Gender identity disorder in children
Childhood Gender Identity Disorders (GID)- these are psychosexual deviations of childhood, characterized by a stable and intense rejection of one's gender, strong desire change it to the opposite. Patients constantly strive to dress and act in accordance with their psychological gender identity. They expect others to treat themselves as a member of the opposite sex. Sometimes disorders of this group develop into transsexualism in adults. Diagnosis is performed by interviewing parents, talking and observing the behavior of the child. Treatment is based on behavioral psychotherapy.
ICD-10
F64.2 Gender identity disorder in childhood
General information
gender identity- the process of establishing the correspondence between the psychological and biological components of gender; awareness and acceptance by a person of the true sex, as well as assigned social roles (husband, brother, mother), behavior, appearance. In childhood, gender disorders appear long before puberty, the symptoms are stable and observed for 1-2 years. AT International classification diseases of the 10th revision, they are allocated in a separate subcategory - F64.2 "Gender identity disorder in childhood". Epidemiological data are unknown, since not all parents, finding symptoms, go to the doctor. Boys are 3 times more likely to be diagnosed.
The reasons
Etiology research is ongoing. Establishing causes allows specialists to determine pathogenic mechanisms, make a prognosis, choose the most effective treatment. The development of disorders is associated with the influence of two groups of factors: constitutional and environmental. These include:
- Prenatal hormonal changes. The endocrine status of a woman during pregnancy can affect the formation of gender identity. Most often, there is an increased or decreased level of testosterone, provoking, respectively, the masculinity or femininity of the child.
- Temporal epilepsy. A positive relationship was found between the frequency of transsexualism and temporal epilepsy. With the timely initiation of anticonvulsant therapy, gender identification disorders can be avoided.
- Pathology of the chromosomal sex. EPI occurs in patients with a change in the number or structure of the sex chromosomes. The most common disease is Klinefelter's syndrome, in which men develop phenotypically feminine traits (gynecomastia, elongated legs and arms) that determine a distorted perception of gender.
- Violation of the parent-child relationship. The basis of the correct gender-role identification is the imitation of the behavioral model of a parent of the same sex. In boys, RPI is formed as a result of a pathological close connection with the mother, fixation in the role small child. In girls, similar distortions occur when they are forced to show independence and aggressiveness from an early age.
- Lack of same-sex friends. Gender models of relationships, socio-cultural expectations are acquired in the process of communication with peers. EPI occur with frequent choice of games of the opposite sex (“Cossacks-robbers” or “daughters-mothers”), in the absence of positive reinforcement correct behavior adults.
Pathogenesis
There are a large number of theories explaining the pathogenetic basis of EPI. Currently, researchers recognize that the formation of gender identity disorders contributes to the combined effects of sensory, biochemical and psychological factors, among which the dominant role is played by the nature of the parents' appeal to early stages child development. A relatively stable idea of gender is formed in a child by the age of 3-5 and usually does not change throughout the rest of his life. But, if, for example, a girl is raised and brought up as a boy, she will perceive herself as a boy, even despite the attitude of others and the development of secondary sexual characteristics (breast enlargement, menstruation, rounding of the hips).
Among the pathological mechanisms of the parent-child relationship, symbiosis is distinguished, when closeness with the parent weakens the child's awareness of his own identity. Another option is the abuse of the father or mother. In such cases, RPI occurs as defense mechanism, based on fantasies that a sex change would improve an adult's attitude ("if I was a girl, they wouldn't beat me"). At the physiological level, there is often a violation of differentiation brain structures responsible for sexual behavior.
Classification
In psychology gender identity is considered as a component of self-consciousness, including subjective perception of oneself and behavioral manifestations of the sexual role at various stages of mental and sexual development. The process of gender identification is subdivided into gender identity, gender identity and sexual orientation. Accordingly, the following options for RPI have been identified:
- Transsexualism. Gender identity is the opposite of biological sex given at birth. Children behave, dress according to psychological perception.
- Transvestism. It is manifested by the desire to change into clothes of representatives of the opposite sex for sensual pleasure. The perception of one's anatomical sex is preserved.
- "Symptomatic" EPI. This group of disorders develops against the background of mental and neuropsychiatric diseases. Most often, gender identification disorders are diagnosed in patients with schizophrenia, nuclear personality disorders, and organic lesions of the central nervous system.
Symptoms of EPI in children
Boys with EPI, starting from preschool age, are more involved in games for girls and, if possible, change into women's clothes, use jewelry and accessories. They spend a lot of time in girls' companies - they jump rope, "classes" and "rubber bands", take on the roles of mothers, daughters, princesses, witches. They are fond of cooking, taking care of pets, maintaining order in the room. Interested in views women's hairstyles, learn to weave braids for dolls and girlfriends. When it is possible to choose a partner for games, girls are preferred. During the period of the child's education in elementary school, contempt grows, and persecution from others arises. Ostrokism reaches its peak in the middle classes. Boys are subjected to humiliating ridicule, verbal and physical aggression from male peers. Open female behavior gradually decreases in late adolescence, but in adolescence and later, a homosexual orientation is formed in 30-60%.
In clinical practice, EPI girls are diagnosed less frequently. The main symptom is boyish behavior. An increased interest in competitive sports, fights, disputes, games that require the application of physical strength is determined. The classic image is a tomboy girl. She rejects dolls, dresses, role plays that require performance. female functions- Child care, cooking, home improvement. best friends boys become, and well-developed physical skills allow them to compete with them in speed, agility, strength and courage. Girls are practically not subjected to condemnation and persecution of others. However, in adolescence and youth, dismissive and humiliating remarks from peers who value femininity are possible. Most patients in their youth refuse to demonstrate masculinity, only a few remain transsexual.
Complications
Children with gender identity disorders need psychological support. Its absence leads to a state of acute maladaptation and emotional and behavioral disorders. Patients experience constant conflicts with relatives, do not find understanding among their peers, are subjected to humiliation and harassment (mobbing). Being alone, they experience shame, despair, fall into depression. In a situation of harsh criticism and pressure, adolescents often decide that suicide is the only way problem resolution. In search of acceptance and love, they may become victims of sexual exploitation. Severe manifestations EPI include rejection of the anatomical structures of the sex. Girls tighten their breasts thick cloth, refuse food to avoid rounding the figure, independently take drugs that prevent menstruation. Boys commit acts of self-harm in an effort to get rid of their penis and testicles.
Diagnostics
Children with suspected gender identity disorders are examined by a psychiatrist. Special techniques have not been developed, the diagnosis is made on the basis of clinical data obtained during observation, conversations with parents, a child. Key diagnostic criterion- a constant desire to be a representative of the sex opposite to biological. This symptom is manifested by specific behavior and appearance.
The disorder usually debuts before school age, less often in early childhood and primary school. Required condition in that the manifestation occurred before the onset of puberty. A characteristic feature of children is the denial of feelings about their biological sex. Negative emotions are associated with impaired social adaptation. Differential diagnosis includes distinguishing EPI with egodystonic gender orientation, sexuality formation disorder, psychosexual developmental disorder.
Treatment of EPI in children
When determining the tactics of therapy, the specialist finds out how much the child or adolescent is motivated to form a gender identity that corresponds to the true sex. If the patient expresses a desire to remain as he is, psychotherapeutic help is limited to recommendations for behavior modification and counseling to help understand diseases and predict the future. The complete treatment regimen includes:
- Cognitive-behavioral psychotherapy. The behavioral component of therapy aims to modify the appropriate opposite sex behavior in order to make it acceptable to the social environment and reduce maladaptation. If the child agrees to change his perception, work is carried out with the image of the body, a positive connection with the true biological sex is formed. The cognitive component of psychotherapy is focused on understanding emotional experiences and learning how to manage them, on drawing up a personal life plan, and discussing sexual preferences.
- Family counseling. The psychologist gives parents information about the nature of the disease, develops in them the acceptance of the position of the child, explains what the lack of therapeutic motivation may be due to, talks about the possible development of true transsexualism, hormone therapy and sex reassignment surgery after reaching 18-22 years. Joint conversations within the framework of family counseling are aimed at developing a communication skill - the ability to speak and negotiate without using reproaches and condemnation.
- Family psychoanalysis. Psychodynamic therapy (psychoanalysis) allows you to process unfinished mental conflicts and problems in family relationships that provoked EPI. At the sessions, the psychotherapist discusses the methods of education, the parents' feelings for the child and its gender, the goals and desires of the parents, the desirability or surprise of pregnancy. A frank conversation with a small patient reveals his fears, anxieties, repressed desires.
Forecast and prevention
The outcome of the disorder is significantly more favorable in cases where the patient has a motivation to achieve an identity corresponding to the anatomical sex - the likelihood of secondary mental disorders decreases, adaptation in the family and school improves, and self-acceptance develops. Prevention of EPI is reduced to the correct sexual education of children. It is necessary to exclude hyperprotection and hypercontrol, parents of the same sex as the child should demonstrate love and respect for their body, their social role, household duties; parents of the opposite sex - to emphasize the difference between themselves and the child (to the girl: "let me carry the bag, I'm a man", to the boy - "son, help me with the bags, you're strong").
One of the most interesting sexual disorders is Gender Identity Disorder, or transsexualism, a disorder in which people constantly feel like they've made a terrible mistake—they don't match their gender (see list in DSM-IV). People of this type would like to get rid of their primary and secondary sexual characteristics and acquire the characteristics of the other sex (APA, 1994) Males with gender identity disorders outnumber females by a ratio of 2:1 on average. People with this problem often become depressed and may contemplate suicide (Bradley, 1995).
People with gender identity disorders tend to feel uncomfortable when they wear their own gender and dress in the opposite sex instead. This case, however, is different from transvestism. People with this paraphilia dress up in order to become sexually aroused; transsexual people have much more deep reasons dressing is a violation of gender identity (Bradley, 1995). In addition to cross-dressing, people with transsexualism often play roles and activities traditionally associated with the other sex (Brown et al., 1996).
Gender identity disorders are sometimes observed in children (Zucker, Bradley & Sullivan, 1996; Sugar, 1995). Just like adults, children with these disorders feel they were meant to be of the opposite sex and strive to be like the opposite sex. This childhood pattern usually disappears during adolescence or early adulthood (Bradley, 1995). So it is possible for transgender adults to have a gender identity disorder as a child (Tsoi, 1992), but most children with gender identity disorder do not develop into transgender adults. Some transsexual adults do not show any symptoms until middle age.
Various psychological theories have been put forward to explain this disorder (Zucker et al., 1996; Sugar, 1995), but little systematic research has been done to test them. Some clinicians suspect that biological factors play a major role in the disorder, and one modern biological research hailed as a breakthrough in this area (Zhou et al., 1995). Dutch scientists conducted an autopsy of the brains of six people who changed their gender from male to female. They found that a group of cells in the hypothalamus, the so-called supporting nucleus of the terminal stria (BST) (bed nucleus of stria terminalis), in these people was half the size of normal men. Since this group of cells in a woman is much smaller than in a man, in fact, in people subject to transsexualism, this group of cells was the same size as in persons of the opposite sex. Scientists don't know exactly what this group of cells does in humans, but it is known to help control sexual behavior in male rats. While there are other ways to interpret this data, it may also be that transsexual men have some significant biological differences, which is why their gender causes them such inconvenience.
Some transsexual adults change their sexual characteristics when they undergo hormonal treatment (Bradley, 1995). Doctors prescribe to men with this type of disorder the female sex hormone estrogen, as a result they have enlarged breasts, reduced body weight, reduced facial hair and changed the composition of fats. Similarly, many women with this disorder are prescribed the male sex hormone testosterone.
Hormone therapy and psychotherapy allows many people with transsexualism to lead a peaceful existence and play the gender role that they feel represents their true identity. For others, this is still not enough and their dissatisfaction leads to the fact that they undergo the procedure, which is the most controversial in medicine: surgical operation on gender reassignment (Bradley, 1995). This surgery is preceded by one or two years of hormone therapy. The operation itself for men includes amputation of the penis, the creation of an artificial vagina, and plastic surgery to change the face. In women, bilateral removal of the mammary gland and removal of the uterus are performed. In some cases, a procedure is performed to create a functioning penis - phalloplasty, but this method is still quite primitive. Physicians have, however, developed a silicone prosthesis that makes the patient appear to have a male genitalia (Hage & Bouman, 1992). Approximately 1,000 gender reassignment surgeries are performed in the US each year. Studies in Europe show that 1 out of every 30,000 men and 1 out of every 100,000 women want to undergo sex reassignment surgery (APA, 1994).
Clinicians are hotly debating whether surgery is an adequate treatment for gender identity disorders.
This is considered by some to be the most humane solution and best suited for people suffering from transsexualism (Cohen-Kettenis & van Goosen, 1997). Others believe that transsexual surgery does not solve a purely psychological problem, just as a lobotomy would not solve it (Restak, 1979). The long-term psychological effect of surgery has not yet been fully elucidated. Some people seem to do well after this procedure (Bradley, 1995), while others have psychological problems.
Our gender is so central to our identity that it's hard for most of us to even imagine wanting to change it, much less imagine the stress that people who question their gender feel. Whether the root cause is biological, psychological, or sociocultural, the violation of gender identity causes a person deep suffering and calls into question the very foundations of their existence.
<James and jen . British writer James Morrison (left) felt like a woman trapped in a male body as he underwent sex-change surgery, which he described in his 1974 autobiography Inside Out. Today, Jen Morris (right) is a successful writer who seems to be quite comfortable with gender reassignment.>
Sex reassignment surgery- a surgical procedure that changes the genitals, facial features and, thereby, sexual identity.
phalloplastyA surgical procedure that creates a functional penis.
Summary
People with gender identity disorders or transsexuals constantly feel that they do not fit their gender and would like to acquire the physical characteristics of the other sex. The number of men with such disorders outnumbers women by a ratio of 2:1. The reasons for this phenomenon have not been fully elucidated. In many cases of this disorder, hormonal treatment and psychotherapy have been used. Sex reassignment surgery is also performed, but surgery as a form of "treatment" for this disorder is hotly debated.
Summing up
Despite the public interest in sexual dysfunction, clinicians have only recently begun to understand the nature of sexual dysfunction and develop effective methods treatment. In addition, scientists have made only minor advances in the explanation and treatment of paraphilias and gender identity disorders.
Formerly people with sexual dysfunctions were doomed to experience sexual frustration all their lives. However, over the past thirty years, sexual functioning has been widely researched, and many psychological, sociocultural, and biological causes have been noted in studies of sexual dysfunction. As we have seen in numerous disorders, various reasons can interact and lead to certain dysfunction, such as erectile dysfunction in men and orgasm in women.
In some sexual disorders, however, a single cause dominates, and complex explanations may be inaccurate and will not benefit the person. So, for example, premature ejaculation, as a rule, has psychological causes, and the cause of dyspareunia is physiological.
Over the past three decades, there has been important progress in the treatment of sexual dysfunctions, and therapy now most often helps people solve their problems. Today, sex therapy is comprehensive program designed to solve certain problems of an individual or a married couple. Again, different techniques can be combined, although in some cases a single method is required to solve a given problem.
One of the most significant conclusions that can be drawn from this work is that knowledge about sexual dysfunctions can be as important as treatment. Sexual myths are still taken so seriously that they often evoke feelings of shame, self-loathing, isolation, and hopelessness, sensations that they themselves create. sexual problems. Even a small amount of information can help a person in need of treatment. In fact, for most people, not just those who need to be treated, it is useful to know how sexual functioning works, so books, television and radio, school programs, presentations of various social groups, and the like attract the attention of clinical scientists. It is important that such promotions continue and increase in number in the future.
Key terms
sexual dysfunction
The sexual response cycle
attraction phase
Reduced sex drive
Sexual disgust
Prolactin
Testosterone
Estrogen
Aphrodisiac
Excitation phase
female sexual arousal disorder
Male erectile dysfunction
penis swelling at night
Action-related anxiety
The role of the observer
Orgasm phase
premature ejaculation
male orgasmic disorder
female orgasmic disorder
vaginismus
Dyspareunia
sex therapy
Mutual responsibility
Focus on feelings
Sense awareness
Self-learning training
teasing technique
Vacuum erection apparatus
penis prosthesis
Stop-start technique
Controlled masturbation training
sex addiction
Paraphilia
Fetishism
Aversive therapy
Latent desensitization
orgasmic reorientation
Transvestite fetishism
Transvestism
Exhibitionism
voyeurism
frotterism
Pedophilia
Relapse Prevention Training
sexual masochism
Hypoxophilia
Autoerotic asphyxia
sexual sadism
Violation of gender identity
Transsexualism
Supporting core of the terminal strand
Sex Reassignment Surgery
phalloplasty
test questions
1. What sexual dysfunctions are associated with the attraction phase of the sexual response cycle? How common are they and what causes them?
2. What are the symptoms and prevalence of female sexual arousal disorders and male erectile dysfunction? What phase of the sexual response cycle are they associated with?
3. What are the possible causes of male erectile dysfunction?
4. What sexual dysfunctions are associated with anxiety about sexual intercourse and the role of the observer?
5. What are the symptoms, signs and main causes of premature ejaculation, orgasmic disorders in men and women? What phase of the sexual response cycle are they associated with?
6. Identify, describe and explain sexual pain disorders.
7. What are the main features of modern sex therapy? What specific techniques are used to treat specific sexual dysfunctions?
8. List, describe and explain the main paraphilias.
9. Describe the technique for applying aversion therapy, masturbation satiety, orgasmic reorientation, and relapse prevention training. What types of paraphilias are these therapies used to treat and how successful are they?
10. What is the difference between transvestism and gender identity disorders (transsexualism). What are the main treatments for gender identity disorders?
Chapter 12. Schizophrenia
What does schizophrenia mean to me? It means fatigue and confusion. These are attempts to divide all events into real and unreal, sometimes not knowing where they overlap each other. These are attempts to think clearly, finding a way in the labyrinth of experiences, when thoughts constantly flow from your head and it is difficult for you to talk to people. It means sometimes feeling inside your head and seeing you walk through your own brain or watching another woman wear your clothes and perform actions as you think of them. It means knowing that you are constantly being watched, that you will never succeed in life because all the laws are against you; to know that ultimate destruction is imminent (Rollin, 1980, p. 162).
This woman describes how a person with schizophrenia feels. People who previously could lead, if not successful, then normal activities, falling ill with schizophrenia, are immersed in a world of unusual sensations, strange thoughts, distorted feelings and movement disorders. This is a psychosis, the main characteristic of which is the loss of contact with reality. The ability of patients to interact with the outside world is so impaired that they lose the ability to conduct normal activities at home, with friends, at school or at work. They may experience hallucinations (false sensory perceptions), delusions (false beliefs), or go into their own inner world. Psychosis can be caused by LSD, amphetamines, or cocaine (see Chapter 10). Psychosis can also be caused by traumatic brain injury (TBI) or organic brain disease. However, as a rule, psychosis manifests itself in the form of schizophrenia.
Schizophrenia- mental illness in which personal life, social and professional activity suffer as a result of the appearance of strange sensations, impaired thinking and motor dysfunctions.
Psychosis- a state in which a person loses contact with reality through key channels for receiving and processing information.
Approximately one in 100 people in the world will develop schizophrenia at some point in their lives (APA, 1994). The financial costs of this disease are extremely high, estimated at more than $100 billion annually, including hospital budgets, lost profits, and disability pensions (Black & Andreasen, 1994). For families of patients, this is also a terrible emotional burden. In addition, people with schizophrenia have high risk suicide or the development of physical illness (Meltzer, 1998; Brown, 1997).
Figure 12.1. Socioeconomic classes and schizophrenia. In the United States, studies have shown that poor people are much more susceptible to schizophrenia than rich people. (Keith et al., 1991, adapted.)
Although schizophrenia occurs in all socioeconomic groups, people with low incomes are most affected (Fig. 12.1), leading some theorists to believe that the trauma of poverty is itself a cause of the disease. However, it is also possible that the victims of schizophrenia fall into a lower socioeconomic level due to illness or remain poor due to the inability to function effectively (Munk & Mortensen, 1992). This theory is sometimes called the "downward drift" theory.
Schizophrenia affects both men and women equally. However, in men, the disease often begins earlier and is more severe (Castle et al., 1995). About 3% of divorced or separated people develop schizophrenia at some point, compared to 1% of married people and 2% of unmarried people (Keith et al., 1991). Again, it is not known whether family problems are a cause or a consequence of the disease.
Approximately 2.1% of African Americans are diagnosed with schizophrenia compared to 1.4% of white Americans (Keith et al., 1991). However, according to the census, African-Americans are more likely to live in poverty and experience difficulties in family life. When these factors are accounted for, the incidence rate for schizophrenia is the same for both racial groups.
<«Вряд ли когда-либо история мира... знала больше безумств, чем в наши дни». - Джон Хоукс, «На возрастание безумства», 1857>
Schizophrenia is the condition that first comes to mind when you hear the word "crazy" (Cutting, 1985). Both in the past and in our days, people are very interested in this disease, flocking in droves to theatrical performances and movies (including popular horror films) that deal with schizophrenia.
But at the same time, you can see that many people with this disease are treated with disdain, their needs are almost completely ignored. They live without adequate treatment, with no opportunity to develop their human potential (Torrey, 1997).
Gender identity disorder is a state of permanent self-identification with the opposite sex. In this condition, people feel as if they are enclosed in a body that is not compatible with their own perception of gender. They consider themselves victims of a biological error. Transsexuals are people who have a form of gender identity disorder that is extremely pronounced.
Actually, gender identity itself is considered a subjective sensation, when a person feels like a man or a woman. Gender identity is considered an internal feeling of femininity or masculinity. The external objective manifestation of a person's belonging to a man, a woman, or a bisexual state is a gender role. At the same time, a person’s behavior is as much as he wants to show himself or others, in order to convince to what extent “he is a woman” or “she is a man”. The role and gender identity of most people is the same. The discrepancy between gender identity and anatomical gender is a gender identity disorder. This mismatch is felt by transsexuals as heavy, long, disturbing, complex. This condition is called a "disorder" because of the distress it often causes. The treatment of such patients should not consist in dissuading them of their gender identity, but in adapting them.
Pathaphysiology and Cause of Identity Disorder and Transsexualism
Gender identity is mainly determined by the prenatal hormonal background, the genetic component and biological factors, however, in order to form a consistent and confident gender role and gender identity, the influence of some social factors is needed, such as the relationship between parents and the child and the nature of the emotional connection of one parent with another.
When upbringing and gender are ambiguous (for genetic syndromes in which the appearance of the genitals is disturbed, insensitivity to androgens, or if the child has genitals of both sexes), the child may be uncertain about his role and gender identity. However, the significance of external factors is controversial at the moment. If the upbringing and gender designation are unambiguous, then even the presence of the genitals of both sexes in the child will not violate his sexual identity. Transsexuals usually face the problem of gender identity in their early childhood. In adulthood, most people who had problems with gender identity in childhood do not experience.
Two years is usually the age at which problems with gender identity arise in children. There are also cases when gender identity disorder does not manifest itself until adolescence. Children who experience problems with gender identity often prefer clothes of the opposite sex, constantly and clearly want to take part in activities and games that are characteristic of the other sex, insist on belonging to the opposite sex, and have a negative attitude towards their own genitals. For example, a little girl insists that she can urinate standing up when her penis grows, while a boy, on the contrary, may urinate sitting down and clearly want to get rid of his genitals. This disorder is not diagnosed until 6-9 years of age, when the disorder is already chronic.
Diagnosis of transsexualism and identity disorders
To make this diagnosis for a child, it is necessary to have identification with the other sex (the child's conviction that he belongs to the opposite sex or his desire to be the opposite sex), as well as a significant mismatch of the child with his gender role or a feeling of discomfort in connection with his gender. The desire to gain any cultural advantage of the opposite sex should not be an identification with the other sex. For example, a boy who talks about his desire to become a girl only in order to receive the same attention that he receives younger sister most likely does not have a gender identity disorder. Behavior that falls on the continuum of traditional femininity or masculinity is associated with gender roles and cultural pressures that increase against people who do not quite fit the traditional dichotomy of women and men. In Western culture, the attitude towards the behavior of little girls as tomboys is more tolerant than the attitude towards the effeminate behavior of boys. In role play, many boys play mothers or girls by trying on mothers and sisters' clothes. Such behavior, as a rule, is the norm of development, and only in extreme cases is it preserved. Many boys with identity disorder as children do not have it as adults, but many are bisexual or homosexual.
In adults, diagnosis is aimed at determining the presence of severe distress or a clear violation in professional, social and other areas of functioning. Opposite-sex behavior, such as cross-dressing, may not require any treatment, provided it is observed without psychological distress or if the person has physical signs of both sexes (genitals of both sexes, congenital adrenal hyperplasia, insensitivity syndrome to androgens).
There are cases of association of transsexualism with the presence of genetic anomalies (Klinefelter or Turner syndrome) or the genitals of both sexes. The majority of transgender people in need of treatment are men who embrace a feminine identity and have great distaste for their own masculinity and genitalia. Basically, such people seek help not for the purpose of obtaining any psychological help, but for a different purpose, such as receiving hormones and surgical operations on their genitals in order to bring their appearance closer to their gender identity. A combination of hormone therapy, psychotherapy, and sex reassignment surgery often cures these patients.
Transsexualism transition from male to female most often first manifested in early childhood: participation in girls' play, fantasies of changing sex, avoidance of competitive and power games, distress with changes in physical fitness in puberty. Many of the transgender people are persuasive in accepting the female role, having the satisfaction of acquiring a effeminate appearance and obtaining papers that indicate their gender, which helps them to live and work in society as a woman. Others are experiencing big problems from depression to suicidal behavior.
Transsexualism transition from woman to man is increasingly seen in psychiatric and medical practice as a treatable transsexualism. Such patients undergo mastectomy, hysterectomy, and then ovariectomy, as well as androgenic hormones that promote voice changes, male-type muscle distribution, and body and facial hair growth. Some patients insist on the formation of a neophallus (artificial phallus). For some patients, surgical treatment helps to better adapt and gain satisfaction from life.
In whatever formats a child and family psychotherapist works - with the whole family, with married couples, with parent-child couples, individually with family problems of adults - psychotherapy is carried out to a large extent thanks to the initiative and interest of the woman.
A woman is much more active in seeking psychotherapeutic help than a man, she trusts a psychologist more, agrees to spend time and money on work that is completely useless from a man's point of view. It is the woman who seeks help from a psychologist in case of conflicts in the family and problems with children. A woman is able to reflect on the causes of her love failures, broken unions, loneliness in old age.
The experience of a child and family psychotherapist shows that marital and family conflicts, problems of parent-child relationships are often generated by violations of women's gender identity. The woman does not present this as a request or complaint. The therapist uncovers this source in the process of working on what the woman is seeking help with.
It may seem that having seen the cause of a woman's problems twice or thrice in violations of sexual identity, the psychotherapist will later look for her right here, "under the lantern." In fact, the temptation is small due to the complexity of the subject. Before understanding how violations of gender identity affect the fate of a woman, her marital and family life, we must try to determine what these violations consist of.
Ideas about the nature of female gender identity, its violations and the manifestation of these violations reflect the author's professional experience as a child and family psychotherapist, and also follow from his observations of the lives of many women around. The author allows himself to proceed from his understanding of gender and gender identity of a person, although he relies on data and concepts recorded in the literature. From literary sources, at his own discretion, he selected only those data or judgments that he unconditionally shares.
The problem of psychological gender
First of all, it is necessary to clarify the content of the concepts of "sex" and "gender identity", with the help of which different sciences describe the phenomena associated with sex. The problem of sex is studied by differential psychology, social psychology, sociology, and anthropology. Each of these sciences identifies aspects of the problem of sex, corresponding to its subject.
Differential psychology considers gender as a complex of bodily, reproductive, social and behavioral characteristics that define an individual as a man or a woman, a boy or a girl (Ilyin, 2003; Kagan, 1991). Until the 1980s, gender researchers proceeded from the concept of the biological determination of the sexual characteristics of men and women. These features were then labeled gender differences, which may not have a biological basis at all. Social sciences and anthropology are developing in this direction.
The introduction of the concept of "gender" into scientific circulation was intended to transfer the analysis of "male" and "female" from the biological level to the social level, to abandon once and for all the postulate of the "natural purpose of the sexes", to show that the concept of "sex" belongs to the number the same significant categories as "class", "race" (Berdyaev, 1991).
The concept of "gender" is interpreted differently depending on the social theory or research paradigm within which the relationship of masculinity-femininity is studied. There are two branches in the studies of gender relations in Russian sociology.
The first examines the relationship of masculinity-femininity in the modern Russian context, the second is an analogue of Western studies of women, appealing to the category of difference - the features of women's experience as associated with inequality, oppression, patriarchy (Zdravomyslova, Temkina, 2001).
There is an opinion among sociologists that it is impossible to separate gender studies and feminism, and that gender studies do not exist outside of feminism. According to this group of scientists, a study cannot be considered gender-based if the researcher does not consider it necessary to recognize the fact of the asymmetry of male and female status in society, the presence of male and female sex roles (Kashina, 2004).
If sociologists, social psychologists, culturologists insist on the historical and cultural determination of differences between men and women, then differential psychologists, relying on experimental data, argue that the differences between men and women are determined not only historically and culturally, but also biologically.
Since the scientific terminology in the study of men and women by different sciences has not been established, often “sex” and “gender” are used as synonyms (unless the scientist shares the extreme points of view given above). The basic sense of belonging of a man and a woman to their gender is called either sexual or gender identity. The normative prescriptions and expectations that a culture imposes on “correct” sexual behavior and that serve as an assessment of the femininity and masculinity of a child or adult are defined as gender, then as gender role(Kagan, 1991; Kohn, 2003).
Psychologists who study the psychological differences between men and women are unlikely to challenge the ideas of gender psychologists that gender identity is developed as a result of a complex interaction of a person's natural inclinations and appropriate socialization, typification, and coding. The individual performs active start in this process, and he himself accepts or rejects the roles and behaviors offered to him (Kon, 2003).
The concept of sexuality is associated with the concepts of "sex" and "gender". According to the definition of the World Health Organization, sexuality is a core aspect of human existence throughout life, from birth to death. It includes gender, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction (Kohn, 2003). As can be seen, in the definition of sexuality, sex is used as a biological category, and gender as a socio-cultural one, thus emphasizing the contribution of biological, psychological, social and cultural factors to the nature of sexuality.
In psychoanalysis, the opposition between masculinity and femininity is conceived in the inseparability of the biological, psychological and social. An individual has a biological sex, civilization (or culture) prescribes certain roles to him (her). The masculine and feminine also have a psychosexual meaning associated with both the biological and the social in man. When evaluating a person's behavior in terms of masculinity or femininity, his deep fantasies are of decisive importance (Laplanche, Pontalis, 1996).
Among domestic psychoanalysts there is no unity in relation to the concepts of "man", "woman". Two approaches are possible here. The first comes from the fact that the main analytical theories (topographic model of personality, object relations theory) do not consider a person as a man or a woman, the process of the formation of gender identity should be analyzed either in the context of the dyadic relationship of the child with the mother, or the triadic relationship of the child with the parents. Other psychoanalysts use the concepts of gender, gender role, masculinity and femininity, male and female identity, interpreting deep processes in the language of psychodynamics (Man and Woman, 2005).
In anthropology and cultural studies, the differentiation of male and female gender roles is explained by their complementarity. The male lifestyle is considered to be predominantly instrumental, while the female one is expressive. The man is the breadwinner, breadwinner, carries out the general management of the family, bears the main responsibility for disciplining children, while the woman, emotional by nature, maintains group solidarity and provides the emotional warmth necessary for the family (Ilyin, 2003; Kagan, 1991; Kon, 2003).
These ideas are supported by the data of differential psychology, according to which women are more sensitive than men to human relations and their motives, men are more inclined towards objective activities associated with overcoming physical difficulties or with the development of abstract ideas, while women have more pronounced artistic interests, etc. (Ilyin, 2003).
Differential psychological studies reveal between men and women, between boys and girls, morphological, physiological differences in the pace of motor development, in the manifestation of properties nervous system and temperament, in the asymmetry of the hemispheres.
In a wide range of works it has been proved that there are differences between a man and a woman in the manifestation of emotions and experiences, in the recognition of emotional states, in the nature of abilities, memory, thinking, and creativity. Differences in values, motivation, communication features, in male and female sexuality have been revealed (Ilyin, 2003; Kagan, 2000).
With all the diversity and often incompatibility of the results of studies of the personality of men and women, there is a certain sequence in the direction and choice of areas of self-realization of men and women, partly coinciding with the difference between men and women on the grounds of instrumentality and expressiveness: a more obvious interest of men in work, career, social success, knowledge, creativity, and women - to the family, communication, love, maintaining health. Differences in orientation and value orientations are found in boys and girls as early as the primary school age, and then are clearly formed in adolescence and youth (Kagan, 1991).
Researchers of the family and family relationships have identified differences in the attitude of fathers and mothers towards children, in the style of interaction between fathers and mothers with children. Reliable data have been obtained on the dependence of marital, parent-child relations, the contribution of a man and a woman to a family on whether the family is egalitarian or patriarchal. Whatever the model of the family, differences in the content of male and female sex roles remain (Ilyin, 2003).
Both differential and social psychologists cannot but recognize the biological nature of sexual dimorphism. The concept of V.A. Geodakyan, who explains sexual dimorphism from the standpoint of evolutionary biology, has firmly established itself in science. There was not even an attempt to challenge it. V.A. Geodakyan sees the expediency of the presence of sexes in their specialization in two main alternative directions of the evolutionary process: conservative (preservation of the properties of the species) and progressive (acquisition of new properties by the species).
Male, according to V.A. Geodakyan, implements the "progressive" trend, and the female - "conservative", ensuring the invariability of the look from generation to generation. The female sex is more phylogenetically stable (rigid), but ontogenetically more plastic. Male - on the contrary: phylogenetically more plastic, but ontogenetically rigid. The male sex is the "avant-garde of evolution", taking on the function of a person's collision with new conditions of existence (Ilyin, 2003; Kon, 2003).
These ideas correspond to the data of domestic biologists, who found a higher genetic conditionality of a number of morphological and physiological characteristics in males and a greater dependence of these traits on environmental influences in women (Nikityuk, 1977). Social psychologists and sociologists insist that V.A. Geodakyan, for all its harmony and irrefutability, cannot explain the process of sexual differentiation and the individual differences between men and women associated with it.
Understanding the phylogenetic functions of sexual dimorphism does not clarify how and why it manifests itself in various areas of human activity, why many properties are inherent in both men and women, and why men and women have properties inherent in the opposite sex. In part, answers to these questions can be obtained if you carefully look at the process of the formation of gender identity.
The way of life of the societies studied by M. Mead convinced her that the formation of sexual identity in children should be considered in the light of “their own bodily experience reinterpreted by them”, which develops in the process of perceiving the bodies of the surrounding men and women. In the process of feeding, the mother, by her attitude and appeal, shows her daughter that they are creatures of the same sex, and her son that he is different, that he is a man. From the age of five, the girl knows that in the future she will become a mother and must protect her femininity in order to marry later.
The boy, realizing his difference from his mother, turns around to face the outside world in order to explore it and act in it. Thus, according to M. Mead, the identification of a woman with her gender occurs quite early, and a man constantly has to confirm his masculinity and redefine it for himself (Mead, 2004).
In the formation of the sexual identity of children, psychologists distinguish several stages. In the second year of life, a child identifies with one sex or another, and this basic gender identity develops by the age of three. By the age of five or six, a gender-role identity is formed. Major changes in gender identity in adolescents occur during puberty (Kagan, 2000). It would not be a mistake to say that the formation of gender identity is completed in adolescence, when relationships with the opposite sex, the first love or sexual experience determines the experience and awareness of oneself as a man or woman.
Researchers of gender identity in children have shown that its development depends on the presence of one or both parents in the family, the images of the father and mother in children as men and women, the relationship of parents, and their attitude towards children (Ilyin, 2003; Kagan, 1991). The formation of children's gender identity is influenced by their peers, siblings, significant adults from their environment, characters in books, films, actors, athletes and other public figures. All this variety of influences leads to the fact that boys and girls perceive, assimilate roles and behaviors that correspond not only to them, but also to the opposite sex.
Different approaches to explaining the mechanisms by which a child learns a sexual role take into account either the significance of the child's unconscious imitation of parents, or the reinforcement of the child's correct or incorrect sexual behavior, or the child's self-awareness, when he himself seeks to conform his behavior with learned ideas (Ilyin, 2003; Kagan, 2000). Apparently, all three factors act in the process of formation of the sexual role in children, but different stages ontogeny acts as a leader, then one, then the other, then the third.
According to R. Stoller, a person identifies himself not only with persons of his own, but also with the opposite sex, and his gender identity is a combination of male and female features (2001). Despite the abundance of points of view and approaches, one of the most unclear questions remains the question of how a man and a woman realize and experience the presence of signs of their own and the other sex.
The idea of the dual nature of men and women was established in the German philosophy of Neoplatonism and was embodied in the famous book by O. Weininger. He argued that a man and a woman are not creatures that could be attributed to one or the other sex. In life there are only individuals approaching these poles. O. Weininger believed that he discovered the law of "sexual attraction": to unite the sexes, you need a perfect man and a perfect woman, who are in two individuals in completely different parts (Weininger, 1991).
The principle of androgyny formed the basis of the Neoplatonic philosophy of love by N. Berdyaev, V. Solovyov, Z. Gippius, the concept of Christian love by S. Bulgakov. According to S. Bulgakov, each person is "an individual identity, a mixture of the elements of male and female, and this causes the tension of the erotic spirit" (Bulgakov, 1991). The interaction of masculine and feminine in love is the desire of “a masculine being to unite with another masculine. Eros builds a double bridge from the masculinity of one human being to the femininity of another, and from the femininity of the first to the masculinity of the second (Gippius, 1991, p. 193).
For K. Jung, a person in his integrity is a bisexual being. In the male unconscious, the feminine (anima) is embodied, in the female - the masculine (animus). In the anime, the representations of the mother, woman, soul merge, in the animus - the representations of the father, man, hero. A man's awareness of his inner femininity, and a woman's awareness of masculinity leads to a person's discovery of his true essence and personality integration (Johnson, 2005a; 2005b).
In the 70s of the last century, androgyny became the subject of research. In the concept of S. Bem, androgyny is considered as the optimal combination of male and female features. S. Bem showed that androgyny provides a man and a woman with greater opportunities for adaptation than extreme manifestations of femininity and masculinity, masculinity and femininity. Data were obtained on the relationship of androgyny with situational flexibility, high self-esteem, motivation to achieve, good performance by men and women of the parental role, and a subjective sense of well-being. Couples where both spouses are androgynous have higher marital satisfaction than couples where one or both of the spouses are gender-typed (Bern, 2004).
The gender concept of S. Bem was widely recognized, although it was criticized by representatives of gender psychology. S. Bem herself lamented that she had to build her concept on the difference between male and female qualities, contrary to the intention of gender psychologists to reduce gender polarization (ibid., 2004).
Analyzing gender identity, we will adhere to the psychological point of view on the nature of personality, gender, sexual behavior. Gender identity is one of the most important components of a person's personal identity, closely related to his self-image, self-concept and self-attitude. It is natural to assume that self-attitude, I-image and I-concept largely determine gender identity and vice versa - gender identity determines various aspects of self-consciousness. This assumption, of course, requires special study, but at present there is no literature evidence of such studies.
Female identity and androgyny
As it became clear from the previous presentation, the author prefers the concept of "gender" to the concept of "gender". Since the integrity of gender includes the biological, social, and cultural, "gender" can be used as a psychological category. Psychological gender is realized and experienced by a person, determines his self-awareness, behavior, his sexual and love life. In order to understand how gender identity determines a person's personal life, his destiny, let us consider gender identity more broadly than is customary, dividing it into several components.
As is customary in the psychology of sex, or gender psychology, we will consider the gender role as a constitutive element of gender identity. For the bearer of a sexual role, it does not matter whether it is biologically determined, culturally imposed, or assigned to them of their own choice. For a man and a woman, the gender role is his (her) own reference point, according to which he (she) acts as persons of a certain gender.
A man and a woman can perform roles corresponding to their own and the opposite sex, mainly the role of their own or the opposite sex. The nature of gender identity depends on how a person relates to the male and female in himself. Several options can be assumed: acceptance of both male and female, rejection of both, acceptance of the part corresponding to one's sex and rejection of the opposite, and vice versa - acceptance of the part corresponding to the opposite sex and rejection of one's own.
The attitudes of men and women in love and sexual life, their inherent mode of behavior will be called male and female eros. The term "eros" used here does not describe sexual behavior person. Eros characterizes a man and a woman in terms of their readiness for love and sexual relationships, the significance of these relationships for them, the degree of activity and initiative in the emergence and development of these relationships.
The nature of a man as a man and a woman cannot be understood, according to N. Berdyaev, “beyond the question of love”, outside the ideas of a man and a woman about the value of love. Love here means special type experiences and relationships (as opposed to such forms of intimate life as passion, falling in love, attraction, etc.). Love as an experience is addressed to the unique and only "other", he is loved regardless of whether he loves in return, whether he is present at all in the life of the lover. In the relationship of love, each confirms the existence of the other, he himself is realized in its entirety and, by his attitude, creates conditions for the other for self-realization.
The quality of erotic, love and marital relationships depends on what kind of partner a man and a woman are tuned in to and what choice they make. They may be oriented towards real person, of those whom they meet in life, or the ideal one created by their imagination. For some people, living in dreams replaces reality and avoids the risk of intimate and deep contact.
Awareness and experience by a man and a woman of their gender includes their perception of their corporality. A man's and a woman's assessment of their physicality is based on their own ideas about the standards accepted at a given time in a given culture, and, accordingly, is experienced by them as acceptable or rejected, harmonious or disharmonious. Men and women, dissatisfied with their physicality, different ways they try to change it, including with the help of clothes (and women use cosmetics) to create a certain image of themselves and broadcast it to others.
There are elements of corporeality that are minimally controlled by people. Expression, gestures, gait, voice, rate of speech are the striped properties of a person (Kreidlin, 2005). In these elements of corporality, in the non-verbal means of communication used by a man and a woman, an attentive observer is able to discern even those features of gender identity that a person is not aware of or tries to hide. The signs of physicality mentioned above, as well as the image created by a man and a woman with the help of external means, we will call appearance.
Based on the identified components of identity, let's turn to its optimal model. Obviously, we are talking about androgynous men and women.
The androgynous man and woman play predominantly the roles of their respective sexes, but also the roles of the opposite sex. They accept both male and female in themselves, with certainty realizing and experiencing themselves as a man or a woman. An androgynous woman can speak loudly, walk with a firm step, but in dialogue she behaves like a woman: she accurately expresses her feelings, is focused on her partner, quickly switches and changes roles. Even if an androgynous man speaks quietly, easily enters into tactile contact, he behaves like a man in a dialogue: he keeps his attention on the main topic of the conversation, is immersed in his own thoughts and the thoughts of the interlocutor, attaches more importance to the words of the interlocutor than to his feelings (Kreidlin, 2005).
In the family, androgynous man and woman fulfill their "natural" sex roles: a woman - mothers and wives, a man - husband and father. They can equally dominate the family, and if one of them dominates, then the other recognizes his right to lead. If an androgynous man is caring, emotional, expressive, this is combined with his desire to take responsibility for others, to act decisively in difficult situations. If the male motivations of an androgynous woman encourage her to professional growth, career achievements, then on this path she will not lose female tact, flexibility and will not compete with a man. Androgynous man and woman experience and realize their sex as integral, taking in themselves the features and properties of both their own and the opposite sex.
The erotic attitude of an androgynous man and an androgynous woman corresponds to their gender role and their ideas about the behavior of a man and a woman in love and sexual relations. They differ in the nature of search behavior, in the degree of initiative, forms of activity, ways of establishing contact with the opposite sex. In the behavior of a man, the attitude towards conquest and possession is realized, and in the behavior of a woman - to wait and seduce, although at the same time a woman can openly demonstrate her interest in a man, and a man can seek a woman by relentless courtship.
At the heart of the personality of androgynous men and women is self-acceptance, a positive attitude that contributes to the formation of a harmonious gender identity. Accepting themselves and other people, including those of the opposite sex, androgynous men and women experience family relationships, friendship, romantic youthful love are prepared to meet with love.
love for them high value, a necessary condition for happiness as "experiencing the fullness of being." "Androgynes" are usually happy in their personal lives, satisfied with their marriage, their parenthood and marriage. They know how to pass without great losses. critical periods in the life of the family and its members, constructively resolve conflicts. In a family created by "androgynes", there are all conditions for the development of a healthy and normal personality in children and for them to assimilate the model of their own family.
Women's Gender Identity Disorders
Gender identity disorders can be of the widest range. Doctors refer to violations of gender identity as individual variations of masculinity and femininity, accompanied by adaptive reactions: gender-role conflict at the personal level as an experience of real or imaginary inconsistency with gender-role standards with personal reactions of a neurotic type; conflict of gender identity as a conscious confrontation, experiencing oneself as a representative of the opposite sex and existing gender-role standards in spite of the passport gender (Kagan, 1991).
Gender identity disorders should be distinguished from gender identity disorders: a condition where an individual's sexual identity does not coincide with his biological sex, causing a desire to change it (Kon, 2003).
We will consider variations of the conflict - conscious or unconscious - correlation of masculinity and femininity in men and women as violations of gender identity, which in a certain way manifest themselves in their behavior and cause various difficulties and problems in the personal and family life of their carriers.
Conflicts of masculinity and femininity are gradually formed in the process of becoming personal disintegration. The earlier in ontogenesis a gender identity is formed and the more closely it is associated with a negative (or low positive) self-attitude, the deeper the conflict in the sphere of masculine-feminine and the grosser the violation.
Violations of gender identity are largely determined by the conflict in the relationship of the child (adolescent, young man) with the objects of identification and their role in his life.
In the process of the formation of gender identity, conflicts in the sphere of masculine and feminine may coincide or be accompanied by conflicts in the structure of self-consciousness, specific to those stages of ontogenesis at which gender identity is formed. The presence of a basic (central for the personality) conflict in the structure of self-consciousness increases the likelihood of an unfavorable for the individual passage through these stages.
It is impossible to understand the causes of the emergence and development of a woman's personal and family problems without analyzing the nature of her gender identity: gender role, the nature of masculinity and femininity, attitudes towards the feminine and masculine in herself, her attitude to a man, to love, and how gender identity manifests itself in behavior of a woman as a mother, wife, lover.
Not always and not in all cases, when working with women's problems, it is required to study all aspects of gender identity. A woman can intuitively come across what lies at the basis of her problems. The psychotherapist will restore the rest as the client reveals herself. In the process of psychotherapy, a woman - even without a psychotherapist - turns to her childhood, adolescence, youth, finds events that determine her development as a woman, and together with the psychotherapist connects these events with what followed them - immediately or delayed.
The psychotherapist does not seek to bring the client to an awareness of how gender identity affects the life of her family, children, and her own destiny. This is important for the psychotherapist himself. He needs to put together fragments of memories, impressions, echoes of a woman's pain into a single picture in order to know where to go with the client. He correlates three existential layers: the experience of the client's life in the parental family, her development as a woman, and the experience of her life in her own family, with her husband and children. In his view, these layers should acquire integrity, within which he can move in search of targets for psychotherapeutic work.
Elena K.'s case demonstrates how a woman's gender identity disorder creates marital and parental problems. Elena K. sought psychotherapeutic help for a thirteen-year-old daughter from her second marriage who was stealing at home. The coldness with which Elena talked about her daughter contrasted with the warmth and tenderness at the mention of the names of her sons from her first marriage. The client admitted that she did not caress the girl even in her childhood, and when her daughter entered adolescence, Elena began to treat her with some hostility.
She was annoyed by her husband's inconsistency in raising his daughter: he either indulges her or is overly strict. Elena's husband did everything possible to make up for the girl's lack of maternal warmth, admired her lovely female being, dreamed that his ideal of a woman would eventually be embodied in the girl. The girl, however, behaved like a teenager going through a teenage crisis: she tried to insist on her own, quarreled with loved ones, was rude and looked like a boy with her habits, upsetting her father.
Elena's parents divorced when she was eight years old. Elena's mother, busy with science, paid little attention to her daughter, was strict and critical of her, and the girl felt lonely. The stepfather hardly noticed Elena, and this hurt her, especially when she saw how he treated his son. She wanted to be like a boy in order to be closer "to them." In the end, already an adult, she became friends with her stepfather. Feminine, she rejected her femininity - as did the sex of her daughter later.
Elena dreamed of being happy in mutual love. She imagined a noble person nearby, a real man. She wanted to have a big family, to give birth to two or three children. Her real husbands were very far from ideal, and Elena treated them condescendingly, in both marriages she was unhappy and did not hide this from her husbands. She was fully happy only when she stayed with her sons.
In her presence, her husband said that she only sees men in them. Elena didn't mind, and apparently she did. She formed a coalition with them as opposed to the husband-daughter coalition. The girl responded to family disharmony by secretly taking money from home. As you can see, domestic theft here is not only a symptom of family dysfunction, but also the result of violations of Elena's gender identity, which determined her female fate: a compromise choice of marriage partners and, as a result, discord in marital and family relationships.
In the relationship of single mothers with adolescent boys, in the development of the personality of boys, violations of the gender identity of women are especially pronounced. Usually they are either divorced or not married at all, do not have a positive love and sexual experience, do not understand the peculiarities of male psychology. These are quite energetic, active women, prone to a directive style of dealing with children. The need to fulfill male roles, to replace the father of the boys nullifies their femininity.
The conflict in the sphere of masculinity-femininity, the woman's experience of her parental incompetence lead to the fall of her authority in the eyes of her son. Boys look for a model of male behavior, an authoritative figure outside the family, and if they find such a person, they fall under his influence, often destructive for the development of their personality. If in adolescence the relationship of boys with their mothers takes the form of either confrontation or open clashes, then in adolescence, with the onset of separation, the struggle with the mother is mediated by alcohol, drugs, sex, etc.
The problems of the children of business women, especially girls, lead the psychotherapist to consider the feminine nature of their mothers. Being identified with the male gender role, they are focused on high achievements, power, big money. It can be said about them that they use their feminine in order to realize their masculine. Women's tricks in creating an image, the impeccability of their appearance are brought to perfection and are used with tough male prudence.
These women, in a feminine way, use men for their unfeminine purposes. Marriage is incompatible with the lifestyle of business women, but they do not want to remain childless. Instead of a busy mother, their children are raised and raised by nannies, governesses, and other substitute figures. Children know that they have fathers, but they are present in their lives mainly in money. At primary school age, the children of a business woman cease to be obedient and educated, they begin to have serious problems with their peers, with teachers, with teaching. They suffer from the absence of a normal family and refuse to be good, diligent and successful in order to return the mother to her parental duties.
When a child and family psychotherapist encounters the femininity of boys and the masculinity of girls in his practice, this does not mean that it is necessary to turn to an analysis of the mother's gender identity. If a mother brings an eleven-year-old boy to an appointment with a psychologist with a complaint that classmates bully him, tease him, are not friends with him, then most likely, peers do not accept femininity in his appearance and behavior.
The boy's mother can be a completely normal feminine woman who, for one reason or another, has formed a coalition with her son (as opposed to, say, a coalition of a father with his eldest son). When the mother-son coalition takes on a symbiotic character, the boy develops feminine ways of behaving and irritates not only his classmates, but also his father and brother. The symbiosis of mother and son is strengthened, and the conflict of masculinity-femininity in the boy is intensified.
The masculine manifestations of adolescent girls are also not always rooted in maternal patterns. By rudeness and arbitrariness, underlined by independence, girls often assert their teenage adulthood. However, this does not mean that they develop according to the masculine type, identifying themselves with a masculine mother (or even father).
Parents may not be the source of gender identity. Adolescent girls' negative self-affirmation is realized in a male pattern of behavior and is of a protective nature. If the girl's conflicts with her parents are resolved or the family seeks psychological help, the girl's masculine traits may disappear as she emerges from adolescence, but they will become fixed in chronic conflicts with adults and, above all, with her father and mother.
Typology of violations of female identity
As a result of studying the personal and family problems of women, according to the parameters described above, five types of women with violations of female gender identity were identified: "masculine", "feminine", "pseudo-masculine", "confused". It turned out to be possible to distinguish two subtypes within the masculine type: “highly” and “moderately” masculine. Let's see what the specifics of each of the selected types are.
The sex role chosen by the highly masculine woman is predominantly masculine. It is focused on male professions, achievements, knowledge, professional success, high official or professional status. In her form one can clearly see male signs: in gait, gestures, postures, voice timbre. In relations with a man as a sexual and love partner, she is quite assertive, active, takes the initiative both in starting relationships and breaking up.
“Highly masculine” accepts the masculine in itself and rejects “female troubles” (tears, weakness, emotionality, specific means of seduction). She hopes to meet a "real" man with whom she could feel like a woman: to obey, to be surrounded by care, attention. Most often, she fails to fulfill her ideal, and she is content to send her life, although she experiences marriage as a compromise with someone who is not equal to her. It is this conflict that is called the “Brünnhilde complex” (named after the giantess from the German epic, who has no equal among men).
A highly masculine woman will not wait for love all her life. The masculine principle pushes her towards a reasonably organized marriage, and she prefers to have an unworthy partner in her husbands, rather than being left alone. In the family, a highly masculine woman dominates by an imperious type: she seeks to assert her ideas about what is due and establish her own rules. She constantly expresses her dissatisfaction with family members and does it in a blunt manner. Usually, husbands give such women leadership in the family, try not to enter into conflicts with them and, as a result, almost do not participate in the upbringing of children.
If children who are dependent on a domineering mother obey her, then in relations with others they are compliant, conforming, and do not know how to stand up for themselves. If children depend on their mother, but this manifests itself in a protest-conflict form, they behave in conflict in any situation and in any relationship. Protesting girls usually develop in a masculine way. An overbearing mother rarely puts pressure on her son - only if he looks like his father. With a son who looks like her, she forms a coalition against other family members as an equal.
It can be thought that the sexual identity of a highly masculine woman is formed in the oedipal phase through identification with a domineering mother, if she inherits her psychotype. During adolescence and adolescence, a girl's masculinity is enhanced by her success in sports or leadership in her peer group. In the family, a highly masculine woman establishes the relationships and interactions that she has learned in her parental family from the behavior of her mother.
The “highly masculine” is self-confident, not prone to reflection and self-change, although she is able to set goals and achieve them. She comes to terms with her lack of fulfillment in the family and in love, she can achieve a lot in her profession and career.
A moderately masculine woman is closest to androgynous. In her sexual role, both male and female tendencies are combined, they are easily visible in her appearance. Most often, she willingly dresses up, decorates herself with pleasure, but she does not always manage to find her own style because of the rather strong masculine principle. In a relationship with a man, she can be active - both in choosing a partner and in establishing a relationship with him, but if she feels that she has gone far, she quickly changes tactics to a more feminine one.
A moderately masculine woman accepts both the masculine and the feminine in herself, and easily demonstrates her masculine traits in behavior and self-presentation. Such a woman has moderate demands on a man as a marriage and love partner, but she will not agree to anyone, just to be married, and is ready to wait for someone who suits her. Love is of high value to her and for the sake of love she will sacrifice marriage if necessary (for example, to be the beloved woman of a married man).
The family life of a moderately masculine woman can develop successfully in two cases. In the first - if she meets an androgynous man, he will appreciate a woman in her, and in this happy union she will overcome her excessive masculinity. Although this option is possible, it rarely occurs in real life. It is more likely that her marriage partner will be a man who is not hindered by her masculinity. He will even benefit from it for himself: he will give his wife leadership in the family, primacy in raising children and in making decisions.
Such women are convenient for men who are absorbed in their work. A moderately masculine woman respects her husband's professional or business employment, takes responsibility for the family and leads it on the basis of her authority. She copes well with the role of the boy's mother, encourages masculine qualities in him, if possible involving her husband in raising her son. With a daughter similar to her, the “moderately masculine” usually conflicts in the girl’s adolescence and youth. If a moderately masculine woman tries to combine family preoccupation with work, she will have to face problems in school and the behavior of children already in their primary school age.
The gender identity of "moderately masculine" as well as "highly masculine" develops in the oedipal phase. For her, too, the mother is a model for the assimilation of the sex role. The father does not have a great influence on the development of the girl due to his employment or non-involvement in education. “Moderately masculine” is similar to her mother in terms of psychotype, and they have a fairly close relationship, although the mother’s authoritarianism and exactingness causes the girl’s protest at different stages of her development.
The masculine features of a girl as she grows up can lead to conflicts with peers in adolescence and love failures in adolescence. These conflicts and failures leave traces in the "moderately masculine" personality and are reflected in her lack of self-confidence. In the family of a moderately masculine woman, thanks to her efforts, much more democratic and respectful relations are established than in the family of a “highly masculine” one. The flexibility of the “moderately masculine,” her willingness to develop, constitute her potential in the movement towards androgyny.
In the practice of counseling and psychotherapy, there are female types with peculiarities of gender identity, which can be legitimately attributed to violations, although these women are extremely feminine. The reader may wonder why this type is called feminine and not feminine. Feminine and masculine should denote a woman and a man if they correspond to their gender, feminine and masculine - those who have strongly pronounced traits of the opposite sex (feminine man and masculine woman).
Despite the fact that the feminine woman has masculine motivations, she generally identifies with the female gender role. She knows that the feminine dominates in her, and she perceives her masculine as gender-neutral, as universal. Erotically, she is a classic woman: she can be flirtatious, gets inspired in the presence of men, she likes to please, she has her own style, and she supports it. A feminine woman is focused on an ideal partner, but not in marriage, but in love. Love is a high value for her, but she lives with the conviction that she is not worthy of love. She deeply does not accept herself, although she knows her worth as a woman.
Most often, such women are realized in the profession, especially if their feminine qualities are in demand in the profession (educator, doctor, psychologist, teacher). "Feminine" cannot be married: to give herself to others is her destiny. In marriage, she is most often unhappy and bears it as the burden of a self-evident and indestructible duty. A feminine woman is a selfless mother, and children love her back.
If she is forced to financially provide for her family, she perceives this as being forced by life to do something that is contrary to her nature. Boy sons willingly support such a woman, her femininity makes them want to help and take care of her. Even if such a mother decides to have a child without a father, her femininity not only does not interfere with the development of masculine traits in her son, but, on the contrary, contributes. Paradoxically, the sons of feminine women are more masculine than the sons of masculine women.
Based on the described female type- conflict structure I, which goes back in its development to preschool age. In childhood, feminine women experience a divorce of their parents, the appearance of a stepfather in the family, difficulties in maintaining relations with a divorced father. Their mothers are most often beautiful, self-centered and admired by everyone. For a girl, this is inaccessible beautiful woman- an object of unrequited love, because the mother is either cold or careless in dealing with her daughter. A loving father fails to compensate his daughter for the lack of motherly love. Adolescence and youth, each in its own way, exacerbate the internal conflict of a feminine girl-girl. Even success with young people cannot convince her that happiness in love is not for her.
The pseudo-masculine woman finds herself predominantly in masculine motivations and in masculine forms of behavior, and in this she is similar to the highly masculine woman. In her appearance there are both male and female features, but there are no distinct signs of gender in it. An erotically pseudo-masculine woman does not manifest herself: she behaves as if this side of life is not for her. She tries to be friends with men, in her youth she plays “her boyfriend”. Apparently, she displaces both the masculine and feminine principles in herself in order not to relate herself to sex. The values of love and marriage are unconsciously rejected by her, and the man as a love and marriage partner is depreciated. For her, he is more dangerous, incomprehensible than attractive. If such a woman sometimes dreams of love, she does not believe that it can be mutual.
Pseudo-masculine women have a high chance of remaining old maids - they rarely marry. In the case of the novel, the “pseudo-masculine” may decide to have a child, but she experiences great difficulties in raising her.
She doesn't understand well feminine nature, but even worse - male. Such a woman wants to raise a person, not a child of a certain gender. With children, the “pseudo-masculine” has problems already in the third year of their life. At the primary school age of children, she already feels like an ineffective parent and constantly resorts to the help of child psychologists. It is especially difficult for a pseudo-masculine woman to cope with raising a boy: she unconsciously suppresses his masculine nature, does not allow her to open up. She also has many problems with the girl, especially in her teenage and early adulthood. She is having a hard time with the separation of children, adult children usually distance themselves from such mothers.
In childhood, a pseudo-masculine woman has a cold, authoritarian, masculine mother who rejects her, a father who obeys her mother, who cannot (or does not want to) create an atmosphere of warmth and care for the girl in the family. The girl does not accept herself, her feminine nature, and learns from her mother masculine ways of behavior in order to be closer to her. A pseudo-masculine type of identity develops in a girl in adolescence, is fixed in adolescence, and finally takes shape in early youth: at 20-22 years old. The girl develops according to a neurotic type with male forms self-affirmation, and this is her protective character.
Among female types with gender identity disorders special place occupies an "obfuscated" type. It presents the greatest difficulty both for description and for diagnosis. Such a woman is closest to the “pseudo-masculine” of all the others: she is also indeterminate in sex, but more feminine. She has both male and female motivations, but she does not know what her gender role is. If you ask her whether she accepts her masculine or feminine in herself, she would be at a loss, because she did not think about it.
She is aware of her feminine needs (to be liked by men, to get married, to have children), but it is not entirely clear to her how to achieve this. For her, both professional life and communication with others are important, but she does not have a certain knowledge of what distinguishes male ways implementation in the profession and in relationships with people from women's. In her appearance, both natural femininity and masculine features coincide: in gait, gestures, postures, and voice. Her erotic behavior combines female ways of attracting a man and straightforward unfeminine activity. Like other women, "confused" dreams of happiness in love - love is a high value for her, but because of self-doubt, she doubts whether this can happen to her. She is looking for a partner equal to herself, but her novels and marriages end unsuccessfully, because her chosen ones are not masculine enough from her point of view.
The “Confused” is able to realize herself in a profession if she does not require certainty in her gender identity, but it is difficult for her to find such a profession and see in it an opportunity for self-realization.
The formation of the sexual identity of a woman of the confused type is similar to how it occurs in the "pseudo-masculine". She also has a domineering mother, a subordinate father, but most often the parents are divorced, and the father hardly communicates with the girl. "Confused" in childhood is brought up either by her grandmother or elder sister or aunt. They take care of her and make up for the mother's coldness. In the oedipal phase, her gender identity develops quite well. At puberty, the "tangled" asserts itself according to male type, and she has fixed masculine traits in behavior and appearance. Love failures in her youth and in early youth increasingly push her feminine and strengthen her masculine.
"Confused" in her maternal role asserts her "learned dominance" - modeled on the authoritarian mother. She, not possessing authority, tries to achieve obedience from children by directive means, but at the same time she can suddenly turn to gentleness and friendliness. Children do not listen to her and often conflict with her. She is unlikely to be able to form a normal sexual identity in children - especially in the absence of a man in the family.
Women with gender identity disorders turn to a psychologist for help, but their willingness to work is different, as are their expectations. "Highly masculine" comes to a psychologist about the behavior of a teenager, the education of a younger student. She willingly accepts psychological and pedagogical recommendations, but avoids psychotherapeutic assistance, confident that she will cope with all her difficulties herself.
"Moderately masculine" is ready for change and, if necessary, works with a psychotherapist in any format: with the whole family, in a married couple, in a parent-child couple, individually.
"Pseudo-masculine" turns to a psychologist to resolve her problems with her children. She, like the “highly masculine”, expects advice and recommendations from him, but if she sees that the problem requires working with her personally, she stops visiting a psychologist. The pseudo-masculine woman is afraid to look into herself and face her problems face to face.
"Confused" willingly communicates with a psychologist, easily returns to the past, explores the present together with a psychotherapist, wants to understand the origins of the problems of her family and children, is able to work in all formats.
"Feminine" seeks help in overcoming her basic insecurities, the consequences of which she constantly faces, especially since she reminds herself of psychosomatic illnesses. She has no problems with children, but to change her married life she considers it impossible, since the husband will not participate in psychotherapy.
Causes of violation of the gender identity of women
As can be seen, violations of the gender identity of women are diverse in the content of its constituent components, in the degree of women's awareness of their role, masculine and feminine, in the nature of women's ideas about their femininity.
At the heart of almost all types of disturbed gender identity is the rejection or insufficient acceptance of the girl by the mother, combined with the lack of proper support and support from the father. The conflict of a woman's awareness and experience of herself as a bearer of her gender enhances the conflict nature of her self-concept, and the defenses with which she protects herself from these conflicts complicate the structure of previously established defenses. Gender identity disorders are one of the most important aspects of a woman's personal disintegration, an indicator of the neurotic development of her personality.
Obviously, in the described variants of violations of gender identity, male characteristics clearly predominate - either as an early-established orientation to the male role, or as protective behavior according to the male type. K. Horney believes that the protective behavior of women according to the masculine type develops in the event of a conflict in the female gender role or when it is perceived as maladaptive (Horney, 1993). This, apparently, explains the protective masculinization of girls in adolescence, and girls - in adolescence.
There were no defenses of the female type in the author's practice. One of the explanations is the insensitivity of Russian men to the defenselessness and emotional sensitivity of women. Men are taught that a woman can protect herself - and no one else but the woman herself.
It would not be an exaggeration to say that in Soviet and post-Soviet culture femininity is not a value (in contrast to the culture of the pre-revolutionary period). Soviet authority freed a woman from all types of oppression, providing her with a variety of opportunities for self-realization: in work, in education, in professional and social activities. Realizing herself as a citizen and a worker, a woman has largely lost her feminine nature. Carrying the hardships of building socialism, war and post-war reconstruction, she performed a variety of male roles.
From generation to generation, Russian girls are brought up by masculine mothers. Historically, socially and culturally determined masculinization of women coincided with the trends of the world process. K. Horney saw the reason for "women's departure from femininity" in their desire to assert themselves next to the men who own civilization, to overcome the feeling of their female inferiority through masculinity (1993).
The spheres of life and roles of men and women were strictly fixed for centuries, and the protest of women against her traditional place in the family and in society began at the end of the nineteenth century - only when the woman herself and social conditions were ripe for this. All the growing trends of feminism say that a woman wants to be equal in rights with a man, but does not want to be a special female being. She fights not for a free woman herself, but for a female person, of the same nature with a man.
Particular attention should be paid to the "confusing" type of violation of women's gender identity: the lack of a clear gender self-determination in such women, the repression of the male and female principles, and the uncertainty in the banded behavior. In the female type described here, "entanglement" in sexual identity is connected with the whole process of personality development and is of a neurotic nature.
The blurring of the boundaries between male and female, the confusion of roles, the shift towards male eros is not only a neurotic, but also a civilizational phenomenon. Currently, in various cultures, there is an ever-increasing uncertainty of sexual self-determination among men and women, an ever-increasing number of people of non-traditional sexual orientation (Shmygun, 2004).
The processes of masculinization of women and the growth of uncertainty in the gender identity of men and women somehow coexist in the modern world and, perhaps, have common roots. It can be expected that in the near future psychology, cultural studies, and anthropology will provide an explanation for these phenomena that satisfies all interested parties.
It is impossible to fully analyze the patterns of formation of women's gender identity and find the causes of its violations without knowing how the gender identity of men is formed, what causes its violations and how they manifest themselves. Since these processes are inseparable from each other, they can only be understood in unity.
The ICD-10 includes pathological gambling, pathological arson (pyromania), pathological stealing (kleptomania), pathological vagrancy (dromomania), and gender identity disorders (sexual desire) to disorders of inclination in psychopathy ICD-10.
Pathological gambling addiction manifests itself in frequent repeated episodes of participation in gambling, which is leading in the life of a person, leads to a decrease in social and professional skills, loss of material and family values. Such persons usually make large debts, break the tax law, evade family responsibilities. They experience a strong attraction to gambling, its irresistibility, uncontrollability of their actions. Outside of gaming activity, they represent the details of the game, experience episodes associated with the excitement of the game, constant internal tension. During such periods, they sleep anxiously, irritable, conflict, quarrelsome. Distinguish them from ordinary players gaming activity, violations of social forms of behavior, indifference to their impoverishment and the well-being of the family. In forensic psychiatric practice, such persons are extremely rare, usually in connection with financial offenses.
pyromania(pathological arson) are characterized by the desire to set fires and admire the fire. Distinguish pyromanias true and false (pseudopyromanias). In the latter cases, arson is committed for the purpose of revenge, concealment of any illegal acts, in a state of intoxication. True pyromaniac acts occur periodically at the height of an agitated state, the only motive of which is admiring the fire or defusing one's inner tension. At the same time, random objects are set on fire; such persons do not leave the fire that has arisen. They are often seen by those around them "enchanted" by the fire. The persons themselves describe these states as an irresistible attraction to fire, while experiencing pleasant sensations, they completely lack a sense of guilt, an assessment of the consequences of their actions. In some cases, they become sexually aroused. The type of fire and the actions of people in extinguishing the fire cause a discharge of affective tension, which is repeated in the future and leads to a desire for new arson. A disorder of attraction in the form of pyromania occurs in different forms psychopathy and is formed into a clinically defined attraction disorder syndrome.
Kleptomania(pathological theft) in the practice of forensic psychiatric examination is extremely rare, although persons held accountable for theft are quite often the subject of examination. With true kleptomania, as well as with other types of impulse disorders, an irresistible desire to steal occurs periodically. It is preceded by a feeling of internal tension, dissatisfaction, anxiety. Theft is always committed alone, is not connected with material necessity and, as a rule, does not entail personal enrichment. Objects accidentally caught in the patient's field of vision are stolen. After the theft, there are no signs of hiding the traces of the crime, and emotional stress is released. Persons who are repeatedly prosecuted for theft often motivate their actions with irresistible desire, but their behavior cannot be regarded as an impulse disorder if their actions do not correspond to those described. clinical features kleptomania.
Dromomania(pathological propensity to vagrancy) means that patients for no apparent reason leave their permanent place of residence and move aimlessly from one city to another, where they roam the streets, beg, and then leave it again. True dromomania must be distinguished from false. The latter is often observed in adolescence and is associated with complex relationships in the family (drunkenness of parents, cruel methods of punishment, etc.). Such adolescents, running away from home, live in attics, basements, sometimes move from place to place, join antisocial groups of adolescents or adults, where they become persons subject to the main forms of behavior of the group. In the future, they can run away from home even in the absence of traumatic situations. Such forms of vagrancy cannot be regarded as dromomanias, as they are conditioned by the situation and over time, as they grow older, they are compensated. This form Inclination disorders are not listed in all classifications of mental disorders, however, in forensic psychiatric practice it occurs in a number of cases and needs a differentiated expert assessment.
Disorders of sexual desire and paraphilia. Modern sexopathology and psychiatry distinguish two types of pathological sexual desires: gender identity disorder and sexual preference disorder.
To gender identity disorders include male and female homosexuality (sodomy, lesbianism). The attitude towards these forms of sexual deviations among sexologists and legislators is ambiguous. Female homosexuality has never been prosecuted by law either in domestic or foreign legislation, while in a number of countries male homosexuality is considered a criminal offense. In accordance with the Criminal Code, only persons who have committed violent homosexual acts, including with minors, are subject to criminal liability (Articles 132-134).
Most often, bisexual acts take place, when a person in a situation of isolation performs homosexual sexual acts, and in ordinary life has normal sexual intercourse. Same-sex sexual relationships arise in situations of prolonged isolation (long voyages, penal colonies, etc.).
At the same time, there are cases in practice when violations of gender identity occur early, without visible external causes, and remain persistent. These cases are true disorders of sexual desire, as a rule, cannot be corrected and have an undoubted biological condition. It is in these cases that hormonal disturbances occur, and sometimes residual phenomena of early organic damage to the central nervous system.
Transsexualism - the desire to be accepted in society as a person of the opposite sex, with a sense of inadequacy and discomfort from one's anatomical sex. Such persons usually wear clothes that do not match their gender, use cosmetics to change their appearance, resort to surgical cosmetic surgery. Sometimes they lead a dual life, at work and in society they present themselves as persons of the same sex, and at home and in a narrow circle of acquaintances they try to show themselves as persons of the opposite sex.
As sexual desires deepen, some patients insist on sex reassignment surgery. This type of operation is carried out both in our country and abroad. However, this is possible only after consulting a psychiatrist, who must state the true form of transsexualism and the absence of any other mental disorders, as well as with the conclusions of a sexologist and endocrinologist. After surgical intervention such persons may be issued documents for a person of the opposite sex with a change in name accordingly. Individuals with this type of impairment rarely commit crimes.
Paraphilia usually formed early against the background of residual phenomena of organic brain damage, which are the biological basis for the formation of abnormal cravings. Special forms of sexual disorders develop in individuals with symptoms chronic alcoholism, which is facilitated by a general decline in personality, emotional coarsening, ignoring the standards of behavior with the destruction of the hierarchy of motives. The formation of paraphilia occurs from simple to more complex forms, it is possible to change the types of attraction with the appearance of aggressive and auto-aggressive tendencies and an increase in the social danger of such persons.
In the psychiatric classification, there is a description of many types of paraphilia, but forensic psychiatric significance has several forms: pedophilia (attraction to children), gerontophilia (attraction to the elderly), necrophilia (sexual intercourse with corpses), exhibitionism (exposing one's genitals), sadomasochism ( causing pain during intercourse).
Pedophilia - sexual attraction to children. It is usually observed in men, including the elderly, with certain sexual dysfunctions. These are depraved acts, accompanied by showing pornography, undressing children, examining their genitals, and masturbating. Sometimes sexual acts are performed with children, both in the usual and in a perverted form. Pedophilia can be combined with sadism. In such cases, children are injuries, sometimes quite severe and incompatible with life. Pedophilic acts are committed both with strangers and with their own or adopted children.
Gerontophilia - a sexual preference disorder in which sexual intercourse is performed with the elderly and old people. Gerontophilia is a relatively rare perversion, often accompanied by sadistic tendencies or brutal murders.
Necrophilia - sexual attraction to corpses. It occurs predominantly in men. This type of attraction disorder is formed in people with deep forms psychopathy or the mentally ill. Necrophiles are often workers in morgues or cemeteries. They usually open graves or mock corpses in morgues. In expert forensic psychiatric practice, they are rare. They are held accountable for hooliganism and desecration of the bodies of the dead and their burial places.
Exhibitionism - a disorder of sexual desire, which manifests itself in a periodic or constant inclination to expose one's genitals, especially in front of persons of the opposite sex (more often in front of women), without the intention of sexual contact. Exposure is accompanied by sexual arousal with an erection. This type of inclination usually manifests itself at the height of emotional stress and alternates with light periods. Such acts are typical for persons with disorders of sexual desire such as exhibitionism.
Sadomasochism - achieving sexual satisfaction by causing suffering to a sexual partner (sadism). Such persons sometimes obtain sexual satisfaction by performing sexual acts with a victim in a state of agony. A variety of sadism is masochism - obtaining sexual satisfaction from the humiliation and suffering inflicted on him by a sexual partner. In practice, a combination of sadism with masochism is more common, which is the syndrome of sadomasochism. As a rule, these persons are characterized by serial murders, which are calculated by several victims. In ordinary life, sadomasochists do not show social maladaptation, do not give the impression of persons with any mental anomalies, so crimes of this kind are difficult to solve.
Forensic Psychiatric Assessment of persons with similar disorders relies on the fact that in forensic psychiatric practice true impulse disorders are rare. Persons prosecuted for various crimes often talk about their attraction to theft, arson, vagrancy, etc. In these cases it is always necessary to distinguish between true disturbances of instincts and false. The latter usually have the character of fixed antisocial habits, lifestyle, psychological attitudes of the individual. The forensic psychiatric assessment of persons with the presence of such forms of behavior is based mainly not on the analysis of the same type of socially dangerous acts, but on the identification of the main soil on which they arise.
If these forms of behavior occur in patients with schizophrenia, manic-depressive psychosis, an organic disease of the central nervous system, then the solution of expert questions depends on the depth and severity of mental disorders characteristic of the underlying disease.
True disorders of attraction are characterized by certain patterns - this is the repetition of the same type of actions without any material interest, the absence of concealment of an illegal act, its pathological motivation, the subordination of actions to the nature of attraction.
Persons who, during the period of forensic psychiatric examination, did not reveal true disorders of drives, but only signs of psychopathy and not pronounced residual phenomena of organic damage to the central nervous system, are not subject to Art. 21 of the Criminal Code. They can be aware of the actual nature and social danger of their actions and direct them and are recognized sane.
The forensic psychiatric assessment of persons suffering from true impulse disorders, regardless of their content, is ambiguous. In cases where violations of impulses do not reach the degree of invincibility, in the presence of partial criticism of their actions, the struggle of motives before the act or are in the process of formation, it is permissible to apply Art. 22 of the Criminal Code of the Russian Federation. It provides for such mental disorder which makes it impossible to fully realize the actual nature and social danger of their actions or the ability to manage them. Application limited sanity to persons with disturbed inclinations implies the presence in the acts of these persons of the motivation for the act, corresponding to the form of disturbed inclinations.
In those cases when drive disorders become the leading feature, merge with the personality, cannot be corrected, the critical assessment of behavior as a whole is violated, the application of the article on insanity.
