1. Essentials of Understanding Abnormal Behavior Chapter Nine
Sexual and Gender Identity Disorders

2. 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

3. 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

4. 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

5. 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.

6. 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

7. 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

8. Frequency of Symptoms in 55 Boys with Cross-Gender Preferences

9. Figure 9.4: Disorders Chart: Gender Identity Disorders
Sources: Data from DSM-IV-TR; Arndt (1991); Laumann et al. (1994).

10. Gender Identity Disorders
Gender identity disorder: Characterized by conflict between a person’s anatomical sex and his/her gender identity, or self-identification as male or female
Prevalence: Relatively rare
Most children with gender identity conflicts do not develop gender identity disorders as adults
Gender Identity Disorder of Childhood can only be diagnosed if the child is markedly interested in activities or clothing of the opposite sex AND/or desire to BE the opposite sex.
Boys with gender identity disorder tend to become homosexuals rather than transsexuals. (there have been no comparable studies of girls) . QUESTION: should these children be considered to be disordered if they become well adjusted (homosexual or heterosexual) adults? They are likely to be mistreated and are, by definition, unhappy with their sex, so they may require treatment.

11. 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, ,000 for females
Gender identity disorder not-otherwise-specified: Disorders not classifiable as specific gender identity disorder
Transsexuals: adults with gender identity disorder: Many (most) desire to change their sex and may do this through surgery. It is rare (1 in 30K males and 1 in 100K females seek surgery). Many transsexuals had gender identity disorder as children (esp. true for female to male transsexuals). If transsexualism is correctly diagnosed, the only effective treatment is sexual reassignment surgery.

12. 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

13. 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

14. 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

15. 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).

16. 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).

17. 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
Fetishism: sexual interest typically centers on some inanimate object. Might be hair or ears, clothing or shoes, for example – especially problematic if the individual feels compelled to steal the required objects- could result because of classical conditioning.
Transvestic Fetishism:– usually begins during adolescence and the motivation for it has been called autogynephilia: paraphilic sexual arousal by thought or fantasy of being a woman. The majority of transvestites are heterosexual, and gay men who dress in drag are not transvestites unless they do so for sexual arousal.

18. 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
Exhibitionism: Generally involves young or middle aged female who the offender does not know, as well as children and adolescents. This is the most commonly reported sex crime in the US, Canada and Europe. May be accompanied by assault and a significant majority have also committed coercive sex crimes .
Voyeurism: Often occurs in young men who feel inadequate relating to the opposite sex and allow them to feel powerful over the opposite sex. May occur with other more serious problems.
Sadism: achievement of sexual stimulation and gratification by inflicting physical or psychic pain on a partner. To meet diagnosis, must be PREFERRED or EXCLUSIVE. Many serial killers are sadists.
Masochism, person who experiences sexual stimulation and gratification from the experience of pain and degradation in relating to a lover. More common than sadism.

19. 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
Although there is a greater number of homosexual exchanges for pedophilic sexual acts than in the general population, this DOES NOT mean that homosexuals are more likely than the general population to become pedophiles. Rather, many pedophiles, who may be heterosexual, are relatively indifferent to the sex of their victim.

20. 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

21. Table 9.2: Sadomasochistic Activities, Ranked by Selected Samples of Male & Female Participants

22. 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

23. 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

24. 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

25. Table 10.6: Sadomasochistic Activities, Ranked by Selected Samples of Male and Female Participants

26. 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

27. 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

28. 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)

29. Table 10.7: What Have You Been Told About Rape? Was It This?

30. 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
Remember, from victim’s perspective, rape is always an act of violence and never pleasurable.
The age distribution of rape victims includes a very high proportion of women in their teens and early twenties.
Rape tends to be a planned act and most rapists repeat acts of rape. 80% happen in the neighborhood where the rapist resides and most take place in an urban setting at night.
More than 1/3 involve more than one offender, and these rapes are often accompanied by beatings.
When the rapist and the victim know each other, the closer their relationship, the more brutally the victim may be beaten.
Possible consequences include psych. Trauma, pregnancy, STDs, AIDS, marriage and relationship issues.
Rape is generally a young man’s crime (60% are under 25), 30-50% in police records are married and living with their lives. They tend to be of lo SES and have prior criminal records. They are typically unskilled workers with lo education, income and intelligence. In police records, 70% were strangers to victims.
Recidivism rates of castrated sex offenders are 3 percent, compared to 50% of uncastrated.

31. 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

32. 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

33. 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)

34. 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.

35. Incest
Incest: Sexual relations between people too closely related to marry legally
Universally taboo in human societies
Incidence: 48, ,000 reported per year
Most frequently reported to law enforcement: Father with daughter/step-daughter
Most frequent: Brother-sister
Rare: Mother-son
Incestuous fathers tend to be of lower intelligence, but do not typically evidence severe pathology. However, they often claim devotion to their families and seem shy. Only 1/5 are pedophiles, but most have experienced substantial sexual dysfunction. Fathers tend to be overprotective, but not necessarily nurturing.

36. 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

37. 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

38. 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)