To meet the criteria for a DSM-IV-TR sexual dysfunction disorder, a disturbance must cause distress or interpersonal diffi culty.

It cannot be
due to another Axis I Disorder (e.g., mood or anxiety disorders), the physiological effects of a substance (e.g., medication, psychoactive
drugs), or a general medical condition. Each disorder can be subtyped as lifelong or acquired, generalized (occurring in all situations) or
situational, and due to psychological factors or due to both biological and psychological factors.
TABLE 13.5 DSM-IV-TR Criteria for a Diagnosis of Gender Identity Disorder
Sexual Desire Disorders Description People with gender identity disorder believe they were born with the wrong sexs genitals and are truly members of the other sex.
Hypoactive sexual desire disorder Recurrent lack of sexual fantasies and desire for sexual activity A. Strong and persistent identification with the other sex. In children, this is manifested by four or more of the following:
Recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual 1. Repeatedly stated desire to be, or insistence that he or she is, the other sex
Sexual aversion disorder 2. In boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypic masculine clothing
contact with a sexual partner
3. Strong and persistent preferences for cross-sex roles in play and in fantasies
4. Intense desire to participate in the stereotypic games and pastimes of the other sex
Sexual Arousal Disorders Description 5. Strong preference for playmates of the other sex In adolescents or adults, identification with the other sex may be manifested with symptoms
Recurrent inability to attain, or to maintain until completion of the sexual activity, an such as the stated desire to be the other sex, frequently passing as the other sex, desire to live or be treated as the other sex, or the conviction that
Female sexual arousal disorder
adequate lubrication-swelling response of sexual excitement he or she has the typical feelings or reactions of the other sex.
Recurrent inability to attain, or to maintain until completion of the sexual activity, an B. Persistent discomfort with his or her sex and sense of inappropriateness in the gender role of that sex.
Male erectile disorder
adequate lubrication-swelling response of sexual excitement C. Disturbance is not concurrent with a physical intersex condition and causes significant distress or problems in functioning.
TABLE 12.1 DSM-IV-TR Diagnostic Criteria for Anorexia Nervosa
Orgasmic Disorders Description The DSM-IV-TR specifies that both intentional extreme weight loss and distorted thoughts about ones body are key features of anorexia nervosa.
Female orgasmic disorder Recurrent delay in, or absence of, orgasm following normal sexual excitement phase A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to a weight at least 15
Male orgasmic disorder Recurrent delay in, or absence of, orgasm following normal sexual excitement phase percent below minimum healthy body weight, or failure to make expected weight gain during a period of growth, resulting in a weight at least 15
percent below minimum healthy body weight).
Recurrent ejaculation with minimal sexual stimulation before, on, or shortly after
Premature ejaculation B. Intense fear of gaining weight or becoming fat, despite being underweight.
penetration and before the person wishes it C. Distortions in the perception of ones body weight or shape, undue influence of body weight or shape on self-evaluation, or denial of the
seriousness of the current low body weight.
Sexual Pain Disorders Description D. In females who have reached menarche, amenorrhea (absence of at least three consecutive menstrual cycles).
Dyspareunia Recurrent genital pain associated with sexual intercourse in either a male or a female TABLE 12.3 DSM-IV-TR Diagnostic Criteria for Bulimia Nervosa
In women, involuntary contractions of the muscles surrounding the vagina, which People with bulimia nervosa regularly binge eat and then attempt to avoid gaining weight from their binge.
Vaginismus interfere A. Recurrent episodes of binge eating, characterized by both of the following:
with sexual functioning 1. Eating, in a discrete period of time (such as within a 2-hour period), an amount of food that is definitely larger than most people would eat during
a similar period of time and under similar circumstances
TABLE 13.3 DSM-IV-TR Paraphilias 2. A sense of lack of control over eating during the episode
B. Recurrent inappropriate behaviors to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other
The paraphilias involve recurrent, intense sexually arousing fantasies, sexual urges, or behaviors medications; fasting; or excessive exercise.
involving (1) nonliving objects, (2) nonconsenting adults, (3) suffering or the humiliation of the C. The binge eating and inappropriate purging behaviors both occur, on average, at least twice a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
person or the persons partner, or (4) children. The fantasies, urges, or behaviors must be present for
TABLE 12.4 DSM-IV-TR Criteria for Binge-Eating Disorder
at least 6 months and must cause clinically significant distress or impairment in social, occupational, A. Recurrent episodes of binge eating that occur in a discrete period of time (within 2 hours) and a sense of loss of control during the eating.
or other important areas of functioning. A diagnosis of sexual sadism, pedophilia, exhibitionism, B. The binge episodes are associated with three or more of the following:
1. Eating more rapidly than normal
voyeurism, or frotteurism is made if the individual has acted on the urges or fantasies, even if the 2. Eating until feeling uncomfortably full
action does not cause distress or impairment. 3. Eating large amounts of food when not hungry
Diagnosis Object of Fantasies, Urges, or Behaviors 4. Eating alone due to embarrassment or guilt
5. Eating amounts that lead to feeling disgusted, depressed, and very guilty
Fetishism Nonliving objects (e.g., female undergarments)
C. Marked distress regarding binge eating is present.
Transvestic fetishism Cross-dressing D. Binge eating occurs at least 2 days a week for a 6-month period
Acts (real, not simulated) in which the psychological or physical suffering E. The binge eating is not associated with the regular use of in - appropriate compensatory behaviors, such as purging, fasting, or excessive exercise,
Sexual sadism
(including humiliation) of the victim is sexually exciting to the person and does not occur exclusively during the course of anorexia or bulimia nervosa.
Sexual masochism Acts (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer TABLE 12.5 Examples of Eating Disorders Not Otherwise Specifi ed (EDNOS)
The act of observing an unsuspecting person who is naked, in the process In these examples, the behaviors do not meet the full criteria for anorexia nervosa or bulimia nervosa but may be given a diagnosis of eating
Voyeurism
of undressing, or engaged in sexual activity disorders not otherwise specifi ed (EDNOS).
Exhibitionism Exposure of ones genitals to an unsuspecting stranger 1. For females, all of the criteria for anorexia nervosa are met except that the individual has regular menses.
Frotteurism Touching and rubbing against a nonconsenting person 2. All of the criteria for anorexia nervosa are met except that, despite signifi cant weight loss, the individuals current weight is in the normal range.
Sexual activity with a prepubescent child or children (generally age 13 years 3. All of the criteria for bulimia nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of
or younger) less than twice a week or for a duration of less than 3 months.
Pedophilia 4. The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-
Note: The person must be at least age 16 years and at least 5 years older than
induced vomiting after the consumption of two cookies).
the target child or children.
5. Repeatedly chewing and spitting out, but not swallowing, large amounts of food.