Chapter 12 Flashcards
Trigger Warning:
In this chapter, we cover sexual disorders and as such we will be discussing sex and sexuality in depth. Some of those topics will involve trauma, rape, or other potentially triggering information. Please practice self care during this lecture and feel free to take a break as needed.
define trigger as in “trigger warning”
Trigger: def – something that triggers a panic attack. Not something that offends you/ upsets you
Do not want to use this word incorrectly
Men vs Women for sexual
Men are more likely to:
Meet diagnostic criteria for paraphilic disorder
Endorse engaging in masturbation and using pornography
Women are more likely to report sexual dysfunction
Gender differences over time
Gender differences in sexuality have decreased over time
gender differences and cultures
Reported gender differences in sexual behavior may reflect respondents’ attempts to match cultural expectations
The Sexual Response Cycle
*Desire phase Sexual interest associated with arousing fantasies or thoughts *Excitement phase Increased blood flow to the genitalia *Orgasm phase Sexual pleasure peaks *Resolution phase Relaxation and sense of well-being following an orgasm Oxytocin kicks in
DSM-5 Sexual Dysfunctions: Three main types
Sexual desire, arousal, and interest disorders
Orgasmic disorders (difficulty achieving orgasm)
Sexual pain disorders
Sexual desire, arousal, and interest disorders
women:Sexual interest/arousal disorder
In men: Male hyposexual disorder and erectile disorder
Orgasmic disorders (difficulty achieving orgasm)
In women: Female orgasmic disorder
In men: Premature ejaculation and delayed ejaculation
Sexual pain disorders
Sexual pain disorders
In women: Genito-pelvic pain/penetration disorder
(Men may not admit to having these issues)
Disorders Involving Sexual Interest, Desire, and Arousal
Female sexual interest/arousal disorder
Male hypoactive sexual desire disorder
Male erectile disorder
Failure to attain or maintain an erection
Female sexual interest/arousal disorder
Persistent deficits in sexual interest (fantasies or urges), biological arousal, or subjective arousal
Male hypoactive sexual desire disorder
Deficient or absent of sexual fantasies and urges
a Sexual desire, arousal, and interest disorder
DSM-5 Criteria:Female Sexual Interest/Arousal Disorder (1 of 2)
- Diminished, absent, or reduced frequency of at least three of the following:
- Interest in sexual activity
- Erotic thoughts or fantasies
- Initiation of sexual activity and responsiveness to partner’s attempts to initiate
- Sexual excitement/pleasure during 75% of sexual encounters
- Sexual interest/arousal elicited by any internal or external erotic cues
- Genital or nongenital sensations during 75% of sexual encounters
Erectile Disorder
On at least 75% of sexual occasions, one of the following occurs:
Inability to attain an erection
Inability to maintain an erection for completion of sexual activity
Marked decrease in erectile rigidity interferes with penetration or pleasure
(men: Sexual desire, arousal, and interest disorder)
Orgasmic Disorders
Female orgasmic disorder
Early ejaculation disorder
Delayed ejaculation disorder
Female orgasmic disorder
Persistent absence or reduced intensity of orgasm after sexual arousal
Early ejaculation disorder
Ejaculation that occurs too quickly
an Orgasmic disorder
Delayed ejaculation disorder
Persistent difficulty in ejaculating
Least common, reported by less than 1% of men
(an Orgasmic disorder)
DSM-5 Criteria: Female Orgasmic Disorder
On at least 75% of sexual occasions:
Marked delay, infrequency, or absence of orgasm, or
Markedly reduced intensity of orgasmic sensation
(Do not want to base this off of one experience)
Premature Ejaculation
DSM
Premature Ejaculation
Tendency to ejaculate during partnered sexual activity within 1 minute of penile insertion on at least 75% of sexual occasions
Delayed Ejaculation
DSM
Delayed Ejaculation
Marked delay, infrequency, or absence of orgasm on at least 75% of sexual occasions
Genito-pelvic pain/penetration disorder
-a Sexual Pain Disorder
Persistent or recurrent pain during intercourse
Diagnosable in both men and women
Very few men seek treatment
R/O medical cause (e.g., infection), lack of vaginal lubrication, or postmenopausal changes
Many can experience sexual arousal and orgasms from manual or oral stimulation that does not involve penetration
Persistent or recurrent difficulties with at least one of the following:
Inability to have vaginal penetration during intercourse
Marked vulvar, vaginal or pelvic pain during vaginal penetration or intercourse attempts
Marked fear or anxiety about pain or penetration
Marked tensing of the pelvic floor muscles during attempted vaginal penetration
Masters & Johnson (1970) two-tier model:
Masters & Johnson (1970) two-tier model:
*Immediate causes (takes place during performance)
Fears about performance
Adoption of spectator role
*Distal (historical) causes
Sociocultural influences
Biological causes
Sexual traumas
(Etiology of Sexual Dysfunction)
Psychosocial Factors
History of rape, sexual abuse, absence of positive sexual experiences
Relationship problems
E.g., anxiety, anger, embarrassment, poor communication
Depression and anxiety
Low physiological arousal
A psycholigist wouldn’t really treat this
Stress and exhaustion
Negative cognitions Self-blame What the cognitive theorest really go at Social and cultural learning Whether to get treatment or nah
Treatments of Sexual Dysfunctions
*Psychoeducation
*Couples therapy
Training in nonsexual COMMUNICATION skills
Focus on nonsexual issues
Focus on communication and restoration of intimacy
Not really of the sexual kind (focusing on emotions between the couple)
*Cognitive interventions
Challenge self-demanding, perfectionistic thoughts
*Sensate focus
Re-establish intimacy by engaging in contact through touch
Treatments for Female orgasmic disorder
Specific Female Sexual Dysfunctions
- a Specific Female Sexual Dysfunctions
Female orgasmic disorder
Directed masturbation
60–90% of that subgroup achieving orgasm post-treatment
Treatments for Genito-pelvic pain/penetration disorder
- a Specific Female Sexual Dysfunctions
Genito-pelvic pain/penetration disorder
Trained in relaxation
Practice inserting smaller and then larger dilators into vagina
Treatments for Premature ejaculation
-Specific Male Sexual Dysfunctions
Premature ejaculation
SSRI (e.g., dapoxetine) taken 1 hour before sex
Squeeze technique
Partner is trained to squeeze the penis in the area where the head and shaft meet to rapidly reduce arousal
Withdraw penis as needed during intercourse to reduce arousal
Psychotherapy to regain confidence after experiences of these symptoms
Treatments for Erectile Disorder
-Specific Male Sexual Dysfunctions
Medication (e.g., Viagra)
Works on physical side of things: blood pressure
83% able to successfully have intercourse
Paraphilic Disorders
-catagories
Recurrent sexual attraction to unusual objects or sexual activities lasting at least 6 months
Should only be diagnosed when:
There is marked distress or impairment
Behaviors are done with nonconsenting persons
Divided categories based on source of arousal:
Sexual attractions based on inanimate objects
Sexual attractions based on children
Accurate prevalence statistics are not available
Fetishistic Disorder
Reliance on an inanimate object or a nongenital part of the body for sexual arousal
Recurrent and intense sexual urges toward these fetishes
Presence of the fetish is strongly preferred or even necessary for sexual arousal
Compulsive attraction to the object
The attraction is experienced as involuntary and irresistible
DSM-5 Criteria: Fetishistic Disorder
For at least 6 months, recurrent and intense sexually arousing fantasies, urges, or Behaviors involving the use of nonliving objects or nongenital body parts
Causes significant distress or impairment in functioning
The sexually arousing objects are not limited to articles of clothing used in cross-dressing or to devices designed to provide tactile genital stimulation, such as a vibrator
Pedophilic Disorder
Diagnosed only when adults act on their sexual urges toward children, or when the urges cause distress
Victims usually known to pedophile
Most pedophilia does not involve violence other than the sexual act
Pedophiles show more arousal to sexual stimuli involving children than to stimuli involving adults
Pedophilic disorder, incest subtype
Sexual relations between close relatives for whom marriage is forbidden (e.g., brother and sister)
DSM-5 Criteria: Pedophilic Disorder
For at least 6 months, recurrent and intense, sexually arousing fantasies, urges, or Behaviors involving sexual contact with a prepubescent child
Person has acted on these urges or the urges and fantasies cause marked distress or interpersonal problems
Person is at least 16 years old and 5 years older than the child
Voyeuristic Disorder
Intense and recurrent desire to obtain sexual gratification by watching:
Unsuspecting others in a state of undress
Having sexual relations
May not find it particularly exciting to watch someone undress for his benefit
The element of risk, and the threat of discovery, is important
Voyeuristic Disorder and gender
Common in men
DSM-5 Criteria: Voyeuristic Disorder
IDK
Exhibitionistic Disorder
Exposing one’s genitals to an unwilling stranger
Seldom an attempt to have other contact with the stranger
Usually involves desire to shock or embarrass the observer
Many exhibitionists masturbate during the exposure
DSM-5 Criteria: Exhibitionistic Disorder
For at least 6 months, recurrent, intense, and sexually arousing fantasies, urges, or Behaviors involving showing one’s genitals to an unsuspecting person
Person has acted on these urges to a nonconsenting person, or the urges and fantasies cause clinically significant distress or interpersonal problems
Frotteuristic Disorder
Sexually oriented touching of a unsuspecting person
Rubbing genitals against a person’s body or fondling a person’s genitals
Often occurs in crowded places
(To a nonconsenting person)
DSM-5 Criteria: Frotteuristic Disorder
For at least 6 months, recurrent and intense and sexually arousing fantasies, urges, or Behaviors involving touching or rubbing against a nonconsenting person
Person has acted on these urges with a nonconsenting person, or the urges and fantasies cause clinically significant distress or problems
Sexual Sadism and Masochism Disorders
Sexual sadism disorder
Sexual masochism disorder
Being subjected to pain or humiliation
Most sadists establish relationships with masochists to derive mutual sexual gratification
Debate over inclusion in DSM-5:
These disorders have become more common
Typically do not cause impairment or distress
Sexual Sadism
*Inflicting pain or psychological suffering (such as humiliation) on another
For at least 6 months, recurrent, intense, and sexually arousing fantasies, urges, or Behaviors involving the physical or psychological suffering of another person
Causes clinically significant distress or impairment in functioning or the person has acted on these urges with a nonconsenting person
Sexual masochism disorder DSM-5 Criteria:
For at least 6 months, recurrent, intense, and sexually arousing fantasies, urges, or Behaviors involving the act of being humiliated, beaten, bound, or made to suffer
Causes marked distress or impairment in functioning
(Not really looking at the nonconsenting person (because the person giving pain, and cant force someone to do that))
Etiology of the Paraphilic Disorders
*Neurobiological factors
Almost all individuals with paraphilias are men
They do not have unusual levels of testosterone or other androgens
*Childhood sexual abuse
40-66% of adult sexual offenders reported a history of sexual abuse
- Psychological Factors
- Loss of control over Behavior
- Heightened impulsivity and poor emotion regulation
- Slightly lower IQ and higher rates of neurocognitive problems
- More minor physical anomalies related to prenatal development
Treatment for the Paraphilic Disorders
Very little is known about the effectiveness of treatments
Research often focuses on men charged with sexual offenses
Very little long-term data is available
Unethical to withhold treatment
Lack of control groups
(No double blind studies)
Enhance motivation for treatment
Bolster hope for control over urges
Focus on benefits for change and consequences of continued engagement in illegal sexual Behaviors
Cognitive Behavioral treatment
Aversion therapy
Pair paraphilic fantasies with aversive stimuli
Counter distorted thinking
Often combined with social skills, sexual impulse control strategies, empathy training, and relapse prevention
Biological treatments Castration used in past Medications (supplement to psychological treatment) Hormonal agents to reduce androgens SSRIs
Treatment for the Paraphilic Disorders : Biological treatments
*Biological treatments
Castration used in past
*Medications (supplement to psychological treatment)
Hormonal agents to reduce androgens
SSRIs
Community Prevention
Balance between protecting the public and protecting the civil liberties of sexual offenders
E.g., laws concerning the public’s “right to know” when a sex offender is released
Megan’s law
Unconstitutional to detain a person based on potential for future crimes:
Supreme Court ruled that a person at high risk for a sex crime can be detained if the risk is related to a psychological disorder diminishing the person’s ability to control sexual Behavior
Receipt of this diagnosis can lead to placement in a psychiatric facility after a prison term is completed
Which of the following brain mechanisms have been implicated in anorexia?
a. ) With puberty, the dramatic increase in female hormones damages centers that control eating in the thalamus and pituitary.
b. ) Excessive exercise depletes the brain of neurotransmitters utilized by areas that regulate hunger or satiation.
c. ) Stress-released hormones reduce the sensitivity of receptors that detect blood-sugar levels and release hormones that induce hunger.
d. ) Starvation releases natural pain-reducing opioids producing a high, which reinforces not eating.
d.) Starvation releases natural pain-reducing opioids producing a high, which reinforces not eating.
Efforts to treat bulimia nervosa using antidepressant drugs have been complicated by
a. ) low federal funding for such studies
b. )frequent side effects
c. ) treatment refusal
d. ) all of the above
c.) treatment refusal
- Research suggests that gender differences in sexuality are
a) consistent across cultures.
b) vary greatly by culture.
c) vary slightly by culture.
d) more of a result of culture than biology.
a) consistent across cultures.
- Which of the following is NOT a subcategory of paraphilia in the DSM-5?
a) fetishistic disorder
b) sexual arousal disorder
c) transvestic disorder
d) exhibitionistic disorder
b) sexual arousal disorder
- According to the Centers for Disease Control and Prevention, __________ percent of women will be
diagnosed with a sexually transmitted illness by the age of 19.
a) 10
b) 25
c) 40
d) 60
b) 25
- Which age group has the highest number of new HIV cases being diagnosed each year?
a) 15-19
b) 20-24
c) 25-29
d) 30-34
b) 20-24
- A person who feels deep within themselves, usually from early childhood, that they are of the
opposite gender is given the diagnosis of
a) gender distortion disorder.
b) gender identity disorder.
c) sexual distortion disorder.
d) all of the above are possible diagnostic labels.
b) gender identity disorder.
dyspareunia
Persistent or recurrent genital pain that occurs just before, during, or after intercourse.
- Jane is finding that her interest in sex has diminished greatly. She not only avoids having sexual
contact with her husband, but has even stopped fantasizing and masturbating. Jane would likely be
diagnosed as having which of the following DSM-5 disorders?
a) female orgasm disorder
b) female sexual arousal disorder
c) hypoactive sexual desire disorder
d) none of the above
c) hypoactive sexual desire disorder
44. Which of the following is a current or proximal cause of sexual dysfunctions, according to Masters and Johnson? a) psychosexual trauma b) fear of performance c) excessive intake of alcohol d) homosexual inclinations
b) fear of performance
- Masters and Johnson found that many individuals who have sexual dysfunction
a) were college-educated.
b) had low socioeconomic status.
c) had negative views of sexuality.
d) were encouraged to express their sexuality at a young age.
c) had negative views of sexuality.
- For women with sexual dysfunctions in the context of marital relationship distress, which of the
following has been found to improve many aspects of sexual functioning?
a) SSRI medications
b) behavioral marital couple’s therapy
c) anti-anxiety medications
d) psychoanalysis
b) behavioral marital couple’s therapy
- Megan’s Law involves
a) notification of members of a community when a convicted sex offender is released and moving into
that neighborhood.
b) additional compensation for victims’ families following sex crimes.
c) more rigid conviction standards for sex offenders.
d) mandates intensive therapy for sex offenders following their first offense.
a) notification of members of a community when a convicted sex offender is released and moving into
that neighborhood.
- True or false? A diagnosis of Pedophilic Disorder requires that an individual have persistent urges to
behave sexually with pre-pubescent children, not necessarily to have acted on them.
TRUE
- Which of these diagnoses does not include a criterion that specifies the victim be non-consenting?
a. Pedophilic Disorder
b. Voyeuristic Disorder
c. Exhibitionistic Disorder
d. Frotteuristic Disorder
a. Pedophilic Disorder
