Psychopathology (Final) Paraphalic Dx, Sexual Dysfunction, Gender Dysphoria

List the paraphilic disorders

voyeruistic exhibitionistic
frotteuristic sexual masochism dx sexual sadism
dx pedophilic dx tranvestic dx fetishistic
dx

What are paraphilic disorders?

intense arousal to inappropriate stimuli

Categories of sexual dysfunction disorders

Desire disorders �lack of sexual desire or interest in sex
Arousal disorders �inability to become physically aroused or
excited during sexual activity Orgasm disorders �delay or
absence of orgasm (climax) Pain disorders � pain during
intercourse

What are sexual dysfunctions

A heterogenous group of disorders that are typically
characterized by clinically significant disturbance in a person�s
ability to respond sexually or to experience sexual pleasure

List of sexual dysfunction disorders

Delayed ejaculation (problem of climax) Erectile
disorder (problems of arousal) Female orgasmic disorder
(problem of climax) Male hypoactive sexual desire
disorder Female sexual interest/ arousal disorder (problem of
arousal/ desire) Genito-pelvic pain/ penetration disorder
(problem of pain) Premature ejaculation (problem of
arousal) Substance/ medication-induced sexual dysfunction
(problem of arousal)

Treatments for sexual dysfunctions

Bibliotherapy (erotica, educational material) Solo
exercises (kegels, relaxation, graduated dilators) Couples
exercises (sensate focus)

Paraphilic disorders: types and treatments

Antidepressants that influence serotonergic pathways
(SSRIs) Medications that reduce androgens (hormones that
influence sexual desire/ activity) Good lives model of
rehab= ID risk factors in relapse, emphasize personal goals and
strengths, use these factors to treat and motivate change
CBT Behavioral= extinguishing arousal response triggered
my inappropriate stimulus

Sensate Focus treatment process

for sexual dysfunctions Stage 1 2 one-hour
sessions per week Touching for interest= breasts and
genitals are off limits; intercourse prohibited; review with
therapist Stage 2 Lift �restrictions�
on body parts ID specific parts of body that are
arousing or unpleasant Stage 3
specific to the sexual dysfunction= anorgasmia, vaginismus,
premature ejaculation problems w treatment
�cheating on assignments� = will touch when they aren�t
supposed to in Stage 1 Disabilities =

Sex

anatomical indicators of being male or female; also termed
natal sex. The sex one is assigned at birth

Gender

the sense that one is male or female. The gender with which one identifies

Gender dysphoria

the distressing experience of an inconsistency between one�s
natal sex and one�s gender (a diagnosable thing in the DSM- a marked
incongruence between one�s experienced/ expressed gender and
assigned gender, ot at least 6 months� duration)

Transsexuals

individuals who take steps towards changing their gender or
appearing as the opposite gender. Some refer to transsexuals as male
to female transsexuals and female to male transsexuals/ More recent
terms that are gaining acceptance are affirmed male or trans man and
affirmed female or trans woman

Transgender

used as a broad term to include individuals who live as a
different gender from their natal sex. May or may not have has sex
reassignment surgery

Gender variance

used even more broadly to include any level of different gender
identification. May or may not meet criteria for gender dysphoria

Gender identity

one�s subjective sense of being male or female

Sexual orientation

to whom one is attracted

Gender nonconformity

presenting or identifying oneself in a manner that is different
from the conventional gender roles of one�s culture

Gender dysphoria in children

Typically involves preference for opposite-sex dress, play
behaviors, playmates, and urinary position More boys than
girls are typically diagnosed with gender dysphoria- may due to
greater parental disapproval of gender nonconformity of boys
(compared to girls) Most children with gender dysphoria do
not continue to have this disorder in adulthood= many indicate that
they have come to accept their gender and that they also have
bisexual or homosexual feelings of attraction as they mature

gender dysphoria in adolescents and adults

May include cross dressing (purpose: express oneself as the
opposite gender to feel consistent with one�s sense of self)

Biological/genetic causes of gender dysphoria

Male-to-female transsexuals have different brain activation
compared to heterosexual, non-gender-dysphoric men during mental
rotation tasks Postpartum brain dissection has revealed
similarities between natal females and male-to-female
transsexuals Biological hypoth4esis: prenatal exposure to
varying levels of sex hormones influences subsequent gender
identity Androgen exposure in the womb has been linked to
comparative finger length on one�s hand With index and ring
fingers = among male-to-female transsexuals, the 2nd
to 4th digit ratio was more similar to natal females�
than to non-trans males� digit ratio
Individuals with a transsexual sibling are more likely to be
trans compared to the general population

Psychosocial and environmental causes of gender dysphoria

Concept of gender is a social construct In most
societies there is a gender binary; in fewer societies there is a
third category= in India; individual who wear women�s clothing but
have male/ intersex/ ambiguous genitalia and do not try to pass as
female Social cognitive perspective= gender identity
development involves learning roles through: Observational
learning Experiencing others� evaluative reactions to
one�s behavior Being rewarded and punished for
gender-typical or gender- atypical behavior
Environmental forces exert pressure on children to conform to
gender norms

Interventions for Gender dysphoria

Transitions to another gender might include:
Medications Voice/ communication therapy
Hair transplants Varying degrees of surgery to
masculinize or feminize the face, neck chest, genitals, etc
Positive mental and physical health outcomes;
dissatisfaction (if any) usually revolve around
dissatisfaction with the surgical procedure (not that it was
actually done) Psychotherapy
Preparing for changes in relationships with others and
broader society; with coming out Deal with
secondary problems of depression, anxiety, substance use,
suicidal thoughts Family therapy and support
groups CBT= help change their thoughts,
feelings, behaviors Male-to-eunuch trans= have been or
want to be castrated in order to become a gender that is neither
male nor female (dislike being a man but have difficulty finding
tx)

Counter-indicated treatments for gender dysphoria

Specific gender identity goals= use coping strategies,
psychoeducation, and support for the gender variant child,
instead Reparative therapy Goals is to change one�s
sexual orientation and gender conformity Harmful to
person�s individual and social wellbeing