1. abnormal PSYCHOLOGY Third Canadian Edition Prepared by: Tracy Vaillancourt, Ph.D. Chapter 14 Sexual and Gender Identity Disorders

2. Sexual & Gender Identity Disorders A. Gender Identity Disorder B. Paraphilias C. Sexual Dysfunctions

3. Gender Identity Disorder (GID) People with GID feel they are the opposite sex Have aversion to same-sex clothing & activities Typically begins in childhood –associated with cross-gender behaviours and developmental lag in achieving gender constancy –usually recognized by parents at age 2-4 –6.6 time more frequent in boys than girls Note. GID is differentiated from transvestic fetishism

4. Why seek clinical assessment? 1.Belief that behaviour no longer a phase that child will grow out of 2.Threshold violation 3.Belief that child was experiencing intense distress about being a boy or a girl 4.Concerns about potential or actual peer rejection

5. Causes of GID Evidence indicates that gender identity is influenced by hormones May be related to sex hormones levels during pregnancy See also …

6. Therapies of GID Two main types of therapies— –Altering body to suit person’s psychology Sex-reassignment surgery Hormone administration –Altering psychology to match person’s body

7. Paraphilias Group of disorders involving sexual attraction to unusual objects or sexual activities that are unusual in nature –Fantasies, urges, or behaviours must last at least six months and must* cause significant distress or impairment *has created problems because not all are distressed or impaired

8. Fetishism Reliance on an inanimate object for sexual arousal –almost always male –usually begins by adolescence –often have other paraphilias pedophilia, sadism, masochism Common fetishes include: –Feet and shoes –Sheer stockings –Rubber products –Toilet articles –Fur garments –Underpants

9. Transvestic Fetishism Transvestic fetishism— A male who is sexually aroused by dressing in women’s clothing, although he still regards himself as a man –Usually begins with partial cross-dressing in childhood or adolescence –Heterosexual –Always males –Masculine in appearance, demeanour, and sexual preference –Many are married Note. Not the same as cross-dressing associated with GID or preferences of some homosexuals

10. Pedophilia Pedophilia—sexual gratification through physical and often sexual contact with prepubescent children –Offender must be at least 16 and at least 5 years older than child Characteristics –Occurs far more frequently in men than in women –Pedophile can be heterosexual or homosexual –Comorbid with mood and anxiety disorders, substance abuse, and other paraphilias

11. Incest Incest— sexual relations between close relatives for whom marriage is forbidden. –Subtype of pedophilia Characteristics –most common between 1) brother and sister 2) father and daughter –unusually patriarchal and traditional family structure –parents tend to neglect and remain emotionally distant from children –more prevalent when mother is absent or disabled

12. Voyeurism and Exhibitionism Voyeurism — involves marked preference for obtaining sexual gratification by watching others in state of undress or having sexual relations Characteristics –Most often men –Typically do not get aroused by watching others who have consented –Often begins in adolescence –Comorbid with other paraphilias Exhibitionism —recurrent, marked preference for obtaining sexual gratification by exposing one’s genitals to an unwilling stranger Characteristics –Most often men –typically begins in adolescence Voyeurism and exhibitionism account for majority of all sexual offences that come to attention of police.

13. Frotteurism Involves the sexually oriented touching of an unsuspecting person Characteristics –Typically men –Begins in adolescence –Comorbid with other paraphilias

14. Sexual Sadism and Masochism Sexual Sadism— marked preference for obtaining or increasing sexual gratification Sexual masochism— marked preference for obtaining or increasing sexual gratification through subjecting oneself to pain or humiliation Characteristics –85% are heterosexual –20-30% are women (20-30%) –Seems to begin in early adulthood –Comorbid with alcohol abuse and dependency Example: hypoxyphilia

15. Etiology Psychodynamic Perspectives Behavioural and Cognitive Perspectives Biological Perspectives

16. Therapies Psychoanalytic Therapy Behavioural Techniques –Orgasmic reorientation Cognitive Treatments Biological Treatment

17. Rape Forced rape— sexual intercourse with an unwilling partner Statutory rape— sexual intercourse with someone under the age of consent –age of consent in Canada is 14 Definition of rape includes oral and anal entry, and vaginal penetration

18. Rape cont. 70% of rapes are associated with intoxication Rape is act of violence, aggression, and domination and an act of sex Most (>80%) assaults perpetrated by men who are familiar to victim Rapists tend to: –have very high hostility toward women –lack social skills –have low self-esteem –low levels of empathy for their victims

19. Sexual Dysfunctions Fall into 4 categories: 1.Sexual desire disorders 2.Sexual arousal disorders 3.Orgasmic disorders 4.Sexual pain disorders

20. Sexual Response Cycle Appetitive  Excitement  Orgasm  Resolution

21. Sexual Dysfunctions Sexual Desire Disorders Hypoactive sexual desire disorder— deficient or absent sexual fantasies and urges –Prevalence 20-30% of general adult population –More women than men Sexual aversion disorder— active avoidance of nearly all genital contact with another person. Sexual Arousal Disorders Female sexual arousal disorder –Prevalence 20% Male erectile disorder –Prevalence 3-9%

22. Sexual Dysfunctions Orgasmic Disorders Female orgasmic disorder— absence of orgasm after period of normal sexual excitement –Prevalence 5-24% Male orgasmic disorder— difficulty ejaculating –Prevalence 3-8% Premature ejaculation –Affects up to 40% of men at some time in their lives Sexual Pain Disorders Dyspareunia— persistent or recurrent pain during sexual intercourse –Prevalence 8%-15% for women –Prevalence < 1% for men Vaginismus— involuntary spasms of the outer third of the vagina to a degree that makes intercourse impossible –normal sexual arousal and have orgasms possible with manual or oral stimulation –Prevalence 12-17% of women seeking sex therapy

23. General Theories of Sexual Dysfunctions

24. Therapies for Sexual Dysfunctions Anxiety Reduction Directed Masturbation Procedures to Change Attitudes and Thoughts –sensory-awareness procedures Skills and Communication Training Couples Therapy Psychodynamic Techniques Medical and Physical Procedures

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