Main directions and trends in the study of gender-role identity in modern psychoanalytic practice

Zhmurin Igor' Evgen'evich ORCID: 0000-0002-2469-4663 PhD in Psychology Associate Professor of the Department of Russian History, State university of education; Director of the Institute of practical psychology, International university of psychological and pedagogical innovations 18 Musa Jalil str., Moscow, 115573, Russia Raketa302@mail.ru Other publications by this author

Korneichik Irina Viktorovna ORCID: 0000-0001-5988-8591 Associate Professor of the Department of Russian History, State university of education; Deputy director of the Institute of practical psychology, International university of psychological and pedagogical innovations 105120, Russia, Moscow, Verkhnyaya Syromyatnicheskaya str., 2 iv.korneichik@mgou.ru

Introduction. The study of gender identity studies is due to the fact that this process is the core of human self-determination. Through identification, each person appropriates certain qualities, properties and attributes of another and transforms himself according to the model of another person ^[6].

Here are some conclusions of experts in the field of psychoanalysis on the problems of gender-role identity, outlining its boundaries.:

"The feeling of sexual identity (i.e., the feeling of being a man or a woman) in a normal individual is formed from three sources: the anatomy and physiology of the genitals; the relationship of parents, brothers, sisters and relatives to the sexual role of the child and the biological force that can modify the influence of the environment to one degree or another" ^[8].

"The oedipal situation manifests itself along with the child's recognition of the parental relationship, in whatever primitive or partial form it may occur. This continues in the child's rivalry with one parent for another and is resolved when the child abandons his sexual demands towards his parents, recognizing the reality of their sexual relationship" ^[2].

"In fact, gender role identity can be considered to be as closely related to nuclear gender identity as it is to object choice: preference for one's own gender can influence the choice of a role socially identifiable with the opposite sex. Conversely, becoming accustomed to the role of the opposite sex can lead to a predisposition to homosexuality. Here we come to the next component of sexuality – the choice of an object" ^[5].

The problem of the formation and development of gender identity is quite relevant for modern science and is actively studied in medicine, biology, psychology, psychiatry and culture, but in recent years the propaganda of freedom in the perception of one's gender and the manifestation of such an attitude in the upbringing of children, building family relationships has been aggressively imposed in Western countries. Gender issues based on non-traditional relations in Europe and the United States have been elevated into something "non-judgmental", a kind of "freedom" of a person and already captures political levels of manifestation, acting as part of the programs of political parties and social movements, and sometimes prescribed in the laws, as a rule, of Western states. These trends are often based on the fact that some Western psychologists and psychiatrists believe that the upbringing of a child should be based not on his biological gender, but on his feelings towards this gender.

Two lines of development can be distinguished in the issue under consideration.

The first of them is related to the consideration of gender identity violations in medical regulatory documents. Psychosexual disorders ("Sexual identity disorders" (transsexualism in adults and sexual identity disorder in children – GID), as a new subclass, were first introduced in 1980 in the DSM-III (DSM – Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association). The editorial board of the DSM-III-R was formed under the active influence of women's and feminist organizations, their public criticism and lobbying for equality with men, and a ban on certain diagnoses. In this document, sexual identity disorders (including transsexualism) have moved from the class of sexual disorders to the class of "disorders that usually first appear in children and adolescents."

The following changes occurred in the subsequent edition of the DSM-IV:

- sexual identity disorders were returned to the group of psychosexual disorders, but the separation of transsexualism and identity disorders in childhood is not indicated;

- the classification unit "sexual identity disorder in adolescents and adults of a non-transexual type" was withdrawn (a state of discomfort from experiencing the undesirability of one's gender, accompanied by dressing up and appropriate behavior, but without the requirements of surgical and hormonal correction);

- the sub-category "unspecified disorders of sexual identity" is included, which includes intersex conditions accompanied by: gender dysphoria; transient stress-related cross-dressing; sustained preoccupation with thoughts of castration, feelings of inadequacy in sexual activities, or other features related to standards of masculinity/femininity ^[3].

In the International Classification of Diseases (ICD-10), transsexualism is highlighted under the heading "disorders of sexual identification" and criteria for disorders of sexual identity in children and dual role transvestism are specified separately. However, in the modern edition of the DSM-5 ^[3], the heading "gender identity disorders" (GID) is missing, but the term "sexual dysphoria" has been retained with a separate chapter. In it, sexual dysphoria is presented as "affective / cognitive dissatisfaction of a person with his prescribed gender (usually established from birth and considered as the gender of birth)" with a duration of manifestation of at least 6 months.

It should be noted that K. Zucker, A. Lawrence, B. Kreukels indicate that during the development of the DSM-5, a working group of specialists on sexual and gender identity disorders published an opinion on the need to include gender dysphoria in the list of disorders in the DSM-5. This was due to the intrusion of transgender activists into the discussion of these issues, who, together with individual clinical specialists, advocated the complete removal of the diagnosis. Arguments were given that gender identity disorder cannot be classified as a mental disorder. In their opinion, gender identity disorders are variants of the norm of cisgender identity, and its inclusion in the DSM is aimed at increasing stigmatization of such people.

At the same time, the working group advocated the preservation of the diagnosis on the basis that its availability ensures the availability of care (primarily the preservation of insurance coverage for sex reassignment operations) and the new content of the diagnosis ^[39]. The preservation of the diagnosis in the DSM-5 was achieved by justifying that "identity" is not considered a sign of a mental disorder, but the discrepancy between the perceived gender and officially established at birth, causing distress and/or deterioration of mental state is recognized as the main manifestation of a mental disorder.

The ICD-11 moved diagnoses related to sexual dysphoria from the section "mental and behavioral disorders" of the ICD-10 to the section that was temporarily named "conditions related to sexual health" with the replacement of the designation adopted by the DSM-5 "sexual dysphoria" to "gender nonconformity." This suggested that the established name would reduce the activity in positioning sexual inconsistency to a psychiatric or non-psychiatric condition. In connection with this decision, K. Zucker, A. Lawrence, and B. Kreukels note ^[39] that the presentation of the heading in the ICD-11 was aimed at providing insurance support by the public health system or private insurance companies and preserved access to assistance to clients experiencing these problems and financially unable.

However, according to G.E. Vvedensky and S.N. Matevosyan, the Standards of Health Care for Transsexuals, Transgender and Gender-Nonconforming Individuals (SOC-7) state that "a disorder is a description of something that a person can struggle with, and not a description of the person himself or his identity" ^[3], which deduces these categories from the concept of "sick". Consequently, the authors note, the distress caused by sexual dysphoria is more likely to be a problem that can be diagnosed and treated, and is available for medical care.

The second line of development of the problem is caused by the intrusion of a complex socio-cultural reality into the modern family (the realization of same-sex marriage, the erasure and mixing of family roles, the transformation of parenthood), as well as the inconsistent legacy from older generations that existed on the basis of the individualistic culture of Western countries and the collapse of the traditions of the Russian family. These trends are eroding the national, cultural, and social bonds of the Russian family, forcing the adoption of new subcultural communities. An example is a study conducted by JAMA Psychiatry, which found that a change in people's gender identity subsequently manifests itself in an increased likelihood of adverse consequences for their mental health, including suicide attempts ^[35].

It is necessary to highlight the accompanying problems of the development of relations between people and their families with alternative forms of family, which strain relations with parents, friends, social and professional space ^[37].

This line of development of the problem of gender identity development affects not only the family space, but also the need to preserve it in traditional (heterogeneous) forms based on national, religious and cultural traditions for the nation's resilience to global disasters, which are similar to the COVID-19 coronavirus pandemic, modern global changes in politics and economics. This is steadily manifested in modern Russia, where the strengthening of legislative acts has strengthened the national, cultural and social bonds of the population. A. Golec de Zavala, K. Bierwiaczonek, T. Baran, O. Keenan, A. Hase single out Poland in this regard, where traditional "family values" based on the foundations of Catholicism and consistent with the provisions of national identity act the basis of gender differentiation, female sexuality and heteronormativity. It was these grounds, according to the authors, that reinforced disagreement with the attack on traditional family norms governing gender and sexual relations, as well as regarding such an attack as a threat to public order and national unity, which led to increased national cohesion during the pandemic ^[22].

Thus, traditional families can be considered as a social space that ensures state security. This was the purpose of the meeting of the State Duma of the Russian Federation on May 25, 2023, at which the necessity and preparation of a bill aimed at prohibiting sex reassignment without surgery, prepared by deputies of all factions, were discussed. The deputies noted that "this is by no means a medical problem.": we see how a huge number of children and teenagers are involved in this system, as in a sect" (speech by Deputy N. Nikolaev, United Russia faction) and "gender reassignment is a mental disorder" (Deputy Chairman of the State Duma V. Davankov, New People faction, curator of the work on the preparation of the bill).

It should be noted that currently, there is a tendency to overcome these problems through the growing interest of the younger generation in studying the history of the family, the state, its family traditions and uniqueness. The consolidation of this progressive movement is realized in the formulation of the basic provisions of family policy, human development and upbringing in the Russian Federation in government documents. This is reflected in:

- art. 67.1. (children are an important priority of state policy), art. 72 (protection of motherhood, family and fatherhood; marriage is a union of a man and a woman) and art. 114 (strengthening and protection of family, family values) The Constitution of the Russian Federation;

- the list of traditional values of our state, presented in Article 5 of Decree of the President of the Russian Federation dated 09.11.2022 No. 809 "On Approval of the Foundations of State Policy for the preservation and strengthening of traditional Russian spiritual and moral values."

In addition, on 06/14/2023, at a meeting of the State Duma of the Russian Federation, deputies supported amendments to the draft law establishing a complete ban on medical interventions aimed at sex reassignment, as well as excluding state registration of sex reassignment without surgery. Consent must be given by the medical commission of the federal state healthcare institution. Of course, the attitude of the country's population and government authorities sets a consistent view of the problem under consideration and the traditional values of the state.

The MAIN PART

The purpose of the study was to study the features of psychoanalytic studies of gender identity in scientific articles published in Russia and other countries.

Research objectives: (1) to identify the basic directions of research on gender-role identity in modern psychoanalysis; (2) to identify the features of modern approaches to the concept of gender-role identity and its substantive components; (3) to highlight the dynamics of research topics and features of psychoanalytic research in comparison with gender, medical research on gender identity.

The hypothesis of empirical research reflects the assumption that modern psychoanalytic research continues to consider the issues of gender identity formation and this problem is considered within the framework of a systematic approach: factors of formation, features of modern development, factors determining this development, the basic components and lines of development of gender identity, as well as the problems of its formation and progressive variants of its violation.

The research program.

Stages of research. The study was implemented in the period from March to May 2023 and included three stages. The 1st stage included the definition of the purpose, objectives of the research and the selection of scientific journals for the analysis of publications. At the 2nd stage, scientific articles were selected by keywords using a system of filters implemented on platforms. At the 3rd stage, a qualitative and quantitative analysis of titles and annotations of publications on gender identity issues was implemented. At the stage, a comparative analysis of publications on gender-role identity in psychoanalytic and non-psychoanalytic journals was carried out to highlight the specifics of considering the problem under study in psychoanalysis.

Description of the selection. A systematic search for scientific articles on the problem of gender identity is implemented in: scientific electronic library eLIBRARY.ru (founded in 1999); online scientific research information platform SpringerLink (1842, as an online platform since 1996); information platform of the Taylor & Francis Group book publishing house (1852); information platform of the independent publishing company SAGE Publishing (formerly SAGE Publications, 1965); the textual database of medical and biological publications PubMed (1996). A search on information platforms provided the most comprehensive analysis of publications on the problem of gender identity.

Theoretical basis and methodology. Historical aspects of the consideration of the problem of gender identity. Within the framework of the psychoanalytic theory of personality development, the concept of identity is recognized as a person's sense of identity with himself, which gives him a sense of wholeness with the self-image he accepts in all properties, characteristics and relationships to the surrounding world ^[7]. The idea of identity was expressed in detail by Z. Freud in 1921 in his work "Psychoanalysis of the Masses and the psychology of the Self". In it, Z. Freud identified three ways of identification ^[6]: (a) primary identification, defined as the primary form of affective connection with an object; (b) identification as a regressive replacement for the previous choice of object; (c) identification with another (not having a sexual orientation), if there is something in common with it (desire related to building relationships or achieving some kind of result).

Of course, Z. Freud associated the preliminary development of identity problems with the choice of the object of the relationship. So, in 1905, in his work "Three Essays on the Theory of Sexuality," he seeks an explanation of how an object implements the choice of an object of the same sex. In this fundamental work, Z. Freud pointed out that infantile sexuality occurs in early childhood, long before puberty. From this moment on, sexuality goes through progressive stages of development and reaches adult sexuality.

In this process, there may be deviations in the formation of sexual identity associated with the peculiarities of the passage of the Oedipus complex. The "Oedipus complex" as a scientific concept was introduced by Z. Freud in 1910, but the idea of describing it arose in 1897 ^[7]. The Oedipus complex suggests that men experience unconscious desires, feelings focused on owning a parent of the opposite sex. This complex, according to Z. Freud, increases in the period of 3-5 years and, after some extinction, manifests itself during puberty. In psychoanalysis, a person's mental development takes into account the "Oedipus complex" and structures an individual's sexual identity, determined by experiences, and this sets the direction of desires and determines the formation of subsequent relationships (choosing a sexual partner).

In 1923, in his work "I and It", Z. Freud develops the importance of the "Oedipus complex" in human life and introduces the concepts of the positive and negative "oedipus complex" ^[10]. The positive experience of the "Oedipus complex" is manifested in the boy's desire to possess a parent of the opposite sex (mother) and the elimination of a rival (father) in these desires. In the process of these desires, the boy identifies himself with his father (a male figure). He is in this relationship with his rival and wants to become like his father. This type of experience in childhood has a significant impact on the choice of a sexual partner, who follows the pattern of his parents (as a rule, boys are ready to experience and participate in competition with peers of their own sex and subsequently with other men in personal and professional relationships). With a negative experience of the "Oedipus complex", a boy develops a desire to possess his father and eliminate his mother from this relationship (the mother acts as a rival in this relationship). In this situation, the boy identifies himself with his mother, reproducing the earliest version of love for the object. The manifestation of passive desires (according to the female pattern) towards one's father entails the rejection of heterosexual desires towards one's mother, and at the same time, the rejection of identification with a male figure (father).

It is important that the negative manifestation of the "Oedipus complex" is described earlier:

- in 1910, the work "Memories of Leonardo da Vinci's Childhood" reveals a special form of homosexuality in Leonardo da Vinci, which is confirmed by his life surrounded by young people for whom he had special loving feelings. According to Z. Freud, a child's strong erotic bond with his mother in the early years of life, reinforced by the severance of ties with his father or his absence, turned his love for his mother into a strong identification with her. Taking his mother's place and directing love towards the young men, Leonardo loved himself. Z. Freud classified this self-love as narcissistic. Based on the content of the myth of narcissus, Z. Freud defines such love as self–love or its more perfect version - love for one's ideal double. In homosexual attraction, this manifestation of love is extremely idealized ^[1].

- in 1918, in the work "The Wolf Man", Z. Freud did not indicate the pathological personality traits in the negative manifestation of the "Oedipus complex". He emphasized that the "Oedipus triangle" is universal and its configuration is always individual in each specific case and is determined by the history of development in childhood.

Psychoanalytic studies of gender-role identity and its distortion. It should be noted that in the course of his psychotherapeutic and research activities, Z. Freud showed that pathology in the field of sexual relations (perversion) in adults originates during the period of infantile sexuality of a child and is associated with the object of incestuous love or with the oedipus complex. Another interesting thought of Z. Freud is related to the fact that the issue of pathology is easily associated with homosexuality and is dissolved in the case of heterosexuality, which is explained by a view from the standpoint of humanism.

Within the boundaries of the modern psychoanalytic approach ^{[5, 34]}, these transformations are considered as follows: a boy's normal relationship with his mother (a person of the opposite sex) develops on the basis of attachment necessary to ensure his life. Gradually, they are filled with libido energy, containing the attachment and erotic desires of the child, which are fully directed and focused on the maternal figure. As he develops, the boy discovers that his first love object is connected with his father and belongs to him. The figure of the father is perceived by the boy as threatening his masculinity and this causes him fear (fear of castration), which directs him to search for the ideal sexual object. If the threat from the father is weak (the father does not make comments, does not scold for frequent contact with the mother, etc.), then the boy will cope with the tension and subsequently is able to find other female figures to replace the mother. In this case, the fatherly figure can act as a model of behavior and develops a healthy masculinity in the boy.

In girls ^{[5, 9]}, sexual development is less difficult. This is due to the fact that the object of a girl's first love is her mother, who matches her gender. Thus, from the very first minutes of her existence, a girl has an obstacle to the development of homosexuality, because she must have "something" to possess her mother. To realize her natural role, a girl must give up her first love for her mother, and for many, according to Z. Freud, this is difficult, and they reject this desire, as well as the desire to have a penis, i.e. switch to her father.

At the same time, R. Stoller supports Z. Freud's position on innate bisexuality, i.e. the presence of opposite traits in a person of a certain gender. This position is extremely important in our study to answer the question of the specifics of the formation of gender identity. R. Stoller believes that this characteristic is manifested in the normal and impaired sexual development of children of both sexes.

To summarize, it should be noted that the normal formation of gender-role identity is manifested in the fact that:

- in boys, the achievement of a correct gender identity takes place through the acquisition of masculinity in the struggle against oedipal conflict, where the desire to possess a mother fights with the fear of castration from the father.;

- for girls, the acquisition of femininity also goes through an Oedipal conflict, but it is connected through the desire to possess their father, fearing the wrath of their mother.

There is also a violation of this development if fear or frustration is strong enough for the child, then this causes the rejection of the child's desire directed at the parent of the opposite sex. According to Z. Freud, this is happening:

- for boys, if he is afraid of his father's harsh attitude, aggressive behavior and high demands, then the boy identifies with the female sex (mother) in order to build a relationship with his father and uses femininity to disguise and display deliberate affection for his father (identification with his mother to build a relationship with his father according to the female version);

- girls who have not coped with the experience of having a penis and having a mother show resistance to the "bisexual dissolution of their own sex" ^[34].

In addition to the innate bisexuality of both sexes, modern psychoanalytic concepts consider the place of development of psychological bisexuality based on the unconscious identification of children with both parents. The consistency of modern and classical psychoanalytic concepts clearly defines the place of correction of bisexuality, which is the dyadic relationship of the child with the mother, where the nuclear sexual identity is determined and fixed.

In the modern psychoanalytic approach, there is a dynamic in relation to the nuclear sexual. So, if Z. Freud believed that early identity in children, regardless of gender, has a masculine character, then R. Stoller ^[34], N. Chodorow ^[12] propose to consider the feminine nature of these relationships, and connects the formation of nuclear sexual identity with three factors: the anatomy and physiology of the child's genitals; the relationship of parents, brothers, sisters, peers with him; his biological strength. In their opinion, these factors interact, and their strength can reliably provide the masculinity necessary for procreation. However, R. Stoller notes that these factors are not mandatory and the following is possible: "The inadequacy of the external genitalia ... in a boy may not destroy the ability to form a clear sexual identity, provided that the parents had no doubt that their child was male" ^[33]. Each time, it emphasizes the importance of family and family relations in the formation of a child and all components of his identity ^{[4, 11, 16]}.

Thus, it should be noted that any child (we mean the presence of a mother) first identifies himself with the maternal figure, since the first steps after the birth of any person are filled with relationships with her.

O. Kernberg notes the significant influence of nuclear gender identity in the development of Self-identity ^[5]. He believes that nuclear gender identity is the basis for the formation of an Ego identity.

The development of Ego identity occurs during the child's development in a relationship with his parents and within a certain family structure. Within the family structure, parents perform certain roles and act as a translator of these roles to their child. It is this translation based on sociocultural norms that requires a distinction between gender and gender. R. Stoller was the first to consider this issue and in 1958 introduced the term "gender", which acted as a sociocultural construct of social gender. In 1963, he spoke about the need to distinguish between the biological and cultural components in the analysis of gender ^[34]. Gender embodies the power of cultural norms that require certain behavior from men and women in accordance with the expectations of society. These norms delineate the boundaries of gender roles.

According to N. Chodorou ^[12], a boy must separate himself from his mother in order to adopt a gender role, while a girl does not need this. This allows us to note that the boy rather separates masculinity from femininity, which is not related to women, i.e. builds his identity from the opposite. Another important conclusion of the author is related to the significant role of the family, where the gender role and expectations of its realization are reproduced. The process of identifying a woman develops on the basis of and in a relationship, and for a man through the denial of the relationship (approx. the authors are with their mother).

On the basis of nuclear gender identity, a gender role identity is formed, characterized by the inclusion of various forms of conscious and unconscious interaction with others due to gender. O.Kernberg, F. Tyson, and R.L. Tyson identify factors that influence the formation of gender-role identity, which acts as a representation of the self of a person and arises after birth in a child-parent relationship. Among the factors they note: the attitudes of each parent regarding the sex of their child; the peculiarities of the father and mother's perception of themselves as representatives of their own sex; the peculiarities of the relationship of parental figures with others. Based on these factors, O. Kernberg, F. Tyson, and R.L. Tyson differentiate gender identity and gender role identity ^{[5, 9]} (see Table 1).

Table 1. Content of concepts

A fairly detailed description of the theoretical provisions and their dynamics is aimed at determining the content of scientific articles with the problems being developed and correlating the depth and focus of the research with the established theoretical provisions of psychoanalysis and its modern features in the study of gender identity.

Therefore, it is necessary to take into account the basic provision on the violation of gender-role identity, prescribed in the framework of sexual dysphoria as a persistent conviction and recognition that a person has typical feelings and reactions of the other sex (any other sex other than the documented one) and the individual's attitude to any other sex other than male or female, is not It is an expression of his autonomy or freedom of expression, and acts as a symptom of a mental disorder ^[3].

Materials and methods of research. The main research methods were:

- a search system for scientific articles based on a given text query, implemented in each scientific journal on the information platforms of psychoanalytic journals. To highlight scientific articles on the problem of gender-role identity, a key phrase in Russian/English was identified, which served as a selection criterion in the filter system of each of the platforms "sex-role identity".

It should be noted that when organizing a search for the keyword "sex-role identity" in the pop-up icon on each of the magazine platforms, phrases similar in name to "gender identity" and "sex roles" appeared, which were also included in the search queries for each a scientific journal.

- qualitative analysis of the titles and contents of abstracts of scientific articles, and the full text of open access articles. The analysis is based on a phenological approach and implemented in the TextAnalyst 2.0 program. The technique of qualitative analysis of the thematic areas of the study of gender identity in psychoanalysis, which are devoted to scientific articles.

The procedure for conducting research on the directions and trends of gender identity research in modern psychoanalytic practice included 4 stages (see Fig. 1):

The 1st stage is a thematic selection of articles on the problem of gender identity in 22 psychoanalytic journals using a system of journal filters and platforms, and in eLibrary.ru .

Stage 2 – comments, reviews, reports, double articles, letters, obituaries and other publication options were excluded from the selected scientific articles. At this stage, review, research and clinical articles were highlighted, which were presented in 13 psychoanalytic journals (in parentheses the journal belongs to psychoanalytic communities): Psychoanalytic Perspectives (National Institute of Psychotherapy, USA); Psychodynamic psychiatry (American Academy of Psychoanalysis and Dynamic Psychiatry; USA); Psychoanalysis and history (UK, Edinburgh University Press, Edinburgh); Psychoanalytic dialogues (USA); Psychoanalytic Social Work (American Psychological Association, Boston Psychoanalytic Society and Institute, International Association of Relational Psychoanalysis and Psychotherapy, Westchester Center for the Study of Psychoanalysis and Psychotherapy, USA); Psychoanalytic inquiry (American Psychoanalytic Association, Canadian, Dutch, Swedish and Swiss Psychoanalytic Societies, Chinese -American Psychoanalytic Alliance, Freud Institute in Zurich); International Forum of Psychoanalysis (International Federation of Psychoanalytic Societies); Contemporary psychoanalysis (W.A. White Institute; W.A. White Psychoanalytic Society; Great Britain); Psychoanalysis, self and context (International Association of Psychoanalytic Psychology); Psychoanalytic Psychotherapy (Association of Psychoanalytic psychotherapy in the public sector and publisher Taylor & Francis, UK); The Psychoanalytic study of the child (UK); The Psychoanalytic quarterly (USA); The International Journal of psychoanalysis (International Psychoanalytic Association; Institute of Psychoanalysis (UK).

1. The scheme of research of scientific articles on the problems of gender-role identity in the psychoanalytic approach.

The 3rd stage included a basic analysis of 6,674 scientific publications on determining the directions and trends of gender identity research in modern psychoanalytic practice.

The 4th stage (additional) arose after the use of the terms "gender identity" and "sex roles" offered by search engines and included a comparative analysis of the basic set of scientific articles (n=6674) and articles of a non-psychoanalytic orientation, but on the problems of gender role, gender identity and sexual role (n=7477) (partially presented in the article).

The results of the study and their discussion. As a result of the analysis of scientific articles, data was obtained, differentiated into qualitative and quantitative (scientometric). The basic analysis included 6275 articles (80.9%) from the total array of foreign articles on the psychoanalysis of gender identity problems. The publications cover a time period of 90 years (from 1932 to 2023) (see Table 2).

Table 2. Total volume and distribution of publications on gender identity by scientific journals

A qualitative analysis allowed us to identify a number of areas of research on gender identity, and in each of these areas, the hierarchy of problems is based on the number of articles.

The first direction combined studies of the basic principles of gender–role identity in modern psychoanalysis - 27.1% (n=1806). Let's consider 4 problematic nodes highlighted in the direction.

The largest number of publications (n=717 articles, 10.7%) is devoted to the consideration and study of the concepts of "gender" and "gender" and their characteristics from the perspective of psychoanalysis, as well as the relationship of psychoanalytic content with medical, social, sociological, and legal views.

The second problem should be the impact of gender identity on the health of the population (n=552.83%).

The third problem is identified as the psychoanalytic study and development of psychodiagnostic tools for the study of gender-role identity (in the structure of identity, family relations and family creation, etc.) (n=419, 6.3%).

Completing the list of this section is the problem of the complexity of implementing psychoanalytic clinical studies of the mental health of the population and interpreting their results due to the confusion of definitions and their lack of a unified position on the content and relationship of the concepts of "gender" and "gender" (n=118, 1.8%).

A review of articles in this area allows us to note that the very concept of "identity" has become the "main signifier" in many humanities and social sciences ^[14], but the specifics of the psychoanalytic approach to the study of gender-role identity are its formation by the processes of projection and introjection, and the compromises underlying it ^[27].

A significant number of authors of articles note that freedom of "choice" has come to the forefront of most scientific discussions about the construction of modern gender identity. Almost every 8th article in this field (n=229, 12.7%) cites the orientation of modern culture in Western countries towards freedom of choice and the right to self-realization as arguments for the diversity of identity. These principles occupy a dominant position in life and set the requirements for more flexible behavior and openness to change, which is embodied in a person's ability to adjust his body and his identity is based on "acquisition imitations" ^[26], where imitation prevails over identification, and primarily over the gender role ^[21].

Gender-role identity has a significant impact on mental health. Thus, representatives of the LGBT+ community have an increased risk of mental disorders, including depression, anxiety, suicide, and self-harm ^{[23, 29]}. A number of authors ^[25] note that the risks vary in different groups of sexual minorities, but compared with heterosexual and cisgender people, representatives of the LGBT community are 2 times more likely to attempt suicide, depression and anxiety disorders. In surveys of the US population, 29.4% of young lesbian, gay and bisexual people reported suicide attempts in 2020, compared with 6.4% of heterosexual youth, and 41% of transgender people reported earlier suicide attempts and more than 90% of these attempts were committed by them under the age of 25 ^[20].

At the same time, a significant part of the LGBT community often postpone or refuse to seek treatment due to concerns about discrimination ^[31], as well as due to considering their identity as mental disorders ^[17].

The second direction is designated as highlighting the features of modern approaches to the concept of gender identity and its substantive components (n=729, 10.9% of the total number of articles). This area combined the following problems:

The first problem of the direction combines articles (n=331, 5.0%) on the assessment of the contribution of the body, social gender and sexuality to the concept of identity, as well as the definition of their differences and the weight of this contribution to its formation.

The second problem highlighted in scientific articles is devoted to the study of the sustainability of the desire to "be transgender" as an organizing identity of adolescents and young people, which manifests itself after puberty and is not accompanied by a previous conflict about gender as such (n=202, 3.0%).

119 (1.8%) psychoanalytic articles are devoted to the problem of heterogeneity of transgender identities and their research experience.

It is interesting to consider another problem, which is defined as the study of the ability of "transgender identity" to include all gender differences and sexual preferences, as well as considering it as a powerful tool for activation and personal identification in modern society (n=77, 1.1%).

The material of the articles is devoted to the contribution of the body image and the possibilities of its transformation due to the development of technologies in biology, cybernetics and medicine. The authors point out that now the manipulation of bodies in reality and the virtual world is achievable and allows you to show any instability in identity. It is the body that occupies a central place in the construction and destruction of the coherence of gender identity. The body allows us to vividly and vividly reflect the experience of people who call themselves transgender and seek to transform it into accordance with the subjective experience of gender identity.

It should be noted that in most psychoanalytic articles, the analysis of gender-role identity is based on the positions of O. Kernberg ^[5] and Stoller ^[8], who believe that gender-role identity, that is, the norm of behavior accepted in a particular society, is typical for women and men and it is closely related to psychosocial factors. Almost every 5th article (n=155, 21.3%) in this area addresses the issue that the development of transsexualism does not depend on genetic, hormonal or physiological genital abnormalities, but is more due to significant violations of early psychosocial interactions and, as a rule, in the family. For example, some authors consider comparative psychoanalytic studies of adult transsexuals and children with abnormal sexual identification, which provide data on the characteristics of patterns of parent-child relationships. The research results showed that transgender men tended to have mothers with pronounced bisexual traits and absent, infantile fathers. A relationship with such a mother provokes the erasure of the boy's masculine qualities, a more rigid identification with his mother and, almost completely, the rejection of the male role, which is not recognized by her due to the unsuccessful realization of the role by the father. Transgender women usually have a rejecting mother and an absent father. Such parents are unable to support the girl in her feminine role or delineate the boundaries of this role (the father's position), which provokes the replacement of the male role in the relationship with the mother. This male role of the daughter is supported by the mother due to her ability to control her daughter and recreate a sense of fullness in family relationships.

The value of the psychoanalytic view of gender-role identity lies in understanding the connection between the body and its sexual function and indicates that it is "a slightly connected consonance, not a rigidly constrained representation" ^[26]. This allows us to understand the mental investments embedded in the body as the key to understanding the subjective experience of incarnation, and they can reflect subjective theories about one's identity. The body acts as the main place of recording and content of the unconscious, and without it, the body represents "real" flesh and bones. Such a representation makes it possible to diagnose and understand the studied connections in gender identity, its diversity in social and gender manifestations, the subjective experience of its embodiment, as well as unconscious identifications of the body and the mental function of body modification.

The issue of combining all existing gender differences and sexual preferences in a "transgender identity" is quite important, which has become a powerful current of activation and personal identification for people with gender identity problems. Unfortunately, instead of an indicator of marginality, the concept of "trans" has become a cultural object ^[36] and currently there is an increase in the number of people who cannot cope with their development, building relationships, as well as sexuality and gender role, classify themselves as transgender. At the same time, many of them are not going to make a complete transition to the "chosen" gender, but they are changing their bodies. Legislative acts regulating these processes have been adopted in Russia and a number of countries.

Determining the dynamics of the topics of psychoanalytic research and their features in comparison with gender and medical research on gender identity was identified as the third area of research (n=747, 11.2%).

The first problem was identified as the peculiarities of psychotherapy with young people with gender identity disorders and difficulties for specialists when working with families (n=299, 4.5%).

211 articles (3.7%) are devoted to research using various theories/approaches: individual gender/gender self-assessment; gender assigned at birth, and current gender/gender identity.

The third problem in this area is the psychoanalytic research of social categories related to intersectionality (for example, socio-economic status), lifestyle and psychosocial factors affecting the development of gender identity and its stability (n=179, 2.7%).

Another problem was the work devoted to the use of psychodiagnostic tools for: assessing internalized sexual/gender roles and external sexual/gender expressions; determining the need to develop and validate appropriate tools for assessing true biological gender, sexual orientation, and ethnic/cultural identity (n=58, 0.9%).

When considering the organization of psychotherapeutic work with people with gender identity disorders, the articles highlight the following difficulties that specialists may encounter:

- the understanding of transgenderism should be perceived as the intersection of the peculiarities of individual psychodynamics of development and the socio-cultural processes in which the patient was involved.;

- attention should be paid to the individual's attitude to the body and its role in the development and maintenance of identity, as well as how, in the process of identification, the method of fixation on the body becomes a way to manage identity disorders or fragmentation.

The articles (n=119, 15.9%) emphasized that the patient's identity as a representative of a certain minority is exposed in the process of psychotherapy. The authors note that one should not evaluate a personality through one of the aspects of a person, and the identity of an LGBT+ representative is associated with several identities. This is, first of all, how a person identifies himself with the role of a child, sibling, parent, spouse/partner, professional, leader, citizen of his city and country, representative of his nation and denomination. ^{[4, 16, 18, 19]}. Naturally, this requires the development or adaptation of psychodiagnostic tools for evaluating these identifications, roles, and other personality characteristics ^[13].

Consistency with these roles has an impact on the fact that even if the gender-role identity of the patient is not a problem of his treatment, its impact on the process of psychotherapy is great. Most often, according to the authors ^[26], the development and maturation of LGBT+ representatives should be considered as another social and cultural experience (it is necessary to recall the options for resolving the Oedipal conflict – presented earlier).

The specificity of psychotherapy with patients with gender identity problems is that their treatment is often preceded by a long period of attempts to figure themselves out and adapt to society. According to psychoanalytic researchers ^{[5, 19, 26]}, adaptation ranges from an open life in an environment supported by the LGBT+ community to relationships in communities where patients must hide their identity from friends, relatives, and family members.

At the same time, psychoanalytic psychotherapists note that in the process of psychotherapy, patients with gender-role identity problems may have problems similar to heterosexual patients, but the following have been identified as specific: (a) minority stress associated with the fact that such individuals are more at risk of mental disorders as a result of stigmatizing attitudes, discriminatory politics and other factors of social stress, which causes them stress, prejudice, hostility and expectation of rejection ^[28]; (b) secrecy/isolation caused by recognizing certain characteristics of the self, which causes difficulties in accurately assessing others' perception of themselves and is harmful to self-esteem, through difficulty recognizing their own achievements ^[15]; (c) "coming out of the toilet" or "revealing myself", meaning telling another person about my orientation – this event is recognized as the first subjective experience of inner recognition, as "returning home" or "finding out who I really am", realizing what was previously unacceptable or as the restoration of denied experiences ^[19], as well as the discovery of others and the fear of rejection ^[5]; (d) the psychotherapeutic search for the "causes" of sexual orientation and gender identity, based on the patient's desire to find a narrative explaining his "difference" from the majority, which takes three forms: theories of normal variations, theories of pathology and theories of immaturity ^[18]. It should also be noted that for such patients, their own etiological theory of "differences" always has a personal meaning and an affective charge, and for psychotherapists, knowledge of the history of psychiatry and theory about LGBT people ^[19] is an important element in understanding resentment, avoidance and resistance in such patients.

The fourth area was the special topics of psychoanalytic research on gender identity – 41 (0.06%). Among the problems in this area, the following should be highlighted (quantitative indicators of the problems are not presented, since the designation of the problems themselves is more important):

- the role of editors, administrators of scientific journals and editorial policy in formulating requirements/rules for the presentation of research results on gender and gender identity;

- a study of the content of content in social networks, mass media and its impact on provoking parasocial relationships, gender identity violations of respondents;

- consideration of gender roles and gender identity in the framework of political speeches, government and social programs.

Editors and the policy of scientific journals as "gatekeepers of science" determine the ethical framework of the publications themselves and influence the conduct of research on gender issues ^[24]. This claim is based on growing concerns about the quality of publications, which is forcing journal editors, publishers, and professional associations to implement publication guidelines. The guidelines define the ethical review of research, primarily in clinical trials ^[38], systematic review reports ^[30], and randomized controlled trials ^[32].

On the one hand, these measures are aimed at improving the quality and transparency of the reported data, but they also promote gender-based analysis of research data in science and society. The promotion lies in the fact that journal editors set the range of actions for article authors, from determining the appropriateness of gender-based data analysis to the absence of gender- and gender-sensitive recommendations in journal policy when developing research and reporting.

At the same time, the lack of a clear theoretical approach by some authors of articles and journal editors to the concepts of "gender", "gender", and "gender-role identity" causes difficulties in presenting data, and the guidelines of journals and publications themselves do not contain clear provisions for the gender diversity of the population and attitudes towards it.

It should be noted that most studies will not be able to identify differences in certain effects for gender-diverse population groups (gays, lesbians, transgender people, etc.) due to the lack of clear scientific definitions of this diversity, attitudes towards it from the standpoint of science, the high dynamics of emerging designations of diversity, as well as support for this diversity by socio-political trends.

Quantitative data

Figure 2 shows the interrelationships between the activities of professional communities and the signal (first) articles on the study of gender identity issues, highlighted in the study of scientific articles in the domestic and foreign scientific space in the psychoanalytic and non-psychoanalytic fields. The publication of publications on gender identity issues covers a period of more than 90 years (since 1932 – The Psychoanalytic Quarterly / Psychoanalytic Quarterly journal).

Fig. 2. The relationship between the activities of professional communities and the activity of scientific publications of research results on gender identity issues.

Note: (1) The abbreviation FIR is gender identity disorder; (2) The activities of professional communities developing diagnostic and statistical guidelines on mental disorders have been prescribed, which have influenced the consideration of gender identity issues in scientific research.

When considering the dynamics of publications, there is a fairly clear activity in creating non-analytical journals that address this issue from different perspectives, as indicated by their names (10 journals are identified, combining 83.6% of articles): Journal of Homosexuality, Journal of Lesbian Studies; Journal of Social Services for Gays and Lesbians, Journal of Bisexuality, Journal of Gay Mental Health and lesbian, LGBT Youth Magazine, LGBTQ+ Family: an interdisciplinary journal, International Journal of Transgender Health, Psychology and Sexuality, Journal of LGBTQ Issues in Counseling. Activity in the creation of magazines has a reactive course in relation to the events indicated in Fig. 2. It was precisely the change in the policy of professional communities, often under pressure from socio-political movements, that led to changes in the basic documents on the registration and diagnosis of mental disorders (ICD and DSM), primarily sexual identity disorders, which changed and continues to change attitudes in Western countries towards the problem of gender, gender and their mutual influence. This trend is causing changes in the policies of Western states and increasing attention to this problem in the scientific community.

After these events (see Fig. 2) the number of journals on LGBT+ issues has increased dramatically, which has influenced, on the one hand, the inclusion of scientists in the consideration of the problem of gender identity and its diverse consideration, and, on the other hand, the broadcasting of the life of these communities, conducting comparative research and shaping attitudes towards them as the naturalness of the mental and social life of society.

Here is one example that allows us to assess the blurring of the negative attention of trans-orientation parents on their children.: "...the results show that parents' gender identity does not negatively affect how children and adolescents perceive their relationships with their parents, but may be relevant to their experiences both at home and abroad" (article from the Journal of LGBT Family Studies, 2019). And, in an article from the International Journal of Transgender Health for 2023, it is stated: "The absence of RCTs (randomized controlled trials – approx. The authors' report on the impact of gender-supportive care on the mental health of trans adolescents does not mean that gender-supportive interventions are based on insufficient evidence. Given the methodological limitations of RCTs, additional and well–planned observational studies (a study based on the observation method - approx. authors) offer more reliable scientific evidence than RCTs, and they should be considered of sufficient quality to guide clinical practice and policy development." This example shows that the trans group demands "its own" norms, and this difference presents the research data as "not refutable" in the scientific community.

The non–psychoanalytic journals presented above were not the original purpose of our research, but when using search engines on foreign information platforms for the keyword "gender role identity", search engines each time offered terms such as "gender identity" ("gender identity"), "sex roles" (sexual role) and they were included in our review, however, these terms in 91.2% of cases belonged to publications from non-psychoanalytic journals.

It should be noted that in domestic articles of the event (see Fig. 2) are indicated in 29.8% (n=119) of articles, in psychoanalytic journals 33.7% (n=2117) and in non–psychoanalytic journals - only 13.5% (n=1009). This fact shows that research in domestic and psychoanalytic journals is supported by documented methodological, diagnostic and statistical standards for use in the provision of psychological assistance and treatment of mental disorders. In the future, for Russia, this can also be used to pay service providers as part of insurance for medical and psychotherapeutic care.

At the same time, one of the specific factors influencing the relatively low rate of mentioning documents on the organization of diagnosis and treatment of gender identity disorders in scientific articles on the analysis of gender identity issues is the editorial policy of some journals. Thus, in 4 psychoanalytic articles, attention is drawn to the fact that the editors of individual non-psychoanalytic journals prescribe in the publication requirements an open refusal to mention individual terms or equality of use of the terms "gender" and "gender". This leads to a special attitude towards publications and can have an impact on the bibliometric parameters of journals (see the example in Table 3).

Table 3. Comparative analysis of bibliometric indicators of journals

The bibliometric data related to the most widely read and most cited articles on gender identity in journals presented in Table 3 is also interesting.:

The most widely read articles: in the International Psychoanalytic Journal – the article "Psychoanalysis with adults, inspired by the psychotherapy of parents and infants: the metaphorical function of the analyst", B. Salomonsson, 08/23/2022, Volume 103, No. 4; in the LGBTQ+ Family: an interdisciplinary journal – "Well, yes, this is how you raise a child": gender-open education in a (non)binary world", E. Rahilli, 07/08/2022, Volume 18, No. 3.

The most cited articles in the same sequence of magazines are: "To think psychoanalytically, to think better: reflections on transgender people", A. Saketopoulou, 10/28/2020, Volume 101, No. 5; "We will accept anything if everything is all right with her": stories of Italian parents about the cuming-out of their transgender children." Friherio, L. Montali, A. Anzani, A. Prunas, 06/04/2021, Volume 17, No. 5. The title of these articles indicates the direction of perception of their content and the depth of consideration of the problem of gender identity.

Conclusions.

The study attempts not only to understand the position of the psychoanalytic approach in the consideration of gender identity, but also to implement a comparative analysis of the breadth and depth of consideration of this problem. The psychoanalytic approach was chosen by the authors taking into account a rather long history and in-depth study of this problem within the framework of theoretical developments of psychoanalysis throughout its existence.

The analysis of scientific publications allowed us to note that:

1. Publications in psychoanalytic scientific journals on gender identity issues are fundamentally relevant to the research of this problem and throughout the history of its development have devoted one of the central places to this problem.

2. The following are defined as the basic directions of psychoanalytic research on gender-role identity problems (the hierarchy of directions is arranged according to the volume of publications): (a) research of the basic provisions of gender-role identity in psychoanalysis; (b) highlighting the features of modern approaches to the concept of gender-role identity and its content; (c) determining the dynamics of the topics of psychoanalytic research and their features in comparison with gender, medical studies of gender-role identity; (d) special topics of psychoanalytic research on gender-role identity, including: the role of editorial policy in formulating the requirements and rules of scientific publications; the impact of various types of content on provoking parasocial relationships and violations of gender identity in respondents; consideration of gender role, gender identity at the political level, within the framework of government and social programs.

3. Scientific publications in psychoanalytic journals coordinate editorial policy with theoretical provisions, requirements of basic professional guidelines and actual problems of modern society. Psychoanalytic publications pay considerable attention to professional activities in the field of psychotherapeutic work, which is focused on addressing the problems of gender-role identity within the framework of norm-pathology, a detailed study of its manifestation and operationalization of new terminology, the development and adaptation of new psychodiagnostic tools and methods of their application, as well as studying the specifics of the psychotherapeutic process with representatives of various representatives of LGBT+ communities.

4. The analysis of scientific publications allowed us to establish that a significant number of activities by professional scientific communities to change diagnostic guidelines and classifications of mental disorders (ICD-11 and DSM-5), carried out quite often, under pressure from various social and political trends, led not only to attract attention to the problem, but also provoked the emergence of a significant number of scientific journals focused on the "translation" of consideration of the problems of gender identity formation from the perspective of its diversity and naturalness in the life of society. This has led to a significant number of studies that do not always meet scientific principles, but their results are more accessible to society.