Abnormal Psychology Ch. 10
Abnormal Psychology Ch. 10 Psych 433
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This 10 page Class Notes was uploaded by Derek Schrick on Saturday March 19, 2016. The Class Notes belongs to Psych 433 at University of Missouri - Kansas City taught by K. Harry in Spring 2016. Since its upload, it has received 116 views. For similar materials see Abnormal Psychology in Psychlogy at University of Missouri - Kansas City.
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Date Created: 03/19/16
Chapter 10- Sexual Dysfunctions, Paraphilia Disorders, and Gender Dysphoria What is Normal Sexuality? “Normal” vs. “Abnormal” sexual behavior - Normative data - Cultural considerations - Gender differences - Age Sexual and gender dysphoria disorders - Gender dysphoria - Sexual dysfunctions - Paraphilias Prevalence of sexual practices - 15 or more partners (lifetime) - M = 29% - F = 9% - 2 or more partners (year) - M = 17% - F = 10% - Homosexual sex attraction or behavior - Men = 10% - Women = 9% - Sexuality in the elderly - Activity can and does last past age 80 - Age 75-85 - M = 38.5% active - F = 16.7% active - Decreases = physical health changes Gender Differences - Masturbation - M = 81% - F = 45% - Frequency 2.5x higher in men - Reasons: - Associations? - Anatomy? - Convenience? Chapter 10- Sexual Dysfunctions, Paraphilia Disorders, and Gender Dysphoria Gender Differences - Casual premarital sex - Men are more permissive, gap is shrinking - Elements of satisfaction - Women = demonstrations of love, intimacy - Men = focus on arousal - No differences in several domains - Acceptability of homosexuality - Acceptability of masturbation - Experience of satisfaction - Sexual self-schemas - Core beliefs about sexual aspects of one’s self - Females - Higher conflict - Experience of passionate and romantic feelings - Openness to sexual experience - Embarrassed, conservative, or self conscious - Males—no negative core beliefs - Summary of sexuality differences - Men - Show more sexual desire and arousal - Self-concept includes power, independence and aggression - Women - Emphasize context of committed relationship - Sexual beliefs are shaped by cultural, situational, and social factors The Development of Sexual Orientation - Genetic/familial component - Homosexuality in twins - Identical = 50% - Fraternal = 16-22% - No specific genes - Biology interacts with environment An Overview of Sexual Dysfunctions - Sexual response cycle - Desire - Arousal - Orgasm - Males and females can experience parallel versions of most disorders - Sexual dysfunctions - Lifelong - Acquired Chapter 10- Sexual Dysfunctions, Paraphilia Disorders, and Gender Dysphoria - Generalized - Situational - Most prevalent class of disorder in U.S. - Men and women experience parallel versions - M = 31% - F = 43% - Must be perceived as distressing - Classification - Lifelong vs. acquired - Generalized vs. specific - Psychological factors - Psychological and medical conditions Sexual Desire Disorders - Male hypoactive sexual desire disorder - Little or no interest in sexual activity - Decreased frequency: - Masturbation - Sexual fantasies - Intercourse - Prevalence = 25% - M = 5% - F = 22% - Female Sexual Interest/Arousal Disorder - Sexual aversion disorder - Little interest in sex - Extreme fear, panic, disgust - Females > males Sexual Arousal Disorders - Male erectile disorder - Difficulty achieving and maintaining an erection - Female sexual arousal disorder - Difficulty achieving and maintaining adequate lubrication - Associated features - Problem is arousal, not desire - Prevalence may increase with age - ED is the main reason men seek treatment Orgasm Disorders - In men delayed ejaculation - In women the condition is referred to as female orgasmic disorder - Adequate desire and arousal - Unable to achieve orgasm - Rare in adult males - 8% delayed or absent Chapter 10- Sexual Dysfunctions, Paraphilia Disorders, and Gender Dysphoria - Common complaint of adult females - 25% report difficulty reaching orgasm Orgasm Disorders Orgasm Disorders - Premature ejaculation - Before the man or partner wishes, 1 minute - Most prevalent male sexual dysfunction - M = 21% - Declines with age - Common in younger, inexperienced males Orgasm Disorders Sexual Pain Disorders - Genito-pelvic pain/penetration disorder - Marked pain during intercourse - Extreme pain during intercourse - Adequate sexual desire, arousal, orgasm - Must rule out medical reasons - Vaginismus - Females only - Involuntary pelvic spasms - Outer third of vagina - Feelings of ripping, burning, or tearing - Prevalence = 6% - Related to conservative views of sexuality - Female pain during intercourse - 15% Assessing Sexual Behavior - Interviews - Clinician must demonstrate comfort - Assess multiple dimensions - Sexual attitudes - Behaviors - Sexual response cycle - Relationship issues - Physical health - Psychological disorders - Medical - Medication side effects - Physical conditions - Psychophysiological - Exposure to erotic material - Sexual arousal response - Males—Penile strain gauge - Females—Vaginal photoplethysmograph Chapter 10- Sexual Dysfunctions, Paraphilia Disorders, and Gender Dysphoria Causes of Sexual Dysfunctions - Biological - Physical disease - Medical illness - Prescription medications - Alcohol and drugs - Psychological contributions - “Anxiety” vs. “distraction” - Performance anxiety - Arousal - Cognitive processes - Negative affect - Social and cultural contributions - Erotophobia- fear of sex - Negative or traumatic experiences - Poor interpersonal relationships - Lack of communication - Interaction of Psychological and Physical Factors - Socially transmitted negative attitudes - + - Relationship difficulties - + - Predisposition to develop performance anxiety Treatment of Sexual Dysfunction - Education - Highly effective - Psychosocial intervention - Education - Eliminate performance anxiety - Sensate focus - Non-demand pleasuring Psychosocial Treatments - Premature ejaculation - Squeeze technique - Female orgasm disorder - Masturbatory training - Vaginismus - Use of dilators - Hypoactive sexual desire - Exposure to erotic material Medical Treatment - Erectile dysfunction Chapter 10- Sexual Dysfunctions, Paraphilia Disorders, and Gender Dysphoria - Viagra, Levitra and Cialis - Combined with CBT - Vasodilating drug injection - Papaverine or prostaglandin - Penile prosthesis or implants - Vacuum device therapy Paraphilic Disorders: Clinical Descriptions - Nature of paraphilias - Sexual attraction and arousal - Socially inappropriate people and/or objects - Often multiple paraphilias - High comorbidity - Anxiety Mood - Substance abuse - Associated with distress and impairment or harm or the threat of harm to others - Types of paraphilias - Frotteuristic disorder, unwanted touching in public - Fetishistic disorder, sexual attraction to nonliving objects - Voyeuristic disorder is the practice of observing, to become aroused, an unsuspecting individual undressing or naked - Exhibitionistic disorder, is achieving sexual arousal and gratification by exposing genitals to unsuspecting strangers - Types of paraphilias - Transvestic disorder, sexual arousal is strongly associated with the act of (or fantasies of) dressing in clothes of the opposite sex - Sexual sadism and sexual masochism are associated with either inflicting pain or humiliation (sadism) or suffering pain or humiliation (masochism) - Pedophilic disorder, sexual attraction to children - Incest, sexual attraction to family member Fetishistic Disorder - Fetishism - Sexual attraction to nonliving objects - Inanimate - Tactile - Partialism? - Examples: rubber, hair, shoes Voyeuristic and Exhibitionistic Disorders - Voyeurism - Observing an unsuspecting individual undressing or naked - Risk is necessary for arousal - Exhibitionism Chapter 10- Sexual Dysfunctions, Paraphilia Disorders, and Gender Dysphoria - Exposure of genitals to unsuspecting strangers - Compulsive, out of control - Thrill and risk are necessary for sexual arousal Transvestic Disorder - Transvestic fetishism - Sexual arousal via cross-dressing - Males may show highly masculine compensatory behaviors - Most do not - Many are married - Behavior is known to spouse Sexual Sadism and Sexual Masochism Disorders - Sexual sadism - Inflicting pain or humiliation - Sexual masochism - Suffering pain or humiliation - Different from hypoxiphilia - Sadistic rape - Some rapists are sadists - Few show paraphilic patterns of arousal - Arousal to violent material - Sexual and non-sexual Pedophilic Disorder and Incest - Pedophiles—sexual attraction to young children - 90% of perpetrators are male - 10% women - Incest—sexual attraction to one’s own children or relatives - Victims are children or young adolescent - Typically female - 12% of men and 17% of women reported being touched inappropriately by adults when they were children - Paraphilic disorders in women - Approximately 5% to 10% of all sexual offenders are women Causes of Paraphilic Disorders - Low levels of arousal to appropriate stimuli - Sexual problems - Social deficits - Early experiences - Inappropriate arousal / fantasy - High sex drive - Low suppression of urges / drive - Reinforcement via orgasm Assessing and Treating Paraphilic Disorders Chapter 10- Sexual Dysfunctions, Paraphilia Disorders, and Gender Dysphoria - Psychophysiological assessment - Deviant patterns of arousal - Desired arousal to adult content - Social skills - Ability to form relationships - Psychosocial interventions - Behavioral - Target deviant and inappropriate sexual associations - Covert sensitization - Orgasmic reconditioning - Family/marital therapy - Coping - Relapse prevention Psychosocial Treatment - Efficacy - Poorest outcomes = Rapists / Multiple paraphilias Chronic course - High relapse rates - Prevention efforts - CBT intervention Drug Treatments - Medications - Cyproterone acetate - Chemical castration, medroxyprogesterone (DepoProvera) - Dangerous sexual offenders - Efficacy - Greatly reduce desire, fantasy, arousal - High relapse when discontinued Gender Dysphoria - Clinical overview - Feels trapped in the body of the wrong sex - Assumes identity of the desired sex - Must distinguish from: - Transvestic fetishism - Disorders of sex development - Homosexual arousal patterns - Clinical overview - Disorders of sex development (DSD), formerly known as intersexuality or hermaphroditism - Statistics - Prevalence = Rare - Female : Male = 1:2.3 - Rates are similar across cultures Chapter 10- Sexual Dysfunctions, Paraphilia Disorders, and Gender Dysphoria - Status differences Causes - Biological - Unclear, but likely genetic contributions - 62-70% - Hormones - In vitro exposure - Brain structure abnormalities - Slightly higher levels of testosterone or estrogen at certain critical periods of development might masculinize a female fetus or feminize a male fetus - Gender dysphoria - 18 and 36 months of age - Parental reinforcement - Gender nonconformity Treatment - Sex-reassignment surgery - 1-2 years in opposite sex role - Stability - Hormone therapy - Surgery - 75% satisfied; 1-7% regret - Better adjustment for female-to-male - 2% attempt suicide after surgery - Treatment of gender nonconformity in children - Work with the child and caregivers to lessen gender dysphoria and decrease cross gender behaviors - “Watchful waiting” - Actively affirming and encouraging cross gender identification Treatment of Disorders of Sex Development (Intersexuality) - Five sex theory - Males - Females - Herms - Merms - Ferms - Prevalence = 1.7% - Treatment - Psychosocial over surgical - Increase adaptation 1. Research regarding sexual orientation suggests that homosexuality is Chapter 10- Sexual Dysfunctions, Paraphilia Disorders, and Gender Dysphoria influenced by multiple factors 2. The effects of alcohol on sexual behavior were well noted by William Shakespeare and can be summarized as B alcohol may increase desire but it decreases performance 3. The procedure that is carried out entirely in the patient’s imagination D. cevert sensitization 4. Treatment for paraphilias is considered successful when someone had D: all of the above 5. Which of the following is True regarding drugs currently available for the treatment of paraphilias? A. drugs eliminate sexual desire but are only effective while they are being taken