Sexual Dysfunctions, Gender Dysphoria, and Disorders Overview

Paraphilias

Atypical sexual interests involving non-normative objects, activities, or individuals (e.g., feet, pain, nonconsenting people).

Paraphilic disorders

Paraphilias that cause distress or impairment, or involve harm/risk to others.

Criteria for paraphilic disorder

It must last ≥6 months and cause distress, impairment, or involve nonconsenting individuals.

Frotteuristic Disorder

Touching/rubbing against nonconsenting person.

Fetishistic Disorder

Use of non-living objects or body parts for sexual arousal, excluding cross-dressing or devices.

Voyeuristic Disorder

Watching unsuspecting person disrobing or engaging in sex.

Exhibitionistic Disorder

Exposing genitals to an unsuspecting person.

Transvestic Disorder

Sexual arousal from cross-dressing, with specifiers (with fetishism/autogynephilia).

Sexual Sadism Disorder

Arousal from others' suffering. Must act on urges or experience distress.

Sexual Masochism Disorder

Arousal from being humiliated or hurt.

Pedophilic Disorder

Attraction to prepubescent children. DSM: ≥16 years old and ≥5 years older than the child.

Prevalence Features of Pedophilia

Mostly males. Some engage in moral or religious compensatory behavior. Some do not act on urges.

Etiology of Paraphilic Disorders

Social: Poor relationships, loneliness; Sexual: Early conditioning or chance pairings of arousal with unusual stimuli (reinforced via masturbation); Childhood/Adolescence: Abuse, neglect, inappropriate modeling.

Psychosocial Treatment Approaches

Covert sensitization, Orgasmic reconditioning, social skills training.

chemical castration

blocks testosterone

Depo Provera

Lowers testosterone; May reduce urges but effects reverse after discontinuation.

Gender Dysphoria

Marked incongruence between assigned sex and experienced gender, with distress or impairment.

Development of Gender Identity

Forms around 18-36 months and becomes relatively fixed thereafter.

Diagnosis Requirements for Gender Dysphoria

Significant distress or functional impairment due to mismatch between gender identity and assigned sex.

Prevalence Rates of Gender Dysphoria

Assigned male at birth: 5-14 per 1,000; Assigned female at birth: 2-3 per 1,000.

Etiology of Gender Dysphoria

Likely biological with genetic component and prenatal hormone influences; no clear single cause.

Support Options for Gender Dysphoria

Psychosocial: Affirmation therapy, social/legal affirmation, family support; Medical: Puberty blockers, hormone therapy, gender-affirming surgery.

Neurodevelopmental Disorders

Disorders with origins in the developmental period.

Impact of Neurodevelopmental Disorders

Involve neurologically-based impairments that affect social, cognitive, emotional, and/or behavioral functioning.

Developmental Disruptions

Early disruptions in skill development (language, attention, motor) can affect future abilities.

Typical Developmental Patterns

Children acquire milestones (speech, interaction, movement) in a predictable order. Delays in these areas may indicate neurodevelopmental disorders.

ADHD

Attention-Deficit/Hyperactivity Disorder.

Clinical Description of ADHD

Persistent inattention and/or hyperactivity-impulsivity.

ADHD Symptoms Age Requirement

Symptoms must appear before age 12 and across 2+ settings.

Inattentive Subtype of ADHD

Poor attention to detail, distractibility, forgetfulness, procrastination.

Hyperactive Subtype of ADHD

Fidgeting, restlessness, excessive talking.

Impulsive Subtype of ADHD

Blurting out, interrupting.

Combined Type of ADHD

Meets full criteria for both inattention and hyperactivity-impulsivity (≥6 symptoms total).

Differential Diagnosis for ADHD

Can be confused with learning disabilities, autism, anxiety, mood disorders, etc.

ADHD Prevalence

5-9% of children worldwide; boys diagnosed 3x more than girls.

ADHD Course

Symptoms often emerge by age 3-4; impulsivity tends to decrease over time, while inattention often persists.

ADHD Etiology - Biological Factors

Genetic; brain volume slightly reduced; dopamine regulation issues.

ADHD Etiology - Environmental Factors

Prenatal tobacco exposure; low birth weight; early trauma.

ADHD Etiology - Psychosocial Factors

Family stress can exacerbate symptoms.

ADHD Supports - Psychosocial

Behavioral therapy, classroom interventions, coaching.

ADHD Supports - Biological

Stimulant medications (Ritalin, Adderall); brain develops more typically with treatment.

ADHD Controversy

Concerns about overdiagnosis and stimulant misuse.

Combined Treatments for ADHD

Combined treatments are most effective.

Autism Spectrum Disorder (ASD)

DSM-5 umbrella term: Includes Autism, Asperger's, Rett Syndrome, PDD-NOS.

Clinical Description of ASD

Deficits in social communication and restricted/repetitive behaviors.

Levels of Severity in ASD

Level 1: Requiring support; Level 2: Substantial support; Level 3: Very substantial support.

ASD Spectrum Presentation

Wide range in symptoms, ability levels, and support needs.

ASD Communication & Interaction Issues

Difficulty forming age-appropriate relationships; impaired joint attention, social reciprocity, nonverbal communication.

ASD Behaviors

Stereotyped movements (e.g., flapping), rigid routines, sensory sensitivity.

ASD Prevalence

Approx. 1 in 68 children; males diagnosed ~4.5x more than females.

ASD Etiology - Historic Views

Cold parenting, vaccines have been debunked.

ASD Etiology - Biological Factors

Strong genetic heritability; twin studies show high concordance; larger early brain growth; issues with oxytocin receptor genes.

ASD Support - Behavioral

Applied Behavioral Analysis (ABA), early intervention.

ASD Support - Integrated Care

Integrated care (speech, OT, family support) most effective.

Substance Use Disorders (SUDs)

Repeated use leads to impairment or distress.

Substance-Induced Disorders

Problems caused directly by substance use (e.g., intoxication, withdrawal, medication-induced psychosis).

Psychoactive Substances

Chemical compounds affecting mood, behavior, or consciousness.

Substance Use

Ingestion without major impairment.

Substance Intoxication

Reversible physiological/psychological effects from recent use.

Substance Use Disorder

Pattern of problematic use causing distress or impairment.

Dependence/Addiction

Loss of control over substance use despite harm.

Physical Dependence

A state where the body adapts to a substance.

Tolerance

Needing more to get the same effect.

Withdrawal

Physical symptoms when stopping use (e.g., tremors, nausea).

Addiction

Loss of control over intense urges to use despite consequences.

Diagnostic Issues: Historical View

Considered a moral failure or symptom of other disorders.

Diagnostic Issues: Current View

Complex interaction of genetic, psychological, and environmental factors.

Depressants

Decrease CNS activity.

Effects of Depressants

Relaxation, sedation.

Examples of Depressants

Alcohol, benzodiazepines, barbiturates.

Alcohol

Initially stimulating (via disinhibition), later depresses brain.

Alcohol Effects

Affects GABA, glutamate, serotonin.

Alcohol Withdrawal

Anxiety, tremors, seizures.

Long-term Effects of Alcohol

Brain damage, liver disease, Wernicke-Korsakoff syndrome.

Stimulants

Increase CNS activity.

Effects of Stimulants

Alertness, elevated mood.

Examples of Stimulants

Cocaine, amphetamines, nicotine, caffeine.

Stimulant Withdrawal

Fatigue, depression, irritability.

Opiates

Reduce pain, produce euphoria.

Examples of Opiates

Heroin, morphine, prescription painkillers.

Effects of Opiates

Euphoria, slowed breathing, drowsiness.

Risks of Opiates

High overdose potential; severe withdrawal.

Hallucinogens

Alter sensory perception.

Examples of Hallucinogens

LSD, psilocybin, PCP.

Effects of Hallucinogens

Hallucinations, paranoia.

Tolerance of Hallucinogens

Develops quickly, but little withdrawal.

Cannabis Effects

Relaxation, altered perception, increased appetite.

Risks of Cannabis

Can impair motivation and memory; mild withdrawal possible.

Inhalants

E.g., glue, paint thinner - rapid effects, brain damage risk.

Anabolic Steroids

Muscle growth, aggression.

Designer Drugs

Synthetic - e.g., MDMA, ketamine; often unpredictable effects.

DSM-5 Criteria for SUD

11 criteria (e.g., craving, tolerance, withdrawal, failure to fulfill obligations).

Severity of SUD

Mild (2-3), Moderate (4-5), Severe (6+).

Distinction in SUD

Substance use ≠ disorder unless there's impairment/distress.

Etiology: Biological

Family history; genes affecting dopamine/pleasure pathways.

Reward circuitry

Ventral tegmental area → nucleus accumbens.

Etiology: Psychological

Positive reinforcement: drug feels good.

Negative reinforcement

Reduces stress/anxiety.

Opponent-process theory

Highs followed by stronger lows.

Expectancy effects and cravings

Influence of expectations on drug use behavior.