Chapter 11: Gender Identity Disorder, Paraphilias & Sexual Dysfunctions
I. Gender Identity Disorder
DSM-IV:
A strong and persistent cross-gender identification
(a) In children, GID is shown by 4 or more of the following:
1. Repeated desire to be the other sex
2. Preference for, or insistence on, wearing clothes that are stereotypically of the
other sex
3. Preference for cross-sex roles in play
4. Desire to play stereotypical games of the other sex
5. Preference for playmates of the other sex
(b) In adults, GID is shown by:
1. Desire to be the other sex
2. Frequent attempts to pass as the other sex
3. Desire to live as the other sex
4. Conviction that he/she has the feelings and reactions of the other sex
"Clinically sig distress or impairment in social, occupational or other important areas
of functioning"
 Disorder in which an individual believes that his/her anatomic gender is
inconsistent with his/her psychological sense of being ♂ or ♀
 Gender differences
 Children vs adults …
Etiology
 *Very little is known about the origins of GID
Suggestions:
 Psychodynamic and behavioural theories …
 Genetically influenced hormonal disturbances or prenatal effects …
Treatment
 Attempts have been made to encourage gender-appropriate and discourage crossgender behaviour among GID children ...
 Other opinion … allow child to live as other gender …
 Some eventually request hormonal treatment or surgery to reassign them to the
opposite sex ...
 Reassignment
– Process …
– Careful evaluation; live as other gender for _____
– Hormones
– Surgery …
–
Is it covered by OHIP?
 Outcomes of gender-reassignment surgery:
II. Sexual Preference Disorders
–
Gender difference: Majority = _____
–
Diversity …
Paraphilia
Recurrent, intense fantasies, urges or behaviours involving …
Fetishism
Non-living objects
 Diversity! … note: __________ for DSM diagnosis
 Origins … (learning theories: conditioning &
observational learning)
 Partialism …
Transvestic Fetishism
Cross-dressing
 Profile …
 Typically, in private
Sexual Masochism
Being humiliated, beaten, bound or otherwise made to suffer
 Practices …
 Hypoxyphilia
Sexual Sadism
Acts that cause phys or psych suffering to another person
Sadomasochism
Mutually gratifying sexual interaction involving both S & M acts;
many times, switch roles
Exhibitionism
Exposure of one's genitals to an unsuspecting stranger
 Typically does NOT seek sex activity …
Voyeurism
Watching an unsuspecting person who is either naked,
disrobing or engaged in sexual activity
 Typically does NOT seek sex activity …
Frotteurism
Touching or rubbing against a non-consenting person
Paraphilia
Recurrent, intense fantasies, urges or behaviours involving …
Pedophilia
Sexual activity with a prepubescent child
 Must be at least 16 yrs old & at least 5 yrs older than victim;
mostly ♂
 Diversity!
 Profile: MOST are …
 NOTE: not all child molesters have pedophilia!!






Other
Klismaphilia
Urophilia
Coprophilia
Necrophilia
Bestiality
Scatalogia
Theoretical Perspectives
Learning Theories:
Conditioning
Observational Learning
Treatment
Behavioural
Therapy
Aversive Conditioning
CBT
•
•
•
Medications
Adaptive thoughts
Social skills
Stress-mgmt skills
III. Sexual Dysfunctions
What is normal sexual functioning? ...
Masters and Johnson:
 Sex response cycle:
– changes that occur in the body with increased sexual arousal, orgasm and
the return to the unaroused state
– Terms:
• Vasocongestion
•
Myotonia
– 4 stages:
1. Excitement
–
–
–
–
Erection in the male
Vaginal lubrication in the female
Increased myotonia, heart rate, and blood pressure
Sex flush
2. Plateau
–
–
–
Increases in vasocongestion, muscle tension, heart rate, and blood pressure
Orgasmic platform
Sex skin
3. Orgasm
–
Contractions!! …
4. Resolution
–
–
Body gradually returns to its prearoused state
Refractory period
III. Sexual Dysfunctions
 DSM-IV categorizes sex dysfunctions according to which of the 3 phases is
affected: desire, arousal or orgasm; Separate category: pain = primary
complaint
 Specifiers:
– Lifelong vs acquired
– Generalized vs situational
 Causes marked distress or interpersonal difficulty
Sexual Desire
Disorders
Hypoactive sexual desire disorder
 Persistent or recurrent deficiency of sexual fantasies and desire for sex
Sexual aversion disorder
 Persistent or recurrent, extreme aversion to, and avoidance of, almost
all genital sex with a partner
Sexual Arousal
Disorders
emotionally and
mentally interested
in sex but person
does not become
physiologically
aroused
Female sexual arousal disorder
 Persistent or recurrent inability to attain or maintain arousal "until
completion of the sexual activity”
Orgasmic
Disorders
Female orgasmic disorder (anorgasmia)
 Persistent or recurrent delay in, or absence of, orgasm following
normal excitement
Male erectile disorder
 Persistent or recurrent inability to reach or sustain an erection "until
completion of the sexual activity"
Male orgasmic disorder
 Same as above
Premature Ejaculation
 Persistently ejaculates with minimal stimulation and often before or
immediately following intromission (entry of penis into vagina)
Sexual Pain
Disorders
Dyspareunia
 Genital pain associated with intercourse; must not be caused
exclusively by lack of lubrication or vaginismus
Vaginismus
 Persistent involuntary contraction of the muscles in the outer 3rd of
the vagina upon attempts at penetration
Etiology
Biological
Perspectives
–
Learning
Perspectives
Cognitive Factors
–
–
Role of
conditioned
anxiety
The following can affect desire &/or sex functioning:
1.
2.
3.
4.
Problems in Relationships
Learning
sex skills …
Sociocultural Perspectives
Psychological Factors
Treatment
Sex Therapy
Sex desire disorders
– Treat sex
dysfunctions by
modifying
couple’s
interactions
Arousal disorders
Orgasmic disorders
Pain disorders
Biological
Treatments
•
For ED:
• Silicone implants
• Hormone treatments
• Vascular surgery
• Viagra (note: mixed results for ♀)
• Injections of muscle relaxants
•
For premature ejaculation: ______________________