1. Chapter 13: Changing views of Sexual Behavior Sexual Dysfunctions Paraphilias Gender identity Disorder Abnormal Psychology Feb 26-Mar 3, 2009 Classes #13-14

2. Changing views of Sexual Behavior The Generational Perspective: Ever-changing attitudes?

3. Sexual and Gender-Identity Disorders DSM-IV recognizes three main types of sexual disorders. Sexual dysfunctions Paraphilias Gender-identity disorders

4. Sexual Dysfunctions These are disorders that involve the absence or failure of the sexual response at some point during the sexual response cycle A loss or impairment of the ordinary physical responses of sexual function

5. Sexual Dysfunctions Sexual Desire Disorders Hypoactive Sexual Desire Sexual Aversion Disorder Sexual Arousal Disorders Female Sexual Arousal Disorder Male Erectile Disorder Orgasmic Disorders Female Orgasmic Disorder Male Orgasmic Disorder Premature Ejaculation Sexual Pain Disorders Dyspareunia Vaginismus

6. Sexual Desire Disorders Sexual desire disorders Disorders in which the person lacks sexual interest or has an active distaste for sex Hypoactive sexual desire Lack of interest in sex Little or no sexual activity in these individuals Sexual Aversion Disorder Find sex unpleasant or repulsive

7. Sexual Arousal Disorders Inability to achieve or sustain arousal until the end of intercourse in a person who is capable of experiencing sexual desire Female sexual arousal disorder The inability of a woman to become sexually aroused or to reach orgasm Erectile disorder The inability of a man to achieve or maintain an erection

8. Orgasmic Disorders Inability to reach orgasm in a person able to experience sexual desire and maintain arousal Female Orgasmic Disorder Rarely reach orgasm Male Orgasmic Disorder Repeatedly cannot reach orgasm or its very delayed Premature ejaculation Inability of a man to inhibit orgasm as long as desired

9. Sexual Pain Disorders Vaginismus: Involuntary muscle spasms in the outer part of the vagina that make intercourse impossible Dyspareunia Extreme pain felt in the genitals during sexual activity

10. Paraphilias The term Paraphilia means “abnormal or unnatural attraction” These are sexual disorders that revolve around abnormal means of achieving sexual arousal

11. Types of Paraphilias Exhibitionism Fetishism Transvestic Fetishism Frotteurism Pedophilia Sexual Masochism Sexual Sadism Voyeurism

12. Exhibitionism This involves having fantasies about or actually exposing the genitals to an unsuspecting stranger A person repeatedly exposes his genitals to a stranger for the purpose of achieving sexual excitement

13. Symptoms No sexual activity involved… They do not become violent They are usually very nervous Often expose themselves and then flee area before police arrive Most are married (at least 60%) Average intelligence, educational level, etc.

14. Possible Cause Psychoanalytic theorists They suggest that childhood trauma (e.g., sexual abuse) or significant childhood experiences can manifest itself in exhibitionistic behavior

15. Fetishism Inanimate object fetishists often collect the object of their favor, and may go to great lengths, including theft, to acquire just the "right" addition for their collection

16. Fetishism In the majority of cases, the person with a fetish poses no danger to others and pursues the use of the fetish object in private Usually through masturbation Researchers have shown that in general fetishists: Have poorly developed social skills Are quite isolated in their lives Have a diminished capacity for establishing intimacy

17. Fetishism Explanations The causes of fetishism are not clearly understood… Some learning theorists believe that it develops from early childhood experiences An object was associated with a particularly powerful form of sexual arousal or gratification Psychoanalytical theories of causality focus on concepts of penis worship and castration anxiety

18. Transvestic Fetishism Heterosexual males with this paraphilia dress in female clothes to produce or enhance sexual arousal This occurs in heterosexual males and is not part of Gender Identity Disorder Cross-dressing Usually without a real partner but with the fantasy that they are the female partner The fantasies, sexual urges, or behaviors must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

19. Transvestic Fetishism Some will wear a single item of female apparel under masculine clothing These heterosexual males may have very few sexual partners and have occasional homosexual relationships When not cross-dressing, they may behave in stereotypic male fashion but this behavior often turns quite feminine when wearing women's clothing It may be a means of reducing anxiety or depression

20. Frotteurism This Paraphilia is characterized by sexual fantasies, urges, or behaviors involving touching or rubbing one's genitals against the body of a non-consenting person The person generally tries to escape detection after touching the victim This often occurs in somewhat conspicuous situations such as on a crowded bus or subway In rare cases, the male may actually fondle a women’s breast and then flee the scene To be considered diagnosable, the fantasies, urges, or behaviors must cause significant distress in the individual or be disruptive to his or her everyday functioning

21. Frotteurism Cause Most experts agree that there are underlying issues related to childhood which play a major role in the etiology Treatment Typically involves psychotherapy aimed at uncovering and working through the underlying cause of the behavior

22. Pedophilia According to the DSM-IV definition, pedophilia involves sexual activity by an adult with a prepubescent child Some individuals prefer females, usually 8- to 10-year-olds Those attracted to males usually prefers slightly older children Some prefer both sexes While some are sexually attracted only to children, others also are sometimes attracted to adults as well Gender difference: Pedophilia is almost always seen in males and is seldom diagnosed in females

23. Pedophilia Pedophiliac activity may involve undressing and looking at the child or more direct physical sex acts All these activities are psychologically harmful to the child, and some may be physically harmful Individuals with pedophilia often go to great lengths to obtain photos, films or pornographic publications that focus on sex with children These individuals commonly explain their activities with excuses or rationalizations that the activities

24. Pedophilia Why do they do it?

25. Treatment Pedophilia generally is treated with cognitive-behavioral therapy The therapy may be prescribed alone or in combination with medication Low levels of serotonin has been linked Selective serotonin reuptake inhibitors have been used with limited success

26. Prognosis Poor Even after intensive treatment, the course of the disorder usually is chronic and lifelong in most patients Which is the reason that most treatment programs emphasize a relapse-prevention model However, both the fantasies and the behaviors often lessen with advancing age in adults (burn- out)

27. Sexual Masochism The disorder is characterized by intense sexually arousing fantasies, urges, or behaviors in which the individual is humiliated, beaten, bound, or made to suffer in some way Person derives sexual pleasure from being abused or humiliated Sexually masochistic behaviors are typically evident by early adulthood, and often start with masochistic or sadistic play in childhood

28. Sexual Masochism These patterns of behavior are not only disruptive to social and occupational functioning, but they run the risk of threat to physical safety. Hypoxyphilia for example, involves the cutting off of oxygen supply for purposes of sexual stimulation One to two deaths per million may be attributable to this practice While some may engage in minor sexual masochism, there are those who increase the risk to safety over the years, often thereby insuring that the risk of serious injury occurs

29. Sexual Sadism Individuals with this Paraphilia use sexual fantasies, urges, or behaviors involving infliction of pain, suffering or humiliation of others to enhance or achieve their own sexual excitement For diagnosis: the person has acted on these urges with a nonconsenting person the sexual urges or fantasies cause marked distress or interpersonal difficulty

30. Sexual Sadism Sadism is deriving pleasure, often sexual, from mistreating others. Like other paraphilias, some people have fantasies which are sadistic, but they never act upon them. Also, some people have sexual urges of a sadistic nature, and they find a willing partner who agrees to participate in the sadistic activity. These people however have sadistic sexual urges who find others whom they victimize with their behavior Some of the severe activities involved in sexual sadism include burning, beating, stabbing, raping, and killing Usually the thoughts and/or behaviors of sexual sadism begin in adolescence or early adulthood The behaviors are not only chronic, but they usually increase in severity with time Often, associated with anti-social personality disorder

31. Voyeurism This disorder is characterized by either intense sexually arousing fantasies, urges, or behaviors in which the individual observes an unsuspecting stranger who is naked, disrobing, or engaging in sexual activity To be considered diagnosable, the fantasies, urges, or behaviors must cause significant distress in the individual or be disruptive to his or her everyday functioning

32. Gender Identity Disorder Diagnostic Criteria A strong and persistent cross-gender identification Persistent discomfort with his/her sex or sense of inappropriateness in the gender role of that sex While this person may be male, he feels as if he is a female

33. Diagnostic Criteria An inconsistency between an individual’s physiological sex identification and his or her gender identity Persistent feelings of gender discomfort and inappropriateness of anatomic sex People with gender identity disorder act and present themselves as members of the opposite sex The disorder affects self-concept, the perception of an ideal partner, and the display of femininity or masculinity through mannerisms, behavior, and dress These feelings persist for at least 2 years

34. Case Study: Reneé Richards Richard Raskin had been an opthomologist and a moderately good professional tennis player In 1976 at age 52, she entered a women’s tennis tournament

35. Gender Identity Disorder: Types Specified Gender Identity Disorder/Transsexualism This is the one we are analyzing tonight Gender Identity Disorder, not otherwise specified Transient cross-dressing behavior Persistent preoccupation with castration without a desire to acquire the sex characteristics of the other sex In both types: May occur in children or adults Rare disorders

36. Symptoms Cross-sex identification Individual wants to be, or claims to be the opposite sex Individual is uncomfortable about his/her sex Rejects traditional gender schemes, and believes that they will become the opposite sex

37. Gender Identity Disorder This is not a choice for these people – they do not feel that they have a choice about their sexual identity While some of these people only suffer mild discomfort with their physiological sex, others may have a sense of actually belonging to the opposite sex

38. Explanations Psychodynamic Learning Cognitive Physiological

39. Psychodynamic Explanation When the Oedipus/Electra Complex is successfully resolved, the child identifies with the same sex parent…if this conflict is not resolved, the child is confused about their gender identity

40. Learning Explanations Parents foster the development of cross-sex behaviors because they wanted a child of the other sex Fathers takes his daughter to football games, throws the ball around, plays rough, etc. Children develop this because broken homes often cause single parenting to take place This might cause some of these many children to identify with the opposite sex parent who is around and possibly to have hostility towards the same sex parent who is not around

41. Learning Explanations Maybe these parental responses are an effect rather than a cause of the behavior The father plays catch with the baseball or football in the backyard because his daughter wants to play catch Also, some parents will often try to force their kids to partake in traditional gender activities Studies can’t seem to find differences in families with or without someone with this disorder – they look the same So, the idea about broken homes might not be a correct hypothesis either

42. Physiological Explanations Exposure to high levels of hormones associated with the opposite sex during the fetal period Girls exposed to androgens tend to be tom- boys, boys exposed to estrogen more feminine Prenatal exposure to anticonvulsant medications Phenobarbital, Dilantin

43. Hormone Therapy Some individuals take hormones consistent with their desired gender Men will take estrogens (female hormones) Females will take amdrogens (male hormones) They will usually develop the secondary sex characteristics of that sex after this treatment (development of breasts, etc.)

44. Sex Reassignment Surgery A more drastic option is to go through a sex- change operation Effective in making individuals look like members of the opposite sex Artificial vagina-like openings for the male-to-female cahnge Orgasm is possible Female-to-male change is more difficult Penis can be attached Erections are not possible though Additionally, these individuals will usually go through the hormone therapy as well

45. Gender Identity Disorder Additionally, those suffering from this disorder should undergo the following types of therapy: Individual Counseling Family Counseling Couple Counseling