Abnormal Psychology Chapter 13

Disorders of
Sex and Gender

Chapter 13
Slides & Handouts by Karen Clay Rhines, Ph.D.

American Public University System
Comer, Abnormal
Psychology, 8e
DSM-5 Update
Disorders of Sex and Gender

Sexual behavior is a major focus of both our
private thoughts and public discussions
Experts recognize two general categories of
sexual disorders:
Sexual dysfunctions problems with sexual
responses
Paraphilic disorders repeated and intense sexual
urges and fantasies in response to socially
inappropriate objects or situations
Comer, Abnormal Psychology,
DSM-5 Update, 8e

DSM-5 also includes a category called gender
dysphoria , a pattern in which people feel that
they have been born to the wrong sex

DSM-5 Update, 8e

Relatively little is known about racial and
other cultural differences in sexuality
Sex therapists and sex researchers have only
recently begun to attend systematically to the
importance of culture and race

DSM-5 Update, 8e
Sexual Dysfunctions
Sexual dysfunctions are disorders in which people
cannot respond normally in key areas of sexual
functioning
As many as 31% of men and 43% of women in the U.S.
suffer from such a dysfunction during their lives
Sexual dysfunctions are typically very distressing,

and often lead to sexual frustration, guilt, loss of
self-esteem, and interpersonal problems
Often these dysfunctions are interrelated; many
patients with one dysfunction experience another as
well
DSM-5 Update, 8e
Sexual Dysfunctions
The human sexual response can be described
as a cycle with four phases:
Desire
Excitement
Orgasm
Resolution
Sexual dysfunctions affect one or more of the

first three phases
DSM-5 Update, 8e

DSM-5 Update, 8e

DSM-5 Update, 8e
Sexual Dysfunctions
Some people struggle with sexual dysfunction
their whole lives (labeled lifelong type) or
others, normal sexual functioning preceded the
disorder (labeled acquired type)
In some cases the dysfunction is present during
all sexual situations (labeled generalized type)
In others it is tied to particular situations (labeled
situational type)

DSM-5 Update, 8e
Disorders of Desire
Desire phase of the sexual response cycle
Consists of an interest in or urge to have sex,
sexual fantasies, and sexual attraction to others
Two dysfunctions affect this phase:

Male hypoactive sexual desire disorder
Female sexual interest/arousal disorder

DSM-5 Update, 8e
10
Disorders of Desire
Male hypoactive sexual desire disorder
Characterized by a lack of interest in sex and little
sexual activity
Physical responses may be normal
Prevalent in about 16% of men

DSM-5 Update, 8e
11
Disorders of Desire
Female sexual interest/arousal disorder
Characterized by a lack of normal interest in
sexual activity
Women with this condition rarely initiate sexual activity
and may experience little excitement during sexual
activity
Reduced sexual interest and desire may be found

in as many as 33% of women

DSM-5 Update, 8e
12
Disorders of Desire
A persons sex drive is determined by a
combination of biological, psychological, and
sociocultural factors, and any of these may
reduce sexual desire
Most cases of low sexual desire are caused
primarily by sociocultural and psychological
factors, but biological conditions can also
lower sex drive significantly

DSM-5 Update, 8e
13
Disorders of Desire
Biological causes
A number of hormones interact to produce sexual desire and
behavior
Abnormalities in their activity can lower sex drive
These hormones include prolactin, testosterone, and estrogen for
both men and women
Recent investigation has also linked sexual desire disorders to

excessive activity of the NTs serotonin and dopamine
Sex drive can also be lowered by some medications (including
birth control pills and pain medications), some psychotropic
drugs, a number of illegal drugs, and chronic illness

DSM-5 Update, 8e
14
Disorders of Desire
Psychological causes
A general increase in anxiety, depression, or anger
may reduce sexual desire in both men and women
Fears, attitudes, and memories may contribute to
sexual dysfunction
Certain psychological disorders, including
depression and obsessive-compulsive disorder,
may lead to sexual desire disorders

DSM-5 Update, 8e
15
Disorders of Desire
Sociocultural causes
Attitudes, fears, and psychological disorders that
contribute to sexual desire disorders occur within a
social context
Many sufferers of desire disorders are feeling situational
pressures
Examples: divorce, death, job stress, infertility, and/or
relationship difficulties
Cultural standards can set the stage for development of

these disorders
The trauma of sexual molestation or assault is especially
likely to produce sexual dysfunction

DSM-5 Update, 8e
16
Disorders of Excitement
Excitement phase of the sexual response cycle
Marked by changes in the pelvic region, general physical
arousal, and increases in heart rate, muscle tension, blood
pressure, and rate of breathing
In men: erection of the penis
In women: swelling of the clitoris and labia and vaginal lubrication
Female sexual interest/arousal disorder may include

dysfunction during the excitement phase
In addition, a male disorder erectile disorder
involves dysfunction in the excitement phase only

DSM-5 Update, 8e
17
Erectile disorder (ED)
Characterized by persistent inability to attain or
maintain an erection during sexual activity
This problem occurs in as much as 10% of the
general male population
According to surveys, half of all adult men have
erectile difficulty during intercourse at least some
of the time

DSM-5 Update, 8e
18
Most cases of erectile disorder result from an
interaction of biological, psychological, and
sociocultural processes

DSM-5 Update, 8e
19
Biological causes
The same hormonal imbalances that can cause male
hypoactive sexual desire can also produce ED
Most commonly, vascular problems are involved
ED can also be caused by damage to the nervous system
from various diseases, disorders, or injuries
The use of certain medications and various forms of

substance abuse may interfere with erections

DSM-5 Update, 8e
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Biological causes
Medical procedures have been developed for
diagnosing biological causes of ED
One strategy involves measuring nocturnal penile
tumescence (NPT)
Men typically have erections during REM sleep; abnormal or
absent nighttime erections usually indicate a physical basis for
erectile failure

DSM-5 Update, 8e
21
Any of the psychological causes of male
hypoactive sexual desire can also interfere with
arousal and lead to erectile dysfunction
For example, as many as 90% of men with severe
depression experience some degree of ED

DSM-5 Update, 8e
22
One well-supported cognitive explanation for ED
emphasizes performance anxiety and the
spectator role
Once a man begins to have erectile difficulties, he
becomes fearful and worries during sexual encounters;
instead of being a participant, he becomes a spectator
and judge
This can create a vicious cycle of sexual dysfunction where the
original cause of the erectile failure becomes less important
than the fear of failure

DSM-5 Update, 8e
23
Each of the sociocultural factors that contribute to
male hypoactive sexual desire has also been linked
to ED
Job and marital distress are particularly relevant

DSM-5 Update, 8e
24
Disorders of Orgasm
Orgasm phase of the sexual response cycle
Sexual pleasure peaks and sexual tension is released
as the muscles in the pelvic region contract
rhythmically
For men: semen is ejaculated
For women: the outer third of the vaginal walls contract
There are three disorders of this phase:

Premature ejaculation
Delayed ejaculation
Female orgasmic disorder

DSM-5 Update, 8e
25
Disorders of Orgasm
Characterized by persistent reaching of orgasm and
ejaculation within one minute of beginning sexual activity
with a partner and before he wishes to
As many as 30% of men experience rapid ejaculation at some time
Psychological, particularly behavioral, explanations of this

disorder have received more research support than other
explanations
The dysfunction seems to be typical of young, sexually
inexperienced men
It may also be related to anxiety, hurried masturbation
experiences, or poor recognition of arousal

DSM-5 Update, 8e
26
Disorders of Orgasm
There is a growing belief among many clinical
theorists that biological factors may also play a key
role in many cases of this disorder
One theory states that some men are born with a genetic
predisposition
A second theory argues that the brains of men with early
ejaculation contain certain serotonin receptors that are
overactive and others that are underactive
A third explanation holds that men with this dysfunction
experience greater sensitivity or nerve conduction in the
area of their penis

DSM-5 Update, 8e
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Disorders of Orgasm
Delayed ejaculation
Characterized by a repeated inability to ejaculate or
by a very delayed ejaculation after normal sexual
activity with a partner
Occurs in 8% of the male population
Biological causes include low testosterone,

neurological disease, and head or spinal cord injury
Medications, including certain antidepressants (especially
SSRIs) and drugs that slow down the sympathetic nervous
system, can also affect ejaculation

DSM-5 Update, 8e
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Disorders of Orgasm
Delayed ejaculation
A leading psychological cause appears to be
performance anxiety and the spectator role, the
cognitive factors involved in ED
Another psychological factor may be past
masturbation habits
This disorder also may develop out of male
hypoactive sexual desire disorder

DSM-5 Update, 8e
29
Disorders of Orgasm
Characterized by persistent failure to reach orgasm,
experiencing orgasms of very low intensity, or delay in
orgasm
Almost 24% of women appear to have this problem
10% or more have never reached orgasm
An additional 9% reach orgasm only rarely
Women who are more sexually assertive and more

comfortable with masturbation tend to have orgasms more
regularly
Female orgasmic disorder is more common in single women
than in married or cohabiting women

DSM-5 Update, 8e
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Disorders of Orgasm
Most clinicians agree that orgasm during intercourse is not
mandatory for normal sexual functioning
Early psychoanalytic theory used to consider lack of orgasm during
intercourse to be pathological
Current evidence suggests that this is untrue
Once again, biological, psychological, and sociocultural

factors may combine to produce these disorders
Because arousal plays a key role in orgasms, arousal difficulties
often are featured in explanations of female orgasmic disorder

DSM-5 Update, 8e
31
Disorders of Orgasm
Biological causes
A variety of physiological conditions can affect a
womans arousal and orgasm
These conditions include diabetes and multiple sclerosis
The same medications and illegal substances that affect

erection in men can affect arousal and orgasm in
women
Postmenopausal changes may also be responsible

DSM-5 Update, 8e
32
Disorders of Orgasm
The psychological causes of female sexual
interest/arousal disorder, including depression, may
also lead to female arousal and orgasmic disorders
Memories of childhood trauma and relationship
distress may also be related

DSM-5 Update, 8e
33
Disorders of Orgasm
For years, the leading sociocultural theory of female
orgasmic problems was that it resulted from sexually
restrictive cultural messages
This theory has been challenged because:
Sexually restrictive histories are equally common in women
with and without disorders
Cultural messages about female sexuality have been changing
while the rate of female sexual dysfunction stays constant

DSM-5 Update, 8e
34
Disorders of Orgasm
Researchers suggest that unusually stressful events,
traumas, or relationships may produce the fears,
memories, and attitudes that characterize these
dysfunctions
Research has also linked orgasmic behavior to certain
qualities in a womans intimate relationships (such as
emotional intimacy)

DSM-5 Update, 8e
35
Disorders of Sexual Pain

Certain sexual dysfunctions are characterized
by enormous physical discomfort during
intercourse and do not fit neatly into a specific
phase of the sexual response cycle
These dysfunctions, collectively called genitopelvic pain/penetration disorder, are experienced
by women much more often than men

DSM-5 Update, 8e
36

Some women with genito-pelvic
pain/penetration disorder experience
involuntary contractions of the muscles of the
outer third of the vagina
Known as vaginismus, severe cases can prevent a
woman from having intercourse
This problem has received relatively little
research, but estimates are that it occurs in fewer
than 1% of all women

DSM-5 Update, 8e
37

Most clinicians agree with the cognitivebehavioral theory that this form of genito-pelvic
pain/penetration disorder is a learned fear
response
A variety of factors can set the stage for this fear,
including anxiety and ignorance about intercourse,
exaggerated stories, trauma caused by an unskilled
partner, and the trauma of childhood sexual abuse or
adult rape
Some women experience painful intercourse

because of infection or disease
DSM-5 Update, 8e
38

Other women with genito-pelvic pain/penetration
disorder experience severe vaginal or pelvic pain
during sexual intercourse
This pattern is known medically as dyspareunia
As many as 14% of women suffer from this problem
This form of genito-pelvic pain/penetration disorder

usually has a physical cause, most commonly from
injury sustained in childbirth
Although psychological factors or relationship difficulties
may contribute to this problem, psychosocial factors alone
are rarely responsible

DSM-5 Update, 8e
39
Treatments for Sexual Dysfunctions

The last 40 years have brought major changes
in the treatment of sexual dysfunction
Early 20th century: psychodynamic therapy
Believed that sexual dysfunction was caused by a
failure to progress through the stages of psychosexual
development
Therapy focused on gaining insight and making broad
personality changes; was generally unhelpful

DSM-5 Update, 8e
40

1950s and 1960s: behavioral therapy
Behavioral therapists attempted to reduce fear by
applying relaxation training and systematic
desensitization
Had some success, but failed to work in cases
where the key problems included misinformation,
negative attitudes, and lack of effective sexual
techniques

DSM-5 Update, 8e
41

1970: Human Sexual Inadequacy
This book, written by William Masters and Virginia
Johnson, revolutionized treatment of sexual
dysfunctions
This original sex therapy program has evolved into a
complex approach
Includes techniques from cognitive, behavioral, couples, and
family systems therapies, along with a number of sexspecific techniques
More recently, biological interventions have also been
incorporated

DSM-5 Update, 8e
42
What Are the General

Features of Sex Therapy?
Modern sex therapy is short-term and
instructive
Therapy typically lasts 15 to 20 sessions
It is centered on specific sexual problems rather
than on broad personality issues

DSM-5 Update, 8e
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What Are the General

Features of Sex Therapy?
Modern sex therapy focuses on:
Assessment and conceptualization of the problem

Mutual responsibility
Education about sexuality
Emotion identification
Attitude change
Elimination of performance anxiety and the spectator role
Increasing sexual and general communication skills
Changing destructive lifestyles and marital interactions
Addressing physical and medical factors

DSM-5 Update, 8e
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What Techniques Are Applied

to Particular Dysfunctions?
In addition to the general components of sex
therapy, specific techniques can help in each
of the sexual dysfunctions

DSM-5 Update, 8e
45

Disorders of Desire
These disorders are among the most difficult to
treat because of the many issues that feed into
them
Therapists typically apply a combination of
techniques, which may include:
Affectual awareness, self-instruction training,
behavioral techniques, insight-oriented exercises, and
biological interventions such as hormone treatments

DSM-5 Update, 8e
46

Erectile disorder
Treatments for ED focus on reducing a mans
performance anxiety and/or increasing his
stimulation
May include sensate-focus exercises such as the tease
technique

DSM-5 Update, 8e
47

Erectile disorder
Biological approaches have gained great
momentum with the development of sildenafil
(Viagra) and other erectile dysfunction drugs
Most other biological approaches have been around for
decades and include gels, suppositories, penile
injections, and a vacuum erection device (VED)
These procedures are now viewed as second-line treatment

DSM-5 Update, 8e
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Premature ejaculation has been successfully treated
for years by behavioral procedures such as the stopstart or pause procedure
Some clinicians use SSRIs, the serotonin-enhancing
antidepressant drugs
Because these drugs often reduce sexual arousal or orgasm,
they may be helpful in delaying premature ejaculation
Many studies have reported positive results with this
approach

DSM-5 Update, 8e
49

Delayed ejaculation
Therapies for this disorder include techniques to
reduce performance anxiety and increase
stimulation
When the cause of the disorder is physical,
treatment may include a drug to increase arousal
of the sympathetic nervous system

DSM-5 Update, 8e
50

Female orgasmic disorders
Specific treatments for this disorder include
cognitive-behavioral techniques, self-exploration,
enhancement of body awareness, and directed
masturbation training
Biological treatments, including hormone therapy or
the use of sildenafil (Viagra), have also been tried, but
research has not found such interventions to be
consistently helpful

DSM-5 Update, 8e
51

Female orgasmic disorders
Again, a lack of orgasm during intercourse is not
necessarily a sexual dysfunction, provided the
woman enjoys intercourse and is orgasmic
through other means
For this reason, some therapists believe that the wisest
course of action is simply to educate women whose
only concern is lack of orgasm through intercourse

DSM-5 Update, 8e
52

Genito-Pelvic Pain/Penetration Disorder
Specific treatment for involuntary contractions of the
vaginal muscles typically involves two approaches:
Practice tightening and releasing the muscles of the vagina
to gain more voluntary control
Overcome fear of penetration through gradual behavioral
exposure treatment
Most women treated using these methods eventually

report pain-free intercourse

DSM-5 Update, 8e
53

Genito-Pelvic Pain/Penetration Disorder
Different approaches are used to treat severe
vaginal or pelvic pain during intercourse
Given that most cases are caused by physical problems,
pain management techniques and medical intervention
may be necessary

DSM-5 Update, 8e
54
What Are the Current Trends

in Sex Therapy?
Sex therapists have moved well beyond the
approach first developed by Masters and
Johnson
Therapists now treat unmarried couples, those
with other psychological disorders, couples with
severe marital discord, the elderly, the medically
ill, the physically handicapped, gay clients, and
clients with no long-term sex partner

DSM-5 Update, 8e
55
What Are the Current Trends

in Sex Therapy?
Therapists are paying more attention to
excessive sexuality, which is sometimes called
hypersexuality or sexual addiction
The use of medications to treat sexual
dysfunction is troubling to many therapists
They are concerned that therapists will choose
biological interventions rather than a more
integrated approach
DSM-5 Update, 8e
56
Paraphilic Disorders
Paraphilias are characterized by intense sexual
urges, fantasies or behaviors that involve
objects or situations outside the usual sexual
norms, including:
Nonhumans
Children
Nonconsenting adults
The experience of suffering or humiliation

DSM-5 Update, 8e
57
According to DSM-5, a diagnosis of paraphilic
disorder should be applied only when the
urges, fantasies, or behaviors cause significant
distress or impairment OR when the
satisfaction of the disorder places the
individual or others at risk of harm either
currently or in the past

DSM-5 Update, 8e
58
Paraphilias
For example, people who initiate sexual
contact with children warrant a diagnosis of
pedophilic disorder regardless of how troubled
the individuals may or may not be over their
behavior

DSM-5 Update, 8e
59
Although theorists have proposed various
explanations for paraphilic disorders, there is
little formal evidence to support them
None of the treatments applied to paraphilias have
received much research or been proved clearly
effective
Psychological and sociocultural treatments have been
available the longest, but todays professionals are
also using biological interventions

DSM-5 Update, 8e
60
Some practitioners administer drugs called
antiandrogens that lower the production of
testosterone
Clinicians are also increasingly administering
SSRIs, the serotonin-enhancing antidepressant
medications, to (hopefully) reduce the
compulsion-like sexual behaviors
These drugs also have a common side effect of
lowered sexual arousal
Comer, Fundamentals of Abnormal

Psychology, 7e
61
Fetishistic Disorder
The key features of this disorder are recurrent
intense sexual urges, sexually arousing fantasies,
or behaviors that involve the use of a nonliving
object, often to the exclusion of all other stimuli
The disorder, far more common in men than women,
usually begins in adolescence
Almost anything can be a fetish
Womens underwear, shoes, and boots are especially
common

DSM-5 Update, 8e
62
Researchers have been unable to pinpoint the
causes of fetishistic disorder
Psychodynamic theorists view fetishes as defense
mechanisms, but therapy using this model has
been unsuccessful

DSM-5 Update, 8e
63
Behaviorists propose that fetishes are learned
through classical conditioning
Fetishes are sometimes treated with aversion therapy,
or covert sensitization
Another behavioral treatment is masturbatory
satiation, in which clients masturbate to boredom
while imagining the fetish object
An additional behavioral treatment is orgasmic
reorientation, a process which teaches individuals to
respond to more appropriate sources of sexual
stimulation

DSM-5 Update, 8e
64
Transvestic Disorder
Also known as transvestism or cross-dressing
Characterized by fantasies, urges, or behaviors
involving dressing in the clothes of the
opposite sex in order to achieve sexual arousal

DSM-5 Update, 8e
65
Transvestic Disorder
The typical person with this disorder is a
heterosexual male who began cross-dressing in
childhood or adolescence
Transvestism is often confused with gender
dysphoria, but the two are separate patterns
The development of the disorder seems to follow
the behavioral principles of operant conditioning

DSM-5 Update, 8e
66
Exhibitionistic Disorder
Characterized by arousal from the exposure of genitals
in a public setting
Most often, the person wants to provoke shock or surprise,
rather than initiate sexual contact
Usually begins before age 18 and is most common in

males
Treatment generally includes aversion therapy and
masturbatory satiation
May be combined with orgasmic reorientation, social skills
training, or cognitive-behavioral therapy

DSM-5 Update, 8e
67
Voyeuristic Disorder
Characterized by repeated and intense sexual
urges to observe people as they undress or
engage in sexual activity
The person may masturbate during the act of
observing or while remembering it later
The risk of being discovered often adds to the
excitement

DSM-5 Update, 8e
68
Voyeuristic Disorder
Many psychodynamic theorists propose that
people with this disorder are seeking power
Behaviorists explain the disorder as a learned
behavior that can be traced to a chance and
secret observation of a sexually arousing
scene

DSM-5 Update, 8e
69
Frotteuristic Disorder
A person with frotteuristic disorder has recurrent
and intense fantasies, urges, or behaviors
involving touching and rubbing against a
nonconsenting person
Almost always male, the person fantasizes during the
act that he is having a caring relationship with the
victim
Usually begins in the teen years or earlier

Acts generally decrease and disappear after age 25

DSM-5 Update, 8e
70
Pedophilic Disorder
This disorder is characterized by fantasies, urges,
or behaviors involving sexual arousal from
prepubescent or early pubescent children
Some people are satisfied with child pornography
Others are driven to watching, fondling, or engaging in
sexual intercourse with children
Evidence suggests that two-thirds of victims are
female

DSM-5 Update, 8e
71
Pedophilic Disorder
People with this disorder develop it in
adolescence
Some were sexually abused as children
Many were neglected, excessively punished, or deprived of
close relationships in childhood
Most are immature, display distorted thinking, and

have an additional psychological disorder
Some theorists have proposed a related biochemical or brain
structure abnormality but clear biological factors have yet to
emerge in research

DSM-5 Update, 8e
72
Pedophilic Disorder
Most people with this disorder are imprisoned
or forced into treatment
Treatments include aversion therapy,
masturbatory satiation, orgasmic reorientation,
and treatment with antiandrogen drugs
Cognitive-behavioral treatment involves relapseprevention training, modeled after programs used
for substance dependence

DSM-5 Update, 8e
73
Sexual Masochism Disorder

This disorder is characterized by fantasies, urges,
or behaviors involving the act or the thought of
being humiliated, beaten, bound, or otherwise
made to suffer
Only those who are very distressed or impaired by
such fantasies receive the diagnosis
Most masochistic fantasies begin in childhood

and seem to develop through the behavioral
process of classical conditioning

DSM-5 Update, 8e
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Sexual Sadism Disorder

A person with sexual sadism disorder, usually
male, is repeatedly and intensely aroused by the
physical or psychological suffering of another
individual
This arousal may be expressed through fantasies,
urges, or behaviors
Named for the infamous Marquis de Sade
People who fantasize about sexual sadism imagine
that they have total control over a sexual victim

DSM-5 Update, 8e
75

Sadistic fantasies may first appear in
childhood or adolescence
Pattern is long-term
Appears to be related to classical conditioning
and/or modeling
Psychodynamic and cognitive theorists view

people with sexual sadism disorder as having
underlying feelings of sexual inadequacy
DSM-5 Update, 8e
76

Biological studies have found signs of possible
brain and hormonal abnormalities
The primary treatment for this disorder is
aversion therapy

DSM-5 Update, 8e
77
A Word of Caution
The definitions of various paraphilic disorders,
like those of sexual dysfunctions, are strongly
influenced by the norms of the particular
society in which they occur
Some clinicians argue that, except when
people are hurt by them, at least some
paraphilic behaviors should not be considered
disorders at all
DSM-5 Update, 8e
78
Gender Dysphoria
According to current DSM-5 criteria, people
with this disorder persistently feel that they
have been assigned to the wrong biological
sex, and gender changes would be desirable

DSM-5 Update, 8e
79
Gender Dysphoria
The DSM-5 categorization of this disorder is
controversial
Many people believe that transgender
experiences reflect alternative not pathological
ways of experiencing ones gender identity
Others argue that gender dysphoria is, in fact, a
medical problem that may produce personal
unhappiness

DSM-5 Update, 8e
80
Gender Dysphoria
People with this disorder would like to get rid of
their primary and secondary sex characteristics
and acquire the characteristics of the other sex
Men with this disorder outnumber women 2 to 1
People with gender dysphoria often experience
anxiety or depression and may have thoughts of
suicide

DSM-5 Update, 8e
81
Gender Dysphoria
The disorder sometimes emerges in childhood
and disappears with adolescence
In some cases it develops into adult gender
dysphoria
Many clinicians suspect biological perhaps

genetic or prenatal factors
Abnormalities in the brain, including the hypothalamus
(particularly the bed nucleus of stria terminalis), are a
potential link

DSM-5 Update, 8e
82
Gender Dysphoria
To more effectively assess and treat those with the
disorder, clinical theorists have tried to distinguish the
most common patterns of gender dysphoria:
Female-to-male
Male-to-female: Androphilic Type
Male-to-female: Autogyneophilic Type
Many adults with gender dysphoria receive

psychotherapy
Some adults with this disorder change their sexual
characteristics by way of hormones; others opt for sexual
reassignment (sex change) surgery

DSM-5 Update, 8e
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Gender Dysphoria
Clinicians have debated heatedly whether
sexual reassignment surgery is appropriate
Some consider it humane, other argue that is a
drastic nonsolution for a complex disorder
Research into the outcomes of such surgery

has yielded mixed results

DSM-5 Update, 8e
84

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Disorders of

Sex and Gender

Slides & Handouts by Karen Clay Rhines, Ph.D.

Disorders of Sex and Gender

Disorders of Sex and Gender

Comer, Abnormal Psychology,

Disorders of Sex and Gender

Comer, Abnormal Psychology,

Sexual dysfunctions are typically very distressing,

Sexual dysfunctions affect one or more of the

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

Two dysfunctions affect this phase:

Comer, Abnormal Psychology,

Prevalent in about 16% of men

Comer, Abnormal Psychology,

Reduced sexual interest and desire may be found

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

Recent investigation has also linked sexual desire disorders to

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

Cultural standards can set the stage for development of

Comer, Abnormal Psychology,

Female sexual interest/arousal disorder may include

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

The use of certain medications and various forms of

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

There are three disorders of this phase:

Comer, Abnormal Psychology,

Psychological, particularly behavioral, explanations of this

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

Biological causes include low testosterone,

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

Women who are more sexually assertive and more

Comer, Abnormal Psychology,

Once again, biological, psychological, and sociocultural

Comer, Abnormal Psychology,

The same medications and illegal substances that affect

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

Comer, Abnormal Psychology,

Disorders of Sexual Pain

Comer, Abnormal Psychology,

Disorders of Sexual Pain

Comer, Abnormal Psychology,

Disorders of Sexual Pain

Some women experience painful intercourse

Disorders of Sexual Pain

This form of genito-pelvic pain/penetration disorder

Comer, Abnormal Psychology,

Treatments for Sexual Dysfunctions

Comer, Abnormal Psychology,

Treatments for Sexual Dysfunctions