1. Chapter 14
Sexual Disorders and
Gender Dysphoria

2. Chapter Outline Gender Identity Disorder and Gender Dysphoria
The Paraphilias
Rape
Sexual Dysfunctions
Source: page 2

3. Overview of Paraphilic Disorders and Sexual Dysfunctions

4. Gender Identity Disorder DSM-IV-TR
DSM:IV-TR: condition termed ‘gender identity disorder’ (GID)
No longer a diagnostic condition (DSM-5)
Sometimes referred to as ‘transsexualism’.
Individuals who feel deeply that 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 (self-acceptance of one’s gender)
Criticism of GID as a mental disorder if no discomfort, according to Bartlett and colleagues review of research
Concerns that GID label could be stigmatizing led to DSM-5 removal of GID as a disorder

5. Gender Dysphoria DSM-5 Gender Dysphoria (DSM-5) is new DSM-5 condition
Emphasize gender incongruence not pathologize cross-gender identification
Experience significant identity-related distress

6. Therapies for gender identity issues
Two main types of therapies:
1. Altering body to suit person’s psychology
Sex-reassignment surgery
More frequent male to female
Criteria that predict successful post-surgery adjustment:
Emotional stability,
adaptation in new role for at least one year,
understanding of surgery limitations,
psychotherapy
Hormone administration
2. Altering psychology to match person’s body
behavioural training alters gender identity
most transexuals refuse such treatment

7. Paraphilias Para – term refers to deviance
Philia – term refers to attraction
Group of conditions involving sexual attraction to unusual objects or sexual activities that are unusual in nature
Involve fantasies, urges, or behaviours
last at least six months
cause significant distress or impairment
Distinction made by DSM-5 between two conditions:
paraphilias (no distress about having atypical attractions)
paraphilic disorders (distress about atypical attractions)

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

9. Transvestic Disorder Transvestism or transvestic disorder
man who is sexually aroused by dressing in women’s clothing, although he still regards himself as a man
Heterosexual
Always males, many are married
Masculine in appearance, demeanour, and sexual preference
usually begins with partial cross-dressing in childhood or adolescence
Cross-dressing may become more frequent over time and may be accompanied by gender dysphoria

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
DSM-5: No longer considered to subtype of pedophilia
Characteristics
Most common between
1. Brother and sister
2. Father and daughter
Unusually patriarchal and traditional family structure (subservient position of women)
Parents tend to neglect and remain emotionally distant from children
More prevalent when mother is absent or disabled

12. Voyeurism and Exhibitionism
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—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
Voyeurism and exhibitionism account for the 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 through inflicting pain or humiliation on others
sexual masochism— marked preference for obtaining or increasing sexual gratification through subjecting oneself to pain or humiliation
Characteristics:
85% are predominantly heterosexual
20-30% of members of sadomasochistic clubs are women
Seems to begin in early adulthood
occasionally associated with acts of murder, mutilation
Sadistic sex offenders differ from other sex offenders:
More likely to impersonate police
More likely to commit serial murders, tie up victims, conceal corpses

15. Other specified paraphilic disorders
Necrophilia – sex with dead people
Zoophilia – sex with animals (bestiality)
Telephone scatologia – urge to make obscene phone calls
Coprophilia – use of feces for sexual excitement
Klismaphilia – use of enemas for sexual excitement
Uruophilia - use of urine for sexual excitement

16. Etiology of Paraphilias
Psychodynamic Perspectives
Protecting ego from dealing with repressed fears and fixations at pre-genital stages of psychosexual development
Behavioural and Cognitive Perspectives
multifactorial causes may include: childhood sexual abuse, disturbed family relations, insecure attachment
Inadequate social skills, cognitive distortions
Biological Perspectives
possible role of androgen (principal male hormone)
disturbances in normal hormonal fetal development
fMRI studies show altered brain activity in frontal and temporal regions

17. Therapies Behavioural Techniques Cognitive Treatment
Orgasmic reorientation involves learning to be aroused by conventional stimuli
Cognitive Treatment
training in challenging distorted thinking
Empathy training to consider impact on victim
Relapse prevention modelled on work with substance use

18. 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
Acquaintance rape – also known as date rape
Up to one-third of Canadian undergraduate women report having experienced sexual coercion while dating
15% of Ontario women undergrads report sexual assault (including 2% who experienced ‘date rape’)

19. Rape (cont.) 70% of rapes are associated with intoxication
Rape is act of violence, aggression, and domination and an act of sex
Most (81%) 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

20. Therapies Related to Rape
Therapies for Rape Victims
Rape crisis centres and telephone hotlines
Treatment for PTSD
CBT and cognitive processing therapy
Therapies for Rapists
Cognitive techniques
Group therapy
Biological treatment

21. Sexual Dysfunctions Categories of sexual dysfunctions:
Sexual desire disorders
Sexual arousal disorders
Orgasmic disorders
Sexual pain disorders

22. Sexual Dysfunctions (Cont.)
Sexual Response Phases
Appetitive 
Excitement
Orgasm
Resolution

23. Sexual Dysfunctions (Cont.)
Sexual Arousal Disorders
No longer label people as ‘frigid’ or ‘impotent’
Female sexual arousal disorder
Prevalence 20%
Male erectile disorder
Prevalence 3-9%
Hypersexual disorder
‘sex addicts’
not a DSM-5 condition
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
So rare that it is no longer considered DSM-5 disorder

24. Sexual Dysfunctions (cont.)
Orgasmic Disorders
Female orgasmic disorder— absence of orgasm after period of normal sexual excitement
Prevalence %
As many as 10% of women have never experienced orgasm
Male orgasmic disorders—delayed ejaculation
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
Linked to lower sexual desire and lower arousal
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

25. General Theories of Sexual Dysfunctions

26. Therapies for Sexual Dysfunctions
Anxiety Reduction
Directed Masturbation
Procedures to Change Attitudes and Thoughts
Sensory-awareness procedures
Skills and Communication Training
Couples Therapy
Medical and Physical Procedures

27. Copyright
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