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Abnormal Psych > Ch 12 (lesson 14) Sexual disorders > Flashcards

Ch 12 (lesson 14) Sexual disorders Flashcards

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1
Q

Cultural influences beliefs about sexuality

A
  • pleasure vs procreation
  • acceptable sexual behaviors vary w times and culture
    • 19th and early 20th c believed excess sexuality was a problem
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2
Q

differences btwn men and women in sexuality

A

men:
- think more about sex/ want more
- masturbate more
- want and have more partners
- consistency across cultures
- have more sexual dysfunction as age

women
- desire for sex more often linked to relationship status/social norms
- tend to be more ashamed of appearance flaws
- may interfere w sexual satisfaction
- all ages, women more likely to report sexual dysfunction
- most common: lack of desire

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3
Q

sexual response cycle

A

Masters and Johnson

1) desire phase (added by kaplan)
- refers to sexual interest
2) excitement phase
- physiological changes
- blood flow to penis/ vagina
- vaginal lubrication
3) orgasm phase
- emission and ejaculation
- outer walls of vagina contract
4) resolution phase
- relaxation, sense of well-being
- men have refractory period, orgasm cannot re-occur

(plateau left out)

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4
Q

Debates about gender dysphoria

A
  • 1/200 transgender in US
  • DSM-5 criteria of gender dysphoria includes that the desire to be opposite sex causes marked distress of functional impairment

why it should not be labeled as a disorder:
- cross-gender behavior is universal, not specific to humans
- diagnosis contradicts the need to transition
- diagnosing gender nonconformity may foster stigma

BUT
diagnosis may be a step in getting insurance coverage for therapy and transition surgery

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5
Q

DSM-5 three categories of sexual dysfunction

A

1) sexual desire, arousal, interest disorders

2) Orgasmic disorders

3) Sexual pain disorders

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6
Q

DSM-IV-TR vs DSM-5 diagnosis of sexual dysfucntions

A

desire and arousal disorders:
- hypoactive sexual desire disorder —> hypoactive sexual desire disorder in men, sexual interest/arousal disorder in women
- erectile disorder (stayed same)
- sexual aversion disorder (no longer disorder)

Orgasmic disorders
- Female orgasmic disorder (same)
- male orgasmic disorder —> delayed ejaculation
- premature ejaculation (same)

sexual pain disorders
- dyspareunia —>
- vaginismus —> both became Genito-pelvic pain/penetration disorder

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7
Q

disorders involving sexual interest, desire, and arousal

A
  • sexual interest/arousal disorder in women
    • persistent deficits in sexual interest (fantasies/urges), biological arousal, or subjective arousal
  • Hypoactive sexual desire disorder in men
    • deficient or absent sexual fantasies/ urges
  • Male erectile disorder
    • failure to attain/maintain erection
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8
Q

DSM-5 criteria for Sexual interest/arousal disorder in women

A

at least 3 diminished, absent, or reduced for 6+ months

  • interest in sex
  • sexual/erotic thoughts/fantasies
    -initiation of sexual activity/ responsiveness to partners initiations
  • sexual excitement/pleasure during encounters
  • sexual interest/ arousal elicited by any internal/external erotic cues
  • genital or nongenital sensations during most sexual encounters

causes marked distress or interpersonal problems

not due to medical illness, another psych disorder (except another sex. disfunction), or effects of a drug

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9
Q

DSM-5 Criteria for Hypoactive Sexual Desire Disorder in men

A
  • persistently deficient or absent sexual fantasies and desires, as judged by clinician
  • causes marked distress or interpersonal problems
  • not due to med illness, another psych disorder (except another sex disorder), or effects of a drug
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10
Q

DSM-5 criteria for Male Erectile Disorder

A

-Persistent inability to attain/mantain erection adequate for completion of sex
- marked decrease in erections interferes w/ penetration or pleasure
- causes marked distress/ int. probs
- symptoms have been present most occasions for atleast 6 months
- not due to illness, another psych disorder (except other sex dysfunc) or effects of a drug

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11
Q

Orgasmic Disorders

A

Female Orgasmic Disorder
- Absence of orgasm after sexual excitement
- many women achieve arousal but not orgasm

Premature Ejaculation Disorder
- Ejaculation that occurs too quickly

Delayed ejaculation disorder
- Persistent difficulty ejaculating

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12
Q

DSM-5 criteria for Female Orgasmic DIsorder

A

on most occasions of sexual activity for at least 6 months
- marked delay, infrequency, or absence of orgasm
- markedly reduced intensity of orgasmic sensation
- causes marked distress or interpersonal problems
- not due to medical illness, another psych disorder (except another sex dysfunc) or effects of a drug

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13
Q

DSM-5 Criteria for Delayed Ejaculation:

A
  • marked delay, infreq., or absence of orgasm on most occasions of sexual activity for atleast 6 months
  • causes marked distress or int. probs
  • not due to med illness, another psych disorder (except sex dysfunc) or drug
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14
Q

DSM-5 Criteria for Premature Ejaculation:

A

-Tendency to ejaculate during partnered sexual activity within one min of sexual activity
- causes clinically significant distress or int. probs
- not due to effects of drug, psych disorder, med condition

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15
Q

Sexual Pain Disorder- Genitopelvic pain/ penetration disorder

A
  • persistent or recurrent pain during intercourse
  • diagnosable in men and women
    • rare in men
  • rule out medicale cause (infection), lack of vaginal lubrication, or menopausal problems
  • most women experience sexual arousal and orgasm from manual/oral stimulation w/out penetration
  • 10%-30% prevalence rates
  • Vaginismus and DYspareunia in DSM-IV-TR
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16
Q

DSM-5 criteria for Genitopelvic pain/ penetration disorder

A

persistent or recurrent difficulties for at least 6 mo w at least 1:
-inability to have intercourse/penetration
- marked vulvovaginal or pelvic pain during vaginal penetration
- marked fear/anxiety about pain/ penetration
- marked tensing of pelvic floor muscles during attempted penetration

causes significant distress/ int probs

not due to drug, psych disorder, med condition

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17
Q

Etiology of Sexual Dysfunction- Masters and Johnson’s two tier model

A

1) immediate causes
- performance fears
- Adoption of “spectator role”
- being an observer vs participant

2) distal (historical) causes
- sociocultural
- biological causes
- sexual traumas
- homosexual inclinations (not anymore)

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18
Q

distal causes/ predictors of sexual dysfunction- biological factors

A

biological factors
- heavy drinking/smoking
- cardiovascular disease
- diabetes
- neurological disease
- hormone dysfunction
- SSRIs
- other illnesses/ meds

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19
Q

distal causes/ predictors of sexual dysfunction- psych factors

A
  • rape/sexual abuse
    • early childhood sexual abuse assoc. w diminished arousal/desire, genital pain, premature ejaculation
  • lack of information/learning about sex
  • relationship difficulties
    • anger, hostility, poor communication
    • underlying anxiety about relationship security
  • neg cultural attitudes towards sex
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20
Q

distal causes/ predictors of sexual dysfunction- psych factors

A

psych factors
- depression and anxiety, panic disorder
- low physiological arousal
- stress and exhaustion
- neg cognitions/ self blame
- spectator role and performance fears ( immediate cause)

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21
Q

treatments of sexual dysfunction

A
  • Anxiety reduction
  • Directed masturbation (often for those w difficulty achieving orgasm)
  • Procedures to change thoughts and attitudes
    • sensory awareness procedures
    • rational-emotive therapy
  • couples therapy
    -Sexual skills and communication training

-medications and physical treatments
- squeeze technique for early ejaculation, SSRI dapoxetine also used
- PDE-inhibitors for erectile dysfunction
- Phosphodiesterase type 5 inhibitors : sildenafil (Viagra), tadafil (Cialis) and vardenafil (levitra)

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22
Q

Paraphilic disorders

A

recurrent sexual attraction to unusual objects or sexual activities
- lasting at least 6 months
- deviation (para) in what the person is attracted to (philia)
- should only be diagnosed if causes marked distress or done w nonconsenting persons
- cross-dressing usually doesn’t involve non-consenting persons or impairment, only diagnosed if individual is distressed by it

23
Q

Paraphilias - 2 categories

A
  • sexual attractions based on inanimate objects
  • sexual attractions based on children
24
Q

Paraphilias included in DSM-5

A
  • Fetishistic disorder - inanimate object or nongenital body park
  • transvestic disorder (dated term)- cross-dressing
  • pedophilic disorder- children
  • Voyeuristic disorder- watching unknowning others undress/have sex
  • exhibitionistic disorder: exposing to strangers
  • frotteuristic disorder- sexual touching of unsuspecting other
  • sexual sadism disorder- inflicting pain
  • sexual masochism disorder- receiving pain
25
Q

Prevalence of paraphilic disorders

A

accurate prevalence statistics not available
- data does indicate, mostly male and heterosexual
- onset for many (includ. fetishistic, voyeuristic, exhibitionistic, pedophilic disorders) occur in adolescents

  • onset of sexual sadism/masochism occur early adulthood
26
Q

Fetishistic Disorder

A

Reliance on inanimate object or unsexual part of body for arousal
- eg shoes, stockings, underwear, rubber garments, hair, feet, etc.
- occurs most often in men
- object strongly prefered and often necessary for sexual arousal

attraction to object irresistable and involuntary

fetishes often co-occur w other paraphilias

27
Q

DSM-5 criteria of fetishistic disorder

A
  • at least 6 mo, recurrent intense fantasies/urges/behaviors involving body parts or objects
  • causes sig distress or impairment in functioning
  • objects not limited to clothing used in cross-dressing or sex toys
28
Q

Pedophilic Disorder

A
  • Pedos = child, philia = attraction
  • sexually arousing urges/ fantasies/ behaviors involving sexual contact with a prepubertal or pubescent child
    • offender at least 16 and 5 years older than victim
    • child pornography widely used

victims usually know to pedophile
- neighbors, family members, friends, clergy
- most pedophilia doesn’t involve violence other than sexual activity

relative interest in children vs adults is more telling about pedophilia- show more arousal for children than adults

29
Q

Incest

A
  • listed as subtype of pedophilic disorder
  • most common btwn brother and sister
  • less common but more pathological: father and daughter
  • incest taboo almost culturally universal
    • genetically adaptive- offspring have greater likelihood of inheriting pairs of recessive genes w possible neg biological effects
30
Q

rape

A
  • attempted/completed intercourse through force/ threat of force/ or when victim incapacitated and unable to give consent
  • 19.3% women raped, 1.7% men
31
Q

etiology of rape

A
  • sexually aggressive men tend to show antisocial and impulsive personality traits
  • unusually high hostility towards women
  • distorted beliefs about sexual coercion
  • exposure to violence may increase likelihood to rape
  • rapists more likely to have been victim of sexual and physical abuse
32
Q

treatment for rapists

A

same general approaches as paraphilic disorders:

  • motivational strategies
  • cognitive behavioral techniques
  • pharmacological treatments

little evidence for effectiveness

33
Q

voyeuristic disorder

A

sexually arousing fantasies, urges, behaviors while observing others who are undressed or engaging in sexual activity
- usually men
- excitement from knowing victim is unaware; element of risk important
- seldom results in physical contact

34
Q

exhibitionistic disorder

A

intense desire to obtain sexual gratification by exposing genitals to unwilling strangers
- sometimes children
- seldom results in physical contact
- usually involves desire to shock or alarm victim

often comorbid w voyeuristic and frotteuristic disorders

DSM-5 criteria includes that person has acted on urges, or it causes distress/interpersonal problems

35
Q

frotteuristic disorder

A

sexually oriented touching of a nonconsenting person
- individual rubs his genitals against a womens body or fondles her
- often occurs in crowded subway/ other public place

36
Q

Sexual sadism disorder

A

intense and recurrent desire to obtain or increase sexual gratification by inflicting pain or psychological suffering on another person

37
Q

sexual masochism disorder

A

intense and recurrent desire to obtain or increase sexual gratification through receiving pain or humiliation
- asphyxiophilia
- sexual arousal by oxygen deprivation
- can result in death or brain damage

more masochists than sadists

38
Q

Etiology of Paraphilias

A

ultimately we don’t understand the etiology

  • Neurobiological factors
    • male hormones or androgens
      • almost all ppl w paraphilias are men
    • don’t have unusual levels of testosterone
  • Classical conditioning
    • research hasn’t supported orgasm conditioning hypothesis (orgasm associated with a certain thing)
  • Operant Conditioning
    • poor social skills or reinforcement of unconventionality
  • History of childhood physical and sexual abuse
    • 1/3 of ppl who commit sexual offenses against children don’t report history of sexual abuse, not whole story
  • Psychological Factors
    • Cognitive distortions
    • heightened impulsivity and poor emotion regulation
    • pedophilia- slightly lower IQ, higher rates of neurocognitive problems,
      • minor physical anomalies related to atypical prenatal development
    • alcohol and negative affect are common triggers
39
Q

Treatment for Paraphilias- treatment studies

A
  • Incarceration and court-ordered treatment are common
  • often difficult to interpret outcome from treatment studies
    • studies vary greatly
    • Many lack control groups
    • dropout rates high
40
Q

types of treatments for paraphilias

A
  • enhance motivation
  • cognitive behavioral treatment
  • biological treatments
41
Q

types of treatments for paraphilias- enhance motivation

A

why to use:
- denial and minimization of problem often present
- blaming the victim
- lack of motivation for treatment
- many drop out

enhancing motivation:
- bolster clients hope that they can gain control over urges
- focus on reasons for change, such as legal consequences

42
Q

types of treatments for paraphilias- Cognitive behavioral treatment

A
  • aversion therapy
    • satiation: pairing a neg association w the attraction
  • covert sensitization
    • make more sensitized to effects of their behavior
  • counter distorted thinking
    • challenge distorted thoughts
  • often combined w social skills and empathy training
  • sexual impulse control strategies
43
Q

types of treatments for paraphilias- Biological treatments

A
  • castration used in past
  • medications
    • hormonal agents to reduce androgens (depo-provera)
    • SSRIs, not much evidence
44
Q

legal issues- protecting the public vs civil liberties of those w paraphilias

A
  • supreme court ruled person high risk for sex crimes can be detained if risk is related to psych disorder that diminishes ability to control their sexual behavior
  • Megan’s law: police publicize whereabouts of registered sex offenders
45
Q

q- Speculations about the role of hormones in paraphilias center on

A

androgens

46
Q

q- someone who derives sexual pleasure from contact with prepubertal children would be diagnosed with

A

pedophilic disorder

47
Q

q- Delayed ejaculation disorder

A

is defined as persistent difficulty in ejaculating.

48
Q

q- Those with fetishistic disorder are sexually aroused by

A

inanimate objects.

49
Q

q- Persistent disruptions in the ability to experience sexual arousal, desire, or orgasms, or pain associated with intercourse, is called

A

sexual dysfunction.

50
Q

q- The squeeze technique is used in the treatment of

A

premature ejaculation

51
Q

q- Persistent or recurrent pain during sexual intercourse is called __________ in the DSM-5

A

Persistent or recurrent pain during sexual intercourse is called __________ in the DSM-5

52
Q

After exhibiting, Ethan said of his victim, “She smiled, so I guess she was amused.” This is an example of

A

minimizing consequences.

53
Q

q- Which of the following is a current or proximal cause of sexual dysfunctions, according to Masters and Johnson?

A

fear of performance

54
Q

q- Which of these diagnoses does not include a criterion specifying that the victim be non-consenting?

A

Sexual masochistic disorder

Abnormal Psych (16 decks)

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