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Abnormal Psych- Chapt 11

Terms in this set (27)

-Desire phase: The phase of the sexual response cycle consisting of an urge to have sex, sexual fantasies, and sexual attraction.
-Two dysfunctions affect the desire phase—male hypoactive sexual desire disorder and female sexual interest/arousal disorder
-Male hypoactive sexual desire disorder: A male dysfunction marked by a persistent reduction or lack of interest in sex and hence a low level of sexual activity.
--Nevertheless, when these men do have sex, their physical responses may be normal and they may enjoy the experience.
--this disorder may be found in as many as 16% of men, and the number seeking therapy has increased during the past decade
-Female sexual interest/arousal disorder: A female dysfunction marked by a persistent reduction or lack of interest in sex and low sexual activity, as well as, in some cases, limited excitement and few sexual sensations during sexual activity.
--many such women experience little excitement during sexual activity, are unaroused by erotic cues, and experience few genital or nongenital sensations during sexual activity
--Reduced sexual interest and arousal may be found in as many as 33% of women
-A number of people experience normal sexual interest but choose, as a matter of lifestyle, not to engage in sexual relations. These individuals are not diagnosed as having one of the sexual desire disorders.
-Most cases of low sexual desire are caused primarily by sociocultural and psychological factors, but biological conditions can also lower sex drive significantly.
-Excitement phase: The phase of the sexual response cycle marked by changes in the pelvic region, general physical arousal, and increases in heart rate, muscle tension, blood pressure, and rate of breathing.
-Erectile disorder: A dysfunction in which a man persistently fails to attain or maintain an erection during sexual activity.
-This problem occurs in as much as 10% of the general male population
-most men with erectile disorder are over the age of 50, largely because so many cases are associated with ailments or diseases of older adults
-The disorder is experienced by 7% of men who are under 30 years old and increases to 50 percent of men over 60
-Moreover, according to surveys, half of all adult men experience erectile difficulty during intercourse at least some of the time.
-Biological Causes-
-The same hormonal imbalances that can cause male hypoactive sexual desire disorder can also produce erectile disorder
-More commonly, however, vascular problems—problems with the body's blood vessels—are involved
-An erection occurs when the chambers in the penis fill with blood, so any condition that reduces blood flow into the penis, such as heart disease or clogging of the arteries, may lead to the disorder
-It can also be caused by damage to the nervous system as a result of diabetes, spinal cord injuries, multiple sclerosis, kidney failure, or treatment by dialysis
-the use of certain medications and various forms of substance abuse, from alcohol abuse to cigarette smoking, may interfere with erections
-Medical procedures, including ultrasound recordings and blood tests, have been developed for diagnosing biological causes of erectile disorder.
-Nocturnal penile tumescence (NPT): Erection during sleep.
-Abnormal or absent nightly erections usually (but not always) indicate some physical basis for erectile failure.
-Viagra and other drugs for erectile disorder are typically given to patients without much evaluation of their problem
-Psychological Causes-
-As many as 90% of all men with severe depression, for example, experience some degree of erectile dysfunction
-Performance anxiety: The fear of performing inadequately and a related tension experienced during sex.
-Spectator role: A state of mind that some people experience during sex, focusing on their sexual performance to such an extent that their performance and their enjoyment are reduced.
-man begins to experience erectile problems, for whatever reason, he becomes fearful about failing to have an erection and worries during each sexual encounter
-Sociocultural Causes-
-Each of the sociocultural factors that contribute to male hypoactive sexual desire disorder has also been tied to erectile disorder.
-Men who have lost their jobs and are under financial stress, for example, are more likely to develop erectile difficulties than other men
-Marital stress, too, has been tied to this dysfunction
-Orgasm phase: The phase of the sexual response cycle during which an individual's sexual pleasure peaks and sexual tension is released as muscles in the pelvic region contract rhythmically.
-Dysfunctions of this phase of the sexual response cycle are early ejaculation and delayed ejaculation in men and female orgasmic disorder in women.
Male Ejaculation Disorder
-Early ejaculation: A dysfunction in which a man persistently reaches orgasm and ejaculates within one minute of beginning sexual activity with a partner and before he wishes to.
-As many as 30% of men in the US experience early ejaculation at some time
-Although the dysfunction is certainly experienced by many young men, research suggests that men of any age may suffer from it
-Clinicians have also suggested that early ejaculation may be related to anxiety, hurried masturbation experiences during adolescence (in fear of being "caught" by parents), or poor recognition of one's own sexual arousal
-Three biological theories have emerged from the limited investigations done so far
--One theory states that some men are born with a genetic predisposition to develop this dysfunction.
--A second theory argues that the brains of men with this problem contain certain serotonin receptors that are overactive and others that are underactive.
--A third explanation holds that men with the dysfunction experience greater sensitivity or nerve conduction in the area of their penis,
Delayed Ejaculation:
-Delayed ejaculation: A male dysfunction characterized by persistent inability to ejaculate or very delayed ejaculations during sexual activity with a partner.
-Occurs with in 8% of the male population
-A low testosterone level, certain neurological diseases, and some head or spinal cord injuries can interfere with ejaculation
-Substances that slow down the sympathetic nervous system (such as alcohol, some medications for high blood pressure, and certain psychotropic medications) can also affect ejaculation
-certain serotonin-enhancing antidepressant drugs appear to interfere with ejaculation in at least 30 percent of men who take them
-A leading psychological cause of delayed ejaculation appears to be performance anxiety and the spectator role, the cognitive-behavioral factors also involved in erectile disorder
-Another psychological cause of delayed ejaculation may be past masturbation habits
-Delayed ejaculation may develop out of male hypoactive sexual desire disorder
Female Orgasmic Disorder
-Female orgasmic disorder: A dysfunction in which a woman persistently fails to reach orgasm, experiences orgasms of very low intensity, or has very delayed orgasms.
-24% of woman apparently have this problem-including more than 1/3 of postmenopausal women
-10% or more of woman have never had an O alone or during sex
-another 9% rarely have O's
-Female orgasmic disorder appears to be more common among single women than among women who are married or living with someone
-Most clinicians agree that orgasm during intercourse is not mandatory for normal sexual functioning
-early psychoanalytic theory considered a lack of orgasm during intercourse to be pathological, evidence suggests that women who rely on stimulation of the clitoris for orgasm are entirely normal and healthy
biological causes
-Diabetes can damage the nervous system in ways that interfere with arousal, lubrication of the vagina, and orgasm.
-Lack of orgasm has sometimes been linked to multiple sclerosis and other neurological diseases, to the same drugs and medications that may interfere with ejaculation in men, and to changes, often postmenopausal, in skin sensitivity and structure of the clitoris, vaginal walls, or the labia—the folds of skin on each side of the vagina
Psychological causes
-The psychological causes of female sexual interest/arousal disorder, including depression, may also lead to female orgasmic disorder
-memories of childhood traumas and relationships have sometimes been associated with orgasm problems.
Sociocultural causes-
-For years many clinicians have believed that female orgasmic problems may result from society's recurrent message to women that they should repress and deny their sexuality, a message that has often led to "less permissive" sexual attitudes and behavior among women than among men
-many women with both arousal and orgasmic difficulties report that they had an overly strict religious upbringing, were punished for childhood masturbation,
-Researchers suggest that unusually stressful events, traumas, or relationships may help produce the fears, memories, and attitudes that often characterize these sexual problems
-the likelihood of reaching orgasm may be tied to how much emotional involvement a woman had during her first experience of intercourse and how long that relationship lasted, the pleasure the woman obtained during the experience, her current attraction to her partner's body, and her marital happiness.
-Genito-pelvic pain/penetration disorder: A sexual dysfunction characterized by significant physical discomfort during intercourse.
-Some women with genito-pelvic pain/penetration disorder experience involuntary contractions of the muscles around the outer third of the vagina that prevent entry of the penis-known as vaginismus
-The problem has received relatively little research, but estimates are that it occurs in fewer than 1% of all women
-Most clinicians agree with the cognitive-behavioral position that this form of genito-pelvic pain penetration disorder is usually a learned fear response, set off by a woman's expectation that intercourse will be painful and damaging
--A variety of factors apparently can set the stage for this fear, including anxiety and ignorance about intercourse, exaggerated stories about how painful and bloody the first occasion of intercourse is for women, trauma caused by an unskilled lover who forces his penis into the vagina before the woman is aroused and lubricated, and the trauma of childhood sexual abuse or adult rape
-Other women with genito-pelvic pain/penetration disorder do not have involuntary contractions of their vaginal muscles, but they do experience severe vaginal or pelvic pain during sexual intercourse, a pattern known medically as dyspareunia
-Surveys suggest that as many as 14% of women suffer from this problem to some degree
-This form of genito-pelvic pain/penetration disorder usually has a physical cause
-among the most common is an injury (for example, to the vagina or pelvic ligaments) during childbirth. Although psychological factors (for instance, heightened anxiety or overattentiveness to one's body) or relationship problems may contribute to this problem
--psychosocial factors alone are rarely responsible for it
-Modern sex therapy is short-term and instructive, typically lasting 15 to 20 sessions.
-It centers on specific sexual problems rather than on broad personality issues
1.Assessment and conceptualization of the problem. Patients are initially given a medical examination and are interviewed concerning their "sex history." The therapist's focus during the interview is on gathering information about past life events and, in particular, current factors that are contributing to the dysfunction. Sometimes proper assessment requires a team of specialists, perhaps including a psychologist, urologist, and neurologist.
2.Mutual responsibility. Therapists stress the principle of mutual responsibility. Both partners in the relationship share the sexual problem, regardless of who has the actual dysfunction, and treatment will be more successful when both are in therapy
3.Education about sexuality. Many patients who suffer from sexual dysfunctions know very little about the physiology and techniques of sexual activity. Thus sex therapists may discuss these topics and offer educational materials, including instructional books, videos, and Internet sites.
4. Attitude change. Following a cardinal principle of cognitive therapy, sex therapists help patients examine and change any beliefs about sexuality that are preventing sexual arousal and pleasure (McCarthy & McCarthy, 2012; Hall, 2010). Some of these mistaken beliefs are widely shared in our society and can result from past traumatic events, family attitudes, or cultural ideas.
5.Elimination of performance anxiety and the spectator role. Therapists often teach couples sensate focus, or nondemand pleasuring, a series of sensual tasks, sometimes called "petting" exercises, in which the partners focus on the sexual pleasure that can be achieved by exploring and caressing each other's body at home, without demands to have intercourse or reach orgasm—demands that may be interfering with arousal. Couples are told at first to refrain from intercourse at home and to limit their sexual activity to kissing, hugging, and sensual massage of various parts of the body, but not of the breasts or genitals. Over time, they learn how to give and receive greater sexual pleasure and they build back up to the activity of sexual intercourse
6.Increasing sexual and general communication skills. Couples are taught to use their sensate-focus skills and apply new sexual techniques and positions at home. They may, for example, try sexual positions in which the person being caressed can guide the other's hands and control the speed, pressure, and location of sexual contact. Couples are also taught to give instructions to each other in a nonthreatening, informative manner ("It feels better over here, with a little less pressure"), rather than a threatening uninformative manner ("The way you're touching me doesn't turn me on"). Moreover, couples are often given broader training in how best to communicate with each other
7.Changing destructive lifestyles and marital interactions. A therapist may encourage a couple to change their lifestyle or take other steps to improve a situation that is having a destructive effect on their relationship—to distance themselves from interfering in-laws, for example, or to change a job that is too demanding. Similarly, if the couple's general relationship is marked by conflict, the therapist will try to help them improve it
8.Addressing physical and medical factors. When sexual dysfunctions are caused by a medical problem, such as disease, injury, medication, or substance misuse, therapists try to address that problem. If antidepressant medications are causing erectile disorder, for example, the clinician may suggest lowering the dosage of the medication, changing the time of day when the drug is taken, or turning to a different antidepressant.
Disorders of Desires
-Male hypoactive sexual desire disorder and female sexual interest/arousal disorder are among the most difficult dysfunctions to treat because of the many issues that may feed into them
-In a technique called affectual awareness, patients visualize sexual scenes in order to discover any feelings of anxiety, vulnerability, and other negative emotions they may have concerning sex
-In another technique, patients receive cognitive self-instruction training to help them change their negative reactions to sex.
-Therapists may also use behavioral approaches to help heighten a patient's sex drive.
-If the reduced sexual desire has resulted from sexual assault or childhood molestation, additional techniques may be needed
-biological interventions, such as hormone treatments, have been used, particularly for women whose problems arose after removal of their ovaries or later in life.
-In addition, several pharmaceutical drugs now are being developed specifically for the treatment of these disorders
Erectile Disorder
-Treatments for erectile disorder focus on reducing a man's performance anxiety, increasing his stimulation, or both, using a range of behavioral, cognitive, and relationship interventions
-n one technique, the couple may be instructed to try the tease technique during sensate-focus exercises: the partner keeps caressing the man, but if the man gets an erection, the partner stops caressing him until he loses it.
-In another technique, the couple may be instructed to use manual or oral sex to try to achieve the woman's orgasm, again reducing pressure on the man to perform
-Biological approaches gained great momentum with the development in 1998 of sildenafil
-This drug increases blood flow to the penis within one hour of ingestion; the increased blood flow enables the user to attain an erection during sexual activity.
-Soon after Viagra emerged, two other erectile dysfunction drugs also were approved—tadalafil (Cialis) and vardenafil (Levitra)
-They effectively restore erections in 75 percent of men who use them.
-A range of other medical procedures were developed for erectile disorder. These procedures are now viewed as "second-line" treatments that are applied primarily when the medications are unsuccessful or too risky for individuals
- Such procedures include gel suppositories, injections of drugs into the penis, and a vacuum erection device (VED), a hollow cylinder that is placed over the penis
Early Ejaculation
-Early ejaculation has been treated successfully for years by behavioral procedures
- In one such approach, the stop-start, or pause, procedure,
-According to clinical reports, after two or three months many couples can enjoy prolonged intercourse without any need for pauses
-Some clinicians treat early ejaculation with SSRIs, the serotonin-enhancing antidepressant drugs.
-The effect of this approach is consistent with the biological theory, mentioned earlier, that serotonin receptors in the brains of men with early ejaculation may function abnormally.
Delayed Ejaculation
-Therapies for delayed ejaculation include techniques to reduce performance anxiety and increase stimulation
-When delayed ejaculation is caused by physical factors such as neurological damage or injury, treatment may include a drug to increase arousal of the sympathetic nervous system
-However, few studies have systematically tested the effectiveness of such treatments
Female Orgasmic Disorder:
-Specific treatments for female orgasmic disorder include cognitive-behavioral techniques, self-exploration, enhancement of body awareness, and directed masturbation training
-Biological treatments, including hormone therapy or the use of sildenafil (Viagra), have also been tried, but research has not consistently found such interventions to be helpful
-Use of directed Masturbation training
--This training program appears to be highly effective: over 90% of female clients learn to have an orgasm during masturbation, about 80% during caressing by their partners, and about 30% during intercourse
Genito-Pelvic Pain/Penetration Disorder
-Specific treatment for involuntary contractions of the muscles around the vagina typically involves two approaches
-Some medical interventions have also been applied
-the most common cause of this problem is physical, such as pain-causing scars, lesions, or infection aftereffects.
-Medical interventions—from topical creams to surgery—may also be tried, but typically they must be combined with other sex therapy techniques to overcome the years of sexual anxiety and lack of arousal
- Many experts believe that, in most cases, both forms of genito-pelvic pain/penetration disorder are best assessed and treated by a team of professionals, including a gynecologist, physical therapist, and sex therapist or other mental health professional
-Paraphilias: Patterns in which individuals have recurrent and intense sexual urges, fantasies, or behaviors involving nonhuman objects, children, nonconsenting adults, or experiences of suffering or humiliation.
-The sexual focus may, for example, involve nonhuman objects, children, nonconsenting adults, or the experience of suffering or humiliation.
-The large Internet and consumer market in paraphilic pornography leads clinicians to suspect that paraphilias are, in fact, quite common
-People whose paraphilias involve children or nonconsenting adults often come to the attention of clinicians as a result of legal issues generated by their inappropriate actions
-Paraphilic disorder: A disorder in which an individual's paraphilia causes great distress, interferes with social or occupational activities, or places the individual or others at risk of harm—either currently or in the past.
--According to DSM-5, a diagnosis of paraphilic disorder should be applied when paraphilias cause individuals significant distress or impairment or when the satisfaction of the paraphilias places the individuals or other people at risk of harm—either currently or in the past
-Although theorists have proposed various explanations for paraphilic disorders, there is little formal evidence to support such explanations
-Moreover, none of the many treatments applied to these disorders have received much research or proved clearly effective
-Some practitioners administer drugs called antiandrogens that lower the production of testosterone, the male sex hormone, and reduce the sex drive
-Although antiandrogens may indeed reduce paraphilic patterns, several of them disrupt normal sexual feelings and behavior as well
-the drugs tend to be applied primarily when the paraphilic disorders are of particular danger either to the individuals themselves or to other people
-Clinicians are also increasingly administering SSRIs, the serotonin-enhancing antidepressant medications, to treat persons with paraphilic disorders, hoping that the drugs will reduce these compulsion-like sexual behaviors just as they help reduce other kinds of compulsions
-Fetishistic disorder: A paraphilic disorder consisting of recurrent and intense sexual urges, fantasies, or behaviors that involve the use of a nonliving object, often to the exclusion of all other stimuli.
-Key features of this disorder are recurrent intense sexual urges, sexually arousing fantasies, or behaviors that involve the use of nonliving objects or nongenital body parts, often to the exclusion of all other stimuli
- Usually the disorder, which is far more prevalent in men than in women, begins in adolescence.
-Almost anything can be a fetish;
-Researchers have not been able to pinpoint the causes of fetishistic disorder.
-Behaviorists propose that fetishes are acquired through classical conditioning
-Behaviorists have sometimes treated fetishistic disorder with aversion therapy
-In another aversion technique, people with fetishistic disorder are guided to imagine the pleasurable object and repeatedly to pair this image with an imagined aversive stimulus until the object of sexual pleasure is no longer desired.
-Masturbatory satiation: A behavioral treatment in which a client masturbates for a very long period of time while fantasizing in detail about a paraphilic object. The procedure is expected to produce a feeling of boredom that becomes linked to the object.
--The procedure is meant to produce a feeling of boredom, which in turn becomes linked to the fetishistic object.
-Orgasmic reorientation: A procedure for treating certain paraphilias by teaching clients to respond to new, more appropriate sources of sexual stimulation.
--People are shown conventional sexual stimuli while they are responding to unconventional objects
-Pedophilic disorder: A paraphilic disorder in which a person has repeated and intense sexual urges or fantasies about watching, touching, or engaging in sexual acts with prepubescent children and may carry out these urges or fantasies.
-Classic Type-Individuals with the disorder may be attracted to prepubescent children
Hebephilic Type- early pubescent children
-pedohebephilic type- both
-Some people with the disorder are attracted only to children; others are attracted to adults as well
-Both boys and girls can be pedophilic victims, but there is evidence suggesting that two-thirds of them are girls
-People with pedophilic disorder usually develop their pattern of sexual need during adolescence.
-Often these individuals are immature: their social and sexual skills may be underdeveloped, and thoughts of normal sexual relationships fill them with anxiety
-Some people with pedophilic disorder also exhibit distorted thinking, such as, "It's all right to have sex with children as long as they agree"
-Similarly, it is not uncommon for pedophiles to blame the children for adult-child sexual contacts or to assert that the children benefited from the experience
-While many people with this disorder believe that their feelings are indeed wrong and abnormal, others consider adult sexual activity with children to be acceptable and normal.
-Studies have found that most men with pedophilic disorder also display at least one additional psychological disorder
- Some theorists have proposed that the pedophilic disorder may be related to biochemical or brain structure abnormalities, but clear biological factors have yet to emerge in research
-Most pedophilic offenders are imprisoned or forced into treatment if they are caught
-Treatments for pedophilic disorder include those already mentioned for other paraphilic disorders, such as aversion therapy, masturbatory satiation, orgasmic reorientation, cognitive-behavioral therapy, and antiandrogen drugs
-One widely applied cognitive-behavioral treatment for this disorder, relapse-prevention training, is modeled after the relapse-prevention training programs used in the treatment of substance use disorders
-In this approach, clients identify the kinds of situations that typically trigger their pedophilic fantasies and actions (such as depressed mood or distorted thinking). They then learn strategies for avoiding those situations or coping with them more effectively. Relapse-prevention training has sometimes, but not consistently, been of help in this and certain other paraphilic disorders
-Sexual sadism disorder: A paraphilic disorder characterized by repeated and intense sexual urges, fantasies, or behaviors that involve inflicting suffering on others.
-This arousal may be expressed through fantasies, urges, or behaviors, including acts such as dominating, restraining, blindfolding, cutting, strangling, mutilating, or even killing the victim.
-Many carry out sadistic acts with a consenting partner, often a person with sexual masochism disorder.
-In all cases, the real or fantasized victim's suffering, humiliation, and/or violent injury are keys to arousal
-Fantasies of sexual sadism, like those of sexual masochism, may first appear in childhood or adolescence
-The pattern is long-term. Sadistic acts sometimes stay at the same level of cruelty, but often they become more and more severe over the years
-Some behaviorists believe that classical conditioning is at work in sexual sadism disorder
-Both psychodynamic and cognitive theorists suggest that people with sexual sadism disorder inflict pain in order to achieve a sense of power or control, necessitated perhaps by underlying feelings of sexual inadequacy.
-Alternatively, certain biological studies have found signs of possible brain and hormonal abnormalities in persons with sexual sadism disorder
-This disorder has been treated by aversion therapy.
-It is not clear that aversion therapy is truly helpful in cases of sexual sadism disorder. However, relapse-prevention training, used in some criminal cases, may be of value
-transgender experiences—a sense that their actual gender identity is different from the gender category to which they were born physically or a sense that it lies outside the usual male versus female categories
-Gender dysphoria: A disorder in which a person persistently feels extremely uncomfortable about his or her assigned sex and strongly wishes to be a member of the opposite sex. Also known as transsexualism.
-The DSM-5 categorization of gender dysphoria is controversial
--Many people believe that transgender experiences reflect alternative—not pathological—ways of experiencing one's gender identity.
--Moreover, they argue, even transgender experiences that bring unhappiness should not be considered a disorder.
-Moreover, they argue, even transgender experiences that bring unhappiness should not be considered a disorder.
-They hold that gender dysphoria should not be categorized as a psychological disorder, just as kidney disease and cancer, medical conditions that may also produce unhappiness, are not categorized as psychological disorders
-People with gender dysphoria typically would like to get rid of their primary and secondary sex characteristics—many of them find their own genitals repugnant—and acquire the characteristics of the other sex
-Men with this disorder outnumber women by around 2 to 1.
-The individuals experience anxiety or depression and may have thoughts of suicide
-Studies also suggest that some people with gender dysphoria further manifest a personality disorder
-Today the term gender dysphoria has replaced the old term transsexualism, although the label "transsexual" is still commonly applied to those individuals who desire and seek full gender change.
-Sometimes gender dysphoria emerges in children
-Wanting to be the other gender childhood pattern usually disappears by adolescence or adulthood, but in some cases it develops into adolescent and adult forms of gender dysphoria
-Surveys of mothers indicate that about 1.5% of young boys wish to be a girl, and 3.5% of young girls wish to be a boy
-yet considerably less than 1% of adults manifest gender dysphoria
1. Female- To- Male Gender Dysphoria:
-People with a female-to-male gender dysphoria pattern are born female but appear or behave in a stereotypically masculine manner from early on—often as young as 3 years of age or younger.
-However, lesbian relationships do not feel like a satisfactory solution to them because they want other women to be attracted to them as males, not as females.
2. Male to Female Dysphoria:
-People with an androphilic type of male-to-female gender dysphoria are born male but appear or behave in a stereotypically female manner from birth
-As children, they are viewed as effeminate, pretty, and gentle; avoid rough games; and hate to dress in boys' clothing. As adolescents, they become sexually attracted to males, and they often come out as gay and develop gay relationships
-But by adulthood, it becomes clear to them that such gay relationships do not truly address their gender dysphoric feelings because they want to be with heterosexual men who are attracted to them as women.
3. MALE-TO-FEMALE GENDER DYSPHORIA:
-People with an autogynephilic type of male-to-female gender dysphoria are not sexually attracted to males; rather, they are attracted to the fantasy of themselves being females
-Like males with the paraphilic disorder transvestic disorder (see page 350), persons with this form of gender dysphoria behave in a stereotypically masculine manner as children, start to enjoy dressing in female clothing during childhood, and, after puberty, become sexually aroused when they cross-dress.
-However, unlike individuals with transvestic disorder, these persons have fantasies of becoming female that become stronger and stronger during adulthood. Eventually they are consumed with the need to be female.
-In short, cross-dressing is characteristic of both men with transvestic disorder (the paraphilic disorder) and men with this type of male-to-female gender dysphoria
-But the former individuals cross-dress strictly to become sexually aroused, whereas the latter develop much deeper reasons for cross-dressing, reasons of gender identity.
-Many adults with gender dysphoria receive psychotherapy
- a large number of them further seek to address their concerns through biological interventions.
- many adults with this disorder change their sexual characteristics by means of hormone treatments
- Physicians prescribe the female sex hormone estrogen for male patients, causing breast development, loss of body and facial hair, and change in body fat distribution. Similar treatments with the male sex hormone testosterone are given to women with gender dysphoria.
-Hormone therapy and psychotherapy enable many persons with this disorder to lead a satisfactory existence in the gender role that they believe represents their true identity
-Sex-change surgery: A surgical procedure that changes a person's sex organs, features, and, in turn, sexual identity. Also known as sexual reassignment surgery.
-This surgery, which is preceded by one to two years of hormone therapy, involves, for men, partial removal of the penis and restructuring of its remaining parts into a clitoris and vagina. In addition, the men undergo face-changing plastic surgery. -For women, surgery may include bilateral mastectomy and hysterectomy
-Alternatively, doctors have developed a silicone prosthesis that can give patients the appearance of having male genitals. One review calculates that 1 of every 3,100 persons in the United States has had or will have sex-change surgery during their life time
-Clinicians have debated heatedly whether sexual reassignment surgery is an appropriate treatment for gender dysphoria
-Research into the outcomes of sexual reassignment surgery has yielded mixed findings
-On the one hand, in several studies, the majority of patients—both female and male—report satisfaction with the outcome of the surgery, improvements in self-satisfaction and interpersonal interactions, and improvements in sexual functioning
--95% of people report happiness after the surgery
-On the other hand, several studies have yielded less favorable findings. A long-term follow-up study in Sweden, for example, found that although sexually reassigned participants did show a reduction in gender dysphoria, they also had a higher rate of psychological disorders and of suicide attempts than the general population
--Individuals with serious pretreatment psychological disturbances (for example, a personality disorder) seem most likely to later regret the surgery .
--All of this argues for careful screening prior to surgical interventions and, of course, for continued research to better understand both the patterns themselves and the long-term impact of the surgical procedure.