4/5-4/7 Notes Psych 380
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This 6 page Class Notes was uploaded by Cara Cahalan on Thursday April 7, 2016. The Class Notes belongs to Psych 380 at University of Nebraska Lincoln taught by Rosemary Esseks in Spring 2016. Since its upload, it has received 7 views. For similar materials see Abnormal Psych in Psychlogy at University of Nebraska Lincoln.
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Date Created: 04/07/16
4/5: Sexual Dysfunctions and Gender Dysphoria Sexual Dysfunctions Involve “clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure” Can be… o Due to psychological, medical, or a combination of factors o Can be generalized or situational o More common during interpersonal encounters than during masturbation Not to be confused with periodic sexual difficulties, which are normal/expected. Desire Disorders Male : Hypoactive sexual desire disorder persistent lack of interest and desire for sexual activity o Often associated with depression, relationship problems, and stress o Prevalence 6% of younger men and 41% of males over 65 report more distress due to reduced desire o Course May begin in puberty and be lifelong Desire naturally declines some with age Female: Sexual interest/arousal disorder persistent lack of or significant decline in sexual desire and arousal. Can involve… o Lack of sexual thoughts/fantasies o Disinclination to initiate/respond to sexual overtures o Lack of/ reduced sexual response/enjoyment o Diagnosis is subjective o Prevalence unknown because newly formulated o Course may be lifelong but more commonly begins in response to a stressor or physical issue and is episodic Arousal Disorder Erectile disorder inability to achieve or maintain an erection until completion of sexual activity during 75100% of sexual encounters for six months o May achieve erection initially but lose it o Often associated with performance anxiety, relationship, and medical issues. o Prevalence 1530 million in the US o Course May be lifelong in individuals who have never achieved an erection More commonly is episodic Orgasm Disorders Female orgasmic disorder delay in or absence of orgasm following a normal process of arousal occurring during 75100% of sexual encounters o Lack of orgasm is reasonably common in women, thus only diagnosed if causes significant distress o Prevalence estimated 25% o Course more common in younger than older women because orgasmic capacity tends to increase with age Premature ejaculation orgasm and ejaculation before it is desired (i.e. after minimal stimulation, within 60 seconds of penetration) occurring during 75100% of sexual encounters for at least 6 months o Can cause embarrassment and social isolation o Prevalence 25% of men report some concern regarding ejaculation o Course tends to decrease with age and time in relationship Sexual Pain Disorders Genitopelvic pain/penetration disorder pain associated with intercourse (usually during, but can be before or after) for women o May involve vaginal pain (due to issues such as inadequate response, or involuntary contractions of pelvic floor muscles), or pain in other areas due to issues such as UTIs and scar tissues o Prevalence 15% of women o Course most common in early adulthood and in the period around menopause Sexual Dysfunctions: Causes Psychological contributions o Stress o Lack of education about normal sexual functioning o Performance anxiety o Negative selftalk “I can’t do this” o Sexual violence victimization o Relationship conflict o Guilt due to cultural attitudes i.e. discouragement of female sexual desire Physical contributions o Age reduce drive/functioning o Medical problems vascular disease o Substance abuse can affect testosterone (alcohol, marijuana), orgasm (opioids), reduce pleasure (cocaine) o Medications can reduce desire and lubrication, affect orgasm o Surgery removal of prostate Sexual Dysfunctions: Treatment Medical treatments o Begin with checkup to rule out/address physical causes o Switch medication to those without sexual sideeffects (i.e. Wellbutrin) o Vasodilating medication Injected or oral (Viagra) o Penile implants generally less satisfactory for partners o For pain use of lubricants/vaginal dilators Psychological treatments o Enhancing communication skills o Sensate focus (Masters and Johnson) Exploring methods of stimulation other than intercourse Works as graduated exposure Overall treatment success rate about 60% o Masturbation to increase body knowledge, enhance desire, compensate for performance anxiety o Squeeze or stop technique for premature ejaculation o Trauma treatment as indicated Gender Dysphoria Distress due to lack of match between one’s experienced gender and gender assigned at birth. Can involve… o Strong belief that one was born the wrong gender o Wanting to be seen as/treated as a member of as the other gender o Belief that one has the emotions and reactions of the other gender o Strong desire to be rid of own primary and/or secondary sex characteristics Not universally experienced by gender nonconforming people Transgender umbrella term for individual whose experienced gender does not match assigned gender. o May prefer the term transgendered: adjective vs. noun, thus more a descriptor than a label. o Currently often used as an umbrella term to include individuals described as… Transsexual individual who has taken steps to alter assigned gender: o MtF: someone in transition or fully transitioned from male to female gender (also known as transwoman). o FtM: someone in transition or fully transitioned from female to male gender (also known as transman). o Posttransition may prefer to be referred to as simply male or female Often teased and rejected, which may affect social/academic/occupational functioning, and cause depressive disorders, suicide attempts, and/or substance abuse o 60% report being a victim of a hate crime, with especially high rates in transgender females of color o Sexual relationships may be hampered by preference that it not involve Prevalence 0.01% of people born male and 0.0025% of those born female Course o Often begins in children ages 24 when understanding of gender develops o Exacerbate in puberty with appearance of secondary sex characteristics Causes o Seen more often in individuals with disorders of sexual development o Some evidence of a genetic link Treatment: o Psychotherapy to address mental health symptoms (i.e. depression and anxiety) and assist through related life stressors (i.e. reactions of family) o Assistance in altering gender expression/gender role to be more in line with experienced gender o Hormone therapy to alter secondary sex characteristics o Gender confirmation surgery including upper (removal of/implantation of breasts) and possibly lower (genital) surgeries Not all transgendered individuals desire all possible gender confirmation interventions. 4/7: Paraphilic Disorder Paraphilic disorder refers to “intense and persistent sexual interest other than genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners.” o Nonhuman objects o The suffering or humiliation of one’s self or one’s partner (bondage) o Children or other nonconsenting persons Causes distress/dysfunction and/or involves coercion Desire is persistent, compulsive (feels out of control) May involve only occasional behavior, or may be the only way the individual can experience sexual arousal If lack of consenting partners, may hire prostitutes or impose selves on unconsenting partners Noncoercive paraphilias may involve solitary or consensual shared behavior, not necessarily violations of each other’s rights Coercive paraphilias involve some degree of force or threat Paraphilic Disorders Individuals with paraphilias may experience o Impaired relationships if sexual partners are repelled by the person’s behavior o Guilt and shame about their unusual sexual habits, leading to depression o Arrest if the sexual behaviors involve infringement on the rights of others o As usual, not diagnosed if doesn’t cause distress or dysfunction to person or others (applicable to all) Noncoercive paraphilias o Fetishistic disorder sexual arousal achieved through use of inanimate object (clothing, nongenital body part) May masturbate while handling the item, or ask partner to wear it May have erectile dysfunction without object o Transvestic disorder sexual arousal achieved by crossdressing May only wear one piece of women’s clothing under male clothing, or dress entirely as female Seem primarily in heterosexual men, but who may have occasional samegender sexual activity o Sexual sadism disorder “recurrent and intense sexual arousal from the physical or psychological suffering of another person” Blindfolding, spanking, whipping, urinating, or defecating upon, raping, or killing another person May involve roleplaying if behavior bothers the individual Severity of sadistic behavior may increase with time o Sexual masochism disorder sexual arousal achieved by experiencing suffering through activities such as being tied up, beating, or humiliated May involve having a partner inflict the suffering, or may do on own Some risk of accidental death if involved in activities such as autoerotic asphyxia (restricting breathing through plastic bags or strangulation) Coercive paraphilias o Voyeuristic disorder sexual arousal achieved by observing unsuspecting others naked of engaged in grooming or sexual activity May fantasize about a relationship with the people viewed, but generally don’t seek actual sexual involvement with targets o Exhibitionist disorder sexual arousal achieved by displaying genitals to unsuspecting others May masturbate while exposing self or while fantasizing about exposure May prefer child, adolescent, or adult victims o Frotteuristic disorder sexual arousal achieved by “touching and rubbing against a nonconsenting person” Rubs genitals against another person, or fondles the other person’s genitals or breasts Generally fantasizes having a genuine and serious relationship with the person Usually in crowded public places (buses) o Pedophilic disorders preference of sexual involvement with prepubescent children Most pedophiles identify themselves as heterosexual Chronic can create hundreds of victims in a lifetime May experience cognitive dissonance and change how view behavior to reduce feelings of distress Not all perpetrates of childhood sexual abuse are true pedophiles may prefer adult victims but choose children because they are easier to control o Perpetrator modes of operation Express sexual interest in children use sexual terms when referring to children, be overly interested in children’s physical development Choose victims with care focus on children who seem lonely and unassertive Engage in grooming escalating pattern of behaviors to gain child’s trust, then violate boundaries Try to keep children from telling by threatening them or their families, insisting that nobody will believe them Rationalize abuse claim teaching child sexual skills Prevalence o Not known tend not to selfreport o Almost never diagnosed in females, except for sexual masochism (occasionally found) and pedophilia (rarely found) o Most common are voyeurism and exhibitionism, less common are sadism and masochism o ½ of those seen clinically are married Course o Commonly some fantasies may begin in childhood o Often begin to act on fantasies in adolescence and early adulthood o Diagnosis is given only for fantasies and behavior that are recurrent (commonly lifelong) o May increase in response to stress o Behaviors and fantasies often decline later in life Causes o Biological explanation abnormal hormone levels, chromosomal abnormalities o Classical conditioning learned association between sexual arousal and something unusual o Operant conditioning early experience of paring of a deviant fantasy with the reinforcement of sexual pleasure o Childhood sexual abuse could be explained as an attempt to reexperience/reprocess the abuse o Link to obsessive compulsive disorder and antisocial personality disorder o Cultural viewing violent porn associated with aggression towards women in laboratory studies Preventing Childhood Sexual Abuse Teach children how to set limits on their own bodies good/bad/secret tough, bathing suit rule Don’t encourage blind obedience to elders Safety in numbers no need for youth group leader to spend a lot of time alone with your child Be choosey about with whom you leave your children Report suspicions of abuse to hotline Listen to your children if child suddenly won’t go to a friend’s house anymore, ask why Treatment: Cognitivebehavioral treatment o Orgasmic reconditioning masturbating to more acceptable fantasies o Aversive approaches pairing the deviant fantasy with punishment (shocks, bad smells) Masturbatory satiation: masturbating beyond the point of orgasm Covert sensitization: engaging in deviant behavior while thinking about negative consequences o Restructuring thoughts involved with sexually assaultive behavior o Relapse prevention exploring conditions in which deviant behavior occurs, and problem solving how to decrease likelihood of recurrence (examining assault cycle) o Enhancing empathy describe what the assault was like for the victim, write apology letter to the victim o Address any underlying trauma o Social skills training to learn skills for meeting needs appropriately Drug therapy o Testosteronereducing medications o SSRIs to reduce sex drive/address OCD aspect ; Physical castration most effective treatment High rates of recidivism (rates of reoffense) with adult offenders better success with adolescents
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