Mythological Underpinnings of Feminine Development.

In the manner of Oedipus Rex, the myth of Myrrha-a story about a daughter's initiation of sex with her father-promises to divulge insights about feminine development. Given parallels between these two myths, the author asks why Jung identified Electra rather than Myrrha as the feminine counterpart to Oedipus, and revisits Freud's and Jung's differing interpretations of the incest theme in personality development. To break open the metaphor of Myrrha's incest, the author analyzes a similar account of incest in the Old Testament story of Lot and his wife and finds that they share a theme of female bitterness related to wounding of the mother and its arresting effect on the daughter's maturation. The article then considers the Demeter-Persephone myth, a tale not of incest but rape in Persephone's initiation into womanhood. In contrast to Myrrha, Persephone's development unfolds with strong maternal support tempered by the opposing claims on her by the masculine. The article draws these stories together to illuminate the archetypal forces that drive feminine development as well as the human affairs that resist and complicate them. The article concludes with a case study of a client whose developmental "stuckness" follows the contours of the Myrrha myth.

À la manière d'Oedipe Roi, le mythe de Myrrha, une histoire sur l'initiation sexuelle d'une fille avec son père promet de divulguer des éclairages concernant le développement féminin. Compte tenu des parallèles entre ces deux mythes, l'auteur se demande pourquoi Jung a identifié Électre plutôt que Myrrha comme la contrepartie féminine d'Œdipe. Il revisite les interprétations différentes de Freud et Jung sur le thème de l'inceste dans le développement de la personnalité. Pour ouvrir la métaphore de l'inceste de Myrrha, l'auteur analyse un récit similaire d'inceste dans l'histoire de Lot et de sa femme dans l'Ancien Testament et constate qu'ils ont en commun le thème de l'amertume féminine lié à la blessure de la mère et à son effet saisissant sur la maturation de la fille. L'article examine ensuite le mythe de Déméter-Perséphone, qui est non pas une histoire d'inceste mais de viol dans l'initiation de Perséphone à la féminité. Contrairement à Myrrha, le développement de Perséphone se déroule avec un fort soutien maternel tempéré par les revendications que le masculin lui oppose. L'article rassemble ces histoires pour éclairer les forces archétypales qui animent le développement féminin ainsi que les affaires humaines qui y résistent et les compliquent. L'article se termine par l'étude d'un cas clinique dont le « blocage ¼ développemental suit les contours du mythe de Myrrha.

A la manera de Edipo Rey, el mito de Mirra, una historia sobre la iniciación sexual de una hija con su padre, promete divulgar conocimientos sobre el desarrollo de lo femenino. Dados los paralelismos entre estos dos mitos, la autora se pregunta por qué Jung identificó a Electra en lugar de Mirra como la contrapartida femenina de Edipo y revisa las diferentes interpretaciones de Freud y Jung sobre el tema del incesto en el desarrollo de la personalidad. Para desentrañar la metáfora del incesto de Mirra, la autora analiza un relato similar de incesto en la historia de Lot y su esposa en el Antiguo Testamento y descubre que comparten el tema de la amargura femenina relacionada con la herida de la madre y su efecto paralizante en la maduración de la hija. A continuación, el artículo examina el mito de Deméter-Perséfone, una historia, no de incesto sino de violación, en la iniciación de Perséfone a la femineidad. A diferencia de Mirra, el desarrollo de Perséfone se desarrolla con un fuerte apoyo materno atenuado por las pretensiones opuestas de lo masculino sobre ella. El artículo reúne estas historias para iluminar las fuerzas arquetípicas que impulsan el desarrollo de lo femenino, así como los asuntos humanos que se resisten a ellas y las complican. El artículo concluye con un estudio de caso de una clienta cuyo "estancamiento" en su desarrollo sigue los devenires del mito de Mirra.

[School Children's COVID-Related Future Anxiety over the Course of 8Months of the Pandemic]. / Coronabezogene Zukunftsangst bei Grundschulkindern im Verlauf von 8 Monaten der Pandemie.

To explore the long-term effects of the COVID-19-pandemic on children, N = 140 8- to 10- year-olds were asked about their COVID-related future anxiety (CRFA) in their classrooms during months 6, 9, and 14 of the pandemic which started inMarch 2020 in Germany. Future anxiety was defined as a "state of apprehension, uncertainty, fear, worry, or anxiety about unfavorable changes in a more distant personal future" which was related to the effects of the COVID- 19-pandemic. In this survey, 13%to 19%of children reported experiencing CRFA "often" on at least one of the four items of the newly developed CRFA scale. Experiencing CRFA "often" was reported by 16% of the children at two and by 8 % of the children at three measurement points, among them more girls and more children from homes with poor educational backgrounds. Analyses uncovered large interindividual differences: For 45 % of the children CRFA decreased between months 6 and 9 of the pandemic, whereas for 43 % it increased. Children of parents with low educational backgrounds weremore likely to report frequent CRFA at all three measurement time points, even after controlling for gender and incidence of COVID-19-in Germany.This confirms predictions that contagion risk and controllability influence future anxiety. The descriptive results additionally support earlier findings that many children already experience future anxiety about macro-level events. The results on chronic CRFA underscore the urgency to examine the long-time effects of CRFA with greater care.This is of paramount importance considering the macro-level challenges of the future.

Gender detransition: a case study.

Within the last decade, there has been a sharp global rise in the number of young people identifying as transgender. More recently, there appears to be an increase in the numbers of young people detransitioning or returning to identifying with their natal sex after pursuing medical transition. A case is presented of a young woman who pursued a gender transition and returned to identifying as female after almost two years on testosterone. The author considers and critiques the affirmative model of care for gender dysphoric youth in light of this case.

Dans les dix dernières années, on a vu un accroissement considérable du nombre de jeunes personnes qui s'identifient transgenre. Plus récemment, il semble qu'il y ait un accroissement du nombre de jeunes personnes qui reviennent en arrière par une détransition, ou qui reviennent à s'identifier à leur sexe de naissance après avoir souhaité une transition médicale. L'article présente le cas d'une jeune femme qui est entrée dans le processus de transition de genre et qui est ensuite revenue à une identification en tant femme, après presque deux années sous testostérone. A la lumière de ce cas, l'auteur examine et critique le modèle de soin qui va dans le sens d'affirmer la dysphorie de genre chez de jeunes personnes.

En la última década, ha habido un crecimiento global agudo de jóvenes que se han identificado como transgénero. Más recientemente, pareciera haber un incremento en el número de jóvenes de-transicionando o retornando a la identificación con su género natal luego de haber realizado una transición médica. Se presenta el caso de una joven mujer quien prosiguió una transición de género y retornó a identificarse como de género femenino, casi dos años después de haber tomado testosterona. La autora considera y critica, a la luz de este caso, el modelo afirmativo de cuidado para la disforia de género en las y los jóvenes.

[Exercise-Associated Hyponatremia in Endurance Performance]. / Die belastungsassoziierte Hyponatriämie im Ausdauersport.

Exercise-Associated Hyponatremia in Endurance Performance Abstract. Exercise-associated hyponatremia is defined as a plasma sodium concentration of <135 mmol/l and was first described by Timothy Noakes at the Comrades Marathon in South Africa in the mid-1980s. A decrease in plasma sodium <135 mmol/l occurs with excessive fluid intake. Risk factors include long to very long endurance performance, extreme climatic conditions, female gender and competitions in the USA. Regarding its prevalence by sport, exercise-associated hyponatraemia tends to occur while swimming and running, but rarely when cycling. While mild exercise-associated hyponatremia does not lead to clinical symptoms, severe hyponatremia due to cerebral edema can lead to neurological deficits and even death. The best prevention of exercise-associated hyponatremia is the reduction of fluid intake during exercise.

Sexualidade, gênero e identidade: questões para a psicanálise / Sexuality, gender and identity:questions for psychoanalysis / Sexualité, genre et identité : questions à la psychanalyse / Sexualidad, género e identidad: cuestiones para el psicoanálisis

O objetivo deste ensaio é analisar a forma pela qual as noções de sexualidade, gênero e identidade colocam questões para a psicanálise, na medida em que problematizam formas de subjetivação presentes em sua prática discursiva. Considerando a análise de Foucault a respeito da formação do dispositivo da sexualidade e a discussão empreendida por Butler sobre o problema da identidade nas discussões de gênero, pretende-se situar o lugar do complexo de Édipo na constituição do sujeito em psicanálise e a crítica de Freud à moralização da sexualidade na experiência moderna. Finalmente, a partir das noções de vulnerabilidade e de despossessão de si, retomam-se os conceitos psicanalíticos de desamparo e de feminilidade com o objetivo de pensar a importância de um pensamento da alteridade para a prática psicanalítica.

This paper aims to analyze in what way the notions of sexuality, gender and identity pose questions to psychoanalysis, as they problematize forms of subjectivation present in their discursive practice. Taking into account Foucault's analysis of the formation of the device of sexuality and Butler's discussion on the problem of identity in gender discussions, we intend to situate the place of the Oedipus complex in the constitution of the subject in psychoanalysis and Freud's critique of the moralization of sexuality in modern experience. To conclude, based on the notions of vulnerability and dispossession of the self, we revisit the psychoanalytic concepts of helplessness and femininity to reflect on the importance of a thinking on otherness for psychoanalytic practice.

Le but de cet article est d'analyser la façon dont les notions de sexualité, de genre et d'identité posent des questions à la psychanalyse, dans la mesure où elles problématisent les formes de subjectivation présentes dans sa pratique discursive. En considérant l'analyse de Foucault sur la formation du dispositif de la sexualité et la discussion de Butler sur le problème de l'identité dans les discussions sur le genre, nous avons l'intention de situer la place du complexe d'Œdipe dans la constitution du sujet dans la psychanalyse et la critique de Freud à la moralisation de la sexualité dans l'expérience moderne. Enfin, à partir des notions de vulnérabilité et de dépossession de soi, les concepts psychanalytiques de détresse et de féminité sont abordés dans le but de réfléchir à l'importance d'une pensée d'altérité pour la pratique psychanalytique.

El objetivo de este ensayo es analizar la forma en la que las nociones de sexualidad, género e identidad plantean cuestiones para el psicoanálisis, en la medida en que problematizan formas de subjetivación presentes en su práctica discursiva. Considerando el análisis de Foucault sobre la formación del dispositivo de la sexualidad, y la discusión iniciada por Butler sobre el problema de la identidad en las discusiones de género, se pretende situar el lugar del complejo de Edipo en la constitución del sujeto en el psicoanálisis y la crítica de Freud a la moralización del sujeto en la experiencia moderna. Finalmente, a partir de las nociones de vulnerabilidad y de desposesión de sí, se reanudan los conceptos psicoanalíticos de desamparo y de femineidad con el objetivo de pensar la importancia de un pensamiento de la alteridad para la práctica psicoanalítica.

Dieser Artikel analysiert auf welche Art und Weise die Begriffe Sexualität, Geschlecht und Identität Fragen an die Psychoanalyse stellen, insoweit als sie die in ihrer diskursiven Praxis vorhandenen Formen der Subjektivierung problematisieren. In Anbetracht der Analyse von Foucault über die Entstehung des Sexualitätsdispositives und Butlers Diskussion des Identitätsproblems in der Genderdiskussion versuchen wir den Platz des Ödipus-Komplexes in der Konstitution des Subjekts in der Psychoanalyse zu erörtern, sowie die Kritik Freuds an die Moralisierung der Sexualität in der modernen Erfahrung. Zum Schluss greifen wir aufgrund der Begriffe Verwundbarkeit und Enteignung des Selbst die psychoanalytischen Konzepte des Aufhebens und der Weiblichkeit erneut auf, um die Bedeutung der Alterität für die psychoanalytische Praxis zu erwägen.

[Barriers and facilitators for the development of sex/gender sensitive clinical practice guidelines: A qualitative interview study]. / Barrieren und Förderfaktoren für die Entwicklung von geschlechtersensiblen medizinischen Leitlinien ­ Eine qualitative Befragung.

INTRODUCTION: Sex and gender health research evaluates biological and psychosocial differences between women and men which can influence the development, progress and experience of diseases. However, despite the increasing body of evidence about relevant differences between women and men regarding healthcare, the prevention, management and treatment of many common diseases do not yet reflect the knowledge of sex/gender characteristics. Furthermore, in the development of clinical practice guidelines, which are a valuable tool for knowledge transfer between scientific evidence and healthcare, sex/gender factors are only rarely explicitly and systematically considered. The goal of the current study therefore is to identify barriers and facilitators for the consideration and integration of sex/gender differences into guidelines, to create a basis for potential solutions and tools to increase the development of sex/gender sensitive guidelines in the future. METHODS: Barriers and facilitators for the development of sex/gender sensitive guidelines were identified by conducting semi-structured interviews with twelve experts in national and international guideline development (guideline authors and coordinators), as well as gender experts (female: n=8). The selection of experts followed a purposeful sampling strategy and the interview data was analyzed using the qualitative content analysis according to Mayring. RESULTS: The views on barriers and facilitators were allocated to and summarized in five categories with ten subcategories. The identified barriers mainly addressed the increasing complexity of guidelines, the lack of availability and quality of sex/gender sensitive evidence, and the shortage of resources. In addition, barriers were identified in an individual/professional context, such as deficiencies in awareness/knowledge about relevant sex/gender differences. The results of facilitating factors showed that experts see political policies and standards from guideline organizations as support for the consideration of sex/gender factors in guideline development. CONCLUSION: The perspective of experts illustrates that besides organizational and political inventions, individual and social factors should also be addressed in order to achieve behavioral change.

Sentimentos de mulheres em sofrimento psíquico grave acerca de suas vivências sexuais / Feelings of women in severe psychic suffering regarding their sexual experiences / Sentiments de femmes en souffrance psychique grave au sujet de leurs expériences sexuelles / Sentimientos de mujeres en sufrimiento psíquico grave sobre sus vivencias sexuales

Objetivo Conhecer os sentimentos relacionados à vivência da sexualidade em mulheres no processo de sofrimento psíquico grave. Procedimentos Foram realizados grupos de rodas de conversas, e seus resultados foram analisados levando-se em consideração o discurso emergente nas falas das mulheres por meio dos significados que as participantes e/ou pesquisadora atribuíram aos fatos. Conclusões As formas de subjetivação acerca da sexualidade interferem no modo como as mulheres participantes do estudo a vivenciam, provocando os mais diversos sentimentos contraditórios.

Objective To know the feelings related to the experience of sexuality in women in the process of severe psychic suffering. Procedures groups of conversation were conducted, and their results were analyzed taking into account the discourse emerging from the women's speeches through the meanings that the participants and/ or researcher attributed to the facts. Conclusions the forms of subjectivation about sexuality interfere in the way the women participating in the study experience it, provoking the most diverse contradictory feelings.

Objectif Examiner les sentiments liés à l'expérience de la sexualité de femmes en souffrance psychique grave. Procédures des groupes discussions ont menés des conversations et les résultats ont été analysés en tenant compte du discours émergent des déclarations de femmes à travers les significations que les participantes et/ ou la chercheuse attribuent aux faits. Conclusions les formes de subjectivation de la sexualité interfèrent dans la façon dont les femmes la vivent, ce qui provoque de divers sentiments contradictoires.

Objetivo conocer los sentimientos relacionados a la vivencia de la sexualidad en mujeres en proceso de sufrimiento psicológico grave. Procedimiento se llevaron a cabo conversaciones grupales, y los resultados se analizaron teniendo en cuenta el discurso emergente, en los comentarios de las mujeres, a través de los significados que las participantes y/o investigadoras atribuyeron a los hechos. Conclusiones las formas de subjetivación sobre la sexualidad interfieren en la forma en la que las mujeres que participaron en el estudio la vivencian, provocando los más diferentes sentimientos contradictorios.

Ziel Gefühle von Frauen mit schweren psychischen Leiden zu erkunden, die im Zusammenhang mit sexuellen Erfahrungen entstehen. Verfahren Gesprächskreise wurden gebildet und die Ergebnisse wurden analysiert unter Berücksichtigung der Berichte von Frauen und den Bedeutungen, welche die Teilnehmerinnen und/ oder die Forscherin den Tatsachen zuordnet. Schlussfolgerungen die Formen der Subjektivierung der Sexualität interferieren in der Art und Weise wie diese Frauen ihre Sexualität leben, was somit die verschiedensten widersprüchlichen Gefühle zur Folge hat.

Transgenderism and transformation: an attempt at a Jungian understanding.

While transgenderism as a cultural phenomenon seems to be based on a collective taste for the sensational, its emergence represents a collective shift towards a new or more differentiated way of experiencing and expressing sex and gender, a movement of world soul. This paper attempts to explore that emergence from a Jungian perspective. The paper utilizes clinical examples which illustrate how dissociated aspects of the personality are seeking assimilation and expression in order to move the personality towards greater wholeness. In that sense, it attempts to understand the teleology of transgenderism on an individual and collective level. The paper is intended as a starting-off point for discussion and explores gender as fantasy, anima/animus dynamics, the psyche/soma relationship, the role of hormones/biochemistry in our experience of ourselves and what transgender people carry and suffer for our culture.

[Dialectical Behavioral Therapy for Male Adolescents with Borderline Symptomatology]. / Dialektisch-Behaviorale Therapie für männliche Jugendliche mit Symptomen einer Borderline-Persönlichkeitsstörung.

Dialectical Behavioral Therapy for Male Adolescents with Borderline Symptomatology The efficacy of Dialectical Behavior Therapy for adolescents (DBT-A) in patients with borderline symptomatology has mainly been shown in female adolescents. However, male adolescents with borderline symptoms are characterized by more aggressive, disruptive, and antisocial behavior. Therefore, the efficacy of the DBT-A has to be investigated in male adolescents. The DBT-A manual was adopted for male adolescents in an inpatient setting. The program has been investigated using a pre-post design in seven male adolescents (on average 14 years of age) with an average of five borderline symptoms according to DSM-IV. Criteria for outcome are symptoms of psychopathology, emotion regulation, aggressive, and self-injurious behavior. After treatment a reduction in aggressive behavior (pre-post effect size d = 1.18) and an improvement in adaptive emotion regulation (d = 0.65) were shown. No improvement could be shown in general symptoms of psychopathology (d = 0.02). The results of these case studies of DBT-A in male adolescents are promising. However, further RCTs with larger sample sizes and a control group will be required.

ALL OUR SONS: THE DEVELOPMENTAL NEUROBIOLOGY AND NEUROENDOCRINOLOGY OF BOYS AT RISK.

Why are boys at risk? To address this question, I use the perspective of regulation theory to offer a model of the deeper psychoneurobiological mechanisms that underlie the vulnerability of the developing male. The central thesis of this work dictates that significant gender differences are seen between male and female social and emotional functions in the earliest stages of development, and that these result from not only differences in sex hormones and social experiences but also in rates of male and female brain maturation, specifically in the early developing right brain. I present interdisciplinary research which indicates that the stress-regulating circuits of the male brain mature more slowly than those of the female in the prenatal, perinatal, and postnatal critical periods, and that this differential structural maturation is reflected in normal gender differences in right-brain attachment functions. Due to this maturational delay, developing males also are more vulnerable over a longer period of time to stressors in the social environment (attachment trauma) and toxins in the physical environment (endocrine disruptors) that negatively impact right-brain development. In terms of differences in gender-related psychopathology, I describe the early developmental neuroendocrinological and neurobiological mechanisms that are involved in the increased vulnerability of males to autism, early onset schizophrenia, attention deficit hyperactivity disorder, and conduct disorders as well as the epigenetic mechanisms that can account for the recent widespread increase of these disorders in U.S. culture. I also offer a clinical formulation of early assessments of boys at risk, discuss the impact of early childcare on male psychopathogenesis, and end with a neurobiological model of optimal adult male socioemotional functions.

PSYCHOLOGY OF BOYS AT RISK: INDICATORS FROM 0-5.

In utero and during the first 5 years of life, boys face unique risks as a result of neurobiological and environmental factors. This introductory article to the Special Issue describes the background of this gender-specific inquiry and outlines some of those risks, drawing attention to the areas that will be covered in depth in the following contributions. We also describe the basis of this inquiry as the link between early life and the subsequent difficulties that adolescent boys and many young men face, and pay particular attention to the circumstances of young men of color and to the growing knowledge about the contributions of fathers to boys' development.

EARLY CHILDHOOD PREDICTORS OF LOW-INCOME BOYS' PATHWAYS TO ANTISOCIAL BEHAVIOR IN CHILDHOOD, ADOLESCENCE, AND EARLY ADULTHOOD.

Guided by a bridging model of pathways leading to low-income boys' early starting and persistent trajectories of antisocial behavior, the current article reviews evidence supporting the model from early childhood through early adulthood. Using primarily a cohort of 310 low-income boys of families recruited from Women, Infants, and Children Nutrition Supplement centers in a large metropolitan area followed from infancy to early adulthood and a smaller cohort of boys and girls followed through early childhood, we provide evidence supporting the critical role of parenting, maternal depression, and other proximal family risk factors in early childhood that are prospectively linked to trajectories of parent-reported conduct problems in early and middle childhood, youth-reported antisocial behavior during adolescence and early adulthood, and court-reported violent offending in adolescence. The findings are discussed in terms of the need to identify at-risk boys in early childhood and methods and platforms for engaging families in healthcare settings not previously used to implement preventive mental health services.

[Ironman Triathlon]. / Der Ironman-Triathlon.

Every year, thousands of triathletes try to qualify for the «Ironman Hawaii¼ (3,8 km swimming, 180 km cycling and 42,195 km running), the World Championship of long-distance triathletes. In this overview, we present the recent findings in literature with the most important variables with an influence on Ironman triathlon performance. The most important performance-influencing factors for a fast Ironman race time for both women and men are a large training volume and a high intensity in training, a large volume being more important than a high intensity, a low percentage of body fat, an ideal age of 30­35 years, a fast personal best in the Olympic distance triathlon (1,5 km swimming, 40 km cycling and 10 km running), a fast personal best in marathon running and origin from the United States of America.

[Psychosocial disadvantages in incarcerated girls and boys]. / Psychosoziale Belastungen bei inhaftierten Mädchen und Jungen.

OBJECTIVE: Longitudinal studies found that criminal behavior in juveniles often concurs with neighborhood disadvantage and family dysfunction, especially in girls. In this study we assessed the psychosocial background in incarcerated juveniles and analyzed the data for each gender separately. METHOD: The Multidimensional Clinical Screening Inventory for delinquent juveniles (MCSI) was used to assess school history, psychiatric history, family background, abuse and neglect and motive for crime. The sample consisted of 294 juveniles (46 females and 248 males). RESULTS: Innerfamilial abuse/neglect was reported by 91% (girls) and 79% (boys). 76% (girls) and 88% (boys) reported school-problems. 57% (girls) and 29% (boys) reported to have recieved psychiatric pretreatment. In girls we found significantly higher prevalence rates for parental divorce, incarceration of mother, abuse/neglect and psychiatric pretreatment. Significantly more girls reported a co-occurrence of school-problems and experiences of separation and loss and abuse (65.2% vs. 46.4%, χ²=5.51, df=1, p<.05). CONCLUSION: Incarcerated juveniles, especially females, are and have been exposed to multiple psychosocial burdens. Therefore it is necessary to implement prevention programs for psychosocially stressed families. Forensic intervention in and after detention has to include a family centered approach.

[Frequency and Type of Traumatic Events in Children and Adolescents with a Posttraumatic Stress Disorder]. / Häufigkeit und Art traumatischer Ereignisse bei Kindern und Jugendlichen mit Posttraumatischer Belastungsstörung.

The risk for children and adolescents to be exposed to a potentially traumatic event (PTE) is high. The present study examines the frequency of PTEs in children and adolescents with Posttraumatic Stress Disorder (PTSD), the type of index trauma, and its relation to PTSD symptom severity and gender. A clinical sample of 159 children and adolescents between 7-16 years was assessed using the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). All reported PTEs from the checklist were analyzed according to frequency. The index events were categorized according to the following categories: cause (random vs. intentional), relation to offender (intrafamilial vs. extrafamilial), patient's role (victim, witness or vicarious traumatization), and type of PTE (physical or sexual violence). Relation between categories and PTSD symptom severity and sex were analyzed with inferential statistics. On average participants reported five PTEs, most frequently physical violence without weapons (57.9%), loss of loved person through death (45.9%), and sexual abuse/assaults (44%). The most frequent index traumata were intentional (76.7%). Regarding trauma type, there was a significant difference concerning higher symptom severity in children and adolescents who experienced sexual abuse/assault compared to physical violence (t=-1.913(109), p=0.05). A significantly higher symptom severity was found for girls compared to boys for the trauma categories extrafamilial offender (z=-2,27, p=0.02), victim (z=-2,11, p=0,04), and sexual abuse/assault (z=-2,43, p=0,01). Clinical and diagnostic implications are discussed in relation to the amendments of PTSD diagnostic criteria in DSM-5.

The seventh penis: towards effective psychoanalytic work with pre-surgical transsexuals.

The author reflects on his contrasting analytic work with two transsexual patients. He uses three previous psychoanalytic studies (Stoller, Morel and Lemma) to explore whether effective analytic work with the issues driving a person's determined wish for sex reassignment surgery (SRS) is possible. Particular consideration is given to how such work might navigate a path between traumatizing and pathologizing the patient on the one hand and avoiding important analytic material out of fear of so doing on the other. The author proceeds to ask whether it is possible to tell in advance, with any degree of reliability, who is and who is not likely to benefit from surgery. He considers certain diagnostic issues in relation to these questions. Illustrations are given of how, in practice, countertransference anxieties about psychopathologizing transsexual patients can contribute to significant difficulties in working clinically with them. It is argued that the understanding and containment of such anxieties could eventually lead to more effective analytic work, and that such work might be further facilitated by considering the contribution of mind-body dissociation to transsexualism.

Age and gender as independent predictors of violence under the influence of alcohol in Zurich, Switzerland.

Violent behaviour associated with alcohol consumption is frequently reported by different media. Clinical data analysing the correlation between alcohol intoxication, age, gender and violence are scarce. The aim of this study was to evaluate the influence of age, gender and blood alcohol content on violent behaviour under the influence of alcohol under central European conditions. Three hundred patients admitted to the emergency department were included into this study in the time period from January 01. to December 31. 2009. The inclusion criteria were a blood alcohol content (BAC) of ≥10 mmol/l, any traumatic injury and an age ≥16 years. Violence was defined as an evitable act committed by others leading to patient's hospitalisation. The data were compared with Wilcoxon and χ2-test for proportions. The data were considered as significant if p<0,05. Predictive quality was evaluated by using receiver operating characteristic (ROC) curve. Independent predictors were analyzed by logistic regression analysis. The average age was 36,9±16,9 years (range: 16-84 years), 259 (86%) males and 41 (24%) females. There was a significant difference in gender (odds ratio for gender male 2,88; CI 95%: 1,24-6,67; p<0,001) and age dependent (odds ratio for each year of age 0,94; CI 95%: 0,93-0,96; p<0,0001) violence with no correlation to blood alcohol content found. Logistic regression analysis revealed male gender and young age as an independent predictor for violence. These results clarify the relationship between alcohol, age, gender and violence and have important implications for municipal-level alcohol policies.

Les comportements violents associés à l'alcoolisme sont fréquemment rapportés dans différentes médias. Les données cliniques analysant la corrélation entre l'intoxication alcoolique, l'âge, le genre et la violence sont rares. Le but de la présente étude était d'évaluer l'influence de l'âge, du genre et de la concentration sanguine d'alcool sur le comportement violent sous l'influence de l'alcool, ceci dans des conditions rencontrées en Europe centrale. 300 malades hospitalisés dans le Département d'urgences de l'Hôpital universitaire de Zürich ont été inclus pendant une période allant du 1.1.2009 au 31.1.2009. Les critères d'inclusion consistaient en une alcoolémie ≥10 mmol/l, une atteinte traumatique de n'importe quelle nature et un âge ≥16 ans. La violence était définie comme un acte évitable commis par d'autres et ayant conduit à l'hospitalisation du malade. Les résultats ont été comparés par un test de Wilcoxon et de chi-carré. Une différence a été considérée comme significative à partir d'un p<0,05. La valeur prédictive a été évaluée sur la base d'une courbe ROC. Les facteurs prédictifs indépendants ont été recherchés à l'aide d'une analyse de régression logistique. L'âge moyen était de 36,9±16,9 (intervalle: 16­84 ans). Il y avait 259 (86%) hommes et 41 femmes (24%). Il y a vait une différence significative entre les genres (odds ratio pour les hommes=2,88; intervalle de confiance 95%: 0,93­0,96; p<0,0001) en ce qui concerne la violence, mais pas de différence du point de vue de l'alcoolémie. L'analyse de régression logistique a mis en évidence le genre masculin et le jeune âge comme des facteurs prédictifs indépendants. Ces résultats clarifient la relation entre l'alcool, l'âge, le genre et la violence. Ils ont ainsi d'importantes implications au niveau municipal pour l'attitude à avoir face à l'alcool.