Abstract
Nine female adolescents with female pseudohermaphroditism resulting from virilizing congenital adrenocortical hyperplasia (CAH) were studied in terms of gender identity, sex-role behavior, psychological adjustment, and psychosexual development. A group of adolescents with chronic illess was used as a control. The Draw-A-Person, the Bem Sex-Role Inventory, Rorschach, TAT, and a questionnaire reviewing peer and romantic activities were administered to both groups. The two groups were comparable on measures of general personality adjustment, with the CAH girls showing a trend toward greater bodily concerns. Sex-role identity for both groups was near the adolescent girl norms for both Femininity and Masculinity, with virilized CAH girls showing slightly higher Androgyny scores. Significant differences were found on gender identity as measured by greater differentiation of the drawn male figure as well as a trend toward drawing the male figure first. The CAH females also showed consistent patterns of psychosocial delay in dating and sexual relations as compared to the control group. Gender identity in this group appears to be mediated by body image. The resulting ambivalence may be evidence of feelings of incompetence, leading to resistance to social interactions and goals involving intimacy and nurturance.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bem, S. (1974). Measurement of psychological androgyny.J. Consul. Clin. Psychol. 42: 155–162.
Connover, W. (1971).Practical Nonparametric Statistics. Wiley, New York, pp. 224–229.
Ehrhardt, A. and Baker, S. (1974). Fetal androgen, human CNS differentiation and behavior sex differences: InSex Differences in Behavior Friedman, R. C., Richard, R. M., Vanderwiele, R. L. (eds.), Wiley, New York.
Ehrhardt, A., Evers, K., and Money, J. (1968). Influence of androgen and some aspects of sexually dimorphic behavior in women with the late-treated adrenogenital syndrome.Johns Hopkins Med. J. 123: 115–122.
Ehrhardt, A., Epstein, R., and Money, J. (1968). Fetal androgens and female gender identity in the early-treated adrenogenital syndrome.John Hopkins Med. J. 122: 160–167.
Exner, J. Jr. (1974).The Rorschach: A Comprehensive System. John Wiley & Sons, New York.
Exner, J. Jr. (1985).Rorschach Workbook for the Comprehensive System, 2nd ed. Rorschach Workshops, Bayville, NY.
Fagot, B., and Leinbach, M. (1985). Gender identity: Some thoughts on an old concept.Child Psychiat. 24: 684–688.
Green, R. (1974).Sexual Identity Conflict in Children and Adults. New York: Basic Books, New York; Gerald Duckworth, London; Penguin, Baltimore.
Hampson, J. G. (1955). Hermaphroditic genital appearance, rearing and eroticism in hyperadrenocorticism.Bull. Johns Hopkins Hosp. 96: 265–273.
Harris, D. (1963).Children's drawings as measures of intellectual maturity. Harcourt, Brace, Jovanovich, New York.
Haworth, M. F. and Normington, C. J. (1961). A sexual differentiation scale for the D-A-P test.J. Project. Tech. 25: 441–450.
Hurtig, A., Radhakrishnan, J., Reyes, H., and Rosenthal, I., (1983). Psychological evaluation of treated females with virilizing congenital adrenal hyperplasia.J. Ped. Surg. 18: 889–893.
Kagan, J. (1960). Thematic apperception techniques with children. In Rabin, A., and Haworth, M. (eds.),Projective Techniques with Children. Grune & Stratton, New York.
Leape, L. (1983). Discussion following paper. Psychological evaluation of treated females with virilizing congenital adrenal hyperplasia.J. Pediat. Surg. 18: 892–893.
Lev-Ran, A. (1974). Gender role differentiation in hermaphrodites,Arch. Sex. Behav. 3: 391–424.
Mahler, M., Pine, F., and Bergman, A. (1975)The Psychological Birth of the Human Infant. Basic Books, New York.
Massad, C. (1982). Sex-role development during childhood and adolescence: a two-year longitudinal study. Paper presented at American Psychological Association Annual Meeting, Washington, D.C.
McGuire, L., Ryan, K., and Omenn, G. (1975). Congenital adrenal hyperplasia: II. Cognitive and behavioral studies.Behav. Genet. 5: 175–188.
Money, J. (1955). Hermaphroditism, gender and precocity in hyperadrenocorticism: Psychologic findings.Bull. John Hopkins Hosp. 96: 253–264.
Money, J., and Ehrhardt, A. (1972).Man and Woman: Boy and Girl. Johns Hopkins University Press, Baltimore.
Money, J., and Schwartz, M. (1979). Dating, romantic and non-romantic friendships and sexuality in 17 early-treated adrenogenital females, aged 16–25. In Lee, P. A., Plotnick, L. P., Kowarski, A. A., and Migeon, C. J. (eds.),Congenital Adrenal Hyperplasia. University Park Press, Baltimore.
Money, J., Hampson, J. G., and Hampson, J. L. (1955). An examination of some basic sexual concepts: The evidence of human hermaphroditism.Bull. Johns Hopkins Hosp. 37: 301–319.
Murray, H. (1943).Thematic Apperception Test. Harvard University Press, Cambridge, MA.
Paluszny, M, Beit-Hallahmi, B., Catford, J., Conley, R., Dull, C., and Guiora, A. (1973). Gender identity and its measurement in childrenCompreh. Psychiat. 14: 281–290.
Rosenwald, A., Handlon, J., Rosenthal, I., Hyde, J., and Bronstein, P. (1958). Psychologic studies before and after clitoridectomy in female pseudohermaphroditism caused by congenital virilizing adrenal hyperplasia.Pediatrics 21: 832–838.
Schilder, P. (1950).The Image and Appearance of the Human Body. International Universities Press, New York.
Spence, J. (1984). Gender, identity and concepts of masculinity and femininity. In Sanderegger, T. B. (ed.),Gender. Nebraska Symposium on Motivation, Lincoln, Nebraska.
Spence, J., and Helmreich, R. (1978).Masculinity and Femininity. University of Texas Press, Austin.
Stoller, R. (1985).Sex and Gender: On the Development of Masculinity and Femininity. Science House, New York.
Swenson, C. H. (1968). Empirical evaluation of human figure drawings: 1957–1966.Psychol. Bull. 70: 20–44.
Weider, A. and Noller, P. (1950). Objective studies of children's drawings of human figures. I: Sex awareness and socio-economic level.J. Clin. Psychol. 6: 319–325.
Zucker, K. J., Finegan, J. K., Doering, R. W. and Bradley, S. J. (1983). Human figure drawings of gender-problem children: A comparison to sibling, psychiatric and normal control.J. Abn. Child Psychol. 11: 287–298.
Zuger, B. (1970). Gender role determination: A critical review of the evidence from hermaphroditism.Psychosom. Med. 32: 449–467.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hurtig, A.L., Rosenthal, I.M. Psychological findings in early treated cases of female pseudohermaphroditism caused by virilizing congenital adrenal hyperplasia. Arch Sex Behav 16, 209–223 (1987). https://doi.org/10.1007/BF01541609
Issue Date:
DOI: https://doi.org/10.1007/BF01541609