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

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

2 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

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

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

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

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

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  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

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

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)


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