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Final Exam

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Konstantine Zakzanis

Chapter 14 Sexual and Gender Identity Disorders GENDER IDENTITY DISORDER Characteristics of Gender Identity Disorder Gender identity disorder (GID) sometimes referred to as transsexualism, feel deep within themselves, usually from early childhood, that they are of the opposite sex They have an aversion to same-sex clothing and activities A man can look at himself in a mirror, see the body of a biological man, and yet personally experience that body as belonging to a woman. He may try to pass as a member of the opposite sex and may even want to have his body surgically altered 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 do not fie the precise criteria of GID When GID begins in childhood, it is associated with cross gender behaviours, such as dressing in opposite-sex clothes GID is associated with a developmental lag in achieving a sense of gender constancy or stability (ie, acceptance that one is a boy or girl for life) GID in a child is usually recognized by parents when the child is between two and four ears old GID is about 6.6 times more frequent in boys than in girls Social factors partly account for the difference in referral rates; cross-gender behaviour is less tolerated when exhibited by boys and a higher threshold has to be met in order for a girl to be referred Factors associated with the decision to seek a clinical assessment includes: 1. A belief that the behaviour was no longer a phase that the child would grow out of 2. A threshold violation (wanting to cross-dress not only at home) 3. Belief that the child was experiencing intense distress about being a boy or a girl 4. Concerns about potential or actual rejection by peers Poor peer relations was the strongest predictor of behaviour problems Most children with GID do not grow up to be disordered in adulthood, even without professional intervention; however, many demonstrate a homosexual orientation Gender Identity Questionnaire for Children helps identify children who fir GID diagnostic criteria Excluded from GID are people with schizophrenia who on very rare occasions claims to be of the other sex, as well as hermaphrodites, so called intersexed individuals, who have both make and female reproductive organs Those with GID often arouse the disapproval of others and experience discrimination in employment when they choose to cross-dress Cross-dressing is less of a problem for women with GID because contemporary fashion allow women to wear clothing similar to what worn by men People with GID often experience anxiety and depression GID in childhood is linked with separation anxiety disorder Causes of Gender Identity Disorder 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 Suggest that GID in children should be removed from the DSM. Viewing GID as a mental disorder may contribute to a labelling process that stigmatizes those children with GID who go on to develop homosexuality Evidence indicates that gender identity is influenced by hormones Offspring of mothers who have taken sex hormones during pregnancy frequently behave like members of the opposite sex and have anatomical abnormalities Although such children were not necessarily abnormal in their gender identity, the mothers ingestion of prenatal sex hormones did apparently give them higher than usual levels of cross-gender interest and behaviour Many people with GID use sex hormones in an effort to alter their bodies according to their wishes Boys with GID have been rated as more attractive than control children, and girls with GID as less attractive Male patients with GID report having has a distant relationship with their fathers; female often report a history of physical or sexual abuse GID is far less prevalent than would be indicated by the numbers of boys who play with dolls and girls who engage in contact sports Therapies for Gender Identity Disorder Body Alterations A person with GID who enters a program that entails alteration of the body is generally required to undergo 6 to 12 months of psychotherapy Therapy typically focuses not only on the anxiety and depression, but also on available options for altering his or her body Some people with GID may choose to have only cosmetic surgery; 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 using such methods, but some take the next step of having sex-reassignment surgery Sex-reassignment surgery an operation in which the existing genitalia are altered to make them more like those of the opposite sex The first sex-reassignment surgery took place in Europe in 1930, but the surgery that attracted worldwide attention was performed on an ex-soldier Sex-reassignment surgery is an option much more frequently exercised by men than by women A 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 Preoperative factors that seemed to predict favourable post-surgery adjustment were: 1. Reasonable emotional stability 2. Successful adaptation in the new role for at least one year before the surgery 3. Adequate understanding of the actual limitations and consequences of the surgery 4. Psychotherapy in the context of an established gender identity program People who undergo these procedures often cut their ties to former friends and family members and to many aspects of their previous lives A person who has sex-reassignment surgery confronts challenges few other have occasion to face, and this adjustment may well have to be made without the social support of family and friends Alterations of Gender Identity Some apparently successful procedures for altering gender identity through behaviour therapy have been reported Treatment involve shaping various specific behaviours, such as mannerisms and interpersonal behaviour, also included attention to cognitive components, such as fantasies Sexual arousal might be transferred, or classically conditioned The positive approach to changing the arousal properties of images and fantasies was complemented by aversion therapy to reduce the attractiveness of men Most transsexuals refuse such treatment. For them, physically altering their bodies is the only legitimate goal THE PARAPHILIAS Paraphilias a group of disorders involving sexual attraction to unusual objects or sexual activities that are unusual in nature. A deviation (para) in what the person is attracted to (philia) The fantasies, urges or behaviours must last at least 6 months and causes significant distress of impairment A person can have the behaviours, fantasies, and urges that a person with a paraphilia has but not be diagnosed with paraphilia if the fantasies or behaviours are not recurrent or not markedly distressed by them The DSM diagnostic criterion of distress or impairment has created some problems because many people with the behavioural features of a paraphilia are neither distressed nor impaired Many researchers in this field hold a more behavioural definition of paraphilias and ignore the distress and disability parts of the DSM definition People often exhibit more than one paraphilia, and such patterns can be aspects of other mental disorders, such as schizophrenia, depression or one of the personality disorders Accurate prevalence statistics are not available for most of the paraphilias That most people with paraphilias, whatever their sexual orientation, are male Fetishism Fetishism involves a reliance on an inanimate object for sexual arousal; almost always a male, has recurrent and intense sexual urges toward nonliving objects, called fetishes and the presence of the fetish is strongly preferred or even necessary for sexual arousal to occur Some can carry on their fetishism by themselves in secret Others need their partner to don the fetish as a stimulant for intercourse The attraction felt by the fetishist toward the object has a compulsive quality; it is experienced as involuntary and irresistible The disorder usually begins by adolescence Fetishists often have other paraphilias such as pedophilia, sadism and masochism Transvestic Fetishism
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