Sexual dysfunction is psychological conditions recognized and defined under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) of 2013 (American Psychiatric Association, 2013). It is defined as an individual or couple having some form of difficulty during sexual activity that has occasioned extreme distress or interpersonal strain for over 6 calendar months (American Psychiatric Association, 2013). This difficulty may be premised on the inability to get or maintain an erection or get aroused, have an orgasm, enjoy sex or perform properly (Paris, 2015). Among the braches of sexual dysfunction is disorder of sexual preference which entails hypersexuality (Boeskey, 2013). This is an addiction to sexual activities that do not involve the active participation of another human being such as pornography and masturbation (Boeskey, 2013).
Gender Dysphoria also known as Gender Identity Disorder (GID) is a form of distress or Dysphoria experienced by individuals who are uncomfortable with the gender with which they were born in (American Psychiatric Association, 2013). This condition is also recognized under the DSM-5 (American Psychiatric Association, 2013). It is however, worthy of clarification that being uncomfortable with one’s gender or any of its attributes does not amount to Gender Dysphoria nor is it a psychological disorder. This is premised on recent research that has established that distaste towards gender can also emanate from biological reasons (American Psychiatric Association, 2013). GID, therefore, only refers specifically to the distress emanating from the distaste towards one’s gender of birth.
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The first case study involves a man who is tending towards his middle age, married, and has two children (Laureate Education, 2012). He is accompanied by his wife to the therapy session in what seems to be a sigh of support. However, along the course of the therapy it becomes clearly apparent that the man may have been compelled by the wife to attend the therapy session. This contention is further supported by his propensity to lie to the therapist, and this shows lack of a genuine intention to seek help. His predicament, as per initial particulars is sexual dysfunction as he is unable to achieve and maintain an erection (Laureate Education, 2012).
This has negatively affected his relationship with his wife as there is no marital sex. However, through coaxing by both the therapist and his wife he admits to masturbation through pornography in the office, at home and using his office phone (Laureate Education, 2012). This has caused him trouble after he was caught in the office, he also stays awake late at night watching pornography but lies to his wife that he is taking an online MBA course (Laureate Education, 2012). From the totality of the foregoing, his DSM diagnosis is Sexual dysfunction under the category Hyper-sexuality whose main symptom is addiction to masturbation through pornography (Boeskey, 2013; Paris, 2015).
The problem is so advanced that the client is unable to function normally and is in the process of losing his job, ruining his family and perchance his life. This is because the situation has reached the point of pathological lies. He has been lying extensively to his wife and workmates and even lied to the therapist. His lies have even matured into storylines, such as the fictitious MBA studies. Therefore, over and above his personal suffering, the disorder is also directly impacting the client’s wife can no longer enjoy her conjugal rights and her children who are about to lose their livelihood. He is, therefore, in need of urgent psychological attention.
The second case study involves a minor, a 13 year old girl, who has seemingly been accompanied to my practice by her parents. Perchance she has actually been compelled as she is clearly uncomfortable with her situation. From the conversation with the client and her parents, the client is a good student and an active athlete in her school. However, her dressing, character and mannerisms resemble that of a boy. This has been so intensive that she has become the subject of teasing by her school mates due to her behavior. The teasing has however not affected her outward appearance. Her conduct also adheres with the appearance. She is a good athlete as aforesaid but will only play with boys. Further, she prefers boyish games and activities.
More concerning however, is her mental perception toward her feminine attributes in general and particularly her breasts, which being pubescent are beginning to develop. The client hates her breasts and even indicates her desire to have them removed. Further, she confirms that she has always desired to be a boy for her entire conscious life. From the totality of the foregoing, the client’s DSM diagnosis is Gender Dysphoria (Drescher & Byne, 2012). Her main symptoms are; hating her gender, desiring the opposite gender, interacting only with the opposite gender, and seeking to look like them.
Up to that point, these are mild symptoms that would only result in a little discomfort and embarrassment for her and her family through jibes. However, the contention that she hates her breasts and would want to have them removed is alarming as it would directly impact her capacity to function normally in life. This is exacerbated by the fact that she is only 13 and her breast will continue to grow much larger in the coming years.
Her distaste for breast can easily provoke a violent or adverse reaction such as chopping them off or developing suicidal tendencies (Drescher & Byne, 2012). Further, albeit there is increased gender equality in the contemporary world, it will be extremely difficult for the client to go through school as a girl, when she so fervently aspires to be a boy. The ridicule emanating therefrom may make her disenchanted with education, develop violent tendencies or even be suicidal. For these reasons, she needs urgent psychiatric attention.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Boskey, E. (2013). Sexuality in the DSM 5. (Cover story). Contemporary Sexuality , 47 (7), 1–5.
Drescher, J., & Byne, W. (2012). Introduction: The treatment of gender dysphoric/gender variant children and adolescents. Journal of Homosexuality , 59 (3), 295–300
Laureate Education. (Producer). (2012). Psychopathology: Sexual dysfunction, schizophrenia spectrum, and other psychotic disorders. [Video file]. Retrieved from https://class.waldenu.edu
Paris, J. (2015 ). The intelligent clinician’s guide to the DSM-5 (2nd ed.). New York, NY: Oxford University Press.
