Chapter 13 Flashcards
(78 cards)
1
Q
Diagnostic Issues for Sexual and Gender Identity Disorders
A
- Distress isn’t always straight-forward
- Aberrant or terrible act doesn’t equal a diagnosis however, no diagnosis does not mean treatment isn’t necessary
- Societal mindset (e.g., homosexuality listed as a disorder in the DSM-II (1968))
2
Q
Gender differences in Sex
A
- Sex drive is equal for men and women
- Men engage in more masturbation, tend to think about sex more often than women, watch porn more frequently, report earlier age of first intercourse, and greater number of sexual partners but this may be a difference in reporting rather than an actual difference in sex
3
Q
Sexual Response Cycle by Masters & Johnson (1966)
A
- Excitement phase : Result of stimuli; Body prepares for sexual intercourse; Vasocongestion occurs
- Plateau : Sexual excitement before orgasm – Increased physiological reactions
- Orgasm : “Rhythmic muscular contractions at about eight-second intervals”
- Resolution : Return to state of pre-arousal
4
Q
Sexual dysfunctions according to DSM 5
A
- Persistent or recurrent problems with sexual interest, arousal, or response.
- 6 months with symptoms 75-100% of the time
5
Q
two general categories of sexual dysfunctions
A
- lifetime vs. acquired and situational vs. generalized.
6
Q
States on Sexual dysfunctions
A
Sexual dysfunctions affect 40% to 45% of adult women and 20% to 30% of adult men at some point in their lives.
7
Q
Hypoactive sexual desire disorder
A
- A person shows little or no sex drive or interest
- Marked distress or interpersonal difficulty
- Psychological reasons
- Focus on whether the person “just doesn’t feel like it”
8
Q
Sexual Desire disorder
A
Desire may occur in some situations but not others
Sexual activity may occur without desire
How much they are having sex does not play into it
9
Q
Sexual aversion disorder
A
Extreme aversion to, and avoidance of, almost all genital sex with a partner
Deleted in DSM 5
10
Q
Male hypoactive sexual desire disorder (MHSDD) and
Female sexual interest/arousal disorder (FSIAD) experience either a lack of, or greatly reduced level of, sexual interest, drive, or arousal.
A
MHSDD
persistently have little, if any, desire for sexual activity or may lack sexual or erotic thoughts or fantasies.
FSIAD
experience either a lack of, or greatly reduced level of, sexual interest, drive, or arousal.
Combination of ‘female hypoactive sexual desire disorder’ and ‘female sexual arousal disorder’
11
Q
Erectile disorder (ED)
A
- A sexual dysfunction in males characterized by difficulty in achieving or maintaining erection during sexual activity.
- Second most common male sexual dysfunction after premature ejaculation
12
Q
Female orgasmic disorder
A
- Also known as Anorgasmia
- A type of sexual dysfunction involving marked delay in reaching orgasm (in women) or an infrequency or absence of orgasm.
The DSM-5 expanded the criteria to include cases in which women experience a sharp reduction in the intensity of orgasmic sensations.
13
Q
Male orgasmic disorder
A
– A marked delay in reaching ejaculation (in men), or an infrequency or absence of ejaculation.
Now called ‘Delayed ejaculation’ in DSM 5
14
Q
Premature ejaculation
A
– A type of sexual dysfunction characterized by a recurrent pattern of ejaculation occurring within about one minute of vaginal penetration and before the man desires it.
- 1998 study – 90% within 1 minute, 60% within 15 seconds
- Affects approximately 20-40% of sexually active men and 75% of men during at least one point in their lifetime
- Must assess for other features
15
Q
Genito-pelvic pain/penetration disorder
A
- A disorder that applies to women who experience sexual pain and/or difficulty engaging in vaginal intercourse or penetration.
- Affected women may experience pain, increased pelvic floor muscle tension, and/or fear or anxiety during attempted or completed vaginal sex activities
Consists of ‘dyspareunia’ and ‘vaginismus’, previously noted as separate disorders in the DSM-IV-TR
16
Q
Vaginismus
A
- A condition in which the muscles surrounding the vagina involuntarily contract whenever vaginal penetration is attempted, making sexual intercourse painful or impossible.
- Penetration can include penis, tampons, fingers, speculum, etc.
- Involves distress involving penetration and avoidance-based behaviors
- The pain cannot be explained by an underlying medical condition, and so is believed to have a psychological component.
17
Q
Dyspareunia
A
– Genital pain associated with intercourse
Must not be caused by lack of lubrication or by vaginismus
- Sexual pain in men not covered in the DSM 5
Considered to be usually associated with medical reasons
18
Q
Hypersexuality
A
- sex addiction
- withdrawl symptoms, unsuccessful attempts to control or reduce behavior, and engaging in the behavior longer than intended
- Listed as a disorder requiring additional research in the DSM 5
19
Q
Etiology – Sexual Desire/Arousal Disorders
A
- Sexual trauma early in life
- Other psychological problems, such as depression and anxiety
- Performance anxiety, which represents an excessive concern about the ability to perform successfully
- Biological factors such as low testosterone levels and disease
- Cardovascular problems involving impaired blood flow both to and through the penis can cause erectile disorder
- Erectile dysfunction is also associated with obesity, diabetes, MS, kidney disease, hypertension, cancer, emphysema, depressant drugs, and narcotics
20
Q
Etiology – Orgasmic Disorders
A
- Relationship problems
- Sexual anxieties
- Limited techniques, understanding about sex, partners who do not understand their needs, etc…
- Certain medical conditions
21
Q
Etiology – Premature Ejaculation
A
Secondary – occurs in men who previously had ejaculatory control
Causes include trauma to sympathetic NS, abdominal or pelvic injuries, urethritis, withdrawal from narcotics
Primary – never had ejaculatory control
May be a conditioned response from early experiences masturbating
Men may avoid sex in general due to feelings of guilt over premature ejaculation
Some men have lower threshold for physical stimulation or more sensitive to touch
22
Q
Etiology – Genito-Pelvic Pain/Penetrations Disorder
A
Negative sexual attitudes
Lack of sexual education
Unpleasant or traumatic sexual experiences
Cognitive styles associated with anxiety
23
Q
Treatment of Sexual Disorders
A
- emphasis on biological or organic factors in the development of sexual problems and the use of medical treatments, such as the drug sildenafil (Viagra), to treat male erectile dysfunction.
- Couple therapy
- Sex therapy using cognitive-behavioral techniques to help individuals enhance their sexual knowledge and skills and relieve performance anxiety
24
Q
Sensate Focus
A
– a form of desensitization applied to sexual fears
- Employed to redirect attention away from the specific sexual response and towards the sexual interaction
- Involves a series of predetermined stages of sexual interaction:
Undress each other with lights on
Massaging/touching in non-erogenous areas
Expand to genital and breast touching
Gradually begin to remove ban on sexual intercourse
25
Treatment - Drive/Desire
- self-stimulation (masturbation) exercises together with erotic fantasies.
- mutual pleasuring exercises for couples to perform at home or encourage couples to expand their sexual repertoire to add novelty and excitement to their sex life.
- testosterone gel patch for men with low testosterone
26
Treatment – Orgasmic Disorders
- Change womens underlying beliefs that sex is dirty or sinful
- Masterbation (70-90% effective) or couple practices
27
Treatment – Genital Pain Disorders
- Medical intervention to determine and treat any underlying physical problems
- Treatment for vaginismus may include a combination of behavioral methods, including relaxation techniques and the gradual exposure method to desensitize the vaginal musculature to penetration by having the woman, over the course of a few weeks, insert fingers or plastic dilators of increasing sizes into the vagina while she remains relaxed.
28
Treatment – Erectile Dysfunction
- Drugs that increase blood flow to the penis, such as Viagra
- Surgery in rare cases in which blocked blood vessels prevent blood flow to the penis, or in which the penis is structurally defective
- Muscle relaxants such as Alprostadil and intracavernous treatment
29
Gender Identity
A person’s basic sense of self as male or female
| First sign of this appears between 18 and 36 months of age
30
Assigned Gender
Usually based on external genital appearance at birth
31
Gender Role
Collection of those characteristics that a society defines as masculine or feminine
32
Hermaphroditism
Reproductive structures are partly female and partly male
33
Gender Identity Disorder in the DSM-IV-TR
- Involves a strong and persistent cross-gender identification
- Also involves gender dysphoria
Persistent discomfort about one’s biological sex or the sense that the gender role of that sex is inappropriate
34
Subtypes used in diagnosing GID in the DSM-IV-TR are based on
Current age and Sexual attraction
35
Changes to GID in DSM 5
- ‘Gender Identity Disorder’ renamed to ‘Gender Dysphoria’
- Moved out of ‘Sexual Disorders’ category into a category of its own
- Two different diagnoses based on age
Children – may grow out of it
Adolescents and adults
- Subtypes based on sexual orientation eliminated
36
Changes to Gender dysphoria in DSM 5
This change heavily emphasizes the importance of distress
37
Psychodynamic theory on GID/GD
Point to extremely close mother–son relationships, empty relationships with parents, and fathers who were absent or detached fostering strong identification with the mother in young males, leading to a reversal of expected gender roles and identity.
Girls with weak, ineffectual mothers and strong masculine fathers may overly identify with their fathers and develop a psychological sense of themselves as “little men.”
38
Learning theory on GID/GD
similarly point to father absence in the case of boys—to the unavailability of a strong male role model.
39
The development of transgender identity
may result from the effects of male sexual hormones on the developing brain during prenatal development.
A combination of genetic and hormonal influences may create a disposition that interacts with early life experiences in leading to the development of transgender identity.
40
treatment options of GID/GD for children
- difficult and controversial issue
- Some feel its inappropriate to try to change gender identity, but evidence suggests that these individuals experience significant distress
- Boys and girls with GID show more behavioural problems and experience more social ostracism than same-sex siblings and age-matched controls
- Attempts made to encourage gender-appropriate behavior and to discourage cross-gender behavior may affect cross-gender behavior in the short-term but are unknown in the long-term
41
Who gets Gender re-assignment surgery
- Those with highest desire for reassignment are those who are most sexually aroused by imagining themselves as having the sexual organs of the opposite sex
- must have 12 months of continuous full time real-life experience
- Usually 12 additional months of continuous hormonal therapy
- Participation in psychotherapy if required by mental health professional
- Satisfactory outcomes in approximately 90 percent of patients
- Usually experience satisfaction with interpersonal functioning and general psych health but negative effects on cosmetic results and sexual functioning
42
Paraphilia in Greek
The word paraphilia was coined from the Greek roots para, meaning “beyond the usual,” and philos, meaning “loving.”
43
Paraphilias
– Unusual or atypical patterns of sexual attraction that involve sexual arousal in response to atypical stimuli.
These atypical patterns of sexual arousal may be labeled by others as deviant, bizarre, or “kinky”.
- The range of atypical stimuli include nonhuman objects such as underwear, shoes, leather, or silk, to humiliation or experience of pain in oneself or one’s partner, or children and other persons who do not or cannot grant consent.
44
Paraphilias in DSM5
- The DSM-5 includes a class of mental disorders called paraphilic disorders.
- For a paraphilic disorder to be diagnosed, the paraphilia must cause personal distress or impairment in important areas of daily functioning, or involve behaviors presently or in the past in which satisfaction of the sexual urge involved harm, or risk of harm, to other people.
45
Fetishism
– A type of paraphilia characterized by recurrent, powerful sexual urges, fantasies, or behaviors involving inanimate objects, such as an article of clothing.
Almost any object, or even behavior, can become a fetish
46
Partialism
– Sole focus on part of the body (e.g., breasts or feet)
47
Transvestism
– A paraphilia (also called transvestic fetishism) in which individuals have recurrent and powerful urges, fantasies, or behaviors related to cross-dressing and are sexually aroused by cross-dressing.
Although other men with fetishes can be satisfied by handling objects such as women’s clothing while they masturbate, transvestite men want to wear them.
48
Sexual masochism
- A type of paraphilia characterized by strong and recurrent sexual urges, fantasies, or behaviors in which the person becomes sexually aroused by being humiliated, bound, flogged, or made to suffer in other ways.
49
Hypoxyphilia
– A paraphilia in which a person seeks sexual gratification by being deprived of oxygen by means of using a noose, plastic bag, chemical, or pressure on the chest.
50
Sexual sadism
– A type of paraphilia or sexual deviation characterized by recurrent, powerful sexual urges, fantasies, or behaviors in which the person becomes sexually aroused by inflicting physical or psychological suffering or humiliation on another person.
- distressed by their behavior or fantasies, or these urges and fantasies lead to problems with other people.
51
Sadomasochism
– Refers to a practice of mutually gratifying sexual interactions between partners involving both sadistic and masochistic acts.
- distressed by their behavior or fantasies, or these urges and fantasies lead to problems with other people.
52
Telephone scatologia
making obscene phone calls
53
Necrophilia
sexual urges or fantasies involving contact with corpses
54
Zoophilia
sexual urges or fantasies involving contact with animals also called beastiality
55
copropilia
Sexual arousal associated with Feces
56
klismaphilia
Sexual arousal associated with Enemas
57
urophilia
Sexual arousal associated with Urine
58
Exhibitionism
– Strong and recurrent urges, fantasies, or behaviors of exposing of one’s genitals to unsuspecting individuals for the purpose of sexual arousal. Typically, the person seeks to surprise, shock, or sexually arouse the victim.
- The person may masturbate while fantasizing about or actually exposing himself (almost all cases involve men).
- The victims are almost always women
- DSM4: Over atlest 6 mo and has acted or has distress
59
Voyeurism
- A type of paraphilia involving strong and recurrent sexual urges, fantasies, or behaviors in which the person becomes sexually aroused by watching unsuspecting people, generally strangers, who are naked, disrobing, or engaging in sexual activity.
- The voyeur usually masturbates while watching or while fantasizing about watching.
- Peeping may be the voyeur’s only sexual outlet. Some people engage in voyeuristic acts in which they place themselves in risky situations.
- The prospects of being discovered or injured apparently heighten their excitement.
- DSM4: Over atlest 6 mo and has acted or has distress
60
Frotteurism
– A type of paraphilia involving recurrent, powerful sexual urges, fantasies, or behaviors in which the person becomes sexually aroused by rubbing against or touching a nonconsenting person.
- Frotteurism, also called “mashing,” often occurs in crowded places, such as subway cars, buses, or elevators.
- The rubbing or touching, not the coercive aspect of the act, sexually arouses the man.
- DSM4: Over atlest 6 mo and has acted or has distress
61
Pedophilia in DSM 4
- A type of paraphilia involving recurrent and powerful sexual urges or fantasies or behaviors involving sexual activity with children (typically 13 years old or younger) for at least 6 months.
- The preson has acted on these sexual uges, or has distress
- To be diagnosed with pedophilia, the person must be at least 16 years of age and at least 5 years older than the child or children toward whom the person is sexually attracted or has victimized.
- In some cases of pedophilia, the person is attracted only to children. In other cases, the person is attracted to adults as well.
62
Child molester
– individual who has engaged in a sexually motivated act against a child
Preference unknown
63
Pedophile
– individual who has displayed a preference for sexual behavior with a child
May or may not have committed an offence against a child
64
Effects of Sexual Abuse on Children
- Increased likelihood of suicidal behavior.
- Younger children sometimes react with tantrums or aggressive or antisocial behavior.
- Older children often develop substance abuse problems.
may become prematurely sexually active or promiscuous in adolescence and adulthood.
- Psychological problems may continue in the form of posttraumatic stress disorder, anxiety, depression, substance abuse, and relationship problems
65
Rape
– Forced sexual intercourse with a nonconsenting person
| - Survivors may become withdrawn, sullen, and mistrustful and often experience both psychological and physical problems
66
Psychodynamic theorists explanation of paraphilias
as defenses against leftover castration anxiety from the phallic period of psychosexual development.
67
Learning theorists explanation of paraphilias
- In terms of conditioning and observational learning.
- Some object or activity becomes inadvertently associated with sexual arousal.
- The object or activity then gains the capacity to elicit sexual arousal.
68
Courtship disorder theory of sexual offending
- Assumes sexual offenders are aroused by their deviant acts
- Four phases of human sexual interactions analogous to animals:
1. Looking for and appraising a potential partner
- Voyeurism
2. Posturing and displaying oneself to a partner
- Exhibitionism
3. Tactile interaction with the partner
- Frotteurism
4. Sexual intercourse
- Rape
- Fixation at a stage produces sexual offending
- Little support
69
Biological Perspectives for paraphilia
- higher-than-average sex drives
- Some professionals refer to the heightened sex drive that may apply to some cases of paraphilia as hypersexual arousal disorder—the opposite of hypoactive sexual desire disorder.
- brain wave patterns in response to paraphilic (fetishistic and sadomasochistic) images and control images (nude women, genital intercourse, oral sex)
70
Childhood effects contributing to paraphilia
Disrupted childhood, poor social skills, lack of self-confidence, history of deviant acts
71
Feminist Theories effects contributing to paraphilia
- Male anger towards females
- Results of a patriarchal society
- Socio-cultural environments (how genders are raised)
72
Problems with treatment for paraphilias
- many people who engage in these behaviors are not motivated to change.
- may not want to alter their behavior unless they believe that treatment will relieve them from serious punishment, such as imprisonment or loss of a family life.
- consequently, they don’t typically seek treatment on their own
73
Pharmacological Treatments for Paraphilias
- SSIs help control the obsessive thoughts or images of the paraphilic object or stimulus and the feelings of being compelled to repeatedly carry out the paraphilic acts.
- Antiandrogen drugs reduce levels of testosterone in the bloodstream.Do not completely eliminate paraphiliac urges, nor do they change the types of erotic stimuli to which the man is attracted.
74
Therapy treatment for Paraphilias
- CBT is briefer and focuses directly on changing problem behavior
- CBT includes a number of specific techniques, such as aversion therapy, covert sensitization and social skills training, to help eliminate paraphiliac behaviors and strengthen appropriate sexual behaviors.
- In many cases a combination of methods is used.
- The goal of aversion therapy is to induce a negative emotional response to paraphiliac stimuli or fantasies
75
Biastophilia
a sexual preference toward nonconsenting and resisting byt not necessarily physically siffering victims
76
Sexual dysfunctions involve problems with
sexual interest, arousal, or response
77
masochists
- People who become sexually aroused by experiencing pain and humiliation
- Many people who engage in masochistic practices are highly educated and occupationally successful.
78
LA's
1. Discuss the difficulties in diagnosing sexual dysfunctions
2. What is the difference between sexual dysfunctions and paraphilias? Give some examples of each
3. Discuss the differences between transvestic fetishism and gender identity disorder
4. Compare and contrast the models of sexual stages presented by Masters and Johnson with that of Helen Singer Kaplan.
5. Discuss the current state of models of the etiology of gender identity disorders.
6. Discuss the treatment programs for sexual offenders.
