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Chapter 14

Chapter 14 - Sexual and Gender Identity Disorders

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Konstantine Zakzanis

Chapter 14 Sexual and Gender Identity Disorders 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 - 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 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 - 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 fetishism fetishists often have other paraphilias, such as pedophilia, sadism, and masochism transvestic fetishism the practice of dressing in clothing of the opposite sex, for the purpose of sexual arousal - when a man is sexually aroused by dressing in womens clothing, although he still regards himself as a man, the term transvestic fetishism, or transvestism applies - transvestites (cross-dressers) are heterosexual, always males, and by and large cross-dress episodically rather than on a regular basis - they tend to be otherwise masculine in appearance, demeanor, and sexual preference; many are married - cross-dressing usually takes place in private and in secret and is known to few members of the family; this is one of the paraphilias for which the DSM distress and disability criteria do not seem to apply at all - the urge to cross-dress may become more frequent over time and sometimes is accompanied by gender dysphoria discomfort with ones anatomical sex but not to the extent found in GID - transvestism is comorbid with other paraphilias, notably masochism pedophilia - DSM-IV-TR requires that the offender be at least 16 years old and at least 5 years older than the child - research doesnt appear to support the DSMs statement that all pedophiles prefer prepubescent children; research revealed that some of them victimize post pubescent children who are younger than the legal age to consent to having sex with an adult - pedophilia is often comorbid with mood and anxiety disorders, substance abuse, and other paraphilias - the pedophile can be heterosexual or homosexual - a recent study found that a child pornography offence is a stronger diagnostic indicator of pedophilia than is an actual history of sexually offending against child victims! - a minority of pedophiles, who might also be classified as sexual sadists or anti-social (psychopathic) personalities, inflict serious bodily harm on the object of their passion - these individuals, whether psychopathic or not, are perhaps best viewed as child rapists and are different form the pedophiles in that they wish to hurt the child physically or at least as much as they wish to obtain sexual gratification incest - incest is listed in the DSM-IV-TR as a subtype of pedophilia www.notesolution.com - a study examined the nature of incest vs. extrafamilial (outside the family) forms of child sexual abuse and found that incest had an earlier onset and longer duration; also, victims of incest has comparatively greater levels of physical injury and emotional distress - almost 2/3 of the incest offenders reported having non-incestuous victims as well, which suggests that theyre also pedophiles; twas concluded that for these men, the main issue is one of opportunity; they have a general sexual attraction to children that may indeed go beyond members of their own family - researchers concluded that pornography only plays a role among men who are already predisposed to sexually offend; men who arent predisposed show little effect - rather than using explicitly pornographic materials, child molesting men appeared to construct in their minds their own sexually stimulating material from sources generally viewed as innocuous - pedophiles generally know the children they molest; theyre neighbors or friends of the family - alcohol use and stress increase the likelihood that a pedophile will molest a child - research suggests that child molesters have sexual fantasies about children when their mood is negative, perhaps as a way to cope with their unease; however, it also appears that having a pedophilic fantasy enhances the negative affect; perhaps this downward spiral can eventually lead to the persons acting on the impulse to molest a child - data suggests that pedophiles are low in social maturity, self-esteem, impulse control, and social skills - conduct disorder and substance abuse are frequent diagnoses made of these youths; anxiety disorders and depression are also common features - a brief measure known as the Screening Scale for Pedophilic Interests (SSPI) and have shown that this screening instrument is quite successful in distinguishing pedophilic child molesters and non-child molesters who have abused older victims - greater pedophilic interest in present when an unrelated victim is involved - a study of pedophiles found that lower levels of intellectual functioning are associated with greater interest in boys and in younger children in general Focus on Discovery 14.2 Child Sexual Abuse: Effects on the Child and Modes of Intervention - more than 4/5 victims are females - pedophilia and incest are forms of child sexual abuse child sexual abuse sexual abuse of children that involves direct physical contact, such as pedophilia or incest Effects on the Child - the majority of children are negatively affected, with problems including anxiety, depression, low self-esteem, and conduct disorder - several factors likely contribute to how CSA affects a child; one is the nature of the abuse itself - sometimes the aftermath of CSA is PTSD - a high level of self-blame and lack of a supportive family environment also increase the chances that the CSA will produce negative reactions - a history of CSA is found among patients in many diagnostic categories notably, dissociative identity disorder, eating disorders, and borderline personality disorder; it has also been proposed that CSA is related to the development of depression - a history of CSA is also associated reliably with sexual revictimization - CSA is also related to sexual dysfunctions - some sexually abused children may even become suicidal in subsequent years Prevention - for CSA, prevention efforts have focused on elementary schools - common elements of the ESPACE program include teaching children to recognize inappropriate adult behavior, resist inducements, leave the situation quickly, and report the incident to an appropriate adult; children are taught to say no in a firm assertive way when an adult talks to or www.notesolution.com touches them in manner that makes them feel uncomfortable Dealing with the Problem - the primary data regarding CSA must come from the childs self report - pedophilic offences, when the perpetrator is not a member of the family, are more frequently reported to police and prosecuted in court - in closing, we should point out that both incest and pedophilia occur much more often in the majority North American culture than was formerly assumed Voyeurism voyeurism marked preference for obtaining sexual gratification by watching others in a state of undress or having sexual relations - for some men, voyeurism is the only sexual activity in which they engage; for others, it is preferred but not absolutely essential for sexual arousal - the looking, often called peeping, is what helps the individual become sexually aroused - the voyeurs orgasm is achieved by masturbation, either while watching or later, remembering what he saw - sometimes the voyeur fantasizes about having sexual contact with the observed person, but it remains a fantasy; in voyeurism, there is seldom contact between the observer and the observed - a true voyeur, almost always a man, doesnt find it particularly exciting to watch a woman who is undressing for his special benefit - the element of risk seems important, for the voyeur is excited by the anticipation of how the woman would react if she knew he was watching - voyeurism typically begins in adolescence; its thought that voyeurs are fearful of more direct sexual encounters with others, perhaps because they lack social skills; their peering serves as a substitute gratification and possibly gives them a sense of power over those watched - it may be that the increased availability of completely frank pictorial and written material, typically used in masturbation, partially satisfied the needs that had made voyeurs of some men in the absence of other outlets Exhibitionism exhibitionism marked preference for obtaining sexual gratification by exposing ones genit
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