Download Sexual and Gender Identity Disorders

Sexual and Gender Identity
Disorders
Assessment & Diagnosis
SW 593
Introduction
• Three categories:
– Sexual dysfunctions
– Paraphilias
– Gender identity disorders
• In the case with sexual dysfunctions the
focus of impairment is relational which
creates barriers in establishing or
maintaining intimate relationships.
Sexual Dysfunctions
• Sexual Aversion Disorder:
– Expresses persistent/recurrent aversion and
avoids sexual contact with a partner.
– Response can vary between moderate anxiety
to extreme psychological distress.
• Hypoactive Sexual Desire Disorder:
– Absence/deficiency in sexual interest
– Extends to both fantasies/sexual activity.
Sexual Dysfunctions
• Male Erectile Disorder:
– Persistent/recurring inability to attain or maintain an
adequate erection during sexual activity.
• Female Sexual Arousal Disorder:
– Persistent/recurring inability to achieve or maintain an
adequate genital lubrication-swelling response during
sexual activity.
• For both instances, it is important to rule out
general medical conditions & substance abuse.
Sexual Dysfunctions
• Male/Female Orgasmic Disorder:
– Persistent/recurrent delay in/or absence of
orgasm following normal sexual excitement
and activity.
• Premature Ejaculation:
– Persistent/recurrent episodes of ejaculation
and orgasm before the person wishes.
– Evidence of limited genital contact prior to
ejaculation.
Sexual Dysfunctions
• Dyspareunia:
– Persistent/recurring genital pain associated
with sexual intercourse.
• Vaginismus:
– Pain characterized by involuntary vaginal
muscle spasms associated with penetration.
Specifiers
• Lifelong vs. acquired
• Pervasive/generalized vs. specific
situations
• Due to Psychological Factors vs. general
medical/substance use vs. combined
factors.
Paraphilias
• Involves variations in the
objects/conditions of sexual fantasies,
urges, or behaviors.
• Symptoms present for at least 6 months.
• Distress or interpersonal impairment is
necessary for diagnoses to be given.
Paraphilias
• Exhibitionism: exposure of genitals
• Fetishism: use of nonliving objects
• Frotteurism: touching and rubbing against
a non-consenting person.
• Pedophilia: focus on prepubescent children
• Sexual Masochism: receiving humiliation
or suffering
Paraphilias
• Sexual Sadism: inflicting humiliation or
suffering
• Transvestic Fetishism: cross-dressing
• Voyeurism: observing sexual activity
• It is essential to distinguish the nonpathological use of fantasy, behavior, or
objects in consensual sexual relations from
Paraphilias.
Gender Identity Disorder
• Feeling intensely uncomfortable with one’s
own biological sex.
• Evidence strong and persistent
identification with the opposite sex.
• Express discomfort with their actual sex
and/or the gender roles of that sex.
• Significant psychosocial distress or
impairment is evidenced.
Gender Identity Disorder
• Coding procedures:
– Children: 302.6 (Caution – vast majority of
children do not carry their symptoms into
adulthood.)
– Adolescents/adults: 302.85
• It should be noted that among
adolescents, the symptoms are resolved
by realizing a bisexual or homosexual
sexual preference.
Assessment
• Essential focus for sexual dysfunction is to
rule out and/or identify and treat any
aspect of the problem related to a general
medical condition.
• Psychometrics:
– Golombok-Rust Inventory of Sexual
Satisfaction (GRISS)
Cultural Considerations
• Clinicians must take into account the
individual’s ethnic, cultural, religious, and
social background.
• These aspects will dramatically influence
expectations and attitudes about sexual
and gender identity issues.
• Age and relational status also influence
expectations regarding these matters.
Cultural Considerations
• Social mores about male sexual behavior
are more stringently “enforced”.
• Sexual functioning vs. fertility
• Women are almost never diagnosed with
Paraphilias, with the exception of Sexual
Masochism.
• Reasons are unknown as to why.