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Psychopathology > Sexual Dysfunction, Paraphilias, and Gender Dysphoria > Flashcards

Sexual Dysfunction, Paraphilias, and Gender Dysphoria Flashcards

1
Q

Sexual Dysfunctions

A
  • Delayed Ejaculation
  • Erectile Disorder
  • Female Orgasmic Disorder
  • Female Sexual Interest/Arousal Disorder
  • Genito-Pelvic Pain/Penetration Disorder
  • Male Hypoactive Sexual Desire Disorder
  • Premature Ejaculation
  • Substance/Medication-Induced Sexual Dysfunction
  • Other Specified Sexual Dysfunction
  • Unspecified Sexual Dysfunction
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2
Q

Sexual Dysfunction Definition

A
  • Disruption in the sexual response cycle
  • Sexual response cycle is “biological” but psychological factors are highly involved
  • Distress, interpersonal difficulty, impairment required for diagnosis
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3
Q

Sexual response Cycle

A
  • Appetitive/Desire
  • Arousal
  • Plateau
  • Orgasm
  • Resolution
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4
Q

What to consider when determining a diagnosis

A
  • Not better explained by another disorder?
  • Is there distress or dysfunction?
  • Not solely due to a medical condition or substance-induced?
  • Is duration lifelong or acquired? (ex: erectile dysfunction normally lifelong if due to chronic medical condition but normally more abrupt if psychological)
  • Is presentation generalized or situational?
  • Are symptoms psychological or combined?
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5
Q

Appetitive/Desire Phase

A
  • Sexual interest or desire
  • Associated with sexually arousing fantasies/libido
  • Early physiological arousal (e.g., increased heart rate)
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6
Q

Male Hypoactive Sexual Desire Disorder

A
  • Deficient (or absent) sexual/erotic thoughts, fantasies, or desires
  • At least 6 months
  • Clinically significant distress (which is what differentiates this from someone who identifies as asexual)
  • Specifiers: lifelong/acquired, generalized/situational, mild/moderate/severe
  • Not better explained by a nonsexual mental disorder or as consequence of severe relationship distress
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7
Q

Female Sexual Interest/Arousal Disorder

A
  • Lack of or reduced sexual interest/arousal as manifested by 3+ of following: absent reduced interest in sex, reduced erotic thoughts or fantasies, reduced initiation of sex and unreceptive to partner’s attempts, reduced sexual excitement during sex, reduced sexual interest in response to erotic cues, reduced genital or nongenital sensations during sex
  • At least 6 months
  • Clinically significant distress
  • Not better explained by a nonsexual mental disorder or as consequence of severe relationship distress
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8
Q

Desire/Interest Disorders Prevalence

A
  • 6% of younger men and 41% of older men
  • Most prevalent sexual dysfunction for women
  • Age and lack of interest correlated for men, not for women
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9
Q

Factors that may affect sexual desire

A
  • Religious upbringing
  • Fear of pregnancy
  • Side effects from medications (SSRIs), depression
  • Lack of attraction for partner
  • Sexual trauma
  • High levels of everyday stress
  • Unhappy relationship
  • Anger
  • Low testosterone levels in men
  • Low estrogen and androgens, disorders of ovarian function in women
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10
Q

Arousal/Excitement Phase

A
  • Subjective sense of sexual pleasure, physiological changes such as increased autonomic arousal (e.g., increased heart rate, muscle tension, arousal of genitalia)
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11
Q

Erectile Disorder

A
  • At least 1 of 3 during almost all (or all) occasions: difficulty obtaining and erection, difficulty maintaining an erection, decrease in erectile rigidity
  • 6 months or more
  • Significant distress
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12
Q

Possible causes of erectile disorder

A
  • Disease, substance use, or hormonal imbalances that affect nerve pathway or blood flow to penis
  • Thorazine and other antipsychotic meds
  • Diabetes
  • Prozac
  • Anxiolytics
  • Kidney problems
  • Anti-hypertensives
  • Chronic ETOH
  • HIV and other viral infections
  • Hypothyroidism
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13
Q

Factors that may affect sexual arousal

A
  • Performance anxiety (spectatoring: had issue before and is now hyperfocused on it)
  • Lack of experience, knowledge about sex, negative expectations
  • Poor communication with partner about what is stimulating
  • Relationship conflicts
  • Medical problems (e.g., low testosterone, diabetes)
  • Drugs
  • Age
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14
Q

Orgasmic Phase

A
  • In women: uterine contractions, contractions of the outer third of the vagina
  • In men: contractions of seminal vesicles, ejaculatory duct, prostate, and penile urethra, ejaculation
  • Debate on whether you can look at purely physiological symptoms or if also need to look at subjective reports
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15
Q

Premature Ejaculation

A
  • Ejaculation occurring within the 1st minute of sexual activity and before the individual wishes it
  • Present at least 6 months and for all or almost all occasions
  • Significant distress
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16
Q

Premature Ejaculation Epidemiology

A
  • Most common sexual dysfunction for men
  • Occurring at some time in 40% of men
  • May ejaculate at lower levels of arousal (lower threshold), may experience hyperarousability, and have longer periods of abstinence
  • Anxiety may increase rate of ejaculation
  • Learning may be a factor, conditioned to have “hurried sex”
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17
Q

Delayed Ejaculation

A
  • Marked delay, infrequency, or absence of ejaculation during partnered encounters (no time limit)
  • All or almost all occasions
  • 6 months or more
  • Significant distress
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18
Q

Delayed Ejaculation causes

A
  • Performance anxiety, fear of pregnancy, hostility in relationship, spinal cord injury, certain tranquilizers, SSRIs
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19
Q

Female Orgasmic Disorder

A
  • Marked delay, infrequency, or absence of orgasm (or reduced intensity of orgasm)
  • During all or almost all occasions of sexual activity
  • 6 or more months
  • Significant distress
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20
Q

Factors contributing to female orgasmic disorder

A
  • Not lack of responsivity to erotic stimuli– women with orgasmic disorder are as responsive to erotic stimuli
  • Low knowledge about anatomy, stimulation, and unable to communicate needs to partner
  • Suggests there may be a learning component (younger age, less education, more religiosity)
  • Societal values
  • Abnormal functioning of epinephrine, norepinephrine, oxytocin, or prolactin systems
  • Damage to sacral/pelvic nerves, MS, heart disease, kidney disease, diabetes, hysterectomy complications
  • SSRIs and other drugs
  • Chronic ETOH use
  • Different thresholds for orgasms
  • Fear of losing control, sexual guilt, high religiosity, anxiety
  • Relationship problems, childhood loss or separation from father
21
Q

Sexual Pain Disorders

A
  • DSM-IV
  • —- Vaginismus: persistent involuntary spasms of the muscles of the outer third of the vaginal muscles that interfered with penetrative intercourse
  • —- Dyspareunia: any type of recurrent pain that was not vaginismus
  • DSM-5: combined the two to form Genito-Pelvic Pain/Penetration Disorder
22
Q

Genito-Pelvic Pain/Penetration Disorder

A

A) Persistent/recurrent difficulties with one or more:
- Vaginal penetration during intercourse
- Pain during intercourse or attempts
- Fear or anxiety of pain in anticipation, during, or result of sex
- Tensing or tightening of pelvic floor muscles during attempted penetration
B) At least 6 months
C) Significant distress
D) Not better explained by other MD, relationship distress, or significant stressors

23
Q

Contributing factors to Genito-Pelvic Pain/Penetration Disorder

A
  • Dermatological disorders, UTIs, uterine fibroids, endometriosis, urinary disease, ovarian disease, provoked vestibulodynia, vulvovaginal atrophy
  • Spasms may be an automatic, physiological response aimed at avoiding pain
  • Fear of pain and anxiety (hyper-awareness) may be both symptoms and causes
  • Negative cognitions
  • Hx of childhood sexual abuse
24
Q

Paraphilic Disorders

A
  • Voyeuristic Disorder
  • Exhibitionistic Disorder
  • Frotteuristic Disorder
  • Sexual Masochism Disorder
  • Sexual Sadism Disorder
  • Pedophilic Disorder
  • Fetishistic Disorder
  • Transvestic Disorder
  • Other Specified Paraphilic Disorder
  • Unspecified Paraphilic Disorder
25
Q

Paraphilic Disorders Definition

A
  • Recurrent sexually arousing fantasies, urges, or behavior related to non-human objects, pain or humiliation, children or non-consenting adults
  • Occurs for at least 6 months
  • Often causes significant distress/impairment or person acts on fantasies leading to harm/risk of harm to others (ex: BDSM if not causing any problems and with other consenting adults is a paraphilia but not a paraphilic disorder)
26
Q

Some paraphilias do not require distress or impairment

A
  • Pedophilia, voyeurism, exhibitionism, frotteurism, sexual sadism/nonconsenting adult
  • If doesn’t cause the person distress/impairment but causes harm to others: ex- nonconsenting partner, within site/sound of unwilling participant, causes psychological or physical harm to victim
27
Q

Paraphilic Disorder Demographics

A
  • Almost only diagnosed in males
  • Most begin in adolescence
  • Generally immature, lack social skills, and are heterosexually ineffective
  • Many are married and have children
28
Q

Voyeuristic Disorder

A
  • Sexual arousal from observing an unsuspecting person who is naked, disrobing, or engaging in sexual behaviors (finds it arousing because other person doesn’t know)
  • Has acted on these urges or the fantasies has caused distress/ impairment
  • 6 or more months
  • At least 18 years old
29
Q

Voyeuristic Disorder Associated Features

A
  • Sexual intercourse with victim is not the goal/doesn’t want victim to know they are watching
  • Primary motivation appears to be control over the unaware victim
  • Highest rate of marriage among the paraphilias
  • May begin from chance observation that occurred during childhood/adolescence; then masturbation to the observation fantasies reinforce the potential of peeping to lead to arousal
30
Q

Exhibitionistic Disorder

A
  • Sexual arousal from exposure of one’s genitals to an unsuspecting person
  • Individual has acted on these urges or fantasies/urges create significant distress/impairment
  • 6 or more months
31
Q

Exhibitionistic Disorder specifiers

A
  • Sexually aroused by exposing genitals to prepubertal children/physically mature individuals/both
  • In a controlled environment (live in institution or setting here no opportunity)
  • In full remission
32
Q

Exhibitionistic Disorder Associated Features

A
  • Most common, highest number of arrests (maybe because easily identifiable)
  • Desired response is shock or arousal, not sex
  • Timid, socially inept
  • Usually in their 20’s
  • About half also engage in voyeuristic behavior
  • Etiology: history of nudity in family of origin; observations of nudity or sexual activity; individual masturbates to fantasy of observation (reinforcing)
33
Q

Frotteuristic Disorder

A
  • Arousal from touching or rubbing against nonconsenting persons
  • Has acted on these urges or urges cause significant distress/impairment
  • 6 or more months
    (might happen in crowded area and play off as accident)
34
Q

Sexual Masochisms Disorder

A
  • Arousal from being humiliated, beaten, bound, or otherwise made to suffer
  • Fantasies, urges, behaviors cause significant distress or impairment
  • 6 or more months
  • specifier: with asphyxiophilia (if the individual engages in practice of achieving sexual arousal related to restriction of breathing)
35
Q

Sexual Sadism Disorder

A
  • Arousal from physical or psychological suffering of another person
  • Has acted on these urges or the urges cause sig distress/impairment
  • 6+ months
36
Q

Pedophilic Disorder

A
  • Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child
  • 6+ months
  • Acted on urges or the urges cause marked distress/impairment
  • At least age 16 years and at least 5 years older than child in Criterion A
  • Specifiers: exclusive (attracted only to children)/nonexclusive type, sexually attracted to males/females/both, limited to incest
37
Q

Pedophilic Disorder Associated Features

A
  • Perpetrator must be at least 16 and 5 years older than victim(s)
  • 50% of victims are 11-13 years old
  • Usually intercourse is not the preferred means of contact and only occurs at the end of a progression
38
Q

Fetishistic Disorder

A
  • Arousal from use of nonliving objects or “a highly specific focus on nongenital body parts”
  • Sig distress or impairment
  • Not limited to article of clothing used in cross-dressing
  • 6+ months
39
Q

Fetishistic Disorder Associated Features

A
  • Most common is clothing: 60%
  • – shoes: 15%
  • – partialism (arousal from seeing/touching a certain part of the body such as the foot): 15%
  • Arousal results from seeing, touching, or wearing the object
  • May steal preferred object, which can lead to legal problems
40
Q

Transvestic Disorder

A
  • Arousal from cross-dressing
  • Significant distress or impairment
  • 6 or more months
    Note: may be only way person can become sexually aroused; almost always in men
41
Q

Transvestic Disorder specifiers

A
  • With fetishism: if sexually aroused by fabrics, materials, or garments
  • With autogynephilia: if sexually aroused by thoughts or images of self as female
42
Q

Transvestic Disorder Associated Features

A
  • Majority are heterosexual and many are married

- Some may enjoy dressing publicly as a woman but few appear in public as a woman

43
Q

Transsexual versus Transgender

A
  • Transsexual: done something to begin biological change (e.g., hormone therapy)
  • Transgender: acting in ways in line with the other gender
  • Sex –> biology
  • Gender –> how you feel subjectively about identity/cultural roles and norms
44
Q

Gender Dysphoria

A

A) Incongruence between experienced/expressed gender and assigned gender for at least 6 months, manifested by at least 2:
- Incongruence between experienced/expressed gender and primary or secondary sex characteristics
- Desire to be rid of sex characteristics
- Desire for sex characteristics of other gender
- Desire to be other gender
- Desire to be treated as other gender
- Strong conviction that one has typical feelings and reactions of other gender
B) Sig distress or impairment
Specify if with a disorder of sex development

45
Q

Lev article

A
  • Problematic to label gender identities and expressions as pathological or disorder
  • Now we have the same pathologizing narrative related to gender identity as we had for homosexuality
  • “collectively oppressed not individually disturbed”
  • Homosexuality was changed in DSM to Ego-dystonic Homosexuality but this didn’t address the issue that it needed to be removed; similar thing happening with Gender Dysphoria
  • Transvestic Disorder also controversial; how can it be harmful? Can cause distress, but this has to do with society’s norms as well
  • Question: does diagnosis increase or decrease stigma and access to health care?
46
Q

Gender Dysphoria in Children

A

A) 6 of following:
- Desire to be other gender
- Preference for wearing clothing of other gender
- Preference for cross-gender roles in make-believe play
- Preference for toys and games stereotypically used by other gender
- Preference for playmates of other gender
- Rejection of gender-typical toys and activities
- Dislike of one’s sexual anatomy
- Desire for sex characteristics of other gender
B) distress impairment

47
Q

Gender Dysphoria Etiology

A
  • Little evidence for genetic link
  • Similarities in brain size and shape between natal males and heterosexual females
  • Congenital adrenal hyperplasia
  • Psychodynamic - parental rejection
48
Q

Wright article

A
  • DSM-5 differentiation between the paraphilias and Paraphilic Disorders has been a step forward in depathologizing consenting adults who engage in unusual sexual behavior
  • Before this, family court judges regularly removed children or restricted custody for parents if there was evidence of their BDSM activities
49
Q

Duschinsky and Chachamu article

A
  • make the sexual dysfunction diagnoses more complex and heterogeneous for women and more unitary and homogenous for men
  • Where, then, is the heterogeneity of male sexual experience and behavior registered by DSM-5? In the paraphilias, which are primarily male disorders.
  • In females, lack of pleasure and distress as pathology. In males, focus is on the desire and the act, which is pathological by virtue of its illegitimate sexual object or source of pleasure

Psychopathology (16 decks)

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