Chap 13 - Abnormal Psych.docx

Chapter 13 – Sexual Variants, Abuse, and Dysfunctions SOCIOCULTURAL INFLUENCES ON SEXUAL PRACTICES AND STANDARDS - men’s greater emphasis on their partner’s attractiveness is cross-culturally universal - people typically behave as though the sexual standards of their time and place are obviously correct - ideas about sexually acceptable behaviour change over time Case 1: Degeneracy and Abstinence Theory - degeneracy theory  central belief that semen is necessary for physical and sexual vigor in men and for masculine characteristics such as beard growth - asserted that 2 practices were especially harmful – masturbation and patronizing prostitutes - abstinence theory  no sex (including masturbation) before marriage - punishment was sewing foreskin with a wire and circumcision without anesthesia (males), and burning the clitoris with acid (females) - many people believed that masturbation caused insanity (because of an anonymous publication in a book in the early 18 C in London)  this idea appear in some psychiatry textbooks as late as the 1940s Case 2: Ritualized Homosexuality in Melanesia - between 10-20% of Melanesian societies practice a form of homosexuality within the context of male initiation rituals that all male members of society must experience - two beliefs are semen conservation and female pollution (female body is unhealthy to males because of menstrual fluids) - males practice semen exchange with each other (fellatio and penetration)  stops after birth of man’s first child Case 3: Homosexuality and North American Psychiatry Homosexuality as a sickness: - in the 16thC homosexual behaviour was a felony punishable by death in England - believed that homosexuality developed in people whose heterosexual desires were too psychologically threatening Homosexuality as nonpathological variation: - gay men and lesbians began to challenge the psychiatric orthodoxy that homosexuality is a mental disorder - the APA voted in 1974 to remove homosexuality from the DSM - the rate of adult homosexuality is between 2 and 6 percent SEXUAL AND GENDER VARIANTS The Paraphilias * refer to DSM-IV-TR criteria on pg 465 * - definition: recurrent, intense sexually arousing fantasies, sexual urges, or behaviours that generally involved (1) nonhuman objects, (2) the suffering or humiliation of oneself or one’s partner, or (3) children or other non-consenting persons  patterns must last as least 6 months - some individuals with paraphilias require orgasmic release as often as 4-10 times per day - nearly all people with paraphilias are male Fetishism - the individual has recurrent, intense sexually arousing fantasies, urges, and behaviours involving the use of some inanimate object to obtain sexual gratification - e.g. of objects include hair, hands, shoes, perfume..Etc. - fetishism does not normally interfere with the rights of others (except asking a partner to wear the object during sexual encounters) - to obtain the required object, a person with a fetish may commit theft or assault  object most commonly stolen are women’s undergarments - only a small number of men develop fetishes  men high in sexual conditionability would be prone to developing a fetish Transvestic Fetishism - heterosexual men who experience recurrent, intense sexually arousing fantasies, urges, or behaviours that involve cross-dressing as a female - onset is during adolescence (usually involves masturbating while wearing female clothing) - motivation of transvestites is called autogynephilia  arousal by thought/fantasy of being a woman - does not cause overt harm to others unless accompanied by an illegal act such as theft Voyeurism - recurrent, intense sexually arousing fantasies, urges, or behaviours involving the observation of unsuspecting females who are undressing or of couples engaging in sexual activity - frequently are masturbating during their ‘peeping’ activity - commit these offences primarily as young men - voyeuristic activities often provide important compensatory feelings of power and secret domination over an unsuspecting victim Exhibitionism - a person with recurrent, intense, urges, fantasies or behaviours that involve exposing his genitals to others (usually strangers) in inappropriate circumstances and without their consent - the exposure is generally repeated under fairly constant conditions, or in the same vicinity and at the same time of day - typical victim is a young or middle aged female who is not known to the offender - exhibitionism usually begins in adolescence or young adulthood  most common sexual offence reported to the police in Canada, USA, and Europe (accounts for one third of all sexual offences) - as many as 20% of women have been the target of exhibitionism or voyeurism - a minority of exhibitionists commit aggressive acts and coercive sex crimes Sadism - recurrent, intense sexually arousing fantasies, urges, or behaviours that involve inflicting psychological or physical pain on another individual - the pain inflicted by sadists may come from whipping, biting, cutting or burning  can result in murder - mild degrees of sadism are involved in sexual foreplay - 5-15% of men and women enjoy sadistic and/or masochistic activities voluntarily on occasion - extreme sexual sadists may mentally replay their torture scenes later while masturbating - although many sadists have had chaotic childhoods, some come from middle-class families and had loving parents Masochism - recurrent, intense sexually arousing fantasies, urges or behaviours involving the act of being humiliated, beaten, or bound, often in a ritualistic pattern of behaviour - sometimes the women who fall into such a pattern with their partners were sexually/physically abused as children - masochism is much more common than sadism and occurs in both men and women - sadomasochistic activities are often performed communally within “dungeons” popular in major cities - autoerotic asphyxia is a dangerous form of masochism (self-strangulation to increase the intensity of orgasm) - victim of autoerotic asphyxia is usually a single male aged 15-29 years - friends and family usually do not find out about the fetish until some mishap has occurred Causal Factors and Treatments for Paraphilias - nearly all people with paraphilia are male - begins around the time of puberty or early adolescence - people with paraphilias often have more than one - perhaps sexual arousal in men depends on physical stimulus features to a greater degree than in women  when observing paraphilic stimuli, boys may masturbate, and the reinforcing orgasm may serve to condition an intense attraction - most people with paraphilias do not seek treatment for their conditions Gender Identity Disorders - characterized by two components: (1) a strong and persistent cross-gender identification, and (2) gender dysphoria (persistent discomfort about one’s biological sex)  can occur in children or adults, and in males or females Gender Identity Disorder of Childhood - boys with gender identity disorder show a marked preoccupation with traditionally feminine activities  may prefer to dress in female clothing  enjoy stereotypical girls’ activities such as playing dolls and playing house  avoid rough-and-tumble play and often express the desire to be a girl - girls with gender identity disorder typically balk at parents’ attempts to dress them in traditional feminine clothes like dresses, preferring boys’ clothes and short hair  fantasy heroes include powerful male figures like Batman or Superman  little interest in dolls and a greater interest in sports  desire to be a boy or grow up as a man - girls with GID are treated better by peers than boys with GID (cross-gender behaviour in girls is better tolerated) - boys with GID outnumber girls with GID 5 to 1 - most common adult outcome of GID in boys is homosexuality, rather than transsexualism - cross-gender behaviour harms no one, however they are constantly mistreated by peers Treatment - often brought to psychotherapy by their parents - children with GID often have other behavioural problems such as anxiety and mood disorders - therapists try to improve peer/parental relations by teaching such children how to reduce their cross-gender behaviour in situations where it might cause interpersonal problems Transsexualism - adults with gender identity disorder who desire to change their sex - transsexualism is a rare disorder 1 per 30,000 adult males and 1 per 100,000 adult females seek sex reassignment surgery - all female-to-male transsexuals had GID as a child - two kinds of male-female transsexuals: homosexual and autogynephilic  homosexual transsexual men – feminine, attracted to biological males, often define themselves as heterosexual women  autogynephilic transsexuals – attraction to fantasies of themselves as women - homosexual transsexuals generally have had gender identity disorder since childhood  hypothesis that there are some prenatal hormonal influences affecting which children develop GID and later become transsexuals - autogynephilic transsexuals almost always occurs in males who usually report a history of transvestic fetishism (may report a sexual attraction to women, both men and women, or neither - autogynephilic transsexuals do not have a very feminine childhood/adulthood, and typically seek sex reassignment surgery much later in life than homosexual transsexuals Treatment - psychotherapy is usually not effective - the only treatment that has been shown to be effective is surgical sex reassignment  in Canada, only available in Montreal - before surgery, they must live for many months with hormonal therapy treatment, and must live for at least a year as the gender they wish to become - the majority of transsexuals are satisfied with the outcome of sex reassignment surgery SEXUAL ABUSE - sexual contact that involves physical or psychological coercion, or at least one individual who cannot reasonably cons