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Transgenderism and Intersexuality in Childhood and Adolescence: Making Choices presents an overview of the research, clinical insights, and ethical dilemmas relevant to clinicians who treat intersex youth and their families. Exploring gender development from a cross-cultural perspective, esteemed scholar Peggy T. Cohen-Kettenis and experienced practitioner Friedemann Pfäfflin focus on assessment, diagnosis, and treatment issues. To bridge research and practical application, they include numerous case studies, definitions of relevant terminology, and salient chapter summaries.

The aim of this study was to re-examine individuals with gender identity disorder after as long a period of time as possible. To meet the inclusion criterion, the legal recognition of participants’ gender change via a legal name change had to date back at least 10 years. The sample comprised 71 participants (35 MtF and 36 FtM). The follow-up period was 10–24 years with a mean of 13.8 years ( SD  = 2.78). Instruments included a combination of qualitative and quantitative methods: Clinical interviews were conducted with the participants, and they completed a follow-up questionnaire as well as several standardized questionnaires they had already filled in when they first made contact with the clinic. Positive and desired changes were determined by all of the instruments: Participants reported high degrees of well-being and a good social integration. Very few participants were unemployed, most of them had a steady relationship, and they were also satisfied with their relationships with family and friends. Their overall evaluation of the treatment process for sex reassignment and its effectiveness in reducing gender dysphoria was positive. Regarding the results of the standardized questionnaires, participants showed significantly fewer psychological problems and interpersonal difficulties as well as a strongly increased life satisfaction at follow-up than at the time of the initial consultation. Despite these positive results, the treatment of transsexualism is far from being perfect.

An obituary for Prof. Horst Kächele, a messenger of empirical research in psychoanalysis, who died on Jun 28, 2020, is presented. After studying medicine in Marburg, Leeds and Munich, Kächele accepted an invitation from Helmut Thomä to take up a scientific position in the Department of Psychotherapy at Ulm University, Germany. He combined his research activities with his psychoanalytic training at the Ulm Institute for Psychoanalysis. In 1990, he succeeded Helmut Thomä as the Director of the Department of Psychotherapy of the Clinic of Psychiatry, Psychosomatic Medicine and Psychotherapy at Ulm University. In 1996, this structure was revised, and he became the Director of the University Clinic of Psychosomatic Medicine and Psychotherapy.

Apart from some general issues related to the Gender Identity Disorder (GID) diagnosis, such as whether it should stay in the DSM-V or not, a number of problems specifically relate to the current criteria of the GID diagnosis for adolescents and adults. These problems concern the confusion caused by similarities and differences of the terms transsexualism and GID, the inability of the current criteria to capture the whole spectrum of gender variance phenomena, the potential risk of unnecessary physically invasive examinations to rule out intersex conditions (disorders of sex development), the necessity of the D criterion (distress and impairment), and the fact that the diagnosis still applies to those who already had hormonal and surgical treatment. If the diagnosis should not be deleted from the DSM, most of the criticism could be addressed in the DSM-V if the diagnosis would be renamed, the criteria would be adjusted in wording, and made more stringent. However, this would imply that the diagnosis would still be dichotomous and similar to earlier DSM versions. Another option is to follow a more dimensional approach, allowing for different degrees of gender dysphoria depending on the number of indicators. Considering the strong resistance against sexuality related specifiers, and the relative difficulty assessing sexual orientation in individuals pursuing hormonal and surgical interventions to change physical sex characteristics, it should be investigated whether other potentially relevant specifiers (e.g., onset age) are more appropriate.

In der Mythologie, Religion und Literatur gibt es zahlreiche Beispiele für Kannibalismus, die über Jahrhunderte tradiert werden und wenig anstößig erscheinen, solange sie sich auf der symbolischen Ebene halten. Problematisch wird es allerdings, wenn kannibalische Impulse wörtlich genommen und in die Tat umgesetzt werden. Außer in extremen Notsituationen, in denen dieses seltene Phänomen noch nachvollziehbar erscheinen mag, kommt dies im Kontext gravierender Sexualstraftaten vor. Vor ca. 15 Jahren wurde in Deutschland der Fall eines Mannes bekannt, der über das Internet Partner gesucht und gefunden hatte, die sich auffressen lassen wollten. Das Einverständnis des Opfers irritierte nicht nur die Öffentlichkeit, sondern auch die Justiz, die zunächst nicht wusste, wie die Tat juristisch angemessen zu bewerten sei. In einem ersten Verfahren vor dem Landgericht Kassel war der Mann im Januar 2004 nur wegen Totschlags zu einer zeitlichen Freiheitsstrafe von vergleichsweise wenigen Jahren verurteilt worden; ein Urteil, das vom Bundesgerichtshof aufgehoben wurde. In einer neuen Verhandlung vor dem Landgericht Frankfurt wurde er im Mai 2006 wegen Mordes zu einer lebenslangen Freiheitsstrafe verurteilt. Im Folgenden wird aus einem psychoanalytischen Blickwinkel untersucht, inwieweit mythologische, religiöse und künstlerische Kannibalismusmodelle etwas grundlegend Anthropologisches zum Ausdruck bringen und wie das konkrete Beispiel vor diesem Hintergrund im Kontext psychoanalytischer Perversionskonzepte zu bewerten ist.

As a psychodynamic theory of both normal development and psychopathology, attachment theory has particular utility for forensic psychiatry. A Matter of Security provides an attachment theory based account of the development of arousal and affect regulation, which offers a new way of thinking about mental disorders in offenders. This book also discusses the development of personality in terms of interpersonal functioning and relationships with others, which is essential to understanding both interpersonal violence and abnormal personality development. Attachment theory also offers a model of therapeutic work with patients that have particular resonance with forensic work because it uses the language of security. This collection focuses on attachment theory applied to forensic psychiatry and psychotherapy.

In mythology, religion, and literature, there are many examples of cannibalism that have been passed down over the centuries and which do not strike us as shocking as long as they remain fixed in a symbolic context. Things only become problematic when cannibalistic impulses are taken literally and put into practice. Apart from situations of extreme emergency in which this rare phenomenon might enjoy a certain sympathy, it also occurs within the context of serious sexual offences. Recently, in Germany, there was the case of a man who used the internet to find a person who wanted to have himself eaten. The victim’s consent unsettled not only the public at large, but also the judiciary, which at first did not know how the case was legally to be appropriately assessed. In a first trial in January 2004, the man was sentenced to a comparatively short prison term of only a few years, a sentence that was lifted by the Federal Supreme Court. In a fresh trial in May 2006, he was sentenced to life imprisonment for murder. In this essay, I discuss to what extent mythological, religious, and artistic models of cannibalism express something fundamentally anthropological and how concrete examples should be assessed against this background.

Transgenderism and Intersexuality in Childhood and Adolescence: Making Choices presents an overview of the research, clinical insights, and ethical dilemmas relevant to clinicians who treat intersex youth and their families. Exploring gender development from a cross-cultural perspective, esteemed scholar Peggy T Cohen-Kettenis and experienced practitioner Friedemann Pfafflin focus on assessment, diagnosis, and treatment issues. To bridge research and practical application, they include numerous case studies, definitions of relevant terminology, and salient chapter summaries.