Sexual & Gender Identity Disorders
Definiitons
Sex
á
An
objective biological variable
á
Types: Male, female, intersex (hermaphrodite;
ambiguous genitalia; fertility varies; .0005%)
Gender
á
A
psychological variable
á
Subjective identification as male, female,
transsexual (identity of the opposite sex)
Sexual & Gender
Identity Disorders
Definitions conÕd
Sex
defined by:
á
Anatomy
o
External
and internal reproductive organs
o
Secondary
characteristics after puberty
¤
e.g.
pubic hair, voice, breasts
á
Sex
chromosomes
Sexual & Gender
Identity Disorders
Sex Chromosomes
á
XX
female XY Male
á
XO
intersex* XO/XY intersex*
á
XYY
intersex* XXY intersex*
*
fertility varies
Sexual & Gender
Identity Disorders
DSM
3
Major Types Of Sexual And Gender Identity Disorders:
1.
Gender Identity Disorder (GID)
i.e.
transsexualism
2.
Paraphilias
3.
Sexual Dysfunctions
Sexual & Gender
Identity Disorders
Gender
Identity Disorder
á
Sense of self as a male or female is not
congruent with anatomy and is distressful
Paraphilias
á
Sexual
attraction to an unusual object or activity that causes distress or dysfunction
Sexual
dysfunctions
á
Sexual
performance or arousal difficulties
that
cause distress or dysfunction
Sexual & Gender
Identity Disorders
Gender Identity
Disorder
á
A
strong
& persistent
cross-gender identification
o
Not just a desire for a perceived
cultural advantage of being the other sex
o Not the result of an intersex condition
i.e. hermaphrodite
á
Prevalence
o 0.00003% males
o 0.00001% females
Defining Abnormal
Behavior
á Statistical
infrequency
á
Violation
of norms
á
Unexpectedness
á Personal distress*
á Disability/dysfunction*
*
GID not controversial but not considered a DX in all cultures or times in
history—e.g. Etruscans
Gender Identity
Disorder
Diagnostic
criteria
(differs by age):
A.
Desire to be the opposite sex
B.
Discomfort with his or her sex
-
Feels an inappropriate sex role
Gender Identity
Disorder
Desire
to be the Opposite Sex
Children
á Verbally insists to be the other sex
á Cross-dressing (how
define?)
á Preference for
cross-sex roles and stereotypical activities/play (how define?)
Gender Identity
Disorder
Desire
to be the Opposite Sex contÕd
Adolescents
& Adults
á
Stated
desire to be the other sex
á
Frequent
passing as the other sex
á
Desire to live & be treated as the
other sex
á Conviction has feelings of the other sex
Gender Identity
Disorder
Discomfort
with Sex
Children:
Boys
á Feels penis/testes
are disgusting
á Feels penis/testes
will disappear
á Asserts preference to
not have a penis/testes
á Rejects stereotypical
male toys, games, and activities (how define?)
Gender Identity
Disorder
Discomfort
with Sex contÕd
Children:
Girls
á Refusal to urinate in
sitting position
á Asserts she will grow
a penis
á Asserts she does not
want breasts
á Aversion toward
feminine clothing
Gender Identity
Disorder
Discomfort
with Sex contÕd
Adolescents
& adults
á Belief born the wrong sex
á Preoccupation with
eliminating primary and secondary sex characteristics
o e.g., hormones or surgery to alter
genitalia
o e.g., electrolysis
Gender Identity
Disorder Etiology
Causes
are:
á Unknown
á Not related to
intersex
á Both hormonal &
learning?
o Reinforcement and modeling?
Gender Identity
Disorder Treatments
Cognitive
Behavioral Treatment
á Classical
conditioning & cognitive restructuring
o Rare case studies report success
Biologial
and Cognitive Behavioral Treatment
á Sex-reassignment
surgery
á Behavioral rehearsal
á Cognitive
restructuring of causal attributions
á Problem-solving
o High success rate for wide age range
Gender Identity
Disorder – Treatments
Sex
Reassignment Surgery and Cognitive Behavioral Treatment Outcome
Docter
(1985)
á 74 year old male
Cohen-Kettenis
& vanGoozen (1997)
á 22 adolescents 16-18 y/o
Sexual & Gender
Identity Disorders
Paraphilias
á
Sexual
attraction is to unusual objects or sexual activities
á
Not
just fantasies, but behavior
á
Creates
distress or dysfunction*
á
Some
illegal (possible harm to others)*
á
Prevalence
unknown
? Common given
commercial market
*not controversial
8 DSM Paraphilias
1.
Fetishism
2.
Transvestic fetishism
3.
Pedophilia*
4.
Voyeurism*
5.
Exhibitionism*
6.
Frotteurism*
7.
Sexual sadism**
8.
Sexual masochism
* dysfunctional = harm to others
**dysfunctional if rape vs. consensual
Paraphilias
PEDOPHILIA
Conviction for Pedophilia
á Pedophiles treated
with more disdain than other criminals (e.g., serial killer)
á Maligned, rejected,
& abused by other inmates
á Publicly humiliated
and loss of rights after serving sentence
o "Megan's Law"
Assumption
that childhood sex is immoral &
harmful to child = empirical question
Paraphilias
PEDOPHILIA conÕd
Long-term
Effects of Childhood Sexual Experiences
Rind
et al. (1998)
á 59 studies of adjustment of college
students who had sexual experiences as children
o adult-child sex
o coerced sex with childhood peers
GENERALIZABILITY
LIMITATION: sample
Paraphilias
PEDOPHILIA conÕd
Long-term
Effects of Childhood Sexual Experiences
Rind
et al. (1998) contÕd
á Adjustment
o 1% of adult adjustment predicted by
childhood sexual experiences
o Family environment (verbal and physical
abuse, neglect, conflict) predicts 9% of adult adjustment among those who
experienced sex as a child
Paraphilias
PEDOPHILIA conÕd
Long-term
Effects of Childhood Sexual Experiences
Rind
et al. (1998) contÕd
á Prevalence of childhood sexual
experiences
o Male 14%
o Female 24%
Not rare for children to have sexual
experiences with adults or coerced by peers
Paraphilias
PEDOPHILIA conÕd
Long-term
Effects of Childhood Sexual Experiences
Rind
et al. (1998) contÕd
á Percentage founding childhood
sexual experiences to be negative at the time
o Male 33%
o Female 72%
Not
all children find sexual experiences to be abusive
Paraphilias
PEDOPHILIA conÕd
Long-term
Effects of Childhood Sexual Experiences
Rind
et al. (1998) contÕd
á Percentage who find childhood
sexual experiences to be negative currently
o Males 26%
o Females 59%
Some adults come to view childhood sexual
experiences as no longer being negative
Paraphilias
PEDOPHILIA conÕd
Long-term
Effects of Childhood Sexual Experiences
Rind
et al. (1998) contÕd
á Percentage who find childhood
sexual experiences to be positive currently
o Males 43%
o Females 16%
Male
adults report childhood sexual experiences to be positive more often than do
female adults
Paraphilias
PEDOPHILIA conÕd
Long-term
Effects of Childhood Sexual Experiences
Rind
et al. (1998) contÕd
á Perceived negative effect of childhood
sexual experiences on adult sexual attitudes & performance
o Male 8.5%
o Female 13 %
Most
adults who had childhood sexual experiences are sexually adjusted
Paraphilias
PEDOPHILIA conÕd
Long-term
Effects of Childhood Sexual Experiences
Rind et al. (1998) contÕd
|
Childhood Sex |
Neg. as Child |
Neg. as Adult |
Pos. as Adult |
Male |
14% |
33% |
26% |
43% |
Female |
24% |
72% |
59% |
16% |
Etiology of
Paraphilias
á
Psychoanalytic/Freudian
o Paraphilias as
defense mechanisms
o Guards ego from
dealing with repressed fears at oral & anal stages
o Represent fixations
at pregenital stages of psychosexual development.
Etiology of
Paraphilias conÕd
á Cognitive-Behavioral
o Classical
conditioning with object/activity
o Modeling
o Poor social skills
relevant to sex partners
o Reinforcement of
unconventional sexual behavior
o Disinformation
o Misattributions
Treatment of
Paraphilias
Legal
á Involuntary
commitment to hospitals
á Imprisonment
á Court-ordered into
outpatient treatment
á "MeganÕs
law"
o Effectiveness highly
variable
o Recidivism increases over time
o Sex offenders often lack motivation to change
Treatment of
Paraphilias conÕd
Cognitive
Behavioral
á Aversion therapy
á Satiation
á 0rgasmic reorientation
á Social skills training
á Alternative behavior competition
á Cognitive restructuring
á Bibliotherapy
Treatment of
Paraphilias conÕd
Biological/
Medical
á Castration
á Drugs to lower testosterone
Sexual & Gender
Identity Disorders
Sexual
Dysfunctions
Range of sexual dissatisfaction that
represent inhibitions in the
normal
human sexual response cycle.
Sexual performance
dissatisfaction is
1.
Persistent
2.
Recurrent
3.
Causes
marked distress OR
interpersonal problems
Sexual & Gender Identity Disorders
Sexual
Dysfunctions
Human
Sexual Response Cycle
1. Appetitive and desire
2. Excitement and tumescence
3. Orgasm
4. Resolution
Sexual & Gender
Identity Disorders
Sexual
Dysfunctions
2
Appetitive/Desire*
á Hypoactive sexual desire disorder**
á Sexual aversion disorder
* Normal desire = ?
**
Hyperactive desire = ?
Sexual
Dysfunctions conÕd
2
Excitement and tumescence
á Female sexual arousal disorder*
á Male erectile disorder*
*
adequate stimulation = ?
May
reflect failure to learn what is sexually arousing, performance anxiety &
organic factors
Sexual
Dysfunctions conÕd
3
Orgasm with tumescence
á Female orgasmic disorder*
á Male orgasmic disorder*
*normal
stimulation for sexual arousal = ?
á Male premature
ejaculation**
**Premature
= ?
**40%
lifetime prevalence = not rare
**Associated
with anxiety
Sexual
Dysfunctions conÕd
2 Resolution and Pain: Females only
á Dyspareunia
á Vaginismus
o associated with
history of rape/molestation
Etiology of Sexual
Dysfunctions
Masters
and Johnson (1960's+)
á Current Factors
The adoption of a spectator role
Fear of performance
Etiology of Sexual
Dysfunctions conÕd
Masters
and Johnson (1960's+) conÕd
á Historical Factors
Religious
orthodoxy
Inadequate
counseling
Excessive
intake of alcohol
Biological
causes (e.g. diabetes)
Etiology of Sexual
Dysfunctions conÕd
Masters
and Johnson (1960's+) conÕd
á Other etiological
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
1st: ban on sexual
activity
2nd: discussion of
couple's sexual value system
3rd: sensate focus
4th: specific
instructions in intercourse
Treatment of
Sexual Dysfunctions conÕd
Other
techniques:
á Anxiety reduction
á Sensory-awareness (e.g., "stop-start" for
pre-mature ejaculation)
á Communication training
á Couples therapy
á Behavior rehearsal with surrogate
Treatment of
Sexual Dysfunctions conÕd
Other
techniques con'd:
á Biological and
Medical
o Hormones
o Anti-anxiety drugs
o Anti-depressant drugs
o Penis implants
o Penis vacuum pump
o Vasodilators
(e.g.,Viagra)
Sexual & Gender
Identity Disorders
Sexual
Dysfunctions
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