Lecture_14_Human Development_Gender Identity & Sexual Orientation

Question 1

Definitions surrounding Biological Sex, Gender Identity, and Sexual Orientation:

Answer 1

• Biological Sex
  
  • Definition: usually viewed as 2 descrete categories: male/female; based on physical/visible characteristics, reproductive functions, & genetics
    
    • EXCEPTIONS:
      
      • person born w/ambiguous genitalia
        
        • blending of both male and female characteristics in the genitals.
      • Chromosomal sex may also be unclear sometimes (e.g. XXY, or apparently unabmbiguous phenotype still not matching genotype)
      • at least 8 known genetic and/or endocrinal conditions can result in intersex state
    • Notes on intersex persons:
      
      • hermaphrodite = historical term now viewed as pejorative and not generally used
      • prevalence: depends on criteria used
        
        • 1.7% with 0.1-0.2% receiving medical intervention
        • 0.018%
    • Issues in medical care: sex assignment surgery
      
      • restore functionality in some cases
      • alter genitalia to more closely resemble one sex or another
      • focus of current debate in medical & larger community whether surgery should occur in infancy or later, or whether it should at all
        
        • advocates: reduces potential social stigma
        • opponents: lack of choice & informed consent by child; results in loss of sexual sensation for some
• Gender Identity
  
  • Definition: social construct of culturally-based expectations typically based on one’s biological sex
    
    • gender role: includes appearance, clothing, speech, manner, interests, play, occupations, etc.
    • gender identity: one’s core self-concept of his/her gender
    • gender expression: how one chooses to outwardly manifest one’s gender identity
  • Notes:
    
    • gender roles differ across cultures and time, but also some similarities that seem to persist
    • concept of differentiating biological sex from gender role & behavior introduced in mid-20th century
  • Evolution of the concept of gender:
    
    • dichotomous categories: masculine & feminine
    • one-dimensional continuum (early gender research)
      
      • increasing masculinity toward one end, & increasing femininity at other
      • person could fall anywhere along range
    • two-dimensional continuum model (X/Y coordinate plane)
      
      • low to high femininity on one dimension
      • low to high masculinity on other
  • Bem Sex Role Inventory (4 classifications)
    
    • sex-typed
      
      • males with high masculinity; low femininity scores
      • females with high femininity; low masculinity scores
    • cross sex-typed
      
      • females with high masculinity; low femininity scores
      • males with high femininity; low masculinity scores
    • androgynous
      
      • females & males with both high masculinity & high femininity scores
    • undifferentiated
      
      • females & males with both low femininity & low masculinity scores
    • (where the line falls between classifications (low vs. high) might be viewed as arbitrary and shifting
  • Transgender identity:
    
    • definition: transgender is a general or umbrella term describing people whose gender identity is not congruent with the usual gender role for their assigned sex. (e.g. biological sex is female but gender identity is masculine)
    • may be of any sexual orientation
    • points of sensitivity & etiquette
      
      • term transgender is an adjective NOT a verb or noun
      • (He/she is transgender) vs. (He/she is transgendered or is a transgender)
      • transgender persons should be referred to by preferred name and gender pronoun
      • issue of accommodations matching gender identity (dressing rooms, restrooms, shared hospital rooms)
      • “Trans” is an informal synonym for transgender that many transgender people prefer to use
    • Can include a number of categories:
      
      • Transexual: person who identifies oneself as, and may wish to live as, a member of the biological sex opposite to that assigned at birth
        
        • usually feels that both gender identity and true sex do not match one’s assigned, or recognized, biological sex
        • may cross-dress, use HRT, and/or undergo sex reassignment surgery to achieve congruence
        • may be of any sexual orientation
      • Androgynous: gender identity may incorporate aspects of both genders or neither
        
        • may include either physical appearance, self-concept, or both
        • refers to people who do not fit easily into one gender identity or gender role
      • Bi-gender: refers to person who moves back & forth between distinct feminine and masculine gender roles
        
        • may have 2 distinct gender identities (i.e. ego states of personality)
        • differs from androgynous person whose gender identity and role may blend *at the same time *(remains consistent)
      • Cross-gender: broad term for people who wear clothing of the “opposite gender” (gender role not usually associated w/one’s bioological sex) for a variety of reasons
        
        • many/most identify as heterosexual in sexual orientation
        • many/most identify w/his/her assigned biological sex
      • Transvestite: synonomous w/cross-dresser; increasingly viewed as outdated term & cross-dresser is increasingly preferred
    • Issues in Medical Care for Transsexual People:
      
      • Gender reassignment therapy
        
        • transsexual patient may seek medical treatment to facilitate gender transition (i.e. alter body to more closely match gender identity)
        • “Sex change” is considered an outdated and pejorative term
      • Gender reassignment Therapy refers t oa spectrum of medical interventions, some or all of which may be desired/used
        
        • HRT
        • sex reassignment surgery (generally refers to genital alteration)
        • other surgical procedures to masculinize or feminize the body (cosmetic surgeries)
      • Health insurance concerns & discrimination
        
        • historically,health insurance rarely covered gender reassignment therapy
        • denied as a “pre-exisiting condition”
        • Now, ACA prevents this discrimination
        • medicare also lifted its ban
        • federal anti-descrimination regulations are still being defined, and insurance companies are still defining their coverage rules to degree allowed w/in the law to save $.
      • transphobia: (discomfort, fear, denigration of transgender people) and lack of knowledge about transgender health issues among HCPs.
      • debate over treatment of children who strongly identify as transsexual
        
        • one approach: supportive approach in childhood (allow cross dressing, adoption of other aspects preferred gender role), hormonal treatment begun by puberty, and possible surgery in young adulthood
        • another approach: psychotherapy w/goal of altering gender identity to match assigned biological sex
    • Issues in Mental Health Care w/Transgender People:
      
      • typical goals of psychotherapy
        
        • address confusion/questions re: gender identity & help patient clarify
        • address inner conflict/emotional distress re: gender identity (41% report attempting suicide)
        • address effects of trauma due to social prejudice, discrimination &/or violence experienced by transgender people
          
          • various startling statistics re: transgender people and their levels of difficulty in life
        • address steps/stages of coming out process (risks/benefits)
      • controversy over requireing mental health evaluation and therapy before sex reassignment therapy can occur
      • controversy over gender identity disorder diagnostic label in DSM IV
        
        • focus on internal symptoms of distress instead of external factors of social stigma and minority stress
      • replaced by gender dysphoria in DSM V
        
        • makes clearer distinction that gender variance itself is not a disorder
        • emphasizes distress is a result of gender identity
        • argument to remove the diagnostic category countered by concern that w/out diagnosis, acces to HCP and insurance could be jeopardized
• Sexual Orientation
  
  • Definition: pattern of emotional, romantic, sexual, and spiritual attraction to males, famles, both or neither
    
    • also involves aspects of individual and social identity based on:
      
      • attractions
      • behavioral expression of these
      • community membership w/others who share them​
    • componenets of definition:
      
      • psychological: direction of desires, fantasies, attractions
      • behavioral: centering around sex of partners w/who these are acted upon
  • typical classifications:
    
    • heterosexual (interested in opposite sex)
    • homosexual (increasingly becoming out of favor, pejorative historical connotation); popular terms gay & lesbian
    • bisexual (interest in both)
    • asexual (no interest)
  • prevalence of same-sex sexual orientation:
    
    • 3-10% of population; variation due in part to how homosexuality is defined by the surveyor and degree of anonymity/confidentiality perceived by those being surveyed.
  • evolution of contemporary conceptualizations of sexual orientation:
    
    • discrete, dichotomous categories: heterosexual & homosexual (1869)
    • single continuum model (Kinsey) (1948 & 1953) range 0-6 hetero-homosexual
    • dual continuum model (Shively & DeCecco 1977; Storms 1980): 2 dimensions = same sex (low high) & opposite sex (low high); both dimensions also rated for emotional/affectional attraction & physical attraction
    • multivariate model (Klein, 1993)
      
      • seven variables separately rated 0-6, same as Kinsey
        
        • sexual behavior, emotional attraction, sexual fantasies, sexual attraction, social preference, lifestyle social world & community, self-identification
      • ratings may/may not vary over time on different variables
    • CONCLUSIONS: as we recognize the increasingly complex array of variables interacting over time, the ability to maintain discrete, fixed categories of sexual orientation becomes increasingly difficult.

Related, but independent constructs

Question 2

Integrative process of identity development for lesbian, gay, bisexual, and transgender (LGBT) people_Koff:

Answer 2

• extra developmental process that LGBT persons must go through
• necessitated by the stigma, isolation, and lack of support experienced as same-sex orientation and/or gender-variant identity emerge
• homophobia and heterosexism in the environment are the main sources of stigma
  
  • terms of homophobia and heterosexism:
    
    • homophobia: irrational fear of, aversion to, hatred of, and/or discrimination against homosexuality, LGBT people, or people perceived to be homosexual
    • internalized homophobia: occurs when LGBT person incorporates repeated negative messages and images about same-sex orientation into his/her slef-concept.
    • heterosexism: attitudes, bias, and discrimination in favor of opposite-sex sexuality and relationships
      
      • can include presumption that everyone is heterosexual or that opposite-sex attractions are preferred or superior
      • heterosexist bias can be exhibited by people of any sexual orientation
  • stages of the integrative process of identity development:
    
    • awareness stage: becoming conscious of same-sex attractions &/or inclinations toward gender nonconformity
      
      • accompanied by feelings of badness, wrongness, not fitting in
      • developing stigma management strategies
      • resolution: acknowledgement and acceptance of same-sex attractions w/in oneself
      • HCP support: if struggling, conflicted, or confused, refer patient to a supportive psychotherapist w/specialized tranining working w/LGBT populations
    • acknoledgement stage:
      
      • moving from acknowlegement to self to acknowledgement to others
      • stage may be delayed due to real or perceived threats of rejection/harm for coming out (& this in turn can limit the regular identity development process of adolescence)
      • _resolution: _ increased self-acceptance characterized by successful self-disclosure and skillful coping with responses of others
      • HCP support: referral to specialized therapist, coming out support group (PFLAG, support group @ local LGBT community center)
    • exploration stage:
      
      • awkwardness and intensity in relationships
      • continued working through awkwardness & internalized homophobia
      • experimentation w/range of sub-cultural and/or gender identities
      • potential relapse into maladaptive coping
      • resolution: increased capacity for intimacy and stability in relationships; reduced intensity and frequency of shame-based responses
      • HCP support:
        
        • couseling regarding safter sex practices & STIs
        • therapist referral if signs of internalized homophobia, including maladaptice coping behavior, othe rrisky behavior
        • youth: connect with GSAs in schools, youth groups & programs @ LGBT community centers
        • adults: connect w/safe/healthy social groups & organizations like LGBT community centers, LGBT groups in affirming churches, & other LGBT organizations
    • intimacy stage:
      
      • increasingly stable, satisfying friendships & romantic relationships
      • sound decision-making around disclosure, consistent w/values/beliefs
      • consistently-employed repertoire of effective coping
    • integration stage:
      
      • energy directed into new areas of life
      • awareness of integration as ongoing process
      • balancing sexual orientation/gender identity and other cultureal identities
      • acknowledgement of losses & gains along the way
  • Issues in mental health services w/lesbian, gay, bisexual people:
    
    • address confusion/questions re: sexual orientation & help patient clarify and come to own conclusion
    • address inner conflict/emotional distress re: sexual orientation
      
      • monitor for, identify, and work through any internalized homophobia
      • conversion therapy/reparative therapy
        
        • attempts to change sexual orientation
        • review of accumulated research & literature suggests it is ineffective and may cause additional psychological harm (APA 2009)
      • appropriate therapeutic responses:
        
        • acceptance, support, and understanding of pts
        • facilitation of pts’ active coping, social support, and identify exploration and development
        • without imposing a specific sexual orientation identify outcome
    • address effects of trauma & “minority stress” dure to social prejudice, discrimination & violence
      
      • minority stress = negative effects associated w/the adverse social conditions experienced by individuals who belong to a stigmatized social minority group.
        
        • leads to higher rates of stress-related psychiatric disorders (anxiety, mood, and substance abuse) than in heterosexual populations
      • LGBT teens are also more likely than straight teens to:
        
        • attempt suicide, experience abuse (verbal & physical assault), become homeless, drop out of school, engage in substance abuse
    • address steps/stages of coming out process (risks/benefits)
    • address frequent spiritual/religious struggles associated w/identity development process
      
      • working through distress/pain/anger directed at own or other religious institutions
      • allow exploration of religious/spiritual alternatives that may be more congruent w/sexual orientation
    • Therapist/HCP factors:
      
      • ​providers should work to reduce/eliminate own residual homophobia
        
        • LGBT pts are highly sensitive to its presence in HCP
        • LGBT pts usually withdraw from treatment if they sense homophobia in HCP
      • assess & correct for heterosexist bias in approaches and practice (e.g. paperwork, terminology used, phrasing of questions)
      • therapist disclosure of own sexual orientation (some say yes, others say no)