Personality Dimensions of Masculinity/Femininity in Gender Dysphoria.
A report of the presentation given by
Dr. Hines spoke about studies using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in relation to gender dysphoria. She reported on 19 male to female and 8 female to male patients seen in her Los Angeles practice. The patients were referred by the Los Angeles Gender Centre for psychological evaluation. None was receiving hormones at the time of the evaluation.
The patients completed the MMPI-2, as well as other questionnaires. They also underwent a clinical interview and a mental status exam as part of the evaluation procedure. All of the information was used for the report to the Gender Centre. For her research report, however, Dr. Hines focused on the patients' scores on the MMPI-2. The MMPI-2 provides scores on 10 dimensions of personality. In addition, it provides several validity scores that aid interpretation. These validity scales can detect, for example, if people are trying to present themselves in a better light than is actually the case or if they are describing themselves as having more problems than they actually do.
The first question Dr. Hines addressed was whether there was a particular MMPI-2 personality profile that was always associated with gender dysphoria. She found that there was not. There was no scale or combination of scales that was always elevated in either the male to female patients or the female to male patients. However, there was one scale that was elevated, more often than not, in both groups.
This was scale 5, the masculinity/ femininity scale. Sixteen of the 19 male to female patients showed elevations on scale 5, indicating that they responded to the questionnaire items more like females in general than males in general. Among the female to male patients, 8 of 9 showed elevations on scale 5, indicating they responded to the items more like males in general than females in general. In addition to elevations on scale 5, a notable percentage of male to female patients showed elevations on other scales suggesting problems with rebelliousness, social alienation, family discord and paranoia. Among female to male patients, notable percentages showed scale elevations associated with overactivity, unrealistic self-appraisals and tendencies to act impulsively.
Dr. Hines concluded that the MMPI-2 scores could not be used on their own for diagnostic purposes, since there was no uniform response or pattern of response characterizing all gender dysphoric patients. However, she noted that information from the MMPI-2 was useful in treatment planning. It served to alert the treating therapist to issues, such as family problems, social alienation, rebelliousness, paranoia and impulsivity, that might be of concern as the patient explored the possibility of, or actually began, living in the other gender. Finally, Dr. Hines noted that the tests might be of use in predicting post-operative outcomes for patients, although evaluation of this possibility would require follow up studies.
Q: Could you give examples of questions you are asked?
A: There are several hundreds of questions, and they are answered as "true" or "false." In general, they refer to things a person might, or might not, do, think or feel. One of the interesting things about the MMPI-2 is that it was developed to avoid people knowing that, by answering a question a certain way, they would be viewed a certain way. The questions might seem irrelevant, but in fact, when you look at groups of people who have certain personality styles, they respond differently.
Q: How consistent are the results that you get? Is this something that is quite transitory or is this something that . . .
A: Would a person who scored today score that way in the future? That's been investigated and they are quite the same over time. So they are studies where people have taken the test repeatedly and their profiles are quite the same from one time to another.
Q: Going back to what I said before in fact if you looked at exactly the same group post- operatively the practice that may change may be the practice that are indicative of something that has been affected by the treatment.
A: What you are suggesting is that post-operatively the personality profile might change? And that might be a function of the treatment? That would be an interesting question. When you first asked about post-operative testing I assumed you meant to see if any of the personality styles were more predictive of good outcomes than others. The personality traits are thought to be enduring characteristics. However, it might be useful to look though to see if they do change, post-operatively, because this is a special situation where you might see more change than in the population at large.
Q: Does the use of this type of scale in this way actually lead people to reinforce the stereotypes that may of course have caused the problem in the first place?
A: Can you be more specific?
Q: Yes. By using scales in terms of masculinity and femininity, is that not reinforcing what the stereotypical male and stereotypical female is and is that not perhaps reinforcing what caused the problem in the first place?
A: Are you suggesting that the patients we are seeing have stereotypes that cause them problems?
Q: What I am suggesting is that the stereotypes themselves - people are brought up male and female stereotypical behaviour, perhaps the overall pattern psychologically, it would be better to move away from stereotypes than reinforce them.
A: Yes. The information from these tests is incorporated into a report that goes to a therapist who is seeing this person every week. And the information is useful to that therapist in helping him, or her, understand how the person is functioning. The person doesn't get feedback that they are thinking more like a woman or responding more like a woman. The scale 5 scores, the masculinity/femininity scores weren't usually the main focus of our clinical report. We thought that some of the other information was more important for the treatment plan, e.g., being depressed or needing better social networks. So I don't think that using the tests in the context of treatment reinforces the stereotypical distinctions. In fact, in some patients we found that they expressed rather rigid stereotypes and we viewed that as an issue that they needed to discuss in therapy.
Q: Transsexuals are faced with a test really. To get through the test they feel they have to answer the questions in a way to get through. This is what they have been saying: we are going to answer the questions in a way we need to get through.
A: That is what the validity scales of the MMPI-2 address. If a person is answering in a way that is just to put on a face of some sort, it's detected in the validity scales. So I don't think that they can do that in this context.
Q: I have actually had this point sitting with people rather than questionnaires and I believe in some instances they have been able to convince someone who hasn't been through it?
A: Yes, that can be done.
Q: You know I would far rather trust a human being than a questionnaire.
Q: Over a period of time it's like any situation. People get to know the answers before they see the questions, so perhaps they are feeding you . . .
A: I don't think so because the validity scales detect that. That's why we picked this test for this situation. It is a situation where people perceive that they may benefit from presenting themselves one way or another. But in regard to the masculinity/femininity scale, it does not determine whether they are referred for hormones or surgery.
Citation: Hines, M., (1994), Personality Dimensions of Masculinity/Femininity in Gender Dysphoria., GENDYS '94, The Third International Gender Dysphoria Conference, Manchester England.
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