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- Defining Sexual Disorders
- Western culture's social morality influenced by religion and sexology
- Definition of sexual normality helped guarantee survival of human
species and the family
- Direction of sex drive influenced by socialization
- Human sexual behavior viewed across culture is extremely variable
- Within culture, attitudes toward sexuality may change over time
- Sexual behavior does not necessarily conform to declared standards
of sexual morality or normality
- Social climate of 1960s and 1970s questioned traditional sexual
morality
- American Psychiatric Association dropped homosexuality from
list of psychological/psychiatric disorders in 1973
- Research suggests that there might not be justification for
regarding homosexuality as a pathological pattern
- Sexual Dysfunction
- Our society has had two upheavals regarding sex
- Sexual revolution of 1960s and 1970s and openness about sex
- Spreading of AIDS by casual sex
- Forms of Sexual Dysfunction
- Sexual dysfunctions are disorders involving disruption
of sexual response cycle or pain during intercourse
- Research of Masters and Johnson led to better understanding of
sexual dysfunction
- Sexual Desire Disorders
- First phase of sexual response cycle is desire phase
- Hypoactive Sexual Desire Disorder
- Hypoactive sexual desire disorder refers to lack
of interest in sexual activity even in sexual fantasy
- Low desire defined within context of age, gender, and
cultural norms
- Biological factors include pain, illness, and reduced
testosterone
- Psychological factors include depression, stress, ambivalence
about sex and conflict in relationship
- Is most common complaint of couples seeking treatment
for sexual dysfunction
- Sexual Aversion Disorder
- Sexual aversion disorder characterized by lack
of interest in sex and disgust or fear of sex
- Related to sexual trauma, dyspareunia
- Sexual Arousal Disorders
- Arousal is second phase of sexual response cycle
- Female Sexual Arousal Disorder
- Female sexual arousal disorder related to insufficient
vaginal lubrication
- Few known biological factors
- Psychological factors include emotional distress, sexual
trauma, and lack of trust
- Male Erectile Disorder
- Male erectile disorder formerly known as impotence
- Related to multiple causes
- Age and medical conditions, substance abuse are factors
- Psychological factors include performance anxiety, stress,
depression
- Orgasmic Disorders
- Third phase of sexual response cycle is orgasm
- Female Orgasmic Disorder
- Female orgasmic disorder involves woman having
trouble reaching orgasm
- Common causes include other sexual problems, inadequate
sexual stimulation, and anxiety about sex
- Antidepressant drugs becoming more frequent cause
- Male Orgasmic Disorder
- Male orgasmic disorder is male's inability to reach
orgasm
- May be caused by antidepressants and problems letting
go with partner
- Premature Ejaculation
- Most common complaint is premature ejaculation,
which is reaching orgasm too soon
- May be due to both psychological and biological causes
- Sexual Pain Disorders
- Dyspareunia
- Dyspareunia is pain during sexual activity
- Usually due to gynecological or urological problems
- Vaginismus
- Vaginismus involves contraction of muscles that
surround outer part of vagina
- Muscles contract causing pain during intercourse
- Often related to sexual trauma
- Diagnosing Sexual Dysfunction
- Lifelong dysfunction refers to problem existing since earliest
sexual experiences
- Acquired dysfunction refers to problem that develops after
normal functioning
- Generalized dysfunction refers to dysfunction present in
all sexual situations
- Situational dysfunction refers to dysfunction present in
some sexual situations or with some partners
- Term sexual dysfunction must meet criteria
- Dysfunction diagnosed with evidence that dysfunction causes
marked distress or interpersonal difficulty
- Dysfunction must persist over time
- One failure often creates anxiety, which impairs sexual responsiveness
on next occasion
- Groups at Risk for Sexual Dysfunction
- More education and money person has, less at risk
- Racial and ethnic differences
- Prevalence varies with gender
- Sexual Dysfunction: Theory and Therapy
- The Psychodynamic Perspective
- Sexual dysfunction attributed to unresolved Oedipal conflict
- Current approach views sexual dysfunction as disturbance in object-relations
- Therapy involves uncovering conflict and working through it
- The Behavioral and Cognitive Perspectives
- Learned Anxiety and the Spectator Role
- Early respondent conditioning in which sexual feelings paired
with shame, disgust, and anxiety over possible failure seen as
central
- Painful experiences cause person to worry and assume spectator
role
- Spectator role caused by several factors
- Assessment
- Assessment important for treatment and takes into account
all relevant factors
- Sexual script developed to describe who does what to whom,
and what thoughts, emotions, and sensations each associates with
sex
- Attitudes, patterns of sexual arousal, and sexual trauma part
of assessment
- Direct Symptomatic Treatment
- Couple is retrained to experience sexual excitement without
performance pressure
- Training is in form of sensate focus exercises
- Allow partners to rediscover sexual response without anxiety
- Improve communication by providing feedback
- Start-stop and squeeze techniques used in premature ejaculation
- Paradoxical instruction used in erectile disorder
- Education and self-exploration exercises used to treat lifelong
orgasmic dysfunction in women
- Sexual aversion disorder treated with systematic desensitization
- Cognitive Psychology and Direct Treatment
- Masters and Johnson used direct treatment of sexual dysfunction
with emphasis on the couple
- Cognitive approach focuses on mental processes underlying
sexual response and attitudes and beliefs hostile to sex
- C. Multifaceted Treatment
- Kaplan: Remote Causes
- Kaplan argues that sexual dysfunction caused by immediate
and remote causes
- Immediate causes include performance anxiety, poor technique,
and poor communication
- Remote causes include intrapsychic conflicts
- Combined direct treatment and psychodynamic treatment into
psychosexual treatment
- Remote causes ignored as long as patient is responding to
immediate causes
- Remote causes may prevent patient from responding
- Direct therapy brings to surface psychological problems
- Family Systems Theory: The Function of the Dysfunction
- Masters and Johnson see patient as the couple
- Sexual dysfunction has function in couple's total relationship
- Questions about power and control may be related to sexual
dysfunction
- Secret payoffs may underlie sexual dysfunctions and must be
dealt with
- 3. Results of Cognitive-Behavioral Direct Treatment
- Outcomes may not match outcomes of Masters and Johnson's therapy
- Research in early stages for many treatments of sexual dysfunction
- Group therapy may be useful for some dysfunctions
- Combining relationship therapy with direct treatment may be
beneficial
- The Neuroscience Perspective
- Some cases of sexual dysfunctions caused by organic factors
- Diagnostic tools used to differentiate between psychological and
organic sexual dysfunctions
- Most sexual dysfunctions involve both psychological and physiological
factors
- Biological treatments have focused on erectile disorder
- Vacuum pump used for enhancing erections
- Injecting a vascular dilation agent
- Using a vasodilator
- The drug called Yohimbine stimulates secretion of norepinephrine
- Penile prosthesis is available
- Oral medications are available; they act on the tissues of
penis itself
- Trend is to integrate biological and psychological treatments
- Paraphilias
- Recognized patterns that deviate from standard are called paraphilias
- Distinction made between paraphilias that involve harm to others
and those that are victimless
- When pattern or object becomes central focus and sine qua non of
person's arousal and gratification, then pattern is considered abnormal
- Fetishism
- Fetishism--reliance on inanimate objects or on a body part
to exclusion of person as a whole for sexual gratification
- Example of spectrum disorder
- Exclusive fascination with inanimate object is known as partialism
- Most fetishes associated with human body such as fur, women's
stockings, shoes, and underpants
- Transvestism
- Transvestism--sexual gratification through dressing in
clothes of opposite sex
- After cross-dressing, transvestite masturbates or has heterosexual
intercourse
- As a group, transvestites no more prone to psychological disturbances
than general population
- Most lead quiet, conventional lives
- Transvestism confused with other forms of cross-dressing
- Cross-dressing for sexual pleasure is transvestism
- Cross-dressing to assume a female role (e.g., drag queens
who are typically homosexual; entertainers as part of performance)
is not transvestism
- Often confused with transsexuals who have gender identity
disorder
- Related disorder is autogynephilia, in which man depends
for sexual arousal on the fantasy of being a woman
- Exhibitionism
- Exhibitionism--sexual gratification through display of
one's genitals to involuntary observer
- Most exhibitionists are not dangerous
- Typical exhibitionist is young man, sexually inhibited, and unhappily
married
- Gratification is derived from women's shock, fear, and revulsion
and then from masturbation
- In some cases, exhibitionism is symptom of more pervasive disturbance
- Most exhibitionists are shy, submissive, immature men who experience
feelings of social and sexual inferiority and doubt their masculinity
- Exposing genitals gives them sense of masculine power
- Best cure for exhibitionist is not to respond to it
- Voyeurism
- Voyeurism--sexual gratification through clandestine observation
of other people's sexual activities or sexual anatomy
- Often occurs alongside normal sexual interest
- Must take into account invasion of person's privacy
- Risk involved in watching strangers is important to gratification
- Voyeurism provides substitute gratification and reassurance of
power
- Most voyeurs are harmless
- Sadism and Masochism (S & M)
- Sadism--sexual gratification through infliction of pain
and/or humiliation on others
- Masochism--sexual gratification through pain and/or humiliation
inflicted on oneself
- Terms named after literary figures who wrote about physical and
psychological cruelty
- Degree of cruelty ranges from sticking person with pin to mutilation
- Sadomasochistic relationship seen in complementary partners
- Most sadists and masochists are heterosexual, well educated, affluent,
and undisturbed by their sexual activities
- Drawing line between normal and abnormal may be difficult
- DSM-IV requires evidence of distress of interpersonal
difficulty
- Many are satisfied with their sexual patterns
- Frotteurism
- Frotteurism--sexual gratification through touching and
rubbing against a nonconsenting person
- Frotteurs operate in crowded places where they can escape easily
- Sense of power over unsuspecting victim is important
- Pedophilia
- Pedophilia--child molesting
- Involves serious violation of child's right; child may suffer
serious psychological harm
- About 10-15% of children and adolescents are victims
- Most pedophiles are male
- Appears to be law-abiding and escapes detection
- Most are acquainted with victim and his/her family and may be related to victim
- Molestation usually does not include physical violence but persuasion
using authority
- Molestation occurs in repeated incidents with same child
- Pedophilia usually accompanied by other paraphilias
- Two types of molesters
- Situational molesters
- More or less normal
- Have heterosexual histories and prefer adult sexual
partners
- Molestation is impulsive and usually response to stress
- Incest offenders usually this type
- Preference molesters
- Prefer children as sexual partners, usually male children
- Do not view their behavior as abnormal
- Child molesting is regular sexual outlet and planned
- Have a higher recidivism rate
- Causes of pedophilia are varied
- May be arrested psychological development
- Early experience of arousal with other children
- Attempt to reenact their histories of molestation
- Children do not report their victimization immediately
- Child victims report sleep and eating disorders and phobias
and fears
- Adults who were victimized as children report depression,
self-destructive behaviors, and distrust of others
- Some types of child abuse seem to be more harmful
- Abuse at early age
- Continuing over long period of time
- Close relationship with pedophile
- Violent or severe abuse
- Incest is sexual relations between family members
- Rate of incest is 7-17%
- Victims of fathers report more harm than other perpetrators
- Abuse by father or stepfather more damaging
- Typical incestuous father limits extramarital sexual
contacts to daughter or several daughters
- Tend to be highly moralistic
- Father-daughter incest occurs in troubled marriage
- Wife is often isolated from other family members
- Daughter may assume caretaking role in family
- Long-term effects on daughter are profound
- Paraphilias: Theory and Therapy
- The Psychodynamic Perspective
- Oedipal Fixation
- Paraphilias are continuation into adulthood of diffuse sexual
preoccupations of child
- Paraphilias result of fixation at pre-genital state resulting
in castration anxiety
- Transvestism seen as denial of mother's presumed castration
- Sadism is seen as attempt to take part of castrator to relieve
anxiety
- Other psychodynamic theories suggest role of person's inability
to disentangle and control basic id impulses
- Group and Individual Therapy
- Usual procedure is to uncover conflict by working through
it
- Group therapy places individual in situation where he learns
he is not the only one
- Research suggests that psychodynamic therapy to be ineffective
- The Behavioral Perspective
- Conditioning
- Deviation results from respondent-conditioning process, whereby
early sexual experiences are associated with unconventional stimuli
- Sadism and masochism involve failure to learn to discriminate
among types of arousal
- Deviations may be due to child being cuddled by parents only
after being punished, pairing physical affection with punishment
- Unlearning Deviant Patterns
- Multifaceted approach combines psychotherapy with techniques
to change arousal patterns
- Goal is to change sexual arousal patterns, beliefs, and behaviors
- First step is to bring deviant sexual behavior under temporary
control
- Behavioral techniques used to eliminate deviant approach
- Stimulus satiation
- Covert sensitization
- Shame aversion therapy
- Treatment attempts to build appropriate sexual orientation
and includes training in social and sexual skills
- Trend toward relapse prevention training
- The Cognitive Perspective
- Learning Deviant Attitudes
- Way sex drive is expressed depends on childhood attitudes
- Sex offenders tend to objectify their victims as sources of
gratification rather than as human beings
- Combating Deviant Beliefs
- Procedures is to identify deviation-supporting beliefs, challenge
them, and replace them with appropriate beliefs
- Many programs include training in victim awareness whereby
they are confronted with emotional damage done to victims
- Another technique is role reversal
- The Neuroscience Perspective
- Deviations may be related to neurological disorders
- Studies have inconclusive results
- Castration, drugs, and brain surgery have been used
- Changes in deviant arousal in laboratory may not generalize
- Treatment Efficacy
- Research and reviews ontreatment efficacy for these
disorders have been mixed.
- Recidivism for many of the parahilias remains high.
- Some treatment methods show promise.
- Gender Identity Disorders (GID)
- Gender identity disorders (GID) characterized by sense that one's
true gender is opposite of one's biological gender
- GID defined by two features
- Gender dysphoria is unhappiness with one's own gender
- Desire to change to other gender
- Cross-dressing known since ancient times
- Transsexual refers to people seeking to change gender by means
of hormones or surgery
- Patterns of Gender Identity Disorder
- Homosexual male-to-female transsexuals
- Homosexual female-to-male transsexuals
- Heterosexual male-to-female transsexuals
- GID can affect people of all ages
- Most children who have desire to be opposite do not grow up to
be transsexual adults
- The Psychodynamic Perspective
- GID seen as disturbance in parent-infant bond
- Males said to be in overlong, symbiotic relationships with mother,
creating a female identity in infant
- Females identify with father instead, because of mother's physical
or emotional absence
- Some argue that psychoanalysis is not appropriate since opposite-sex
parent part of core identity and cannot be changed
- The Behavioral Perspective
- GID is caused by gender role behavior being shaped toward opposite
sex by caretaker
- Treatment involves stopping reinforcement for cross-dressing behavior
and providing reinforcement for gender-appropriate behavior
- Another idea suggests that GID is result of imprinted gender fixation
- The Neuroscience Perspective
- Hypothesis suggests GID due to hormone imbalance
- Difference in brain also believed to be involved
- Gender Reassignment
- One solution is to change the identity to fit body
- Alternative is to change body to fit identity in process called
gender reassignment
- Process involves steps
- Undergoes detailed evaluation by mental health professional
- At least three months of psychotherapy
- Hormone treatments to initiate physical changes
- In real-life test, individual must live completely in desired
gender for at least one year
- Last phase is surgery
- Outcomes of gender reassignment surgery is improvement
or satisfaction in two-thirds to nine-tenths of patients
- Some regretted surgery, having serious psychological
breakdowns
- Outcomes of surgery influenced by several factors
- The longer the patient is kept in real-life test and
the more realistic the expectations, the better the outcome
- Female-to-male reassignment yields more satisfaction
- Person's prior psychological health also predictor of
success
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