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Chapter 14

chapter 14

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University of Toronto Scarborough
Konstantine Zakzanis

1 Chapter 14: Sexual and Gender Identity Disorders When fantasies or desires begin to affect us or others in unwanted or harmful ways, they qualify as abnormal Human sexual thoughts, feelings and actions that are regarded as abnormal and dysfunctional are listed in DSM-IV-TR as sexual and gender identity disorders (people who believe they are of the opposite sex) Paraphilias: people are attracted to unusual sexual activities or objects Rape is not part of the DSM listing Sexual dysfunction is the disruption in normal sexual functioning found in many people who are in otherwise reasonably sound psychological health Gender Identity Disorder Our gender identity is our sense of ourselves as male or female Sexual identity or sexual orientation is the preference we have for the sex of a partner Characteristic of GID Also referred to as transsexualism: feel deep within themselves, usually from early childhood, that they are of the opposite sex Have an aversion to same-sex clothing and activities They have normal genitals and usually secondary sex characteristics (beard growth for men and breasts for women); this does not persuade them that they are what others see them to be They might look in the mirror and see a biological man or women but may personally experience that the body belongs to the opposite sex; they may try to pass as a member of the opposite sex and even want body surgically altered to bring it in life with their gender identity Most GID cases are specified as GIDNOS; person may have symptoms that meet such of the description of GID but there are some unique features that do not fit the precise criteria of GID When GID is not differentiated from transvestic fetishism; they often dress in clothing typical of the opposite sex, but transvestites do not identify themselves as of the opposite sex When GID begins in childhood it is associated with cross-gender behaviour such as dressing in the opposite sex clothes, preferring opposite sex playmates and engaging in play that would usually be considered more typical of the opposite sex 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 child is usually recognized by child at the age b/w 2-4 years It is 6.6 times more common in boys than girls and this is a result of social factors; 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 Zuckers chart review had several factors associated with the decision to seek a clinical assessment A belief that the behaviour was no longer a phase that the child would grow out of A threshold violation Belief that the child was experiencing intense distress about being a boy or a girl Concerns about potential or actual rejection by peersstrongest predictor of behaviour problems Most children with GID do not grow up to be disordered in adulthood, even w/o professional interventionmany show a homosexual orientation Excluded from GIF are people with schizophrenia and hermaphrodites (intersexed individuals who have both male and female reproductive organs) Male with GID experiences his sexual interest in men as a conventional heterosexual preference because he considers himself a women 2 Those with GID often arouse disapproval of others and experience discrimination in employment when they choose to cross dress People with GID often experience anxiety and depression not surprising given their psychological predicament and negative attitudes most people have towards them GID in childhood is linked with separation anxiety disorder Prevalence rates for GID are slight: 1 in 30 000 men and 1 in 100 000 to 150 000 women Causes of GID Bartlett 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 Some suggest that GID in children should be removed from the DSM because it may contribute to labelling process that stigmatizes those children with GID who go on to develop homosexuality Patterns of GID can come from physical disturbance Gender identity is influenced by hormones in an experiment the participants were unable to produce hormones that shape the penis and scrotum in males during fetal development- born with small penises that looked like labial folds2/3 of them raised as girls but at puberty their testosterone levels increased and their sex organs changed (penis enlarged and testicles described into the scrotum) 17 of the 18 participants developed a male gender identity Castration is the construction of female genitals and later treatment with sex hormones Reassigned female gender identity is evident despite the presence of masculine tendencies (nurture) ; and in other cases it doesnt work because of perhaps a biological cause (nature) Humans 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; the children were not necessarily abnormal in their gender identity, but the mothers ingestion of prenatal sex hormones did apparently give them higher than usual levels of cross-gender interest and behaviour Progestin: girl more tomboyish Female hormones: boy more girly There are few differences in hormones levels among men with GID , male heterosexuals and male homosexuals Some women with GID had elevated levels of male hormones, but others did not These differences are difficult to interpret because many GID patients use sex hormones in an effort to alter their bodies according to their wishes Research on chromosomal abnormalities is less conclusive than hormonal abnormalities; efforts to find difference in brain structures b/w transsexuals and control group subjects have been negative Environment can also play a role; many young children engage in cross-gendered behaviour now and then and in some homes this may be reinforced by parents or relatives; this contributes in a major way to conflict b/w their anatomical sex and acquired gender identity Childs attractiveness is a factor that may contribute to this pattern of parental behaviour; boys with GID have been rated more attractive than control children and girls with GID as less attractive Male patients with GID report have distant relationship with their fathers; females report history of physical and sexual abuse Feminine behaviour in boys is encouraged by mothers who prior to childs birth wanted very much to have a girl GID is far less prevalent than would be indicated by number of boys how play with dolls an girls who engage in contact sports Therapies for GID: attempt to alter body to suit psychology and other is designed to alter psychology to match the body 1) Body alterations: 3 Have to undergo 6-12 months of psychotherapy; it focuses not only on anxiety and depression that the person has been likely experiencing but also available options for altering his or her body Some people 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 apple Many take hormones to bring their bodies physically close to their beliefs about their gender Many do not go further than this but some take next step of having sex-reassignment surgery which is an operation in which existing genitalia are altered to make them more like those of the opposite sex; surgery is done by men more than women There was no advantage to the individuals in terms of social rehab 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 adjustments were (1) reasonable emotional stability (2) successful adaptation in the new role for at least one year b4 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 Sexual responsiveness and sexual satisfaction increase dramatically in both male to female and female to male transsexuals with an overall high level of satisfaction with results of the surgery patients point at the importance of postoperative psychotherapy in helping them with the adjustment 1) Alterations of Gender Identity Surgery and associated hormone admin used to be considered the only viable treatment for GID because psychological attempts to shift gender identity had consistently failed Some apparently successful procedures for altering gender identity thru behaviour therapy have been reportedshape specific behaviours like mannerism and interpersonal behaviour and also attention is given to cognitive components like fantasies Cross-gender identity is amenable to change The people in these programs were different from other transsexuals because they consented on participating whereas transsexuals refuse treatment and altering bodies is the only legit goal The Paraphilias: group of disorders involving sexual attraction to unusual objects or sexual activities that are unusual in nature There is a deviation (para) in what the person is attracted to (philia) Fantasies, urges or behaviours must last at least 6 months and cause significant distress or impairment Person can have behaviours, fantasies and urges that a person with
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