Transcript Gender Identity Disorder

Chapter 13:
Changing views of Sexual Behavior
Sexual Dysfunctions
Paraphilias
Gender identity Disorder
Abnormal Psychology
Feb 26-Mar 3, 2009
Classes #13-14
Changing views of Sexual Behavior

The
Generational
Perspective:
Ever-changing
attitudes?
Sexual and Gender-Identity
Disorders

DSM-IV recognizes three main types of
sexual disorders.



Sexual dysfunctions
Paraphilias
Gender-identity disorders
Sexual Dysfunctions


These are disorders that involve the
absence or failure of the sexual response
at some point during the sexual response
cycle
A loss or impairment of the ordinary
physical responses of sexual function
Sexual Dysfunctions

Sexual Desire Disorders



Sexual Arousal Disorders



Female Sexual Arousal Disorder
Male Erectile Disorder
Orgasmic Disorders




Hypoactive Sexual Desire
Sexual Aversion Disorder
Female Orgasmic Disorder
Male Orgasmic Disorder
Premature Ejaculation
Sexual Pain Disorders


Dyspareunia
Vaginismus
Sexual Desire Disorders

Sexual desire disorders

Disorders in which the person lacks sexual interest or
has an active distaste for sex
 Hypoactive sexual desire
 Lack of interest in sex
 Little or no sexual activity in these individuals
 Sexual Aversion Disorder
 Find sex unpleasant or repulsive
Sexual Arousal Disorders

Inability to achieve or sustain arousal until
the end of intercourse in a person who is
capable of experiencing sexual desire

Female sexual arousal disorder


The inability of a woman to become sexually
aroused or to reach orgasm
Erectile disorder

The inability of a man to achieve or maintain an
erection
Orgasmic Disorders

Inability to reach orgasm in a person able to experience
sexual desire and maintain arousal
 Female Orgasmic Disorder
 Rarely reach orgasm
 Male Orgasmic Disorder
 Repeatedly cannot reach orgasm or its very
delayed
 Premature ejaculation
 Inability of a man to inhibit orgasm as long as
desired
Sexual Pain Disorders

Vaginismus:


Involuntary muscle spasms in the outer part of the
vagina that make intercourse impossible
Dyspareunia

Extreme pain felt in the genitals during sexual activity
Paraphilias


The term Paraphilia means “abnormal or
unnatural attraction”
These are sexual disorders that revolve
around abnormal means of achieving
sexual arousal
Types of Paraphilias








Exhibitionism
Fetishism
Transvestic Fetishism
Frotteurism
Pedophilia
Sexual Masochism
Sexual Sadism
Voyeurism
Exhibitionism


This involves having
fantasies about or
actually exposing the
genitals to an
unsuspecting stranger
A person repeatedly
exposes his genitals to a
stranger for the purpose
of achieving sexual
excitement
Symptoms

No sexual activity involved…





They do not become violent
They are usually very nervous
Often expose themselves and then flee area
before police arrive
Most are married (at least 60%)
Average intelligence, educational level, etc.
Possible Cause

Psychoanalytic theorists
 They suggest that childhood trauma
(e.g., sexual abuse) or significant
childhood experiences can manifest
itself in exhibitionistic behavior
Fetishism

Inanimate object
fetishists often collect
the object of their favor,
and may go to great
lengths, including theft,
to acquire just the "right"
addition for their
collection
Fetishism


In the majority of cases, the
person with a fetish poses no
danger to others and pursues
the use of the fetish object in
private
 Usually through
masturbation
Researchers have shown that in
general fetishists:
 Have poorly developed
social skills
 Are quite isolated in their
lives
 Have a diminished capacity
for establishing intimacy
Fetishism Explanations

The causes of fetishism are not clearly
understood…

Some learning theorists believe that it develops from
early childhood experiences


An object was associated with a particularly powerful form of
sexual arousal or gratification
Psychoanalytical theories of causality focus on
concepts of penis worship and castration anxiety
Transvestic Fetishism


Heterosexual males with this paraphilia
dress in female clothes to produce or
enhance sexual arousal
This occurs in heterosexual males and
is not part of Gender Identity Disorder



Cross-dressing
Usually without a real partner but with the
fantasy that they are the female partner
The fantasies, sexual urges, or
behaviors must cause clinically
significant distress or impairment in
social, occupational, or other important
areas of functioning
Transvestic Fetishism




Some will wear a single item of female apparel
under masculine clothing
These heterosexual males may have very few
sexual partners and have occasional
homosexual relationships
When not cross-dressing, they may behave in
stereotypic male fashion but this behavior often
turns quite feminine when wearing women's
clothing
It may be a means of reducing anxiety or
depression
Frotteurism



This Paraphilia is characterized by sexual
fantasies, urges, or behaviors involving touching
or rubbing one's genitals against the body of a
non-consenting person
 The person generally tries to escape
detection after touching the victim
This often occurs in somewhat conspicuous
situations such as on a crowded bus or subway
 In rare cases, the male may actually fondle a
women’s breast and then flee the scene
To be considered diagnosable, the fantasies,
urges, or behaviors must cause significant
distress in the individual or be disruptive to his
or her everyday functioning
Frotteurism


Cause
 Most experts agree that there
are underlying issues related
to childhood which play a
major role in the etiology
Treatment
 Typically involves
psychotherapy aimed at
uncovering and working
through the underlying cause
of the behavior
Pedophilia



According to the DSM-IV definition,
pedophilia involves sexual activity by an
adult with a prepubescent child
 Some individuals prefer females,
usually 8- to 10-year-olds
 Those attracted to males usually
prefers slightly older children
 Some prefer both sexes
While some are sexually attracted only to
children, others also are sometimes
attracted to adults as well
Gender difference:
 Pedophilia is almost always seen in
males and is seldom diagnosed in
females
Pedophilia




Pedophiliac activity may involve
undressing and looking at the child or
more direct physical sex acts
All these activities are psychologically
harmful to the child, and some may be
physically harmful
Individuals with pedophilia often go to
great lengths to obtain photos, films or
pornographic publications that focus on
sex with children
These individuals commonly explain
their activities with excuses or
rationalizations that the activities
Pedophilia

Why do they do it?
Treatment

Pedophilia generally is treated with
cognitive-behavioral therapy


The therapy may be prescribed alone or in
combination with medication
Low levels of serotonin has been linked

Selective serotonin reuptake inhibitors have
been used with limited success
Prognosis

Poor



Even after intensive treatment, the course of the
disorder usually is chronic and lifelong in most
patients
Which is the reason that most treatment programs
emphasize a relapse-prevention model
However, both the fantasies and the behaviors
often lessen with advancing age in adults (burnout)
Sexual Masochism

The disorder is characterized by
intense sexually arousing fantasies,
urges, or behaviors in which the
individual is humiliated, beaten,
bound, or made to suffer in some
way


Person derives sexual pleasure from
being abused or humiliated
Sexually masochistic behaviors are
typically evident by early adulthood,
and often start with masochistic or
sadistic play in childhood
Sexual Masochism




These patterns of behavior are not only
disruptive to social and occupational functioning,
but they run the risk of threat to physical safety.
Hypoxyphilia for example, involves the cutting
off of oxygen supply for purposes of sexual
stimulation
One to two deaths per million may be
attributable to this practice
While some may engage in minor sexual
masochism, there are those who increase the
risk to safety over the years, often thereby
insuring that the risk of serious injury occurs
Sexual Sadism


Individuals with this Paraphilia use sexual
fantasies, urges, or behaviors involving
infliction of pain, suffering or humiliation of
others to enhance or achieve their own sexual
excitement
For diagnosis:


the person has acted on these urges with a
nonconsenting person
the sexual urges or fantasies cause marked
distress or interpersonal difficulty
Sexual Sadism

Sadism is deriving pleasure, often sexual, from
mistreating others.


These people however have sadistic sexual urges who
find others whom they victimize with their behavior



Like other paraphilias, some people have fantasies which are
sadistic, but they never act upon them. Also, some people have
sexual urges of a sadistic nature, and they find a willing partner
who agrees to participate in the sadistic activity.
Some of the severe activities involved in sexual sadism include
burning, beating, stabbing, raping, and killing
Usually the thoughts and/or behaviors of sexual sadism begin in
adolescence or early adulthood
The behaviors are not only chronic, but they usually
increase in severity with time

Often, associated with anti-social personality disorder
Voyeurism


This disorder is characterized by either intense
sexually arousing fantasies, urges, or behaviors
in which the individual observes an
unsuspecting stranger who is naked, disrobing,
or engaging in sexual activity
To be considered diagnosable, the fantasies,
urges, or behaviors must cause significant
distress in the individual or be disruptive to his
or her everyday functioning
Gender Identity Disorder

Diagnostic Criteria


A strong and persistent cross-gender
identification
Persistent discomfort with his/her sex or
sense of inappropriateness in the gender role
of that sex

While this person may be male, he feels as if he is
a female
Diagnostic Criteria





An inconsistency between an individual’s physiological
sex identification and his or her gender identity
Persistent feelings of gender discomfort and
inappropriateness of anatomic sex
People with gender identity disorder act and present
themselves as members of the opposite sex
The disorder affects self-concept, the perception of an
ideal partner, and the display of femininity or masculinity
through mannerisms, behavior, and dress
These feelings persist for at least 2 years
Case Study: Reneé Richards


Richard Raskin had
been an
opthomologist and a
moderately good
professional tennis
player
In 1976 at age 52,
she entered a
women’s tennis
tournament
Gender Identity Disorder:
Types



Specified Gender Identity Disorder/Transsexualism
 This is the one we are analyzing tonight
Gender Identity Disorder, not otherwise specified
 Transient cross-dressing behavior
 Persistent preoccupation with castration without a
desire to acquire the sex characteristics of the other
sex
In both types:
 May occur in children or adults
 Rare disorders
Symptoms

Cross-sex identification


Individual wants to be, or claims to be the
opposite sex
Individual is uncomfortable about
his/her sex

Rejects traditional gender schemes, and
believes that they will become the opposite
sex
Gender Identity Disorder


This is not a choice for these people –
they do not feel that they have a choice
about their sexual identity
While some of these people only suffer
mild discomfort with their physiological
sex, others may have a sense of actually
belonging to the opposite sex
Explanations




Psychodynamic
Learning
Cognitive
Physiological
Psychodynamic Explanation

When the Oedipus/Electra Complex is
successfully resolved, the child identifies
with the same sex parent…if this conflict is
not resolved, the child is confused about
their gender identity
Learning Explanations

Parents foster the development of cross-sex
behaviors because they wanted a child of the
other sex


Fathers takes his daughter to football games, throws
the ball around, plays rough, etc.
Children develop this because broken homes
often cause single parenting to take place

This might cause some of these many children to
identify with the opposite sex parent who is around
and possibly to have hostility towards the same sex
parent who is not around
Learning Explanations

Maybe these parental responses are an effect
rather than a cause of the behavior



The father plays catch with the baseball or football in
the backyard because his daughter wants to play
catch
Also, some parents will often try to force their kids to
partake in traditional gender activities
Studies can’t seem to find differences in families
with or without someone with this disorder – they
look the same

So, the idea about broken homes might not be a
correct hypothesis either
Physiological Explanations

Exposure to high levels of hormones
associated with the opposite sex during
the fetal period


Girls exposed to androgens tend to be tomboys, boys exposed to estrogen more
feminine
Prenatal exposure to anticonvulsant
medications

Phenobarbital, Dilantin
Hormone Therapy


Some individuals take hormones
consistent with their desired gender
 Men will take estrogens (female
hormones)
 Females will take amdrogens (male
hormones)
They will usually develop the secondary
sex characteristics of that sex after this
treatment (development of breasts, etc.)
Sex Reassignment Surgery

A more drastic option is to go through a sexchange operation


Effective in making individuals look like members of
the opposite sex
Artificial vagina-like openings for the male-to-female
cahnge


Female-to-male change is more difficult

Penis can be attached


Orgasm is possible
Erections are not possible though
Additionally, these individuals will usually go
through the hormone therapy as well
Gender Identity Disorder

Additionally, those suffering from this
disorder should undergo the following
types of therapy:



Individual Counseling
Family Counseling
Couple Counseling