Lecture 5

• What is (ab)normal? Psychological approach

  The four D’s:

  • Deviance

  • Distress

  • Dysfunction

  • Danger
• Categories in DSM-5R referring to sexuality and gender- sexual dysfunctions


  = persistent inability to function normally in some area of the sexual response cycle
• People with paraphilic disorders...

  ...have repeated and intense sexual urges or fantasies in response to objects or situations that society deems inappropriate, and they may behave inappropriate as well
• Persons with gender dysphoria...

  persistently feel that they have been born to the wrong sex, identify with the other gender, and experience significant distress or impairment because of these feelings
• Sexual Dysfunctions


  • Set of disorders in which people have difficulty responding sexually or experiencing sexual pleasure

  To be diagnosed problems must:

  • Occur most of the time for at least 6 months

  • Cause significant distress or impairment

  • Not be due to another nonsexual psychiatric problem
• the sexual response cycle

  desire phase -> arousal phase -> plateau phase -> orgasm phase -> resolution phase
• The Sexual Response Cycle- explanations


  image:

  
• Sexual response cycle (linear model)


  image:

  
• Sexual Dysfunctions


  table:

  
• DSM-IV TR → DSM-5

  table:

  
• Sexual Dysfunctions - Female orgasmic disorder-Checklist

  • Individual usually displays a significant delay, infrequency, or absence of orgasm, and/or is unable to achieve past orgasmic intensity

  • Individual experiences significant distress

  • Present for at least 6 months
• Interplay of Biological, Psychological, and Social Factors in Sexuality


  image:

  
• Paraphilic disorders


  • Characterized by intense sexual urges, fantasies, or behaviors involving objects or situations outside the usual sexual norms

  • May involve multiple paraphilia displays

  • Relatively few people receive a formal diagnosis

  • In general, a diagnosis is applied when paraphilias cause a person significant distress or impairment or when the satisfaction of the paraphilias places the person or other people at risk of harm
• Types of paraphilias


  Involve:

  • The consent of others versus nonconsenting others

  • Contact with others versus those that do not necessarily require contact with others
• Paraphilic Disorders


  Recurrent & intense sexual arousing fantasies, urges, or behaviors involving objects or situations outside the usual sexual norms (e.g. nonhuman objects, nongenital body parts; the suffering or humiliation of oneself or one's partner; or children or other nonconsenting persons)
• Paraphilic Disorders


  • At least 6 months
  • Experience significant distress or impairment over the fantasies, urges, or behaviors
• Some cases of paraphilic disorders are without distress or impairment or paraphilic behavior as indicator for disorder (e.g.pedophilic disorder, exhibitionistic disorder, voyeuristic disorder, frotteuristic disorder, and sexual sadism disorder)
• DSM-5TR: fantasizing or watching pornographic material is no longer considered to be a pedophilic disorder
• DSM-5TR: If someone is diagnosed with this disorder, then the option 'in remission' is no longer possible. A diagnosis is for life
• Paraphilic Disorders- Explanations and research

  • little formal evidence to support explanations for paraphilias

  • Definitions of these disorders are strongly influenced by the norms of the society in which they occur
• Paraphilic Disorders- treatments


  • No treatments have received much research or been proven clearly effective

  • Psychological and sociocultural treatments have been available for the longest period of time, but today's professionals are also using biological interventions
• Paraphilic disorders


  • Fetishistic disorder

  • Transvestic disorder (transvestism, cross-dressing)

  • Exhibitionistic disorder

  • Voyeuristic disorder

  • Frotteuristic disorder

  • Pedophilic disorder

  • Sexual masochism disorder

  • Sexual sadism disorder
• Gender Variations


  • People differ in terms of gender identity, biological sex and gender expression

  • Most people have an identity consistent with their assigned gender (birth anatomy); cisgender

  • Traditional view: gender binary (male or female)

  • Current view: continuous view, but this view is also still in development
• Non-binary


  when a person does not make a choice in gender identity male or female. Non-binary persons feel a little boy/man and girl/woman, or just neither

  • Or they sometimes feel boy/man and sometimes girl/woman. This is called gender fluidity

  • Others do not feel boy/man but also do not feel girl/woman. They feel genderless and or agender

  • Other words for non-binary is genderqueer or gender neutra
• Transgender individuals

  • Gender identity differs from their assigned (based on external genitals) gender

  • Affects 25 million people worldwide (0.6% of the adult population)

  • Estimations in the Netherlands based on self-identification, between 0.15-0.58%
• Gender dysphoria (DSM-5TR checklist)

  • For 6 months or more, an individual's gender-related feelings and/or behaviors are at odds with those of his or her assigned gender
  • Two or more of the following symptoms are present:
• Symptoms of gender dysphoria

  • Gender-related feelings and/or behaviors clearly contradict the individual's primary or secondary sex characteristics
  • Powerful wish to eliminate one's sex characteristics
  • Yearning for the sex characteristics of another gender
  • Powerful wish to be a member of another gender
  • Yearning to be treated as a member of another gender
  • Firm belief that one's feelings and reactions are those that characterize another gender
• Significant distress or impairment


  Individual experiences significant distress or impairment
• nterventions- gender variations


  • Psychological: Build awareness of needs and feelings; reduce anxiety, depression, and anger; improve self-image; develop coping skills

  • Biological: Gender change procedures*| gender reassignment surgery | gender

  confirmation surgery | gender-affirming surgery, hormone therapy (estrogen/testosterone)

  • Cognitive-behavioral: Transgender education programs, support programs