gender dysphoria & paraphilia Flashcards
gender dysphoria
a marked incongruence between one’s experienced gender & assigned gender
- at least 6 months
prevalence of gender dysphoria
very rare
4.6 in 100,00 ppl or 0.6-1.7%
hard to get good estimate bcuz of stigma
age of gender dysphoria
can occur as early as childhood but not everyone how has it in childhood has is later in life
causes of gender dysphoria
poorly understood
gender identity may be strongly influenced by sex hormones especially during prenatal period – exposed to more androgens (speculation)
treatment of gender dysphoria
- 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
gender dysphoria criteria in adolescents/adults
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
gender dysphoria criteria in children
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
paraphilic disorder
a paraphilia that either leads to subjective distress or social impairment for the person or that causes harm to, or threatens, other people
typical symptoms of paraphilic disorders
- 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
diagnosis of paraphilic disorders
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
prevalence, age & gender of paraphilic disorders
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
fetishistic disorder
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
transvestic disorder
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
sexual masochism disorder
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
sexual sadism disorder
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
exhibitionistic disorder
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
voyeuristic disorder
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
frotteuristic disorder
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
pedophilic disorder
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
endocrine system in paraphilic disorders
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
neurological abnormalities in paraphilic disorders
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
social factors in paraphilic disorders (mating processes)
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
social/personal factors that may increase risk of paraphilia
- 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
psychological factors in paraphilic disorder (lovemap)
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
classical & operant conditioning in paraphilic disorders
classical & operant conditioning – paraphilia can be conditioned if object is present & becomes associated with orgasms
can also be caused by vicarious condition through modelling
aversion therapy for paraphilic disorders
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
CBT for paraphilic disorders
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
hormones & medication for paraphilic disorders
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
