4/24/2017 PowerPoint  Lecture Notes Presentation Chapter 13 Sexual and Gender Identity Disorders Abnormal Psychology, Eleventh Edition by Ann M. Kring, Gerald C. Davison, John M. Neale, & Sheri L. Johnson

Sexual and Gender Identity Disorders Sexual dysfunction Disruption in sexual functioning Gender Identity disorder People who believe they are of the opposite sex Paraphilias Attraction to unusual sexual activities or objects

Table 13.1 Sexual and Gender Identity Disorders

Gender and Sexuality Men Women Think more about sex Want more sex Want more and have more partners Consistency across cultures Have more sexual dysfunction as they age Women Desire for sex more often linked to relationship status and social norms Tend to be more ashamed of appearance flaws May interfere with sexual satisfaction Do not have more sexual problems than younger women At all ages, women more likely than men to report sexual dysfunction

Figure 13.1 The Sexual Response Cycle

The Sexual Response Cycle Appetitive phase Excitement phase Orgasm phase Resolution phase Copyright 2009 John Wiley & Sons, NY

Sexual Dysfunctions DSM-IV-TR four categories of sexual dysfunction Sexual desire disorders Sexual arousal disorders Orgasmic disorders Sexual pain disorders

Figure 13.3 Sexual Dysfunctions by Phase of the Sexual Response Cycle

1. Sexual Desire Disorders 4/24/2017 1. Sexual Desire Disorders Hypoactive sexual desire disorder Deficient or absent sexual fantasies and urges Low sex drive Cultural norms influence perceptions of how much sex a person should want Sexual aversion disorder Individual actively avoids nearly all genital contact with another person

2. Sexual Arousal Disorders Female Sexual Arousal Disorder Consistently inadequate vaginal lubrication for comfortable completion of intercourse Male Erectile Disorder Persistent failure to attain or maintain an erection through completion of the sexual activity Physiological causes, especially in older adults

3. Orgasmic Disorders Female orgasmic disorder Male orgasmic disorder Absence of orgasm after sexual excitement Many women achieve arousal but not orgasm Male orgasmic disorder Persistent difficulty ejaculating Premature ejaculation Ejaculation that occurs too quickly

4. Sexual Pain Disorders Dyspareunia Vaginismus Persistent or recurrent pain during intercourse Diagnosable in both men and women Prevalence in women from 10% to 30% Rare in men Medical cause (e.g., infection), lack of vaginal lubrication, or menopausal problems Vaginismus Involuntary spasms of the outer third of the vagina Prevent penetration

Etiology of Sexual Dysfunction Psychoanalytic Underlying repressed conflicts e.g., Premature ejaculation reflects unconscious hostility towards partner who reminds him of his mother Lack empirical support Masters & Johnson (1970) two tier model Historical causes Current causes Performance fears Adoption of spectator role Observer vs. participant

Figure 13.4 Historical and Current Causes of Sexual Inadequacies

Etiology of Sexual Dysfunction: Biological factors Diseases of vascular system Diseases of the nervous system Low levels of testosterone or estrogen Heavy alcohol consumption before sex History of chronic alcoholism Heavy cigarette smoking Medications Antihypertensives SSRIs

Etiology of Sexual Dysfunction: Psychosocial Factors Rape Early childhood sexual abuse Relationship problems Anger, hostility, poor communication Underlying anxiety about relationship security Psychological disorders Major depression, anxiety, or panic disorder Low physiological arousal Stress and exhaustion Negative cognitions

Treatment of Sexual Dysfunction Anxiety reduction Directed masturbation Procedures to change thoughts & attitudes Sensory awareness procedures Rational-emotive therapy Sexual skills training Communication training Couples therapy Medications and physical treatments Squeeze technique for premature ejaculation Viagra for erectile dysfunction

Gender Identity Disorder Formerly known as transsexualism Individuals feel that they are of the opposite sex Despite normal genitals Feelings usually present since childhood May seek out surgery to alter body Feelings must cause distress or impairment or no diagnosis is given Individuals with GID may be sexually attracted to same or opposite sex individuals Prevalence: 1 in 12,000 in men 1 in 30,000 in women

Gender Identity Disorder Controversial diagnostic category Should it be a psychiatric disorder? Diagnosis pathologizes a natural diversity found in nature Also carries stigma GID can be diagnosed in children Cross-gender behaviors common in kids Most children with GID grow up to be comfortable with their biological sex without professional intervention

Etiology of Gender Disorder Genetic factors symptoms of gender identity during childhood are at least moderately heritable Neurobiological factors Exposure to high levels of sex hormones in utero Social and psychological factors Reinforcement of cross gender behaviors

Treatment of Gender Identity Disorder Sex reassignment surgery Genitalia altered to look like those of opposite sex 1 year living as opposite sex before surgery recommended Behavioral treatment to alter gender identity Shaping of more masculine behaviors May only be effective for individuals who want treatment for GID

Table 13.4 Paraphilias included in DSM-IV-TR

Fetishism Reliance on an inanimate object for sexual arousal e.g., shoes, stockings, underwear, rubber garments Occurs most often in men Object often necessary for sexual arousal Attraction to object irresistible and involuntary Fetishes often co-occur with other paraphilias

Transvestic Fetishism Transvestic Fetishism orTransvestism Recurrent and intense sexual arousal from cross-dressing No desire to be of the opposite sex Always men, many of whom are married and conventional in other ways Often comorbid with other paraphilias Especially masochism

Pedophilia DSM-IV-TR Victims usually known to pedophile Sexually arousing urges, fantasies or behaviors involving sexual contact with a prepubescent child Offender at least 16 years old and 5 years older than victim Victims usually known to pedophile Neighbors, family members, friends ½ of child molestation committed by adolescent males Academic and criminal activity are common Often meet criteria for conduct disorder and substance abuse Most pedophilia does not involve violence other than the sexual activity Offender may deny that sexual contact is forced on child.

Incest Subtype of pedophilia Most common Brother and sister Less common but more pathological Father and daughter Incest taboo almost culturally universal Genetically adaptive Offspring of father-daughter or brother-sister have a greater likelihood of inheriting pairs of recessive genes with possible negative biological effects.

Voyeurism Voyeuristic fantasies are common Sexually arousing fantasies, urges, or behaviors while observing other who are unclothed or engaging in sexual activity Almost always men Excitement comes from knowing the victim is unaware of the voyeur Seldom results in physical contact Orgasm achieved by masturbation Victims unaware that they are being watched Voyeuristic fantasies are common Fantasies that are not distressing do not warrant diagnosis

Exhibitionism Intense desire to obtain sexual gratification by exposing one’s genitals to unwilling stranger Victims can be children Seldom results in physical contact Usually involves desire to shock or alarm victim Often comorbid with voyeurism and frotteurism

Frotteurism Sexually oriented touching of a nonconsenting person The individual rubs his genitals against a women’s body or fondles her breast or genitals Often occurs in crowded subway or other public place

Sexual Sadism and Sexual Masochism Intense and recurrent desire to obtain or increase sexual gratification by inflicting pain or psychological suffering on another person Sexual Masochism Intense and recurrent desire to obtain or increase sexual gratification through receiving pain or humiliation Infantilsm Desire to be treated like an infant and dressed in diapers Hypoxyphilia Sexual arousal by oxygen deprivation Can result in death or serious brain damage Begin by early adulthood Occur in both gay and heterosexual individuals 20 to 30% are women

Sexual Sadism and Sexual Masochism Some individuals achieve orgasm by engaging in these behaviors For others, behaviors are one aspect of sexual intercourse Sadism and masochism have become more acceptable over time Diagnose only if cause distress or impairment Small percentage of sadists mutilate or murder

Etiology of Paraphilias Neurobiological Factors Male hormones or androgens Almost all individuals with paraphilias are men Dysfunctional temporal lobe Psychodynamic Factors Fixation at pregenital stage of development Paraphilia a defense against repressed fears and conflicts Castration anxiety

Etiology of Paraphilias Psychological factors Classical conditioning Research has not supported orgasm conditioning hypothesis Operant conditioning Poor social skills or reinforcement of unconventionality History of childhood physical and sexual abuse Alcohol & negative affect are common triggers Cognitive distortions “Because the child doesn’t run away, she must want me to fondle her”

Treatment for Paraphilias Incarceration and court ordered treatment are common Often difficult to interpret outcome from treatment studies Studies vary greatly Many lack control groups Drop out rates high Denial and minimization of problem often present Lack of motivation for treatment Some blame the victim

Treatment for Paraphilias Aversion therapy Covert sensitization Satiation therapy Cognitive therapy Counter distorted thinking Often combined with social skills and empathy training Biological treatments Castration used in past Medications Hormonal agents to reduce androgens Depo-Provera SSRIs

Rape Forced Sexual intercourse with unwilling partner Statutory Sexual intercourse with a minor 25 to 30% of women will be raped in their lifetimes Most rapists known to their victims Reasons that less than ½ rapes are reported Rape is a private matter Fear of reprisal Belief that police will be ineffective or insensitive

Rape Typical characteristics of rapists Treatment of rapists Hostility towards women Antisocial and impulsive personality traits Sexual dysfunction Treatment of rapists Empathy training, anger management, treatment for substance abuse Biological agents to reduce sex drive by lowering male hormone levels