Paraphilic disorders, sexual dysfunctions & Gender Dysphoria ( Psychopathology) ( Final exam)

Paraphilic disorders

Behaviors in which an individual has recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving (1) nonhuman objects (2) children or other nonconsenting persons or (3) the suffering or humiliation of self or partner.

Essential feature of a paraphilic disorder:

becomes psychologically dependent on the target of desire and are unable to experience sexual arousal unless this target is present in some form. Must experience the condition for at least 6 months

Pedophilic Disorder: 

a paraphilic disorder in which an adult is sexually aroused by children or adolescents. Must be at least and at least 5 years older than the children whom attracted to.

Pedophilic Disorder key feature:

sexual arousal with children that is equal to or even greater than what is felt with fellow adults.

Exhibitionistic Disorder:

person has intense sexual urges and arousing fantasies involving the exposure of genitals to a stranger. Often comorbid conditions include major depressive disorder and substance abuse.

Voyeuristic Disorder:

person has a compulsion to derive sexual gratification from observing the nudity or sexual activity of others. Most common paraphilia.

Fetishistic Disorder:

person is preoccupied with an object and depends on this object rather than sexual intimacy with partner for achieving sexual gratification.

Partialism:

: interested solely in sexual gratification from a specific body part other than the genitals, such as feet.

Frotteuristic Disorder:

person has intense sexual urges and sexually arousing fantasies of rubbing against or fondling an unsuspecting stranger.

Sexual masochism disorder:

(“masochism”-seeking pleasure from being in pain) marked by an attraction to achieving sexual gratification by having painful stimulation applied to one’s own body. Aroused by being beaten, bound or otherwise made to suffer.

Sexual sadism disorder:

sexually aroused from the physical or psychological suffering of another person. 

Transvestic disorder: 

:  (“transvestism” or “cross-dressing” refers to the behavior of dressing in the clothing of the other sex. 

Transvestic disorder diagnosis

must show symptoms of a paraphilic disorder and have distress or impairment.

Biological:

genetic, hormonal and sensory factors.

Also, issues with the temporal lobe which is believed to alter sexual arousal combined with early physical or sexual abuse.

treatment: castration

: intended to destroy the body’s production of testosterone through surgical castration (removal of the testes) or chemical castration (medication that suppress the production of testosterone)

treatment: medication

alters neurotransmitter levels, esp. some antidepressants and those that involve GABA or glutamate receptors which decrease the  activity of dopamine (neurotransmitter involved in sexual arousal)

Psychological Perspective

Freud’s psychoanalytic view.

-John Money: lovemaps view.

-“victim-to-abuser cycle” or “abused-abusers phenomenon” view.

treatment

CBT

Empathy training

Impulse control training

Relapse prevention

most effective treatment

combination of hormonal drugs intended to reduce androgens (male sex hormone levels) and psychotherapy

Sexual Dysfunction:

abnormality in an individual’s sexual responsiveness and reactions.

Can’t attribute divergence to a psychological disorder, effects of a substance such as drug abuse or medication, or a general medical condition.

Clinicians rate sexual dysfunction based on

whether it is lifelong or acquired and generalized or situational. 

lifelong

since sexually active

acquired

at some point prior asymptomatic

generalized

all sexual situations

situational

only occur with certain types of sexual stimulation, situations or partners

Masters & Johnson Sexual Response Cycle (4 phases)

Excitement (arousal)

Plateau

Orgasm

Resolution

Arousal disorders:

when sexual disorders occur during the initial phases of the sexual response cycle, have low or no sexual desire or are unable to achieve physiological arousal.

As a result, avoid having or been unable to have sexual intercourse

Male hypoactive sexual desire disorder:

males have abnormally low levels of interest in sexual activity. 

Female sexual interest/arousal disorder:

interested in having intercourse but her body does not physiologically respond during the arousal phase.

Interest/arousal replace desire

DSM-5 now characterizes female sexual interest/arousal disorder as involving a range of behaviors including:

Loss of interest, arousal, erotic thoughts and enjoyment of sexual activity or intensity of sensations during sexual activity.

Erectile disorder:

male cannot attain or maintain an erection during sexual activity that is sufficient to allow him to initiate or maintain sexual activity.

Most researched of all sexual dysfunction disorders.

“The Working Group for a New View of Women’s Sexual Problems”,

Criticized the DSM for failing to take into account the greater focus in women on relational aspects of sexuality and individual variations in sexual experiences.

Emotional, physical or relational.

males (causes)

physiological abnormalities, vascular, neurological or hormonal or caused by alcohol, drugs & smoking.

Male (medications)

Viagra, Levitra & Cialis: all work as phosphodiesterase (PDE) inhibitors which increase blood flow to the penis during sexual stimulation.

females(biological)

hormonal replacement therapy (estrogen & progesterone), estrogen cream, testosterone therapy

females (psychological)

cognitive work, couples therapy, sensate focus

sensate focus

method of treating sexual dysfunction in which the interaction is not intended to lead to orgasm, but to experience pleasurable sensations during the phases prior to orgasm.

Gender dysphoria:

distress that may accompany the incongruence between a person’s experienced or expressed gender and that person’s assigned gender.

Biological sex:

sex determined by a person’s chromosomes

Gender identity:

: sense of maleness or femaleness

Current criteria for gender dysphoria:

must identify with the other sex, having the feeling of “in the wrong body” and must cause discomfort and sense of inappropriateness about assigned gender.

Transsexualism:

a term sometimes used to refer to gender dysphoria, specifically pertaining to individuals choosing to undergo sex reassignment surgery. Unlike transvestic disorder.  No sexual gratification from cross-dressing

DSM-5 changed gender identity disorder to gender dysphoria

With this change in the term the focus of treatment has changed from what is “wrong” to a more fluid view of gender.  Avoid the binary male-female dichotomy.

Transphobia:

the negative stereotyping and fear of people who are transgendered.