Sexual and Gender Identity disorders

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The DSM-IV classifies these disorders into sexual dysfunctions, paraphilia, and gender identity disorders.

Sexual Dysfunctions
Sexual dysfunctions are sexual disorders associated with alterations in the sexual response cycle (Table 9-4) or with pain associated with sexual activity. The specific sexual dysfunctions are defined in Table 9-5.

Paraphilias
Paraphilias include sexual disorders related to culturally unusual sexual activity (Table 9-6). A key criterion for the diagnosis of a paraphilia (as in all psychiatric disorders) is that the disorder must cause an individual to experience significant distress or impairment in social or occupational functioning. In other words, an individual with unusual sexual practices who does not suffer significant distress or impairment would not be diagnosed with a psychiatric illness.

Sexual and Gender Identity disorders
Gender identity disorder remains a controversial diagnosis in psychiatry. Individuals with this disorder experience distress and interpersonal impairment as a result of their desire to be a member of the opposite sex. Criteria for the diagnosis require a pervasive cross-gender identification and persistent discomfort with one’s assigned sex. In addition, the diagnosis is made only in those individuals who do not have an intersex condition (e.g., ambiguous genitalia). Children with this disorder may engage in genderatypical play; adults may assume the societal role, dress, and behavior associated with the opposite sex.

In addition, patients with gender identity disorder may seek sex reassignment surgery and hormonal supplements. Individuals with gender identity disorder appear to have the same range of sexual orientations as do persons without this disorder. 

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