Essentials of Understanding Abnormal Behavior Chapter Nine

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Essentials of Understanding Abnormal
BehaviorChapter Nine

• Sexual and Gender Identity Disorders

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Sexual and Gender Identity Disorders

• Sexual dysfunctions Problems of inhibited sexual
  desire, arousal, and response
• Gender-identity disorders Incongruity or
  conflict between ones anatomical sex and ones
  psychological feeling of being male or female
• Paraphilias Sexual urges and fantasies about
  situations, objects, or people not part of the
  usual arousal pattern leading to reciprocal and
  affectional sexual activity

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What Is Normal Sexual Behavior?

• Shifting perspectives make the line between
  normal and abnormal difficult to define
• Definitions depend on such factors as culture and
  time period
• Legal decisions reflect past moods and morals,
  questionable and idiosyncratic views

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What Is Normal Sexual Behavior? (contd)

• Merck Manuals process for judging if a behavior
  constitutes a sexual problem
• Persistence/recurrence over long period of time
• Personal distress
• Negative effect on relationship with ones sexual
  partner

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The Study of Human Sexuality

• Freud made the discussion of sexual topics more
  acceptable by incorporating sex (libido) as an
  important part of his theory
• Contemporary understanding of human sexual
  physiology, practices, and customs
• Is based on research of Alfred Kinsey, William
  Masters and Virginia Johnson, and The Janus
  Report
• While controversial, these studies dispelled
  myths and provided clear evidence about human
  sexuality.

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Homosexuality

• Attitudes concerning homosexuality
• American Psychiatric Association and American
  Psychological Association Homosexuality is not a
  mental disorder
• Negative attitudes are held by many political
  figures and religious leaders
• Homophobia Irrational fear of homosexuality

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Homosexuality Research Findings

• No physiological differences in sexual arousal
  and response for homosexuals/heterosexuals
• No significant differences on measures of
  psychological disturbance
• Gender conflicts due to societal intolerance, not
  gender identity confusion
• Sexual concerns differ because of societal
  context
• A naturally occurring phenomenon, not a lifestyle
  choice

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Frequency of Symptoms in 55 Boys with
Cross-Gender Preferences
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Figure 9.4 Disorders Chart Gender Identity
Disorders
Sources Data from DSM-IV-TR Arndt (1991)
Laumann et al. (1994).
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Gender Identity Disorders

• Gender identity disorder Characterized by
  conflict between a persons anatomical sex and
  his/her gender identity, or self-identification
  as male or female
• Prevalence Relatively rare
• Most children with gender identity conflicts do
  not develop gender identity disorders as adults

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Gender Identity Disorders (contd)

• Transsexualism (specified gender identity
  disorder) Strong and persistent cross-gender
  identification and persistent discomfort with
  ones anatomical sex, causing significant
  impairment in social, occupational, or other
  areas of functioning
• Prevalence 1100,000-30,000 for males
  1400,000-100,000 for females
• Gender identity disorder not-otherwise-specified
  Disorders not classifiable as specific gender
  identity disorder

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Etiology of Gender Identity Disorders

• Etiology is unclearprobably an interaction of
  multiple variables
• Biological Possibly neurohormonal factors
• Psychodynamic Unconscious childhood conflicts
  resulting from failure to deal successfully with
  separation-individuation phases of life, or
  inability to resolve Oedipus complex
• Behavioral Childhood experiences based on
  operant conditioning and social learning

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Treatment of Gender Identity Disorders

• Children Sex education peer group interaction
  training
• Parents Learn to reinforce appropriate gender
  behaviors and extinguish inappropriate behaviors
• Modeling and rehearsal
• Sex-change operations

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Paraphilias

• Paraphilias 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 objects
• Nonconsenting others, or
• Real or simulated suffering or humiliation Often
  involves multiple paraphilias
• More common in males than in females

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Figure 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).
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Figure 9.5 Disorders Chart Paraphilia
Disorders (Contd)
Sources Data taken from DSM-IV-TR Tsoi (1993)
Kinsey et al. (1953) Spector and Carey (1990
Allgeier and Allgeier (1998).
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Paraphilias Involving Nonhuman Objects

• Fetishism Extremely strong sexual attraction and
  fantasies involving inanimate objects, such as
  female undergarments
• Transvestic fetishism Intense sexual arousal
  obtained through cross-dressing (wearing clothes
  appropriate to the opposite gender) do not
  confuse with transsexualism
• If arousal is not present/has disappeared over
  time, more appropriate diagnosis is gender
  identity disorder

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Paraphilias Involving Nonconsenting Persons

• Exhibitionism Urges, acts, or fantasies about
  exposing ones genitals to strangers
• Voyeurism Urges, acts, or fantasies involving
  observation of an unsuspecting person disrobing
  or engaging in sexual activity
• Frotteurism Recurrent and intense sexual urges,
  acts, or fantasies of touching or rubbing against
  a nonconsenting person

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Paraphilias Involving Nonconsenting Persons
(contd)

• Pedophilia Adult obtains erotic gratification
  through urges, acts, or fantasies involving
  sexual contact with a prepubescent child
• 20-30 of women report childhood sexual
  encounters with a man most likely a relative,
  friend, or casual acquaintance

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Paraphilias 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 others
• Masochism A paraphilia in which sexual urges,
  fantasies, or acts are associated with being
  humiliated, bound, or made to suffer

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Table 9.2 Sadomasochistic Activities, Ranked by
Selected Samples of Male Female Participants
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Childhood Sexual Abuse

• Victims of childhood sexual abuse
• 25 are younger than age 6 25 are age 6-10
  50 are 11-13
• Relapse rate for pedophiles 35
• Physical symptoms of victims
• Urinary tract infections, poor appetite, headaches

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Childhood Sexual Abuse (contd)

• Victims of childhood sexual abuse (contd)
• Psychological symptoms of victims
• Nightmares, difficulty sleeping, decline in
  school performance, acting-out behaviors,
  sexually focused behavior
• Some exhibit posttraumatic stress disorder
  flashbacks, diminished responsiveness to
  environment, hyperalertness, and jumpiness

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Paraphilias 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 others
• Masochism A paraphilia in which sexual urges,
  fantasies, or acts are associated with being
  humiliated, bound, or made to suffer
• Most sadomasochists engage in both submissive and
  dominant roles
• Brain pathology and life experiences may underlie
  sadism

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Table 10.6 Sadomasochistic Activities, Ranked by
Selected Samples of Male and Female Participants
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Etiology and Treatment of Paraphilias

• Conflicting findings regarding genetic,
  neurohormonal, and brain anomaly explanations
• Psychodynamic Unconscious childhood conflicts
• Castration anxiety due to unresolved Oedipus
  complex
• Treatment Help patient understand relationship
  between deviation and unconscious conflict

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Etiology and Treatment of Paraphilias (contd)

• Behavioral
• Learning theory stresses early conditioning
  experiences
• Preparedness Prepared to associate some stimuli
  with reinforcers, but not others
• Treatment Extinction or aversive conditioning
  (aversive behavior rehearsal) acquiring/strengthe
  ning appropriate behaviors developing
  appropriate social skills

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Sexual Aggression

• Sexual aggression Actions, such as rape, incest,
  and any type of sexual activity performed against
  a persons will through use of force, argument,
  pressure, alcohol or drugs, or authority
• Sexual coercion Any/all forms of sexual pressure
  (pleading, arguing, cajoling, force, or threat of
  force)

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Table 10.7 What Have You Been Told About Rape?
Was It This?
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Rape

• Rape An act of intercourse accomplished through
  force or threat of force
• Statutory rape Sexual intercourse with a child
  younger than a certain age
• Date rape Majority of all rapes (8-25 of female
  college students report having unwanted sexual
  intercourse)
• Sexual aggression by men is common

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Rape (contd)

• Characteristics of rapists
• Create situations for sexual encounters
• Interpret friendliness as provocation, protest as
  insincerity
• Manipulate women with alcohol/other drugs
• Attribute failed attempts at sexual encounters to
  perceived negative features of the woman
• Childhood background of parental neglect/physical
  or sexual abuse
• Initiate coitus earlier and have more sexual
  partners than non-sexually aggressive men

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Effects of Rape

• Physical injury 20 incur minor injuries, 4
  suffer serious injuries
• Rape trauma syndrome Consistent with
  posttraumatic Stress Disorder
• Psychological distress
• Phobic reactions
• Sexual dysfunction
• Acute phase Disorganization, feelings of
  self-blame, fear, depression
• Long-term phase Reorganization, lingering
  fears/phobic reactions, difficulty resuming
  sexual activity/enjoyment

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Etiology of Rape

• Power 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)

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Etiology of Rape (contd)

• Media portrayals of violent sex reflect/affect
  societal values concerning violence and women
• Cultural spillover theory Rape is high in
  environments that encourage violence
• Only rapists can stop rape. Rape is not caused
  by poor judgment on the part of the victim.

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Incest

• Incest Sexual relations between people too
  closely related to marry legally
• Universally taboo in human societies
• Incidence 48,000-250,000 reported per year
• Most frequently reported to law enforcement
  Father with daughter/step-daughter
• Most frequent Brother-sister
• Rare Mother-son

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Treatment for Sex Offenders

• Some treatment is effective with child molesters
  and exhibitionists, but poor for rapists
• Conventional
• Imprisonment offers little/no treatment
• In cases of incest, sometimes attempt to keep
  families intact

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Treatment for Sex Offenders (contd)

• Behavioral treatment for rapists and pedophiles
• Assess sexual preferences/measure erectile
  responses
• Reduce deviant interests (aversion therapy)
• Orgasmic reconditioning/masturbation training to
  appropriate stimuli
• Social skills training
• Assessment after treatment

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Treatment for Sex Offenders (contd)

• Controversial treatments
• Surgical castration (used in Europe) Low relapse
  rates
• Chemical 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)