Chapter 17. Gender Identity Disorders and Paraphilias

Judith V. Becker, Ph.D.; Bradley R. Johnson, M.D.
DOI: 10.1176/appi.books.9781585623402.305219



Sexuality is an important part of the lives of people. Thus, it is important that students of human behavior be informed about and conversant with issues such as normative sexual development, gender roles, gender identity, sexual orientation, and the wide range of sexual behaviors individuals may fantasize about or engage in. When sexual behaviors are defined by cultures or society as being atypical, they are referred to as paraphilias. This chapter focuses on gender identity disorders and paraphilias.

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FIGURE 17–1. Multiple paraphiliac diagnoses.
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TABLE 17–1. DSM-IV-TR diagnostic criteria for gender identity disorder
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TABLE 17–2. Paraphilias
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TABLE 17–3. Psychosexual assessment
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TABLE 17–4. Sexual history
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TABLE 17–5. Some psychosexual tests and checklists
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Whereas the genetic sex of an individual is determined at conception, gender identity develops during the early years of life.

Gender identity disorder requires a strong and persistent cross-gender identification and a persistent discomfort with one's sex or sense of inappropriateness in the gender role of that sex.

The term transsexualism was eliminated in DSM-IV and replaced by gender identity disorder.

Approximately 1 in 30,000 adult males and 1 in 100,000 females seek sex reassignment surgery. After surgery, patients report few problems and marked improvement in their sexuality.

The paraphilias are characterized by experiencing, over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors, generally involving nonhuman objects or nonconsenting partners.

The most common paraphilias are exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, transvestic fetishism, and voyeurism.

The numerous other sexually deviant fantasies or behaviors are given the diagnosis of paraphilia not otherwise specified.

A variety of behavioral therapies, hormonal treatments, and psychopharmacological treatments have been used to manage paraphilias.


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De Cuypere et al. (2005) conducted a follow-up study of 55 transsexual patients (both male-to-female and female-to-male) after sex reassignment surgery. Among their findings were that. . .
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