Chapter 14 for FALL 2010 semester

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1 Apr 2011

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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
- 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
- most children with GID do not grow up to be disordered in adulthood, even without professional
intervention; however, many become gay
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- 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
- 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
- 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
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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
- 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 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 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
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