Chapter 9: Gender Identity, Paraphilias, and Sexual Dysfunctions Flashcards
Gender Identity
one’s psychological sense of being female or male
Gender Dysphoria
disorder in which an individual experiences significant personal distress or impaired functioning as a result of a discrepancy between his or her anatomic sex and gender identity
Transgender Identity
a type of gender identity in which the individual has the psychological sense of belonging to one gender while possessing the sexual organs of the other
Paraphilic Disorders
types of sexual disorders in which a person experiences recurrent sexual urges and sexually arousing fantasies involving nonhuman objects (such as articles of clothing), inappropriate or nonconsenting parties (e.g. children), or situation producing humiliation or pain to oneself or one’s partner
the person has either acted on such urges or is strongly distressed by them
Exhibitionistic Disorder
type of paraphilic disorder almost exclusively occurring in males in which the man experiences persistent and recurrent sexual urges and sexually arousing fantasies involving the exposure of his genitals to a stronger and either has acted on these urges or feels strongly distressed by them
Fetishistic Disorder
type of paraphilic disorder in which a person uses an inanimate object or a non-genital body part (partialism) as a focus of sexual interest and as a source of arousal
Transvestic Disorder
type of paraphilic disorder characterized by recurrent sexual urges and sexually arousing fantasies involving cross-dressing, in which the person has either acted on these urges or is strongly by them
also called transvestism
Voyeuristic Disorder
type of paraphilic disorder characterized by recurrent sexual urges and sexually arousing fantasies involving the act of watching unsuspecting other who are naked, in the act of undressing, or engaged in sexual activity, in which the person has either acted in these urges or is strongly distressed by them
Frotteuristic Disorder
type of paraphilic disorder characterized by recurrent sexual urges or sexually arousing fantasies involving bumping and rubbing against nonconsenting victims for sexual gratification
the person has either acted on these urges or is strongly distressed by them
Pedophilic Disorder
type of paraphilic disorder characterized by recurrent sexual urges or sexually arousing fantasies involving sexual activity with prepubescent children
Sexual Masochism Disorder
type of paraphilic disorder characterized by sexual urges and sexually arousing fantasies involving receiving humiliation or pain
the person has either acted on these urges or is strongly distressed by them
Hypoxyphilia
paraphilic disorder in which a person seeks gratification by being deprived of oxygen by means of using a noose, plastic bag, chemical, or pressure on the chest
Sexual Sadism Disorder
type of paraphilic disorder or sexual deviation characterized by recurrent sexual urges and sexually arousing fantasies involving inflicting humiliation or physical pain on sex partners
the person has either acted on these urges or is strongly distressed by them
Sadomasochism
sexual activities between consenting partners involving the attainment of gratification by means of inflicting and receiving pain and humiliation
Sexual Assault
nonconsensual bodily contact for a sexual purpose
Aggravated Sexual Assault
sexual assault in which the victim is maimed or disfigured or has his or her endangered
Sexual Dysfunctions
psychological disorders involving persistent difficulties with sexual interest, arousal, or response
Male Hypoactive Sexual Desire Disorder
a type of sexual dysfunction in men involving a persistent or recurrent lack of sexual interest or sexual fantasies
Female Sexual Interest/Arousal Disorder
a type of sexual dysfunction in women involving either a lack of or greatly reduced level of sexual interest drive, or arousal
women with problem becoming sexually aroused may lack feelings of sexual pleasure or excitement that normally accompany sexual arousal, or they may experience little or no sexual interest or pleasure
Erectile Disorder
sexual dysfunction in males characterized by difficulty in achieving or maintaining erection during sexual activity
Female Orgasmic Disorder
type of sexual dysfunction in women involving difficulties achieving orgasm
Delayed Ejaculation
type of sexual dysfunction in men involving persistent difficulties achieving orgasm
Premature Ejaculation
type of sexual dysfunction involving a persistent or recurrent pattern of ejaculation occurring during sexual activity at a point before the man desires it
Genito-Pelvic Pain/Penetration Disorder
persistent or recurrent pain experienced during vaginal intercourse or penetration attempts
Vaginismus
the involuntary spasm of the muscles surrounding the vagina when vaginal penetration is attempted, making sexual intercourse difficult or impossible
Performance Anxiety
fear relating to the threat of failing to perform adequately
Sensate Focus Exercises
in sex therapy, mutual pleasuring activities between partners that are focused on the partners taking turns giving and receiving physical pleasure
Self-Spectatoring
tendency to observe one’s behavior as if one were a spectator of oneself
people with sexual dysfunctions often become self-spectators in the sense of focusing their attention during sexual activity on the response of their sex organs rather than on their partners or the sexual stimulation itself
What is the criteria that must be met in order for sexual behavior to be labelled as abnormal?
deviates from the norms of one’s society
is self-defeating/causes personal distress
harms others
interferes with one’s ability to function
What is the DSM-5 criteria for gender dysphoria?
a marked incongruence between one’s experienced/expressed gender
a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics
a strong desire to be rid of one’s primary and/or 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
a strong conviction that one has the typical feelings and reactions of the other gender
associated with clinically significant distress
What is the DSM-5 criteria for gender dysphoria with the post-transition specifier?
the individual has transitioned to full-time living in the desired gender and has undergone (or preparing to have) at least one cross-sex medical procedure or treatment regimen
What is gender expression?
the way one presents their gender outwardly
What is gender identity?
one’s psychological sense of being female or male
What is gender dysphoria?
a disorder in which the individual believes that her or his anatomic gender is inconsistent with his or her psychological sense of being male or female
What are treatments for gender dysphoria?
hormone therapy: secondary sex characteristics of the other gender
living as the identified gender for about one year, RLE (real life experience), legal requirement, controversial to prolong treatment
What is sex reassignment surgery?
tracheal shave (get rid of Adam’s apple)
breast removal/construction
What is vaginoplasty?
surgical removal of the penis and creation of a vagina
What is phalloplasty?
clitoris embedded in shaft of penis created from skin taken from thigh or forearm, normal size penis, erection via prosthesis
What is metoidioplasty?
vaginal lining is scraped and allowed to heal together to seal closed
alternative to phalloplasty
starts with hormone therapy to enlarge clitoris to about 5 cm
labia are fashioned into a scrotum, usually with prosthetic testicles
clitoris located at end; maintains orgasmic capacity
How is psychotherapy used to treat gender dysphoria?
necessary throughout
important to screen for other conditions motivating the desire for gender change
since these are major, and partly irreversible surgeries, the decision to move forward should be made cautiously
excessive delays/refusal can also be risk factors
What is exhibitionistic disorder?
erotic pleasure from displaying their genitals
What is fetishistic disorder?
arousal because of particular objects
What is transvestic disorder?
process disorder
interest in doing something
cross-dressing for erotic purposes
elaborate ritual
not to be confused with ender dysphoria
heterosexual, male identifying individuals
What is frotteuristic disorder?
rubbing genitals against an un-consenting party
What is toucheristic disorder?
touch someone without their consent
could be subtle or non subtle
What is klismaphilic disorder?
enema
insert something into your butt, flush it out with water
What is pedophilic disorder?
erotic preference for children
What is the development of persistent sexual offending against children?
two components: antisociality, sexual attraction to prepubescent children
the presence of both significantly increases likelihood that a person will offend against children
What is the DSM-5 criteria for paraphilic disorders such as exhibitionistic disorder?
over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one’s genitals to un unsuspecting person, as manifested by fantasies, urges, or behaviors
the individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
What are the specifiers for exhibitionistic disorder?
sexually aroused by exposing genitals to prepubescent children
sexually aroused by exposing genitals to physically mature individuals
sexually aroused by exposing genitals to prepubertal children and physically mature individuals
What does the paraphilic specifier “in a controlled environment” mean?
this specifier is primarily applicable to individuals living in institutional or other settings where opportunities to expose one’s genitals are restricted
What does the paraphilic specifier “in full remission” mean?
the individual has not acted on the urges with a nonconsenting 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
What are the means of assessing 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
How is VRT (visual reaction test) used to assess erotic preference?
indirect, based on viewing times and pattern
accurately measure where on the screen they are viewing
Abel battery: also elicits a subjective rating from 1 (disgusting) to 7 (highly arousing), not always accepted in court (cannot be compelled to provide evidence against themselves)
How are plethysmographic studies used to assess erotic preference?
more direct
invasive, requires cooperation, all variables are controlled
measurement of arousal while watching/hearing stimuli in several categories
measurement of blood flow to the penis
What are the psychodynamic perspectives on paraphilic disorders?
castration anxiety leads to projection of sexual desires onto “safer” targets
the penis vanishing into a vagina is symbolic of castration in this view
masochism is symbolic aggression toward the internalized father (you hate your father, getting punished hurts internalized father)
What are the learning theory perspectives on paraphilic disorders?
learned associations between sexual pleasure and contextual stimuli
implications for partner intimacy/sustained attraction?
fails to explain why paraphilias (esp fetishes) aren’t more common
observation (vicarious) learning: online pornography puts ideas into their heads about what is normal
any kind of fantasy can be positively reinforced (persons preference are shaped by experience)
What are the psychodynamic treatments of paraphilias?
resolution of the Oedipal complex (and corresponding castration anxiety) allows the mergence of non-paraphilic interests
can’t change partner preferences (conversion therapy)
What are the behavior therapy treatments of paraphilias?
aversive conditioning; using ammonia or electric shock, extinction effects, no maintenance, short-term, no evidence you can fundamentally change preference, but can change if they act on it
prone to extinction, no promotion of alternate interest
CBT: development of adaptive thoughts and social skills
pharmacological: SSRIs are sometimes helpful, reduce impulsivity
What is sexual assault?
forcible rape (physically dominate, absence of consent) and statutory rape (absence of legal consent)
What are the possible effects of sexual assault?
post traumatic stress disorder (PTSD)
depression
impaired intimate relationships (not just sexually)
increased substance abuse
lower sexual drive/enjoyment
physical symptoms (e.g. headache, disrupted menses)
What is the treatment of rape survivors?
it is never the victim’s fault
assurance that it will never happen again (protect yourself)
provide a safe environment without fear of judgement
What is level 1 sexual assault?
non-consensual bodily contact for sexual purpose
What is level 2 sexual assault?
assault with a weapon
What is level 3 sexual assault?
aggravated; physical harm and/or threat of death
What are the types of sexual dysfunction?
sexual interest disorder
sexual arousal disorder
orgasm disorder
sexual pain disorder
What are the DSM-5 categories of sexual dysfunction?
sexual interest/arousal disorders
orgasm disorders
sexual pain disorders
What are sexual desire disorders?
hypoactive sexual desire disorder
sexual aversion disorder (have no positive feelings about sex)
What are sexual arousal disorders?
female sexual interest/arousal disorder (not common in men)
male erectile disorder (neural damage, circulatory damage, wants an erection but can’t get one, physiologically or psychologically
orgasm disorders: female orgasmic disorder, male orgasmic disorder, premature ejaculation
What are genito-pelvic pain/penetration disorders?
dyspareunia: gynological, more than psychological, entry or deep
vaginismus: very painful, involuntary muscle contraction, usually psychological, treatment: CBT, dialators
What are biological perspectives on sexual dysfunction?
testosterone as treatment for men and women
too much can have adverse effects
What are the psychodynamic perspectives on sexual dysfunction?
castration anxiety
guilt
What are the learning perspectives on sexual dysfunction?
cognitive perspectives
expectations/self-fulfilling prophecies
What are the sociocultural factors on sexual dysfunction?
performance anxiety
men are taught they need to have a big penis and have lots of sex
What are treatments for sexual dysfunction?
directed masturbation: for females, give them permission to gain comfort with their own body and what arousal feels like for them
sensate focus exercise: prohibited from experiencing orgasm for an amount of time, lay nude, how quality time together, go slow, enjoy sensation of being touched without sexual expectations or touching of genitals
