Psychosexual Dysfunction And Paraphilia Flashcards
Diagnosis of Paraphilia (DSM IV)
At least 6 months, includes: fetishism, transvestic fetishism, voyerism, exhibitionism, paedophilia, frotturism
Added criterion B of Paraphilia (DSM V)
Causes stress and impairment, causes risk and harm to self and others, requires intervention
Aetiology of Paraphilia
Early experiences, dysfunctional beliefs, behavioural explanations (classical conditioning, modelling, social learning hypothesis)
Paedophilia
Recurrent sexual urges towards prepubescent child
Therapy goals for paedophilia
Modify patterns of arousal, modify cognitions and social responses, improve social interactions, reduce sex drive and trigger behaviours
Aversion therapy for paedophilia
Slides paired with shock/unpleasant events
Marshall and laws (2003) aversion therapy:
Can improve control of arousal, but no evidence of maintenance
CBT for paedophilia
Target cognitions and behaviours that increase risk of offending, teach recognition of risky behaviours, Relapse intervention programme
Kenworthy et al (2004)- CBT for paedophilia
Review of 9 RCTs, 500+ male offenders, CBT may reduce reoffending but may contribute to rearrest up to 10 years later.
Relapse intervention programme
Identify high lapses, identify lapses, develop avoidance and coping strategies
Marques et al (2005) Relapse intervention programme
No differences between programme and control group prisoners in 8 year follow up.
What is Paraphilia?
Atypical variations in sexual behaviours, urges and fantasies
Sexual dysfunction
Impairment in sexual desire or gratification
DSM General criteria for sexual dysfunction
Caused by marked distress or interpersonal difficulty
DSM 5 (2013) criteria for sexual dysfunction disorder
Lifelong, at least 6 months, desire and arousal occur together, gender-specific, includes factors (religious, cultural)
Hypoactive sexual desire disorder
Little drive or interest in sex. In extremes, becomes sexual aversion disorder (avoidance of gentian contact)
Psychological factors of hypo sexual desire disorder
Low relationship satisfaction, daily hassle, conflicts and resentment, reduced affectionate behaviours
Treatment for hyposexual desire disorder
No drugs, so psychological treatment focuses on: education, communication skills, cognitive restructuring of beliefs, sexual fantasy training
The Sexual arousal disorders are:
Male erectile disorder and female sexual arousal disorder
Male sexual erectile disorder criteria
Distraction of negative thoughts reinforces by loss of erection
Treatment for male erectile disorder
Medical erection promoters (viagra, injection muscle relaxants, penile implants) viagra is 70% successful in promoting erections but not for enhancing libido
Female sexual arousal disorder
Basson et al (2000): lack of physical response of lubrication and swelling. Added physical distress after panel of 19 experts from 5 countries
Hypothesised causes of female sexual arousal disorder
Early sexual trauma, moralisation, disgust with patients, sexual repertoire, decrease in oestrogen, SSRIs.
Treatment of female sexual arousal disorder
Meston and Bradford (2007) almost no trials; vaginal lube masks and treats symptoms. Education, retraining, sensory-focus training
