Gender dysphoria, paraphilic disorders, sexual dysfunctions

Gender identity

Sense of being male, female, intersex, transgender, nonbinary, etc.

• Normally based on anatomic gender

Gender dysphoria

Individual experiences significant personal distress when anatomic sex & gender identity do not align

Transgender identity

Psychological sense of belonging to one gender while possessing the sexual organs of the other

Gender roles

Social expectations of behaviours appropriate for men & women

Hijra (India), Fa’afafine (Samoa)

Group of individuals who are considered to be a third gender

• Neither male or female, having traits of both

Two-spirit

People who embody a higher level of integration of male & female spirits

• Many Indg people believe that all human beings have both male & female elements

Psychodynamic theorists & gender dysphoria

They point to:

• parents w/ empty relationships

• Fathers who were absent or detached

• Extremely close mother-son relationships

Learning theorists & gender dysphoria

Point to father absence in the case of boys, unavailability of strong male role model

Treatment goal for gender dysphoria

Optimizing psychological health & self-fulfillment

Treatment for gender dysphoria

• Hormone therapy

• Real-life experience

• Gender affirming surgery

• Psychotherapy

Gender affirming surgery

Surgeons attempt to construct external genitalia that are as close as possible to those of the preferred gender

Paraphilic disorders

Strong & recurrent sexual arousal to atypical stimuli. Evidenced by fantasies, urges, or behaviours for 6+ months. Has either acted on them or is strongly distressed by them

• Nonhuman objects

• Inappropriate or nonconsenting partners

• Situations producing humiliation or pain to oneself or one’s partner

Exhibitionistic disorder

Exposing one’s genitals to an unsuspecting stranger to surprise, shock, or sexually arouse the victim

• Typically not interested in actual sexual contact

• Motivated by wish to shock & dismay unsuspecting observers

Fetishistic disorder

Inanimate object or nongenital body part as a focus of sexual interest & source of arousal

Fetish

Object or situation of sexual interest

Fetishist

Person who has a fetish

Transvestic disorder

Cross-dressing for purposes of sexual arousal

Autogynephilia

Sexual arousal associated w/ the fantasy of being a woman

Voyeuristic disorder

Watching unsuspecting people, generally strangers, who are undressed, disrobing, or engaging in sexual activity

• Purpose of watching is to attain sexual excitement

Frotteuristic disorder

Rubbing against or touching a nonconsenting person

Generally occurs in crowded places

Pedophilic disorder

Sexual activity w/ prepubescent children

Diagnosis of pedophilic disorder

Person must be:

• 16+ years of age

• 5+ years older than the children they are sexually attracted to or have victimized

Michael Seto, developmental theory of persistent sexual offending against children

2 pathways to sexual offending against children

• Antisociality stemming from psychopathy or adverse disadvantages

• Sexual attraction to prepubescent children

Sexual masochism disorder

Receiving humiliation or pain

Hypoxyphilia, autoerotic asphyxiation

Sexually aroused by being deprived of oxygen

• Dangerous expression of masochism

Sexual sadism disorder

Sexually aroused by inflicting physical suffering or humiliation on another person

Sadistic rapists

Stalk & assault nonconsenting victims, become aroused by inflicting pain or suffering on them

Sadomasochism

Mutually gratifying sexual interaction involving both sadistic & masochistic acts

Telephone scatologia

Making obscene phone calls for sexual arousal

Necrophilia

Sexual contact w/ corpses

Zoophilia

Sexual contact w/ animals

Coprophilia

Sexual arousal from fecesOften involves the use of feces in sexual acts or fantasies.

Klismaphilia

Sexual arousal from enemas

Urophilia

Sexual arousal from urine

Psychodynamic theorists & paraphilic disorders

Defences against leftover castration anxiety from Oedipal period

Learning theorists & paraphilic disorders

Explained in terms of conditioning & observational learning

• Some object or activity becomes inadvertently associated w/ sexual arousal

• Object or activity can then elicit sexual arousal

Hypersexual arousal disorder

Heightened sex drive that may apply to some cases of paraphilia

Money multifactorial model of paraphilic disorders

Traces development of paraphilic disorders to childhood

• Childhood experiences etch a pattern that determines the kinds of stimuli & behaviours that come to arouse people sexually

Psychoanalysis & paraphilic disorders

Attempt to bring childhood sexual conflicts into awareness so they can be resolved in the light of the individual’s adult personality

CBT treatment of paraphilic disorders

Focuses directly on changing the problem behaviour

• Aversive conditioning to induce negative emotional reaction to paraphilic stimuli or fantasies

National sex offender programs

CB interventions that are designed to be therapeutic, not solely didactic or psychoeducational program

High intensity national sex offender program

Individuals who are at a high risk of reoffending sexually

Moderate intensity national sex offender program

Individuals who are at moderate risk of reoffending sexually

National sex offender maintenance program

Follow up program to reinforce the skills taught in treatment programs for sex offenders

Tupiq program

Sex offender treatment & maintenance program for Inuit men who have either a moderate or high risk of reoffending sexually

SSRIs & paraphilic disorders

Drugs may act to reduce sexual drives

• Don’t specifically target deviant sexual fantasies

Antiandrogen drugs & paraphilic disorders

Reduce levels of testosterone in the bloodstream

• May reduce sexual drives & urges

Sexual assault

Nonconsensual bodily contact for a sexual purpose

Level 1 sexual assault

Any non-consensual bodily contact for a sexual purpose

Level 2 sexual assault

Sexual assault w/ weapon

Level 3 sexual assault

Aggravated sexual assault

Aggravated sexual assault

Victim is maimed or disfigured, or has their life endangered

Treatment of sexual assault

2 phase process

• Assisting women in coping w/ immediate aftermath

• Helping w/ long-term adjustment

Sexual dysfunction

Problem w/ sexual interest, arousal, or response

• Causes distress to affected person & partner

Acquired sexual dysfunction

Problem beings following a period of normal functioning

Situational sexual dysfunction

Occurs in some situations but not others

Generalized sexual dysfunction

Occurs in all situations & every time individual engages in sexual activity

3 categories of sexual dysfunction

1. disorders of sexual interest or arousal

2. Orgasm disorders

3. Genito-pelvic pain/penetration disorder

Male hypoactive sexual desire disorder

Persistent or recurrent lack of sexual interest or sexual fantasies

Female sexual interest/arousal disorder

Lack of or greatly reduced level of sexual interest, drive, or arousal

• Lack feelings of sexual pleasure or excitement that normally accompany sexual arousal

• May experience little or no sexual interest or pleasure

Erectile disorder

Difficulty in achieving or maintaining erection during sexual activity

• problem must be present for 6+ months & must occur on all or almost all occasions of sexual activity

Female orgasmic disorder

Difficulties in achieving orgasm

• Marked delay in reaching orgasm

• Infrequency or absence of orgasm

Delayed ejaculation

Persistent difficulties in achieving orgasm

• Marked delay in ejaculation

• Infrequency or absence of ejaculation

Premature ejaculation

Persistent or recurrent pattern of ejaculation occurring during sexual activity at a point before the man desires it

Genito-pelvic pain/penetration disorder

Women who experience sexual pain or difficulty engaging in vaginal intercourse or penetration

Vaginismus

Muscles surrounding the vagina involuntarily contract whenever vaginal penetration is attempted

• makes sex painful or impossible

Biological perspectives for sexual dysfunctions

• Deficient testosterone production

• Thyroid overactivity or under activity

• Medical conditions

• Temporary physical conditions

Learning perspectives & sexual dysfunctions

Role of conditioned anxiety in the development of sexual dysfunctions

Sexual fulfilment based on learning sexual skills - sometimes taboo in certain cultures

Cognitive perspectives & sexual dysfunctions

Irrational beliefs & attitudes contributing

• Sexual arousal becoming disconnected from positive emotions - anxiety has inhibiting effects

Performance anxiety

Type of anxiety that involves excessive concern about whether we will be able to perform successfully

Sociocultural perspectives & sexual dysfunction

Stereotypical attitudes toward female sexuality - women w/ these are unlikely to become aware of their sexual potential

Equating self-esteem w/ ability to orgasm

Sensate focus exercises

Mutual pleasuring activities between partners that are focused on the partners taking turns giving & receiving physical pleasure

self-spectatoring

Tendency to observe one’s behaviour as if they were a spectator of themselves

Treating disorders of sexual interest or arousal

Helping people w/ low sexual desire kindle their sexual appetite through use of self-stimulation exercises w/ erotic fantasies

Treating disorders of orgasm

• Masturbation to learn about one’s own body

• Treating delayed ejaculation by focusing on increasing sexual stimulation & reducing performance anxiety

• SSRIs can help men w/ early ejaculation problems

Treating genito-pelvic pain/penetration disorder

• CB exercises

• Relaxation techniques

• Vaginal dilators to gradually desensitize the vaginal musculature

Stop-start, stop-go technique

Suspend sexual activity when man is about to ejaculate, resume stimulation when his sensations subside

Partialism

Sexual interest in nongenital body part

Sexual script

How we think sex is supposed to go

3 themes for sexual offending against kids

• Antisocial theme

• Limited intellectual ability & social skills - find comfort w/ children

• Pure pedophilia - sexually attracted to kids

Sexual assault, antisocial theme

Want to dominate women & express hatred toward women

Paraphilia, deviant sexual arousal, theme & sexual assault

• Violence or stalking behaviour is sexually arousal

• Sexual pleasure sometimes can only happen when the victim is humilated

Sexual assault, psychological theme

Socialization can set social culture where sexual assault is normal