Download Sexual Abnormalities

Essentials of
Understanding
Abnormal Behavior
Chapter Nine
Sexual and Gender Identity
Disorders
Sexual and Gender Identity
Disorders
Sexual dysfunctions: Problems of inhibited
sexual desire, arousal, and response
 Gender-identity disorders: Incongruity or
conflict between one’s anatomical sex and
one’s psychological feeling of being male
or female
 Paraphilias: Sexual urges and fantasies
about situations, objects, or people not
part of the usual arousal pattern leading to
reciprocal and affectional sexual activity

What Is “Normal” Sexual
Behavior?
Shifting perspectives make the line
between normal and abnormal difficult to
define
 Definitions depend on such factors as
culture and time period
 Legal decisions reflect past moods and
morals, questionable and idiosyncratic
views

What Is “Normal” Sexual
Behavior? (cont’d)

Merck Manual’s process for judging if a
behavior constitutes a sexual problem:
 Persistence/recurrence
over long period of
time
 Personal distress
 Negative effect on relationship with one’s
sexual partner
The Study of Human Sexuality


Freud made the discussion of sexual topics
more acceptable by incorporating sex (libido) as
an important part of his theory
Contemporary understanding of human sexual
physiology, practices, and customs:
 Is
based on research of Alfred Kinsey, William
Masters and Virginia Johnson, and The Janus Report
 While controversial, these studies dispelled myths
and provided clear evidence about human sexuality.
Homosexuality

Attitudes concerning homosexuality:
 American
Psychiatric Association and
American Psychological Association:
Homosexuality is not a mental disorder
 Negative attitudes are held by many political
figures and religious leaders
 Homophobia: Irrational fear of homosexuality
Homosexuality: Research
Findings





No physiological differences in sexual arousal
and response for homosexuals/heterosexuals
No significant differences on measures of
psychological disturbance
Gender conflicts due to societal intolerance, not
gender identity confusion
Sexual concerns differ because of societal
context
A naturally occurring phenomenon, not a lifestyle
choice
Frequency of Symptoms in 55 Boys
with Cross-Gender Preferences
Figure 9.4: Disorders Chart:
Gender
Identity Disorders
Sources: Data from DSM-IV-TR; Arndt (1991); Laumann et al. (1994).
Gender Identity Disorders

Gender identity disorder: Characterized by
conflict between a person’s anatomical
sex and his/her gender identity, or selfidentification as male or female
 Prevalence:
Relatively rare
 Most children with gender identity conflicts do
not develop gender identity disorders as
adults
Gender Identity Disorders (cont’d)

Transsexualism (“specified gender identity
disorder”): Strong and persistent cross-gender
identification and persistent discomfort with
one’s anatomical sex, causing significant
impairment in social, occupational, or other
areas of functioning
 Prevalence:
1:100,000-30,000 for males; 1:400,000100,000 for females

Gender identity disorder not-otherwise-specified:
Disorders not classifiable as specific gender
identity disorder
Etiology of Gender Identity
Disorders




Etiology is unclear—probably an interaction of
multiple variables
Biological: Possibly neurohormonal factors
Psychodynamic: Unconscious childhood
conflicts resulting from failure to deal
successfully with separation-individuation
phases of life, or inability to resolve Oedipus
complex
Behavioral: Childhood experiences based on
operant conditioning and social learning
Treatment of Gender Identity
Disorders
Children: Sex education; peer group
interaction training
 Parents: Learn to reinforce appropriate
gender behaviors and extinguish
inappropriate behaviors
 Modeling and rehearsal
 Sex-change operations

Paraphilias

Paraphilias: Sexual disorders lasting at
least 6 months during which the person
has either acted on, or is severely
distressed by, recurrent urges or fantasies
involving:
 Nonhuman
objects
 Nonconsenting others, or
 Real or simulated suffering or humiliation
Often involves multiple paraphilias

More common in males than in females
Figure 9.5: Disorders Chart:
Paraphilia Disorders
Sources: Data taken from DSM-IV-TR; Tsoi (1993); Kinsey et al. (1953); Spector and Carey (1990; Allgeier and Allgeier (1998).
Figure 9.5:
Disorders
Chart:
Paraphilia
Disorders
(Cont’d)
Sources: Data taken from DSM-IV-TR; Tsoi (1993); Kinsey et al. (1953); Spector and Carey (1990; Allgeier and Allgeier (1998).
Paraphilias Involving Nonhuman
Objects


Fetishism: Extremely strong sexual attraction
and fantasies involving inanimate objects, such
as female undergarments
Transvestic fetishism: Intense sexual arousal
obtained through cross-dressing (wearing
clothes appropriate to the opposite gender); do
not confuse with transsexualism
 If
arousal is not present/has disappeared over time,
more appropriate diagnosis is gender identity disorder
Paraphilias Involving
Nonconsenting Persons
Exhibitionism: Urges, acts, or fantasies
about exposing one’s genitals to strangers
 Voyeurism: Urges, acts, or fantasies
involving observation of an unsuspecting
person disrobing or engaging in sexual
activity
 Frotteurism: Recurrent and intense sexual
urges, acts, or fantasies of touching or
rubbing against a nonconsenting person

Paraphilias Involving
Nonconsenting Persons (cont’d)

Pedophilia: Adult obtains erotic
gratification through urges, acts, or
fantasies involving sexual contact with a
prepubescent child
 20-30%
of women report childhood sexual
encounters with a man; most likely a relative,
friend, or casual acquaintance
Paraphilias Involving Pain or
Humiliation
Sadism: Form of paraphilia in which
sexually arousing urges, fantasies, or acts
are associated with inflicting physical or
psychological suffering on others
 Masochism: A paraphilia in which sexual
urges, fantasies, or acts are associated
with being humiliated, bound, or made to
suffer

Table 9.2: Sadomasochistic Activities,
Ranked by Selected Samples of Male
& Female Participants
Childhood Sexual Abuse

Victims of childhood sexual abuse:
 ~25%
are younger than age 6; 25% are age
6-10; 50% are 11-13
 Relapse rate for pedophiles: 35%
 Physical symptoms of victims:

Urinary tract infections, poor appetite, headaches
Childhood Sexual Abuse (cont’d)

Victims of childhood sexual abuse (cont’d):
 Psychological
symptoms of victims:
Nightmares, difficulty sleeping, decline in school
performance, acting-out behaviors, sexually
focused behavior
 Some exhibit posttraumatic stress disorder:
flashbacks, diminished responsiveness to
environment, hyperalertness, and jumpiness

Paraphilias Involving Pain or
Humiliation




Sadism: Form of paraphilia in which sexually
arousing urges, fantasies, or acts are associated
with inflicting physical or psychological suffering
on others
Masochism: A paraphilia in which sexual urges,
fantasies, or acts are associated with being
humiliated, bound, or made to suffer
Most sadomasochists engage in both
submissive and dominant roles
Brain pathology and life experiences may
underlie sadism
Table 10.6:
Sadomasochistic
Activities, Ranked
by Selected
Samples of Male
and Female
Participants
Etiology and Treatment of
Paraphilias
Conflicting findings regarding genetic,
neurohormonal, and brain anomaly
explanations
 Psychodynamic: Unconscious childhood
conflicts

 Castration
anxiety due to unresolved Oedipus
complex
 Treatment: Help patient understand
relationship between deviation and
unconscious conflict
Etiology and Treatment of
Paraphilias (cont’d)

Behavioral:
 Learning
theory stresses early conditioning
experiences
 Preparedness: Prepared to associate some
stimuli with reinforcers, but not others
 Treatment: Extinction or aversive conditioning
(aversive behavior rehearsal);
acquiring/strengthening appropriate
behaviors; developing appropriate social skills
Sexual Aggression

Sexual aggression: Actions, such as rape,
incest, and any type of sexual activity
performed against a person’s will through
use of force, argument, pressure, alcohol
or drugs, or authority
 Sexual
coercion: Any/all forms of sexual
pressure (pleading, arguing, cajoling, force, or
threat of force)
Table 10.7:
What Have You
Been Told
About Rape?
Was It This?
Rape
Rape: An act of intercourse accomplished
through force or threat of force
 Statutory rape: Sexual intercourse with a
child younger than a certain age
 Date rape: Majority of all rapes (8-25% of
female college students report having
“unwanted sexual intercourse”)
 Sexual aggression by men is common

Rape (cont’d)

Characteristics of rapists:
 Create
situations for sexual encounters
 Interpret friendliness as provocation, protest as
insincerity
 Manipulate women with alcohol/other drugs
 Attribute failed attempts at sexual encounters to
perceived negative features of the woman
 Childhood background of parental neglect/physical or
sexual abuse
 Initiate coitus earlier and have more sexual partners
than non-sexually aggressive men
Effects of Rape


Physical injury: 20% incur minor injuries, 4%
suffer serious injuries
Rape trauma syndrome: Consistent with
posttraumatic Stress Disorder
 Psychological
distress
 Phobic reactions
 Sexual dysfunction
 Acute phase: Disorganization, feelings of self-blame,
fear, depression
 Long-term phase: Reorganization, lingering
fears/phobic reactions, difficulty resuming sexual
activity/enjoyment
Etiology of Rape
Power rapist: Compensate for feelings of
personal/sexual inadequacy by trying to
intimidate victims (55% of rapists)
 Anger rapist: Angry at women in general
(40% of rapists)
 Sadistic rapist: Derives satisfaction from
inflicting pain; may torture or mutilate
victims (5% of rapists)

Etiology of Rape (cont’d)
Media portrayals of violent sex
reflect/affect societal values concerning
violence and women
 “Cultural spillover” theory: Rape is high in
environments that encourage violence
 Only rapists can stop rape. Rape is not
caused by poor judgment on the part of
the victim.

Incest

Incest: Sexual relations between people
too closely related to marry legally
 Universally
taboo in human societies
 Incidence: 48,000-250,000 reported per year
 Most frequently reported to law enforcement:
Father with daughter/step-daughter
 Most frequent: Brother-sister
 Rare: Mother-son
Treatment for Sex Offenders
Some treatment is effective with child
molesters and exhibitionists, but poor for
rapists
 Conventional:

 Imprisonment
offers little/no treatment
 In cases of incest, sometimes attempt to keep
families intact
Treatment for Sex Offenders
(cont’d)

Behavioral treatment for rapists and
pedophiles:
 Assess
sexual preferences/measure erectile
responses
 Reduce deviant interests (aversion therapy)
 Orgasmic reconditioning/masturbation training
to appropriate stimuli
 Social skills training
 Assessment after treatment
Treatment for Sex Offenders
(cont’d)

Controversial treatments:
 Surgical
castration (used in Europe): Low
relapse rates
 Chemical therapy (usually use of
Depo-Provera):
Reduces self-reports of sexual urges in pedophiles
(i.e., psychological desire)
 Does not reduce genital arousal (erectile
capabilities)
