Alexander C. Rosen

Theoretical and diagnostic issues in child gender disturbances

Abstract A distinction is made between two different but closely related syndromes—“cross gender identification” and “gender behavior disturbance”—in male children. Based on assessment data and systematic clinical observations of a group of 47 such children in a longitudinal research study, a set of factors are identified as relevant to the diagnostic task. Specific diagnostic procedures were developed for the clinical evaluation and psychological testing of male children referred for potential gender dysphoric problems, and these procedures are presented in detail with accompanying rationale.

Brief Report of MMPI Characteristics of Sexual Deviation

The notion that disturbances in sexual identity and desire for sexual change are accompanied by severe defects in ego structure were examined. Findings from 3 in-depth case studies with psychological tests and MMPI data for 34 individuals who presented problems in gender identity, with choice of sexual partner, and transvestism. Data suggest no consistent MMPI pattern to confirm the above contention. There was evident psychopathology but no clear evidence of personality disorganization in those seeking sexual change or having difficulties in sexual identity It was concluded that the presenting symptom of difficulty in gender identity or a wish for gender change is not prima facie evidence of distortion of reality or conspicuous ego defect.

Childhood gender identity change: Operant control over sex-typed play and mannerisms

Abstract To our knowledge this case is the first successful change of childhood gender identity that is documented by pre- and post-diagnostic assessment procedures. Deviant sex-typed behaviors were modified in a 5-yr-old boy judged by an independent clinician to be a high risk for adult transsexualism. In Study 1, the childs mother was trained to reinforce “masculine” play behaviors and to extinguish “feminine” play behaviors in the clinic. This intrasubject study introduced new procedures designed to maximize the generalization of the treatment effect to play in the alone condition. Study 2 was designed to modify the childs cross-gender mannerisms through the use of a response-cost and verbal prompt procedure. The cross-gender mannerism “flexed elbow” decreased as a function of the treatment. At the follow-up 25 months after treatment terminated, the evaluation by an independent clinician indicated the therapeutic change to a male gender identity.

Contingency Management in the Treatment of Adolescent Alcohol Drinking Problems.

Three case studies demonstrated that social and monetary reinforcement for abstinence reduced the rate of excessive alcohol drinking in adolescents. The self-monitoring and extrinsic reinforcement procedures (ABA reversal design) resulted in complete abstinence in a 15-year-old boy with a 10-year history of excessive alcohol abuse and hospitalization for an alcohol-induced psychosis. In the cases of the 13-year-old and 15-year-old girls with extensive alcohol abuse histories, the behavioral interventions decreased the rate of alcohol consumption during treatment phases, but alcohol abuse increased markedly with the removal of the intervention procedures.

Genetic and physical studies of male children with psychological gender disturbances

Twelve male children were diagnosed with psychological gender disturbances by 3 independent clinical psychologists using independent data sources focusing on behavioural deviance from normal comparison groups, on conventional psychological testing, and on parent report instruments which had been validated on normal comparison samples. These children received a paediatric evaluation consisting of a medical history, complete physical examination, chromosome analysis including 2 cells karyotyped and 15 counted, and sex chromatin studies. All gender disturbed boys were found to be normal genetically and physically with the exception of one subject with one undescended testicle.

Some Differences in Self Perceptions between Alcoholics and Non-Alcoholics

An effort was made to extract some principles from the literature which described the model alcoholic personality. A sample of 100 items were selected, 25 of each from the four major categories of personality traits: (1) anger, hostility, handling of aggression, (2) effectiveness in social and personal interaction, (3) the handling of oral and dependency needs, and (4) the management of anxiety and depression. Q-sort deck was analyzed both for mean sortings for the significant groups and by means of interpersonal correlation matrices. It did not appear that the uniqueness of the alcoholic personality could be conspicuously delineated even with items which on the basis of theoretical formulation were heavily loaded with characters and qualities customarily assigned to the alcoholic. There was little evidence in the data as gathered to support the notion that there is a unique, special, or modal alcoholic personality which clearly differentiates him from other kinds of socially maladaptive or psychiatric maladaptive individuals. Specific factor characteristics within the alcoholic group were described. It is suggested that there may be two types of alcoholics in our sample of patients from a University-based Outpatient Mental Hygiene Clinic.

PROJECTIVE TEST FINDINGS FOR BOYS WITH GENDER DISTURBANCE: DRAW-A-PERSON TEST, IT SCALE, AND MAKE-A-PICTURE STORY TEST '

With 66 boys, aged 3 yr. to 17 yr. who were referred for potential gender-identity disorder, this study examined intrapsychic manifestations as reflected in their projections to the Draw-A-Person Test, the Brown IT Scale for Children, and the Shneidman Make-A-Picture Story Test. Without access to these projective test findings, an independent clinical psychologist provided a diagnostic rating on the severity of gender disturbance on a five-point diagnostic rating scale, based on clinical interviews of the child and his parents and a systematic behavioral assessment based on previously published normative standardization data. For each of the three projective measures, significant correlations were found between the clinician ratings on severity of gender disturbance and the test findings in the feminine direction (D-A-P, r = .44; IT Scale, r = .64; M-A-P-S, r = .35). These results validated the use of intrapsychic phenomena of fantasy and self-perception as measured by these projective tests for the diagnosis of gender disturbance in male children and adolescents.

Treatment of pedophilia using multistage aversion therapy and social skills training

Abstract A successful case study of behavior therapy with a pedophile is described, in which pedophilia is viewed as a multifaceted pattern of aberrant sexual arousal with accompanying excesses and deficits in other significant social and sexual areas. Aversive deconditioning procedures and graded social skills training were employed. The implications of this study are discussed with regard to therapy strategies and generalization effects.

Long term follow-up in two cases of transvestism treated with aversion therapy

Abstract Two case studies of behavior therapy with transvestites are described. Aversive conditioning procedures with variations were employed along with programs for increasing appropriate gender-related behavior. While therapy was successful in the short term follow-up, long term follow-up revealed total relapse in both cases. The implications of this outcome are discussed with regard to therapy strategies with transvestism.

GENDER STEREOTYPY IN GENDER-DYSPHORIC YOUNG BOYS

This study examined the effects of behavioral treatment of 22 gender-dysphoric boys on measures of male- and female-role stereotyped behavior. The sample included 10 treated and 4 untreated gender-dysphoric boys and 8 normal boys. The findings show no such effect and no evidence of a masculinizing enhancement or a feminizing extinction of behaviors following behavioral treatment of gender-disturbed boys (contrary to statements by critics of the process).