NURS 6670: Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults | Week 11

I have been under a lot of stress lately. Between my job, the house and kids, and my wife complaining, I don’t seem to have the “staying power” I used to. Our sex life used to be perfect, but now I cannot perform as well or as often as I used to. My wife does not seem to understand and now I am feeling inadequate. I have a long life in front of me and I don’t want to live without feeling like a true man.”

Larry, age 40

This week’s topics include gender dysphoria, paraphilic disorders, and sexual dysfunction. The term gender dysphoria is the diagnosis describing those persons who experience incongruence between their gender assigned at birth and their experienced gender. Paraphilic disorders include pedophilia, exhibitionism, fetishism, and voyeurism, for example. Sexual dysfunction disorders include, most commonly, male erectile disorder, female orgasmic disorder, and other disorders. These diagnoses may be treated with pharmacologic and psychotherapy modalities.

This week, you will explore ways to assess and care for persons with gender dysphoria, paraphilic disorders, and sexual dysfunction disorders as outlined in the DSM-5.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

• Standard 16 “Environmental Health” (pages 84-85)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 17, “Human Sexuality and Sexual Dysfunctions” (pp. 564–599)
• Chapter 18, “Gender Dysphoria” (pp. 600–607)

Note: This is review from the Learning Resource in Week 3.

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

• Chapter 37, “Sexual Dysfunctions”
• Chapter 38, “Paraphilias and Paraphilic Disorders”
• Chapter 39, “Gender Dysphoria”

Note: You will access this book from the Walden Library databases.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Gender Dysphoria”
• “Paraphilic Disorders”
• “Sexual Dysfunctions”

Note: You will access this book from the Walden Library databases.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Note: All Stahl resources can be accessed through the Walden Library using the link below. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

To access information on specific medications, click on The Prescriber’s Guide, 5^th Ed. tab on the Stahl Online website and select the appropriate medication.

Johnson, L., Shipherd, J., & Walton, H. M. (2016). The psychologist’s role in transgender-specific care with U.S. veterans. Psychological Services, 13(1), 69–76. doi:10.1037/ser0000030

Note: You will access this article through the Walden Library databases.

Levenson, J. S., & Grady, M. D. (2016). The influence of childhood trauma on sexual violence and sexual deviance in adulthood. Traumatology, 22(2), 94–103. doi:10.1037/trm0000067

Note: You will access this article through the Walden Library databases.

Hawes, S. W., Boccaccini, M. T., & Murrie, D. C. (2013). Psychopathy and the combination of psychopathy and sexual deviance as predictors of sexual recidivism: Meta-analytic findings using the Psychopathy Checklist—Revised. Psychological Assessment, 25(1), 233–243. doi:10.1037/a0030391

Note: You will access this article through the Walden Library databases.

Required Media – NURS 6670:Week 11: Gender Dysphoria, Paraphilic Disorders, and Sexual Dysfunction

Johnson, S. (Producer). (n.d.). Emotionally focused therapy with same-sex couples [Video file]. Mill Valley, CA: Psychotherapy.net.

Note: You will access this video through the Walden Library databases.

Discussion: Assessment and Treatment of Gender Dysphoria, Paraphilic Disorders, and Sexual Dysfunction

Sexuality is an important part of each person’s quality of life. Research indicates that awareness of sexual identity and its importance may begin as early as age 3. However, individuals with varying diagnoses, disorders, or dysfunctions may grapple with issues related to their sexuality in their teen years, as well as into adulthood.

In this Discussion, you will explore the assessment and treatment of gender dysphoria, paraphilic disorders, and sexual dysfunction.

Learning Objectives

Students will:

• Analyze diagnostic criteria for gender dysphoria, paraphilic disorders and sexual dysfunction
• Analyze evidence-based psychotherapy and psychopharmacologic treatments for gender/sexual disorders
• Compare differential diagnostic features of gender/sexual disorders

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!

To prepare for this Discussion:

• Select a gender dysphoria, paraphilic disorder, or sexual dysfunction that interests you.
• Review the Learning Resources.

By Day 3

Post:

• Explain the diagnostic criteria for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected.
• Explain the evidenced-based psychotherapy and psychopharmacologic treatment for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected.
• Support your rationale with references to the Learning Resources or other academic resource.

By Day 6

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you selected to the diagnostic features of the disorder your colleag

Assignment: Final Exam

This exam is designed to assess how well you have synthesized the information from all your PMHNP courses. It draws upon the material from all the textbooks from NURS 6630, NURS 6640, NURS 6670, NURS 6660, and NURS 6670. It is very similar to what you will experience in your certification exam.

Learning Objectives

Students will:

• Assess knowledge of adult and older adult psychotherapy concepts and principles (E)

This exam will cover the following topics:

• Obsessive-Compulsive Disorders
• Neurocognitive Disorders
• Schizophrenia Spectrum and Other Psychotic Disorders
• Sleep/Wake Disorders, Parasomnias
• Gender Dysphoria, Paraphilic Disorders, & Sexual Dysfunction

By Day 7

Complete the Final Exam by. Prior to starting the exam, you should review all of your materials. There is a 2-hour time limit to complete this 75-question exam. You may only attempt this exam once.

This exam is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.

NURS 6670:Week 11: Gender Dysphoria, Paraphilic Disorders, and Sexual Dysfunction

ADDITIONAL INFORMATION 

Gender Dysphoria, Paraphilic Disorders, and Sexual Dysfunction

Introduction

Gender dysphoria is a distressful condition that can affect anyone, regardless of age, gender identity or sexual orientation. People who experience this may have a persistent sense of being trapped in the wrong body. In addition to experiencing distress, those with gender dysphoria may also experience depression and anxiety. Paraphilic disorders are illnesses that involve unusual sexual behaviors or fantasies but don’t meet diagnostic criteria for a mental disorder such as schizophrenia or bipolar disorder (which includes manic depression).

Diagnostic Considerations

Gender dysphoria is a persistent and intense distress with one’s assigned sex, accompanied by the desire to be of a different gender. The distress must not be due to any physical intersex condition. It must also be accompanied by clinically significant distress or impairment in social, academic, or occupational functioning.

The person has experienced the distress for at least 6 months; it is continuous; and it results in marked subjective suffering that cannot be attributed entirely to another mental disorder, such as depression or anxiety disorder (American Psychiatric Association [APA], 2013).

Gender Dysphoria

Gender dysphoria is a condition in which a person experiences distress because of a mismatch between their gender identity and their assigned sex. In other words, you might have gender dysphoria if you believe that your gender is different from the one assigned at birth.

Gender nonconformity (also called gender nonconformity or cross-gender identification) refers to the desire for someone’s behavior to be more congruent with their core self image as opposed to society’s norms; this can include dressing up in attire traditionally associated with another sex, but it does not necessarily lead people into transition or surgery (although it does sometimes).

Paraphilic Disorders

Paraphilic disorders are diagnosed when a person experiences distress or impaired functioning as a result of recurrent intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, or situations.

These disorders include paraphilias (exhibitionism and voyeurism), transvestic disorder (cross-dressing), fetishism/fetishistic transvestic disorder (cross-dressing), and orgasms from pain.

Sexual Dysfunction

Sexual dysfunction is defined as a problem that interferes with the ability to have or enjoy sex. Sexual dysfunction can have many causes, including stress, relationship problems, depression, and anxiety.

Some of the common sexual dysfunctions are:

• Difficulty reaching orgasm (orgasmic disorder)

• Pain during intercourse or lack of pleasure during penetration (dyspareunia)

• Problems getting an erection (impotence)

Conclusion

It is important to be aware of these issues and make sure you are getting the care that you need for your mental health. Hopefully, this article has given you some information about what gender dysphoria is and how to recognize it in yourself or a loved one. In addition, we hope that it has provided some insight into the other conditions that may contribute to sexual dysfunction among transgender people.