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Behavioral Health--> Module One > Gender Dysphoria, Sexual Dysfunctions, & Paraphilic Disorders > Flashcards

Gender Dysphoria, Sexual Dysfunctions, & Paraphilic Disorders Flashcards

1
Q

What is the diagnostic criteria for gender dysphoria (GD)?

A

1) Marked incongruence between one’s assigned (natal) gender and one’s experienced gender
2) Incongruence results in clinically significant distress or functional impairment
3) Symptoms endure at least SIX MONTHS

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2
Q

Describe the onset and course of GD

A

evident at an early age (2-4y.o)

persist, regardless of social pressure

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3
Q

What is the etiology of GD?

A

More what happened in utero then the environment.

may have been an absent or atypical hormone (androgen) during critical development period.

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4
Q

Is there any evidence of atypical hormone exposure in utero for GD patients?

A

yes bed nucleus of the stria terminalis (BNST) in GD

BNST is larger in males than females due to androgen exposure in utero

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5
Q

In male-to - female GD (trans female) describe the BNST

A

BNST is more similar in size to non transgender females (suggesting lack of androgen exposure)

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6
Q

How does one manage GD cases?

A

Hormone treatment
transgender living
surgical sex reassignment

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7
Q

What is the diagnosis criteria for sexual dysfunctions?

A

Problems related to the normal sexual response cycle

Problems persist for at least 6 months

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8
Q

A possible diagnose for sexual dysfunction in females is female sexual interest/arousal disorder, what is the problem in these females?

A

problems with libido and/or physiological arousal

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9
Q

Another possible diagnose for sexual dysfunction in females is female orgasmic disorder, what is the problem with these females?

A

a delay in, the inability, or having low intensity orgasms.

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10
Q

The last possible diagnose for sexual dysfunction in females is genito-pelvic pain/penetration disorder, what is the problem with these females?

A

Difficulties with vaginal penetration or vulvovaginal/pelvic pain during vaginal intercourse or penetration attempts.

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11
Q

What are the male sexual dysfunction diagnosis’s?

A

1) Male hypoactive sexual desire disorder -> (low libido)
2) Erectile Disorder –> (problems maintaining or attaining an erection)
3) Premature Ejaculation –> (ejaculation occurring during partnered activities within 1 min)
4) Delayed Ejaculation –> (marked delay in, or absence of, ejaculation)

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12
Q

What are the two specifiers for sexual dysfunctions?

A

generalized or situational

life long or acquired

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13
Q

What are some various causes of sexual dysfunction?

A

psychological factors are primary

medical condition may co exist but insufficiently explains the symptom

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14
Q

What are ways to assess sexual dysfunction in the patient?

A

1) Taking a sexual history –> ROUTINELY ask questions
2) Consider whether sexual dysfunction is related to a medication side effect –> SSRIs cause this
3) Consider whether sexual dysfunction is related to recreational drug use –> alcohol…………hmm…
4) Consider whether sexual dysfunction is related to a medical/physical problem –> diabetes, surgery, thyroid, etc.
5) Consider whether the sexual problem is normal for ones age. With age expect –> slower erection, decreased intensity of orgasm, longer refractory period
6) Be familiar with tests to differentiate a psychiatric vs organic basis for a sexual problem

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15
Q

What is the snap gauge test?

A

determines whether erections occur during REM. If REM erection occur, then the problem is not organic

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16
Q

Does libido wane with age?

A

not necessarily ( just a decline in certain aspects of sex)

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17
Q

One of the treatment options for sexual dysfunctions is behavioral therapy and specifically dual sex therapy, what does this therapy do?

A

1) If dysfunction, then both partners are treated
2) Therapy is short term with behavioral focus
* Sex Education
* Communication skills training
* Anxiety reduction through sensate focus exercises

18
Q

Another treatment options for behavioral sexual dysfunction is treating specific problems. Each card will go through one. 1 –>

A
  1. Premature Ejaculation –>
    * squeeze technique (partner squeeze the glans penis to cause discomfort)
    * Start and stop technique –> partner ceases stimulation of the partner to reduce pleasure
19
Q

2nd sexual dysfunction specific problem treatment

A
  1. Genito-Pelvic Pain/Penetration Disorder

* Use of dilators to expand vaginal opening in conjunction with relaxation techniques

20
Q

3rd sexual dysfunction specific problem treatment

A
  1. Female Orgasmic Disorder

* Strengthen the pubococcygeal muscle to increase orgasm potential.

21
Q

Besides behavioral sexual dysfunction treatment, pharmacotherapy can be used. Which drugs should be used?

A

Adjunct to behavioral therapy

1) Stimulants –> increase libido
2) SSRIs –> slow ejaculation
3) Phosphodiesterase-5 (PDE5) inhibitors –> for erections

22
Q

What does PLISSIT stand for in regards to sexual dysfunction treatment?

A

Overall Treatment Strategy:
P–> permission (give approval to enjoy sex)
LI –> limited information (provide basic sex education)
SS –> Specific Suggestions
IT –> refer on to specialists (intensive therapy)

23
Q

The next group of disorders in regard to sex are the paraphilic disorders. The first disorder is paraphilia, describe the diagnostic criteria

A

an intense and persistent >6 months deviant sexual interest
If an individual:
a) acts on an urge with a non consenting person
b) acts on an urge with a consenting person and the actions cause significant distress/functional impairment
c) does not act on the urge but the urge causes significant distress/functional impairment

24
Q

what is the definition of deviant?

A

sexual interest other than for genital stimulation or preparatory fondling with phenotypically normal physically mature consenting human partners.

25
Q

There are multiple various diagnosis or types for paraphillia, each card will go through the diagnosis’s/types. 1 –>

A

1) Exhibitionism –> sexual arousal from exposing genitals to an unsuspecting stranger.

26
Q

The next type of paraphilia is…

A

2) Voyeurism –> sexual arousal from observing unsuspecting person either naked, in the process of disrobing, or engaging in sexual activity
PERSON HAS TO BE AT LEAST 18 Y.O

27
Q

The next type of paraphilia is…

A

3) Fetishism –> sexual arousal from nonliving objects or a highly specific sexual focus on a non-genital body part

28
Q

The fourth type of paraphilia is…

A

4) Transvestism –> sexual arousal by cross-dressing

29
Q

The fifth type of paraphilia is…

A

5) Frotteurism –> sexual arousal from touching or rubbing against a non-consenting person

30
Q

The sixth type of paraphilia is….

A

6) Sexual Sadism –> sexual arousal from causing psychological/physical suffering of another person.

31
Q

The seventh type of paraphilia is…

A

7) Sexual Masochism –> sexual arousal from receiving psychological/physical suffering

32
Q

The eighth type of paraphilia is….

A

8) Pedophilia –> sexual arousal by a prepubescent child

33
Q

In pedophilia what is the age criteria for the perpetrator?

A

Perpetrator –> 16 y.o and 5 yrs older than the child

34
Q

Describe the epidemiology of people with paraphiliac disorders?

A

rare
almost exclusively males
frequent offenders

35
Q

For individuals with paraphiliac disorders what is the onset and course?

A

urges –> start in childhood/teens with action becoming better defined with age

36
Q

What are the suggested causes of paraphilia disorders (because it is unknown)

A

1) Biological Influences –> testosterone levels or frontal lobe dysfunction and serotonin dysregulation
2) Psychosocial/Environmental Influences –> classical conditioning (object/situation was previously paired with sexual excitement and now triggers the same sexual excitement) and imitation (person repeating behavior that was personally experienced in the past)

37
Q

What is an example of classical conditioning in regards to psychosocial/environmental influences and paraphilia disorders?

A

Child masterbating to underwear magazine and now child associates pleasure and sex to underwear

38
Q

Possible treatment for paraphilia are behavioral therapy, what are the two different behavioral therapies?

A
  1. Aversion therapy –> punishing deviant ways with actual noxious stimulus or patient imagines aversive consequences (covert sensitization).
  2. Masturbating Reconditioning –> directed masturbation phase (appropriate fantasy while masturbating to orgasm) and satiation phase (during post orgasmic refractory period patient masturbates to deviant fantasy without ability to orgasm)
39
Q

The next possible treatment for paraphilic disorders is pharmacotherapy, what are the two main drugs used?

A

1) Antidepressants -> SSRIs –>reduce libido, control impulses and reduce obsessions
2) Anti-Androgens —> Medroxyprogesterone acetate(depo-provera) –> decrease testosterone levels

40
Q

Are antidepressants or anti-androgen drugs better for paraphilic disorders?

A

Anti-Androgens (again completely kills sex drive)

41
Q

Legally a sex offender has to do what when living in a county?

A

1) Registration and 2) Notification

Behavioral Health--> Module One (21 decks)

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