SEXUAL AND GENDER IDENTITY DISORDERS

Sex = a biological variable

male, female, intersex (hermaphrodite; ambiguous genitalia; fertility varies; .0005%)

Gender = a psychological variable

concerning identification as

male, female, transsexual (identity of the opposite sex)

Sex defined by:

anatomy

-external and internal reproductive organs

-secondary characteristic

(e.g. pubic hair, voice)

sex chromosomes

Sex Chromosomes

XX female

XY male

XO intersex*

XXY intersex*

XO/XY intersex*

XYY intersex*

* fertility varies

DSM's 3 Major Types Of Sexual And Gender Identity Disorders

1. Gender Identity Disorder

(transsexualism)

2. Paraphilias

3. Sexual Dysfunctions

1. Gender Identity Disorder

-sense of self as a male or female is not congruent with anatomy

2. Paraphilias

-sexual attraction to an unusual object or activity

3. Sexual dysfunctions

-sexual performance or arousal difficulties

Gender Identity Disorder

= a strong and persistent cross-gender identification

not just a desire for any perceived cultural advantage of being the other sex

not a result of an intersex condition (hermaphrodite)

prevalence: .00003% males

.00001% females

Gender Identity Disorder con'd

2 diagnostic criteria

(differ by age)

A. desire to be the opposite sex

B. discomfort with his or her sex

(feels in an inappropriate sex role)

Gender Identity Disorder con'd

A. desire

Children:

-verbally insists to be the other sex

-cross-dressing

-preference for cross-sex roles and stereotypical activities/play

Gender Identity Disorder con'd

A. desire con'd

Adolescents & Adults

-stated desire to be the other sex

-frequent passing as the other sex

-desire to live & be treated as the other sex

-conviction has feelings of the other sex

Gender Identity Disorder con'd

B. discomfort

Children-boys

-feels penis/testes are disgusting

-feels penis/testes will disappear

-asserts preference to not have a penis/testes

-rejects stereotypical male toys, games, and activities

Gender Identity Disorder con'd

B. discomfort con'd

Children-girls

-refusal to urinate in sitting position

-asserts she will grow a penis

-asserts she does not want breasts

-aversion toward feminine clothing

Gender Identity Disorder con'd

B. discomfort con'd

Adolescents & adults

-belief born the wrong sex

-preoccupation with eliminating primary and secondary sex characteristics

e.g., hormones,

surgery to alter genitalia

Gender Identity Disorder con'd

Etiology unknown

? both hormones & learning

(reinforcement and modeling)

Treatments

classical conditioning & cognitive restructuring

(case studies only)

sex-reassignment surgery

(high success rate for wide age range)

Gender Identity Disorder con'd

Sex-reassignment surgery con'd

Docter (1985) 74 year old male

Cohen-Kettenis & vanGoozen (1997) 22 adolescents 16-18 y/o

diagnosed GID for years

psychologically stable

live as opposite sex a year +

hormones for a year while live as opposite sex

surgery

(no penis for female to male as technical advances are underway)

Gender Identity Disorder con'd

Treatments con'd sex-reassignment surgery con'd

Cohen-Kettenis & vanGoozen (1997) con'd

RESULTS

gender dyphoria reduced

self-esteem improved

100% satisfied with treatment

none regretted surgery

71% w/ sex partner satisfied with sex life (14% neutral; 14% dissatisfied)

89% felt accepted

Paraphilias

sexual attraction is to unusual objects or sexual activities

not just fantasies, but behavior

creates distress or dysfunction

some are illegal

e.g., adult sex with children

prevalence unknown

(believed to be common given commercial market for paraphernalia and pornography)

8 DSM Paraphilias

Fetishism
Transvestic fetishism
Pedophilia
Voyeurism
Exhibitionism
Frotteurism
Sexual sadism
Sexual masochism

Effects of Pedophilia

pedophiles are treated with more disdain than most any other criminal (e.g., serial killer)

maligned, rejected, and abused by other prison inmates

publicly humiliated after serving prison sentence ("Megan's Law")

assumption that childhood sex is immoral and psychopathological

LONG — TERM EFFECTS OF CHILDHOOD SEXUAL EXPERIENCES

Rind et al. (1998)

Reviewed 59 studies of the adjustment of college students who had sexual experiences as children, including :

adult-child sex

coerced sex with childhood peers

LONG — TERM EFFECTS OF CHILDHOOD SEXUAL EXPERIENCES con'd Rind et al. (1998) con'd

RESULTS

sexual experiences as a child predicts 1% of adult adjustment

family environment (verbal and physical abuse, neglect, conflict) predicts 9% of adult adjustment among those who experienced sex as a child

Rind et al. (1998) con'd RESULTS con'd

Prevalence of childhood sexual experiences

Male 14%

Female 24%

not rare for children to have sex with adults or coerced by peers

Rind et al. (1998) con'd RESULTS con'd

Percentage who found childhood sexual experiences to be negative at the time

Male 33%

Female 72%

Not all children find sexual experiences to be abusive

Rind et al. (1998) con'd RESULTS con'd

Percentage who find childhood sexual experiences to be negative currently

Males 26%

Females 59%

Percentage who find childhood sexual experiences to be positive currently

Males 43%

Females 16%

Females report childhood sexual experiences to be negative more often than males do

Rind et al. (1998) con'd RESULTS con'd

Perceived negative effect of childhood sexual experiences on adult sexual attitudes and performance

Male 8.5%

Female 13 %

Most adults who had childhood sexual experiences are adjusted

Treatment = validation, empathy, and cognitive restructuring

Etiology of the Paraphilias

Psychodynamic theorists

-paraphilias are defense mechanisms

-guard the ego from dealing with repressed fears at oral and anal stages

-represent fixations at pregenital stages of psychosexual development.

Etiology of the Paraphilias con'd

Behaviorists

Classical conditioning

Modeling

Poor social skills

Reinforcement of unconventional sexual behavior

Treatments for the Paraphilias

LEGAL

Involuntary commitment to mental hospitals

Imprisonment

Court-ordered into treatment

"Megan’s law"

-effectiveness highly variable

-recidivism increases over time

-sex offenders often lack motivation to change

Treatments for the Paraphilias con'd

BEHAVIORAL

Aversion therapy
Satiation
0rgasmic reorientation

Social skills training
Alternative behavior competition
Cognitive procedures

Treatments for the Paraphilias con'd

MEDICAL

Castration

Drugs to lower testosterone

SEXUAL DYSFUNCTIONS

range of sexual problems that represent inhibitions in the normal sexual response cycle.

sexual problems are

persistent,

recurrent, and

cause marked distress or

interpersonal problems

Human Sexual Response Cycle

(1) appetitive (sexual desire; libido)

(2) excitement (sexual pleasure and accompanying physiologic changes such as tumescence)

(3) orgasm (the peak of sexual pleasure)

(4) resolution (relaxation following orgasm)

Sexual Dysfunctions

APPETITIVE/DESIRE

Hypoactive sexual desire disorder

(normal desire is not defined)

= lacking sexual fantasies and urges

(hyperactive desire not a DSM disorder)

Sexual aversion disorder

= actively avoids genital contact

Sexual Dysfunctions con'd

AROUSAL/EXCITEMENT

Female sexual arousal disorder

Male erectile disorder.

= "adequate" stimulation does not lead to arousal

-may reflect failure to learn what stimulation is sexually arousing

-may result from performance anxiety and organic factors

Sexual Dysfunctions con'd

ORGASM

Female orgasmic disorder

Male orgasmic disorder

= inhibited orgasm after a period of "normal" sexual excitement

-tumescence occurs (engorged vagina and erect penis)

Male premature ejaculation

-"premature" not defined

-40% lifetime prevalence

-associated with anxiety

Sexual Dysfunctions con'd

PAIN (females)

Dyspareunia

= pain before, during, or after sexual intercourse---not due to lack of lubrication

Vaginismus

= involuntary spasms of the outer 1/3^rd of vagina, preventing intercourse---associated with hx of rape/molestation

Etiology of Sex Dysfunctions

Masters and Johnson (1960's+)

CURRENT FACTORS

-the adoption of a spectator role

-fears of performance

HISTORICAL FACTORS

-religious orthodoxy

-psychosexual trauma

-inadequate counseling

-excessive intake of alcohol

-biological causes (e.g. diabetes)

Etiology of Sex Dysfunctions con'd

Other etiologic factors

-partner/marital conflict

-the meaning of a sexual problem for a person (e.g., reinforcement)

-lack of knowledge or skill

-poor communication by partners

-fear of acquiring sexually transmitted diseases

Treatment of Sexual Dysfunctions

-behavioral & cognitive-behavioral

Masters and Johnson

1^ST: a ban on sexual activity

2^ND discussion of the couple's sexual value system.

3^RD sensate focus, or pleasurable touching without intercourse & communicate desires to partner

4^th specific instructions for approaching intercourse

Treatment of Sexual Dysfunctions con'd

Other techniques:

anxiety reduction techniques

sensory-awareness procedures (e.g., "stop-start" for pre-mature ejaculation)

communication training

couples therapy

behavior rehearsal with surrogate

Treatment of Sexual Dysfunctions con'd

Other techniques con'd:

medical and physical procedures

-hormones

-anti-anxiety drugs

-anti-depressant drugs

-penis implants

-penis vacuum pump

-vasodilators (e.g.,Viagra)

Sex Abuse Treatment Center

55 Merchant Street, 22nd Floor

Honolulu, HI 96813

Emergency 24-Hour Crisis Hotline: 524-7273.

www.kapiolani.org/facilities/programs-sex.html

TEXTBOOK'S CASE STUDY:GID

Sex = female
Gender = male

History of reinforcement male behavior
No known biological cause

Female to male transsexual
Psychotherapy to assure GID
Hormone therapy
No surgery

Well-adjusted