gender dysphoria & paraphilia

Question 1

gender dysphoria

Answer 1

a marked incongruence between one’s experienced gender & assigned gender
- at least 6 months

Question 2

prevalence of gender dysphoria

Answer 2

very rare
4.6 in 100,00 ppl or 0.6-1.7%
hard to get good estimate bcuz of stigma

Question 3

age of gender dysphoria

Answer 3

can occur as early as childhood but not everyone how has it in childhood has is later in life

Question 4

causes of gender dysphoria

Answer 4

poorly understood

gender identity may be strongly influenced by sex hormones especially during prenatal period – exposed to more androgens (speculation)

Question 5

treatment of gender dysphoria

Answer 5

• many forms of psychotherapy used to alter gender identity but results are neg

current treatments:
- gender affirming surgery – genitals are changed to match gender identity
- hormone replacement therapy
both have generally pos results

Question 6

gender dysphoria criteria in adolescents/adults

Answer 6

involves a difference between one’s experienced/expressed gender & assigned gender + sig distress or problems functioning
lasts at least 6 months

strong desire…
- to be rid of primary and/or secondary sex characteristics
- for primary and/or secondary sex characteristic of other gender
- to be of the other gender
- to be treated as the other gender
- conviction that one has the typical feeling & reactions of the other gender

Question 7

gender dysphoria criteria in children

Answer 7

involves at least 6 months of the following + sig distress or impairment in function

a strong…
- desire to be of the other gender
- preference for wearing clothes of other gender
- preference for cross-gender roles in playing
- preference for playmate of other gender
- rejection of toys/games/activities of assigned gender
- dislike for one’s sexual anatomy
- desire for physical sex characteristics of other gender

Question 8

paraphilic disorder

Answer 8

a paraphilia that either leads to subjective distress or social impairment for the person or that causes harm to, or threatens, other people

Question 9

typical symptoms of paraphilic disorders

Answer 9

• problems w sexual appetite
• unusual erotic pre-occupation + pressure to act on erotic fantasy
• inability to experience arousal unless target is present
• compulsion & lack of flexibility
• trouble functioning in daily life & relationships

Question 10

diagnosis of paraphilic disorders

Answer 10

paraphilic urges lasting at least 6 months
- diagnosis only made if urges lead to clinically sig impairment or distress

for pedo, exhibi, voy & frott - acting on the urge is enough for diagnosis

for maso, fetish & trans - acting not enough, must lead to distress and interfere w functioning

Question 11

prevalence, age & gender of paraphilic disorders

Answer 11

prevalence: unknown due to stigma - ppl don’t seek treatment

age: typically begin in adolescence & tend to be chronic

gender: all are basically only male disorders (95%) - except masochism

Question 12

fetishistic disorder

Answer 12

the association of sexual arousal with non living objects
- range of objects is basically unlimited – most often women’s underwear, shoes & boots, or products made out of rubber or leather
- may be unable to become sexually aroused in the absence of object

Question 13

transvestic disorder

Answer 13

cross-dressing for the purpose of sexual arousal
- primarily among heterosexual men
- keep a collection of female clothes used to cross-dress – some only wear a single article of clothing (e.g. underwear), other dress completely
- may be done in public or only in private

Question 14

sexual masochism disorder

Answer 14

recurrent, intense sexually arousing fantasies, urges or impulses involving being made to suffer (psychologically or physically)
- act on impulses by themselves or w a partner
- desire certain types of pain but go to great lengths to avoid injury
- tend to be highly educated & successful = may be motivated by attempt to escape from constant burden of maintaining personal control & pursuing self-esteem
- also common in women

Question 15

sexual sadism disorder

Answer 15

intense, sexually arousing fantasies, urges or behaviors that involve the psychological or physical suffering of a victim
- fantasies often involve asserting dominance over victim – experience of power & control may be as imp as inflicting pain

Question 16

exhibitionistic disorder

Answer 16

recurrent & intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges or behaviors
- some masturbate at the time & others shortly after while fantasizing about the victim’s reaction – usually women or children
- intent is usually to shock but sometimes have fantasies that the victim will become aroused
- rarely attempt to touch or molest victims

Question 17

voyeuristic disorder

Answer 17

observing an unsuspecting person who is naked, in the process of disrobing or engaging in sexual activity
- not aroused by watching people who know they’re being observed
- direct contact is not sought – secret nature + risk of discovery is arousing
- may masturbate during observation or later when remembering
- most common paraphilic disorder + comorbid with masochism/sadism & cross-dressing

Question 18

frotteuristic disorder

Answer 18

a person who is fully clothed becomes sexually aroused by touching or rubbing his genitals against other, non-consenting people
- usually choose crowded places that he can easily escape arrest
- either rubs his genitals against victim’s thighs and butt or fingers her genitalia or breasts
- high-frequency – may engage in hundreds of individual paraphilic acts
- do not want further sexual contact

Question 19

pedophilic disorder

Answer 19

recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child
- diagnosis: person must 16/18 years and at least 5 years older than the child
- arousal has to be the same or more intense than when engaging with a consenting adult
- some are attracted only to children, others are also attracted to adults
- most are heterosexual and victims are more often girls, but some are attracted to both

Question 20

endocrine system in paraphilic disorders

Answer 20

elevated levels of testosterone found in convicted sex offenders

skepticism – p’s only sex offenders = cannot be generalized to all people with paraphilic disorders + high rates of alcoholism & drug abuse in convicted sex offenders = abnormalities might be caused by smth else

Question 21

neurological abnormalities in paraphilic disorders

Answer 21

amygdala & hippocampus involved in control of aggression & sexual behavior
- form a circuit that regulates significant behaviors: feeding, fighting, fleeing & fornication
- men w pedophilic & exhibitionistic disorder show subtle forms of left temporal lobe dysfunction – abnormal patterns of electrophysiological response & impaired performance on tests

Kluver-Bucy syndrome = results from damage in temp lobe = abnormalizes in 4Fs = abnormalities in choosing sexual partners

Question 22

social factors in paraphilic disorders (mating processes)

Answer 22

sexual behavior involves a sequence of steps that prepare for intercourse – voy, exhibit & frot may represent abnormal version of these processes
- smth disrupts the mechanisms that facilitate the identification of a sexual partner & govern sexual behaviors = failure to learn more adaptive forms of courtship

Question 23

social/personal factors that may increase risk of paraphilia

Answer 23

• early crossing of normative sexual boundaries through direct (e.g. sexual abuse) or indirect experience (hearing about atypical sexual behavior)
• lack of consistent parental env where normative sexual behavior & values were modeled
• lack of self-esteem
• lack of confidence & ability in social interactions
• ignorance & poor understanding of human sexuality

Question 24

psychological factors in paraphilic disorder (lovemap)

Answer 24

love map = schemas about love, romance & sex
- written early in life & are quite persistent
- children learn their love maps during sexual play, imitation of parents/adults, & messages from popular media
- in optimal conditions – lovemap includes intercourse as preferred form of sexual expression + learns that love & lust can be directed at the same person
- distorted love map – occurs if child learns that romantic attachment & sexual desire are incompatible

Question 25

classical & operant conditioning in paraphilic disorders

Answer 25

classical & operant conditioning – paraphilia can be conditioned if object is present & becomes associated with orgasms

can also be caused by vicarious condition through modelling

Question 26

aversion therapy for paraphilic disorders

Answer 26

therapist repeatedly presents the stimulus that elicited inappropriate arousal with an aversive stimulus (e.g. electric shock, bad smell)
- rationale was to create a new association with the inappropriate stimulus it will no longer elicit arousal
- fell into disfavor & no longer a serious option

Question 27

CBT for paraphilic disorders

Answer 27

California’s sex offender treatment & evaluation project – designed for men convicted of rape or child molestation

• men were transferred to a special hospital unit for several months – received education in human sexuality & CBT + relapse prevention component
• men in treatment group were compared to control group - % of men who were arrested for another sex offense was the same in both groups
• suggests that a broadly based behavioral program doesn’t lead to obviously better outcomes

Question 28

hormones & medication for paraphilic disorders

Answer 28

Cyproterone acetate = blocks the effects of testosterone
- produced sig reduction in some aspects of sexual behavior, especially sexual fantasies
- pedophilic disorders – found greater reduction of sexual fantasies of children

Triptorelin = reduces testosterone secretion by inhibiting pituitary-gonadal function
- showed reduction in deviant fantasies & in number of incidents of paraphilic behaviors (only when paired w therapy)

SSRIs – can cause sexual dysfunction