The document discusses sexual and gender identity disorders, including paraphilic disorders. It defines paraphilias as recurrent sexual fantasies or behaviors involving nonconsenting persons, suffering, or humiliation. Seven specific paraphilic disorders are described: exhibitionistic disorder, fetishistic disorder, frotteuristic disorder, pedophilic disorder, sexual masochism disorder, sexual sadism disorder, and transvestic disorder. Predisposing biological, psychoanalytic, and behavioral factors are discussed. Treatment options mentioned include biological treatments, psychoanalytic therapy, and behavior therapy.

1. SEXUAL AND GENDER
IDENTITY DISORDER
PRESENTED BY:-
Kshirabdhi Tanaya
Msc Tutor,SUM Nursing
college
S‘O’A DTU,Bbsr.

2. INTRODUCTION
Humans are sexual beings. Sexuality is a
basic human need and an innate part of the
total personality. It influences our thoughts,
actions, and interactions, and is involved in
aspects of physical and mental health.

3. Sexuality
Sexuality is the constitution and life of an
individual relative to characteristics
regarding intimacy. It reflects the
totality of the person and does not relate
exclusively to the sex organs or sexual
behavior.

4. SEXUAL DISORDERS
Paraphilic Disorders
The term paraphilia is used to identify repetitive
or
preferred sexual fantasies or behaviors that
involve
(1) nonhuman objects, (2) suffering or
humiliation of oneself or one’s partner, or (3)
nonconsenting persons.

5. In a paraphilic disorder, these sexual fantasies or
behavior are recurrent over a period of at least
6months and cause the individual clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.

6. Types of Paraphilic Disorders:-
The following types of paraphilic disorders are
identified by the DSM-5:
•Exhibitionistic Disorder
•Fetishistic Disorder
•Frotteuristic Disorder
•Pedophilic Disorder
•Sexual Masochism Disorder
•Sexual Sadism Disorder
•Transvestic Disorder
•Voyeuristic Disorder

7. 1-Exhibitionistic Disorder :-
Exhibitionistic disorder is characterized by recurrent
and intense sexual arousal (manifested by fantasies,
urges, or behaviors of at least 6 months’ duration)
from the exposure of one’s genitals to an
unsuspecting individual (APA, 2013).
•Masturbation may occur during the exhibitionism. In
most cases of exhibitionism,
the perpetrators are men and the victims are women.

10. 2-Fetishistic Disorder
Fetishistic disorder involves recurrent and intense
sexual arousal (manifested by fantasies, urges, or
behaviors of at least 6 months’ duration) from the use
of either non-living objects or specific non-genital
body part(s) (APA, 2013).
•A common sexual focus is on objects intimately
associated with the human body(e.g., shoes, gloves,
stockings).
• The fetish object is usually used during masturbation
or incorporated into sexual activity with another
person in order to produce sexual excitation.

12. 3-Frotteuristic Disorder
Frotteuristic disorder is the recurrent and intense sexual
arousal (manifested by urges, behaviors, or fantasies of at
least 6 months’ duration) involving touching or rubbing
against a nonconsenting person
(APA, 2013).
•Sexual excitement is derived from the actual touching or
rubbing, coercive nature of the act. Almost without
exception, the gender of the frotteur is male.
•The individual usually chooses to commit the act in
crowded places, such as on buses or subways during rush
hour.

15. 4-Pedophilic Disorder
•The essential feature of pedophilic disorder is sexual
arousal from prepubescent or early pubescent children .
•The age of the molester is at least 16 years, and he or
she is at least 5 years older than the child. This category
of paraphilic disorder is the most common of sexual
assaults.
•Sexual abuse of a child may include a wide range of
behaviors, including speaking to the child in a sexual
manner, indecent exposure and masturbation in the
presence of the child, and inappropriate touching or acts.

18. 5-Sexual Masochism Disorder
The identifying feature of sexual masochism disorder is
recurrent and intense sexual arousal (manifested by
urges, behaviors, or fantasies of at least 6 months’
duration) from the act of being humiliated, beaten,
bound, or otherwise made to suffer (APA, 2013).
•These masochistic activities may be fantasized (e.g.,
being raped) and may be performed alone (e.g., self-
inflicted pain) or with a partner (e.g., being restrained,
spanked(hit several times on buttocks) or beaten by the
partner).
•Some masochistic activities have resulted in death,

21. 6-Sexual Sadism Disorder
The DSM-5 identifies the essential feature of sexual
sadism disorder as recurrent and intense sexual arousal
(manifested by urges, behaviors, or fantasies of at least 6
months’ duration) from the physical or psychological
suffering of another individual (APA,
2013).
• The sadistic activities may be fantasized or acted on
with a consenting or nonconsenting partner.
•In all instances, sexual excitation occurs in response to
the suffering of the victim. Examples of sadistic acts
include restraint, beating, burning, rape, cutting,
torture,and even killing.
•The course of the disorder is usually chronic, with the
severity of the sadistic acts often increasing over time.

24. 7-Transvestic Disorder
Transvestic disorder involves recurrent and intense
sexual arousal (as manifested by fantasies, urges, or
behaviors of at least 6 months’ duration) from dressing
in the clothes of the opposite gender.
The individual is commonly a heterosexual man who keeps a
collection of women’s clothing that he intermittently uses to dress
in when alone.
The sexual arousal may be produced by an accompanying
fantasy of the individual as a woman with female genitalia, or
merely by the view of himself fully clothed as a woman without
attention to the genitalia.
The disorder causes marked distress to the individual, or
interferes with social, occupational, or other important areas of
functioning.

26. 8-Voyeuristic Disorder
Voyeuristic disorder is identified by recurrent and
intense sexual arousal (manifested by urges, behaviors,
or fantasies of at least at least 6 months’ duration)
involving the act of observing an unsuspecting
individual who is naked, in the process of disrobing, or
engaging in sexual activity (APA, 2013).
•Onset of voyeuristic behavior commonly occurs
during adolescence, but the minimum age for a
diagnosis of voyeuristic disorder is 18 years (APA,
2013).

29. PREDISPOSING FACTORS TO PARAPHILIC DISORDERS
1-Biological Factors
•Various studies have implicated several organic factors in
the etiology of paraphilic disorder. Destruction of parts of
the limbic system in animals has been shown to cause
hypersexual behavior.(Becker & Johnson,2008).
•Temporal lobe diseases, such as psychomotor seizures or
temporal lobe tumors, have been implicated in some
individuals with paraphilic disorder.
•Abnormal levels of androgens also may contribute to
inappropriate sexual arousal.

30. 2-Psychoanalytic Theory
•The psychoanalytic approach defines an
individual with paraphilic disorder as one who
has failed the normal developmental process
toward heterosexual adjustment (Sadock &
Sadock, 2007).
•This occurs when the individual fails to resolve
the Oedipal crisis and either identifies with the
parent of the opposite gender or selects an
inappropriate object for libido cathexis.

31. 3-Behavioral Theory
•The behavioral model hypothesizes that
whether or not an individual engages in
paraphilic behavior depends on the type of
reinforcement he or she receives following the
behavior.
•The initial act may be committed for various
reasons. Some examples include recalling
memories of experiences from an individual’s
early life (especially the first shared sexual
experience),

32. modeling behavior of others who have carried out
paraphilic acts, mimicking sexual behavior depicted in the
media, and recalling past trauma such as one’s own
molestation (Sadock & Sadock, 2007).
•Once the initial act has been committed, the individual
with paraphilic disorder consciously evaluates the
behavior and decides whether to repeat it.
•A fear of punishment or perceived harm or injury to the
victim, or a lack of pleasure derived from the experience,
may extinguish the behavior.

33. TREATMENT

34. 1-Biological Treatment
•Biological treatment of individuals with paraphilic
disorders has focused on blocking or decreasing the
level of circulating androgens.
•The most extensively used of the antiandrogenic
medications are the progestin derivatives that
block testosterone synthesis or block androgen
receptors.
•They are not meant to be the sole source of
treatment and work best when given in
conjunction with participation in individual or
group psychotherapy.

35. Psychoanalytic Therapy
•In this type of therapy, the therapist helps the client to
identify unresolved conflicts and traumas from early
childhood.
•The therapy focuses on helping the individual resolve
these early conflicts, thus relieving the anxiety that
prevents him or her from forming appropriate sexual
relationships.
• In turn the individual has no further need for paraphilic
fantasies.

36. Behavior Therapy
•Aversion techniques have been used to modify
undesirable behavior.
•Aversion therapy methods in the treatment of paraphilic
disorders involve pairing noxious stimuli, such as electric
shocks and bad odors,with the impulse, which then
diminishes.
• Behavioral therapy also includes skills training and
cognitive restructuring in an effort to change the
individual’s maladaptive beliefs.