a.
Define the major DSM IV-TR categories of sexual and
gender identity, eating, and personality disorders.
b.
Examine the various classifications of sexual and
gender identity, eating, and personality disorders.
c.
Summary
of the biological, emotional, cognitive, and behavioral components of sexual
and gender identity, eating, and personality disorders.
d.
Thesis
statement.
II. ` Sexual and Gender Identity Disorders
a.
Sexual Dysfunctions
i.
Sexual Desire Disorders
1.
Hypoactive sexual desire disorder
(302.71)
a.
Deficient or absent sexual desire.
2.
Sexual aversion disorder (302.79)
a.
Extreme avoidance of genital contact with
partner.
ii.
Sexual Arousal Disorders
1.
Female sexual arousal disorder (302.72)
a.
Trouble producing or maintaining
sufficient lubrication and swelling response to sexual arousal.
2.
Male erectile disorder (302.72)
a.
Inability to produce or maintain an
adequate erection.
b.
Frequently associated with sexual
anxiety, performance anxiety, and decreased excitement and pleasure.
iii.
Orgasmic Disorders
1.
Female orgasmic disorder (302.73)
a.
Delay or absence of orgasm with adequate
sexual stimulation.
2.
Male orgasmic disorder (302.74)
a.
Delay or absence of orgasm with normal
level of sexual excitement during sexual activity.
3.
Premature ejaculation (302.75)
a.
Reoccurring ejaculation with little
stimulation, and before the man desires or orgasm.
iv.
Sexual Pain Disorders
1.
Vaginismus (305.51)
a.
Involuntary spasms of the muscle located
at the outer third part of the vagina, which interferes with intercourse.
2.
Dyspareunia
v.
Sexual dysfunction due to general medical
condition
1.
Sexual dysfunction with evidence that the
dysfunction is due to the psychological effects of a general medical
condition.
vi.
Substance-induced sexual dysfunction
1.
Sexual dysfunction that occurs during substance
intoxication, or within a month of intoxication.
2.
Substance is related to the disorder.
3.
Specifiers
a.
With impaired desire
b.
With impaired arousal
c.
With impaired orgasm
d.
With sexual pain
e.
With onset during intoxication
vii.
Sexual dysfunction not otherwise specified
(302.70)
1.
A sexual dysfunction is present with the
inability to categorize it as primary, due to a medical condition, or substance
induced.
b.
Paraphilias
i.
Diagnostic Criteria for the Paraphilias
1.
Exhibitionism (302.4)
a.
Recurrent sexual urges, fantasies, or
behaviors associated with exposing one’s genital to a stranger.
2.
Voyeurism (302.82)
a.
Recurrent sexual urges, fantasies, or
behaviors associated with watching an unsuspecting person get undressed, while
naked, or during sexual activities.
b.
Had acted on these urges, distress, or
interpersonal difficulties.
3.
Fetishism (302.81)
a.
Recurrent sexual urges, fantasies, or
behaviors associated with nonliving objects.
b.
Causes distress and effects important
areas of functioning.
4.
Sexual sadism (302.84)
a.
Recurrent sexual urges, fantasies, or
behaviors associated with causing another person to psychologically or
physically suffer, which causes sexual arousal to the individual with sexual
sadism.
b.
Acted on these urges, or cause distress
and difficulties with interpersonal relationships.
5.
Sexual masochism (302.83)
a.
Recurrent sexual urges, fantasies, or
behaviors associated with being humiliated, bound, beaten, and made to suffer.
b.
Causes distress or impairment of
important everyday functioning.
6.
Pedophilia (302.2)
a.
Recurrent sexual urges, fantasies, or
behaviors associated with children who are prepubescent, usually 13 years and
younger.
b.
Offender is at least 16 and is 5 years
older than victim.
c.
Specify type
i.
Exclusive type
1.
Attracted to only children
ii.
Nonexclusive type
1.
Attracted to adults as well
7.
Frotteurism (302.89)
a.
Recurrent sexual urges, fantasies, or
behaviors associated with rubbing or touching a nonconsenting person.
b.
Cause distress and difficulty with
interpersonal relationships.
8.
Transvestic fetishism (302.3)
a.
A heterosexual male who has recurrent
sexual urges, fantasies, or behaviors associated with cross-dressing.
b.
Cause distress or impairment of important
everyday functioning.
c.
Specify with gender dysphoria
i.
Persistent discomfort with gender identity
or gender role (American
Psychiatric Association, 2002).
9.
Paraphilia not otherwise specified
(302.9)
ii.
Cognitive-Behavioral Components
1.
A physical reaction in response to an
inappropriate stimulus (Hansell & Damour, 2008).
2.
Classical conditioning
a.
A neutral stimuli is paired accidentally
or automatically associated with an emotional reflex, the two become strongly
connected to one another.
3.
Social learning
a.
Through the observation of others
children can develop a tendency toward inappropriate sexual behavior.
b.
A child could witness a sexually abusive
relationship or be encouraged or rewarded for sexual behavior.
iii.
Biological components
1.
Illness or injury can contribute to
inappropriate sexual behavior, such as brain tumors, brain injury, temporal lobe
epilepsy, or degenerative diseases.
2.
Studies show that women with mental
retardation and a history of physical and sexual abuse have a higher prevalence
for sexual offenses.
c.
Gender Identity Disorder (GID)
i.
Strong/persisting identification with cross-gender
(more than a desire).
1.
Strong desire to be the opposite sex.
2.
Insisting that he or she is of the
opposite sex.
ii.
Code based on current age:
1.
302.6 Gender identity in children
2.
302.85 Gender identity in adolescents or
adults.
iii.
Specify if:
1.
Sexually attracted to Males
2.
Sexually attracted to Females
3.
Sexually attracted to Both
4.
Sexually attracted to Neither
iv.
Prevalence
1.
No data shown for United States
2.
European statistics show 1 in 30,000
males and 1 in 100,000 females seek/desire sex-reassignment surgery.
v.
Gender identity disorder not otherwise
specified
1.
Concurrent congenital intersex condition
2.
Preoccupation with desire to have
characteristics of the opposite sex.
vi.
Biological Components
1.
Temperament
2.
Congenital virilizing adrenal hyperplasia
(CVAH or CAH)
3.
Androgen insensitivity syndrome
4.
Studies show that transsexual men have an
area in the hypothalamus that is close to the same size of a woman’s.
vii.
Behavioral Components
1.
Could be learned through operant
conditioning.
2.
Parental wishes (conscious and
unconscious).
3.
Social reinforcement.
d.
Sexual Disorder not otherwise specified
(302.9)
i.
Feeling inadequate at sexual performances
or masculinity/femininity.
ii.
Distress associated with sexual
orientation.
iii.
Distress about previous partners who are
seen by the individual as objects to be used.
III.
Eating Disorders
a.
Anorexia Nervosa
i.
Translates to “not eating because of
nervous causes” (Meyers,
Chapman, & Weaver, 2009).
ii.
Patient is underweight with an extreme
fear of becoming fat.
iii.
Refusal to maintain normal weight.
iv.
Disturbed self-evaluation or denial
v.
Disturbed menstrual cycle.
vi.
Subtypes
1.
Restricted type: does not binge eat or
purge food.
2.
Binge-eating/purge type: Engages in
binge-eating or purging food.
vii.
Physical signs of starvation and
emaciation, with possible dryness of skin, hypothermia, and hypotension.
viii.
Specific culture, age, and gender
features.
1.
More prevalent in industrialized
cultures, such as the United States, Australia, Canada, Japan, Europe, South
Africa, and New Zealand.
a.
Especially among women when
attractiveness is associated with being skinny.
2.
More than 90% of diagnoses are in
females.
ix.
Prevalence
1.
Lifetime prevalence for females is about
0.5%
2.
Only 10% of diagnoses are in males.
3.
Prevalence has recently increased.
x.
Course
1.
Usually develops in adolescence (usually
age 14-18).
2.
Onset could be associated with stressful
events.
3.
Recovery varies; a person could recover
after one episode, or he or she could go on to have bulimia nervosa.
4.
Over 10% of admittances to hospitals for anorexia
nervosa have long-term mortality.
5.
Death results from electrolyte imbalance,
starvation, and suicide.
xi.
Familial Pattern
1.
Increased prevalence in first-degree
biological relatives.
2.
Mood disorders are also increased in
first-degree biological relatives.
b.
Bulimia Nervosa (307.51)
i.
Reoccurring episodes of binge eating.
1.
Eating a large amount of food in a short
period of time.
2.
Feelings of lack of control associated
with eating during episodes.
ii.
Reoccurring episodes of inappropriately
compensating to prevent gaining weight.
1.
Self-induced vomiting
2.
Misuse of enemas, diuretics, laxatives,
and other medications.
3.
Fasting
4.
Excessive exercising.
iii.
Occurs twice a week for 3 months.
iv.
Disturbed self-evaluation
v.
Subtypes
1.
Purging type
a.
During current episode person is misusing
laxatives, enemas, or diuretics, or has self-induced vomited.
2.
Nonpurging type
a.
During current episode the person has
used other means of compensatory behavior, such as excessive excise or fasting,
but has not purged.
vi.
Specific culture, age, and gender
features
1.
Similar frequencies in industrialized
countries, which include the US, Japan, South Africa, Europe, New Zealand, and
Canada.
2.
Primarily white.
3.
90% are female.
vii.
Prevalence
1.
Lifetime prevalence in women: 1% - 3%
2.
Occurrence in men: one-tenth of that in
females.
viii.
Course
1.
Onset is usually in adolescence or early
adulthood.
2.
Usually follows dieting.
3.
Usually follows disturbed eating
behaviors.
4.
Short term outcome varies.
5.
Most individuals end up going into
remission.
c.
Eating disorder not otherwise specified
(307.50)
i.
Eating disorders that do not meet the
full criteria for Anorexia nervosa or bulimia nervosa.
d.
Cognitive-Behavioral Components
i.
Enmeshing
ii.
Physical shape = value and self-worth
iii.
“Black and White” thinking associated with
food and weight.
iv.
Creating rigid rules.
v.
Cognitive thoughts influence behavior
1.
Example: extreme fear of becoming fat
leads to binge eating and purging, which leads to relief.
e.
Biological Components
i.
Genetic factors
ii.
Hormonal and neurotransmitter abnormalities
iii.
Structural brain abnormalities
IV.
Personality Disorders
a.
Cluster A
i.
Paranoid Personality Disorder (302.0)
1.
Suspiciousness and distrust.
2.
Believes others are harming, deceiving,
or exploiting him or her.
3.
A result of childhood experiences and
parental influence
4.
Projection of their own feelings and
cognition onto others.
5.
Prevalence
a.
0.5% - 2.5% in general population
b.
10% - 30% of inpatient psychiatric
facilities
c.
2% - 10% of outpatient mental health
clinics
ii.
Schizoid Personality Disorder (301.20)
1.
Socially detached and restricted
expression of emotion.
2.
Withdrawal from relationships in order to
avoid pain.
3.
Intellectualize; Emotions are thought
about (cognitive), not felt.
4.
Results from a combination of a troubled
relationship with parents and a “difficult” temperament.
5.
Prevalence: uncommon
6.
Increased prevalence in family members
with schizophrenia and schizoid personality disorder.
iii.
Schizotypal Personality Disorder (301.22)
1.
“A pattern of eccentricities of behavior,
cognitive or perceptual distortions, and acute discomfort in close
relationships” (Hansell & Damour, 2008, p. 411).
2.
Impaired
reasoning skills.
3.
Ideas
of reference; believing that outside events have special meaning to him or her.
4.
Magical
thinking; believing that his or her thoughts impact the outside world.
5.
Brain
patterns show similar to schizophrenia, but less severe.
6.
Both
genetic and cognitive.
7.
“People
with schizotypal personality disorder make strange connections among disparate
phenomena, have highly idiosyncratic views of causal relationships (such as Martin’s
belief that the color of one’s clothes can alter another person’s mood), and
can become easily lost in the back alleys of their own cognitive processes (as
cited in Hansell & Damour, 2008, p. 420).
8.
Prevalence:
3% of the general population, and more common among family members with
schizophrenia.
9.
Course: SPD is relatively stable, with minimal
amounts of individuals that go on to develop schizophrenia or other psychotic
disorders.
b.
Cluster B
i.
Antisocial Personality Disorder (301.7)
1.
Lack of concern for others; violation of
others.
2.
Partially genetic; mostly learned
behavior.
3.
Projecting his or her emotionally
traumatic and physically abusive past onto others.
4.
Making others feel as he or she has in
the past, such as helpless, victimized, and powerless.
5.
Inability to realistically associate
actions with consequences.
6.
Anxiety deficiency; opposite end of the
anxiety continuum as those with high anxiety/anxiety disorders.
7.
Specific culture, age, and gender
features
a.
More common among low socioeconomic individuals.
b.
More common in males.
8.
Prevalence
a.
Samples show 3% in males and 1% in
females.
b.
Higher prevalence associated with
substance abuse, forensic, and prison settings.
9.
Course
a.
Likely to decrease with age.
ii.
Borderline Personality Disorder (301.83)
1.
Self-destructive behavior; unstable
emotions, relationships, and self-image.
2.
Self-mutilation and manipulation of
others through threats of suicide.
3.
Fear of abandonment.
4.
Results from extremely unreliable and
abusive parents or caregivers. The
severity of the circumstances correlates with the severity of the
disorder.
5.
Splitting; defense mechanism in which he
or she categorized oneself and others as being good or bad in order to avoid
conflicting feelings and ambivalence.
6.
Low levels of serotonin.
7.
Specific culture, age, and gender
features.
a.
75% of diagnosed individuals are female.
8.
Prevalence
a.
2% among general populations
b.
10% in outpatient mental health clinics
c.
20% in inpatient psychiatric facilities
d.
30% - 60% in patients with personality
disorders.
9.
Course
a.
10 years after outpatient care, over half
of patients have shown to not fit the full criteria for BPD.
10. Family pattern
a.
Five-times more likely among immediate
family members than the general public.
iii.
Histrionic Personality Disorder (301.50)
1.
Seeking attention, manipulation of
others, and emotionally superficial.
2.
Results from detached, superficial, and
uncompassionate parents.
3.
Repression; defense mechanism use to
forget painful memories, which influences personality traits causing him or her
to be shallow, superficial, and naïve.
4.
Attention and approval seeking, which
causes him or her to be self-dramatizing.
5.
Prevalence
a.
2%-3% of the general population
b.
10% - 15% of inpatient and outpatient
mental health facilities.
iv.
Narcissistic Personality Disorder
(301.81)
1.
Lack of empathy, grandiosity, jealousy,
and seeking admiration.
2.
Idealization; viewing oneself as being
perfect to protect him or herself from negative feelings.
3.
Devaluation; seeing others as being
less-than to protect him or herself from a negative self-view.
4.
Results from overly indulgent and
accommodating parents.
5.
Specific age and gender features
a.
50% - 75% are males.
b.
Physical and occupational limitations
increase with age.
6.
Prevalence
a.
Less that 1% of general population
b.
2% - 16% of clinical population
c.
Cluster C
i.
Avoidant Personality Disorder (301.82)
1.
“A
pattern of social inhibition, feelings of inadequacy, and hypersensitivity to
negative evaluation” (Hansell & Damour, 2008, p. 411).
2.
Results
from extreme shame during childhood and a shy temperament.
3.
Escape
into fantasy; daydreaming to avoid negative feelings.
4.
Specific
culture, age, and gender features
a.
Immigration
influences avoidant behavior.
b.
Equally
prevalent in men and women.
5.
Prevalence
a.
0.5%
- 1% of general population
b.
10%
of outpatient mental health population
6.
Course
a.
Becomes
less evident or goes into remission with age.
ii.
Dependent Personality Disorder (301.6)
1.
Clingy and submissive behavior; need for
others to care for them.
2.
Regression; defense mechanisms used to
avoid anxiety that comes along with development and independence by returning
to childlike behaviors.
3.
Theoretically caused by parents who
promoted clingy and needy behavior by undermining his or her child’s
assertiveness and independence.
4.
Reaction formation; defense mechanism
where undesired emotions or impulses are turned into the opposite.
5.
Undoing; defense mechanism is which one
thought or action is used to cancel the other.
6.
Isolation of affect; defense mechanism in
which a person thinks without having feelings associated.
7.
Specific culture, age, and gender
features
a.
Appropriateness of behavior varies in
cultures.
b.
More prevalent in females, although some
studies show equal prevalence among males and females.
8.
Prevalence
a.
One of the most frequently encountered
personality disorders.
iii.
Obsessive-Compulsive Personality Disorder
(301.4)
1.
Orderliness, control, and perfectionism
at the expense of enjoyment, spontaneity, and flexibility.
2.
Extreme attention to detail; missing the
larger picture.
3.
Resulting from fixation of the anal
phase; punitive, controlling, and anxious parents associated with messes.
4.
Prevalence
a.
Twice as likely among males.
b.
1% of general population
c.
3% - 10% of mental health patients.
V.
Conclusion
a.
Thesis statement.
b.
Summarize
i.
Sexual
and gender identity disorders
ii.
Eating
disorders
iii.
Personality
disorders.
References
American
Psychiatric Association. (2002). DSM-IV-TR. Retrieved from American Psychiatric
Association, PSY410 - Abnormal Psychology website.
Hansell,
J., & Damour, L. (2008). Abnormal
psychology (2nd ed.). Hoboken, NJ: Wiley.
Meyer,
R., Chapman, L. K., & Weaver, C. M. (2009). Case studies in abnormal behavior. (8th ed.). Boston, MA:
Pearson/Allyn & Bacon.
