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Chapter 14

Abnormal Psych Chapter 14.doc

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 14: Sexual and Gender Identity Disorders • Sexual and gender identity disorder: full range of human sexual thoughts, feelings and actions that are generally regarded as abnormal and dysfunctional Gender Identity Disorder • Gender identity: our sense of ourselves as male or female Characteristics of Gender Identity Disorder • Transsexualism: people with gender identity disorders are sometimes referred to as this; they feel deep within themselves (usually from early childhood) that they are of the opposite sex • They may want to pass as a member of the opposite sex or even have surgery • In childhood – associated with cross-gender behaviours  dressing in opposite-sex clothes, preferring opposite-sex playmates, and engaging in play that would be more typical of the opposite sex • They are usually recognized by their parents at age 2-4 • GID is 6.6x more frequent in boys than girls • (Zucker) factors associated with decision to seek clinical assessment o Belief that the behaviour was no longer a phase that the child would grow out of o Threshold violation (wanting to dress certain way outside of home also) o Belief that the child was experiencing intense distress about being a boy or girl o Concerns about potential or actual rejection by peers • Most children with GID do not grow up to be disordered in adulthood, even without professional intervention; many demonstrate homosexual orientation • GID people often experience anxiety and depression • GID in childhood is linked with separation anxiety disorder • Prevalence rate  1/30,000 (men)  1/100,000-150,000 (women) Causes of Gender Identity Disorder • More information is needed on the cause of GID in order to resolve this debate • Evidence indicates that gender identity is influenced 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 and have anatomical abnormalities • Brain structures differences are also being investigated C h a p t e r 1 4 : S e x u a l & G e n d e r I d e n t i t y D i s Page 1e r s • Environment may play a huge factor as well (male patients report having distant relationships with their fathers; females often report history of physical/sexual abuse) Therapies for Gender Identity Disorder • There are 2 main types  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 • Prior to body alterations the person is required to go through 6-12 months of psychotherapy • The therapy focuses on anxiety & depression as well as options available to the person on altering their body • Some people may chose just to have cosmetic surgery (facial hair, adams apple removal etc), and take hormone pills • Sex reassignment surgery: an operation in which the existing genitalia are altered to make them more like those of the opposite sex • It is much more frequently exercised by men than by women • Satisfactory factors (not regretting) of postsurgery was based on o Reasonable emotional stability o Successful adaptation in the new role for at least 1 year before surgery o Adequate understanding of the actual limitations and consequences of the surgery o Psychotherapy in the context of an established gender identity program Alterations of Gender Identity • Some apparently successful procedures for altering gender identity through behaviour therapy have been reported • One technique paired slides of women with slides of men, the idea being that sexual arousal from the latter might be transferred to the former – this positive approach to changing the arousal properties of images and fantasies was complemented by aversion therapy to reduce the attractiveness of men The Paraphilias • Paraphilias: a group of disorders involving sexual attraction to unusual objects or sexual activities that are unusual in nature • These fantasies, urges or behaviours must last at least 6 months and cause significant distress or impairment • The distress & impairment part has caused some problems because many people with it are neither distressed nor impaired (so it’s usually ignored) • Most people with paraphilias are male Fetishism C h a p t e r 1 4 : S e x u a l & G e n d e r I d e n t i t y D i s Page 1e r s • Fetishism: involves a reliance on an inanimate object for sexual arousal • Almost always male & has recurrent and intense sexual urges toward non living objects • The presence of the fetish is strongly preferred or even necessary for sexual arousal to occur • Examples  feet, shoes, sheer stockings, rubber products, toilet articles, fur garments, underpants • The attraction felt has a compulsive quality (involuntary and irresistible) • Erotic focalization: the exclusive and very special status the object occupies as a sexual stimulant • The disorder begins in adolescence • Fetishists often have other paraphilias (peudophilia, sadism, and masochism) Transvestic Fetishism • Transvestic fetishism: or transvestism; when a man is sexually aroused by dressing in women’s clothing, although he still regards himself as a man • Varies from wearing women’s underwear under clothes to full cross- dressing • Impersonators are not considered transvestic unless the cross-dressing is associated with sexual arousal • It should not be confused with cross-dressing associated with GID or with the cross-dressing preferences of some homosexuals • Autogynephilia: a man’s tendency to become sexually aroused at the thought or image of himself as a women (typically found in association with transvestism) • Usually begins with partial cross dressing in childhood or adolescence • Transvestites are heterosexual, always males, and by and large cross- dress episodically rather than on a regular basis • They tend to be masculine in appearance & many are married • Cross-dressing usually takes place in private and in secret and is known to few members of the family • Distress & disability don’t seem to apply at all to transvestics • Over time it may get stronger and they may feel discomfort with their anatomical sex ( gender dysphoria )  but not to the extent of GID • Its comorbid with other paraphilias like masochism Pedophilia and Incest • Pedophilia: adults who derive sexual gratification through physical and often sexual contact with prepubescent children unrelated to them • The offenders must be at least 16 years old and at least 5 years older than the child • Occurs more frequently in males C h a p t e r 1 4 : S e x u a l & G e n d e r I d e n t i t y D i s o Page 1r s • Often comorbid with mood and anxiety disorders, substance abuse, and other paraphilias • The use of internet has made it easier for them to acquire a child • A minority of pedophiles, who might also be classified as sexual sadists or antisocial (psychopathic) personalities, inflict serious bodily harm on the object of their passion (they wish to hurt the child physically at least as much as they wish to obtain sexual gratification) • Homicidal child molesters show greater physiological response to and preference for descriptions of assaults on children • Incest: sexual relations between close relatives for whom marriage is forbidden o Most common between brothers and sisters, then father-daughter (considered more pathological) • The incest taboo has adaptive evolutionary significance (negative biological effects) • It is more present when mothers is absent or disabled • Incest is listed in DSM as a subtype of pedophilia • Difference between incest & pedophilia o Incest is by definition between members of the same sex o Incest victims tend to be more older than pedophile’s victims they desire  Incest is usually when they are mature physically whereas in pedophile is when they are sexually immature • Gynephile: an adult who is incestuous with a child in the absence of a mature, adults sex partner • Plethysmograph measures have been described as phallometric tests and they have been used to identity males – both adults and adolescents with pedophilic interests • Alcohol use and stress increases the likelihood that a pedophile will molest a child • 1 ½ of all child molestations (also within families) are committed by adolescent males (50% of adult offenders began in early teens). Their homes often lacked structure and positive support • Cluster analyses of scores on California Psychological Inventory have identified 4 types of offenders o Antisocial/impulsive – more pathological characteristics o Unusual/isolated – more pathological characteristics o Ovecontrolled/reserved  have a more + orientation toward others and overly shy o Confident/aggressive  The adolescence have relatively + orientation toward others, but can be narcisstic and hostile at times • Screening scale for Pedophilic Interests (SSPI): screening instrument that is quite successful in distinguishing pedophilic child molesters and non child molesters who have abused older victims C h a p t e r 1 4 : S e x u a l & G e n d e r I d e n t i t y D i s Page 1e r s Voyeurism - THE BOX on Page 449 • Voyeurism: involves a marked preference for obtaining sexual gratification by watching others in a state of undress or having sexual relations • There is seldom contact with the observer and the observed • Almost always a man • The voyeur is excited by the anticipation of how the women would react if she knew he was watching • Voyeurs are most often charged with loitering rather than with peeping itself • Onset - adolescence • It’s thought that they are more fearful of more direct sexual encounters with others, because they may lack social skills Exhibitionism • Exhibitionism: recurrent, marked preference for obtaining sexual gratification by exposing one’s genitals to an unwilling stranger, sometimes a child • Onset – adolescence • It’s seldom an attempt to have contact with the stranger but those who do are arrested • There is a desire to shock or embarrass the observer • Voyeurism and exhibitionism account for the majority of sexual offenses that go to the police • More frequent among men (who are arrested for indecent exposure) • The urge to expose is overwhelming and virtually uncontrollable to the exhibitionist, or flasher, and is apparently triggered by anxiety and restlessness as well as by sexual arousal • Sometimes it so strong that they become oblivious to the social/legal consequences of what they are doing • In desperation and tension of the moment they may experience headaches, palpitations and have a sense of unreality  after they feel trembling and remorse • ½ are married but with unsatisfactory marriages • Exhibitionist showed significantly greater arousal in response to slides of fully clothed women in non sexual situations Frotteurism • Frotteurism: involves the sexually oriented touching of an unsuspecting person • He may rub his penis against a women’s thigh or buttocks or fondle her breasts or genitals • Typically occur in places that provide easy means of escape (crowded bus or sidewalk) • Onset – adolescence • Typically occurs along with other paraphilias C h a p t e r 1 4 : S e x u a l & G e n d e r I d e n t i t y D i s o Page 1r s Sexual Sadism and Sexual Masochism • Sexual sadism: marked preference for obtaining or increasing sexual gratification by inflicting pain or psychological suffering (ex. humiliation) on another • Sexual masochism: marked preference for obtaining or increasing sexual gratification through subjecting oneself to pain or humiliation • Both are found in heterosexual and homosexual relationships (85% heterosexual) • 20-30% females • Onset – early adulthood • They are relatively comfortable with their unconventional sexual practises • Majority of sadist establish relationships with masochists to derive mutual sexual gratification • 5-10% of population have engaged in some form of sadomasochistic activity (blindfolding; but few do regularly) • Sadists may derive full orgasmic pleasure by inflicting pain on his or her partner, and the masochist may be completely gratified by being subject to pain • For other partners, sadistic and masochistic practises, such as spanking, are a lead up to or an aspect of sexual intercourse • Masochists outnumber sadists o Restrain (physical bondage) o Blindfolding (sensory bondage) o Spanking o Whipping o Electric shocks o Cutting o Humiliation (being urinated or defecated on, being forced to wear a collar and bark like a dog, or being put on display naked, or taking the role of slave and submitting to orders and commands  Infantilism: desire to be treated like a helpless infant and clothed in diapers • Hypoxyphilia: (dangerous) involves sexual arousal by oxygen deprivation, which can be achieved using a noose, a plastic bag, chest compression, or a chemical that produces a temporary decrease in brain oxygen by peripheral vasodilatation • Occasionally, sadists murder and mutilate; some are sex offenders who are imprisoned for torturing their victims o They are more likely to impersonate police officers, commit serial murders and tie up their victims Paraphilias not otherwise specified • Necrophilia: sex with dead people • Zoophilia: bestiality • Telephone scatalogia: repeated urges to make obscene phone calls C h a p t e r 1 4 : S e x u a l & G e n d e r I d e n t i t y D i s Page 1e r s • Scatalogia: repeated urges to make obscene phone calls • Coprophilia: the use of feces of sexual excitement Etiology of the Paraphilias Psychodynamic Perspective • Paraphilias are viewed as defensive in nature, protecting the ego from having to deal with repressed fears and memories and representing fixations at pregential stages of psychosexual development • They are seen to be fearful of heterosexual relationship and heterosocial relationships that don’t involve sex • Their sexual development is immature, stunted and inadequate for both social and heterosexual intercourse with the adult world Behavioural and Cognitive Perspectives • Paraphilias arise from classical conditioning that by chance has linked sexual arousal with classes of stimuli o This orgasm-conditioning hypothesis has very little empirical support • Most other behavioural/cognitive theories are multidimensional and take childhood sexual abuse and parent-child relationships into consideration • Alcohol and negative affect are often triggers of incidents of pedophilia, voyeurism, and exhibitionism • Cognitive distortions also play a role (they may think that these women like it) • Operant conditioning perspective – Paraphilias are considered an outcome of inadequate social skills or reinforcement of unconventionality by parents or relatives (ex. Praised as a child for wearing mother’s dress) Biological Perspectives • Majority are male; so androgen has been suspected as the principle male hormone that plays a role • Dysfunction in the temporal lobe may be relevant to a minority of cases of sadism and exhibitionism Therapies for Paraphilias • Because they are illegal, many are imprisoned and their treatment is ordered by court • Most offenders begin in adolescence • They often lack the motivation for treatment • Minimization of the seriousness of their problem, a belief that their victims will not be credible witnesses, and the confidence that they can control their behaviour without professional help  they are frequently judged to be inappropriate for treatment programs • Methods to enhance motivation o The therapist can empathize with the offender  reduces the offenders defensiveness and hostility C h a p t e r 1 4 : S e x u a l & G e n d e r I d e n t i t y D i s o Page 1r s o Therapist can point out to the offender the treatments that might help him control his behaviour better and emphasize the negative consequences of refusing treatment o Can tell them the benefits of the treatment o Therapist can explain that there will be psychophysiolgical assessment of the patients sexual arousal  so it will be revealed without his a
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