Sexual Disorders and Gender Identity Disorders - Handouts | PSYC 3150, Study notes of Abnormal Psychology

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Slides & Handouts by Karen Clay Rhines, Ph.D. Northampton Community College Comer, Abnormal Psychology, 7e Sexual Disorders and Gender Identity Disorder Chapter 13 Handouts 2Comer, Abnormal Psychology, 7e Sexual Disorders and Gender Identity Disorder  Sexual behavior is a major focus of both our private thoughts and public discussions  Experts recognize two general categories of sexual disorders:  Sexual dysfunctions – problems with sexual responses  Paraphilias – repeated and intense sexual urges and fantasies in response to socially inappropriate objects or situations 5Comer, Abnormal Psychology, 7e Sexual Dysfunctions  The human sexual response can be described as a cycle with four phases:  _________________________________  _________________________________  _________________________________  _________________________________  Sexual dysfunctions affect one or more of the first three phases Male High 3 Orgasm a £ <= ws 2 on 2 go 2 % Excitement Resolution a ra o ov = 4 Desire Low Time Comer, Abnormal Psychology, 7e 6 Female High B Orgasm (Orgasm) 3 ab o af <= a 8 Resolution s a 8 without a v 8 a 2o%,>, orgasm 2S 2 Excitement £ ve a * ee 3S = Resolution D with = orgasm Desire Low Time Comer, Abnormal Psychology, 7e 7 10Comer, Abnormal Psychology, 7e Disorders of Desire  Hypoactive sexual desire disorder  Characterized by a ________________________ and __________________________________________  Physical responses may be normal  Prevalent in about 16% of men and 33% of women  DSM-IV-TR refers to “deficient” sexual interest/ activity but ____________________________________  In reality, this criterion is difficult to define 11Comer, Abnormal Psychology, 7e Disorders of Desire  Sexual aversion disorder  Characterized by a ____________________ _______________________________________  Sexual advances may sicken, repulse, or frighten  This disorder seems to be rare in men and more common in women 12Comer, Abnormal Psychology, 7e Disorders of Desire  A person’s sex drive is determined by a combination of biological, psychological, and sociocultural factors, and any of these may reduce sexual desire  Most cases of low sexual desire or sexual aversion are caused primarily by sociocultural and psychological factors, but biological conditions can also lower sex drive significantly 15Comer, Abnormal Psychology, 7e Disorders of Desire  Sociocultural causes  Attitudes, fears, and psychological disorders that contribute to sexual desire disorders occur within a social context  Many sufferers of desire disorders are feeling ______________________________________  Examples: divorce, death, job stress, infertility, and/or relationship difficulties  Cultural standards can impact the development of these disorders  The trauma of sexual molestation or assault is also likely to produce sexual dysfunction 16Comer, Abnormal Psychology, 7e Disorders of Excitement  Excitement phase of the sexual response cycle  Marked by changes in the pelvic region, general physical arousal, and increases in heart rate, muscle tension, blood pressure, and rate of breathing  In men: _______________________________________  In women: ____________________________________  Two dysfunctions affect this phase:  Female sexual arousal disorder (formerly “frigidity”)  Male erectile disorder (formerly “impotence”) 17Comer, Abnormal Psychology, 7e Disorders of Excitement  Female sexual arousal disorder  Characterized by _____________________________ ______________________________________________  Many with this disorder also have desire or orgasmic disorders  It is estimated that more than _____% of women experience this disorder  Because this disorder is so often tied to an orgasmic disorder, researchers usually _____________________; causes of the two disorders will be examined together 20Comer, Abnormal Psychology, 7e Disorders of Excitement  Biological causes  The same hormonal imbalances that can cause hypoactive sexual desire can also produce ED  Most commonly, _______________ are involved  ED can also be caused by damage to the nervous system from various diseases, disorders, or injuries  The use of ______________________________ may interfere with erections 21Comer, Abnormal Psychology, 7e Disorders of Excitement  Biological causes  Medical devices have been developed for diagnosing biological causes of ED  One strategy involves measuring nocturnal penile tumescence (NPT)  Men typically have erections during REM sleep; abnormal or absent nighttime erections usually indicate a physical basis for erectile failure 22Comer, Abnormal Psychology, 7e Disorders of Excitement  Psychological causes  Any of the psychological causes of hypoactive sexual desire can also interfere with arousal and lead to erectile dysfunction  For example, as many as 90% of men with severe depression experience some degree of ED  One well-supported cognitive explanation for ED emphasizes __________________________________  Once a man begins to have erectile difficulties, he becomes fearful and worried during sexual encounters; instead of being a participant, he becomes a spectator and judge  ________________________________________________________ ________________________________________________________ 25Comer, Abnormal Psychology, 7e Disorders of Orgasm  Rapid or Premature ejaculation  Characterized by ____________________________ _____________________________________________  About ____% of men experience rapid ejaculation at some time  Psychological, particularly behavioral, explanations of this disorder have received more research support than other explanations  The dysfunction seems to be typical of young, sexually inexperienced men  It may also be related to anxiety, hurried masturbation experiences, or poor recognition of arousal 26Comer, Abnormal Psychology, 7e Disorders of Orgasm  Rapid or Premature ejaculation  There is a growing belief among many clinical theorists that biological factors may also play a key role in many cases of this disorder  One theory states that some men are born with a genetic predisposition  A second theory argues that the brains of men with rapid ejaculation contain certain serotonin receptors that are overactive and others that are underactive  A third explanation holds that men with this dysfunction experience greater sensitivity or nerve conduction in the area of their penis 27Comer, Abnormal Psychology, 7e Disorders of Orgasm  Male orgasmic disorder  Characterized by ___________________________ or by _____________________________ after normal sexual excitement  Occurs in 8% of the male population  Biological causes include low testosterone, neurological disease, and head or spinal cord injury  ______________________________________________________ ______________________________________________________ ______________________________________________________ 30Comer, Abnormal Psychology, 7e Disorders of Orgasm  Female orgasmic disorder  Most clinicians agree that orgasm during intercourse is _____________________ for normal sexual functioning  Early psychoanalytic theory used to consider lack of orgasm during intercourse to be pathological  Typically linked to female sexual arousal disorder  The two disorders tend to be studied and treated together  Once again, biological, psychological, and sociocultural factors may combine to produce these disorders 31Comer, Abnormal Psychology, 7e Disorders of Orgasm  Female orgasmic disorder  Biological causes  A variety of physiological conditions can affect a woman’s arousal and orgasm  These conditions include diabetes and multiple sclerosis  The same medications and illegal substances that affect erection in men can affect arousal and orgasm in women  Postmenopausal changes also may be responsible 32Comer, Abnormal Psychology, 7e Disorders of Orgasm  Female orgasmic disorder  Psychological causes  The psychological causes of hypoactive sexual desire and sexual aversion, including depression, may also lead to female arousal and orgasmic disorders  ___________________________________________ ___________________________________________ 35Comer, Abnormal Psychology, 7e Disorders of Sexual Pain  Two sexual dysfunctions do not fit neatly into a specific phase of the sexual response cycle  These are the sexual pain disorders:  Vaginismus  Dyspareunia 36Comer, Abnormal Psychology, 7e Disorders of Sexual Pain  Vaginismus  Characterized by ______________________ ________________________________________  Severe cases can prevent a woman from having intercourse  Perhaps 20% of women occasionally have pain during intercourse, but less than ____% of all women have vaginismus 37Comer, Abnormal Psychology, 7e Disorders of Sexual Pain  Vaginismus  Most clinicians agree with the cognitive- behavioral theory that vaginismus ____________  A variety of factors can set the stage for this fear, including anxiety and ignorance about intercourse, trauma caused by an unskilled partner, and childhood sexual abuse  Some women experience painful intercourse because of infection or disease, leading to “__________” vaginismus  Most women with vaginismus also have other sexual disorders 40Comer, Abnormal Psychology, 7e  1950s and 1960s: __________________  Behavioral therapists attempted to reduce fear by applying relaxation training and systematic desensitization  Had moderate success, but failed to work in cases where the key problems included misinformation, negative attitudes, and lack of effective sexual techniques Treatments for Sexual Dysfunctions 41Comer, Abnormal Psychology, 7e  1970: Human Sexual Inadequacy  This book, written by William Masters and Virginia Johnson, revolutionized treatment of sexual dysfunctions  This original “sex therapy” program has evolved into a complex, multidimensional approach  Includes techniques from cognitive, behavioral, couples, and family systems therapies, along with a number of sex-specific techniques  More recently, biological interventions have also been incorporated Treatments for Sexual Dysfunctions 42Comer, Abnormal Psychology, 7e What Are the General Features of Sex Therapy?  Modern sex therapy is short-term and instructive  Therapy typically lasts 15 to 20 sessions  It is centered on specific sexual problems rather than on broad personality issues 45Comer, Abnormal Psychology, 7e What Techniques Are Applied to Particular Dysfunctions?  Hypoactive sexual desire and sexual aversion  These disorders are among the most difficult to treat because of the many issues that feed into them  Therapists typically apply a combination of techniques, which may include:  Affectual awareness, self-instruction training, behavioral techniques, insight-oriented exercises, and biological interventions such as hormone treatments 46Comer, Abnormal Psychology, 7e What Techniques Are Applied to Particular Dysfunctions?  Erectile disorder  Treatments for ED focus on reducing a man’s performance anxiety and/or increasing his stimulation  _____________________________________________ _____________________________________________ 47Comer, Abnormal Psychology, 7e What Techniques Are Applied to Particular Dysfunctions?  Erectile disorder  Biological approaches, used when the ED has biological causes, have gained great momentum with the development of _____________________ and other erectile dysfunction drugs  Most other biological approaches have been around for decades and include gels, suppositories, penile injections, and a vacuum erection device (VED)  These procedures are now viewed as “second-line” treatment  Another biological approach – penile implant surgery – is performed only rarely 50Comer, Abnormal Psychology, 7e What Techniques Are Applied to Particular Dysfunctions?  Female arousal and orgasmic disorders  Specific treatments for these disorders include cognitive-behavioral techniques, self- exploration, enhancement of body awareness, and directed masturbation training  Biological treatments, including hormone therapy or the use of sildenafil (Viagra), have also been tried, but research has not found such interventions to be consistently helpful 51Comer, Abnormal Psychology, 7e What Techniques Are Applied to Particular Dysfunctions?  Female arousal and orgasmic disorders  Again, a lack of orgasm during intercourse is not necessarily a sexual dysfunction, provided the woman enjoys intercourse and is orgasmic through other means  For this reason, some therapists believe that the wisest course of action is simply to educate women whose only concern is lack of orgasm through intercourse 52Comer, Abnormal Psychology, 7e What Techniques Are Applied to Particular Dysfunctions?  Vaginismus  Specific treatment for vaginismus takes two approaches:  Practice tightening and releasing the muscles of the vagina to gain more voluntary control  Overcome fear of intercourse through _____________ ____________________________________________  Most women treated for vaginismus using these methods eventually report pain-free intercourse 55Comer, Abnormal Psychology, 7e What Are the Current Trends in Sex Therapy?  Therapists are paying more attention to excessive sexuality, which is sometimes called hypersexuality or sexual addiction  The use of medications to treat sexual dysfunction is troubling to many therapists  They are concerned that therapists will choose biological interventions rather than a more integrated approach 56Comer, Abnormal Psychology, 7e Paraphilias  These disorders are characterized by unusual fantasies and sexual urges or behaviors that are recurrent and sexually arousing  Often involve:  Nonhumans  Children  Nonconsenting adults  Humiliation of self or partner 57Comer, Abnormal Psychology, 7e Paraphilias  According to the DSM-IV-TR, paraphilias should be diagnosed only when the urges, fantasies, or behaviors last at least 6 months  For most paraphilias, the urges, fantasies, or behaviors must also cause great distress or impairment  _______________________________________________________ _____________________________________________________  Example: ______________________________________________ 60Comer, Abnormal Psychology, 7e Paraphilias  Although theorists have proposed various explanations for paraphilias, there is little formal evidence to support the theories  None of the treatments applied to paraphilias have received much research or been proved clearly effective  Psychological and sociocultural treatments have been available the longest, but today’s professionals are also using biological interventions 61Comer, Abnormal Psychology, 7e Fetishism  The key features of fetishism are recurrent intense sexual urges, sexually arousing fantasies, or behaviors that involve ________ ___________________________________________  The disorder usually begins in adolescence  Almost anything can be a fetish  ___________________, __________________, and ___________________ are especially common 62Comer, Abnormal Psychology, 7e Fetishism  Researchers have been unable to pinpoint the causes of fetishism  Psychodynamic theorists view fetishes as defense mechanisms, but therapy using this model has been unsuccessful 65Comer, Abnormal Psychology, 7e Transvestic Fetishism  The typical person with transvestism is a _______________ who began cross-dressing in childhood or adolescence  Transvestism is often confused with gender identity disorder (transsexualism), but the two are separate patterns  The development of the disorder seems to follow the behavioral principles of ________________________ 66Comer, Abnormal Psychology, 7e Exhibitionism  Characterized by arousal from the exposure of genitals in a public setting  Also known as “_______________”  Sexual contact is _____________________________  Usually begins before age 18 and is most common in males  Treatment generally includes aversion therapy and masturbatory satiation  May be combined with orgasmic reorientation, social skills training, or cognitive-behavioral therapy 67Comer, Abnormal Psychology, 7e Voyeurism  Characterized by repeated and intense sexual desires to observe people as they undress or to spy on couples having intercourse; may involve acting upon these desires  The person may masturbate during the act of observing or while remembering it later  The risk of discovery often adds to the excitement 70Comer, Abnormal Psychology, 7e Pedophilia  Characterized by fantasies, urges, or behaviors involving ____________________ _________________, usually 13 years of age or younger  Some people are satisfied with child pornography  Others are driven to watching, fondling, or engaging in sexual intercourse with children  Evidence suggests that two-thirds of victims are female 71Comer, Abnormal Psychology, 7e Pedophilia  People with pedophilia develop the disorder in adolescence  Some were sexually abused as children  Many were neglected, excessively punished, or deprived of close relationships in childhood  Most are immature, display distorted thinking, and have an additional psychological disorder  Some theorists have proposed a related biochemical or brain structure abnormality but clear biological factors have yet to emerge in research 72Comer, Abnormal Psychology, 7e Pedophilia  Most people with pedophilia are imprisoned or forced into treatment  Treatments include aversion therapy, masturbatory satiation, orgasmic reorientation, and treatment with antiandrogen drugs  Cognitive-behavioral treatment involves relapse-prevention training, modeled after programs used for substance dependence 75Comer, Abnormal Psychology, 7e Sexual Sadism  Sadistic fantasies may first appear in childhood  Pattern is long-term  Appears to be related to classical conditioning and/or modeling  Psychodynamic and cognitive theorists view people with sexual sadism as having underlying feelings of sexual inadequacy 76Comer, Abnormal Psychology, 7e Sexual Sadism  Biological studies have found possible abnormalities in the endocrine system  The primary treatment for this disorder is aversion therapy 77Comer, Abnormal Psychology, 7e A Word of Caution  _____________________________________ _____________________________________ _____________________________________  Some clinicians argue that, except when people are hurt by them, paraphilic behaviors should not be considered disorders at all 80Comer, Abnormal Psychology, 7e Gender Identity Disorder  Men with gender identity disorder outnumber women 2 to 1  People with gender identity disorder often experience anxiety or depression and may have thoughts of suicide 81Comer, Abnormal Psychology, 7e Gender Identity Disorder  The disorder sometimes emerges in childhood and disappears with adolescence  In some cases it develops into adult gender identity disorder  Several theories have been proposed to explain this disorder, but research is limited and generally weak  Some clinicians suspect biological – perhaps genetic or prenatal – factors  Abnormalities in the hypothalamus (particularly the bed nucleus of stria terminalis) are a potential link 82Comer, Abnormal Psychology, 7e Gender Identity Disorder  To more effectively assess and treat those with the disorder, clinical theorists have tried to distinguish the most common patterns of gender dysphoria:  Female-to-male  Male-to-female: Androphilic Type  Male-to-female: Autogyneophilic Type  Some adults with this disorder change their sexual characteristics by way of hormones; others opt for sexual reassignment (sex change) surgery