Chapter 12: Sexual Variants, Abuse, and Dysfunction

Question 1

There are fewer sex researchers than researchers for many other disorders. Give two reasons as to why this may be?

Answer 1

1. Sex is taboo.
2. Many issues related to sexuality—including homosexuality, teenage sexuality, abortion, and childhood sexual abuse—are among the most divisive and controversial in our society.

Question 2

Why is it difficult to say what kind of behaviour should be considered “abnormal” in relation to sex?

Answer 2

There are cultural differences (muslims covering their whole body vs. western culture), with none of the views being “right” or “wrong”. Opinions about “acceptable” and “normal” sexual behaviour may change dramatically over time.

Question 3

What is degeneracy theory?

Answer 3

The central belief of which was that semen is necessary for physical and sexual vigor in men and for masculine characteristics such as beard growth. We now know that loss of the male hormone testosterone (not semen), is responsible for the relevant characteristics of those who have been castrated.

Question 4

What did degeneracy theory deem to be harmful?

Answer 4

Masturbation and patronizing prostitutes (as it wasted semen).

Question 5

Discuss ritualized homosexuality in Melanesia.

Answer 5

The best-studied society has been the Sambia of Papua New Guinea.

Two beliefs reflected in Sambian sexual practices are semen conservation and female pollution. To obtain or maintain adequate amounts of semen, young Sambian males practiced semen exchange with each other. They also maintained the female pollution doctrine, which is the belief that the female body is unhealthy to males, primarily because of menstrual fluids.

Question 6

A Melanesian adolescent who refuses to practice homosexuality would have been viewed as?

Answer 6

Abnormal.

Question 7

T or F: Around 1950, the view of homosexuality as sick-ness began to be challenged by both scientists and homosexual people themselves

Answer 7

True.

Question 8

When was homosexuality removed from the DSM-II?

Answer 8

1974.

Question 9

What are paraphilic disorders?

Answer 9

Characterized by recurrent, intense sexually arousing fantasies, sexual urges, or behaviours that generally involve (1) abnormal targets of sexual attraction (e.g., shoes, children), (2) unusual courtship behaviours (e.g., watching others undress without their knowledge, or exposing oneself to others against their wishes), or (3) the desire for pain and suffering of oneself or others

Question 10

Make the distinction between paraphilias and paraphilic disorders.

Answer 10

Paraphilias are unusual sexual interests, but they need not cause harm either to the individual or to others. Only if they cause such harm do they become paraphilic disorders. Thus, foot fetishists have a paraphilia, but only those who suffer due to their sexual interest have a paraphilic disorder.

Question 11

Are men or women more likely to have paraphilic disorders?

Answer 11

Men.

Question 12

The DSM-5 recognizes 8 paraphilias. What are they?

Answer 12

(1) fetishism, (2) transvestic fetishism, (3) pedophilia, (4) voyeurism, (5) exhibitionism, (6) frotteurism, (7) sexual sadism, and (8) sexual masochism.

Question 13

What is fetishism (paraphilia)?

Answer 13

Recurrent, intense sexually arousing fantasies, urges, and behaviours involving the use of some inanimate object or a part of the body not typically found erotic (e.g., feet) to obtain sexual gratification

Question 14

What is transvestic disorder (paraphilia)?

Answer 14

Heterosexual men who experience recurrent, intense sexually arousing fantasies, urges, or behaviours that involve cross-dressing as a female if they experience significant distress or impairment due to the condition

Question 15

What is autogynephilia?

Answer 15

Paraphilic sexual arousal by the thought or fantasy of being a woman - considered a motivation for transvestites.

Question 16

What is voyeuristic disorder (paraphilia)?

Answer 16

Recurrent, intense sexually arousing fantasies, urges, or behaviours involving the observation of unsuspecting females who are undressing or of couples engaging in sexual activity

Question 17

T or F: Voyeurism is believed to be the least common illegal sexual activity.

Answer 17

False. It is believed to be the most common.

Question 18

What is exhibitionistic disorder (paraphilia)?

Answer 18

Recurrent, intense urges, fantasies, or behaviours that involve exposing his genitals to others (usually strangers) in inappropriate circumstances and without their consent

*the element of shock in the victim is highly arousing to these individuals.

Question 19

T or F: exhibitionism is the most common sexual offence reported to the police (US + Canada.

Answer 19

True.

Question 20

What is frotteurism (paraphilia)?

Answer 20

Sexual excitement at rubbing one’s genitals against, or touching, the body of a nonconsenting person.

Question 21

T or F: frotteuristic disorder is diagnosed if frotteuristic acts occur, whether or not the frotteurer is, himself, bothered by his urges.

Answer 21

True.

Question 22

What is sexual sadism disorder (paraphilia)?

Answer 22

Recurrent, intense sexually arousing fantasies, urges, or behaviours that involve inflicting psychological or physical pain on another individual

Question 23

DSM-5 requires that the diagnosis of sadism be reserved for cases either in which…

Answer 23

the victim is nonconsenting or in which the sadistic experience is marked by distress or interpersonal difficulties.

Question 24

What is sexual masochism disorder (paraphilia)?

Answer 24

A person experiences sexual stimulation and gratification from the experience of pain and degradation in relating to a lover. The person must have experienced recurrent, intense sexually arousing fantasies, urges, or behaviours involving the act of being humiliated, beaten, bound, or otherwise made to suffer.

Question 25

What is autoerotic asphyxia?

Answer 25

A dangerous form of masochism involving self-strangulation.

Question 26

T or F: It has been suggested that male vulnerability to paraphilias is closely linked to their greater dependence on visual sexual imagery.

Answer 26

True (as opposed to women who may be more dependent on emotional connection).

Question 27

What is gender dysphoria?

Answer 27

Discomfort with one’s sex-relevant physical characteristics or with one’s assigned gender.

Question 28

What are the two different life stages that gender dysphoria can be diagnosed?

Answer 28

Gender dysphoria can be diagnosed at two different life stages, either during childhood (gender dysphoria in children) or adolescence or adulthood (i.e., gender dysphoria in adolescents and adult

Question 29

T or F: Gender dysphoria is typically treated psychodynamically—that is, by examining inner conflicts

Answer 29

True.

Question 30

T or F: Most children with gender dysphoria do not become adults with gender dysphoria.

Answer 30

True.

Question 31

T or F: Individuals who are still gender dysphoric into adolescence are likely to remain so into adulthood, and they are also likely to take medical steps to transform their bodies.

Answer 31

True.

Question 32

What is transsexualism?

Answer 32

Occurs in adults with gender dysphoria who desire to change their sex, and surgical advances have made this goal, although expensive, partially feasible

Question 33

There are two kinds of male-to-female transsexuals, with very different causes and developmental courses. Identify and define them.

Answer 33

Homosexual and autogynephilic transsexuals.

Homosexual transsexual men are generally very feminine and have the same sexual orientation as gay men: They are sexually attracted to biological males (their pre-operative biological sex). However, because these trans-sexual men experience their gender identity as female, they often define their sexual orientation as heterosexual and resent being labeled gay.

Autogynephilic transsexuals are motivated by autogynephilia—a paraphilia in which their attraction is to thoughts, images, or fantasies of themselves as a woman. Autogynephilic transsexuals fantasize that they have female genitalia, which can lead to acute gender dysphoria, motivating their desire for sex reassignment surgery.

Question 34

T or F: transsexuals are especially hostile to the notion of autogynephilia.

Answer 34

True. They object because they say that their motivation to change their sex is not sexual.

Question 35

What is sexual abuse?

Answer 35

Sexual abuse is sexual contact that involves physical or

psychological coercion of at least one individual who cannot reasonably consent to the contact (e.g., a child).

Question 36

T or F: Pedophilia is not included in the DSM-5 under sexual abuse.

Answer 36

False. Only pedophilia is included in DSM-5.

Question 37

T or F: People who are sexually abused during childhood are approximately twice as likely as children who were not sexually abused to develop a later mental disorder

Answer 37

True. The highest risk being for fear/anxiety and substance use disorder.

Question 38

What is pedophilic disorder?

Answer 38

Recurrent, intense sexual urges or fantasies about sexual activity with a prepubertal child; acting on these desires is not necessary for the diagnosis if they cause the pedophile distress

Question 39

What is hebephilia?

Answer 39

attraction to pubescent children—children in the early stages of puberty

Question 40

T or F: adolescent and adult men with pedophilia are much more likely to have been sexually or physically abused as children than are adults who sexually abuse other adults.

Answer 40

True.

Question 41

What is incest?

Answer 41

Refers to culturally prohibited sexual relations between family members such as a brother and sister or a parent and child.

Question 42

T or F: Brother–sister incest is the most common form of incest.

Answer 42

True.

Question 43

What is rape?

Answer 43

Sexual intercourse that occurs under actual or threatened forcible coercion of one person by another

Question 44

What is sexual assault?

Answer 44

Acts, separate from rape, that involve unwanted sexual contact, such as groping or fondling another per-son without their consent.

Question 45

T or F: A very high proportion of rape victims are women in their teens and early 20s, who are generally considered the most sexually attractive.

Answer 45

True.

Question 46

What are rape shield laws?

Answer 46

These laws protect rape victims by, for example, preventing the prosecutor from using evidence of a victim’s prior sex history.

*Problems still remain.

Question 47

In terms of personality, what are rapists typically characterized by?

Answer 47

impulsivity, quick loss of temper, lack of personally intimate relationships, and insensitivity to social cues or pressures

Question 48

What is Megan’s Law?

Answer 48

Mandates that upon release, convicted sex offenders register with police and that authorities notify neighbours that convicted sex offenders have moved in by distributing fliers, alerting local organizations, and canvassing door-to-door.

Question 49

T or F: Sex offender recidivism is markedly lower than for many other kinds of crimes.

Answer 49

True. However, sex offenders with deviant sexual preferences (e.g., exhibitionists, severe sadists, and those who are most attracted to children) have particularly high rates of sexual recidivism.

Question 50

What is aversion therapy (sexual offender treatment)?

Answer 50

A paraphilic stimulus such as a slide of a nude prepubescent girl for a man with pedophilia is paired with an aversive event such as forced inhalation of noxious odours or a shock to the arm.

Question 51

What is covert sensitization?

Answer 51

The patient imagines a highly aversive event while viewing or imagining a paraphilic stimulus.

Question 52

What is assisted covert sensitization?

Answer 52

A foul odor is introduced to induce nausea at the point of peak arousal when viewing or imaging a paraphilic stimulus.

Question 53

T or F: aversion therapy is used as a sole form of treatment for sexual offenders.

Answer 53

False.

Question 54

How does cognitive restructuring work for sexual offenders?

Answer 54

Attempts to eliminate sex offenders’ cognitive distortions because these may play a role in sexual abuse

Question 55

How does social-skills training work for sexual offenders?

Answer 55

Aims to help sex offenders (especially rapists) learn to process social information from women more effectively and to interact with them more appropriately

Question 56

T or F: antidepressants from the SSRI (selective serotonin reuptake inhibitor) category have been found to be useful in treating a variety of paraphilias by reducing paraphilic desire and behaviour.

Answer 56

True. However, they are not useful in the treatment of sexual offenders.

Question 57

What is sexual dysfunction?

Answer 57

Impairment either in the desire for sexual gratification or in the ability to achieve it.

Question 58

Researchers and clinicians typically identify four different phases of the human sexual response. According to DSM-5, sexual dysfunctional disorders can occur in any of the first three phases. What are the four stages?

Answer 58

The first phase is the desire phase, which consists of fantasies about sexual activity or a sense of desire to have sexual activity.

The second phase is the excitement, or arousal, phase. It is characterized both by a subjective sense of sexual pleasure and by physiological changes that accompany this subjective pleasure, including penile erection in the male and vaginal lubrication and clitoral enlargement in the female.

The third phase is orgasm, during which there is a release of sexual tension and a peaking of sexual pleasure.

The final phase is resolution, during which the person has a sense of relaxation and well-being.

Question 59

What is hypoactive sexual desire disorder?

Answer 59

Diagnosed in men who have for at least 6 months been distressed or impaired due to low levels of sexual thoughts, desires, or fantasies.

*Predictors of low desire included daily alcohol use, stress, unmarried status, and poorer health.

Question 60

T or F: Most experts believe that male hypoactive sexual desire disorder is acquired or situational rather than lifelong.

Answer 60

True.

Question 61

T or F: Erectile problems occur in as many as 90 percent of men on certain antidepressant medications

Answer 61

True. It is one of the primary reasons men cite for dis-continuing these medications.

Question 62

What is priapism?

Answer 62

An erection that will not diminish even after a couple of hours, typically unaccompanied by sexual excitement. This tends to lead to erectile dysfunction.

Question 63

What is the pause-and-squeeze technique (behavioural therapy)?

Answer 63

This technique requires the man to monitor his sexual arousal during sexual activity. When arousal is intense enough that the man feels that ejaculation might occur soon, he pauses, and he or his partner squeezes the head of the penis for a few moments until the feeling of pending ejaculation passes, repeating the stopping of intercourse as many times as needed to delay ejaculation

Question 64

T or F: Antidepressants have been found to significantly prolong ejaculatory latency in men with early ejaculatio.

Answer 64

True. However, in other men, these same medications—especially the SSRIs—sometimes delay or prevent orgasm to an unpleasant extent

Question 65

T or F: psychological factors appear to be more important than biological factors in regard to female sexual interest/arousal disorder?

Answer 65

True.

Question 66

What is genito­pelvic pain/penetration disorder?

Answer 66

Combines the genital pain of dyspareunia with muscle tension (not muscle spasms) and fear and anxiety related to genital pain or penetrative sexual activity.

*more likely to have organic than psychological causes.

Question 67

What is female orgasmic disorder?

Answer 67

Diagnosed in women who are readily sexually excitable and who otherwise enjoy sexual activity but who show persistent or recurrent delay in or absence of orgasm following a normal sexual excitement phase and who are distressed by this.

Question 68

T or F: Cognitive-behavioral treatment of orgasmic dysfunction usually involves education about female sexuality and female sexual anatomy, as well as directed masturbation exercises.

Answer 68

True.