PSYCHOSEXUAL DISORDERS
Abnormal sexual behaviour causes harm to other
people and causes an individual to experience
persistent or recurrent distress or important areas of
functioning.
When evaluating a given sexual behavior, the contest
is extremely important, as are customs and mores,
which change over time. Many attitudes and behaviors
related to sex have changed in recent decades.
The psychosexual disorders are:
A) Paraphilic Disorders
B) Sexual Dysfunctions
C) Gender Identity Disorders
PARAPHILIC DISORDERS
Paraphilias
“Para” meaning ‘faulty’ or ‘abnormal’, and “Philia”
meaning “attraction’’
Most apparent to clinicians will be the distinction
between paraphilias — defined as atypical sexual
practices — and paraphilic disorders, which include
distress or impairment in functioning.
Specific criteria for paraphilic disorders are not
changed except for the addition of specifiers for “in
remission” or “in a controlled environment” to indicate
course of illness; the latter specifier would be used, for
instance, in the case of someone with a pedophilic
disorder who no longer engages in sexual activity with
children because the individual is incarcerated.
Paraphilias are disorders in which an individual has
recurrent, intense sexually arousing fantasies, sexual
urges or behaviors involving: (1) non-human objects,
(2) children or other non-consenting persons, and (3)
suffering or humiliation of one’s self or partner.
Characteristics of Persons with Paraphilia
 usually lasts for 6 months
 always thinking to carry out their unusual
behavior
 overly obsessed that if the individual cannot get
to their desired object, they get stressed
 individual will lose sight of other goals and
concentrate of the fulfillment of their sexual
desires if worse
 causes intense personal distress or impairment
in social, work, and other areas of life
functioning
 except for sexual masochism, almost all cases
of paraphilia involve men
Examples of Paraphilias
Telephone Scatologia – making obscene phone calls,
such as describing one’s masturbatory activity,
threatening to rape the victim, or trying to find out the
victim’s sexual activities
Necrophilia – deriving sexual gratification from
viewing or having sexual contact with a corpse
Zoophilia – having sex with animals or having
recurrent fantasies of sex with animals
Coprophilia – deriving sexual pleasure from contact
with feces
Klismaphilia – deriving sexual pleasure from the use
of enemas
Urophilia – deriving sexual pleasure from contact with
urine
Autagonistophilia – having sex in front of others
Somnaphilia – having sex with a sleeping person
Stigmatophilia – deriving sexual pleasure from skin
piercing or a tattoo
Autonepiophilia – wearing diapers for sexual
pleasure
Keep in Mind!
Paraphilias are not fleeting whims or daydreams about
unusual sexual practices, but are conditions that last at
least 6 months.
Pedophilia
Pedophilia is where an adult (16 years above) has
uncontrollable sexual urges to sexually immature
children (13 below) that persists from months to even
years.
Forms of sexual acts against children include
kidnapping, sexual abuse, fondling, and penetration or
intercourse.
Types of Pedophilia
Situational Molesters – normal sexual development
and interest; but when stress calls for it, they
sometimes want to become sexual with a child
Preference Molesters – pedophillic behavior is
already ingrained in the individual’s lifestyle, clear
preference for children, especially boys, and will do
anything (even marry) to hide his behavior, and clearly
sees nothing wrong with his unusual behavior
Child Rapist – a violent child abuser whose behavior
is an expression of hostile sexual drives
Treatment for Pedophilia
There is no one best treatment for Pedophilia.
Clinicians aim the problem at the endocrine system
and usually use testosterone-reducing drugs to ease
sexual excitement among males.
Psychologists track the problem rooting from the
abuser’s childhood stage, early life experience, and
others.
Exhibitionism
The person has intense sexual urges and arousing
fantasies involving the exposure of genitals to a group
of stranger/s. He or she does not expect a sexual
reaction from the stranger but finds the shock or fear in
the onlooker to be arousing. He or she also has the
fantasy that the onlooker will be sexually aroused.
Treatment for Exhibitionism
Treatment is usually a multi-faceted approach ad
involves reliance on learning principles, like counter
conditioning or aversive conditioning.
Treatment aims to unlearn the connection between
sexual behavior and exhibitionist behavior.
Fetishism
Fetishism is where a person feels a strong recurrent
sexual attraction to a non-living object.
People with this are always preoccupied with the object
of desire, and they become dependent to it as an object
for sexual gratification. Objects include shoes, gloves,
underwear, stockings, swimsuits, etc.
Partialism is another variant of fetishism. People with
partialism are solely interested in the sexual
gratification from a specific body part. Examples are
feet, neck, underarms, back, etc.
Characteristics of Fetishism
 They do unusual actions to the desired object,
like sucking, smelling, fondling, rubbing, burning,
and cutting.
 They have no desires to intercourse with the
partner with the desired object. Rather, they
would masturbate to the desired object.
 It involves compulsive rituals that are beyond the
control of the individual, which can cause
distress and interpersonal problems.
Treatment for Fetishism
Aversion Therapy – where the individual is exposed
to a different sexual stimulus other than the desired
object
Orgasmic Reconditioning – behavioral method
geared toward a relearning process. In this procedure,
an individual is instructed to arouse himself with a
fantasy of the unacceptable object, then masturbate
while looking at an appropriate sexual stimulus, such
as a picture of an adult partner. If his arousal
decreases, he may return to the fantasy of the
unacceptable object, but he is to attain orgasm only
while focusing on the acceptable stimulus.
Frotteurism
‘Frotter’ meaning ‘to rub’
Frotteurism refers to the masturbation that involves
rubbing against another person.
Frotteur has recurrent sexual desires on rubbing into
people.
Targets of Frotteurs are not consenting people. Rather,
they target strangers.
Characteristics of a Frotteur
 obsessed with the rubbing of selves to
unsuspecting strangers, finding it sexually
pleasurable
 often acts quickly or undetected
 fantasizes that they are in an intimate
relationship with the stranger
Treatment for Frotteurism
Treatment includes extinction and covert conditioning.
Sexual Masochism
Sexual Masochism. This comes from the name of an
Austrian Writer Leopold Baron von Sacher-Masoch,
who is known for his novels about men being sexually
humiliated by women. A masochist is someone who
seeks pleasure from being subjected to pain.
Sexual masochism is a disorder marked by an
attraction to achieving sexual gratification by having
painful stimulation applied to one’s own body, either
alone or with a partner. Men and women with this
disorder achieve sexual satisfaction by such means
like binding, ropes, whips, or injuries.
 Characteristics of Sexual Masochism
Masochists have the urge and desire and recurrent
sexual fantasies of receiving pain and submissive to
punishments.
Sexual Sadism
Sexual Sadism. The term sadism comes from the
name of French author Marquis de Sade, who wrote
extensively about obtaining sexual enjoyment from
inflicting cruelty.
The converse of sexual masochism. It involves deriving
sexual gratification from activities that harm, or from
urges to harm, another person. Seeing or imagining
another’s pain excites the sadist. In contrast to sexual
masochism, which does not require a partner, sexual
sadism clearly requires a partner to enact sadistic
fantasies.
Characteristics of Sexual Sadism
Sadists have the urge and desire and recurrent sexual
fantasies of inflicting pain, seeing physical pain and
humiliation of another person.
Changes from DSM IV – TR to DSM V
Name Change from Paraphilia to Paraphilic Disorder
The term paraphilia was first introduced into DSM-III to
replace the DSM-II term sexual deviation “because it
correctly emphasizes that the deviation (para-) lies in
that to which the person is attracted (philia)” (Ref. 8, p
267). Although paraphilia has been used to refer to
disorders of atypical sexual arousal up through DSM-
IV-TR, no term was available in DSM-IV-TR to indicate
nonpathological, atypical sexual interests.
In contrast, DSM-5 redefines the term paraphilia so
that it now refers to a persistent, intense, atypical
sexual arousal pattern, independent of whether it
causes any distress or impairment, which, by itself,
would not be considered disordered.
DSM-5 instead uses the term paraphilic disorder to
refer to the disorder-worthy entities included in The
Manual, which are defined as persistent and intense
atypical sexual arousal patterns that are accompanied
by clinically significant distress or impairment.
Concomitant with this name change, DSM-5 also
introduces the novel distinction between ascertaining a
paraphilia and diagnosing a paraphilic disorder.
According to DSM-5, “the term diagnosis should be
reserved for individuals who meet both Criterion A and
Criterion B (i.e., individuals who have a paraphilic
disorder)” (Ref. 1, p 686). Examples of the difference
between ascertaining a paraphilia and diagnosing a
paraphilic disorder are provided throughout the text.
Proposals
One of its proposals is to add two new disorders (i.e.,
paraphilic coercive disorder and hypersexual disorder)
and to broaden the pedophilic disorder diagnosis to
include attraction to pubescent as well as
prepubescent children.
Other controversial proposals involved making
significant changes to the criteria sets, including
operationalizing the harm component by having it
depend on the number of victims and including the use
of child pornography. Ultimately, the proposals for
adding paraphilic coercive disorder and hypersexual
disorder and for expanding pedophilia to include
hebephilia were rejected. Moreover, most of the other
proposed criteria set changes were not implemented,
so that the final criteria sets closely resemble their
DSM-IV-TR counterparts.
OTHER SEXUAL DISORDERS
Transvestic Fetishism
Transvestic fetishism, or cross-dressing, is a
disorder in which a man has an uncontrollable urge to
wear a woman’s clothing, as primary means of
achieving sexual gratification. This sexual gratification
has a compulsive quality, and consumes a lot of
emotional energy.
Characteristics of Transvestic Fetishism
 over a period of at least 6 months, in a
heterosexual male, recurrent, intense sexually
arousing fantasies, sexual urges, or behaviors
involving cross-dressing
 fantasies, sexual urges, or behaviors cause
clinically significant distress or impairment in
social, occupational, or other important areas of
functioning
 specify if with gender dysphoria: if the person
has persistent discomfort with gender role or
identity
 Causes of Transvestic Fetishism
 adolescent curiosity
 a young boy dresses up in the clothes of an older
sister or his mother
 boy's mother may initiate the cross-dressing
Symptoms of Transvestic Fetishism
 touching or wearing items of clothing that are
considered typically feminine
 wearing undergarments or other items that can
be hidden from the view of others while providing
arousal to the wearer
Diagnosis for Transvestic Fetishism
The patient has been markedly distressed by inability
to dress in such a manner or if the disorder is interfering
with his education, occupation, or social life.
Treatment for Transvestic Fetishism
 behavioral therapy
o aversion therapy
o orgasmic reorientation
Changes in DSM V for Transvestic Fetishism
Transvestic disorder no longer specifies “in a
heterosexual male”.
Specify if:
 with Fetishism (sexually aroused by fabrics,
materials, or garments)
 with Autogynephilia (sexually aroused by
thought or image of self as female)
Voyeurism
‘Voir’, meaning “to see”
Voyeurism is a sexual disorder where an individual
compulsively seeks sexual gratification from observing
nudity or sexual activity of others who are unaware that
they are being watched.
This disorder is more common in men.
The term “Peeping Tom” usually refers to voyeur.
Characteristics of Voyeurism
 over a period of at least 6 months, recurrent,
intense sexually arousing fantasies, sexual
urges, or behaviors involving the act of
observing an unsuspecting person who is
naked, in the process of disrobing, or engaging
in sexual activity
 person has acted on these urges, or the sexual
urges or fantasies cause marked distress or
interpersonal difficulty
 voyeurs often get sexually frustrated and feels
incapable of establishing a regular sexual
relationship with the person he observes --- he
prefers to masturbate either during or after the
voyeuristic activity
 exhibiting stress and is being impaired by these
attractions and has sought sexual gratification
from observing at least three or more
unsuspecting targets on separate occasions
when they were naked, disrobing or engaging in
a sexual activity of any kind
Treatment for Voyeurism
 psychotherapy, marital therapy, group therapy,
family therapy, cognitive therapy,
psychoanalysis, and pharmacotherapy
 SSRIs are used to alter the balance of this
dysfunctional serotonergic system
Changes in DSM V for Voyeurism
Voyeuristic Disorder
 nonconsenting person, or distress/impairment
 >18
 specifier: controlled environment or in remission
SEXUAL DYSFUNCTIONS
Sexual dysfunction refers to an abnormality in an
individual’s sexual responsiveness and reactions.
DSM-IV-TR Diagnostic Criteria for
Sexual Dysfunctions
Sexual Desire Disorders
Hypoactive Sexual Desire Disorder – persistently or
recurrently deficient (or absent) sexual fantasies and
desire for sexual activity
Sexual Aversion Disorder – persistent or recurrent
extreme aversion to, and avoidance of, all (or almost
all) genital sexual contact with a sexual partner
Sexual Arousal Disorders
Female Sexual Arousal Disorder – persistent or
recurrent inability to attain, or to maintain until
completion of the sexual activity, an adequate
lubrication swelling response of sexual excitement
Male Erectile Disorder – persistent or recurrent
inability to attain, or to maintain until completion of the
sexual activity, an adequate erection
 Orgasmic Disorders DSM 5 Sexual Dysfunctions

Female Orgasmic Disorder – peristent or recurrent Female

delay in, or absence of, orgasm following a normal
sexual excitement phase; women exhibit wide  sexual interest or arousal disorder
variability in the type or intensity of stimulation that  genitopelvic pain or penetration disorder
triggers orgasm  female orgasmic disorder

Male Orgasmic Disorder – persistent or recurrent Male

delay in, or absence of, orgasm following a normal  male hypoactive sexual desire disorder
sexual excitement phase during sexual activity that the
 delayed ejaculation
clinician, taking into account the person’s age, judges
 erectile disorder
to be adequate in focus, intensity, and duration
 premature ejaculation
Premature Ejaculation – persistent or recurrent
ejaculation with minimal sexual stimulation before, on, DSM 5 Diagnostic Criteria for Sexual Dysfunctions
or shortly after penetration and before the person
wishes it; clinician must take into account factors that  required minimum duration of approximately 6
affect duration of the excitement phase, such as age, months
novelty of the sexual partner or situation, and recent  a frequency of 75% – 100%
frequency of sexual activity  the disorder must be deemed to have
caused significant distress
Sexual Pain Disorders
GENDER IDENTITY DISORDERS
Dyspareunia – recurrent or persistent genital pain
associated with sexual intercourse in either a male or Gender Dysphoria
a female
Gender dysphoria is the condition of feeling one's
Vaginismus – recurrent or persistent involuntary
emotional and psychological identity as male or female
spasm of the musculature of the outer third of the
to be opposite to one's biological sex.
vagina that interferes with sexual intercourse
In Children and Young People
Diagnostic Criteria for Sexual Dysfunctions
In children, the disturbance is manifested by six (or
 The disturbance causes marked distress or
more) of the following for at least a 6-month duration:
interpersonal difficulty.
 The sexual dysfunction is not better accounted  repeatedly stated desire to be, or insistence that
for by another Axis I disorder (except another he or she is, the other sex
Sexual Dysfunction) and is not due exclusively  in boys, preference for cross-dressing or
to the direct physiological effects of a substance simulating female attire; in girls, insistence on
(e.g., a drug of abuse, a medication) or a general wearing only stereotypical masculine clothing
medical condition.  strong and persistent preferences for cross-sex
roles in make-believe play or persistent
Causes of Sexual Dysfunctions fantasies of being the other sex
 a strong rejection of typical toys or games
typically played by one’s sex
 intense desire to participate in the stereotypical
games and pastimes of the other sex
 strong preference for playmates of the other sex
 a strong dislike of one’s sexual anatomy
 a strong desire for the primary (e.g., penis,
vagina) or secondary (e.g., menstruation) sex
characteristics of the other gender

Treatment for Sexual Dysfunctions Treatments include:

 family therapy
 Intensive Therapy
 individual child psychotherapy
 Cognitive Therapy Approach
 parental support or counselling
 Cognitive Behavior Therapy Approach
  group work for young people and their parents
 regular reviews to monitor gender identity
development
 hormone therapy

In Adults

In adolescents and adults, the disturbance is

manifested by symptoms such as:

 a stated desire to be the other sex

 frequent passing as the other sex
 desire to live or be treated as the other sex
 the conviction that he or she has the typical
feelings and reactions of the other sex
The disturbance is not concurrent with a physical
intersex condition, and causes clinically significant
distress or impairment in social, occupational, or other
important areas of functioning.
Treatments include:

 mental health support, such as counselling

 cross-sex hormone treatment
 speech and language therapy – to help alter your
voice, to sound more typical of your gender
identity
 hair removal treatments, particularly facial hair
 peer support groups – to meet other people with
gender dysphoria
 relatives' support groups, for your family

Specifiers for Gender Dysphoria

Post-transition, i.e., the individual has transitioned to

full-time living in the desired gender (with or without
legalization of gender change) has undergone (or is
undergoing) at least one cross-sex medical procedure
or treatment regimen, namely, regular cross-sex
hormone treatment or gender reassignment surgery
confirming the desired gender.