Psychosexual Disorders

Gender identity disorders

Gender identity disorder is a condition characterized by a

persistent feeling of discomfort or inappropriateness

concerning one's anatomic sex.
The disorder typically begins in childhood with gender
identity problems and is manifested in adolescence or
adulthood by a person dressing in clothing appropriate for
the desired gender, as opposed to one's birth gender.
In extreme cases, persons with gender identity disorder
may seek gender reassignment surgery, also known as a
sex-change operation.
This disorder is different fromtransvestitism or
transvestic fetishism, in whichcross-dressingoccurs
for sexual pleasure. Furthermore, the transvestite does
not identify with the other sex.

Causes
There is no clearly understood or universally agreed-upon cause

for gender identity disorder. However, most experts agree that

there may be a strong biological basis for the disorder.
Recent post-mortem studies conducted on male-to-female
transsexuals, non-transsexual men, and non-transsexual women
show a significant difference in the volume of a portion of the
hypothalamus that is essential for sexual behavior. While further
investigations are needed, these initial studies seem to confirm
that one's sense of gender resides in the brain and that it may be
chemically determined.
In addition to biological factors, environmental conditions, such
as socialization, seem to contribute to gender identity disorder.
Social learning theory, for example, proposes that a combination
of observational learning and different levels and forms of
reinforcementby parents, family, and friends determine a
child's sense of gender, which, in turn, leads to what society
considers sex-appropriate or inappropriate behavior.

Symptoms
The subsequent development of unwanted secondary sex

characteristics, especially in males, increases a person's

anxiety and frustrations.
This anxious state is characterized by feelings of confusion,
shame, guilt, and fear.
These individuals are confused over their inability to handle
their problem.
They feel shame over their inability to control what society
considers "perverse" activities. Even though cross-dressing
and cross-gender fantasies provide relief, the respite is
temporary.
These activities often leave individuals with a profound shame
over their thoughts and activities.
Gender identity disorder is more prevalent in males than in
females.

Diagnosis
According to the Diagnostic and Statistical Manual of

Mental Disorders, fourth edition text revised(DSM-IVTR), the following criteria must be met to establish a
diagnosis of gender identity disorder. More specific
descriptions and examples of the first two criteria follow
the list;
A strong and persistent cross-gender identification.
Persistent discomfort with his or her sex or having a sense
of inappropriateness in the gender role of one's birth sex.
The disturbance is not concurrent with a physical intersex
condition, such as hermaphroditism in which a person is
born with the genitalia of both male and female.
The disturbance causes clinically significant distress or
impairment in social, occupational, or other important
areas of functioning.

In children, the disturbance is manifested by four (or more) of

the following:
Repeatedly stating a desire to be, or insistence that he or she
is, a member of the other sex.
Strong preference for wearing clothes of the opposite gender.
In boys, displaying a preference for cross-dressing or
simulating female attire; in girls, insistence on wearing only
stereotypical masculine clothing.
Displaying strong and persistent preferences for crosssex rolesin make-believe play or experiencing persistent
fantasies of being a member of the other sex.
Having an intense desire to participate in the games and
pastimes that are stereotypical of the other sex.
Exhibiting a strong preference for playmates of the other sex.

Among children, the disturbance is manifested by any

of the following:
Among boys, asserting that his penis or testes are
disgusting or will disappear, asserting that it would be
better not to have a penis, or having an aversion
toward rough-and-tumble play and rejecting male
stereotypical toys, games, and activities.
Among girls, rejecting the gender-typical practice of
urinating in a sitting position, asserting that she has
or will grow a penis, or stating that she does not want
to grow breasts or menstruate, or having a marked
aversion toward normative feminine clothing.

Treatments
One common form of treatment for gender

identity disorder ispsychotherapy.

The initial aim of treatment is to help
individuals function in their biologic sex
roles to the greatest degree possible.

Prevention
Providing gender-appropriate clothing and toys

in infancy and early childhood is helpful in

preventing or mitigating gender identity
disorder.
Avoiding derogatory comments about a child's
toy, clothing, or activity preference reduces the
potential for inadvertentpsychicharm.
Most individuals with gender identity disorder
require and appreciate support from several
sources. Families, as well as the person with the
disorder, need and appreciate both information
and support.

Sexual dysfunction

Sexual Desire Disorders

Hypoactive Sexual Desire Disorder
A. Persistently or recurrently deficient (or absent)
sexual fantasies and desire for sexual activity. The
judgment of deficiency or absence is made by the
clinician, taking into account factors that affect
sexual functioning, such as age and the context of
the persons life.
B. The disturbance causes marked distress or
interpersonal difficulty.
C. The sexual dysfunction is not better accounted for
by another Axis I disorder (except another Sexual
Dysfunction) and is not due exclusively to the direct
physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical condition.

Sexual Aversion Disorder

A. Persistent or recurrent extreme aversion
to, and avoidance of, all (or almost all)
genital sexual contact with a sexual
partner.
B. The disturbance causes marked distress
or interpersonal difficulty.
C. The sexual dysfunction is not better
accounted for by another Axis I disorder
(except another Sexual Dysfunction).

Sexual Arousal Disorders

Female Sexual Arousal Disorder
A. Persistent or recurrent inability to attain, or to

maintain until completion of the sexual activity, an

adequate lubricationswelling response of sexual
excitement.
B. The disturbance causes marked distress or
interpersonal difficulty.
C. The sexual dysfunction is not better accounted for
by another Axis I disorder (except another Sexual
Dysfunction) and is not due exclusively to the direct
physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical condition.

Male Erectile Disorder

A. Persistent or recurrent inability to attain,
or to maintain until completion of the
sexual activity, an adequate erection.
B. The disturbance causes marked distress
or interpersonal difficulty.
C. The erectile dysfunction is not better
accounted for by another Axis I disorder
(other than a Sexual Dysfunction) and is
not due exclusively to the direct
physiological effects of a substance (e.g., a
drug of abuse, a medication) or a general
medical condition.

Orgasmic Disorders
Female Orgasmic Disorder
A. Persistent or recurrent delay in, or absence of, orgasm
following a normal sexual excitement phase. Women exhibit
wide variability in the type or intensity of stimulation that
triggers orgasm. The diagnosis of Female Orgasmic Disorder
should be based on the clinicians judgment that the womans
orgasmic capacity is less than would be reasonable for her age,
sexual experience, and the adequacy of sexual stimulation she
receives.
B. The disturbance causes marked distress or interpersonal
difficulty.
C. The orgasmic dysfunction is not better accounted for by
another Axis I disorder (except another Sexual Dysfunction) and
is not due exclusively to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general
medical condition.

Male Orgasmic Disorder

A. Persistent or recurrent delay in, or absence of,

orgasm following a normal sexual excitement phase

during sexual activity that the clinician, taking into
account the persons age, judges to be adequate in
focus, intensity, and duration.
B. The disturbance causes marked distress or
interpersonal difficulty.
C. The orgasmic dysfunction is not better accounted
for by another Axis I disorder (except another Sexual
Dysfunction) and is not due exclusively to the direct
physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical condition.

Premature Ejaculation
A. Persistent or recurrent ejaculation with minimal

sexual stimulation before, on, or shortly after

penetration and before the person wishes it. The
clinician must take into account factors that affect
duration of the excitement phase, such as age,
novelty of the sexual partner or situation, and recent
frequency of sexual activity.
B. The disturbance causes marked distress or
interpersonal difficulty.
C. The premature ejaculation is not due exclusively to
the direct effects of a substance (e.g., withdrawal
from opioids).

Sexual Pain Disorders

Dyspareunia
A. Recurrent or persistent genital pain associated

with sexual intercourse in either a male or a female.

B. The disturbance causes marked distress or
interpersonal difficulty.
C. The disturbance is not caused exclusively by
Vaginismus or lack of lubrication, is not better
accounted for by another Axis I disorder (except
another Sexual Dysfunction), and is not due
exclusively to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a
general medical condition.

Vaginismus
A. Recurrent or persistent involuntary

spasm of the musculature of the outer third

of the vagina that interferes with sexual
intercourse.
B. The disturbance causes marked distress
or interpersonal difficulty.
C. The disturbance is not better accounted
for by another Axis I disorder (e.g.,
Somatization Disorder) and is not due
exclusively to the direct physiological
effects of a general medical condition.

Paraphillas
a condition in which a person's sexual

arousal and gratification depend on

fantasizing about and engaging in sexual
behavior that is atypical and extreme.
A paraphilia can revolve around a particular
object (children, animals, underwear) or
around a particular act (inflicting pain,
exposing oneself).
Most paraphilias are far more common in
men than in women. The focus of a
paraphilia is usually very specific and
unchanging.

Diagnosing
Most people with atypical sexual interests

do not have a mental disorder. To be

diagnosed with a paraphilic disorder, DSM-5
requires that people with these interests:
feel personal distress about their interest,
not merely distress resulting from societys
disapproval; or
have a sexual desire or behavior that
involves another persons psychological
distress, injury, or death, or a desire for
sexual behaviors involving unwilling
persons or persons unable to give legal
consent.

Reference
Read more: http://

www.minddisorders.com/Flu-Inv/Gender-ident
ity-disorder.html#ixzz3lLJqbRnf
: Reprinted with permission from the
Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, Text Revision.
(Copyright 2000). American Psychiatric
Association.
https://
www.psychologytoday.com/conditions/paraph
ilias