Sexual and Gender Identity Disorders Flashcards
_________ denotes any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners.
Paraphilia
Paraphilic Disorder prevalence ?
Rarely diagnosed in clinical settings—possibly, in part, because many of the acts are illegal and reporting methods (ie, self-reporting) may be unreliable.
**rarely dx cause they are illegal more in adolescents and can persist through life with no genetics **
Paraphilic Disorder Etiology & Risk factors ?
15-25 year
Paraphilic Disorder genetic?
Unclear if any association
Paraphilic Disorder DDx ?
Alcoholism Depression Mental Retardation Obsessive-Compulsive Disorder Personality Disorders Posttraumatic Stress Disorder Schizophrenia
Paraphilic Disorder Prognosis ?
Highly variable and many have a high recidivism rate
Paraphilic Disorder Medications ?
SSRIs / Benzodiazepines
Paraphilic Disorder procedures /therapy / surgery ?
Individual and group therapy may be beneficial but variable
Voyeruristic Disorder ?
Formerly known as Voyeurism in DSM-IV, this disorder refers to (for over a period of at least 6 months) having recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity
** (spying on others in private activities),**
Voyeruristic Disorder: Diagnostic Criteria ?
Over a period of 6 months, recurrent and intense sexual arousal from observing unsuspecting person who is naked
Individual has acted on these urges with non consenting person, or they are causing costal or occupational impairment
At least 18 years old
Exhibitionistic disorder ?
a mental health condition that centers on a need to expose one’s genitals to other people (typically strangers caught off guard) in order to gain sexual satisfaction.
exposing the genitals)
Exhibitionistic disorder diagnostic criteria ?
over a period of 6 months, recurrent and arousal from exposing genitals to unsuspecting person
The individual has acted on these urges with non consenting person or the urges are causing impairment in important areas of functioning
Included specifiers:
specify wether the arousal if from exposing to prepubertal children, physically mature individuals or both
specify if it is in a controlled environment (institutionalized) or in full remission ( for at least 5 years)
Exhibitionistic disorder diagnostic criteria: full remission ?
individual has not acted on these urges with non consenting persons nd has no distress or functional impairment for at least 5 years while in a uncontrolled environment
Frotteuristic Disorder ?
is a paraphilic interest in rubbing, usually one’s pelvic area or erect penis, against a non-consenting person for sexual pleasure.
touching or rubbing against a non-consenting individual
Frotteuristic Disorder diagnostic criteria ?
over a period of 6 months, recurrent arousal from rubbing to touching against a nonconsenting person
Individual has acted on these urges with non consenting person, or these urges are causing functional impairment causes distress
Sexual masochism disorder?
is the condition of experiencing recurring and intense sexual arousal OF SELF in response to enduring extreme pain, suffering, or humiliation
undergoing humiliation, bondage, or suffering
M - myself
Sexual masochism disorder diagnostic criteria ?
over a period of 6 months, arousal from the act of being humiliated, beaten bound or otherwise made to suffer
the urges are causing functional impairment
Included specifiers:
Specify if: with asphyxiophilia - related to restriction of breathing
Specify if: in a controlled environment of if in full remission - 5 years no sxs.
Sexual sadism disorder?
is the condition of experiencing sexual arousal in response to the extreme pain, suffering, or humiliation of OTHERS.
inflict ing humiliation, bondage, or suffering
S - someone else
Sexual sadism disorder diagnostic criteria?
over a period of 6 months, arousal from the physical or psychological suffering of another person
Individual has acted on there urges with a non consenting person , or the urges are causing distress or impairment of functioning
Memory tip for masochism and sadism?
Masochism is ME.
ME as in hurting “me
Sadism is hurting others – someone may say they are “sadistic” because they like to hurt other people
Pedophilic Disorder ?
is termed pedophilic disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and the manual defines it as a paraphilia involving intense and recurrent sexual urges towards and fantasies about prepubescent children
(sexual focus on children
Pedophilic Disorder diagnostic criteria ?
over a period of 6 months, arousal involving sexual activity with a prepubescent child or children (13 years or younger)
individual has acted on these urges, or the urge cause marked distress or interpersonal difficulty
The individual is at least 16 years and at least 5 years older than the child or children
Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12 or 13 year old
Fetishistic Disorder ?
(formerly known as Fetishism) involves the eroticization of nonliving objects and/or body parts for sexual gratification. Among the more common non-living fetish objects are women’s underpants, bras, stockings, shoes, boots, or other wearing apparel. An individual with a fetish for a body part (e.g., feet, hair) will focus primarily on the eroticizes non-genital body part during sexual encounter.
(using nonliving objects or having a highly specific focus on non-genital body parts
Fetishistic Disorder diagnostic criteria?
Over a period of 6 months of recurrent arousal from either the use of nonliving objects or highly specific focus on congenital body parts
The urges cause clinically significant distress or impairment in social, occupational or other important areas of functioning
The fetish objects are not limited to articles of clothing used in cross-dressing or devices specifically designed for the purpose of tactile genital stimulation (vibrator)
Included specifiers:
Specify:
Body part
Nonliving object
Other
Transvestic Disorder ?
Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing.
** (engaging in sexually arousing cross-dressing)**
Transvestic Disorder diagnostic criteria ?
Over 6 months arousal from cross dressing, as manifested by urges or behaviors
The urges and fantasies causes clinically significant distress or impairment in social, occupational or other areas of functioning
Included specifier:
Specify:
With fetishism: aroused by fabrics, materials, or garments
With autogyneophilia: aroused by thoughts or images of self as female
______ ____________ are a heterogeneous group of disorders that are typically characterized by a clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure.
Sexual dysfunctions
**An individual may have several sexual dysfunctions at the same time. In such cases, all of the dysfunctions should be diagnosed. **
**this tends to be more personal and people affected by it rather than the other ones that are more criminal **
Examples of Sexual dysfunctions ?
delayed ejaculation,
erectile disorder,
female orgasmic disorder,
female sexual interest/arousal disorder,
genito-pelvic pain/penetration disorder,
male hypoactive sexual desire disorder,
premature (early) ejaculation,
substance/medication- induced sexual dysfunction,
other specified sexual dysfunction, and unspecified sexual dysfunction.
Delayed ejaculation diagnostic criteria?
A. Either the following sxs. must be experienced on most all or all occasions of partnered sexual activity and w/o the individual desiring delay:
- marked delayed ejaculation
- marked infrequency or absence of ejaculation
B. Duration for a minimum of 6 months
C. sxs cause significant distress
D. not better explained by a nonsexual mental disorder or anything things else
- *most commonly SSRIs
- *
Erectile Disorder ?
A. At least one of the three following sxs. must be experienced on most all or all occasions of sexual activity.
- difficulty obtaining erection during sexual activity
- difficulty maintaining an erection until the completion of sexual activity
- decreased erectile rigidity
B. duration of a minimum of approximately 6 months
C. Sxs cause significant distress
D. not better explained by a nonsexual mental disorder or anything things else
**drinking - duffle bag it **
Female Sexual Interest / Arousal Disorder ?
Lack of or significantly reduced sexual interest / arousal with at least 3 of:
Absent / reduced : Interest in sexual activity Interest in sexual thoughts or fantasy Initiation of sexual activity Sexual excitement/pleasure during sexual activity Genital / non-genitalia sensations
sxs for 6 months
causing distress
not explained by something else
**they dont even think about sex **
Female Sexual Interest / Arousal Disorder prevalence ?
26% to 43% of women
really common
Female Sexual Interest / Arousal Disorder etiology and risk factors?
Multiple sclerosis
Pelvic nerve damage
Vulvovaginal atrophy ( as you are older and estrogen production is not as great)
Spinal cord injury
Physical and mental health and relationship problems are strongly associated with orgasm difficulties
Female Sexual Interest / Arousal Disorder genetics?
Unclear
Female Sexual Interest / Arousal Disorder DDx?
Medication side effect (SSRIs,
Benzodiazepines, beta
blockers)
Hormonal imbalance
Psychogenic causes
Female Sexual Interest / Arousal Disorder Prognosis?
Variable depending on the underlying cause
Female Sexual Interest / Arousal Disorder Medications ?
Consider Bupriprion as an alternative SSRI if the SSRI is the cause
Female Sexual Interest / Arousal Disorder Procedure, therapy, surgery ?
CBT
sex education, training in communication skills, and Kegel exercises may be beneficial adjuncts to therapy
Female orgasmic disorder ?
presence of:
- delay, infrequency, or absence of orgasm
- reduced intensity of orgasms
last for 6 months
cause distress
not explained by something else
Gentio-Pelvic Pain / Penetration Disorder ?
presence of difficulties with one of the following:
- vaginal penetration during intercourse
- vulvovaginal pr pelvic pain during intercourse or penetration attempts
- fear or anxiety about pain in anticipation of during vaginal penetration
- tensing or tightening of pelvic floor muscles during attempted penetration
for at least 6 months
causes distress
not explained by something else
Male Hypoactive Sexual Desire Disorder disgnostic criteria ?
A. deficiency sexual/erotic thoughts or fantasies and desire for sex. Clinician judges deficiency taking functioning and sociocultural contexts
B. duration for 6 months
C. causes distress
D. not explained by something else
**this focus not on the physical but more mental, lack of arousal and lack of thoughts **
Male Hypoactive Sexual Desire Disorder ?
Persistent deficit sexual/erotic thoughts or fantasies and desire for sexual activities
6+ months
Causes clinically significant distress
Not better explained by a medical condition
See DSM 5 for subtypes i/e/ lifelong, generalized, situational, etc
Male Hypoactive Sexual Desire Disorder Prevalence ?
13% to 28% of men
Male Hypoactive Sexual Desire Disorder Etiology and risk factors?
Unknown but may be due to psychological or hormonal issues and deficits
Male Hypoactive Sexual Desire Disorder genetics ?
Unclear
Male Hypoactive Sexual Desire Disorder DDx?
Complex interplay of psychological and hormonal issues.
Acquired (i.e. boredom)
Prolactinoma
Delayed sexual maturation
Sexual anhedonia
Male Hypoactive Sexual Desire Disorder Prognosis ?
Depends on the underlying cause. i.e. if hypogonadism then testosterone may be very effective.
Male Hypoactive Sexual Desire Disorder medications?
If psychological then therapy may be better than psych meds due to sexual side effects (i.e. sexual dysfunction caused by SSRIs)
**low testestore and we can actually test for it **
Male Hypoactive Sexual Desire Disorder procedures / therapy / surgery ?
Removal of the underlying cause(s) such as hormonal or psychological issues
Premature (early) ejaculation diagnostic criteria ?
Persistent ejaculation occurring during sex within 1 minute after penetration before the individual wishes
no duration criteria established for premature ejaculation not involving vaginal penetration
6 months sxs. present
sxs. cause clinical distress
Not explained by something else
Substance / Medication-Induced sexual Dysfunction diagnostic criteria ?
A. significant disturbance in sexual function is predominant in the clinical picture
B. Evidence from Hx, PE, or lab findings
C. not better explained by something else
D. does not occur exclusively during the course of delirium
E. cause clinical
Substance / Medication-Induced sexual Dysfunction occurs with ?
Occur with intoxication/withdrawal from alcohol; opioids; sedatives, hypnotics, or anxiolytics; stimulants (including cocaine); and other substances.
Gender Dysphoria prevalence ?
Extremely rare: 0.005-0.014%
Gender Dysphoria etiology and risk factors ?
Many theories but little evidence to support causation
Gender Dysphoria genetics?
Many theories but little evidence to support genetic cause
Gender Dysphoria DDx?
Body Dysmorphic Disorder
Schizophrenia
Transvestic Disorder
Noncomformity to gender roles ( female cuts her hair short but she still wants to to be a girl)
Gender Dysphoria Prognosis?
Diagnosing and treating this disorder early can reduce the chances of depression, emotional distress, and suicide.
Gender Dysphoria Medications ?
SSRIs may help with coexisting conditions
Gender Dysphoria Procedure / therapy / surgery ?
Complex depending on the desires and age of the patient
Psychological intervention may be beneficial. Individual treatment focuses on understanding and dealing with gender issues. Group, marital, and family therapy can provide a helpful and supportive environment.
Gender Dysphoria diagnostic criteria in children?
A marked incongruence between ones experience/expressed gender and assigned gender of at least 6 months duration and by at least 6 of the following:
- strong desire to be of other gender or insistence that one is the other gender
- In boys: preference for cross-dressing or stimulating female attire, or in girls: preference for wearing only typical masculine clothing or resistance to wear female clothing
- preference for cross-dressing
- preference for toys and games stereotypically used by the opposite sex
- desire for playmates of the other gender
- In boys: strong rejection of masculine toys or games or in girls: rejection for feminine toys or activities
- dislike of ones anatomy
- desire for primary or secondary sec characteristics that match ones experienced gender
B. condition is clinically distressful and cause impairment of functioning
**think about the child abuse and the approach to the interview it is delicate and careful - this disease is the same way when it come to approach , sometime the external genitalia do not match the chromosomal make up, think about when it is not and when it is okay to interject you opinions ,5 is not necessarily by it self is dx but it is usually in conjunction with some of the other number **
Gender Dysphoria diagnostic criteria in adolescents and adults?
A marked incongruence between ones experience/expressed gender and assigned gender of at least 6 months duration and by at least 2 of the following:
- marked incongruence between ones experienced/expressed gender and primary or secondary sec characteristics
- desire to rid of sex characteristics because marked congruence, adolescents desire to prevent the development of the anticipated secondary sex characteristics
- desire for the primary and/or secondary sex characteristics of the other gender
- desire to be the other gender
- desire to be treated as the other gender
- string conviction that one has the typical feeling and reactions of the other gender
B. condition is ass. w/ clinically significant distress or impairment of functioning
