474 CHAPTER 11
to distress or problems in their relationships. In addition, families, communities,
or cultures determine which sexual fantasies, urges, and behaviors are considered
“deviant” or “abnormal.” These socially defined sexual “abnormalities” differ
across cultures and shift over time. For example, masturbation and oral sex were
once considered to be deviant. More recently, homosexuality was considered a psy-
chological disorder until 1973, when it was removed from the DSM. Moreover, like
most other psychological problems and disorders, normal and abnormal sexuality
and sexual behavior fall on a continuum. However, DSM-IV-TR uses the categorical
approach to defi ne sexual disorders; that is, according to DSM-IV-TR, sexual fanta-
sies, urges, and behaviors are either normal or not normal.
As we’ll see in this chapter, the diagnosis of most—though not all—sexual dis-
orders in DSM-IV-TR hinges on the patient’s experience of distress or impaired
functioning as a result of the sexual symptoms (First & Frances, 2008). Simply hav-
ing unusual or “deviant” sexual fantasies or engaging in unusual sexual behaviors is
not generally suffi cient for a diagnosis.
The diagnostic criteria for various disorders in the DSM-IV-TR category of
sexual and gender disorders address neuropsychosocial factors. That said, some
disorders have predominantly neurological and other biological criteria (the sexual
dysfunctions) whereas others have primarily psychological and social criteria (the
paraphilias and gender identity disorder). Let’s examine these disorders.Gender Identity Disorder
Last year, Mike became confused when his good friend, Sam, began to dress
like and live as a woman. In fact, Sam was changing his name to Sandy and
would, within the next couple of years, have surgery to acquire female genitals.
Sam had dated girls occasionally in high school and seemed “normal,” so Mike
didn’t know how to make sense of Sam’s change. Seeing Sam as a woman made
Mike uncomfortable, and now they only saw each other occasionally. Mike told
Laura about Sam’s change to Sandy, but he hasn’t told her about his feelings
about the change. Mike found himself wondering what life—and sex—had been
like for Sam, and what it was like now for Sandy. Mike surfed the Internet for
reputable information about Sam’s condition, and discovered that it is called
gender identity disorder.What is viewed as normal and abnormal sexuality
is partly based on the cultural views of appropri-
ate sexual behavior.Richard B. Levine/Newscom Alaska Stock Images
Gender identity
The subjective sense of being male or female,
as these categories are defi ned by the
person’s culture.Gender identity disorder
A psychological disorder characterized by
a cross-gender identifi cation that leads the
individual to be chronically uncomfortable
with his or her biological sex.Gender role
The outward behaviors, attitudes, and traits
that a culture deems masculine or feminine.