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Chapter 11

Chapter 11: Paraphilic Disorders, Sexual Dysfunctions, and Gender Dysphoria

What is abnormal sexual behavior?

} When evaluating the “normality” of a given sexual behavior, the context is extremely important. } Attitudes and behaviors related to sexuality are continually

evolving over time. } Contemporary human sexuality researchers:

} Alfred Kinsey } William Masters } Virginia Johnson

Paraphilic disorders

} Behaviors in which an individual has recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving: 1. nonhuman objects 2. children or other non-consenting persons 3. the suffering or humiliation of self or partner

} Psychological dependence on the target of desire that results in inability to experience sexual arousal without target.

Table 1: Paraphilic Disorders

Pedophilic disorder

} A paraphilic disorder in which an adult is sexually aroused by children or adolescents. } This arousal is equal to or greater than sexual arousal of a

physically mature individual. } This diagnosis includes both people who have acted upon

these urges and those who have not. } 2/3 of all sexual assault victims are children & adolescents } Nearly 2/3 of victims are female } Vast majority of perpetrators are male } About 1/3 of offenders are relatives of the victimized children

Exhibitionistic disorder

} A person has intense sexual urges and arousing fantasies involving the exposure of genitals to a stranger.

} Exhibitionistic disorder begins early in adulthood and persists throughout life.

} This disorder is often comorbid with conditions such as major depressive disorder and substance abuse.

Voyeuristic disorder

} The individual has a compulsion to derive sexual gratification from observing the nudity or sexual activity of others who are unaware of being watched.

} Persons with this disorder are sexually aroused by: } Observing an unsuspecting person who is:

} Naked } In the process of disrobing } Engaging in sexual activity

} Voyeurism is the most common paraphilia. } Law officials are unlikely to apprehend individuals with this

disorder and these individuals are even less likely to seek treatment

Fetishistic disorder

} People with fetishistic disorder are aroused by an object not specifically intended to be used in a sexual context. } Arousal depends on the object rather than sexual intimacy

with a partner for achieving sexual gratification } Behavior is not fetishistic when involving an object

specifically designed for sexual excitation } Vibrator

Fetishistic disorder

} Partialism } The individual is sexually aroused by the presence of a

specific body part, such as the feet } The attraction to objects or body parts must be

recurrent, intense, and have lasted at least 6 months.

Frotteuristic disorder

} The individual has intense sexual urges and sexually arousing fantasies of rubbing against or fondling an unsuspecting stranger. } From French frotter (“to rub”)

} Men with frotteuristic disorder seek out crowded places in which they can safely rub up against their unsuspecting victims such as in a crowded rush-hour subway train.

Sexual masochism disorder

} This disorder involves persons seeking pleasure from being in pain.

} People with sexual masochism disorder are sexually aroused by being beaten, bound, or otherwise made to suffer.

Sexual sadism disorder

} This disorder involves sexual arousal from the physical or psychological suffering of another person.

} DSM-5 does not classify bondage, domination, and sadomasochism (BDSM) as a disorder in and of itself.

} Little scientific research exists for both sexual sadism and sexual masochism. } People with this disorder do not often seek out treatment and

do not feel the need to change.

Transvestic disorder

} Diagnosis applied to individuals who engage in transvestic behavior and have the symptoms of a paraphilic disorder } Refers to the behavior of dressing in the clothing of the

other sex. } Only diagnosed if distress or impairment is experienced } Commonly displayed by men

Theories and treatment of paraphilic disorders

• Biological perspectives • Castration • Psychotherapeutic medications

• Psychological perspectives • Lovemaps • Group therapy • The cognitive behavioral perspective • Relapse prevention

Sexual Dysfunctions

Sexual dysfunctions

} Abnormality in an individual’s sexual responsiveness and reactions } Feelings of significant distress or impairment } Lifelong or acquired } Generalized or situational

Sexual arousal disorders

} Male hypoactive sexual desire disorder: } Abnormally low level or no level of interest in sexual activity.

} Including few or no sexual fantasies.

} Female sexual interest/arousal disorder: } Persistent or recurrent inability to attain or maintain normal

physiological and psychological arousal responses during sexual activity.

} Lower levels of arousal, fewer erotic thoughts, less enjoyment of sexual activity, and less intense sensations during sexual activity.

Sexual arousal disorders

} Erectile disorder: Male cannot attain or maintain an erection during sexual activity that is sufficient to allow them to initiate or maintain sexual activity. } Even if they are able to achieve an erection, they are unable to

penetrate or to experience pleasure during a sexual encounter.

Disorders involving orgasm

} Female orgasmic disorder: A sexual dysfunction in which a woman experiences problems having an orgasm during sexual activity. } Women are more likely than men to report sexual difficulties

involving the subjective quality of the experience.

Disorders involving orgasm

} Delayed ejaculation } A sexual dysfunction in which a man experiences problems

having an orgasm during sexual activity. } Also known as inhibited male orgasm.

} Premature ejaculation } A sexual dysfunction that causes men to reach orgasm with

minimal sexual stimulation before, on, or shortly after penetration and before wishing to do so (within 1 minute)

Disorders involving pain

} Genito-pelvic pain/penetration disorder } The individual experiences recurrent or persistent genital pain

before, during, or after sexual intercourse. } Can affect both males and females.

Sexual dysfunctions: theories and treatments

• Biological perspective • Erectile dysfunction - Medications to treat include the

prescription drugs Viagra, Levitra, and Cialis • Hormonal replacement therapy • Application of corticosteroids and physical therapy

Sexual dysfunctions: theories and treatments

} Psychological perspectives } Macho myth } Sensate focus

Gender Dysphoria

Gender dysphoria

} Gender dysphoria } Distress that may accompany the incongruence between a

person’s experienced or expressed gender and that person’s biological sex

} Gender identity: } A person’s inner sense of maleness or femaleness

} Biological sex: } The sex determined by a person’s chromosomes.

Gender dysphoria

} Transsexualism: The phenomenon in which a person has an inner feeling of belonging to the other sex. } Some people with gender dysphoria disorders wish to live as

members of the other sex, and they act and dress accordingly. } Unlike individuals with transvestic disorder, these people

do not derive sexual gratification from cross-dressing.

Gender dysphoria: theories and treatments

} New approaches are used that emphasize a more fluid view of gender than the binary male-female dichotomy.

} New DSM 5 terminology reflects a theoretical perspective that does not focus specifically on what is “wrong” with people whose self-identification differs from their biological characteristics or social roles. } Clients will still likely struggle with transphobia

} New therapeutic approaches encourage clients to create their own gender identities, which can result in an improved sense of well-being.

Table 2: APA Standards of Care for the Treatment of Gender Identity Disorders

Table 2: APA Standards of Care for the Treatment of Gender Identity Disorders (Continued…)

The biopsychosocial perspective

} Clinicians are increasingly developing models that incorporate integrated treatment

} DSM-5’s sweeping changes reflect: } Expansion of the empirical approaches to sexual disorders } Adoption of a broader, more inclusive, and socio-culturally

sensitive approach to their understanding and treatment