Question/Answer

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.
} Law 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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