Transcript AP8_Lecture_13 - Forensicconsultation.org

Disorders of
Sex and Gender
Chapter 13
Slides & Handouts by Karen Clay Rhines, Ph.D.
American Public University System
Comer, Abnormal Psychology, 8e
DSM-5 Update
Disorders of Sex and Gender

Sexual behavior is a major focus of both our
private thoughts and public discussions

Experts recognize two general categories of
sexual disorders:

Sexual dysfunctions – problems with sexual
responses

Paraphilic disorders– repeated and intense
sexual urges and fantasies in response to
socially inappropriate objects or situations
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Sex and Gender

DSM-5 also includes a category called
gender dysphoria , a pattern in which
people feel that they have been born to the
wrong sex
Comer, Abnormal Psychology,
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Disorders of Sex and Gender

Relatively little is known about racial and
other cultural differences in sexuality

Sex therapists and sex researchers have only
recently begun to attend systematically to the
importance of culture and race
Comer, Abnormal Psychology,
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Sexual Dysfunctions

Sexual dysfunctions are disorders in which people
cannot respond normally in key areas of sexual
functioning


As many as 31% of men and 43% of women in the U.S.
suffer from such a dysfunction during their lives
Sexual dysfunctions are typically very distressing,
and often lead to sexual frustration, guilt, loss of
self-esteem, and interpersonal problems

Often these dysfunctions are interrelated; many
patients with one dysfunction experience another as
well
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Sexual Dysfunctions


The human sexual response can be
described as a cycle with four phases:

Desire

Excitement

Orgasm

Resolution
Sexual dysfunctions affect one or more of
the first three phases
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Comer, Abnormal Psychology,
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Comer, Abnormal Psychology,
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Sexual Dysfunctions

Some people struggle with sexual dysfunction
their whole lives (labeled “lifelong type”) or
others, normal sexual functioning preceded
the disorder (labeled “acquired type”)

In some cases the dysfunction is present
during all sexual situations (labeled
“generalized type”)

In others it is tied to particular situations (labeled
“situational type”)
Comer, Abnormal Psychology,
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Disorders of Desire

Desire phase of the sexual response cycle


Consists of an interest in or urge to have sex,
sexual fantasies, and sexual attraction to others
Two dysfunctions affect this phase:

Male hypoactive sexual desire disorder

Female sexual interest/arousal disorder
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Desire

Male hypoactive sexual desire disorder

Characterized by a lack of interest in sex and
little sexual activity


Physical responses may be normal
Prevalent in about 16% of men
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Desire

Female sexual interest/arousal disorder

Characterized by a lack of normal interest in
sexual activity


Women with this condition rarely initiate sexual
activity and may experience little excitement during
sexual activity
Reduced sexual interest and desire may be
found in as many as 33% of women
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Desire

A person’s sex drive is determined by a
combination of biological, psychological,
and sociocultural factors, and any of these
may reduce sexual desire

Most cases of low sexual desire are caused
primarily by sociocultural and
psychological factors, but biological
conditions can also lower sex drive
significantly
Comer, Abnormal Psychology,
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Disorders of Desire

Biological causes

A number of hormones interact to produce sexual desire
and behavior




Abnormalities in their activity can lower sex drive
These hormones include prolactin, testosterone, and estrogen for
both men and women
Recent investigation has also linked sexual desire disorders
to excessive activity of the NTs serotonin and dopamine
Sex drive can also be lowered by some medications
(including birth control pills and pain medications), some
psychotropic drugs, a number of illegal drugs, and chronic
illness
Comer, Abnormal Psychology,
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Disorders of Desire

Psychological causes

A general increase in anxiety, depression, or
anger may reduce sexual desire in both men
and women

Fears, attitudes, and memories may contribute
to sexual dysfunction

Certain psychological disorders, including
depression and obsessive-compulsive disorder,
may lead to sexual desire disorders
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Desire

Sociocultural causes

Attitudes, fears, and psychological disorders that
contribute to sexual desire disorders occur within
a social context

Many sufferers of desire disorders are feeling situational
pressures



Examples: divorce, death, job stress, infertility, and/or
relationship difficulties
Cultural standards can set the stage for development of
these disorders
The trauma of sexual molestation or assault is especially
likely to produce sexual dysfunction
Comer, Abnormal Psychology,
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Disorders of Excitement

Excitement phase of the sexual response cycle

Marked by changes in the pelvic region, general
physical arousal, and increases in heart rate, muscle
tension, blood pressure, and rate of breathing




In men: erection of the penis
In women: swelling of the clitoris and labia and vaginal
lubrication
Female sexual interest/arousal disorder may
include dysfunction during the excitement phase
In addition, a male disorder – erectile disorder –
involves dysfunction in the excitement phase only
Comer, Abnormal Psychology,
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Disorders of Excitement

Erectile disorder (ED)

Characterized by persistent inability to attain
or maintain an erection during sexual activity

This problem occurs in as much as 10% of the
general male population

According to surveys, half of all adult men
have erectile difficulty during intercourse at
least some of the time
Comer, Abnormal Psychology,
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Disorders of Excitement

Most cases of erectile disorder result from
an interaction of biological, psychological,
and sociocultural processes
Comer, Abnormal Psychology,
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Disorders of Excitement

Biological causes

The same hormonal imbalances that can cause
male hypoactive sexual desire can also produce ED

Most commonly, vascular problems are involved


ED can also be caused by damage to the nervous system
from various diseases, disorders, or injuries
The use of certain medications and various forms
of substance abuse may interfere with erections
Comer, Abnormal Psychology,
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Disorders of Excitement

Biological causes

Medical procedures have been developed for
diagnosing biological causes of ED

One strategy involves measuring nocturnal penile
tumescence (NPT)

Men typically have erections during REM sleep; abnormal
or absent nighttime erections usually indicate a physical
basis for erectile failure
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Excitement

Psychological causes

Any of the psychological causes of male
hypoactive sexual desire can also interfere with
arousal and lead to erectile dysfunction

For example, as many as 90% of men with severe
depression experience some degree of ED
Comer, Abnormal Psychology,
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Disorders of Excitement

Psychological causes

One well-supported cognitive explanation for
ED emphasizes performance anxiety and the
spectator role

Once a man begins to have erectile difficulties, he
becomes fearful and worries during sexual
encounters; instead of being a participant, he
becomes a spectator and judge

This can create a vicious cycle of sexual dysfunction where
the original cause of the erectile failure becomes less
important than the fear of failure
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Excitement

Sociocultural causes

Each of the sociocultural factors that
contribute to male hypoactive sexual desire has
also been linked to ED

Job and marital distress are particularly relevant
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Orgasm

Orgasm phase of the sexual response cycle

Sexual pleasure peaks and sexual tension is
released as the muscles in the pelvic region
contract rhythmically



For men: semen is ejaculated
For women: the outer third of the vaginal walls contract
There are three disorders of this phase:



Premature ejaculation
Delayed ejaculation
Female orgasmic disorder
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Orgasm

Premature ejaculation

Characterized by persistent reaching of orgasm and
ejaculation within one minute of beginning sexual
activity with a partner and before he wishes to


As many as 30% of men experience rapid ejaculation at some
time
Psychological, particularly behavioral, explanations of
this disorder have received more research support than
other explanations


The dysfunction seems to be typical of young, sexually
inexperienced men
It may also be related to anxiety, hurried masturbation
experiences, or poor recognition of arousal
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Orgasm

Premature ejaculation

There is a growing belief among many clinical
theorists that biological factors may also play a key
role in many cases of this disorder



One theory states that some men are born with a genetic
predisposition
A second theory argues that the brains of men with early
ejaculation contain certain serotonin receptors that are
overactive and others that are underactive
A third explanation holds that men with this dysfunction
experience greater sensitivity or nerve conduction in the
area of their penis
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Orgasm

Delayed ejaculation

Characterized by a repeated inability to ejaculate
or by a very delayed ejaculation after normal
sexual activity with a partner


Occurs in 8% of the male population
Biological causes include low testosterone,
neurological disease, and head or spinal cord
injury

Medications, including certain antidepressants
(especially SSRIs) and drugs that slow down the
sympathetic nervous system, can also affect ejaculation
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Orgasm

Delayed ejaculation

A leading psychological cause appears to be
performance anxiety and the spectator role,
the cognitive factors involved in ED

Another psychological factor may be past
masturbation habits

This disorder also may develop out of male
hypoactive sexual desire disorder
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Orgasm

Female orgasmic disorder

Characterized by persistent failure to reach
orgasm, experiencing orgasms of very low
intensity, or delay in orgasm

Almost 24% of women appear to have this problem




10% or more have never reached orgasm
An additional 9% reach orgasm only rarely
Women who are more sexually assertive and more
comfortable with masturbation tend to have orgasms
more regularly
Female orgasmic disorder is more common in single
women than in married or cohabiting women
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Orgasm

Female orgasmic disorder

Most clinicians agree that orgasm during intercourse is
not mandatory for normal sexual functioning

Early psychoanalytic theory used to consider lack of orgasm
during intercourse to be pathological


Current evidence suggests that this is untrue
Once again, biological, psychological, and
sociocultural factors may combine to produce these
disorders

Because arousal plays a key role in orgasms, arousal difficulties
often are featured in explanations of female orgasmic disorder
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Orgasm

Female orgasmic disorder

Biological causes

A variety of physiological conditions can affect a
woman’s arousal and orgasm

These conditions include diabetes and multiple sclerosis

The same medications and illegal substances that
affect erection in men can affect arousal and orgasm
in women

Postmenopausal changes may also be responsible
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Orgasm

Female orgasmic disorder

Psychological causes

The psychological causes of female sexual
interest/arousal disorder, including depression, may
also lead to female arousal and orgasmic disorders

Memories of childhood trauma and relationship
distress may also be related
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Orgasm

Female orgasmic disorder

Sociocultural causes

For years, the leading sociocultural theory of female
orgasmic problems was that it resulted from
sexually restrictive cultural messages

This theory has been challenged because:

Sexually restrictive histories are equally common in
women with and without disorders

Cultural messages about female sexuality have been
changing while the rate of female sexual dysfunction stays
constant
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Orgasm

Female orgasmic disorder

Sociocultural causes

Researchers suggest that unusually stressful events,
traumas, or relationships may produce the fears,
memories, and attitudes that characterize these
dysfunctions

Research has also linked orgasmic behavior to
certain qualities in a woman’s intimate
relationships (such as emotional intimacy)
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Sexual Pain

Certain sexual dysfunctions are
characterized by enormous physical
discomfort during intercourse and do not
fit neatly into a specific phase of the sexual
response cycle

These dysfunctions, collectively called genitopelvic pain/penetration disorder, are
experienced by women much more often than
men
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Sexual Pain

Some women with genito-pelvic
pain/penetration disorder experience
involuntary contractions of the muscles of
the outer third of the vagina

Known as vaginismus, severe cases can prevent
a woman from having intercourse

This problem has received relatively little
research, but estimates are that it occurs in
fewer than 1% of all women
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Sexual Pain

Most clinicians agree with the cognitivebehavioral theory that this form of genitopelvic pain/penetration disorder is a learned
fear response


A variety of factors can set the stage for this fear,
including anxiety and ignorance about intercourse,
exaggerated stories, trauma caused by an unskilled
partner, and the trauma of childhood sexual abuse
or adult rape
Some women experience painful intercourse
because of infection or disease
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Disorders of Sexual Pain

Other women with genito-pelvic pain/penetration
disorder experience severe vaginal or pelvic pain
during sexual intercourse

This pattern is known medically as dyspareunia


As many as 14% of women suffer from this problem
This form of genito-pelvic pain/penetration
disorder usually has a physical cause, most
commonly from injury sustained in childbirth

Although psychological factors or relationship
difficulties may contribute to this problem,
psychosocial factors alone are rarely responsible
Comer, Abnormal Psychology,
DSM-5 Update, 8e
39
Treatments for Sexual
Dysfunctions

The last 40 years have brought major
changes in the treatment of sexual
dysfunction

Early 20th century: psychodynamic therapy

Believed that sexual dysfunction was caused by a
failure to progress through the stages of
psychosexual development

Therapy focused on gaining insight and making
broad personality changes; was generally unhelpful
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Treatments for Sexual
Dysfunctions

1950s and 1960s: behavioral therapy

Behavioral therapists attempted to reduce fear
by applying relaxation training and systematic
desensitization

Had some success, but failed to work in cases
where the key problems included
misinformation, negative attitudes, and lack of
effective sexual techniques
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Treatments for Sexual
Dysfunctions

1970: Human Sexual Inadequacy


This book, written by William Masters and
Virginia Johnson, revolutionized treatment of
sexual dysfunctions
This original “sex therapy” program has evolved
into a complex approach


Includes techniques from cognitive, behavioral, couples,
and family systems therapies, along with a number of
sex-specific techniques
More recently, biological interventions have also been
incorporated
Comer, Abnormal Psychology,
DSM-5 Update, 8e
42
What Are the General
Features of Sex Therapy?

Modern sex therapy is short-term and
instructive

Therapy typically lasts 15 to 20 sessions

It is centered on specific sexual problems
rather than on broad personality issues
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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What Are the General
Features of Sex Therapy?

Modern sex therapy focuses on:









Assessment and conceptualization of the problem
Mutual responsibility
Education about sexuality
Emotion identification
Attitude change
Elimination of performance anxiety and the spectator role
Increasing sexual and general communication skills
Changing destructive lifestyles and marital interactions
Addressing physical and medical factors
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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What Techniques Are Applied
to Particular Dysfunctions?

In addition to the general components of
sex therapy, specific techniques can help in
each of the sexual dysfunctions
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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What Techniques Are Applied
to Particular Dysfunctions?

Disorders of Desire

These disorders are among the most difficult to
treat because of the many issues that feed into
them

Therapists typically apply a combination of
techniques, which may include:

Affectual awareness, self-instruction training,
behavioral techniques, insight-oriented exercises,
and biological interventions such as hormone
treatments
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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What Techniques Are Applied
to Particular Dysfunctions?

Erectile disorder

Treatments for ED focus on reducing a man’s
performance anxiety and/or increasing his
stimulation

May include sensate-focus exercises such as the
“tease technique”
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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What Techniques Are Applied
to Particular Dysfunctions?

Erectile disorder

Biological approaches have gained great
momentum with the development of sildenafil
(Viagra) and other erectile dysfunction drugs

Most other biological approaches have been around
for decades and include gels, suppositories, penile
injections, and a vacuum erection device (VED)

These procedures are now viewed as “second-line”
treatment
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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What Techniques Are Applied
to Particular Dysfunctions?

Premature ejaculation


Premature ejaculation has been successfully
treated for years by behavioral procedures such as
the “stop-start” or “pause” procedure
Some clinicians use SSRIs, the serotoninenhancing antidepressant drugs


Because these drugs often reduce sexual arousal or
orgasm, they may be helpful in delaying premature
ejaculation
Many studies have reported positive results with this
approach
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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What Techniques Are Applied
to Particular Dysfunctions?

Delayed ejaculation

Therapies for this disorder include techniques
to reduce performance anxiety and increase
stimulation

When the cause of the disorder is physical,
treatment may include a drug to increase
arousal of the sympathetic nervous system
Comer, Abnormal Psychology,
DSM-5 Update, 8e
50
What Techniques Are Applied
to Particular Dysfunctions?

Female orgasmic disorders

Specific treatments for this disorder include
cognitive-behavioral techniques, selfexploration, enhancement of body awareness,
and directed masturbation training

Biological treatments, including hormone therapy
or the use of sildenafil (Viagra), have also been
tried, but research has not found such interventions
to be consistently helpful
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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What Techniques Are Applied
to Particular Dysfunctions?

Female orgasmic disorders

Again, a lack of orgasm during intercourse is
not necessarily a sexual dysfunction, provided
the woman enjoys intercourse and is orgasmic
through other means

For this reason, some therapists believe that the
wisest course of action is simply to educate women
whose only concern is lack of orgasm through
intercourse
Comer, Abnormal Psychology,
DSM-5 Update, 8e
52
What Techniques Are Applied
to Particular Dysfunctions?

Genito-Pelvic Pain/Penetration Disorder


Specific treatment for involuntary contractions of
the vaginal muscles typically involves two
approaches:

Practice tightening and releasing the muscles of the
vagina to gain more voluntary control

Overcome fear of penetration through gradual
behavioral exposure treatment
Most women treated using these methods
eventually report pain-free intercourse
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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What Techniques Are Applied
to Particular Dysfunctions?

Genito-Pelvic Pain/Penetration Disorder

Different approaches are used to treat severe
vaginal or pelvic pain during intercourse

Given that most cases are caused by physical
problems, pain management techniques and
medical intervention may be necessary
Comer, Abnormal Psychology,
DSM-5 Update, 8e
54
What Are the Current Trends
in Sex Therapy?

Sex therapists have moved well beyond the
approach first developed by Masters and
Johnson

Therapists now treat unmarried couples, those
with other psychological disorders, couples
with severe marital discord, the elderly, the
medically ill, the physically handicapped, gay
clients, and clients with no long-term sex
partner
Comer, Abnormal Psychology,
DSM-5 Update, 8e
55
What Are the Current Trends
in Sex Therapy?

Therapists are paying more attention to
excessive sexuality, which is sometimes
called hypersexuality or sexual addiction

The use of medications to treat sexual
dysfunction is troubling to many therapists

They are concerned that therapists will choose
biological interventions rather than a more
integrated approach
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Paraphilic Disorders

Paraphilias are characterized by intense
sexual urges, fantasies or behaviors that
involve objects or situations outside the
usual sexual norms, including:

Nonhumans

Children

Nonconsenting adults

The experience of suffering or humiliation
Comer, Abnormal Psychology,
DSM-5 Update, 8e
57
Paraphilic Disorders

According to DSM-5, a diagnosis of
paraphilic disorder should be applied only
when the urges, fantasies, or behaviors
cause significant distress or impairment
OR when the satisfaction of the disorder
places the individual or others at risk of
harm – either currently or in the past
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Paraphilias

For example, people who initiate sexual
contact with children warrant a diagnosis
of pedophilic disorder regardless of how
troubled the individuals may or may not be
over their behavior
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Paraphilic Disorders

Although theorists have proposed various
explanations for paraphilic disorders, there is
little formal evidence to support them

None of the treatments applied to paraphilias have
received much research or been proved clearly
effective

Psychological and sociocultural treatments have
been available the longest, but today’s
professionals are also using biological
interventions
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Paraphilic Disorders

Some practitioners administer drugs called
antiandrogens that lower the production of
testosterone

Clinicians are also increasingly administering
SSRIs, the serotonin-enhancing
antidepressant medications, to (hopefully)
reduce the compulsion-like sexual behaviors

These drugs also have a common side effect of
lowered sexual arousal
Comer, Fundamentals of Abnormal
Psychology, 7e
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Fetishistic Disorder

The key features of this disorder are recurrent
intense sexual urges, sexually arousing
fantasies, or behaviors that involve the use of
a nonliving object, often to the exclusion of all
other stimuli

The disorder, far more common in men than
women, usually begins in adolescence

Almost anything can be a fetish

Women’s underwear, shoes, and boots are especially
common
Comer, Abnormal Psychology,
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Fetishistic Disorder

Researchers have been unable to pinpoint
the causes of fetishistic disorder

Psychodynamic theorists view fetishes as
defense mechanisms, but therapy using this
model has been unsuccessful
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Fetishistic Disorder

Behaviorists propose that fetishes are learned
through classical conditioning



Fetishes are sometimes treated with aversion
therapy, or covert sensitization
Another behavioral treatment is masturbatory
satiation, in which clients masturbate to boredom
while imagining the fetish object
An additional behavioral treatment is orgasmic
reorientation, a process which teaches individuals
to respond to more appropriate sources of sexual
stimulation
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Transvestic Disorder

Also known as transvestism or crossdressing

Characterized by fantasies, urges, or
behaviors involving dressing in the clothes
of the opposite sex in order to achieve
sexual arousal
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Transvestic Disorder

The typical person with this disorder is a
heterosexual male who began cross-dressing
in childhood or adolescence

Transvestism is often confused with gender
dysphoria, but the two are separate patterns

The development of the disorder seems to
follow the behavioral principles of operant
conditioning
Comer, Abnormal Psychology,
DSM-5 Update, 8e
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Exhibitionistic Disorder

Characterized by arousal from the exposure of
genitals in a public setting

Most often, the person wants to provoke shock or
surprise, rather than initiate sexual contact

Usually begins before age 18 and is most common
in males

Treatment generally includes aversion therapy and
masturbatory satiation

May be combined with orgasmic reorientation, social
skills training, or cognitive-behavioral therapy
Comer, Abnormal Psychology,
DSM-5 Update, 8e
67
Voyeuristic Disorder

Characterized by repeated and intense
sexual urges to observe people as they
undress or engage in sexual activity

The person may masturbate during the act of
observing or while remembering it later

The risk of being discovered often adds to the
excitement
Comer, Abnormal Psychology,
DSM-5 Update, 8e
68
Voyeuristic Disorder

Many psychodynamic theorists propose
that people with this disorder are seeking
power

Behaviorists explain the disorder as a
learned behavior that can be traced to a
chance and secret observation of a sexually
arousing scene
Comer, Abnormal Psychology,
DSM-5 Update, 8e
69
Frotteuristic Disorder

A person with frotteuristic disorder has
recurrent and intense fantasies, urges, or
behaviors involving touching and rubbing
against a nonconsenting person


Almost always male, the person fantasizes during
the act that he is having a caring relationship with
the victim
Usually begins in the teen years or earlier

Acts generally decrease and disappear after age 25
Comer, Abnormal Psychology,
DSM-5 Update, 8e
70
Pedophilic Disorder

This disorder is characterized by fantasies,
urges, or behaviors involving sexual arousal
from prepubescent or early pubescent
children

Some people are satisfied with child pornography

Others are driven to watching, fondling, or
engaging in sexual intercourse with children

Evidence suggests that two-thirds of victims are
female
Comer, Abnormal Psychology,
DSM-5 Update, 8e
71
Pedophilic Disorder

People with this disorder develop it in
adolescence

Some were sexually abused as children


Many were neglected, excessively punished, or deprived
of close relationships in childhood
Most are immature, display distorted thinking,
and have an additional psychological disorder

Some theorists have proposed a related biochemical or
brain structure abnormality but clear biological factors
have yet to emerge in research
Comer, Abnormal Psychology,
DSM-5 Update, 8e
72
Pedophilic Disorder

Most people with this disorder are
imprisoned or forced into treatment

Treatments include aversion therapy,
masturbatory satiation, orgasmic reorientation,
and treatment with antiandrogen drugs

Cognitive-behavioral treatment involves
relapse-prevention training, modeled after
programs used for substance dependence
Comer, Abnormal Psychology,
DSM-5 Update, 8e
73
Sexual Masochism Disorder

This disorder is characterized by fantasies,
urges, or behaviors involving the act or the
thought of being humiliated, beaten, bound,
or otherwise made to suffer


Only those who are very distressed or impaired by
such fantasies receive the diagnosis
Most masochistic fantasies begin in childhood
and seem to develop through the behavioral
process of classical conditioning
Comer, Abnormal Psychology,
DSM-5 Update, 8e
74
Sexual Sadism Disorder

A person with sexual sadism disorder, usually
male, is repeatedly and intensely aroused by
the physical or psychological suffering of
another individual

This arousal may be expressed through fantasies,
urges, or behaviors

Named for the infamous Marquis de Sade

People who fantasize about sexual sadism imagine
that they have total control over a sexual victim
Comer, Abnormal Psychology,
DSM-5 Update, 8e
75
Sexual Sadism Disorder


Sadistic fantasies may first appear in
childhood or adolescence

Pattern is long-term

Appears to be related to classical conditioning
and/or modeling
Psychodynamic and cognitive theorists
view people with sexual sadism disorder as
having underlying feelings of sexual
inadequacy
Comer, Abnormal Psychology,
DSM-5 Update, 8e
76
Sexual Sadism Disorder

Biological studies have found signs of
possible brain and hormonal abnormalities

The primary treatment for this disorder is
aversion therapy
Comer, Abnormal Psychology,
DSM-5 Update, 8e
77
A Word of Caution

The definitions of various paraphilic
disorders, like those of sexual dysfunctions,
are strongly influenced by the norms of the
particular society in which they occur

Some clinicians argue that, except when
people are hurt by them, at least some
paraphilic behaviors should not be
considered disorders at all
Comer, Abnormal Psychology,
DSM-5 Update, 8e
78
Gender Dysphoria

According to current DSM-5 criteria,
people with this disorder persistently feel
that they have been assigned to the wrong
biological sex, and gender changes would
be desirable
Comer, Abnormal Psychology,
DSM-5 Update, 8e
79
Gender Dysphoria

The DSM-5 categorization of this disorder
is controversial

Many people believe that transgender
experiences reflect alternative – not
pathological – ways of experiencing one’s
gender identity

Others argue that gender dysphoria is, in fact,
a medical problem that may produce personal
unhappiness
Comer, Abnormal Psychology,
DSM-5 Update, 8e
80
Gender Dysphoria

People with this disorder would like to get rid
of their primary and secondary sex
characteristics and acquire the characteristics
of the other sex

Men with this disorder outnumber women 2
to 1

People with gender dysphoria often
experience anxiety or depression and may
have thoughts of suicide
Comer, Abnormal Psychology,
DSM-5 Update, 8e
81
Gender Dysphoria

The disorder sometimes emerges in
childhood and disappears with adolescence


In some cases it develops into adult gender
dysphoria
Many clinicians suspect biological –
perhaps genetic or prenatal – factors

Abnormalities in the brain, including the
hypothalamus (particularly the bed nucleus of stria
terminalis), are a potential link
Comer, Abnormal Psychology,
DSM-5 Update, 8e
82
Gender Dysphoria

To more effectively assess and treat those with the
disorder, clinical theorists have tried to distinguish
the most common patterns of gender dysphoria:




Female-to-male
Male-to-female: Androphilic Type
Male-to-female: Autogyneophilic Type
Many adults with gender dysphoria receive
psychotherapy

Some adults with this disorder change their sexual
characteristics by way of hormones; others opt for
sexual reassignment (sex change) surgery
Comer, Abnormal Psychology,
DSM-5 Update, 8e
83
Gender Dysphoria

Clinicians have debated heatedly whether
sexual reassignment surgery is appropriate


Some consider it humane, other argue that is a
“drastic nonsolution” for a complex disorder
Research into the outcomes of such surgery
has yielded mixed results
Comer, Abnormal Psychology,
DSM-5 Update, 8e
84