PSYB32H3 Lecture Notes - Gender Dysphoria, Plastic Surgery, Paraphilia

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23 Jun 2011

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Chapter 14 Sexual and Gender Identity Disorders
sexual and gender identity disorders in DSM-IV, disorders comprising the paraphilias, sexual
dysfunctions, and gender identity disorder
Gender Identity Disorder
- our sense of ourselves as male or female, our gender identity, is so deeply ingrained from earliest
childhood that whatever stress is suffered at one time or another, the vast majority of people are certain
beyond a doubt of their gender
- in contrast, sexual identity or sexual orientation is the preference we have for the sex of a partner
- for example, a man may be attracted to men a matter of sexual orientation, without believing he is a
woman a matter of gender identity
Characteristics of Gender Identity Disorder
gender identity disorder (GID) a disorder in which there is a deeply felt incongruence between
anatomic sex and the sensed gender; transsexualism and gender identity disorder of childhood are
transsexualism the state of being a transsexual; a transsexual is a person who believes he/she is
opposite in sex to his/her own biological endowment; sex-reassignment surgery is frequently desired
- people with transsexualism have an aversion to same-sex clothing and activities; the evidence of their
anatomy normal genitals and the usually secondary sex characteristics, such as beard growth for men
and developed breasts for women doesn’t persuade them that they’re what others see them to be
- Levine stated that the majority of GID cases are diagnosed as GIDNOS (gender identity disorder not
otherwise specified)
- that is, the person has symptoms that meet much of the description of GID, but there are some unique
features that don’t fit the precise criteria for GID
- although transvestites often dress in clothing typical of the opposite sex, they do not identify themselves
as of the opposite sex
- when GID begins in childhood, it is associated with cross-gender behaviors, such as dressing in
opposite sex clothes, preferring opposite sex playmates, and engaging in play that would usually be
considered more typical of the opposite sex (eg: a boy playing with Barbie dolls)
- GID is associated with a developmental lag in achieving a sense of gender constancy or stability (i.e.,
acceptance that one is a boy or girl for life)
- GID in a child is usually recognized by parents when the child is between 2-4 years old
- twas found that GID is about 6.6 times more frequent in boys than in girls; twas concluded that social
factors partly account for the difference in referral rates; cross-gender behavior is less tolerated when
exhibited by boys and a higher threshold has to be met in order for a girl to be referred
- most children with GID do not grow up to be disordered in adulthood, even without professional
intervention; however, many become gay
- excluded from GID are people with schizophrenia who on very rare occasions claim to be of the other
sex, as well as hermaphrodites, so-called intersexed individuals, who have both male and female
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reproductive organs
- a male with GID experiences his sexual interest in men as a conventional heterosexual preference,
since he considers himself a woman
- cross-dressing is less of a problem for women with GID because contemporary fashions allow women to
wear clothing similar to that worn by men
- people with GID often experience anxiety and depression, not surprising given their psychological
predicament and the negative attitudes most people have toward them
- GID in childhood is linked with separation anxiety disorder
- the prevalence rates for GID are slight: 1/30,000 for men and 1/100,000 to 150,000 in women
Causes of Gender Identity Disorder
- researchers concluded that children who experience a sense of inappropriateness in the culturally
prescribed gender role of their sex but who do not experience discomfort with their biological sex should
not be considered to have GID
- because of flaws in the DSM-IV-TR definition of mental disorder, and limitations of the current research
base, there is simply not enough evidence to make any conclusive statement regarding children who
experience discomfort with their biological sex
- these same researchers said that GID in children should be removed from the DSM; they said that
viewing GID as a mental disorder my contribute to a labeling process that stigmatizes those children with
GID who go on to develop homosexuality
- evidence indicates that gender identity is influence by hormones
- other research shows that human and other primate offspring of mothers who have taken sex hormones
during pregnancy frequently behave like members of the opposite sex an have anatomical abnormalities
- many, perhaps most, young children engage in cross-gender behavior now and then; in some homes,
such behavior may receive too much attention and reinforcement from parents and other relatives
- interviews with the parents of children who show signs of GID often reveal that they didn’t discourage,
and in many instances clearly encouraged, cross-dressing behavior in their atypical children
- the child’s attractiveness is a factor that may contribute to this pattern of parental behavior
- boys with GID have been rated as more attractive than control children, and girls with GID as less
- also, male patients with GID report having had a distant relationship with their fathers; females often
report a history of physical/sexual abuse
- our society has a low tolerance for boys who engage in activities more typical of girls, whereas girls can
play games and dress in a manner more typical of boys and still conform to acceptable standards of
behavior for girls
Therapies for Gender Identity Disorder
- there are 2 types of interventions available to help people with GID: one attempts to alter the body to
suit the person’s psychology; the other is designed to alter the psychology to match the person’s body
Body Alterations
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- a person with GID who enters a program that entails alteration of the body is generally required to
undergo 6-12 months of psychotherapy
- the therapy typically focuses not only on the anxiety and depression that the person has likely been
experiencing, but also on available options for altering his/her body
- some people with GID may choose to have only cosmetic surgery; a male-to-female transsexual may
have electrolysis to remove facial hair and surgery to reduce the size of the chin and Adams apple
- many transsexuals also take hormones to bring their bodies physically closer to their beliefs about their
- many people with GID go no further than taking hormones, but some take the next step of having sex-
reassignment surgery
sex-reassignment surgery an operation removing existing genitalia of a transsexual and constructing
a substitute for the genitals of the opposite sex
- the 1st sex-reassignment operation took place in Europe in 1930
- sex-reassignment surgery is an option much more frequently exercise by men than by women
- an review of 20 years of research showed an overall improvement in social adaptation rates because of
the surgery, with female-to-male transsexuals having greater success than male-to-female transsexuals
- of 130 female-to-male, about 97% could be judged satisfactory; of 220 male-to-female surgeries, 87%
were satisfactory
- preoperative factors that seemed to predict favorable post-surgery adjustment were:
reasonable emotional stability
successful adaptation in the new role for at least 1 year before the surgery
adequate understanding of the actual limitations and consequences of the surgery
psychotherapy in the context of an established gender identity program
- a subsequent study indicated that sexual responsiveness and sexual satisfaction increased dramatically
in both male-to-female and female-to-male transsexuals, with an overall high level of satisfaction with the
results of the surgery
- its estimated that each year in the US, more than 1,000 transsexuals are surgically altered to the
opposite sex
- if surgery is evaluated in terms of how happy such people are afterward, then it can probably be said
that most GID patients who have crossed over anatomically are generally better off, although some are
Alterations of Gender Identity
- gender identity was assumed to be too deep-seated to alter; some apparently successful procedures for
altering gender identity through behavior therapy have been reported, however
- cross-gender identity may be amenable to change; this can be done through shaping various specific
behaviors, such as mannerisms and interpersonal behavior; they also included attention to cognitive
components, such as fantasies
- most transsexuals refuse such therapy programs that are aimed at changing gender identity
The Paraphilias
paraphilias sexual attraction to unusual objects and sexual activities unusual in nature
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