Monday, January 13, 2014

Sexual and Gender Identity, Personality, and Eating Disorders Outline and Case Analysis

Eating Disorder Diagnoses: As for the DSM-IV-TR, the characteristics of these disorders are disturbances of eating behavior, such as eating too little, too much, or in an unhealthy manner that is extreme (American Psychiatric Association, 2013). Biological components include hormonal deficiencies and excesses, as well as neural activity, which is abnormal. Individuals suffering from bulimia or anorexia have low levels of serotonin and abnormal brain structures. As for emotional components, disordered eating is a complex reaction to societal expectations or beliefs concerning one’s self-image. As for cognitive components, focus is on starvation or eating experiences and behavior after eating which reinforce one’s distorted thoughts about body images. Individuals with distorted self-images have a need of losing weight, or have a fear of gaining weight. As for behavioral components, these include binge eating and compensatory behaviors to prevent one from gaining weight. Eating disorders are the result of inappropriate experiences and thoughts, which reinforce extreme eating behaviors.
Anorexia Nervosa
·         A disorder, whereas one refuses to maintain at least a minimal normal body weight (Hansell & Damour, 2008)
·         This involves extreme thinness, achieved often through self-starvation
Bulimia Nervosa
·         Is a disorder of binge eating and compensatory behaviors, which are an inappropriate means to avoid gaining weight
Eating Disorder NOS
·         This is a disorder with disordered eating, which fails in meeting the diagnostic criteria for bulimia nervosa or anorexia (Hansell & Damour, 2008)

Sexual Disorders: As for the DSM-IV-TR, these disorders involve sexual symptoms. As for biological components, medical illnesses (such as heart conditions and diabetes), aging, poor dieting, substance use, and several medications can contribute to these disorders. As for emotional components, research emphasizes deficient or deviant or deficient relationships. As for cognitive components, included are cognitive deficits, fantasies and related interpersonal schemas. Cognitive deficits occur in areas such as social skills, empathy, coping strategies, and impulse control. As for behavioral components, learned deviant sexual behavior occurs by observing, participating in, or experiencing such behavior. Rewards and punishments for sexual behavior, which are inappropriate, can lead to other sexual behaviors.
Sexual Dysfunctions
·         These are disorders, which involve continual problems as for with orgasm, sexual response, or sexual interest
Sexual Desire Disorders
·         Hypoactive sexual desire, continual sex fantasies and desires in regards to sexual activity, which are deficient and cause interpersonal difficulty or distress (Hansell & Damour, 2008)
·          Hansell and Damour (2008), “persistent extreme aversion to, and avoidance of, genital sexual contact with a sexual partner, causing distress or interpersonal difficulty” (p. 374).
Sexual Arousal Disorders
·         Female sexual arousal disorder, the continual inability of maintaining or attaining, enough lubrication-swelling response of sexual excitement, which causes interpersonal difficulty or distress (Hansell & Damour, 2008)
·         Male erectile disorder, the continual inability of attaining, or maintaining, a sufficient erection; which, causes interpersonal difficulty or distress (Hansell & Damour, 2008)
Orgasmic Disorders
·         Female orgasmic disorder, continual absence of, or delayed orgasm that follows a sexual excitement phase that is normal; which, causes interpersonal difficulty or distress
·         Male orgasmic disorder, continual absence of, or delay in an orgasm that follows a sexual excitement phase that is normal; which, causes interpersonal difficulty or distress
·         Premature ejaculation, continual ejaculation with minimum sexual stimulation shortly after, on, or before penetration and before the one wishes to ejaculate, which causes interpersonal difficulty or distress (Hansell & Damour, 2008)
Sexual Pain Disorders
·         Vaginismus, continual involuntary spasms of the musculature, the vagina’s outer third, which disrupts sexual intercourse and causes interpersonal difficulty or distress
·         Dyspareunia, continual pain of the genitals affiliated with sexual intercourse, which causes interpersonal difficulty or distress
·         Disorders that involve aberrant sexual preferences and relationships
Gender Identity Disorders
·         Disorders that involve intense discomfort with an individual’s biological sex and the desire to change his or her sex (Hansell & Damour, 2008)

Personality Disorders: As for the DSM-IV-TR, theses disorders have characteristics of rigid and extreme behavior, which causes distress and impairments in functioning. Biological components include abnormal structures of the brain, reduced white and gray matter volume, abnormalities of various neurotransmitter, and low levels of serotonin. Certain types of these disorders result from overlapping environmental and of genetic effects. Emotional components include the reflection of disruptive childhoods; whereas, children learn to depend on maladaptive defense mechanisms. As for cognitive components, notions of experiences of one’s childhood shape certain thought patterns and have a significant effect on patterns of the individual's behavior and perception which subsequently becomes the personality. As for behavioral components, these disorders are the result of maladaptive behaviors and thought processes.
Paranoid Personality Disorder
·         This is a disorder with patterns of extreme suspiciousness and distrust
Schizoid Personality Disorder
·         A disorder with detachment patterns from social interactions and a limited scope of emotional expressions (Hansell & Damour, 2008)
Schizotypical Personality Disorder
·         A disorder with patterns of eccentricities of perceptual, cognitive, or behavior distortions, and severe discomfort within close relationships
Antisocial Personality Disorder
·         This is a disorder with patterns of violations of, and disregards for, other individual’s rights
Borderline Personality Disorder
·         A disorder with patterns of self-destructive behavior, and instability in self-image, emotions, interpersonal relationships, and impulsivity (Hansell & Damour, 2008)
Histrionic Personality Disorder
·         A disorder with patterns of attention seeking and emotionality, which is superficial and excessive
Narcissistic Personality Disorder
·         This is a disorder with patterns of a lack of empathy, the need of admiration, and grandiosity
Avoidant Personality Disorder
·         This is a disorder with patterns of emotions of inadequacy, hypersensitivity as for negative evaluation, and social inhibition
Dependent Personality Disorder
·         This is a disorder with patterns of clingy and submissive behavior related to a need, which is excessive in relation to be taken care of by other individuals
Obsessive-Compulsive Personality Disorder
·         A disorder with preoccupied patterns of perfectionism, orderliness, and control at the expense of enjoyment, flexibility, and spontaneity (Hansell & Damour, 2008)

Case Analysis
          The case of David Reimer is one of the more so influential and controversial cases gender identity development. Reimer, christened originally as Bruce Reimer, born in Winnipeg in Manitoba, Canada, in 1965 as a pair of boys who were identical twin. Until the age of seven months, both twins had a healthy and blissful existence in an affectionate and caring environment. During this particular time, Reimer’s mother noticed skin on the tip of her sons’ penises, which made urination particularly difficult and painful. A condition referred to as phimosis. To correct this problem, the twins needed circumcisions, a routine medical procedure. However, Reimer suffered a botched circumcision; whereas burns occurred on his penis that rendered it lifeless and useless as well as lifeless. Meyer, Chapman, and Weaver (2009), “eventually, Bruce’s penis dried up and flaked away until there was no sign that he had ever had any sort of genital appendage” (p. 148).
          Instead of subjecting Reimer to several painful, and intricate surgeries during his youth to construct an artificial penis (phalloplasty or phallic reconstruction) his parents followed the advice of Dr. Money. This advice included raising Reimer as a female. Therefore, his name changed to Brenda as he underwent surgical castration, which removed both testicles and construction of an exterior vagina occurred at 22 months of age (Meyer, Chapman, and Weaver, 2009).  Throughout part of her life, Brenda fought the forced femininity change. At the age of 14 Brenda finally learned through her parents that she was a male and wanted to become a male, such as she was. She even changed her name to David and went through the surgeries necessary to become a male again anatomically. David fell in love, married, and started living a happy life but with the trauma of his childhood, suicide of his twin brother, unemployed, divorce from his wife, financial difficulties, and with an onset of depression David on the fifth of May 2004, sawed off a shotgun and used it to kill himself. David Reimer suffered from a sexual disorder, specifically, gender identity disorder.
Components of
          As for the DSM-IV-TR, gender identity disorder (GID) is a sexual disorder that involves server discomfort with an individual’s anatomical sex and the need to change his or her sex (Hansell & Damour, 2008). GID involves a disruption in one’s gender identity, whereas it shares a close relationship with sexuality. The three symptoms of GID are that of an individual’s psychological gender identity and biological sex are the exact opposite. As for one’s biological sex, one is extremely uncomfortable with it, and one with this disorder experiences significant impairment or distress in functioning (Hansell & Damour, 2008). There is still an uncertainty as for gender identity disorder’s origins and causes. However, David Reimer’s GID case is different from the normal case because he was born a male, which is eventually the sex he was surgically reassigned (Hansell & Damour, 2008).  
          Biological components of GID address inborn connections between it and temperament or behavioral tendencies. Males with GID typically have lower activity levels, which points to the genetic basis probability of temperamental differences. The mechanisms of genetically temperamental differences mechanism may involve the hormonal system that is an influence of several behaviors, which are sexual and gender-linked (Hansell & Damour, 2008). Certain experts suspect that postpubertal, postnatal, or prenatal hormonal anomalies may contribute to gender abnormalities that occur in GID; however, there is not any consistent evidence. However, there is preliminary evidence that brain structure differences in transsexual men in comparison to nontranssexual males. Hansell and Damour (2008), “Zhou and colleagues (1997) found that an area of the hypothalamus in six transsexual males was half the normal size of that in nontranssexual men, making it close to its typical size in women” (p. 400).
          The emotional components of GID emphasize the role of emotional ill relationships between mothers and sons as for the development of GID in males. However, psychodynamic theorists disagree with the effects of the son and mother problem (Hansell & Damour, 2008). Greenson and Stoller held the belief that gratifying, and overly close mother and son relationships combined with a distant father, and son relationship were the feature elements that produce a male’s female identification. However, through the empirical studies of GID conducted by Coates and her colleagues found that the GID male/feminine interest and behaviors were attempts of connecting with a withdrawn, depressed mother, instead of a symbiosis of a mother who is overly gratifying.
            Cognitive components of GID point to one forming a concept of him or herself as either a male or female, which is a cognitive task. Certain theorists make the argument that gender identity can change because of a function of normal developments in one’s cognitive ability, specifically in logical thinking. Other cognitive factors of influence are the progresses of gender identity, such as providing one with accurate information in regard to how one decides gender.
          As for behavioral components, gender behavior, such as other behavior, is a result of the environment. Behavioral theorists have the belief that the featured cause of GID are sets of environmental reinforcements, which are a result of children learning cross-gender behavior that results in rewards and gender-consistent behavior that results in punishment. Cross-gender social reinforcement can contribute to GID.
            David Reimer suffered from a sexual disorder, specifically, gender identity disorder. Reimer’s gender identity disorder case is different from a typical GID case because he was a male, and that was the sex surgically reassigned to him. The environmental efforts of raising Reimer as a female rather than as his biological sex were the origin of his GID. Gender identity disorder (GID) has components of biological, emotional, cognitive, and behavioral components, which help in explaining why this disorder occurs. These components also overlap with one another.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Meyer, R., Chapman, L. K., & Weaver, C. M. (2009). Case studies in abnormal behavior. (8th ed.). Boston, MA: Pearson/Allyn & Bacon.

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