Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Psychosexual Disorders


Related Terms

  • Exhibitionism
  • Female Sexual Arousal Disorder
  • Fetishism
  • Frotteurism
  • Gender Identity Disorder
  • Hypoactive Sexual Desire Disorder
  • Male Erectile Disorder
  • Orgasmic Disorders
  • Paraphilia
  • Pedophilia
  • Premature Ejaculation
  • Sexual Arousal Disorders
  • Sexual Aversion Disorder
  • Sexual Disorder Not Otherwise Specified
  • Sexual Dysfunction
  • Sexual Masochism
  • Sexual Pain Disorders
  • Sexual Sadism
  • Transvestic Fetishism
  • Voyeurism

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Gynecologist
  • Internal Medicine Physician
  • Psychiatrist
  • Urologist

Comorbid Conditions

  • Endocrine disorders
  • Mood disorders
  • Personality disorder
  • Phobias
  • Side effects of medication
  • Substance abuse

Factors Influencing Duration

Most treatment for psychosexual disorders consists of outpatient appointments that should not affect ability to stay on a normal work schedule. After sexual reassignment surgery, individuals may have a decreased level of function if they suffer from poor social support, poor surgical outcome, poor self-esteem, suicidal thoughts, or noncompliance with treatment plans.

Medical Codes

ICD-9-CM:
302.0 - Ego-dystonic Sexual Orientation; Ego-dystonic Lesbianism; Sexual Orientation Conflict Disorder
302.1 - Zoophilia; Bestiality
302.2 - Pedophilia
302.3 - Transvestism Fetishism
302.4 - Exhibitionism
302.50 - Trans-sexualism with Unspecified Sexual History
302.51 - Trans-sexualism with Asexual History
302.52 - Trans-sexualism with Homosexual History
302.53 - Trans-sexualism with Heterosexual History
302.6 - Psychosexual Identity, Disorders of
302.70 - Psychosexual Dysfunction, Unspecified; Sexual Dysfunction NOS
302.79 - Psychosexual Dysfunction, Unspecified; Sexual Dysfunction NOS; with Other Specified Psychosexual Dysfunctions; Sexual Aversion Disorder
302.81 - Fetishism
302.82 - Voyeurism
302.83 - Sexual Masochism
302.84 - Sexual Sadism
302.85 - Gender Identity Disorder in Adolescents or Adults
302.89 - Psychosexual Disorders, Other; Frotteurism; Nymphomania; Satyriasis
302.9 - Psychosexual Disorder, Unspecified; Fetishism, Voyeurism, Sexual Masochism, Sexual Sadism, Gender Identity Disorder of Adolescent or Adult Life

Overview

Psychosexual disorders are disturbances in sexual function secondary to emotional and/or mental causes. This category includes sexual dysfunctions, sexual perversions (paraphilias), and gender identity disorders, and is separate from sexual disorders that may arise from an underlying medical condition.

Sexual dysfunctions may be characterized as a disturbance of sexual desire, arousal, or orgasm; sexual pain; or difficulties with sexual performance. Causes may be mental or physical, and can result in the individual’s inability to fully enjoy sexual intercourse. In men, sexual dysfunctions may manifest as reduced sexual desire, premature or delayed ejaculation, impotence, or painful intercourse. In women, sexual dysfunctions may manifest as reduced sexual desire, inadequate lubrication, difficulty or inability to achieve orgasm, or painful intercourse. Because sexual dysfunctions may be related to a medical condition, medication, or substance abuse, adequate medical workup is imperative before the initiation of treatment.

Sexual perversions (paraphilias) involve strong and recurrent sexual desire for unusual situations or objects. Examples are displaying one's genitals (exhibitionism); sexual desire for children (pedophilia), non-consenting adults (sexual sadism), objects (fetishism); observing other people unclothed or engaged in sexual activities (voyeurism); rubbing against someone or something for purposes of sexual stimulation (frottage or frotteurism); and cross-dressing (transvestic fetishism). Paraphiliac behavior usually begins in adolescence.

Gender identity disorders characterize individuals who desire to be—or insist that they are—members of the other sex. Gender identity disorder symptoms can develop as early as ages 2 to 4. In boys, the cross-gender identification is manifested by a preoccupation with toys, dress and activities that are stereotypically female. Girls identify with the opposite gender in the preoccupation of role-play, dreams and fantasies. However, only a small number of children will continue to have symptoms that meet criteria for this disorder in adolescence or adulthood. In adults, such gender-identification can lead to sex-change operations (sexual reassignment surgery).

Incidence and Prevalence: The prevalence of painful sex from a sexual dysfunction is distributed among 3% of males and 15% of females. Orgasmic problems are reported by 10% of males and 25% of females. Ten percent of males also report that they have trouble maintaining erections, whereas 20% of females have trouble sustaining arousal (DSM-IV-TR 538, 569, 578).

The incidence of paraphilias is hard to establish since it is a diagnosis that is difficult to make due to afflicted individuals' reluctance to talk about these sexual concerns. Sexual masochism has a 20:1 male to female ratio. Hypoxyphilia, a form of sexual masochism where, in order to enhance sexual pleasure, individuals deprive themselves of oxygen either with a noose or other means, has a death rate of 2 per 1 million population in US, UK, Canada, and Australia (DSM-IV-TR 527-573). There is no data on the prevalence of gender identity disorder in the US. In Europe 1 per 30,000 males and 1 per 100,000 females see a clinician requesting sexual reassignment surgery (DSM-IV-TR 579).

Source: Medical Disability Advisor



Diagnosis

History: History varies with the specific sexual disorder. DSM-IV-TR criteria for sexual perversions require that unusual or bizarre imagery or acts are necessary for sexual excitement, are consistently or involuntarily repetitive, and interfere to varying degrees with the capacity for mutually affectionate sexual activity, usually over a period of 6 months.

Physical exam: The exam may reveal a medical cause of sexual dysfunction, but is not helpful in identifying the sexual perversions. Observation of an individual's orientation, dress, mannerisms, behavior, and content of speech provide essential signs to diagnose Gender Identity Disorder. Both sexes can benefit from a neurological, psychiatric, and psychological evaluation.

Tests: Tests should be performed for both men and women to rule out physical and/or medical concerns that may cause a sexual dysfunction disorder. Hormone tests may include thyroid function tests to rule out hyperthyroidism or hypothyroidism; sex hormone binding globulin (SHBG); testosterone, estradiol, and prolactin levels; and follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels in women. Toxicology screens can be performed to rule out the presence of substances or medication that may be causing the condition.

A test for erections (penile tumescence) may be done for sexual perversion (while individual views images of sexual obsession) or done to check for erectile failure (at night). Ultrasound studies may also be performed to measure genital blood flow.

Source: Medical Disability Advisor



Treatment

Once potential medical causes underlying psychosexual disorders are ruled out, sex therapy may be helpful if the individual is involved in a relationship. Both members of the relationship are treated simultaneously. Sex therapy may be combined with supportive psychotherapy either individually or with the couple. Behavioral therapy may also involve desensitization and assertiveness training. Hypnotherapy may be helpful, focusing on the distressing symptoms. Group therapy can help support those with guilt, shame, or anxiety concerning a sexual problem. Family and marital therapy can be helpful.

Androgen blockers can be useful for sexual perversions such as pedophilia or exhibitionism. Selective serotonin reuptake inhibitors (SSRIs) are used for sexual perversions including voyeurism, exhibitionism, pedophilia, frotteurism, and also for rapists. Estrogen, progesterone, and anti-androgens are given for compulsive sexual behavior in men. Behavior therapy is also used in sexual perversions and cognitive therapy addresses self-beliefs that sex leads to deviant behavior. Peer groups such as Sex Addicts Anonymous can be helpful. Psychodynamic psychotherapy and psychoanalysis are not usually effective.

Gender identity disorders can be treated with hormone therapy and sex change surgery to help the individual physically resemble the opposite sex. These measures are generally taken only after rigorous psychological evaluation.

Source: Medical Disability Advisor



Prognosis

Outcome depends on the specific psychosexual disorder, but the disorders generally worsen when the amount of stress increases in an individual's life. Most sexual perversions are life-long. Some behaviors decline in frequency as an individual gets older. About 87% of men who undergo sexual reassignment surgery are satisfied with the outcome compared to 97% of females (Levy). Transsexuals with comorbid psychiatric conditions who are heterosexual and have a later development of gender identity disorder have a worse outcome when given sexual reassignment surgery.

Source: Medical Disability Advisor



Complications

Sexual dysfunctions can result in a failed relationship and subsequent depression. Sexual perversions may lead to arrest, criminal conviction, and loss of the individual's job or marriage. Surgery or hormonal treatments used in gender identity disorders may lead to complications or side effects. Sexual reassignment surgery can cause scarring of the vagina and breast tissue.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work modifications are usually not relevant for psychosexual disorders.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual fit the criteria for a psychosexual disorder?
  • Has diagnosis been confirmed?
  • In sexual dysfunction, have underlying medical conditions, medications, or substance abuse been ruled out?
  • Has psychological testing been completed?

Regarding treatment:

  • Has treatment for sexual dysfunction included medical options for erectile failure, hormone therapy for reduced desire or arousal, and behavioral or sex therapy?
  • Has hypnotherapy been used to focus on distressing symptoms?
  • Has group therapy proved to be supportive if individual is experiencing guilt, shame or anxiety about a sexual problem?
  • Have medications helped curtail inappropriate behaviors?
  • Did behavior or cognitive therapy effectively address the individual's beliefs that led to the sexually inappropriate behavior?

Regarding prognosis:

  • What life stressors is the individual dealing with at present?
  • Because sexual perversions are life-long and generally worsen when stress increases in the individual's life, what stress reduction skills has individual been taught?
  • Would individual benefit from involvement in a peer group such as Sex Addicts Anonymous?

Source: Medical Disability Advisor



References

Cited

Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Levey, Robert, and W. Corbet Curfman. "Sexual and Gender Identity Disorders." eMedicine. Eds. Denis F. Darko, et al. 16 Apr. 2004. Medscape. 14 Oct. 2004 <http://emedicine.com/med/topic3439.htm>.

Source: Medical Disability Advisor






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