Nov 052013

News for the month of October - CC BY 2.0 - flickr user  cygnus921It’s that time of month again! No, not when we try to take over the world… it’s time for the monthly news! In no particular order, then, here we go:

  • Analysis of herbal supplements finds that many are contaminated with species not listed in the ingredients label. Herbs are typically classified as supplements in the United States, and are not regulated by the Food and Drug Administration the way medications are. The FDA website has more on the regulation of herbsSource.
  • One dose of Gardasil may be enough to protect against cervical cancer (but please remember to follow your physician’s instructions about vaccines!). Source. At the same time, the HPV vaccines may be less effective for people of African heritage than for people of European heritage. Source.
  • More evidence that monthly changes in sex hormones in cisgender women are associated with changes in sex drive. Source.
  • Germany’s “indeterminate” birth certificate sex designation law comes into effect. The “Indeterminate” marker is, from what I understand, intended to denote intersex babies, not transgender people. The BBC did a fairly good summary of some community reactions. Source.
  • Low prolactin levels in cisgender men as they age has been correlated with reduced sexuality and sexual functioning. Low prolactin levels were also correlated with general unwellness. Prolactin is a hormone most well known for being involved with lactation in breast-feeding parents, but has other effects too. Source.
  • A new study examining sexual satisfaction in women with complete androgen insensitivity syndrome (CAIS) or Mayer-Rokitansky-Küster-Hauser Syndrome (MRKH Syndrome, aka Müllerian agenesis). Women with CAIS reported less sexual satisfaction and confidence than women with MRKH Syndrome, who mostly reported being satisfied with their sex life. The abstract on this paper is fairly scarce so I’ll try to grab a copy for better examination. Source.
  • A study in Ontario, Canada found that 1/3 of trans people needed emergency medical services in 2012, but only 71% were actually able to receive it. 1/4th of those in the survey reported avoiding the emergency room because they are trans, and just over half needed to educate their provider. Source.
  • Another study has found a decrease in psychopathology (i.e., symptoms of mental illness, such as depression or anxiety) when trans people transition. The biggest drop was just after starting hormone therapy. Source.
  • A study on the changes in sexual desire/activity in trans people was published. In a nutshell, sex drive went down for trans women with hormone therapy but recovered a bit after surgery (compared with those who wanted/planned surgery but hadn’t had it yet). In contrast, trans men generally had their sex drive go up with hormones/surgery. Source.
Aug 152013

Rope (often used in BDSM ) smiley face - CC BY 3.0 Rose Lovell

A new psychological study of BDSM practitioners has just been published. This is the first such research to specifically examine the “Big Five” personality characteristics.

For those of you not interested in the nitty-gritty, here’s the digest: As a group, people who practice BDSM report a better sense of well-being and are more open to new experiences, extraverted, conscientious, and less sensitive to rejection than people who don’t practice BDSM. As with all correlations, this does not mean that BDSM activities caused these differences. Rather, people with these characteristics may be more likely to investigate BDSM.

Are you interested in the details? Cool! Let’s break this study down then.

First, some basics on BDSM. As some readers may remember, BDSM is an acronym standing for: Bondage, Dominance/Submission, SadoMasochism… and probably a few others besides. BDSM is considered an “alternative” sexuality and is highly stigmatized here in the United States. BDSM is often misrepresented as a purely sexual practice focused on pain. In truth, it’s often more sensual than sexual or painful. Many forms of BDSM “play” involve no sex or pain at all. Specific practices vary a lot depending on the people involved**.

Within BDSM, a person is typically in one of three roles: dominant (dom/domme), submissive (sub), or switch. The terms are fairly self explanatory. Dominant “has” control, submissive “gives” control, a switch is someone who switches roles*. Sometimes being a dom/sub/switch is referred to as an orientation, sometimes it’s a role for a particular activity (“scene”)***.

What about these personality characteristics? In personality psychology, there’s the concept of the “big five” personality characteristics, OCEAN: Openness, Conscientiousness, Extraversion, Agreeableness, and Neuroticism. Personality characteristics are thought to be innate. You’re born with a certain personality, and it’s relatively unchangeable. Each of the “big five” can be thought of as a line, and each person falls somewhere along that line. To wit….

  • Openness: How open to new experiences are you? Open vs cautious
  • Conscientiousness: How tidy, thorough and responsible are you? Organized vs careless
  • Extraversion: How much do you enjoy being around other people? Extravert vs introvert
  • Agreeableness: How trusting and cooperative are you? Friendly vs cold
  • Neuroticism: How easily do things tip you emotionally off balance? Easily upset vs steady

Some of these traits are associated with greater happiness and resiliency (e.g., Openness, Agreeableness and Extraversion) whereas others are associated with mental instability or illness (e.g., Neuroticism). There are nuances, overlaps, and arguments over these concepts that I won’t address here, but I hope that gives you a good starting place for understanding the study results. Let me know in the comments if it doesn’t and I’ll gladly expand. This study looked at more than just the “big five”. It also included measures of rejection sensitivity, attachment style, and subjective well being.

So why look at the “big five” and all those others in the context of BDSM? The arguments of the researchers make some sense. While BDSM and the “big five” have not been directly compared before, there is some evidence that the “big five” is associated with certain sexual attitudes. The more open you are, the more permissive your attitudes around sex. The more neurotic you are, the less stable your relationships, thus impacting your sexual life. And so on. Similarly, people with secure attachment styles are more likely to have a wide variety of sexual behaviors and better trust with partner(s) than people with insecure attachment styles.

So we have our variables: the “big five”, rejection sensitivity, attachment style, subjective well-being. What about our participants?

BDSM participants were 902 Dutch people, 464 male and 438 female (no mention of trans or genderqueer folks), recruited from one Dutch BDSM forum. Control participants were 434 Dutch people screened for BDSM behavior, 129 male and 305 female, recruited from magazine ads or websites having to do with “secrets”. Men in the study were older than women. I’m really not sure this control is an adequate control for this study because of the recruitment methods… but I’m not sure it’s not either. Differences between the groups? There certainly were some other than the practice of BDSM. There were significantly more women in the control group than the BDSM group. The control group was younger and less well educated than the BDSM group, although both were more well educated than the average Dutch citizen. Whether these differences affected the study results is unknown, but a possibility.

The researchers also note a gender difference between roles in the BDSM group. Men were 33.4% submissive, 18.3% switch, and 48.3% dominant identified. Women, on the other hand, were 75.6% submissive, 16.4% switch, and 8% dominant. This is certainly reflected in the stereotypes associated with BDSM activities.

Results included:

  • People who practice BDSM were more Open, Extraverted, and Conscientious than the control participants.
  • People who practice BDSM were less Neurotic and Agreeable than the control participants
  • People who practice BDSM were less sensitive to rejection than people who didn’t practice BDSM. Within the BDSM participants, submissives were more sensitive to rejection than dominants
  • People who practice BDSM had a greater sense of well-being than control participants. Dominants scored the highest on well-being.
  • Relatively few differences between BDSM participants and control participants was found when attachment styles were examined. When there was a difference, BDSM participants had a more secure attachment than control participants.

Effect sizes were small to medium. That is about average for a psychological study.

The OCEAN results make sense within the context of BDSM. In order to even try BDSM activities, you’d need to be open to new experiences. Conscientiousness is also valued, in order to be safe. Extraversion is helpful within a community setting. The rejection sensitivity results also make sense to me – a timid person may not continue to explore BDSM after one or two rejections. But this is all after-the-fact reasoning, and not particularly predictive or scientific.

The authors note that these results contradict the long-standing assumption that women who participate in BDSM so do because they were abused as children. But they didn’t ask directly about childhood sexual abuse. Rather, they draw this conclusion from the established relationship between attachment styles and abuse history. Childhood abuse is associated with insecure attachment. But in this study, BDSM folk were more likely to have a secure attachment than the control group. I think this logic is fairly sound, though a definitive answer will need to wait for a study where childhood abuse is specifically asked about.

The most obvious limitations to this study are the participants. The BDSM and control participants were not necessarily comparable, and there were significant known differences between the groups. Those differences could have affected the study’s results. Also, as usual, this study’s results may not be generalizable to BDSM communities in other countries (e.g., the United States).

Despite the limitations, these results are a delightful breath of fresh air, when so much of the literature treats BDSM as psychopathology. People who practice BDSM has long argued that there is nothing inherently “wrong”, “sick” or “dangerous” about their sexuality. These results absolutely support their assertion. The study authors state “We therefore conclude that these results favor the view […] that BDSM may be thought of as a recreational leisure, rather than the expression of psychopathological processes.” Yes, yes and yes.

The study was published in the Journal of Sexual Medicine. The abstract is publicly available.

* This is a highly simplified description. Power, and the exchange of power, is complex.

** It’s important to note, though, that for many people who participate in BDSM pain is very important, if not the central experience.

*** In addition to Dom/Sub/Switch, there’s also the idea of “topping” and “bottoming”. Topping and bottoming are much more transitory than Dom/Sub/Switch. In any particular activity, the Top is the “do-er” and the Bottom is the “do-ee”. But being Top or Bottom is activity specific and not as much of an orientation as Dom/Sub/Switch.

Feb 202013

CC BY-NC-ND 2.0 - Santiago Alvarez

A new study has come out examining the differences between eating disorders and transsexuality. It’s not immediately obvious why those two should be compared. The causes of both are unknown. When you don’t know the cause of a phenomenon it’s often useful to compare it to other phenomena that seems similar. Both eating disorders and transsexuality can be categorized as body-centered phenomena; eating disorders involve weight, transsexuality involves sex characteristics. However there are differences; people with eating disorders are more likely to have other psychiatric diagnoses (e.g., borderline personality disorder) than trans people are. Trans people seem to have psychiatric diagnoses as frequently as the general population, though the data are still tentative.

This Italian study compared three groups, all roughly the same size (100 participants):

  • Trans people, both trans women and trans men. Both pre-op (no sexual reassignment surgery) and post-op folk were included. There were roughly equal numbers of trans men and trans women, and of pre-ops and post-ops. Trans participants had to have a diagnosis of Gender Identity Disorder.
  • People with eating disorders, divided into three groups: anorexia nervosa, bulimia nervosa and binge eating disorder. These participants were mostly female, except in the binge eating group which was half female.
  • Control participants with normal BMI who did not have an eating disorder and were not trans.

What did they measure? The researchers measured demographics, “anthropometric measurements” such as height and weight, psychiatric evaluations to verify diagnoses, psychological symptoms, and body uneasiness. Body uneasiness is multifaceted, including general body/weight dissatisfaction, compulsive self-monitoring (e.g., spending a lot of time in front of the mirror), feeling disconnected from one’s body, and worrying about specific body parts.

What did they find? Results included…

  • Pre-op trans folk had: a) higher levels of body uneasiness than people with eating disorders, b) lower levels of body satisfaction than post-op trans folk, and c) higher levels of depersonalization than all other groups.
  • There was no difference in overall body uneasiness between trans men and trans women. However, there were differences in various aspects of body uneasiness. Trans women were more likely to be concerned about weight gain than trans men. Trans women also self-monitored about as much as people with eating disorders, more than trans men and the control group.
  • Trans participants had lower levels of psychopathology than people with eating disorders. There was no difference between the trans participants and the control group for psychopathology.
  • Pre-op trans women were more likely to have adjustment disorder than all the other groups.

So how do we interpret this? First there’s the difference between trans folk and people with eating disorders. This study confirmed the findings of previous studies. It agrees that trans people are much less likely to have psychiatric diagnoses than people with eating disorders. It also agrees that, in general, trans people are not at elevated risk for psychopathology than the general population. Given the way many psychiatric disorders come in clusters (e.g., mood and anxiety disorders), this may be further evidence that transsexuality is not a psychiatric condition.

The finding that pre-op trans women are more likely to have adjustment disorder requires explanation. Adjustment disorder is not like mood or psychotic disorders. It means that the person is having difficulty adjusting to a life change. For pre-op trans women, the source is obvious: their transition is a major life change and a major stressor. The fear of being “outed” and assaulted or ostracized is very real. Pre-op trans women are also likely o be early in transition and hormone therapy and have a harder time “passing” than trans men.

Why might trans women worry about weight more than trans men? The authors comment, “It could be speculated that [trans women]’s drive for thinness is a way to suppress masculinity and to correspond to a female ideal of attractiveness.” Absolutely! Trans women are women, and so they get all the societal messages encouraging thinness that all Western women receive.

I do, however, feel that one “finding” of theirs must be questioned. As part of demographics, the authors asked about sexual orientation. They then categorized their participants by attraction according to “genotypic sex” (XX, XY, XXY, XO, etc) So when they later reported that their trans participants were more likely to be attracted to the same genotypic sex than their controls and people with eating disorders, they were actually comparing straight trans people to gay cis people. That makes no sense! Of course there were more straight trans people than gay cis people – there are more straight people than gay people overall. Further, “genotypic sex” as a category makes no sense unless you actually check the genotype! Even then, it doesn’t necessarily correspond to phenotypic sex (the sex that the person looks like).The primary limitation to this study is their inclusion of only gender binary trans people who were diagnosed with Gender Identity Disorder. This excludes all genderqueer folk, who may have more difficulty with transition because of societal pressure to be seen as either male or female. Otherwise, I think this study was fairly well put together.

The authors conclude saying that “Our findings suggest that in eating disorder patients [body] uneasiness is primarily linked to general psychopathology, whereas in [transsexuality] this relationship is lacking.” In other words, they suggest that eating disorders come from a general state of psychological illness and that transsexuality does not. The data I have seen, as well as anecdotes from the trans community, agree with this conclusion.