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PSYB32H3 (614)

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University of Toronto Scarborough
Konstantine Zakzanis

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 examples 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 doesnt persuade them that theyre 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 dont 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 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 didnt discourage, and in many instances clearly encouraged, cross-dressing behavior in their atypical children - the childs 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 attractive - 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 persons psychology; the other is designed to alter the psychology to match the persons body Body Alterations - 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 gender - 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 1 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 not 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 - paraphilias are a group of disorders involving sexual attraction to unusual objects or sexual activities that are unusual and in nature - in other words, there is a deviation (para) in what the person is attracted to (philia) - the fantasies, urges, or behaviors must last at least 6 months and cause significant distress or impairment - a person can have the behaviors, fantasies, and urges that a person with a paraphilia has (such as exhibiting the genitals to an unsuspecting stranger or fantasizing about doing so) but not be diagnosed with a paraphilia if the fantasies or behaviors are not recurrent or if he/she is not markedly distressed by them - the DSM diagnostic criterion of distress or impairment has created some problems because many people with the behavioral features of a paraphilia are neither distressed nor imp
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