Jennifer I. Downey

Mood disorders, psychiatric symptoms, and distress in women presenting for infertility evaluation.

Women who undergo treatment for infertility frequently report depression, but it is crucial to distinguish between subjective distress, symptoms, and clinical depressive disorders. In the initial assessment of a prospective, longitudinal study, 59 women presenting for infertility treatment were compared with 35 women presenting for routine gynecological care. Infertility patients and controls were not significantly different on self-report measures of partner satisfaction, sexual functioning, or self-esteem. There was also no difference in psychiatric symptomatology, or in the percentage of subjects who were currently experiencing or had ever experienced a major depressive episode. However, the infertility patients perceived themselves to have been already quite affected by their inability to conceive. For instance, 49.2% reported changes in their sexual functioning and 74.6% reported changes in their mood.

Psychopathology and social functioning in women with Turner syndrome.

Turner syndrome (TUS) in women is associated with sex chromosome abnormalities, ovarian dysgenesis with estrogen deficiency, and short stature. The goal of this study was to assess the long-term effects of these sex chromosome and hormonal anomalies on psychopathology and social functioning. We report interview and questionnaire data concerning lifetime history of mental disorders and current psychiatric symptoms. Also reported are data from questionnaires and interviews evaluating social functioning as measured by education, occupation, personal resources, and sexual behavior. Twenty-three TUS women were studied and compared with 23 closely matched women with constitutional short stature (CSS) and with 10 normal sisters of the TUS women. TUS women reported generally less mental disorder and comparable rates of psychiatric symptoms. On the other hand, they had lower overall functioning on a measure of global psychological health and had more impairment in social functioning as measured by achievement of adult milestones. We conclude that TUS women display less mental illness by positive symptom-oriented criteria but also less mental health when day-to-day functioning is considered. Our data suggest that differences in TUS women cannot be explained solely by short stature and may be related to other psychosocial, genetic, endocrine, or CNS effects of the syndrome.

Cognitive Ability and Everyday Functioning in Women with Turner Syndrome

This paper presents results from an assessment of cognitive ability and everyday functioning in a group of adult women with Turner syndrome (TUS). Twenty-three TUS women were compared with 23 matched controls with constitutional short stature (CSS). A subgroup of 10 TUS women were compared with their nondisabled female siblings. On the Wechsler Adult Intelligence Test-Revised (Wechsler, 1981), no significant group differences were found in Verbal IQ. There were significant group differences for Performance IQ and Full Scale IQ, largely due to specific deficits in the area of spatial and mathematical ability. These difficulties were also evident on the Benton Visual Retention Test-Revised (Benton, 1974). TUS individuals had significantly lower educational attainment than CSS controls but did not differ from their siblings. TUS individuals had significantly lower occupational attainment than the women in both comparison groups.

Psychoanalysis, Psychobiology, and Homosexuality

The potential role of biological influences in human sexual orientation was considered more seriously during the early phases of psychoanalysis than in the years since World War II. Recently studies of homosexuality and heterosexuality in the neurosciences have attracted widespread attention both in the scientific and lay communities. The salience of these new data for psychoanalytic theory and practice is just beginning to be explored. In this article, we review research on sexual orientation in the following areas: genetics, crosscultural studies, studies of development in individuals with abnormal prenatal hormone exposure, childhood play patterns, and brain studies in both nonhumans and humans. Differences between male and female homosexuality are explored. We propose that psychoanalytic theory can grow and profit from a careful consideration of new findings in the psychobiology of sexuality, and that the interaction between mind and body is the appropriate purview of psychoanalysis.

Sex hormones in lesbian and heterosexual women.

The authors measured plasma testosterone (T), androstenedione (A), and cortisol (C) levels in seven lesbian and seven heterosexual women matched for age and socioeconomic status. In addition, psychiatric symptoms, physical activity levels, depression, subjective sense of stress, and sexual behavior variables were assessed. There were no significant differences in sex hormone levels between the two groups of women, who were also comparable in psychiatric symptom levels, depression, and self-perceived stress. Lesbian women reported significantly more current physical activity relative to peers. Other than the sexual orientation difference which was a prerequisite for entry into the study, there were virtually no significant differences in sexual behavior although lesbian women tended to have achieved psychosexual milestones at a younger age. We were not able to corroborate the finding of Gartrell, Loriaux, and Chase (1977) that lesbian women have higher T levels, possibly due to the fact that the two groups were closely matched on several behavioral variables potentially affecting testosterone levels.

Multifetal Pregnancy Reduction: Psychodynamic Implications

New reproductive technologies, such as advanced infertility treatments, may have significant implications for womens psychological experience of pregnancy and motherhood. This paper examines some of the psychodynamic implications of multifetal pregnancy reduction, a medical procedure in which some of the fetuses in a multiple pregnancy are aborted while other fetuses are carried to term. Forty-four women who had undergone pregnancy reductions were interviewed about their emotional experience of this medical intervention and their subsequent pregnancies. A qualitative analysis of their experience was conducted from five psychoanalytically-informed vantage points: drive theory, ego psychology, object relations theory, self psychology and a developmental perspective. Women experienced having to abort some of their fetuses as a stressful and distressing life event, and a fourth of the women experienced bereavement reactions which impaired their functioning for at least two weeks. Conscious and unconscious responses to the procedure included ambivalence, guilt, and a sense of narcissistic injury, increasing the complexity of their attachment to the remaining babies. However, the achievement of the developmental goal of parenting healthy birth children helped most women feel that they had made the right decision for themselves and their families. Further research is indicated, including interviews before the reduction and long-term follow-up of mothers and surviving children.

Female Homosexuality: Classical Psychoanalytic Theory Reconsidered

The psychoanalytic theory of female homosexuality occupies an unusual position in modern psychoanalytic thought because it continues to be influenced by models of the mind that have largely been discarded in other areas of psychoanalytic psychology. Psychoanalytic ideas regarding female homosexuality are considered here from an historical perspective. It is suggested that modern psychoanalytic theory about sexual orientation in women must include recent contributions on the psychological development of women, the psychoanalytic psychology of male homosexuality, and relevant extraanalytic observations.

Biology and the Oedipus complex

Recent observations in the behavioral and neurosciences have raised questions about the ubiquity of the oedipus complex as well as about its significance for psychological development. The authors argue that the construct Freud called the oedipus complex in males is best examined in its component parts. One component--the incestuous wish--does not occur in all individuals. Another component--the boys urge to engage competitively with other male figures, including the father--does appear to be biologically based in testosterones effect on the brain and to be manifested in childhood rough and tumble play behavior. It is proposed that reexamination of the oedipus complex in light of recent findings about the brain and behavior is indicated and that play, in particular, can usefully be considered as a separate developmental line.

Gender role development in two clinical syndromes: Turner syndrome versus constitutional short stature.

Abstract Turner syndrome (TUS) in girls causes sex chromosome abnormalities, ovarian dysgenesis with estrogen deficiency, and short stature. The goal of this study was to assess the long-term effects of sex chromosome and hormonal anomalies on female gender role development. The authors report data from an interview assessing gender role development in 23 TUS women, compared with 23 closely matched women with constitutional short stature and with 10 normal sisters of the TUS women. The results show more stereotypic feminine behavior in childhood, adolescence, and adulthood in the TUS subjects. The authors conclude that the clinical features of TUS do not impede normal female gender development. Furthermore, the data suggest that the tendency to greater femininity in TUS women cannot be explained solely by short stature and may be related to other psychosocial, endocrine, or brain effects of the syndrome.

SEXUAL DIFFERENTIATION OF BEHAVIOR : THE FOUNDATION OF A DEVELOPMENTAL MODEL OF PSYCHOSEXUALITY

The sexual differentiation of the brain and behavior occurs as the result of prenatal hormonal influences. Knowledge of this area is helpful for the construction of an appropriately modern psychoanalytically informed developmental paradigm of psychosexuality.