Sexual Disturbances in Children

According to DSM IV, gender identity disorder is defined as “ a strong and persistent identification of the self with another gender.”

A. In children, the disturbance is manifested by four ( or more ) of the following :

1. Repeatedly stated desire to be, or insistence that he or she is, the other sex.

2. In boys, preference for cross - dressing or simulating female attire;

in girls, insistence on wearing only stereotypical masculine clothing.

3. Strong and persistent preferences for cross - sex roles in make – believe play or

Persistent fantasies of being the other sex.

4. Intense desire to participate in the stereotypical games and pastimes of the other


5. Strong preferences for playmates of the other sex.

B. In children, the disturbance is manifested by any of the following :

- In boys, assertion that his penis or testes are disgusting or will disappear

or assertion that it will be better not to have a penis, or aversion toward

rough – and – tumble play and rejection of male stereotypical toys, games

and activities;

- In girls, rejection of urinating in the sitting position, assertion that she has

or will grow a penis, or assertion that she does not want to grow breasts

or menstruate, or marked aversion toward normative feminine clothing.

C. The disturbance is not concurrent with a physical intersex condition.

D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Sexual Disturbances: Where can they stem from?

In seeking the etiology of sexual disturbances which occur during childhood, we examine the various theoretical models underline these disorders

( psychoanalytic, biological, behavioral and cognitive ).

The traditional psychoanalytic explanation for paraphilias is that children are

functioning at an immature level of psychosexual development ( e.g. they are

fixated to an earlier stage of development ) and that they are still struggling with a

variety of basic conflicts. Therefore, psychoanalysis pays considerable

attention to postulated unconscious instinctual drives as well as to the separation

individuation process. The processes of separation and individuation begin

sometime after the physical separation of the inborn from the mother. Secure

attachment to the love object seems to inoculate the child against sexually deviant

behaviors, whereas anxious, ambivalent and avoidant attachment establishes a

predisposition nonintimate, nonconsensual and deviant sexual behaviors. Finally,

psychodynamic theorists attribute paraphilias to attempts to defend against

castration anxiety and to the melding of sexual and aggressive drives. Early

psychoanalytic formulations were largely derivative from Freud’s analysis

of psychodynamic factors in perversion. Freud himself argued that “ the child’s

sexuality is polymorphous perverse ” that is, undifferentiated and unintegrated,

motivated by “ partial instincts ” such as sexualized mouthing, looking, exposing,

dominating and being dominated.

The essential ingredient of any perverse act is the unconscious and imperative

need to pursue and experience sexual pleasure and orgastic release in a particular

manner or with a specific, particular object. This act expresses, in a distorted way,

repressed, forbidden impulses and usually brings temporary relief, either partial or

complete, from warring intrapsychic forces. The perverse mechanism for the relief

of unconscious conflict exists at any level of libidinal fixation and ego

development, from the most primitive to the more highly developed levels of

organization ( Socarides, 1990 ).

As far as the biological perspective is concerned, there is no clear physiological

explanation for paraphilias, but it is assumed that they stem from excessively

high sex drive. It is believed that males with paraphilias have higher than normal

levels of the male hormone testosterone. The underlying notion seems to be that

the high level of drive, somehow “ spills over ” into inappropriate sexual behavior

or drives the child to abnormal behavior. However, the data supporting this

explanation are very limited and inconsistent ( Holmes, 1994 ).

With regard to the behavioral standpoint, learning theorists stress models of

interaction for the acquisition of behavior. They attribute paraphilias to

classical conditioning, and they suggest that there is one way in which

conditioning can lead to paraphilias. It involves an accidental pairing of sexual

arousal with a particular object or activity. For example, a young boy may

experience sexual arousal while being punished. This pairing may lead to an

association between punishment and sexual arousal, which means that in the future

when the child is punished, he will experience sexual arousal, providing the

basis for the development of sexual masochism. It is interesting to mention here

how does the sexual arousal originally get paired with a nonsexual stimuli ( e.g.

punishment ). Since emotions such as anxiety, anger, amusement and sex result

in similar patterns of physiological arousal, it is assumed that arousal generated by

an emotion can be transferred and can provide the basis for another one ( relabeling

of the arousal ). This transfer of arousal across emotions is referred to as arousal

transference ( Holmes, 1994 ).

The basic notion of the cognitive perspective is that abnormal behavior results

from problems with cognitive content or disruptions in the thought processes. That

is, problems with cognitions lead to problems with behaviors. The erroneous

thoughts that lead to abnormal behavior result from problems in the way we

perceive, store, and retrieve information. As far as childhood psychopathology is

concerned however, there is no cognitive model that could give a specific

explanation ( Wenar, 1983 ).

* With an exception on homosexuality, DSM IV identifies seven types of paraphilias:

Compulsive masturbation,




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