Sex, Gender, and the Sexual Disorders

Classifying Sexual Disorders: The DSM-IV-TR Categories

• Paraphilias• Disorders involving persistent sexual desires

or preferences that are considered abnormal

• Gender identity disorder (transsexualism)• Disorder in which individuals feel that they

have the body of the wrong sex and want to change sexes

Paraphilias

• Exhibitionism

• Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one’s genitals to an unsuspecting stranger

• Voyeurism

• Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity

Paraphilias

Paraphilias

• Fetishism

• Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of nonliving objects

Paraphilias• Transvestic fetishim

(transvestitism) • Recurrent, intense sexually

arousing fantasies, sexual urges, or behaviors involving crossdressing in a heterosexual male

Paraphilias• Sexual sadism • Recurrent, intense

sexually arousing fantasies, sexual urges, or behaviors involving acts in which a victim’s psychological or physical suffering is sexually exciting

Paraphilias• Sexual masochism • Recurrent, intense sexually arousing fantasies,

sexual urges, or behaviors involving the act of being humiliated, beaten, bound, or otherwise made to suffer

Paraphilias

• Pedophilia • Recurrent, intense sexually arousing

fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children

Paraphilias• Frotteurism • Recurrent, intense sexually arousing fantasies,

sexual urges, or behaviors involving touching and rubbing against a nonconsenting person

Paraphilias• Paraphilias not otherwise specified• Necrophilia • Zoophilia (or bestiality) • Coprophilia• Urophilia • Telephone scatologia

Explaining And Treating Sexual Disorders: The Paraphilias

• Psychodynamic Components• Freud’s emphasized the idea that these

represented the direct expression in adulthood of “fixated” sexual interests from the developmental phases of childhood

• Contemporary theorists view paraphilias as a defense mechanism in response to an childhood experiences that resulted in humiliation.• Turning passive into active (identification with the

aggressor)

Explaining And Treating Sexual Disorders: The Paraphilias

• Cognitive-Behavioral Components• Classical conditioning• Social learning

• Cognitive-behavioral interventions• Phallometric assessment• Masturbatory satiation• Cognitive restructuring

Explaining And Treating Sexual Disorders: The Paraphilias

• Biological Components• Disinhibiting brain injuries or illness• Among women, mental retardation

plus history of abuse

• Biological interventions• Chemical castration• Antidepressant medications

Gender Identity Disorders• Disorder involving intense

discomfort with one’s biological sex…

and the desire to change it• Gender • A person’s psychological

sense of being male or female

Gender Identity Disorders• Strong and persistent cross-

gender identification

• Persistent discomfort with one’s sex or discomfort in the gender role of that sex

• Significant distress or functional impairment related to the condition

Gender Identity Disorders• Prevalence data:

extremely rare condition

• Male to female more common• GID more common

among children than among adults

Explaining Gender Identity Disorders• Biological components• Temperament issues

• Hormonal theories

• Psychodynamic components• Attempt to connect with a

depressed, withdrawn mother

Explaining Gender Identity Disorders• Behavioral components• Environmental reinforcement for cross-gender

behavior

• Sociocultural and family systems components• Family variables associated with GID: GID boys

often have many brothers and are among younger siblings; significant family-wide psychopathology

• Multiple causality in GID

Treating GID• Childhood GID:

Practical and ethical issues

• Adult GID: Sex change/reassignment protocols