. 197-204).