DSM III and Psychosocial disorder in childhood.

DSM III and Psychosocial disorder in childhood. The Diagnostic and Statistical Manual of Mental Disorders Diagnostic and Statistical Manual of Mental Disorders/Di��ag��nos��tic and Sta��tis��ti��cal Man��u��al of Men��tal Dis��or��ders/ (DSM) a categorical system of classification of mental disorders, published by the American Psychiatric Association, that delineates objective , ThirdEdition (DSM-III), divides psychosexual psychosexual/psy��cho��sex��u��al/ (-sek��shoo-al) pertaining to the mental or emotional aspects of sex. psy��cho��sex��u��aladj.Of or relating to the mental and emotional aspects of sexuality. disorders into four groups.Gender identity disorders are characterized by the individual'sfeelings of discomfort with an inappropriateness about his or heranatomic sex and by persistent behaviors generally associated with theother sex. Paraphilias are characterized by arousal in response tosexual objects or situations that are not part of normative arousalactivity patterns and that, in varying degrees, may interfere with thecapacity for reciprocal affectionate sexual activity. Psychosexualdysfunctions are characterized by inhibitions in sexual desire or thepsychophysiological changes that characterize the sexual response cycle sexual response cyclePhysiology A term that encompasses the phases of a sexual act from prearousal to denouement; the SRC is divided into 4 phases. Cf Sexual dysfunction. .Finally, there is a residual class of other psychosexual disorders thathas two categories: ego dystonic ego dystonicPsychiatry adjective Referring to the aspects of a person's behavior, thoughts, and attitudes viewed as repugnant or inconsistent with the total personality. homosexuality and psychosexualdisorders not elsewhere classified. The only category specifically related to children is 302.60,Gender Identity Disorder Gender Identity DisorderDefinitionThe psychological diagnosis gender identity disorder (GID) is used to describe a male or female that feels a strong identification with the opposite sex and experiences considerable distress because of their actual of Childhood The diagnostic criteria for this category for females is: A. Strongly and persistently stated desire to be a boy orinsistence that she is a boy (not merely a desire for any perceivedcultural advantages from being a boy). B. Persistent repudiation of female anatomic structures, asmanifested by at least one of the following repeated assertions: 1. That she will grow up to become a man (not merely in role). 2. That she is biologically unable to become pregnant. 3. That she will not develop breasts. 4. That she has no vagina. 5. That she has or will grow a penis. C. Onset of the disturbance before puberty. The diagnostic criteria for males: A. Strongly and persistently stated desire to be a girl orinsistence that he is a girl. B. Either one or two. 1. Persistent repudiation of male anatomic structures as manifestedby at least one of the following repeated assertions: a. That he will grow up to become a woman (not merely in role). b. That his penis or testes are disgusting or will disappear. c. That it would be better not to have a penis or testes. 2. Preoccupation with female stereotypical activities, asmanifested by a preference for either cross-dressing or simulatingfemale attire or by a compelling desire to participate in the games andpastimes of girls. C. Onset of the disturbance before puberty. Paraphilias The essential feature of disorders in this sub-class is thatunusual or bizarre imagery or acts are necessary for sexual excitement.Such imagery or acts tend to be insistently and involuntarily repetitiveand generally involve either 1) preference for use of a non human objectfor sexual arousal, 2) repetitive sexual activity with humans involvingreal or simulated suffering or humiliation or 3) repetitive sexualactivity with non consenting partners. Since paraphilic imagery isnecessary for erotic arousal, it must be included in masturbatory mas��tur��ba��to��ry?adj.1. Of or relating to masturbation.2. Excessively self-indulgent or self-involved: "[The play's]star . . . orcoital co��i��tus?n.Sexual union between a male and a female involving insertion of the penis into the vagina.[Latin, from past participle of co fantasies if not actually acted out. In the absence of paraphilicimagery, there is no relief from erotic tension; and sexual excitementand/or orgasm is not attained. The imagery in a paraphilic fantasy(rape, S&M, bestiality BestialitySee also Perversion.AsteriusMinotaur born to Pasiphaë and Cretan Bull. [Gk. Myth.: Zimmerman, 34]Ledaraped by Zeus in form of swan. [Gk. Myth. , etc.) or the object of sexual excitement ina paraphilia paraphilia/para��phil��ia/ (par?ah-fil��e-ah) a psychosexual disorder marked by sexual urges, fantasies, and behavior involving objects, suffering or humiliation, or children or other nonconsenting partners. is frequently the stimulus for sexual excitement inindividuals without psychosexual disorder. Paraphilic imagery or the useof objects would be considered normative in childhood masturbationsexual patterns because of children's limited sexual knowledge andoptions. In that regard, fetish behavior is not included as a diagnosisin childhood. Before the onset of post pubescent pubescent/pu��bes��cent/ (pu-bes��int)1. arriving at the age of puberty.2. covered with down or lanugo.pu��bes��centadj.1. partner sex, thecriteria of "repeatedly preferred" (to partner sex) is notassessable; and when masturbation is the only sanctioned or availablesexual option, the use of inanimate objects to enhance the experience iscommon. When other options (partners) are sanctioned and available, the"exclusive or consistently preferred" use of inanimate objectsis considered a fetish. Although the age of onset The age of onset is a medical term referring to the age at which an individual acquires, develops, or first experiences a condition or symptoms of a disease or disorder.Diseases are often categorized by their ages of onset as congenital, infantile, juvenile, or adult. for fetishes is in childhood oradolescence, paraphilic attachments of childhood and adolescence mayrecede in their importance or degree of dependency when other sexualoptions become available. For example, the panty fetish (one of the mostcommon) may begin in childhood as a young boy stimulates himself withthoughts of, procurement of and masturbation with or into femalepanties pant��ieor pant��y ?n. pl. pant��iesShort underpants for women or children. Often used in the plural.[Diminutive of pant2. . However, the adult obsession with collecting panties for sexualuse, accompanied by diminished erotic response to partner sex, is notnecessarily the eventual result of this early childhood fixation. Theadult transition to gratifying partner sex may be smooth anduncomplicated, with childhood sexual patterns giving way to appropriateadult patterns as increasingly varied sexual options and opportunitiesbecome available. The adult male's interest in panties as a sexualstimulant may remain, but may become less important in the overall adultsex pattern. Fantasies about panties as a part of sexual arousal and/ormasturbation, the purchase of panties as a personal gift to the partner,requesting the partner to wear panties as a part of sexual foreplay foreplay/fore��play/ (for��pla) the sexually stimulating play preceding intercourse. fore��playn.The sexual stimulation that precedes intercourse. ,etc., may not be considered a fetish because it is not the consistentlypreferred, necessary or exclusive sexual pattern. Sometimes a young boy's erotization of panties leads him topublic behavior that is socially unacceptable. Stealing panties fromfamily members or from clotheslines and peeping, especially in thewindows of neighbors, may bring a child to the attention of the policeor mental health professionals; and treatment is required. The behavioris asocial a��so��cialadj.1. Avoiding or averse to the society of others; not sociable.2. Unable or unwilling to conform to normal standards of social behavior; antisocial. and may be obsessive, but the diagnosis of fetishism fetishism,in psychiatry, a paraphilia (see perversion, sexual) in which erotic interest and satisfaction are centered on an inanimate object or a specific, nongenital part of the anatomy. Generally occurring in males, fetishism frequently centers on a garment (e.g. is stillpremature: This and other asocial behavior such as public exposing ofgenitalia genitalia/gen��i��ta��lia/ (jen?i-tal��e-ah) [L.] the reproductive organs.ambiguous genitalia , may or may not be accompanied by a mental disorder; and adifferential diagnosis is imperative. Given the contradictory andconfusing way that Western culture handles sexual development, it iserroneous to assume that asocial sexual acts of children are vis-a-vischaracterological pathology. Psychosexual Dysfunctions Psychosexual dysfunctions, characterized by inhibitions in sexualdesire or the physiological changes that characterize the sexualresponse cycle, are undiagnosable in children, although there is reasonto assume that they may be manifest. There is no help for children whohave developmental sexual problems (e.g., arousal, orgasm, pain, guilt,low sensation, etc.). Lack of knowledge and misunderstanding is a majorproblem, and most children and adolescents worry about being normal.What is still lacking in any shape or form in childhood is an opendiscussion about sexual anxieties, sexual expectations, different sexualacts and feelings about sex. In one study, 33% of girls (14-18) were notsure if they had an orgasm because they had no idea what it was supposedto feel like. Most post pubescent adolescents masturbate mas��tur��batev.To perform an act of masturbation. , but themajority feel guilty, ashamed, dirty, stupid, embarrassed or abnormalafter the act (Hass, 1979). Although are no studies on sexual dysfunction in childhood,retrospective sex histories of adults and case histories of children inpsychotherapy suggest that all is not well. We have underestimated thesignificance of sexual interactions and fantasies in childhood. Until webetter understand the development of the erotic response throughchildhood and adolescence and until normative behavior gradients areestablished, children's sexual needs will not be properly addressedby the mental health community. Ego Dystonic Homosexuality Undesired homosexuality is undiagnosable in childhood. Althoughmany adult homosexuals retrospectively identify indications of theiradult orientation in childhood events, same-sex experimentation inchildhood is a common experience in the sex histories of heterosexualadults. It is well to remember that homosexuality is a behavior which isdependent on the preference of same-sex partners. The adolescentdiscovers and defines the elements of sexual attraction, unique andindividual to him/herself as an ongoing process of differentiation. Thehomosexual discovers that s/he is sexually excited by same-sex stimuliin the same way that the heterosexual discovers that s/he is excited byopposite sex stimuli; and within these categories, they both discovereven more specific attractants (e.g., body types, body parts, sex acts,positions, odors, words, etc.). It is possible for a homophobicadolescent to be disgusted with his or her feelings of attraction tosame-sex peers and to fear the consequences of a Gay life; however, egodystonic homosexuality would rarely be diagnosed before early adulthood.We have come to understand that even the most serious love affair with asame-sex partner may not be generalized to an ongoing same-sexattraction; thus, adolescence is too early to make a definitivediagnosis. The lack of child sex syndromes described in DSM 1. DSM - Data Structure Manager.An object-oriented language by J.E. Rumbaugh and M.E. Loomis of GE, similar to C++. It is used in implementation of CAD/CAE software. DSM is written in DSM and C and produces C as output. III does notmean that children and adolescents are free from sexual problems or thatclinicians are not consulted about the sexual behaviors of children andadolescents. Sexual problems of children, as seen on an out-patientbasis by mental or physical health care professionals, are usuallypublic or semi-public behaviors that cause adults (usually the parent)embarrassment and concern because they are a departure fromsociety's expectations. There are many sexual events and/orbehaviors that cause children to be referred for psychologicalevaluation. The parents' decision to seek professional consultationis the solution to their feelings of worry that the child is not normal,fear that if they don't intervene, the child will grow up to be asexually deviant adult, doubt that they have the knowledge or skill tochange the behavior pattern and guilt that they have caused orcontributed to the undesirable behavior. Gender Identity Disorder in Children with Normal Genitalia Gender Identity Disorder (GID 1. (operating system) gid - group identifier.2. (filename extension) gid - global index. ) is a persistent belief thatone's gender has been wrongly assigned and a persistent repudiationof one's assigned anatomical gender. In children, it is oftenconfused with homosexuality; and parents seek diagnosis and treatmentfor their child in response to symptoms of opposite sex mannerisms andbehavior. Their concerns include embarrassment to the family members,stigmatizing of the child and potential homosexuality. Actually, theadult manifestation of GID is transsexualism transsexualismSelf-identification with one sex by a person who has the external genitalia and secondary sexual characteristics of the other sex. Early in life, such a person adopts the behaviour characteristic of the opposite sex. , expressed as the feelingof being trapped in the body of the opposite sex. Gender Behavior Disorder Gender behavior disorder in children (mostly males) ischaracterized by cross gender or androgynous an��drog��y��nous?adj.1. Biology Having both female and male characteristics; hermaphroditic.2. Being neither distinguishably masculine nor feminine, as in dress, appearance, or behavior. behavior that is learnedand reinforced by the environment rather than being linked to apersistent belief that they are, in fact, the other sex. The adultmanifestation of GBD GBD Global Burden of DiseaseGBD Glass Break Detector (security systems)GBD Golden, Brown and DeliciousGBD Ground Branch DirectorGBD Global Burst DetectorGBD Generation BreakdownGBD Geometric Data Base is transvestism transvestism:see homosexuality. TransvestismKlinger, Cpl.dresses in women’s clothes to try to win discharge from the army. [Am. TV: M ° A ° S ° H in Terrace] and effeminate ef��fem��i��nate?adj.1. Having qualities or characteristics more often associated with women than men. See Synonyms at female.2. Characterized by weakness and excessive refinement. behavior. It isimportant to differentiate GID from GBD in the diagnostic process. Thechild who believes s/he is wrongly assigned suffers from chronic andsevere cognitive dissonance, whereas children who know their anatomicalgender but who enjoy androgynous behavior will suffer only if theenvironment is punitive and non supportive. Sexual reassignment ofchildren is considered only in cases of gender dysphoria or non-specificamorphous genital structure. A GID adult with normal genitalia mightrequest gender reassignment surgery Gender Reassignment SurgeryDefinitionAlso known as sex change surgery or sex reassignment surgery, gender reassignment surgery is a procedure that changes a person's external genital organs from those of one gender to those of the other. as a matter of choice. Excessive or Compulsive Masturbation Masturbation frequency is highly variable in an individual child,as well as between children. Although normative frequency data forspecific ages is unavailable, children are often referred to cliniciansfor excessive or compulsive masturbation. This is a subjectivequantification taken to mean that the child is preoccupied withmasturbatory activity to the exclusion of other age appropriate pursuitsand/or that the scope of the masturbation activity is resulting instigmatizing censure from others that may create secondary adjustmentproblems for the child. Sexologists believe that masturbation is a viable sexual activitythroughout the life span and that it need not be considered a poor postpubescent substitute for sex with a partner. Research in femalesexuality (Hite, 1976) and the treatment of anorgasmia anorgasmia/an��or��gas��mia/ (an?or-gaz��me-ah) inability or failure to experience orgasm.anorgas��mic in adult women(Barbach, 1975; Chapman, 1977; Dodson, 1974) suggest that masturbationto orgasm is an important developmental step and possibly, aprerequisite to becoming reliably orgasmic in adult partner sex. It isoften a treatment of choice for male and female sexual dysfunction(Kaplan, 1979) and is reported as a childhood activity of someimportance by most adults (Hass, 1979; Hite, 1976, 1978; Kinsey, 1948,1953). Sexologists suggest that young boys be encouraged to prolong thearousal stage of their masturbation so as not to condition a rapidstimulus response bond between erection and ejaculation ejaculation/ejac��u��la��tion/ (e-jak?u-la��shun) forcible, sudden expulsion; especially expulsion of semen from the male urethra. . Young girlsshould be encouraged to look at and identify their external genitaliaand to connect their erotic feelings and sexual response cycle toappropriate genital body parts along with others they might alreadyhave. Parents need to understand that childhood masturbation is a normaland beneficial behavior that needs to be managed to coincide with socialetiquette. Precocious Sexual Interest and Behavior Clinicians are often consulted by parents who are anxious abouttheir child's interest in sexual topics, masturbation or sex playwith siblings and peers. If the child's basic interest in sex iscomplimented by unsupervised opportunity to engage in trial-and-errorlearning with a partner, sexual rehearsal play is predictable. Somesexologists suggest that not only is sexual rehearsal play quitepredictable in children, it is advisable and should be encouraged inorder to forestall adult sexual problems (Money, 1975; Yates, 1978). Intense and continued or intermittent sexual interest in childrenshould be accommodated as any other interest would be. Age appropriatebooks and conversations with parents endorse the child's curiosityabout this important part of life and encourage an open and unashamed un��a��shamed?adj.Feeling or showing no remorse, shame, or embarrassment:una��sham quest for sexual knowledge. In contrast, a child who shows littleinterest or curiosity about sex should not be overwhelmed with sexinformation by over-zealous parents. Some children personalize theirsexuality very early and are uncomfortable with candid sexconversations. They appreciate appropriate sex materials to be used inprivate and occasional one-on-one talks with a parent to clear up anytroublesome sexual ideas or feelings. A few parents may worry about achild with low sex interest, but lack of sex interest is more oftenconsidered normal in children. Of greater concern is the child who isvery public with sex talk and sex play, masturbation with self or withpeers. Parents are concerned that the child is abnormal genetically orhormonally, that s/he will be censured by other adults and children,that his/her sexual behavior will reflect badly on siblings and family,that s/he will be a target for sexual abuse or exploitation by adults orthat s/he will grow up to be promiscuous or perverted. Three-year old D was a highly sexed boy who had been involved insex play with age mates and an older child. He asked his therapist ifshe wanted to put her mouth on his "dinky." When she repliedin the negative, he pleaded "you'll like it,""I'll pay you money," "I'll be your bestfriend." When asked if he liked to "play dinky," hefrowned menacingly, clenched clench?tr.v. clenched, clench��ing, clench��es1. To close tightly: clench one's teeth; clenched my fists in anger.2. his fists and aggressively replied,"yes, I like it, and I'm not going to stop!" Children who are pseudo-mature in any sense are special childrenwith special needs. They demand more from parents and may be considereda blessing or a curse, depending on the value system and resources ofthe parents. Intellectual genius, superior athletic potential andexceptional musical talent are all considered valuable gifts that shouldnot be wasted. The child who is sexually precocious in development orinterest is, in contrast, shunned and pitied. The parents of thesechildren need help, not only in the management of the child'sbehavior, but also in considering that precocity in this area need notbe thought of as an affliction. Children Who Report Sexual Contact with an Adult Which Cannot BeSubstantiated Psychological literature and the popular press report and oftensensationalize sen��sa��tion��al��ize?tr.v. sen��sa��tion��al��ized, sen��sa��tion��al��iz��ing, sen��sa��tion��al��iz��esTo cast and present in a manner intended to arouse strong interest, especially through inclusion of exaggerated or lurid details: the plight of the traumatized child whose story of sexualactivity with an adult is not believed and, conversely, of thevictimized adult who steadfastly denies the sexual accusations of achild. The most commonly reported pedophilic situation is that of theadult male and the prepubescent prepubescent/pre��pu��bes��cent/ (pre?pu-bes��ent) prepubertal. pre��pu��bes��centadj.Of or characteristic of prepuberty.n.A prepubescent child. female. This is not to say that sexbetween an adult female and a prepubescent male does not occur, but itwould probably not be reported; and if it were, it would probably not beconsidered a traumatic experience for the child. In Western culture, there is a time-honored tradition of young boysbeing sexually initiated by an experienced older woman. Girls, incontrast, are considered permanently damaged by early sexual initiationby an adult male. The society's attitude that the child has beendamaged by a sexual experience is extended to boys only if the sexualencounter is homosexual or if residual physical damage is sustained.Sexual behavior between an adult female and a female child is the leastreported pedophilic possibility and is of least interest to lawenforcement and the community at large. It is difficult to generalize about adult/child sex because of thevariability of age and sex in any individual case. It is important tonote that if the sexual encounter occurred and if it was traumatic forthe child, the diagnostic process with a clinical child sexologist istherapeutic. Psychotherapy consists of talking about traumaticsituations in order to bring the experience into cognitive awareness andto work through the feelings engendered by the event. Properly handled,a sexual trauma is no exception to this process. A client is ill servedby a therapist who feels that the child has been permanently damaged bythe experience and relates to him/her as a victim. Many adult women have reported satisfying non traumaticprepubescent incestuous in��ces��tu��ousadj.1. Of, involving, or suggestive of incest.2. Having committed incest. relationships from which they graduated to postpubescent sex with peers without undue incident. In contrast, manypatients in psychotherapy report unresolved conflicts in associationwith childhood sexual experiences; and there is some evidence to suggestthat the greater the age differential between participants, the greaterthe potential for trauma. It is important to note that most reportedpedophilic sex is incestuous and that incest is a family rather than anindividual pathology. Post-pubescent Sex with a Partner, Heterosexual Sexologists have attempted to deal with the question of sexualreadiness in terms of chronological age; and there is a reasonableconsensus that around the age of 16, adolescents are physiologically andpsychologically ready. The older adolescent is interested in formingprimary relationships outside the nuclear family, and sexual sharing isan integral part of these relationships. Sexuality is a major concern of adolescence; and in that regard,adolescents are poorly served by the professional community, the family,the school and the culture (Hass, 1979). The professional mental health worker sees a small fraction ofadolescents and may or may not address sexual issues. Family membershave little credibility in sexuality if the foundation was notaccomplished in childhood. The school is still concentrating onreproductive biology and venereal disease, while the adolescent needshelp with socio-sexual issues. The culture simultaneously stimulates andmisinforms, encourages and prohibits, punishes and rewards theadolescent for sexual interest and behavior. The revered notion that sex is natural, happening with style,sensitivity and spirituality when two people love each other, is a myththat significantly departs from most reported first encounters. It doeshowever, perpetuate a rationale for those who oppose real sex educationand dooms the teenager who is misinformed by the exploitive messages ofthe marketplace. Post-pubescent Sex with a Partner, Homosexual Increasingly, counselors and therapists are consulted when parentssuspect or know that their adolescent is in love with a person of thesame sex. Even though societal attitudes are relaxing and homosexualityis no longer a disease category in the APA (All Points Addressable) Refers to an array (bitmapped screen, matrix, etc.) in which all bits or cells can be individually manipulated. APA - Application Portability Architecture DSM-III, for the individualfamily, it is a major trauma. Professional consultation is sought by theparent with the initial purpose of curing the errant behavior, but thefamily system is the actual patient or client. Both parents and childneed to know that a same-sex love affair does not automatically meanthat either participant has a homosexual orientation or that aheterosexual love affair guarantees a heterosexual orientation. It maybe that the love object happens to be of the same sex, but the lovefeelings are unique to that individual and may not be generalized toothers of the same sex. Perhaps a bisexual resolution will occur, witheither or both sexes being available as primary partners throughout aspecific life phase or across the life span. Additionally, the firstsame-sex love may be the expression of an exclusively homosexual lifepattern to come. It is well to keep in mind that the child is doing whatcomes naturally. Children experience their erotic and love feelings inassociation with certain people and events and not in association withother people and events. Occasionally, an adolescent will seek consultation about homosexualfeelings or experiences without parental knowledge. A few adolescentsare totally unaccepting of homosexuality and are repulsed by anysame-sex attraction they might feel. They are traumatized by a same-sexapproach or experience, even though they may have been a willingparticipant. They seek professional help to get rid of whatever iscausing their attraction to and by members of the same sex. Most parents fervently hope that their child's same-sexpreference is a phase they are passing through, and they are unwillingto disown dis��own?tr.v. dis��owned, dis��own��ing, dis��ownsTo refuse to acknowledge or accept as one's own; repudiate.disownVerbto deny any connection with (someone)Verb their homosexual child. Some families or individual familymembers may be unwilling or incapable of accepting homosexuality, thusprecipitating the Gay adolescent's premature emancipation fromfamily. Sexual Concerns of the Physically and Mentally Disabled The myth of the sexual innocence of childhood is most secure in thehomes of the disabled child. Close parental supervision, limitedautonomy with peers, identity as a physically disabled child or childwith special needs and rejection by peers as a potential sex partner allcontribute to the negation of sexuality of the physically or mentallydisabled child. Disabled children have sexual curiosity and sexualfeelings. Despite the conspiracy of silence Noun 1. conspiracy of silence - a conspiracy not to talk about some situation or event; "there was a conspiracy of silence about police brutality"conspiracy, confederacy - a secret agreement between two or more people to perform an unlawful act , they need basic sexualknowledge and information regarding how they can be sexual, given theirspecific limitations. As adolescents, they need opportunities toexperience their sexual response cycle, to learn what their individualsexual limitations and abilities are and perhaps, more importantly, howto negotiate for sex with a partner, especially the orthopedicallyhandicapped, who are assumed to be incapable of being sexual by most nondisabled people. A physically healthy child with mental retardation poses anothertype of problem. They may be quite normal in physical and sexualdevelopment and as an adolescent, may be attractive enough to beselected as a potential sex partner by a peer or an adult. Impairedmental function may, however, disallow To exclude; reject; deny the force or validity of.The term disallow is applied to such things as an insurance company's refusal to pay a claim. good judgment in sexualsituations. Their own sexual desire, coupled with this lack ofdiscrimination, makes them an easy target for sexual exploitation. Thementally retarded child needs explicit sex education; reinforced,plainly stated rules about socio-sexual conduct; adequate supervisionand effective birth control at the appropriate age. Families of disabled adolescents who live at home and caretakers ofinstitutionalized teens, need to facilitate the sexual opportunities oftheir charges. Even if s/he can acquire potential partners, the disabledadolescent needs a safe place, privacy and, perhaps, some physicalassistance to have a successful sexual experience. The issues of birthcontrol and paid partners are complicated for adolescents or youngadults in institutions or on public assistance, as charges for theseservices are not reimbursable by third party payers. As a society, bydefault, we have decided that the disabled shall not have sex lives. Theadvocacy groups for individuals with special needs have not provided ordemanded sexual equality and sexual rights, which, for many disabledpeople, are as important as access to public buildings or the SpecialOlympics. Sexual Guilt as a Factor in the Treatment of the Hospitalized Child Psychological services for the child hospitalized on the medical orsurgical ward have become standard practice in many hospitals. In bothroutine ward service and psychological referrals, the alleviation ofsexual guilt with regard to masturbation is often a significant factorin the understanding and treatment of the physical illness. From theconcrete thinking of the young child to the maturing moralism mor��al��ism?n.1. A conventional moral maxim or attitude.2. The act or practice of moralizing.3. Often undue concern for morality. of theteenager, the cause-and-effect rationale is predominant. The simplistic sim��plism?n.The tendency to oversimplify an issue or a problem by ignoring complexities or complications.[French simplisme, from simple, simple, from Old French; see simple link from bad thoughts to bad deeds usually includes the forbiddensexual behaviors. A frank discussion about masturbation, what it is andwhat it isn't, allows the therapist to assuage as��suage?tr.v. as��suaged, as��suag��ing, as��suag��es1. To make (something burdensome or painful) less intense or severe: assuage her grief.See Synonyms at relieve.2. the child'sguilt about masturbation, to demythologize de��my��thol��o��gize?tr.v. de��my��thol��o��gized, de��my��thol��o��giz��ing, de��my��thol��o��giz��es1. To rid of mythological elements in order to discover the underlying meaning: and disconnect sexualbehavior as the cause of the injury or illness, to impart accurateinformation and to give permission for continued masturbatory behaviorin the hospital, helps to facilitate trust in the therapist about thesepersonal concerns and others (e.g., recovery, abandonment, death, etc.). Most adults are ambivalent about children's masturbation.Medical and hospital personnel may need some help in understanding thepurpose of dealing with masturbation when health concerns are primary.Masturbation is an effective tension- and anxiety reducer in childrenand adults, and it is self affirming. It is an activity that reclaimsthe body and offsets intrusive hospital procedures. The cessation of aregular masturbation pattern constitutes an unnecessary deprivation andadded stress to an already stressful situation. Child Prostitution and Kiddie Porn The exploitation of children is an anathema in our humanitariansociety. We have laws to protect children from unscrupulous adults;however, there is a societal reluctance to intrude on the autonomy ofthe nuclear family. The campaign for the recognition of the batteredchild as a syndrome of ongoing abuse was hard-fought in the 1960s. Noone wanted to believe or admit that it was a widespread phenomenon thathad crossed all educational, socioeconomic, racial, ethnic and religiouslines. Child prostitution and kiddie porn are similarly societal problemsthat adults are trying hard not to address. Runaways who become streetchildren, with no jobs (many are too young to work legally), no money,no shelter, etc., quickly learn that they have only one negotiablecommodity--their sexuality. Male or female, they can sell their bodiesto adult men. Although the ranks of street children relegated toprostitution and other forms of sexual exploitation grow consistently,some children are encouraged by a parent into prostitution to augmentthe family income and upgrade the standard of living of mother andsiblings. These children are usually female, living with a mother as asingle parent. Girls in this situation are more apt to come to theattention of authorities and be referred for evaluation and therapy thanstreet children, who are rarely seen professionally. Any individual canbe psychologically evaluated and can benefit from the self-knowledgegained in psychotherapy; however, child prostitution and kiddie porn arebroad spectrum societal problems that will not be alleviated byindividual psychotherapy. Other Symptoms of Sexual Significance Peeping Toms, stealing underwear and sex with animals are asocialand illegal activities which may be transient attempts to satisfy childor adolescent sexual curiosity, or they may be the development ofaberrant patterns of voyeurism VoyeurismSee also Eavesdropping.Actaeonturned into stag for watching Artemis bathe. [Gk. Myth.: Leach, 8]elders of Babylonwatch Susanna bathe. , fetishism and bestiality. The behaviormay be in response to a lack of knowledge or an expression of underlyingpsychopathology psychopathology/psy��cho��pa��thol��o��gy/ (-pah-thol��ah-je)1. the branch of medicine dealing with the causes and processes of mental disorders.2. abnormal, maladaptive behavior or mental activity. . It is helpful to the child if the differentialdiagnosis is made by a therapist who doesn't over-react to thesymptoms. It is well to remember that society's messages about sexare contradictory and confusing to children and adolescents. Whether theresultant dissonance is expressed as private worry, fear and doubt orerupts into public behavior, children are well served by accurateinformation, endorsement of the normalcy of sexual feelings and desires,their right to be sexual and an opportunity to learn culturallyacceptable socio-sexual behavior and skills. REFERENCES Barback, Lonnie G. (1975). For Yourself. NY, NY: Doubleday &Co. Inc. Chapman, J. Dudley (1977). The Sexual Equation. NY, NY:Philosopical Library. DeMause, Lloyd (1974). The History of Childhood. NY, NY:Psychohistory psy��cho��his��to��ry?n. pl. psy��cho��his��to��riesA psychological or psychoanalytic interpretation or study of historical events or persons: the psychohistory of the Nazi era. Press. Dodson, Betty (1974). Sex for One. NY, NY: Random House, Inc. Farson, Richard E. (1974). Birthrights. NY, NY: McMillianPublishing Co. Ford, Clellan S., & Beach, Frank A. (1951). Patterns of SexualBehavior. Harper & Brothers Publishers. Hamilton, Eleanor (1978). Sex, With Love. Boston, MA: Beacon Press. Hass, Arron (1979). Teenage Sexuality. NY, NY: McMillian PublishingCo. Hite, Shere (1976). The Hite Report. NY, NY: McMillian PublishingCo. Hite, Shere (1978). The Hite Report on Male Sexuality. NY, NY:Alfred A. Knopf. Kaplan, Helen Singer (1979). Disorders of Sexual Desire. NY, NY:Brunner/Mazel Publishing. Kinsey, Alfred C., Pomeroy, Wardell B., & Martin, Clyde E.(1948). Sexual Behavior in the Human Male. Philadelphia: W.B. SaundersCo. Kinsey, Alfred C., Pomeroy, Wardell B., Martin, Clyde E., &Gebhard, Paul H. (1953). Sexual Behavior in the Human Female.Philadelphia: W.B. Saunders Co. Money, John, & Tucker, Patricia (1975). Sexual Signatures: OnBeing a Man or Woman. Boston: Little Brown. Spitz spitzAny of several northern dogs, including the chow chow, Pomeranian, and Samoyed, characterized by a dense, long coat, erect pointed ears, and a tail that curves over the back. In the U.S. , Rene A. (1952). Authority & Masturbation: Some remarkson a bibliographical investigation. Psychoanalytic Quarterly, 21,490-527. Yates, Alayne (1978). Sex Without Shame: Encouraging theChild's Healthy Sexual Development. NY, NY: William Morrow &Co.