psychopathology chapter 10= sexuality and gender related disorders

normal vs. abnormal sexual behavior

normative data- what is expected vs. unexpected

gender

age

have to be tangible/problematic to diagnose

sexual and gender related disorder come in three sub-categories:

sexual dysfunctions

paraphilias

gender dysphoria

sexual dysfunctions

when someone is struggling with the sexual behavior/performance

sexual dysfunction considerations:

often treated by medical doctors, driven by psychological issues

lifelong vs. acquired - often treated by medical doctors, driven by psychological issues

generalized- sexual dysfunction always shows up vs. situational - or at certain times usually physical/ psychological

medical conditions - medical rule outs always important

psychological factors

dysfunction in the sexual response cycle:

desire - for sex or intimacy

arousal

orgasm

or: pain associated with sex

Male Sexual Hypoactive Desire Disorder

-lose desire to have sex

-not common with men

Prevalence: Men = 5%

Female Sexual Interest/Arousal Disorder

-lose desire to have sex

-common with women

-only diagnostic if bothering the person

Prevalence Women = 22%

sexual desire disorders - ex. female/male interest/arousal disorder

Little to no desire in sexual activity

Decreased frequency in:

- Sexual intercourse

- Masturbation

- Sexual fantasy

Apathy related to condition/Anxiety more likely related to response of others

Age considerations

Medical rule-outs are important

sexual aversion disorder

Very little interest in sex

Active avoidance of sexual interaction

Fear, Panic and/or Disgust related to sex

More likely to be concerning to client

Erotophobia - fear of sexual behavior, nudity, etc.

Relationship to trauma - sexual trauma

More common among women

Can be present in people regardless of gender

active avoidance, deeper component with it

Male Erectile Dysfunction Disorder

Difficulty achieving and/or maintaining an erection

Female Sexual Arousal Disorder

Difficulty achieving and maintaining proper lubrication

sexual arousal disorders facts

Is it Situational?

Relationship to anxiety/stress

Medical rule outs are important

Age considerations are important

Often related to relationship/sexual communication with partner

orgasm disorders

examples: Delayed Ejaculation (Males), Female Orgasmic Disorder (Females)

Adequate desire and arousal

Unable to achieve orgasm (or delayed in males)

8% Prevalence in males; 25% in females

Diagnostic issues related to gender

Situational? Masturbation?

Premature Ejaculation (Can only be diagnosed in males)

Ejaculating prior to when wished

< 1 Minute

Most Prevalent Male Disorder (21%)

Improves with age/experience

Often, made worse by anxiety

Responds well to treatment- being comfortable, sleeping better, etc.

sexual pain disorders

EX. Genito-pelvic pain/penetration disorder (no male equivalent)

Regular pain during intercourse

At times, extreme pain

May lead to avoidance

No other noticeable issues related to sexual stages

15 % Prevalence rate

paraphilic disorders (paraphilia)

nvolve sexual attraction and arousal

Socially inappropriate people/objects

Associated with distress and/or harm/threat of harm to others

Gender splits very, but ALL more common among men

More than 50% of people with paraphilia have more than one

Co-morbid with anxiety (social phobia), depression, substance abuse, personality

disorders

paraphilic disorders: Frotteuristic Disorder

paraphilia where people are sexually aroused by rubbing up against unknowing people

paraphilic disorders: Fetishistic Disorder

when some is attracted to something that is not innately attractive

Inanimate objects

Partialism - only attracted to one part of someones body ex. foot fetish

Idiosyncratic sexual behavior - BDSM, popping balloons

Tactile - things need to be on body - fur, leather

Voyeuristic Disorder ex. of paraphilic disorder

when someone is watching people naked or having sex ex. peeping tom in window

Exhibitionism Disorder ex. of paraphilic disorder

being sexually aroused by exposing himself to someone else

Transvestic Disorder ex. of paraphilic disorder

being sexually aroused by wearing the clothes of other gender, mainly straight men

sexual sadism ex. of paraphilic disorder

dangerous, rare, when people become aroused by causing pain and humiliation to others, not wanting the other person to enjoy it

sexual masochism ex. of paraphilic disorder

when people are sexually aroused by being hurt or humiliated when having sex

hypoxiphilia

desire to be choked to point of losing consciousness, or severely choked

pedophilic disorder (clinical term)

-not criminal

exual attraction to pre-pubescent children

Can be diagnosed without presence of acting out-behavior

Some do seek treatment without ever committing an act of childhood sexual abuse - don’t engage, feel its wrong

90-95% Males

Can be attracted to children of one sex or both

Pedophiles with victims of both sexes = worse prognosis/higher recidivism

12% of men; 18-20% of women report being touched inappropriately as children

-exclusive pedophilia is far more dangerous

paraphilic disorder causes

Low levels of arousal to appropriate stimuli

Sexual problems when engagaging in healthy, consenual relationships

Social deficits - perceived as not fitting in

Early experiences

High sex drive - higher than normal, paired with…

Low suppression of urges / drive

Inappropriate arousal / fantasy (CLASSICAL CONDITIONING) - explain how bond is formed

Reinforcement via orgasm (OPERANT CONDITIONING) - how it stays there ex. pairing arousal with a fetish paired together = dangerous

paraphilic disorder treatments

Behavioral Therapy

- Modification - counter conditioning

- Orgasmic reconditioning

Cognitive Behavioral therapy

- Coping mechanisms

- Cognitive modification

- Empathy training - can be helpful

Treating co-morbid conditions

- Social anxiety

- Substance abuse

making people more whole

Chemical Castration - taking medication that stiffles one’s sex drive

paraphilic disorder treatments - worst prognosis

Sexual sadism – rapists

- Predatory pedophiles

- Early onset - pre puberty= bad

- Significant Co-morbidity = prognosis bad

- Multiple Paraphilias - becomes very hard to treat

gender dysphoria

dysphoric if bothered

Identifies with a sex different than was assigned at birth…

Leading to psychological/emotional discomfort (anxiety, depression, detachment etc.)

NOT: An Intersex condition (although there can be overlap)

Transvistic Disorder - not this ex. Tanner Syndrome

More common among people assigned male at birth

Seen across all cultures – where it has been studied

Gender non-conformity begins in early childhood; increases throughout childhood

While common among transgender people; not synonymous with transgenderism

gender dysphoria causes and treatment

Strong genetic causes

High heritability rate

Slightly higher levels of testosterone or estrogen at certain critical periods of development - might masculinize a

female fetus or feminize a male fetus

increasingly de-stigmatized; but still diagnostic

Preferred treatment = gender confirming treatments (sometime including surgery)

- At least two years of stated desire

- Psychologically stable

- Hormone replacement

- Surgery option

 75% satisfied

 1-7% regret

 Better adjustment = female to male