Sexual Dysfunctions, Gender Dysphoria, and Paraphilic Disorders

Question 1

Q: Changes from DSM-IV to DSM-5 for Sexual Dysfunction
Duration Requirement

Answer 1

A: DSM-IV did not specify a minimum duration for sexual dysfunctions, whereas DSM-5 introduced a requirement of at least 6 months of symptoms to diagnose sexual dysfunctions. This change aimed to prevent over-diagnosing transient sexual difficulties.

Question 2

Q: Changes from DSM-IV to DSM-5 for Sexual Dysfunction
Gender-Specific Categories

Answer 2

A: DSM-IV did not categorize sexual dysfunctions by gender. In contrast, DSM-5 introduced gender-specific categories such as Female Sexual Interest/Arousal Disorder and Male Hypoactive Sexual Desire Disorder to reflect differences in sexual functioning between males and females.

Question 3

Q: Changes from DSM-IV to DSM-5 for Sexual Describe Dysfunction
Combination of Disorders

Answer 3

A: DSM-IV classified Dyspareunia and Vaginismus as separate diagnoses. DSM-5 combined these into Genito-Pelvic Pain/Penetration Disorder, simplifying diagnostic criteria and addressing overlap in symptoms.

Question 4

Q: Changes from DSM-IV to DSM-5 for Sexual Dysfunction
Sexual Aversion Disorder

Answer 4

A: DSM-IV included Sexual Aversion Disorder, characterized by aversion to sexual contact. DSM-5 removed this category due to infrequent diagnosis and lack of empirical support.

Question 5

Q: Changes from DSM-IV to DSM-5 for Sexual Dysfunction
Female Sexual Interest/Arousal Disorder

Answer 5

A: DSM-IV had separate diagnoses for Female Sexual Arousal Disorder and Hypoactive Sexual Desire Disorder. DSM-5 combined these into Female Sexual Interest/Arousal Disorder to better capture overlapping symptoms.

Question 6

Q: Changes from DSM-IV to DSM-5 for Sexual Dysfunction
Subtypes

Answer 6

A: DSM-IV included various subtypes based on onset, context, and etiology of sexual dysfunctions. DSM-5 simplified subtypes (e.g., lifelong vs. acquired, generalized vs. situational, mild vs. severe) to enhance clinical utility and diagnostic clarity.

Question 7

Q: Changes from DSM-IV to DSM-5 for Sexual Dysfunction
Emphasis on Individual Experience

Answer 7

A: DSM-5 placed greater emphasis on the individual’s experience and relational context of sexual dysfunctions. This update recognizes the influence of relationship factors and personal distress in understanding and diagnosing sexual disorders.

Question 8

Q: Changes from DSM-IV to DSM-5 for Sexual Dysfunction
Combination into Genito-Pelvic Pain/Penetration Disorder

Answer 8

A: In DSM-IV, Vaginismus and Dyspareunia were separate diagnoses. DSM-5 combined these into Genito-Pelvic Pain/Penetration Disorder, which encompasses difficulties with vaginal penetration, pain during intercourse, or fear of pain or penetration. This change aimed to streamline diagnosis and capture the overlap in symptoms related to pelvic pain and penetration issues.

Question 9

Q: What does the DSM-5 describe about sexual dysfunctions?

Answer 9

A: The DSM-5 defines sexual dysfunctions as clinically significant disturbances in a person’s ability to respond sexually or experience sexual pleasure. Before diagnosing a sexual dysfunction, it’s essential to rule out nonsexual mental disorders, relationship issues, stressors, or drug and medical effects. Specifiers in DSM-5 indicate onset (lifelong or acquired), extent (generalized or situational), and severity (mild, moderate, severe), except for genito-pelvic pain/penetration disorder, which specifies onset and severity.

Question 10

Q: What symptoms must be present for a diagnosis of Erectile Disorder according to DSM-5?

Answer 10

A: The person must have at least one of three symptoms on 75 to 100% of all occasions of sexual activity: marked difficulty obtaining an erection, marked difficulty maintaining an erection until completion of sexual activity, or marked decrease in erectile rigidity. Symptoms must persist for at least six months and cause significant distress. Organic causes can be ruled out if the person experiences spontaneous erections in non-sexual contexts, morning erections, or erections during masturbation or with a different sexual partner.

Question 11

Q: What symptoms must be present for a diagnosis of Erectile Disorder according to DSM-5?

Answer 11

A: The person must have at least one of three symptoms on 75 to 100% of all occasions of sexual activity: marked difficulty obtaining an erection, marked difficulty maintaining an erection until completion of sexual activity, or marked decrease in erectile rigidity. Symptoms must persist for at least six months and cause significant distress. Organic causes can be ruled out if the person experiences spontaneous erections in non-sexual contexts, morning erections, or erections during masturbation or with a different sexual partner.

Question 12

Q: What are the diagnostic criteria for Premature (Early) Ejaculation according to DSM-5?

Answer 12

A: Premature (Early) Ejaculation involves a persistent or recurrent pattern of ejaculation during partnered sexual activity within approximately one minute of vaginal penetration and before the person desires it. Symptoms must be present for at least six months, occur in 75 to 100% of all sexual activities, and cause significant distress.

Question 13

Q: How is Premature (Early) Ejaculation typically treated?

Answer 13

A: Treatment usually includes behavioral techniques and pharmacotherapy. Behavioral techniques such as sensate focus and the start-stop or pause-squeeze techniques are employed to reduce performance anxiety and help individuals learn to control ejaculation. Pharmacotherapy options include SSRIs like paroxetine, which can increase serotonin levels and delay ejaculation in some men.

Question 14

Q: What are the diagnostic criteria for Genito-Pelvic Pain/Penetration Disorder according to DSM-5?

Answer 14

A: Genito-Pelvic Pain/Penetration Disorder involves persistent or recurrent difficulties with at least one of the following: vaginal penetration during intercourse, marked vulvovaginal or pelvic pain during penetration attempts, marked anxiety about pain related to penetration, or marked tensing of pelvic floor muscles during attempted penetration. Symptoms must persist for at least six months and cause significant distress.

Question 15

Q: How is Genito-Pelvic Pain/Penetration Disorder typically treated?

Answer 15

A: Treatment interventions may include relaxation training to reduce pelvic floor muscle tension, sensate focus exercises to enhance comfort and reduce anxiety during sexual activity, the use of topical anesthetics to minimize pain sensations, vaginal dilators to gradually increase tolerance to penetration, and Kegel exercises to improve pelvic floor muscle control.

Question 16

Q: What are the changes in the diagnosis of Gender Dysphoria from DSM-IV to DSM-5?

Answer 16

A: DSM-5 replaced the diagnosis of Gender Identity Disorder (GID) from DSM-IV with Gender Dysphoria, emphasizing distress related to the incongruence between assigned and experienced gender. Unlike GID, Gender Dysphoria focuses on the distress and impairment caused by the incongruence rather than labeling it as a disorder in itself.

Question 17

Q: What are the diagnostic criteria for Gender Dysphoria in DSM-5?

Answer 17

A: Gender Dysphoria involves a marked incongruence between one’s experienced/expressed gender and assigned gender, lasting at least six months, and manifested by at least two of the following: strong desire to be of the other gender, discomfort with one’s assigned gender, or significant distress or impairment in social, occupational, or other important areas of functioning.

Question 18

Q: What are the subtypes of Gender Dysphoria recognized in DSM-5?

Answer 18

A: DSM-5 recognizes subtypes of Gender Dysphoria based on age and developmental stage: for children, adolescents, and adults. Each subtype specifies the duration and nature of gender dysphoric symptoms relevant to that developmental stage.

Question 19

Q: How does the DSM-5 define a paraphilia?

Answer 19

A: A paraphilia involves intense and persistent sexual interest in objects, situations, or individuals that deviate from phenotypically normal, physically mature, consenting human partners.

Question 20

Q: What distinguishes a paraphilic disorder from a paraphilia according to the DSM-5?

Answer 20

A: A paraphilic disorder is a paraphilia that currently causes distress or impairment to the individual or has resulted in personal harm or risk of harm to others.

Question 21

Q: What are some treatments for paraphilic disorders?

Answer 21

A: Treatments include cognitive-behavior therapy (CBT), group therapy, marital therapy, and pharmacotherapy. Cognitive strategies involve restructuring thoughts and empathy training. Behavioral strategies include covert sensitization and orgasmic reconditioning.

Question 22

Q: Describe covert sensitization as a treatment for paraphilic disorders.

Answer 22

A: Covert sensitization is a form of aversive counterconditioning where the person replaces sexual arousal to the paraphilic object or behavior with an aversive response, conducted in imagination rather than real-life scenarios.

Question 23

Q: What is orgasmic reconditioning in the context of treating paraphilic disorders?

Answer 23

A: Orgasmic reconditioning involves instructing the individual to switch fantasies during masturbation from the paraphilic object or behavior to more appropriate stimuli, aiming to redirect sexual arousal patterns.

Question 24

Q: Name some pharmacological treatments for severe paraphilic disorders and their challenges.

Answer 24

A: Drugs like gonadotropin-releasing hormones (e.g., Lupron) and antiandrogens (e.g., Depo-Provera) are used, but they can reduce sexual desire with serious side effects and a high risk of relapse upon discontinuation.

Question 25

Q: When might SSRIs be prescribed for individuals with paraphilic disorders?

Answer 25

A: SSRIs may be prescribed for individuals with less severe disorders to alleviate depression or compulsions that trigger paraphilic behavior, potentially reducing the urge for paraphilic activities.

Question 26

Question
What does “posttransition” refer to in the context of gender dysphoria?

Answer 26

Answer
“Posttransition” refers to individuals who have completed medical interventions, such as hormone therapy or surgeries, to align their physical characteristics with their gender identity. In DSM-5, it acknowledges the different stages and experiences of gender dysphoria, including those who have completed transition.

Question 27

Question
What characterizes Frotteuristic Disorder according to DSM-5?

Answer 27

Answer
Frotteuristic Disorder involves recurrent and intense sexual arousal from touching or rubbing against a nonconsenting adult, lasting at least six months, causing distress or impaired functioning. Diagnosis requires acting on urges or significant distress from fantasies.

Question 28

Question
What is Transvestic Disorder as defined in DSM-5?

Answer 28

Answer
Transvestic Disorder involves cross-dressing for sexual arousal lasting at least six months, causing distress or impaired functioning. Most individuals are heterosexual but may engage sexually with men while cross-dressed.

Question 29

Question
Describe Pedophilic Disorder according to DSM-5.

Answer 29

Answer
Pedophilic Disorder involves recurrent and intense sexual arousal focused on children aged 13 or younger, lasting at least six months, causing distress or interpersonal problems. Diagnosis requires acting on urges or significant distress from fantasies.

Question 30

Question
What characterizes Fetishistic Disorder according to DSM-5?

Answer 30

Answer
Fetishistic Disorder involves recurrent and intense sexual arousal from nonliving objects or specific non-genital body parts, lasting at least six months, causing distress or impaired functioning.

Question 31

Question (Front):
Describe Exhibitionistic Disorder as defined in DSM-5.

Answer 31

Answer (Back):
Exhibitionistic Disorder involves recurrent and intense sexual arousal from exposing genitals to unsuspecting individuals, lasting at least six months, causing distress or impaired functioning. Subtypes include arousal towards prepubertal children, physically mature individuals, or both.

Question 32

Q: How were paraphilic disorders categorized in DSM-IV-TR compared to DSM-5?

Answer 32

A: In DSM-IV-TR, paraphilias were listed as separate disorders (e.g., Exhibitionism, Fetishism). In DSM-5, they are categorized under “Paraphilic Disorders.”

Question 33

Q: What significant change was made to the distress criterion in DSM-5 regarding paraphilic disorders?

Answer 33

A: DSM-IV-TR required paraphilias to cause “marked distress or interpersonal difficulty.” DSM-5 removed this criterion and focuses instead on whether the paraphilia causes distress or impairment to the individual or involves harm or risk of harm to others.

Question 34

Q: What specifiers were introduced in DSM-5 for paraphilic disorders?

Answer 34

A: DSM-5 introduced specifiers to describe the severity and course of paraphilic disorders, such as “in remission” or “in a controlled environment.”

Question 35

Q: How did DSM-5 accommodate cases that do not fit specific criteria for paraphilic disorders?

Answer 35

A: DSM-5 includes categories for “Other Specified Paraphilic Disorder” and “Unspecified Paraphilic Disorder” to cover cases that do not meet specific diagnostic criteria but still involve atypical sexual interests causing distress or impairment.

Question 36

Q: How does the DSM-5 distinguish between paraphilias and paraphilic disorders?

Answer 36

A: Paraphilias are intense and persistent non-normative sexual interests or behaviors. A paraphilic disorder is diagnosed when these interests cause distress or impairment to the individual or have entailed personal harm or risk of harm to others.