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
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Table 13.1 Sexual
and Gender Identity
Disorders
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Table 13.2 Participation in Selected
Sexual Behaviors in the Past Year
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Gender and Sexuality

Men
» 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
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Figure 13.1 The Sexual Response
Cycle
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The Sexual Response Cycle
1.
2.
3.
4.
Appetitive phase
Excitement phase
Orgasm phase
Resolution phase
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Figure 13.2 Male and Female Sexual
Anatomy
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Sexual
Dysfunctions

DSM-IV-TR four categories of sexual
dysfunction
1.
2.
3.
4.
Sexual desire disorders
Sexual arousal disorders
Orgasmic disorders
Sexual pain disorders
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Table 13.3 Self-Reported Rates of Sexual
Problems in the Past 12 Months
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Figure 13.3 Sexual Dysfunctions by Phase
of the Sexual Response Cycle
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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
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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

R/O physiological causes, especially in older
adults
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3. Orgasmic Disorders

Female 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
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4. Sexual Pain Disorders

Dyspareunia
» Persistent or recurrent pain during intercourse
» Diagnosable in both men and women
– Prevalence in women from 10% to 30%
– Rare in men
» R/O medical cause (e.g., infection), lack of vaginal
lubrication, or menopausal problems

Vaginismus
» Involuntary spasms of the outer third of the vagina
» Prevent penetration
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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
1. Historical causes
2. Current causes
A. Performance fears
B. Adoption of spectator role
A.
Observer vs. participant
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Figure 13.4 Historical and Current Causes
of Sexual Inadequacies
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Figure 13.5 Predictors of Sexual
Functioning
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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
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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
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Figure 13.6 Devices for Measuring
Sexual Arousal
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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
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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
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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
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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
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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
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Table 13.4 Paraphilias included in
DSM-IV-TR
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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
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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
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Pedophilia

DSM-IV-TR
» 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.
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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.
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Voyeurism

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
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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
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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
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Sexual Sadism and Sexual
Masochism

Sexual Sadism
» 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
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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
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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
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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”
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Table 13.5 Examples of Cognitive Distortions
and Justifications in Sexual Paraphilias
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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
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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
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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
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Rape

Typical characteristics 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
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Figure 13.7 Rates of Sexual Assault
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Table 13.6 Behaviors that College Students
Report after a Partner Refuses Sexual Contact
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Copyright 2009 by John Wiley & Sons, New
York, NY. All rights reserved. No part of the
material protected by this copyright may be
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