Sexual Disorders and Gender Dysphoria

Abnormal Psychology: Sexual Disorders and Gender Dysphoria

Chapter Outline

• 1. Gender Identity Disorder and Gender Dysphoria

• 2. The Paraphilias

• 3. Rape

• 4. Sexual Dysfunctions

Gender Identity Disorder and Gender Dysphoria

Gender Identity Disorder (GID)

• Definition: As per DSM-IV-TR, GID refers to individuals who experience a deep-seated identity as the opposite sex.

• Features:
    - Typically begins in childhood.
    - Associated behaviors:
      - Cross-gender behaviors.
      - Developmental lag in achieving gender constancy (self-acceptance of one's gender).
      - Aversion to same-sex clothing and activities.

• Criticism:
    - Bartlett and colleagues argue against the classification of GID as a mental disorder if there is no distress.
    - Concerns about stigma led to removal of GID from DSM-5 as a disorder.

• Current Status:
    - No longer classified as a mental disorder in DSM-5, which better reflects the experiences without pathologizing the condition.

Gender Dysphoria

• Definition: The DSM-5 defines Gender Dysphoria as the distress experienced by individuals who feel a significant discrepancy between their anatomical sexual makeup and their psychological gender identity.

• Focus:
    - Emphasis on the distress rather than pathologizing cross-gender identification.
    - Recognition of those suffering from significant identity-related distress.
  

Individual Variability in Gender Dysphoria

• Case Study:
    - John & Jos: Rejected femininity; learned masculine topics; began living as a boy at age 20.
    - Experiences varied widely, illustrating individual journeys and outcomes.

Interventions for Gender Identity Issues

Two Main Types of Interventions:

1. Alter the body: sex-reassignment surgery.
      - Increased frequency of procedures.
      - Criteria for successful adjustment:
        - Emotional stability.
        - Adaptation in a new role for at least one year.
        - Understanding limitations of surgery.
        - Psychotherapy (Green & Fleming, 1990).

2. Alter the psyche: Conversion therapy and its controversial application varying by region.

Overview of Paraphilic Disorders and Sexual Dysfunctions

Paraphilic Disorders

• Define as sexual attraction to unusual objects or activities, of which the following are included:
    1. Fetishistic disorder
    2. Transvestic disorder
    3. Pedophilic disorder
    4. Exhibitionistic disorder
    5. Voyeuristic disorder
    6. Frotteuristic disorder
    7. Sexual masochism disorder
    8. Sexual sadism disorder
    9. Other specified paraphilic disorder (e.g., zoophilia, necrophilia)
    10. Unspecified paraphilic disorder

Sexual Dysfunctions

• Sexual dysfunctions cover a range of problems in the sexual response cycle:
    1. Sexual Desire Disorders
       - Male hypoactive sexual desire disorder
    2. Sexual Arousal Disorders
       - Female sexual interest/arousal disorder
       - Erectile disorder
    3. Orgasmic Disorders
       - Female orgasmic disorder (inhibited female orgasm)
       - Male orgasmic disorder (inhibited male orgasm)
       - Premature ejaculation
       - Delayed ejaculation
    4. Genito-Pelvic Pain/Penetration Disorders
    5. Substance/Medication-Induced Sexual Dysfunction

Definitions and Details of Paraphilias

General Characteristics of Paraphilias

• Para (deviance) + Philia (attraction)

• Involves sexual attraction to objects or activities outside typical norms lasting at least ___ and causing significant distress or impairment.

• Distinction (DSM-5):
    - Paraphilias (no distress caused) versus Paraphilic disorders (causing distress).

• Statistics: Prevalence of such disorders may be underestimated; often comorbid with other mental disorders.

Fetishism

• Defined as reliance on an inanimate object for sexual arousal.
    - Primarily develops by adolescence and often becomes necessary for sexual arousal.
    - Common fetishes include:
      - Feet and shoes
      - Sheer stockings
      - Rubber products
      - Fur garments
      - Underpants

Transvestic Disorder

• Definition: A heterosexual male who derives sexual excitement from dressing in women’s clothing while identifying as a man.

• Characteristics:
    - Usually begins in childhood/adolescence, may become more frequent over time.
    - Often comorbid with sexual masochism.

Pedophilia

• Defined as sexual gratification through contact with prepubescent children.

• Legal Definition: Offender must be at least 16 and at least 5 years older than the child.

• Often associated with mood and anxiety disorders, substance abuse, and other paraphilias.

Incest

• Defined as sexual relations between close relatives.

• Characteristics:
    - Often happens within a patriarchal family structure where emotional distance exists.

Childhood Sexual Abuse

• Forms of Childhood Sexual Abuse include both physical and psychological impacts; typically lead to long-term effects such as anxiety, depression, and suicidal ideation.

• Prevalence statistics indicate about 26.6% for girls and 5.1% for boys have experienced such abuse.

Voyeurism and Exhibitionism

• Voyeurism: Sexual gratification by observing others without consent.

• Exhibitionism: Sexual gratification through exposing oneself to a stranger, typically characterized by a tendency to misread social cues.

Frotteurism

• Defined as sexually oriented touching of an unsuspecting person.

• Underreported incidents noted in surveys, with significant prevalence in young populations.

Sexual Sadism and Masochism

• Sexual Sadism: Deriving pleasure from inflicting pain or humiliation on others.

• Sexual Masochism: Deriving pleasure from being subjected to pain or humiliation.

• Often involves complex psychological profiles, including higher likelihood of criminal behavior.

Other Paraphilic Disorders

• Include: necrophilia, zoophilia, telephone scatologia, coprophilia, klismaphilia, and urophilia.

Etiology of Paraphilias

Psychodynamic Perspectives

• Rooted in protecting the ego from repressed fixations and fears during psychosexual development.

Behavioral and Cognitive Perspectives

• May arise from distorted beliefs and inadequate social skills, often coupled with childhood trauma.

Biological Perspectives

• Possible influence of hormonal disturbances during fetal development.

• Neuroimaging research showing altered brain activity in individuals with paraphilic disorders.

Therapies for Paraphilias

• Treatment success rates range from 30%-90%.

• Behavioural Techniques may include:
    - Aversion therapy
    - Satiation approaches
    - Orgasmic reorientation

• Cognitive Treatment includes empathy training and challenging distorted thought processes.

Rape

Definitions

• Forced Rape: Sexual intercourse without consent.

• Statutory Rape: Sexual intercourse involving minors below the age of consent (age of consent in Canada is ___).

Characteristics of Rape

• Most perpetrators are familiar with the victims.

• Rape is categorized as an act of violence rather than sexual activity.

• Significant predictors of recidivism in rapists include psychopathy and past history of sexual deviance.

Therapies Related to Rape

• For rapists: Focus on cognitive restructuring and group therapy.

• For victims: CBT, trauma-focused therapies, and mental health support systems.

Sexual Dysfunctions

Definition

• Sexual Dysfunction: A range of issues inhibiting normal sexual response, causing distress or interpersonal problems.

Categories of Sexual Dysfunctions

1. Sexual Desire Disorders

2. Sexual Arousal Disorders

3. Orgasmic Disorders

4. Sexual Pain Disorders

General Theories of Sexual Dysfunctions

• Causes may be historical, physiological, or socio-cultural.

Therapies for Sexual Dysfunctions

• Anxiety Reduction: Gradual exposure to anxiety-provoking situations.

• Directed Masturbation: Focus on pleasurable sensations and communication with partners.

• Couples Therapy: Addressing dysfunctions often embedded in relationship difficulties.