1
Q
Sexual dysfunction
A
- impairment in desire for sexual gratification or in ability to achieve it
- caused by psychological, interpersonal, or physical factors
- in men disorders in interest and arousal are separate, in women they are combined (interest/arousal disorder)
- prevalence not known
2
Q
4 phases of human sexual response
A
- Desire phase: fantasies ab sexual activity/desire to have sexual activity
- Arousal phase: subjective sense of sexual pleasure and physiological changes
- Orgasm: release of sexual tension and peak of sexual pleasure
- Resolution: sense of relaxation and well-being
3
Q
Male Hypoactive Sexual Desire Disorder
A
- men who have been distressed/impaired due to low levels of sexual thoughts/desires/fantasies (at least 6mo)
- predictors of low desires: daily alcohol use, stress, unmarried status, poorer health
- acquired/situational rather than lifelong
- lack of evidence-based treatments
4
Q
Erectile disorder
A
- formerly called impotence
- inability to maintain an erection sufficient for sexual intercourse
- lifelong: adequate desire but inability to sustain an erection
- acquired/situational: adequate desire and intermittent ability to maintain/produce penile rigidity
- contributors: antidepressants, vascular disease, smoking, obesity, alcohol use
- can treat w viagra (started out as heart medication)
5
Q
Premature (Early) Ejaculation
A
- persistent and recurrent onset of orgasm/ejaculation w minimal sexual stimulation (15secs/thrusts)
- most common male sexual dysfunction (under 60)
- treatments include behavioral therapy and some antidepressants; pause and squeeze technique
6
Q
Delayed Ejaculation Disorder
A
- persistent inability to ejaculate during intercourse
- physical problems (ie multiple sclerosis, meds like SSRIs) may be involved
- treatment psychologically based, includes couples therapy
7
Q
Female Sexual Interest/Arousal Disorder
A
- psychological factors appear to be more important than biological
- psychological contributions: relationship problems, daily hassles, history of unwanted sexual experiences
- biological contributions: mental illness, low testosterone, use of antidepressants
- birth control can lower sexual desire (one study)
8
Q
Genito-Pelvic Pain/Penetration Disorder
A
- persistent (6mo+) experience of physical pain during sexual intercourse associated w sign. psych. distress
- more organic than psychological causes (Irving Binik argued it should be a pain disorder, not sexual dysfunction)
- cognitive-behavioral and medical treatments
9
Q
Female orgasmic disorder
A
- readily sexually excitable and otherwise enjoy sexual activity but show persistent/recurrent delay/absence of orgasm following normal sexual arousal phase
- are distressed by this
- additional mechanical stimulation required for orgasm
- causal factors not well understood
- high rates of success w instruction and guidance, situational cases more difficult to treat
- can be situational or lifelong
10
Q
Gender Dysphoria
A
- persistent distress resulting from mismatch between assigned gender and gender identity
- diagnosed at 2 life stages: childhood, adolescence/adulthood (in children doesn’t always persist into adulthood)
- 16-26% of children w gender dysphoria continue to experience gender dysphoria later in life
- likely to be removed in DSM6
11
Q
Gender Dysphoria - Clinical Picture
A
- children express desire to be a different gender
- disagreements on if this should be a mental disorder
- some non-western cultures don’t stigmatize gender-nonconforming children
- adults w GD suffer elevated risks of other mental disorders
12
Q
Treatment for Gender Dysphoria
A
- children/teens often brought to therapy by parents
- often have other general psychological/behavioral problems
- most children w GD don’t become adults w GD
- crucial period when children desist or persist is 10-13
13
Q
Paraphilic Disorders
A
- recurrent, intense sexually arousing fantasies/sexual urges/behaviors
- not necessarily associated w distress in individual
- abnormal targets of attraction
- unusual courtship behaviors
- desire for pain and suffering of oneself/others
14
Q
Voyeuristic Disorder
A
- most common paraphilic disorder
- observation of unsuspecting people who are undressing/engaging in sexual activity
- meets individual’s needs while avoiding possible rejection
- not usually associated w other serious criminal/antisocial behaviors
15
Q
Exhibitionistic Disorder
A
- indecent exposure in legal terms
- exposing genitals to others (usually strangers) in inappropriate circumstances/without consent
- exposure may be public or secluded
- begins in adolescence/young adulthood
- most common sexual offense reported to police in US, Canada, and Europe
- some men who expose themselves might do it bc they have antisocial PD
16
Q
Frotteuristic Disorder
A
- Frotteurism: sexual excitement at rubbing one’s genitals against or touching the body of a non-consenting person
- inappropriate/persistent interest in something that many ppl enjoy in consensual context
- victims often regular bus/subway riders
- no evidence to support concern that they will move on to more serious offending
17
Q
Sexual Sadism Disorder
A
- inflicting psychological/physical pain on another individual
- fantasies often include themes of dominance, control, humiliation
- serial killers tend to be sexual sadists
- no clear understanding of causal factors
18
Q
Sexual Masochism Disorder
A
- sexual stimulation/gratification from experience of pain and degradation in relation to a lover
- more common than sadism, occurs in both males and females (most other conditions men are disproportionately affected)
- Autoerotic asphyxia: involves self-strangulation and results in 500-1000 deaths per year in US
19
Q
Fetishistic Disorder
A
- use of inanimate object or part of body not typically found to be erotic to obtain sexual gratification
- patterns must last at leasr 6mo, rare in females
- classical conditioning/social learning can be involved in development
20
Q
Transvestic Disorder
A
- cross-dressing as female
- diagnosed if experience significant distress/impairment
- onset typically in adolescence
- Autogynephilia: sexual arousal by thought or fantasy of being a woman (strength of this is strong predictor of gender dysphoria)
21
Q
Causal Factors and Treatments for Paraphilic Disorders
A
- almost all are male
- usually begin at puberty/early adolescence
- strong sex drive (many masturbate many times/day)
- CBT and behavioral management skills show positive effect
- some pharmacological treatments might be effective
- don’t know much about effective treatments
22
Q
Pedophilic Disorder
A
- diagnosed when adult has recurrent, intense, sexual urges/fantasies ab sexual activity w prepubertal child (usually under 13y)
- almost all pedophiles are male
- about 2/3 of victims are girls 8-11
- believe that children benefit from sexual contact and initiate sexual contact
- many work w children/youth so that they have extensive access to them
- higher rate of homosexuality among pedophiles
- may involve certain perturbations of early neurodevelopment
23
Q
Aversion Therapy
A
- paraphilic stimulus paired w aversive event (ie shock)
- try to change conditioned association of child to pleasure
24
Q
Covert sensitization
A
- patient imagines highly aversive event while viewing/imagining paraphilic stimulus
25
Assisted covert sensitization
- foul odor introduced to induce nausea at point of peak arousal
26
Cognitive restructuring
- attempts to eliminate sex offenders' cognitive distortions bc these may play a role in sexual abuse
27
Social-skills training
- aims to help sex offenders learn to process social info from women more effectively and interact w them more appropriately
28
Biological and surgical treatments - paraphelias
- SSRIs not useful in treating sexual offenders
- controversial treatment involving 'chemical castration' very effective in controlling deviant fantasies
- recidivism rate for surgically castrated offenders >3%
29
Childhood Sexual Abuse
- 2x more likely to develop a mental disorder
- most likely fear/anxiety and substance use disorders
- 1.6% prevalence – but 4-6% in the US
PSYC 337
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