Chapter 13 - Sexual and Gender Identity Disorders Flashcards
Categories of Sexual disorders in DSM5
1) Paraphilic disorders - sexual “deviance”
2) Sexual dysfunctions - sexual “malfunctioning”
3) Gender dysphoria - transgender
Key criteria for all sexual disorders
- emotional discress
- impairment (esp interpersonal)
- harm to others
Examples of impact of cultural norms on diagnoses
- homosexuality and masturbation
- both now widely accepted
Criteria for paraphilic disorders
Para (outside) philia (love)
- recurrent, intense, arousing fantisies, urges or beh
- non-human
- suffering or humiliation
- children or non-consenting
- 6mos +
- clinical distress or impairment
- acting on urges if illegal (not duration dependent… acting alone will gain diagnosis)
Associated features of paraphilia
- acting, hobbies, collections, dimension of distress experience
- highly comorbid: anxiety, mood, substance
- interpersonal difficulties
- sometimes sex dysfunctions
- personality disorder
- multiple paraphilias
Course of paraphilia
- chronic, begins in childhood/adolescence (puberty)
- fluctuates w stress
- declines w age
Paraphilia in men/women
- almost exclusive w men
- except S&M
Types of paraphilias - “variations” (consenting)
1) Fetishes
- media vs form
- form = object, usually related to human body
2) Transvestic fetishes
- aroused by dressing
3) S&M
- ritual
T or F: rape is a mental disorder
- false. Sick vs bad
- crime
- may be named paraphilic coercive disorder
Types of paraphilias - “offenses” (non consenting)
1) Voyerisum
2) Exhibitionism - most common arrested
3) Frotteurism - rubbing
4) Pedophilia
T or F: child molestation is same as pedophilia
- False
- not all molesters are pedo
- sometimes just who is available
- patient must be at least 15, victim at least 5 years younger
- will rationalize beh as being in love
Conditioning views of paraphilia
Classical: fetish - masturbate holding something, become conditioned
Operant: orgasm while activities is positively reinforcing
Etiology of paraphilia
- vulnerabilities in childhood
- conditioning experiences
- disrupted childhood (i.e. abuse)
- personality disturbance (low empathy, egocentric)
- poor social skills, relationships
- low self-confidence
- sociocultural factors (feminist theory)
- patriarchial structures, male dominance, violence, power
- precipitated by stress
- anger, depression, boredom, intoxication
- poor coping skills
Draw diagram of paraphilia
see word doc
Treatment of paraphilia
Objective: keep out of prison, forensic setting
- Meds: SSRIs, antiandrogens
- Beh techniques: aversion therapy (classical conditioning)
- Cog/Beh:
- covert sensitization (consequences)
- restructuring - attitudes & beliefs
- social skills training
- stress management training
3-40% reduction in recidivism rates vs no treatment
Phases of sex (response cycle)
1) Desire
2) Arousal
3) Plateau
4) Orgasm
5) Resolution
Describe sexual dysfunctions
- ego dystonic
- disturbances in response cycle
- typically in: desire, arousal and orgasm phase
- often more than one dysfunction
Subtypes of sex dysf
- lifelong vs acquired
- generalized vs situational
- psych factors vs combined factors
Describe sex desire disorders
1) hypoactive (persisent, recurrent, deficient or absent)
- often there’s other sex issues
2) Sex aversion disorder - like a phobia, panic
Describe sex arousal disorder
1) Male erectile disorder (aka impotence)
- most common why men seek therapy
- sympathetic activation interferes w parasympathetic
2) Femal sexual arousal disorder
Describe orgasmic disorder
1) Biomedical factors - diabetes, cardiov, hormone (testos, estro)
2) Psychological factors
- situational: anxiety, spectatoring, bad communicate, lack stimulation, neg cognitions
- longer-term: prior experiences, relationship probs, fear intimacy
Define spectatoring
observing one’s selt, self-aware, self-conscious
Treatment of sexual dysfunctions
1) Sex therapy (beh) approaches (M&Johnson)
- education
- eliminate performance anxiety
- sensate focus (systematic desensitation)
- squeeze technique
- masturbation
2) Couples
3) Individ psychoth
4) Medical interventions - drugs, surgery
Difference between transgender and transsexual
Xgender: which gender you identify with, not necessarily outwardly
Xsexual: once start living as opposite sex
Diagnostic criteria of gender dysphoria
- strong, persistent cross-gender id
- gender dysphoria (persistent discomfort w one’s bio sex)
- clin sig distress or impairment in social, occupational or other functioning (i.e. pub washrooms)
Prevalence of Gender dysphoria
more common in kids than adults
- 3% in boys, 1% in girls
- 1/30k men vs 1/100k women sex reassignment
- actual prevalence is unknown
Course - childhood
- dysphoria in childhood
- rarely continues to adulthood
- transgendered identity
- attracted to same bio sex
- more commonly develops in to homo or bisexual orientation w/out transgendered identity
- most likely to desire sex reassignment surgery
Course - late adolescent or adult
- often starts w transvestic fetishism (arousal in xdressing)
- most likely heterosexual
- ambivalent re sex reassingment surgery
Etiology of gender dysphoria
- cause unknown
- Bio: abnormal hormone during fetal development
- Psycho: parent rearing practices
Define anorgasmia
- female orgasmic disorder
What is IELT
- Intravaginal ejaculatory latency
- lasts 5-6mins
premature: <1min 90% of time
Dyspareunia
genital pain related to intercourse
Vaginismus
involuntary contraction of pelvic muscles
Nymphomania: ___ :: whanson@ualberta.ca: ___
Nympho -> women
Satyriasis -> men
Difference between primary and secondary premature ejaculation
Primary: long time, usually conditioning
Secondary: used to have control, now don’t. trauma to sympathetic nervous system, or body part
