Is he mentally ill?

Preferred victims are girls or young women

Indirect means of expressing hostility toward women, but they aren’t in touch with this

About 50% report erections during, usually masturbate later

Few are women—women who do this are typically motivated by rage/revenge

• Few are women—women who do this are typically motivated by rage/revenge

• Males—motivated by desire for sexual excitement

• Most aren’t dangerous, don’t make repeated calls to the same person

• Many patterns—obscenities, breathe heavily, sexual overtures, sex surveys, etc.

• Life exhibitionist-socially inadequate heterosexual male who can’t form intimate rel.

Sexual sadism—sexual arousal from inflicting pain on another person

• Sexual sadism—sexual arousal from inflicting pain on another person

• Sexual masochism—experiencing pain

• Masochism is the only paraphilia found with any frequency in women—about 5% of masochists are women

• Sadomasochism is highly ritualized—not all pain is gratifying

• In a mild form—not uncommon

• Pain may be symbolic—like rubber paddle

• Serious injury is usually avoided

• Survey from S&M magazine—3/4 male, most married, men interested since childhood, women introduced to it

• Causes

• May have bio links to pleasure—pain causes release of endorphins, but this doesn’t explain symbolic pain or sadism
• Learning theorists—being spanked for masturbation
• Sociologists—losing control, letting go

Problems—

• Problems—

• 1) Don’t want/seek tx
• 2) No motivation to change even if in tx (thus cog tx doesn’t work)
• 3) Should therapist impose own goals?
• 4) Perceived responsibility—client must know he can change

• Behavior tx

• Systematic desensitization—pair relaxation with arousing images
• Aversion tx—shock, nausea inducing drugs
• Social skills training
• Orgasmic reconditioning—begin with old images, then switch to appropriate ones

• Drugs

• Prozac—some effectiveness for exhibitionism, voyeurism, fetishism (OCD-type beh)
• Anti-androgen drugs—depo provera—decreases sexual desire in those at risk for sexual offenses. Decreases desire—not urges or behavior in a particular direction. High refusal and drop out rates for this treatment.

Money (1978)—8 variables of gender

• Money (1978)—8 variables of gender

• Chromosomal (xx vs. xy)
• Gonadal (testes vs. ovaries)
• Prenatal hormonal gender
• Prenatal and neonatal brain hormonalization
• Internal accessory organs
• External genital appearance
• Pubertal hormonal gender
• Assigned gender identity

1) Persistent cross-gender identification

• 1) Persistent cross-gender identification

• 2) Profound discomfort or disgust with biological sex

• In kids

• Girls—tomboys
• Boys—less interest in rough and tumble play, lower activity levels, more creative, theatrical. More often described as beautiful or feminine babies. Typically show cross-gender preferences as early as 2 or 3—around that age—boys will seek dolls, may tuck away penis when playing.
• Typically ostracized in school.

• Transsexualism, also known as transgender—people with GID who do something about it

• Male to female 3x as common ; 1/30000 males, 1/100,000 females seek surgery.
• Also more effective

• Don’t consider selves to be homosexual

• Found throughout history

• Typically show cross gender preferences in play and dress early in childhood. Many say they have felt this way forever.

There is no clear cause or understanding of this disorder.

• There is no clear cause or understanding of this disorder.

• Psychotherapy typically fails.
• May be influenced by prenatal hormonal imbalances
• Also possibility that they are treated inappropriately or ambiguously by parents

• Sexual reassignment surgery—long process

• Counseling to assure adjustment (ie not someone who is lonely or schizophrenia)
• Hormone tx
• Real life test—live 1-2 yrs as new gender
• Surgery—male—remove genitalia without severing nerves. Then artificial vagina is created with skin of penis. Use device to dilate it for next 6 mos so it doesn’t close. Female—penis and scrotum are created from tissues in genital area. Need implants to stiffen penis.
• Largely cosmetic.
• Hormones for life.

• Outcome—Lundstrom et al (1984)—international literature—90% happy with surgery, positive results.

• Less unhappy with life. Those with better looking results have more positive outcome.

Links between childhood sexual abuse and many negative outcomes

• Links between childhood sexual abuse and many negative outcomes

• PTSD, low self-esteem, depression, anxiety, sexual precocity, sexual withdrawal
• About 1/3 show no signs

• Prevalence—depends on definition, but about 10-12% men and 15-20% of women

• Recovered memories—induction of false memories

• Effects are more negative

• Ongoing
• Penetration
• Threat or force
• Step or bio father
•