Week 2 Flashcards
Chapter 11, chapter 12, chapter 5 (142 cards)
1
Q
Where does the term anorexia nervosa stand for?
A
anorexia - loss of appetite
nervosa - the loss is due to emotional reasons
2
Q
What are the 3 features of anorexia nervosa?
A
- restriction of behaviors that promote healthy body weight - weight is less than normal. (lower BMI)
- Strong fear of gaining weight or behavior that interferes with gaining weight. (this fear is not reduced by weight loss. Too thin doesn’t exist)
- Distorted body image or sense of body shape. (they typically weigh themselves frequently. Mesure the size of body parts and faze in the mirror.)
3
Q
The severity of anorexia nervosa is based on…
A
BMI
- the lower the BMI the higher the severity
4
Q
Anorexia more frequent in woman or in men?
A
woman
5
Q
What are the physical consequences of anorexia nervosa
A
- blood pressure fakks
- heart rate slows
- kidney problems
- bone mass declines
- skin dries out
- hormone levels change
- lanugo (fine soft hair on their bodies)
6
Q
How many people recover
A
from 50-70%
7
Q
atypical anorexia nervosa
A
- include all the symptoms of anorexia nervosa. Except for a very low body weight. Can even be overweight
8
Q
Bulimia nervosa
A
This disorder involves episodes of rapid consumption of a large amount of food, followed by compensatory behavior such as vomiting, fasting, or excessive exercise to prevent weight gain.
9
Q
A binge of bulimia (characteristics)
A
- eating excessive amount of food, much more than most people would it in a short period of time.
- Feeling of losing control over eating, like you can’t stop.
*Bulimia nervosa is not
diagnosed if the bingeing and purging occur only in the context of anorexia nervosa and its
extreme weight loss
10
Q
What is the key difference between anorexia and bulimia
A
Weight loss, people with anorexua lose a lot of weight. People with bulimia mostly not.
11
Q
What typically triggers binge episodes in bulimia nervosa?
A
Stress, negative emotions, and negative social interactions often trigger binges, which usually occur in secret until the person is uncomfortably full.
12
Q
What kinds of foods are commonly involved in binge episodes?
A
Foods that can be rapidly consumed, especially sweets like ice cream and cake.
13
Q
What behaviors characterize the compensatory phase after a binge in bulimia nervosa?
A
Purging through vomiting (often self-induced), laxative/diuretic abuse, fasting, and excessive exercise to prevent weight gain.
14
Q
How do people with bulimia nervosa typically view their weight and body?
A
They are highly dissatisfied with their bodies, and unlike people without eating disorders, they tend to report their weight and height accurately.
15
Q
What is the typical onset and prevalence of bulimia nervosa?
A
Usually begins in late adolescence or early adulthood; about 90% of cases are women; prevalence is about 1-2% of the population.
16
Q
What are some common comorbid disorders with bulimia nervosa?
A
Depression, personality disorders, anxiety disorders, substance use disorders, and conduct disorder.
17
Q
What are some physical consequences of bulimia nervosa?
A
Potassium depletion, electrolyte imbalance, irregular heartbeat, throat and stomach tissue damage, loss of dental enamel, swollen salivary glands; mortality rate is lower than anorexia but still elevated.
18
Q
What are the main diagnostic criteria for binge eating disorder (BED)?
A
Recurrent binge episodes (at least once a week for 3 months), loss of control during binges, distress about bingeing, rapid eating, and eating alone.
19
Q
How is binge eating disorder different from bulimia nervosa?
A
BED has no compensatory behaviors like purging, fasting, or excessive exercise, which are present in bulimia nervosa.
20
Q
How is binge eating disorder different from anorexia nervosa?
A
BED does not involve weight loss, whereas anorexia involves significant weight loss.
21
Q
What is the typical body weight status of people with binge eating disorder?
A
Most people with BED are obese (BMI > 30), but not all obese individuals have BED—only those with binge episodes and loss of control qualify.
22
Q
What disorders are commonly comorbid with binge eating disorder?
A
Mood disorders, anxiety disorders, ADHD, conduct disorder, and substance use disorders.
23
Q
What are some risk factors for developing binge eating disorder?
A
Childhood obesity, critical comments about weight, childhood weight-loss attempts, low self-esteem, depression, and childhood physical or sexual abuse.
24
Q
What are the physical consequences and prognosis of binge eating disorder?
A
Physical consequences often relate to obesity, including type 2 diabetes, cardiovascular problems, chronic pain, and sleep issues; prognosis shows 25–82% recovery rate with average duration around 4 years.
25
What do family and twin studies reveal about the genetic influence on eating disorders?
Heritability estimates: anorexia (0.48–0.74), bulimia (0.55–0.62).
First-degree relatives of men with anorexia have higher anorexia risk.
Relatives of people with binge eating disorder and obesity are more likely to have BED (20% vs. 9%).
Monozygotic twins show higher concordance rates than dizygotic twins, indicating genetic influence.
Genetic factors explain part of variance, but unique environmental factors (like different peer groups) also play a major role.
26
What specific genetic findings and heritable traits are associated with eating disorders?
Traits like body dissatisfaction, strong desire to be thin, binge eating, and weight preoccupation are heritable.
Genetic factors link personality traits (negative emotionality, constraint) with eating disorders.
Largest GWAS on anorexia (17,000 cases) identified eight genetic loci but results are not yet fully replicated.
Due to anorexia’s rarity, identifying all relevant genes and mutations is challenging.
27
What role does the hypothalamus play in eating disorders like anorexia nervosa?
Hypothalamus regulates hunger and eating.
Lesions to lateral hypothalamus in animals cause loss of appetite and weight.
Hormonal changes (e.g., cortisol) in anorexia result from self-starvation, not cause it.
People with anorexia starve despite hunger and interest in food, unlike animals with hypothalamic lesions.
Hypothalamic dysfunction is unlikely to be a causal factor for anorexia since it doesn’t explain body image disturbance or fear of weight gain.
28
What have brain imaging studies revealed about reward processing in anorexia nervosa?
People with anorexia show different brain activation patterns in response to food stimuli.
Ventral striatum (reward area) activates similarly in anorexia and controls.
Dorsal striatum (linked to habitual behavior and anxiety) activates differently, suggesting restrictive eating becomes habitual and rewarding.
Dopamine system changes likely result from the disorder, not cause it.
29
How does dopamine influence eating disorders, especially binge eating and cravings?
Dopamine relates to “liking” (pleasure) and “wanting” (craving) food.
In binge eating, bulimia, and obesity, excessive “wanting” but not necessarily more “liking” drives overeating.
Environmental food cues (ads, packaging) trigger dopamine, causing cravings hard to resist.
Brain studies show stronger dopamine-related activation to food cues predicts future weight gain.
People with binge eating disorder are especially sensitive to food cravings and cues.
30
What is the role of serotonin in eating disorders, and what limitations exist in neurobiological explanations?
Serotonin is involved in eating and satiety; people with anorexia and bulimia show low serotonin metabolite levels.
Changes in serotonin may be consequences of eating disorders, not causes.
Antidepressants affecting serotonin can help treat bulimia and binge eating disorder.
Neuroscience research mainly explains hunger and satiety but doesn’t fully address fear of weight gain.
Brain changes are correlated with, but may not cause, eating disorders—often resulting from under- or overeating.
31
What do cognitive-behavioral theories say about the development and maintenance of anorexia nervosa?
Focus is on distorted body image, fear of weight gain, and loss of control over eating.
Body-image disturbance strongly reinforces weight loss behavior.
Weight loss is negatively reinforced by reduced anxiety and positively reinforced by compliments and a sense of control or mastery.
Dieting often begins the onset of anorexia.
Criticism from peers and parents, especially during adolescence, contributes to body dissatisfaction and risk of eating disorders.
Obesity in early adolescence can lead to teasing, body dissatisfaction, and eating disorder symptoms later.
32
How do emotional factors influence anorexia nervosa?
Negative emotions and restricted eating reinforce each other bidirectionally.
Restricting food can lead to more negative emotions, and vice versa.
People with anorexia may intensely feel positive emotions (e.g., pride) after avoiding food but struggle to distinguish between positive feelings (low positive emotion differentiation).
This emotional confusion can reinforce disordered behaviors like vomiting, excessive exercise, weight checking, or laxative use.
Both intense negative emotions and low emotion differentiation predict disordered behaviors.
33
What are the cognitive-behavioral and emotional factors involved in bulimia nervosa and binge eating disorder?
Individuals often tie self-worth to weight and shape, leading to rigid, restrictive eating patterns.
Breaking dietary rules can trigger binges, followed by shame, disgust, and purging to reduce distress.
This creates a vicious cycle: binge → purge → temporary relief → lower self-esteem → more bingeing.
Negative emotions and stress predict binge episodes. EMA studies show bingeing often follows rises in negative affect and guilt.
In binge eating disorder, bingeing tends to reduce negative emotions but doesn’t increase positive ones.
In bulimia, bingeing can both reduce negative and increase positive emotions; purging also relieves distress.
34
How do cognitive processes and emotional regulation affect eating disorders like bulimia and binge eating disorder?
- People with eating disorders show biased attention toward food and body-related cues.
- They better remember food words when full, and focus more on body images than emotions.
- They tend to over-attend to both their own and others’ body shape and weight.
- Low positive emotion differentiation (difficulty telling apart positive emotions like pride vs. happiness) predicts binge episodes.
- Cognitive behavioral therapy (CBT) aims to retrain attention, memory, and emotion regulation patterns in these individuals.
35
How have sociocultural standards and weight-related trends influenced eating disorders in recent decades?
Cultural ideals, especially in the U.S., have shifted toward extreme thinness for women over the past 60 years.
Obesity rates have increased (over 40% obese in the U.S.), creating a greater gap between ideals and reality.
Many women diet extensively; 1/3 of women aged 25–45 have spent half their lives trying to lose weight.
Bariatric surgeries and liposuction have become common weight-loss methods.
Dieting and body dissatisfaction often precede eating disorders.
36
What role does the media play in promoting body dissatisfaction and disordered eating?
Media portrayals of thin models promote unrealistic standards.
Experimental studies show media exposure increases body dissatisfaction, even when disclaimers about digital alteration are provided.
Women still view altered images as realistic and feel worse after viewing them.
Social media and AI-enhanced images likely intensify these effects.
37
How do stigma and online communities contribute to eating disorder risk?
Being overweight is linked to stereotypes (lazy, stupid, unsuccessful) even among health professionals.
Online "pro-ana" and "pro-mia" communities (e.g., #thinspo, #edtwitter) glamorize extreme thinness.
Women who visit such sites report more eating disorder symptoms and body dissatisfaction.
Experimental studies show that viewing these sites can lead to increased food restriction, suggesting causality.
38
Why do eating disorders occur more often in women than men?
Western culture emphasizes thinness for women, while men are encouraged to be muscular or average-weight.
39
How do eating disorder rates compare among sexual and gender minorities?
Gay, lesbian, bisexual, and gender-minoritized individuals have higher rates of eating disorders than heterosexual people.
40
What is self-objectification and its impact on eating behavior?
It's when women view their bodies through others' eyes. It leads to body shame and is linked to disordered eating.
41
How do eating disorder symptoms change as women age?
Symptoms and concerns decline after age 30; by age 50, fewer women meet diagnostic criteria. Men’s concerns increase slightly.
42
Are there racial or ethnic differences in eating disorder prevalence?
Anorexia is more common in White women, but bulimia and binge eating occur at similar rates across groups. Acculturation raises risk.
43
How does personality influence the development or maintenance of eating disorders?
Personality can both influence and be shaped by eating disorders. For example, research from a 1940s semistarvation study showed that extreme food restriction causes fatigue, obsession with food, irritability, and depression, suggesting that some traits seen in anorexia may result from the illness, not cause it. Still, perfectionism—a tendency to set unrealistically high standards and be self-critical—is often present in people with eating disorders and remains high even after treatment. This perfectionism can be self-, other-, or socially oriented, and is linked to both anorexia and bulimia. Additionally, body dissatisfaction, poor interoceptive awareness (difficulty identifying bodily signals), and a tendency toward negative emotions have been shown to predict disordered eating over time.
44
What role do family characteristics play in eating disorders?
People with eating disorders often report growing up in families with high conflict, but this perception isn't always confirmed by parents. Research shows that family dynamics can vary widely, and findings depend on who is reporting the information. In many cases, child and parent perspectives on family functioning don’t match, making it difficult to draw firm conclusions. Still, family environment may influence risk, particularly when combined with individual traits like perfectionism or emotional sensitivity.
45
How effective are medications in treating eating disorders like bulimia, anorexia, and binge eating disorder?
Antidepressants have shown effectiveness in reducing bingeing and purging in bulimia nervosa, supported by randomized controlled trials. However, medications have had little success in treating core symptoms of anorexia nervosa, including weight gain. For binge eating disorder, the evidence is limited, and antidepressants appear ineffective for reducing binge episodes or promoting weight loss. In one study, cognitive behavioral therapy (CBT) combined with a placebo outperformed both fluoxetine alone and CBT with fluoxetine, with better outcomes even a year later.
46
What are the two main treatment goals for anorexia nervosa and how is CBT used?
The first goal is short-term weight restoration to prevent medical risks and ensure survival, often requiring hospitalization. The second, more challenging goal is long-term weight maintenance. Cognitive behavioral therapy (CBT) is used post-hospitalization and has shown lasting reductions in anorexia symptoms, with older and more severely affected patients benefiting most. Though CBT and supportive psychotherapy both reduce symptoms and depression, average BMI often remains below healthy levels.
47
How effective is family therapy in treating anorexia nervosa, and what factors predict better outcomes?
Family therapy, especially Family-Based Therapy (FBT), is among the most effective treatments for anorexia, particularly for weight gain and symptom remission. FBT empowers parents to help restore their child’s health and improve family dynamics. In clinical trials, more girls achieved full remission after FBT than after individual therapy. Early weight gain—especially by the fourth session—strongly predicts better long-term outcomes.
48
What are the main therapeutic principles and goals of CBT for bulimia nervosa?
CBT for bulimia encourages patients to challenge societal beauty standards and change distorted beliefs about food, body image, and self-worth. The aim is to develop healthier eating habits, like eating three meals and snacks daily without triggering binges. Patients are taught that setbacks, such as eating high-calorie foods, do not mean failure, and that purging only reinforces a cycle of guilt, low self-esteem, and depression. Therapy focuses on identifying emotional and situational triggers and developing more adaptive coping strategies.
49
How effective is CBT for bulimia nervosa and what alternative forms exist?
CBT is the most validated and effective treatment for bulimia, reducing bingeing and purging by 70% to over 90%, with benefits lasting up to 10 years. CBT is more effective than medications alone and often more effective than psychoanalytic therapy or IPT in the short term. A promising variation, CBT-guided self-help (CBT-gsh), involves minimal therapist guidance with structured self-help materials. It's recommended as the first-line treatment for bulimia in the UK, especially for binge eating and perfectionism-related issues.
50
What other psychological therapies are used for bulimia nervosa besides CBT?
Interpersonal therapy (IPT) is effective but works more slowly than CBT, reaching comparable results by 1-year follow-up. Meta-analyses suggest CBT may have a slight edge over IPT. Family-based therapy has also shown success, particularly for adolescents, with reduced bingeing and purging at 6- and 12-month follow-ups. While CBT is the recommended treatment for adults, family therapy is advised for youth according to international guidelines.
51
What are the most effective psychological treatments for binge eating disorder and how do they compare?
CBT is the most studied and effective treatment for binge eating disorder, targeting binge episodes through self-monitoring, self-control, and problem-solving. It is more effective than fluoxetine and maintains gains up to 1 year. IPT and CBT-guided self-help (CBT-gsh) are also effective, with comparable outcomes to CBT. Behavioral weight-loss programs help with weight loss but are less effective at reducing binge eating. Therapist-led CBT groups result in the greatest binge reduction and lowest dropout rates, though therapist-assisted and structured self-help groups also show positive results, offering accessible alternatives.
52
What is the Body Project and how effective is it in preventing eating disorders?
The Body Project is a dissonance-based prevention program aimed at reducing internalization of the thin ideal among adolescents and young adults. It includes interactive exercises like discussion, writing, and role-play to challenge sociocultural beauty standards. Studies show that it reduces negative affect, body dissatisfaction, and risk factors for eating disorders up to 4 years later. Compared to the Healthy Weight program, the Body Project is more effective and has been successfully implemented both in person and online (eBodyProject).
53
How did 19th- and early-20th-century Western views on sexuality differ from contemporary perspectives?
In the 19th and early 20th centuries, Western societies viewed sexual excess—particularly masturbation—as dangerous and harmful. Influential figures like von Krafft-Ebing believed that early masturbation depleted a finite reservoir of sexual energy and damaged sexual organs, leading to dysfunction in adulthood. To curb sexual behavior, strategies such as promoting bland diets (e.g., corn flakes, graham crackers) and discouraging genital contact in children (e.g., using metal mittens) were used. In contrast, contemporary Western views often see repression of sexual expression as problematic and emphasize sexual well-being as part of a healthy life.
54
What impact did the birth control pill and the AIDS epidemic have on sexual norms in the 20th century?
The introduction of the birth control pill played a significant role in the sexual revolution of the 1970s by reducing the risks associated with premarital sex and allowing people more freedom to express their sexuality. In contrast, the AIDS epidemic of the 1980s reintroduced serious risks to sexual activity, prompting changes in sexual behavior and increasing public awareness about sexually transmitted infections. Both events significantly influenced attitudes and norms around sex in the Western world.
55
How do cultural norms influence views on sexuality and same-gender behavior?
Cultural beliefs greatly shape how sexuality is understood and accepted. In some societies, sexual expression is seen as vital to individual well-being and pleasure, while others limit its value to procreation. Acceptance of same-gender sexual behavior also varies widely. For instance, Sambian rituals in Papua New Guinea involve sexual acts between males as a rite of passage, whereas other cultures strongly stigmatize such behavior. In the U.S., homosexuality was considered a mental disorder in the DSM until 1973. More recent data shows increasing identification with LGBTQ+ identities, reflecting changing societal norms.
56
What methods are used to study normative sexual behavior, and what challenges do researchers face?
Researchers use a variety of methods to study normative sexual behavior, including self-report surveys, interviews, and physiological measurements. Tools like penile and vaginal plethysmographs measure biological arousal by tracking blood flow to the genitalia while participants view erotic stimuli. However, challenges include ensuring the honesty of participants' responses, especially on stigmatized topics. Response biases may vary based on gender, age, cultural background, and generational cohort, which can affect the accuracy and interpretation of result
57
What did research found about women’s motivation for sex?
They found that many women reported sexual attraction and physical gratification—not relationship closeness—as their primary motivation for having sex, challenging common gender stereotypes.
58
How do cultural attitudes toward gender equality affect gender differences in sexuality?
Gender differences in sexuality tend to decrease in cultures that support more empowered roles for women, showing that such differences may be shaped by social context rather than biology alone.
59
What did the "sham lie detector" study by Alexander & Fisher (2003) reveal about gender differences in self-reported sexual behavior?
When participants believed they were being monitored by a lie detector, men and women reported similar levels of masturbation and pornography use, suggesting that typical gender differences in surveys may result from social desirability bias rather than actual behavior.
60
True or False: Women’s biological and subjective arousal are usually strongly correlated.
False. Women's biological arousal often does not match their subjective arousal. Many women show genital blood flow without feeling subjectively aroused.
61
How does the timing of sexual interest and arousal differ between men and women?
In men, sexual interest typically precedes subjective and then biological arousal. In women, sexual interest and subjective arousal often co-occur or even follow biological arousal.
62
How does biological arousal in response to erotic stimuli differ between men and women?
Men show greater biological arousal to stimuli that match their sexual orientation. Women, however, often show automatic genital arousal to both male and female erotic stimuli, regardless of orientation.
63
What are the DSM-5-TR diagnoses of sexual dysfunction related to sexual interest, desire, and arousal for women and men?
- Women: Female sexual interest/arousal disorder
- Men: Male hypoactive sexual desire disorder and erectile disorder
These diagnoses reflect difficulties in initiating or maintaining sexual interest or arousal, which can interfere with sexual satisfaction and functioning.
64
What are the three categories of sexual dysfunction in the DSM-5-TR, and what criteria must be met for diagnosis?
DSM-5-TR categorizes sexual dysfunctions into:
1. Sexual desire, arousal, and interest disorders
2. Orgasmic disorders
3. Sexual pain disorders
To be diagnosed, the dysfunction must be persistent and recurrent, cause clinically significant distress, and not be due entirely to a medical condition or another psychological disorder.
65
Why might community surveys overestimate the prevalence of sexual dysfunction?
Community surveys often report symptoms lasting at least 3 months, but DSM-5 requires symptoms to persist for 6 months and cause distress. Surveys also don't always account for relationship issues, such as partner abuse or dissatisfaction, which can influence sexual concerns but aren't classified as sexual dysfunctions.
66
How can one sexual dysfunction lead to another, and how might it affect a partner?
Sexual dysfunctions can create a vicious cycle. For example, premature ejaculation may lead to anxiety, which then causes issues with sexual desire or arousal. Additionally, one partner’s sexual difficulties can contribute to sexual problems in the other partner, affecting relationship dynamics.
67
What is female sexual interest/arousal disorder according to the DSM-5-TR?
Female sexual interest/arousal disorder involves persistent deficits in sexual interest, biological arousal, or subjective arousal. It reflects difficulties in becoming or staying interested or aroused during sexual activity.
68
What are the two DSM-5-TR diagnoses for lack of sexual desire or arousal in men?
- 1. Male hypoactive sexual desire disorder – characterized by deficient or absent sexual fantasies and urges.
- 2. Erectile disorder – characterized by difficulty attaining or maintaining an erection through completion of sexual activity.
69
What are the DSM-5-TR defining symptoms of Female Sexual Interest/Arousal Disorder?
Requires at least 3 of the following symptoms (diminished, absent, or reduced frequency):
- Interest in sexual activity
- Erotic thoughts or fantasies
- Initiation of and responsiveness to partner’s sexual attempts
- Sexual excitement/pleasure during ≥75% of encounters
- Arousal in response to internal or external erotic cues
- Genital or nongenital sensations during ≥75% of encounters
70
What is the defining symptom of Male Hypoactive Sexual Desire Disorder?
Sexual fantasies and desires are deficient or absent, as judged by the clinician.
71
What are the DSM-5-TR defining symptoms of Erectile Disorder?
On ≥75% of sexual occasions, one or more of the following:
- Inability to attain an erection
- Inability to maintain an erection through completion of sexual activity
- Marked decrease in erectile rigidity interfering with penetration or pleasure
72
How do women typically experience and report female sexual interest/arousal disorder?
Women often report subjective lack of desire—that previously exciting stimuli (e.g., a partner’s touch) no longer trigger arousal. Vaginal plethysmograph studies show that many of these women still have normal biological responses, highlighting the distinction between subjective and biological arousal in women.
73
How is erectile disorder different from low sex drive in men?
Erectile disorder involves issues with physical arousal, not desire. Men with erectile disorder may still have frequent sexual desires, but experience difficulty attaining or maintaining an erection. Prevalence increases with age—up to 50% of men 60+ report some erectile difficulties.
74
What factors influence how distressing low sexual desire is for individuals, especially women?
Cultural norms and age influence distress. American women report more distress about low desire than European women. Postmenopausal women report lower desire but less distress than younger women.
75
What distinction is important in understanding female sexual interest/arousal disorder?
There is a key distinction between subjective desire/arousal and biological arousal. Women may report low desire subjectively but still show normal biological responses on physiological measures.
76
What characterizes erectile disorder and how does it differ from low sex drive in men?
Erectile disorder involves physical difficulty attaining or maintaining erections despite possibly frequent sexual desire. It is not the same as low sex drive. Erectile dysfunction prevalence rises sharply with age.
77
Why is ruling out medical disease important when diagnosing sexual dysfunction?
Because sexual dysfunctions can be caused by medical illnesses, and DSM-5-TR includes separate diagnoses for dysfunctions caused by medical conditions.
78
Which biological conditions and lifestyle factors can contribute to sexual dysfunction?
Diabetes, multiple sclerosis, spinal cord injury, heavy alcohol use (chronic and before sex), heavy cigarette smoking, hormone imbalances, and medications like SSRIs.
79
What biological factors are particularly relevant to erectile disorder and premature ejaculation?
Erectile disorder is often related to vascular problems restricting blood flow; premature ejaculation may be linked to abnormal serotonin receptors influenced by SSRI treatment.
80
How can childhood sexual abuse influence sexual dysfunction?
It is linked to diminished arousal and desire, higher rates of genital pain, and in men, doubled rates of premature ejaculation.
81
What role do relationship problems play in sexual dysfunction?
Relationship difficulties, poor communication about sex, and concerns about a partner’s affection can lower sexual satisfaction and contribute to dysfunction.
82
How do depression and anxiety relate to sexual dysfunction?
They significantly increase the risk of sexual dissatisfaction and are often comorbid with sexual pain, low desire, arousal issues, and orgasmic disorders.
83
What impact do negative cognitions have on sexual functioning?
Worries about pregnancy, STIs, performance anxiety, body image issues, and self-blame can interfere with sexual enjoyment and lead to recurring sexual problems.
84
How do biological and psychosocial factors interact to contribute to sexual dysfunction?
They often combine and amplify each other—for example, cardiovascular disease may cause erectile dysfunction biologically, while depression or anxiety about performance worsens distress and further reduces arousal.
85
What is a key initial step in treating sexual dysfunctions with biological causes?
Addressing the biological factors first, often in combination with relationship and focused sex therapy techniques.
86
Why is cultural humility important in treating sexual dysfunction?
Because cultural and religious backgrounds shape comfort with treatment, attitudes toward sexuality, and personal values, requiring sensitivity from therapists.
87
What is the role of psychoeducation in treating sexual dysfunction?
It normalizes symptoms, reduces anxiety and self-blame, models healthy communication about sexuality, and helps clients understand the biological and psychological bases of their issues.
88
How does couples therapy help address sexual dysfunction?
By improving nonsexual communication, resolving relationship issues, encouraging romantic intimacy, and promoting open communication about sexual likes and dislikes.
89
What are cognitive interventions in the treatment of sexual dysfunction?
They challenge perfectionistic and self-critical thoughts, reduce performance pressure, promote positive body image, and may include mindfulness to foster nonjudgmental awareness.
90
What is sensate focus and how does it help treat sexual dysfunction?
Sensate focus involves non-genital touching exercises that help couples reconnect through sensual pleasure, reduce performance anxiety, and improve communication about sexual preferences.
91
What medications are FDA-approved for treating female sexual interest/arousal disorder, and what are their limitations?
Flibanserin (Addyi) and bremelanotide (Vyleesi) are approved; Addyi shows limited efficacy compared to placebo, and both have high rates of side effects.
92
What is directed masturbation, and how does it help treat female orgasmic disorder?
A stepwise technique where a woman explores her genitals, uses masturbation and vibrators, and then involves her partner to increase comfort and ability to orgasm; effective especially for lifelong inability to orgasm.
93
How is genito-pelvic pain/penetration disorder typically treated?
Through relaxation training and gradual vaginal insertion exercises using fingers or dilators, starting small and working up to larger sizes
94
What treatments are used for premature ejaculation?
SSRI antidepressants like dapoxetine (Priligy) taken before sex, and behavioral techniques such as the squeeze technique and withdrawal method; psychotherapy may help regain confidence.
95
What is the main treatment for erectile disorder and how effective is it?
Phosphodiesterase type 5 (PDE-5) inhibitors (e.g., sildenafil/Viagra) relax smooth muscles to improve blood flow and erection; about 83% efficacy in enabling intercourse compared to 45% with placebo; side effects exist but are generally tolerated.
96
What is the core feature of paraphilic disorders according to DSM-5-TR?
Recurrent sexual attraction to unusual objects or activities lasting at least 6 months, involving a deviation (para) in what the person is attracted to (philia).
97
How does DSM-5-TR differentiate paraphilic disorders?
Based on the source of arousal, such as attraction focused on causing pain versus attraction focused on childre
98
What distinguishes normative paraphilic interests from paraphilic disorders?
Paraphilic disorders cause marked distress, impairment, or involve nonconsenting others; normative interests do not.
99
What is the stance of WHO and DSM-5-TR on diagnosing paraphilias involving consenting adults without distress?
WHO removed some paraphilias from their classification if no distress or nonconsent is involved; DSM-5-TR retains these but adds "disorder" to emphasize distress, impairment, or nonconsent is required for diagnosis.
100
What demographic and onset patterns are common in paraphilic disorders?
Most individuals are male and heterosexual; onset of disorders like sexual sadism and masochism is typically by early adulthood, with many paraphilic interests emerging in adolescence.
101
What is the diagnostic criteria for pedophilic disorder according to DSM-5-TR?
Sexual gratification from contact with prepubescent children (or intense urges causing distress), person must be 16 or older and at least 5 years older than the child, with urges or behaviors lasting 6+ months.
102
When is pedophilic disorder diagnosed?
When adults act on urges toward children or when recurrent urges/fantasies cause marked distress or interpersonal problems.
103
What are common characteristics of people with pedophilic disorder?
Mostly men, heterosexual or gay, about half have never been married, usually molest children they know.
104
How is sexual arousal measured in pedophilic disorder research?
Using penile plethysmography, which measures arousal response to pictures of children; strong predictor of repeated offenses but not perfectly specific.
105
How does arousal differ between those with and without pedophilic disorder?
Those with the disorder show more arousal to children’s stimuli than adults’; those without show more arousal to adults.
106
What is incest as it relates to pedophilic disorder, and why is it taboo?
Incest is sexual relations between close relatives (commonly brother-sister or father-daughter), taboo due to high risk of recessive genetic defects in offspring and universal cultural prohibition.
107
What defines a paraphilic disorder according to DSM-5-TR?
Recurrent sexual attraction to unusual objects/activities for ≥6 months, causing distress, impairment, or involving nonconsenting individuals. Diagnoses are made only if these criteria are met.
108
What are the features of voyeuristic disorder?
Sexual arousal from watching unsuspecting people who are naked, disrobing, or having sex. Must be ≥18 years old, act on urges or experience distress, and symptoms persist ≥6 months.
109
Compare exhibitionistic and frotteuristic disorders.
Exhibitionistic: Arousal from exposing genitals to an unsuspecting person.
Frotteuristic: Arousal from touching/rubbing against a nonconsenting person.
Both require ≥6 months of symptoms, acting on urges or distress/impairment.
110
What defines pedophilic disorder and how is incest related?
Pedophilic disorder involves sexual urges/fantasies/acts with prepubescent children, with distress or behavior. Person must be ≥16 and 5 years older than the child. Incest, a subtype, involves sexual acts between close relatives, most often between siblings or father-daughter.
111
What’s the difference between sexual sadism and masochism disorders?
Sadism: Arousal from inflicting pain or humiliation.
Masochism: Arousal from receiving pain or humiliation.
Diagnosis requires ≥6 months of symptoms and distress/impairment or involvement of nonconsenting others.
112
Why are some paraphilias controversial in diagnosis?
Some, like fetishism and sadomasochism, are common and not inherently harmful. DSM-5-TR includes them only if they cause distress, impairment, or involve nonconsent. WHO removed several from its system due to limited evidence of harm.
113
What biological and developmental factors contribute to paraphilic disorders?
Androgens: No consistent link to elevated testosterone.
Neurodevelopment: Some with pedophilic disorder show lower IQ, neurocognitive issues, and prenatal anomalies.
Childhood sexual abuse: Reported by 40–66% of adult offenders, but most abused children don't offend.
Small, biased samples: Most research is based on men arrested for offenses.
114
What psychological patterns are common in paraphilic disorders?
Linked to emotion regulation issues, negative mood, and impulse control problems.
Alcohol use lowers inhibition and is common in offenses.
Offenders often lack empathy and may have hostile attitudes toward victims.
Sexual acts may provide escape from negative emotions.
115
What psychological traits differentiate men with pedophilic disorder who offend from those who don't?
- Offenders: Poor at reading children's emotions; may show higher impulsivity or psychopathy.
- Non-offenders: Better at empathy, esp. recognizing children’s feelings.
- Subtypes: Some show intense sexual preoccupation and emotional identification with children; others fit a more antisocial profile.
116
What treatments are used for paraphilic disorders, and how effective are they?
CBT: Includes aversion therapy, cognitive restructuring, empathy training, and relapse prevention; results are mixed, with few RCTs showing strong long-term effects.
Medications: Hormonal agents (e.g., MPA, CPA) reduce arousal but have serious side effects; SSRIs are used, but efficacy is unproven.
Motivation building is key, as denial and drop-out are common.
117
What are community-based prevention strategies for paraphilic disorders?
Dunkelfeld Project (Germany): Offers CBT and meds to non-offending individuals; over 11,000 reached, 1,000+ treated.
Online programs now offer anonymous help (e.g., Troubled Desire), but data on their effectiveness is limited.
Challenges: Mandatory reporting laws may deter honesty and participation.
118
What legal and ethical concerns are tied to paraphilic disorders?
Civil commitment: Legal to detain high-risk individuals with paraphilic diagnoses post-prison if control is impaired.
Megan’s Law: Public registry of sex offenders aims to prevent repeat crimes; evidence of effectiveness is mixed.
Risks: Public registries can lead to vigilante violence; civil liberties groups challenge these laws.
119
What are mood disorders characterized by?
Profound disturbances in emotion, ranging from deep sadness (depression) to extreme elation/irritability (mania).
120
What are the two broad categories of mood disorders in the DSM-5-TR?
Unipolar depressive disorders (only depressive symptoms)
Bipolar disorders (involving manic symptoms)
121
What are the main unipolar depressive disorders in DSM-5-TR?
Major depressive disorder
Persistent depressive disorder
Premenstrual dysphoric disorder
Disruptive mood dysregulation disorder
122
What are the main bipolar disorders in DSM-5-TR?
Bipolar I disorder
Bipolar II disorder
Cyclothymia
123
Criteria for Major Depressive Disorder (MDD)?
Sad mood or anhedonia + at least 5 symptoms (e.g., sleep/appetite changes, fatigue, guilt, suicidal thoughts)
Present nearly every day for at least 2 weeks
124
What is anhedonia?
Inability to experience pleasure, even from activities that were once enjoyable.
125
What is psychomotor agitation vs psychomotor retardation?
Agitation: fidgeting, restlessness
Retardation: slowed movement and thoughts
126
Is one depressive symptom profile common across patients?
No, over 1,000 symptom combinations identified; no single profile appears in more than 2% of patients.
127
What kind of disorder is MDD considered, and how long can an untreated episode last?
Episodic disorder; episodes may last 6+ months, often recur.
128
What is Persistent Depressive Disorder (PDD)?
Chronic low mood and at least 2 symptoms for 2 years (or 1 year in youth), with no symptom-free period longer than 2 months.
129
Is PDD less severe than MDD?
No—though fewer symptoms are required, its chronicity leads to more impairment and higher risk of suicide/hospitalization.
130
Gender and socioeconomic differences in depression rates?
Depression is 2x more common in women
3x more common in people living in poverty
131
What is the relationship between MDD and anxiety disorders?
Highly comorbid—45% of those with MDD will also meet criteria for an anxiety disorder.
132
How are MDD and PDD related?
Often comorbid—many with PDD have MDD episodes, and 30% of MDD cases persist long enough to become PDD.
133
What are the 3 types of bipolar disorders?
Bipolar I, Bipolar II, Cyclothymic Disorder.
134
What is the defining feature of all bipolar disorders?
Manic symptoms.
135
How does Bipolar I differ from Bipolar II?
Bipolar I includes mania (no depression required); Bipolar II includes hypomania and depression.
136
How long must a manic episode last?
At least 1 week, or any duration if hospitalization or psychosis is present.
137
How long must a hypomanic episode last?
At least 4 days, with noticeable changes but no psychosis or hospitalization.
138
What is cyclothymia?
Chronic mood shifts between mild depression and hypomania for 2+ years.
139
What risky behaviors are common during mania?
Overspending, reckless driving, impulsive sex.
140
How do bipolar symptoms differ by gender?
Woman have more depressive episodes than men
141
What disorders are commonly comorbid with bipolar?
Anxiety and substance use disorders.
142
What is the long-term risk with cyclothymia?
Risk of developing full mania or depression.
