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In the manner of Oedipus Rex, the myth of Myrrha-a story about a daughter's initiation of sex with her father-promises to divulge insights about feminine development. Given parallels between these two myths, the author asks why Jung identified Electra rather than Myrrha as the feminine counterpart to Oedipus, and revisits Freud's and Jung's differing interpretations of the incest theme in personality development. To break open the metaphor of Myrrha's incest, the author analyzes a similar account of incest in the Old Testament story of Lot and his wife and finds that they share a theme of female bitterness related to wounding of the mother and its arresting effect on the daughter's maturation. The article then considers the Demeter-Persephone myth, a tale not of incest but rape in Persephone's initiation into womanhood. In contrast to Myrrha, Persephone's development unfolds with strong maternal support tempered by the opposing claims on her by the masculine. The article draws these stories together to illuminate the archetypal forces that drive feminine development as well as the human affairs that resist and complicate them. The article concludes with a case study of a client whose developmental "stuckness" follows the contours of the Myrrha myth.

À la manière d'Oedipe Roi, le mythe de Myrrha, une histoire sur l'initiation sexuelle d'une fille avec son père promet de divulguer des éclairages concernant le développement féminin. Compte tenu des parallèles entre ces deux mythes, l'auteur se demande pourquoi Jung a identifié Électre plutôt que Myrrha comme la contrepartie féminine d'Œdipe. Il revisite les interprétations différentes de Freud et Jung sur le thème de l'inceste dans le développement de la personnalité. Pour ouvrir la métaphore de l'inceste de Myrrha, l'auteur analyse un récit similaire d'inceste dans l'histoire de Lot et de sa femme dans l'Ancien Testament et constate qu'ils ont en commun le thème de l'amertume féminine lié à la blessure de la mère et à son effet saisissant sur la maturation de la fille. L'article examine ensuite le mythe de Déméter-Perséphone, qui est non pas une histoire d'inceste mais de viol dans l'initiation de Perséphone à la féminité. Contrairement à Myrrha, le développement de Perséphone se déroule avec un fort soutien maternel tempéré par les revendications que le masculin lui oppose. L'article rassemble ces histoires pour éclairer les forces archétypales qui animent le développement féminin ainsi que les affaires humaines qui y résistent et les compliquent. L'article se termine par l'étude d'un cas clinique dont le « blocage ¼ développemental suit les contours du mythe de Myrrha.

A la manera de Edipo Rey, el mito de Mirra, una historia sobre la iniciación sexual de una hija con su padre, promete divulgar conocimientos sobre el desarrollo de lo femenino. Dados los paralelismos entre estos dos mitos, la autora se pregunta por qué Jung identificó a Electra en lugar de Mirra como la contrapartida femenina de Edipo y revisa las diferentes interpretaciones de Freud y Jung sobre el tema del incesto en el desarrollo de la personalidad. Para desentrañar la metáfora del incesto de Mirra, la autora analiza un relato similar de incesto en la historia de Lot y su esposa en el Antiguo Testamento y descubre que comparten el tema de la amargura femenina relacionada con la herida de la madre y su efecto paralizante en la maduración de la hija. A continuación, el artículo examina el mito de Deméter-Perséfone, una historia, no de incesto sino de violación, en la iniciación de Perséfone a la femineidad. A diferencia de Mirra, el desarrollo de Perséfone se desarrolla con un fuerte apoyo materno atenuado por las pretensiones opuestas de lo masculino sobre ella. El artículo reúne estas historias para iluminar las fuerzas arquetípicas que impulsan el desarrollo de lo femenino, así como los asuntos humanos que se resisten a ellas y las complican. El artículo concluye con un estudio de caso de una clienta cuyo "estancamiento" en su desarrollo sigue los devenires del mito de Mirra.

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Reciprocal partner or spousal caregiving in romantic relationships has been identified as a key determinant of the quality of couple relationships. In this article, we interrogate this premise concerning the presumed reciprocity of caregiving in romantic relationships, focusing on cisgender heterosexual relationships and offering implications for relationships of all genders and sexualities. Looking beyond the conventional focus on individual or dyadic processes, we theorize imbalances in care as gendered. Feminists have repeatedly critiqued gender ideology that devalues caring labor and allocates it to women. Gendered power dynamics can lead to imbalances in care-seeking and care provision. We discuss how the gendering of care and care inequalities can manifest in couple therapy, illustrating with examples from recorded interactions. Implications for therapy practice are discussed.

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BACKGROUND: This study profiles ceramides extracted from visceral and subcutaneous adipose tissue of human subjects by liquid chromatography-mass spectrometry to determine a correlation with status of diabetes and gender. METHODS: Samples of visceral and abdominal wall subcutaneous adipose tissue (n = 36 and n = 31, respectively) were taken during laparoscopic surgery from 36 patients (14 nondiabetic, 22 diabetic and prediabetic) undergoing bariatric surgery with a body mass index (BMI) >35 kg/m2 with ≥1 existing comorbidity or BMI ≥40 kg/m2 . Sphingolipids were extracted and analyzed using liquid chromatography-mass spectrometry. RESULTS: After logarithm 2 conversion, paired analysis of visceral to subcutaneous tissue showed differential accumulation of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) in visceral tissue of prediabetic/diabetic female subjects, but not in males. Within-tissue analysis showed higher mean levels of ceramide species linked to insulin resistance, such as Cer(d18:1/18:0) and Cer(d18:1/16:0), in visceral tissue of prediabetic/diabetic patients compared with nondiabetic subjects and higher content of Cer(d18:1/14:0) in subcutaneous tissue of insulin-resistant female patients compared with prediabetic/diabetic males. Statistically significant differences in mean levels of ceramide species between insulin-resistant African American and insulin-resistant Caucasian patients were not evident in visceral or subcutaneous tissue. CONCLUSIONS: Analysis of ceramides is important for developing a better understanding of biological processes underlying type 2 diabetes, metabolic syndrome, and obesity. Knowledge of the accumulated ceramides/dihydroceramides may reflect on the prelipolytic state that leads the lipotoxic phase of insulin resistance and may shed light on the predisposition to insulin resistance by gender.

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Couple interventions are limited in their effectiveness for reducing marital distress and dissolution. One explanation for this may be the narrow focus on conflict management and a limited understanding of how other domains in marriage influence one another over time. We present the first test of the relational domain spillover model (RDSM) to understand the extent to which poor functioning in either positive or negative areas of the relationship spill over into other aspects of relationship functioning across time. Husbands and wives reported annually on the quality of five relationship domains (emotional intimacy, sex, support, power/control, and conflict) over the first seven years of marriage. Longitudinal dyadic multilevel modeling techniques were used to examine how domains change over time and how earlier declines in positive areas of couple functioning predict later problems in negative areas of couple functioning and vice versa. We found support for both directions of the RDSM model. Earlier declines in sexuality and support predicted later declines in conflict, and, for wives, earlier declines in couple sexuality were linked to later control issues. Earlier declines in conflict communication and control predicted later problems with emotional intimacy. For men, longitudinal associations between sexuality and conflict, and control, were bidirectional. These findings point to the need to move toward a multi-dimensional, dynamic conceptualization of relationship functioning across time and the importance of focusing on different relational domains as targets for couple interventions.

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Within the last decade, there has been a sharp global rise in the number of young people identifying as transgender. More recently, there appears to be an increase in the numbers of young people detransitioning or returning to identifying with their natal sex after pursuing medical transition. A case is presented of a young woman who pursued a gender transition and returned to identifying as female after almost two years on testosterone. The author considers and critiques the affirmative model of care for gender dysphoric youth in light of this case.

Dans les dix dernières années, on a vu un accroissement considérable du nombre de jeunes personnes qui s'identifient transgenre. Plus récemment, il semble qu'il y ait un accroissement du nombre de jeunes personnes qui reviennent en arrière par une détransition, ou qui reviennent à s'identifier à leur sexe de naissance après avoir souhaité une transition médicale. L'article présente le cas d'une jeune femme qui est entrée dans le processus de transition de genre et qui est ensuite revenue à une identification en tant femme, après presque deux années sous testostérone. A la lumière de ce cas, l'auteur examine et critique le modèle de soin qui va dans le sens d'affirmer la dysphorie de genre chez de jeunes personnes.

En la última década, ha habido un crecimiento global agudo de jóvenes que se han identificado como transgénero. Más recientemente, pareciera haber un incremento en el número de jóvenes de-transicionando o retornando a la identificación con su género natal luego de haber realizado una transición médica. Se presenta el caso de una joven mujer quien prosiguió una transición de género y retornó a identificarse como de género femenino, casi dos años después de haber tomado testosterona. La autora considera y critica, a la luz de este caso, el modelo afirmativo de cuidado para la disforia de género en las y los jóvenes.

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Background: There are large gender differences in PTSD prevalence. Gender differences in a wide range of trauma symptoms including disturbances in self-organization have not been extensively researched. Objective: To explore gender differences in a wide range of trauma symptoms by comparing victimization trauma (VT) with accidental trauma (AT). Method: A cross-sectional study of 110 traumatized patients attending a mental health outpatient clinic in Oslo, Norway (38.2% men, Mage = 40.4, 40% ethnic Norwegians). The trauma was categorized as VT or AT based on the Life Events Checklist. The Structured Clinical Interview for DSM-IV-PTSD-module and Structured Interview for Disorders of Extreme Stress Not-Otherwise-Specified (DESNOS) assessed a wide range of trauma symptoms. First, we examined gender differences within the trauma categories, then MANCOVA for an adjusted two-by-two between-groups analysis. Results: Among VT patients, men reported more symptoms of alteration of negative self-perception (p = .02, ES = 0.50) and alteration in systems of meaning (p < .01, ES = 1.04). Within the AT group, women reported more symptoms of affect and impulses (p = .01, ES = 0.94). The VT-AT difference was significantly higher in men in intrusion (p < .01, η2 = 0.04), affect and impulses (p < .01, η2 = 0.12), negative self-perception (p < .01, η2 = 0.11), difficulty in relations (p = .01, η2 = 0.10) and alterations in systems of meaning (p = .01, η2 = 0.14). Conclusion: Comparing the VT-AT differences between the genders, men with VT had relatively more symptoms of intrusion, self-organization, identity, ideology/meaning, cognition, and relations difficulties. Effect sizes were moderate to large. Men may be relatively more vulnerable to VT than AT, while women may be more equally affected by VT and AT. Acknowledging possible gender differences in a wider range of trauma symptoms depending on trauma category may have clinical benefits.

Antecedentes: Existen grandes diferencias de género en la prevalencia del trastorno de estrés postraumático. Las posibles diferencias de género en una amplia gama de síntomas de trauma, incluidas las alteraciones en la autoorganización, no se han investigado exhaustivamente.Objetivo: Explorar las diferencias de género en una amplia gama de síntomas de trauma comparando el trauma de victimización (TV) con los traumas accidentales (TA).Método: Un estudio transversal de 110 pacientes traumatizados que asistían a una clínica ambulatoria de salud mental en Oslo, Noruega (38,2% hombres, edad promedio = 40,4, 40% de etnia noruega). El trauma primario se clasificó como TV o TA según la Lista de verificación de eventos vitales. La Entrevista clínica estructurada para el módulo DSM-IV-TEPT y la Entrevista estructurada para trastornos de estrés extremo no especificado (DESNOS en su sigla en inglés) evaluaron una amplia gama de síntomas de trauma, principalmente analizando puntuaciones brutas de síntomas. Primero, examinamos las diferencias de género dentro de las categorías de trauma. Luego usamos MANCOVA para un análisis ajustado de dos por dos entre grupos.Resultados: Entre los afectados por TV, los hombres reportaron más síntomas de alteración de la autopercepción negativa (p = .02, ES = 0.50) y alteración en los sistemas de significado (p < .01, ES = 1.04). Dentro del grupo TA, las mujeres informaron más síntomas de afecto e impulsos (p = 0.01, ES = 0,94). La diferencia TV-TA fue significativamente mayor en los hombres en uno de los tres grupos de síntomas de TEPT, intrusión (p < .01, η2 = 0.04), y cuatro de seis dominios de DESNOS, afecto e impulsos (p < .01, η2 = 0.12), autopercepción negativa (p < .01, η2 = 0.11), dificultad en las relaciones con los demás (p = .01, η2 = 0.10) y alteraciones en los sistemas de significado (p = .01, η2 = 0.14).Conclusión: Al comparar las diferencias de TV y TA entre los géneros, los hombres con TV tenían relativamente más síntomas de intrusión, autoorganización, identidad, ideología/significado, cognición y dificultades en las relaciones. Los tamaños del efecto fueron de moderados a grandes. Los hombres pueden ser relativamente más vulnerables al TV que al TA, mientras que las mujeres pueden verse más igualmente afectadas por el TV y el TA. Reconocer las posibles diferencias de género en una gama más amplia de síntomas de trauma según la categoría del trauma puede tener beneficios clínicos.

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Conflict and tension in the couple relationship transfers to the parent-child relationship, amplifying the stress parents experience while parenting young children. Pinpointing moderating and individual-level factors that exist in this spillover process may identify both couple and individual areas where spillover might be mitigated. This study used a within-couple approach to test for gender differences in marital-to-parenting spillover and to examine the moderating roles of gender, parental identity, and the emotion regulation strategy cognitive reappraisal in the linkages between marital-parenting spillover. From a larger study of parenting experiences, 96 mother-father couples of young children (mean age = 3.22 years) reported on measures of marital satisfaction, cognitive reappraisal, parenting identity, and parenting stress. Using path model comparisons, we found more similarities than differences between mothers and fathers and, contrary to the hypothesis, that mothers experienced greater spillover between marital satisfaction and parental distress than fathers. Results differed between outcome measures, suggesting that parents experience more spillover from marital satisfaction to parenting in the context of parental distress than in dysfunctional interactions with their child. Importantly, we found that higher parental identity strengthened marital-to-parenting spillover for mothers in contrast to expectations based on theoretical assumptions, whereas cognitive reappraisal weakened marital-to-parenting spillover, supporting the broader emotion regulation literature. These results signify the importance of situating the marriage to parenting transfer in the context of affective experiences and intensified parenting expectations, wherein flexibility in role identity may help alleviate parenting stress.

El conflicto y la tensión en la relación de pareja se traslada a la relación entre padres e hijos, lo cual intensifica el estrés que sufren los padres mientras crían a niños pequeños. La detección de los factores moderadores e individuales que existen en este proceso de desbordamiento puede identificar las áreas tanto a nivel de la pareja como individual donde el desbordamiento podría mitigarse. En este estudio se usó un enfoque dentro de la pareja para examinar las diferencias de género en el desbordamiento del matrimonio hacia la crianza de los niños y para analizar los roles moderadores del género, la identidad parental y la revaluación cognitiva de la estrategia de regulación emocional en las asociaciones entre el desbordamiento desde el matrimonio hacia la crianza. De un estudio más extenso de experiencias de crianza, 96 parejas de madres y padres de niños pequeños (edad promedio = 3.22 años) informaron medidas de satisfacción conyugal, revaluación cognitiva, identidad parental y estrés por la crianza. Utilizando comparaciones del modelo de pautas, encontramos más similitudes que diferencias entre las madres y los padres, y, contrariamente a la hipótesis, las madres experimentaron un mayor desbordamiento entre la satisfacción conyugal y el distrés parental que los padres. Los resultados variaron entre los criterios de valoración, lo cual indica que los padres experimentan más desbordamiento desde la satisfacción conyugal hacia la crianza en el contexto del distrés parental que en las interacciones disfuncionales con su hijo. Cabe destacar que descubrimos que una mayor identidad parental fortaleció el desbordamiento del matrimonio hacia la crianza en las madres en contraste con las expectativas basadas en supuestos teóricos, mientras que la revaluación cognitiva debilitó el desbordamiento desde el matrimonio hacia la crianza, lo cual respalda la bibliografía más amplia sobre regulación emocional. Estos resultados indican la importancia de ubicar el traslado desde el matrimonio a la crianza en el contexto de las experiencias afectivas y las expectativas de crianza intensificadas, donde la flexibilidad en la identidad de roles puede contribuir a aliviar el estrés por la crianza.

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Increasingly, couple therapists are called to promote equity in their clinical practice, yet little research illuminates the intricacy of doing this work. The purpose of this study was to clarify the clinical processes involved when therapists facilitate a more equitable balance of power in couple relationships while utilizing a sociocontextual frame of reference. It is part of larger research explicating Socio-Emotional Relationship Therapy (SERT), an approach that places equity and social justice at the core. The sample included 72 SERT sessions with nine heterosoexual couples in which there was an observable power difference between partners. Using Charmaz's (2014, Constructing grounded theory: A practical guide through qualitative analysis, Sage) grounded theory coding, theoretical sampling, and interpretive methods, we examined therapist/client responses over multiple sessions to explain shifts in the couples' power balance. Analysis identified sociocultural attunement to vulnerability as the core clinical process and detailed five sociocultural expressions: socialized vulnerability, socialized invulnerability, reactive (in)vulnerability, reactive vulnerability, and shared vulnerability. Shifts in power involved each of three therapist stances: (a) identification of the societal power context of vulnerability, (b) therapist leadership and responsive persistence, and (c) facilitating mutual sociocultural attunement to vulnerability to promote shared relational responsibility and influence. Implications address the connections between power and vulnerability in couples work and what therapists can do to more effectively facilitate relational equity.

Cada vez más, se exige a los terapeutas de pareja que promuevan la igualdad en su práctica clínica, sin embargo, existen pocas investigaciones que diluciden la complejidad de hacer este trabajo. El propósito de este estudio fue aclarar los procesos clínicos implicados cuando los terapeutas facilitan un equilibrio de poder más equitativo en las relaciones de pareja y a su vez utilizan un marco de referencia sociocontextual. Este estudio forma parte de una investigación más extensa que expone la terapia relacional socioemocional, un método que ubica a la igualdad y a la justicia social como ejes centrales. La muestra incluyó 72 sesiones de terapia relacional socioemocional con nueve parejas heterosexuales en las cuales había una diferencia de poder visible entre los integrantes de la pareja. Utilizando la codificación en la teoría fundamentada, el muestreo teórico y los métodos interpretativos de Charmaz (2014, Constructing grounded theory: A practical guide through qualitative analysis, Sage), analizamos las respuestas de los terapeutas/los pacientes durante varias sesiones para explicar los cambios en el equilibrio de poder de las parejas. El análisis identificó la adaptación sociocultural a la vulnerabilidad como proceso clínico principal y detalló cinco expresiones socioculturales: la vulnerabilidad socializada, la invulnerabilidad socializada, la (in)vulnerabilidad reactiva, la vulnerabilidad reactiva y la vulnerabilidad compartida. Los cambios en el poder implicaron cada una de tres posturas del terapeuta: (a) identificación del contexto de vulnerabilidad del poder social, (b) liderazgo del terapeuta y persistencia receptiva, y (c) facilitación de la adaptación sociocultural mutua a la vulnerabilidad para promover la responsabilidad y la influencia relacionales compartidas. Las implicancias abordan las conexiones entre el poder y la vulnerabilidad en el trabajo de las parejas y qué pueden hacer los terapeutas para facilitar más eficazmente la igualdad relacional.

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Highlights In normoalbuminuric diabetic patients at low cardiovascular risk, the risk of transition from normo- to microalbuminuria is lower in women, despite the nonprotective effects of the angiotensin receptor blocker olmesartan. Additional methods of assessment of albuminuria in clinical studies (eg, measurements of albumin and creatinine excretion rate) should be implemented or the actually accepted higher urine albumin creatinine ratio (UACR) cutoff values for microalbuminuria in women reconsidered.

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Prior research indicates that couples who cope with chronic illness from a relational "we" orientation experience more positive outcomes than couples that cope individually; however, little prior research identifies clinical processes that promote reciprocity or how societal gender processes are involved. This grounded theory analysis of 25 videotaped therapy sessions with six heterosexual couples coping with chronic liver disease (LD) used a feminist-informed relational lens to focus on the clinical processes involved in shifting from an individual to a relational orientation. Findings identified three contextual barriers to attaining a "we orientation": (a) autonomy discourse, (b) illness-related power, and (c) gendered power. Analysis detailed therapist actions that decreased the impact of barriers to reciprocity and fostered relational coping. Clinical implications attend to complex intersections among gender, caregiving, and contextual barriers to reciprocity.

Investigaciones anteriores indican que las parejas que hacen frente a una enfermedad crónica desde una orientación relacional basada en el "nosotros" tienen resultados más positivos que las parejas que la enfrentan individualmente; sin embargo, existen escasas investigaciones previas que identifiquen los procesos clínicos que promueven la reciprocidad o la manera en la que están implicados los procesos de género social. Este análisis de teoría fundamentada de 25 sesiones de terapia videograbadas con seis parejas heterosexuales que enfrentan una enfermedad hepática crónica utilizó una óptica relacional fundamentada en el feminismo para centrarse en los procesos clínicos relacionados con el paso de una orientación individual a una relacional. Los hallazgos identificaron tres obstáculos contextuales para lograr una "orientación basada en el nosotros": (a) el discurso de autonomía, (b) el poder relacionado con la enfermedad, y (c) el poder asociado al género. El análisis detalló las medidas del terapeuta que redujeron el efecto de los obstáculos para la reciprocidad y fomentaron el afrontamiento relacional. Las implicancias clínicas tratan de las intersecciones complejas entre el género, el cuidado y los obstáculos contextuales para la reciprocidad.

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Healthy romantic relationships entail understanding the needs of the self and other when interpreting conflict events. Yet how couples make meaning around specific conflicts and their capacity to reflect on their own and their partners' unmet needs is understudied. Using narratives, we examined destructive (e.g., extreme anger and break-up anxiety) and constructive (e.g., perspective taking) interpretations of past romantic conflicts in 80 emerging adult heterosexual couples and the extent to which such interpretations varied by viewpoint and gender. Couple members were interviewed separately about two conflict episodes in which their partner did not meet their needs (victim viewpoint) and two episodes in which they did not meet their partners' needs (perpetrator viewpoint). As anticipated, destructive interpretations were more evident in the victim viewpoint and for female couple members. In contrast, within constructive interpretations, the use of insight was greater in the perpetrator than the victim viewpoint. Although perspective taking was expected to be more common in the perpetrator viewpoint and in female narratives, this was not the case, as this type of constructive interpretation was infrequent in narratives about conflict. The findings revealed aspects of meaning making that might be useful to mental health professionals concerned with building skills to improve romantic competence in emerging adult couples.

Las relaciones amorosas saludables implican comprender las necesidades del yo y del otro a la hora de interpretar situaciones de conflicto. Sin embargo, hay pocos estudios sobre la manera en la que las parejas dan sentido a conflictos específicos y su capacidad de reflexionar sobre sus propias necesidades no satisfechas y las de sus parejas. Utilizando relatos, analizamos interpretaciones destructivas (p. ej.: enfado intenso y ansiedad por una separación) y constructivas (p. ej.: adopción de un punto de vista) de conflictos amorosos del pasado en 80 parejas heterosexuales de adultos emergentes y la medida en que dichas interpretaciones variaron según el punto de vista y el género. Se entrevistó por separado a los integrantes de las parejas acerca de dos episodios de conflicto en los cuales su pareja no satisfizo sus necesidades (punto de vista de la víctima) y dos episodios en los cuales ellos no satisficieron las necesidades de sus parejas (punto de vista del perpetrador). Como se anticipó, las interpetaciones destructivas fueron más evidentes en el punto de vista de la víctima y en los integrantes femeninos de la pareja. Por el contrario, dentro de las interpretaciones constructivas, el uso de comprensión fue mayor en el punto de vista del perpetrador que en el de la víctima. Aunque se esperaba que la adopción de perspectivas fuera más común en el punto de vista del perpetrador y en los relatos femeninos, no fue así, ya que este tipo de interpretación constructiva fue infrecuente en los relatos sobre los conflictos. Los resultados revelaron aspectos de la creación de significado que podrían ser útiles para los profesionales de la salud mental interesados en el desarrollo de habilidades orientadas a mejorar la aptitud amorosa en las parejas de adultos emergentes.

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Background: Posttraumatic stress disorder (PTSD) related to exposure to abuse and neglect during childhood is associated with particularly severe and persistent deleterious outcomes. Amygdala hyperreactivity has been observed in childhood trauma survivors and implicated in symptoms of PTSD. Objective: The neuropeptide oxytocin holds promise as a potential treatment for PTSD due to its ability to attenuate amygdala response to threat cues. However, the effect of oxytocin on amygdala reactivity in individuals with childhood trauma-related PTSD has not been investigated. Method: We employed a double-blind, randomized, placebo-controlled crossover design to examine the effects of intranasal oxytocin (24 IU) versus placebo on amygdala reactivity to fearful faces among childhood-trauma exposed individuals with PTSD (n = 17) and without PTSD (control group; n = 16). Results: Region-of-interest based amygdala fMRI signal magnitude did not differ by group, drug, or group x drug interaction. Self-report of childhood trauma exposure severity was negatively associated with the oxytocin-related change in left amygdala response in the PTSD group, but not in the control group. Supplementary and exploratory whole-brain analyses conducted separately in each group revealed that left amygdala reactivity to fearful faces was absent on placebo but increased on oxytocin in the control group. The PTSD group showed right amygdala activation to fearful faces in both the oxytocin and placebo conditions, but the left amygdala response observed in the placebo condition was diminished on oxytocin. Conclusions: Findings extend the literature pertaining to the potential for oxytocin to attenuate neural correlates of PTSD to a childhood trauma-related PTSD sample.

Antecedentes: El trastorno de Estrés Postraumático (TEPT) relacionado con exposición a abuso y negligencia durante la infancia se asocia con consecuencias deletéreas particularmente persistentes y severas. Se ha observado una hiperreactividad de la amígdala en sobrevivientes de trauma infantil y también se ha implicado en los síntomas de TEPT. Objetivo: El neuropéptido oxitocina es prometedor como un potencial tratamiento para el TEPT debido a su habilidad de atenuar la respuesta de la amígdala frente a señales de amenaza. Sin embargo, el efecto de la oxitocina en la reactividad de la amígdala en individuos con TEPT relacionado a trauma infantil no ha sido investigado. Método: Empleamos un diseño doble ciego, aleatorizado, cruzado placebo-control para examinar los efectos de la oxitocina intranasal (24 IU) versus placebo en la reactividad de la amígdala a las caras de miedo entre individuos expuestos a trauma infantil con TEPT (n=17) y sin TEPT (grupo control; n=16). Resultados: La magnitud de la señal por IRMf de la amígdala basada en la región de interés no difirió por grupo, droga, o interacción droga x grupo. El auto-reporte de la severidad de la exposición a trauma infantil se asoció negativamente con el cambio asociado a oxitocina en la respuesta de la amígdala izquierda en el grupo con TEPT, pero no en el grupo control. Los análisis suplementarios de todo el cerebro revelaron que la reactividad de la amígdala izquierda a caras de miedo estuvo ausente con placebo, pero aumentó con la oxitocina en el grupo control. El grupo con TEPT mostró una activación de la amígdala derecha a caras de miedo en ambas condiciones, con oxitocina y con placebo, pero la respuesta de la amígdala izquierda observada en la condición de placebo estuvo disminuida con la oxitocina. Conclusiones: Los hallazgos amplían la literatura sobre el potencial de la oxitocina para atenuar los correlatos neurales del TEPT a una muestra de TEPT relacionado con trauma infantil.

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BACKGROUND: It is accepted that HbA1c is an effective indicator to evaluate glycemic control. Fetal hemoglobin (HbF) is seldom measured because traditional detection is inconvenient. In this regard, there may be an advantage in using HPLC autoanalysis of HbA1c as a surrogate method for HbF detection. The aim of the present study was to explore the distribution of HbA1c and HbF in a large Chinese Han population. METHODS: In all, 70 553 blood samples were collected between January 2012 and June 2016. Study subjects were inpatients undergoing routine medical care and were divided into four groups based on age: Group A, 20-39 years; Group B, 40-59 years; Group C, 60-79 years; and Group D, ≥80 years. Blood HbA1c and HbF concentrations were measured by HPLC using a Tosho Bioscience (Tokyo, Japan) G8 analyzer. RESULTS: There was a positive association between HbA1c and age, and a negative association between HbF and age. The concentration range of HbF was narrow and HbF concentrations were significantly higher in females than males, regardless of age (median 0.7% vs 0.6%, respectively; P < 0.0001). There was a low degree of correlation between HbF and HbA1c (r = 0.181, P < 0.0001). Although median HbA1c levels were higher in male than female subjects aged 20-59 years (5.5% vs 5.4%, respectively, in Group A; 5.9% vs 5.8%, respectively in Group B), in the 60-79 years group, HbA1c levels were lower in males than females (6.1% vs 6.2%, respectively; P < 0.0001). CONCLUSIONS: The data suggest that sex and age should be considered in clinical interpretation of HbA1c.

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BACKGROUND: The E23K variant of the potassium voltage-gated channel subfamily J member 11 (KCNJ11) gene has been reported to be associated with type 2 diabetes (T2D) in many populations. However, little is known about the role of E23K in the development of prediabetes in Chinese youth. METHODS: To investigate the role of E23K in the development of prediabetes, 279 subjects with prediabetes and 240 normal controls (mean [± SD] age 18.1 ± 3.2 and 17.8 ± 4.3 years, respectively) were recruited to the study. Height, weight, and hip and waist circumferences were measured by trained physicians. Genotyping of KCNJ11 polymorphisms and clinical laboratory tests to determine cholesterol, triglyceride (TG), blood glucose, and insulin levels were performed. RESULTS: The carrier rate of K23 allele-containing genotypes was higher for prediabetic than control subjects (P = 0.005). Logistic regression analyses revealed that higher body mass index percentiles (P = 0.013), lower insulin levels at 30 min during an oral glucose tolerance test (P = 0.001), a higher ratio of total cholesterol: high-density lipoprotein cholesterol (P = 0.001), and a K allele-containing genotype (P = 0.019) are independent risk factors for prediabetes in Chinese Han youth. Furthermore, K23 allele-containing genotypes were associated with impaired indices of insulin secretion and ß-cell function in female youth with prediabetes. These effects were not seen in male youth with prediabetes. CONCLUSIONS: The results confirm that the common E23K polymorphism of KCNJ11 carries a higher susceptibility to the development of prediabetes in the Chinese Han population. The results suggest that E23K may have a greater effect on the development of T2D in female Chinese youth.

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BACKGROUND: There may be sex-specific cardiometabolic mechanisms early in life that affect the development of type 2 diabetes mellitus (T2DM) through mid-adulthood. However, few studies have examined whether early life course interactions between cardiometabolic risk factors and sex are associated with incident T2DM. METHODS: This study followed 7725 children (3834 [49.6%] females, 3891 [50.4%] males) from the Bogalusa Heart Study through mid-adulthood to examine whether low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), or systolic blood pressure (SBP) differentially affect the risk of T2DM for females versus males. Potential sex interactions were tested after adjusting for age, race, triglycerides, smoking, follow-up time, puberty stage, use of birth control, and enrollment year. RESULTS: Mean (± SD) age at baseline was 9.4 ± 3.5 years. There were 176 cases of T2DM (cumulative incidence = 2.3%) during a median follow-up of 9.1 years. In females versus males, LDL-C and SBP were differentially associated with T2DM (P ≤ 0.001 and P = 0.017, respectively). The relationships of BMI and HDL-C with T2DM were non-differential between females and males (P = 0.79 and P = 0.27, respectively). CONCLUSIONS: This study is the first to show evidence of sex-specific differential effects of LDL-C and SBP on the risk of T2DM from childhood to adulthood. Greater LDL-C places girls at disproportionally higher risk of T2DM as women, whereas greater SBP differentially exposes boys to a greater risk of T2DM as men. Additional studies within existing child cohorts are needed to confirm and investigate the mechanisms underlying these differential effects.

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While transgenderism as a cultural phenomenon seems to be based on a collective taste for the sensational, its emergence represents a collective shift towards a new or more differentiated way of experiencing and expressing sex and gender, a movement of world soul. This paper attempts to explore that emergence from a Jungian perspective. The paper utilizes clinical examples which illustrate how dissociated aspects of the personality are seeking assimilation and expression in order to move the personality towards greater wholeness. In that sense, it attempts to understand the teleology of transgenderism on an individual and collective level. The paper is intended as a starting-off point for discussion and explores gender as fantasy, anima/animus dynamics, the psyche/soma relationship, the role of hormones/biochemistry in our experience of ourselves and what transgender people carry and suffer for our culture.

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Family therapists and scholars increasingly adopt poststructural and postmodern conceptions of social reality, challenging the notion of stable, universal dynamics within family members and families and favoring a view of reality as produced through social interaction. In the study of gender and diversity, many envision differences as social constructed rather than as "residing" in people or groups. There is a growing interest in discourse or people's everyday use of language and how it may reflect and advance interests of dominant groups in a society. Despite this shift from structures to discourse, therapists struggle to locate the dynamics of power in concrete actions and interactions. By leaving undisturbed the social processes through which gendered and other subjectivities and relations of power are produced, therapists may inadvertently become complicit in the very dynamics of power they seek to undermine. In this article, we argue that discourse analysis can help family therapy scholars and practitioners clarify the link between language and power. We present published examples of discourse analytic studies of gender and sexism and examine the relevance of these ideas for family therapy practice and research.

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The persistence of gender inequality in postindustrial societies is puzzling in light of a plethora of changes that destabilize it, including shifts in economy, legislation, and the proliferation of feminist politics. In family relations, such persistence manifests as a disconnect between couples aspiring to be more egalitarian yet continuing to enact traditional gender roles and hierarchies. There is an emerging consensus that gender inequality persists because of people's continued reliance on sexist ideology or gendered assumptions that constitute women as innately distinct from and inferior to men. Sexist ideology changes its form to accommodate to changing socio-economic conditions. Contemporary forms of sexism are old ways of legitimizing male power articulated in new and creative ways, often by incorporating feminist arguments. To effectively recognize and address "new sexism," scholars and practitioners require new, innovative research frameworks. Our objective in writing this article is two-fold. First, we seek to advance discursive (i.e., focused on language in use) approaches to the study of sexism. Second, we present the results of a discursive analysis of "new" sexist discourse in the context of couple therapy. The study provides preliminary evidence that, despite endorsing egalitarian norms, couples studied continue to rely on gender binaries and remain entrenched in old-fashioned patterns of gender inequality. Implications of these results for the practice of couple therapy and for future research are discussed.

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Asian Americans juggle the intersections of multiple social identities and societal discourses as they respond to experiences of immigration, marginalization, and patriarchy, integrate collectivist and individualistic family values, and form families and intimate relationships. In this study we examine what we have learned as we apply Socio-Emotional Relationship Therapy (SERT) with heterosexual couples of Asian heritage. SERT begins with sociocultural attunement and the assumption that relationships should mutually support each partner. Drawing on case examples, we illustrate how we practice sociocultural attunement as couples respond to the relational processes that comprise the Circle of Care (mutual influence, vulnerability, attunement, and shared relational responsibility). We emphasize three key socioemotional themes that intersect with gender: (1) intangible loss; (2) quiet fortitude/not burdening others; and (3) duty to the family.

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Mexican-origin families are a large and rapidly increasing subgroup of the U.S. population, but they remain underrepresented in family scholarship. This paper introduces a special section of four papers on Mexican-origin families designed to contribute to the advancement of research on how cultural, family, and gender socialization processes unfold across key developmental periods and life transitions in this cultural context. Two longitudinal studies of Mexican-origin families provided the data for these four papers: (a) The Juntos Project, an 8-year longitudinal study of mothers, fathers, and adolescent sibling pairs in 246 Mexican-origin families; and (b) The Supporting MAMI Project, a study following 204 adolescent mothers and their mother figures from the third trimester of pregnancy through their young children's 5th birthdays. In this introductory paper, we highlight four themes, including (a) differential acculturation and reciprocal socialization, (b) interdependence in families, (c) the intersection of culture and gender, and (d) methodological issues. We end with suggestions for future research.

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