Presentation on theme: "Essentials of Understanding Abnormal Behavior Chapter Nine"— Presentation transcript:
1Essentials of Understanding Abnormal Behavior Chapter Nine Sexual and Gender Identity Disorders
2Sexual and Gender Identity Disorders Sexual dysfunctions: Problems of inhibited sexual desire, arousal, and responseGender-identity disorders: Incongruity or conflict between one’s anatomical sex and one’s psychological feeling of being male or femaleParaphilias: Sexual urges and fantasies about situations, objects, or people not part of the usual arousal pattern leading to reciprocal and affectional sexual activity
3What Is “Normal” Sexual Behavior? Shifting perspectives make the line between normal and abnormal difficult to defineDefinitions depend on such factors as culture and time periodLegal decisions reflect past moods and morals, questionable and idiosyncratic views
4What 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 timePersonal distressNegative effect on relationship with one’s sexual partner
5The Study of Human Sexuality Freud made the discussion of sexual topics more acceptable by incorporating sex (libido) as an important part of his theoryContemporary understanding of human sexual physiology, practices, and customs:Is based on research of Alfred Kinsey, William Masters and Virginia Johnson, and The Janus ReportWhile controversial, these studies dispelled myths and provided clear evidence about human sexuality.
6Homosexuality Attitudes concerning homosexuality: American Psychiatric Association and American Psychological Association: Homosexuality is not a mental disorderNegative attitudes are held by many political figures and religious leadersHomophobia: Irrational fear of homosexuality
7Homosexuality: Research Findings No physiological differences in sexual arousal and response for homosexuals/heterosexualsNo significant differences on measures of psychological disturbanceGender conflicts due to societal intolerance, not gender identity confusionSexual concerns differ because of societal contextA naturally occurring phenomenon, not a lifestyle choice
8Frequency of Symptoms in 55 Boys with Cross-Gender Preferences
9Figure 9.4: Disorders Chart: Gender Identity Disorders Sources: Data from DSM-IV-TR; Arndt (1991); Laumann et al. (1994).
10Gender 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 femalePrevalence: Relatively rareMost children with gender identity conflicts do not develop gender identity disorders as adultsGender 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.
11Gender 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 functioningPrevalence: 1:100,000-30,000 for males; 1:400, ,000 for femalesGender identity disorder not-otherwise-specified: Disorders not classifiable as specific gender identity disorderTranssexuals: 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.
12Etiology of Gender Identity Disorders Etiology is unclear—probably an interaction of multiple variablesBiological: Possibly neurohormonal factorsPsychodynamic: Unconscious childhood conflicts resulting from failure to deal successfully with separation-individuation phases of life, or inability to resolve Oedipus complexBehavioral: Childhood experiences based on operant conditioning and social learning
13Treatment of Gender Identity Disorders Children: Sex education; peer group interaction trainingParents: Learn to reinforce appropriate gender behaviors and extinguish inappropriate behaviorsModeling and rehearsalSex-change operations
14ParaphiliasParaphilias: 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 objectsNonconsenting others, orReal or simulated suffering or humiliation Often involves multiple paraphiliasMore common in males than in females
15Figure 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).
16Figure 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).
17Paraphilias Involving Nonhuman Objects Fetishism: Extremely strong sexual attraction and fantasies involving inanimate objects, such as female undergarmentsTransvestic fetishism: Intense sexual arousal obtained through cross-dressing (wearing clothes appropriate to the opposite gender); do not confuse with transsexualismIf arousal is not present/has disappeared over time, more appropriate diagnosis is gender identity disorderFetishism: 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.
18Paraphilias Involving Nonconsenting Persons Exhibitionism: Urges, acts, or fantasies about exposing one’s genitals to strangersVoyeurism: Urges, acts, or fantasies involving observation of an unsuspecting person disrobing or engaging in sexual activityFrotteurism: Recurrent and intense sexual urges, acts, or fantasies of touching or rubbing against a nonconsenting personExhibitionism: 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.
19Paraphilias Involving Nonconsenting Persons (cont’d) Pedophilia: Adult obtains erotic gratification through urges, acts, or fantasies involving sexual contact with a prepubescent child20-30% of women report childhood sexual encounters with a man; most likely a relative, friend, or casual acquaintanceAlthough 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.
20Paraphilias 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 othersMasochism: A paraphilia in which sexual urges, fantasies, or acts are associated with being humiliated, bound, or made to suffer
21Table 9.2: Sadomasochistic Activities, Ranked by Selected Samples of Male & Female Participants
22Childhood Sexual Abuse Victims of childhood sexual abuse:~25% are younger than age 6; 25% are age 6-10; 50% are 11-13Relapse rate for pedophiles: 35%Physical symptoms of victims:Urinary tract infections, poor appetite, headaches
23Childhood 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 behaviorSome exhibit posttraumatic stress disorder: flashbacks, diminished responsiveness to environment, hyperalertness, and jumpiness
24Paraphilias 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 othersMasochism: A paraphilia in which sexual urges, fantasies, or acts are associated with being humiliated, bound, or made to sufferMost sadomasochists engage in both submissive and dominant rolesBrain pathology and life experiences may underlie sadism
25Table 10.6: Sadomasochistic Activities, Ranked by Selected Samples of Male and Female Participants
26Etiology and Treatment of Paraphilias Conflicting findings regarding genetic, neurohormonal, and brain anomaly explanationsPsychodynamic: Unconscious childhood conflictsCastration anxiety due to unresolved Oedipus complexTreatment: Help patient understand relationship between deviation and unconscious conflict
27Etiology and Treatment of Paraphilias (cont’d) Behavioral:Learning theory stresses early conditioning experiencesPreparedness: Prepared to associate some stimuli with reinforcers, but not othersTreatment: Extinction or aversive conditioning (aversive behavior rehearsal); acquiring/strengthening appropriate behaviors; developing appropriate social skills
28Sexual AggressionSexual 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 authoritySexual coercion: Any/all forms of sexual pressure (pleading, arguing, cajoling, force, or threat of force)
29Table 10.7: What Have You Been Told About Rape? Was It This?
30RapeRape: An act of intercourse accomplished through force or threat of forceStatutory rape: Sexual intercourse with a child younger than a certain ageDate rape: Majority of all rapes (8-25% of female college students report having “unwanted sexual intercourse”)Sexual aggression by men is commonRemember, 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.
31Rape (cont’d) Characteristics of rapists: Create situations for sexual encountersInterpret friendliness as provocation, protest as insincerityManipulate women with alcohol/other drugsAttribute failed attempts at sexual encounters to perceived negative features of the womanChildhood background of parental neglect/physical or sexual abuseInitiate coitus earlier and have more sexual partners than non-sexually aggressive men
32Effects of RapePhysical injury: 20% incur minor injuries, 4% suffer serious injuriesRape trauma syndrome: Consistent with posttraumatic Stress DisorderPsychological distressPhobic reactionsSexual dysfunctionAcute phase: Disorganization, feelings of self-blame, fear, depressionLong-term phase: Reorganization, lingering fears/phobic reactions, difficulty resuming sexual activity/enjoyment
33Etiology of RapePower 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)
34Etiology 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 violenceOnly rapists can stop rape. Rape is not caused by poor judgment on the part of the victim.
35IncestIncest: Sexual relations between people too closely related to marry legallyUniversally taboo in human societiesIncidence: 48, ,000 reported per yearMost frequently reported to law enforcement: Father with daughter/step-daughterMost frequent: Brother-sisterRare: Mother-sonIncestuous 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.
36Treatment for Sex Offenders Some treatment is effective with child molesters and exhibitionists, but poor for rapistsConventional:Imprisonment offers little/no treatmentIn cases of incest, sometimes attempt to keep families intact
37Treatment for Sex Offenders (cont’d) Behavioral treatment for rapists and pedophiles:Assess sexual preferences/measure erectile responsesReduce deviant interests (aversion therapy)Orgasmic reconditioning/masturbation training to appropriate stimuliSocial skills trainingAssessment after treatment
38Treatment for Sex Offenders (cont’d) Controversial treatments:Surgical castration (used in Europe): Low relapse ratesChemical 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)