Exam 4 Flashcards
what does “normal” sexual behavior depend on?
Depends on moral, legal, and statistical behavioral models.
Sexual dysfunctions are disorders in which people cannot respond normally in key areas of sexual functioning:
- ?
- ?
- ?
- desire
- excitement
- orgasm
what are the DSM distinctions of sexual dysfunctions?
“Life long type” vs. “Acquired type”
“Generalized type” vs. “Situational type”
Problems with urge to have sex, sexual fantasies and sexual attraction
disorders of desire
Absent or low sexual interest/desire
This must be a concern to be considered disorder.
Hypoactive sexual desire disorder
What typically causes hypoactive sexual desire disorder?
typically physical issue, hormones, thyroid
Total aversion (disgust of) sex Typically learned behavior
Sexual aversion disorder
Repeated inability to maintain lubrication or clitoral swelling during sexual activity
Female sexual arousal disorder
what percentage of women are affected with female sexual arousal disorder
10%
Repeated inability to attain or maintain adequate erection during sexual activity.
male erectile disorder
what percentage of men are affected with erectile disorder during intercourse at some point in life
50%
biological causes of disorders of excitement in females?
Lower levels of estrogen
Autoimmune diseases (Schwargers) = decrease amount in lubrication production (all over body).
Not as much with age.
biological causes of disorders of excitement in men
heart issues
age
psychological causes of disorders of excitement?
With younger men it is more of an anxiety response.
sociocultural causes of disorders of excitement
Relationship conflict (w/partner)
Not so much cause, but can increase preexisting conditions
Ejaculation with minimal sexual stimulation
“Premature”/early ejaculation
percentage of men who have “premature”/early ejaculation
30-50% of men
what causes premature ejaculation
anxiety based
what age is premature ejaculation more common in
younger men
Repeated inability to reach (very delayed) orgasm
male orgasmic disorder
biological causes of male orgasmic disorder
Testosterone levels
Spinal cord injury
Persistent delay/absence of orgasm following normal sexual excitement.
Female orgasmic disorder
percentage of women who experience female orgasmic disorder? percentage that never do?
25% women experience it
10% never experience it
biological causes of female orgasmic disorder
Decrease levels of estrogen
Side effect of Rx
psychological causes of female orgasmic disorder
trauma (assault)
sociocultural causes of female orgasmic disorder
stress/conflict (with partner)
disorders of sexual pain
vaginismus
dyspareunia
what is vaginismus
Vagina is very tense (all muscle contractions); involuntary, is with outer 1/3 of vagina.
Typically with learned fear response (body trying to protect itself)
what is dyspareunia?
Severe pain in genitals during sexual activity
most often physical causes
biological treatments for sexual dysfunction
Hormone therapy
Rx (for heart problems or thyroid infection)
psychological treatments for sexual dysfunction
Education
Anxiety reduction
Structured behavior exercises
Increase sexual communication skills
what are paraphilias?
Unusual fantasies, sexual urges or behaviors that are recurrent (6+ months) and sexual arousing
what do paraphilias unusual fantasies, sexual urges or behaviors often involve?
Non human objects
Non consenting people
Children
Humiliation of self/partner
Recurrent intense sexual urges, fantasies, or behaviors involving nonliving object.
fetishism
when do fetishisms usually begin
adolescence
what is a cause of fetishism?
Behaviorists propose classical conditioning (Pavlov) (paring of sex w/ objects, many times)
Fantasies, urges, or behaviors involving putting on clothes of opposite sex causing arousal.
transvestism or cross-dressing
transvestic fetishism is mostly in who?
heterosexual males
what type of conditioning leads to development of transvestic fetishism
operant conditioning
Arousal from exposure of genitals in public
Exhibitionism (no consenting piece)
who is exhibitionism an issue for
males (learned response)
treatments for exhibitionism
Behavioral retraining
Aversion therapy (to change behavior, associate with something bad)
Masturbatory satiation (masturbate after flash, eventually pleasure decreases and flashed end)
Repeated and intense sexual desire to observe people undressing or spy on couples engaging in sexual activity
Voyeurism
why is voyeurism on the rise
due to easy access to porn
what adds to excitements for people with voyeurism
risk of discovery
Fantasies, urges, or behaviors of touching and rubbing against non-consenting person
frotteurism
what do people with frotteurism fantasize about in regards to relationships
caring relationship with victim
when does frotteurism usually begin
teens or earlier
when does frotteurism usually disappear
age 25
what gender is frotteurism almost alway in
males
person with frotteurism thinks fantasies, urges, or behaviors of touching and rubbing against non-consenting person are what in a relationship?
step 1 to relationships
Fantasies, urges, or behaviors involving sexual activity with prepubescent child (usually 12 or younger)
pedophilia
etiology of pedophilia
Some were sexually abused, neglected, excessively punished, or deprived of close relationships as children
- Learned it was appropriate behavior
Most immature and have co-morbid disorder (anxiety and depression – rarely comes by itself)
Possible brain structure abnormality, certainly sociocultural
- Can see sexual disorder after traumatic brain injury
- People are being sexualized at younger ages
Sexual preference for pubescent aged children, usually ages 11-14
hebephilia
how much more common is hebephilia diagnosed than pedophilia in research
2-3x more
Preference for older children, usually ages 15-19
Ephebophila
Preference for adults
Teleiophilia
Preference for elderly people
Gerontophilia
sexual arousal, fantasies, urges, or behaviors from inflicting suffering on others
sadism
sexual response associated with being humiliated, bound, or made to suffer
masochism
Statutory rape?
Someone of or over age of consent has sex with someone below the age of consent (18 in Wisconsin, unless spouse; 16 under no circumstance)
what age and % are most victims of rape?
teens or twenties
90%
what percentage of rapes are acquaintances or partners
2/3
what percentage of rapes involve alcohol intoxication or rohypnol
70%
how many reported sexual assaults each year?
500,000
only 50% actually reported
cultural spillover theory?
Rape rates higher in cultures or environments that encourage violence
Also: rates increase shortly after country gains access to violent US TV shows
etiology of rape?
Power (55%): compensate for feelings of personal or sexual inadequacy
Anger (40%): angry at women in general
Sadistic (5%): satisfaction by inflicting pain
who we are physically attracted to
sexual identity
our internal sense of gender (how you define your gender – do you go with or against societies definition)
gender identity
someone who acts the way society defines gender
cisgender
% of gays and lesbians that display stereotyped gender expressions
10%
Experiencing strong and persistent cross-gender identification and persistent discomfort with his/her anatomical sex
gender dysphoria
males with gender dysphoria out number females ___
2:1
etiology of gender dysphoria
(research limited and weak)
Some support: abnormalities in hypothalamus
Production of hormones differs
Lack or excess of specific sex hormones in utero
-Either lower or higher particular hormones
treatment of gender dysphoria
Psychotherapy
Hormone therapy
Sexual reassignment surgery
what is substance?
anything that changes a persons thought process, behavioral states, and/or emotional state involuntarily
what are types of substance use?
abuse and dependence
what are substance-induced problems?
withdrawal
disorders
person not physically dependent on substance
substance abuse
criteria for substance abuse?
Maladaptive pattern of use, significant impairment or distress, and one symptom in 12- month period:
- Use leads to failed role obligations
- Use in hazardous situations (to yourself or others)
- Recurrent substance-related problems
- Continued use despite problems
Doesn’t meet criteria for Dependence
Criteria for substance dependence?
Maladaptive pattern of use, significant impairment or distress, and 3+ symptoms in 12- month period
- Tolerance
- Withdrawal
- Increase amounts taken or over longer periods
- Unsuccessful at reducing/controlling use
- Increase time spent using, getting, or recovering from use
- Give up social, occupational, or recreational things
- Continue use despite known negative effects
Criteria for substance withdrawal?
- Development of substance-specific syndrome due to reduction in heavy use
- Syndrome causes significant distress
- Not due to medication condition
Meets criteria for another DSM diagnosis, but onset of symptoms developed during, or within in month of, Substance Intoxication or Withdrawal
substance-induced disorder
changes in DSM-5 for substance use disorders?
Substance Use Disorders
10 Classes of substances
- Alcohol, Caffeine, Cannabis, Hallucinogens, Inhalants, Opioids, Sedatives, Stimulants, Tobacco, Other/Unknown
Each class has 3 disorders: -Use, Intoxication, and Withdrawal
Example: Substance use disorder, alcohol, withdrawal
DSM-4 disorders?
substance abuse
substance dependence
substance withdrawal
substance-induced disorder
what is addiction
brain disease (biological/physical)
developmental disease
Characterized by:
- Compulsive behavior
- Continued abuse despite negative consequences
- Persistent changes in brain’s structure and function
physical problem that happens to people when they use a substance
addiction
what age is highest chance of addiction?
12-17
18-25
what factors does addiction involve
biology/genes
environment
brain mechanisms
(determine risk factors for addiction)
Drugs of abuse engage what in the brain?
engage motivation and pleasure pathways
what happens in the brain when a substance goes into it?
forces it to pump out more dopamine, leading to a pleasant feeling
brain gets exhausted or damaged
what are natural rewards that elevate dopamine levels
food and sex
What happens to dopamine receptors with prolong use of a substance
they decrease (destroyed)
what percentage of people get addicted to drugs
10%
people with genetically higher or lower amounts of dopamine receptors are more likely to get addicted to a drug?
lower
dopamine receptors influence what?
drug liking
what is a gene cluster associated with?
nicotine dependence
comorbidity of drug users?
Drug users have a higher risk of developing mental disorders
- Psychosis
- Depression
- Anxiety
- Panic Attacks
environmental factors that contribute to addiction?
- Stress
- Early physical or sexual abuse
- Witnessing violence
- Peers who use drugs
- Drug availability
why can’t addicts just quit?
because addiction changes brain circuits
control part of brain gets damaged
relapse rates are similar for drug addiction and other ____?
chronic illnesses (type I diabetes, hypertension, asthma)
what is predictive of sustained recovery of addiction?
extended abstinence (brain begins to recover)
Treatment of drug addiction reduces what?
drug use and recidivism (criminal behavior)
traditional treatment for drug addiction?
- abstinence programs
- 12 step - cognitive-behavior therapy
- learn coping skills
- abstain or use in moderation
- behavioral contracting - impatient programs/interventions
- short term
Addicted to a physiological reaction associated with gambling
pathological gambling
Addicted to a physiological reaction associated with stealing
kleptomania
Addicted to a physiological reaction associated with fire setting
pyromania
Addicted to a physiological reaction associated with acting out in an angry or aggressive way towards others
intermittent explosive disorder
Addicted to a physiological reaction associated with pulling hair off their body
trichotillomania
4 theories to why we sleep?
1) Cellular replenishment and construction
2) Neuronal remodeling
3) Filing/storing of gist of memories
- Shifting memories from short term to long term
4) Improvement of immune system
how much sleep do infants need?
10-18 hours
how much sleep do toddlers/children need?
9-15 hours
how much sleep do adolescents need?
8.5-9.5 hours
how much sleep do adults need?
7-9 hours
how long does one sleep cycle take
75 minutes
2 types of deep sleep?
NREM
REM
when does dreaming occur
50 minutes after falling asleep
what are sleep stages characterized by
type of brain waves
how many cycles of sleep need to be gone through each night
5
Abnormal sleep patterns that interfere with physical, mental, and emotional functioning
sleep disorder
amount of americans who will meet criteria for a sleep disorder?
1/3
dyssomnia is characterized by dysfunction in what?
Total amount of time person sleeps (sleep too much or too little)
Quality of sleep
Time of day person sleeps
Inadequate sleep quality AND quantity
- Difficulty staying/falling asleep
- Waking up very early
insomnia
Potential causes of insomnia?
Stress, illness, or discomfort
Noise, light, extreme temperatures
Interference in normal sleep schedule
disorder with presence of sleep attacks
chronic neurological disorder
narcolepsy
3 other major symptoms of narcolepsy?
Sleep paralysis (occurs in stage 5) -Won’t actually fall asleep (conscious)
Cataplexy
-Paralysis of a particular muscle group in body – usually limbs
Hallucinations
-Not psychosis, comes from sleep
Cause of narcolepsy?
Loss of cells in hypothalamus
-In control of sleep/wake cycle and extreme emotions
Often brought on by extreme emotions
ways to manage narcolepsy (no cure)?
Stimulants – reduce frequency and durations of sleep attacks
Take short, regularly scheduled naps at times when sleepiest
-Your body is unable to have a sleep attack when you are waking up from sleep
characteristics of sleep apnea
Periodic gasping/”snorting” noises
Breathing stops and sleep is interrupted
Body is alarmed and pulls person close to waking up and makes them restart their cycle
Never able to get into the lower stages of sleep
Treatment for sleep apnea?
Various mouth appliances and therapies
- CPAP – forces oxygen into system
Losing excess weight, surgery, avoid alcohol and certain medications
Excessive sleeping
Body triggered to sleep more often
NEVER FEEL RESTED
hypersomnia
Mismatch between individual’s sleep-wake schedule and his/her sleep-wake pattern
circadian rhythm sleep disorder
what are parasomnias?
Disruptive sleep disorders
- Undesirable physical or verbal behaviors
Occur in specific stages of sleep
- During arousals from REM (stage 5) or partial arousals from NREM (stage 4) sleep
characteristics of night mare disorder?
Repeatedly awaken with recall of frightening dreams during REM stage
Quickly becomes alert and oriented with what is going on around them
- remembers nightmare
Themes of dreams for people with nightmare disorder
threats to security, self-esteem or survival
characteristics of sleep terror disorder
Similar to nightmares, but during NREM
Episodes of intense crying, fear and autonomic arousal while sleep
- no memory of it
what increases sleep terror disorder
stress
medications
fever
% of children who experience sleep terror disorder
5%
what causes sleep terror disorder?
underdeveloped maturation of hypothalamus (child problem)
when does sleep walking occur?
NREM
Characteristics of sleep walking?
During NREM
Engaging in a habitual behavior they do frequently
Eyes wide open, but don’t respond and won’t remember
Tends to run in families
What can bring on sleep walking?
sleep deprivation
stress
alcohol
pregnancy
menstruation
Consequences of sleep deprivation
decreased alertness and performance
memory and cognitive impairment
weight gain
accidents
common treatment for sleep disorders
relaxation training
cognitive therapy
stimulus control and sleep restriction therapy
sleep hygiene (routine)
Why is it difficult to assess dangerousness?
Presence of diagnosis does not = increased violence
- 90% of diagnosed neither violent nor dangerous
Violence is function of context as much as personality
Best predictor is previous conduct or violence
Definition of “dangerous is unclear
civil commitment?
involuntarily committing person determined to be mentally ill and/or threat to self/others
Relative or profession files petition; judge decides if person is hospitalized involuntarily
how many days can someone be involuntarily committed who is deemed dangerous?
30 days
Individual voluntarily seeks treatment
Can leave when desired
Staff can file petition for involuntary commitment if threat determined
voluntary commitment
criminal commitment?
Can plead not guilty by reason of insanity and placed in psychiatric institution
Determined by courts
two categories of sexual disorders?
sexual dysfunction
paraphilias
is “insanity” defense a legal or medical term?
legal
what would an individual plead for the “insanity” defense?
Not Guilty Due to Insanity or Mental Defect
percent of felony cases that plead Not Guilty Due to Insanity or Mental Defect
<1%
what was the first case that pleaded not guilty be insanity?
M’Naghten Rule
- voices telling him to kill prime minister, killed secretary
Presence of mental defect means you cannot be held legally responsible for any of your behavior
Led to issues and rule was revised
Durham Rule
what replaced Durham rule?
Guidelines by the American Law Institute (ALI)
What is the Guidelines by the American Law Institute (ALI)
- current standard
- at time of crime do you have a mental issue
- were you in a situation where you knew right from wrong
What does the Guidelines by the American Law Institute (ALI) not include?
does not include an abnormality manifested only by repeated criminal behaviors
aka antisocial disorder
Confidentiality is a ___ standard that protects clients from disclosure of information without consent
ethical
not a legal obligation; ethical principle
what is the belief to therapy?
cornerstone believe
what is privileged communication?
narrower, legal concept that prevents disclosure of confidential communication with out consent
in privileged communication who is the “holder of the privilege”?
client
Exemptions of privileged communication?
Therapist believes client is danger to self/others
If mental condition is used as defense in legal action
If therapist believes client (<16 or dependent adult) is victim of incest, rape, or child/elder abuse
when does a therapist have the duty to warn
Potential victim must be warned if the victim is known and is an imminent threat
Tarasoff v. regents of U of California
difference between duty to warn and duty to protect?
Difference: where is the information coming from?
Duty to protect - you can use 3rd party information if it comes from a reliable source
Ewing v. Goldstein
What does FERPA cover?
educational records - who has access to records
Shin v. MIT
When should a psychologist avoid dual relationships?
if impairs objectivity, competence or effectiveness in perform his/her job
Sex and ethics code? (Ethical Principle: Dual Relationship)
Do NOT have sex with
- Current therapy clients/patients
- Relatives or significant others of current clients/patients
Do NOT do therapy with
- Former sexual partners
What about “Sexual Intimacies With Former Therapy Clients/Patients?”
APA says…
- Not for at least 2 years after ending therapy (having no contact)
- Not really ever “except in the most unusual circumstances. Bear the burden of demonstrating that there has been no exploitation (aka manipulation)”
