Lesson 1: Clinical Disorders – Part E
| Site: | MoodleHUB.ca 🍁 |
| Course: | Abnormal Psychology 35 RVS |
| Book: | Lesson 1: Clinical Disorders – Part E |
| Printed by: | Guest user |
| Date: | Thursday, 30 October 2025, 1:14 AM |
Table of contents
- Section/Lesson Objectives
- Introduction
- 1 - Sexual Disorders and Gender Dysphoria
- 2 - What Is Sexual Orientation?
- 3 - What Causes a Person to have a Particular Sexual Orientation?
- 4 - Is Sexual Orientation a Choice?
- 5 - Is Homosexuality a Mental Illness or Emotional Problem?
- 6 - Can Therapy Change Sexual Orientation?
- 7 - Why is the “Coming Out” Process Difficult for some Gay, Lesbian, and Bisexual People?
- 8 - Gender Dysphoria
- 9 - Gender Dysphoria - Case Study 15
- Lesson Review
Section/Lesson Objectives
The student will ...
• Understand and describe the general symptoms of the clinical disorders discussed in the course [This lesson]
• Discuss the possible causes of clinical disorders [This lesson]
• Understand and describe the general symptoms of the cognitive disorders discussed in the course
• Discuss the possible causes of cognitive disorders
• Understand and describe the general symptoms of mental retardation
• Discuss the possible causes of mental retardation
• Understand and describe the general symptoms of the personality disorders discussed in the course
• Discuss the possible causes of personality disorders
Introduction
Sexual Disorders and Gender Dysphoria
Sexual disorders can be categorized into paraphilias and sexual dysfunctions. In paraphilias, sexual arousal occurs predominantly because of an inappropriate desire for objects, individuals, situations, or sensations. This desire is considered abnormal when it affects individuals negatively. For example, if a person is sexually aroused by wearing neon green socks (a type of fetish) and is not troubled by it, then he or she would not have a sexual disorder. If the person is disturbed by the behaviour, however, he or she would have a sexual disorder. Also, if another person is harmed by the behaviour, the behaviour would be considered disordered and, in some situations, illegal (e.g., pedophilia, voyeurism, exhibitionism). Criminal laws exist to protect the victims of such behaviours.
PART E
Sexual Disorders and Gender Identity Disorders
Paraphilias include the following:
| • voyeurism – receiving gratification by watching others without their knowledge • fetishism – sexual desire for objects such as leather, feathers, lace • transvestic fetishism – sexual obsession for women’s clothes (cross-dressing in men) • sexual sadism – experiencing orgasm through inflicting pain • sexual masochism – experiencing orgasm through receiving pain or humiliation • exhibitionism – intense sexual arousal from exposing genitals in a public setting • pedophilia – powerful desire for sexual contact with children (prepubescent individuals) • others – (e.g., frotteurism, coprophilia, necrophilia) |
More detailed information regarding the paraphilias is beyond the scope of this course. You may obtain information from your nearest library or the Internet.
The second category of sexual disorders is sexual dysfunctions. People with sexual dysfunctions have difficulty performing adequately when having sex. They can experience problems with either desire or arousal. From male erectile disorder (inability to achieve or maintain an erection) and female sexual arousal disorder (inability to achieve or maintain sufficient lubrication) to inhibited orgasm and dyspareunia (persistent or frequent pain before, during, or after intercourse), the range of problems is wide. For the purposes of this course, orgasm is defined as an intense pleasurable sensation resulting from sexual arousal. Orgasm is usually accompanied by the ejaculation of semen in the male and by vaginal contractions in the female.
Sexual dysfunctions can result from psychological factors, physical and/or biological factors, and/or the interaction of psychological factors with physical and/or biological factors. A few examples are listed in Table 11.1.
Table 1.1:
Factors Linked to Sexual Dysfunction
|
Psychological Factors
|
Physical/Biological
Factors |
| - fear of inadequacy - fear of pregnancy - depression - sexual trauma - fear of AIDs - low attraction to partner |
- neurological damage to the genitals - inadequate blood flow to the penis resulting from vascular disease - chronic congestive diseases (heart or lung diseases) - side effects from prescription medication - alcoholism |
Depending on the type and cause of the sexual dysfunction, treatment can involve medication alone or in combination with cognitive exercises. Some disorders have high recovery rates while others may persist over the lifetime of the individual. As with the paraphilias, more information on specific sexual dysfunctions can be obtained from the Internet, libraries, and specialized health care professionals.
Please note that the following information, a preamble to gender identity disorder, is reprinted with permission from the American Psychological Association.
PART E
What Is Sexual Orientation?
Sexual orientation is an enduring emotional, romantic, sexual, or affectional attraction to another person. It is easily distinguished from other components of sexuality including biological sex, gender identity (the psychological sense of being male or female), and the social gender role (adherence to cultural norms for feminine and masculine behaviour). Sexual orientation exists along a continuum that ranges from exclusive homosexuality to exclusive heterosexuality and includes various forms of bisexuality. Bisexual persons can experience sexual, emotional, and affectional attraction to both their own sex and the opposite sex. Persons with a homosexual orientation are sometimes referred to as gay (both men and women) or as lesbian (women only). Sexual orientation is different from sexual behaviour because it refers to feelings and self-concept. Persons may or may not express their sexual orientation in their behaviours.
PART E
What Causes a Person to have a Particular Sexual Orientation?
There are numerous theories about the origins of a person’s sexual orientation; most scientists today agree that sexual orientation is most likely the result of a complex interaction of environmental, cognitive, and biological factors. In most people, sexual orientation is shaped at an early age. Considerable recent evidence suggests that biology, including genetic or inborn hormonal factors, plays a significant role in a person’s sexuality. To recognize that there are probably many reasons for a person’s sexual orientation is important, and the reasons may be different for different people.
PART E
Is Sexual Orientation a Choice?
Human beings cannot choose to be either gay or straight. Sexual orientation emerges for most people in early adolescence without any prior sexual experience. Although we can choose whether to act on our feelings, psychologists do not consider sexual orientation to be a conscious choice that can be voluntarily changed.
PART E
Is Homosexuality a Mental Illness or Emotional Problem?
Neither. Psychologists, psychiatrists, and other mental health professionals agree that homosexuality is not an illness, mental disorder, or an emotional problem. Over 35 years of objective, well-designed scientific research has shown that homosexuality is not associated with mental disorders or emotional or social problems. Homosexuality was once thought to be a mental illness because mental health professionals and society had biased information. In the past the studies of gay, lesbian, and bisexual people involved only those in therapy, thus biasing the resulting conclusions. When researchers examined data about people who were not in therapy, the idea that homosexuality was a mental illness was quickly determined to be untrue.
In 1973 the American Psychiatric Association confirmed the importance of the new, better designed research and removed homosexuality from the official manual that lists mental and emotional disorders. Two years later, the American Psychological Association passed a resolution supporting the removal. For more than 25 years, both associations have urged all mental health professionals to help dispel the stigma of mental illness that some people still associate with homosexual orientation.
On July 20, 2005, Canada became the fourth country in the world, to legalize same-sex marriage nationwide, with the enactment of the Civil Marriage Act which provided a gender neutral marriage definition.
PART E
Can Therapy Change Sexual Orientation?
No. Although most homosexuals live successful, happy lives, some homosexual or bisexual people may seek to change their sexual orientation through therapy, sometimes pressured by the influence of family members or religious groups. The reality is that homosexuality is not an illness. It does not require treatment and is not changeable.
However, not all gay, lesbian, and bisexual people who seek assistance from a mental health professional want to change their sexual orientation. Gay, lesbian, and bisexual people may seek psychological help with the coming out process or for strategies to deal with prejudice, but most go into therapy for the same reasons and life issues that bring straight people to mental health professionals.
PART E
Why is the “Coming Out” Process Difficult for some Gay, Lesbian, and Bisexual People?
For some gay, lesbian, and bisexual people, the coming out process is difficult; for others, it is not. Often lesbian, gay, and bisexual people feel afraid, different, and alone when they first realize that their sexual orientation is different from the community norm. This is particularly true for people becoming aware of their gay, lesbian, or bisexual orientation as a child or adolescent. Depending on their families and where they live, they may have to struggle against prejudice and misinformation about homosexuality. Children and adolescents may be particularly vulnerable to the deleterious effects of bias and stereotypes. They may also fear being rejected by family, friends, co-workers, and religious institutions. Some gay people have to worry about losing their jobs or being harassed at school if their sexual orientation became well known. Unfortunately, gay, lesbian and bisexual people are at a higher risk for physical assault and violence than are heterosexuals. Studies done in California in the mid 1990s showed that nearly one-fifth of all lesbians who took part in the study and more than one-fourth of all gay men who participated had been the victims of hate crimes based on their sexual orientation. In another California study of approximately 500 young adults, half of all the young men participating in the study admitted to some form of anti-gay aggression from name-calling to physical violence.
Video: Mark Tewksbury, an Olympic swimming champion talks about his experience in coming out.
PART E
Gender Dysphoria
In the DSM-5, people whose gender at birth is contrary to the one they identify with are diagnosed with gender dysphoria instead of the old term "gender identity disorder". As they mature, many people have occasional thoughts about the advantages of being the opposite 
gender. A little girl may say she wishes she were a boy so she could go topless at the community swimming center like her brother. A little boy may say he wishes he were a girl so he could play with his sister’s dolls. As most people mature, however, they are content to be the gender they are. Unlike the majority of people, individuals with gender dysphoria are discontent with their gender. They feel they really are the other gender – despite what their reproductive organs indicate. They feel trapped in the body of the wrong gender.
People with gender dysphoria are often aware of their conflicting feelings in early childhood. Individuals will often repeatedly state they wish to be the other gender and insist they are the other gender. They prefer to wear clothing associated with the opposite gender, and they will often act out the appropriate cultural roles of their preferred gender when playing. They will often choose playmates and toys of the gender they believe they are.
Individuals with gender dysphoria are also uncomfortable with their physical sex and/or sexual roles. Children with gender dysphoria generally dislike their own reproductive organs as well as the clothing and roles associated with their gender. A girl who prefers playing football over putting on make-up, but is happy being a girl, does not have this disorder. A boy who prefers cooking to sports, but also indicates that he likes being a boy, does not have this disorder.
Video: Transgender Tween
Gender dysphoria causes much stress for many affected individuals. People often feel rejected and out of place in society; consequently, suicide attempts and substance abuse are common. Some individuals have an intense desire to change their sexual identity and anatomical status (transsexualism), and they may undergo hormone therapy and/or gender re-assignment surgery. Other individuals may have no desire to change their anatomy but will cross-dress and/or live as members of the opposite sex (non-transsexualism).
Bruce Jenner (now Caitlyn Jenner), the former American gold medalist Olympian in the decathlon announced that he is transgender and under went transitioning to become a woman. In his televised interview, he discusses the struggles he has been through throughout his life as he tried to come to terms with his gender identity.
Videos: Caitlyn Jenner Interviews with Diane Sawyer and then on the Ellen show after the transition.
For an example of gender dysphoria please read Case Study 15.
PART E
Gender Dysphoria - Case Study 15
|
Description The parents of Charlie, a six year-old boy, sought treatment regarding his desire to be a girl. While the parents tried to encourage friendships between Charlie and other boys, he preferred to play with his sister, other girls, or to be with his mother or female babysitter. Although Charlie was above average in height, well-built for his age, and co-ordinated, he disliked physical play and aggressive behaviour. He preferred to pretend-play with his sister – assuming the roles of mother or big sister. He also imitated female characters from television shows and books; in essence, he preferred to idolize Wonder Woman over Superman. Toy cars and trains held no interest for Charlie - he liked to play wedding, pregnancy, or lady doctor instead. He liked to draw female figures and cross-dress (he used towels for skirts, long t-shirts for dresses, and veils for long hair.) He also liked to have bows in his hair and was fascinated with jewelry and make-up. Although his parents tried to restrict this modeling behaviour, Charlie persisted in acting like a girl and stated that he wanted to be a girl, that he did not want to be a boy, and that he did not want to play army or other boy games. Medical examination determined that Charlie was a healthy and robust child with normal intellectual development. The pregnancy and birth were uneventful, and neither parent showed any obvious mental illness. When Charlie was two years-old, |
his sister was born and, shortly after this, Charlie’s desire to be a girl (and the accompanying behaviours) became more pronounced. When Charlie was four years-old, his sister went to their grandparents for a holiday. When they returned, Charlie complained that his sister received more attention than he did. He asked, “Why can’t I be a girl? Why didn’t God make me a girl?” When Charlie was three, he attended nursery school where the teacher noted that he was more sensitive than the other children, that he dressed up frequently, and that he avoided rough play. These behaviours continued through first and second grade - his teacher even had to restrict access to the doll corner because of his fascination with doll play. The teacher noted that he was very good at imitating girls (their inflection and walk) and that he often commented that he wanted to be a mother when he grew up. Diagnosis Charlie repeatedly stated that he desired to become a “she”. He preferred female company, drew female figures, imitated female roles, and preferred to dress and act like a girl instead of a boy. He preferred stereotypical female toys and rejected toys that other boys liked. He wanted to be a girl – not just act like a girl. Charlie’s symptoms indicate that he has strong features of gender dysphoria and as such, his DSM-5 diagnosis for Axis I is gender dysphoria. |
Lesson Review
Lesson 1 Part E is all about sleep, did you succomb to sleep while reading the course material
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To summarize: • Sexual disorders can be categorized into paraphilias and sexual dysfunctions. • Paraphilias • Sexual dysfunctions • Sexual dysfunctions can result from psychological factors, physical and/or biological factors, and/or the interaction of psychological factors with physical and/or biological factors. • Sexual orientation is an enduring emotional, romantic, sexual, or affectional attraction to another person. Sexual orientation exists along a continuum that ranges from exclusive homosexuality to exclusive heterosexuality and includes various forms of bisexuality. • There are numerous theories about the origins of a person’s sexual orientation; most scientists today agree that sexual orientation is most likely the result of a complex interaction of environmental, cognitive, and biological factors. • Human beings cannot choose to be either gay or straight. Sexual orientation emerges for most people in early adolescence without any prior sexual experience. • Psychologists, psychiatrists, and other mental health professionals agree that homosexuality is not an illness, mental disorder, or an emotional problem. Over 35 years of objective, well-designed scientific research has shown that homosexuality is not associated with mental disorders or emotional or social problems. • Can Therapy Change Sexual Orientation? No. Although most homosexuals live successful, happy lives, some homosexual or bisexual people may seek to change their sexual orientation through therapy, sometimes pressured by the influence of family members or religious groups. The reality is that homosexuality is not an illness. It does not require treatment and is not changeable. • Why is the “Coming Out” Process Difficult for some Gay, Lesbian, and Bisexual People? Often lesbian, gay, and bisexual people feel afraid, different, and alone when they first realize that their sexual orientation is different from the community norm. This is particularly true for people becoming aware of their gay, lesbian, or bisexual orientation as a child or adolescent. • Unlike the majority of people, individuals with gender identity disorder are discontent with their gender. They feel they really are the other gender – despite what their reproductive organs indicate. They feel trapped in the body of the wrong gender. |