Essentials of Understanding Abnormal Behavior Chapter Nine

1. Essentials of Understanding Abnormal BehaviorChapter Nine Sexual and Gender Identity Disorders

2. Sexual and Gender Identity Disorders • Sexual dysfunctions: Problems of inhibited sexual desire, arousal, and response • Gender-identity disorders: Incongruity or conflict between one’s anatomical sex and one’s 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

3. 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

4. What Is “Normal” Sexual Behavior? (cont’d) • Merck Manual’s process for judging if a behavior constitutes a sexual problem: • Persistence/recurrence over long period of time • Personal distress • Negative effect on relationship with one’s sexual partner

5. 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.

6. 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

7. 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

8. Frequency of Symptoms in 55 Boys with Cross-Gender Preferences

9. Figure 9.4: Disorders Chart: Gender Identity Disorders Sources: Data from DSM-IV-TR; Arndt (1991); Laumann et al. (1994).

10. Gender Identity Disorders • Gender identity disorder: Characterized by conflict between a person’s 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

11. Gender Identity Disorders (cont’d) • Transsexualism (“specified gender identity disorder”): Strong and persistent cross-gender identification and persistent discomfort with one’s anatomical sex, causing significant impairment in social, occupational, or other areas of functioning • Prevalence: 1:100,000-30,000 for males; 1:400,000-100,000 for females • Gender identity disorder not-otherwise-specified: Disorders not classifiable as specific gender identity disorder

12. Etiology of Gender Identity Disorders • Etiology is unclear—probably 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

13. 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

14. 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

15. 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).

16. Figure 9.5: Disorders Chart: Paraphilia Disorders (Cont’d) Sources: Data taken from DSM-IV-TR; Tsoi (1993); Kinsey et al. (1953); Spector and Carey (1990; Allgeier and Allgeier (1998).

17. 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

18. Paraphilias Involving Nonconsenting Persons • Exhibitionism: Urges, acts, or fantasies about exposing one’s 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

19. Paraphilias Involving Nonconsenting Persons (cont’d) • 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

20. 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

21. Table 9.2: Sadomasochistic Activities, Ranked by Selected Samples of Male & Female Participants

22. 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

23. Childhood Sexual Abuse (cont’d) • Victims of childhood sexual abuse (cont’d): • 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

24. 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

25. Table 10.6: Sadomasochistic Activities, Ranked by Selected Samples of Male and Female Participants

26. 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

27. Etiology and Treatment of Paraphilias (cont’d) • 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/strengthening appropriate behaviors; developing appropriate social skills

28. Sexual Aggression • Sexual aggression: Actions, such as rape, incest, and any type of sexual activity performed against a person’s 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)

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

30. 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

31. Rape (cont’d) • 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

32. 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

33. 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)

34. Etiology of Rape (cont’d) • 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.

35. 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

36. 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

37. Treatment for Sex Offenders (cont’d) • 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

38. Treatment for Sex Offenders (cont’d) • 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)