Kunrath, Kamila; Cash, Philip; Li-Ying, Jason
A designer’s professional identity (DPI) develops through both education and professional experience, building on core personality traits and innate skills. In this paper a systematic literature review and a secondary narrative review were developed in order to map personal attributes and design...
Few psychological disorders in the Diagnostic Statistical Manual have generated as much controversy as Dissociative Identity Disorder (DID). For the past 35 years diagnoses of DID, previously referred to as Multiple Personality Disorder (MPD), have increased exponentially, causing various psychological researchers and clinicians to question the…
Blom, Rianne M.; Hennekam, Raoul C.; Denys, Damiaan
Introduction: Body Integrity Identity Disorder (BIID) is a rare, infrequently studied and highly secretive condition in which there is a mismatch between the mental body image and the physical body. Subjects suffering from BIID have an intense desire to amputate a major limb or severe the spinal
De Gascun, C
Gender Identity Disorder (GID) is a relatively rare condition of atypical gender development in which there is a psychological perception of self as masculine or feminine which is incongruent with ones phenotype. GID replaced the term Transsexualism in DSM-IV in 1994. The demographics of GID in Ireland have not been established. Since 2000 we have received 52 referrals of individuals with confirmed GID to our endocrine service for consideration for hormonal treatment (HT). Of the 52 patients 45 have male to female (MTF) GID (mean age 38.9 years) and 7 have female to male (FTM) GID (mean age 30.7 years). The age at presentation in this group is approximately 9 years older than in international series for both MTF (39 years v 30yrs) and FTM (31 yrs v 22yrs). The karyotype where analysed has been normal for their phenotypic sex. Twenty-three of the patients had received HT prior to attending our clinic that in only one case had been prescribed by a specialist. A number of patients had obtained HT via the internet or from overseas sources without medical review. Eighteen of the patients have been or are married and 14 of the group have children. The scale of referrals confirms that GID exists in the Irish population to a significant degree. Thus an appropriate care pathway for people with the condition needs to be established. This will facilitate optimum medical management of the patient group and a coherent approach to the many difficult social issues faced individuals with this disorder.
Blom, Rianne M; Hennekam, Raoul C; Denys, Damiaan
Body Integrity Identity Disorder (BIID) is a rare, infrequently studied and highly secretive condition in which there is a mismatch between the mental body image and the physical body. Subjects suffering from BIID have an intense desire to amputate a major limb or severe the spinal cord in order to become paralyzed. Aim of the study is to broaden the knowledge of BIID amongst medical professionals, by describing all who deal with BIID. Somatic, psychiatric and BIID characteristic data were collected from 54 BIID individuals using a detailed questionnaire. Subsequently, data of different subtypes of BIID (i.e. wish for amputation or paralyzation) were evaluated. Finally, disruption in work, social and family life due to BIID in subjects with and without amputation were compared. Based on the subjects' reports we found that BIID has an onset in early childhood. The main rationale given for their desire for body modification is to feel complete or to feel satisfied inside. Somatic and severe psychiatric co-morbidity is unusual, but depressive symptoms and mood disorders can be present, possibly secondary to the enormous distress BIID puts upon a person. Amputation and paralyzation variant do not differ in any clinical variable. Surgery is found helpful in all subjects who underwent amputation and those subjects score significantly lower on a disability scale than BIID subjects without body modification. The amputation variant and paralyzation variant of BIID are to be considered as one of the same condition. Amputation of the healthy body part appears to result in remission of BIID and an impressive improvement of quality of life. Knowledge of and respect for the desires of BIID individuals are the first steps in providing care and may decrease the huge burden they experience.
Rianne M Blom
Full Text Available INTRODUCTION: Body Integrity Identity Disorder (BIID is a rare, infrequently studied and highly secretive condition in which there is a mismatch between the mental body image and the physical body. Subjects suffering from BIID have an intense desire to amputate a major limb or severe the spinal cord in order to become paralyzed. Aim of the study is to broaden the knowledge of BIID amongst medical professionals, by describing all who deal with BIID. METHODS: Somatic, psychiatric and BIID characteristic data were collected from 54 BIID individuals using a detailed questionnaire. Subsequently, data of different subtypes of BIID (i.e. wish for amputation or paralyzation were evaluated. Finally, disruption in work, social and family life due to BIID in subjects with and without amputation were compared. RESULTS: Based on the subjects' reports we found that BIID has an onset in early childhood. The main rationale given for their desire for body modification is to feel complete or to feel satisfied inside. Somatic and severe psychiatric co-morbidity is unusual, but depressive symptoms and mood disorders can be present, possibly secondary to the enormous distress BIID puts upon a person. Amputation and paralyzation variant do not differ in any clinical variable. Surgery is found helpful in all subjects who underwent amputation and those subjects score significantly lower on a disability scale than BIID subjects without body modification. CONCLUSIONS: The amputation variant and paralyzation variant of BIID are to be considered as one of the same condition. Amputation of the healthy body part appears to result in remission of BIID and an impressive improvement of quality of life. Knowledge of and respect for the desires of BIID individuals are the first steps in providing care and may decrease the huge burden they experience.
Tschöke, S; Steinert, T
We present a case of dissociative identity disorder in which Schneiderian first rank symptoms were present besides of various states of consciousness. Thus the diagnosis of schizophrenia had to be considered. Formally, the symptoms met ICD-10 criteria for schizophrenia. However, taking into account the lack of formal thought disorder and of negative symptoms as well as a typical history of severe and prolonged traumatisation, we did not diagnose a co-morbid schizophrenic disorder. There is good evidence for the existence of psychotic symptoms among patients with dissociative disorders. However, in clinical practice this differential diagnosis is rarely considered.
Dissociative identity disorder is characterised by the presence in one individual of two or more alternative personality states (alters). For such individuals, the memory representation of a particular event can have full episodic, autonoetic status for one alter, while having the status of knowledge or even being inaccessible to a second alter. This phenomenon appears to create difficulties for a purely representational theory and is presented to Mahr & Csibra (M&C) for their consideration.
The past two years have seen a steadily more consistent brand identity for the NHS. Branding will become more important as foundation status and PCT commissioning makes acute hospitals more competitive. This has put pressure on some trusts that have their own strong identities.
Larsen, Henry; Huijboom, Nina; Holm Nielsen, Anne
and identities that resonate more with freelancing and portfolio careers than with the intention of creating firms that are intended to expand. We recognized a pattern where freelancers build up their work as a portfolio by moving from one engagement to another, a process that we will call sequential freelancing...
Gillig, Paulette Marie
A brief description of the controversies surrounding the diagnosis of dissociative identity disorder is presented, followed by a discussion of the proposed similarities and differences between dissociative identity disorder and borderline personality disorder. The phenomenon of autohypnosis in the context of early childhood sexual trauma and disordered attachment is discussed, as is the meaning of alters or alternate personalities. The author describes recent neurosciences research that may relate the symptoms of dissociative identity disorder to demonstrable disordered attention and memory processes. A clinical description of a typical patient presentation is included, plus some recommendations for approaches to treatment.
Kong, Lauren L; Allen, John J B; Glisky, Elizabeth L
Controversy surrounding dissociative identity disorder (DID) has focused on conflicting findings regarding the validity and nature of interidentity amnesia, illustrating the need for objective methods of examining amnesia that can discriminate between explicit and implicit memory transfer. In the present study, the authors used a cross-modal manipulation designed to mitigate implicit memory effects. Explicit memory transfer between identities was examined in 7 DID participants and 34 matched control participants. After words were presented to one identity auditorily, the authors tested another identity for memory of those words in the visual modality using an exclusion paradigm. Despite self-reported interidentity amnesia, memory for experimental stimuli transferred between identities. DID patients showed no superior ability to compartmentalize information, as would be expected with interidentity amnesia. The cross-modal nature of the test makes it unlikely that memory transfer was implicit. These findings demonstrate that subjective reports of interidentity amnesia are not necessarily corroborated by objective tests of explicit memory transfer. Copyright (c) 2008 APA, all rights reserved.
Farrell, Helen M
Persons with dissociative identity disorder (DID) often present in the criminal justice system rather than the mental health system and perplex experts in both professions. DID is a controversial diagnosis with important medicolegal implications. Defendants have claimed that they committed serious crimes, including rape or murder, while they were in a dissociated state. Asserting that their alter personality committed the bad act, defendants have pleaded not guilty by reason of insanity (NGRI). In such instances, forensic experts are asked to assess the defendant for DID and provide testimony in court. Debate continues over whether DID truly exists, whether expert testimony should be allowed into evidence, and whether it should exculpate defendants for their criminal acts. This article reviews historical and theoretical perspectives on DID, presents cases that illustrate the legal implications and controversies of raising an insanity defense based on multiple personalities, and examines the role of forensic experts asked to comment on DID with the goal of assisting clinicians in the medicolegal assessment of DID in relation to crimes.
The aim of this paper is to present result from the first period of implementing models of blended learning in two Danish educations centers at a University College. The question addressed is how activation of blended learning models in undergraduate education for teacher and radiography affects...... knowledge development and which are the constraints or challenges to take into consideration in the process of implementation. The research takes its departure in the two different models of blended learning designed by teachers in undergraduate education centers. This is an investigation of the first...... in educations...
Blom, Rianne M.; Hennekam, Raoul C. M.
Body integrity identity disorder (BIID) is a rare neuropsychiatric disorder in which patients experience a mismatch between the real and experienced body from childhood. BIID results in a strong desire to amputate or paralyse one or more limbs. We describe two BIID patients. A 40-year-old healthy
van Schalkwyk, Gerrit I; Klingensmith, Katherine; Volkmar, Fred R
In this review, we briefly summarize much of the existing literature on gender-related concerns and autism spectrum disorders (ASD), drawing attention to critical shortcomings in our current understanding and potential clinical implications. Some authors have concluded that gender identity disorder (GID), or gender dysphoria (GD), is more common in individuals with ASD, providing a range of potential explanations. However, existing literature is quantitatively limited, and our capacity to draw conclusions is further complicated by conceptual challenges regarding how gender identity is best understood. Discourses that emphasize gender as a component of identity formation are gaining prominence and seem particularly salient when applied to ASD. Individuals with ASD should enjoy equal rights with regard to treatment for gender dysphoria. Clinicians may be able to assist individuals in understanding this aspect of their identity by broadening the social frame and facilitating an exploration of gender roles.
Full Text Available Individuals with dissociative identity disorder (DID have been known to show varied skills and talents as they change from one dissociative state to another. For example, case reports have described people who have changed their handedness or have spoken foreign languages during their dissociative states. During an interview with a patient with DID, a surprising talent emerged when she wrote a sentence for the Folstein Mini-Mental State Exam—mirror writing. It is not known whether her mirror writing had a deeper level of meaning; however, it does emphasize the idiosyncratic nature of dissociative identity disorder.
Le, Catherine; Smith, Joyce; Cohen, Lewis
Individuals with dissociative identity disorder (DID) have been known to show varied skills and talents as they change from one dissociative state to another. For example, case reports have described people who have changed their handedness or have spoken foreign languages during their dissociative states. During an interview with a patient with DID, a surprising talent emerged when she wrote a sentence for the Folstein Mini-Mental State Exam-mirror writing. It is not known whether her mirror writing had a deeper level of meaning; however, it does emphasize the idiosyncratic nature of dissociative identity disorder.
According to DSM-IV criteria, gender identity disorder(GID) is characterized as follows: 1) Strong, persistent cross-gender identification. 2) Persistent discomfort with one's assigned sex or the Sense of inappropriateness in that gender role. 3) Not due to an intersex condition. In this chapter, symptoms, diagnosis and treatment of GID are briefly described. Possible pathogenesis of GID is also discussed.
Huntjens, Rafaële J C; Wessel, Ineke; Hermans, Dirk; van Minnen, Agnes
A lack of adequate access to autobiographical knowledge has been related to psychopathology. More specifically, patients suffering from depression or a history of trauma have been found to be characterized by overgeneral memory, in other words, they show a relative difficulty in retrieving a specific event from memory located in time and place. Previous studies of overgeneral memory have not included patients with dissociative disorders. These patients are interesting to consider, as they are hypothesized to have the ability to selectively compartmentalize information linked to negative emotions. This study examined avoidance and overgeneral memory in patients with dissociative identity disorder (DID; n = 12). The patients completed the autobiographical memory test (AMT). Their performance was compared with control groups of posttraumatic stress disorder (PTSD) patients (n = 26), healthy controls (n = 29), and DID simulators (n = 26). Specifically, we compared the performance of separate identity states in DID hypothesized to diverge in the use of avoidance as a coping strategy to deal with negative affect. No significant differences in memory specificity were found between the separate identities in DID. Irrespective of identity state, DID patients were characterized by a lack of memory specificity, which was similar to the lack of memory specificity found in PTSD patients. The converging results for DID and PTSD patients add empirical evidence for the role of overgeneral memory involved in the maintenance of posttraumatic psychopathology.
Le, Catherine; Smith, Joyce; Cohen, Lewis
Individuals with dissociative identity disorder (DID) have been known to show varied skills and talents as they change from one dissociative state to another. For example, case reports have described people who have changed their handedness or have spoken foreign languages during their dissociative states. During an interview with a patient with DID, a surprising talent emerged when she wrote a sentence for the Folstein Mini-Mental State Exam—mirror writing. It is not known whether her mirror...
Le Heuzey, M-F
There has been an explosion of public interest and concern about children and adolescents who show an interest in changing their gender. And it is an emerging problem for pediatricians, which brings many inquiries about what to do? Both the diagnosis and treatment of gender identity disorder are controversial. But there are a new early treatment using puberty blocking hormones. Copyright © 2012 Elsevier Masson SAS. All rights reserved.
Jegan Yogaratnam; Rajesh Jacob
Dissociative symptoms can dominate the clinical picture in many psychiatric conditions and possess a huge challenge to the clinicians in management. We present a case report of a female with a strong family history of schizophrenia who initially presented with features suggestive of dissociative identity disorder, which is itself a rare clinical entity, was later diagnosed to have schizophrenia. Authors would like to emphasise that clinicians should have a high index of suspicion for schizoph...
O'Brien, Michael T.
The Diagnostic and Statistical Manual of Mental Disorders III Revised rubric of identity disorder is linked to career theory and research findings on vocational identity, career indecisiveness, vocational maturity, and to the theories of Erikson and Kohut. Identity disorder has been found in career counseling clients. It appears that the brief…
Dorahy, Martin J; Brand, Bethany L; Sar, Vedat; Krüger, Christa; Stavropoulos, Pam; Martínez-Taboas, Alfonso; Lewis-Fernández, Roberto; Middleton, Warwick
Despite its long and auspicious place in the history of psychiatry, dissociative identity disorder (DID) has been associated with controversy. This paper aims to examine the empirical data related to DID and outline the contextual challenges to its scientific investigation. The overview is limited to DID-specific research in which one or more of the following conditions are met: (i) a sample of participants with DID was systematically investigated, (ii) psychometrically-sound measures were utilised, (iii) comparisons were made with other samples, (iv) DID was differentiated from other disorders, including other dissociative disorders, (v) extraneous variables were controlled or (vi) DID diagnosis was confirmed. Following an examination of challenges to research, data are organised around the validity and phenomenology of DID, its aetiology and epidemiology, the neurobiological and cognitive correlates of the disorder, and finally its treatment. DID was found to be a complex yet valid disorder across a range of markers. It can be accurately discriminated from other disorders, especially when structured diagnostic interviews assess identity alterations and amnesia. DID is aetiologically associated with a complex combination of developmental and cultural factors, including severe childhood relational trauma. The prevalence of DID appears highest in emergency psychiatric settings and affects approximately 1% of the general population. Psychobiological studies are beginning to identify clear correlates of DID associated with diverse brain areas and cognitive functions. They are also providing an understanding of the potential metacognitive origins of amnesia. Phase-oriented empirically-guided treatments are emerging for DID. The empirical literature on DID is accumulating, although some areas remain under-investigated. Existing data show DID as a complex, valid and not uncommon disorder, associated with developmental and cultural variables, that is amenable to
The Metamorphoses Greek myth includes a story about a woman raised as a male falling in love with another woman, and being transformed into a man prior to a wedding ceremony and staying with her. It is therefore considered that people who desire to live as though they have the opposite gender have existed since ancient times. People who express a sense of discomfort with their anatomical sex and related roles have been reported in the medical literature since the middle of the 19th century. However, homosexual, fetishism, gender identity disorder, and associated conditions were mixed together and regarded as types of sexual perversion that were considered ethically objectionable until the 1950s. The first performance of sex-reassignment surgery in 1952 attracted considerable attention, and the sexologist Harry Benjamin reported a case of 'a woman kept in the body of a man', which was called transsexualism. John William Money studied the sexual consciousness about disorders of sex development and advocated the concept of gender in 1957. Thereafter the disparity between anatomical sex and gender identity was referred to as the psychopathological condition of gender identity disorder, and this was used for its diagnostic name when it was introduced into DSM-III in 1980. However, gender identity disorder encompasses a spectrum of conditions, and DSM-III -R categorized it into three types: transsexualism, nontranssexualism, and not otherwise specified. The first two types were subsequently combined and standardized into the official diagnostic name of 'gender identity disorder' in DSM-IV. In contrast, gender identity disorder was categorized into four groups (including transsexualism and dual-role transvestism) in ICD-10. A draft proposal of DSM-5 has been submitted, in which the diagnostic name of gender identity disorder has been changed to gender dysphoria. Also, it refers to 'assigned gender' rather than to 'sex', and includes disorders of sexual development
Blom, R M; Braam, A W; de Boer-Kreeft, N; Sonnen, M P A M
Body integrity identity disorder (BIID) is a rare condition in which a person, for no apparent physical reason, is tormented by the experience that a body-part, such as a limb, does not really belong to the body. Patients experience an intense desire for the limb to be amputated (a 'desire' formerly referred to as 'apotemnophilia'). We report on a 58-year-old male patient with BIID who froze one of his legs so that he could amputate it himself. A surgeon ultimately intervened and amputated the leg professionally. The patient was extremely relieved and was still experiencing relief at a follow-up three years later.
Gentile, Julie P.; Dillon, Kristy S.; Gillig, Paulette Marie
There is a wide variety of what have been called “dissociative disorders,” including dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, and forms of dissociative disorder not otherwise specified. Some of these diagnoses, particularly dissociative identity disorder, are controversial and have been questioned by many clinicians over the years. The disorders may be under-diagnosed or misdiagnosed, but many persons who have experienced trauma rep...
Borowsky, Hannah M.; Eisenberg, Marla E.; Bucchianeri, Michaela M.; Piran, Niva; Neumark-Sztainer, Dianne
Using data from a community-based sample (Project EAT-III), this study (N = 1241; mean age = 25.2) examined the relationship of feminist identity with body image and disordered eating. Feminist-identified women reported significantly higher body satisfaction than non-feminist women and women who did not identify as feminists but held feminist beliefs. However, feminist-identified women did not differ from non-feminist women in disordered eating. Women holding feminist beliefs and non-feminist women did not differ in body satisfaction. Our findings suggest that self-identification as a feminist may promote positive body image in young adult women, but may be insufficient to change behaviors. PMID:26694553
Borowsky, Hannah M; Eisenberg, Marla E; Bucchianeri, Michaela M; Piran, Niva; Neumark-Sztainer, Dianne
Using data from a community-based sample (Project EAT-III), this study (N = 1241; mean age = 25.2) examined the relationship of feminist identity with body image and disordered eating. Feminist-identified women reported significantly higher body satisfaction than non-feminist women and women who did not identify as feminists but held feminist beliefs. However, feminist-identified women did not differ from non-feminist women in disordered eating. Women holding feminist beliefs and non-feminist women did not differ in body satisfaction. Our findings suggest that self-identification as a feminist may promote positive body image in young adult women, but may be insufficient to change behaviors.
The diagnostic validity of dissociative identity disorder (DID) continues to inspire controversy, with some commentators claiming that DID is a modern variant of "hysteria"; that is, attention-seeking behavior. The author asserts that DID is indeed a valid psychiatric disorder, and believes that this skeptical reaction can largely be attributed to a specific set of transference/countertransference interactions that these patients tend to inspire. The paper delineates several clinical features of DID that can easily be mistaken for hysterical phenomena, and attempts to find the roots of this confusion in the DID patients' experience of interpersonal powerlessness, which leads them to present their symptoms in an unconvincing, "hysterical" manner. Confusion between the vertical split seen in the dissociative disorders and the horizontal split characteristic of the classic hysterical personality is discussed, as is the powerful effect of observer bias in creating hysterical-appearing phenomena. The term "pseudo-hysteria" is used to denote a situation in which a genuine psychiatric disorder, DID, is perceived as an hysterical production.
Reinders, A A T Simone; Nijenhuis, Ellert R S; Quak, Jacqueline; Korf, Jakob; Haaksma, Jaap; Paans, Anne M J; Willemsen, Antoon T M; den Boer, Johan A
Dissociative identity disorder (DID) patients function as two or more identities or dissociative identity states (DIS), categorized as 'neutral identity states' (NIS) and 'traumatic identity states' (TIS). NIS inhibit access to traumatic memories thereby enabling daily life functioning. TIS have access and responses to these memories. We tested whether these DIS show different psychobiological reactions to trauma-related memory. A symptom provocation paradigm with 11 DID patients was used in a two-by-two factorial design setting. Both NIS and TIS were exposed to a neutral and a trauma-related memory script. Three psychobiological parameters were tested: subjective ratings (emotional and sensori-motor), cardiovascular responses (heart rate, blood pressure, heart rate variability) and regional cerebral blood flow as determined with H(2)(15)O positron emission tomography. Psychobiological differences were found for the different DIS. Subjective and cardiovascular reactions revealed significant main and interactions effects. Regional cerebral blood flow data revealed different neural networks to be associated with different processing of the neutral and trauma-related memory script by NIS and TIS. Patients with DID encompass at least two different DIS. These identities involve different subjective reactions, cardiovascular responses and cerebral activation patterns to a trauma-related memory script.
Furnham, Adrian; Sen, Radhika
This study examined lay theories regarding gender identity disorder (GID). Pilot interviews were completed with participants (n = 10) regarding their views on possible causes and treatments of GID. Participants (mainly young British people and students; n = 124) then completed a questionnaire that was based on the interviews and a review of the salient literature on lay theories. As hypothesized, participants believed most in biomedical causes and treatments of GID. Factor analysis (with varimax rotation) identified 4 factors in relation to causes of GID: upbringing and personal factors, pregnancy and brain abnormalities, environmental factors, and biomedical causes. Five factors that were identified in relation to the cure/treatment of GID were psychological assistance and personal factors, extreme medical and behavioral changes, alternative therapies, external factors, and medical treatments. The results indicated that participants neither agreed nor strongly disagreed about causes and cures regarding GID, but that these beliefs were logically related. Limitations, particularly of sampling, were considered.
Gold, Steven N; Elhai, Jon D; Rea, Bayard D; Weiss, Donna; Masino, Theodore; Morris, Staci Leon; McIninch, Jessica
Evidence for the effectiveness of contextual therapy, a new approach for treating adult survivors of prolonged child abuse (PCA), is provided via case studies of three women with Dissociative Identity Disorder (DID). Contextual therapy is based on the premise that it is not only traumatic experiences that account for PCA survivors' psychological difficulties. Even more fundamentally, many survivors grow up in an interpersonal context in which adequate resources for secure attachment and acquisition of adaptive living skills are not available. As a result, they are left with lasting deficits that undermine not only their current functioning, but also their ability to cope with reliving their traumatic memories in therapy. The primary focus of this treatment approach, therefore, is on developing capacities for feeling and functioning better in the present, rather than on extensive exploration and processing of the client's trauma history or, in the case of DID, of identity fragments. Treatment of the three cases presented ranged from eight months to two and one-half years' duration, and culminated in very positive outcomes. The women's reports of achievements, such as obtaining and maintaining gainful employment, greater self-sufficiency, and the establishment of more intimate and gratifying relationships, indicated marked improvements in daily functioning. Objective test data obtained at admission and discharge, and in one case, at follow-up, documented substantial reductions in dissociative, posttraumatic stress, depressive, and other symptoms.
Huntjens, R.J.C.; Verschuere, B.; McNally, R.J.
Background A major symptom of Dissociative Identity Disorder (DID; formerly Multiple Personality Disorder) is dissociative amnesia, the inability to recall important personal information. Only two case studies have directly addressed autobiographical memory in DID. Both provided evidence suggestive
Huntjens, R.J.C.; Verschuere, B.; McNally, R.J.
Background: A major symptom of Dissociative Identity Disorder (DID; formerly Multiple Personality Disorder) is dissociative amnesia, the inability to recall important personal information. Only two case studies have directly addressed autobiographical memory in DID. Both provided evidence suggestive
Ross, Colin A
The author reviewed a two-part critique of dissociative identity disorder published in the Canadian Journal of Psychiatry. The two papers contain errors of logic and scholarship. Contrary to the conclusions in the critique, dissociative identity disorder has established diagnostic reliability and concurrent validity, the trauma histories of affected individuals can be corroborated, and the existing prospective treatment outcome literature demonstrates improvement in individuals receiving psychotherapy for the disorder. The available evidence supports the inclusion of dissociative identity disorder in future editions of the Diagnostic and Statistical Manual of Mental Disorders.
Galle, Per; Kroes, Peter
explicit arguments’ in its defence. This calls for an in-depth conceptual clarification of the science-design relationship. The aims of the present paper are to take up the gauntlet thrown by Farrell and Hooker, and in so doing, to provide such a clarification. We first analyse Farrell & Hooker's arguments...
Ross, Colin A.
The author reviewed a two-part critique of dissociative identity disorder published in the "Canadian Journal of Psychiatry". The two papers contain errors of logic and scholarship. Contrary to the conclusions in the critique, dissociative identity disorder has established diagnostic reliability and concurrent validity, the trauma histories of…
Dragowski, Eliza A.; Scharron-del Rio, Maria R.; Sandigorsky, Amy L.
Childhood gender identity development is reviewed in the context of biological, environmental, cultural, and diagnostic factors. With the upcoming 5th revision of the "Diagnostic and Statistical Manual of Mental Disorders," the authors offer a critical consideration of childhood gender identity disorder, along with proposed diagnostic changes.…
Ross, Colin A; Ferrell, Lynn; Schroeder, Elizabeth
The literature indicates that, among individuals with borderline personality disorder, pathological dissociation correlates with a wide range of impairments and difficulties in psychological function. It also predicts a poorer response to dialectical behavior therapy for borderline personality disorder. We hypothesized that (a) dissociative identity disorder commonly co-occurs with borderline personality disorder and vice versa, and (b) individuals who meet criteria for both disorders have more comorbidity and trauma than individuals who meet criteria for only 1 disorder. We interviewed a sample of inpatients in a hospital trauma program using 3 measures of dissociation. The most symptomatic group was those participants who met criteria for both borderline personality disorder and dissociative identity disorder on the Dissociative Disorders Interview Schedule, followed by those who met criteria for dissociative identity disorder only, then those with borderline personality disorder only, and finally those with neither disorder. Greater attention should be paid to the relationship between borderline personality disorder and dissociative identity disorder.
This paper is a case presentation and study of the introduction of treatment for Dissociative Identity Disorder (DID). Since one manifestation of the pathology of DID is that sufferers avoid relying on others, at the start of treatment we try to stabilise the relationship between clinicians and patients; that is to say, we aim to build a treatment relationship which will be able to gradually overcome the patients' dread of relying on clinicians. In parallel with this we undertake a thorough psychiatric assessment of their condition. This is a standard treatment plan, which follows the general principles of clinical psychiatry. On the other hand, the specialist aspect of DID treatment calls for handling the unique behaviours of a group of mutually opposed alternating personalities appropriately, while always paying consistent attention to the traumatic memories which are connected to the formation and maintenance of the condition. This paper presents the first DID case which the author has taken charge of. There were some difficulties in the early stages of treatment, but after modifying some parts to acknowledge the alternating personalities as independent personalities in face-to-face interviews and psychological education for families, the stabilisation of the treatment structure progressed gradually and the stability of the relationship between clinicians and patients itself has become the focus.
Patients diagnosed with dissociative identity disorder (DID) usually present with alternative personality states (alters) who take separate control of consciousness. Commonly, one alter will claim they have no awareness of events which took place when another alter was in control. However, some kinds of material are transferred across the alter boundary. Huntjens et al. devised an objective method of demonstrating such transfer. In the main study, following Huntjens et al., for three patients, two alters were taught different sets of nouns. The following week, one of the alters was given a recognition memory test including both sets plus distractor words. The patients in the Huntjens experiment responded in the same way to words in both sets. In the present experiemnt, two of the patients tested had pairs of alters where there was no interference from the material which was presented to the other alter. In one of these cases, there was breakthrough with one pairing of alters, a pattern matched in a subsidiary experiment. The population of individuals with DID are not homogeneous with respect to the depth of the blocking of episodic material from one alter to another.
Nguyen Le Quynh, Nga; Carvalho, Maria Clara da Costa
The thesis is a document in building the brand image for the authors’ own start-up Avec Orima. It is motivated by the need to take the company from the planning stage to the next very first step of implementing the business – designing the company’s brand identity. The thesis focused on the process of designing the brand identity. The process began with analysing the company and Finnish target market to have the insights on what the company stands for and wants to achieve. The study then ...
Gentile, Julie P; Dillon, Kristy S; Gillig, Paulette Marie
There is a wide variety of what have been called "dissociative disorders," including dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, and forms of dissociative disorder not otherwise specified. Some of these diagnoses, particularly dissociative identity disorder, are controversial and have been questioned by many clinicians over the years. The disorders may be under-diagnosed or misdiagnosed, but many persons who have experienced trauma report "dissociative" symptoms. Prevalence of dissociative disorders is unknown, but current estimates are higher than previously thought. This paper reviews clinical, phenomenological, and epidemiological data regarding diagnosis in general, and illustrates possible treatment interventions for dissociative identity disorder, with a focus on psychotherapy interventions and a review of current psychopharmacology recommendations as part of a comprehensive multidisciplinary treatment plan.
Duišin, Dragana; Batinić, Borjanka; Barišić, Jasmina; Djordjevic, Miroslav L; Vujović, Svetlana; Bizic, Marta
Investigations in the field of gender identity disorder (GID) have been mostly related to psychiatric comorbidity and severe psychiatric disorders, but have focused less on personality and personality disorders (PDs). The aim of the study was to assess the presence of PDs in persons with GID as compared to cisgendered (a cisgender person is a person who is content to remain the gender they were assigned at birth) heterosexuals, as well as to biological sex. The study sample consisted of 30 persons with GID and 30 cisgendered heterosexuals from the general population. The assessment of PDs was conducted by application of the self-administered Structured Clinical Interview for DSM-IV Axis II PDs (SCID-II). Persons with GID compared to cisgender heterosexuals have higher presence of PDs, particularly Paranoid PD, avoidant PDs, and comorbid PDs. In addition, MtF (transwomen are people assigned male at birth who identify as women) persons are characterized by a more severe psychopathological profile. Assessment of PDs in persons with GID is of great importance as it comprises a key part of personalized treatment plan tailoring, as well as a prognostic factor for sex-reassignment surgery (SRS) outcome.
Full Text Available Background. Investigations in the field of gender identity disorder (GID have been mostly related to psychiatric comorbidity and severe psychiatric disorders, but have focused less on personality and personality disorders (PDs. Aims. The aim of the study was to assess the presence of PDs in persons with GID as compared to cisgendered (a cisgender person is a person who is content to remain the gender they were assigned at birth heterosexuals, as well as to biological sex. Methods. The study sample consisted of 30 persons with GID and 30 cisgendered heterosexuals from the general population. The assessment of PDs was conducted by application of the self-administered Structured Clinical Interview for DSM-IV Axis II PDs (SCID-II. Results. Persons with GID compared to cisgender heterosexuals have higher presence of PDs, particularly Paranoid PD, avoidant PDs, and comorbid PDs. In addition, MtF (transwomen are people assigned male at birth who identify as women persons are characterized by a more severe psychopathological profile. Conclusions. Assessment of PDs in persons with GID is of great importance as it comprises a key part of personalized treatment plan tailoring, as well as a prognostic factor for sex-reassignment surgery (SRS outcome.
Vermetten, Eric; Schmahl, Christian; Lindner, Sanneke; Loewenstein, Richard J.; Bremner, J. Douglas
Objective Smaller hippocampal volume has been reported in several stress-related psychiatric disorders, including posttraumatic stress disorder (PTSD), borderline personality disorder with early abuse, and depression with early abuse. Patients with borderline personality disorder and early abuse have also been found to have smaller amygdalar volume. The authors examined hippocampal and amygdalar volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma. Method The authors used magnetic resonance imaging to measure the volumes of the hippocampus and amygdala in 15 female patients with dissociative identity disorder and 23 female subjects without dissociative identity disorder or any other psychiatric disorder. The volumetric measurements for the two groups were compared. Results Hippocampal volume was 19.2% smaller and amygdalar volume was 31.6% smaller in the patients with dissociative identity disorder, compared to the healthy subjects. The ratio of hippocampal volume to amygdalar volume was significantly different between groups. Conclusions The findings are consistent with the presence of smaller hippocampal and amygdalar volumes in patients with dissociative identity disorder, compared with healthy subjects. PMID:16585437
Vermetten, Eric; Schmahl, Christian; Lindner, Sanneke; Loewenstein, Richard J; Bremner, J Douglas
Smaller hippocampal volume has been reported in several stress-related psychiatric disorders, including posttraumatic stress disorder (PTSD), borderline personality disorder with early abuse, and depression with early abuse. Patients with borderline personality disorder and early abuse have also been found to have smaller amygdalar volume. The authors examined hippocampal and amygdalar volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma. The authors used magnetic resonance imaging to measure the volumes of the hippocampus and amygdala in 15 female patients with dissociative identity disorder and 23 female subjects without dissociative identity disorder or any other psychiatric disorder. The volumetric measurements for the two groups were compared. Hippocampal volume was 19.2% smaller and amygdalar volume was 31.6% smaller in the patients with dissociative identity disorder, compared to the healthy subjects. The ratio of hippocampal volume to amygdalar volume was significantly different between groups. The findings are consistent with the presence of smaller hippocampal and amygdalar volumes in patients with dissociative identity disorder, compared with healthy subjects.
In this article, I argue that persons suffering from Body Integrity Identity Disorder (BIID) can give informed consent to surgical measures designed to treat this disorder. This is true even if the surgery seems radical or irrational to most people. The decision to have surgery made by a BIID patient is not necessarily coerced, incompetent or uninformed. If surgery for BIID is offered, there should certainly be a screening process in place to insure informed consent. It is beyond the scope of this work, however, to define all the conditions that should be placed on the availability of surgery. However, I argue, given the similarities between BIID and gender dysphoria and the success of such gatekeeping measures for the surgical treatment of gender dysphoria, it is reasonable that similar conditions be in place for BIID. Once other treatment options are tried and gatekeeping measures satisfied, A BIID patient can give informed consent to radical surgery.
Labott, Susan M; Wallach, Heather R
Verification of dissociative identity disorder presents challenges given the complex nature of the illness. This study addressed the concern that this disorder can be successfully malingered on objective and projective psychological tests. 50 undergraduate women were assigned to a Malingering or a Control condition, then completed the Rorschach Inkblot Test and the Dissociative Experiences Scale II. The Malingering group were asked to simulate dissociative identity disorder; controls received instructions to answer all materials honestly. Analysis indicated that malingerers were significantly more likely to endorse dissociative experiences on the Dissociative Experiences Scale II in the range common to patients with diagnosed dissociative identity disorder. However, on the Rorschach there were no significant differences between the two groups. Results suggest that the assessment of dissociative identity disorder requires a multifaceted approach with both objective and projective assessment tools. Research is needed to assess these issues in clinical populations.
Huntjens, Rafaele JC; Verschuere, Bruno; McNally, Richard J
Background: A major symptom of Dissociative Identity Disorder (DID; formerly Multiple Personality Disorder) is dissociative amnesia, the inability to recall important personal information. Only two case studies have directly addressed autobiographical memory in DID. Both provided evidence suggestive of dissociative amnesia. The aim of the current study was to objectively assess transfer of autobiographical information between identities in a larger sample of DID patients. Methods: Using a c...
Huntjens, Rafaële J C; Peters, Madelon L; Postma, Albert; Woertman, Liesbeth; Effting, Marieke; van der Hart, Onno
Patients with Dissociative Identity Disorder (DID) frequently report episodes of interidentity amnesia, that is amnesia for events experienced by other identities. The goal of the present experiment was to test the implicit transfer of trauma-related information between identities in DID. We hypothesized that whereas declarative information may transfer from one identity to another, the emotional connotation of the memory may be dissociated, especially in the case of negative, trauma-related emotional valence. An evaluative conditioning procedure was combined with an affective priming procedure, both performed by different identities. In the evaluative conditioning procedure, previously neutral stimuli come to refer to a negative or positive connotation. The affective priming procedure was used to test the transfer of this acquired valence to an identity reporting interidentity amnesia. Results indicated activation of stimulus valence in the affective priming task, that is transfer of emotional material between identities.
Dissociative identity disorder (DID), once considered rare, was frequently diagnosed during the 1980s and 1990s, after which interest declined. This is the trajectory of a medical fad. DID was based on poorly conceived theories and used potentially damaging treatment methods. The problem continues, given that the DSM-5 includes DID and accords dissociative disorders a separate chapter in its manual.
Unfortunately, due to the length of the treatment processes, which last for the whole life of the patient, its hard to identify the cases with full integration of identity and full recovery. As a conclusion, authors define DID as an important issue in modern psychiatry which should be further addressed in neurobiological and pharmacological studies.
Savoy, R L; Frederick, B B; Keuroghlian, A S; Wolk, P C
Patients who suffer from dissociative identity disorder present unique scientific and clinical challenges for psychology and psychiatry. We have been fortunate in working with a patient who-while undergoing functional MRI-can switch rapidly and voluntarily between her main personality (a middle-aged, high-functioning woman) and an alternate personality (a 4-6-year-old girl). A unique task was designed to isolate the processes occurring during the switches between these personalities. Data are from two imaging sessions, conducted months apart, each showing the same activated areas during switches between these personalities. The activated areas include the following: the primary sensory and motor cortex, likely associated with characteristic facial movements made during switching; the nucleus accumbens bilaterally, possibly associated with aspects of reward connected with switching; and prefrontal sites, presumably associated with the executive control involved in the switching of personalities.
Huntjens, Rafaële J C; Peters, Madelon L; Woertman, Liesbeth; van der Hart, Onno; Postma, Albert
The present study aimed to determine interidentity retrieval of emotionally valenced words in dissociative identity disorder (DID). Twenty-two DID patients participated together with 25 normal controls and 25 controls instructed to simulate DID. Two wordlists A and B were constructed including neutral, positive and negative material. List A was shown to one identity, while list B was shown to another identity claiming total amnesia for the words learned by the first identity. The identity claiming amnesia was tested for intrusions from list A words into the recall of words from list B and recognition of the words learned by both identities. Test results indicated no evidence of total interidentity amnesia for emotionally valenced material in DID. It is argued that dissociative amnesia in DID may more adequately be described as a disturbance in meta-memory functioning instead of an actual retrieval inability.
Huntjens, Rafaële J. C.; Verschuere, Bruno; McNally, Richard J.
Background A major symptom of Dissociative Identity Disorder (DID; formerly Multiple Personality Disorder) is dissociative amnesia, the inability to recall important personal information. Only two case studies have directly addressed autobiographical memory in DID. Both provided evidence suggestive of dissociative amnesia. The aim of the current study was to objectively assess transfer of autobiographical information between identities in a larger sample of DID patients. Methods Using a concealed information task, we assessed recognition of autobiographical details in an amnesic identity. Eleven DID patients, 27 normal controls, and 23 controls simulating DID participated. Controls and simulators were matched to patients on age, education level, and type of autobiographical memory tested. Findings Although patients subjectively reported amnesia for the autobiographical details included in the task, the results indicated transfer of information between identities. Conclusion The results call for a revision of the DID definition. The amnesia criterion should be modified to emphasize its subjective nature. PMID:22815769
Huntjens, Rafaële J C; Verschuere, Bruno; McNally, Richard J
A major symptom of Dissociative Identity Disorder (DID; formerly Multiple Personality Disorder) is dissociative amnesia, the inability to recall important personal information. Only two case studies have directly addressed autobiographical memory in DID. Both provided evidence suggestive of dissociative amnesia. The aim of the current study was to objectively assess transfer of autobiographical information between identities in a larger sample of DID patients. Using a concealed information task, we assessed recognition of autobiographical details in an amnesic identity. Eleven DID patients, 27 normal controls, and 23 controls simulating DID participated. Controls and simulators were matched to patients on age, education level, and type of autobiographical memory tested. Although patients subjectively reported amnesia for the autobiographical details included in the task, the results indicated transfer of information between identities. The results call for a revision of the DID definition. The amnesia criterion should be modified to emphasize its subjective nature.
Rafaële J C Huntjens
Full Text Available BACKGROUND: A major symptom of Dissociative Identity Disorder (DID; formerly Multiple Personality Disorder is dissociative amnesia, the inability to recall important personal information. Only two case studies have directly addressed autobiographical memory in DID. Both provided evidence suggestive of dissociative amnesia. The aim of the current study was to objectively assess transfer of autobiographical information between identities in a larger sample of DID patients. METHODS: Using a concealed information task, we assessed recognition of autobiographical details in an amnesic identity. Eleven DID patients, 27 normal controls, and 23 controls simulating DID participated. Controls and simulators were matched to patients on age, education level, and type of autobiographical memory tested. FINDINGS: Although patients subjectively reported amnesia for the autobiographical details included in the task, the results indicated transfer of information between identities. CONCLUSION: The results call for a revision of the DID definition. The amnesia criterion should be modified to emphasize its subjective nature.
Manning, Mark L; Manning, Rana L
Although dissociative identity disorder, a condition in which multiple individuals appear to inhabit a single body, is a recognized psychiatric disorder, patients may yet encounter health professionals who declare that they simply "do not believe in multiple personalities." This article explores the proposal that resistance to the disorder represents a failure to apply an appropriate paradigm from which the disorder should be interpreted. Trauma and sociocognitive explanations of dissociative identity disorder are contrasted. The trauma hypothesis is further differentiated into paradigms in which trauma affects a defense mechanism, and one in which trauma serves to inhibit the normal integration sequence of parallel processes of the self in childhood. This latter paradigm is shown to be broadly consistent with current models of cortical processing in another system, the cortical visual system.
George, Rita; Stokes, Mark A
Clinical impressions indicate that there is an overrepresentation of gender-dysphoria within the autism spectrum disorder. However, little is presently known about the demographics of gender-identity issues in autism spectrum disorder. Based upon what little is known, we hypothesized that there would be an increased prevalence of gender-dysphoria among those with autism spectrum disorder compared to a typically developing population. We surveyed gender-dysphoria with the Gender-Identity/Gender-Dysphoria Questionnaire among 90 males and 219 females with autism spectrum disorder and compared these rates to those of 103 males and 158 females without autism spectrum disorder. When compared to typically developing individuals, autistic individuals reported a higher number of gender-dysphoric traits. Rates of gender-dysphoria in the group with autism spectrum disorder were significantly higher than reported in the wider population. Mediation analysis found that the relationship between autistic traits and sexual orientation was mediated by gender-dysphoric traits. Results suggest that autism spectrum disorder presents a unique experience to the formation and consolidation of gender identity, and for some autistic individuals, their sexual orientation relates to their gender experience. It is important that clinicians working with autism spectrum disorder are aware of the gender-diversity in this population so that the necessary support for healthy socio-sexual functioning and mental well-being is provided.
Meyer, J K
Experience with more than 500 patients over the last decade has led to the conclusion that the quest for sex reassignment is a symptomatic compromise formation serving defensive and expressive functions. The symptoms are the outgrowth of developmental trauma affecting body ego and archaic sense of self and caused by peculiar symbiotic and separation-individuation phase relationships. The child exists in the pathogenic (and reparative) maternal fantasy in order to repair her body image and to demonstrate the interconvertability of the sexes. Gender identity exists not as a primary phenomenon, but in a sense as a tertiary one. There is, no doubt, a tendency to gender-differentiate in a way concordant with biological endowment. Nevertheless, gender formation is seriously compromised by earlier psychological difficulty. Gender identity is a fundamental acquisition in the developing personality, but it is part of a hierarchical series beginning with archaic body ego, early body image, and primitive selfness, representing their extension into sexual and reproductive spheres. Gender identity consolidates during separation-individuation and gender pathology bears common features with other preoedipal syndromes. Transsexualism is closely linked to perversions, and the clinical syndromes may shade from one into another. However, what is kept at the symbolic level in the perversions must be made concrete in transsexualism. In this regard there is a close relation to psychosis. The clinical complaint of the transsexual is a condensation of remarkable proportions. When the transsexual says that he is a girl trapped in a man's body, he sincerely means what he says. As with other symptoms, however, it takes a long time before he begins to say what he means.
Foote, Brad; Park, Jane
Schizophrenia and dissociative identity disorder (DID) are typically thought of as unrelated syndromes--a genetically based psychotic disorder versus a trauma-based dissociative disorder--and are categorized as such by the DSM-IV. However, substantial data exist to document the elevated occurrence of psychotic symptoms in DID; awareness of these features is necessary to prevent diagnostic confusion. Recent research has also pointed out that schizophrenia and DID overlap not only in psychotic symptoms but also in terms of traumatic antecedents, leading to a number of suggestions for revision of our clinical, theoretical, and nosologic understanding of the relationship between these two disorders.
Full Text Available Gender identity disorder (GID is a complex disorder and can be defined as a group of disorders whose common feature is a strong and persistent preference for living as a person of the other sex. It is associated with significant impairment in social, occupational, interpersonal, and other areas of functioning. We describe the case of an adolescent, biologically male who was brought to our outpatient department primarily with symptoms of adjustment disorder with GID and the management provided. The role of a psychiatrist in the management, ethical and legal issues involved is also discussed.
Kim, Ilbin; Kim, Daeho; Jung, Hyun-Jin
Although dissociative identity disorder (DID), the most severe of the dissociative disorders, has retained its own diagnostic entity since its introduction in the DSM-III, cases of DID are rarely seen in South and East Asia, likely due to the higher prevalence of possession disorder. We report two patients with DID who were recently admitted to our inpatient psychiatric unit and demonstrated distinct transitions to several identities. Their diagnoses were confirmed through a structured interview for dissociative disorders and possible differential diagnoses were ruled out by psychological, neuroimaging, and laboratory tests. The rapid transition to a Westernized, individualized society along with an increase in child abuse, might contribute to an increase in DID, previously under-diagnosed in this region.
Sar, Vedat; Unal, Seher N; Ozturk, Erdinc
The aim of the study was to investigate if there were any characteristics of regional cerebral blood flow (rCBF) in dissociative identity disorder. Twenty-one drug-free patients with dissociative identity disorder and nine healthy volunteers participated in the study. In addition to a clinical evaluation, dissociative psychopathology was assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders, the Dissociative Experiences Scale and the Clinician-Administered Dissociative States Scale. A semi-structured interview for borderline personality disorder, the Hamilton Depression Rating Scale, and the Childhood Trauma Questionnaire were also administered to all patients. Normal controls had to be without a history of childhood trauma and without any depressive or dissociative disorder. Regional cerebral blood flow (rCBF) was studied with single photon emission computed tomography (SPECT) with Tc99m-hexamethylpropylenamine (HMPAO) as a tracer. Compared with findings in the control group, the rCBF ratio was decreased among patients with dissociative identity disorder in the orbitofrontal region bilaterally. It was increased in median and superior frontal regions and occipital regions bilaterally. There was no significant correlation between rCBF ratios of the regions of interest and any of the psychopathology scale scores. An explanation for the neurophysiology of dissociative psychopathology has to invoke a comprehensive model of interaction between anterior and posterior brain regions.
Huntjens, Rafaele J. C.; Peters, Madelon L.; Woertman, Liesbeth; van der Hart, Onno; Postma, Albert
The present study aimed to determine interidentity retrieval of emotionally valenced words in dissociative identity disorder (DID). Twenty-two DID patients participated together with 25 normal controls and 25 controls instructed to simulate DID. Two wordlists A and B were constructed including
Describes the case studies of two inmates detained in a maximum security prison having been diagnosed with Dissociative Identity Disorder and receiving individual therapy. Although treatment is ongoing, mid-treatment progress indicates the treatment is successful and the prognosis is excellent. Accentuates the practicality and rewards of working…
Levy, Benjamin; Swanson, Janine E.
College counseling professionals address a wide range of complex student mental health concerns. Among these, accurately identifying client presentations of dissociative identity disorder (DID) can be especially challenging because students with DID sometimes present as if they are experiencing another problem, such as a mood, anxiety, or…
Kreukels, B.P.C.; Cohen-Kettenis, P.T.
The use of gonadotropin-releasing hormone analogs (GnRHa) to suppress puberty in adolescents with gender dysphoria is a fairly new intervention in the field of gender identity disorders or transsexualism. GnRHa are used to give adolescents time to make balanced decisions on any further treatment
Bergin, Audrey E.; Niclas, Mary Ann
The treatment of children with Gender Identity Disorder is laden with important ethical and moral considerations. Gender-typed behavior is defined by culture; therefore, it is of paramount importance that therapists clarify their own biases and expectations of gender-based behavior before attempting treatment. Two case studies are presented. (LSR)
Bou Khalil, Rami; Richa, Sami
Apotemnophilia or body integrity identity disorder (BIID) denotes a syndrome in which a person is preoccupied with the desire to amputate a healthy limb. In this report, we review the available case reports in the literature in order to enhance psychiatrists' and physicians' comprehension of this disorder. A search for the case reports available via MEDLINE was done since the first case report published by Money et al in 1977 till May 2011, using the following terms: apotemnophilia, self-demand amputation, body integrity identity disorder, and BIID. In all, 14 case reports were found relevant to our search. The desire to amputate one's healthy limb seems to be related to a major disturbance in the person's perception of one's own identity, where limb amputation can relieve temporarily the patient's feeling of distress without necessarily and uniformly adjusting the patient's own identity misperception. More investigations are needed in this domain in order to develop noninvasive treatment strategies that approach this aspect of the patient's distress within a globalist perspective. In addition, the health professionals' awareness regarding this disorder is required to ensure professional management of patients' suffering.
Gavriel-Fried, Belle; Peled, Einat; Ajzenstadt, Mimi
Women with a gambling problem bear a negative social stigma. Based on the theory of symbolic interactionism, this study examined the construction of social identities by 17 Israeli women diagnosed with a gambling disorder. Interpretive interactionist analysis revealed how they construct their identity through correspondence with patterns of behavior that are perceived as normative, and identified 3 major themes: "I'm not actually a gambler" (the presentation of a multidimensional identity comprising other identities besides that of a gambler); "Staying normative during gambling"; and "I have changed" (reformed gamblers' presentation of themselves as having changed for the better). The findings underscore the complex dialogue behind the identity construction put forward by women with a gambling problem, their yearning to be perceived by society as normative women and to fit in despite their stigmatized behavior, and the tension they feel in society's relationship toward them. The findings also suggest that practitioners who work with women gamblers may want to pay attention to the power relations shaping identity construction in an interview setting, and look more closely at the women's awareness of the stigma they bear and the complex processes that make up their multidimensional identity. (c) 2015 APA, all rights reserved).
Tracey, Monica W.; Hutchinson, Alisa
Design thinking positions designers as the drivers of the design space yet academic discourse is largely silent on the topic of professional identity development in design. Professional identity, or the dynamic narratives that individuals construct and maintain to integrate their personal qualities with professional responsibilities, has not been…
Full Text Available Objective: The purpose of this study is to investigation of personality disorders and personality traits in men who have gender identity disorder (GID. Identification of personality disorders can be useful for enhancement of the quality of help to the patients. Materials & Methods: This analytical and cross-sectional study was a comparative and case – control research. 40 men with gender identity disorder were selected by convenient sampling from individuals who have been referred to Tehran Navab Safavi welfare center. Also, 40 available individuals who have no any diagnostic criteria about gender identity disorder in DSM-IV-TR and worked in Islamic Azad University (Tehran Sciences and Researches Unit were selected as control group and matched with patients. Personality disorders and those frequencies were evaluated with Millon Clinical Multiaxial Inventory-II (MCMI-II. Data were analyzed using by Chi-square and Independent T tests. Results: The results showed that gender identity disorder patients get higher scores as compared to control group in scales “Dependent” (P=0/038, “Histrionic” (P<0/001, “Antisocial” (P=0/017, “Passive – aggressive” (P=0/007, “Borderline” (P<0/001 and “Paranoid” (P=0/021 and their difference was significant. Conclusion: Generally, the results of this study showed persons who have gender identity disorder also have some symptoms of personality disorders more than normal people.
Rodewald, Frauke; Wilhelm-Göling, Claudia; Emrich, Hinderk M; Reddemann, Luise; Gast, Ursula
The aim of this study was to investigate axis-I comorbidity in patients with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS). Using the Diagnostic Interview for Psychiatric Disorders, results from patients with DID (n = 44) and DDNOS (n = 22) were compared with those of patients with posttraumatic stress disorder (PTSD) (n = 13), other anxiety disorders (n = 14), depression (n = 17), and nonclinical controls (n = 30). No comorbid disorders were found in nonclinical controls. The average number of comorbid disorders in patients with depression or anxiety was 0 to 2. Patients with dissociative disorders averagely suffered from 5 comorbid disorders. The most prevalent comorbidity in DDNOS and DID was PTSD. Comorbidity profiles of patients with DID and DDNOS were very similar to those in PTSD (high prevalence of anxiety, somatoform disorders, and depression), but differed significantly from those of patients with depression and anxiety disorders. These findings confirm the hypothesis that PTSD, DID, and DDNOS are phenomenologically related syndromes that should be summarized within a new diagnostic category.
Ravi Philip Rajkumar
Gender identity disorder (GID), recently renamed gender dysphoria (GD), is a rare condition characterized by an incongruity between gender identity and biological sex. Clinical evidence suggests that schizophrenia occurs in patients with GID at rates higher than in the general population and that patients with GID may have schizophrenia-like personality traits. Conversely, patients with schizophrenia may experience alterations in gender identity and gender role perception. Neurobiological res...
Sollberger, Daniel; Gremaud-Heitz, Daniela; Riemenschneider, Anke; Küchenhoff, Joachim; Dammann, Gerhard; Walter, Marc
Patients with borderline personality disorder (BPD) suffer from instability in their relationships, their affectivity, and their identity. However, the associations between these dimensions are not clear. The purpose of the present study was to investigate the relation between identity diffusion and psychopathology in BPD. In the second week of inpatient treatment, 52 patients with BPD were assessed with the Inventory of Personality Organization (IPO) and questionnaires measuring general psychiatric symptoms, mood states, and negative affects (SCL-90-R, BDI, STAI, and STAXI). A median split was examined to differentiate BPD patients with high identity diffusion from those with low identity diffusion. BPD patients with high identity diffusion did not differ in their social data from BPD patients with low identity diffusion. However, BPD patients with high identity diffusion showed significantly higher levels of psychiatric symptoms, as well as higher anxiety, anger, and depression scores (p personality disorders (p identity diffusion with psychopathological symptoms and features of personality disorder and emphasize the clinical significance of identity diffusion for patients with BPD. Copyright © 2011 S. Karger AG, Basel.
Ross, Colin A
Dissociative trance disorder, which includes possession experiences, was introduced as a provisional diagnosis requiring further study in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Consideration is now being given to including possession experiences within dissociative identity disorder (DID) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), which is due to be published in 2013. In order to provide empirical data relevant to the relationship between DID and possession states, I analyzed data on the prevalence of trance, possession states, sleepwalking, and paranormal experiences in 3 large samples: patients with DID from North America; psychiatric outpatients from Shanghai, China; and a general population sample from Winnipeg, Canada. Trance, sleepwalking, paranormal, and possession experiences were much more common in the DID patients than in the 2 comparison samples. The study is preliminary and exploratory in nature because the samples were not matched in any way.
Green, Melinda A; Scott, Norman A; Riopel, Cori M; Skaggs, Anna K
Passive Acceptance (PA) and Active Commitment (AC) subscales of the Feminist Identity Development Scale (FIDS) were examined as predictors of eating disorder diagnostic status as assessed by the Questionnaire for Eating Disorder Diagnoses (Q-EDD). Results of a hierarchical regression analysis revealed PA and AC scores were not statistically significant predictors of ED diagnostic status after controlling for diagnostic subtype. Results of a multiple regression analysis revealed FIDS as a statistically significant predictor of ED diagnostic status when failing to control for ED diagnostic subtype. Discrepancies suggest ED diagnostic subtype may serve as a moderator variable in the relationship between ED diagnostic status and FIDS. (c) 2008 Wiley Periodicals, Inc.
Tschöke, Stefan; Eisele, Frank; Steinert, Tilman
The case of a young woman with still ongoing incest and forced prostitution is presented. The criteria for a dissociative identity disorder (DID) were met. Due to persistent contact to the perpetrator she was repeatedly revictimized. Based on the model of trauma-related dissociation we discuss to what extent she was capable of self-determined decision making as well as therapeutic consequences resulting therefrom. © Georg Thieme Verlag KG Stuttgart · New York.
The present paper reviews the theoretical and empirical literature on children and adolescents with gender variant behaviors. The organizational framework underlying this review is one that presents gender behavior in children and adolescents as a continuum rather than as a dichotomy of normal versus abnormal categories. Seven domains are reviewed in relation to gender variant behavior in general, and to Gender Identity Disorder (GID) in particular: theories of normative gender development, phenomenology, prevalence, assessment, developmental trajectories, comorbidity and treatment.
Herman, S. P.
Markedly effeminate behavior in a young boy is a source of concern and confusion for parents, teachers, and the child. It also represents a therapeutic dilemma for the child psychiatrist. The case of a five-year-old boy with gender identity disorder of childhood is presented and the literature on hypotheses of etiology, treatment, and long-term follow-up is reviewed. The ethical and philosophical questions posed by such a case are discussed.
The rare phenomenon in which a person desires amputation of a healthy limb, now often termed body integrity identity disorder, raises central questions for biomedical ethics. Standard bioethical discussions of surgical intervention in such cases fail to address the meaning of bodily integrity, which is intrinsic to a theological understanding of the goodness of the body. However, moral theological responses are liable to assume that such interventions necessarily represent an implicitly docet...
Baltieri, Danilo Antonio; De Andrade, Arthur Guerra
According to the Brazilian Federal Medical Association, transsexualism is recognized as a gender identity disorder if a long-term diagnostic therapeutic process has demonstrated that the transposition of gender roles is irreversible, and if only hormonal and surgical procedures are appropriate to relieve the stress associated with the gender identity. Although such treatment will only be initiated with caution and after a long phase of intense diagnostic screening, the differentiation between pure identity disorders and transsexual feelings secondary to an ongoing psychopathologic process, such as schizophrenia, can be arduous for many health professionals. To report a case of a female patient with schizophrenia and transsexualism and the risks of a potential diagnostic confusion. A 19-year-old black woman, with an 8-year history of undifferentiated schizophrenia and intense gender dysphoria, was referred for sex reassignment surgery evaluation in the Ambulatory for the Treatment of Sexual Disorders of the ABC Medical School. After a more adequate antipsychotic treatment, her masculine behavior has persisted, but her desire to change her own genital organs has decreased. A better acceptance of the multiplicity of possible genders should neither contribute to inadequate interpretations of the signs and symptoms of our patients nor facilitate dangerous clinical or surgical recommendations.
Mohammad Reza Mohammadi
Full Text Available Gender identity includes individual sense of being male or female personality. Which will has been typical figured by the ages of 3 or 4 years. There are two criteria in DSM-IV A A strong and steady identification with opposite sex, B Inappropriate permanent feeling with self gender or unsuitable belief in self gender role. The frequency of this disorder have consisted various rates of 6-16% among nonformal epidemiologic studies. In order to evaluate of this disorder, we would already consider the parents reports, behavioral methods projective techniques. Meanwhile depression, behavioral abnormality and personality disorders can he figured as comorbidities of GID. There is no exact known relationship between sexual – orientation and sexual identification. It's been revealed bio-psycho-social etiological influenced factors in this case. On basis of Zucher, Bradly and Coates theorical models, exposed that there are usually two interactive factors which known as the major causes of gender Identity disorder: A general main factor which enforces the child anxiety and as a specific factor that poses dynamically among family members or in child own himself/herself. Behavioral techniques, psychoanalysis and family training can be considered as management modalities, but personal and self authorization, particularly within concern to comorbidities other psychosocial problems are felt so great importance.
Reiner, William G; Reiner, D Townsend
Disorders of sex development (DSD), like gender dysphoria, are conditions with major effects on child sexuality and identity, as well as sexual orientation. Each may in some cases lead to change of gender from that assigned neonatally. These similarities-and the conditions' differences-provide a context for reviewing the articles in this issue about clinical approaches to children with gender dysphoria, in relation to assessment, intervention, and ethics.
Lakshmanan, Manu N; Meier, Stacey L Colton; Meier, Robert S; Lakshmanan, Ramaswamy
We present a case where dissociative identity disorder was effectively treated with memory retrieval psychotherapy. However, the patient's comorbid bipolar disorder contributed to the patient's instability and fortified the amnesiac barriers that exist between alter personality states in dissociative identity disorder, which made memory retrieval difficult to achieve. Implications from this case indicate that a close collaboration between psychologist and psychiatrist focused on carefully diagnosing and treating existing comorbid conditions may be the most important aspect in treating dissociative identity disorder. We present our experience of successfully treating a patient with dissociative identity disorder and bipolar disorder using this collaborative method.
Moreira-Almeida, Alexander; Neto, Francisco Lotufo; Cardeña, Etzel
We studied the similarities and differences between Brazilian Spiritistic mediums and North American dissociative identity disorder (DID) patients. Twenty-four mediums selected among different Spiritistic organizations in São Paulo, Brazil, were interviewed using the Dissociative Disorder Interview Schedule, and their responses were compared with those of DID patients described in the literature. The results from Spiritistic mediums were similar to published data on DID patients only with respect to female prevalence and high frequency of Schneiderian first-rank symptoms. As compared with individuals with DID, the mediums differed in having better social adjustment, lower prevalence of mental disorders, lower use of mental health services, no use of antipsychotics, and lower prevalence of histories of physical or sexual childhood abuse, sleepwalking, secondary features of DID, and symptoms of borderline personality. Thus, mediumship differed from DID in having better mental health and social adjustment, and a different clinical profile.
Huntjens, Rafaële J C; Peters, Madelon L; Woertman, Liesbeth; Bovenschen, Loes M; Martin, Roy C; Postma, Albert
Although included in the current edition of the DSM, there does not seem to be consensus among mental health professionals regarding the diagnostic status and scientific validity of dissociative identity disorder (DID). This study was aimed at the detection of simulation of inter-identity amnesia in DID. A sample of 22 DID patients was included, together with a matched control sample of subjects instructed to simulate inter-identity amnesia, a guessor group that had no knowledge of the stimulus material and a normal control group. A multiple-choice recognition test was included. The rate of incorrect answers was determined. Moreover, the specific simulation strategy used was examined by providing subjects with a range of choices that varied in extent of disagreement with the correct answer and determining whether plausible or implausible answer alternatives were selected. On the recognition test DID patients selected incorrect answers above chance like simulators. Patients thus seem to use their knowledge of the correct answer in determining their given answer. They were not characterized by a well-thought-out simulating behaviour style, as indicated by the differences in selection of specific answer alternatives found between patients and simulators. DID patients were found not to be characterized by an actual memory retrieval inability, in contrast to their subjective reports. Instead, it is suggested that DID may more accurately be considered a disorder characterized by meta-memory problems, holding incorrect beliefs about their own memory functioning.
Sar, Vedat; Alioğlu, Firdevs; Akyuz, Gamze; Tayakısı, Emre; Öğülmüş, Ezgi F; Sönmez, Doğuş
This study inquires into identity alteration among college students and its relationship to borderline personality disorder (BPD) and/or dissociative disorders (DDs). Steinberg Identity Alteration Questionnaire (SIAQ), Childhood Trauma Questionnaire (CTQ), and self-report screening tool of the BPD section of the Structured Clinical Interview for DSM-IV (SCID-BPD) were administered to 1301 college students. Participants who fit the diagnostic criteria of BPD (n = 80) according to the clinician-administered SCID-BPD and 111 non-BPD controls were evaluated using the Structured Clinical Interview for DSM-IV DDs (SCID-D) by two psychiatrists blind to the group membership and scale scores. Test-retest evaluations and internal consistency analyses suggested that SIAQ was a reliable instrument. Of the participants, 11.3% reported a SIAQ score 25 or above alongside some impairment. SIAQ scores differentiated participants who fit the diagnostic criteria for a DD from those who did not. While self-report identity alteration was correlated with all childhood trauma types, clinician-assessed identity alteration was correlated with childhood sexual abuse only. Those who fit criteria for both disorders had the highest identity alteration scores in self-report and clinician-assessment. Although both syndromes had significant effect on self-report identity alteration total scores, in contrast to DD, BPD did not have an effect on the clinician-administered evaluation. An impression of personality disorder rather than a DD may seem more likely when identity alteration remains subtle in clinical assessment, notwithstanding its presence in self-report. Lack of recognition of identity alteration may lead to overdiagnosis of BPD among individuals who have a DD.
Rajkumar, Ravi Philip
Gender identity disorder (GID), recently renamed gender dysphoria (GD), is a rare condition characterized by an incongruity between gender identity and biological sex. Clinical evidence suggests that schizophrenia occurs in patients with GID at rates higher than in the general population and that patients with GID may have schizophrenia-like personality traits. Conversely, patients with schizophrenia may experience alterations in gender identity and gender role perception. Neurobiological research, including brain imaging and studies of finger length ratio and handedness, suggests that both these disorders are associated with altered cerebral sexual dimorphism and changes in cerebral lateralization. Various mechanisms, such as Toxoplasma infection, reduced levels of brain-derived neurotrophic factor (BDNF), early childhood adversity, and links with autism spectrum disorders, may account for some of this overlap. The implications of this association for further research are discussed.
Ravi Philip Rajkumar
Full Text Available Gender identity disorder (GID, recently renamed gender dysphoria (GD, is a rare condition characterized by an incongruity between gender identity and biological sex. Clinical evidence suggests that schizophrenia occurs in patients with GID at rates higher than in the general population and that patients with GID may have schizophrenia-like personality traits. Conversely, patients with schizophrenia may experience alterations in gender identity and gender role perception. Neurobiological research, including brain imaging and studies of finger length ratio and handedness, suggests that both these disorders are associated with altered cerebral sexual dimorphism and changes in cerebral lateralization. Various mechanisms, such as Toxoplasma infection, reduced levels of brain-derived neurotrophic factor (BDNF, early childhood adversity, and links with autism spectrum disorders, may account for some of this overlap. The implications of this association for further research are discussed.
Lemaire, Mathieu; Thomazeau, Barbara; Bonnet-Brilhault, Frédérique
We describe the case of a 23-year-old woman with Gender Identity Disorder (GID) asking for a cross-sex hormonal treatment with sex reassignment surgery and who was recently diagnosed with Autism Spectrum Disorder (ASD). Gender identity clinics are now reporting an overrepresentation of individuals with ASD among GID patients. The prevalence of ASD is 10-fold higher among GID patients than in general population. However, few case reports or studies have explored the co-occurrence of ASD and GID. This co-occurrence is relevant for diagnostic and clinical management and also raises important theoretical issues.
Yang, Jennifer H; Baskin, Laurence S; DiSandro, Michael
Many concerns have been raised regarding the treatment and long-term outcome of infants born with complex genital anomalies. Debate among clinicians, psychologists, ethicists, and patient advocate groups regarding the optimal management of these individuals is ongoing. Although determining the most appropriate gender is a difficult task, this review will help clarify some of the issues at hand. A literature review which addresses the challenges of advising families about gender identity in infants and children with disorders of sex development. The evidence for endocrine effects on neurobiological development with regard to sexual behavior is compelling, although the existing outcome studies are largely anecdotal and somewhat contradictory. Gender assignment in infants born with a disorder of sex development remains only one of the many difficult decisions faced by both the treatment team and the family. Improved long-term follow-up of these patients will provide much needed feedback on previous and contemporary management. 2010 Elsevier Inc. All rights reserved.
Blom, Rianne M; Hennekam, Raoul C M
Body integrity identity disorder (BIID) is a rare neuropsychiatric disorder in which patients experience a mismatch between the real and experienced body from childhood. BIID results in a strong desire to amputate or paralyse one or more limbs. We describe two BIID patients. A 40-year-old healthy male suffered daily from his desire for amputation, and therefore made a request for amputation at our academic medical centre. A 61-year-old male proceeded to self-amputation to create the body he had wished for, thereby curing himself from BIID. To date, no treatment has been found for BIID. Therefore patients often proceed to self-amputation, which could lead to serious and even dangerous complications. These case histories suggest that elective amputation may be a treatment for BIID. Many doctors, however, will question the admissibility of amputation of a healthy limb.
Full Text Available Introduction: Eating disorder symptomatology, comprising both psychological and behavioral aspects of subclinical eating concerns, constitutes a clear precursor of developing eating disorders. It is crucial to investigate its antecedents and correlates to subsequently inform eating disorder prevention programs. The present study focused on identity formation, a core developmental task in adolescence, that has increasingly been linked to eating disorder development. Our main aim was to examine the temporal sequence between eating disorder symptomatology and identity formation.Methods: Data on eating disorder symptomatology and identity formation were collected in 530 high school students (at Time 1: mean age = 15 years; SD = 1.84; range: 12–18 years; 50.6% females using self-report questionnaires at three annual measurement points. Cross-lagged structural equation modeling was performed to examine the directionality of effects.Results: Results indicated bidirectional effects between eating disorder symptomatology and identity formation. Identity confusion seemed to increase vulnerability to body dissatisfaction and bulimia symptoms, whereas identity synthesis seemed to protect against their development. Additionally, identity synthesis seemed to protect against the development of drive for thinness as well. At the same time, body dissatisfaction and bulimia symptoms positively predicted identity confusion and negatively predicted identity synthesis over time.Conclusion: The present study adds to the growing body of literature on identity and eating disorders by focusing on their temporal interplay in a community sample of adolescents. As bidirectional effects emerged, a greater emphasis on identity formation in eating disorder prevention programs is advocated.
Verschueren, Margaux; Claes, Laurence; Bogaerts, Annabel; Palmeroni, Nina; Gandhi, Amarendra; Moons, Philip; Luyckx, Koen
Introduction: Eating disorder symptomatology, comprising both psychological and behavioral aspects of subclinical eating concerns, constitutes a clear precursor of developing eating disorders. It is crucial to investigate its antecedents and correlates to subsequently inform eating disorder prevention programs. The present study focused on identity formation, a core developmental task in adolescence, that has increasingly been linked to eating disorder development. Our main aim was to examine the temporal sequence between eating disorder symptomatology and identity formation. Methods: Data on eating disorder symptomatology and identity formation were collected in 530 high school students (at Time 1: mean age = 15 years; SD = 1.84; range: 12-18 years; 50.6% females) using self-report questionnaires at three annual measurement points. Cross-lagged structural equation modeling was performed to examine the directionality of effects. Results: Results indicated bidirectional effects between eating disorder symptomatology and identity formation. Identity confusion seemed to increase vulnerability to body dissatisfaction and bulimia symptoms, whereas identity synthesis seemed to protect against their development. Additionally, identity synthesis seemed to protect against the development of drive for thinness as well. At the same time, body dissatisfaction and bulimia symptoms positively predicted identity confusion and negatively predicted identity synthesis over time. Conclusion: The present study adds to the growing body of literature on identity and eating disorders by focusing on their temporal interplay in a community sample of adolescents. As bidirectional effects emerged, a greater emphasis on identity formation in eating disorder prevention programs is advocated.
An incongruence between one's physiological sex and the gender identity that is one's basic sense of self as a man or a woman is known as gender identity disorder. In general, the conditions of physiological men having female gender identity and physiological women having male gender identity are called male-to-female and female-to-male gender identity disorder, respectively. Although the precise pathogenesis of gender identity disorder remains unclear, the prevalence of gender identity disorder is quite high, with the rates calculated for male-to-female to be 1:25,000 and female-to-male to be 1:12,000 in Hokkaido, Japan. The diagnosis and treatment of gender identity disorder in Japan are based on the Diagnostic and Therapeutic Guidelines for Patients with Gender Identity Disorder, 4th edition. Although gender identity disorder was previously thought to be a psychiatric condition, it is extremely difficult to assign gender identity to physiological sex by psychiatric and psychological treatments. To adapt the figure of the body to the native gender identity, physical treatments such as administration of cross-sex steroids and sex reassignment surgery are considered. However, there are very few institutions that routinely carry out sex reassignment surgery in Japan, even though it is mandatory for changing sex on the census register at the present time. Sex reassignment surgery for male-to-female and female-to-male patients includes orchiectomy, penectomy, clitoroplasty, vaginoplasty and vulvoplasty, and hysterectomy, ovariectomy, metoidioplasty and phalloplasty, respectively. To provide accurate information about physical treatment for patients with gender identity disorder, even urologists who are not actively involved in the diagnosis and treatment of gender identity disorder should understand the fundamental aspects and contemporary problems of gender identity disorder. © 2012 The Japanese Urological Association.
Laddis, Andreas; Dell, Paul F
Dissociative symptoms, first-rank symptoms of schizophrenia, and delusions were assessed in 40 schizophrenia patients and 40 dissociative identity disorder (DID) patients with the Multidimensional Inventory of Dissociation (MID). Schizophrenia patients were diagnosed with the Structured Clinical Interview for the DSM-IV Axis I Disorders; DID patients were diagnosed with the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised. DID patients obtained significantly (a) higher dissociation scores; (b) higher passive-influence scores (first-rank symptoms); and (c) higher scores on scales that measure child voices, angry voices, persecutory voices, voices arguing, and voices commenting. Schizophrenia patients obtained significantly higher delusion scores than did DID patients. What is odd is that the dissociation scores of schizophrenia patients were unrelated to their reports of childhood maltreatment. Multiple regression analyses indicated that 81% of the variance in DID patients' dissociation scores was predicted by the MID's Ego-Alien Experiences Scale, whereas 92% of the variance in schizophrenia patients' dissociation scores was predicted by the MID's Voices Scale. We propose that schizophrenia patients' responses to the MID do not index the same pathology as do the responses of DID patients. We argue that neither phenomenological definitions of dissociation nor the current generation of dissociation instruments (which are uniformly phenomenological in nature) can distinguish between the dissociative phenomena of DID and what we suspect are just the dissociation-like phenomena of schizophrenia.
Reinders, Antje A. T. S.; Willemsen, Antoon T. M.; den Boer, Johan A.; Vos, Herry P. J.; Veltman, Dick J.; Loewenstein, Richard J.
Imaging studies in posttraumatic stress disorder (PTSD) have shown differing neural network patterns between hypo-aroused/dissociative and hyper-aroused subtypes. Since dissociative identity disorder (DID) involves different emotional states, this study tests whether DID fits aspects of the
Hofman, E.; Halman, J.I.M.; Ion, R.A.
House builders in different countries are exploring ways to deliver higher levels of customisation in housing design. To create such variety at acceptable cost, it is important to know how potential buyers of new houses prioritise the different elements such as bathroom, kitchen and roof type of a
Full Text Available The objective of the study is to find the solution to the problem outlined, which is to create an alternative design for corporate identity of ASITA. ASITA is a non-profit organization to foster tours and travel agencies in Indonesia. The writer conducted interview to the ASITA Jakarta Chapter, which was appointed to represent ASITA in providing the data needed by the writer. The writer interviewed the advisor of the organization, which had once served as chairperson of ASITA. The result of the research is new corporate identity system of ASITA based on a concept that ASITA as an organization, serves as a compass that guides and assists in every direction. The writer found that corporate identity is an important element to define an organization as well as giving impact on its first impression. To create good corporate identity, several things such as elements of design, color, typography, etc need to be put into attention.
Full Text Available Dissociative Identity Disorder (DID (American Psychiatric Association 2013 is examined in this paper from the perspective of its relevance to the criminologist. As this psychiatric condition is linked to severe and prolonged childhood abuse, accounts of DID patients inevitably involve reports of serious crimes, in which the person was the victim, perpetrator or witness. These reports can thus contain crucial information for criminal investigations by the police or for court proceedings. However, due to the person’s dissociation, such reports are often very confusing, hard to follow, hard to believe and difficult to obtain. They also frequently state that the person had ‘no choice’, a thorny notion for the criminologist (as well as for the clinician. Through the analysis of clinical examples, the paper explores how decisions are made by a person with DID, the notions of choice and ‘competent reasoning’, and the practical and ethical ways for interviewing a person with DID.
Yousafzai, Abdul Wahab; Bhutto, Naila
A person with a Gender Identity Disorder (GID) is a person who strongly identifies with the other sex. The individual may identify with the opposite sex to the point of believing that he/she is, in fact, a member of the other sex who is trapped in the wrong body. The treatment option is sex reassignment surgery. In Pakistan There is no specialized facility sex reassignment surgery. This case report deals with possible serious outcome of GID in Pakistan as a result of castration procedure which is carried out by 'gurus' in Pakistan. A systemic research in our country to this effect is required to find out the outcome of GID in Pakistan.
Kreukels, Baudewijntje P C; Cohen-Kettenis, Peggy T
The use of gonadotropin-releasing hormone analogs (GnRHa) to suppress puberty in adolescents with gender dysphoria is a fairly new intervention in the field of gender identity disorders or transsexualism. GnRHa are used to give adolescents time to make balanced decisions on any further treatment steps, and to obtain improved results in the physical appearance of those who opt to continue with sex reassignment. The effects of GnRHa are reversible. However, concerns have been raised about the risk of making the wrong treatment decisions, as gender identity could fluctuate during adolescence, adolescents in general might have poor decision-making abilities, and there are potential adverse effects on health and on psychological and psychosexual functioning. Proponents of puberty suppression emphasize the beneficial effects of GnRHa on the adolescents' mental health, quality of life and of having a physical appearance that makes it possible for the patients to live unobtrusively in their desired gender role. In this Review, we discuss the evidence pertaining to the debate on the effects of GnRHa treatment. From the studies that have been published thus far, it seems that the benefits outweigh the risks. However, more systematic research in this area is needed to determine the safety of this approach.
Sar, Vedat; Onder, Canan; Kilincaslan, Ayse; Zoroglu, Süleyman S; Alyanak, Behiye
The aim of this study was to determine the prevalence of dissociative identity disorder (DID) and other dissociative disorders among adolescent psychiatric outpatients. A total of 116 consecutive outpatients between 11 and 17 years of age who were admitted to the child and adolescent psychiatry clinic of a university hospital for the 1st time were evaluated using the Adolescent Dissociative Experiences Scale, adolescent version of the Child Symptom Inventory-4, Childhood Trauma Questionnaire, and McMaster Family Assessment Device. All patients were invited for an interview with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) administered by 2 senior psychiatrists in a blind fashion. There was excellent interrater reliability between the 2 clinicians on SCID-D diagnoses and scores. Among 73 participants, 33 (45.2%) had a dissociative disorder: 12 (16.4%) had DID, and 21 (28.8%) had dissociative disorder not otherwise specified. There was no difference in gender distribution, childhood trauma, or family dysfunction scores between the dissociative and nondissociative groups. Childhood emotional abuse and family dysfunction correlated with self-reported dissociation. Of the dissociative adolescents, 93.9% had an additional psychiatric disorder. Among them, only separation anxiety disorder was significantly more prevalent than in controls. Although originally designed for adults, the SCID-D is promising for diagnosing dissociative disorders in adolescents, its modest congruence with self-rated dissociation and lack of relationship between diagnosis and childhood trauma and family dysfunction suggest that the prevalence rates obtained with this instrument originally designed for adults must be replicated. The introduction of diagnostic criteria for adolescent DID in revised versions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, would refine the assessment of dissociative disorders in this age group.
Zucker, Kenneth J
In this article, I review the diagnostic criteria for Gender Identity Disorder (GID) in children as they were formulated in the DSM-III, DSM-III-R, and DSM-IV. The article focuses on the cumulative evidence for diagnostic reliability and validity. It does not address the broader conceptual discussion regarding GID as "disorder," as this issue is addressed in a companion article by Meyer-Bahlburg (2009). This article addresses criticisms of the GID criteria for children which, in my view, can be addressed by extant empirical data. Based in part on reanalysis of data, I conclude that the persistent desire to be of the other gender should, in contrast to DSM-IV, be a necessary symptom for the diagnosis. If anything, this would result in a tightening of the diagnostic criteria and may result in a better separation of children with GID from children who display marked gender variance, but without the desire to be of the other gender.
Church, H A; O'Shea, D; Lucey, J V
To describe the relationship between parents with gender identity disorder (GID) and their child(ren) as described by the parent and to understand how being a parent affects transitioning from one gender to the other. Fourteen parents with GID underwent a semi-structured interview and completed the Index of Parental Attitudes (IPA). An IPA score of greater than 30 indicates parent–child relationship difficulties (range 0–100). The authors also conducted the SCID-I to establish other Axis I disorders. We assessed 12 male to female and two female to male parents with GID residing in Ireland. In total, 14 GID parents had 28 children. Three children had no relationship with their GID parent. The other 25 children, as reported by the parent, had good relationships with their children. In addition, these 25 children average score IPA score was 6.4 (range 0–25). Twelve GID parents (86 %) believed that being a parent had no effect on their desired level of transitioning, while two were influenced not to transition. Eleven GID parents (79 %) reported that being a parent had increased the time taken to commence transitioning, two have stopped transitioning altogether, while one cited no effect on time. Parents with GID report positive relationships or no relationship with their children and the IPA revealed no clinical problems. Being a parent can prolong transitioning time in people with GID and can affect overall achieved level of transitioning.
Puspita Putri Nugroho
Full Text Available The research objective is to create a logo as the main visual identity. It is together with the graphic elements to support the overall visual identity of the organization and also apply the corporate identity to various applications to effectively foster the professional and trustworthy image of the organization as the foundation in Indonesia aiming for preserving and advancing Batik as the national asset. The writer used qualitative and quantitative method. Qualitative method included Face-to-face interview with the vice secretary of YBI, e-mail interview with the previous logo designer and direct survey to Textile Museum Jakarta and Batik Gallery; and Quantitative method through online survey. The result of the project is a new visual identity for Yayasan Batik Indonesia, which portrays its vision and mission. Design is the core in attaining an advantageous visual identity that could portray the image of the respected organization. When a consistency is applied through the whole visual identity, professional character of the organization is achieved.
The polarized nature of the ongoing controversies surrounding the genesis and validity of dissociative identity disorder pit advocates who see and work with dissociative identity disorder sufferers against skeptics who claim it to be an artificial iatrogenically produced phenomenon. This paper suggests that such a dichotomy is unwarranted and…
Lakshmanan, Manu N.; Meier, Stacey L. Colton; Meier, Robert S.; Lakshmanan, Ramaswamy
We present a case where dissociative identity disorder was effectively treated with memory retrieval psychotherapy. However, the patient’s comorbid bipolar disorder contributed to the patient’s instability and fortified the amnesiac barriers that exist between alter personality states in dissociative identity disorder, which made memory retrieval difficult to achieve. Implications from this case indicate that a close collaboration between psychologist and psychiatrist focused on carefully dia...
Laddis, Andreas; Dell, Paul F; Korzekwa, Marilyn
A total of 75 patients were diagnosed with the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised as having dissociative identity disorder (DID), and 100 patients were diagnosed with the Structured Interview for DSM-IV Personality as having borderline personality disorder (BPD). Both groups were administered the Multidimensional Inventory of Dissociation (MID). DID patients had significantly higher MID scores than BPD patients, different distributions of MID scores, and different MID subscale profiles in 3 ranges of MID scores (0-15, 15-30, 30-45). The core MID symptoms-exhibited at all ranges of MID scores-for DID patients (the presence of alters, identity confusion, and memory problems) and BPD patients (flashbacks, identity confusion, and memory problems) were ostensibly similar but were considered to be mostly produced by different underlying processes. Multiple regression analyses showed that the core MID symptoms of DID patients had different predictors than did the core MID symptoms of BPD patients. Alter identities seemed to generate most-but not all-dissociative phenomena in DID patients, whereas only the 24% highest scoring BPD patients (MID ≥45) seemed to manifest alter-driven dissociative experiences. Most BPD dissociative experiences appeared to be due to 5 other mechanisms: (a) BPD-specific, stress-driven, rapid shifts of self-state; (b and c) nondefensive disruptions of the framework of perceptual organization with or without an accompanying BPD-specific, dissociation-like disintegration of affective/neurocognitive functioning; (d) a defensive distancing or detachment from distress (i.e., simple depersonalization); and (e) Allen, Console, and Lewis's (1999) severe absorptive detachment.
Macintosh, Heather B
Couple therapy in the context of dissociative identity disorder (DID) has been neglected as an area of exploration and development in the couple therapy and trauma literature. What little discussion exists focuses primarily on couple therapy as an adjunct to individual therapy rather than as a primary treatment for couple distress and trauma. Couple therapy researchers have begun to develop adaptations to provide effective support to couples dealing with the impact of childhood trauma in their relationships, but little attention has been paid to the specific and complex needs of DID patients in couple therapy (H. B. MacIntosh & S. Johnson, 2008 ). This review and case presentation explores the case of "Lisa," a woman diagnosed with DID, and "Don," her partner, and illustrates the themes of learning to communicate, handling conflicting needs, responding to child alters, and addressing sexuality and education through their therapy process. It is the hope of the author that this discussion will renew interest in the field of couple therapy in the context of DID, with the eventual goal of developing an empirically testable model of treatment for couples.
Brand, Bethany L; Chasson, Gregory S; Palermo, Cori A; Donato, Frank M; Rhodes, Kyle P; Voorhees, Emily F
Elevated scores on some MMPI-2 (Minnesota Multiphasic Inventory-2) validity scales are common among patients with dissociative identity disorder (DID), which raises questions about the validity of their responses. Such patients show elevated scores on atypical answers (F), F-psychopathology (Fp), atypical answers in the second half of the test (FB), schizophrenia (Sc), and depression (D) scales, with Fp showing the greatest utility in distinguishing them from coached and uncoached DID simulators. In the current study, we investigated the items on the MMPI-2 F, Fp, FB, Sc, and D scales that were most and least commonly endorsed by participants with DID in our 2014 study and compared these responses with those of coached and uncoached DID simulators. The comparisons revealed that patients with DID most frequently endorsed items related to dissociation, trauma, depression, fearfulness, conflict within family, and self-destructiveness. The coached group more successfully imitated item endorsements of the DID group than did the uncoached group. However, both simulating groups, especially the uncoached group, frequently endorsed items that were uncommonly endorsed by the DID group. The uncoached group endorsed items consistent with popular media portrayals of people with DID being violent, delusional, and unlawful. These results suggest that item endorsement patterns can provide useful information to clinicians making determinations about whether an individual is presenting with DID or feigning. © 2016 American Academy of Psychiatry and the Law.
Snyder, Briana L
Women with dissociative identity disorder (DID) are significantly more likely than other women to experience intimate partner violence (IPV). The purpose of this qualitative investigation was to explicate the experiences of women with DID who experience IPV and describe how they cope. Grounded theory was used to conduct this investigation. Purposive sampling was used to recruit participants (N = 5) for face-to-face, semi-structured interviews. Verbatim transcripts were coded and categorized, and reflective memos were developed to explicate substantive categories. Women with DID used coping strategies that were consistent with their diagnoses, such as switching and dissociating. These coping mechanisms reflect past self-preservation strategies that were developed in association with severe childhood maltreatment. Women with DID who experienced IPV sought to mitigate and safeguard themselves from danger using strategies they developed as maltreated children. Nurses can use these findings to better recognize and understand the motivations and behaviors of women with DID who experience IPV. [Journal of Psychosocial Nursing and Mental Health Services, 56(5), 26-32.]. Copyright 2018, SLACK Incorporated.
Reinders, A A T S; Chalavi, S; Schlumpf, Y R; Vissia, E M; Nijenhuis, E R S; Jäncke, L; Veltman, D J; Ecker, C
To examine the two constitutes of cortical volume (CV), that is, cortical thickness (CT) and surface area (SA), in individuals with dissociative identity disorder (DID) with the view of gaining important novel insights into the underlying neurobiological mechanisms mediating DID. This study included 32 female patients with DID and 43 matched healthy controls. Between-group differences in CV, thickness, and SA, the degree of spatial overlap between differences in CT and SA, and their relative contribution to differences in regional CV were assessed using a novel spatially unbiased vertex-wise approach. Whole-brain correlation analyses were performed between measures of cortical anatomy and dissociative symptoms and traumatization. Individuals with DID differed from controls in CV, CT, and SA, with significantly decreased CT in the insula, anterior cingulate, and parietal regions and reduced cortical SA in temporal and orbitofrontal cortices. Abnormalities in CT and SA shared only about 3% of all significantly different cerebral surface locations and involved distinct contributions to the abnormality of CV in DID. Significant negative associations between abnormal brain morphology (SA and CV) and dissociative symptoms and early childhood traumatization (0 and 3 years of age) were found. In DID, neuroanatomical areas with decreased CT and SA are in different locations in the brain. As CT and SA have distinct genetic and developmental origins, our findings may indicate that different neurobiological mechanisms and environmental factors impact on cortical morphology in DID, such as early childhood traumatization. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Chalavi, Sima; Vissia, Eline M.; Giesen, Mechteld E.; Nijenhuis, Ellert R. S.; Draijer, Nel; Barker, Gareth J.; Veltman, Dick J.; Reinders, Antje A. T. S.
Neuroanatomical evidence on the relationship between posttratimatic stress disorder (PTSD) and dissociative disorders is still lacking. We acquired brain structural magnetic resonance imaging (MRI) scans from 17 patients with dissociative identity disorder (DID) and co-morbid PTSD (DID-PTSD) and 16
AIT (Adolescent Identity Treatment) - an Integrative Treatment Model for the Treatment of Personality Disorders Personality disorders are patterns of maladaptive personality traits that have an impact on the individual throughout the life span. Borderline Personality Disorder (BPD) is a very severe, but treatable mental disorder. Identity disturbance is seen as the central construct for detecting severe personality pathology - and, most notably, borderline personality disorder - in adults and adolescents. Crises in the development of identity usually resolve into a normal and consolidated identity with flexible and adaptive functioning whereas identity diffusion is viewed as a lack of integration of the concept of the self and significant others. It is seen as the basis for subsequent personality pathology, including that of borderline personality disorder. Although BPD has its onset in adolescence and emerging adulthood the diagnosis is often delayed. In most cases, specific treatment is only offered late in the course of the disorder and to relatively few individuals. Adolescent Identity Treatment (AIT) is a treatment model that focuses on identity pathology as the core characteristic of personality disorders. This model integrates specific techniques for the treatment of adolescent personality pathology on the background of object-relation theories and modified elements of Transference-Focused Psychotherapy. Moreover, psychoeducation, a behavior-oriented homeplan and intensive family work is part of AIT.
Reinders, Antje A T S; Willemsen, Antoon T M; den Boer, Johan A; Vos, Herry P J; Veltman, Dick J; Loewenstein, Richard J
Imaging studies in posttraumatic stress disorder (PTSD) have shown differing neural network patterns between hypo-aroused/dissociative and hyper-aroused subtypes. Since dissociative identity disorder (DID) involves different emotional states, this study tests whether DID fits aspects of the differing brain-activation patterns in PTSD. While brain activation was monitored using positron emission tomography, DID individuals (n=11) and matched DID-simulating healthy controls (n=16) underwent an autobiographic script-driven imagery paradigm in a hypo-aroused and a hyper-aroused identity state. Results were consistent with those previously found in the two PTSD subtypes for the rostral/dorsal anterior cingulate, the prefrontal cortex, and the amygdala and insula, respectively. Furthermore, the dissociative identity state uniquely activated the posterior association areas and the parahippocampal gyri, whereas the hyper-aroused identity state uniquely activated the caudate nucleus. Therefore, we proposed an extended PTSD-based neurobiological model for emotion modulation in DID: the hypo-aroused identity state activates the prefrontal cortex, cingulate, posterior association areas and parahippocampal gyri, thereby overmodulating emotion regulation; the hyper-aroused identity state activates the amygdala and insula as well as the dorsal striatum, thereby undermodulating emotion regulation. This confirms the notion that DID is related to PTSD as hypo-aroused and hyper-arousal states in DID and PTSD are similar. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
à Campo, Joost; Nijman, Henk; Merckelbach, H; Evers, Catharine
In the Netherlands, it is considered good medical practice to offer patients with gender identity disorder the option to undergo hormonal and surgical sex reassignment therapy. A liberalization of treatment guidelines now allows for such treatment to be started at puberty or prepuberty. The question arises as to what extent gender identity disorder can be reliably distinguished from a cross-gender identification that is secondary to other psychiatric disorders. The authors sent survey questionnaires to 382 board-certified Dutch psychiatrists regarding their experiences with diagnosing and treating patients with gender identity disorder. One hundred eighty-six psychiatrists responded to the survey. These respondents reported on 584 patients with cross-gender identification. In 225 patients (39%), gender identity disorder was regarded as the primary diagnosis. For the remaining 359 patients (61%), cross-gender identification was comorbid with other psychiatric disorders. In 270 (75%) of these 359 patients, cross-gender identification was interpreted as an epiphenomenon of other psychiatric illnesses, notably personality, mood, dissociative, and psychotic disorders. These data suggest that there is little consensus, at least among Dutch psychiatrists, about diagnostic features of gender identity disorder or about the minimum age at which sex reassignment therapy is a safe option. Therapy options proposed to patients with gender identity disorder appear to depend on personal preferences of psychiatrists. These results underline the need for more specific diagnostic rules in this area.
Lewis, D O; Yeager, C A; Swica, Y; Pincus, J H; Lewis, M
The skepticism regarding the existence of dissociative identity disorder as well as the abuse that engenders it persists for lack of objective documentation. This is doubly so for the disorder in murderers because of issues of suspected malingering. This article presents objective verification of both dissociative symptoms and severe abuse during childhood in a series of adult murderers with dissociative identity disorder. This study consisted of a review of the clinical records of 11 men and one woman with DSM-IV-defined dissociative identity disorder who had committed murder. Data were gathered from medical, psychiatric, social service, school, military, and prison records and from records of interviews with subjects' family members and others. Handwriting samples were also examined. Data were analyzed qualitatively. Signs and symptoms of dissociative identity disorder in childhood and adulthood were corroborated independently and from several sources in all 12 cases; objective evidence of severe abuse was obtained in 11 cases. The subjects had amnesia for most of the abuse and underreported it. Marked changes in writing style and/or signatures were documented in 10 cases. This study establishes, once and for all, the linkage between early severe abuse and dissociative identity disorder. Further, the data demonstrate that the disorder can be distinguished from malingering and from other disorders. The study shows that it is possible, with great effort, to obtain objective evidence of both the symptoms of dissociative identity disorder and the abuse that engenders it.
Zucker, Kenneth J; Bradley, Susan J; Owen-Anderson, Allison; Kibblewhite, Sarah J; Wood, Hayley; Singh, Devita; Choi, Kathryn
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.
By utilizing the symmetric property known as the Ward-Takahashi identity in disordered systems, we explore the novel symmetry relations which hold in one-dimensional systems with inverse square interaction (the Calogero-Sutherland model). The identities emerge totally from the algebraic structure of the model. They show that the dynamical correlators are connected with one another, involving the higher-order integrals of motion. We obtain the result for the coupling strengths λ=1/2, 1, and 2, and conjecture that a similar relation may hold for arbitrary rational λ. copyright 1997 The American Physical Society
Reinders, A. A. T. Simone
Dissociative identity disorder (DID) is probably the most disputed of psychiatric diagnoses and of psychological forensic evaluations in the legal arena. The iatrogenic proponents assert that DID phenomena originate from psychotherapeutic treatment while traumagenic proponents state that DID
Full Text Available We presented a study of the features of gender identity in people undergoing gender, psychological and psychiatric examination to address the issue of gender reassignment. We analyze the specifics of gender identity, levels of masculinity and femininity, the similarities and differentiation within four nosological groups, which include persons with gender identity disorders (GID with transsexualism, personality disorders, diseases of the schizophrenia spectrum, and with organic mental disorders. We address the question of the differential diagnosis in the process of psychological screening of people with transsexualism and other types of GID. The analytical description of the four algorithms and their comparison are psychologically specific, qualitative research, almost impossible using statistical method of data processing. The data presented may be useful to specialists involved in the study of persons with gender identity disorders
Baars, E.W.; van der Hart, O.; Nijenhuis, E.R.S.; Chu, J.A.; Glas, G.; Draaijer, N.
The purpose of this study was to develop an expertise-based prognostic model for the treatment of complex posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID).We developed a survey in 2 rounds: In the first round we surveyed 42 experienced therapists (22 DID and 20 complex
Chalavi, Sima; Vissia, Eline M.; Giesen, Mechteld E.; Nijenhuis, Ellert R. S.; Draijer, Nel; Cole, James H.; Dazzan, Paola; Pariante, Carmine M.; Madsen, Sarah K.; Rajagopalan, Priya; Thompson, Paul M.; Toga, Arthur W.; Veltman, Dick J.; Reinders, Antje A. T. S.
Smaller hippocampal volume has been reported in individuals with post-traumatic stress disorder (PTSD) and dissociative identity disorder (DID), but the regional specificity of hippocampal volume reductions and the association with severity of dissociative symptoms and/or childhood traumatization
Chalavi, S.; Vissia, E.M.; Giesen, M.E.; Nijenhuis, E.R.S.; Draijer, N.; Cole, J.H.; Dazzan, P.; Pariante, C.M.; Madsen, S.K.; Rajagopalan, P.; Thompson, P.M.; Toga, A.W.; Veltman, D.J.; Reinders, A.A.T.S
Smaller hippocampal volume has been reported in individuals with post-traumatic stress disorder (PTSD) and dissociative identity disorder (DID), but the regional specificity of hippocampal volume reductions and the association with severity of dissociative symptoms and/or childhood traumatization
Huntjens, Rafaële J C; Wessel, Ineke; Ostafin, Brian D; Boelen, Paul A; Behrens, Friederike; van Minnen, Agnes
This study examined the content of self-defining autobiographical memories in different identities in patients with Dissociative Identity Disorder (DID) and comparison groups of patients with PTSD, healthy controls, and DID simulators. Consistent with the DID trauma model, analyses of objective ratings showed that DID patients in trauma identities retrieved more negative and trauma-related self-defining memories than DID patients in avoidant identities. Inconsistent with the DID trauma model, DID patients' self-rated trauma-relatedness of self-defining memories and future life goals did not differ between trauma identities and trauma avoidant identities. That is, the DID patients did not seem to be "shut off" from their trauma while in their avoidant identity. Furthermore, DID patients in both identities reported a higher proportion of avoidance goals compared to PTSD patients, with the latter group scoring comparably to healthy controls. The simulators behaved according to the instructions to respond differently in each identity (i.e., to report memories and goals consistent with the identity tested). The discrepant task behavior by DID patients and simulators indicated that DID patients did not seem to intentionally produce the hypothesized differences in performance between identities. In conclusion, for patients with DID (i.e., in both identities) and patients with PTSD, trauma played a central role in the retrieval of self-defining memories and in the formulation of life goals. Copyright Â© 2016 Elsevier Ltd. All rights reserved.
Boat, Barbara W.; Peterson, Gary
Describes reasons why therapists may hesitate to address the needs of children when treating parents with Dissociative Identity Disorder (DID) (formerly Multiple Personality Disorder). Summarizes the literature supporting assessment of these children, relates clinical observations on the potential impact of DID on children, and suggests…
Blom, Rianne M.; Vulink, Nienke C.; van der Wal, Sija J.; Nakamae, Takashi; Tan, Zhonglin; Derks, Eske M.; Denys, Damiaan
Body integrity identity disorder (BIID) is a condition in which people do not perceive a part of their body as their own, which results in a strong desire for amputation or paralyzation. The disorder is likely to be congenital due to its very early onset. The English literature describes only
Ross, Colin A; Ness, Laura
The authors used the Dissociative Disorders Interview Schedule to compare structured interview symptom patterns in a general population sample (N= 502) and a sample of patients with clinical diagnoses of dissociative identity disorder (N= 303). Based on the Trauma Model, the authors predicted that the patterns would be similar in the 2 samples and that symptom scores would be higher in participants reporting childhood sexual abuse in both samples. They predicted that symptom scores would be higher among women with dissociative identity disorder reporting sexual abuse than among women in the general population reporting sexual abuse, with the clinical sample reporting more severe abuse. These predictions were supported by the data. The authors conclude that symptom patterns in dissociative identity disorder are typical of the normal human response to severe, chronic childhood trauma and have ecological validity for the human race in general.
Mattila, Aino K; Fagerholm, Riitta; Santtila, Pekka; Miettinen, Päivi J; Taskinen, Seppo
Gender identity and gender role orientation were assessed in 24 female assigned patients with disorders of sex development. A total of 16 patients were prenatally exposed to androgens, of whom 15 had congenital adrenal hyperplasia and 1 was virilized due to maternal tumor. Eight patients had 46,XY karyotype, of whom 5 had partial and 3 had complete androgen insensitivity syndrome. Gender identity was measured by the 27-item Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults with 167 female medical students as controls, and gender role was assessed by the femininity and masculinity subscales of the 30-item Bem Sex Role Inventory with 104 female and 64 male medical students as controls. No patient reached the cutoff for gender identity disorder on the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. However, patients with 46,XY karyotype demonstrated a somewhat more conflicted gender identity, although the overall differences were relatively small. As to gender role orientation, patients with complete androgen insensitivity syndrome had high scores on the femininity and masculinity scales of the Bem Sex Role Inventory, which made them the most androgynous group. Our findings, although clinically not clear cut, suggest that patients with disorders of sex development are a heterogeneous group regarding gender identity and gender role outcomes, and that this issue should be discussed with the family when treatment plans are made. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
In this paper, a Unified Identity System is proposed where single electronic identity (eID) is issued that can be used ... online commerce and public sector organizations. Because ..... SearchUnifiedCommunications.com Definitions, Access date.
Foster, Aroutis; Shah, Mamta
This study used the Dynamic Systems Model of Role Identity (DSMRI) to examine the extent to which a game, Land Science, afforded identity change opportunities as exploration of science identities, science content knowledge, science confidence, action possibilities, and interest/valuing in an intentional manner. Analysis of the game and existing…
Vissia, E. M.; Giesen, M. E.; Chalavi, S.; Nijenhuis, E. R. S.; Draijer, N.; Brand, B. L.; Reinders, A. A. T. S.
Objective: The Trauma Model of dissociative identity disorder (DID) posits that DID is etiologically related to chronic neglect and physical and/or sexual abuse in childhood. In contrast, the Fantasy Model posits that DID can be simulated and is mediated by high suggestibility, fantasy proneness,
Sollberger, Daniel; Gremaud-Heitz, Daniela; Riemenschneider, Anke; Agarwalla, Puspa; Benecke, Cord; Schwald, Oliver; Küchenhoff, Joachim; Walter, Marc; Dammann, Gerhard
Patients with borderline personality disorder (BPD) show various psychopathological symptoms and suffer especially from disturbance in their identity. The purpose of the study was to investigate changes-particularly in affective BPD symptoms and identity diffusion-during a structured, disorder-specific inpatient treatment (DST) that combined a psychodynamic transference-focused psychotherapy approach with modules of dialectical behavioural skills training. In a prospective, two-group comparison trial, 44 patients with BPD were assessed with questionnaires addressing identity diffusion and state, as well as trait affective psychopathology, before and after 12 weeks of inpatient treatment. Thirty-two patients received DST, whereas 12 patients were given inpatient treatment-as-usual (TAU). The patients were allocated in a non-random procedure for two groups, in order of admission and availability of treatment options in the DST unit. In the pre-post-comparison, the DST group showed a significant decrease in identity diffusion (p borderline symptomatology and in the personality structure feature of identity diffusion. This highlights the significance of a short-term specific inpatient therapy for BPD. A structured, disorder-specific inpatient treatment of patients diagnosed with borderline personality disorder (BPD) combined a psychodynamic transference-focused psychotherapy treatment approach (focusing on pathological features in personality organization, particularly on non-integrated images of self and others) with modules of dialectical behavioural skills training. This treatment is associated with a decrease in identity diffusion of these patients after 12 weeks of treatment. The treatment is also related to a significant decrease in borderline typical psychopathological symptoms such as depressive symptoms, as well as an improvement in state anger. The outcomes of this structured, disorder-specific inpatient treatment of severely ill BPD patients indicated
Dale, Karl Yngvar
Dissociative identity disorder (DID; APA, 1994), previously labeled Multiple personality (APA, 1980) and Multiple Personality Disorder (APA, 1987), has good diagnostic validity (Gleaves, May, & Cardeña, 2001) and is supported by taxometric research, whereby two types of dissociation have been identified: Pathological dissociation, whose features are consistent with DID, and nonpathological dissociation (Waller, Putnam, & Carlson, 1996). On these grounds, we aimed to contribute to a further...
Body Integrity Identity Disorder (BIID) is a condition in which individuals experience an intense desire for amputation of an healthy limb. Recently, McGeoch and colleagues provided the first direct evidence that this syndrome may be neurological rather than psychological in its origin. However, before including BIID in body ownership disorders, several concerns should be clarified, exploring other components of body representation and not only somatosensory perception.
Şar, Vedat; Dorahy, Martin J; Krüger, Christa
Dissociative identity disorder (DID) is a chronic post-traumatic disorder where developmentally stressful events in childhood, including abuse, emotional neglect, disturbed attachment, and boundary violations are central and typical etiological factors. Familial, societal, and cultural factors may give rise to the trauma and/or they may influence the expression of DID. Memory and the construction of self-identity are cognitive processes that appear markedly and centrally disrupted in DID and are related to its etiology. Enduring decoupling of psychological modes may create separate senses of self, and metamemory processes may be involved in interidentity amnesia. Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied. Comparison of well-selected samples of DID patients with non-dissociative subjects who have other psychiatric disorders would further delineate the neurobiological and cognitive features of the disorder, whereas genetic research on DID would further illuminate the interaction of the individual with environmental stress. As such, DID may be seen as an exemplary disease model of the biopsychosocial paradigm in psychiatry.
Full Text Available This study aims at better understanding the subjective experience, the so-called Erlebnis, in individuals diagnosed with Eating Disorders (ED. We shall highlight the particular way in which people with such disorders perceive their own bodies and specifically how they perceive their bodies in the presence of other people. To this end we shall analyze the subjective experience by means of two concepts as described by French philosopher Jean-Paul Sartre: "body-self" and "body-forothers". Our hypothesis is that some people suffering from eating disorders, especially those with a diagnosis of Eating Disorders Not Otherwise Specified (EDNOS, experience their body mainly as body-for-others. Rather than a diagnostic category, EDNOS could be conceived as an anthropological configuration vulnerable to ED. Eating disorders appear as an "identity disorder" characterized by a suspension of the experiential polarity between self and other-than-self.
Wilson, C. E.; Brock, J.; Palermo, R.
Background: Previous research suggests that individuals with autism spectrum disorder (ASD) have a reduced preference for viewing social stimuli in the environment and impaired facial identity recognition. Methods: Here, we directly tested a link between these two phenomena in 13 ASD children and 13 age-matched typically developing (TD) controls.…
Leonard, Hayley C.; Annaz, Dagmara; Karmiloff-Smith, Annette; Johnson, Mark H.
Previous research into face processing in autism spectrum disorder (ASD) has revealed atypical biases toward particular facial information during identity recognition. Specifically, a focus on features (or high spatial frequencies [HSFs]) has been reported for both face and nonface processing in ASD. The current study investigated the development…
Gandotra, Kamal; Golish, Joseph; Rosenberg, Carl; Strohl, Kingman
We present a case of a patient with dissociative identity disorder and symptomatic sleep apnea who was treated with continuous positive airway pressure (CPAP). CPAP use depended upon which personality the patient exhibited but apnea reduction did not. This case illustrates in one individual how personality can positively or negatively affect CPAP adherence. © 2018 American Academy of Sleep Medicine.
Paap, M.C.S.; Kreukels, B.P.C.; Cohen-Kettenis, P.T.; Richter-Appelt, H.; De Cuypere, G.; Haraldsen, I.R.
Studies involving patients with gender identity disorder (GID) are inconsistent with regard to outcomes and often difficult to compare because of the vague descriptions of the diagnostic process. A multisite study is needed to scrutinize the utility and generality of different aspects of the
Paap, Muirne; Kreukels, Baudewijntje P.C.; Cohen-Kettenis, Peggy; Richter-Appelt, Hertha; De Cuypere, Griet; Haraldsen, Ira R.
Introduction: Studies involving patients with gender identity disorder (GID) are inconsistent with regard to outcomes and often difficult to compare because of the vague descriptions of the diagnostic process. A multisite study is needed to scrutinize the utility and generality of different aspects
Cohen-Kettenis, P.T.; Pfafflin, F.
Apart from some general issues related to the Gender Identity Disorder (GID) diagnosis, such as whether it should stay in the DSM-V or not, a number of problems specifically relate to the current criteria of the GID diagnosis for adolescents and adults. These problems concern the confusion caused by
Dewinter, J.; De Graaf, H.; Begeer, S.
This study compared sexual orientation and romantic relationship experience in a large sample of adolescents and adults with autism spectrum disorder (ASD) (n = 675) and general population peers (n = 8064). Gender identity was explored in the ASD group in relation to assigned gender at birth. Compared to general population peers, more people with…
Ringrose, Jo L.
Psychotherapy for clients with Dissociative Identity Disorder (DID) is different to therapy with most clients because these clients are multiple, comprising one or more host, and one or more alter personalities. The necessary components to be addressed in order that clients can live successfully either as a multiple or as an integrated person are…
Dewinter, J.; De Graaf, H.; Begeer, S.
This study compared sexual orientation and romantic relationship experience in a large sample of adolescents and adults with autism spectrum disorder (ASD) (n = 675) and general population peers (n = 8064). Gender identity was explored in the ASD group in relation to assigned gender at birth.
van Dijk, Milenna T.; van Wingen, Guido A.; van Lammeren, Anouk; Blom, Rianne M.; de Kwaasteniet, Bart P.; Scholte, H. Steven; Denys, Damiaan
Our body feels like it is ours. However, individuals with body integrity identity disorder (BIID) lack this feeling of ownership for distinct limbs and desire amputation of perfectly healthy body parts. This extremely rare condition provides us with an opportunity to study the neural basis
Sorene, E D; Heras-Palou, C; Burke, F D
A case report is presented of self-amputation of a healthy hand. We have reviewed the literature and seek to broaden the scope of understanding of Body Integrity Identity Disorder. This rare condition can constitute a pitfall for the unsuspecting hand surgeon.
Kaveh Alavi, MD
Conclusion: Iranian FM‐GID individuals were less feminine than normal men. However, MF‐GID individuals were similar to normal women or more feminine. Cultural considerations remain to be investigated. Alavi K, Eftekhar M and Jalali Nadoushan AH. Comparison of masculine and feminine gender roles in Iranian patients with gender identity disorder. Sex Med 2015;3:261–268.
Full Text Available Dissociative identity disorder (DID is a widely contested diagnosis. The dominant posttraumatic model (PTM considers early life trauma to be the direct cause of the creation of alter identities and assumes that working directly with alter identities should be at the core of the therapeutic work. The socio-cognitive model, on the other hand, questions the validity of the DID diagnosis and proposes an iatrogenic origin of the disorder claiming that reigning therapeutic and socio-cultural discourses create and reify the problem. The author argues that looking at the underlying psychical dynamics can provide a way out of the debate on the veracity of the diagnosis. A structural conception of hysteria is presented to understand clinical and empirical observations on the prevalence, appearance and treatment of DID. On a more fundamental level, the concept of identification and the fundamental division of human psychic functioning are proposed as crucial for understanding the development and treatment of DID.
Dissociative identity disorder (DID) is a widely contested diagnosis. The dominant posttraumatic model (PTM) considers early life trauma to be the direct cause of the creation of alter identities and assumes that working directly with alter identities should be at the core of the therapeutic work. The socio-cognitive model, on the other hand, questions the validity of the DID diagnosis and proposes an iatrogenic origin of the disorder claiming that reigning therapeutic and socio-cultural discourses create and reify the problem. The author argues that looking at the underlying psychical dynamics can provide a way out of the debate on the veracity of the diagnosis. A structural conception of hysteria is presented to understand clinical and empirical observations on the prevalence, appearance and treatment of DID. On a more fundamental level, the concept of identification and the fundamental division of human psychic functioning are proposed as crucial for understanding the development and treatment of DID. PMID:28559875
Dissociative identity disorder (DID) is a widely contested diagnosis. The dominant posttraumatic model (PTM) considers early life trauma to be the direct cause of the creation of alter identities and assumes that working directly with alter identities should be at the core of the therapeutic work. The socio-cognitive model, on the other hand, questions the validity of the DID diagnosis and proposes an iatrogenic origin of the disorder claiming that reigning therapeutic and socio-cultural discourses create and reify the problem. The author argues that looking at the underlying psychical dynamics can provide a way out of the debate on the veracity of the diagnosis. A structural conception of hysteria is presented to understand clinical and empirical observations on the prevalence, appearance and treatment of DID. On a more fundamental level, the concept of identification and the fundamental division of human psychic functioning are proposed as crucial for understanding the development and treatment of DID.
Full Text Available Vedat Şar,1 Martin J Dorahy,2 Christa Krüger3 1Department of Psychiatry, Koç University School of Medicine, Istanbul, Turkey; 2Department of Psychology, University of Canterbury, Christchurch, New Zealand; 3Department of Psychiatry, University of Pretoria, Pretoria, South Africa Abstract: Dissociative identity disorder (DID is a chronic post-traumatic disorder where developmentally stressful events in childhood, including abuse, emotional neglect, disturbed attachment, and boundary violations are central and typical etiological factors. Familial, societal, and cultural factors may give rise to the trauma and/or they may influence the expression of DID. Memory and the construction of self-identity are cognitive processes that appear markedly and centrally disrupted in DID and are related to its etiology. Enduring decoupling of psychological modes may create separate senses of self, and metamemory processes may be involved in interidentity amnesia. Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied. Comparison of well-selected samples of DID patients with non-dissociative subjects who have other psychiatric disorders would further delineate the neurobiological and cognitive features of the disorder, whereas genetic research on DID would further illuminate the interaction of the individual with environmental stress. As such
In this paper, a Unified Identity System is proposed where single electronic identity (eID) is issued that can be used across the various platforms of business transaction. The activity/state diagram of the model is presented, and the means of authentication is based on the Secure Assertion Markup Language (SAML) ...
Bakula, Dana M; Mullins, Alexandria J; Sharkey, Christina M; Wolfe-Christensen, Cortney; Mullins, Larry L; Wisniewski, Amy B
Disorders/differences of sex development (DSD) comprise multiple congenital conditions in which chromosomal, gonadal, and/or anatomical sex are discordant. The prediction of future gender identity (i.e., self-identifying as male, female, or other) in children with DSD can be imprecise, and current knowledge about the development of gender identity in people with, and without DSD, is limited. However, sex of rearing is the strongest predictor of gender identity for the majority of individuals with various DSD conditions. When making decisions regarding sex of rearing biological factors (e.g., possession of a Y chromosome, degree and duration of pre- and postnatal androgen exposure, phenotypic presentation of the external genitalia, and fertility potential), social and cultural factors, as well as quality of life should be considered. Information on gender identity outcomes across a range of DSD diagnoses is presented to aid in sex of rearing assignment. Copyright © 2017 Elsevier Inc. All rights reserved.
Gold, Natalie; Kyratsous, Michalis
We consider how conceptions of the self and identity from the philosophical literature can help us to understand identity disturbance in borderline personality disorder (BPD). We present 3 philosophical approaches: connectedness, narrative, and agency. We show how these map on to 3 different ways in which the self can be temporally extended. The connectedness approach is dominant in philosophy, and the narrative approach has been used by psychiatry, but we argue that the lesser-known agency approach provides a promising way to theorize some aspects of identity disturbance in BPD. It relates the 2 diagnostic criteria of identity disturbance and disinhibition and is consistent with evidence of memory deficits and altered self-processing in BPD patients. © 2017 The Authors. Journal of Evaluation in Clinical Practice Published by John Wiley & Sons Ltd.
Kunrath, Kamila; Cash, Philip; Li-Ying, Jason
Designers’ Professional identity (DPI) is a social- and self-perceptive construct through which designers are able to identify themselves. To understand the development of DPI, not just as a profession but also as an educational process, there is a need to consider the designer as both individual...... and trained professional. These interactions become also a necessary foundation for professionalism that is especially important for design activity. For this study, a psychometric survey was developed by taking in consideration both aspects of DPI, making use of a set of elements distilled from literature...... to the process of identity consolidation over the educational period. Further, DPI consolidates through a lifelong learning process. These results provide an initial insight into the development of DPI and the challenges of measuring this subjective aspect over education....
Beatriz Vera Poseck
Full Text Available The cinema has been especially attracted by the portrayal of mental illness and those suffering from it. Of all the disturbances of the human mind currently known, Dissociative Identity Disorder (previously known as multiple personality disorder is undoubtedly the one that has best served script-writers and directors in their films. The surprising manifestations of this illness mean that it is particularly suited as a support for some rather elusive and effect-oriented plots based on unexpected turns of the action that spark the surprise of the spectator. However, the marked interest of the seventh art in dissociative identity disorder has not led to a correct interpretation of the pathology; quite the contrary, in most cases it has been presented in a mistaken and confusing light.
Floris, Jessica; McPherson, Susan
This research examines how individuals diagnosed with dissociative identity disorder construe their experiences of being labeled with a contested diagnosis. Semistructured interviews were conducted in the United Kingdom with 5 women and 2 men diagnosed with dissociative identity disorder. A framework analysis was conducted. The analysis identified 2 overarching themes: diagnosis cross-examined and navigating care systems. The diagnosis appeared to be continually assessed by participants for its fit with symptoms, and the doubt among professionals seemed to be unhelpfully reflected in participants' attempts to understand and come to terms with their experiences. The findings are considered in light of labeling theory, the iatrogenic effects of professional doubt, and current debates concerning the reliability and validity of psychiatric diagnostic systems that have been reinvigorated by the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Full Text Available There is a lack of initiative from the designers to integrate the environmental resources in the material and design production of local urban landscape elements that reflects human culture and lifestyle. Based on criteria and principles of symbol design and transformation process, this paper describes the symbiotic relationship between local plants (flower and designs of landscape elements. Using visual analysis, the researcher manipulated shapes and forms of local plant images in producing possible shapes and forms for a design of landscape element (lamp post. The results indicate that the design transformation is a systematic process that allows for variations in design without losing the core characteristics and identity of the basic elements of nature.
Singh, Devita; McMain, Shelley; Zucker, Kenneth J
In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revision (DSM-IV-TR) (and earlier editions), a disturbance in "identity" is one of the defining features of borderline personality disorder (BPD). Gender identity, a person's sense of self as a male or a female, constitutes an important aspect of identity formation, but this construct has rarely been examined in patients with BPD. In the present study, the presence of gender identity disorder or confusion was examined in women diagnosed with BPD. We used a validated dimensional measure of gender dysphoria. Recalled gender identity and gender role behavior from childhood was also assessed with a validated dimensional measure, and current sexual orientation was assessed by two self-report measures. A consecutive series of 100 clinic-referred women (mean age, 34 years) with BPD participated in the study. The women were diagnosed with BPD using the International Personality Disorder Exam-BPD Section. None of the women with BPD met the criterion for caseness on the dimensional measure of gender dysphoria. Women who self-reported either a bisexual or a homosexual sexual orientation had a significantly higher score on the dimensional measure of gender dysphoria than the women who self-reported a heterosexual sexual orientation, and they also recalled significantly more cross-gender behavior during childhood. Results were compared with a previous study on a diagnostically heterogeneous group of women with other clinical problems. The importance of psychosexual assessment in the clinical evaluation of patients with BPD is discussed. © 2010 International Society for Sexual Medicine.
Boals, Adriel; Hayslip, Bert; Knowles, Laura R; Banks, Jonathan B
Older adults report fewer posttraumatic stress disorder (PTSD) symptoms than younger adults, but the reasons for this age difference are unclear. In the current study, the authors explored the extent to which they may be due to age differences in event centrality (the extent to which a person construes a stressful event as central to their identity). A sample of older and younger adults nominated their most stressful event and completed measures of PTSD symptoms and event centrality. The results revealed that older adults were less likely to construe a stressful event as central to identity, even after controlling for type of event, how long ago the event occurred, and gender. In addition, the results of a mediation analysis indicated that age-related differences in event centrality partially mediated age-related differences in PTSD symptoms. The results are consistent with the Socioemotional Selectivity Theory view that older adults tend to use cognitive strategies designed to protect emotional health.
De Meulemeester, Celine; Lowyck, Benedicte; Vermote, Rudi; Verhaest, Yannic; Luyten, Patrick
Individuals with borderline personality disorder (BPD) are characterized by problems in interpersonal functioning and their long-term social integration often remains problematic. Extant theories have linked identity diffusion to many of the interpersonal problems characteristic of BPD patients. Recent theoretical accounts have suggested that identity diffusion results from problems with mentalizing or reflective functioning, that is, the capacity to understand oneself and others in terms of intentional mental states. In this study we tested these assumptions, i.e., whether identity diffusion plays a mediating role in the relationship between mentalizing difficulties and interpersonal problems, in a sample of 167 BPD patients. Highly significant correlations were found between mentalizing impairments, identity diffusion and interpersonal problems. Mediation analyses showed that identity diffusion fully mediated the relationship between mentalizing difficulties and interpersonal problems. This study provides preliminary evidence that impairments in mentalizing are related to identity diffusion, which in turn is related to interpersonal problems in BPD. Further longitudinal research is needed to further substantiate these conclusions. Copyright © 2017 Elsevier B.V. All rights reserved.
Barany, Amanda; Shah, Mamta; Cellitti, Jessica; Duka, Migela; Swiecki, Zachari; Evenstone, Amanda; Kinley, Hannah; Quigley, Peter; Shaffer, David Williamson; Foster, Aroutis
Few digital tools are designed to support identity exploration around careers in science, technology, engineering, and mathematics (STEM) that may help close existing representation gaps in STEM fields. The aim of this project is to inform the design of games that facilitate learning as identity change as defined by the Projective Reflection…
Edwards, Mark J; Alonso-Canovas, Araceli; Schrag, Arnette; Bloem, Bastiaan R; Thompson, Philip D; Bhatia, Kailash
Fixed dystonia is a disabling disorder mainly affecting young women who develop fixed abnormal limb postures and pain after apparently minor peripheral injury. There is continued debate regarding its pathophysiology and management. We report 5 cases of fixed dystonia in patients who sought amputation of the affected limb. We place these cases in the context of previous reports of patients with healthy limbs and patients with chronic regional pain syndrome who have sought amputation. Our cases, combined with recent data regarding disorders of mental rotation in patients with fixed dystonia, as well as previous data regarding body integrity identity disorder and amputations sought by patients with chronic regional pain syndrome, raise the possibility that patients with fixed dystonia might have a deficit in body schema that predisposes them to developing fixed dystonia and drives some to seek amputation. The outcome of amputation in fixed dystonia is invariably unfavorable. Copyright © 2011 Movement Disorder Society.
Bao, Ai-Min; Swaab, Dick F
During the intrauterine period a testosterone surge masculinizes the fetal brain, whereas the absence of such a surge results in a feminine brain. As sexual differentiation of the brain takes place at a much later stage in development than sexual differentiation of the genitals, these two processes can be influenced independently of each other. Sex differences in cognition, gender identity (an individual's perception of their own sexual identity), sexual orientation (heterosexuality, homosexuality or bisexuality), and the risks of developing neuropsychiatric disorders are programmed into our brain during early development. There is no evidence that one's postnatal social environment plays a crucial role in gender identity or sexual orientation. We discuss the relationships between structural and functional sex differences of various brain areas and the way they change along with any changes in the supply of sex hormones on the one hand and sex differences in behavior in health and disease on the other. Copyright © 2011 Elsevier Inc. All rights reserved.
Boysen, Guy A; VanBergen, Alexandra
Dissociative Identity Disorder (DID) has long been surrounded by controversy due to disagreement about its etiology and the validity of its associated phenomena. Researchers have conducted studies comparing people diagnosed with DID and people simulating DID in order to better understand the disorder. The current research presents a systematic review of this DID simulation research. The literature consists of 20 studies and contains several replicated findings. Replicated differences between the groups include symptom presentation, identity presentation, and cognitive processing deficits. Replicated similarities between the groups include interidentity transfer of information as shown by measures of recall, recognition, and priming. Despite some consistent findings, this research literature is hindered by methodological flaws that reduce experimental validity. Copyright © 2013 Elsevier Ltd. All rights reserved.
Teilum, Kaare; Olsen, Johan Gotthardt; Kragelund, Birthe Brandt
as a strong determinant for their function. This has fostered the notion that IDP's bind with low affinity but high specificity. Here we have analyzed available detailed thermodynamic data for protein-protein interactions to put to the test if the thermodynamic profiles of IDP interactions differ from those...... of other protein-protein interactions. We find that ordered proteins and the disordered ones act as non-identical twins operating by similar principles but where the disordered proteins complexes are on average less stable by 2.5 kcal mol(-1)....
Cohen-Kettenis, P.T.; Pfafflin, F.
Apart from some general issues related to the Gender Identity Disorder (GID) diagnosis, such as whether it should stay in the DSM-V or not, a number of problems specifically relate to the current criteria of the GID diagnosis for adolescents and adults. These problems concern the confusion caused by similarities and differences of the terms transsexualism and GID, the inability of the current criteria to capture the whole spectrum of gender variance phenomena, the potential risk of unnecessar...
Suetani, Shuichi; Markwick, Elizabeth
Dissociative identity disorder (DID) is a controversial psychiatric diagnosis. This case review presents a retired psychiatrist with a history of DID. This case is used to illustrate current thinking about the characteristics and aetiology of DID. It also argues for the importance of being aware of both our personal and professional biases in our own clinical practice. © The Royal Australian and New Zealand College of Psychiatrists 2014.
Pécoud, P; Pralong, F; Bauquis, O; Stiefel, F
Gender identity disorder is defined as a permanent desire to relieve one's own sexual features to acquire the sexual features and line to life of the opposite sex. The diagnosis is based on the psychiatric evaluation and treatment on an interdisciplinary approach by endocrinologists, surgeons and psychiatrists, and can be conceptualized into distinct phases: diagnostic evaluation, real life experience, hormonal treatment and surgery. Multiples challenges have to be faced, especially by the psychiatrist who follows the patient during the whole process.
Jain, A; Bradbeer, C
As sex reassignment surgeries become more common and advanced, health professionals are more likely to see patients with gender identity disorders (GID) in their clinics. This can be challenging in many ways, and the challenges continue even after gender reassignment surgery as each case may present with unique anatomy. This article reviews the definition and treatment of GID, service provision in National Health Service and post-transition care of such patients.
Selvaggi, Gennaro; Ceulemans, Peter; De Cuypere, Griet; VanLanduyt, Koen; Blondeel, Phillip; Hamdi, Moustapha; Bowman, Cameron; Monstrey, Stan
After studying this article, the participant should be able to discuss: 1. The terminology related to male-to-female gender dysphoria. 2. The different theories regarding cause, epidemiology, and treatment of gender dysphoria. 3. The surgical goals of sex reassignment surgery in male-to-female transsexualism. 4. The surgical techniques available for sex reassignment surgery in male-to-female transsexualism. Gender identity disorder (previously "transsexualism") is the term used for individuals who show a strong and persistent cross-gender identification and a persistent discomfort with their anatomical sex, as manifested by a preoccupation with getting rid of one's sex characteristics, or the belief of being born in the wrong sex. Since 1978, the Harry Benjamin International Gender Dysphoria Association (in honor of Dr. Harry Benjamin, one of the first physicians who made many clinicians aware of the potential benefits of sex reassignment surgery) has played a major role in the research and treatment of gender identity disorder, publishing the Standards of Care for Gender Dysphoric Persons. The authors performed an overview of the terminology related to male-to-female gender identity disorder; the different theories regarding cause, epidemiology, and treatment; the goals expected; and the surgical technique available for sex reassignment surgery in male-to-female transsexualism. Surgical techniques available for sex reassignment surgery in male-to-female transsexualism, with advantages and disadvantages offered by each technique, are reviewed. Other feminizing nongenital operative interventions are also examined. This review describes recent etiopathogenetic theories and actual guidelines on the treatment of the gender identity disorder in male-to-female transsexuals; the penile-scrotal skin flap technique is considered the state of the art for vaginoplasty in male-to-female transsexuals, whereas other techniques (rectosigmoid flap, local flaps, and isolated skin
Dewinter, J.; De Graaf, H.; Begeer, S.
This study compared sexual orientation and romantic relationship experience in a large sample of adolescents and adults with autism spectrum disorder (ASD) (n?=?675) and general population peers (n?=?8064). Gender identity was explored in the ASD group in relation to assigned gender at birth. Compared to general population peers, more people with ASD, especially women, reported sexual attraction to both same- and opposite-sex partners. About half of the participants with ASD was in a relation...
van Dijk, Milenna T.; van Wingen, Guido A.; van Lammeren, Anouk; Blom, Rianne M.; de Kwaasteniet, Bart P.; Scholte, H. Steven; Denys, Damiaan
Our body feels like it is ours. However, individuals with body integrity identity disorder (BIID) lack this feeling of ownership for distinct limbs and desire amputation of perfectly healthy body parts. This extremely rare condition provides us with an opportunity to study the neural basis underlying the feeling of limb ownership, since these individuals have a feeling of disownership for a limb in the absence of apparent brain damage. Here we directly compared brain activation between limbs ...
Thiel, Aylin; Ehni, Franziska J F; Oddo, Silvia; Stirn, Aglaja
The Body Integrity Identity Disorder (BIID) is a fairly unknown and unexplored psychic illness. Very little cases underwent a psychotherapeutic treatment. We report on the two-and-a-half year psychotherapy with a 37 years old man, who wants an amputation of his two legs. Origin and meaning of the amputation desire were uncovered in psychotherapy. The psychodynamic oriented therapy with cognitive-behavioral elements can be used to develop further treatment approaches. © Georg Thieme Verlag KG Stuttgart · New York.
Bennyson, René; Hansen, Birgitte Kjølner; Blond, Malene
the student’s job entry in the industry as opposed to professional mentoring within the industry where professionals mentor professionals for career development In conclusion this article is seeking to present an example of how a student becomes aware of a professional identity by being a legitimate...
De Preester, Helena
Body integrity identity disorder (BIID), formerly also known as apotemnophilia, is characterized by a desire for amputation of a healthy limb and is claimed to straddle or to even blur the boundary between psychiatry and neurology. The neurological line of approach, however, is a recent one, and is accompanied or preceded by psychodynamical, behavioural, philosophical, and psychiatric approaches and hypotheses. Next to its confusing history in which the disorder itself has no fixed identity and could not be classified under a specific discipline, its sexual component has been an issue of unclarity and controversy, and its assessment a criterion for distinguishing BIID from apotemnophilia, a paraphilia. Scholars referring to the lived body-a phenomenon primarily discussed in the phenomenological tradition in philosophy-seem willing to exclude the sexual component as inessential, whereas other authors notice important similarities with gender identity disorder or transsexualism, and thus precisely focus attention on the sexual component. This contribution outlines the history of BIID highlighting the vicissitudes of its sexual component, and questions the justification for distinguishing BIID from apotemnophilia and thus for omitting the sexual component as essential. Second, we explain a hardly discussed concept from Maurice Merleau-Ponty's Phenomenology of Perception (1945a), the sexual schema, and investigate how the sexual schema could function in interaction with the body image in an interpretation of BIID which starts from the lived body while giving the sexual component its due.
Brand, Bethany L; Sar, Vedat; Stavropoulos, Pam; Krüger, Christa; Korzekwa, Marilyn; Martínez-Taboas, Alfonso; Middleton, Warwick
Dissociative identity disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research base, but a number of misconceptualizations and myths about the disorder remain, compromising both patient care and research. This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID: (1) belief that DID is a fad, (2) belief that DID is primarily diagnosed in North America by DID experts who overdiagnose the disorder, (3) belief that DID is rare, (4) belief that DID is an iatrogenic, rather than trauma-based, disorder, (5) belief that DID is the same entity as borderline personality disorder, and (6) belief that DID treatment is harmful to patients. The absence of research to substantiate these beliefs, as well as the existence of a body of research that refutes them, confirms their mythical status. Clinicians who accept these myths as facts are unlikely to carefully assess for dissociation. Accurate diagnoses are critical for appropriate treatment planning. If DID is not targeted in treatment, it does not appear to resolve. The myths we have highlighted may also impede research about DID. The cost of ignorance about DID is high not only for individual patients but for the whole support system in which they reside. Empirically derived knowledge about DID has replaced outdated myths. Vigorous dissemination of the knowledge base about this complex disorder is warranted.
This paper outlines the author's attempt to design and introduce a corporate identity into the Department of Medical Illustration at the South Buckinghamshire NHS Trust. It is intended to furnish the reader with an insight into the process of designing a corporate identity and to relate one department's experience. This may be useful for those who wish to develop a corporate identity of their own or contribute, as a department, towards an identity for their own Trust or other institution. A major change in government policy about the identity of NHS Trusts has meant that use of the department's new logo has had to be abandoned in favour of the new NHS corporate identity.
Tomlinson, Kendal; Baker, Charley
Dissociative Identity Disorder (DID) is an uncommon disorder that has long been associated with exposure to traumatic stressors exceeding manageable levels commonly encompassing physical, psychological and sexual abuse in childhood that is prolonged and severe in nature. In DID, dissociation continues after the traumatic experience and produces a disruption in identity where distinct personality states develop. These personalities are accompanied by variations in behaviour, emotions, memory, perception and cognition. The use of literature in psychiatry can enrich comprehension over the subjective experience of a disorder, and the utilisation of 'illness narratives' in nursing research have been considered a way of improving knowledge about nursing care and theory development. This research explores experiences of DID through close textual reading and thematic analysis of five biographical and autobiographical texts, discussing the lived experience of the disorder. This narrative approach aims to inform empathetic understanding and support the facilitation of therapeutic alliances in mental healthcare for those experiencing the potentially debilitating and distressing symptoms of DID. Although controversies surrounding the biomedical diagnosis of DID are important to consider, the lived experiences of those who mental health nurses encounter should be priority.
Lawrence, Anne A
Desire for amputation of a healthy limb has usually been regarded as a paraphilia (apotemnophilia), but some researchers propose that it may be a disorder of identity, similar to Gender Identity Disorder (GID) or transsexualism. Similarities between the desire for limb amputation and nonhomosexual male-to-female (MtF) transsexualism include profound dissatisfaction with embodiment, related paraphilias from which the conditions plausibly derive (apotemnophilia and autogynephilia), sexual arousal from simulation of the sought-after status (pretending to be an amputee and transvestism), attraction to persons with the same body type one wants to acquire, and an elevated prevalence of other paraphilic interests. K. Freund and R. Blanchard (1993) proposed that nonhomosexual MtF transsexualism represents an erotic target location error, in which men whose preferred erotic targets are women also eroticize their own feminized bodies. Desire for limb amputation may also reflect an erotic target location error, occurring in combination with an unusual erotic target preference for amputees. This model predicts that persons who desire limb amputation would almost always be attracted to amputees and would display an increased prevalence of gender identity problems, both of which have been observed. Persons who desire limb amputation and nonhomosexual MtF transsexuals often assert that their motives for wanting to change their bodies reflect issues of identity rather than sexuality, but because erotic/romantic orientations contribute significantly to identity, such distinctions may not be meaningful. Experience with nonhomosexual MtF transsexualism suggests possible directions for research and treatment for persons who desire limb amputation.
Full Text Available In biology proteins from different structural classes interact across and within classes in ways that are optimized to achieve balanced functional outputs. The interactions between intrinsically disordered proteins (IDPs and other proteins rely on changes in flexibility and this is seen as a strong determinant for their function. This has fostered the notion that IDP’s bind with low affinity but high specificity. Here we have analyzed available detailed thermodynamic data for protein-protein interactions to put to the test if the thermodynamic profiles of IDP interactions differ from those of other protein-protein interactions. We find that ordered proteins and the disordered ones act as non identical twins operating by similar principles but where the disordered proteins complexes are on average less stable by 2.5 kcal mol-1.
Boysen, Guy A; VanBergen, Alexandra
The purpose of this study was to assess the scientific and etiological status of dissociative identity disorder (DID) by examining cases published from 2000 to 2010. In terms of scientific status, DID is a small but ongoing field of study. The review yielded 21 case studies and 80 empirical studies, presenting data on 1171 new cases of DID. A mean of 9 articles, each containing a mean of 17 new cases of DID, emerged each year. In terms of etiological status, many of the central criticisms of the disorder's validity remain unaddressed. Most cases of DID emerged from a small number of countries and clinicians. In addition, documented cases occurring outside treatment were almost nonexistent. Finally, people simulating DID in the laboratory were mostly indistinguishable from individuals with DID. Overall, DID is still a topic of study, but the research lacks the productivity and focus needed to resolve ongoing controversies surrounding the disorder.
Foote, Brad; Van Orden, Kim
Dialectical Behavior Therapy (DBT), created by Marsha Linehan, has been shown to be an effective therapy for the treatment of borderline personality disorder (BPD) and for suicidal and self-harming behavior. Dissociative identity disorder (DID) is a complex post-traumatic disorder which is highly comorbid with BPD, shares a number of clinical features with BPD, and which like BPD features a high degree of suicidality. The DID treatment literature emphasizes the importance of a staged approach, beginning with the creation of a safe therapeutic frame prior to addressing traumatic material; DBT is also a staged treatment, in which behavioral and safety issues are addressed in Stage 1, and trauma work reserved for Stage 2. The authors describe adapting DBT, and especially its techniques for Stage 1 safety work, for work with DID patients. Basic theoretical principles are described and illustrated with a case example.
Marantz, S; Coates, S
This pilot study compared mothers of boys with gender identity disorder (GID) with mothers of normal boys to determine whether differences in psychopathology and child-rearing attitudes and practices could be identified. Results of the Diagnostic Interview for Borderlines and the Beck Depression Inventory revealed that mothers of boys with GID had more symptoms of depression and more often met the criteria for Borderline Personality Disorder than the controls. Fifty-three percent of the mothers of boys with GID compared with only 6% of controls met the diagnosis for Borderline Personality Disorder on the Diagnostic Interview for Borderlines or had symptoms of depression on the Beck Depression Inventory. Results of the Summers and Walsh Symbiosis Scale suggested that mothers of probands had child-rearing attitudes and practices that encouraged symbiosis and discouraged the development of autonomy.
Bayne, Tim; Levy, Neil
Should surgeons be permitted to amputate healthy limbs if patients request such operations? We argue that if such patients are experiencing significant distress as a consequence of the rare psychological disorder named Body Integrity Identity Disorder (BIID), such operations might be permissible. We examine rival accounts of the origins of the desire for healthy limb amputations and argue that none are as plausible as the BIID hypothesis. We then turn to the moral arguments against such operations, and argue that on the evidence available, none is compelling. BIID sufferers meet reasonable standards for rationality and autonomy: so as long as no other effective treatment for their disorder is available, surgeons ought to be allowed to accede to their requests.
McNamara, Niamh; Parsons, Harriet
Retention of a positively valued illness identity contributes to poor outcomes for individuals with eating disorders (EDs). Consequently, dis-identification from the illness identity and the adoption of a recovery identity are vital for successful recovery. While social identity processes have been shown to influence ED maintenance, their role in recovery is rarely considered. This study explores how a sense of shared identity helps individuals with EDs manage their condition and promotes recovery. Transcripts from 18 online support sessions involving 75 participants were thematically analysed. Our findings suggest that the illness identity initially operates as a social identity that forms the basis for connections with similar others. For those wishing to recover, identity-based support is then perceived to be more effective than that found outside the group. Online interactions also facilitate construction of a new shared recovery identity which promotes a shift from the illness identity as a primary source of definition and endorses group norms of illness disclosure and treatment engagement. While in the clinical literature, ED identity is seen as problematic and interventions are targeted at challenging an individual's self-concept, we suggest that interventions could instead harness identity resources to support a transition to a recovery identity. © 2016 The British Psychological Society.
Schlumpf, Yolanda R.; Reinders, Antje A. T. S.; Nijenhuis, Ellert R. S.; Luechinger, Roger; van Osch, Matthias J. P.; Jaencke, Lutz
Background: In accordance with the Theory of Structural Dissociation of the Personality (TSDP), studies of dissociative identity disorder (DID) have documented that two prototypical dissociative subsystems of the personality, the "Emotional Part'' (EP) and the "Apparently Normal Part'' (ANP), have
Meyer-Bahlburg, Heino F L
The categorization of gender identity variants (GIVs) as "mental disorders" in the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association is highly controversial among professionals as well as among persons with GIV. After providing a brief history of GIV categorizations in the DSM, this paper presents some of the major issues of the ongoing debate: GIV as psychopathology versus natural variation; definition of "impairment" and "distress" for GID; associated psychopathology and its relation to stigma; the stigma impact of the mental-disorder label itself; the unusual character of "sex reassignment surgery" as a psychiatric treatment; and the consequences for health and mental-health services if the disorder label is removed. Finally, several categorization options are examined: Retaining the GID category, but possibly modifying its grouping with other syndromes; narrowing the definition to dysphoria and taking "disorder" out of the label; categorizing GID as a neurological or medical rather than a psychiatric disorder; removing GID from both the DSM and the International Classification of Diseases (ICD); and creating a special category for GIV in the DSM. I conclude that-as also evident in other DSM categories-the decision on the categorization of GIVs cannot be achieved on a purely scientific basis, and that a consensus for a pragmatic compromise needs to be arrived at that accommodates both scientific considerations and the service needs of persons with GIVs.
V. V. Khramtsova
Full Text Available Negative bodily experience due to health complications and disability is perceived as a difficult life situation. The success of adaptation, commitment to treatment and cooperation with a doctor depend on the personality characteristics that define behavioral representations. Aim. Investigate the structure of identity and mechanisms of social-psychological adaptation of patients with the hepatobiliary system disease. Contingent and methods. 75 patients with a diffuse liver disease - chronic hepatitis, mostly of viral etiology (36 people and liver cirrhosis (39 patients have been examined. We have applied clinical, clinical-psychological, mathematical and empirical methods, semi-structured cross-interviews ("patient-doctor", "patient-psychologist", diagnostics of personal characteristics, identity structure, social-psychological components of adaptation. Three leading personality profiles have been highlighted. Results. Persons with a disharmonious personality development are characterized by disorders in the area of identity formation and development. Fragmentation, the impossibility of personal integration and severe penetrability from the environment contribute to social-psychological maladjustment. The coping is aimed at preserving the problem situation and intensifying the intrapersonal conflict. For persons with difficulties in the adaptation of the personality, a violation of activity interaction with the surrounding world is characteristic, a ban on one's self-identity. Social adaptation is often disrupted due to instability in the emotional-volitional sphere and choosing low-adaptive coping strategies. Genuine "I" and identity formation is impeded for the individuals suppressing aggressive impulses. Adaptability tends to be discrete. With mental stress increasing, the likelihood of choosing low-adaptive coping strategies increases. Conclusions. When drafting psycho-correction programs and medical treatment of people with a hepatobiliary
The aim of this thesis is to create a brand and a visual identity for a beauty-salon called Narsissi. Narsissi offers a relaxing environment where both men and women can get lasting beauty treatment results. For a firm being branded is unavoidable. Everything from the look of the logo to the smoothness of service communicates something to the possible customer. In today's market, to be competitive means to be in control of the brand. A huge part of a brand's effectiveness is visual. T...
Dipeolu, Abiola; Sniatecki, Jessica L.; Storlie, Cassandra A.; Hargrave, Stephanie
This study examined dysfunctional career thoughts and attitudes as predictors of vocational identity among high school students with Attention Deficit Hyperactivity Disorder (ADHD). Regression analysis results indicated that dysfunctional career thoughts and attitudes were significant predictors of vocational identity, accounting for 42% of the…
Krebs, Julia F.; Biswas, Ajanta; Pascalis, Olivier; Kamp-Becker, Inge; Remschmidt, Helmuth; Schwarzer, Gudrun
The current study investigated if deficits in processing emotional expression affect facial identity processing and vice versa in children with autism spectrum disorder. Children with autism and IQ and age matched typically developing children classified faces either by emotional expression, thereby ignoring facial identity or by facial identity…
Rhea, Deborah J; Thatcher, W Gregory
The purpose of this study was two-fold: to determine the relationship between ethnic identity and self-esteem as dimensions of one's self-concept; and to determine if differences exist among one's ethnicity, ethnic identity, and/or self-esteem when examining at-risk eating disordered behaviors. A total of 893 urban adolescent females completed three behavioral subscales: the Eating Disorder Inventory, Rosenberg's Self-Esteem Scale, and Phinney's Multigroup Ethnic Identity Measure. As hypothesized, ethnic identity was significantly associated with self-esteem to form one's self-concept. When compared to Mexican American and White females, only Black females who were in the higher ethnic identity and self-esteem categories had significantly lower at-risk eating disordered scores. Our findings suggest eating disorder status in Mexican American and White females may not be associated as much with ethnic identity as with other acculturation and self-concept factors. Further, this study demonstrated ethnicity, self-esteem, and ethnic identity play significant roles in eating disorder risks.
Weigelt, Sarah; Koldewyn, Kami; Kanwisher, Nancy
Face recognition--the ability to recognize a person from their facial appearance--is essential for normal social interaction. Face recognition deficits have been implicated in the most common disorder of social interaction: autism. Here we ask: is face identity recognition in fact impaired in people with autism? Reviewing behavioral studies we find no strong evidence for a qualitative difference in how facial identity is processed between those with and without autism: markers of typical face identity recognition, such as the face inversion effect, seem to be present in people with autism. However, quantitatively--i.e., how well facial identity is remembered or discriminated--people with autism perform worse than typical individuals. This impairment is particularly clear in face memory and in face perception tasks in which a delay intervenes between sample and test, and less so in tasks with no memory demand. Although some evidence suggests that this deficit may be specific to faces, further evidence on this question is necessary. Copyright Â© 2011 Elsevier Ltd. All rights reserved.
Shinohara, Yoshie; Nakatsuka, Mikiya
We focus on Japanese individuals with gender identity disorder (GID), especially male-to-female (MTF) GID, who have experienced difficulty in adapting to social life. We clarify what gender dysphoria is, and we examine methods of intervention. Semi-structured interviews were conducted with 11 individuals with MTF-GID from August 2015 to April 2017. We categorized the subjects'experiences regarding dysphoria into the 'Onset of gender dysphoria,' 'Experience of feeling gender dysphoria,' and 'Changes due to receiving medical care.' The subjects reported experiencing great pain and distress because they did not fully understand that they were experiencing dysphoria and could not align their gender identity and their self-identity. All subjects described their experiences of dysphoria as negative. Additionally, all said that the dysphoria was alleviated by a medical intervention such as visiting a gender clinic, receiving a diagnosis and treatment, and changing their physical sex to the sex congruent with their gender identity. The provision of information at the gender clinic and the physical changes achieved by medical intervention exerted a positive effect both mentally and socially on the subjects, who suffered various physical, mental and social problems.
Chlebowski, Susan M; Gregory, Robert J
Dissociative Identity Disorder (DID) is an under-researched entity and there are no clinical trials employing manual-based therapies and validated outcome measures. There is evidence that borderline personality disorder (BPD) commonly co-occurs with DID and can worsen its course. The authors report three cases of DID with co-occurring BPD that we successfully treated with a manual-based treatment, Dynamic Deconstructive Psychotherapy (DDP). Each of the three clients achieved a 34% to 79% reduction in their Dissociative Experiences Scale scores within 12 months of initiating therapy. Dynamic Deconstructive Psychotherapy was developed for treatment refractory BPD and differs in some respects from expert consensus treatment of DID. It may be a promising modality for DID complicated by co-occurring BPD.
Canipe, Martha Murray
Preservice elementary teachers often have concerns about teaching science that may stem from a lack of confidence as teachers or their own negative experiences as learners of science. These concerns may lead preservice teachers to avoid teaching science or to teach it in a way that focuses on facts and vocabulary rather than engaging students in the doing of science. Research on teacher identity has suggested that being able to envision oneself as a teacher of science is an important part of becoming a teacher of science. Elementary teachers are generalists and as such rather than identifying themselves as teachers of particular content areas, they may identify more generally as teachers of students. This study examines three preservice teachers' identities as teachers of science and teachers of students and how these identities are enacted in their student teaching classrooms. Using a narrated identity framework, I explore stories told by preservice teachers, mentor teachers, student teaching supervisors, and science methods course instructors about who preservice teachers are as teachers of science and teachers of students. Identities are the stories that are told about who someone is or will become in relation to a particular context. Identities that are enacted are performances of the stories that are an identity. Stories were collected through interviews with each storyteller and in an unmoderated focus group with the three preservice teachers. In addition to sorting stories as being about teachers of science or students, the stories were categorized as being about preservice teachers in the present (actual identities) or in the future (designated identities). The preservice teachers were also observed teaching science lessons in their student teaching placements. These enactments of identities were analyzed in order to identify which aspects of the identity stories were reflected in the way preservice teachers taught their science lessons. I also analyzed the
Apotemnophilia, Amputee Identity Disorder or Body Integrity Identity Disorder (BIID) is the intensive feeling that the body will be "more complete" after amputation of a limb. The article disputes the question of matching personality characteristics of these subjects and asks for motives. Based on reports of nine individuals, triggering experiences are referred. In contrast to other children, often these subjects were fascinated by the sight of a handicapped person. In the article is investigated, whether the concerned limb showed more affections. Described is typical pretending behavior. Parallels to body dysmorphic disorder (BDD), fetishism, or delusions are investigated. These were minor, in most cases the wish was fixated on a specific limb, the subjects were aware of the abnormity of their desire and quarreled with the pros and cons. Sexual motives were found in one third. Some of the interviewed persons were in medical or psychological therapy; this did not let the desire disappear. In several BIID sufferers the wish for amputation changed, e. g. from the left to the right leg. This finding is not in accordance with the brain-dysfunction-theory. These people rather have an ideal of a "perfect" body minus one arm or leg. Most admire the beauty of a stump, and see amputees as "heroes" who still master their life in spite of their handicap. BIID is not a homogenous disturbance, one should separate three axes: 1. Strength of neuronal dysfunction, 2. Psychic components (e. g. secondary morbid gain) and 3. Intensity of sexual interests.
Di Ceglie, Domenico; Thümmel, Elizabeth Coates
This article gives an account of an experience of group work with parents and carers who had children or adolescents with gender identity disorder (GID). The history of this intervention within the context of a service for children with gender identity problems is outlined. The limited literature on the subject is reviewed. Group meetings were held monthly for 6 months, facilitated by two therapists (the authors). Selection criteria for group participants, the aims of the group and the methodology for achieving those aims are described. Some information about the group's composition is provided. The structure and content of the group sessions are outlined together with details of some group interactions. Finally, we present the results of an evaluation of the intervention through feedback questionnaires and discuss the value for the children and young people of running such groups.
Dewinter, J; De Graaf, H; Begeer, S
This study compared sexual orientation and romantic relationship experience in a large sample of adolescents and adults with autism spectrum disorder (ASD) (n = 675) and general population peers (n = 8064). Gender identity was explored in the ASD group in relation to assigned gender at birth. Compared to general population peers, more people with ASD, especially women, reported sexual attraction to both same- and opposite-sex partners. About half of the participants with ASD was in a relationship (heterosexual in most cases) and most of them lived with their partner. A notable number of autistic participants, again more women than men, reported gender non-conforming feelings. Attention to gender identity and sexual diversity in education and clinical work with people with ASD is advised.
Blom, Rianne M; Vulink, Nienke C; van der Wal, Sija J; Nakamae, Takashi; Tan, Zhonglin; Derks, Eske M; Denys, Damiaan
Body integrity identity disorder (BIID) is a condition in which people do not perceive a part of their body as their own, which results in a strong desire for amputation or paralyzation. The disorder is likely to be congenital due to its very early onset. The English literature describes only Western patients with BIID, suggesting that the disorder might be merely prevalent in the West. To scrutinize this assumption, and to extend our knowledge of the etiology of BIID, it is important to trace cases with BIID in non-Western populations. Our objective was to review Chinese and Japanese literature on BIID to learn about its presence in populations with a different genetic background. A systematic literature search was performed in databases containing Japanese and Chinese research, published in the respective languages. Five Japanese articles of BIID were identified which described two cases of BIID, whereas in the Chinese databases only BIID-related conditions were found. This article reports some preliminary evidence that BIID is also present in non-Western countries. However, making general statements about the biological background of the disorder is hampered by the extremely low number of cases found. This low number possibly resulted from the extreme secrecy associated with the disorder, perhaps even more so in Asian countries.
Costantini, Giulio; De Panfilis, Chiara
We argue that the series of traits characterizing Borderline Personality Disorder samples do not weigh equally. In this regard, we believe that network approaches employed recently in Personality and Psychopathology research to provide information about the differential relationships among symptoms would be useful to test our claim. To our knowledge, this approach has never been applied to personality disorders. We applied network analysis to the nine Borderline Personality Disorder traits to explore their relationships in two samples drawn from university students and clinical populations (N = 1317 and N = 96, respectively). We used the Fused Graphical Lasso, a technique that allows estimating networks from different populations separately while considering their similarities and differences. Moreover, we examined centrality indices to determine the relative importance of each symptom in each network. The general structure of the two networks was very similar in the two samples, although some differences were detected. Results indicate the centrality of mainly affective instability, identity, and effort to avoid abandonment aspects in Borderline Personality Disorder. Results are consistent with the new DSM Alternative Model for Personality Disorders. We discuss them in terms of implications for therapy. PMID:29040324
Fisher, Alessandra D; Bandini, Elisa; Ricca, Valdo; Ferruccio, Naika; Corona, Giovanni; Meriggiola, Maria C; Jannini, Emmanuele A; Manieri, Chiara; Ristori, Jiska; Forti, Gianni; Mannucci, Edoardo; Maggi, Mario
Male-to-Female Gender Identity Disorder (MtF GID) is a complex phenomenon that could be better evaluated by using a dimensional approach. To explore the aggregation of clinical manifestations of MtF GID in order to identify meaningful variables describing the heterogeneity of the disorder. A consecutive series of 80 MtF GID subjects (mean age 37 +/- 10.3 years), referred to the Interdepartmental Center for Assistance Gender Identity Disorder of Florence and to other Italian centers from July 2008 to June 2009, was studied. Diagnosis was based on formal psychiatric classification criteria. Factor analysis was performed. Several socio-demographic and clinical parameters were investigated. Patients were asked to complete the Bem Sex Role Inventory (BSRI, a self-rating scale to evaluate gender role) and Symptom Checklist-90 Revised (SCL-90-R, a self-rating scale to measure psychological state). Factor analysis identified two dimensional factors: Factor 1 was associated with sexual orientation, and Factor 2 related to behavioral and psychological correlates of early GID development. No correlation was observed between the two factors. A positive correlation between Factor 2 and feminine BSRI score was found, along with a negative correlation between Factor 2 and undifferentiated BSRI score. Moreover, a significant association between SCL-90-R Phobic subscale score and Factor 2 was observed. A variety of other socio-demographic parameters and clinical features were associated with both factors. Behavioral and psychological correlates of Factor 1 (sexual orientation) and Factor 2 (gender identity) do not constitute the framework of two separate clinical entities, but instead represent two dimensions of the complex MtF GID structure, which can be variably intertwined in the same subject. By using factor analysis, we offer a new approach capable of delineating a psychopathological and clinical profile of MtF GID patients.
Spack, Norman P; Edwards-Leeper, Laura; Feldman, Henry A; Leibowitz, Scott; Mandel, Francie; Diamond, David A; Vance, Stanley R
To describe the patients with gender identity disorder referred to a pediatric medical center. We identify changes in patients after creation of the multidisciplinary Gender Management Service by expanding the Disorders of Sex Development clinic to include transgender patients. Data gathered on 97 consecutive patients gender behaviors, provided letters from current mental health professional, and parental support. Main descriptive measures included gender, age, Tanner stage, history of gender identity development, and psychiatric comorbidity. Genotypic male:female ratio was 43:54 (0.8:1); there was a slight preponderance of female patients but not significant from 1:1. Age of presentation was 14.8 ± 3.4 years (mean ± SD) without sex difference (P = .11). Tanner stage at presentation was 4.1 ± 1.4 for genotypic female patients and 3.6 ± 1.5 for genotypic male patients (P = .02). Age at start of medical treatment was 15.6 ± 2.8 years. Forty-three patients (44.3%) presented with significant psychiatric history, including 20 reporting self-mutilation (20.6%) and suicide attempts (9.3%). After establishment of a multidisciplinary gender clinic, the gender identity disorder population increased fourfold. Complex clinical presentations required additional mental health support as the patient population grew. Mean age and Tanner Stage were too advanced for pubertal suppressive therapy to be an affordable option for most patients. Two-thirds of patients were started on cross-sex hormone therapy. Greater awareness of the benefit of early medical intervention is needed. Psychological and physical effects of pubertal suppression and/or cross-sex hormones in our patients require further investigation.
Lambert, Ann Marie; Gagnon, Lise; Fontaine, Francine S
A literature review about transference in the treatment of dissociative identity disorder (DID) is presented. Common transference reactions resulting from serious traumas are explored, considering that those kind of trauma are higly present in the pathways of DID patients. Post traumatic transference aspects specific to DID are also presented. In addition, common transference patterns and dissociative aspects of transference in the treatment of DID are explained. Transference is also discussed in relationship to the possible impact of disorganized attachment, which is a main component in the development of DID. The clinical implications of this proposition will be discussed and supported by a case example.
Shinohara, Yoshie; Nakatsuka, Mikiya
We focus on Japanese individuals with gender identity disorder (GID), especially male-to-female (MTF) GID, who have experienced difficulty in adapting to social life. We clarify what gender dysphoria is, and we examine methods of intervention. Semi-structured interviews were conducted with 11 individuals with MTF-GID from August 2015 to April 2017. We categorized the subjects’experiences regarding dysphoria into the ‘Onset of gender dysphoria,’ ‘Experience of feeling gender dysphoria,’ and ‘C...
Yu Saito; Kazuhiro Nakamura; Shigeto Itani; Kiyoaki Tsukahara
Objective. In most cases, about the voice of the patient with female-to-male/gender identity disorder (FTM/GID), hormone therapy makes the voice low-pitched. In success cases, there is no need for phonosurgery. However, hormone therapy is not effective in some cases. We perform type 3 thyroplasty in these cases. Method. Hormone therapy was started in 2008 but did not lower the speaking fundamental frequencies (SFFs). We therefore performed TP3 under local anesthesia. Results. In our case, the...
Scroppo, J C; Drob, S L; Weinberger, J L; Eagle, P
This study compared 21 female adult psychiatric patients diagnosed with dissociative identity disorder (DID) with 21 female adult nondissociative psychiatric patients to determine whether DID patients exhibit a distinguishing set of clinical features, and perceptual, attentional, and cognitive processes. Participants were assessed with the Dissociative Disorders Interview Schedule to assess diagnostic status. Group scores on the Dissociative Experiences Scale, Tellegen Absorption Scale, Childhood Trauma Questionnaire, Brief Symptom Inventory, and the Rorschach test were compared. DID participants reported earlier and more severe childhood trauma, more dissociative symptoms, and a greater propensity for altered states of consciousness. The DID participants also exhibited increased projective and imaginative activity, a diminished ability to integrate mental contents, a complex and driven cognitive style, and a highly unconventional view of reality.
Dale, Karl Yngvar; Flaten, Magne Arve; Elden, Åke; Holte, Arne
A group of persons with dissociative identity disorder (DID) was compared with a group of persons with other dissociative disorders, and a group of nondiagnosed controls with regard to prepulse inhibition (PPI) of the acoustic startle reflex. The findings suggest maladaptive attentional processes at a controlled level, but not at a preattentive automatic level, in persons with DID. The prepulse occupied more controlled attentional resources in the DID group compared with the other two groups. Preattentive automatic processing, on the other hand, was normal in the DID group. Moreover, startle reflexes did not habituate in the DID group. In conclusion, increased PPI and delayed habituation is consistent with increased vigilance in individuals with DID. The present findings of reduced habituation of startle reflexes and increased PPI in persons with DID suggest the operation of a voluntary process that directs attention away from unpleasant or threatening stimuli. Aberrant voluntary attentional processes may thus be a defining characteristic in DID. PMID:18830396
Leonard, David; Tiller, John
To identify problems that interfere with the recognition, diagnosis and management of people with dissociative identity disorder (DID) presenting to psychiatric outpatient and inpatient services and suggest solutions. Problems and suggested solutions associated with clinical presentations and management of people with DID are outlined with references to relevant literature. Problems in the recognition and management of DID are described. These lead to delays in diagnosis and costly, inappropriate management, destructive to services, staff and patients alike. Problems include lack of understanding and experience and scepticism about the disorder, resulting in failure to provide appropriate treatment.Some suggestions to improve recognition and management are included. Better recognition, diagnosis and management of DID will lead to better and more cost effective outcomes. © The Royal Australian and New Zealand College of Psychiatrists 2015.
Nordander, Catarina; Ohlsson, Kerstina; Balogh, Istvan; Hansson, Gert-Ake; Axmon, Anna; Persson, Roger; Skerfving, Staffan
For unknown reasons, females run a higher risk than males of work-related musculoskeletal disorders. The aim of this study was to evaluate whether male and female workers, with identical repetitive work tasks, differ concerning risk of disorders, physical or psychosocial exposures. Employees in two industries were studied; one rubber manufacturing and one mechanical assembly plant. These industries were selected since in both, large groups of males and females worked side by side performing identical repetitive work tasks. Physical exposure was measured by technical equipment. Postures and movements were registered by inclinometry for the head and upper arms, and by electrogoniometry for the wrists. Muscular activity (muscular rest and %max) was registered by surface electromyography for m. trapezius and the forearm extensors (18 males and 19 females). Psychosocial work environment was evaluated by the demand-control-support model (85 males and 138 females). Musculoskeletal disorders were assessed (105 males and 172 females), by interview (last 7-days complaints), and by physical examination (diagnoses). Concerning physical exposure, females showed higher muscular activity related to maximal voluntary contractions [(%MVE); m. trapezius: females 18 (SD 9.2), males 12 (SD 4.3); forearm extensors: females 39 (SD 11), males 27 (SD 10), right side, 90th percentile]. Working postures and movements were similar between genders. Also, concerning psychosocial work environment, no significant gender differences were found. Females had higher prevalences of disorders [complaints: age-adjusted prevalence odds ratio (POR) 2.3 (95% CI 1.3-3.8) for neck/shoulders, 2.4 (1.4-4.0) for elbows/hands; diagnoses: neck/shoulder 1.9 (1.1-3.6), elbows/hands 4.1 (1.2-9.3)]. In 225 workers, PORs were adjusted for household work, personal recovery and exercise, which only slightly affected the risk estimates. In identical work tasks, females showed substantially higher muscular activity in
Alavi, Kaveh; Eftekhar, Mehrdad; Jalali Nadoushan, Amir Hossein
Gender identity disorders (GID) are heterogeneous disorders that may be influenced by culture and social norms. The aim of this study was to determine masculine and feminine gender roles in a group of Iranian patients with GID and compare these roles with two control groups. Twelve male-to-female (MF) and 27 female-to-male (FM) individuals with GID referred to Tehran Psychiatric Institute in Tehran, I. R. Iran were evaluated by self-report inventories and were compared with two groups of healthy controls (81 men and 89 women). Diagnoses were established based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. Data analysis was done using analysis of variance and chi-squared test. Masculine and feminine gender roles were assessed by two questionnaires: (i) Gender-Masculine (GM) and Gender-Feminine (GF) scales derived from the Minnesota Multiphasic Inventory-2 (MMPI-2); (ii) Bem Sex Role Inventory (BSRI). In the scales of masculinity, MF-GID individuals scored as male controls, but lower than female controls. FM-GID individuals scored similar to female controls and higher than male controls. In femininity scales, MF-GID individuals and control women seemed similar, and both scored higher than the other groups. FM-GID persons were considered less feminine than both controls in the GF scale of MMPI-2, but not in the BSRI. In both scales, FM-GID persons had higher scores than control women and MF-GID individuals. Iranian FM-GID individuals were less feminine than normal men. However, MF-GID individuals were similar to normal women or more feminine. Cultural considerations remain to be investigated. Alavi K, Eftekhar M and Jalali Nadoushan AH. Comparison of masculine and feminine gender roles in Iranian patients with gender identity disorder. Sex Med 2015;3:261-268.
Boysen, Guy A
Dissociative identity disorder (DID) remains a controversial diagnosis due to conflicting views on its etiology. Some attribute DID to childhood trauma and others attribute it to iatrogenesis. The purpose of this article is to review the published cases of childhood DID in order to evaluate its scientific status, and to answer research questions related to the etiological models. I searched MEDLINE and PsycINFO records for studies published since 1980 on DID/multiple personality disorder in children. For each study I coded information regarding the origin of samples and diagnostic methods. The review produced a total of 255 cases of childhood DID reported as individual case studies (44) or aggregated into empirical studies (211). Nearly all cases (93%) emerged from samples of children in treatment, and multiple personalities was the presenting problem in 23% of the case studies. Four US research groups accounted for 65% of all 255 cases. Diagnostic methods typically included clinical evaluation based on Diagnostic and Statistical Manual of Mental Disorder criteria, but hypnosis, structured interviews, and multiple raters were rarely used in diagnoses. Despite continuing research on the related concepts of trauma and dissociation, childhood DID itself appears to be an extremely rare phenomenon that few researchers have studied in depth. Nearly all of the research that does exist on childhood DID is from the 1980s and 1990s and does not resolve the ongoing controversies surrounding the disorder. Copyright © 2011 S. Karger AG, Basel.
Wilson, C. Ellie; Palermo, Romina; Brock, Jon
Background Previous research suggests that many individuals with autism spectrum disorder (ASD) have impaired facial identity recognition, and also exhibit abnormal visual scanning of faces. Here, two hypotheses accounting for an association between these observations were tested: i) better facial identity recognition is associated with increased gaze time on the Eye region; ii) better facial identity recognition is associated with increased eye-movements around the face. Methodology and Principal Findings Eye-movements of 11 children with ASD and 11 age-matched typically developing (TD) controls were recorded whilst they viewed a series of faces, and then completed a two alternative forced-choice recognition memory test for the faces. Scores on the memory task were standardized according to age. In both groups, there was no evidence of an association between the proportion of time spent looking at the Eye region of faces and age-standardized recognition performance, thus the first hypothesis was rejected. However, the ‘Dynamic Scanning Index’ – which was incremented each time the participant saccaded into and out of one of the core-feature interest areas – was strongly associated with age-standardized face recognition scores in both groups, even after controlling for various other potential predictors of performance. Conclusions and Significance In support of the second hypothesis, results suggested that increased saccading between core-features was associated with more accurate face recognition ability, both in typical development and ASD. Causal directions of this relationship remain undetermined. PMID:22666378
Haraldsen, I R; Opjordsmoen, S; Egeland, T; Finset, A
We explored whether the cognitive performance of gender identity disorder patients (GID) was comparable to that of their biological sex or skewed towards that of their gender identity. We tested four potentially sex-sensitive cognitive factors (rotation, visualization, perception, and verbalization) as well as two neutral factors (logic and arithmetic) in GID patients from Norway (GID-N, n = 33) or the USA (GID-US, n = 19) and in a control group (C, n = 29). The testing was undertaken prior to cross sex hormone treatment. Four-way ANOVA was applied in the final analysis of the cognitive performance and its dependency on different predictors (age, biological sex, education, group). In both GID groups as well as in the control group (C) males excelled in visualization and rotation, also when controlling for potential confounders (biological sex, group, age and education). No female advantage was detected. Furthermore, no interaction between biological sex and group assignment was revealed in the samples. In this study the cognitive pattern of GID patients is consistent with that of their biological sex and not that of their gender identity.
Problem theory points to an a priori relation between six key problems of living, to which people have adapted through evolution. Children are guided through the problems one by one, learning to switch between them automatically and unawares. The first problem of raising hope of certainty (about the environment), is dealt with in the right hemisphere (RH). The second of raising hope of freedom (or power to control), is dealt with in the left hemisphere (LH). Here adventurousness and ignoring the goodness of outcomes potentially create recklessness. When uncertainty rises the RH activates a backup with an override that substitutes immobility, takes over sensory inputs, but allows obedience to parental commands, and a cut-out that stops new work on the freedom problem. Support for the use of the backup by infants is found in the immobility that precedes the crying in strange conditions, and in childhood EEGs. The hypothesis that the backup is active in deep hypnosis imposes accord on findings that appear contradictory. For example it accounts for why observations during deep hypnosis emphasize the activity of the RH, but observations of responsive people not under hypnosis emphasize the activity of the LH. The hypothesis that the backup is active in post-traumatic stress disorder (PTSD) is supported by (a) fMRI observations that could reflect the cut-out, in that part of the precuneus has low metabolism, (b) the recall of motionlessness at the time of the trauma, (c) an argument that playing dead as a defence against predators is illogical, (d) the ease of hypnosis. With dissociative identity disorder (DID), the theory is consistent with up to six alters that have executive control and one trauma identity state where childhood traumas are re-experienced. Support for the cut-out affecting the trauma identity state comes from suppression of part of the precuneus and other parts of the parietal lobe when the trauma identity state is salient and a general script about a
Chalavi, Sima; Vissia, Eline M.; Giesen, Mechteld E.; Nijenhuis, Ellert R.S.; Draijer, Nel; Cole, James H.; Dazzan, Paola; Pariante, Carmine M.; Madsen, Sarah K.; Rajagopalan, Priya; Thompson, Paul M.; Toga, Arthur W.; Veltman, Dick J.; Reinders, Antje A.T.S.
Smaller hippocampal volume has been reported in individuals with posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID), but the regional specificity of hippocampal volume reductions and the association with severity of dissociative symptoms and/or childhood traumatization are still unclear. Brain structural MRI scans were analyzed for 33 outpatients (17 with DID and 16 with PTSD only) and 28 healthy controls (HC), all matched for age, sex, and education. DID patients met criteria for PTSD (PTSD-DID). Hippocampal global and subfield volumes and shape measurements were extracted. We found that global hippocampal volume was significantly smaller in all 33 patients (left: 6.75%; right: 8.33%) compared to HC. PTSD-DID (left: 10.19%; right: 11.37%) and PTSD-only with a history of childhood traumatization (left: 7.11%; right: 7.31%) had significantly smaller global hippocampal volume relative to HC. PTSD-DID had abnormal shape and significantly smaller volume in the CA2-3, CA4-DG and (pre)subiculum compared to HC. In the patient groups, smaller global and subfield hippocampal volumes significantly correlated with higher severity of childhood traumatization and dissociative symptoms. These findings support a childhood trauma-related etiology for abnormal hippocampal morphology in both PTSD and DID and can further the understanding of neurobiological mechanisms involved in these disorders. PMID:25545784
Chalavi, Sima; Vissia, Eline M; Giesen, Mechteld E; Nijenhuis, Ellert R S; Draijer, Nel; Cole, James H; Dazzan, Paola; Pariante, Carmine M; Madsen, Sarah K; Rajagopalan, Priya; Thompson, Paul M; Toga, Arthur W; Veltman, Dick J; Reinders, Antje A T S
Smaller hippocampal volume has been reported in individuals with post-traumatic stress disorder (PTSD) and dissociative identity disorder (DID), but the regional specificity of hippocampal volume reductions and the association with severity of dissociative symptoms and/or childhood traumatization are still unclear. Brain structural magnetic resonance imaging scans were analyzed for 33 outpatients (17 with DID and 16 with PTSD only) and 28 healthy controls (HC), all matched for age, sex, and education. DID patients met criteria for PTSD (PTSD-DID). Hippocampal global and subfield volumes and shape measurements were extracted. We found that global hippocampal volume was significantly smaller in all 33 patients (left: 6.75%; right: 8.33%) compared with HC. PTSD-DID (left: 10.19%; right: 11.37%) and PTSD-only with a history of childhood traumatization (left: 7.11%; right: 7.31%) had significantly smaller global hippocampal volume relative to HC. PTSD-DID had abnormal shape and significantly smaller volume in the CA2-3, CA4-DG and (pre)subiculum compared with HC. In the patient groups, smaller global and subfield hippocampal volumes significantly correlated with higher severity of childhood traumatization and dissociative symptoms. These findings support a childhood trauma-related etiology for abnormal hippocampal morphology in both PTSD and DID and can further the understanding of neurobiological mechanisms involved in these disorders. © 2014 Wiley Periodicals, Inc.
Brand, Bethany L; McNary, Scot W; Loewenstein, Richard J; Kolos, Amie C; Barr, Stefanie R
Little is known about how to detect malingered dissociative identity disorder (DID). This study presents preliminary data from an ongoing study about the performance of DID patients on the Structured Interview of Reported Symptoms (SIRS, Rogers, Bagby, & Dickens, 1992), considered to be a "gold standard" structured interview in forensic psychology to detect feigning of psychological symptoms. Test responses from 20 dissociative identity disorder (DID) patients are compared to those of 43 well informed and motivated DID simulators. Both the simulators and DID patients endorsed such a high number of symptoms that their average overall scores would typically be interpreted as indicative of feigning. The simulators' mean scores were significantly higher than those of the DID patients on only four out of 13 scales. These results provide preliminary evidence that well informed and motivated simulators are able to fairly successfully simulate DID patients and avoid detection on the SIRS. Furthermore, many DID patients may be at risk for being inaccurately labeled as feigning on the SIRS.
Piegza, Magdalena; Leksowska, Aleksandra; Pudlo, Robert; Badura-Brzoza, Karina; Matysiakiewicz, Jerzy; Gierlotka, Zbigniew; Gorczyca, Piotr W
Nowadays, it is becoming increasingly difficult to clearly classify the issues associated with the phenomenon of gender dysphoria due to the fact that one identifies oneself in the context of increasingly fluid categories of gender identity-- an intrinsic sense of being a woman or a man. The authors present a woman whose internal problems connected with her sexuality and incomplete identification with the role attributed to her gender originate from her family history. Long-lasting, traumatic experiences of incestuous abuse and violence on the part of close relatives disturbed her development in many areas of personality and functioning. The aim of the study was to verify the hypothesis of the existence of gender identity disorder accompanied by depressive disorders. In addition to the medical history, the study of patient's problems included the following diagnostic tools: the Minnesota Multiphasic Personality Inventory (MMPI) and the Rorschach Inkblot Test in a CSR Exner system (TPA). The study revealed that as for sexual identification, the patient unambiguously identifies herself as a woman. Her behaviour to become like a man does not deny her sex, or even involve a temporary need of belonging to the opposite sex. It should be interpreted in the broader context of her traumatic experiences, not just sexual, but also concerning different aspects of a female gender role.
Jensen, Kim Ebensgaard
-specialized language in which it also serves a number of functions – some of which are quite fundamental to society as such. In other words, the lexeme identity is a polysemic word and has multiple, well, identities. Given that it appears to have a number of functions in a variety of registers, including terminologies...... in Academic English and more everyday-based English, identity as a lexeme is definitely worth having a look at. This paper presents a lexicological study of identity in which some of its senses are identified and their behaviors in actual discourse are observed. Drawing on data from the 2011 section...... of the Corpus of Contemporary American English, a behavioral profile of the distributional characteristics of identity is set up. Behavioral profiling is a lexicographical method developed by the corpus linguist Stefan Th. Gries which, by applying semantic ID tagging and statistical analysis, provides a fine...
Kraemer, Bernd; Noll, Thomas; Delsignore, Aba; Milos, Gabriella; Schnyder, Ulrich; Hepp, Urs
From early childhood, gender identity and the 2nd to 4th finger length ratio (2D:4D) are discriminative characteristics between sexes. Both the human brain and 2D:4D may be influenced by prenatal testosterone levels. This calls for an examination of 2D:4D in patients with gender identity disorder (GID) to study the possible influence of prenatal testosterone on gender identity. Until now, the only study carried out on this issue suggests lower prenatal testosterone levels in right-handed male-to-female GID patients (MtF). We compared 2D:4D of 56 GID patients (39 MtF; 17 female-to-male GID patients, FtM) with data from a control sample of 176 men and 190 women. Bivariate group comparisons showed that right hand 2D:4D in MtF was significantly higher (feminized) than in male controls, but similar to female controls. The comparison of 2D:4D ratios of biological women revealed significantly higher (feminized) values for right hands of right handed FtM. Analysis of variance confirmed significant effects for sex and for gender identity on 2D:4D ratios but not for sexual orientation or for the interaction among variables. Our results indirectly point to the possibility of a weak influence of reduced prenatal testosterone as an etiological factor in the multifactorially influenced development of MtF GID. The development of FtM GID seems even more unlikely to be notably influenced by prenatal testosterone.
The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image.
Schiepek, Günter K; Stöger-Schmidinger, Barbara; Aichhorn, Wolfgang; Schöller, Helmut; Aas, Benjamin
Objective: The aim of this case report is to demonstrate the feasibility of a systemic procedure (synergetic process management) including modeling of the idiographic psychological system and continuous high-frequency monitoring of change dynamics in a case of dissociative identity disorder. The psychotherapy was realized in a day treatment center with a female client diagnosed with borderline personality disorder (BPD) and dissociative identity disorder. Methods: A three hour long co-creative session at the beginning of the treatment period allowed for modeling the systemic network of the client's dynamics of cognitions, emotions, and behavior. The components (variables) of this idiographic system model (ISM) were used to create items for an individualized process questionnaire for the client. The questionnaire was administered daily through an internet-based monitoring tool (Synergetic Navigation System, SNS), to capture the client's individual change process continuously throughout the therapy and after-care period. The resulting time series were reflected by therapist and client in therapeutic feedback sessions. Results: For the client it was important to see how the personality states dominating her daily life were represented by her idiographic system model and how the transitions between each state could be explained and understood by the activating and inhibiting relations between the cognitive-emotional components of that system. Continuous monitoring of her cognitions, emotions, and behavior via SNS allowed for identification of important triggers, dynamic patterns, and psychological mechanisms behind seemingly erratic state fluctuations. These insights enabled a change in management of the dynamics and an intensified trauma-focused therapy. Conclusion: By making use of the systemic case formulation technique and subsequent daily online monitoring, client and therapist continuously refer to detailed visualizations of the mental and behavioral network and
Guenter Karl Schiepek
Full Text Available Objective. The aim of this case report is to demonstrate the feasibility of a systemic procedure (synergetic process management including modeling of the idiographic psychological system and continuous high-frequency monitoring of change dynamics in a case of dissociative identity disorder. The psychotherapy was realized in a day treatment center with a female client diagnosed with borderline personality disorder (BPD and dissociative identity disorder. Methods. A three hour long co-creative session at the beginning of the treatment period allowed for modeling the systemic network of the client’s dynamics of cognitions, emotions, and behavior. The components (variables of this idiographic system model (ISM were used to create items for an individualized process questionnaire for the client. The questionnaire was administered daily through an internet-based monitoring tool (Synergetic Navigation System, SNS, to capture the client’s individual change process continuously throughout the therapy and after-care period. The resulting time series were reflected by therapist and client in therapeutic feedback sessions. Results. For the client it was important to see how the personality states dominating her daily life were represented by her idiographic system model and how the transitions between each state could be explained and understood by the activating and inhibiting relations between the cognitive-emotional components of that system. Continuous monitoring of her cognitions, emotions, and behavior via SNS allowed for identification of important triggers, dynamic patterns, and psychological mechanisms behind seemingly erratic state fluctuations. These insights enabled a change in management of the dynamics and an intensified trauma-focused therapy. Conclusion. By making use of the systemic case formulation technique and subsequent daily online monitoring, client and therapist continuously refer to detailed visualizations of the mental and
Sajatovic, Martha; Micula-Gondek, Weronika; Tatsuoka, Curtis; Bialko, Christopher
It has been demonstrated that 46% to 48% of individuals with bipolar disorder (BD) are at least partially nonadherent with prescribed medication. Reports of whether male gender is a predictor of treatment nonadherence in BD have been inconsistent. The construct of gender may also be a matter of cultural orientation, and psychological gender, as a component of self-perception, may affect the experience of mental illness. Gender identity is the subjective experience of one's individuality as male or female. This cross-sectional study evaluated gender and gender identity among men and women with BD as they relate to self-reported medication treatment adherence. This secondary analysis of a larger study on treatment adherence evaluated men and women with BD being treated with mood-stabilizing medications in a community mental health clinic. Gender identity and treatment adherence were evaluated using the Bem Sex Role Inventory (BSRI) and the Tablets Routine Questionnaire, respectively. Other measures included assessing BD symptoms using the Hamilton Depression Rating Scale and mania symptoms using the Young Mania Rating Scale, as well as psychosocial support with the Interpersonal Support Evaluation List and locus of control with the Multidimensional Health Locus of Control Scale. Mean age of the 70 men and 70 women with type I BD was 43.1 years for adherent patients and 40.8 years for nonadherent patients. Women with BD had mean scores on the BSRI consistent with general population norms, whereas men with BD had scores suggesting lower levels of self-perceived masculinity than population norms. There were no differences between men and women on adherence; however, men with high BSRI masculinity scores had less adherence than other men in the sample (P = 0.04). Lower scores on the "powerful others" dimension of locus of control were associated with lower adherence. For women, there was no relationship between BSRI masculinity scores and adherence. Gender identity in
Vissia, E M; Giesen, M E; Chalavi, S; Nijenhuis, E R S; Draijer, N; Brand, B L; Reinders, A A T S
The Trauma Model of dissociative identity disorder (DID) posits that DID is etiologically related to chronic neglect and physical and/or sexual abuse in childhood. In contrast, the Fantasy Model posits that DID can be simulated and is mediated by high suggestibility, fantasy proneness, and sociocultural influences. To date, these two models have not been jointly tested in individuals with DID in an empirical manner. This study included matched groups [patients (n = 33) and controls (n = 32)] that were compared on psychological Trauma and Fantasy measures: diagnosed genuine DID (DID-G, n = 17), DID-simulating healthy controls (DID-S, n = 16), individuals with post-traumatic stress disorder (PTSD, n = 16), and healthy controls (HC, n = 16). Additionally, personality-state-dependent measures were obtained for DID-G and DID-S; both neutral personality states (NPS) and trauma-related personality states (TPS) were tested. For Trauma measures, the DID-G group had the highest scores, with TPS higher than NPS, followed by the PTSD, DID-S, and HC groups. The DID-G group was not more fantasy-prone or suggestible and did not generate more false memories. Malingering measures were inconclusive. Evidence consistently supported the Trauma Model of DID and challenges the core hypothesis of the Fantasy Model. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Chalavi, Sima; Vissia, Eline M; Giesen, Mechteld E; Nijenhuis, Ellert R S; Draijer, Nel; Barker, Gareth J; Veltman, Dick J; Reinders, Antje A T S
Neuroanatomical evidence on the relationship between posttraumatic stress disorder (PTSD) and dissociative disorders is still lacking. We acquired brain structural magnetic resonance imaging (MRI) scans from 17 patients with dissociative identity disorder (DID) and co-morbid PTSD (DID-PTSD) and 16 patients with PTSD but without DID (PTSD-only), and 32 healthy controls (HC), and compared their whole-brain cortical and subcortical gray matter (GM) morphological measurements. Associations between GM measurements and severity of dissociative and depersonalization/derealization symptoms or lifetime traumatizing events were evaluated in the patient groups. DID-PTSD and PTSD-only patients, compared with HC, had similarly smaller cortical GM volumes of the whole brain and of frontal, temporal and insular cortices. DID-PTSD patients additionally showed smaller hippocampal and larger pallidum volumes relative to HC, and larger putamen and pallidum volumes relative to PTSD-only. Severity of lifetime traumatizing events and volume of the hippocampus were negatively correlated. Severity of dissociative and depersonalization/derealization symptoms correlated positively with volume of the putamen and pallidum, and negatively with volume of the inferior parietal cortex. Shared abnormal brain structures in DID-PTSD and PTSD-only, small hippocampal volume in DID-PTSD, more severe lifetime traumatizing events in DID-PTSD compared with PTSD-only, and negative correlations between lifetime traumatizing events and hippocampal volume suggest a trauma-related etiology for DID. Our results provide neurobiological evidence for the side-by-side nosological classification of PTSD and DID in the DSM-5. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
In 1930, Italian psychiatrist Giovanni Enrico Morselli described the history, diagnosis, and treatment of his patient Elena. The case of Elena has been considered in literature as one of the most remarkable cases of multiple personality ever published. In fact, before treatment, Elena showed alternating French- and Italian-speaking personalities, with the Italian personality knowing nothing of her French counterparts. After a difficult treatment involving recovered memories of incestuous attacks by her father, which were proven to be true, Elena fully recovered from her symptoms. In this article, the author presents details of the case that were not available in the international literature before. He also discusses Elena's psychological and somatoform symptoms according to a contemporary perspective on the relationally traumatic origins of dissociation and dissociative identity disorder.
Urbina, Theresa M; May, Tania; Hastings, Michelle
This case illustrates previously undiagnosed dissociative identity disorder (DID) in a middle-aged female with extensive childhood trauma, who was high functioning prior to a trigger that caused a reemergence of her symptoms. The trigger sparked a dissociative state, attempted suicide, and subsequent inpatient psychiatric hospitalization. Practitioners should include in their differential and screen for undiagnosed DID in patients with episodic psychiatric hospitalizations refractory to the standard treatments for previously diagnosed mental illnesses. Case study. During hospitalization, the diagnosis of DID became apparent and treatment included low-dose risperidone, mirtazapine, sertraline, unconditional positive regard, normalization of her dissociative states in an attempt to decrease her anxiety during treatment, and documentation for the patient via written notes following interviews. These methods helped her come to terms with the diagnosis and allowed the treatment team to teach her coping skills to lessen the impact of dissociative states following discharge.
Miyajima, Tsuyoshi; Kim, Yoon Taek; Oda, Hiromi
The aim of this study was to determine the effect of increasing estrogen and decreasing androgen in males and increasing androgen and decreasing estrogen in females on bone metabolism in patients with gender identity disorder (GID). We measured and examined bone mineral density (BMD) and bone metabolism markers retrospectively in GID patients who were treated in our hospital. In addition, we studied the effects of treatment on those who had osteoporosis. Patients who underwent a change from male to female (MtF) showed inhibition of bone resorption and increased L2-4 BMD whereas those who underwent a change from female to male (FtM) had increased bone resorption and decreased L2-4 BMD. Six months after administration of risedronate to FtM patients with osteoporosis, L2-4 BMD increased and bone resorption markers decreased. These results indicate that estrogen is an important element with regard to bone metabolism in males.
Transgender children who are not treated for their condition are at high risk of violence and suicide. As a matter of survival, many are willing to take whatever help is available, even if this is offered by illegal sources, and this often traps them into the juvenile criminal system and exposes them to various threats. Endocrinology offers a revolutionary instrument to help children/adolescents with gender identity disorder: suspension of puberty. Suspension of puberty raises many ethical issues, and experts dissent as to when treatment should be commenced and how children should be followed up. This paper argues that suspension of puberty is not only not unethical: if it is likely to improve the child's quality of life and even save his or her life, then it is indeed unethical to defer treatment.
Jørgensen, Carsten René; Berntsen, Dorthe; Bech, Morten; Kjølbye, Morten; Bennedsen, Birgit E; Ramsgaard, Stine B
Disturbed identity is one of the defining characteristics of Borderline Personality Disorder manifested in a broad spectrum of dysfunctions related to the self, including disturbances in meaning-generating self-narratives. Autobiographical memories are memories of personal events that provide crucial building-blocks in our construction of a life-story, self-concept, and a meaning-generating narrative identity. The cultural life script represents culturally shared expectations as to the order and timing of life events in a prototypical life course within a given culture. It is used to organize one's autobiographical memories. Here, 17 BPD-patients, 14 OCD-patients, and 23 non-clinical controls generated three important autobiographical memories and their conceptions of the cultural life script. BPD-patients reported substantially more negative memories, fewer of their memories were of prototypical life script events, their memory narratives were less coherent and more disoriented, and the overall typicality of their life scripts was lower as compared with the other two groups. Copyright © 2012 Elsevier Inc. All rights reserved.
Brand, Bethany L; Loewenstein, Richard J; Spiegel, David
Some claim that treatment for dissociative identity disorder (DID) is harmful. Others maintain that the available data support the view that psychotherapy is helpful. We review the empirical support for both arguments. Current evidence supports the conclusion that phasic treatment consistent with expert consensus guidelines is associated with improvements in a wide range of DID patients' symptoms and functioning, decreased rates of hospitalization, and reduced costs of treatment. Research indicates that poor outcome is associated with treatment that does not specifically involve direct engagement with DID self-states to repair identity fragmentation and to decrease dissociative amnesia. The evidence demonstrates that carefully staged trauma-focused psychotherapy for DID results in improvement, whereas dissociative symptoms persist when not specifically targeted in treatment. The claims that DID treatment is harmful are based on anecdotal cases, opinion pieces, reports of damage that are not substantiated in the scientific literature, misrepresentations of the data, and misunderstandings about DID treatment and the phenomenology of DID. Given the severe symptomatology and disability associated with DID, iatrogenic harm is far more likely to come from depriving DID patients of treatment that is consistent with expert consensus, treatment guidelines, and current research.
Korte, Alexander; Lehmkuhl, Ulrike; Goecker, David; Beier, Klaus Michael; Krude, Heiko; Grüters-Kieslich, Annette
Gender identity disorders (GID) can appear even in early infancy with a variable degree of severity. Their prevalence in childhood and adolescence is below 1%. GID are often associated with emotional and behavioral problems as well as a high rate of psychiatric comorbidity. Their clinical course is highly variable. There is controversy at present over theoretical explanations of the causes of GID and over treatment approaches, particularly with respect to early hormonal intervention strategies. This review is based on a selective Medline literature search, existing national and international guidelines, and the results of a discussion among experts from multiple relevant disciplines. As there have been no large studies to date on the course of GID, and, in particular, no studies focusing on causal factors for GID, the evidence level for the various etiological models that have been proposed is generally low. Most models of these disorders assume that they result from a complex biopsychosocial interaction. Only 2.5% to 20% of all cases of GID in childhood and adolescence are the initial manifestation of irreversible transsexualism. The current state of research on this subject does not allow any valid diagnostic parameters to be identified with which one could reliably predict whether the manifestations of GID will persist, i.e., whether transsexualism will develop with certainty or, at least, a high degree of probability. The types of modulating influences that are known from the fields of developmental psychology and family dynamics have therapeutic implications for GID. As children with GID only rarely go on to have permanent transsexualism, irreversible physical interventions are clearly not indicated until after the individual's psychosexual development ist complete. The identity-creating experiences of this phase of development should not be restricted by the use of LHRH analogues that prevent puberty.
Schley, W R; Wagenfeld, M O
Proponents of the medical models have held that mental disorder is best measured in terms of some inventory of symptoms indicative of an underlying disease. Alternatively, critics have argued that mental disorder is the result of a degraded ascribed role, a discrepancy between the person and his environment, or the degradation of identity. The issue goes beyond academic debate, with important implications for case-finding and program development in community mental health. Theodore Sarbin has developed a 58-item "Conduct Impairment Scale" to operationalize the concept of "Identity Degradation" and proposed it as a substitute for the medical model. Three dimensions are posited: status, value, and involvement. An appropriate level of reliability and clustering of scale items are reported by Sarbin. In order to subject the scale to a more rigorous test, it was administered to a random sample of 208 respondents in four neighborhoods in Grand Rapids, Michigan, as part of a larger epidemiological study. In an effort to assess the validity of the scale, factor analytic methods were employed. A principal components model with varimax rotation was performed. It was found that items purporting to tap the three theoretical dimensions explicated by Sarbin did not load in the expected pattern. Additionally, the first three extracted factors accounted for only a small proportion of the total variance. Efforts to assess the reliability of the scale were more fruitful. A corrected split-half of .82 and coefficient alpha of .86 were obtained. It was concluded that the validity of the scale was not adequately demonstrated, and its use as an alternative to the medical model open to serious reservation.
Karl Yngvar Dale
Full Text Available Karl Yngvar Dale1, Magne Arve Flaten1, Åke Elden1, Arne Holte21Department of Psychology, University of Tromsø, Norway; 2The Norwegian Institute of Public Health, Department of Mental Health, Oslo, Norway and University of Oslo, NorwayAbstract: A group of persons with dissociative identity disorder (DID was compared with a group of persons with other dissociative disorders, and a group of nondiagnosed controls with regard to prepulse inhibition (PPI of the acoustic startle reflex. The findings suggest maladaptive attentional processes at a controlled level, but not at a preattentive automatic level, in persons with DID. The prepulse occupied more controlled attentional resources in the DID group compared with the other two groups. Preattentive automatic processing, on the other hand, was normal in the DID group. Moreover, startle reflexes did not habituate in the DID group. In conclusion, increased PPI and delayed habituation is consistent with increased vigilance in individuals with DID. The present findings of reduced habituation of startle reflexes and increased PPI in persons with DID suggest the operation of a voluntary process that directs attention away from unpleasant or threatening stimuli. Aberrant voluntary attentional processes may thus be a defining characteristic in DID.Keywords: dissociation, DID, PPI, startle, habituation
Brand, Bethany; Loewenstein, Richard J
Proponents of the iatrogenic model of the etiology of dissociative identity disorder (DID) have expressed concern that treatment focused on direct engagement and interaction with dissociated self-states harms DID patients. However, empirical data have shown that this type of DID treatment is beneficial. Analyzing data from the prospective Treatment of Patients With Dissociative Disorders (TOP DD) Study, we test empirically whether DID treatment is associated with clinically adverse manifestations of dissociated self-states: acting so differently that one feels like different people, hearing voices, and dissociative amnesia. We show that, over the course of the study, there were significant decreases in feeling like different people and hearing voices. These results indicate that this form of DID treatment does not lead to symptomatic worsening in these dimensions, as predicted by the iatrogenic model. Indeed, treatment provided by TOP DD therapists reduced, rather than increased, the extent to which patients experienced manifestations of pathological dissociation. Because severe symptomatology and impairment are associated with DID, iatrogenic harm may come from depriving DID patients of treatment that targets DID symptomatology.
This case study investigated an intervention that enabled an individual with Posttraumatic Stress Disorder (PTSD), Dissociative Identity Disorder (DID), and satanic ritual abuse to return to work after discharge from psychiatric inpatient treatment. The Occupational Questionnaire  revealed past difficulties in organization, awareness of time, communication, cooperation, frustration tolerance, competition, stress management, goal setting, and amnesia resulting in incomplete tasks and sporadic attendance at work. The Role Checklist  identified alters valuing work and employed in the past. The Modified Interest Checklist  identified running as an interest that 24 alters shared. Based on the initial evaluations, three times a week treadmill running was used as an intervention that built work skills (as measured by the Clerical Work Sample of the Valpar Component Work Sample Series ) necessary to sustain gainful employment upon discharge. After intervention, this individual improved in awareness of time, stress management, and goal setting abilities and was less amnestic as per the Occupational Questionnaire  and four additional alters expressed an interest in work according to the Modified Interest Checklist .
Byne, William; Bradley, Susan J; Coleman, Eli; Eyler, A Evan; Green, Richard; Menvielle, Edgardo J; Meyer-Bahlburg, Heino F L; Pleak, Richard R; Tompkins, D Andrew
Both the diagnosis and treatment of Gender Identity Disorder (GID) are controversial. Although linked, they are separate issues and the DSM does not evaluate treatments. The Board of Trustees (BOT) of the American Psychiatric Association (APA), therefore, formed a Task Force charged to perform a critical review of the literature on the treatment of GID at different ages, to assess the quality of evidence pertaining to treatment, and to prepare a report that included an opinion as to whether or not sufficient credible literature exists for development of treatment recommendations by the APA. The literature on treatment of gender dysphoria in individuals with disorders of sex development was also assessed. The completed report was accepted by the BOT on September 11, 2011. The quality of evidence pertaining to most aspects of treatment in all subgroups was determined to be low; however, areas of broad clinical consensus were identified and were deemed sufficient to support recommendations for treatment in all subgroups. With subjective improvement as the primary outcome measure, current evidence was judged sufficient to support recommendations for adults in the form of an evidence-based APA Practice Guideline with gaps in the empirical data supplemented by clinical consensus. The report recommends that the APA take steps beyond drafting treatment recommendations. These include issuing position statements to clarify the APA's position regarding the medical necessity of treatments for GID, the ethical bounds of treatments of gender variant minors, and the rights of persons of any age who are gender variant, transgender or transsexual.
Gender Identity Disorder (GID) is regarded as a mental illness and included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It will also appear in the DSM-V, due to be published in 2013. The classification of GID as a mental illness is contentious. But what would happen to sufferers if it were removed from the diagnostic manuals? Would people lose their entitlement to funded medical care, or to reimbursement under insurance schemes? On what basis should medical treatment for GID be provided? What are the moral arguments for and against funded or reimbursed medical care for GID? This paper starts out with a fiction: GID is removed from the diagnostic manuals. Then the paper splits in two, as in happened in the Howitt's 1998 film Sliding Doors. The two scenarios run parallel. In one, it is argued that GID is on a par with other body modifications, such as cosmetic and racial surgery, and that, for ethical reasons, treatment for GID should be privately negotiated by applicants and professionals and privately paid for. In the other scenario, it is argued that the comparison between GID and other body modifications is misleading. Whether or not medical treatment should be funded or reimbursed is independent of whether GID is on a par with other forms of body dissatisfaction.
Cohen-Kettenis, Peggy T; Pfäfflin, Friedemann
Apart from some general issues related to the Gender Identity Disorder (GID) diagnosis, such as whether it should stay in the DSM-V or not, a number of problems specifically relate to the current criteria of the GID diagnosis for adolescents and adults. These problems concern the confusion caused by similarities and differences of the terms transsexualism and GID, the inability of the current criteria to capture the whole spectrum of gender variance phenomena, the potential risk of unnecessary physically invasive examinations to rule out intersex conditions (disorders of sex development), the necessity of the D criterion (distress and impairment), and the fact that the diagnosis still applies to those who already had hormonal and surgical treatment. If the diagnosis should not be deleted from the DSM, most of the criticism could be addressed in the DSM-V if the diagnosis would be renamed, the criteria would be adjusted in wording, and made more stringent. However, this would imply that the diagnosis would still be dichotomous and similar to earlier DSM versions. Another option is to follow a more dimensional approach, allowing for different degrees of gender dysphoria depending on the number of indicators. Considering the strong resistance against sexuality related specifiers, and the relative difficulty assessing sexual orientation in individuals pursuing hormonal and surgical interventions to change physical sex characteristics, it should be investigated whether other potentially relevant specifiers (e.g., onset age) are more appropriate.
Giummarra, Melita J; Bradshaw, John L; Hilti, Leonie M; Nicholls, Michael E R; Brugger, Peter
Body incongruity in body integrity identity disorder (BIID) manifests in the desire to have a healthy limb amputated. We describe a variant of the disorder: the desire to become paralyzed (paralysis-BIID). Sixteen otherwise healthy participants, recruited through Internet-based forums, websites, or word of mouth, completed questionnaires about details of their desire and accompanying symptoms. Onset of the desire for paralysis typically preceded puberty. All participants indicated a specific level for desired spinal cord injury. All participants simulated paralysis through mental imagery or physical pretending, and 9 (56%) reported erotic interest in paraplegia and/or disability. Our key new finding was that 37.5% of paralysis-BIID participants were women, compared with 4.4% women in a sample of 68 individuals with amputation-BIID. BIID reflects a disunity between self and body, usually with a prominent sexual component. Sex-related differences are emerging: unlike men, a higher proportion of women desire paralysis than desire amputation, and, while men typically seek unilateral amputation, women typically seek bilateral amputation. We propose that these sex-related differences in BIID manifestation may relate to sex differences in cerebral lateralization, or to disruption of representation and/or processing of body-related information in right-hemisphere frontoparietal networks.
Full Text Available Rianne M Blom,1 Nienke C Vulink,1 Sija J van der Wal,1 Takashi Nakamae,1–3 Zhonglin Tan,1,4 Eske M Derks,1 Damiaan Denys1,5 1Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 2Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 3Department of Neural Computation for Decision-Making, ATR Brain Information Communication Research Laboratory Group, Kyoto, Japan; 4Department of Psychiatry, Hangzhou Mental Health Center, Hangzhou, People’s Republic of China; 5Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands Abstract: Body integrity identity disorder (BIID is a condition in which people do not perceive a part of their body as their own, which results in a strong desire for amputation or paralyzation. The disorder is likely to be congenital due to its very early onset. The English literature describes only Western patients with BIID, suggesting that the disorder might be merely prevalent in the West. To scrutinize this assumption, and to extend our knowledge of the etiology of BIID, it is important to trace cases with BIID in non-Western populations. Our objective was to review Chinese and Japanese literature on BIID to learn about its presence in populations with a different genetic background. A systematic literature search was performed in databases containing Japanese and Chinese research, published in the respective languages. Five Japanese articles of BIID were identified which described two cases of BIID, whereas in the Chinese databases only BIID-related conditions were found. This article reports some preliminary evidence that BIID is also present in non-Western countries. However, making general statements about the biological background of the disorder is hampered by the extremely low number of cases found. This low number possibly resulted from the extreme secrecy
Baars, Erik W; van der Hart, Onno; Nijenhuis, Ellert R S; Chu, James A; Glas, Gerrit; Draijer, Nel
The purpose of this study was to develop an expertise-based prognostic model for the treatment of complex posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID). We developed a survey in 2 rounds: In the first round we surveyed 42 experienced therapists (22 DID and 20 complex PTSD therapists), and in the second round we surveyed a subset of 22 of the 42 therapists (13 DID and 9 complex PTSD therapists). First, we drew on therapists' knowledge of prognostic factors for stabilization-oriented treatment of complex PTSD and DID. Second, therapists prioritized a list of prognostic factors by estimating the size of each variable's prognostic effect; we clustered these factors according to content and named the clusters. Next, concept mapping methodology and statistical analyses (including principal components analyses) were used to transform individual judgments into weighted group judgments for clusters of items. A prognostic model, based on consensually determined estimates of effect sizes, of 8 clusters containing 51 factors for both complex PTSD and DID was formed. It includes the clusters lack of motivation, lack of healthy relationships, lack of healthy therapeutic relationships, lack of other internal and external resources, serious Axis I comorbidity, serious Axis II comorbidity, poor attachment, and self-destruction. In addition, a set of 5 DID-specific items was constructed. The model is supportive of the current phase-oriented treatment model, emphasizing the strengthening of the therapeutic relationship and the patient's resources in the initial stabilization phase. Further research is needed to test the model's statistical and clinical validity.
Blom, Rianne M; van Wingen, Guido A; van der Wal, Sija J; Luigjes, Judy; van Dijk, Milenna T; Scholte, H Steven; Denys, D.
BACKGROUND: Body Integrity Identity Disorder (BIID) is a condition in which individuals perceive a mismatch between their internal body scheme and physical body shape, resulting in an absolute desire to be either amputated or paralyzed. The condition is hypothesized to be of congenital nature, but
Blom, Rianne M.; van Wingen, Guido A.; van der Wal, Sija J.; Luigjes, Judy; van Dijk, Milenna T.; Scholte, H. Steven; Denys, Damiaan
Body Integrity Identity Disorder (BIID) is a condition in which individuals perceive a mismatch between their internal body scheme and physical body shape, resulting in an absolute desire to be either amputated or paralyzed. The condition is hypothesized to be of congenital nature, but evidence for
Blom, Rianne M; van der Wal, Sija J; Vulink, Nienke C; Denys, D.
BACKGROUND: Body integrity identity disorder (BIID)-a strong desire for amputation or paralysis-is often accompanied by feelings and cognitions of sexual arousal, although this sexual component has been largely neglected in the recent literature. AIM: To examine the presence of BIID-related sexual
Blom, Rianne M.; van der Wal, Sija J.; Vulink, Nienke C.; Denys, Damiaan
Body integrity identity disorder (BIID)-a strong desire for amputation or paralysis-is often accompanied by feelings and cognitions of sexual arousal, although this sexual component has been largely neglected in the recent literature. To examine the presence of BIID-related sexual arousal in
van Heugten-van der Kloet, Dalena; Huntjens, Rafaele; Giesbrecht, Timo; Merckelbach, Harald
Sleep disturbances, fantasy proneness, cognitive failures, and dissociative symptoms are related to each other. However, the co-occurrence of these phenomena has been primarily studied in non-clinical samples. We investigated the correlations between these phenomena in dissociative identity disorder
Lingam, R P; Novak, C; Emond, A; Coad, J E
The aim of the current study was to gain an understanding of the experiences and aspirations of young people living with Developmental Coordination Disorder (DCD) in their own words. Eleven young people aged 11-16 years with a prior diagnosis of DCD were identified from child health records of two participating NHS trusts. The sample included seven boys and four girls, from different socio-economic backgrounds living in different parts of one large urban area in England. In depth one-to-one semi-structured interviews and subsequent follow-up small group interviews were carried out with the young people. Interviews were enhanced using participatory arts-based techniques. All interviews were recorded verbatim and transcribed. Narrative data were analysed using Lindseth's interpretive phenomenology. The central theme of 'We're all different' described how the young person saw themselves and encompassed the formation of identity. Subthemes illustrated the attitude of the young people to their day to day lives, their difficulties and strategies used by the young people to overcome these difficulties in school and at home. The attitude of the school to difference, the presence of bullying, the accepting nature of the class, teachers and peers were vitally important. Areas of life that encouraged a positive sense of identity and worth included being part of a social network that gave the young people a sense of belonging, potentially one that valued differences as well as similarities. The current work highlights the need for services to adopt a model of DCD where the young person talks about what they can do and considers strategies of overcoming their difficulties. This has implications for education and future intervention strategies that focus on fostering psychological resilience and educational coping strategies rather than simply attempting to improve motor skills. © 2013 John Wiley & Sons Ltd.
Kunrath, Kamila; Cash, Philip; Li-Ying, Jason
Designers’ Professional Identity (DPI) combines social- and self-perceptive awareness through which one is able to identify as a designer. However, self-perception can be different from the expectations associated with an ideal designer, especially during education. Thus, this paper reports...... a survey where self-perceived design skills and expectation are compared at different points in a design education. Findings indicate that changes in mindset modify the alignment between self-perception and expectations, which provides implications for education and for a broader understanding of DPI....
Full Text Available Background Gender identity disorder (GID is considered as a very complicated clinical case and there are usually various variables in the inside-family-communication atmosphere. Objectives The aim of this study was to determine attachment styles in people with GID and compare them with normal people in Fars province, Iran. Materials and Methods This case-control study with accessible sampling was conducted in Fars province, Iran, in 2014 using 60 visitors to the Fars province forensics head office who had been diagnosed as having GID by the commission of psychology (the case group and 204 individuals in dispose, whom psychologists diagnosed as having no psychological disorder and in synchronization with the sample group (controls. The demographic questionnaire and Collins and Read attachment style questionnaires were used in both groups. Data were collected and then analyzed using the SPSS software version 18, Kormogrov Smirnov’s normality test and Pearson’s correlation coefficient. A significance level of P < 0.05 was considered significant. Results Findings showed that the highest frequency (71% in terms of secure attachment and the lowest frequency (0% in terms of avoidant attachment were observed in patients with GID who had been operated and the highest frequency of avoidant attachment (62.1% and the lowest frequency of secure attachment (0% were observed in patients with GID who had not been operated. Conclusions According to the findings of this study, GID patients who have been operated are more secure in attachment styles than those who have not been operated, and there is a significant correlation between age, education and gender with attachment style among these individuals.
Paap, Muirne C S; Kreukels, Baudewijntje P C; Cohen-Kettenis, Peggy T; Richter-Appelt, Hertha; de Cuypere, Griet; Haraldsen, Ira R
Studies involving patients with gender identity disorder (GID) are inconsistent with regard to outcomes and often difficult to compare because of the vague descriptions of the diagnostic process. A multisite study is needed to scrutinize the utility and generality of different aspects of the diagnostic criteria for GID. To investigate the way in which the diagnosis-specific Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria for GID were used to reach a psychiatric diagnosis in four European countries: the Netherlands (Amsterdam), Norway (Oslo), Germany (Hamburg), and Belgium (Ghent). The main goal was to compare item (symptom) characteristics across countries. The current study included all new applicants to the four GID clinics who were seen between January 2007 and March 2009, were at least 16 years of age at their first visit, and had completed the diagnostic assessment (N = 214, mean age = 32 ± 12.2 years). Mokken scale analysis, a form of Nonparametric Item Response Theory (NIRT) was performed. Operationalization and quantification of the core criteria A and B resulted in a 23-item score sheet that was filled out by the participating clinicians after they had made a diagnosis. We found that, when ordering the 23 items according to their means for each country separately, the rank ordering was similar among the four countries for 21 of the items. Furthermore, only one scale emerged, which combined criteria A and B when all data were analyzed together. Our results indicate that patients' symptoms were interpreted in a similar fashion in all four countries. However, we did not find support for the treatment of A and B as two separate criteria. We recommend the use of NIRT in future studies, especially in studies with small sample sizes and/or with data that show a poor fit to parametric IRT models. © 2010 International Society for Sexual Medicine.
The guideline for the treatment of people with gender identity disorder (GID) of the Japanese Society of Psychiatry and Neurology was revised in January 2012. The guideline eased restrictions for the endocrine treatment of transsexual adolescents. A medical specialist can start treating transsexual adolescents at the age of 15 after the diagnosis of GID. It recommends that transsexual adolescents (Tanner stage 2 [mainly 12-13 years of age]) are treated by endocrinologists to suppress puberty with gonadotropin-releasing hormone (GnRH) agonists until the age of 15 years old, after which cross-sex hormones may be given. Female-to-male transsexuals do not necessarily want to start androgen therapy before presenting female secondary sexual characteristics because androgen can easily stop menstruation, cause beard growth, and lower the voice. On the contrary, male-to-female transsexuals want to start estrogen therapy before presenting male secondary sexual characteristics because estrogen cannot alter the beard and low voice. It is important to identify children with gender dysphoria in school and help them receive medical advice. However, approximately half of school teachers think that children with gender dysphoria are very rare and they do not know of the notification from Ministry of Education, Culture, Sports, Science and Technology, JAPAN, which aims to help children with gender dysphoria. The revision of the guideline for the treatment of transsexual people and endocrine treatment of transsexual adolescents by medical specialists may prevent them from attempting suicide, being depressive, and refusing to attend school. Furthermore, the treatment may help avoid mental disorders, aid being employed with the desired sexuality, and, subsequently, getting married and having children.
Brand, Bethany L; Chasson, Gregory S
Due to high elevations on validity and clinical scales on personality and forensic measures, it is challenging to determine if individuals presenting with symptoms of dissociative identity disorder (DID) are genuine or not. Little research has focused on malingering DID, or on the broader issue of the profiles these patients obtain on the Minnesota Multiphasic Personality Inventory (MMPI-2), despite increasing awareness of dissociation. This study sought to characterize the MMPI-2 profiles of DID patients and to determine the utility of the MMPI-2 in distinguishing DID patients from uncoached and coached DID simulators. The analyses revealed that Infrequency, Back Infrequency, and Infrequency-Psychopathology (Fp) distinguished simulators from genuine DID patients. Fp was best able to discriminate simulated DID. Utility statistics and classification functions are provided for classifying individual profiles as indicative of genuine or simulated DID. Despite exposure to information about DID, the simulators were not able to accurately feign DID, which is inconsistent with the iatrogenic/sociocultural model of DID. Given that dissociation was strongly associated with elevations in validity, as well as clinical scales, including Scale 8 (i.e., Schizophrenia), considerable caution should be used in interpreting validity scales as indicative of feigning, and Scale 8 as indicative of schizophrenia, among highly dissociative individuals. (c) 2015 APA, all rights reserved).
Hartmann, Ellen; Benum, Kirsten
This case study used test data from a patient with Dissociative Identity Disorder (DID; American Psychiatric Association, 2013 ) to illustrate how two main personality states of the patient ("Ann" and "Ben") seemed to function. The Rorschach Performance Assessment System (R-PAS; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011 ) and the Inventory of Interpersonal Problems-Circumplex (IIP-64; Horowitz, Alden, Wiggins, & Pincus, 2000 ), administered to Ann and Ben in separate settings, exposed two diverse R-PAS and IIP-64 profiles. Ann's R-PAS profile suggested an intellectualized style of information processing with few indications of psychological problems. Ben's profile indicated severe perceptual, cognitive, and interpersonal difficulties combined with suspicion and anxiety. Ann's IIP-64 profile suggested minor interpersonal problems, whereas Ben's indicated serious relational difficulties. The findings were discussed in relation to the theory of trauma-related structural dissociation of the personality (van der Hart, Nijenhuis, & Steele, 2006 ), which implies an enduring split in the organization of the personality with more or less separate entities with their own sense of self, perception of the world, and ways of organizing emotional, cognitive, and social functions. The DID personality structure is seen as a defense strategy and as a pathway in the personality development producing serious psychological pain and symptoms.
Shumer, Daniel E; Spack, Norman P
The approach to gender identity disorder (GID) in childhood and adolescence has been rapidly evolving and is in a state of flux. In an effort to form management recommendations on the basis of the available literature, The Endocrine Society published clinical practice guidelines in 2009. The guidelines recommend against sex role change in prepubertal children, but they recommend the use of gonadotropin-releasing hormone (GnRH) agonists to suppress puberty in adolescence, and the use of cross-sex hormones starting around age 16 for eligible patients. In actual practice, the approach to GID is quite variable due to continued lack of consensus and specific barriers to treatment that are unique to GID. Recent literature has focused on the mental health approach to prepubertal children with GID and short-term outcomes using pubertal suppression and cross-sex steroids in adolescents with GID. This review will describe the literature published since the release of The Endocrine Society guidelines regarding the management of GID in both children and adolescents.
Kato, Keizo; Abe, Hiroshi; Hanawa, Noriko; Fukuzawa, Junya; Matsuo, Ryota; Yonezawa, Takeshi; Itoh, Sadahiro; Sato, Yoshiyuki; Ika, Makiko; Shimizu, Shohei; Endo, Shinji; Hano, Hiroshi; Izu, Asami; Sugitani, Masahiko; Tsubota, Akihito
A 32-year-old Japanese woman was admitted to our hospital for the diagnosis and treatment of multiple liver tumors. She had been receiving 125 mg testosterone enanthate every 2 weeks following female-to-male gender identity disorder (GID) diagnosis at 20 years of age. Ultrasonography, computed tomography, and magnetic resonance imaging showed 11 hepatic nodular tumors with a maximum diameter of 28 mm. Liver tumors with hepatocellular adenoma (HCA) were diagnosed with needle biopsy. Segmentectomy of the left lateral lobe including two lesions, subsegmentectomy of S6 including two lesions, enucleation of each tumor in S5 and S7, and open surgical radiofrequency ablation for each tumor in S4 and S7 were performed. Immunohistochemical specimens showed that the tumor cells were diffusely and strongly positive for glutamine synthetase and that the nuclei were ectopically positive for β-catenin. Thus, the tumors were diagnosed as β-catenin-activated HCA (b-HCA). Transcatheter arterial chemoembolization plus subsequent radiofrequency ablation was performed for the 3 residual lesions in S4 and S8. Although testosterone enanthate was being continued for GID, no recurrence was observed until at least 22 months after the intensive treatments. HCA development in such patients receiving testosterone should be closely monitored using image inspection.
Haraldsen, I R; Haug, E; Falch, J; Egeland, T; Opjordsmoen, S
Hormonally controlled differences in bone mineral density (BMD) between males and females are well studied. The effects of cross-sex hormones on bone metabolism in patients with early onset gender identity disorder (EO-GID), however, are unclear. We examined BMD, total body fat (TBF) and total lean body mass (TLBM) in patients prior to initiation of sex hormone treatment and during treatment at months 3 and 12. The study included 33 EO-GID patients who were approved for sex reassignment and a control group of 122 healthy Norwegians (males, n=77; females, n=45). Male patients (n=12) received an oral dose of 50 mug ethinylestradiol daily for the first 3 months and 100 mug daily thereafter. Female patients (n=21) received 250 mg testosterone enantate intramuscularly every third week. BMD, TBF and TLBM were estimated using dual energy X-ray absorptiometry (DXA). In male patients, the DXA measurements except TBF were significantly lower compared to their same-sex control group at baseline and did not change during treatment. In female patients, the DXA measurements were slightly higher than in same-sex controls at baseline and also remained unchanged during treatment. In conclusion, this study reports that body composition and bone density of EO-GID patients show less pronounced sex differences compared to controls and that bone density was unaffected by cross-sex hormone treatment.
Saito, Yu; Nakamura, Kazuhiro; Itani, Shigeto; Tsukahara, Kiyoaki
In most cases, about the voice of the patient with female-to-male/gender identity disorder (FTM/GID), hormone therapy makes the voice low-pitched. In success cases, there is no need for phonosurgery. However, hormone therapy is not effective in some cases. We perform type 3 thyroplasty in these cases. Hormone therapy was started in 2008 but did not lower the speaking fundamental frequencies (SFFs). We therefore performed TP3 under local anesthesia. In our case, the SFF at the first visit was 146 Hz. The postoperative SFF was 110 Hz. TP3 was performed under local anesthesia in a patient with FTM/GID in whom hormone therapy proved ineffective. With successful conversion to a lower-pitched voice, the patient could begin to live daily life as a male. QOL improved significantly with TP3. If hormone therapy proves ineffective, TP3 may be selected as an optional treatment and appears to show few surgical complications and was, in this case, a very effective treatment.
Colizzi, Marco; Costa, Rosalia; Pace, Valeria; Todarello, Orlando
Gender identity disorder may be a stressful situation. Hormonal treatment seemed to improve the general health as it reduces psychological and social distress. The attachment style seemed to regulate distress in insecure individuals as they are more exposed to hypothalamic-pituitary-adrenal system dysregulation and subjective stress. The objectives of the study were to evaluate the presence of psychobiological distress and insecure attachment in transsexuals and to study their stress levels with reference to the hormonal treatment and the attachment pattern. We investigated 70 transsexual patients. We measured the cortisol levels and the perceived stress before starting the hormonal therapy and after about 12 months. We studied the representation of attachment in transsexuals by a backward investigation in the relations between them and their caregivers. We used blood samples for assessing cortisol awakening response (CAR); we used the Perceived Stress Scale for evaluating self-reported perceived stress and the Adult Attachment Interview to determine attachment styles. At enrollment, transsexuals reported elevated CAR; their values were out of normal. They expressed higher perceived stress and more attachment insecurity, with respect to normative sample data. When treated with hormone therapy, transsexuals reported significantly lower CAR (P treatment seemed to have a positive effect in reducing stress levels, whatever the attachment style may be. © 2013 International Society for Sexual Medicine.
Full Text Available Objective. In most cases, about the voice of the patient with female-to-male/gender identity disorder (FTM/GID, hormone therapy makes the voice low-pitched. In success cases, there is no need for phonosurgery. However, hormone therapy is not effective in some cases. We perform type 3 thyroplasty in these cases. Method. Hormone therapy was started in 2008 but did not lower the speaking fundamental frequencies (SFFs. We therefore performed TP3 under local anesthesia. Results. In our case, the SFF at the first visit was 146 Hz. The postoperative SFF was 110 Hz. Conclusions. TP3 was performed under local anesthesia in a patient with FTM/GID in whom hormone therapy proved ineffective. With successful conversion to a lower-pitched voice, the patient could begin to live daily life as a male. QOL improved significantly with TP3. If hormone therapy proves ineffective, TP3 may be selected as an optional treatment and appears to show few surgical complications and was, in this case, a very effective treatment.
Ruppin, Ulrike; Pfäfflin, Friedemann
The aim of this study was to re-examine individuals with gender identity disorder after as long a period of time as possible. To meet the inclusion criterion, the legal recognition of participants' gender change via a legal name change had to date back at least 10 years. The sample comprised 71 participants (35 MtF and 36 FtM). The follow-up period was 10-24 years with a mean of 13.8 years (SD = 2.78). Instruments included a combination of qualitative and quantitative methods: Clinical interviews were conducted with the participants, and they completed a follow-up questionnaire as well as several standardized questionnaires they had already filled in when they first made contact with the clinic. Positive and desired changes were determined by all of the instruments: Participants reported high degrees of well-being and a good social integration. Very few participants were unemployed, most of them had a steady relationship, and they were also satisfied with their relationships with family and friends. Their overall evaluation of the treatment process for sex reassignment and its effectiveness in reducing gender dysphoria was positive. Regarding the results of the standardized questionnaires, participants showed significantly fewer psychological problems and interpersonal difficulties as well as a strongly increased life satisfaction at follow-up than at the time of the initial consultation. Despite these positive results, the treatment of transsexualism is far from being perfect.
Hewitt, Jacqueline K; Paul, Campbell; Kasiannan, Porpavai; Grover, Sonia R; Newman, Louise K; Warne, Garry L
To describe the experience of hormone treatment of gender identity disorder (GID) in children and adolescents within a specialist clinic. Cohort study by medical record review of children aged 0-17 years referred during 2003-2011 for management at the GID clinic in a tertiary paediatric referral centre - the Royal Children's Hospital, Melbourne, Victoria. Clinical characteristics of the patient population, hormone treatment provided, frequency of referrals with time. Thirty-nine children and adolescents were referred for gender dysphoria. Seventeen individuals were pubertal with persistent GID, and were considered eligible for hormone treatment. Seven patients, comprising three biological males and four biological females, had legally endorsed hormone treatment. In this group, gender dysphoria was first noted at 3-6 years of age. Hormone treatment with GnRH analogue to suppress pubertal progression (phase 1) was given at 10-16 years of age. Treatment with cross-sex hormones (phase 2) was given at 15.6-16 years. One patient purchased cross-sex hormone treatment overseas. One patient received oestrogen and progesterone for menstrual suppression before phase 1. The annual frequency of new referrals increased continuously over the study period. Hormone treatment for pubertal suppression and subsequent gender transition needs to be individualised within stringent protocols in multidisciplinary specialist units.
Diemer, Elizabeth W; White Hughto, Jaclyn M; Gordon, Allegra R; Guss, Carly; Austin, S Bryn; Reisner, Sari L
Purpose: To investigate whether the prevalence of eating disorders (EDs) differs across diverse gender identity groups in a transgender sample. Methods: Secondary analysis of data from Project VOICE, a cross-sectional study of stress and health among 452 transgender adults (ages 18-75 years) residing in Massachusetts. Age-adjusted logistic regression models were fit to compare the prevalence of self-reported lifetime EDs in female-to-male (FTM), male-to-female (MTF), and gender-nonconforming participants assigned male at birth (MBGNC) to gender-nonconforming participants assigned female at birth (FBGNC; referent). Results: The age-adjusted odds of self-reported ED in MTF participants were 0.14 times the odds of self-reported ED in FBGNC participants ( p =0.022). In FTM participants, the age-adjusted odds of self-reported ED were 0.46 times the odds of self-reported ED in FBGNC participants, a marginally significant finding ( p =0.068). No statistically significant differences in ED prevalence were found for MBGNC individuals. Conclusions: Gender nonconforming individuals assigned a female sex at birth appear to have heightened lifetime risk of EDs relative to MTF participants. Further research into specific biologic and psychosocial ED risk factors and gender-responsive intervention strategies are urgently needed. Training clinical providers and ensuring competency of treatment services beyond the gender binary will be vital to addressing this disparity.
Beginning with classic Hollywood melodramas of the 1940s, cinema has maintained a prolific output of films with their own take on mental illnesses-none more so than the rare syndrome of dissociative identity disorder (DID). DID films are a popular and enduring genre, whose influence can be seen throughout mainstream cinema. Exploration of DID in cinema is a useful exercise in that it touches on issues in film studies, psychiatry and the mythology around mental illness. Despite "detective story" narratives and conformity to the codes of the psychological thriller, DID representations correspond closely to contemporary thinking about its phenomenology and aetiology. That said, some films confuse DID with schizophrenia, and many reinforce two other misconceptions within film psychiatry: mental illness as violence and the belief that every mentally ill person harbours one "great dark secret". Those sceptical about DID have suggested that popular written accounts increase its profile: so too, powerful cinematic images may suggest the possibility of DID to susceptible people, including clinicians. Recent DID films reflect the real debate within psychiatry about the diagnostic validity and scientific basis of DID.
Diemer, Elizabeth W.; White Hughto, Jaclyn M.; Gordon, Allegra R.; Guss, Carly; Austin, S. Bryn; Reisner, Sari L.
Abstract Purpose: To investigate whether the prevalence of eating disorders (EDs) differs across diverse gender identity groups in a transgender sample. Methods: Secondary analysis of data from Project VOICE, a cross-sectional study of stress and health among 452 transgender adults (ages 18–75 years) residing in Massachusetts. Age-adjusted logistic regression models were fit to compare the prevalence of self-reported lifetime EDs in female-to-male (FTM), male-to-female (MTF), and gender-nonconforming participants assigned male at birth (MBGNC) to gender-nonconforming participants assigned female at birth (FBGNC; referent). Results: The age-adjusted odds of self-reported ED in MTF participants were 0.14 times the odds of self-reported ED in FBGNC participants (p=0.022). In FTM participants, the age-adjusted odds of self-reported ED were 0.46 times the odds of self-reported ED in FBGNC participants, a marginally significant finding (p=0.068). No statistically significant differences in ED prevalence were found for MBGNC individuals. Conclusions: Gender nonconforming individuals assigned a female sex at birth appear to have heightened lifetime risk of EDs relative to MTF participants. Further research into specific biologic and psychosocial ED risk factors and gender-responsive intervention strategies are urgently needed. Training clinical providers and ensuring competency of treatment services beyond the gender binary will be vital to addressing this disparity. PMID:29359198
Milenna T van Dijk
Full Text Available Our body feels like it is ours. However, individuals with body integrity identity disorder (BIID lack this feeling of ownership for distinct limbs and desire amputation of perfectly healthy body parts. This extremely rare condition provides us with an opportunity to study the neural basis underlying the feeling of limb ownership, since these individuals have a feeling of disownership for a limb in the absence of apparent brain damage. Here we directly compared brain activation between limbs that do and do not feel as part of the body using functional MRI during separate tactile stimulation and motor execution experiments. In comparison to matched controls, individuals with BIID showed heightened responsivity of a large somatosensory network including the parietal cortex and right insula during tactile stimulation, regardless of whether the stimulated leg felt owned or alienated. Importantly, activity in the ventral premotor cortex depended on the feeling of ownership and was reduced during stimulation of the alienated compared to the owned leg. In contrast, no significant differences between groups were observed during the performance of motor actions. These results suggest that altered somatosensory processing in the premotor cortex is associated with the feeling of disownership in BIID, which may be related to altered integration of somatosensory and proprioceptive information.
First, Michael B; Fisher, Carl E
Body integrity identity disorder (BIID) is a rare and unusual psychiatric condition characterized by a persistent desire to acquire a physical disability (e.g., amputation, paraplegia) since childhood that to date has not been formally described in the psychiatric nosology. Most BIID sufferers experience a chronic and dysphoric sense of inappropriateness regarding their being able-bodied, and many have been driven to actualize their desired disability through surreptitious surgical or other more dangerous methods. This review aims to characterize the history and phenomenology of this condition, to present its differential diagnosis, and to consider possible etiologies, treatment options, and ethical considerations. Review of the psychiatric and neurological literature. A growing body of data suggests the existence of a discrete entity with onset by early adolescence and a negative impact on functioning. Parallel neurological conditions and preliminary experimental investigations suggest a possible neurobiological component in at least a portion of cases. While attempts at treatment have been described, no systematic evidence for efficacy has emerged. BIID is a unique nosological entity with significant consequences for its sufferers and as such may warrant inclusion in some form in the forthcoming DSM-5 and ICD-11. Copyright © 2011 S. Karger AG, Basel.
van Dijk, Milenna T; van Wingen, Guido A; van Lammeren, Anouk; Blom, Rianne M; de Kwaasteniet, Bart P; Scholte, H Steven; Denys, Damiaan
Our body feels like it is ours. However, individuals with body integrity identity disorder (BIID) lack this feeling of ownership for distinct limbs and desire amputation of perfectly healthy body parts. This extremely rare condition provides us with an opportunity to study the neural basis underlying the feeling of limb ownership, since these individuals have a feeling of disownership for a limb in the absence of apparent brain damage. Here we directly compared brain activation between limbs that do and do not feel as part of the body using functional MRI during separate tactile stimulation and motor execution experiments. In comparison to matched controls, individuals with BIID showed heightened responsivity of a large somatosensory network including the parietal cortex and right insula during tactile stimulation, regardless of whether the stimulated leg felt owned or alienated. Importantly, activity in the ventral premotor cortex depended on the feeling of ownership and was reduced during stimulation of the alienated compared to the owned leg. In contrast, no significant differences between groups were observed during the performance of motor actions. These results suggest that altered somatosensory processing in the premotor cortex is associated with the feeling of disownership in BIID, which may be related to altered integration of somatosensory and proprioceptive information.
Dissociative identity disorder poses numerous medico legal issues whenever the insanity defence emerges. Within the context of the South African criminal law, the impact of dissociative identity disorder on criminal responsibility has only been addressed very briefly in one decided case. Various questions arise as to the impact that the distinctive diagnostic features of dissociative identity disorder could possibly have on the defence of pathological criminal incapacity, or better known as the insanity defence, within the ambit of the South African criminal law. In this contribution the author reflects on the mental disorder known as dissociative identity disorder or multiple personality disorder, against the backdrop of the defence of pathological criminal incapacity. Reflections are also provided pertaining to the various medico legal issues at stake whenever this defence has to be adjudicated upon.
Over the last decade the nosology status of obsessive-compulsive and related disorders has been topic of debate. Whereas in DSM-IV (Diagnostic and Statistical Manual of Mental Disorders IV) obsessive-compulsive disorder (OCD) was classified as an anxiety disorder, in DSM-V it is classified as a
Carol del Carmen Terán González
Full Text Available The present investigation takes as a fundamental goal, the elaboration of an instructional digital design that contributes to the strengthening of the regional identity of the students. The study is based on the theoretical postulates of: UNESCO (2004, CBN (1997, Ausubel (1983, Vygotsky, Rodríguez (2001, Careaga (2001, Galvis (1992, Pastorini, (2000, Salazar (2008, Rosario (2005, Bernice McCarthy (1987, among others. The same one, adopted the type of descriptive investigation, with a field design placed in the modality of viable project. The population is constituted by 12 teachers, and 40 students of the sixth degree. For the diagnostic phase a questionnaire will be applied with 14 items for teachers and students, the validation will be of content across the experts' judgment. In conclusion, there exists weakness for the constitutive elements of the historical memory as part of the regional identity.
The third versions of the guideline for treatment of people with gender identity disorder (GID) of the Japanese Society of Psychiatry and Neurology does not include puberty-delaying hormone therapy. It is recommended that feminizing/masculinizing hormone therapy and genital surgery should not be carried out until 18 year old and 20 year old, respectively. On the other hand, the sixth (2001) and the seventh (2011) versions of the standards of care for the health of transsexual, transgender, and gender nonconforming people of World Professional Association for Transgender Health (WPATH) recommend that transsexual adolescents (Tanner stage 2, [mainly 12-13 years of age]) are treated by the endocrinologists to suppress puberty with gonadotropin-releasing hormone (GnRH) agonists until age 16 years old, after which cross-sex hormones may be given. A questionnairing on 181 people with GID diagnosed in the Okayama University Hospital (Japan) showed that female to male (FTM) transsexuals hoped to begin masculinizing hormone therapy at age of 15.6 +/- 4.0 (mean +/- S.D.) whereas male to female (MTF) transsexuals hoped to begin feminizing hormone therapy as early as age 12.5 +/- 4.0, before presenting secondary sex characters. After confirmation of strong and persistent cross-gender identification, adolescents with GID should be treated with cross-gender hormone or puberty-delaying hormone to prevent developing undesired sex characters. These treatments may prevent transsexual adolescents from attempting suicide, being depressive, and refusing to attend school. Subsequent early breast and genital surgery may help being employed in desired sexuality.
Burke, Sarah M; Menks, Willeke M; Cohen-Kettenis, Peggy T; Klink, Daniel T; Bakker, Julie
Click-evoked otoacoustic emissions (CEOAEs) are echo-like sounds that are produced by the inner ear in response to click-stimuli. CEOAEs generally have a higher amplitude in women compared to men and neonates already show a similar sex difference in CEOAEs. Weaker responses in males are proposed to originate from elevated levels of testosterone during perinatal sexual differentiation. Therefore, CEOAEs may be used as a retrospective indicator of someone's perinatal androgen environment. Individuals diagnosed with Gender Identity Disorder (GID), according to DSM-IV-TR, are characterized by a strong identification with the other gender and discomfort about their natal sex. Although the etiology of GID is far from established, it is hypothesized that atypical levels of sex steroids during a critical period of sexual differentiation of the brain might play a role. In the present study, we compared CEOAEs in treatment-naïve children and adolescents with early-onset GID (24 natal boys, 23 natal girls) and control subjects (65 boys, 62 girls). We replicated the sex difference in CEOAE response amplitude in the control group. This sex difference, however, was not present in the GID groups. Boys with GID showed stronger, more female-typical CEOAEs whereas girls with GID did not differ in emission strength compared to control girls. Based on the assumption that CEOAE amplitude can be seen as an index of relative androgen exposure, our results provide some evidence for the idea that boys with GID may have been exposed to lower amounts of androgen during early development in comparison to control boys.
Schlumpf, Yolanda R.; Reinders, Antje A. T. S.; Nijenhuis, Ellert R. S.; Luechinger, Roger; van Osch, Matthias J. P.; Jäncke, Lutz
Background: In accordance with the Theory of Structural Dissociation of the Personality (TSDP), studies of dissociative identity disorder (DID) have documented that two prototypical dissociative subsystems of the personality, the "Emotional Part'' (EP) and the "Apparently Normal Part'' (ANP), have different biopsychosocial reactions to supraliminal and subliminal trauma-related cues and that these reactions cannot be mimicked by fantasy prone healthy controls nor by actors. Methods: Arterial ...
Blom, Rianne M; van Wingen, Guido A; van der Wal, Sija J; Luigjes, Judy; van Dijk, Milenna T; Scholte, H Steven; Denys, D.
BACKGROUND: Body Integrity Identity Disorder (BIID) is a condition in which individuals perceive a mismatch between their internal body scheme and physical body shape, resulting in an absolute desire to be either amputated or paralyzed. The condition is hypothesized to be of congenital nature, but evidence for a neuro-anatomical basis is sparse. METHODS: We collected T1-weighted structural magnetic resonance imaging scans on a 3T scanner in eight individuals with BIID and 24 matched healthy c...
Pollock, Brianna E; Macfie, Jenny; Elledge, L Christian
We report on the treatment and successful outcome of a 58-year-old Native American male with a history of complex trauma presenting with dissociative identity disorder (DID) and major depressive disorder. The treatment included a trauma-informed phase-based psychotherapy as recommended by the International Society for the Study of Trauma and Dissociation for treating DID. We assessed symptoms at baseline and at three additional time points over the course of 14 months. We utilized the Reliable Change Index to examine statistically significant change in symptoms over the course of treatment. Significant symptom improvements were realized posttreatment across all measured domains of functioning, including dissociative symptoms, alcohol abuse, depression, anxiety, and emotion regulation skills. Moreover, the client no longer met criteria for DID, major depressive disorder, or alcohol abuse. Results are discussed in terms of the effectiveness of trauma-focused, phase-based treatment for DID for cases of complex trauma with comorbid disorders.
Over the last decade the nosology status of obsessive-compulsive and related disorders has been topic of debate. Whereas in DSM-IV (Diagnostic and Statistical Manual of Mental Disorders IV) obsessive-compulsive disorder (OCD) was classified as an anxiety disorder, in DSM-V it is classified as a separate entity with compulsivity as the main symptom. The first part of this thesis consists of studies that contributed to this debate, investigating the prevalence of obsessions in the general popul...
Barlow, M Rose; Chu, James A
Some people with dissociative identity disorder (DID) have very little communication or awareness among the parts of their identity, while others experience a great deal of cooperation among alternate identities. Previous research on this topic has been sparse. Currently, there is no empirical measure of integration versus fragmentation in a person with DID. In this study, we report the development of such a measure. The goal of this study was to pilot the integration measure (IM) and to address its psychometric properties and relationships to other measures. The IM is the first standardized measure of integration in DID. Eleven women with DID participated in an experiment that included a variety of tasks. They filled out questionnaires about trauma and dissociation as well as the IM. They also provided verbal results about switching among alternate identities during the study sessions. Participants switched among identities an average of 5.8 times during the first session, and switching was highly correlated with trauma. Integration was related to switching, though this relationship may be non-linear. Integration was not related to time in psychotherapy. The IM provides a useful beginning to quantify and study integration and fragmentation in DID. Directions for future research are also discussed, including expanding the IM from this pilot. The IM may be useful in treatment settings to assess progress or change over time.
Margaret Rose Barlow
Full Text Available Background: Some people with dissociative identity disorder (DID have very little communication or awareness among the parts of their identity, while others experience a great deal of cooperation among alternate identities. Previous research on this topic has been sparse. Currently, there is no empirical measure of integration versus fragmentation in a person with DID. In this study, we report the development of such a measure. Objective: The goal of this study was to pilot the integration measure (IM and to address its psychometric properties and relationships to other measures. The IM is the first standardized measure of integration in DID. Method: Eleven women with DID participated in an experiment that included a variety of tasks. They filled out questionnaires about trauma and dissociation as well as the IM. They also provided verbal results about switching among alternate identities during the study sessions. Results: Participants switched among identities an average of 5.8 times during the first session, and switching was highly correlated with trauma. Integration was related to switching, though this relationship may be non-linear. Integration was not related to time in psychotherapy. Conclusions: The IM provides a useful beginning to quantify and study integration and fragmentation in DID. Directions for future research are also discussed, including expanding the IM from this pilot. The IM may be useful in treatment settings to assess progress or change over time.
Objective: This study looks at how the WHO programme Mental Disorders in Primary Care should be adapted for GPs in the South African context in order to positively impact the recognition and management of mental disorders. Design: Participatory action research was used to adapt the WHO programme. There were 3 ...
Keyes, K M; Martins, S S; Hatzenbuehler, M L; Blanco, C; Bates, L M; Hasin, Deborah S
To examine aspects of Latino experience in the US as predicting service utilization for mood, anxiety, and substance disorders. Latino participants 18 and older in the NESARC (N = 6,359), a US national face to face survey. Outcomes were lifetime service utilization for DSM-IV lifetime mood/anxiety or substance disorders, diagnosed via structured interview (AUDADIS-IV). Main predictors were ethnic subgroup, ethnic identity, linguistic/social preferences, nativity/years in the US, and age at immigration. Higher levels of Latino ethnic identity and Spanish language/Latino social preferences predicted lower service utilization for mood disorders [ethnic identity OR = 0.52, language/social OR = 0.44] and anxiety disorders [ethnic identity OR = 0.67, language/social OR = 0.47], controlling for ethnic subgroup, disorder severity, time spent in the US, and economic and practical barriers Service utilization for alcohol/drug disorders was low across all Latino subgroups, without variation by examined predictors. Ethnic/cultural factors are strong determinants of service utilization for mood/anxiety, but not substance use disorders among Latinos in the US strategies to increase service utilization among Latinos with psychiatric disorders should be disorder specific, and recognize the role of ethnicity and identity as important components of a help-seeking model.
Fisher, A D; Ristori, J; Fanni, E; Castellini, G; Forti, G; Maggi, M
Disorders of Sex Development (DSD) are a wide range of congenital conditions characterized by an incongruence of components involved in sexual differentiation, including gender psychosexual development. The management of such disorders is complex, and one of the most crucial decision is represented by gender assignment. In fact, the primary goal in DSD is to have a gender assignment consistent with the underlying gender identity in order to prevent the distress related to a forthcoming Gender Dysphoria. Historically, gender assignment was based essentially on surgical outcomes, assuming the neutrality of gender identity at birth. This policy has been challenged in the past decade refocusing on the importance of prenatal and postnatal hormonal and genetic influences on psychosexual development. (1) to update the main psychological and medical issues that surround DSD, in particular regarding gender identity and gender assignment; (2) to report specific clinical recommendations according to the different diagnosis. A systematic search of published evidence was performed using Medline (from 1972 to March 2016). Review of the relevant literature and recommendations was based on authors' expertise. A review of gender identity and assignment in DSD is provided as well as clinical recommendations for the management of individuals with DSD. Given the complexity of this management, DSD individuals and their families need to be supported by a specialized multidisciplinary team, which has been universally recognized as the best practice for intersexual conditions. In case of juvenile GD in DSD, the prescription of gonadotropin-releasing hormone analogues, following the World Professional Association for Transgender Health and the Endocrine Society guidelines, should be considered. It should always be taken into account that every DSD person is unique and has to be treated with individualized care. In this perspective, international registries are crucial to improve the
Mushtaq, Raheel; Shoib, Sheikh; Arif, Tasleem; Shah, Tabindah; Mushtaq, Sahil
Dissociative identity disorder (DID) is one of the most fascinating disorders in psychiatry. The arduous search to reveal the obscurity of this disorder has led to colossal research in this area over the years. Although drug-assisted interviews are not widely used, they may be beneficial for some patients that do not respond to conventional treatments such as supportive psychotherapy or psychopharmacotherapy. Drug-assisted interviews facilitate recall of memories in promoting integration of dissociative information. We report a case of a 16-year-old female with dissociative identity disorder (DID) that was treated with lorazepam-assisted interview and there was rapid improvement in symptoms after the interview.
Stein, Karen Farchaus; Corte, Colleen
There is broad consensus that the eating disorders of anorexia nervosa and bulimia nervosa stem from fundamental disturbances in identity development, but theoretically based empirical support is lacking. To extend work on the identity impairment model by investigating the relationship between organizational properties of the self-concept and change in disordered eating behaviors (DEB) in an at-risk sample of college women transitioning between freshman and sophomore years. The number, valence, and organization of self-schemas; availability of a fat body weight self-schema; and DEB were measured at baseline in the freshman year and 6 and 12 months later in a community-based sample of college women engaged in subthreshold DEB (n = 77; control: n = 41). Repeated-measures analyses of variances were used to examine group differences, and hierarchical regression analyses were used to predict disordered eating behaviors. Women in the DEB group had more negative self-schemas at baseline and showed information-processing evidence of a fat self-schema compared with the controls. The groups did not differ in the number of positive self-schemas or interrelatedness. The number of negative self-schemas predicted increases in the level of DEB at 6- and 12-month follow-up, and these effects were mediated through the fat self-schema. The number of positive self-schemas predicted the fat self-schema score but was not predictive of increases in DEB. Interrelatedness of the self-concept was not a significant predictor in this model. Impairments in overall collection of identities are predictive of the availability in memory of a fat self-schema, which in turn is predictive of increases in DEB during the transition to college in a sample of women at risk for an eating disorder. Therefore, organizational properties of the self-concept may be an important focus for effective primary and secondary prevention.
Bardram, JE; Frost, Mads; Szántó, Károly
usefulness of the system was high. Based on this study, the paper discusses three HCI questions related to the design of personal health technologies; how to design for disease awareness and self-treatment, how to ensure adherence to personal health technologies, and the roles of different types...
Stott, C; Hutchison, P; Drury, J
During the 1998 Football World Cup Finals in France, English supporters were, once again, involved in major incidents of collective 'disorder'. Explanations for these incidents concentrated on the conflictual norms held by 'hooligans'. In contrast, Scottish supporters attending the tournament displayed norms of non-violence, explained by the popular press in terms of the absence of 'hooligans'. This study challenges this tendency to explain the presence or absence of 'disorder' in the context of football solely in terms of the presence or absence of 'hooligan' fans. Using data obtained from an ethnographic study of both Scottish and English supporters attending the tournament (N = 121), we examine the processes through which ordinarily 'peaceful' supporters would or would not become involved in collective conflict. In line with the Elaborated Social Identity Model (ESIM) of crowd behaviour, the analysis highlights the role of the intergroup context. Where out-group activity was understood as illegitimate in in-group terms, in-group members redefined their identity such that violent action toward out-group members came to be understood as legitimate. By contrast, where there was no out-group hostility, in-group members defined themselves through an explicit contrast with the 'hooligan' supporters of rival teams. This analysis represents an advance on previous studies of crowd behaviour by demonstrating how the ESIM can account for not only the presence, but also the absence, of collective 'disorder'.
Bhuvaneswar, Chaya; Spiegel, David
Physiologic changes, including neurological or pseudo-neurological symptoms, occur across identity states in dissociative identity disorder DID) and can be objectively measured. The idea that dissociative phenomena might be associated with changes in brain function is consistent with research on the brain effects of hypnosis. The authors report a case of psycho-physiologic differences among 4 alter personalities manifested by a 35-year-old woman with DID. Differences in visual acuity, frequency of pendular nystagmus, and handedness were observed in this patient both when the alter personalities appeared spontaneously and when elicited under hypnosis. The authors consider several diagnostic possibilities for these findings and discuss whether prevailing treatment recommendations for DID patients could possibly be modified to ameliorate such visual and neurologic symptoms.
Goyal, Shrigopal; Deb, Koushik Sinha; Elawadhi, Deeksha; Kaw, Nanaji
Persons suffering from gender identity disorder (GID) are often severely marginalized in India and mostly live outside the society as a part of a minority community called the Hijras. Although substance abuse is considered a way of life in them, such patients rarely seek treatment because of the stigma and fear of discrimination. We report a case of GID presenting to tertiary care centre for treatment of multiple substance use dependence (SUD). The case is the first to highlight the use and dependence of multiple substances in the Hijra community of India. Further, the case emphasizes that SUD treatment might be a worthwhile intervention to bring such marginalized population under treatment, when further complicated issues on gender identity can be addressed. Copyright © 2014. Published by Elsevier B.V.
Smits, J.E.P.; van der Hoeven, F.D.
This paper discusses design considerations for creating high quality infrastructural artefacts with an emphasis on bridges. The authors pursue a design study and analysis approach to highlight the specifics of infrastructure design for regional identity, based on their own work on a bridge
Katja Gutschke; Aglaja Stirn; Erich Kasten
Background: The urge to be permanently blind is an extremely rare mental health disturbance. The underlying cause of this desire has not been determined yet, and it is uncertain whether the wish for blindness is a condition that can be included in the context of body integrity identity disorder, a condition where people feel an overwhelming need to be disabled, in many cases by amputation of a limb or through paralysis. Objective: The aim of this study is to test the hypothesis that people wi...
After explaining the essential trans* terminology, I offer a short historical overview of the way health care has dealt with the subject of gender, trans* and health in different times. In the third section, I compare the world's most important diagnostic manuals, namely the International statistical classification of diseases and related health problems (ICD) and the Diagnostic and statistical manual of mental disorders (DSM), i.e. their criteria for 'gender identity disorders' (ICD-10) and 'gender dysphoria' (DSM-5). The fourth section branch out the factors which influence every diagnostic conception - of no matter whom - in the health care system. The last section discusses the implications resulting from this diagnostic dilemma for the health situation of gender nonconforming people.
Zucker, Kenneth J; Wood, Hayley; Singh, Devita; Bradley, Susan J
This article provides a summary of the therapeutic model and approach used in the Gender Identity Service at the Centre for Addiction and Mental Health in Toronto. The authors describe their assessment protocol, describe their current multifactorial case formulation model, including a strong emphasis on developmental factors, and provide clinical examples of how the model is used in the treatment.
While acknowledging the discursive constitution of student identities through the interplay of unequal power relations and discriminatory processes, the article discusses the ways in which social, emotional and behaviour difficulties (SEBD) are "produced" and "managed" within current schooling. SEBD are routinely framed in…
Claes, Laurence; Luyckx, Koen; Bijttebier, Patricia; Turner, Brianna; Ghandi, Amarendra; Smets, Jos; Norre, Jan; Van Assche, Leen; Verheyen, Els; Goris, Yvienne; Hoksbergen, Ingrid; Schoevaerts, Katrien
In the present study, we investigated the association between non-suicidal self-injury (NSSI) and problems in identity formation among patients with eating disorder (ED). NSSI is highly prevalent in ED, and problems with identity formation are characteristic of both NSSI and ED. Few studies, however, have investigated identity formation in patients with ED with and without NSSI while taking into account comorbid psychopathology (e.g. anxiety and depression). Therefore, we investigated the relationships between NSSI characteristics, identity confusion/synthesis, and anxiety/depression in 99 female patients with ED by means of self-report questionnaires. The results showed that 58.6% of the patients with ED engaged in at least one type of NSSI (most frequently cutting), with no significant differences in rates of NSSI or identity problems among ED subtypes. Presence, versatility and automatic negative reinforcement functions of NSSI were each significantly and positively related to identity confusion and negatively related to identity synthesis. Even after controlling for age, anxiety, and depression, lack of identity synthesis remained a significant predictor of NSSI in patients with ED. Given that NSSI may constitute an effort to deal with identity confusion/synthesis in patients with ED, therapists should take this developmental task into account while treating patients with ED with NSSI. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
Zhu, Zhijuan; Zhou, Qi; Li, Bin; Visser, Steve
Research on numerical control (NC) equipment has been more and more abundant; however, there are few existing studies in the field of appearance design for NC equipments. This paper provided a method to generate new appearance design of NC equipments based on product identity (PI). For the purpose of providing guidelines to generate new concept of NC equipment design, this paper, therefore, took the DMG Company (a Germen NC equipment company) as a case, examined the total products of this company from two aspects: Product Image and Product Family. Task 1 was an evaluate task about the Product Image by using the semantic differential (SD) evaluation method; Task 2 was a study task about Product Family to find out features of the products and classify these features. During the Task 2, several features have been found out and summarized, and these features were classified into 3 different levels according to their frequency and importance. In the end, two appearance design samples have been generated based on the analysis above to prove the application of the research.
Dalena eVan Heugten - Van Der Kloet
Full Text Available Sleep disturbances, fantasy proneness, cognitive failures, and dissociative symptoms are related to each other. However, the co-occurrence of these phenomena has been primarily studied in non-clinical samples. We investigated the correlations between these phenomena in dissociative identity disorder patients, post-traumatic stress disorder patients, and healthy controls. Both patient groups reported more sleep problems and lower sleep quality and displayed higher levels of fantasy proneness and cognitive failures than controls. However, the two patient groups did not differ with regard to these variables. Moreover, a higher level of unusual sleep experiences tended to predict participants belonging to the DID group, while specifically a lower sleep quality and more cognitive failures tended to predict participants belonging to the PTSD group.
van Heugten-van der Kloet, Dalena; Huntjens, Rafaele; Giesbrecht, Timo; Merckelbach, Harald
Sleep disturbances, fantasy proneness, cognitive failures, and dissociative symptoms are related to each other. However, the co-occurrence of these phenomena has been primarily studied in non-clinical samples. We investigated the correlations between these phenomena in dissociative identity disorder (DID) patients, post-traumatic stress disorder (PTSD) patients, and healthy controls. Both patient groups reported more sleep problems and lower sleep quality and displayed higher levels of fantasy proneness and cognitive failures than controls. However, the two patient groups did not differ with regard to these variables. Moreover, a higher level of unusual sleep experiences tended to predict participants belonging to the DID group, while specifically a lower sleep quality and more cognitive failures tended to predict participants belonging to the PTSD group.
Haraldsen, Ira R; Egeland, Thore; Haug, Egil; Finset, Arnstein; Opjordsmoen, Stein
Cognitive performance in untreated early onset gender identity disorder (GID) patients might correspond to their born sex and not to their perceived gender. As a current mode of intervention, cross-sex hormone treatment causes considerable physical changes in GID patients. We asked, as has been suggested, whether this treatment skews cognitive performance towards that of the acquired sex. Somatically healthy male and female early onset GID patients were neuropsychologically tested before, 3 and 12 months after initiating cross-sex hormone treatment, whereas untreated healthy subjects without GID served as controls (C). Performance was assessed by testing six cognitive abilities (perception, arithmetic, rotation, visualization, logic, and verbalization), and controlled for age, education, born sex, endocrine differences and treatment by means of repeated measures analysis of variance. GID patients and controls showed an identical time-dependent improvement in cognitive performance. The slopes were essentially parallel for males and females. There was no significant three-way interaction of born sex by group by time for the six investigated cognitive abilities. Only education and age significantly influenced this improvement. Despite the substantial somatic cross-sex changes in GID patients, no differential effect on cognition over time was found between C and GID participants. The cognitive performance of cross-sex hormone-treated GID patients was virtually identical to that of the control group. The documented test-retest effect should be taken into consideration when evaluating treatment effects generally in psychiatry.
Blom, Rianne M; van der Wal, Sija J; Vulink, Nienke C; Denys, Damiaan
Body integrity identity disorder (BIID)-a strong desire for amputation or paralysis-is often accompanied by feelings and cognitions of sexual arousal, although this sexual component has been largely neglected in the recent literature. To examine the presence of BIID-related sexual arousal in subjects with BIID and explore clinical and demographic variables of subjects with BIID who do and do not possess this sexual arousal. Eighty individuals with BIID responded to an internet-based survey we created. For all subjects, restoring identity was the primary motivation for preferred body modification. We collected data about respondents' demographic, clinical, and sexual characteristics. Based on responses to questions about BIID-specific sexual desires, subjects were assigned to the group with BIID-related sexual feelings (S-BIID; n = 57) or the group without such feelings (NS-BIID; n = 23). Differences in clinical, demographic, and sexual characteristics between S-BIID and NS-BIID groups. Of the respondents, 71.3% endorsed S-BIID. Subjects with S-BIID were significantly more often men, religious, and of a homosexual identity compared with the NS-BIID group. Subjects with S-BIID also significantly more often reported a change in localization and/or intensity of their BIID feelings over time. Furthermore, 66.7% of subjects with S-BIID reported S-BIID as an additional motivation for body modification. Seven of the 57 subjects with S-BIID achieved their preferred body modification through (self)-amputation, whereas none of the subjects with NS-BIID did. BIID is a heterogeneous disorder in which subjects who self-reported comorbid sexual arousal more often resorted to (self-induced) amputation. This study contains the largest BIID cohort presented in the literature and is the first to genuinely research sexuality in BIID. The first limitation is the lack of face-to-face interviews with the subjects, so no clinical diagnoses could be made. Moreover, there is an
The results of present-day research in the field of "Dissociation Paradigm", regarding the capacity of the human mind to perceive, learn, and store information that in appearance passes as unnoticed, support the constructivist hypothesis of the active, selective and constructive condition of consciousness, in addition to the existence of a tacit dimension of knowledge that operates in functional relationship with the former. Unconscious mental states are intrinsically intentional. This is to say that they imply a semantic or cognitive connotation that is capable of affecting phenomenical experience and therefore behavior. In addition, the precocious existence of a tacit metarepresentational system in normally developed children has been proven, which is essential for guaranteeing the deployment of the process of functional coevolution between affectivity and consciousness, by which the experience of personal identity is acquired. These discoveries allow the inference of a "tacit affective metarepresentational recurrence", the organizational foundation on which a unified, sustainable, and continuous sense of the experience of personal identity is structured, and also allow us to hypothesize a "tacit metarepresentational mourning", a specific type of grief which is the chief foundation of the majority of psychopathological disorders. This concept may represent a potential explanation of the severe mental disorders of adolescence and young adulthood. The hypothesis of the present work is that, in the ambiguous context of Postmodern Culture, the prolongation of the adolescent period, facilitated by the welfare state, hinders the dealing with the aforementioned mourning, leading to an increment of depressive states and suicidal behavior among young people.
Full Text Available Besides being useful for protecting food, packaging design also serves as a media campaign. So hopefully, Mahlzeit Bread n 'Das Brot can compete with other bakers and even can be a pioneer as an authentic German bread maker in Indonesia. This research was conducted by collecting information from the client (Mahlzeit n 'Das Brot owner. This information was used to obtain a verbal brand identity, then translated visually. The use of illustrations also becomes the most important visual images to present the image of Germany Elegant Vintage and privilege in explaining the products of Mahlzeit n 'Das Brot. The colors used are natural colors and traditionally the colors brown and green to indicate an authentic image of Mahlzeit n 'Das Brot.
Coverdale, Tonjia Simmone
The objective of this study is to propose and test the Social Identity Approach to Website Design research model, which extends the traditionally examined interaction between website design and e-Commerce Success by considering the role of Social Identity in the development of e-Loyalty in women online shoppers. The Social Identity Approach is a…
Littlejohn, Deborah Kathleen
This research concerns the culture of design education in the context of great change in the social and professional conditions of practice. Findings illuminate interrelationships among pedagogy, professional identity and the design of the instructional setting in programs that teach visual communication and interaction design. Participants'…
Bhui, K; Khatib, Y; Viner, R; Klineberg, E; Clark, C; Head, J; Stansfeld, S
Cultural integration is the healthiest outcome for young people living in multicultural societies. This paper investigates the influence of different cultural identities on the risk of common mental disorders among Bangladeshi and white British pupils. The cultural identity of 11-14-year-old school pupils was assessed by their preferences for friends and clothes of their own or other cultural groups; using this information pupils were classified into traditional, integrated, assimilated or marginalised groups. We undertook prospective analyses of cultural identity and its impacts on the later mental health of young people. East London. In 2001, white British (573) and Bangladeshi (682) school pupils from a representative sample of schools completed a self-report questionnaire that assessed their cultural, social and health characteristics. In 2003, 383 white British and 517 Bangladeshi pupils were resurveyed and completed measures of mental health. Strengths and difficulties questionnaire. Bangladeshi pupils preferring clothes from their own cultural group (traditional clothing) were less likely to have later mental health problems when compared with Bangladeshi pupils showing an equal preference for clothing from their own and other cultures (integrated clothing; odds ratio (OR) 0.3, 95% CI 0.1 to 0.9). In gender-specific analyses, this finding was sustained only among Bangladeshi girls (OR 0.1, 95% CI 0.1 to 0.7). Integrated clothing choices were least risky only for white British adolescents. Friendship choices showed no prospective associations with later mental health problems. Cultural identity, expressed by clothing preferences, influences mental health; the effects differ by gender and ethnic group.
Dale, Karl Yngvar; Berg, Renate; Elden, Ake; Ødegård, Atle; Holte, Arne
A total of 14 women meeting criteria for dissociative identity disorder (DID) based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]) were compared to a group of women (n = 10) with other dissociative diagnoses and a group of normal controls (n = 14) with regard to dissociativity, absorption, trauma related symptoms and hypnotizability. Both of the clinical groups reported histories of childhood trauma and attained high PTSD scores. The DID group differed significantly from the group with other dissociative diagnoses and the non-diagnosed comparison group with regard to hypnotizability, the variety of dissociative symptomatology, and the magnitude of dissociative symptomatology. However, no significant differences between the two clinical groups were detected with regard to absorption, general dissociative level, or symptoms related to traumatic stress. Results support the notion that DID can be regarded as a clinical entity which is separable from other dissociative disorders. Results also indicated that hypnotizability is the most important clinical feature of DID.
Giummarra, Melita J; Bradshaw, John L; Nicholls, Michael E R; Hilti, Leonie M; Brugger, Peter
Body integrity identity disorder (BIID) is characterised by profound experience of incongruity between the biological and desired body structure. The condition manifests in "non-belonging" of body parts, and the subsequent desire to amputate, paralyse or disable a limb. Little is known about BIID; however, a neuropsychological model implicating right fronto-parietal and insular networks is emerging, with potential disruption to body representation. We argue that, as there is scant systematic research on BIID published to date and much of the research is methodologically weak, it is premature to assume that the only process underlying bodily experience that is compromised is body representation. The present review systematically investigates which aspects of neurological processing of the body, and sense of self, may be compromised in BIID. We argue that the disorder most likely reflects dysregulation in multiple levels of body processing. That is, the disunity between self and the body could arguably come about through congenital and/or developmental disruption of body representations, which, together with altered multisensory integration, may preclude the experience of self-attribution and embodiment of affected body parts. Ulimately, there is a need for official diagnostic criteria to facilitate epidemiological characterisation of BIID, and for further research to systematically investigate which aspects of body representation and processing are truly compromised in the disorder.
Oddo, S; Möller, J; Skoruppa, S; Stirn, A
In BIID a disorder of body identity, concerned subjects desire an amputation of a healthy limb. So far, no psychiatric comorbidity was found in the few studies on BIID-subjects. This study explored clinical symptoms, personality characteristics, interpersonal aspects and coping strategies in 15 BIID persons. Psychometric testing on the topics (1) clinical symptoms, (2) personality and interpersonal aspects, (3) coping strategies, (4) attitudes towards the body were used and statistically evaluated with the T-test for one sample. Some psychopathologies such as depression, anxiety and obsessive-compulsive disorders (OCD) could be excluded although an increased tendency of depressiveness was found. BIID subjects showed specific personality and interpersonal characteristics: high agreeableness, autonomy, autarky and restrained behaviour towards others. Stress and conflicts are managed by self-control and self-affirmation. Their subjective physical attractiveness was low. BIID persons do not exhibit psychopathological characteristics (such as anxiety, depression or OCD), but do show specifics in personality, relationships and coping mechanisms. In the future, further personality traits and personality disorders should be investigated to shed more light on the categorisation and treatment of BIID. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available People, as living organisms, exist in symbiosis with nature; therefore, contact with nature is a basic human need. City nature is an important aspect of the urban living environment because people need an escapist experience from the everyday city life that they should find within their close environment. The outdoor lighting of urban nightscapes has a major influence on people's perception of space. Cities with an increasing number of inhabitants and late-night economic activity transform into 24-hour operating cities. This means that more attention should be given to investigating the social needs of public spaces in terms of night-time urban lighting, creating experiences and identities with nature. This paper aims to emphasize the potential hidden in nature-inspired lighting as a topic for further development in the field of lighting design. Nature inspired lighting is based on a transdisciplinary approach, where terms like biomimicry, biophilia, and urban green space adopted from other subject fields than lighting influence the lighting design process in order to create a product addressing human inner connectedness to nature. The example used in this paper presents the concept of a lighting master plan called “The Sensitive Organism”.
A relative large number of women on college campuses report experiencing eating afflictions. About 61% of college women indicated that they either occasionally or regularly used extreme measures to control their weight (Mintz & Betz, 1988). No clear consensus on the relative prevalence of eating disorder symptoms across ethnic groups has…
Edwards, M.J.; Alonso-Canovas, A.; Schrag, A.; Bloem, B.R.; Thompson, P.D.; Bhatia, K.
Fixed dystonia is a disabling disorder mainly affecting young women who develop fixed abnormal limb postures and pain after apparently minor peripheral injury. There is continued debate regarding its pathophysiology and management. We report 5 cases of fixed dystonia in patients who sought
Cox, Bradley E.; Thompson, Kerry; Anderson, Amelia; Mintz, Amanda; Locks, Taylor; Morgan, Lindee; Edelstein, Jeffrey; Wolz, Abigail
Individuals with autism spectrum disorder (ASD) are completing high school with reasonable expectations for postsecondary success. College educators are likely ill prepared to provide appropriate support for these students. Based on personal interviews with a diverse group of students with autism, this study (a) amplifies these students' voices,…
Edwards, Mark J; Alonso-Canovas, Araceli; Schrag, Arnette; Bloem, Bastiaan R; Thompson, Philip D; Bhatia, Kailash
Fixed dystonia is a disabling disorder mainly affecting young women who develop fixed abnormal limb postures and pain after apparently minor peripheral injury. There is continued debate regarding its pathophysiology and management. We report 5 cases of fixed dystonia in patients who sought amputation of the affected limb. We place these cases in the context of previous reports of patients with healthy limbs and patients with chronic regional pain syndrome who have sought amputation. Our cases...
Callens, Nina; Van Kuyk, Maaike; van Kuppenveld, Jet H; Drop, Stenvert L S; Cohen-Kettenis, Peggy T; Dessens, Arianne B
The magnitude of sex differences in human brain and behavior and the respective contributions of biology versus socialization remain a topic of ongoing study in science. The preponderance of evidence attests to the notion that sexual differentiation processes are at least partially hormonally mediated, with high levels of prenatal androgens facilitating male-typed and inhibiting female-typed behaviors. In individuals with Disorders/Differences of Sex Development (DSD), hormonal profiles or sensitivities have been altered due to genetic influences, presumably affecting gender(ed) activity interests as well as gender identity development in a minority of the affected population. While continued postnatal androgen exposure in a number of DSD syndromes has been associated with higher rates of gender dysphoria and gender change, the role of a number of mediating and moderating factors, such as initial gender assignment, syndrome severity and clinical management remains largely unclear. Limited investigations of the associations between these identified influences and gendered development outcomes impede optimization of clinical care. Participants with DSD (n=123), recruited in the context of a Dutch multi-center follow-up audit, were divided in subgroups reflecting prenatal androgen exposure, genital appearance at birth and gender of rearing. Recalled childhood play and playmate preferences, gender identity and sexual orientation were measured with questionnaires and semi-structured interviews. Data were compared to those of control male (n=46) and female participants (n=79). The findings support that (a) prenatal androgen exposure has large effects on (gendered) activity interests, but to a much lesser extent on sexual orientation and that (b) initial gender of rearing remains a better predictor of gender identity contentedness than prenatal androgen exposure, beyond syndrome severity and medical treatment influences. Nonetheless, 3.3% of individuals with DSD in our
Miyajima, Eiichi; Taira, Naoki; Koda, Munenaga; Kondo, Tsuyoshi
The present study aimed to investigate differences in personality traits among male-to-female (MtF), female-to-male (FtM) gender identity disorder (GID) subjects and non-transsexual male (M) and female (F) controls. Subjects were 72 MtF and 187 FtM GID subjects without psychiatric comorbidities together with 184 male and 159 female non-transsexual controls. Personality traits were assessed using a short version of the Temperament and Character Inventory (TCI-125). Group comparisons were made by two-way ANOVA. Statistical significances were observed as follows: 1) lower novelty seeking in FtM than in M or MtF, 2) higher reward dependence in FtM than in M, 3) higher cooperativeness in FtM than in M or MtF, 4) the highest self-transcendence in MtF among all the groups. The highest self-transcendence in MtF subjects may reflect their vulnerable identity and constrained adaptation to society as the minority. Nevertheless, higher reward dependence and cooperativeness in FtM subjects can be related to more determined motivation for the treatments of GID and might promise better social functioning and adjustment than MtF subjects. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Full Text Available This article is based on research among a group of Muslim youth living in the west of Ireland as part of a study on "social belonging" and identity. One part of the research involved designing a youth centered, participatory research method, in the form of a blog site, to investigate what young people say and do when they are asked to talk about themselves and their relationships, with minimal researcher involvement. Participants were presented with a "blank virtual canvas" where they determined what became discussed. Twenty-two teenaged Muslims—comprising close friends as well as fellow students of the same school and living in the same West of Ireland town—contributed to a time limited, closed blog site over a four month period. The blog site offers interesting snippets of Muslim identification, and how they choose to present themselves to others. In the process of contributing to this exercise, we can also observe subtle means through which inclusion and exclusion co-exist online, refracting young people's offline worlds. The blog affords an opportunity to consciously "do" friendship by presenting to each other images, symbols and statements of friendship that invoke both cohesion and closure. The research unravels certain gendered patterns in online performances. In demonstrating this evidence, we argue that the study of online interactions of youth can provide an alternative window in exploring relationships, identification and social positioning. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs130115
Full Text Available Dissociative identity disorder (DID is one of the most fascinating disorders in psychiatry. The arduous search to reveal the obscurity of this disorder has led to colossal research in this area over the years. Although drug-assisted interviews are not widely used, they may be beneficial for some patients that do not respond to conventional treatments such as supportive psychotherapy or psychopharmacotherapy. Drug-assisted interviews facilitate recall of memories in promoting integration of dissociative information. We report a case of a 16-year-old female with dissociative identity disorder (DID that was treated with lorazepam-assisted interview and there was rapid improvement in symptoms after the interview.
The present paper reviews the theoretical and empirical literature on children and adolescents with gender identity disorder. The organizational framework underlying this review is one that presents gender behavior in children and adolescents as a continuum rather than as a dichotomy of normal versus abnormal categories. Theories of normative gender development, prevalence, assessment, developmental trajectories, and comorbidity were investigated. There is a greater fluidity and likelihood of change in the pre-pubertal period. It was reported that the majority of affected children had been eventually developing a homosexual orientation. As an approach to determine the prevalence of GID in clinical samples in our child psychiatry clinic, screening instruments that include items on cross-gender or cross-sex identification were used. We applied the Child Behavior Checklist (CBCL). Of the 113 items in the Japanese version of the CBCL, there are two measures of cross-gender identification: "behaves like opposite sex" and "wishes to be opposite sex." Like the other items, they are scored on a 3-point scale of: 0-not true, 1- somewhat true, and 2-very true. Our study of 323 clinically-referred children aged 4-15 years reported that, among the boys, 9.6% assigned a score of 1 (somewhat true) or a score of 2 (very true) to the two items. The corresponding rates for the clinically-referred girls were 24.5%. The item of diagnosis of GID in our clinical sample was significantly higher than in non-referred children, reported as 2-5% using the same method. Two clinical case histories of screened children are also presented. Both of them were diagnosed with PDDNOS. Together with the literature review, most of the gender-related symptoms in autistic spectrum disorders (ASD) could be related to the behavioral and psychological characteristics of autism as shown in case histories. ASD subjects in adolescence can sometimes develop a unique confusion of identity that occasionally
de Vries, Annelou L C; Steensma, Thomas D; Doreleijers, Theo A H; Cohen-Kettenis, Peggy T
Puberty suppression by means of gonadotropin-releasing hormone analogues (GnRHa) is used for young transsexuals between 12 and 16 years of age. The purpose of this intervention is to relieve the suffering caused by the development of secondary sex characteristics and to provide time to make a balanced decision regarding actual gender reassignment. To compare psychological functioning and gender dysphoria before and after puberty suppression in gender dysphoric adolescents. Of the first 70 eligible candidates who received puberty suppression between 2000 and 2008, psychological functioning and gender dysphoria were assessed twice: at T0, when attending the gender identity clinic, before the start of GnRHa; and at T1, shortly before the start of cross-sex hormone treatment. Behavioral and emotional problems (Child Behavior Checklist and the Youth-Self Report), depressive symptoms (Beck Depression Inventory), anxiety and anger (the Spielberger Trait Anxiety and Anger Scales), general functioning (the clinician's rated Children's Global Assessment Scale), gender dysphoria (the Utrecht Gender Dysphoria Scale), and body satisfaction (the Body Image Scale) were assessed. Behavioral and emotional problems and depressive symptoms decreased, while general functioning improved significantly during puberty suppression. Feelings of anxiety and anger did not change between T0 and T1. While changes over time were equal for both sexes, compared with natal males, natal females were older when they started puberty suppression and showed more problem behavior at both T0 and T1. Gender dysphoria and body satisfaction did not change between T0 and T1. No adolescent withdrew from puberty suppression, and all started cross-sex hormone treatment, the first step of actual gender reassignment. Puberty suppression may be considered a valuable contribution in the clinical management of gender dysphoria in adolescents. © 2010 International Society for Sexual Medicine.
Tsujimura A, Kiuchi H, Soda T, et al. The Pattern of Sexual Interest of Female-to-Male Transsexual Persons With Gender Identity Disorder Does Not Resemble That of Biological Men: An Eye-Tracking Study. Sex Med 2017;5:e169–e174.
Schlumpf, Yolanda R.; Nijenhuis, Ellert R. S.; Chalavi, Sima; Weder, Ekaterina V.; Zimmermann, Eva; Luechinger, Roger; La Marca, Roberto; Reinders, A. A. T. Simone; Jaencke, Lutz
Objective: The Theory of Structural Dissociation of the Personality (TSDP) proposes that dissociative identity disorder (DID) patients are fixed in traumatic memories as "Emotional Parts" (EP), but mentally avoid these as "Apparently Normal Parts" of the personality (ANP). We tested the hypotheses
Allen, V.H.; Backer, S.; Smith, M.T.
Irradiated fuel discharged from CANDU power reactors is stored underwater and, in order to comply with the requirements of International Safe-guards, the fuel is stacked in sealed containers which are examined at intervals by IAEA inspectors. The seals are verified for identity and integrity and this report describes the design of an identity/integrity element for the seals. The element is in the form of a random coil of wire which is interrogated by ultrasonic methods. An evaluation of thirty-six seals is reported. The application of seals to stacks of fuel was simulated in a water-filled bay at CRNL and repetitive verification measurements were made which simulated inspection procedures. The seal identity signatures were compared using cross-correlation methods and the results show that a broken or tampered seal can be identified with a high level of confidence
Stang Våland, Marianne; Georg, Susse
In this paper, we analyze how architectural design, and the spatial and material changes this involves, contributes to the continuous shaping of identities in an organization. Based upon a case study of organizational and architectural change in a municipal administration at a time of major public...... sector reforms, we examine how design interventions were used to (re)form work and professional relationships. The paper examines how engagements with spatial arrangements and material artifacts affected people’s sense of both occupational and organizational identity. Taking a relational approach...... to sociomateriality, the paper contributes to the further theorizing of space in organization studies by proposing the concept of spacing identity to capture the fluidity of identity performance....
This article describes a clinical program designed to address broadly defined mental health needs of children who experience stress related to not fitting into normative gender types and argues for the need for integrated services that address the spectrum of gender variance. An array of services useful to children and their families is proposed. The article describes the clinical population served, common clinical and social problems, and a rationale for the interventions provided.
Vermaat, Lieke E W; van der Miesen, Anna I R; de Vries, Annelou L C; Steensma, Thomas D; Popma, Arne; Cohen-Kettenis, Peggy T; Kreukels, Baudewijntje P C
The purpose of this study was to (1) investigate autism spectrum disorder (ASD) symptoms in a sample of adults referred for gender dysphoria (GD) compared to typically developing (TD) populations, (2) see whether males assigned at birth with GD (MaB GD s) and females assigned at birth with GD (FaB GD s) differ in ASD symptom levels, (3) study the role of sexual orientation, and (4) investigate ASD symptoms' correlation with GD symptoms. The Autism-Spectrum Quotient (AQ) was used to measure ASD symptoms, and the Utrecht Gender Dysphoria Scale (UGDS) was used to measure the intensity of GD. Mean AQ scores of adults referred for GD (n = 326; 191 MaB GD and 135 FaB GD ) were compared to three TD populations taken from the literature (n = 1316; 667 male and 644 female, 5 birth-assigned sex unknown). The mean AQ score in individuals referred for GD was similar to the TD samples. FaB GD s showed higher mean AQ scores than MaB GD s, and they had mean scores similar to TD individuals of the same experienced gender (TD males). After selecting individuals with an UGDS score indicative of GD, a positive association between ASD and GD symptoms was found. The co-occurrence of GD and ASD in adults may not be as prevalent as previously suggested. Attenuation of sex differences in ASD might explain FaB GD s' and MaB GD s' ASD symptoms' similarity to those of TD individuals of the same experienced gender. Intensity of ASD symptoms might be correlated with intensity of GD symptoms, warranting further studies to elaborate on their potential co-occurrence.
Comello, Maria Leonora G; Farman, Lisa
Advertisements, movies, and other forms of media content have potential to change behaviors and antecedent psychological states by appealing to identity. However, the mechanisms that are responsible for persuasive effects of such content have not been adequately specified. A recently proposed model of communication effects (the prism model) advances the study of mechanisms and argues that identity can serve as both a moderator and mediator of communication effects on behavior-relevant outcomes. These intervening roles are made possible by the complex nature of identity (including multiple self-concepts and sensitivity to cues) and messages that cue the importance of and activate particular self-concepts. This article builds on development of the model by presenting empirical support based on re-analysis of an experiment in which participants viewed either a more-stigmatizing or less-stigmatizing portrayal of a recovering drug addict. In line with the model's propositions, exposure to the less-stigmatizing condition led to increases in perspective taking which then led to more acceptance (mediation by identity), while level of perspective taking also changed the effect of condition on acceptance (moderation by identity). These results provide support for the model's proposition of simultaneous intervening roles. The authors discuss implications for strategic communication research and practice.
Kurahashi, Hiroaki; Watanabe, Masami; Sugimoto, Morito; Ariyoshi, Yuichi; Mahmood, Sabina; Araki, Motoo; Ishii, Kazushi; Nasu, Yasutomo; Nagai, Atsushi; Kumon, Hiromi
Gender identity disorder (GID) results from a disagreement between a person's biological sex and the gender to which he or she identifies. With respect to the treatment of female to male GID, testosterone replacement therapy (TRT) is available. The uric acid (UA) level can be influenced by testosterone; however, the early effects and dose-dependency of TRT on the serum UA concentration have not been evaluated in this population. We herein conducted a dose-response analysis of TRT in 160 patients with female to male GID. The TRT consisted of three treatment groups who received intramuscular injections of testosterone enanthate: 125 mg every two weeks, 250 mg every three weeks and 250 mg every two weeks. Consequently, serum UA elevation was observed after three months of TRT and there was a tendency toward testosterone dose-dependency. The onset of hyperuricemia was more prevalent in the group who received the higher dose. We also demonstrated a positive correlation between increased levels of serum UA and serum creatinine. Since the level of serum creatinine represents an individual's muscle volume and the muscle is a major source of purine, which induces UA upregulation, the serum UA elevation observed during TRT is at least partially attributed to an increase in muscle mass. This is the first study showing an association between serum UA elevation and a TRT-induced increase in muscle mass. The current study provides important information regarding TRT for the follow-up and management of the serum UA levels in GID patients.
Korte, Alexander; Beier, Klaus M; Vukorepa, Julia; Mersmann, Maik; Albiez, Verena
Gender identity disorder (GID), gender dysphoria (GD) respectively, is considered a multifactorial disease whose etiology is subject to complex bio-psycho-social conditions, each with different weighting. As a result, therapists, who treat children and adolescents with GID/GD, have to deal with a very heterogeneous group with individually varying causes, differing psychopathology and varying disease progression. In addition to general psychiatric aspects of development, particularly psychiatric comorbidity, but also the different individual psychodynamics--i. e. the specific constellation of conflicts and possible ego deficits and structural deficits in the learning history of the person are of differential importance. In regard to the indication for gender reassignment measures this sometimes is relevant for the decision. The difficulties arising for decision making and the usefulness of a systematic evaluation of case reports as a basis for further optimization of the treatment recommendations are illustrated by two case reports. In the course of this, also the disadvantages and potential dangers of too early diagnostic definition and introduction of gender somato-medical and legal measures are shown exemplarily.
Blom, Rianne M; van Wingen, Guido A; van der Wal, Sija J; Luigjes, Judy; van Dijk, Milenna T; Scholte, H Steven; Denys, Damiaan
Body Integrity Identity Disorder (BIID) is a condition in which individuals perceive a mismatch between their internal body scheme and physical body shape, resulting in an absolute desire to be either amputated or paralyzed. The condition is hypothesized to be of congenital nature, but evidence for a neuro-anatomical basis is sparse. We collected T1-weighted structural magnetic resonance imaging scans on a 3T scanner in eight individuals with BIID and 24 matched healthy controls, and analyzed the data using voxel-based morphometry. The results showed reduced grey matter volume in the left dorsal and ventral premotor cortices and larger grey matter volume in the cerebellum (lobule VIIa) in individuals with BIID compared to controls. The premotor cortex and cerebellum are thought to be crucial for the experience of body-ownership and the integration of multisensory information. Our results suggest that BIID is associated with structural brain anomalies and might result from a dysfunction in the integration of multisensory information, leading to the feeling of disunity between the mental and physical body shape.
Brandhorst, Allan R.
One of the greatest challenges to a peace education curriculum is preparing young people to deal with conflicts over issues central to identity. These kinds of conflict can threaten beliefs derived from authority and, accordingly, may be characterized by cognitive rigidity. Various factors central to constructive conflict resolution are…
Punchihewa, Himan K G; Gyi, Diane E
Work-related Musculoskeletal Disorders (MSDs) affect the well-being of workers. Unfortunately, user requirements for design to reduce workplace risk factors for MSDs are not always effectively communicated to designers creating a mismatch between the user requirements and what is ultimately produced. To understand the views of practitioners of design and ergonomics regarding tools for participatory design and features they would like to see in such tools. An online questionnaire survey was conducted with a cohort of practitioners of ergonomics and design (n = 32). In-depth interviews were then conducted with a subset of these practitioners (n = 8). To facilitate discussion, a prototype integrated design tool was developed and demonstrated to practitioners using a verbalized walkthrough approach. According to the results of the questionnaire survey, the majority (70%) believed an integrated approach to participatory design would help reduce work-related MSDs and suggested ways to achieve this, for example, through sharing design information. The interviews showed the majority (n = 7) valued being provided with guidance on design activities and ways to manage and present information. It is believed that an integrated approach to design in order to help reduce work-related MSDs is highly important and a provision to evaluate design solutions would be desirable for practitioners of design and ergonomics.
Seyyed Salman Alavi
Full Text Available Objective: Smart phones have rapidly become an integral, and for some, an essential communication device worldwide. The issue of identity has always been a subject of interest among psychologists. The present study was conducted to compare personal and national identity and their subscales between cell phone addicts and non-addicts.Method: In this cross-sectional study, 500 student cell phone users from various universities in Tehran were recruited using stratified sampling. Participants completed cell phone addiction questionnaires including Mobile Phone Problematic Use Scale (MPPUS, Cell Phone Dependency Questionnaire (CPDQ, Personal Identity Development Questionnaire, Extended Objective Measure of Ego Identity Status (EOMEIS and National Identity Questionnaire. Then, the subscales of these instruments were analyzed using SPSS Version 20.Results: Results of this study revealed significant differences between cell phone addicts and non-addicts in the scores of national identity, personal identity, and most subscales, except for some subscales (P<0.05. In addition, a negative and significant relationship was found between personal and national identity and cell phone addiction (r=-0.35, -0.33, respectively.On the other hand, after controlling for the confounder variables, we found that national identity had an effect on cell phone addiction(OR=0.05, CI=0.92-0.98.Conclusion: The results of this study indicated that cell phone overuse may be correlated with defects in some aspects of national and personal identity.
It is important to understand and record the impact of therapy on severe mental health conditions through the use of clinical assessment measures. In this article, I propose to extend outcome evaluation by measuring service use and cost prior to and during the commencement of psychological therapy over a period of 4 years for 2 people diagnosed with dissociative identity disorder. The treatment was provided within an outpatient setting in a U.K. National Health Service hospital trust following therapeutic guidelines set out by the International Society for the Study of Trauma and Dissociation. Results show that service use in both inpatient and out-of-hours crisis services reduced as the 2 people received therapy over the 4-year time period. Based on these 2 cases, it appears to be cost effective to provide specialized therapy for dissociative identity disorder in outpatient settings.
Mannon, Bethany Ober
The field of narrative medicine holds that personal narratives about illness have the potential to give illness meaning and to create order out of disparate facets of experience, thereby aiding a patient's treatment and resisting universalizing medical discourse. Two narratives of bipolar disorder, Kay Redfield Jamison's prose memoir An Unquiet Mind (1995) and Ellen Forney's graphic memoir Marbles (2012) challenge these ideas. These writers demonstrate that one result of bipolar disorder is a rupture to their sense of identity, making straightforward and verbal forms of narrative impossible. During periods of relative mood stability, reliable memories of mania or depression are equally impossible. As a result, these memoirists seek to develop sources of self-knowledge other than memory and introspection, long the foundations of personal narrative. Finally, An Unquiet Mind and Marbles return attention to questions of selfhood at a time when scholarship on memoir rejects interpretations of life stories as clear and reliable expressions of identity.
Stein, Karen Farchaus; Corte, Colleen
The cognitive model of the self-concept was used to test the theoretical proposition that disturbances in overall identity development are a core vulnerability that lead to formation of a fat body weight self-definition and eating disorder symptomatology. Structural properties of the self-concept, availability in memory of a fat body weight self-schema, and eating disordered attitudes and behaviours were measured in women with anorexia nervosa (AN) (n = 26), bulimia nervosa (BN) (n = 53) and controls (n = 32). Women with (AN) and (BN) had fewer positive and more negative and highly interrelated self-schemas compared to controls, and women with BN showed information processing evidence of a fat self-schema available in memory. These self-concept properties predicted eating disordered attitudes and behaviour. Disturbances in the overall collection of identities--an impoverished self--is an important contributor to eating disorder symptomatology. The development of new positive selves may be an important factor in recovery. 2006 John Wiley & Sons, Ltd and Eating Disorders Association
Schlumpf, Yolanda R; Reinders, Antje A T S; Nijenhuis, Ellert R S; Luechinger, Roger; van Osch, Matthias J P; Jäncke, Lutz
In accordance with the Theory of Structural Dissociation of the Personality (TSDP), studies of dissociative identity disorder (DID) have documented that two prototypical dissociative subsystems of the personality, the "Emotional Part" (EP) and the "Apparently Normal Part" (ANP), have different biopsychosocial reactions to supraliminal and subliminal trauma-related cues and that these reactions cannot be mimicked by fantasy prone healthy controls nor by actors. Arterial spin labeling perfusion MRI was used to test the hypotheses that ANP and EP in DID have different perfusion patterns in response to rest instructions, and that perfusion is different in actors who were instructed to simulate ANP and EP. In a follow-up study, regional cerebral blood flow of DID patients was compared with the activation pattern of healthy non-simulating controls. Compared to EP, ANP showed elevated perfusion in bilateral thalamus. Compared to ANP, EP had increased perfusion in the dorsomedial prefrontal cortex, primary somatosensory cortex, and motor-related areas. Perfusion patterns for simulated ANP and EP were different. Fitting their reported role-play strategies, the actors activated brain structures involved in visual mental imagery and empathizing feelings. The follow-up study demonstrated elevated perfusion in the left temporal lobe in DID patients, whereas non-simulating healthy controls had increased activity in areas which mediate the mental construction of past and future episodic events. DID involves dissociative part-dependent resting-state differences. Compared to ANP, EP activated brain structures involved in self-referencing and sensorimotor actions more. Actors had different perfusion patterns compared to genuine ANP and EP. Comparisons of neural activity for individuals with DID and non-DID simulating controls suggest that the resting-state features of ANP and EP in DID are not due to imagination. The findings are consistent with TSDP and inconsistent with the idea
Yolanda R Schlumpf
Full Text Available In accordance with the Theory of Structural Dissociation of the Personality (TSDP, studies of dissociative identity disorder (DID have documented that two prototypical dissociative subsystems of the personality, the "Emotional Part" (EP and the "Apparently Normal Part" (ANP, have different biopsychosocial reactions to supraliminal and subliminal trauma-related cues and that these reactions cannot be mimicked by fantasy prone healthy controls nor by actors.Arterial spin labeling perfusion MRI was used to test the hypotheses that ANP and EP in DID have different perfusion patterns in response to rest instructions, and that perfusion is different in actors who were instructed to simulate ANP and EP. In a follow-up study, regional cerebral blood flow of DID patients was compared with the activation pattern of healthy non-simulating controls.Compared to EP, ANP showed elevated perfusion in bilateral thalamus. Compared to ANP, EP had increased perfusion in the dorsomedial prefrontal cortex, primary somatosensory cortex, and motor-related areas. Perfusion patterns for simulated ANP and EP were different. Fitting their reported role-play strategies, the actors activated brain structures involved in visual mental imagery and empathizing feelings. The follow-up study demonstrated elevated perfusion in the left temporal lobe in DID patients, whereas non-simulating healthy controls had increased activity in areas which mediate the mental construction of past and future episodic events.DID involves dissociative part-dependent resting-state differences. Compared to ANP, EP activated brain structures involved in self-referencing and sensorimotor actions more. Actors had different perfusion patterns compared to genuine ANP and EP. Comparisons of neural activity for individuals with DID and non-DID simulating controls suggest that the resting-state features of ANP and EP in DID are not due to imagination. The findings are consistent with TSDP and inconsistent
Heylens, Gunter; Verroken, Charlotte; De Cock, Sanne; T'Sjoen, Guy; De Cuypere, Griet
At the start of gender reassignment therapy, persons with a gender identity disorder (GID) may deal with various forms of psychopathology. Until now, a limited number of publications focus on the effect of the different phases of treatment on this comorbidity and other psychosocial factors. The aim of this study was to investigate how gender reassignment therapy affects psychopathology and other psychosocial factors. This is a prospective study that assessed 57 individuals with GID by using the Symptom Checklist-90 (SCL-90) at three different points of time: at presentation, after the start of hormonal treatment, and after sex reassignment surgery (SRS). Questionnaires on psychosocial variables were used to evaluate the evolution between the presentation and the postoperative period. The data were statistically analyzed by using SPSS 19.0, with significance levels set at P < 0.05. The psychopathological parameters include overall psychoneurotic distress, anxiety, agoraphobia, depression, somatization, paranoid ideation/psychoticism, interpersonal sensitivity, hostility, and sleeping problems. The psychosocial parameters consist of relationship, living situation, employment, sexual contacts, social contacts, substance abuse, and suicide attempt. A difference in SCL-90 overall psychoneurotic distress was observed at the different points of assessments (P = 0.003), with the most prominent decrease occurring after the initiation of hormone therapy (P < 0.001). Significant decreases were found in the subscales such as anxiety, depression, interpersonal sensitivity, and hostility. Furthermore, the SCL-90 scores resembled those of a general population after hormone therapy was initiated. Analysis of the psychosocial variables showed no significant differences between pre- and postoperative assessments. A marked reduction in psychopathology occurs during the process of sex reassignment therapy, especially after the initiation of hormone therapy. © 2013
Nakamura, Aya; Watanabe, Masami; Sugimoto, Morito; Sako, Tomoko; Mahmood, Sabina; Kaku, Haruki; Nasu, Yasutomo; Ishii, Kazushi; Nagai, Atsushi; Kumon, Hiromi
Gender identity disorder (GID) is a conflict between a person's actual physical gender and the one they identify him or herself with. Testosterone is the key agent in the medical treatment of female to male GID patients. We conducted a dose-response analysis of testosterone replacement therapy (TRT) in 138 patients to determine the onset of the therapeutic effects. The TRT consisted of intramuscular injection of testosterone enanthate and patients were divided into three groups; 250 mg every two weeks, 250 mg every three weeks and 125 mg every two weeks. The onset of deepening of voice, increase in facial hair and cessation of menses was evaluated in each group. At one month after the start of TRT, the onset of these physical changes was more prevalent in the group receiving the higher dose of testosterone, and there were dose-dependent effects observed between the three treatment groups. On the other hand, at six months after the start of TRT, most of the patients had achieved treatment responses and there were no dose-dependent effects with regard to the percentage of patients with therapeutic effects. No significant side effects were observed in any of the treatment groups. We demonstrated that the early onset of the treatment effects of TRT is dose-dependent, but within six months of starting TRT, all three doses were highly effective. Current study provides useful information to determine the initial dose of TRT and to suggest possible changes that should be made in the continuous dosage for long term TRT.
Gutschke, Katja; Stirn, Aglaja; Kasten, Erich
The urge to be permanently blind is an extremely rare mental health disturbance. The underlying cause of this desire has not been determined yet, and it is uncertain whether the wish for blindness is a condition that can be included in the context of body integrity identity disorder, a condition where people feel an overwhelming need to be disabled, in many cases by amputation of a limb or through paralysis. The aim of this study is to test the hypothesis that people with a desire for blindness suffer from a greater degree of visual stress in daily activities than people in a healthy visual control group. We created a Likert scale questionnaire to measure visual stress, covering a wide range of everyday situations. The wish for blindness is extremely rare and worldwide only 5 people with an urge to be blind were found to participate in the study (4 female, 1 male). In addition, a control group of 35 (28 female, 7 male) visually healthy people was investigated. Questions addressing issues that may be experienced by participants with a desire to be blind were integrated into the questionnaire. The hypothesis that people with a desire for blindness suffer from a significantly higher visual overload in activities of daily living than visually healthy subjects was confirmed; the significance of visual stress between these groups was p < 0.01. In addition, an interview with the 5 affected participants supported the causal role of visual overload. The desire for blindness seems to originate from visual overload caused by either ophthalmologic or organic brain disturbances. In addition, psychological reasons such as certain personal character traits may play an active role in developing, maintaining, and reinforcing one's desire to be blind.
Full Text Available Background: The urge to be permanently blind is an extremely rare mental health disturbance. The underlying cause of this desire has not been determined yet, and it is uncertain whether the wish for blindness is a condition that can be included in the context of body integrity identity disorder, a condition where people feel an overwhelming need to be disabled, in many cases by amputation of a limb or through paralysis. Objective: The aim of this study is to test the hypothesis that people with a desire for blindness suffer from a greater degree of visual stress in daily activities than people in a healthy visual control group. Method: We created a Likert scale questionnaire to measure visual stress, covering a wide range of everyday situations. The wish for blindness is extremely rare and worldwide only 5 people with an urge to be blind were found to participate in the study (4 female, 1 male. In addition, a control group of 35 (28 female, 7 male visually healthy people was investigated. Questions addressing issues that may be experienced by participants with a desire to be blind were integrated into the questionnaire. Results: The hypothesis that people with a desire for blindness suffer from a significantly higher visual overload in activities of daily living than visually healthy subjects was confirmed; the significance of visual stress between these groups was p < 0.01. In addition, an interview with the 5 affected participants supported the causal role of visual overload. Conclusions: The desire for blindness seems to originate from visual overload caused by either ophthalmologic or organic brain disturbances. In addition, psychological reasons such as certain personal character traits may play an active role in developing, maintaining, and reinforcing one’s desire to be blind.
Purpose: The purpose of this paper is to explore how legacy organizational identity and death relate to each other and, thereby, contribute to closing the gap in knowledge on organizational identity constructions in times of death. Design/methodology/approach: The paper opted for an exploratory....../value: This paper addresses an apparent gap in the literature on identity and death; exploring identity narratives in a bankrupted bank, the paper considers constructions of legacy organizational identities in times of disruptive death....
Full Text Available Architecture and urbanism in Iran during the contemporary period have been influenced by inside and outside social and economic developments. These changes are so fundamental that have caused many challenges and styles in architectural space of Iran, both in conceptual and physical space. Indeed, objectified areas caused by intellectual movements such as: West-oriented, economic-oriented can be known as the root of identity crisis for Iranian cities from the architecture and urbanism perspective. The most important weaknesses and problems in today Iranian architecture include: lack of attention to cultural infrastructures, capability of integrating all cultural spheres, paying too much attention to the economic aspects in the constructions, lack of commitment in some of the builders, weakness of the management system and monitoring in the field of architecture and urbanism, lack of explanation of Iranian traditional architecture patterns, consumable culture of Iranian society, lack of attention to the potential of traditional tissues to integrate with today's architecture and more. While this article is presenting and checking the list of factors affecting this process - identity crisis - attempts to seek its causes and ultimately preparing the ground for achieving overcoming solutions of this crisis.
Capobianco, Brenda M.; Yu, Ji H.; French, Brian F.
The integration of engineering concepts and practices into elementary science education has become an emerging concern for science educators and practitioners, alike. Moreover, how children, specifically preadolescents (grades 1-5), engage in engineering design-based learning activities may help science educators and researchers learn more about children's earliest identification with engineering. The purpose of this study was to examine the extent to which engineering identity differed among preadolescents across gender and grade, when exposing students to engineering design-based science learning activities. Five hundred fifty preadolescent participants completed the Engineering Identity Development Scale (EIDS), a recently developed measure with validity evidence that characterizes children's conceptions of engineering and potential career aspirations. Data analyses of variance among four factors (i.e., gender, grade, and group) indicated that elementary school students who engaged in the engineering design-based science learning activities demonstrated greater improvements on the EIDS subscales compared to those in the comparison group. Specifically, students in the lower grade levels showed substantial increases, while students in the higher grade levels showed decreases. Girls, regardless of grade level and participation in the engineering learning activities, showed higher scores in the academic subscale compared to boys. These findings suggest that the integration of engineering practices in the science classroom as early as grade one shows potential in fostering and sustaining student interest, participation, and self-concept in engineering and science.
Why is branding important? It is because people often choose a product based on the per-ceived value of what they think the product is worth rather than its actual value. Accordingly, visual identity, in this case, has an important role in increasing perceived value of a product and in establishing and nurturing a sustainable relationship with customers. In this project, the designer taps into her ability to see and recognize the value of her client’s brand, and transforms that understand...
Argues that the practice and influence of design history can benefit from new forms of visual and chronological analysis. Identifies and discusses a unique phenomenon, the "historical visual narrative." Examines special instances of this phenomenon in twentieth-century design and visual culture, which are tied to the theme of the…
Do consanguineous parents of a child affected by an autosomal recessive disease have more DNA identical-by-descent than similarly-related parents with healthy offspring? Design of a case-control study
Cornel Martina C
Full Text Available Abstract Background The offspring of consanguineous relations have an increased risk of congenital/genetic disorders and early mortality. Consanguineous couples and their offspring account for approximately 10% of the global population. The increased risk for congenital/genetic disorders is most marked for autosomal recessive disorders and depends on the degree of relatedness of the parents. For children of first cousins the increased risk is 2-4%. For individual couples, however, the extra risk can vary from zero to 25% or higher, with only a minority of these couples having an increased risk of at least 25%. It is currently not possible to differentiate between high-and low-risk couples. The quantity of DNA identical-by-descent between couples with the same degree of relatedness shows a remarkable variation. Here we hypothesize that consanguineous partners with children affected by an autosomal recessive disease have more DNA identical-by-descent than similarly-related partners who have only healthy children. The aim of the study is thus to establish whether the amount of DNA identical-by-descent in consanguineous parents of children with an autosomal recessive disease is indeed different from its proportion in consanguineous parents who have healthy children only. Methods/Design This project is designed as a case-control study. Cases are defined as consanguineous couples with one or more children with an autosomal recessive disorder and controls as consanguineous couples with at least three healthy children and no affected child. We aim to include 100 case couples and 100 control couples. Control couples are matched by restricting the search to the same family, clan or ethnic origin as the case couple. Genome-wide SNP arrays will be used to test our hypothesis. Discussion This study contains a new approach to risk assessment in consanguineous couples. There is no previous study on the amount of DNA identical-by-descent in consanguineous
Tsujimura, Akira; Kiuchi, Hiroshi; Soda, Tetsuji; Takezawa, Kentaro; Fukuhara, Shinichiro; Takao, Tetsuya; Sekiguchi, Yuki; Iwasa, Atsushi; Nonomura, Norio; Miyagawa, Yasushi
With Gender Identity Disorder Does Not Resemble That of Biological Men: An Eye-Tracking Study. Sex Med 2017;5:e169-e174. Copyright © 2017. Published by Elsevier Inc.
Farmer, Caroline; Farrand, Paul; O'Mahen, Heather
There is a significant treatment gap for patients with depression. A third of sufferers never seek help, and the vast majority of those who do only do so after considerable delay. Little is understood regarding poor help-seeking rates amongst people with depression, with existing research mainly focussed on the impact of barriers to treatment. The current study explored psychological factors affecting help-seeking behaviour in clinically depressed individuals. Semi-structured interviews were conducted with 20 current or previously clinically depressed participants who either had or had not sought professional help. Thematic analysis was used to analyse results. The onset of depressive symptoms created conflict with participants' identity and personal goals. Delays in seeking help were primarily attributed to the desire to protect identity and goals from the threat of depressive symptoms. Participants used avoidance strategies to reduce the perceived threat of depressive symptoms on identity. These strategies interfered with help-seeking. Help-seeking was only undertaken once participants reached a point of acceptance and began to make concessions in their identity and goals, at which time they reduced their use of avoidance. Difficulties resolving conflict between identity and depressive symptoms may account for significant delays in seeking help for depression. The results have implications for predicting health behaviour and improving treatment uptake for depression, and may inform existing help-seeking models.
周宇; 李毅; 中塚幹也
性别认同障碍(gender identity disorder,GID),指对于自己的性别认同与生物解剖学上的性别不一致的情况,并且常伴随内心痛苦想要改变生物学上的性别,心理治疗对性别认同障碍的干预,即想要使患者的性别认同与生物性别一致的情况早已被证实无效,性别认同障碍的患者往往会选择荷尔蒙治疗甚至手术来使自己的生物性别与性别认同趋向一致.2013年5月美国《精神疾病诊断及统计手册》第五版(DSM-Ⅴ)将性别认同障碍修改为性别烦恼(gender dysphoria),不再认为性别认同问题是障碍或疾病,承认性别多样性的存在.本文从对日本性别认同障碍患者的一般调查研究数据,包括荷尔蒙疗法及性别转变手术在内的性别认同障碍的治疗以及生殖医疗三个方面来描述日本性别认同障碍目前的发展状况.%Gender Identity Disorder (GID) refers to the inconformity between gender identity and biological gender.Individuals with GID typically suffer from the inconformity and wants to change their biological gender.It is found useless to provide psychotherapy for such individuals which tries to unify their psychological and biological gender identity.Most choose to change their biological gender through feminize or masculinize therapy or even operation.The Diagnostic and Statistical Manual of Mental Disorders (DSM-Ⅴ) published in 2013 changed gender dysphoria to gender dysphoria and admitted the diversity of gender identity.This article introduces the status and development of GID in Japan from three perspectives i.e.hormone therapy,sex reassignment surgery,and reproductive health.
Fossati, Andrea; Borroni, Serena; Feeney, Judith; Maffei, Cesare
The aims of this study were to assess whether Borderline Personality Disorder (BPD) features could be predicted by Big Five traits, impulsivity, identity orientation, and adult attachment patterns in a sample of 1,192 adult nonclinical participants, and to evaluate the consistency of these regression models across four age groups (49 years, and >50 years, respectively). In the full sample, measures of neuroticism (N), impulsivity, and anxious insecure attachment were substantial predictors of BPD features (adjusted R(2) = .38, p personality traits and disturbed attachment patterns.
Although a large body of research focuses on discrimination as a risk for depression among African-Americans, only a dearth of research focuses on internalized racism (i.e., endorsement of negative stereotypes of one's racial group) as a risk factor. In addition, no studies have yet to examine mediators and/or moderators of the relationship between internalized racism and depression. To this end, the present study examined the mediating and moderating roles of (a) self-esteem and (b) ethnic identity on the relationship between internalized racism and past-year major depressive disorder (MDD), in a nationally representative sample of African-American adults (N = 3570) from the National Survey of American Life. Results from this study revealed an indirect association between internalized racism and past-year MDD via self-esteem, but no indirect relationship via ethnic identity. Further, results show that both self-esteem and ethnic identity individually moderate the relationship between internalized racism and past-year MDD. Collectively, these findings suggest a need to further investigate mechanisms through which internalized racism impacts mental health and factors that strengthen and/or weaken the association between internalized racism and depression.
Hensing, Gunnel; Spak, Fredrik
The aim of this study was to analyse in women the association between four dimensions of gender identity, heavy episodic drinking (HED) and alcohol use disorders (AUD), taking into account age, personality, psychiatric co-morbidity and level of education. An initial screening of alcohol consumption was followed by a structured psychiatric interview in a sample of women drawn from the Gothenburg population and women attending primary care, maternity and hospital services (n = 930). Gender identity was assessed using the Masculinity-Femininity Questionnaire (M/F-Q) (items grouped into four dimensions: leadership, caring, self-assertiveness and emotionality). The Karolinska Scale of Personality was administered. Clinical psychiatric diagnoses according to DSM were made in face-to-face interviews. HED was defined as consumption of at least 60 g of ethanol on a single day at least once a month. Women who scored low on the leadership dimension were twice as likely to have AUD [age-adjusted odds1.98 (95% confidence interval 1.30-3.01)] compared to those with medium scores. These odds ratios were significant after adjustment for personality [2.21 (1.35-3.63)], psychiatric disorders [2.09 (1.25-3.47)] and level of education [1.95 (1.17-3.26)]. Low scores on the leadership dimension were associated with HED [1.55 (0.98-2.44)] after adjustment for age, personality, psychiatric disorders and level of education. High scores on leadership were not significantly associated with AUD or HED after these adjustments. The odds ratios for those who scored low on caring were non-significant throughout the analyses of associations with both AUD and HED. A similar pattern was found for the self-assertiveness dimension. Low emotionality was associated with decreased odds for AUD [0.42 (0.25-0.70)] and HED [0.66 (0.44-0.99)], and increased odds for AUD [2.14 (1.38-3.31)] and HED [2.33 (1.58-3.44)], after adjusting for age. These associations became non-significant after adjustment for
Transsexualism is characterised by a discrepancy between biological sex and gender identification, in spite of hormonal levels that are normal with respect to the biological sex. Generally, having the diagnosis ‘transsexualism’ or ‘Gender Identity Disorder’ (GID) is a prerequisite for hormonal and surgical treatment. Since transsexualism is such a rare phenomenon, and a so-called ‘gold standard’ against which the diagnosis could be evaluated is lacking, it is of utmost importance that reliabl...
Wade, Mark; Prime, Heather; Madigan, Sheri
Neurodevelopmental disorders represent a broad class of childhood neurological conditions that have a significant bearing on the wellbeing of children, families, and communities. In this review, we draw on evidence from two common and widely studied neurodevelopmental disorders—autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD)—to demonstrate the utility of genetically informed sibling designs in uncovering the nature and pathogenesis of these conditions. Speci...
Bech-Larsen, Tino; Esbjerg, Lars; Grunert, Klaus G.
on consumers' self-identities. The second part explored the role of food and beverage products in the construction of self-identities. The final part focused on the construction of brand identity for Supermalt. Findings - The article provides information on the self-identities constructed by Afro......-Caribbean informants. The food and beverage consumption of informants reflects their mixed cultural identity. The brand identity Supermalt appears to be malleable, with ample room for consumer co-construction. Perceptions of brand identity differ markedly among informants, who are all able to construct Supermalt......Purpose - The objective of this article is to conduct a case study of the Supermalt brand of malt beer, which has become the preferred beverage of Afro-Caribbean consumers in Brixton on a very limited marketing budget. Design/methodology/approach - The article uses the concepts of personal identity...
Bardram, Jakob Eyvind; Frost, Mads; Tuxen, Nanna
This position paper presents our preliminary design of context-aware cognitive behavioral therapy for unipolar and bipolar disorders. We report on the background for this study and the methods applied in the ongoing design process. The paper ends by presenting and discussing different design...
Byun, Tara McAllister; Hitchcock, Elaine R; Ferron, John
Single-case experimental designs are widely used to study interventions for communication disorders. Traditionally, single-case experiments follow a response-guided approach, where design decisions during the study are based on participants' observed patterns of behavior. However, this approach has been criticized for its high rate of Type I error. In masked visual analysis (MVA), response-guided decisions are made by a researcher who is blinded to participants' identities and treatment assignments. MVA also makes it possible to conduct a hypothesis test assessing the significance of treatment effects. This tutorial describes the principles of MVA, including both how experiments can be set up and how results can be used for hypothesis testing. We then report a case study showing how MVA was deployed in a multiple-baseline across-subjects study investigating treatment for residual errors affecting rhotics. Strengths and weaknesses of MVA are discussed. Given their important role in the evidence base that informs clinical decision making, it is critical for single-case experimental studies to be conducted in a way that allows researchers to draw valid inferences. As a method that can increase the rigor of single-case studies while preserving the benefits of a response-guided approach, MVA warrants expanded attention from researchers in communication disorders.
Full Text Available This paper derives new results for the adaptive backstepping controller design for the anti-synchronization of identical WINDMI systems (Wind-Magnetosphere-Ionosphere models with unknown parameters and also details the SPICE implementation of the proposed adaptive backstepping controller. In the anti-synchronization of chaotic systems, the sum of the outputs of master and slave systems is made to converge asymptotically to zero with time. The adaptive controller design for the anti-synchronization of identical WINDMI systems with unknown parameters has been established by applying Lyapunov stability theory. MATLAB simulations have been shown for the illustration of the adaptive anti-synchronizing backstepping controller for identical WINDMI chaotic systems. Finally, the proposed controller has been implemented using SPICE and circuit simulation results have been detailed.
Design: Participatory action research was used to adapt the WHO programme. There were 3 phases to the study. Firstly a co-operative inquiry group of 10 GPs adapted the WHO materials. Secondly the findings of the inquiry were incorporated into the design of a web-based distance education programme. Thirdly the ...
Cohen-Kettenis, Peggy T; Owen, Allison; Kaijser, Vanessa G; Bradley, Susan J; Zucker, Kenneth J
This study examined demographic characteristics, social competence, and behavior problems in clinic-referred children with gender identity problems in Toronto, Canada (N = 358), and Utrecht, The Netherlands (N = 130). The Toronto sample was, on average, about a year younger than the Utrecht sample at referral, had a higher percentage of boys, had a higher mean IQ, and was less likely to be living with both parents. On the Child Behavior Checklist (CBCL), both groups showed, on average, clinical range scores in both social competence and behavior problems. A CBCL-derived measure of poor peer relations showed that boys in both clinics had worse ratings than did the girls. A multiple regression analysis showed that poor peer relations were the strongest predictor of behavior problems in both samples. This study-the first cross-national, cross-clinic comparative analysis of children with gender identity disorder-found far more similarities than differences in both social competence and behavior problems. The most salient demographic difference was age at referral. Cross-national differences in factors that might influence referral patterns are discussed.
Full Text Available Often collective identities are classified depending on their contents and rarely depending on their forms. Differentiation between soft identity and hard identity is applied to diverse collective identities: religious, political, national, tribal ones, etc. This classification is made following the principal dimensions of collective identities: type of classification (univocal and exclusive or relative and contextual, the absence or presence of conflictsof loyalty, selective or totalitarian, objective or subjective conception, among others. The different characteristics analysed contribute to outlining an increasingly frequent type of identity: the authoritarian identity.
Mancilla, Desla; Moczygemba, Jackie
The crime of medical identity theft is a growing concern in healthcare institutions. A mixed-method study design including a two-stage electronic survey, telephone survey follow-up, and on-site observations was used to evaluate current practices in admitting and registration departments to reduce the occurrence of medical identity theft. Survey participants were chief compliance officers in acute healthcare organizations and members of the Health Care Compliance Association. Study results indicate variance in whether or how patient identity is confirmed in healthcare settings. The findings of this study suggest that information systems need to be designed for more efficient identity management. Admitting and registration staff must be trained, and compliance with medical identity theft policies and procedures must be monitored. Finally, biometric identity management solutions should be considered for stronger patient identification verification.
Delmonte, Romara; Lucchetti, Giancarlo; Moreira-Almeida, Alexander; Farias, Miguel
The aim of this article is to examine whether the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are able to differentiate between nonpathological religious possession and dissociative identity disorder (DID). We use the case study of an individual who leads an Afro-Brazilian religious group (Umbanda), focusing on her personal development and possession experiences from early childhood to the present, spanning a period of more than 40 years, and examine these data following DSM-5 criteria for DID (300.14). Her experiences of possession can be broken into 2 distinct stages. In the 1st stage (childhood and early adulthood), she displayed intrusive thoughts and a lack of control over possession states, which were associated with a heightened state of anxiety, loneliness, amnesia, and family conflict (meeting all 5 criteria for DID). In the 2nd stage (late 20s up to the present), she regularly experienced possession states but felt in control of their onset and found them religiously meaningful. In this 2nd stage, she only fulfilled 3 criteria for DID. We question the accuracy of diagnosing this individual with DID in her earlier life and suggest that the DSM-5 criteria fail to address the ambiguity of affect surrounding possession experiences (positive at the individual level, negative at the interpersonal level) and lack a clearer acknowledgment of the prevalence of possession and other unusual experiences in general populations.
Sani-Bozkurt, Sunagul; Vuran, Sezgin; Akbulut, Yavuz
The current study aimed to design technology-supported interactive social stories to teach social skills to children with autism spectrum disorder (ASD). A design-based research was implemented with children with ASD along with the participation of their mothers, teachers, peers and field experts. An iterative remediation process was followed…
Full Text Available 團體認同度影響大學圖書館工作人員知識分享的意圖和品質,目前,從館員職務設計和工作任務特點的角度,探討團體認同度和圖書館內部知識共享之影響的相關研究尚不多。本研究發現團體認同度對於改善大學圖書館的知識共享意圖和品質有其重要的影響,而職務設計和工作任務的適當與否,亦影響館員的團體認同度。Group identity in academic library determinants the intention of knowledge sharing and knowledge quality. However, the investigation of job design and task characteristics influences group identity and internal library knowledge sharing is still very rudimentary. The study indicated that group identity is important in improving knowledge sharing intentions in academic libraries. Group identity is associated with different kinds of task characteristics. Both organizational prestige and task characteristics are able to explain significant amounts of variance of group identity.
Hendriks, P.H.J.; Fruytier, B.G.M.
Studies addressing the connections between knowledge and organization structures can be divided into two classes. One class holds that a perspective on knowledge signals shortcomings of classical design principles and calls for flatter hierarchy and less specification of the production structure.
Questioning the assumption that identities can be controlled through a shared organisational culture, the article explores the inculcation of a discourse of diversity into leadership identities in a Danish bank and building society. Thus, it intends to demonstrate that, on the one hand, discourse...... plays a significant role in identity construction and, on the other, that leaders’ constructions may have many sources of inspiration within and outside the organisation, emphasising that identity construction is a complex process in which organisational efforts to promote a common leadership identity...... to construct their leadership identities. While the respondents present comparable identities to the interviewer, the analysis reveals that the they draw on different discourses and employ a number of different discursive means to present this identity. This, the article argues, may be the result of a number...
Geldenhuys, Werner J; Youdim, Moussa B H; Carroll, Richard T; Van der Schyf, Cornelis J
The incidence of neurodegenerative diseases has seen a constant increase in the global population, and is likely to be the result of extended life expectancy brought about by better health care. Despite this increase in the incidence of neurodegenerative diseases, there has been a dearth in the introduction of new disease-modifying therapies that are approved to prevent or delay the onset of these diseases, or reverse the degenerative processes in brain. Mounting evidence in the peer-reviewed literature shows that the etiopathology of these diseases is extremely complex and heterogeneous, resulting in significant comorbidity and therefore unlikely to be mitigated by any drug acting on a single pathway or target. A recent trend in drug design and discovery is the rational design or serendipitous discovery of novel drug entities with the ability to address multiple drug targets that form part of the complex pathophysiology of a particular disease state. In this review we discuss the rationale for developing such multifunctional drugs (also called designed multiple ligands or DMLs), and why these drug candidates seem to offer better outcomes in many cases compared to single-targeted drugs in pre-clinical studies for neurodegenerative diseases such as Alzheimer's and Parkinson's disease. Examples are drawn from the literature of drug candidates that have already reached the market, some unsuccessful attempts, and others that are still in the drug development pipeline. Copyright © 2011. Published by Elsevier Ltd.
Devchand, Chandrashekar; Fairlie, David; Nuyts, Jean; Weingart, Gregor
The ternary commutator or ternutator, defined as the alternating sum of the product of three operators, has recently drawn much attention as an interesting structure generalizing the commutator. The ternutator satisfies cubic identities analogous to the quadratic Jacobi identity for the commutator. We present various forms of these identities and discuss the possibility of using them to define ternary algebras.
Chefetz, Richard A
The identified "problem self-state" in a dissociative disorder consultation is like the identified patient in a family therapy; the one who is identified may have an assigned role to be blamed which serves the function of deflecting the activities of painful self-states in other family members. In consultation, the "family" includes the therapist in addition to the patient. When the state identified as a problem self-state is an abuser/protector self-state, complications often involve the profound nature of transference-countertransference enactments between patient and therapist, the delusion of separateness, chronic and acute threats of suicide, negative therapeutic reactions, and the evocation of intense negativity. They also involve affect phobia in both patient and therapist, and the emergence of intense shame in the clinical dyad amongst additional potential burdens in these complicated treatments. The task of the consultant is to protect both patient and therapist from an untoward outcome while relieving the painful burdens entailed by the treatment. The typical core dynamic of the abuser/protector state is as a repository for shame/humiliation welded to anger/rage. This dynamic, and others, must be understood in order to resolve these impasses and create useful movement toward growth in both patient and therapist.
Becker, Anne E
Although the relationship between media exposure and risk behavior among youth is established at a population level, the specific psychological and social mechanisms mediating the adverse effects of media on youth remain poorly understood. This study reports on an investigation of the impact of the introduction of television to a rural community in Western Fiji on adolescent ethnic Fijian girls in a setting of rapid social and economic change. Narrative data were collected from 30 purposively selected ethnic Fijian secondary school girls via semi-structured, open-ended interviews. Interviews were conducted in 1998, 3 years after television was first broadcast to this region of Fiji. Narrative data were analyzed for content relating to response to television and mechanisms that mediate self and body image in Fijian adolescents. Data in this sample suggest that media imagery is used in both creative and destructive ways by adolescent Fijian girls to navigate opportunities and conflicts posed by the rapidly changing social environment. Study respondents indicated their explicit modeling of the perceived positive attributes of characters presented in television dramas, but also the beginnings of weight and body shape preoccupation, purging behavior to control weight, and body disparagement. Response to television appeared to be shaped by a desire for competitive social positioning during a period of rapid social transition. Understanding vulnerability to images and values imported with media will be critical to preventing disordered eating and, potentially, other youth risk behaviors in this population, as well as other populations at risk.
Steingrimsdottir, Hanna Steinunn; Arntzen, Erik
Within-participant research designs are frequently used within the field of behavior analysis to document changes in behavior before, during, and after treatment. The purpose of the present article is to show the utility of within-participant research designs when working with older adults with neurocognitive disorders. The reason for advocating for these types of experimental designs is that they provide valid information about whether the changes that are observed in the dependent variable are caused by manipulations of the independent variable, or whether the change may be due to other variables. We provide examples from published papers where within-participant research design has been used with patients with neurocognitive disorders. The examples vary somewhat, demonstrating possible applications. It is our suggestion that the within-participant research design may be used more often with the targeted client group than is documented in the literature at the current date.
Mäläskä, Minna; Jones, Richard Ian
Purpose: To study the emergence of corporate brand identity in SMEs and to develop a typology of brand identity drivers that reflects a co-creative approach to the emergence of brand identity. Design / Methodology / Approach : Existing approaches to brand identity are summarised. A narrative...... studies. The research is important since it suggests an iterative and co-creative approach to brand identity. A typology of brand identity formation for SMEs is presented: entrepreneur driven, market driven, stakeholder driven. Practical implications: The three paths to creating a strong brand identity...... challenge existing notions that brand identity is based solely on the values of the entrepreneur. This typology suggests that SMEs should be open to creating an identity that draws from their stakeholder eco-system. Originality / value: this research challenges the existing assumption that brand identity...
Purpose: To examine philosophical stances underpinning medical identity and assess the conceptual relationship between physician, medical practice and culture. Argument: Medical identity is about the ideals and moral positions that physicians take when justifying themselves. Medical identity...... hedonistic versus sentimentalist approaches to medical identity. The sociocultural philosophical analysis of medical identity can shed light on what it means conceptually for a physician to harbor beliefs associated with him/her being taken to be an autonomous professional. It is important because it touches...... on the meaning of being a compassionate, good and skilled physician, making its relevance to person-centered medicine self-evident. Conclusion: Medical identity should be analyzed with reference to literature, philosophy and medical practice in order for the physician to exercise a reflective position...
Full Text Available The article considers paradoxical nature of identity that emerges from: 1 the very concept of identity whose abstract generality unites various and even opposite features; 2 the processual nature of reality that is easier to express in the poetical metaphors or abstract principles than in unambiguous conceptual networks; 3 the oppose relationship between being and knowledge, mind and matter, subject and object, self and personality. Entangled in the labyrinth which evade efforts to be conceptually defined, the modern thinking of identity moves towards abandoning the idea of “self” on behalf of the “ego” and towards the misapprehension of identity as being identical. This corresponds to the “time of the lost spirit” stretched between the simultaneous need to find an identity and to give it up.
Patients with the controversial diagnosis of body integrity identity disorder (BIID) report an emotional discomfort with having a body part (usually a limb) that they feel should not be there. This discomfort is so strong that it interferes with routine functioning and, in a majority of cases, BIID patients are motivated to seek amputation of the limb. Although patient requests to receive the best available treatment are generally respected, BIID demands for amputation, at present, are not. However, what little has been said in the ethics literature on the subject tends to favour doing so in cases of BIID. The general argument is that BIID demands should be respected, first, because of the importance that is already placed on respecting autonomy in medical decision-making contexts and second, because of the potential harm of not providing amputation coupled with the fact that no alternative means of relieving suffering exists. The defence of the right to self-demanded amputation is thus typically supported by the use of analogies with other unproblematical cases in order to show that the denial of BIID patient demands is inconsistent with conventional medical norms and practices. This paper criticises the appropriateness of the particular analogies that are thought to shed light on the allegedly unproblematical nature of BIID demands and argues that a proper understanding of the respect for autonomy in the medical decision-making context prohibits agreeing to BIID demands for amputation.
Jensen, Lilli Kirkeskov; Rytter, Søren; Bonde, Jens Peter
Previous studies have described an increased risk of developing tibio-femoral osteoarthritis (TF OA), meniscal tears and bursitis among those with a trade as floor layers. The purpose of this study was to analyse symptomatic knee disorders among floor layers that were highly exposed to kneeling w...... work tasks compared to graphic designers without knee-demanding work tasks....
Social Security Administration — Provides information for identity management services on the creation, modification and eventual deletion of accounts and entitlements based on user relationships on...
Horn, Line Helverskov
The study aims at exploring how identity is enacted within the context of a two-year programme in Service, Hospitality, and Tourism Management (SHTM). This research thus investigates how students and educators go about their daily lives in different educational contexts both on and off campus...... as a contribution to the body of literature of ANT-based studies. Second, it contributes to existing identity theories by exemplifying a socio-material approach to identity issues. Third, the study enables reflections upon how educational institutions as fundamentally identity-producing organisations acknowledge...
Petersen, Lars Axel
In this paper I will go through a catalogue of examples of contexts in which the term civil identity is currently used, ranging from the formal and technical process of linking a set of administrative and other events to an individual biological person by means of identity cards, fingerprints, iris...... of Israel to Luce Irigaray's Feminist agenda of elaborating gender specific civil identities. My intention is to investigate whether these different employments of 'civil identity' point towards a common, and fairly well defined object field asking questions of contemporary relevance to the philosophy...
Wade, Mark; Prime, Heather; Madigan, Sheri
Neurodevelopmental disorders represent a broad class of childhood neurological conditions that have a significant bearing on the wellbeing of children, families, and communities. In this review, we draw on evidence from two common and widely studied neurodevelopmental disorders-autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD)-to demonstrate the utility of genetically informed sibling designs in uncovering the nature and pathogenesis of these conditions. Specifically, we examine how twin, recurrence risk, and infant prospective tracking studies have contributed to our understanding of genetic and environmental liabilities towards neurodevelopmental morbidity through their impact on neurocognitive processes and structural/functional neuroanatomy. It is suggested that the siblings of children with ASD and ADHD are at risk not only of clinically elevated problems in these areas, but also of subthreshold symptoms and/or subtle impairments in various neurocognitive skills and other domains of psychosocial health. Finally, we close with a discussion on the practical relevance of sibling designs and how these might be used in the service of early screening, prevention, and intervention efforts that aim to alleviate the negative downstream consequences associated with disorders of neurodevelopment.
Deaux, Kay; Burke, Peter
Sociology and psychology are no strangers in the theoretical world of self and identity. Early works by William James (1890), a psychologist, and George Herbert Mead (1934), a sociologist, are often taken as a starting point by investigators in both fields. In more recent years, with the development of a number of identity theories in both fields,…
Instead of differentiating themselves by building "brand identities," colleges and universities often focus on competing with price. As a result, fewer and fewer institutions base their identities on value, the combination of quality and price. Methods of building two concepts to influence customers' brand image and brand loyalty are…
van der Beek, Suzanne
Rituals are often used as opportunities for self-reflection and identity construction. The Camino to Santiago de Compostela, which has become a singularly popular pilgrimage since the late 1980s, is an example of a ritual that is explicitly used to gain a deeper understanding of one’s identity
Hatch, Mary Jo; Schultz, Majken
This text presents the classic works on organizational identity alongside more current thinking on the issues. Ranging from theoretical contributions to empirical studies, the readings in this volume address the key issues of organizational identity, and show how these issues have developed through...
Identity is a keyword in a number of academic fields as well as in public debate and in politics. During the last decades, references to identity have proliferated, yet there is no simple definition available that corresponds to the use of the notion in all contexts. The significance of the notion...
Background Improper workstation, work procedures and tools are found to be the risk factors for the development of musculoskeletal disorders among the informal sector workers of the developing countries. Low cost ergonomic interventions can effectively improve such adverse conditions. Case presentation In the present article some studies related to design interventions in different informal and agricultural sectors were discussed and their efficacies were analyzed. It was observed that with the help of appropriate interventions musculoskeletal disorders were reduced, adverse physiological conditions were improved when awkward postures were corrected and ultimately the organisational productivity was increased. Conclusion Proper implementation of ergonomic interventions can ultimately improve the economy of the nation. PMID:25009740
We dress to communicate who we are, or who we would like others to think we are, telling seductive fashion narratives through our adornment. Yet, today, fashion has been democratized through high-low collaborations, social media and real-time fashion mediation, complicating the basic dynamic...... of identity displays, and creating tension between personal statements and social performances. Fashioning Identity explores how this tension is performed through fashion production and consumption,by examining a diverse series of case studies - from ninety-year old fashion icons to the paradoxical rebellion...... by readdressing Fred Davis' seminal concept of 'identity ambivalence' in Fashion, Culture and Identity (1992), Mackinney-Valentin argues that we are in an epoch of 'status ambivalence', in which fashioning one's own identity has become increasingly complicated....
Burdick, Katherine E.; Ketter, Terence A.; Goldberg, Joseph F.; Calabrese, Joseph R.
OBJECTIVE Neurocognitive impairment in schizophrenia has been recognized for more than a century. In contrast, only recently have significant neurocognitive deficits been recognized in bipolar disorder. Converging data suggest the importance of cognitive problems in relation to quality of life in bipolar disorder, highlighting the need for treatment and prevention efforts targeting cognition in bipolar patients. Future treatment trials targeting cognitive deficits will be met with methodological challenges due to the inherent complexity and heterogeneity of the disorder, including significant diagnostic comorbidities, the episodic nature of the illness, frequent use of polypharmacy, cognitive heterogeneity, and a lack of consensus regarding measurement of cognition and outcome in bipolar patients. Guidelines for use in designing future trials are needed. PARTICIPANTS The members of the consensus panel (each of the bylined authors) were selected based upon their expertise in bipolar disorder. Dr. Burdick is a neuropsychologist who has studied cognition in this illness for 15 years; Drs. Ketter, Calabrese, and Goldberg each bring considerable expertise in the treatment of bipolar disorder both within and outside of controlled clinical trials. This consensus statement was derived from work together at scientific meetings (e.g. symposium presention at the 2014 Annual meeting of the American Society of Clinical Psychopharmacology, among others) and ongoing discussions by conference call. With the exception of the public presentations on this topic, these meetings were closed to outside participants. EVIDENCE A literature review was undertaken by the authors to identify illness-specific challenges relevant to the design and conduct of treatment trials targeting neurocognition in bipolar disorder. Expert opinion from each of the authors guided the consensus recommendations. CONSENSUS PROCESS Consensus recommendations, reached by unanimous opinion of the authors, are
Hensler, Stefanie; Herren, Daniel B; Marks, Miriam
Opening packaged food is a complex daily activity carried out worldwide. Peelable packaging, as used for cheese or meat, causes real problems for many consumers, especially elderly people and those with hand disorders. Our aim was to investigate the possibility of producing meat packaging that is easier for patients with hand disorders to open. One hundred patients with hand osteoarthritis were asked to open a meat package currently available in supermarkets (Type A) and a modified, newly designed version (Type B), and rate their experiences with a consumer satisfaction index (CSI). The mean CSI of the Type B packs was 68.9%, compared with 41.9% for Type A (p food packages that afford greater consumer satisfaction. Such future packaging would benefit not only people with hand disorders but also the population as a whole. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.
Chowdhury, Tanvir K; Chowdhury, Md Zonaid; Mili, Fahmida; Hutson, John M; Banu, Tahmina
In developing countries like Bangladesh, delayed presentation for disorders of sex development (DSD) is common, and provides some special problems for management. There remains significant controversy about appropriate sex assignment in this group. We aimed, therefore, to assess gender identity (GI) in 50 consecutive patients with DSD presenting to a referral centre in Chittagong, Bangladesh, and correlate it with Prader score, to see if the latter could be used to predict GI. A cross-sectional, case-control study of 50 consecutive children with DSD and 50 children with vascular anomalies was conducted in the Pediatric Surgical Clinic, Chittagong Medical College and Hospital. After informed consent, patients and controls provided oral answers to a GI questionnaire and had a detailed history and physical examination. Sex-typed activities were assessed by observations of a structured toy play and the child's selection of a toy to keep. Both patients and parents then completed the Child Game Participation Questionnaire. There were no differences in age (2-16 years, mean 8.74) between controls and DSD patients (11 46, XX DSD, 32 46, XY DSD, 4 MGD, 3 ovo-testicular DSD). Fifteen of the DSD patients (30 %) came from consanguineous marriages and only 2 of the control patients had consanguinity of their parents. For the 13-question GI interview, there was no overall difference between DSD cases and controls. For the 46, XX DSD subgroup, there was a significantly higher score (11.1 ± 7.1) compared with control girls (4.5 ± 4.7) (p gender-related behaviour correlated with Prader score for DSD patients (r = 0.61) (p gender-role behaviour should be assessed routinely in DSD patients presenting after the neonatal period, so that sex assignment is in accordance with behaviour. Prader scores showed a good correlation with GI and gender role behaviour.
This paper introduces identity management concepts and discusses various issues associated with its implementation. It will try to highlight technical, legal, and social aspects that must been foreseen when defining the numerous processes that an identity management infrastructure must support. Grid interoperability as well as cross platform interoperability is addressed on the technical aspect, followed by a short discussion on social consequences on userâs privacy when completed traceability is enforced and some examples on how identity management has been implemented at CERN
Pace, A [CERN, Geneva (Switzerland)
This paper introduces identity management concepts and discusses various issues associated with their implementation. It will try to highlight technical, legal, and social aspects that must been foreseen when defining the numerous processes that an identity management infrastructure must support. Grid interoperability as well as cross platform interoperability is addressed on the technical aspect, followed by a short discussion on social consequences on user's privacy when completed traceability is enforced. The paper will finally give some examples on how identity management has been implemented at CERN.
This paper introduces identity management concepts and discusses various issues associated with their implementation. It will try to highlight technical, legal, and social aspects that must been foreseen when defining the numerous processes that an identity management infrastructure must support. Grid interoperability as well as cross platform interoperability is addressed on the technical aspect, followed by a short discussion on social consequences on user's privacy when completed traceability is enforced. The paper will finally give some examples on how identity management has been implemented at CERN
de Andrade, Norberto Nuno Gomes; Argles, David
With the increasing availability of electronic services, security and a reliable means by which identity is verified is essential.Written by Norberto Andrade the first chapter of this book provides an overview of the main legal and regulatory aspects regarding electronic identity in Europe and assesses the importance of electronic identity for administration (public), business (private) and, above all, citizens. It also highlights the role of eID as a key enabler of the economy.In the second chapter Lisha Chen-Wilson, David Argles, Michele Schiano di Zenise and Gary Wills discuss the user-cent
Olivardia, R; Pope, H G; Mangweth, B; Hudson, J I
This study was designed to assess the characteristics of men with eating disorders in the community. The authors recruited 25 men meeting DSM-IV criteria for eating disorders and 25 comparison men through advertisements in college newspapers. A second comparison group comprised 33 women with bulimia nervosa who were recruited and interviewed with virtually identical methods. The men with eating disorders closely resembled the women with eating disorders but differed sharply from the comparison men in phenomenology of illness, rates of comorbid psychiatric disorders, and dissatisfaction with body image. Homosexuality did not appear to be a common feature of men with eating disorders in the community. Childhood physical and sexual abuse appeared slightly more common among the eating-disordered men than among the comparison men. Eating disorders, although less common in men than in women, appear to display strikingly similar features in affected individuals of the two genders.
Full Text Available Neurodevelopmental disorders represent a broad class of childhood neurological conditions that have a significant bearing on the wellbeing of children, families, and communities. In this review, we draw on evidence from two common and widely studied neurodevelopmental disorders—autism spectrum disorder (ASD and attention-deficit hyperactivity disorder (ADHD—to demonstrate the utility of genetically informed sibling designs in uncovering the nature and pathogenesis of these conditions. Specifically, we examine how twin, recurrence risk, and infant prospective tracking studies have contributed to our understanding of genetic and environmental liabilities towards neurodevelopmental morbidity through their impact on neurocognitive processes and structural/functional neuroanatomy. It is suggested that the siblings of children with ASD and ADHD are at risk not only of clinically elevated problems in these areas, but also of subthreshold symptoms and/or subtle impairments in various neurocognitive skills and other domains of psychosocial health. Finally, we close with a discussion on the practical relevance of sibling designs and how these might be used in the service of early screening, prevention, and intervention efforts that aim to alleviate the negative downstream consequences associated with disorders of neurodevelopment.
Frederiksen, Signe Hedeboe
Entrepreneurship education theory and practice show increasing interest in identity work as an important part of entrepreneurial learning. Entrepreneurship programs become identity workspaces where pedagogical designs stimulate entrepreneurial identity work and support individuals’ discovery...... of themselves as entrepreneurs. This article investigates how entrepreneurship education is practiced as an identity workspace, when reflective identity work is turned into a pedagogical strategy for entrepreneurial learning. I present empirical data from a qualitative fieldstudy in an eleven week mandatory...... and identities. Exposed to identity work practices in class, learners experienced conflicting demands participating as succesful students and participating as potential entrepreneurs. The study draws attention to how an education setting contextualises identity work as a social practice. It critisises...
Full Text Available With the intensification of neoliberalism, it is useful to examine how some individuals might cope with the irrationality of the system. Neoliberalism cloaks the execution of the corporate agenda behind rhetorical manipulation that advocates for limited government. The corollary absence of government involvement on behalf of the citizenry writ large disarms the means of social redress for the individual. Democracy funded and fueled by corporate power thereby disenfranchises the individual, provoking some to search for empowerment through identity politics. The argument set forth suggests that individuals construct, reinforce, or escalate allegiance to identities as a coping mechanism, some of which manifest in violent identity politics.
Crawford, Megan R; Turner, Arlener D; Wyatt, James K; Fogg, Louis F; Ong, Jason C
Chronic insomnia disorder is a prevalent condition and a significant proportion of these individuals also have obstructive sleep apnea (OSA). These two sleep disorders have distinct pathophysiology and are managed with different treatment approaches. High comorbidity rates have been a catalyst for emerging studies examining multidisciplinary treatment for OSA comorbid with insomnia disorder. In this article, we describe a randomized clinical trial of cognitive behavioral treatment for insomnia (CBT-I) and positive airway pressure (PAP) for OSA. Participants are randomized to receive one of three treatment combinations. Individuals randomized to treatment Arm A receive sequential treatment beginning with CBT-I followed by PAP, in treatment Arm B CBT-I and PAP are administered concurrently. These treatment arms are compared to a control condition, treatment Arm C, where individuals receive PAP alone. Adopting an incomplete factorial study design will allow us to evaluate the efficacy of multidisciplinary treatment (Arms A & B) versus standard treatment alone (Arm C). In addition, the random allocation of individuals to the two different combined treatment sequences (Arm A and Arm B) will allow us to understand the benefits of the sequential administration of CBT-I and PAP relative to concurrent treatment of PAP and CBT-I. These findings will provide evidence of the clinical benefits of treating insomnia disorder in the context of OSA. Copyright © 2016 Elsevier Inc. All rights reserved.
Mohammadi, Mohammad Reza; Salmanian, Maryam; Ghobari-Bonab, Bagher; Bolhari, Jafar
Objective: Spiritual psychotherapy has been conceptualized in the context of love and belief as principles of existence. Spiritual psychotherapy can provide an opportunity to design programs to treat conduct disorder. The aim of this study was to introduce the Spiritual Psychotherapy Package for Adolescents with Conduct Disorder and execute it as a pilot study. Method: The intervention is a manual-guided program conducted over 14 group sessions, using the perspectives of object relations and attachment approach. It was executed for a group of eight adolescent boys with conduct disorder (mean age: 17.01 years) at Tehran reformatory. The Aggression Questionnaire and the Attachment to God Inventory were completed pre- and post-intervention. Results: There were no significant differences in outcome measures from pre- to post- intervention. Cohen's dav was applied to estimate the measure of the effect size in this study. Cohen's dav measures of avoidance and anxious attachment to God showed acceptable effect sizes. However, Cohen's dav measure of verbal aggression indicated a small effect size. Conclusion: We found evidence indicating acceptability of spiritual psychotherapy among adolescents with conduct disorder in attachment to God.
Schlumpf, Yolanda R; Nijenhuis, Ellert R S; Chalavi, Sima; Weder, Ekaterina V; Zimmermann, Eva; Luechinger, Roger; La Marca, Roberto; Reinders, A A T Simone; Jäncke, Lutz
The Theory of Structural Dissociation of the Personality (TSDP) proposes that dissociative identity disorder (DID) patients are fixed in traumatic memories as "Emotional Parts" (EP), but mentally avoid these as "Apparently Normal Parts" of the personality (ANP). We tested the hypotheses that ANP and EP have different biopsychosocial reactions to subliminally presented angry and neutral faces, and that actors instructed and motivated to simulate ANP and EP react differently. Women with DID and matched healthy female actors (CON) were as ANP and EP (DIDanp, DIDep, CONanp, CONep) consecutively exposed to masked neutral and angry faces. Their brain activation was monitored using functional magnetic resonance imaging. The black-and-white dotted masks preceding and following the faces each had a centered colored dot, but in a different color. Participants were instructed to immediately press a button after a perceived color change. State anxiety was assessed after each run using the STAI-S. Final statistical analyses were conducted on 11 DID patients and 15 controls for differences in neural activity, and 13 DID patients and 15 controls for differences in behavior and psychometric measures. Differences between ANP and EP in DID patients and between DID and CON in the two dissociative parts of the personality were generally larger for neutral than for angry faces. The longest reaction times (RTs) existed for DIDep when exposed to neutral faces. Compared to DIDanp, DIDep was associated with more activation of the parahippocampal gyrus. Following neutral faces and compared to CONep, DIDep had more activation in the brainstem, face-sensitive regions, and motor-related areas. DIDanp showed a decreased activity all over the brain in the neutral and angry face condition. There were neither significant within differences nor significant between group differences in state anxiety. CON was not able to simulate genuine ANP and EP biopsychosocially. DID patients have dissociative
Tanti, Chris; Stukas, Arthur A; Halloran, Michael J; Foddy, Margaret
This study investigated the proposition that adolescence involves significant shifts in social identity as a function of changes in social context and cognitive style. Using an experimental design, we primed either peer or gender identity with a sample of 380 early- (12-13 years), mid- (15-16 years), and late-adolescents (18-20 years) and then measured the effect of the prime on self-stereotyping and ingroup favouritism. The findings showed significant differences in social identity across adolescent groups, in that social identity effects were relatively strong in early- and late-adolescents, particularly when peer group identity rather than gender identity was salient. While these effects were consistent with the experience of change in educational social context, differences in cognitive style were only weakly related to ingroup favouritism. The implications of the findings for theory and future research on social identity during adolescence are discussed. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.
Lizotte, Todd E.; Ohar, Orest P.; Tuttle, Tracie
Performance of diffractive optics is determined by high-quality design and a suitable fabrication process that can actually realize the design. Engineers who are tasked with developing or implementing a diffractive optic solution into a product need to take into consideration the risks of using grayscale versus binary fabrication processes. In many cases, grayscale design doesn't always provide the best solution or cost benefit during product development. This fabrication dilemma arises when the engineer has to select a source for design and/or fabrication. Engineers come face to face with reality in view of the fact that diffractive optic suppliers tend to provide their services on a "best effort basis". This can be very disheartening to an engineer who is trying to implement diffractive optics. This paper will compare and contrast the design and performance of a 1 to 24 beam, two dimensional; beam splitter fabricated using a fifty (50) phase level grayscale and a five (5) phase level binary fabrication methods. Optical modeling data will be presented showing both designs and the performance expected prior to fabrication. An overview of the optical testing methods used will be discussed including the specific test equipment and metrology techniques used to verify actual optical performance and fabricated dimensional stability of each optical element. Presentation of the two versions of the splitter will include data on fabrication dimensional errors, split beam-to-beam uniformity, split beam-to-beam spatial size uniformity and splitter efficiency as compared to the original intended design performance and models. This is a continuation of work from 2005, Laser Beam Shaping VI.
McHugo, G J; Kammerer, N; Jackson, E W; Markoff, L S; Gatz, M; Larson, M J; Mazelis, R; Hennigan, K
The Women, Co-occurring Disorders, and Violence Study (WCDVS) was a multi-site cooperative study to evaluate new service models for women with co-occurring mental health and substance use disorders and a history of physical and/or sexual abuse. Despite common features in the service interventions and evaluation procedures, diversity across the nine sites plus differences introduced by non-random assignment led to numerous methodological challenges. This article describes the design, measurement, and analysis decisions behind the WCDVS and lays the foundation for understanding participant-level outcomes and service costs. This article also describes the study population, as recruited and following attrition at the 6-month follow-up, in order to address the threat of selection bias to inferences drawn from this multi-site study.
Basu, Sankar; Mukharjee, Debasish
There has been considerable debate about the contribution of salt bridges to the stabilization of protein folds, in spite of their participation in crucial protein functions. Salt bridges appear to contribute to the activity-stability trade-off within proteins by bringing high-entropy charged amino acids into close contacts during the course of their functions. The current study analyzes the modes of association of salt bridges (in terms of networks) within globular proteins and at protein-protein interfaces. While the most common and trivial type of salt bridge is the isolated salt bridge, bifurcated salt bridge appears to be a distinct salt-bridge motif having a special topology and geometry. Bifurcated salt bridges are found ubiquitously in proteins and interprotein complexes. Interesting and attractive examples presenting different modes of interaction are highlighted. Bifurcated salt bridges appear to function as molecular clips that are used to stitch together large surface contours at interacting protein interfaces. The present work also emphasizes the key role of salt-bridge-mediated interactions in the partial folding of proteins containing long stretches of disordered regions. Salt-bridge-mediated interactions seem to be pivotal to the promotion of "disorder-to-order" transitions in small disordered protein fragments and their stabilization upon binding. The results obtained in this work should help to guide efforts to elucidate the modus operandi of these partially disordered proteins, and to conceptualize how these proteins manage to maintain the required amount of disorder even in their bound forms. This work could also potentially facilitate explorations of geometrically specific designable salt bridges through the characterization of composite salt-bridge networks. Graphical abstract ᅟ.
in reaction to their environment. They reflect an individual’s internal or external, conscious or subconscious , overt or covert, voluntary or...identity activities under a range of legal authorities, policy constraints, transnational threats, regional concerns and biases , and most likely...Biography. A baseline and descriptive analytic product that supports the development of the behavioral influences analysis ( BIA ) individual behavioral
"A new survey by the Federal Trade Commission indicates that over the last five years one in four American households has been hit by identity theft, which can result in thieves tapping their victims' credit cards or bank accounts" (1 page).
depends on the conceptual or ideological constellation in which it takes part. This volume on one hand demonstrates the role of notions of identity in a variety of European contexts, and on the other hand highlights how there may be reasons to challenge the use of the term and corresponding social...
Maheswaran, Muthucumaru; Ali, Bader; Ozguven, Hatice; Lord, Julien
Online identities play a critical role in the social web that is taking shape on the Internet. Despite many technical proposals for creating and managing online identities, none has received widespread acceptance. Design and implementation of online identities that are socially acceptable on the Internet remains an open problem. This chapter discusses the interplay between online identities and social networking. Online social networks (OSNs) are growing at a rapid pace and has millions of members in them. While the recent trend is to create explicit OSNs such as Facebook and MySpace, we also have implicit OSNs such as interaction graphs created by email and instant messaging services. Explicit OSNs allow users to create profiles and use them to project their identities on the web. There are many interesting identity related issues in the context of social networking including how OSNs help and hinder the definition of online identities.
Nelson, Eric Derrand
This work describes the design and construction of an open source, entity resolution system that enables users to assign and maintain persistent identifiers for master data items. Two key features of this system that are not available in current ER systems and that make persistent identification possible are (1) The capture and management of…
Capobianco, Brenda M.; Yu, Ji H.; French, Brian F.
The integration of engineering concepts and practices into elementary science education has become an emerging concern for science educators and practitioners, alike. Moreover, how children, specifically preadolescents (grades 1-5), engage in engineering design-based learning activities may help science educators and researchers learn more about…
Topilina, Natalya I; Ermolenkov, Vladimir V; Sikirzhytski, Vitali; Higashiya, Seiichiro; Lednev, Igor K; Welch, John T
A de novo polypeptide GH(6)[(GA)(3)GY(GA)(3)GE](8)GAH(6) (YE8) has a significant number of identical weakly interacting beta-strands with the turns and termini functionalized by charged amino acids to control polypeptide folding and aggregation. YE8 exists in a soluble, disordered form at neutral pH but is responsive to changes in pH and ionic strength. The evolution of YE8 secondary structure has been successfully quantified during all stages of polypeptide fibrillation by deep UV resonance Raman (DUVRR) spectroscopy combined with other morphological, structural, spectral, and tinctorial characterization. The YE8 folding kinetics at pH 3.5 are strongly dependent on polypeptide concentration with a lag phase that can be eliminated by seeding with a solution of folded fibrillar YE8. The lag phase of polypeptide folding is concentration dependent leading to the conclusion that beta-sheet folding of the 11-kDa amyloidogenic polypeptide is completely aggregation driven.
Full Text Available Autoimmune disorders, that occur when autoreactive immune cells are induced to activate their responses against self-tissues, affect one percent of the world population and represent one of the top 10 leading causes of death. The major histocompatibility complex (MHC is a principal susceptibility locus for many human autoimmune diseases, in which self-tissue antigens providing targets for pathogenic lymphocytes are bound to HLA molecules encoded by disease-associated alleles. In spite of the attempts to design strategies for inhibition of antigen presentation targeting the MHC-peptide/TCR complex via generation of blocking antibodies, altered peptide ligands (APL, or inhibitors of costimulatory molecules, potent therapies with minimal side effects have yet to be developed. Copaxone (glatiramer acetate, GA is a random synthetic amino acid copolymer that reduces the relapse rate by about 30% in relapsing-remitting multiple sclerosis (MS patients. Based on the elucidated binding motifs of Copaxone and of the anchor residues of the immunogenic myelin basic protein (MBP peptide to HLA-DR molecules, novel copolymers have been designed and proved to be more effective in suppressing MS-like disease in mice. In this report, we describe the rationale for design of second-generation synthetic random copolymers as candidate drugs for a number of MHC class-II-associated autoimmune disorders.
Jung, Emanuel; Pick, Oliver; Schlüter-Müller, Susanne; Schmeck, Klaus; Goth, Kirstin
In the revision of the Diagnostic and Statistical Manual (DSM-5), "Identity" is an essential diagnostic criterion for personality disorders (self-related personality functioning) in the alternative approach to the diagnosis of personality disorders in Section III of DSM-5. Integrating a broad range of established identity concepts, AIDA (Assessment of Identity Development in Adolescence) is a new questionnaire to assess pathology-related identity development in healthy and disturbed adolescents aged 12 to 18 years. Aim of the present study is to investigate differences in identity development between adolescents with different psychiatric diagnoses. Participants were 86 adolescent psychiatric in- and outpatients aged 12 to 18 years. The test set includes the questionnaire AIDA and two semi-structured psychiatric interviews (SCID-II, K-DIPS). The patients were assigned to three diagnostic groups (personality disorders, internalizing disorders, externalizing disorders). Differences were analyzed by multivariate analysis of variance MANOVA. In line with our hypotheses, patients with personality disorders showed the highest scores in all AIDA scales with T>70. Patients with externalizing disorders showed scores in an average range compared to population norms, while patients with internalizing disorders lay in between with scores around T=60. The AIDA total score was highly significant between the groups with a remarkable effect size of f= 0.44. Impairment of identity development differs between adolescent patients with different forms of mental disorders. The AIDA questionnaire is able to discriminate between these groups. This may help to improve assessment and treatment of adolescents with severe psychiatric problems.
Tennant-Gadd, Laurie; Sansone, Kristina Lamour
Identity is the focus of the middle-school visual arts program at Cambridge Friends School (CFS) in Cambridge, Massachusetts. Sixth graders enter the middle school and design a personal logo as their first major project in the art studio. The logo becomes a way for students to introduce themselves to their teachers and to represent who they are…
Neergaard, Helle; Robinson, Sarah; Jones, Sally
, as well as the resources they have when they come to the classroom. It also incorporates perspectives from (ii) transformational learning and explores the concept of (iii) nudging from a pedagogical viewpoint, proposing it as an important tool in entrepreneurship education. The study incorporates......This paper develops the concept of ‘pedagogical nudging’ and examines four interventions in an entrepreneurship classroom and the potential it has for student identity transformation. Pedagogical nudging is positioned as a tool, which in the hands of a reflective, professional......) assists students in straddling the divide between identities, the emotions and tensions this elicits, and (iv) transform student understanding. We extend nudging theory into a new territory. Pedagogical nudging techniques may be able to unlock doors and bring our students beyond the unacknowledged...
Tanti, Chris; Stukas, Arthur A.; Halloran, Michael J.; Foddy, Margaret
This study investigated the proposition that adolescence involves significant shifts in social identity as a function of changes in social context and cognitive style. Using an experimental design, we primed either peer or gender identity with a sample of 380 early- (12-13 years), mid- (15-16 years), and late-adolescents (18-20 years) and then…
Full Text Available A defined and formed identity is the foundation of human mental functioning. The sense of one’s own existence as an individual, together with the conscious image of oneself, plays a fundamental role in regulating behaviors. The ability to see the limits of one’s own body is a significant milestone in human development, because it allows the development of a global sense of self, and that is the basis for the process of identifying one’s own identity.
Padula, Rosimeire Simprini; Comper, Maria Luiza Caires; Sparer, Emily H; Dennerlein, Jack T
To better understand job rotation in the manufacturing industry, we completed a systematic review asking the following questions: 1) How do job-rotation programs impact work-related musculoskeletal disorders (MSDs) and related risk control for these MSDs, as well as psychosocial factors? and 2) How best should the job rotation programs be designed? We searched MEDLINE, EMBASE, Business Source Premier, ISI Web of Knowledge, CINAHL, PsyINFO, Scopus, and SciELO databases for articles published in peer-reviewed journals. Eligible studies were examined by two independent reviewers for relevance (population of manufacturing workers, outcomes of musculoskeletal disorders, physical factors, psychosocial factors, and strategies used in job-rotation implantation) and methodological quality rating. From 10,809 potential articles, 71 were read for full text analysis. Of the 14 studies included for data extraction, two were non-randomized control trial studies, one was a case-control study, and 11 were cross-sectional comparisons. Only one, with a case-control design, was scored with good methodological quality. Currently, weak evidence exists supporting job rotation as a strategy for the prevention and control of musculoskeletal disorders. Job rotation did not appear to reduce the exposure of physical risk factors; yet, there are positive correlations between job rotation and higher job satisfaction. Worker training has been described as a crucial component of a successful job-rotation program. The studies reported a range of parameters used to implement and measure job-rotation programs. More rigorous studies are needed to better understand the full impact of job rotation on production and health. CRD42014013319. Copyright © 2016 Elsevier Ltd. All rights reserved.
van Asselt Thea
Full Text Available Abstract Background Schema Therapy (ST is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality disorders. Its effectiveness and efficiency have been demonstrated in a few randomized controlled trials, but ST has not been evaluated in regular mental healthcare settings. This paper describes the study protocol of a multisite randomized 2-group design, aimed at evaluating the implementation of outpatient schema therapy for patients with borderline personality disorder (BPD in regular mental healthcare and at determining the added value of therapist telephone availability outside office hours in case of crisis. Methods/Design Patient outcome measures will be assessed with a semi-structured interview and self-report measures on BPD, therapeutic alliance, quality of life, costs and general psychopathology at baseline, 6, 12, 18 and 36 months. Intention-to-treat analyses will be executed with survival analysis for dichotomous variables, and one-sample t-tests and ANCOVAs for continuous variables with baseline as covariate and condition as between group factor. All tests will be two-tailed with a significance level of 5%. Discussion The study will provide an answer to the question whether ST can be effectively implemented and whether phone support by the therapist has an additional value. Trial Registration The Dutch Cochrane Center, NTR (TC = 1781.
Li, Jin-rang; Sun, Yan-yan; Xu, Wen
To design a speech voice sample text with all phonemes in Mandarin for subjective auditory perceptual evaluation of voice disorders. The principles for design of a speech voice sample text are: The short text should include the 21 initials and 39 finals, this may cover all the phonemes in Mandarin. Also, the short text should have some meanings. A short text was made out. It had 155 Chinese words, and included 21 initials and 38 finals (the final, ê, was not included because it was rarely used in Mandarin). Also, the text covered 17 light tones and one "Erhua". The constituent ratios of the initials and finals presented in this short text were statistically similar as those in Mandarin according to the method of similarity of the sample and population (r = 0.742, P text were statistically not similar as those in Mandarin (r = 0.731, P > 0.05). A speech voice sample text with all phonemes in Mandarin was made out. The constituent ratios of the initials and finals presented in this short text are similar as those in Mandarin. Its value for subjective auditory perceptual evaluation of voice disorders need further study.
Cohen-Kettenis, PT; Owen, A; Kaijser, VG; Bradley, SJ; Zucker, KJ
This study examined demographic characteristics, social competence, and behavior problems in clinic-referred children with gender identity problems in Toronto, Canada (N = 358), and Utrecht, The Netherlands (N = 130). The Toronto sample was, on average, about a year younger than the Utrecht sample
Ke, Fengfeng; Lee, Sungwoong
This exploratory case study examined the process and potential impact of collaborative architectural design and construction in an OpenSimulator-based virtual reality (VR) on the social skills development of children with high-functioning autism (HFA). Two children with a formal medical diagnosis of HFA and one typically developing peer, aged…
Steensma, Thomas D; Kreukels, Baudewijntje P C; de Vries, Annelou L C; Cohen-Kettenis, Peggy T
This article is part of a Special Issue "Puberty and Adolescence".This article aims to provide an outline of what is currently known on trajectories, and contributing factors to gender identity development in adolescence. We give a historical overview of the concept of gender identity, and describe general identity development in adolescence, gender identity development in the general population and in gender variant youth. Possible psychosocial (such as child and parental characteristics) and biological factors (such as the effects of prenatal exposure to gonadal hormones and the role of genetics) contributing to a gender variant identity are discussed. Studies focusing on a number of psychosocial and biological factors separately, indicate that each of these factors influence gender identity formation, but little is known about the complex interplay between the factors, nor about the way individuals themselves contribute to the process. Research into normative and gender variant identity development of adolescents is clearly lagging behind. However, studies on persons with gender dysphoria and disorders of sex development, show that the period of adolescence, with its changing social environment and the onset of physical puberty, seems to be crucial for the development of a non-normative gender identity. Copyright © 2013 Elsevier Inc. All rights reserved.
Byun, Tara McAllister; Hitchcock, Elaine R.; Ferron, John
Purpose: Single-case experimental designs are widely used to study interventions for communication disorders. Traditionally, single-case experiments follow a response-guided approach, where design decisions during the study are based on participants' observed patterns of behavior. However, this approach has been criticized for its high rate of…
Kjærgaard, Annemette Leonhardt; Morsing, Mette; Ravasi, Davide
This paper reports a longitudinal field study on the effects of positive media coverage on the reconstruction of organizational identity. The study highlights how intense positive coverage – to the point of turning an organization into a ‘celebrity’– influences both the way members understand...... their organization (sensemaking effect) and the gratification they derive from its positive representation (self-enhancement effect). Our findings suggest that positive media representations foster members' alignment around an emergent new understanding of what their organization is. Over time, however, celebrity...
Abstract The decision to go to war by the government of the day is assumed to be a decision taken on behalf of all citizens of the nation, conceived as a collective united by a harmony of interests. Yet in the case of the Iraq War, there is clearly no unified voice of support from the British people. There is division between the state and its citizens, and the latter also reflect the multilayered identities of an increasingly multicultural society. How do individuals displaying mu...
Creese, Sadie; Gibson-Robinson, Thomas; Goldsmith, Michael; Hodges, Duncan; Kim, Dee DH; Love, Oriana J.; Nurse, Jason R.; Pike, William A.; Scholtz, Jean
into account the difficulty of the inferences, allowing the user to consider different scenarios depending on the perceived resources of the attacker, or to prioritize lines of investigation. It also has a number of interesting visualizations that are designed to aid the user in understanding the model. The tool works by considering the inferences as a graph and runs various graph-theoretic algorithms, with some novel adaptations, in order to deduce various properties. Using the Model To help investigators exploit the model to perform identity attribution, we have developed the Identity Map visualization. For a user-provided set of known starting elements and a set of desired target elements for a given identity, the Identity Map generates investigative workflows as paths through the model. Each path consists of a series of elements and inferences between them that connect the input and output elements. Each path also has an associated confidence level that estimates the reliability of the resulting attribution. Identity Map can help investigators understand the possible ways to make an identification decision and guide them toward the data-collection or analysis steps required to reach that decision.
Pearcy, Benjamin T D; Roberts, Lynne D; McEvoy, Peter M
Internet Gaming Disorder (IGD) is in the early stages of recognition as a disorder, following its inclusion in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5; American Psychiatric Association(1)) as a condition for further study. Existing measures of Internet gaming pathology are limited in their ability to measure IGD as defined in the DSM-5. We present the initial development and validation of a new measure derived from the proposed DSM-5 criteria for IGD, the Personal Internet Gaming Disorder Evaluation-9 (PIE-9). A student sample (n = 119) and a community sample (n = 285), sourced through a variety of online gaming forums, completed an online survey comprising the new measure, existing measures of IGD, and a range of health and demographic questions. Exploratory and confirmatory factor analysis supported a single factor structure for the 9-item PIE-9. Internal consistency (α = 0.89) and test-retest reliability (intraclass correlation [ICC] = 0.77) were high. Convergent validity was demonstrated with similar gaming addiction measures. Predictive validity was established through significant differences in distress and disability between those who met the criteria for IGD and those who did not. The distress and disability associated with meeting IGD criteria fell within the range of other common DSM-5 disorders. Preliminary testing of the PIE-9 has demonstrated that it is an efficient and straightforward measure for use in further research of IGD, and as a potential screening measure in clinical practice.
Full Text Available Abstract Background Previous studies have described an increased risk of developing tibio-femoral osteoarthritis (TF OA, meniscal tears and bursitis among those with a trade as floor layers. The purpose of this study was to analyse symptomatic knee disorders among floor layers that were highly exposed to kneeling work tasks compared to graphic designers without knee-demanding work tasks. Methods Data on the Knee injury and Osteoarthritis Outcome Score (KOOS were collected by questionnaires. In total 134 floor layers and 120 graphic designers had a bilateral radiographic knee examination to detect TF OA and patella-femoral (PF OA. A random sample of 92 floor layers and 49 graphic designers had Magnetic Resonance Imaging (MRI of both knees to examine meniscal tears. Means of the subscales of KOOS were compared by analysis of variance. The risk ratio of symptomatic knee disorders defined as a combination of radiological detected knee OA or MRI-detected meniscal tears combined with a low KOOS score was estimated by logistic regression in floor layers with 95% confidence interval (CI and adjusted for age, body mass index, traumas, and knee-straining sports activities. Symptomatic knee OA or meniscal tears were defined as a combination of low KOOS-scores and radiographic or MRI pathology. Results Symptomatic TF and medial meniscal tears were found in floor layers compared to graphic designers with odds ratios 2.6 (95%CI 0.99-6.9 and 2.04 (95% CI 0.77-5.5, respectively. There were no differences in PF OA. Floor layers scored significantly lower on all KOOS subscales compared to graphic designers. Significantly lower scores on the KOOS subscales were also found for radiographic TF and PF OA regardless of trade but not for meniscal tears. Conclusions The study showed an overall increased risk of developing symptomatic TF OA in a group of floor layers with a substantial amount of kneeling work positions. Prevention would be appropriate to reduce the
Moulos, Ioannis; Maramis, Christos; Mourouzis, Alexandros; Maglaveras, Nicos
The recent immense diffusion of smartphones has significantly upgraded the role of mobile user interfaces in interventions that build and/or maintain healthier lifestyles. Indeed, high-quality, user-centered smartphone applications are able to serve as advanced front-ends to such interventions. These smartphone applications, coupled with portable or wearable sensors, are being employed for monitoring day to day health-related behaviors, including eating and physical activity. Some of them take one step forward by identifying unhealthy behaviors and contributing towards their modification. This work presents the design as well as the preliminary implementation of the mobile user interface of SPLENDID, a novel, sensor-oriented intervention for preventing obesity and eating disorders in young populations. This is implemented by means of an Android application, which is able to monitor the eating and physical activity behaviors of young individuals at risk for obesity and/or eating disorders, subsequently guiding them towards the modification of those behaviors that put them at risk. Behavior monitoring is based on multiple data provided by a set of communicating sensors and self-reported information, while guidance is facilitated through a feedback/encouragement provision and goal setting mechanism.
Full Text Available Communication difficulties are among the most frequent characteristics of children with autism spectrum disorders (ASD. Lack of communication can have a significant impact on the child’s life. Augmentative and alternative communication (AAC apps are a common form of AAC interventions that involve a combination of affordable technology with software that can be utilized to assist with communication. While AAC apps have been found to have some impact on improving the communication skills of children with ASD, current research exploring this topic is still limited. Focusing on the design process of AAC apps may provide better insight into improving clinical outcomes and user success. The user-centered design process incorporates a continuous cycle of user feedback to help inform and improve the functions and the capabilities of the technology, and it is an essential component in AAC app development. This article outlines how the user-centered design process could be adopted for the development of AAC apps for children with ASD.
Byron G. Adams
Full Text Available Orientation: This study explored strategies for identity work that are central to the negotiation and regulation of employee work identity.Research purpose: The main aim of this study was to explore employee narratives and identify the strategies available to them in the process of identity work, as they defined themselves at work.Motivation for the study: As there is a scarcity of research on identity work in South Africa, this study wanted to advance knowledge about identity work and the strategies used for regulating and negotiating an identity at work by exploring these constructs in this context.Research design, approach and method: A qualitative research process formed the basis for this study. Nineteen employees from a global manufacturing company participated in two semi-structured in-depth interviews. Grounded theory was applied to analyse and interpret the data.Main findings: Nine strategies for identity work were identified and categorised into four broad themes (personal philosophies; relationships; career management and negotiating balance.Practical/managerial implications: Employees followed various strategies for defining themselves at work and this may have some implications for employee work engagement and productivity.Contribution/value-add: This study expands on current theoretical knowledge of identity work, and provides insights into the strategies people use to regulate and negotiate their identities at work.
Full Text Available This paper shows the difference between a corporate identity and image, the defining elements of identity, a case study in the evolution of an existing company logo design but also an identity of a virtual company.
Barker, Alex B; Lincoln, Nadina B; Hunt, Nigel; dasNair, Roshan
Mood disorders are highly prevalent in people with multiple sclerosis (MS). MS causes changes to a person's sense of self. The Social Identity Model of Identity Change posits that group membership can have a positive effect on mood during identity change. The family is a social group implicated in adjustment to MS. The objectives of this study were to investigate whether family identity can predict mood in people with MS and to test whether this prediction was mediated by social support and connectedness to others. This cross-sectional survey of 195 participants comprised measures of family identity, family social support, connectedness to others, and mood. Family identity predicted mood both directly and indirectly through parallel mediators of family social support and connectedness to others. Family identity predicted mood as posited by the Social Identity Model of Identity Change. Involving the family in adjustment to MS could reduce low mood.
Chadwick, David W.
Abstract. This paper addresses the topic of federated identity management. It discusses in detail the following topics: what is digital identity, what is identity management, what is federated identity management, Kim Camerons 7 Laws of Identity, how can we protect the users privacy in a federated environment, levels of assurance, some past and present federated identity management systems, and some current research in FIM.
Dodder, R.S; Jones, E.F.; Hamilton, J.H.
Spontaneous fission of 252 Cm was studied with 72 large Compton suppressed Ge detectors in Gamma sphere. New isotopes 160 Sm and 162 Gd were identified. Through X-ray-γ and γ-γ-γ) coincidence measurements, level energies were established to spins 14 + to 20 + in 152 , 154 156 60 Nd 92 94 96 , 156 , 158 , 160 62 Sm 94 , 96 , 98 , and 160 , 162 64 Gd 96 , 98 . These nuclei exhibit a remarkable variety of identical bands and bands where the energies and moments of inertia are shifted by the same constant amount for every spin state from 2 + to 12 + for various combinations of nuclei differing by 2n, 4n, 2p, 4p, and α
Smith, Justin D.; Handler, Leonard; Nash, Michael R.
The Therapeutic Assessment (TA) model is a relatively new treatment approach that fuses assessment and psychotherapy. The study examines the efficacy of this model with preadolescent boys with oppositional defiant disorder and their families. A replicated single-case time-series design with daily measures is used to assess the effects of TA and to…
Wiley, Rachel E; Berman, Steven L
The purpose of this study was to examine the relationships of identity development and identity distress to psychological adjustment within adolescents affected by psychological problems. Participants included 88 adolescents (43.2% female) ranging from 11 to 20 years of age who were receiving services from a community mental health center. A high proportion of the participants (22.7%) met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision criteria for Identity Problem. Regression analyses found psychopathology symptom score was associated with identity distress, identity exploration, and identity commitment, while identity distress was only related to psychopathology symptom score and not the other two identity variables. Adolescents with a clinical diagnosis may report significant levels of identity distress. Given that the relationship between psychopathology and identity distress may be reciprocal, assessing for identity issues might be prudent when conducting clinical diagnostic interviews and useful in treatment planning. © 2013 Wiley Periodicals, Inc.
March John S
Full Text Available Abstract This paper presents the rationale, design, and methods of the Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II, which investigates two different cognitive-behavior therapy (CBT augmentation approaches in children and adolescents who have experienced a partial response to pharmacotherapy with a serotonin reuptake inhibitor for OCD. The two CBT approaches test a "single doctor" versus "dual doctor" model of service delivery. A specific goal was to develop and test an easily disseminated protocol whereby child psychiatrists would provide instructions in core CBT procedures recommended for pediatric OCD (e.g., hierarchy development, in vivo exposure homework during routine medical management of OCD (I-CBT. The conventional "dual doctor" CBT protocol consists of 14 visits over 12 weeks involving: (1 psychoeducation, (2, cognitive training, (3 mapping OCD, and (4 exposure with response prevention (EX/RP. I-CBT is a 7-session version of CBT that does not include imaginal exposure or therapist-assisted EX/RP. In this study, we compared 12 weeks of medication management (MM provided by a study psychiatrist (MM only with two types of CBT augmentation: (1 the dual doctor model (MM+CBT; and (2 the single doctor model (MM+I-CBT. The design balanced elements of an efficacy study (e.g., random assignment, independent ratings with effectiveness research aims (e.g., differences in specific SRI medications, dosages, treatment providers. The study is wrapping up recruitment of 140 youth ages 7–17 with a primary diagnosis of OCD. Independent evaluators (IEs rated participants at weeks 0,4,8, and 12 during acute treatment and at 3,6, and 12 month follow-up visits. Trial registration NCT00074815
Full Text Available Abstract Background Obesity is often comorbid with depression and individuals with this comorbidity fare worse in behavioral weight loss treatment. Treating depression directly prior to behavioral weight loss treatment might bolster weight loss outcomes in this population, but this has not yet been tested in a randomized clinical trial. Methods and design This randomized clinical trial will examine whether behavior therapy for depression administered prior to standard weight loss treatment produces greater weight loss than standard weight loss treatment alone. Obese women with major depressive disorder (N = 174 will be recruited from primary care clinics and the community and randomly assigned to one of the two treatment conditions. Treatment will last 2 years, and will include a 6-month intensive treatment phase followed by an 18-month maintenance phase. Follow-up assessment will occur at 6-months and 1- and 2 years following randomization. The primary outcome is weight loss. The study was designed to provide 90% power for detecting a weight change difference between conditions of 3.1 kg (standard deviation of 5.5 kg at 1-year assuming a 25% rate of loss to follow-up. Secondary outcomes include depression, physical activity, dietary intake, psychosocial variables and cardiovascular risk factors. Potential mediators (e.g., adherence, depression, physical activity and caloric intake of the intervention effect on weight change will also be examined. Discussion Treating depression before administering intensive health behavior interventions could potentially boost the impact on both mental and physical health outcomes. Trial registration NCT00572520
Willson, Rob; Veale, David; Freeston, Mark
Individuals with body dysmorphic disorder (BDD) often experience negative distorted images of their appearance, and research suggests these may be linked to memories of adverse events such as bullying or teasing. This study evaluates imagery rescripting (ImR) as an intervention for BDD. In this article, we present a multiple-baseline single-case experimental design testing imagery rescripting as a brief, stand-alone intervention, with six individuals with BDD that related to aversive memories. The impact of the intervention was assessed by self-reported daily measures of symptom severity (preoccupation with appearance, appearance-related checking behaviors, appearance-related distress, and strength of belief that their main problem is their appearance) and standardized clinician ratings of BDD severity (Yale-Brown Obsessive Compulsive Scale modified for BDD). Four out of six of the participants responded positively to the intervention, with clinically meaningful improvement in symptomatology. Overall response was rapid; improvements began within the first week post-ImR intervention. From a small sample it is cautiously concluded that imagery rescripting may show promise as a module in cognitive-behavioral therapy for BDD, and is worthy of further investigation. Copyright © 2015. Published by Elsevier Ltd.
Schneider, Kristin L; Bodenlos, Jamie S; Ma, Yunsheng; Olendzki, Barbara; Oleski, Jessica; Merriam, Philip; Crawford, Sybil; Ockene, Ira S; Pagoto, Sherry L
Obesity is often comorbid with depression and individuals with this comorbidity fare worse in behavioral weight loss treatment. Treating depression directly prior to behavioral weight loss treatment might bolster weight loss outcomes in this population, but this has not yet been tested in a randomized clinical trial. This randomized clinical trial will examine whether behavior therapy for depression administered prior to standard weight loss treatment produces greater weight loss than standard weight loss treatment alone. Obese women with major depressive disorder (N = 174) will be recruited from primary care clinics and the community and randomly assigned to one of the two treatment conditions. Treatment will last 2 years, and will include a 6-month intensive treatment phase followed by an 18-month maintenance phase. Follow-up assessment will occur at 6-months and 1- and 2 years following randomization. The primary outcome is weight loss. The study was designed to provide 90% power for detecting a weight change difference between conditions of 3.1 kg (standard deviation of 5.5 kg) at 1-year assuming a 25% rate of loss to follow-up. Secondary outcomes include depression, physical activity, dietary intake, psychosocial variables and cardiovascular risk factors. Potential mediators (e.g., adherence, depression, physical activity and caloric intake) of the intervention effect on weight change will also be examined. Treating depression before administering intensive health behavior interventions could potentially boost the impact on both mental and physical health outcomes. NCT00572520.
Full Text Available This study aims to design a training tool for therapy of children with autism spectrum disorder (ASDs. Typically, ASDs pass through obstacle track several times with sandbags, which should be picked up from starting point and threw into a box at the end during sensory integration therapy. Counting the sandbags can help ASDs to have concept about the progress of mission. We redesign the counting box named “Skybox” which can help counting by playing sound after detect something throw in it. Aims to probe into the sound preference of two main subjects, an experiment with four kinds of sounds is conducted in this paper by using the method of paired comparisons. The result shows they like animals most, followed by human voice and nature sounds, and music instrument is the last. The material preference experiment shows two subjects like acrylic most, wood and paper are secondary while furry is the last. Skybox shortens their training time for 23.53%, 29.87% and 37.37% in three different projects. We consider that Skybox attracts ASDs therefore reduces their distraction and improves their performance in the usability test.
Bhat, Shubha; Varambally, Shivarama; Karmani, Sneha; Govindaraj, Ramajayam; Gangadhar, B N
Some yoga-based practices have been found to be useful for patients with obsessive compulsive disorder (OCD). The authors could not find a validated yoga therapy module available for OCD. This study attempted to formulate a generic yoga-based intervention module for OCD. A yoga module was designed based on traditional and contemporary yoga literature. The module was sent to 10 yoga experts for content validation. The experts rated the usefulness of the practices on a scale of 1-5 (5 = extremely useful). The final version of the module was pilot-tested on patients with OCD (n = 17) for both feasibility and effect on symptoms. Eighty-eight per cent (22 out of 25) of the items in the initial module were retained, with modifications in the module as suggested by the experts along with patients' inputs and authors' experience. The module was found to be feasible and showed an improvement in symptoms of OCD on total Yale-Brown Obsessive-Compulsive Scale (YBOCS) score (p = 0.001). A generic yoga therapy module for OCD was validated by experts in the field and found feasible to practice in patients. A decrease in the symptom scores was also found following yoga practice of 2 weeks. Further clinical validation is warranted to confirm efficacy.
Bayu D. Wicaksono
Full Text Available Autism Spectrum Disorder (ASD is a term that used to explain neurological problems which affect mind, perception and concentration. The unfortunate condition of children with ASD lead more difficult to do long-distance communication, not only because of the lack of device that can be used exclusively by children with ASD (the physical as well as its interface, but also because of their general habits tends to destroy something in this case is a commercial cellphone. Identification of ASD children’s habit will be conducted by distributing questionnaires and interviews of the parties which are well acquainted with their daily activities such as parents and school teachers. To validate the questionnaire, has also been conducted ethnographic video capture. The design of cell phone’s prototype and dial & call software/application interface in it is done using the Quality Function Deployment (QFD method as the results have been obtained from the collection of data on the habits of ASD children. In addition, there is also made a sound maker app.
Kellett, Stephen; Hardy, Gillian
Paranoid personality disorder (PPD) presents as chronic and widespread interpersonal distrust, whereby the actions of others are interpreted as malevolent and malicious. This research details the assessment, formulation and treatment of a case of PPD within a 24-session contract of cognitive analytic therapy (CAT). The outcome methodology was an A/B with extended follow-up single case experimental design (SCED). The SCED was supplemented with qualitative patient interviewing via the Change Interview regarding their experience of CAT, whether change had taken place and detailing of any identified change mechanisms. Quantitative results show that five out of the six daily rated paranoia target complaint measures were extinguished during the treatment phase. Qualitatively, the patient attributed change to the therapy conducted. The results suggest that CAT was an effective intervention in this case of PPD and are discussed in terms of identified methodological shortcomings, treatment implications and the potential for generating a convincing evidence base for the psychotherapy of PPD. Narrative reformulation using a CAT model offers a key opportunity for the patient to achieve a new understanding of their paranoia. Psychotherapy for PPD requires a cognitive component, within a boundaried and relational therapy, that is able to reflect on paranoid enactments and ruptures within the therapeutic relationship.There is a large role for clinician-researchers in developing a PPD outcome evidence base. Copyright © 2013 John Wiley & Sons, Ltd.
Fornaro, Michele; Kardash, Lubna; Novello, Stefano; Fusco, Andrea; Anastasia, Annalisa; De Berardis, Domenico; Perna, Giampaolo; Carta, Mauro Giovanni
Bipolar disorder (BD) is a considerable burden to the affected individual. The need for novel drug targets and improved drug design (DD) in BD is therefore clear. Areas covered: The following article provides a brief, narrative, clinician-oriented overview of the most promising novel pharmacological targets for BD along with a concise overview regarding the general DD process and the unmet needs relevant to BD. Expert opinion: A number of novel potential drug targets have been investigated. With the notable exception of the kynurenine pathway, available evidence is too scarce to highlight a definitive roadmap for forthcoming DD in BD. BD itself may present with different facets, as it is a polymorphic clinical spectrum. Therefore, promoting clinical-case stratification should be based on precision medicine, rather than on novel biological targets. Furthermore, the full release of raw study data to the scientific community and the development of uniform clinical trial standards (including more realistic outcomes) should be promoted to facilitate the DD process in BD.
Autism spectrum disorders (ASD) are a group of developmental neuropsychiatric disorders, comprised of three diagnostic entities - autistic disorder (AD), Asperger's disorder (AS), and Pervasive Developmental Disorder Not Otherwise Specified (including atypical autism) (PDD-NOS). A number of intervention techniques are currently used to reduce some of the associated challenges, with techniques ranging from behavioral therapy to dietary interventions and traditional counseling. This positional paper proposes the use of video games which leverage affective computing technologies as intervention in autism spectrum disorders in the context of the use of traditional play therapy with adolescents, who may feel uncomfortable engaging in traditional play with toys they may be too old for. It aims to explore the potential for greater 'social physics' made possible by affective computing technologies. This involves computationally 'recognizing' emotions in a user, often through the use of multimodal affective sensors, including facial expressions, postural shifts, and physiological signals such as heart rate, skin conductivity, and EEG signals. However, it is suggested that this should be augmented by researching the effect of social game design mechanisms on social-emotional development, particularly for those who experience difficulty with social interaction.
Kilburn, Tina R; Sørensen, Merete Juul; Thastum, Mikael; Rapee, Ronald M; Rask, Charlotte Ulrikka; Arendt, Kristian Bech; Thomsen, Per Hove
Autism spectrum disorder (ASD) is found in approximately 1% of the population and includes core symptoms that affect general and social development. Beside these core symptoms, it is suggested that up to 60% of children with ASD suffer from comorbid anxiety disorders which may further affect educational, social and general development as well as quality of life. The main goal of this study is to examine the effectiveness of a manualized cognitive behavioral therapy (CBT) anxiety program adapted for children with ASD. This study is a randomized controlled trial (RCT). Fifty children with ASD and anxiety, aged 7 to 13 years, will be randomly assigned to group CBT or a wait-list control (WL) condition. The design will follow a two (CBT and WL) by two (pre-post assessment) mixed between-within design. The control group will receive intervention after the waitlist period of 13 weeks. Primary outcomes are diagnostic status and severity of the anxiety disorders, measured with The Anxiety Disorder Interview Schedule for DSM-IV, Parent and Child Versions. Secondary outcomes are parent and child ratings on questionnaires on the child's level of anxiety and impact on everyday life. Additional outcomes entail information gathered from parents, child and teachers on the child's behavior and negative self-statements, together with social and adaptive skills. Follow-up data will be collected 3 months after intervention. This study aims to evaluate the effectiveness of a manualized CBT program in Danish children with ASD and anxiety within a mental health clinic setting. The hypothesis is that training anxiety reduction skills will decrease anxiety in children, as well as ensure better psychosocial development for the child in general. https://ClinicalTrials.gov ( NCT02908321 ). Registered 19th of September 2016.
Wetzelaer, Pim; Farrell, Joan; Evers, Silvia M A A; Jacob, Gitta A; Lee, Christopher W; Brand, Odette; van Breukelen, Gerard; Fassbinder, Eva; Fretwell, Heather; Harper, R Patrick; Lavender, Anna; Lockwood, George; Malogiannis, Ioannis A; Schweiger, Ulrich; Startup, Helen; Stevenson, Teresa; Zarbock, Gerhard; Arntz, Arnoud
Borderline personality disorder (BPD) is a severe and highly prevalent mental disorder. Schema therapy (ST) has been found effective in the treatment of BPD and is commonly delivered through an individual format. A group format (group schema therapy, GST) has also been developed. GST has been found to speed up and amplify the treatment effects found for individual ST. Delivery in a group format may lead to improved cost-effectiveness. An important question is how GST compares to treatment as usual (TAU) and what format for delivery of schema therapy (format A; intensive group therapy only, or format B; a combination of group and individual therapy) produces the best outcomes. An international, multicentre randomized controlled trial (RCT) will be conducted with a minimum of fourteen participating centres. Each centre will recruit multiple cohorts of at least sixteen patients. GST formats as well as the orders in which they are delivered to successive cohorts will be balanced. Within countries that contribute an uneven number of sites, the orders of GST formats will be balanced within a difference of one. The RCT is designed to include a minimum of 448 patients with BPD. The primary clinical outcome measure will be BPD severity. Secondary clinical outcome measures will include measures of BPD and general psychiatric symptoms, schemas and schema modes, social functioning and quality of life. Furthermore, an economic evaluation that consists of cost-effectiveness and cost-utility analyses will be performed using a societal perspective. Lastly, additional investigations will be carried out that include an assessment of the integrity of GST, a qualitative study on patients' and therapists' experiences with GST, and studies on variables that might influence the effectiveness of GST. This trial will compare GST to TAU for patients with BPD as well as two different formats for the delivery of GST. By combining an evaluation of clinical effectiveness, an economic evaluation
Byron G. Adams
Research purpose: The main aim of this study was to explore employee narratives and identify the strategies available to them in the process of identity work, as they defined themselves at work. Motivation for the study: As there is a scarcity of research on identity work in South Africa, this study wanted to advance knowledge about identity work and the strategies used for regulating and negotiating an identity at work by exploring these constructs in this context. Research design, approach and method: A qualitative research process formed the basis for this study. Nineteen employees from a global manufacturing company participated in two semi-structured in-depth interviews. Grounded theory was applied to analyse and interpret the data. Main findings: Nine strategies for identity work were identified and categorised into four broad themes (personal philosophies; relationships; career management and negotiating balance. Practical/managerial implications: Employees followed various strategies for defining themselves at work and this may have some implications for employee work engagement and productivity. Contribution/value-add: This study expands on current theoretical knowledge of identity work, and provides insights into the strategies people use to regulate and negotiate their identities at work.
Wetzelaer, P.; Farrell, J.; Evers, S.M.A.A.; Jacob, G.A.; Lee, C.W.; Brand, O.; van Breukelen, G.; Fassbinder, E.; Fretwell, H.; Harper, R.P.; Lavender, A.; Lockwood, G.; Malogiannis, I.A.; Schweiger, U.; Startup, H.; Stevenson, T.; Zarbock, G.; Arntz, A.
Background: Borderline personality disorder (BPD) is a severe and highly prevalent mental disorder. Schema therapy (ST) has been found effective in the treatment of BPD and is commonly delivered through an individual format. A group format (group schema therapy, GST) has also been developed. GST has
Dissociative identity disorder (DID) is characterized by the presence of two or more distinct identities or personality states that recurrently take control of the individual s behavior. Between 95 and 100 % of DID patients report experiences of blank spells for periods of time when other identities
Full Text Available This paper presents patient and caregiver perspective on ICTs supporting bipolar disorder management in multinational healthcare provisioning contexts. The envisioned mHealth solutions should adopt general requirements that could be instantiated into different clinical settings. Engagement of users in designing new technologies for mental health is crucial to ensure empowerment and patient-centeredness of services. We performed focus groups to understand user needs, attitudes and experiences towards the supportive ICTs in two target regions where the expected solutions will operate. The survey offered valuable inputs for the construction of the clinical requirements used to produce a trans-national call for tender on mobile health solutions aimed at supporting bipolar disorders treatment among public purchasers in different European countries. The study was part of the NYMHPA-MD (Next Generation Mobile Platform for Health in Mental Disorders project, co-funded by the European Commission.
Alex de Toledo Ceará
Full Text Available CONTEXTO: Em nossa sociedade, sujeitos de orientação homossexual (SOHom têm sido expostos de maneira incisiva a atitudes de discriminação e preconceito. OBJETIVO: Investigar as dimensões saúde mental, qualidade de vida e identidade psicossocial em homossexuais na maturidade e na velhice. MÉTODO: Os sujeitos foram captados pela estratégia "bola de neve". Foram utilizados procedimentos quantitativos e qualitativos com os instrumentos: MINI Plus, WHOQOL-bref, e entrevistas semiestruturadas por meio do inventário de identidade psicossocial. Foram entrevistados 40 SOHom (grupo de estudo, comparando-os a 40 sujeitos de orientação heterossexual (SOHet (grupo contraste, pareados individualmente por gênero, idade, escolaridade e classe social. RESULTADOS: Verificou-se maior frequência de transtornos mentais no grupo de estudo com 15 (37,5% casos, em comparação ao grupo contraste, com oito (20%. O risco de suicídio estava presente em três (7,5% participantes do grupo de estudo. Dos sujeitos no grupo de estudo com algum transtorno mental, 11 (73,3% não revelavam a orientação homossexual em áreas significativas de sua vida (p = 0,00001. Os sujeitos homossexuais apresentaram melhor qualidade de vida no domínio social em comparação aos heterossexuais. CONCLUSÃO: Os sujeitos homossexuais desta pesquisa revelaram, na maturidade e na velhice, maior frequência de transtornos mentais, porém melhor qualidade de vida. É possível que a homofobia internalizada possa estar associada a dificuldades psicossociais. Sendo assim, pode-se sugerir que a não revelação da homossexualidade e o esforço no curso da vida em ocultá-la talvez representem fatores associados à maior ocorrência de transtornos mentais.BACKGROUND: In our society subjects with homosexual orientation have been strongly exposed to attitudes of discrimination and prejudice. OBJECTIVE: To investigate the mental health, life quality and psychosocial identity dimensions in
Gross, Michal; Hochberg, Nurit
How do pre-service teachers perceive place identity, and is there a connection between their formative place identity and the development of their professional teaching identity? These questions are probed among pre-service teachers who participated in a course titled "Integrating Nature into Preschool." The design of the course was…
Birkhölzer, Marc; Goth, Kirstin; Schrobildgen, Christian; Schmeck, Klaus; Schlüter-Müller, Susanne
A paradigm shift towards early detection and intervention of personality disorders in adolescence to prevent persistent and chronic suffering is currently taking place. Aside further distinct areas of impaired psychosocial integrity, disturbed identity development is seen as one core component of personality disorders. Thus, the detection of early antecedents of impaired identity development is an important step to allow for early intervention. The self-report questionnaire Assessment of Identity Development in Adolescence (AIDA) is a reliable and valid diagnostic instrument to detect disturbed identity development. This questionnaire allows for global assessment of identity and a differentiation in fundamental subdomains as well and distinguishes between identity diffusion on one side and consolidated and stable identity on the other. In clinical practice, it supports the differentiation between severely disturbed identity as the core component of personality disorders and identity crisis or stable identity development that can be found in other mental disorders.
Bode, Dyon; Mugge, Winfred; Schouten, Alfred C.; van Rootselaar, Anne-Fleur; Bour, Lo J.; van der Helm, Frans C. T.; Lammertse, Piet
Tremor, characterized by involuntary and rhythmical movements, is the most common movement disorder. Tremor can have peripheral and central oscillatory components which properly assessed may improve diagnostics. A magnetic resonance (MR)-safe haptic wrist manipulator enables simultaneous measurement
Nadort, M.; Arntz, A.; Smit, J.H.; Giesen-Bloo, J.; Eikelenboom, M.; Spinhoven, P.; Asselt, T. van; Wensing, M.J.P.; Dyck, R. van
BACKGROUND: Schema Therapy (ST) is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality disorders.
López-Ibor, Juan J; Ortiz, Tomás; López-Ibor, María I
Physician has to know the patient in the disease and not only the disease in the patient, from the dual perspective of the body as object and the body as subject. This also affects the patient who has to cope with the reality of having a body that bursts into the subject's consciousness as a vital threat, as source of discomfort and inability and being a body (Marcel). The human body in its dual aspect has been and is a great unknown, if not a great outrage in spite of the fact that we are our body and our body is each of us. We sometimes do not feel as we are and thus a confrontation arises, sometimes more normal, others more morbid. This forces the physician to face complex ethics considerations and the scientist to accept a personal identity disorder. Dualism considers that there are two substances in us, one that distinguishes us from other beings and from the rest of the individuals of the human species, the soul, the psychic life, mind or consciousness, and another more insubstancial one, the body. The aim of the first substance is to dominate the body, to survive it after death when it is, already a corpse is meant to become putrefied, is buried, incinerated or thrown to the depth of the sea. This dualism aims to explain the origin of the evil and the attitude to defeat it and it does so efficiently. This anthropology has very ancient roots (the Upvanishads, in the orphic texts, in Plato), it is the core of Gnostic thought and the foundation of the modern science since Descartes. Some monist perspectives are a masked dualism or a mereologic fallacy, according to which, the brain is conscious, when that what is conscious is the subject, although the subject, with the brain could not be conscious. Therefore, a new perspective is proposed, chiasmatic or janicular monism, that considers the adaptive value of focusing on the reality from two perspectives, as physical universe and the world of interpersonal relationships. In the agnosias and in the phantom limb
The challenges in diagnosis and gender assignment in disorders of sex development presenting to a pediatric surgical unit in a developing country: the role of laparoscopy and simple tests for gender identity.
Chowdhury, Tanvir K; Kabir, Mahfuzul; Chowdhury, Md Zonaid; Hutson, John M; Banu, Tahmina
We aimed to assess how the diagnosis and determination of gender identity of disorders of sex development (DSD) is different in a developing country from Western medicine, and whether a pediatric surgery department can determine the underlying diagnosis and use simple tools to determine the likely gender identity (GI). We reviewed the records of DSD patients admitted to the Department of Pediatric Surgery, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh, from January 2006 to December 2012 and performed a cross-sectional study on GI and gender-related behavior in these patients during the year 2012. DSD boys and girls answered a GI interview and had their gender role behavior assessed by observations of structural toy play and analyzed for differences in scores. This cohort of DSD patients presented in mid-childhood (6 months-16 years, mean 6.9 years) rather than infancy, and 30% came from consanguineous unions. Congenital adrenal hyperplasia (CAH) constituted only 11 of 50 (22%) of the DSD cohort, and not all families had access to steroid hormone replacement. A simple assessment of GI and gender-related behavior allowed effective gender assignment, as there was significant difference between DSD boys and girls in GI and gender-related behavior score. DSD management in Bangladesh provides some unique challenges because of limited resources. A national reference laboratory for biochemical and genetic testing and development of a quaternary referral center for DSD patients will be helpful. Continued use of the GI interview and gender-related behavior study will enable effective interim decisions about diagnosis and management. Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Ohm, Julie Juhye
The formation of ego identity in Asian American late adolescents attending Virginia Tech was examined within the frameworks of Erikson's psychosocial theory and Berry, Trimble, and Olmedo's model of acculturation. Ego identity was measured using the Achieved sub-scale of the Revised Version of the Extended Objective Measure of Ego Identity Status, an instrument based on the theoretical constructs of Erikson. Ethnic identity was measured using the Multigroup Ethnic Identity Measure and America...
Kettler, Nele; Frenzel Baudisch, Nicolas; Micheelis, Wolfgang; Klingenberger, David; Jordan, A Rainer
Little is known regarding young and future dentists' career choices, professional identity, and working conditions in Germany. While the dental healthcare environment and demands in treatment are changing, it remains unclear what job perceptions young dentists have developed at the beginning of their work life and if and how these perceptions change during the subsequent years. The aim of this study was to survey future and young dentists regarding their professional identity, planned career paths, and working conditions and strains to understand career decisions and choices and enable policy makers to include future dentists' views and expectations in their decisions. This study is a longitudinal nationwide survey over a time span of 4 years of dental students and young dentists in Germany and is comprised of three waves. The first wave focuses on dental students in their final year before the state examination and is composed of a qualitative pre-study in the form of focus groups and a quantitative main survey in the form of a questionnaire. The end points were established to analyse (1) the professional identity of the young future dentists; (2) their career paths, preparation for a career, and basic career conditions; and (3) perceived conditions and strains. The aim of the overall survey was to depict the development of these three aspects during the first years of work life. All of the questions were evaluated with a descriptive univariate analysis. The analysed subgroups were grouped according to gender, target working condition (employed/self-employed), and primary socialisation (parents dentists/parents not dentists). To our knowledge, this is the only study which focuses on career choices, professional identity, and working conditions of future and young dentists in Germany. The longitudinal observation provides information that is essential for professional and purposive dental health care planning, and to meet the oral health demands and needs of the
The present study sought to investigate the relationship between challenging behavior, comorbid psychopathology, and Attention-Deficit\\/Hyperactivity Disorder (AD\\/HD) in Fragile X Syndrome (FRAX). Additionally, this study sought to examine how such disorders are predicted by gender, presence of autism spectrum disorder (ASD), and presence of intellectual disability (ID). A total of 47 children and adolescents with FRAX were assessed. Results revealed high levels of challenging behavior and AD\\/HD symptoms within the sample, with some participants exhibiting symptoms of comorbid psychopathology. Further analysis revealed that challenging behavior and comorbid psychopathology were positively correlated, with stereotypy correlating most strongly with comorbid psychopathology. In addition, ASD was found to predict challenging behavior, and gender was found to predict AD\\/HD symptoms. The implications of these findings are discussed.
This paper reviews the empirical literature on identity work and identifies two distinct approaches to incorporating emotion. The majority of empirical studies use emotion to describe the experiences of identity work. In doing so, the authors (a) mention the emotions that people feel in situations...... that trigger identity work, (b) illustrate identity work as an emotional endeavour, and (c) describe the emotional impact of successful and unsuccessful identity work. There is also an emerging literature that examines the mutual constitution of emotions and identity work. These authors address emotional...... labour, affective social identification, emotional attachment and detachment, and humour when studying identity work. This paper suggests that, to understand better the relation between emotions and identity work, future research should examine the role of emotions in problematizing identity...
K.E. Horton (Kate); P.S. Bayerl (Saskia); G. Belschak-Jacobs (Gabriele)
textabstractAs individuals, we define ourselves according to various characteristics that include our values and beliefs. This gives us our identity. As organisations become increasingly complex, understanding the concept of identity conflict may mean the difference between success and failure.
The introductory discussion focuses on the change in the current scientific climate regarding the role of heredity in the etiology of behavioral disorders. The author and his colleagues embarked on a series of studies, using naturally occurring adoptions as their subject source, to tease apart hereditary and environmental factors thought to be…
I Am: Remix Your Web Identity explores methods of designing and developing a personal website with RSS feeds that aggregate blog posts along with posts on social networks, such as Flickr, YouTube, Goodreads, Last.fm, and Delicious, in order to regain control and ownership (as well as authorship) of one's identity in one consistent and customized location. The book provides a short overview of the evolution of digital identity and the transformation of personal websites from Geocities to blogs...
Michev, Iordan P.
In the first part of this paper we consider the transformation of the cubic identities for general Korteweg-de Vries (KdV) tau functions from [Mishev, J. Math. Phys. 40, 2419-2428 (1999)] to the specific identities for trigonometric KdV tau functions. Afterwards, we consider the Fay identity as a functional equation and provide a wide set of solutions of this equation. The main result of this paper is Theorem 3.4, where we generalize the identities from Mishev. An open problem is the transformation of the cubic identities from Mishev to the specific identities for elliptic KdV tau functions
Oshima, Sae; Asmuß, Birte
Identity has been widely acknowledged as playing a central role in various organizational processes, yet there is still a need to better understand the dynamics and functions of identity work in modern organizations. The present paper is centered within this concern, and examines identity......) reveal the intersubjective, multimodal and embodied nature of identity work; 2) demonstrate identity work as organizational practices, used in order to accomplish specific actions; and 3) pose a question on the view on identity as a layered/leveled phenomenon....
Miketić Sanja D.
Full Text Available The relationship between culture and nationality and in that sense - national identity of a particular community - is a known thing for a long time. Nationality is usually strongly connected to culture. We will only mention few of their joint characteristics: language, religion, art, customs, tradition etc. In this article special attention will be paid to one of the features of national identity - language - and we will focus on the usage of Cyrillic alphabet of our target group (students of University of Priština, with temporary head office in Kosovska Mitrovica. The study consists of two smaller researches. In the first part we explored reactions of students at University of Priština and we assumed that they will have different reactions towards Cyrillic alphabet and Latin alphabet used as stimuli-words comparing to pupils of Belgrade and Zrenjanin high schools and students of University of Belgrade, Novi Sad and Niš presented in The associative dictionary of Serbian language (Asocjativni rečnik srpskog jezika, 2005. In the second part we tried to find out if our informants prefer the usage of Cyrillic or Latin alphabet, and which one they find better in the esthetic sense. We compared attitudes of students who enroll University of Priština to attitudes of students who enroll University of Belgrade and differences between their attitudes. With both researches we wanted to see if there are formed verbal stereotypes with positive or negative connotation, and what are the attitudes on using Cyrillic alphabet among students in the age of expansion of Latin alphabet. We concluded that Cyrillic alphabet is more used and valued at University of Priština than in the rest of Republic of Serbia and the reason for that might be the stronger sense of national identity among these students.
Full Text Available Abstract Background Panic disorder (PD and generalized anxiety disorder (GAD are two of the most disabling and costly anxiety disorders seen in primary care. However, treatment quality of these disorders in primary care generally falls beneath the standard of international guidelines. Collaborative stepped care is recommended for improving treatment of anxiety disorders, but cost-effectiveness of such an intervention has not yet been assessed in primary care. This article describes the aims and design of a study that is currently underway. The aim of this study is to evaluate effects and costs of a collaborative stepped care approach in the primary care setting for patients with PD and GAD compared with care as usual. Methods/design The study is a two armed, cluster randomized controlled trial. Care managers and their primary care practices will be randomized to deliver either collaborative stepped care (CSC or care as usual (CAU. In the CSC group a general practitioner, care manager and psychiatrist work together in a collaborative care framework. Stepped care is provided in three steps: 1 guided self-help, 2 cognitive behavioral therapy and 3 antidepressant medication. Primary care patients with a DSM-IV diagnosis of PD and/or GAD will be included. 134 completers are needed to attain sufficient power to show a clinically significant effect of 1/2 SD on the primary outcome measure, the Beck Anxiety Inventory (BAI. Data on anxiety symptoms, mental and physical health, quality of life, health resource use and productivity will be collected at baseline and after three, six, nine and twelve months. Discussion It is hypothesized that the collaborative stepped care intervention will be more cost-effective than care as usual. The pragmatic design of this study will enable the researchers to evaluate what is possible in real clinical practice, rather than under ideal circumstances. Many requirements for a high quality trial are being met. Results of
Review of: Researching Identity and Interculturality / by F. Dervin and K. Risager (eds.). Routledge 2015, 245 pp.......Review of: Researching Identity and Interculturality / by F. Dervin and K. Risager (eds.). Routledge 2015, 245 pp....
Christensen, Lars Thøger
The article reviews the book "Understanding Identity and Organizations," by Kate Kenny, Andrea Whitle, and Hugh Wilmott.......The article reviews the book "Understanding Identity and Organizations," by Kate Kenny, Andrea Whitle, and Hugh Wilmott....
Full Text Available As far as the construction of a community’s identity and territory is concerned, the question about the usefulness of a project of public art is a priority in any kind of initiative. Especially when the public dimension makes the intervention subject to ideological manipulations. It is necessary to establish if the potentialities of the work of art are worthy of the risk of its exploitation. I’ll try to answer to this question on one hand stressing the importance of the spatial support in the construction of new territorial identities. On the other hand I’ll specify the ways in which the artistic device can help this process. I ‘m proposing semiotics as an instrument of control: the reason lays in the communicational value of the artistic project and in its cognitive role in terms of image. The power of image is in its figurative features, but also in the ability of continuously establishing webs of relations, possibly subject to manipulation. Semiotics contributes with the description of values underlay to a specific artistic project, as a deep founding level of its conception: at the same time, itenables us with the possibility to control those meaning distortions which can transform the artistic project in a disaggregating factor.
Full Text Available Training based on competency is a government effort to improve employee candidates’ job competence. The T echnical Implementation Unit of the Technopark Ganesha Sukowati Sragen is a training centre in the Sragen Regency. Ergonomic issues have still not received attention in some training programmes. The work system design is constructed to support the achievement of the agency’s vision and mission, using the macro-ergonomic analysis and design approach (MEAD. Research results show that the key variance is the installation of embroidery hoops, which is difficult and time-consuming. Integration of the work system with ergonomic designs is necessary to create a pleasant training environment and to improve job competence. The new designs include adjustable seats, embroidery hoops tables with a foot rest, improved lighting, facemasks, earplugs, and a drinking water facility. The workshop layout is designed to follow the work process. The trainees also participated in stretching exercises before training began. A t-test was conducted with the same research design and the same subject, and the results showed a reduction of up to 60.39 per cent in musculoskeletal disorders and a reduction of up to 22.2 per cent in the risk of injury.
Shively, Michael G.; DeCecco, John P.
This paper examines the four components of sexual identity: biological sex, gender identity, social sex-role, and sexual orientation. Theories about the development of each component and how they combine and conflict to form the individual's sexual identity are discussed. (Author)
Identity management consists of the processes and all underlying technologies for the creation, management, and usage of digital identities. Business rely on identity management systems to simplify the management of access rights to their systems and services for both their employees and their
van Rooij, R.; Gutzmann, D.; Köpping, J.; Meier, C.
Identity and identification are very important concepts in philosophy and logic. They are crucial for the analysis of quantification and for counting. According to some philosophers, many examples that are supposed to show that identity is contingent, in fact show that the notion of identity is
Holck, Lotte; Muhr, Sara Louise; Villeseche, Florence
– The work can encourage policy makers, diversity and HR managers to question their own practices and assumptions leading to more theoretical informed diversity management practices. Originality/value – The theoretical connections between identity and diversity literature have so far not been reviewed......The purpose of this paper is to examine the relationship between the identity and diversity literatures and discuss how a better understanding of the theoretical connections between the two informs both diversity research and diversity management practices. Design/methodology/approach – Literature...... and limitations – is crucial for successful diversity management research and practice. Research limitations/implications – The authors argue for a better understanding of differences, overlaps and limits of different identity perspectives, and for a stronger engagement with practice. Practical implications...
Thermolia, Chryssa; Bei, Ekaterini S; Petrakis, Euripides G M; Kritsotakis, Vangelis; Tsiknakis, Manolis; Sakkalis, Vangelis
The new movement to personalize treatment plans and improve prediction capabilities is greatly facilitated by intelligent remote patient monitoring and risk prevention. This paper focuses on patients suffering from bipolar disorder, a mental illness characterized by severe mood swings. We exploit the advantages of Semantic Web and Electronic Health Record Technologies to develop a patient monitoring platform to support clinicians. Relying on intelligently filtering of clinical evidence-based information and individual-specific knowledge, we aim to provide recommendations for treatment and monitoring at appropriate time or concluding into alerts for serious shifts in mood and patients' non response to treatment.
Huntjens, R.J.C.; Wessel, I.; Hermans, D.; Minnen, A. van
A lack of adequate access to autobiographical knowledge has been related to psychopathology. More specifically, patients suffering from depression or a history of trauma have been found to be characterized by overgeneral memory, in other words, they show a relative difficulty in retrieving a
Huntjens, Rafaële J. C.; Wessel, Ineke; Hermans, Dirk; van Minnen, Agnes
A lack of adequate access to autobiographical knowledge has been related to psychopathology. More specifically, patients suffering from depression or a history of trauma have been found to be characterized by overgeneral memory, in other words, they show a relative difficulty in retrieving a
Full Text Available Information technologies have been widely used for entertainment and learning purposes by children with Autism Spectrum Disorders (ASD. Nonetheless, learning objects aiming at specific skills development in children with ASD require both a well bounded learning domain and a user-centered design process, considering skill levels of the users and the local geographical context and language. “Proyect@ Matemáticas” is a multi-touch based app designed for developing pre-calculus and functional mathematical skills in children with ASD, according to the Chilean regulations of learning goals for children with special educational necessities. This paper presents the User-centered design process conducted in order to develop the learning object, which included the evaluation by 15 experts in special educational needs, testing by 10 ASD-diagnosed children with different functional levels, and a multidisciplinary development team that also included a graphic designer diagnosed with ASD of high functionality. The development process yields to a validated learning object in terms of interactivity, design, engagement, and usability, from the point of view of the experts, and successful usage tests with ASD diagnosed children in terms of performance and achievement of learning outcomes. The application is currently available for download in the Google Play store for free, and currently has more than 15,000 downloads and an average rating of 4.2 out of 5 points.
Raj, Medha; Fast, Nathanael J; Fisher, Oliver
Despite evidence that large professional networks afford a host of financial and professional benefits, people vary in how motivated they are to build such networks. To help explain this variance, the present article moves beyond a rational self-interest account to examine the possibility that identity shapes individuals' intentions to network. Study 1 established a positive association between viewing professional networking as identity-congruent and the tendency to prioritize strengthening and expanding one's professional network. Study 2 revealed that manipulating the salience of the self affects networking intentions, but only among those high in networking identity-congruence. Study 3 further established causality by experimentally manipulating identity-congruence to increase networking intentions. Study 4 examined whether identity or self-interest is a better predictor of networking intentions, providing support for the former. These findings indicate that identity influences the networks people develop. Implications for research on the self, identity-based motivation, and professional networking are discussed.
Hofmann, Stefan G; Curtiss, Joshua; Khalsa, Sat Bir S; Hoge, Elizabeth; Rosenfield, David; Bui, Eric; Keshaviah, Aparna; Simon, Naomi
Generalized anxiety disorder (GAD) is a common disorder associated with significant distress and interference. Although cognitive behavioral therapy (CBT) has been shown to be the most effective form of psychotherapy, few patients receive or have access to this intervention. Yoga therapy offers another promising, yet under-researched, intervention that is gaining increasing popularity in the general public, as an anxiety reduction intervention. The purpose of this innovative clinical trial protocol is to investigate the efficacy of a Kundalini Yoga intervention, relative to CBT and a control condition. Kundalini yoga and CBT are compared with each other in a noninferiority test and both treatments are compared to stress education training, an attention control intervention, in superiority tests. The sample will consist of 230 individuals with a primary DSM-5 diagnosis of GAD. This randomized controlled trial will compare yoga (N=95) to both CBT for GAD (N=95) and stress education (N=40), a commonly used control condition. All three treatments will be administered by two instructors in a group format over 12 weekly sessions with four to six patients per group. Groups will be randomized using permuted block randomization, which will be stratified by site. Treatment outcome will be evaluated bi-weekly and at 6month follow-up. Furthermore, potential mediators of treatment outcome will be investigated. Given the individual and economic burden associated with GAD, identifying accessible alternative behavioral treatments will have substantive public health implications. Copyright © 2015 Elsevier Inc. All rights reserved.
de Melo, Pedro Lopes; de Andrade Lemes, Lucas Neves
Sleep breathing disorders are estimated to be present in 2%-4% of middle-aged adults. Serious adverse consequences, such as systemic arterial hypertension, myocardial infraction, and cerebrovascular disease, can be related to these conditions. Intellectual deficits associated with attention, memory, and problem-solving have also been associated with a poor quality of sleep. The main causes of these disorders are obstructions resulting from repetitive narrowing and closure of the pharyngeal airway, which have been monitored by indirect measurements of temperature, displacement, and other highly invasive procedures. The measurement of mechanical impedance of the respiratory system by the forced oscillation technique (FOT) has recently been suggested to quantify the respiratory obstruction during sleep. It is claimed that the noninvasive and dynamic characteristics of this technique would allow a noninvasive and accurate analysis of these events. In spite of this high scientific and clinical potential, there is no detailed description of a complete instrumentation system to implement this promising technique in sleep studies. In this context, the purpose of this study was twofold: (1) describe the development of a new computer-based system for identification of the mechanical impedance of the respiratory system during sleep by the FOT and (2) evaluate the performance of this device in the description of respiratory events in conditions including no, mild, serious disease, and therapeutic procedures. These evaluations confirmed the desirable features achieved in laboratory tests and the high scientific and clinical potential of this system.