Chapter 12

Question 1

Sexual dysfunction

Answer 1

• 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

Question 2

4 phases of human sexual response

Answer 2

1. Desire phase: fantasies ab sexual activity/desire to have sexual activity
2. Arousal phase: subjective sense of sexual pleasure and physiological changes
3. Orgasm: release of sexual tension and peak of sexual pleasure
4. Resolution: sense of relaxation and well-being

Question 3

Male Hypoactive Sexual Desire Disorder

Answer 3

• 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

Question 4

Erectile disorder

Answer 4

• 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)

Question 5

Premature (Early) Ejaculation

Answer 5

• 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

Question 6

Delayed Ejaculation Disorder

Answer 6

• persistent inability to ejaculate during intercourse
• physical problems (ie multiple sclerosis, meds like SSRIs) may be involved
• treatment psychologically based, includes couples therapy

Question 7

Female Sexual Interest/Arousal Disorder

Answer 7

• 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)

Question 8

Genito-Pelvic Pain/Penetration Disorder

Answer 8

• 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

Question 9

Female orgasmic disorder

Answer 9

• 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

Question 10

Gender Dysphoria

Answer 10

• 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

Question 11

Gender Dysphoria - Clinical Picture

Answer 11

• 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

Question 12

Treatment for Gender Dysphoria

Answer 12

• 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

Question 13

Paraphilic Disorders

Answer 13

• 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

Question 14

Voyeuristic Disorder

Answer 14

• 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

Question 15

Exhibitionistic Disorder

Answer 15

• 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

Question 16

Frotteuristic Disorder

Answer 16

• 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

Question 17

Sexual Sadism Disorder

Answer 17

• 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

Question 18

Sexual Masochism Disorder

Answer 18

• 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

Question 19

Fetishistic Disorder

Answer 19

• 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

Question 20

Transvestic Disorder

Answer 20

• 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)

Question 21

Causal Factors and Treatments for Paraphilic Disorders

Answer 21

• 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

Question 22

Pedophilic Disorder

Answer 22

• 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

Question 23

Aversion Therapy

Answer 23

• paraphilic stimulus paired w aversive event (ie shock)
• try to change conditioned association of child to pleasure

Question 24

Covert sensitization

Answer 24

• patient imagines highly aversive event while viewing/imagining paraphilic stimulus

Question 25

Assisted covert sensitization

Answer 25

• foul odor introduced to induce nausea at point of peak arousal

Question 26

Cognitive restructuring

Answer 26

• attempts to eliminate sex offenders’ cognitive distortions bc these may play a role in sexual abuse

Question 27

Social-skills training

Answer 27

• aims to help sex offenders learn to process social info from women more effectively and interact w them more appropriately

Question 28

Biological and surgical treatments - paraphelias

Answer 28

• 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%

Question 29

Childhood Sexual Abuse

Answer 29

• 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