Sex and Gender in DSM(COMPLETE) Flashcards
Why is sex being referenced in a psychology class
sex is an important domain of functioning
psychological factors can cause cause difficulties and therefore significant distress/impairment
What are sexual dysfunctions?
Problems with desire, arousal, interest, climax or pain
What are paraphilic disorders?
Attraction to unusual sexual activities or objects
Background on sexual dysfunction
They are disorders where people do not respond normally in key areas of sexual functioning
Men and women are diagnosed based on differences of anatomy.
They can occur at different phases of the sexual response cycle.
What is the prevalence of sexual dysfunction of women and men in Ireland and in US and what’s the most common form of sexual dysfunction in Ireland?
31% of men in america
43% of women in america
49.6% of men in Ireland - most common is low sexual desire
What is normal sexuality
It has a wide variety of behaviours
But religious and cultural factors usually set the norms for:
What normal sexual practices are
Who normal sexual partners are
How often it should be engaged in
Gender roles
Back then modesty was perceived as good and ‘sex before marriage’ looked down on
But now the opposite
What are the 3 broad categories of sexual dysfunction?
- Desire, arousal and or interest
- Orgasm/climax
- Sexual pain
What are the other general DSM criteria for sexual dysfunction
Symptoms must be present for at least 6 months
Must lead to impairment or distress
What are the disorders of desire and what are the disorders?
Little or no interest in sexual activity that causes distress or impairment for self or partner
- Male hypoactive sexual desire disorder
- Erectile disorder
- Female sexual interest/ arousal disorder
What is male hypoactive sexual desire disorder?
The male may be able to get aroused but doesn’t experience any desire.
What is erectile disorder?
Failure to attain or maintain erection on at least 75% of sexual occasions
What is female sexual interest/arousal disorder?
Deficit in frequency in 3 of the following:
- Interest in sex
- Erotic thoughts or fantasies
- Initiation of sex or response to initiation by
partner - Excitement/pleasure
- Interest/arousal by erotic cues
- Genital or non-genital sensations
What is erectile dysfunction
Inability to attain, or to maintain until completion of the sexual
activity, an adequate erection
Sexual desire is usually intact
Most common problem for which men seek
treatment
Prevalence increases dramatically with age
What are the disorders of orgasm/ climax?
- Premature Ejaculation (men only)
- Delayed Ejaculation (men only)
- Female Orgasmic Disorder
What is Premature Ejaculation
Ejaculation with minimal sexual stimulation, less than a minute following insertion on more than 75% of occasions.
Common- 21%
What is Delayed Ejaculation?
Delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity.
What is female Orgasmic Disorder
Delay in, or absence of, orgasm following a normal sexual
excitement phase during sexual activity.
Common (24%)
What is the sexual pain disorder?
Genito-Pelvic Pain/Penetration Disorder
What are the criteria for Genito- pelvic pain disorder/penetration disorder?
women only
Inability to have vaginal/penetration during
intercourse
Marked vulvar, vaginal or pelvic pain during vaginal
penetration or intercourse attempts
Marked fear or anxiety about pain or penetration
Marked tensing of the pelvic floor muscles during
attempted penetration (formerly vaginismus)
What are the 2 categories of causes/aetiology of sexual dysfunciton?
Medical
Psychological/social/cultural
What’s the medical Aetiology of sexual dysfunction?
Diseases like diabetes, MS, spinal cord injuries
Hormones
Medication side effects, alcohol use, some antidepressants, heavy cigarette use
What’s the psychological/social/ cultural aetiology of sexual dysfunction?
- Sexual Abuse
- Depression, Anxiety, Panic Disorder
- Low physiological arousal (e.g. exhaustion, stress)
- Excessive worry (pregnancy, STIs, body image, performance)
- Relationship factors (mismatch with desires, often poor communication)
What are the biological treatments for dysfunctional disorders?
Antidepressants/anxiolytic medication
Erectile dysfunction medication
Slidenafil/ Viagra
(phosphodietrase type 5 inhibitor PDE-5)
Increases blood flow to the penis when stimulated
What are the medical options for female sexual dysfuntion?
Its controversial due to rates of success being really low and because they come with a lot of side effects
Flibanserin- Addy which was approved in 2015 to boost sex drive
What are the psychological treatments for sexual dysfunction?
Psychosocial treatments
Individual/couple therapy
Psychoeducation can be very useful
What’s Masters and Johnson’s psychosocial intervention for sexual dysfunction
Education about sexual responses/ foreplay
Sensate focus therapy- focusing on having sex to achieve sensation without trying to achieve a climax
This decreases performance anxiety and improves intimacy
What are paraphilias/ general criteria
Sexual attraction and arousal focused on
inappropriate people or objects
It manifests in fantasies, urges arousals
Has to be present for at least 6 months
Experiences clinically significant distress/ impairment
or
Acts on urges with a nonconsenting person
What’s makes paraphilia disordered
Experiences clinically significant distress or impairment
Acts on urges with a nonconsenting person
Its not just a kink/ unconventional preference
What are the DSM 5 categories of paraphilia
- Sexual desire/activity toward “inappropriate
situations or stimuli - Sexual desire/activity toward nonconsenting others
- Involving pain, suffering, humiliation
What are the categories of paraphilia regarding:
Sexual desire/activity toward inappropriate situations or stimuli
Fetishistic Disorder
Transvestic Fetishism
These are not necessarily pathological
Only considered as disorders if they cause significant distress/impairment
What’s fetishistic disorder?
Sexual attraction to nonliving objects as the preferred or exclusive source of arousal
e.g shoes or clothing or objects
What’s transvestic Fetishism
Dresses in opposite sex clothing as primary means of
becoming sexually aroused
Not based on gender identity issues
Nothing to do with drag queens
What are the categories of paraphilia regarding:
Sexual desire/activity toward nonconsenting others
- Voyeurism
- Exhibitionism
- Frotteurism
- Paedophillia
All of these are disorders cuz when they act on them its non-consensual
What is voyeurism?
Desire/excitement with “peeping”: observing an
unsuspecting person undressing/etc
What is exhibitionism?
Sexual gratification by exposing one’s self to
involuntary observers
What is frotteurism
Sexual gratification by fondling a nonconsenting
person
Often in times of confinement (public transport, in a lift)
What is paedophillia
Sexual desire or behaviours focused on children
Paedophiles are least 16 years old and 5 years older than the child (age 13 or under)
What are the categories of paraphilia regarding:
Involving pain, suffering, humiliation
- Sadism
- Masochism
They may be disorders if they are non-consensual or cause distress/impairment
What is sadism?
Sexual gratification obtained through inflicting pain and humiliation on one’s
partner
What is masochism?
Sexual gratification obtained through experiencing pain and humiliation at the
hands of one’s partner
What are the causes/ aetiology of paraphilias?
Biological
Environmental
Psychological/cognitive
What are the biological aetiology of paraphilias
- Much more prevalent in males, but no known role for hormones
What is the environmental aetiology of paraphilias?
Two thirds of sexual offenders were abused as
children (3x more than non-sexual criminal offenders)
less than 5 percent of boys who are abused go on to abuse as adults (5x more than in those not abused).
What is the psychological/cognitive aetiology of paraphilias?
Difficulty forming “normal” relationships, deficits in typical sexual experiences
Heightened impulsivity and poor emotion regulation
Lower IQ and more cognitive problems, lack of empathy
Alcohol (which disinhibits) often involved in incidents.
What is the biological/medical treatment for paraphilias?
SSRIs
Chemical castration via hormonal- anti androgen drugs- which aim to lower testosterone and reduce sex drive
Medroxyprogesterone acetate- depo-provera
Cyproterone acetate- androcur
What are the effects of medication treatment for paraphilias.
Reduces desire and fantasy dramatically, but they return after drug removal.
They are ethically dubious cuz they have harmful side effects and informed consent issues
Meta-Analysis w/ >1000 sexual offenders showed 30% drop in repeat offending following treatment.
What are the psychological treatments for paraphilias
Enhancing motivation for change- telling them abs the legal consequences
Stimulus control(borrowed from relapse prevention)
Change lifestyle to reduce exposure to triggering situations,ie. blocking computer access
Cognitive therapy
Challenge thought distortions- the woman doesn’t want to be touched
Empathy training- consider how the behaviour affects others
What is gender
Socially-constructed notion of what it means to be more
masculine or feminine. Can relate also to one’s perception of oneself as male, female, both, or neither
What is sex
a person’s gender based on their genitals and sex
chromosomes
all embryos are identical for first 8 weeks
male hormones produce male development
What’s a gender role
a person’s belief about how they should behave as a male or a female in society
What are not considered as disorders unless they cause significant distress/impairment.
Fluid
nonbinary
cross-gender identity
What is Disorders of Sex Development(formally intersex_
When a person is born with biological features of both sexes
Individuals with DSD often undergo surgical procedures right at birth (sex assignment) and may have hormone therapy after
Some but not all experience gender dysphoria
What is gender dysphoria
A state of psychological distress that arises from a mismatch between one’s experienced/expressed gender and assigned
gender
What’s the DSM 5 criteria for gender dysphoria in adults
At least 2 of the following
- 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 desire to be treated as the other gender
- A strong conviction that one has the typical feelings and reactions of
the other gender
Lasting more than 6 months or causing significant distress/impairment
What is the DSM 5 criteria for gender dysphoria in children?
Marked incongruence between experienced gender and natal
gender demonstrated by SIX of the following criteria present:
- Strong desire to be of the other gender/insistence that one is the
alternative gender required criterion - A strong preference for wearing clothing corresponding to the other
gender (cross-dressing) - Strong preference for cross-gender roles in play
- Strong preference for toys, games, activities stereotypically associated
with the other gender - Strong preference for playmates of other gender
- Rejection of games, play and activities typically associated with natal
sex (i.e., rough and tumble play) - Strong dislike of one’s sexual anatomy
- Desire for sex characteristics that match one’s experienced gender
Lasting more than 6 months or causing significant distress/impairment
Why is the criteria for gender dysphoria stricter for children than for adults
to prevent over-diagnosis
What’s the epidemiology of trans people
Estimated 25 million transgender ppl worldwide
Rising dramatically
More females seeking care
What’s the etiology of gender dysphoria?
Genetic: not very compelling evidence
Hormones:Most trans ppl have no changed to sex hormones but the role of hormones in animals suggests they may:
Females injected with high doses of androgens in the newborn period show behaviour more typical of males
Males that are castrated or given anti-androgens show behaviour more
typical of females
Brain: Pre-treatment, some evidence that brains are more closely aligned with gender identity than physical sex characteristics
How to not treat gender dysphoria
Reparative therapy- trying to make them accept their birth sex
Conversion therapy
How to treat gender dysphoria
Gender confirmation surgery
Psychological evaluations
then hormones
then live as sex for years
then surgery
What’s the satisfaction rate for ppl who get gender confirmation surgery?
75% satisfied
9% regret
Should medical intervention occur in kids for gender dysphoria?
Gender nonconformity is increasingly common and may not lead to gender dysphoria
Support the exploration of gender identity
Affirm and encourage gender identity
Psychological support and family intervention
Should gender dysphoria be classified as a mental disorder?
Yes: Then can be free in health care to treat
No: More damage and creating a stigma, ie homosexuality treated as mental illness until 1970s
