4 Eating and Sleep-Wake Disorders

Question 1

In _____, out-ofcontrol eating episodes, or binges, are followed by self-induced vomiting, excessive use of laxatives, or other attempts to purge (get rid of) the food.

Answer 1

bulimia nervosa

Question 2

In _____, the person eats nothing beyond minimal amounts of food, so body weight sometimes drops dangerously.

_____ has the highest mortality rate of any psychological disorder reviewed in this book, including depression.

Answer 2

anorexia nervosa

Question 3

In _____ disorder, individuals may binge repeatedly and find it distressing, but they do not attempt to purge the food.

Answer 3

binge-eating

Question 4

In these (eating) disorders, unlike most others, the strongest contributions to etiology seem to be _____ rather than psychological or biological factors.

Answer 4

sociocultural

Question 5

_____ is not considered an official disorder in the DSM, but we consider it here because it is thought to be one of the most dangerous epidemics confronting public health authorities around the world
today.

Answer 5

Obesity

Question 6

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight

E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Specify if:
In partial remission: After full criteria for _____ were previously met, some, but not all, of the criteria, have been met for a sustained period of time.
In full remission: After full criteria for _____ were previously met, none of the criteria have been met for a sustained period of time.

Specify current severity:
The minimum level of severity is based on the frequency of inappropriate compensatory behaviors (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.

Mild: An average of 1-3 episodes of inappropriate compensatory behaviors per week.
Moderate: An average of 4-7 episodes of inappropriate compensatory behaviors per week.
Severe: An average of 8-13 episodes of inappropriate compensatory behaviors per week.
Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.

Answer 6

Bulimia Nervosa

Question 7

The hallmark of _____ is eating a larger amount of food—typically, more junk food than fruits and vegetables—than most people would eat under similar circumstances

Answer 7

bulimia nervosa

Question 8

An individual with bulimia usually presents with additional psychological disorders, particularly _____ disorders.

Answer 8

anxiety and mood

Question 9

For a number of years, one prominent theory suggested that eating disorders are simply a way of expressing _____. But most evidence indicates that _____ follows bulimia and may be a reaction to it.

Answer 9

depression

Question 10

In summary, bulimia seems strongly related to anxiety disorders and somewhat less so to mood and _____ disorders.

Answer 10

substance use

Question 11

A. Restriction of energy intal17kg/m2
Moderate: BM116-16.99 kg/m2
Severe: BM115-15.99 kg/m2
Extreme: BMI < 15 kg/m2

Answer 11

Anorexia Nervosa

Question 12

Individuals with anorexia nervosa (which literally means a “_____”— an incorrect definition because appetite often remains healthy) differ in one important way from individuals with bulimia.

Answer 12

nervous loss of appetite

Question 13

The major difference seems to be whether the individual is successful at losing weight.

People with anorexia are _____ of both their diets and their extraordinary control.

People with bulimia are ashamed of both their eating issues and their lack of control.

Answer 13

proud

Question 14

Although decreased body weight is the most notable feature of anorexia nervosa, it is not the core of the disorder. Many people lose weight because of a medical condition, but people with anorexia have an _____ of obesity and relentlessly pursue thinness.

Answer 14

intense fear

Question 15

DSM-5 specifies two subtypes of anorexia nervosa. In the restricting type, individuals diet to limit calorie intake; in the _____ type, they rely on purging

Answer 15

binge-eating–purging

Question 16

Unlike individuals with bulimia, _____ anorexics binge on relatively small amounts of food and purge more consistently, in some cases each time they eat.

Answer 16

binge-eating–purging

Question 17

One common medical complication of anorexia nervosa is cessation of menstruation (_____), which also occurs relatively often in bulimia

Answer 17

amenorrhea

Question 18

Also, it is relatively common to see _____, downy hair on the limbs and cheeks.

Answer 18

lanugo

Question 19

Interestingly, one anxiety disorder that seems to co-occur often with anorexia is _____.

Answer 19

obsessive-compulsive disorder (OCD)

Question 20

_____ is also common in individuals with anorexia nervosa, and, in conjunction with anorexia, is a strong predictor of mortality, particularly by suicide.

Answer 20

Substance abuse

Question 21

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

B. The binge-eating episodes are associated with three (or more) of the following:

1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling physically hungry.
4. Eating alone because of feeling embarrassed by how much one is eating.
5. Feeling disgusted with oneself, depressed, or very guilty afterward.

C. Marked distress regarding binge eating is present.

D. The binge eating occurs, on average, at least once a week for 3 months.

E. Binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Specify if:
In partial remission: After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time.
In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time.

Specify current severity:
The minimum level of severity is based on the frequency of episodes of binge eating (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.
Mild: 1-3 binge-eating episodes per week.
Moderate: 4-7 binge-eating episodes per week.
Severe: 8-13 binge-eating episodes per week.
Extreme: 14 or more binge-eating episodes per week

Answer 21

Binge-Eating Disorder

Question 22

Beginning in the 1990s, research focused on a group of individuals who experience marked distress because of binge eating but do not engage in extreme _____ behaviors and therefore cannot be diagnosed with bulimia.

Answer 22

compensatory

Question 23

Ridicule and teasing in children may increase obesity through _____.

Answer 23

depression and binge eating

Question 23

Ridicule and teasing in children may increase obesity through _____.

Answer 23

depression and binge eating

Question 24

There are two forms of maladaptive eating patterns in people who are obese. The first is _____ eating, and the second is _____ eating syndrome.

Answer 24

binge, night

Question 25

Individuals with _____ syndrome consume a third or more of their daily intake after their evening meal and get out of bed at least once during the night to have a high-calorie snack.

Answer 25

night eating

Question 26

_____ eating syndrome described later in the chapter in the section about sleep disorders. In that condition, individuals get up during the night and raid the refrigerator but never wake up. They also may eat uncooked or other dangerous foods while asleep.

Answer 26

Nocturnal

Question 27

This mutual neurobiological connection suggests that _____ and sleep may be interrelated in important ways, although the exact nature of the relationship is still unknown.

Answer 27

anxiety

Question 28

The clearest and most comprehensive picture of your sleep habits can be determined only by a _____ (PSG) evaluation.

Answer 28

polysomnographic

Question 29

A. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:

1. Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
3. Early-morning awakening with inability to return to sleep.

B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.

C. The sleep difficulty occurs at least 3 nights per week

D. The sleep difficulty is present for at least 3 months.

E. The sleep difficulty occurs despite adequate opportunity for sleep.

F. The _____ is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).

G. The _____ is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).

H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of _____.

Specify if:
With non-sleep disorder mental comorbidity, including substance use disorders
With other medical comorbidity
With other sleep disorder

Specify if:
Episodic: Sy(nptoms last at least 1 month but less than 3 months.
Persistent: Symptoms last 3 months or longer.
Recurrent: Two (or more) episodes within the space of 1 year

Answer 29

Insomnia Disorder

Question 30

A. Self-reported excessive sleepiness (_____) despite a main sleep period lasting at least 7 hours, with at least one of the following symptoms:

1. Recurrent periods of sleep or lapses into sleep within the same day
2. A prolonged main sleep episode of more than 9 hours per day that is nonrestorative (i.e., unrefreshing).
3. Difficulty being fully awake after abrupt awakening

B. The _____ occurs at least three times per week, for at least 3 months.

C. The _____ is accompanied by significant distress or impairment in cognitive, social, occupational, or other important areas of functioning.

D. The _____ is not better explained by and does not occur exclusively during the course of another sleep disorder (e.g., narcolepsy, breathing-related sleep disorder, circadian rhythm sleep-wake disorder, or a parasomnia).

E. The _____ is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).

F. Coexisting mental and medical disorders do not adequately explain the predominant complaint of _____.

Specify if:
With mental disorder, including substance use disorders
With medicai condition
With another sleep disorder

Specify if:
Acute: Duration of less than 1 month.
Subacute: Duration of 1-3 months.
Persistent: Duration of more than 3 months

Specify severity based on degree of difficulty maintaining daytime alertness as manifested by the occurrence of multiple attacks of irresistible sleepiness within any given day occurring, for example, while sedentary, driving, visiting with friends, or working.
Mild: Difficulty maintaining daytime alertness 1-2 days/week.
Moderate: Difficulty maintaining daytime alertness 3-^ days/week.
Severe: Difficulty maintaining daytime alertness 5-7 days/week

Answer 30

Hypersomnolence Disorders

Question 31

A. Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day. These must have been occurring at least three times per week over the past 3 months.

B. The presence of at least one of the following:
1. Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times per month:

a. In individuals with long-standing disease, brief (seconds to minutes) episodes of sudden bilateral loss of muscle tone with maintained consciousness that are precipitated by laughter or joking.
b. In children or in individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any obvious emotional triggers.

2. Hypocretin deficiency, as measured using cerebrospinal fluid (CSF) hypocretin-1 immunoreactivity values (less than or equal to one-third of values obtained in healthy subjects tested using the same assay, or less than or equal to 110 pg/mL). Low CSF levels of hypocretin-1 must not be observed in the context of acute brain injury, inflammation, or infection.
3. Nocturnal sleep polysomnography showing rapid eye movement (REM) sleep latency less than or equal to 15 minutes, or a multiple sleep latency test showing a mean sleep latency less than or equal to 8 minutes and two or more sleep-onset REM periods.

Specify current severity:
Mild: Infrequent cataplexy (less than once per week), need for naps only once or twice per day, and less disturbed nocturnal sleep.
Moderate: Cataplexy once daily or every few days, disturbed nocturnal sleep, and need for multiple naps daily.
Severe: Drug-resistant cataplexy with multiple attacks daily, nearly constant sleepiness, and disturbed noctumal sleep (i.e., movements, insomnia, and vivid dreaming).

Answer 31

Narcolepsy

Question 32

In addition to daytime sleepiness, some people with narcolepsy experience _____, a sudden loss of muscle tone

Answer 32

cataplexy

Question 33

They (narcolepsy) commonly report sleep _____, a brief period after awakening when they can’t move or speak that is often frightening to those who go through it.

Answer 33

paralysis

Question 34

The last characteristic of narcolepsy is _____, vivid and often terrifying experiences that begin at the start of sleep and are said to be unbelievably realistic because they include not only visual aspects but also touch, hearing, and even the sensation of body movement.

Answer 34

hypnagogic hallucinations

Question 35

Sleep paralysis commonly co-occurs with anxiety disorders, in which case the condition is termed _____ sleep paralysis.

Answer 35

isolated

Question 36

Previous research with Doberman pinschers and Labrador retrievers, which also inherit this disorder, suggests that narcolepsy is associated with a cluster of genes on chromosome _____, and it may be an autosomal recessive trait.

Answer 36

6

Question 37

A. Either (1) or (2):

1. Evidence by polysomnography of at least five obstructive apneas or hypopneas per hour of sleep and either of the following sleep symptoms:
   a. Nocturnal breathing disturbances: snoring, snorting/gasping, or breathing pauses during sleep
   b. Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep that is not better explained by another mental disorder (including a sleep disorder) and is not attributable to another medical condition.
2. Evidence by polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying symptoms.

Specify current severity:
Mild: Apnea hypopnea index is less than 15.
Moderate: Apnea hypopnea Index is 15-30.
Severe: Apnea hypopnea index is greater than 30

Answer 37

Obstructive Sleep Apnea Hypopnea Syndrome

Question 38

A. Evidence by polysomnography of five or more central apneas per hour of sleep
B. The disorder is not better explained by another current sleep disorder.

Answer 38

Central Sleep Apnea

Question 39

Unlike people with obstructive sleep apnea hypopnea syndrome, those with central sleep apnea _____ frequently during the night but they tend not to report excessive daytime sleepiness and often are not aware of having a serious breathing problem.

Answer 39

wake up

Question 40

A. Polysomnograpy demonstrates episodes of decreased respiration associated with elevated CO2 levels. (Note: In the absence of objective measurement of CO2 , persistent low levels of hemoglobin oxygen saturation unassociated with apneic/hypopneic events may indicate hypoventilation.)
B. The disturbance is not better explained by another current sleep disorder

The third breathing disorder, sleep-related hypoventilation, is a decrease in airflow without a complete pause in breathing. This tends to cause an increase in carbon dioxide (CO2) levels.

Answer 40

Sleep-Related Hypoventilation

Question 41

A. A persistent or recurrent pattern of sleep disruption that is primarily due to an alteration of the _____ system or to a misalignment between the endogenous _____ rhythm and the sleep-wake schedule required by an individual’s physical environment or social or professional schedule.
B. The sleep disruption leads to excessive sleepiness or insomnia, or both.
C. The sleep disturbance causes clinically significant distress or impairment in social, occupational, and other important areas of functioning.

Answer 41

Circadian Rhythm Sleep-Wake Disorders

Question 42

A. Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity and that generally occur during the second half of the major sleep episode.

B. On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert.

C. The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The _____ symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication)

E. Coexisting mental and medical disorders do not adequately explain the predominant complaint of dysphoric dreams.

Specify if:
Acute: Duration of period of _____ is 1 month or less.
Subacute: Duration of period of _____ is greater than 1 month but less than 6 months.
Persistent: Duration of period of _____ is 6 months or greater.

Mild: Less than one episode per week on average.
Moderate: One or more episodes per week but less than nightly.
Severe: Episodes nightly.

Answer 42

Nightmare Disorder

Question 43

To qualify as a nightmare disorder, according to DSM-5 criteria, these experiences must be so _____ that they impair a person’s ability to carry on normal activities (such as making a person too anxious to try to sleep at night).

Answer 43

distressful

Question 44

_____ are defined as disturbing dreams that awaken the sleeper; bad dreams are those that do not awaken the person experiencing them.

Answer 44

Nightmares

Question 45

_____, which most commonly afflict children, usually begin with a piercing scream.

Answer 45

Sleep terrors

Question 46

A. Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode, accompanied by either one of the following:

1. Sleepwalking: Repeated episodes of rising from bed during sleep and walking about. While sleepwalking, the individual has a blank, staring face; is relatively unresponsive to the efforts of others to communicate with him or her; and can be awakened only with great difficulty
2. Sleep terrors: Recurrent episodes of abrupt terror arousals from sleep, usually beginning with a panicky scream. There is intense fear and signs of autonomic arousal, such as mydriasis, tachycardia, rapid breathing, and sweating, during each episode. There is relative unresponsiveness to efforts of others to comfort the individual during the episodes.

B. No or little (e.g., only a single visual scene) dream imagery is recalled

C. Amnesia for the episodes is present

D. The episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).

F. Coexisting mental and medical disorders do not explain the episodes of sleepwalking or sleep terrors.

Specify whether:
307.46 (F51.3) Sleepwalking type
Specify if:
With sleep-related eating
With sleep-related sexual behavior (sexsomnia)

307.46 (F51.4) Sleep terror type

Answer 46

Non-Rapid Eye Movement Sleep Arousal Disorders

Question 47

One approach to reducing chronic sleep terrors is the use of _____ awakenings

Answer 47

scheduled

Question 48

This means that when people walk in their sleep, they are probably not acting out a dream.

It might surprise you to learn that sleepwalking (also called _____) occurs during NREM sleep.

Answer 48

somnambulism

Question 49

We do not yet clearly understand why some people sleepwalk, although factors such as extreme fatigue, previous sleep deprivation, the use of sedative or hypnotic drugs, and stress have been implicated.

On occasion, sleepwalking episodes have been associated with violent behavior, including _____.

Answer 49

homicide and suicide

Question 50

_____ syndrome, is when individuals rise from their beds and eat while they are still asleep.

Answer 50

Nocturnal eating

Question 51

A. Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors.

B. These behaviors arise during rapid eye movement (REM) sleep and therefore usually occur more than 90 minutes after sleep onset, are more frequent during the later portions of the sleep period, and uncommonly occur during daytime naps.

C. Upon awakening from these episodes, the individual is completely awake, alert, and not confused or disoriented.

D. Either of the following:

1. REM sleep without atonia on polysomnographic recording.
2. A history suggestive of REM sleep behavior disorder and an established synucleinopathy diagnosis (e.g., Parkinson’s disease, multiple system atrophy).

E. The behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (which may include injury to self or the
bed partner).

F. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

G. Coexisting mental and medical disorders do not explain the episodes.

Answer 51

Rapid Eye Movement Sleep Behavior Disorder

Question 52

_____; acting out sexual behaviors such as masturbation and sexual intercourse with no memory of the event.

Answer 52

Sexsomnia

Question 53

Two disorders are sex specific: Premature (early) ejaculation occurs only in males, and _____ pain/penetration disorder—which includes difficulties with penetration during intercourse due in many cases to painful contractions or spasms of the vagina—appears only in females

Answer 53

genitopelvic

Question 54

A. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts of the individual’s life.

B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C. The symptoms in Criterion A cause clinically significant distress in the individual

D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to thes effects of a substance/medication or another medical condition.

Specify whether:
Lifelong: The disturbance has been present since the Individual became sexually active.
Acquired; The disturbance began after a period of relatively normal sexual function.

Specify whether:
Generaiized: Not limited to certain types of stimulation, situations, or partners.
Situational: Only occurs with certain types of stimulation, situations, or partners.

Specify current severity:
Mild: Evidence of mild distress over the symptoms in Criterion A.
Moderate: Evidence of moderate distress over the symptoms In Criterion A.
Severe: Evidence of severe or extreme distress over the symptoms in Criterion A

Answer 54

Male Hypoactive Sexual Desire Disorder

Question 55

A. Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following:

1. Absent/reduced interest in sexual activity.
2. Absent/reduced sexual/erotic thoughts or fantasies
3. No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate.
4. Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).
5. Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual).
6. Absent/reduced genital or nongenital sensations during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts)

B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months

C. The symptoms in Criterion A cause clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexuai mental disorder or as a consequence of severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

Specify whether:
Lifelong: The disturbance has been present since the Individual became sexually active.
Acquired; The disturbance began after a period of relatively normal sexual function.

Specify whether:
Generaiized: Not limited to certain types of stimulation, situations, or partners.
Situational: Only occurs with certain types of stimulation, situations, or partners.

Specify current severity:
Mild: Evidence of mild distress over the symptoms in Criterion A.
Moderate: Evidence of moderate distress over the symptoms In Criterion A.
Severe: Evidence of severe or extreme distress over the symptoms in Criterion A

Answer 55

Female Sexual Interest/Arousal Disorder

Question 56

_____ disorder is a specific disorder of arousal. The problem here is not desire. Many males with erectile dysfunction have frequent sexual urges and fantasies and a strong desire to have sex.

Answer 56

Erectile

Question 57

A. Presence of either of the following symptoms and experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):

1. Marked delay in, marked infrequency of, or absence of orgasm.
2. Markedly reduced intensity of orgasmic sensations.

B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C. The symptoms in Criterion A cause clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

Specify whether:
Lifelong: The disturbance has been present since the individual became sexually active.
Acquired: The disturbance began after a period of relatively normal sexual function.

Specify whether:
Generaiized: Not limited to certain types of stimulation, situations, or partners.
Situational: Only occurs with certain types of stimulation, situations, or partners.

Specify if:
Never experienced an orgasm under any situation.
Specify current severity:
Mild: Evidence of mild distress over the symptoms in Criterion A.
Moderate: Evidence of moderate distress over the symptoms in Criterion A.
Severe: Evidence of severe or extreme distress over the symptoms in Criterion A

Answer 57

Female Orgasmic Disorder

Question 58

A. A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it.
Note: Although the diagnosis of premature (early) ejaculation may be applied to individuals engaged in nonvaginal sexual activities, specific duration criteria have not been established for these activities.

B. The symptom in Criterion A must have been present for at least 6 months and must be experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts).

C. The symptom in Criterion A causes clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

Specify whether;
Lifelong: The disturbance has been present since the individual became sexually active.
Acquired: The disturbance began after a period of relatively normal sexual function.

Specify whether:
Generalized: Not limited to certain types of stimulation, situations, or partners.
Situational: Only occurs with certain types of stimulation, situations, or partners.

Specify current severity:
Mild: Ejaculation occurring within approximately 30 seconds to 1 minute of vaginal penetration.
Moderate: Ejaculation occurring within approximately 15-30 seconds of vaginal penetration.
Severe: Ejaculation occurring prior to sexual activity, at the start of sexual activity, or within approximately 15 seconds of vaginal penetration.

Answer 58

Premature (Early) Ejaculation

Question 59

Occasionally men suffer from _____ ejaculation, in which ejaculatory fluids travel backward into the bladder rather than forward. This phenomenon is almost always caused by the effects of certain drugs or a coexisting medical condition and should not be confused with delayed ejaculation.

Answer 59

retrograde

Question 60

A. Persistent or recurrent difficulties with one (or more) of the following:
. Persistent or recurrent difficulties with one (or more) of the following:
1. Vaginal penetration during intercourse
2. Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts
3. Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration.
4. Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.

B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C. The symptoms in Criterion A cause clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of a severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

Specify whether:
Lifelong: The disturbance has been present since the individual became sexually active.
Acquired: The disturbance began after a period of relatively normal sexual function.

Specify current severity:
Mild: Evidence of mild distress over the symptoms in Criterion A.
Moderate: Evidence of moderate distress over the symptoms in Criterion A.
Severe: Evidence of severe or extreme distress over the symptoms in Criterion A.

Answer 60

Genlto-Pelvic Pain/Penetration Disorder

Question 61

In other cases severe anxiety or even _____ may occur in anticipation of possible pain during intercourse with Genlto-Pelvic Pain/Penetration Disorder.

Answer 61

panic attacks

Question 62

But the most usual presentation of this disorder is referred to as ____, in which the pelvic muscles in the outer third of the vagina undergo involuntary spasms when intercourse is attempted.

Answer 62

vaginismus

Question 63

_____ increases sexual arousal.

Answer 63

anxiety

Question 64

Although it is not known for sure why some people develop problems, many people learn early that sexuality can be negative and somewhat threatening, and the responses they develop reflect this belief.

Donn Byrne and his colleagues call this negative cognitive set _____. They have demonstrated that erotophobia, presumably learned early in childhood from families, religious authorities, or others, seems to predict sexual difficulties later in life.

Answer 64

erotophobia

Question 65

These disorders of sexual arousal, if they cause distress or impairment to the individual, or cause personal harm, or the risk of harm to others are called _____ disorders.

Answer 65

paraphilic

Question 66

Furthermore, it is not uncommon for individuals with paraphilic disorder to also suffer from comorbid mood, _____, and substance abuse disorders.

Answer 66

anxiety

Question 67

A. Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors

B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:
In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to touch or rub against a nonconsenting person are restricted.
In full remission: The individual has not acted on the urges with a nonconsenting person, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

Answer 67

Frotteuristic Disorder

Question 68

Because the victims cannot escape easily, the frotteuristic act is usually _____.

Answer 68

successful

Question 69

A. Over a period of at least 6 months, recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s), as manifested by fantasies, urges, or behaviors.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The fetish objects are not limited to articles of clothing used in cross-dressing (as in transvestic disorder) or devices specifically designed for the purpose of tactile genital stimulation (e.g., vibrator).

Specify:
Body part(s)
Nonliving object(s)
Other

Specify if:
in a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in fetishistic behaviors are restricted.
in full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at least 5 years while in an uncontrolled environment.

Answer 69

Fetishistic Disorder

Question 70

A. Over a period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors.

B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

C. The individual experiencing the arousal and/or acting on the urges is at least 18 years of age.

Specify if:
In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in voyeuristic behavior are restricted.
In full remission: The individual lias not acted on the urges with a nonconsenting person, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

Answer 70

Voyeuristic Disorder

Question 71

A. Over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors.

B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify whether:
Sexually aroused by exposing genitals to prepubertal children
Sexually aroused by exposing genitals to physically mature individuals
Sexually aroused by exposing genitals to prepubertal children and to physically mature individuals

Specify if;
In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to expose one’s genitals are restricted.
In full remission: The individual has not acted on the urges with a nonconsenting person, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

Answer 71

Exhibitionistic Disorder

Question 72

Remember that _____ actually increases arousal under some circumstances. Many voyeurs just don’t get the same satisfaction from attending readily available strip shows at a local bar.

Answer 72

anxiety

Question 73

Exhibitionistic disorder is often associated with lower levels of education, but not always. Note again that the thrilling element of _____ is an important part of exhibitionistic disorder.

Answer 73

risk

Question 74

A. Over a period of at least 6 months, recurrent and intense sexual arousal from crossdressing, as manifested by fantasies, urges, or behaviors.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:
With fetishism: If sexually aroused by fabrics, materials, or garments.
With autogynephiiia: If sexually aroused by thoughts or images of self as female

Specify if:
in a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to cross-dress are restricted,
In full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at least 5 years while in an uncontrolled environment.

Answer 74

Transvestic Disorder

Question 75

A. Over a period of at least 6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or othenwise made to suffer, as manifested by fantasies, urges, or behaviors.

B. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:
With asphyxiophilia: If the individual engages in the practice of achieving sexual arousal related to restriction of breathing.

Specify if:
In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in masochistic sexual behaviors are restricted.
In full remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at last 5 years while in an uncontrolled environment.

Answer 75

Sexual Masochism Disorder

Question 76

A. Over a period of at least 6 months, recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors.
B. The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Specify if:
In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in sadistic sexual behaviors are restricted.
In full remission: The individual has not acted on the urges with a nonconsenting person, and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment

Answer 76

Sexual Sadism Disorder

Question 77

An individual accidentally hangs himself, an event that should be distinguished from the closely related condition called _____, which involves self-strangulation to reduce the flow of oxygen to the brain and enhance the sensation of orgasm.

Answer 77

hypoxiphilia

Question 78

Instead, many rapists meet criteria for _____ personality disorder and may engage in a variety of _____ and aggressive acts.

Answer 78

antisocial

Question 79

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).

B. The individual has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty

C. The individual is at least age 16 years and at least 5 years older than the child or children in Criterion A.
Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old.

Specify whether:
Exclusive type (attracted only to children)
Nonexclusive type

Specify if:
Sexually attracted to males
Sexually attracted to females
Sexually attracted to both

Specify if:
Limited to incest

Answer 79

Pedophilic Disorder

Question 80

Telephone _____ is a paraphilia characterized by a pattern of sexual arousal associated with exposing an unsuspecting victim to sexual and obscene material over the phone. The caller frequently will masturbate either while speaking to the victim or later while recalling the encounter

Answer 80

scatologia

Question 81

abnormal interest and pleasure in feces and defecation.

Answer 81

coprophilia

Question 82

The term _____ refers to the receiving of sexual arousal from introducing liquids into the rectum and colon via the anus. This paraphilia often involves the use of enemas.

Answer 82

Klismaphilia

Question 83

A paraphilia characterized by recurrent sexually arousing fantasies, sexual urges, or behaviour involving urinating or being urinated on. Also called undinism, urolagnia.

Answer 83

Urophilia

Question 84

Many individuals with pedophilic disorder also report being abused themselves as _____, which turns out to be a strong predictor of later sexual abuse by the victim.

Answer 84

children

Question 85

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following (one of which must be Criterion A1):

1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender).
2. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire: or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing.
3. A strong preference for cross-gender roles in make-believe play or fantasy play
4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.
5. A strong preference for playmates of the other gender.
6. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities
7. A strong dislike of one’s sexual anatomy.
8. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender.

B. The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning.

Specify if;
With a disorder of sex development (e.g., a congenital adrenogenital disorder such as 255.2 [E25.0] congenital adrenal hyperplasia or 259.50 [E34.50] androgen insensitivity syndrome).

Answer 85

Gender Dysphoria in Children

Question 86

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least two of the following:

1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).
2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)

Answer 86

Gender Dysphoria in Adolescents and Adults

Question 87

If the individual has made the transition to full time living in their experienced gender (by interacting with people in their daily lives in a consistent manner in their desired gender) and they are preparing for, or have undergone sex reassignment surgery then they are referred to as _____, and this is specified in the diagnostic criteria for gender dysphoria.

Answer 87

“posttransition”

Question 88

Gender dysphoria can also occur among individuals with Disorders of Sex Development (DSD), formerly known as intersexuality or _____ who are born with ambiguous genitalia associated with documented hormonal or other physical abnormalities

Answer 88

hermaphroditism

Question 89

In some cultures, individuals with a different gender experience are often accorded the status of “shaman” or _____ and treated as wisdom figures. A shaman is almost always a male adopting a female role.

Answer 89

“seer”

Question 90

The researchers found that gender _____ was related to psychological distress (depression, anxiety), but only for gay men and not for lesbians.

Answer 90

nonconformity

Question 91

Anne Fausto-Sterling, who suggests that there are actually five sexes:

1. Males
2. Females

Answer 91

3. “herms” who are named after true hermaphrodites, or people born with both testes and ovaries;
4. “merms” who are anatomically more male than female but possess some aspect of female genitalia;
5. “ferms” who have ovaries but possess some aspect of male genitalia.