Tag Archives: gender identity disorders

Sexual Dysfunction vs. Sexual Disorder


A “dysfunction” is literally defined as an abnormality or disturbance of function.  (Colman, 2009, p. 232)  It may also be defined as abnormal or unhealthy interpersonal behavior or interactions.  (Merriam-Webster Online Dictionary [MWOD], 2010)  Specifically, sexual dysfunctions are defined as “conditions that impair the desire or ability to achieve sexual satisfaction.”  (Blaney & Millon, 2009, p. 399)  With and within the DSM-IV-TR, the term sexual dysfunction is conceptualized as an umbrella category that encompasses a wide variety of sex related conditions, some of which may or may not “belong” in a manual that is intended to cover and contain “mental disorders.”  This essay will give a brief overview of what are currently considered under the broad title of Sexual Dysfunctions, and provide some subjective thought on efficacy of continued inclusion as we move toward the newest revision of the “psychiatric bible,” the DSM-V.

Add to FacebookAdd to DiggAdd to Del.icio.usAdd to StumbleuponAdd to RedditAdd to BlinklistAdd to TwitterAdd to TechnoratiAdd to Yahoo BuzzAdd to Newsvine

Under the rubric set forth by the current DSM, the DSM-IV-TR, the following disorders are considered under the broader category of Sexual Dysfunctions: Sexual Desire Disorders (i.e., Hypoactive Sexual Desire Disorder, Sexual Aversion Disorder), Sexual Arousal Disorders (i.e., Female Sexual Arousal Disorder, Male Erectile Disorder), and Orgasmic Disorders (i.e., Female Orgasmic Disorder, Male Orgasmic Disorder, and Premature Ejaculation), Sexual Pain Disorders (i.e., Dyspareunia, Vaginismus), Sexual Dysfunction Due to a General Medical Condition, Substance-Induced Sexual Dysfunction, and Sexual Dysfunction Not Otherwise Specified (NOS).  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 535)  Comparatively speaking, a “disorder” is literally defined as an abnormal physical or mental condition.  (MWOD, 2010)  In the DSM-IV-TR, sexual dysfunctions are differentiated from Paraphilias and Gender Identity Disorders (GIDs).  The essential features of a Paraphilia are arousing fantasies, sexual urges, or behaviors generally involving non-hum, the suffering or humiliation of oneself or one’s partner, or children or other non-consenting persons.  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 566)  Paraphilias include Exhibitionism, Fetishism, Frotteurism, Pedophilia, Sexual Sadism, Transvestic Fetishism, Voyeurism, and Paraphilia NOS.  Conversely, GID is characterized by strong and persistent cross-gender identification coupled with a persistent discomfort about one’s assigned sex and/or gender role.  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 576)

Among those disorders, there are some that appear to fit better than others.  Take the Sexual Desire Disorders (i.e., Hypoactive Sexual Desire Disorder, Sexual Aversion Disorder) for example… what is considered normal libido?  Is there any objective way to quantify or qualify the need or desire to have sexual relations?  Honestly, I don’t think there is.  What is normal sexual activity to me and my partner may be too much or too little for another.  Like most disorders, one of the key diagnostic criterions of the DSM-IV-TR sexual dysfunctions is “marked distress or interpersonal difficulty.”  As a result, it’s not a problem unless the potential client makes it one, regardless of the presence of desire to engage in sexual activity.  Furthermore, it’s not a disorder unless a deficiency is detected and deemed appropriate by the clinician, thereby inserting another level of subjectivity.  It should come as no surprise that inter-rater reliability is lacking, and epidemiological data is mixed based on the definition of the disorder.

Another example is Sexual Arousal Disorders (i.e., Female Sexual Arousal Disorder, Male Erectile Disorder).  Although at the core, there may be some genetic or psychological factors at play, I am not sure I could consider it a disorder if someone simply isn’t attracted to their potential partner?  There are so many variables at play in Female Sexual Arousal Disorder that it may be increasing difficult to identify specific etiology.  Perhaps her partner is less than skilled.  Perhaps there is a developmental basis for the lack of lubrication (menopause).  Perhaps there are underlying biological causes in the form of circulatory problems that contribute to an inability to attain sufficient swelling response during periods of sexual arousal.  All of these situations are in fact treatable, but should we consider them “mental disorders?”  In some cases yes, where psychological factors are at play… however, there are an abundance of situations where psychological factors have little relevance in the diagnosis and treatment of Sexual Arousal Disorders.

Orgasmic Disorders (i.e., Female Orgasmic Disorder, Male Orgasmic Disorder, and Premature Ejaculation) may be propagated by psychological factors, and subsequently appropriate for inclusion in the DSM-V.  Conversely, there are a whole host of “combined factors,” including a very wide variability in type or intensity of stimulation that can trigger organism, that are likely less than “psychological” in nature.  Take premature ejaculation for example.  I think we would be hard pressed to find men who don’t want to last longer… and that inability may be a significant cause of duress for some men.  But as currently envisioned, there is no baseline as to what constitutes a threshold between a disorder, and simply being “excitable.”

Paraphilias are a hot topic in the psychological community because the presence of “mental disorders” like pedophilia seems to justify the behavior.  It would appear to me that any suggestion that paraphilias are in fact a mental disorder would present the opportunity to present a legal argument that “he or she is mentally ill, and as a result, can’t be considered liable for these actions.  In my opinion, simply having a legal option like that is counterintuitive and reprehensible.

We have addressed what is present; however, there is one glaring absence in the current nosology.  Where is the diagnostic category of “sexual dysfunction due to mental disorder?”  One possible solution is to redefine sexual dysfunction due to substance abuse as a dysfunction due to mental disorder “with onset during intoxication.”  (Segraves & Balon, 2007)  Including such a category would be intuitive in my opinion, despite the fact that our meanings of the words disorder and dysfunction have become rather convoluted in their practical application.  It seems to meet the definition of “abnormal or unhealthy,” more so than some of what we currently consider to be dysfunctions.  Without, there is a great deal of work that needs to be done in terms of clarification and codification as we approach the watershed appearance of the latest version of the DSM.

Add to FacebookAdd to DiggAdd to Del.icio.usAdd to StumbleuponAdd to RedditAdd to BlinklistAdd to TwitterAdd to TechnoratiAdd to Yahoo BuzzAdd to Newsvine

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.

Colman, A. M. (2009). Oxford dictionary of psychology (3rd ed.). Oxford, NY: Oxford University Press.

Merriam-Webster Online Dictionary. (2010). disorder. Retrieved May 23, 2010, from http://www.merriam-webster.com/dictionary/disorder

Merriam-Webster Online Dictionary. (2010). dysfunction. Retrieved May 23, 2010, from http://www.merriam-webster.com/dictionary/dysfunction

Segraves, R. T., & Balon, R. (2007, Aug). Toward an improved nosology of sexual dysfunctions in DSM-V. Psychiatric Times, 24(9), 44. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1313390581&Fmt=2&clientId=4683&RQT=309&VName=PQD

Gender Identification Disorder (GID)


The term gender identity, as used in the diagnosis of Gender Identification Disorder (GID), generally refers to issues surrounding the basic knowledge of understanding that he is a male or that she is a female.  These individuals have a persistent cross-gender identification that frequently manifests in a stated desire to be (or insistence that he or she is) the other sex.  Furthermore, individuals present with persistent discomfort with gender roles (Criterion B), although this particular criterion is quite ambiguous as it would seem that anyone who self-refers themselves to a therapist for diagnosis or treatment of GID is under some form of duress?

Add to FacebookAdd to DiggAdd to Del.icio.usAdd to StumbleuponAdd to RedditAdd to BlinklistAdd to TwitterAdd to TechnoratiAdd to Yahoo BuzzAdd to Newsvine

“Children who met the complete criteria for GID were significantly younger, of a higher social-class background, and more likely to come from an intact, two-parent family than the children who did not meet the complete criteria.”  (Netherton, Holmes, & Walker, 1999, p. 370)  Despite this apparent correlation, very little is known about the etiology of GID or the antecedents that would or could contribute to its onset or maintenance.   What is known, is that the wish to change sex is negatively related to age, thereby making older children less likely to verbalize wishes to proceed with sex change procedures (hormonal treatment, surgical procedures, etc).  It has been suggested that this may be because of social desirability factors, but I suspect it is also due to the permanency of the procedures themselves.  What if they proceed and they change their minds?  What a quandry?

I was puzzled by the statement “unlike adult females with GID, who are invariably attracted sexually to biological females, adult males with GID are about equally likely to be attracted to biological males or females.”  (Netherton et al., 1999, p. 372)  What could possibly account for such a difference?  This leads me to believe that the male and female versions of this disorder are qualitatively different.

I am unsurprised that boys are referred more often than girls for concerns regarding GID.  I think this is likely driven by fathers who innately have different expectations for their sons than they do their daughters.  “Adults are less tolerant of cross-gender behavior in boys than girls…”  (Netherton et al., 1999, p. 375)  As a result, it has been suggested that girls would be required to display more extreme cross-gender behavior than boys before parents sought out a clinical assessment.  When someone refers to a girl as a “tom-boy” I think… “cute.”  When someone refers to a boy as a “sissy,” there is a distinctly negative connotation.  There is no culturally neutral term for a boy who sexually identifies with the female gender… so, despite the fact that girls are more likely to display masculine behavior compared to boys who display feminine behavior… the latter not the former are referred more often.  Seems backwards to me, but hey, that’s culture.

I was suitably surprised that the typical age of onset is so early!  Pre-school years (or even earlier) is when GID traits typically begin to appear… with nearly 90% of kids who intend to cross-dress “coming out” by their 5th birthday.  Differences have appeared as early as a child’s 2nd birthday… which may suggest some genetic/biological or prenatal influence on the phenomenon. (Something other than environmental, in any event)

Transvestic Fetishism (TF) typically manifests during adolescence or adulthood, unlike GID which typically manifests in early childhood.  It is perceived to occur almost exclusively in biological males, although a few cases of adult females demonstrating cross-dressing sexual arousal have been reported.  (Netherton et al., 1999, p. 384)  Unlike GID, childhood gender development of adolescents with GF is typically heterosexual (masculine).  TF would appear to serve some typify of self serving function, and as a result, the nature of cross-dressing in TF and in GID is qualitatively different. (Netherton et al., 1999, p. 386)  Some have suggested that TF develops as a reaction to “petticoat punishment” (forced cross-dressing during childhood) although this is a very rare occurrence.  (Netherton et al., 1999, p. 388)

Add to FacebookAdd to DiggAdd to Del.icio.usAdd to StumbleuponAdd to RedditAdd to BlinklistAdd to TwitterAdd to TechnoratiAdd to Yahoo BuzzAdd to Newsvine

Reference

Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.

Sexual disorders


Sexual disorders are divided into two categories; paraphilias and gender identity disorders (GIDs).  Most paraphilias occur more frequently in males when compared to females, but GIDs are more evenly distributed.  “The term paraphilia denotes any powerful and persistent sexual interest other than sexual interest in copulatory or precopulatory behavior with phenol-typically normal, consenting human partners.”  (Blaney & Millon, 2009, p. 527)

Add to FacebookAdd to DiggAdd to Del.icio.usAdd to StumbleuponAdd to RedditAdd to BlinklistAdd to TwitterAdd to TechnoratiAdd to Yahoo BuzzAdd to Newsvine

I was wholly unaware that hebephilia (the preference for pubescent age partners) was different from pedophilia (sexual interest in prepubescent children).  Even though pedophilia is more widely discussed, hebephilia may be the greater of the two in terms of being a problem.  Typical behaviors of pedophiles (and hebephiles) consist of touching breasts, buttocks, or genitalia of the child… or, by inducing the child to touch or fellate the offender.  (Blaney & Millon, 2009, p. 528)  Makes me sick just writing about it, that’s the honest truth.

Fetishism comes in many different forms.  Fetishism in general denotes sexual interest focused on classes of objects or features of objects other than the external reproductive organs of people, applying specifically to instances where objects are the central feature rather than a supporting element in sexual activity.  Stuff fetishism refers to the erotic interest in specific materials such as rubber, leather, or fur.  Clothing fetishism is stuff fetishism, but more centrally focused on clothing (generally emblematic of gender).  I found the following statement to be revealing… “If I buy the kind of shoes I prefer and ask a woman I know to wear them for me, it doesn’t have the same appeal as if they were her own shoes.  I guess this is because they don’t seem to be as much a part of her.”  (Blaney & Millon, 2009, p. 529)

The concept of autoeroticism is fascinating… suggesting that that the fantasies of people whom suffer from erotic identity disorder pertain less to any sexual partners and more to their transformed images of themselves.  (Blaney & Millon, 2009, p. 531)  This transformed self image may be of the opposite gender, of a different age (specifically children, as in infantilism), or even of being an amputee apotemnophilia).  It has been suggested that these conditions are in fact “erotic target location errors,” and that they may in fact represent autoerotic forms of other conditions (infantilism as an autoerotic form of pedophilia, for example).

Sadism refers to the erotic interest in inflicting fear, humiliation, and/or suffering.  It is the pain the carries the erotic value, differentiating them from people whom suffer from biastophilia.  There also exist individuals who seek to inflict pain or humiliation, but only on willing partners… this has been called the “hyperdominance pattern” of sexual behavior.  (Blaney & Millon, 2009, p. 532)

I was particularly interested in telephone scatalogia, mostly because we periodically get a call like that.  This condition refers to the erotic interest in using a telephone to expose unsuspecting persons to vulgar or sexual language, or, to elicit it from them.  (Blaney & Millon, 2009, p. 534)  Our caller is the “shock caller” variety.  Ole’ boy will call up out of the blue and say some of the nuttiest stuff I have ever heard… and then just hang up.  Then he’ll lay low for 6-8 months, rinse and repeat.  It’s almost entertaining to be honest.

“Gender identity disorders are a heterogeneous class of syndromes characterized, in adults, by the persistent idea that one is, or should have been, a member of the opposite sex and, in children, by pervasive patterns of behavior consistent with such a belief.”  (Blaney & Millon, 2009, p. 540)  I’m not sure that the latter is confined to children, and for that reason, I am not sure that’s the best working definition I have ever heard.  GIDs come in homosexual and non-homosexual varieties, and are marked by the individual believing that “on the inside, they really are member of the opposite sex.”  As a result, oftentimes, these individuals will not identify themselves as gay or homosexual… instead referring to themselves as transgender.

Add to FacebookAdd to DiggAdd to Del.icio.usAdd to StumbleuponAdd to RedditAdd to BlinklistAdd to TwitterAdd to TechnoratiAdd to Yahoo BuzzAdd to Newsvine

Reference

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.