?url_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.title=Is+gender+dysphoria+dysphoric%3F+Elevated+depression+and+anxiety+in+gender+dysphoric+and+non-dysphoric+homosexual+and+bisexual+men+in+an+HIV+sample.&rft.creator=Weinrich%2C+James+D&rft.creator=Atkinson%2C+J+Hampton&rft.creator=McCutchan%2C+J+Allen&rft.creator=Grant%2C+Igor&rft.creator=Group%2C+the+HNRC&rft.subject=Evolutionary+Psychology&rft.subject=Social+Psychology&rft.description=Although+most+cases+of+HIV+infection+in+North+America+have+been+acquired+sexually%2C+only+a+few+sex+researchers+have+applied+their+unique+perspectives+and+skills+to+the+AIDS+epidemic%2C+and+few+mainstream+psychiatrists+and+psychologists+have+addressed+the+sexual+aspects+of+the+disease.+That+is%2C+there+has+been+little+cross-fertilization+of+ideas+between+the+psychiatric+research+community+and+the+sex+research+community.++The+present+report+is+an+attempt+to+introduce+what+might+be+called+a+traditional+sexological+perspective+into+a+mainstream+psychiatric+research+program+on+HIV+disease+and+neuropsychology%2C+with+results+that+may+be+pertinent+to+questions+of+interest+to+a+broad+range+of+scientists+and+clinicians.+The+HIV+Neurobehavioral+Research+Center+(HNRC)+is+a+large%2C+federally+funded+interdisciplinary+research+project+affiliated+with+the+Department+of+Psychiatry+at+the+University+of+California%2C+San+Diego.+Its+basic+mission+is+to+investigate+the+natural+history+and+prevalence+of+the+neuropsychological+sequelae+of+HIV+infection%2C+with+attention+given+to+neurology%2C+psychiatry%2C+virology%2C+medicine%2C+brain+imaging%2C+and+other+disciplines.++A+central+concern+of+the+HNRC+is+the+assessment+of+rates+of+psychiatric+morbidity+such+as+depression+and+anxiety.+We+have+found+that+the+levels+of+depression+and+anxiety+in+our+homosexual+subjects%2C+whether+HIV+positive+or+HIV+negative%2C+are+substantially+higher+than+those+found+in+representative+general+population+samples.+For+example%2C+our+homosexual+populations+(HIV-positive+and+HIV-negative)+had+lifetime+frequencies+of+major+depression+(diagnosed+by+the+Diagnostic+Interview+Schedule+for+DSM-+III+of+31-32%25+(N+%3D+135)%2C+compared+to+9%25+in+22+HIV-negative+heterosexual+controls+(Atkinson+et+al.%2C+1989).+Similar+findings+have+been+presented+from+other+investigators+of+AIDS-related+homosexual+samples+(Hays+et+al.%2C+1990%3B+Perry+et+al.%2C+1990%3B+Viney+et+al.%2C+1991%3B+Williams+et+at.%2C+1991)%2C+although+the+finding+is+not+universal.++Of+course%2C+AIDS+is+a+life-threatening+disease+arguably+capable+of+triggering+depression+in+and+of+itself.+It+could+do+so+indirectly+through+the+conscious+recognition+of+one's+increased+likelihood+of+mortality+due+to+the+disease%2C+or+directly+via+hypothesized+effects+on+neurotransmitters+or+other+forms+of+CNS+morbidity.+However%2C+some+of+the+studies+that+found+high+levels+of+depression+in+HIV-related+samples+of+homosexual+men+reported+that+the+history+of+depression+predated+the+AIDS+epidemic+(Atkinson+et+al.%2C+1988%3B+Joseph+et+al.%2C+1990%3B+Williams+et+at.%2C+1991).+Accordingly%2C+the+higher+levels+of+depression+now+observed+can+probably+not+be+explained+merely+as+the+result+of+the+undoubted+pressures+caused+by+this+epidemic.++Although+it+might+in+theory+be+expected+that+homosexuals+living+in+a+hostile+society+may+experience+depression+as+a+reaction+to+the+social+stigma+attached+to+their+orientation%2C+in+fact+there+is+little+if+any+documentation+of+such+an+increased+level+of+rigorously+diagnosed+depression+from+nonclinical+samples+studied+before+the+AIDS+epidemic+(Saghir+and+Robins%2C+1973%3B+Gonsiorek%2C+1991).+We+found+two+reports+of+higher+depression+from+this+period%2C+but+these+studies+did+not+assess+depression+with+a+clinical+interview+or+standardized+questionnaire.+One+found+higher+depression+among+homosexual+men+(compared+with+the+general+population)+in+samples+from+three+different+countries+(Weinberg+and+Williams%2C+1974%2C+p.+152)%2C+and+higher+levels+among+effeminate+homosexual+men+than+among+those+who+were+not+effeminate+(p.+172).+Although+this+result+corresponds+well+to+those+we+report+presently%2C+that+study's+measure+of+depression+was+the+subjects'+responses+to+an+item+asking+if+they+%22felt+they+were+happy%22+persons.+The+other+study+used+subjects'+answers+to+seven+questions+likewise+not+previously+standardized+(e.g.%2C+how+frequently+did+they+feel+life+was+worthwhile%2C+experience+hurt+feelings%2C+etc.%3A+Bell+and+Weinberg%2C+1978%2C+pp.+200-201).+Even+the+latter+study+found+that+levels+of+depression+were+not+elevated+among+the+male+homosexuals+who+were+in+monogamous+relationships+or+who+were+%22functional%22+(i.e.%2C+uncoupled+but+functioning+successfully+in+the+gay+world).+One+notable+study+from+this+period+which+used+more+rigorous+psychiatric+methodology+found+no+difference+in+levels+of+depression+by+sexual+orientation+(Saghir+and+Robins%2C+1973%2C+pp.+113-+118).++Accordingly%2C+it+is+important+to+ascertain+which+aspects+of+sexual+orientation+are+associated+with+depression+in+homosexual+populations%2C+if+any.+Given+the+unfortunate+history+of+the+classification+of+homosexuality+per+se+as+a+disease%2C+it+is+worthwhile+to+study+depression+in+this+population+without+presupposing+that+it+is+a+reflection+of+an+underlying+pathology+but+might+instead+be+a+response+to+environmental+circumstances+or+even+an+intermittent+aspect+of+otherwise+normal+personality+in+certain+personality+types.++One+of+the+few+psychological+traits+that+has+been+shown%2C+in+both+retrospective+and+prospective+studies%2C+to+be+both+statistically+and+substantively+significant+when+differentiating+and+contrasting+the+average+backgrounds+of+heterosexual+and+homosexual+men+has+been+termed+childhood+gender+nonconformity+(CGN)+by+some+authors+(Bell+and+Weinberg%2C+1978)%2C+childhood+femininity+by+others+(Green%2C+1974%2C+1987%3B+Freund+et+al.%2C+1974)%2C+and+gender+dysphoria+in+the+DSM-III-R.+Such+behaviors+are+far+from+universal+in+the+histories+of+homosexual+men+in+Western+societies%2C+but+they+are+not+uncommon%2C+and+they+are+apparently+much+less+common+among+men+who+identify+themselves+as+heterosexual.+One+questionnaire+used+to+assess+such+behavior+is+the+Freund+Feminine+Gender+Identity+questionnaire+(FGI%3B+Freund+et+al.%2C+1974%2C+1977).++We+have+observed+a+mild+correlation+between+homosexual+men's+scores+on+the+FGI+and+their+interest+in+receptive+anal+intercourse+(Weinrich+et+al.%2C+1992).+(Note+that+we+did+not+assume+a+priori+that+sex-role+nonconformity+such+as+that+measured+by+the+FGI+must+necessarily+be+related+to+variability+in+sexual+orientation+or+preferences+for+particular+erotosexual+roles%3B+we+observed+that+a+moderate+correlation+existed.)+This+correlation+alone+should+alert+AIDS+researchers+that+CGN+may+be+a+personality+variable+that+contributed+to+HIV+exposure+(before+the+era+of+safer+sex)%2C+which+might+in+turn+suggest+that+HIV-related+samples+are+likely+to+have+a+higher+proportion+of+high-CGN+men+than+more+widely+representative+samples.+And+it+should+alert+researchers+that+CGN+could+be+important+to+study+whenever+sexual+orientation+is+investigated.++Logically+speaking%2C+a+desire+to+be+a+member+of+the+opposite+sex+(whether+in+adulthood+or+childhood)+is+not+necessarily+dysphoric.+Anyone+expressing+a+desire+to+change+an+important+facet+of+their+life+might+be+suspected+of+being+dysphoric+about+their+current+circumstances%2C+but+whether+this+presumed+dysphoria+actually+exists%2C+can+be+detected+by+our+measurement+instruments%2C+and+ever+reaches+the+level+of+clinical+depression+are+empirical+questions.+Accordingly%2C+we+thought+it+important+to+assess+the+extent+to+which+CGN%2C+as+measured+by+FGI%2C+is+in+fact+associated+with+dysphoria+and+to+that+extent+might+account+for+some+of+the+differences+in+depression+observed+between+heterosexual+and+homosexual+male+samples.+Note+that+one+of+the+early+papers+on+the+FGI+found+that+homosexual+psychiatric+patients+scored+higher+on+the+FGI+than+did+a+group+of+homosexual+nonpatients+(Freund+et+al.%2C+1977%2C+p.+512).++If+it+is+indeed+the+case+that+the+previously+cited+samples+of+homosexual+men+from+before+the+AIDS+epidemic+show+no+evidence+of+clinically+depressed+mood%2C+but+most+samples+of+HIV-positives+and+HIV-+negatives+report+high+levels+of+a+lifetime+diagnosis+of+major+depression+perhaps+dating+from+before+the+epidemic%2C+then+we+face+some+troubling+and+intriguing+questions.+Are+sample+selection+biases+before+and+after+the+advent+of+AIDS+so+different+that+they+could+account+for+such+a+striking+difference+in+findings+about+depression%3F+This+is+counterintuitive%2C+albeit+possible.+Are+homosexual+men+who+are+currently+depressed+by+the+HIV+health+crisis+likely+to+retroactively+distort+their+accounts+of+lifetime+depression%3F+This+would+challenge+well-validated+clinical+interviewing+instruments.+Societal+pressures+and+stigmatization+attached+to+homosexuality+might+account+for+a+proportion+of+the+elevated+lifetime+rates+of+major+depression%2C+but+there+seems+to+be+little+evidence+that+this+stigmatization+is+higher+now+than+it+was+when+the+previous+studies+were+conducted+(indeed%2C+it+seems+likely+that+just+the+opposite+would+be+the+case%2C+given+the+progress+made+in+struggles+for+gay+rights).+However%2C+individual+developmental+factors%2C+which+are+now+just+becoming+measurable%2C+may+add+to+our+understanding+of+this+process.++The+purpose+of+the+present+paper+is+to+see+whether+anxiety%2C+depression%2C+and+their+related+symptoms+might+be+illuminated+by+measuring+CGN+within+a+homosexual+and+bisexual+sample.+Our+specific+hypothesis+is+that+men+with+high+FGI+scores+would+show+elevated+average+levels+of+anxiety+and+depression.+If+confirmed%2C+this+hypothesis+would+predict+that+samples+of+homosexual+men+varying+in+average+CGN+could+easily+have+different+average+levels+of+syndromic+depression+and%2For+depressed+or+anxious+symptoms+(all+of+which+would+have+predated+the+AIDS+epidemic).+If+there+were+reason+to+expect+that+AIDS-related+samples+of+homosexual+men+would+be+skewed+toward+individuals+of+higher+CGN%2C+then+this+hypothesis+would+receive+additional+support.+&rft.date=1995&rft.type=Journal+(Paginated)&rft.type=PeerReviewed&rft.format=text%2Fhtml&rft.identifier=http%3A%2F%2Fcogprints.org%2F603%2F1%2Fdysphoric.html&rft.identifier=++Weinrich%2C+James+D+and+Atkinson%2C+J+Hampton+and+McCutchan%2C+J+Allen+and+Grant%2C+Igor+and+Group%2C+the+HNRC++(1995)+Is+gender+dysphoria+dysphoric%3F+Elevated+depression+and+anxiety+in+gender+dysphoric+and+non-dysphoric+homosexual+and+bisexual+men+in+an+HIV+sample.++%5BJournal+(Paginated)%5D+++++&rft.relation=http%3A%2F%2Fcogprints.org%2F603%2F