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SEXUAL and GENDER IDENTITY DISORDERS Paraphilia Means

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SEXUAL and GENDER IDENTITY DISORDERS Paraphilia Means SEXUAL AND GENDER IDENTITY DISORDERS Paraphilia means “abnormal or unnatural attraction”. The sexual relationships of these people differ from normal individuals in regard to their preferred sexual objects or in the ways they relate to those objects. Their sexual activities revolve around the themes of: 1. Objects or non-human animals 2. Humiliation or suffering of the patient or partner 3. Non-consenting persons, including children The most common parphilias in descending order are Pedophilia, Exhibitionism, Voyeurism, and Frotteurism. In many patients, the paraphilic behavior may be present much of the time, though other patients may indulge in it only occasionally (when under stress). Almost all paraphilia patients are male. Most fantasize sexual contact with their victims. Paraphilia is not diagnosed if someone is merely sexually excited by images and ideas such as women’s panties and bras, but do not act on their ideas and are not distressed by them. Most paraphilias begin during adolescence. This is also the time when people begin to discover and explore their sexuality; teenage boys in particular typically experiment with a variety of sexual behaviors. Terminology of Paraphilias 1. Exhibitionism The patient has urges to expose the genitals to a stranger who does not expect it. 2. Fetishism The patient has sexual urges related to the use of inanimate objects. 3. Frotterism The patient has urges related to rubbing the genitals against a person who has not consented to this (commonly done in a subway or crowded transportation area). 4. Pedophilia The patient has urges involving sexual activities with children. 5. Sexual Masochism The patient has sexual urges related to being injured, bound, or humiliated. 6. Sexual Sadism The patient has sexual urges related to inflicting suffering or humiliation on someone else. 7. Transvestic Fetishism A heterosexual man has sexual urges related to cross-dressing. 8. Voyeurism The patient has urges related to viewing some unsuspecting person disrobing, naked, or engaging in sexual activity. 2 9. Paraphilia Not Otherwise Specified There are quite a few paraphilias that are not widely practiced or that have received too little clinical attention to be assigned their own DSM_IV code. They include sexual urges involving dead people, animals, feces, urine, enemas, and making obscene phone calls. PEDOPHILIA The term means “love of children”. This is the most common paraphilia that involves actual sexual contact. Although estimates vary, it is thought by the age of 18, up to 20% of American children have been sexually molested in some way. The perpetrator is usually a relative, friend, or neighbor, not a stranger. The vast majority of pedophiles are men, but Pedophilia has been occasionally reported in women; however, adequate studies are lacking. The types of acts vary. Some pedophiles will only look; others want to touch or undress a child. But most acts involve oral sex or touching of the genitals of the child or perpetrator. In cases other than incest, most pedophiles don’t require actual penetration. When they do, however, they may use force to achieve it. Victim are usually age 12 or under. The behavior usually begins in later teenage years, though some pedophiles do not start until midlife. It may be more common among persons who were themselves abused as children. Once pedophilia has begun, it tends to run a chronic course. It is believed that up to 50% of pedophiles use alcohol as a prelude to their contacts with children. Pedophiles, like other paraphilic individuals, develop a degree of cognitive distortion about their activities: they tell themsleves that sexual experience is important for children’s development or that children enjoy it. Most pedophiles do not force their attentions on children, but depend on guile, friendship, and persuasion. A number of studies suggest that children who are lonely or otherwise uncared for may be at special risk for accepting the advances of a pedophile. Overall, around 15-25% of those convicted re-offend within a few years of their release from prison. Men who prefer boys are about twice as likely to re-offend as are those who prefer girls. Criteria for Pedophilia · Repeatedly for at least six months, the patient has intense sexual desires, fantasies, or behaviors concerning sexual activity with a sexually immature child (usually 13 or under) · This causes clinically important distress or impairs work, social, or personal functioning. · The patient is 16 or older and at least five years older than the child. FETISHISM A fetish was an idol or other object that had magical significance. In the context of sexual activity, it refers to something that excites an individual’s sexual fantasies or desires. Such objects typically can include underwear, shoes, stockings, and other inanimate objects. Bras and panties are the most common objects used as fetishes. Some people collect great numbers of their preferred fetishes; some may resort to stealing (from 3 stores or clotheslines) to get them. They may smell, rub, or handle these objects while masturbating, or they may ask sex partners to wear them. Without a fetish, such a person may be unable to get an erection. The onset of Fetishism is usually in adolescence, although many patients report similar interests even in childhood. Although some women may show a degree of Fetishism, nearly all fetishists are men. The disorder tends to be a chronic condition. Criteria for Fetishism: · Repeatedly for at least six months, the patient has intense sexual desires, fantasies or behavior concerning the use of inanimate objects (such as shoes or underwear). · This results in clinically important distress or impairs work, social, or personal functioning. · The objects are not used solely in cross-dressing and are not equipment intended to stimulate the genitals (such as a vibrator). TRANSVESTIC FETISHISM Transvestic fetishists are defined as hetersexual males who cross dress in order to achieve sexual excitement; they experience frustration when this behavior is interfered with. Some men will do it only occasionally, while alone; others frequently go out in public. Some limit it to underwear; others get dressed up completely. Many will masturbate or have intercourse when they cross dress. They may fantasize about themselves as girls and keep a collection of female clothing, often wearing it under their normal attire. The onset of transvestic fetishism is usually during adolescence, or even in childhood. Most of these individuals were not effeminate boys. Like other types of Fetishism, this behavior often gradually replaces normal sex. Through videos, magazines, or personal interaction, there may be considerable involvement in the transvestite culture. A small number of these men gradually feel increasingly comfortable dressed as women and become transsexual. Criteria for Transvestic Fetishism: · Repeatedly for at least six months, a heterosexual male has intense sexual desires, fantasies, or behavior concerning cross-dressing. · This causes clinically important distress or impairs work, social, or personal functioning. GENDER IDENTITY DISORDER Patients with gender identity disorder feel intensely uncomfortable with their own biological sex. Some actually detest their own genitalia. They wish to live as members of the opposite sex, and many of them do take on dress and mannerisms of the opposite sex. Cross-dressing is a common first step toward a complete gender change. Next, they may request to take hormones to suppress menstruation, enlarge their breasts, or otherwise change their body appearance or functioning. A few persons with this disorder are so uncomfortable with their sex that they request sex reassignment surgery. Although many patients who have such surgery are reportedly satisfied and live contentedly in their new gender, some ultimately request to be changed back. 4 GID, which is also known as trans-sexualism, is one of the more recently described disorders in the DSM_IV. Until the 1950s, clinicians did not even recognize that people existed who were so intensely uncomfortable with their biological sex. It was only the widespread publicity that occurred in 1952 when Christine Jorgensen received sex reassignment surgery in Denmark and emerged as a woman that this disorder became generally acknowledged. GID is rare (3 of every 100,000 males; 1 of every 100,000 females). It begins in childhood and appears to be chronic. Many male patients have low sex drive; if they have sex at all, most prefer other men. Nearly all affected women are sexually attracted to women. It is far more common for boys with gender disturbance to grow up to become homosexual than to develop GID; Other Individuals in the News for this disorder: Renee Richards– was a physician. After surgery became a seeded women’s tennis player. Criteria for Gender Identity Disorder: · The patient strongly and persistently identifies with the other sex. This is not simply a deisre for a perceived cultural advantage of being a member of the other sex. In adolescents and adults, this desire may be manifested by any of the following: Stated desire to be the other sex Often passing as the other sex Wish to live or be treated as the other sex Belief that the patient’s feelings and reactions are typical of the other sex. · There is strong discomfort with the patient’s own sex or a feeling that the gender role of that sex is inappropriate for the patient. This is shown by symptoms such as: Preoccupation with hormones, surgery, or other physical means to change one’s sex characteristics. Patient’s belief in having been born the wrong sex. · The patient does not have a physical intersex condition. · These symptoms cause clinically important distress or impair work, social, or personal functioning. EATING DISORDERS Primary Eating Disorders: Each of the primary eating disorders is defined by abnormal eating behaviors, and they have a number of other features in common. Patients in both groups may binge and purge with laxatives.
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