1. Gender Identity Disorder in Children, Adolescents, and Adults Historical Background Diagnosis

2. Historical Background Mythology and Ancient History Venus Castina- goddess who responded with sympathy and understanding to the yearnings of feminine souls who are locked in male bodies. Philo commented of the males of Hellenistic society: they are disconnected with the male roles to the point of wanting to be transformed into women. Medieval History Middle ages in Europe- story that Pope John VIII was actually a woman Malleues Maleficarum- contains an eye witness account of a girl changed to a boy by the devil in Rome. (Green, 1978)

3. Historical Background continued:.......... 19th Century to present 1853- Phenomenon of transexualism first mentioned in the medical literature (Midence & Hargreaves, 1977) 1860’s- sexual orientation first gains widespread research Kraft-Ebing: male and female sex centers in the brain control gender identity. (Green, 1978) 1930- first sex reassignment operation took place in Europe 1949- Claudwell first described the term psychopathia transsexualis 1966- Benjamin’s book, The Transsexual Phenomenon; becomes a condition to be recognized and diagnosed Transsexualism is first defined as an illness in the third edition of DSM in 1980. (Midence & Hargreaves, 1977)

4. Diagnostic Criteria, DSM-IV Strong and persistent cross-dressing identification (not merely a desire for perceived cultural advantages of the other sex) Children identification…….. repeatedly stated desire to be, or insistence that he/she is the opposite sex in boys, preference for cross-dressing or simulating female attire. in girls, insistence on wearing masculine clothing strong and persistent preferences for cross-sex roles in make- believe play or persistent fantasies of being the other sex intense desire to participate in the stereotypical games and pastimes of the other sex strong preference for playmates of the other sex

5. In adolescents and adults……. stated desire to be the other sex frequent passing as the other sex desire to live or be treated as the other sex or the conviction of having typical feelings and reactions of the other sex Persistent discomfort with his/her sex or sense of inappropriateness in gender role of that sex: Disturbances not concurrent with physical intersex condition The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning. Specifiers: sexually attracted to males, females, both, or neither

6. Eating Disorders

12. SLEEP DISORDERS

13. The Normal Sleep Cycle Lasts about 90 minutes and is repeated 4 to 6 times per night. Consists of the following: Stage 1 sleep: is the initial stage upon falling to sleep; is consumes approximately 2-5 % of a normal night sleep. Stage 2 Sleep: it composes approximately 45-55 % of a normal night sleep. Stage 3 sleep: called one of the "slow wave" sleep stages because brain activity slows down dramatically as the person progresses to stage 4 sleep Stage 4 Sleep: "slow wave sleep" similar to stage 3, brain activity slows dramatically. Stages 3 and 4 combined are called "slow wave sleep” Stage 5: REM (Rapid Eye Movement Sleep): a very active stage of sleep.

14. The cycle includes 2 different types of sleep. Active Sleep: Breathing , heart rate and brain wave activity quicken. Vivid dreams can occur. Sleep Specialists call this 5th stage of sleep "REM" rapid eye movement sleep because if one is to watch a person in this stage, their eyes are moving rapidly about. After REM stage, the body usually returns to stage 2 sleep. Quiet Sleep: The body cycles or "drifts" through the four stages of sleep: Stage 1, 2, 3, and 4. Heart rate and respiration becomes slower. The body then returns to stage 2 before moving into "active sleep". Without sleep our bodies and minds suffer, symptoms include:

15. Symptoms of Sleep Deprivation fatigue irritability depression reduced attention, concentration and memory more frequent illnesses lost productivity workplace accidents or auto accidents, significantly increased when alcohol is combined with sleep disorders.

16. Dyssomnias Primary Insomnia Initial Middle EMA Primary Hypersomnia Excessive sleepiness with prolonged sleep episodes or almost daily daytime sleep episodes Narcolepsy Irresistible attacks of refreshing sleep that occur daily Over at least 3 months At least one of the following: Cataplexy Intrusions in REM (hypnopompic/hypnagogic hallucinations)

17. Breathing-Related Sleep Disorder Sleep disruption, leading to excessive sleepiness or insomnia There are 3 types of Sleep Apnea: Obstructive sleep apnea is fairly common The airway becomes blocked by the tongue, excesses tissue or relaxed throat muscles during sleep. Breathing usually stops for 10 to 90 seconds. The body struggles for air --- briefly waking the sleeper. Breathing then begins again. The person may wake hundreds of times per night. Waking does necessarily mean the person opens their eyes and then returns to sleep. It may simply lighten the person sleeping thus inhibiting the normal sleep cycle, thus interrupting good quality sleep.

18. Central Sleep Apnea...is fairly rare. It usually affects adults over age 60. The brain "forgets" to tell the breathing muscles to move. The lack of oxygen causes the brain to wake the sleeping person. Then breathing resumes. The person may remember waking, but not remember why. Mixed Sleep Apnea involves brief periods of central sleep apnea followed by longer periods of obstructive sleep apnea. Signs of sleep apnea: loud snoring followed by breathless pause .... ending with a gasp or snort. People with central sleep apnea usually do not snore. Restless movements, High blood pressure, Irregular heartbeat, Morning headache, Impotence, Problems with memory and concentration Extreme tiredness or sleepiness

19. The End