Psychosexual disorder

Psychosexual disorder is a sexual problem that is psychological, rather than physiological in origin.

The causes of a psychosexual disorder can lie in feelings of guilt, stress, nervousness, fear, anxiety, or in previous emotional or physical trauma. Other factors based on psychosocial and cultural aspects, such as ignorance or improper sex education, conflicts of values to do with family or religion (for example, the attitude that sex is dirty or sinful) can also be a cause of psychosexual disorder symptoms.

There are three main categories of psychosexual disorder: sexual dysfunction, paraphilias and gender identity disorders.

Sexual dysfunction is characterised by a lack of sexual desire, erectile dysfunction, premature ejaculation, painful sex, lack of sexual enjoyment, sexual addiction and sexual aversion.

Paraphilias is unusual or abnormal sexual behaviour, including sexual attraction to unusual objects or activity, such as fetishism, exhibitionism, sadism and voyeurism, amongst others.

Exhibitionism is the impulsive behavior of exposing the genitalia to unsuspecting strangers in order to achieve sexual excitation.

Transvestism consists of recurrent cross-dressing behavior for the purpose of sexual excitation.

Voyeurism involves the achievement of sexual arousal by watching the activities of an unsuspecting person, usually in various stages of undress or sexual activity.

Pedophilia is the use of a child of either sex to achieve sexual arousal and, in many cases, gratification.

Incest involves a sexual relationship with a person in the immediate family, most frequently a child.

Sexual sadism is the attainment of sexual arousal by inflicting pain upon the sexual object. Sexual masochism is the achievement of erotic pleasure by being humiliated, enslaved, physically bound, and restrained.

Gender identity disorders manifest as a variation between a person’s biological sexual identity and their own sense of sexual identity, causing difficulties in adjusting to a normal lifestyle and a desire to alter sexual orientation by becoming a member of the opposite sex.

In the DSM-5 all paraphilia disorders can be diagnosed by two main criteria that are referred to criteria A and criteria B respectively. The A and B criteria include a duration in which the behavior must be present for (typically six months) and specific details of actions or thoughts that are correlated specifically with the respective disorder being diagnosed.

Once the nature and characteristics of the problem have been identified, a personalised treatment plan for the patient can be agreed. This may include psychotherapy which can help establish ways to deal with stressful or painful issues, or behavioural therapy such as CBT (Cognitive Behavioural Therapy) which is used to help ‘unlearn’ automatic behaviours displayed in specific situations. Often a combination of these will be used to help the patient overcome their psychosexual issues.