Download Sexual & Gender Identity Disorders

Sexual &
Gender Identity Disorders
Not Sexual Abuse - Child or Adult
Nor Relational Problems
Disorders
Sexual Dysfunctions
Paraphilias
Gender Identity Disorders
Sexuality
A most uncomfortable topic
 for beginning counselors
Next to death
the most shunned topic in society
Males
Less likely to discuss sexual problems
Females
Less likely to recognize problems
Sexual Dysfunctions
 Typified by inhibitions
 in appetite or psychophysiological changes
characterizing sexual response cycle
Must cause marked distress or interpersonal difficulty
Must be both recurrent & persistent, although some
dysfunctions may be short-lived or episodic
Divided as related to
 Sexual desire
 Sexual arousal
 Orgasm
 Sexual pain
Diagnosis of Sexual Dysfunction
 Depends on
Extent to which it
troubles client
Clinician's judgment
Adequacy of sexual
stimulation
 Sometimes multiple
sexual dysfunctions
diagnosable
 Desire, arousal, &
orgasm problems
correspond to 3 phases of
4 in sexual response
cycle
 Appetitive/desire
 Excitement
 Orgasm
 Resolution
Sexual Disorders
Hypoactive Sexual Desire disorder
Sexual Aversion disorder
Sexual Arousal disorders
Female Sexual Arousal Disorder
Male Erectile disorder
Orgasmic disorder
Female Orgasmic Disorder
Male Orgasmic Disorder
Premature Ejaculation Disorder
More Sexual Disorders
 Sexual pain disorders
 Dyspareunia (Not due to GMC)









Recurrent or persistent genital pain associated with sexual intercourse
Either male or female
Not caused exclusively by Vaginismus or lack of lubrication
Associated with marital disturbance & avoidance of sexual situations
Vaginismus (not to GMC)—involuntary spasm of muscles
May include some secual function but not intromission
Could involve past traumaa
Or young age
Could also happen with other insertions, tampon, etc.
 Sexual Dysfunction due to GMC
 Substance-Induced Sexual Dysfunction
 Sexual Dsyfunction NOS
Subtypes & Associated Features
 Lifelong vs acquired
 Generalized versus
situational
 Due to psychological
factors vs to
combined factors
 Often occur
with or focus on
interpersonal
relationship problems
With depression,
anxiety, or somatic
symptoms
Anxiety & excessively
high subjective
standards for
performance
Age & Cultural Factors
 Advancing age may equal
decreased functioning
 Family values & stereotypes
may play a role
 If Axis I Dx primary cause of
sexual problems, do not
diagnosis sexual dysfunction
 Negative attitudes toward
sexuality





Past experiences
Internal conflicts
Inadequate education
Rigid cultural values
Severe mental disorders
Treatment
 Need extensive training; FL
licensing law
 Ethics presents referral to
expert
 Sexual therapists highly
trained & know ethics
 Not uncommon to see more
than 1 therapist
 Higher rate of success for
some sexual & especially
sexual pain disorders
 Concept of accepting
responsibility to make changes
(Adlerian theory)
 Behavior modification,
psychotherapy & medication
from Masters & Johnson early
work
 Meds
 Anti-anxiety agents
 Tricyclic antidepressants to
prolong sexual response for
premature ejaculation
 Meds to Improve sexual desire
 VIAGRA & others… what
must be present
 Testosterone to affect libido for
low sexual desire
Paraphilias
 Conditions in which sexual instincts are
expressed
socially prohibited
unacceptable or
biologically undesirable
 Sexual arousal is
In response to sexual objects or situations
not part of normative arousal-activity patterns
 Essential – unusual or bizarre imagery or acts
necessary fro arousal
Pharaphilias acts
Involve:
 Preference for nonhuman
objects
 Repetitive activity
 with humans involving
real or simulated suffering
or humiliation
 with nonconsenting
partners, statistically
male-related & may have
legal significance
 Impairment to being
involved in reciprocal
affectionate relationships
 Psychosexual
dysfunctions common
 Often antisocial people
 if behavior is destructive &
exploitive
 Virtually all reported
cases (except S&M) are
males
Pharaphilias – Needed to achieve sexual
excitement
 Exhibitionism
repetitive act of exposing
genitals to unsuspecting
stranger
 Fetishism
preferred or exclusive
use of nonliving objects
 Frotteurism
involves touching &
rubbing nonconsenting
person
 Pedophilia
recurrent, intense,
sexual urges & sexually
arousing fantasies
Involves sexual activity
with prepubescent child
 Zoophilia
use of animals
 Necrophilia
intercourse with the
dead
More Paraphilias
 Sexual Sadism
 sexually aroused through
infliction of physical or
psychological suffering on
another person
 Must prevail
 Either inflicting suffering on
nonconsenting partner
 OR With consenting partner,
but use of humiliation or mild
injury
 Or Body injure extensive,
permanent, or possibly mortal
on consenting partner
 Sexual Masochism – preferred
mode
 beaten, humiliated, bound, or
made to suffer; often participates
intentionally in physical harm or
life threats
 Transvestic Fetishis
 involves cross dressing
 Voyeurism
 repeated viewing of unsuspected
people who are naked, disrobing,
or engaging in sexual activity
 Enjoy thinking of observed as
helpless & humiliated if known
seen
 Visual types who may not go
beyond showing & looking
Treatment of Paraphilias
 Treatment sought due to
negative consequences
 Difficult to treat
 Lack of dysphoria
 High physical gratification
 Prognosis depends on
 Treatment success rates low
 Psychotherapy alone not
usually productive
 Medication & therapy together
 Must be therapeutic not
punitive
 Many behavior therapies
 Cognitive on faulty beliefs
 Age of onset
 Frequency
 Concurrent substance
 Interpretation of child’s docility
abuse
as desire
 Feelings of guilt or shame  Relaxation training
 Outlook best if normal
 Group therapy
intercourse experienced
in past
 Virtually no literature
 Outlook good if high
motivation to change
Gender Identity Disorders
Characterized by feelings of discomfort
about anatomic sex
Not same as transvestite
Code based on current age
Sufficiently strong & persistent crossgender identification
 that one desires to be, or believes one should
be, a member of opposite sex
GID
 Clinically significant
distress or impairment in
social/occupational
 Feeling of discomfort or
inappropriateness with
current sex or sex role
 In children
 strong preference for
behaviors & activities
related to opposite sex
while avoiding those of
own sex
 What about tomboys?
Others?
 Adults function in oppositesex role whenever possible
& often alter bodies
 Hormonal treatment
 Surgery
 Including genital-change
procedures
 Specify if: (for sexually mature
individuals)
 Sexually attracted to males
 Sexually attracted to
females
 Sexually attracted to both
 Sexually attracted to neither
Other features
 Associated features
 Social problems or ostracism,
often begun in childhood
 Males sometimes have
childhood memories of parent
encouraging “cute” dressing &
mimicking female mannerisms
 Course
 Most children not continue all
criteria as adults
 Although 75% describe
homo/bisexual gender
preference in late adolescence
or adulthood
 Differential Diagnosis
 Change in sex solely for perceived
social/cultural advantage &
nonconformity
 Chromosomal or congenital
abnormality not diagnosed here
 No psychotic symptoms to support
 Some men meet both GID &
Transvestic Fetishism
 could be comorbid yet most do not
meet TF