PROBLEM 2: PARAPHILIA AND GENDER DYSPHORIA
Learning objectives
Case 1:
What are paraphilias?
What paraphilias are described in DSM-5? (clinical features/epidemiology)
What causes paraphilias? (etiological models)
Can paraphilias be treated? And if so, how?
Case 2:
What is gender identity and how does it develop?
What is gender dysphoria? (including clinical features / epidemiology/ treatment)
What is the difference between gender dysphoria and transsexuality?
What causes gender dysphoria? (aetiology)
How is gender dysphoria treated?
Case 3:
What is the DSM?
What are the benefits and disadvantages of a diagnostic system like the DSM?
What are other perspectives on mental disorders?
Paraphilia
Paraphilias: atypical sexual preferences
Sexual preferences
Not mental disorders = PARAPHILIC DISORDER
- Paraphilia that is currently causing the individual significant distress or impairment or entails
personal harm or risk of others.
- Recurrent, intense sexually arousing fantasies, urges
Divided into:
- those that involve consent of others and those that involve nonconsenting others
- those that do involve contact with others (paedophilia) and those that do not necessarily
involve contact with others (fetishes)
DMV-5:
Presence of a paraphilia does not constitute a disorder and a diagnosis can only be given when
behaviour causes distress or impairment or causes others harm.
Paraphilic coercive disorder:
- sexual pleasure from coercing others into non-consensual sex
, - was rejected! – rape is a criminal act not a mental disorder
hypersexual disorder
- excessive preoccupation with sexual fantasies, urges and actives
- rejected! - insufficient evidence for its validity as a psychiatric disorder
Paraphilic Disorders
Recurrent, intense, sexual fantasies, sexual urges or behaviours that involve targets of sexual
attraction, unusual courtship behaviours or desire for pain/suffering of oneself or others.
Fetishistic disorder:
- use of non-living objects or non-genital body parts for sexual arousal or gratification
- e.g., Feet, toes, hair, underwear
- does not interfere with rights of others
- often kept a secret
- occurs frequently in context of sadomasochism
- Partialism: atypical behaviour with object
- Eitology hypothesis: importance of classical conditioning and social learning
Transvestic disorder:
- Dressing in clothes of the opposite sex as means of becoming sexually aroused
- Autogynephilic: attraction or arousal to thoughts, images or fantasies of being woman
- Diagnosis required: cross-dressing behaviour cause the individual significant distress or
impairment
- Half the men who engage for sexual gratification find the behaviour acceptable and thus do
not meet the DSM-5 criteria for the disorder
- 2.8% men & 0.4% women engage in cross-dressing behaviour
Learning objectives
Case 1:
What are paraphilias?
What paraphilias are described in DSM-5? (clinical features/epidemiology)
What causes paraphilias? (etiological models)
Can paraphilias be treated? And if so, how?
Case 2:
What is gender identity and how does it develop?
What is gender dysphoria? (including clinical features / epidemiology/ treatment)
What is the difference between gender dysphoria and transsexuality?
What causes gender dysphoria? (aetiology)
How is gender dysphoria treated?
Case 3:
What is the DSM?
What are the benefits and disadvantages of a diagnostic system like the DSM?
What are other perspectives on mental disorders?
Paraphilia
Paraphilias: atypical sexual preferences
Sexual preferences
Not mental disorders = PARAPHILIC DISORDER
- Paraphilia that is currently causing the individual significant distress or impairment or entails
personal harm or risk of others.
- Recurrent, intense sexually arousing fantasies, urges
Divided into:
- those that involve consent of others and those that involve nonconsenting others
- those that do involve contact with others (paedophilia) and those that do not necessarily
involve contact with others (fetishes)
DMV-5:
Presence of a paraphilia does not constitute a disorder and a diagnosis can only be given when
behaviour causes distress or impairment or causes others harm.
Paraphilic coercive disorder:
- sexual pleasure from coercing others into non-consensual sex
, - was rejected! – rape is a criminal act not a mental disorder
hypersexual disorder
- excessive preoccupation with sexual fantasies, urges and actives
- rejected! - insufficient evidence for its validity as a psychiatric disorder
Paraphilic Disorders
Recurrent, intense, sexual fantasies, sexual urges or behaviours that involve targets of sexual
attraction, unusual courtship behaviours or desire for pain/suffering of oneself or others.
Fetishistic disorder:
- use of non-living objects or non-genital body parts for sexual arousal or gratification
- e.g., Feet, toes, hair, underwear
- does not interfere with rights of others
- often kept a secret
- occurs frequently in context of sadomasochism
- Partialism: atypical behaviour with object
- Eitology hypothesis: importance of classical conditioning and social learning
Transvestic disorder:
- Dressing in clothes of the opposite sex as means of becoming sexually aroused
- Autogynephilic: attraction or arousal to thoughts, images or fantasies of being woman
- Diagnosis required: cross-dressing behaviour cause the individual significant distress or
impairment
- Half the men who engage for sexual gratification find the behaviour acceptable and thus do
not meet the DSM-5 criteria for the disorder
- 2.8% men & 0.4% women engage in cross-dressing behaviour
