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Disorders
Chapter 9
Sexual and Gender Identity Disorders: An Overview
• sexual dysfunctions
• paraphilias
Figure 9.2
Defining Gender Identity Disorder (transsexualism)
• Clinical Overview
– Person feels trapped in the body of the wrong sex
– Assume the identity of the desired sex, but the goal is not sexual
• Causes are Unclear
• Sex-Reassignment as a Treatment of Gender Identity Disorder
– Who is a candidate? – Some basic prerequisites before surgery
– 75% report satisfaction with new identity
– Female-to-male conversions adjust better than male-to-female
• Psychosocial Treatment of Gender Identity Disorder
– Involve realigning the persons psychological gender with their
biological sex
– Few large scale studies
Overview of Sexual Dysfunctions
Figure 9.3
Sexual Desire Disorders: An Overview
• Premature Ejaculation
• Comprehensive Interview
• Medical Examination
• Psychophysiological Evaluation
• Biological Contributions
– Physical disease and medical illness
– Prescription medications
– Use and abuse of alcohol and other drugs
• Psychological Contributions
– The role of “anxiety” vs. “distraction”
– The nature and components of performance anxiety
– Psychological profiles associated with sexual dysfunction
• Social and Cultural Contributions
– Erotophobia – Learned negative attitudes about sexuality
– Negative or traumatic sexual experiences
– Deterioration of interpersonal relationships, lack of communication
A model of functional and dysfunctional sexual arousal
Figure 9.5
Treatment of Sexual Dysfunction
• Education Alone
– Is surprisingly effective
– Education
• Erectile Dysfunction
– Vascular surgery
• Nature of Paraphilias
– Sexual attraction and arousal to inappropriate people, or objects
– Often multiple paraphilic patterns of arousal
– High comorbidity with anxiety, mood, and substance abuse
disorders
• Main Types of Paraphilias
– Fetishism
– Voyeurism
– Exhibitionism
– Transvestic fetishism
– Sexual sadism and masochism
– Pedophilia
Voyeurism and Exhibitionism
• Voyeurism
• Exhibitionism
• Fetishism
• Transvestic Fetishism
• Sexual Sadism
• Sexual Masochism
– Some rapists are sadists, but most do not show paraphilic patterns
of arousal
Figure 9.6
Pedophilia
• Overview
– Pedophiles – Sexual attraction to young children
– Incest – Sexual attraction to one’s own children
– Both may involve male and/or female children or very young
adolescents
– Pedophilia is rare, but not unheard of, in females
• Associated Features
– Most pedophiles and incest perpetrators are male
– Incestuous males may be aroused to adult women; not true for
pedophiles
– Most rationalize the behavior and engage in other moral
compensatory behavior
Pedophilia: Causes and Assessment
• Causes of Pedophilia
• Psychosocial Interventions
– Most are behavioral and target deviant and inappropriate sexual
associations
– Covert sensitization – Imaginal procedure involving aversive
consequences
– Orgasmic reconditioning – Associate masturbation with appropriate
stimuli
– Family/marital therapy – Address interpersonal problems
– Coping and relapse prevention – Teaches self-control and coping
with risk
• Efficacy of Psychosocial Interventions
– About 70% to 100% of cases show improvement
– Poorest outcomes are for rapists and persons with multiple
paraphilias
Pedophilia: Drug Treatments