Abnormal Psych Notes
Abnormal Psych Notes Psyc 3330 - 01
University of Louisiana at Lafayette
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This 6 page Class Notes was uploaded by Lauren Notetaker on Sunday March 13, 2016. The Class Notes belongs to Psyc 3330 - 01 at Tulane University taught by Constance Patterson in Winter 2016. Since its upload, it has received 20 views. For similar materials see Abnormal Psychology in Psychlogy at Tulane University.
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Date Created: 03/13/16
Abnormal Psych week 9 and 10 day 2 • Religious founders of our country had very repressed views of sexual behavior (“puritanical”) • Sex continues to be viewed within religious traditions as necessary for procreation and generally discouraged for any other reasons • Result: Very little open conversation about sex, sexuality, and sexual practices and sex education remains “under attack” Early research on sexuality • Alfred Kinsey, Indiana University: Sexual Behavior in the Human Male (1948) and Sexual Behavior in the Human Female (1953) • Documented range and frequency of sexual behaviors across people from different walks of life • Highly controversial • Methods criticized but likely accurate Human sexual response • William H. Masters and Virginia E. Johnson studied the human sexual response, and diagnosis and treatment of sexual disorders and dysfunctions, working from 1957 until the 1990s ◦ Had surrogate ppl with multiple sex partners and ppl asked how does that make this different from prostitution • Human Sexual Response (1966) and Human Sexual Inadequacy (1970) • Worked at Washington University, St. Louis and later in a private research facility in St. Louis What is "normal" sexual behavior? • Middle school students have reported popularity of *rainbow parties where girls put on different shades of lipstick and have oral sex with multiple partners, leaving “rainbows” on the boys’ penises • 61% of 13 year olds in a recent survey said oral sex is NOT sex. • *Note: some have argued this is a media creation and not a real phenomenon • 36% of teens (15-17) have had oral sex. • 75%of teens (15-17) who have had intercourse have also had oral sex • 13 % of teens (15-17) who never had intercourse have engaged in oral sex. • 25% of 10th graders, in upper middle class school district (New England) reported multiple oral sex partners in past year. • Females reported 3 – 4 partners. • Freud originally proposed that everyone was born bisexual and through development, became either heterosexual or homosexual and that either was “normal” • Kinsey found a broad range of sexual behaviors were common among the general public • NOTE: It is important not to confuse behavior and identity • Sociocultural factors/tradition deﬁne “normal” • Gender roles/social attitudes guide the judgments about what is “normal” and acceptable behavior • Roles of family, culture, social group, religion all impact expression of sexuality • Despite the same hormones, similar body types and feelings, people express sexuality differently • Sexuality is more ﬂuid than we have believed • Expression of sexuality = varied and not necessarily linked to sexual orientation/identity: Behavior does not provide deﬁnition: Asexuality, Heterosexuality, Homosexuality, Bisexuality • Gender noncomformity is increasingly common • A growing number of young people do not embrace labeling and do not want to be identiﬁed by their sexual orientation or their sexual behavior Grouping in dsm-5 • Somewhat arbitrary grouping • Inclusion of categories of “problems” traditionally inﬂuenced by social values ◦ In 1973, millions were “cured” of their mental illnesses when Homosexuality was deleted from the DSM by the American Psychiatric Association ◦ 43 years later, we are still ﬁghting the assertion that this is a condition that can be “cured” Gender dysporia and sexual disorders • DSM-5 changes “Gender Identity Disorder” to Gender Dysphoria (unhappiness): a person believes that they were born in the wrong body and should be the other sex ◦ Born into the wrong body • There are 2 additional categories of sexual disorders we will discuss: ◦ Sexual dysfunctions – problems with sexual responses (Desire/Excitement/ Orgasm/Pain) ◦ Paraphilias – sexual urges and fantasies in response to socially inappropriate objects or situations Sexual identity • Three Parts of Sexual Identity: ◦ 1. Direction of sexual orientation: heterosexual, homosexual, or bisexual. ◦ 2. Style of behavior, e.g., female may be "tomboy" or feminine-type; male may be "macho guy" or a "sensitive boy." ◦ 3. Core gender identity, essentially the deep inner feeling about whether he or she is a male or female. • May 12, 2001 issue of New Scientist; #3 is most difﬁcult to ascertain Gender dysporia • Gender dysphoria (also called transgender) is about core identity ◦ People with this disorder persistently believe they were born as the wrong biological sex • They usually want to remove their primary and secondary sex characteristics and acquire the characteristics of the opposite sex • BUT is this truly a disorder? Should it be in DSM-5? • The awareness emerges in childhood and becomes acute with adolescence • People with gender dysphoria usually feel uncomfortable wearing the clothing associated with their biological sex and may adopt clothing styles of the other gender ◦ NOTE: This is distinctly different from a transsexual fetish cross dressing; there is no sexual arousal related to dress ◦ This is also different from intersex situations where the person is born with ambiguous or multiple sexual characteristics (genitalia) • Research group that said if you were born with both, how they'd assign the sex and be treated • Male to female transgender outnumber Female to male transgender 3 to 1 (are there potential difﬁculties with data?) • Sexual attraction/arousal is independent of identity (heterosexual/homosexual) • People with gender dysphoria often experience pervasive anxiety or depression, may feel trapped in their own bodies, and may have thoughts of suicide • Several theories have been proposed to explain this disorder, but research is limited and generally weak • Some clinicians suspect biological, perhaps genetic factors, for example: ◦ Abnormalities in the hypothalamus (particularly the bed nucleus of stria terminalis) are a potential link ◦ Hormonal differences for mom while pregnant may provide at least partial explanation • Cultural expectations may or may not allow variation ◦ (Expectations begin before birth when gender is known) • Up until the 1880s and in some tribes in the present, Native American tribes in the plains states honored a tradition of “two spirit” people • Mexico: Zapotec culture includes a third gender, the Muxe • Samoa: speciﬁc roles for male to female transgender individuals as Fa’afaﬁne Treatment for gender dysporia • Signiﬁcant psychotherapeutic intervention is required before sexual reassignment surgery is allowed • Generally must spend at least 1 year living as the sex they believe they should be • Some adults with Gender Dysphoria change sexual characteristics using hormones; others also have sexual reassignment (“sex change”) surgery; Some do both. "cruel and unusal punishment" • A transgender inmate (Massachusetts) won the right to have the state pay for her gender-reassignment surgery (2006); US District Court agreed surgery was medically necessary (2012); First Circuit Ct. ruled against Kosilek; Upon appeal, the U.S. Supreme Court declined to hear the case which functioned as a rejection of Kosilek’s request for sexual reassignment surgery (2014) • Kosilek: “Everybody has the right to have health care needs met, whether they are in prison or out on the streets…People in prisons who have bad hearts, hips or knees have surgery to repair those things. My medical needs are no less or more important than the person in the cell next to me.” Sexual dysfunctions • Sexual dysfunctions are disorders in which people cannot respond normally in key areas of sexual functioning ◦ Healthy humans may have ﬂeeting characteristics of these problems which are not pathological ◦ Problems can occur regardless of sexual orientation ◦ During a lifetime, up to 31% of men and 43% of women in the U.S. could be diagnosed with this kind of dysfunction ◦ Sexual dysfunctions cause considerable distress, result in sexual frustration, guilt, lower self-esteem, and problems in interpersonal relationships • The human sexual response consists of a cycle with four phases: ◦ Desire ◦ Excitement ◦ Orgasm ◦ Resolution • Sexual dysfunctions can affect one or more of the ﬁrst three phases • Note experience of pain may also inhibit sexual functioning and lead to dysfunction • Charts • Some experience normal sexual functioning before developing a disorder = “acquired type” • Some people struggle with sexual dysfunction their whole lives = “lifelong type” • When dysfunction is present during all sexual situations = “generalized type” • Some cases are tied to particular situations = “situational type” Sexual desire disorders • Desire phase of the sexual response cycle • Consists of urge to have sex, sexual fantasies, and experience of sexual attraction to others • (both physiological and psychological components) • Two dysfunctions are diagnosed for this phase: ◦ Male Hypoactive Sexual Desire Disorder ◦ Female Sexual Interest/Arousal Disorder • Male Hypoactive Sexual Desire Disorder ◦ A general lack of interest in sex and a low level of sexual activity ◦ Physical responses when engaged in sexual behavior may be normal • About 16% of men ◦ Keep in mind men are less likely to get help • Persistent or recurrent deﬁciency of sexual thoughts or fantasies and desire for sexual activity, lasting 6 months or more • Signiﬁcant distress or impairment • Female Sexual Interest/Arousal Disorder ◦ Lack of sexual interest and/or arousal for 6 months or more with at least three of these: • Absent/reduced frequency or intensity of ▪ sexual interest ▪ sexual thoughts or fantasies ▪ sexual initiation or receptiveness to a partner’s sexual initiation ▪ sexual interest, excitement or pleasure during almost all sexual encounters ▪ responsiveness to sexual cues ▪ genital and non-genital sensations during almost all sexual encounters • Human sex drive is determined by biological, psychological, and sociocultural factors in combination. Features of any of these may affect (increase or decrease) sexual desire ◦ Low levels of sexual desire or sexual aversion are usually caused by and/or complicated by sociocultural and psychological factors ◦ Biological conditions can also cause lower sex drive ◦ Effects of stress, anxiety, and depression • Biological causes ◦ A number of hormones interact to produce sexual desire and behavior • Abnormalities in hormone secretion and activity can result in lower sex drive • Hormones include prolactin, testosterone, and estrogen for both men and women • Some data points to excessive dopamine and serotonin • Chronic illness, some medications, some psychotropic drugs, and illegal drugs are known to negatively impact sex drive and performance • Psychological causes • Increases in anxiety or ongoing frustration and anger may reduce sexual desire for both women and men • Fears, attitudes, and memories may contribute to sexual dysfunction (e.g., sexual abuse and other trauma) • Psychological disorders, including depression and obsessive-compulsive disorder, may be associated with sexual desire disorders • Sociocultural -Social context impacts attitudes, fears, and psychological disorders and these contribute to sexual desire disorders • Many with desire disorders are experiencing ongoing situational pressures • Examples: divorce, death, job stress, infertility, and/or relationship difﬁculties • Cultural standards can impact the development of these disorders (family messages/ media/religion) • Trauma associated with a history of sexual molestation or sexual assault is likely to produce sexual dysfunction