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Sexual and Gender Identity Disorders


Research articles:

Chen, L. P., Murad, M., Paras, M. L., Colbenson, K. M., Sattler, A. L., Goranson, E. N., & ... Zirakzadeh, A. (2010). Sexual abuse and lifetime diagnosis of psychiatric disorders: Systematic review and meta-analysis. Mayo Clinic Proceedings, 85(7), 618-629. doi:10.4065/mcp.2009.0583

OBJECTIVE: To systematically assess the evidence for an association between sexual abuse and a lifetime diagnosis of psychiatric disorders. PATIENTS AND METHODS: We performed a comprehensive search (from January 1980-December 2008, all age groups, any language, any population) of 9 databases: MEDLINE, EMBASE, CINAHL, Current Contents, PsycINFO, ACP Journal Club, CCTR, CDSR, and DARE. Controlled vocabulary supplemented with keywords was used to define the concept areas of sexual abuse and psychiatric disorders and was limited to epidemiological studies. Six independent reviewers extracted descriptive, quality, and outcome data from eligible longitudinal studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects model. The I2 statistic was used to assess heterogeneity. RESULTS: The search yielded 37 eligible studies, 17 case-control and 20 cohort, with 3,162,318 participants. There was a statistically significant association between sexual abuse and a lifetime diagnosis of anxiety disorder (OR, 3.09; 95% CI, 2.43-3.94), depression (OR, 2.66; 95% CI, 2.14-3.30), eating disorders (OR, 2.72; 95% CI, 2.04-3.63), posttraumatic stress disorder (OR, 2.34; 95% CI, 1.59-3.43), sleep disorders (OR, 16.17; 95% CI, 2.06-126.76), and suicide attempts (OR, 4.14; 95% CI, 2.98-5.76). Associations persisted regardless of the victim's sex or the age at which abuse occurred. There was no statistically significant association between sexual abuse and a diagnosis of schizophrenia or somatoform disorders. No longitudinal studies that assessed bipolar disorder or obsessive-compulsive disorder were found. Associations between sexual abuse and depression, eating disorders, and posttraumatic stress disorder were strengthened by a history of rape. CONCLUSION: A history of sexual abuse is associated with an increased risk of a lifetime diagnosis of multiple psychiatric disorders. [ABSTRACT FROM AUTHOR]

Cole, M. (1986). Socio-sexual characteristics of men with sexual problems. Sexual & Marital Therapy, 1, 89-108. Retrieved from EBSCOhost.

Studied 114 men with disorders of erection, 31 with premature ejaculation, and 45 who were defined as heterophobic and who were largely without coital experience. Mean age of the whole sample was 33.6 yrs. The object of the investigation was to establish reliable baseline data from a UK population of males presenting with sex disorders and to reveal differences that would contribute to an understanding of the etiology of 3 categories of sex disorders. Results illustrate a number of significant differences, such as religious affiliation, the extent of adolescent sex play, and the incidence of attempted suicide. Comparisons between the 3 categories reveal differences in 8 parameters, including the extent of adolescent sex behavior, adult masturbation frequency, the incidence of adult wet dreams, occurrence of REM erections, age at first coitus, and the number of coital partners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Coxell, A. W., & King, M. B. (1996). Male victims of rape and sexual abuse. Sexual & Marital Therapy, 11(3), 297-308. Retrieved from EBSCOhost.

Introduces literature on the sexual assault of adult males. Various myths concerning the survivors, perpetrators, and plausibility of such assaults are challenged. Assault prevalence data from a community sample of 1,480 males is presented, along with data from a study of coercion in gay relationships. Problems reported after sexual assault by males are discussed, including confusion about sexual orientation, sexual problems, posttraumatic stress disorder, problems forming close relationships, mistrust of adult men, suicide, and various mood disorders. Sexual assault by females may leave men less traumatized than sexual assaults by men because they are less likely to involve physical force and because same-sex sexual contact, which heterosexuals may find traumatic in itself, is not involved. Both early and delayed management in the treatment of survivors are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Gutierrez, P. M., Thakkar, R. R., & Kuczen, C. (2000). Exploration of the relationship between physical and/or sexual abuse, attitudes about life and death, and suicidal ideation in young women. Death Studies, 24, 675-688. doi:10.1080/074811800750036569

Experiencing sexual and/or physical abuse at any point in one's life can be quite traumatic. In addition to the immediate effects of the abuse, numerous long-term consequences have been identified, including an increased risk of developing psychological disorders and attempting suicide. The authors sought to determine if a relationship exists between abuse experiences, attitudes about life and death, and suicidal ideation by surviving 644 college women between the ages of 18 and 24. Participants completed packets containing standardized abuse questionnaires, the Multi-Attitude Suicide Tendency Scale, and the Adult Suicidal Ideation Questionnaire. The authors concluded that abuse plays a role in how these young women think about life and death. Specifically, less repulsion by death and more repulsion by life were reported by women with more significant abuse histories. In addition, these same women endorsed higher levels of current suicidal ideation. It was also determined that women who had experienced more abuse tended to have been in therapy for longer periods of time. Implications of this study for mental health professionals working with suicidal young adults are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Krakow, B., Artar, A., Warner, T. D., Melendrez, D., Johnston, L., Hollifield, M., & ... Koss, M. (2000). Sleep disorder, depression and suicidality in female sexual assault survivors. Crisis, 21, 163-170. doi:10.1027//0227-5910.21.4.163

The role of sleep in psychiatric illness in general, and depression and suicidality in particular, is poorly understood and has not been well researched despite the pervasiveness of sleep complaints in these conditions. As an exploratory, hypothesis-generating study, 153 female sexual assault survivors with posttraumatic stress disorder who had enrolled in a nightmare-treatment program were assessed for subjectively determined sleep breathing and sleep movement disorders. Diagnoses of potential disorders were based on clinical practice parameters and research algorithms from the field of sleep disorders medicine. Potential sleep breathing and sleep movement disorders were present in 80% of the Ss and included three subgroups: sleep-disordered breathing only; sleep movement disorder only; and both sleep disorders. Based on the Hamilton Depression Rating Scale and Suicide subscale, Ss with potential sleep disorders suffered greater depression and greater suicidality in comparison to Ss without potential sleep disorders. The group with both sleep disorders suffered from the most severe depression and suicidality. A provisional hypothesis is formulated that describes how sleep disorders may exacerbate depression and suicidality through the effects of chronic sleep fragmentation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Maniglio, R. R. (2011). The role of child sexual abuse in the etiology of suicide and non-suicidal self-injury. Acta Psychiatrica Scandinavica, 124(1), 30-41. doi:10.1111/j.1600-0447.2010.01612.x

The role of child sexual abuse in the etiology of suicide and non-suicidal self-injury. To address the best available scientific evidence on the role of child sexual abuse in the etiology of suicide and non-suicidal self-injury. Seven databases were searched, supplemented with hand-search of reference lists from retrieved papers. The author and a psychiatrist independently evaluated the eligibility of all studies identified, abstracted data, and assessed study quality. Disagreements were resolved by consensus. Four reviews, including about 65 851 subjects from 177 studies, were analyzed. There is evidence that child sexual abuse is a statistically significant, although general and non-specific, risk factor for suicide and non-suicidal self-injury. The relationship ranges from small to medium in magnitude and is moderated by sample source and size. Certain biological and psychosocial variables, such as serotonin hypoactivity and genes, family dysfunction, other forms of maltreatment, and some personality traits and psychiatric disorders, may either act independently or interact with child sexual abuse to promote suicide and non-suicidal self-injury in abuse victims, with child sexual abuse conferring additional risk, either as a 'distal' and indirect cause or as a 'proximal' and direct cause. Child sexual abuse should be considered one of the several risk factors for suicide and non-suicidal self-injury and included in multifactorial etiological models. [ABSTRACT FROM AUTHOR]

Marsh, P. J., Odlaug, B. L., Thomarios, N., Davis, A. A., Buchanan, S. N., Meyer, C. S., & Grant, J. E. (2010). Paraphilias in adult psychiatric inpatients. Annals of Clinical Psychiatry, 22(3), 129-134. Retrieved from EBSCOhost.

Background: The goal of the present study was to examine the prevalence of paraphilias in an adult inpatient psychiatric population. Methods: One hundred twelve consecutive, voluntarily admitted, adult male psychiatric inpatients were administered the Structured Clinical Interview for DSM-IV, Sexual Disorders Module, Male Version, to assess the rates of DSM-IV paraphilias. Results: Fifteen patients (13.4%) reported symptoms consistent with at least one lifetime DSM-IV paraphilia. The most common paraphilias were voyeurism (n = 9 [8.0%]), exhibitionism (n = 6 [5.4%]), and sexual masochism (n = 3 [2.7%]). Patients who screened positive for a paraphilia had significantly more psychiatric hospitalizations ([sub] P[/sub]P = .006) and, on a trend level, were more likely to have attempted suicide. In addition, patients with paraphilias were significantly more likely to report having been sexually abused than patients without a paraphilia (P = <.001). Only 2 of the 15 paraphilic patients (13.3%) carried an admission diagnosis of a paraphilia. Conclusions: Paraphilias appear to be more common in adult male psychiatric inpatients than previously estimated. The study also demonstrated that these disorders were not screened for by the treating physician and thus may go untreated. Further, larger-scale studies are necessary in order to further examine the rates of these disorders in the general population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

McDuffie, E., & Brown, G. R. (2010). 70 U.S. veterans with gender identity disturbances: A descriptive study. International Journal of Transgenderism, 12, 21-30. doi:10.1080/15532731003688962

This study describes the largest population of veterans referred for a gender identity disorder (GID) evaluation. Most were self-referred, others were referred by their commanding officer. A search of the English language literature revealed no similar studies on veterans other than a pilot project by the second author. Methods: Retrospective descriptive data were obtained from chart reviews of 70 U.S. veterans who were evaluated by the second author for gender disturbances over a 20-year period (1987 to 2007). The modal veteran with gender identity disturbance was a natal male (91%) identifying as female, >40 years old, Caucasian, employed, with more than 12 years of education. Fifty-seven percent were parents with a history of sexual involvement with opposite sex individuals. Histories of autogynephilia were not elicited in vets interviewed since 1997. Classic “flight into hypermasculinity” was described by a majority of the natal male vets as a retrospective understanding of why they joined the military. Psychiatric comorbidities (43%) included post traumatic stress disorder (PTSD), depression, schizophrenia (N = 1), substance use disorders (17%), dissociative identity disorder (N = 1), and personality disorders (11%). Ninety-three percent met criteria for diagnosis of GID or GID not otherwise specified; suicidal ideation was reported by 61% with one or more suicide attempts by 11% of 56 responding; and 4% reported genital self-harm. Although 11% expressed active thoughts of surgical self-treatment, most expressed a desire for physician-performed sex reassignment surgery (SRS). Cross-dressing behaviors were common, and currently reported arousal with cross-dressing was reported by 13%, 63% of whom were not diagnosed with GID. Conclusion: Veterans often reported that they joined the military in an attempt to purge their transgender feelings, believing the military environment would “make men” of them. Most were discharged before completing a 20-year career. More than half received health care at veterans affairs medical centers, often due to medical or psychiatric disabilities incurred during service. Comorbid Axis I diagnoses were common, as were suicidal thoughts and behaviors. [ABSTRACT FROM AUTHOR]

Yue, Z., Montoro, R., Igartua, K., & Thombs, B. D. (2010). Suicidal ideation and attempt among adolescents reporting "unsure" sexual identity or heterosexual identity plus same-sex attraction or behavior: Forgotten groups?. Journal of the American Academy of Child & Adolescent Psychiatry, 49(2), 104-113. doi:10.1016/j.jaac.2009.11.003

The article presents a study which compared risk of suicide ideation and attempts among adolescents with unsure identity; heterosexual identity with same sex attraction; and gay, lesbian, or bisexual (GLB) identity in Montreal, Quebec. Results showed that those with GLB and unsure identities are at greater risk of committing suicide than heterosexual youth without the same attraction to the opposite sex. Participants of the study were teenage students from public and private high schools.


05/15/2014 at 12:10 PM
Why did you say heterosexuals are attracted to the same sex? (Or am I just reading that wrong?) Heterosexual means straight.
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