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
» 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

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 The Sexual Response Cycle

1. Appetitive phase
2. Excitement phase
3. Orgasm phase
4. Resolution phase

Copyright 2009 John Wiley & Sons, NY 6

 Sexual
Dysfunctions

 DSM-IV-TR four categories of sexual

dysfunction
1. Sexual desire disorders
2. Sexual arousal disorders
3. Orgasmic disorders
4. Sexual pain disorders

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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
 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
» 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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 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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 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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 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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