clinical disorders pt two

sex

physical, biological sex (male, female), non binary → chromsome and hormonal changes

gender

socially constructed roles, behaviors activites and attributes that a given society considers apprpriate for men and women, exists on a continuum

sexual orientation

sexual attraction and behaviors, exists on a continuum and non binary

obstacles to science

good normative data absent or week, shame, discomform, or moral objection to sexuallity, gender identity and sexuality highly politicized, political poloration affects grant funding, human sexyalitity cultural variation, rapid shift of sexual norms, DSM system often mirrors cultural changes

paraphilias disorders

fetishistic, frotteuristic, voyeuristic, exhibitionistic, tranvestic, sexual sadism, sexual masochism, pedophilic disorder

paraphilias definition

para = abnormal, philia = sexual attraction, sexual attraction to people, action, animals, objects that are not consenting adults, has to be longer than 6 mos, 90% male

For paraphilias to be a disorder

Cause impairment or destress or harm to others longer than 6 mos

3 types of attraction to non living

1. inanimate objects (shoes), 2. specific tactile stimulation (rubber/plastic), 3. specific parts of body = partialism (feet)

Fetishistic Disorder

A. over a peroid of at least 6 mos, recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body parts as manifested by fantasies, urges, or behaviors

b. the fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning '

c. the festis objects are not limited to articles of clothing or devices designed for genital stimulation

Frotteuristic Disorder

a. over 6 mos recurrent and inteses sexual arousal from touching/rubbing against non consenting person → manifested by fantasies, urges, or behaviors

b. individual acted on sexual urges with non consenting person or sexual urges/fantasies cause clinically significant distress or impariment on function

Voyeuristic disorder

a. 6 mos or more, recurrent and intesnt sexual arousal from observing unsuspecting person who is naked, engaing in sexual activity, as manifested by fantasies, urges, or behaviors

b. the indicidual has acted on these sexual urges with non consenting person or the urges are causing impairment in functioning

c. indicidual experiencing arousal or acting on urges is at least 18 yrs of age

exhibitionistic disorder

a. 6 mos, recurrent and intense sexual arousal from exposure of one’s genitals to unsuspecting person, manifested by fantasies, urges, or behaviors

b. indicidual has acted on these sexual urges with non consenting person or have impariemnt in fucntion

transvestic disorder

a. 6 mos, recurrenta ndintense sexual arousal from cross dressing, manifested by fantaseis etc

b. fantasies exual urges or behaviors cause clinically significant distress or impairment in function

fransvestic with fetishism

if sexually aroused by fabrics, materials, or garments, focused on clothing

transvestic disorder with autogynephilia

sexually aroused by thoughts or images of self as other gender

sexual sadism

a. 6 mos, recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors

b. individual has acted on these sexual urges with nonconsenting person, or sexual urges or fantasies cause clinically significant distress or impairment in fucntioning

sexual masochism

a. 6 mos, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as maifested by fantasies, urges, or behaviors

b. the fantasies, sexual urges, or behaviors cause impairment

specificy with asphyxiophilia

pedophilic disorder

a. 6 mos, recurrent intense sexually arousal fantasies, sexual urges, or behaviors involving sexual activity with prepubesent child/children (generally age 13 yr or younger)

b. idividual acted on urges, or urges cause marked distress or interpsonal difficulities

c. individual is at least 16 yrs old and at least 5 yrs older than child/children in cirteria a

speficiy if exulsive (only children), nonexclusive, or limited to incest

Pedohilic disorder correlates

downlowding child porn strong predictor, normal adult arousal more common in incest, maladaptive cognitions = cognitive dissonance reduction, act to alleviate enxiety, depression and loneliness

what causes pedophillia

experience early sexual abuse, high use of porn, highest in people who are victums of incest and pedopheillia

what causes sadism

antipersonality diorder, evieormental differences, prenatal enviornment

causes of paraphilic disorders

early inapprpriate sexual experience → inappropraite stimulus w/ arousal → focuse only on that not focused on age appropraite realtionships → forbidden = arousing, trying to stop makes it more arousing

treatment for paraphilic disorders

target inapprpriate sexual associations, convert sensitization → pair sexual fantasy with fantasy of negative outcome (imaginal exposure), orgasmic reconditioning → masturbate to fantasy switch to approtpriate target right before, coping/relapse prevention → low efficacy, not super helpful , medication

medication for paraphilic disorder

used when only thing that helps, cyproterone acetate = “chemical castration”, depo-proverna (weekly injections) → usally for men lowers testosterone could be a parol requirement

Gender dysphoria

makred incongruence betwettn one’s experienced/expressed gender and assigned gender → desire to feel other gender, felling as if they are the other gender

• in children → cross-gender dress, play, dislike for sex characteristics, desire to other gender sex roles

• in adults → desire to be other gender, deisre to rid self of sex characteristics, must have those of other gender

distress or impariemtn in functiomning

personality

characteristic way a person behaves, thinks, and realtes to others, enduring and realtiverly stabel predisopsitions, other described in terms of traits

five factor model of personality

OCEAN

O

openness to experience

c

conscientiousness → reliable, organized

E

extraversion

A

agreeableness

N

neuroticism/emotional instability

personality disorders

enduring patters of preceive thinks, realting to others, thinking about world, causes significant subjectuve distress or impairment → often distress is with others instead of individuals, pervasive across social/personal contexts, a personality taht is highly inflexible and maladaptive, chronic long term

facts and statistics about personality disorders

prevelance around 0.5% to 2.5% depends on disorder → higher in inpatient (10-30%) and outpatient (2-10%)

Personality in the DSM

10 speficif PD, originate in childhood and continue througout life → don’t diagnose until age 18. High levels of comobility 50% have another PD, 75% w/ PD jave another diagnosis that is not PD

Issues in diagnosis PD

many personality disorders overlap → hard to distinguish one from another, low agreement between diagnosticians → concerns about validity and reliability, possible gender bias in diagnosis → may result from crieteria and or assessment

Gender Biases in PD diagnosis