Sexual Disorders and Gender Dysphoria

Chapter 13: 

• Para = beyond the usual 

• Philia = attraction or love  

• Paraphilia = unusual sexual attraction 

• Paraphilias involve the experience of: 

  • intense, persistent, sexual interest in anything other than a physically mature, consenting human 

  • Present for 6 months (A criterion) 

• A paraphilic disorder is a paraphilia that causes: 

  • Distress or impairment to the individual, or harms or is a risk of harm to others

  • Only paraphilic disorders are mental disorders 

• Fetishistic Disorder 

  • Highly specific focus on a non-genital body part 

    • Ex. feet 

    • Women's shoes, underwear

    • Less common: 

      • Cars 

      • Baby carriage 

      • Diapers  

• Clothing used for cross-dressing is excluded 

  • Transvestic disorder  

• Must be the preferred sexual outlet

• Often accompanied by masturbation

• Intercourse may be impossible without it

• Onset in childhood or adolescence

• Course is usually chronic

• More common in males 

• Person often is quite normal otherwise

• Most people with a fetish do not have Fetishistic Disorder

  • No distress, impairment, or harm to others

• Transvestic Disorder 

  • Cross-dressing: usually men in womens clothes for the purpose of sexual arousal 

  • Not transsexuals 

  • Primairly in heterosexual males 

  • Onset in childhood or adolescence 

  • Differentiated from Fetishistic Disorder because:

  • No particular item of women's clothing is required and

  • Women's clothing must be worn for arousal

  • Sometimes comorbid with Autogynephilia

  • Sexual arousal by thoughts or images of self as female

• Sexual sadism disorder or sexual masochism disorder 

  • Sexual Sadism

    • Sexual gratification by inflicting pain or humiliation on another

  • Sexual Sadism Disorder

    • A non-consenting person was involved, or

    • Distress / impairment present

  • Sexual Masochism

    • Sexual gratification by having pain or humiliation inflicted on self

  • Sexual Masochism Disorder

    • Distress / impairment present

• “BDSM “or “kink” refer to consensual sexual sadism / masochism

• Fairly common  activity in general population

• 20-30 % of BDSM clubs are female

• Most lead otherwise conventional lives

• Most are comfortable with their sex practices

• Average age of onset:

• Masochism: childhood to late teens

• Sadism: Late teens to early adulthood

Exhibitionistic Disorder 

• •Exposing genitals to an unwilling stranger

• •Masturbation common

• •Desire to shock victim

• •Most do not attempt actual contact with victim

• •But 12% have committed rape

• •Most frequent sexual offense in Western countries

• •Sometimes comorbid with Voyeurism

• •Immature interpersonal skills with women

• •Over half are married but sex life is poor

• •Most common in males

• •Onset in adolescence

Voyeuristic Disorder 

• •Voyeurs have a preference for watching others undress or have sex

• •It is important that the victim be unaware

• •Masturbation during or after is common

• •Rarely attempt contact with the victim

• •Often socially unskilled

• •Often fearful of direct sexual encounters

• •Most common in males

• •Onset in adolescence, often before 15

• •Must be the preferred sexual activity 

Frotteuristic Diorder

• •Sexually touching an unsuspecting victim

• •Usually in crowded places like buses, skytrains, clubs

• •Almost exclusively males

• •Often involves rubbing genitals against a woman’s buttocks to orgasm, or fondling her

• •Some offenders try to make the touching appear “accidental”, some do not

• •Some researchers believe it is similar to rape

• •Onset in adolescence

Pedophilic Disorder 

• Prepubescent children – generally 13 and younger

• •Has acted on the urges or the urges cause distress/impairment

• •The 6-month criteria still must be met

• •Pedos = Greek for “child”

• •More common in men but data indicate that women molest too

• •Can be heterosexual or homosexual

• •Person must be at least 16 and 5 years older than the child

• •E.g., a 15-year-old molesting an 11-year-old could not be diagnosed  

Pedophilia 

• A pedophile has a preference for children but might not have offended (acted)

Other paraphilic Disorder:

• •Zoophilia (bestiality)

• •Telephone scatalogia

  • •Obscene phone calls

• •Necrophilia

  • •Sex with dead people

• •Coprophilia

  • •Use of feces for sexual excitement

• •Uruophilia

  • •Use of urine for sexual excitement

• •Klismaphilia

  • •Sexual arousal by enemas

• •Acrotomophilia

  • •Sexual arousal to people with amputations

• •Apotemnophilia

  • •Sexual arousal from own amputations

• •Autassassinophilia

  • •Sexual arousal from being in a life-threatening situation

• •Objectophilia

  • •A fetish for objects or structures