Putting It Together: Sexual Deviations

In this module, you learned about sexual deviations, such as gender dysphoria and paraphilic disorders. At this point, you hopefully have a better understanding of how each diagnosis is unique in its presentation of symptoms, how the different disorders are treated, and which biopsychosocial perspectives prevail in the etiology of these disorders.

The module started out with a discussion on the distress a person may feel when there is a mismatch between their gender identity and their sex assigned at birth. You now know that this condition is referred to as gender dysphoria. You then had a thorough review of various types of sexual dysfunction and how sexual functioning is a complex bio-psycho-social process. The module ended with a somewhat disturbing review of deviant or disordered sexual behavior, from the different types of paraphilias to the different types of sexual violence. Interestingly enough, the same psychologist who baffled the scientific community on his treatment of David Reimer also proposed a plausible viewpoint that paraphilias are the expression of lovemaps gone awry or vandalized, hypothesizing that an individual is, in a sense, programmed to act out fantasies that are socially unacceptable and often harmful.

It’s important to take time to think critically on what has been presented, and also to reflect on the concepts presented in the module and how each one has firm roots in empirical research.

Here’s a review of the disorders discussed in this module:

• Gender dysphoria is a diagnostic category in DSM-5 that describes individuals who do not identify as their biological gender. This dysphoria must persist for at least six months and result in significant distress or dysfunction to meet DSM-5 diagnostic criteria. In order for children to be assigned this diagnostic category, they must verbalize their desire to become the other gender.
• Early-onset gender dysphoria is behaviorally visible in childhood. Sometimes gender dysphoria will desist in this group and they will identify as gay or homosexual for a period of time, followed by recurrence of gender dysphoria. This group is usually sexually attracted to members of their natal sex in adulthood.
• Late-onset gender dysphoria does not include visible signs in early childhood, but some report having had wishes to be the opposite sex in childhood that they did not report to others.
• Paraphilias are persistent and recurrent sexual interests, urges, fantasies, or behaviors of marked intensity involving objects, activities, or even situations that are atypical in nature.
• Fetishism is the use of nonliving objects, most commonly shoes and undergarments, for sexual pleasure.
• Transvestic fetishism is the derivation of sexual arousal from cross-dressing or dressing in clothes of the opposite sex.
• Exhibitionism is the exposure of an individual’s genitalia to unsuspecting strangers for sexual satisfaction.
• Voyeurism is the viewing of an unsuspecting person engaging in disrobing or sexual activity.
• Frotteurism is the touching of or rubbing against a nonconsenting person.
• Sexual masochism is the derivation of sexual arousal from being the recipient of physical or mental abuse and/or humiliation.
• Sexual sadism is when sexual arousal is gained from inflicting mental or physical suffering on a nonconsenting person.
• Pedophilia is any sexual activity with a prepubescent child, where the offender/patient is at least sixteen years of age, and the victim is at least five years younger.