Eating/Sleep/Sexual Disorders Flashcards
Feautures of AN
The main features of anorexia nervosa are:
● Very low body weight (defined as being 15% below
the standard weight, or body mass index (BMI) of less
than 17.5 kg/m2), which is maintained by restriction
of energy intake.
● Extreme concern about weight and shape, characterized by an intense fear of gaining weight and becoming fat and a strong desire to be thin.
● An undue influence of body weight or shape on
self-evaluation.
● Lack of recognition of the seriousness of low body
weight.
● ICD-10, but not DSM-5, includes amenorrhoea as a
criterion in women.
Greatest incidence rates of AN
The incidence of anorexia nervosa based upon primary
care and mental health surveys is about 5 per 100,000.
Rates in the community are considerably higher.
Incidence is greatest among young women, with 40%
of all incident cases occurring in 15–19-year-old females.
Heritability of AN
28-74%
Etiology of AN
Genetics- heritability
Neurobiology- difficulty shifting between tasks, serotonin alterations, grey matter volume increased in OFC and insula
Sociocultural- response to dieting, not dieting itself
Psychological- perfectionism, low self esteem
Family- Minuchin et al. (1978) held that a specific pattern of
relationships could be identified, consisting of ‘enmeshment, overprotectiveness, rigidity and lack of conflict
resolution’. They also suggested that the development of
anorexia nervosa in the patient served to prevent dissent
within the family.
Assessment of eating
What is a typical day’s eating? What are the mealtime
arrangements at home and at school/work?
To what degree is the patient attempting restraint?
Is there a pattern? Does it vary? Is eating ritualized?
Does the patient avoid particular foods? If so, why?
Does she restrict fluids?
What is the patient’s experience of hunger or of any
urge to eat?
Does she binge? Are these objectively large binges?
Does she feel out of control?
How do binges begin? How do they end? How often do
they occur?
Does she make herself vomit? If so, how?
Does she take laxatives, diuretics, emetics, or appetite
suppressants? If so, with what effects?
Does she fast for a day or longer?
Can she eat in front of others?
Does she exercise? Is this to ‘burn off calories’?
Evidence for antidepressants in AN
Systematic reviews show no
clear effect of antidepressants on weight gain, maintenance, or psychological symptoms during re-feeding Antidepressants are also used to treat depression in
anorexia nervosa. The evidence for their effectiveness
in this situation is weak, and guidelines suggest that
antidepressants should not be used until it is apparent
that the symptoms are not merely due to starvation,
and that they persist during restoration of weight (
First description of Bulimia
The syndrome of bulimia nervosa was
first described by Russell (1979) in an influential paper
in which he named the condition and described the key
clinical features in 30 patients who were seen between
1972 and 1978. The prevalence of bulimic behaviours
and the associated harms soon became apparent, and
the syndrome was first included in DSM-III.
Classification of sleep-wake disorders in DSM V
Insomnia disorder Hypersomnolence disorder Narcolepsy Breathing-related sleep disorders Circadian rhythm sleep–wake disorders Non-rapid eye movement (REM) sleep arousal disorders Nightmare disorders REM sleep behaviour disorder Restless legs syndrome Substance/medication-induced sleep disorder
Groups at +risk of persistent sleep problems
Groups at particular risk of persistent sleep problems
include young children and adolescents (Stores, 2015),
the elderly, the physically ill, and those with learning
disability (Heussler, 2016)
Assessment of sleep problems
Screening questions
Do you sleep well enough and long enough?
Are you very sleepy during the day?
Is your sleep disturbed at night?
Sleep history Detailed history of the sleep complaint and a typical sleep–wake cycle Factors that improve or worsen sleep Effect on mood and functioning Past and present treatment History from bed partner Sleep diary Systematic 2-week or longer record
Possible investigations Video recording Actigraphy (wrist-worn) Polysomnography HLA typing Cerebrospinal fluid orexin (hypocretin) levels
Sleep hygeine
Sleep environment Familiar and comfortable Dark Quiet Encourage
Bedtime routines
Consistent time for going to bed and waking up
Going to bed only when tired
Thinking about problems before going to bed
Regular exercise
Avoid Late-evening exercise Caffeine-containing drinks late in the day Using mobile devices or watching TV in bed Excessive alcohol and smoking Excessive daytime sleep Large late meals Too much time in bed lying awake
Causes of excessive daytime sleepiness
Insufficient sleep Narcolepsy Depression Other medical disorders (e.g. hypothyroidism, Prader– Willi syndrome) Shift-work sleep disorder Use of sedative medications Obstructive sleep apnoea
Cataplexy
The most striking of these REM-like states is cataplexy: sudden episodes
of partial or complete paralysis of voluntary muscles
Important comorbidities in narcolepsy
Obesity
Depression
Aetiology of narcolepsy
Type 1 narcolepsy is characterized by
cataplexy and by marked reduction of a peptide called
orexin-A (also called hypocretin-1) in the cerebrospinal
fluid (CSF). This occurs because of a severe and selective loss of the hypothalamic neurons that make this
peptide, which is known to be involved in regulation
of wakefulness. Type 2 narcolepsy is not associated with
cataplexy, and CSF orexin-A levels are normal; its diagnosis is therefore more challenging, and its biological
basis less well understood.
The predominant genetic association to narcolepsy
is HLA-DQB1*06:02
Treatment of narcolepsy
Stimulants
Modafanil
Amphetamines
Venlafaxine, clomipramine can decrease cataplexy
Kleine-Levin Syndrome
This very rare secondary sleep disorder consists of episodes of somnolence, increased appetite, and hypersexuality, often lasting for days or weeks, with long
intervals of normality between them. It usually affects
adolescent boys. The symptoms suggest a hypothalamic
disorder, but its aetiology is unknown. There is no established treatment, but stimulants, lithium, and other
mood stabilizers, are used.
Night terrors
A few hours after going to sleep, the child,
while in stage 3–4 non-REM sleep, sits up and appears
terrified. They may scream, and they usually appear
confused. There are marked increases in heart rate and
respiratory rate.
After a few minutes the child slowly settles and returns
to normal calm sleep. There is little or no dream recall.
A regular bedtime routine and improved sleep hygiene
have been shown to be helpful.
In what stage does sleep walking occur
non-REM sleep
5-12 yo, 15% walk in their sleep at least once
Rapid eye movement sleep behaviour disorder
Rapid eye movement (REM) sleep behaviour disorder is a parasomnia that should be considered when behavioural
problems, particularly agitation or aggression, occur during the night. It is thought to occur when the normal
atonia of REM sleep is lost, so that dreams are acted out.
It is more common in the elderly, particularly men. It is
associated with, and can precede the onset of, neurodegenerative disorders, particularly Parkinson’s disease and
Lewy body dementia (Boeve et al., 2013). Clonazepam
and donepezil may be effective
Risk factors for RLS
2.5%
of the population having significant symptoms. Risk factors include female gender, pregnancy, ageing, low iron
status, and parkinsonism.
How do mood stabilisers impact sexual function
Lower bioavailability of testosterone
Drugs that may impair sexual function
Therapeutic agents Diuretics and antihypertensive agents ● β-blockers, calcium channel blockers, spironolactone Antidepressants and mood stabilizers ● SSRIs, tricyclic antidepressants, monoamine oxidase inhibitors, lithium Anxiolytics and hypnotics ● Benzodiazepines Antipsychotics Antihistamines and histamine H2 -receptor antagonists ● Diphenhydramine ● Ranitidine Parkinson’s disease medications Misused substances Alcohol, heroin, amphetamine, MDMA, cocaine, marijuana
Treatments for sexual dysfunction
Advice, information, and reassurance Treatment of underlying cause Psychological methods Sexual skills training Sex therapy (including sensate focus exercises) CBT Marital therapy Systematic desensitization Educational intervention Drug treatments PDE-5 inhibitors Other physical treatments Vacuum devices Dilators
Systematic investigations of paraphilias
The systematic investigation of these disorders began in the 1870s. Krafft-Ebing,
a professor of psychiatry in Vienna, wrote a systematic
account of paraphilias in his book Psychopathia Sexualis,
which was first published in 1886
Aetiology of gender dysphoria
Genetic- In a study of twins
with gender dysphoria, 39% of monozygotic twins were
concordant for gender dysphoria, whereas none of the
dizygotic twins were concordant
Sex-dimorphic brain structure and function
Psychosocial processes
Which of the following is not true about sexual addiction?
A. Individuals who engage addictively in one form of
sexual behavior are likely also to engage addictively
in other forms of sexual behavior.
B. Sexual addiction is usually a chronic disorder.
C. There is a higher prevalence of sexual addiction
among women.
D. Obsessions and compulsions with sexual content can
occur in individuals with obsessive-compulsive disorder
(OCD).
E. Hypersexual behavior can occur in individuals with
bipolar disorder.
The answer is C
There is a higher prevalence of sexual addiction in men than in
women. The same is true of paraphilias. Theories as to the reason
for this include the higher levels of testosterone in men (testosterone
is the libido driving hormone in both men andwomen) and
the particular challenge little boys face during the oedipal phase
of development. At this time, the boy must give up his identification
with the primary caregiver—usually the mother—and
instead identify with his father. Other factors cited as contributants
to sex addiction include a history of abuse (whether sexual,
emotional, or physical) or having been an “eroticized child,” that
is, the object of a highly seductive parent.
With regard to innervation of sex organs, all of the following
are true except
A. Penile tumescence occurs through the synergistic activity
of parasympathetic and sympathetic pathways.
B. Clitoral engorgement results from parasympathetic
stimulation.
C. Vaginal lubrication results from sympathetic stimulation.
D. Sympathetic innervation is responsible for ejaculation.
E. Sympathetic innervation facilitates the smooth muscle
contraction of the vagina, urethra, and uterus during
orgasm.
The answer is C
Innervation of the sexual organs is mediated primarily through
the autonomic nervous system (ANS). Penile tumescence occurs
through the synergistic activity of two neurophysiologic
pathways. A parasympathetic (cholinergic) component mediates
reflexogenic erections via impulses that pass through the
pelvic splanchnic nerves (S2, S3, and S4). A thoracolumbar
pathway transmits psychologically induced impulses. Both parasympathetic and sympathetic mechanisms are thought to
play parts in relaxing the smooth muscles of the penile corpora
cavernosa, which allow the penile arteries to dilate and cause the
inflow of blood that results in penile erection. Relaxation of cavernosal
smooth muscles is aided by the release of nitric oxide, an
endothelium-derived relaxing factor. Clitoral engorgement and
vaginal lubrication also result from parasympathetic stimulation
that increases blood flow to genital tissue.
Evidence indicates that the sympathetic (adrenergic) system
is responsible for ejaculation. Through its hypogastric plexus,
the adrenergic impulses innervate the urethral crest; the muscles
of the epididymis; and the muscles of the vas deferens, seminal
vesicles, and prostate. Stimulation of the plexus causes emission.
In women, the sympathetic system facilitates the smooth muscle
contraction of the vagina, urethra, and uterus that occurs during
orgasm.
The ANS functions outside of voluntary control and is influenced
by external events (e.g., stress, drugs) and internal events
(hypothalamic, limbic, and cortical stimuli). It is not surprising,
therefore, that erection and orgasm are so vulnerable to dysfunction.
Which part of the brain is directly involved in sexual drive in mammals? A. Temporal lobe B. The limbic system C. Neo cortex D. Frontal lobe E. Parietal lobe
The answer is B
The limbic system is directly involved with elements of sexual
drive. In all mammals, the limbic system is involved in behavior
required for self-preservation and the preservation of the species.
Among the following, the sexual dysfunction not correlated
with phases of the sexual response cycle is
A. sexual aversion disorder
B. vaginismus
C. premature ejaculation
D. postcoital dysphoria
E. male erectile disorder
The answer is B
Seven major categories of sexual dysfunction are listed in the
DSM-IV-TR: (1) sexual desire disorders, (2) sexual arousal disorders,
(3) orgasm disorders, (4) sexual pain disorders, (5) sexual
dysfunction due to a general medical condition, (6) substanceinduced
sexual dysfunction, and (7) sexual dysfunction
NOS.
Which of the following statements is true about paraphilias?
A. Paraphilias are usually not distressing to the person
with the disorder.
B. Paraphilias are found equally among men and
women.
C. According to the classic psychoanalytic model, paraphilias
are caused by a failure to complete the process
of genital adjustment.
D. With an early age of onset, paraphilias are associated
with a good prognosis.
E. Paraphilias such as pedophilia usually involve vaginal
or anal penetration of the victim.
The answer is C
Paraphilias, according to the classic psychoanalytic model, are
caused by a failure to complete the process of genital adjustment.
However bizarre its manifestation, the paraphilia provides an
outlet for the sexual and aggressive drives that would otherwise
have been channeled into proper sexual behavior. Paraphilias are
usually distressing to the person with the disorder. Paraphilias are
not found equally among men and women. As usually defined,
paraphilias seem to be largely male conditions. Paraphilias with
an early age of onset are associated with a poor prognosis, as are
paraphilias with a high frequency of the acts (Table 20.1), no guilt
or shame about the acts, and substance abuse. Paraphilias such
as pedophilia usually do not involve vaginal or anal penetration
of the victim. The majority of child molestations involve genital
fondling or oral sex.
The term partialism refers to fetishes involving A. a specific item of clothing B. a nonsexual body part C. a specific type of material D. a nonsexual behavior E. a specific food item
The answer is B
The term partialism refers to fetishes involving non sexual body
parts (e.g., a foot fetish). Individuals who achieve sexual gratification
with the use of objects, most commonly women’s undergarments,
shoes, stockings, or other clothing items, are fetishists.
Fetishists often collect the object of their sexual gratification.
Some of the more common objects are women’s lingerie or specific
materials such as silk, leather, or fur. Fetishism has been
exclusively described in men and often exists with other paraphilias.
Research has indicated that
A. a majority of married people are unfaithful to their
spouses
B. the median number of sexual partners over a lifetime
for men is six and for women two
C. vaginal intercourse is considered the most appealing
type of sexual experience by a large majority of men
and women
D. masturbation is more common among those 18 to
24 years old than among those 24 to 34 years old
E. the percentage of single women reporting “usually
or always” having an orgasm during intercourse is
greater than the percentage of married women reporting
this
The answer is C
A 1994 study, which was based on a representative United
States population between the ages of 18 and 59, found the
following:
1. Eighty-five percent of married women and 75 percent of married
men are faithful to their spouses.
2. Forty-one percent of married couples have sex twice a week
or more compared with 23 percent of single persons.
3. Cohabiting single persons have the most sex of all, twice a
week or more.
4. The median number of sexual partners over a lifetime for
men is 12 (not six) and for women, six (not two).
5. Ahomosexual orientationwas reported by 2.8 percent of men
and 1.4 percent ofwomen, with 9 percent of men and 5 percent
of women reporting that they had at least one homosexual
experience after puberty.
6. Vaginal intercourse is considered the most appealing type
of sexual experience by the majority of both men and
women.
7. Both men and women who as children had been sexually
abused by an adult were more likely as adults to have had
more than 10 sex partners, to engage in group sex, to report
a homosexual or bisexual identification, and to be unhappy.
8. About one man in four and one woman in 10 masturbates
at least once a week, and masturbation is less common (not
more common) among those 18 to 24 years of age than among
those 24 to 34 years old.
9. Three-quarters of the married women said “they usually
or always” had an orgasm during sexual intercourse compared
with 62 percent of single women. Among men, married
or single, 95 percent said they usually or always had an
orgasm.
Measures used to help differentiate organically caused
impotence from functional impotence include
A. monitoring of nocturnal penile tumescence
B. glucose tolerance tests
C. follicle-stimulating hormone (FSH) determinations
D. testosterone level tests
E. all of the above
The answer is E (all)
A variety of measures is used to differentiate organically caused
impotence from psychologically caused impotence. The monitoring
of nocturnal penile tumescence is a noninvasive procedure;
normally, erections occur during sleep and are associated
with rapid eyemovement (REM) sleep periods.Tumescence may
be determined with a simple strain gauge. In most cases in which
organic factors account for the impotence, the man has minimal
or no nocturnal erections. Conversely, in most cases of psychologically
caused or psychogenic impotence, erections do occur
during REM sleep.
Other diagnostic tests that delineate organic bases of impotence
include glucose tolerance tests, follicle stimulating hormone
(FSH) determinations, and testosterone level tests. The
glucose tolerance curve measures the metabolism of glucose
over a specific period and is useful in diagnosing diabetes, of
which impotence may be a symptom. FSH is a hormone produced
by the anterior pituitary, which stimulates the secretion of
estrogen from the ovarian follicle inwomen; it is also responsible
for the production of sperm from the testes in men. An abnormal
finding suggests an organic cause for impotence. Testosterone is
the male hormone produced by the interstitial cells of the testes.
In men, a low testosterone level produces a lack of desire as the
chief complaint, which may be associated with impotence. If the
measure of nocturnal penile tumescence is abnormal, indicating
the possibility of organic impotence, a measure of plasma
testosterone is indicated.
Psychiatric interventions used to assist the paraphilia patient include A. dynamic psychotherapy B. external control C. cognitive behavioral therapy D. treatment of comorbid conditions E. all of the above
The answer is E (all)
Five types of psychiatric interventions are used to assist the paraphilia
patient to rebalance internal control mechanisms, cease
victimization of others, and enhance the capacities to relate to
others: external control, reduction of sexual drives, treatment of
comorbid conditions, cognitive behavioral therapy, and dynamic
psychotherapy. The art of therapy is to select and modify these
various elements for the individual patient
Which of the following substances have been associated with sexual dysfunction? A. Cocaine B. Trazodone C. Amoxapine D. Antihistamines E. All of the above
The answer is E (all)
Intoxication with cocaine and alcohol, among other substances,
produces sexual dysfunction. Medications such as antihistamines,
antidepressants, and antiepileptics, among others, can
cause arousal and orgasmic disorders as well as decreased sexual
interest. Trazodone (Desyrel) is one of the substances associated
with priapism, and amoxapine (Asendin) is associated
with painful orgasm. Still other substances implicated in sexual
dysfunction include antihypertensives, antiparkinsonian agents,
anxiolytics, hypnotics, sedatives, amphetamines, and anabolic
steroids.
In the most severe forms of paraphilia,
A. persons never experience normal sexual behavior
with partners
B. the specific paraphilia imagery or activity is absolutely
necessary for any sexual function
C. the need for sexual behavior consumes so much
money, time, concentration, and energy that persons
describe themselves as out of control
D. orgasm does not produce satiety in the same way it
typically does for age mates
E. all of the above
The answer is E (all)
The DSM-IV-TR recognizes the paraphilias as consisting of recurrent,
intensely sexually arousing fantasies, sexual urges, or
sexual behaviors that involve nonhuman objects and the suffering
of the self, partner, children, or nonconsenting persons. To
qualify as a diagnosis, however, these patterns must have existed
for at least 6 months, and they have to cause clinically significant
distress or impairment in social; occupational; or some other
important area, such as sexual function.
The DSM-IV-TR specifies nine paraphiliac diagnoses: (1)
exhibitionism or genital exposure; (2) voyeurism, or clandestine observation of another person’s undressing, toileting, or sexual
behavior; (3) sadism, or causing suffering during sexual behavior;
(4) masochism or being humiliated during sexual behavior;
(5) pedophilia, or sexual behavior with prepubescent or peripubertal
children; (6) fetishism, or use of nonliving objects for
sexual behavior; frotteurism or rubbing against or touching a
nonconsenting person; (7) transvestic fetishism, or use of clothing
of the opposite sex for arousal; and (8) paraphilia NOS for
other observed atypical sexual patterns such as dressing in diapers,
requiring a partner who has an amputated limb, and others.
All paraphilia behaviors are rehearsed repeatedly in fantasy;
often these unusual fantasies have been present since childhood
or puberty. Some persons with paraphilias never experience any
sexual behavior with partners. The shame of the paraphilia interest
and the fear of negative consequences may contribute to a
lifelong avoidance of intimate contact.
In the most severe forms of paraphilia, the specific paraphiliac
imagery or activity is absolutely necessary for any sexual
function. The final parameter of severity is the degree of drive
to masturbate or act out the fantasy with a partner.
The most severe form of compulsivity is the loss of autonomy.
The loss of autonomy has three characteristics: (1) the need for
sexual behavior consumes so much money, time, concentration,
and energy that the patient describes himself as out of control; (2)
intrusive, unwanted paraphiliac thoughts prevent concentration
on other life demands and are the source of anxiety; and (3)
orgasm does not produce satiety in the way it typically does for
age mates.
A. Vaginismus B. Sexual aversion disorder C. Anorgasmia D. Hypoactive sexual desire disorder E. Dyspareunia
Avoidance of genital sexual contact with a sexual partner
b
Sexual aversion disorder is defined in the DSM-IV-TR as a “persistent
or recurrent and extreme aversion to, and avoidance of, all
or almost all, genital sexual contact with a sexual partner.” Some
researchers consider the line between hypoactive desire disorder
and sexual aversion disorder blurred, and in some cases, both diagnoses
are appropriate. Lowfrequency of sexual interaction is a
symptom common to both disorders. The clinician should think
of the words “repugnance” and “phobia” in relation to patients
with sexual aversion disorder.
A. Vaginismus B. Sexual aversion disorder C. Anorgasmia D. Hypoactive sexual desire disorder E. Dyspareunia
Patient has few or no sexual thoughts or fantasies
d
Hypoactive sexual desire disorder is experienced by both
men and women; however, they may not be hampered by any
dysfunction after they are involved in the sex act. Conversely,
hypoactive desire may be used to mask another sexual dysfunction.
Lack of desire may be expressed by decreased frequency
of coitus, perception of the partner as unattractive, or overt complaints
of lack of desire. Upon questioning, the patient is found to
have few or no sexual thoughts or fantasies, a lack of awareness
of sexual cues, and little interest in initiating sexual experiences
A. Vaginismus B. Sexual aversion disorder C. Anorgasmia D. Hypoactive sexual desire disorder E. Dyspareunia
Recurrent and persistent inhibition of female orgasm
c
Female orgasmic disorder (also known as inhibited female
orgasm or anorgasmia) is defined as the recurrent and persistent
inhibition of the female orgasm, manifested by the absence or
delay of orgasm after a normal sexual excitement phase that the
clinician judges to be adequate in focus, intensity, and duration.
Women who can achieve orgasm with noncoital clitoral stimulation
but cannot experience it during coitus in the absence of
manual stimulation are not necessarily categorized as anorgasmic.
A. Vaginismus B. Sexual aversion disorder C. Anorgasmia D. Hypoactive sexual desire disorder E. Dyspareunia
Recurrent pain during intercourse
e
Dyspareunia refers to recurrent and persistent pain during
intercourse in either a man or a woman. In women, the dysfunction
is related to and often coincides with vaginismus. Repeated
episodes of vaginismus may lead to dyspareunia and vice versa,
but in either case, somatic causes must be ruled out. Dyspareunia
should not be diagnosed as such when a medical basis for
the pain is found or when (in a woman) it is associated with
vaginismus or with lack of lubrication.
A. Vaginismus B. Sexual aversion disorder C. Anorgasmia D. Hypoactive sexual desire disorder E. Dyspareunia
Involuntary and persistent constrictions of the outer onethird
of the vagina
a
Vaginismus is an involuntary and persistent constriction of
the outer third of the vagina that prevents penile insertion and
intercourse. The response may be demonstrated during a gynecological
examination when involuntary vaginal constriction
prevents introduction of the speculum into the vagina, although
some women only have vaginismus during coitus.
A. Fetishism B. Voyeurism C. Frotteurism D. Exhibitionism E. Sexual masochism F. Sexual sadism G. Transvestic fetishism
Rubbing up against a fully clothed woman to achieve
orgasm
c
A. Fetishism B. Voyeurism C. Frotteurism D. Exhibitionism E. Sexual masochism F. Sexual sadism G. Transvestic fetishism
Sexual urges by heterosexual men to dress in female
clothes for the purposes of arousal
g
A. Fetishism B. Voyeurism C. Frotteurism D. Exhibitionism E. Sexual masochism F. Sexual sadism G. Transvestic fetishism
Preoccupation with fantasies and acts that involve observing
people who are naked or engaging in sexual activity.
b
A. Desire phase
B. Excitement phase
C. Orgasm phase
D. Resolution phase
Vaginal lubrication
a
A. Desire phase
B. Excitement phase
C. Orgasm phase
D. Resolution phase
Orgasmic platform
b
A. Desire phase
B. Excitement phase
C. Orgasm phase
D. Resolution phase
Testes increase in size by 50 percent
a
A. Desire phase
B. Excitement phase
C. Orgasm phase
D. Resolution phase
Slight clouding of consciousness
b
A. Desire phase
B. Excitement phase
C. Orgasm phase
D. Resolution phase
Detumescence
b
A. Sexual identity
B. Gender identity
C. Sexual orientation
D. Sexual behavior
Sense of maleness or femaleness
b
Gender identity is a person’s sense of maleness or femaleness.
By the age of 2 or 3 years, almost everyone has a firm
conviction that “I am male” or “I am female.” Gender identity
results from an almost infinite series of clues derived from experiences
with family members, peers, and teachers and from
cultural phenomena. For instance, male infants tend to be handled
more vigorously, and female infants to be cuddled more
A. Sexual identity
B. Gender identity
C. Sexual orientation
D. Sexual behavior
The object of a person’s sexual impulses
c
Sexual orientation describes the object of a person’s sexual
impulses: heterosexual (opposite sex), homosexual (same sex),
or bisexual (both sexes).
A. Sexual identity
B. Gender identity
C. Sexual orientation
D. Sexual behavior
Chromosomes
a
Sexual identity is the pattern of a person’s biological sexual
characteristics: chromosomes, external and internal genitalia,
hormonal composition, gonads, and secondary sex characteristics.
In normal development, these characteristics form a cohesive
pattern that leaves persons in no doubt about his or
her sex.
A. Sexual identity
B. Gender identity
C. Sexual orientation
D. Sexual behavior
Gonads and secondary sex characteristics
a
