Chapter 11
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Chapter 11: Paraphilic Disorders, Sexual Dysfunctions,
and Gender Dysphoria
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What is abnormal sexual behavior?
} When evaluating the “normality” of a given sexual
behavior, the context is extremely important.
} Attitudes and behaviors related to sexuality are continually
evolving over time.
} Contemporary human sexuality researchers:
} Alfred Kinsey
} William Masters
} Virginia Johnson
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Paraphilic disorders
} Behaviors in which an individual has recurrent, intense
sexually arousing fantasies, sexual urges, or behaviors
involving:
1. nonhuman objects
2. children or other non-consenting persons
3. the suffering or humiliation of self or partner
} Psychological dependence on the target of desire that
results in inability to experience sexual arousal without
target.
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Table 1: Paraphilic Disorders
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Pedophilic disorder
} A paraphilic disorder in which an adult is sexually
aroused by children or adolescents.
} This arousal is equal to or greater than sexual arousal of a
physically mature individual.
} This diagnosis includes both people who have acted upon
these urges and those who have not.
} 2/3 of all sexual assault victims are children & adolescents
} Nearly 2/3 of victims are female
} Vast majority of perpetrators are male
} About 1/3 of offenders are relatives of the victimized children
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Exhibitionistic disorder
} A person has intense sexual urges and arousing fantasies
involving the exposure of genitals to a stranger.
} Exhibitionistic disorder begins early in adulthood and
persists throughout life.
} This disorder is often comorbid with conditions such as
major depressive disorder and substance abuse.
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Voyeuristic disorder
} The individual has a compulsion to derive sexual
gratification from observing the nudity or sexual activity
of others who are unaware of being watched.
} Persons with this disorder are sexually aroused by:
} Observing an unsuspecting person who is:
} Naked
} In the process of disrobing
} Engaging in sexual activity
} Voyeurism is the most common paraphilia.
} officials are unlikely to apprehend individuals with this
disorder and these individuals are even less likely to seek
treatment
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Fetishistic disorder
} People with fetishistic disorder are aroused by an object
not specifically intended to be used in a sexual context.
} Arousal depends on the object rather than sexual intimacy
with a partner for achieving sexual gratification
} Behavior is not fetishistic when involving an object
specifically designed for sexual excitation
} Vibrator
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Fetishistic disorder
} Partialism
} The individual is sexually aroused by the presence of a
specific body part, such as the feet
} The attraction to objects or body parts must be
recurrent, intense, and have lasted at least 6 months.
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Frotteuristic disorder
} The individual has intense sexual urges and sexually
arousing fantasies of rubbing against or fondling an
unsuspecting stranger.
} From French frotter (“to rub”)
} Men with frotteuristic disorder seek out crowded places
in which they can safely rub up against their unsuspecting
victims such as in a crowded rush-hour subway train.
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Sexual masochism disorder
} This disorder involves persons seeking pleasure from
being in pain.
} People with sexual masochism disorder are sexually
aroused by being beaten, bound, or otherwise made to
suffer.
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Sexual sadism disorder
} This disorder involves sexual arousal from the physical or
psychological suffering of another person.
} DSM-5 does not classify bondage, domination, and
sadomasochism (BDSM) as a disorder in and of itself.
} Little scientific research exists for both sexual sadism and
sexual masochism.
} People with this disorder do not often seek out treatment and
do not feel the need to change.
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Transvestic disorder
} Diagnosis applied to individuals who engage in
transvestic behavior and have the symptoms of a
paraphilic disorder
} Refers to the behavior of dressing in the clothing of the
other sex.
} Only diagnosed if distress or impairment is experienced
} Commonly displayed by men
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Theories and treatment of paraphilic disorders
• Biological perspectives
• Castration
• Psychotherapeutic medications
• Psychological perspectives
• Lovemaps
• Group therapy
• The cognitive behavioral perspective
• Relapse prevention
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Sexual Dysfunctions
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Sexual dysfunctions
} Abnormality in an individual’s sexual responsiveness and
reactions
} Feelings of significant distress or impairment
} Lifelong or acquired
} Generalized or situational
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Sexual arousal disorders
} Male hypoactive sexual desire disorder:
} Abnormally low level or no level of interest in sexual activity.
} Including few or no sexual fantasies.
} Female sexual interest/arousal disorder:
} Persistent or recurrent inability to attain or maintain normal
physiological and psychological arousal responses during
sexual activity.
} Lower levels of arousal, fewer erotic thoughts, less enjoyment
of sexual activity, and less intense sensations during sexual
activity.
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Sexual arousal disorders
} Erectile disorder: Male cannot attain or maintain an
erection during sexual activity that is sufficient to allow
them to initiate or maintain sexual activity.
} Even if they are able to achieve an erection, they are unable to
penetrate or to experience pleasure during a sexual encounter.
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Disorders involving orgasm
} Female orgasmic disorder: A sexual dysfunction in which
a woman experiences problems having an orgasm during
sexual activity.
} Women are more likely than men to report sexual difficulties
involving the subjective quality of the experience.
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Disorders involving orgasm
} Delayed ejaculation
} A sexual dysfunction in which a man experiences problems
having an orgasm during sexual activity.
} Also known as inhibited male orgasm.
} Premature ejaculation
} A sexual dysfunction that causes men to reach orgasm with
minimal sexual stimulation before, on, or shortly after
penetration and before wishing to do so (within 1 minute)
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Disorders involving pain
} Genito-pelvic pain/penetration disorder
} The individual experiences recurrent or persistent genital pain
before, during, or after sexual intercourse.
} Can affect both males and females.
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Sexual dysfunctions: theories and treatments
• Biological perspective
• Erectile dysfunction – Medications to treat include the
prescription drugs Viagra, Levitra, and Cialis
• Hormonal replacement therapy
• Application of corticosteroids and physical therapy
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Sexual dysfunctions: theories and treatments
} Psychological perspectives
} Macho myth
} Sensate focus
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Gender Dysphoria
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Gender dysphoria
} Gender dysphoria
} Distress that may accompany the incongruence between a
person’s experienced or expressed gender and that person’s
biological sex
} Gender identity:
} A person’s inner sense of maleness or femaleness
} Biological sex:
} The sex determined by a person’s chromosomes.
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Gender dysphoria
} Transsexualism: The phenomenon in which a person has
an inner feeling of belonging to the other sex.
} Some people with gender dysphoria disorders wish to live as
members of the other sex, and they act and dress accordingly.
} Unlike individuals with transvestic disorder, these people
do not derive sexual gratification from cross-dressing.
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Gender dysphoria: theories and treatments
} New approaches are used that emphasize a more fluid
view of gender than the binary male-female dichotomy.
} New DSM 5 terminology reflects a theoretical perspective
that does not focus specifically on what is “wrong” with
people whose self-identification differs from their
biological characteristics or social roles.
} Clients will still likely struggle with transphobia
} New therapeutic approaches encourage clients to create
their own gender identities, which can result in an
improved sense of well-being.
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Table 2: APA Standards of Care for the Treatment of
Gender Identity Disorders
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Table 2: APA Standards of Care for the Treatment of
Gender Identity Disorders (Continued…)
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The biopsychosocial perspective
} Clinicians are increasingly developing models that
incorporate integrated treatment
} DSM-5’s sweeping changes reflect:
} Expansion of the empirical approaches to sexual disorders
} Adoption of a broader, more inclusive, and socio-culturally
sensitive approach to their understanding and treatment
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