Chapter 9 - Gender Identity, Paraphilia, and Sexual Dysfunction Flashcards
gender identity
psychological sense of being male or female
gender dysphoria
individual experiences significant distress or impaired functioning as a result of a discrepancy between their anatomic sex and gender identity
transgender identity
a type of gender identity in which the person has the psychological sense of belonging to one gender while possessing the sexual organs of the other
not all have gender dysphoria but some do
-Sexual Behavior may be labeled as abnormal if it:
- deviates from the norms of one’s society
- is self-defeating/causes personal distress
- harms others
- interferes with one’s ability to function
DSM-5 Gender Dysphoria (Adult and Adolescent)
- A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least two of the following:
- A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).
- A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics).
- A strong desire for the primary and/or secondary sex characteristics of the other gender.
- A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
- A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).
- A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender).
- B. The condition is associated with clinically significant distress or impairment in social, occupational or other important areas of functioning.
- Specify if: Post-transition: The individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is preparing to have) at least one cross-sex medical procedure or treatment regimen—namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male; mastectomy or phalloplasty in a natural female)
gender dysphoria often begins
in childhood
typically more prevalent
in males than females
Treatment of gender dysphoria
- Hormone therapy
- Living as the identified gender – approx. 1 year (RLE; real life experience)
- sex reassignment surgery
- tracheal shave
- Breast removal/construction
- Vaginoplasty – removal of penis and creation of vagina
- Phalloplasty – clitoris embedded in shaft of penis created from skin taken from thigh and forearm
- normal penis size, erection achieved via prosthesis
- Metroidplastly
- vaginal lining is scarred and allowed to heal altogether to seal closed
- alternate to phalloplasty
- starts with hormone therapy to enlarge clitoris to about 5cm
- labia are fashioned tinpot scrotum, usually with prosthesis testicles
- clitoris located a t end; maintains orgasmic capacity
- psychotherapy
- necessary throughout b
- important to screen for other conditions leading to the desire for gender change
- since these are major, and partly irreversible surgeries, the decisions to move forward should be made cautiously
- excessive delays/refusal can also be risk factors
theoretical perspectives on gender dysphoria
no one knows what the main cause is
psychodynamic
- point to close relationships in mother-son dynamic
- parents with empty relationships
- absent fathers
learning theorists
- absent father, no male role model
- socialization patterns as a child
- the vast majority of people in these situation however, do not form gender dysphoria
- hormones during the formation of the brain may play a role, but that is mostly speculation
paraphilic disorder
types of sexual disorders in which a person experiences recurrent sexual urges and sexually arousing fantasies involving nonhuman objects (such as clothes), inappropriate, nonconsenting partners, or situations producing humiliation or pain to oneself or the partner. The person has acted on these urges or is strongly distressed by them
Paraphiliac Disorders (too many to count)
- Exhibitionistic
- Fetishistic
- not a direct reproductive utility, broken glass, bondage
- Transvestic
- not to be confused with Gender Dysphoria
- Voyeuristic
- observing a person in a sexual act or out of clothes
- Frotteuristic
- Toucheristic
- Klismaphilic
- Pedophilic
The Development of Persistent Sexual Offending Against Children
-2 components:
- Antisocial
- Sexual attraction to prepubescent children
- the presence of both significantly increased likelihood that a person will offend against children
DSM-5 Exhibitionist Disorder
A. Over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors.
B. The individual has acted on these sexual urges with a non-consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify whether:
-Sexually aroused by exposing genitals to prepubertal children
-Sexually aroused by exposing genitals to physically mature individuals
-Sexually aroused by exposing genitals to prepubertal children and to physically mature individuals
• Specify if;
• In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to expose one’s genitals are restricted.
• In full remission: The individual has not acted on the urges with a non-consenting person, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment
exhibitionist disorder
recurrent urges and sexually arousing fantasies about exposing genitals to a stranger and ahs either acted on it or feels strongly distressed by them
typically not interested in actual sexual contact with the victim
motivated by the shock and dismay shown by their victims and the arousal they feel by showing themselves
fetishistic disorder
person uses inanimate objects or a non-genial body part (partialism) as a focus of sexual interest and as a source of arousal
prefer the object to the person wearing it
can sometimes be traced to a childhood event
transvestic disorder
recurrent sexual urges and sexual arousing fantasies involving cross-dressing, the person has either acted on them or is distressed by them
Assessment of Erotic Preference
- Primary means is by patient self-report, though this is highly prone to distortion, especially when motivated by shame or possible legal censure
- Examining web-browsing history
- VRT – Visual Reaction time
- Indirect. Based on viewing times and pattern
- Abel battery:
- also elicits a subjective rating form 1 (disgusting) to 7 (highly arousing)
- Plethysmographic studies
- more direct. Measurement of arousal while watching/hearing stimulus in several categories
- first use was for digital blood flow, measures changes in blood flow
- Vaginal Photoplethysmograph
- detects changes of coloring inside the vagina
- infrared diode
- photo detecter
voyeuristic disorder
urges and arousing fantasies involving the act of watching unsuspecting others who are naked, undressing, or engaging in sexual activity. Acted upon or causing distress
frotteuristic disorder
urges or arousing fantasies involving bumping and rubbing against nonconsenting victims for sexual gratification. acted upon or is distressed
pedophilic disorder
sexual urges of sexually arousing fantasies involving sexual activity with prepubescent children
must be at least 16 years old and 5 years older than the person
sexual masochism disorder
urges and fantasies involving receiving humiliation or pain. acted upon or causing distress
hypoxyphilia
sexual gratification by being deprived of oxygen
sexual sadism disorder
urges or fantasies involving inflicting humiliation or pain on others. acted upon or causing distress
sadomasochism
sexual activities between consenting partners involving the attainment of gratification through the means of giving and receiving pain and humiliation
Theoretical Perspectives
- Psychodynamic theory
- castration anxiety leads to projection of sexual desires onto “safer” targets.
- Oedipal complex is unresolved and used part of his fathers identity into part of his own
- the penis vanishing into vagina is symbolic of castration in this view
- masochism is symbolic aggression toward the internalized father
- Learning Theory
- learned associations between sexual pleasure and contextual stimuli (occasion setters)
- implications for partner intimacy/sustained attraction?
- fails to explain why paraphilias (especially fetishes) aren’t more common
- observational (vicarious) learning
Treatment of Paraphilias
-very little evidence to change a person’s sexual partner preference
- Psychodynamic
- resolution of the Oedipal complex (and corresponding castration anxiety) allows the emergence of non-paraphilic interests
- little empirical support
- resolution of the Oedipal complex (and corresponding castration anxiety) allows the emergence of non-paraphilic interests
- Behavior Therapy: Aversive Conditioning
- Prone to extinction
- no promotion of alternate interests
- noxious odor therapy
- stimulus relevance (biological stench, an extreme smell that typically causes vomiting)
- electrodes on the things near the scrotum
- the best treatment is multi-modal, cognitive behavioral, behavioral and psychosocial interventions. Got to hit it with everything you’ve got
- CBT
- development of adaptive and social skills
- Pharmacological
- SSRIS are sometimes helpful
- could paraphilia’s be a subtype of OCD?
- SSRIS are sometimes helpful
Sexual Assault
not a diagnosable disorder but meets several criteria
- Forcible Rape & “Statutory Rape” (legal distinction)
- Incidence of Rape & Other Forms of Sexual Assault
aggravated sexual assault (level 3)
sexual assault that results in the victim being maimed or disfigured, life was endangered
level 2 sexual assault
assault with a weapon
level 1 sexual assault
the non consensual act of the assault - without a weapon
in 80% of assault cases
the woman is acquainted with the assailant
theoretical perspective on sexual assault
there is no single kind of perpetrator in sexual assault
more to do with violent impulses than sexual gratification
• Possible Effects of Sexual Assault
- Post Traumatic Stress Disorder (PTSD)
- Depression
- Impaired intimate relationships
- Increased substance abuse
- Lower sexual drive/enjoyment
- Physical symptoms (eg, headache, disrupted menses)
• Treatment of Rape Survivors
assists women with coping with the immediate aftermath of the assault and then helps them with long-term adjustment
sexual dysfunctions
psychological disorder involving persistent difficulties with sexual interest, arousal or response
-Types of Sexual Dysfunction
- Sexual interest disorder in
- little interest in the act- Sexual arousal disorder
- willing to take part, but unable to get or stay aroused
- orgasm disorder
- they may be able to enjoy, but cannot climax
- sexual pain disorder
- pain during
- Sexual arousal disorder
-The DSM-5 groups sexual dysfunctions into the following categories:
- Sexual interest/arousal disorders
- Orgasm Disorder
- Sexual Pain Disorder
- The first 2 categories correspond to the first 3 phases of the sexual response cycle
sexual dysfunctions are classified to two general categories
lifelong and acquired, situational and generalized
fear of failure
fears relating to failure to achieve or maintain erection or orgasm
spectator role vs performer role
monitoring and evaluating your body’s reactions during sex
male hypoactive sexual desire disorder
dysfunction in men involving persistent or recurrent lack of sexual interest or sexual fantasies
female sexual interest / arousal disorder
lack or greatly reduced level of sexual interest, drive or arousal.
erectile disorder
achieving or maintain erection difficulties
female orgasmic disorder
issues with achieving orgasms’
delayed ejaculation
men issues with orgasm
-Genito-pelvic pain/penetration disorder
- Dysparenuria
- painful during
tends to appear during the postpartum, perimenopausal, and postmenopausal periods
-Vaginismus
-involuntary contraction
Sexual Dysfunction Theoretical Perspectives
- Biological
- Testosterone: Men and Women
- thyroid overactivity
- diabetes - lubrication and erections
- Learning Perspective
- conditioned anxiety, abuse
- sexual skills
Cognitive Perspectives
- expectations / self-fulfilling prophecies
- performance anxiety
- Sociocultural factors
- sexual taboo beliefs
- restrictive beliefs
- religion
- female genital mutilation
- sense of manhood
- women and self-esteem
Treatment of sex disorders
-sex therapy - how the partners interact with one another, expectancies, communication,
interest or arousal - masturbation, mutual pleasuring exercises, underlying issues such as depression, hormone treatment, couples therapy
-sensate focus exercises - mutual pleasuring activities that are focused on taking turns giving and receiving pleasure. nondemand contacts
- Biological Treatments of Male Sexual Dysfunction
- Phosphodiesterase 5 (PDE-5) Inhibitors: Viagra, Cialis, Levitra
- SSRIs: delay ejaculation
disorders of orgasm - modification of negative attitudes about sex, sensate focus, directed masturbation,.
-stop and go technique for premature ejaculation.
• Vaginismus & Dyspareunia
- use of vaginal dilators - CB exercises to relieve the fear of entry - treat underlying Psychological or medical issue
self-spectator
tendency to observe one’s behavior as if they were a spectator, not the performer
