Abn Psych Exam 4

Genito-Pelvic Pain/Penetration Disorder

- 12 to 39 percent of women report frequent pain during intercourse -The pain may be shallow during intromission (insertion of the penis into the vagina) or deep during penile thrusting. Some women also experience pain when inserting tampons, having a gynecological exam, riding a bike, or even walking -can be the result of dryness of the vagina caused by antihistamines or other drugs, infection of the clitoris or vulval area, injury or irritation to the vagina, or tumors of the internal reproductive organs. -Pain during intercourse is rare in men, but when it does occur, it involves painful erections or pain during thrusting -vaginismus: women experience involuntary contraction of the muscles surrounding the outer third of the vagina when penetration with a penis, finger, tampon, or speculum is attempted -Women who for approximately 6 months recurrently experience either pain or muscle tightening during sex, or who have marked fear or anxiety about experiencing such pain, can be diagnosed -estimated that 5 to 17 percent of women experience such muscle tightening

Biological contributors: Gender Dysphoria

- In genetic females, female-to-male gender dysphoria has been associated with hormonal disorders resulting in prenatal exposure to high levels of androgens, whereas in genetic males, male-to-female gender dysphoria has been associated with prenatal exposure to very low levels of androgens -A cluster of cells in the hypothalamus called the bed nucleus of the stria terminalis, which plays a role in sexual behavior, has been implicated in gender dysphoria in multiple studies - this cluster of cells is smaller in women's brains than in men's. Studies have found that this cluster of cells is half as large in men with gender dysphoria as in men without the disorder and close to the size usually found in women's brains. -Hormonal disorders contributing to gender dysphoria may be tied to genetic abnormalities.

alcohol facts

- It takes less alcohol to reach a high blood-alcohol level in women than in men because women generally are smaller and have a lower body water content than men, leading to higher concentrations of alcohol in the blood for a given dose. --Most U.S. states consider a person to be under the influence of alcohol if his or her blood-alcohol level is 0.08 or above. -Heavy drinking can be part of the culture of a peer group, but it still can lead to alcohol use disorder in some members. -Drinking large quantities of alcohol can be fatal, even in people who are not chronic alcohol abusers. - About one-third of such deaths result from respiratory paralysis, usually due to a final large dose of alcohol in people who are already intoxicated. - Alcohol can also interact fatally with a number of substances, including some antidepressant drugs

Spectrum of EDisorders

- No ED: 90% - Other ED 5% - Binge ED 3% -AN 1% -BN 1%

long term effects of alcohol misuse

- One of the most common medical conditions associated with alcohol misuse is low-grade hypertension -Heavy alcohol use increases the risk of cancer, particularly breast cancer in women -eavy prolonged use of alcohol is a risk factor for dementia, a permanent substance-induced major neurocognitive disorder involving loss of intellectual abilities, including memory, abstract thinking, judgment, and problem solving, and often accompanied by personality changes such as increased paranoia - Subtler deficits due to central nervous system damage (e.g., substance-induced mild neurocognitive disorder) are observed in many chronic abusers of alcohol, even after they quit drinking

Other CNS Depressants

- People use cross-tolerant drugs to relieve withdrawals, but using them adds intoxication and more withdrawal from that drug -Prescription pills: Benzodiazepines and Barbiturates -Gas, glue, paint thinners, nitrous oxide : Inhalants -intoxication and withdrawal like alcohol

Treatments ED

- Phase 1: Achieve healthy weight --> calorie increase; hospitalization Low weight risky--> organ failure;Bradycardia; death

Alcohol:CNS Depressant

- intoxication Low doses: create euphoria confidence relaxation High Doses: creates cognitive impairment, depression/aggressin, poor coordination, fatigue respiratory paralysis: death/coma

transvestic disorder

- transvestic disorder, or dressing in the clothes of the opposite sex as a means of becoming sexually aroused. The diagnosis requires that the cross-dressing behavior cause the individual significant distress or impairment. -One community-based study found that 2.8 percent of men and 0.4 percent of women reported engaging in cross-dressing for sexual arousal -Most adults who engage in cross-dressing report that the behavior began secretly prior to or during puberty -With age, the sexual function of cross-dressing may diminish even as men continue to cross-dress as a self-soothing behavior to achieve feelings of comfort or well-being

Nicotine Stimulants

-"fight or flight-like" response -Withdrawal: depressed, anxious, restless, hungry - Nicotine can harden veins--more likely to have a heart attack

Alcohol: CNS Depressant

-1st Stage: "shakes", weakness, perspiration, headache, nausea -2nd Stage: Seizures -3rd Stage: Delirium Tremens (DTs) hallucinations and delusions, fever, irregular heartbeat Deadly in 10% of cases

Stimulants: Cocaine

-Activates CNS: Blocks dopamine reuptake -Intoxication -At first: Rush of euphoria High energy High self-esteem -High doses: Grandiosity Impulsiveness Compulsive behavior, agitation, anxiety, paranoia Heart attack, stroke, seizure -Withdrawal -Dysphoria, fatigue, sleep problems, increased appetite - High goes down very quickly

Psychological causes of sexual disorders

-Again, the DSM-5 criteria for the diagnosis of sexual dysfunction exclude that caused by other (nonsexual) mental disorders, but a number of mental disorders can cause sexual dysfunction - loss of sexual desire in people with depressions, schizo, an anxiety disorder, such as generalized anxiety disorder, panic disorder, or obsessive-compulsive disorder, Cognitions -People who have been taught that sex is dirty, disgusting, or sinful or is a "necessary evil" understandably may lack the desire to have sex -This fear of loss of control may result from a distrust of one's partner, a sense of shame about sex, a poor body image, or a host of other factors. -performance anxiety

Amphetamines

-Amphetamines: stimulant drugs that can produce symptoms of euphoria, self-confidence, alertness, agitation, paranoia, perceptual illusions, and depression -methamphetamines are stimulants prescribed for the treatment of attention problems (e.g., Ritalin, Adderall), narcolepsy, and chronic fatigue. -They also are found in antihistamines (e.g., Sudafed) and diet drugs. -As of 2012, 1.2 million Americans reported using the drug -Amphetamines release the neurotransmitters dopamine and norepinephrine and block their reuptake. The symptoms of intoxication are similar to those of cocaine intoxication: euphoria, self-confidence, alertness, agitation, and paranoia - Like cocaine, amphetamines can produce perceptual illusions. -Tolerance develops quickly, as does physical dependence. -Acute withdrawal symptoms typically subside within a few days, but chronic users may experience mood instability, memory loss, confusion, paranoid thinking, and perceptual abnormalities for weeks, months, or even years. They often battle the withdrawal symptoms with another speed run -abuse of amphetamines and methamphetamines can lead to a number of medical issues, particularly cardiovascular problems—including rapid or irregular heartbeat, increased blood pressure, and irreversible, stroke-producing damage to the small blood vessels in the brain. Elevated body temperature and convulsions can occur during overdoses, leading to death. -ationwide studies find that 13.4 percent of college students report ever having used amphetamines or methamphetamines, with 9.3 percent reporting their use in the last year

Behavioral theories: Paraphilias

-Behavioral theories of the paraphilias explain them as being due to an initial classical pairing of intense early sexual arousal with a particular stimulus -For example, a child may become aroused when spying on the babysitter's lovemaking with her boyfriend or while being held down and tickled erotically. This may be followed by intensive operant conditioning in which the stimulus is present during masturbation. For example, the individual may repeatedly fantasize about a particular scenario, such as watching the babysitter have sex, while masturbating. -This reinforces the association between the stimulus and sexual arousal. The individual may try to suppress the undesired arousal or behaviors, but these attempts at inhibition increase the frequency and intensity of the fantasies. -These classic behavioral theories have been supplemented with principles of social learning theory -which suggest that the larger environment of a child's home and culture influences his or her tendency to develop deviant sexual behavior. Children whose parents frequently use corporal punishment and engage in aggressive contact with each other are more likely to engage in impulsive, aggressive, and perhaps sexualized acts toward others as they grow older. -sex offenders with various types of paraphilia found that they had higher rates of childhood abuse and family dysfunction than did offenders who had committed property crimes and did not have a paraphilia (Lee, Jackson, Pattison, & Ward, 2002). Childhood sexual abuse was a particularly strong predictor of pedophilia. Similarly, studies of juvenile sex offenders, most of whom assaulted a younger child, find that many likely suffered sexual abuse

Behavioral treatments SA

-Behavioral treatments based on aversive classical conditioning are sometimes used alone or in combination with biological or other psychosocial therapies (Finney & Moos, 1998; Schuckit, 1995). -Drugs such as disulfiram (Antabuse) that make the ingestion of Page 416alcohol unpleasant or toxic are given to people who are alcohol dependent. -Eventually, through classical conditioning, people develop conditioned responses to alcohol—namely, nausea and vomiting. Then, through operant conditioning, they learn to avoid alcohol in order to avoid the aversive response. -Aversive conditioning is effective in reducing alcohol consumption, at least in the short term (Schuckit, 1995). - "Booster" sessions often are needed to reinforce this conditioning, because its effects tend to weaken with time. -Covert sensitization therapy uses imagery to create associations between thoughts of alcohol use and thoughts of highly unpleasant consequences. -Contingency management programs provide reinforcements for individuals to curtail their use of substances—for example, employment, housing, or vouchers for purchases at local stores. Studies show that individuals dependent on heroin, cocaine, marijuana, or alcohol will remain in treatment longer and be much more likely to become abstinent when they are provided with incentives contingent on submitting drug-free urine specimens

Social Pressures -ED

-Body dissatisfaction fed by pressures to be thin is one of the strongest predictors of risk for the development of eating disorders in young women. -Many of the women athletes with eating disorders reported Page 349 feeling that the physical changes of puberty had decreased their competitive edge.

Categories of Abused Substances

-Central Nervous System Depressants: Alcohol, Benzodiazepines, Barbiturates, Inhalants -Central Nervous System Stimulants: cocaine, amphetamines -opiods -hallucinogens -canabis

sexual dysfunction

-Characterized by a clinically significant disturbance in the ability for a person to respond sexually or to experience sexual pleasure. -Sexual dysfunction is considered an issue if it causes a person a high level of distress and has been present for 6 months or longer. -Interruption in the sexual response cycle. -Life long vs acquired -Generalized vs Situational

BN Treatment

-Cognitive-behavioral therapy (CBT) has received the most empirical support for treating bulimia nervosa -CBT is based on the view that the extreme concerns about shape and weight are the central features of the disorder -The therapist teaches the client to monitor the cognitions that accompany her eating, particularly the binge episodes and purging episodes. Then the therapist helps the client confront these cognitions and develop more adaptive attitudes toward weight and body shape. -The behavioral components of this therapy involve introducing forbidden foods -Controlled studies of the efficacy of cognitive-behavioral therapy for bulimia find that about half the clients completely stop the binge/purge cycle (Fairburn, 2005; Shapiro et al., 2007). Clients undergoing this therapy also show a decrease in depression and anxiety, an increase in social functioning, and a lessening of concern about dieting and weight. Cognitive-behavioral therapy is more effective than drug therapies in producing complete cessation of binge eating and purging and in preventing relapse over the long term -Expanded cognitive-behavioral therapies that also address emotion-regulation difficulties are especially effective in people with a combination of eating disorders and depression - In interpersonal therapy, the client and the therapist discuss interpersonal problems related to the client's eating disorder, and the therapist works actively with the client to develop strategies to solve these problems. -In supportive-expressive psychodynamic therapy, the therapist also encourages the client to talk about problems related to the eating disorder—especially interpersonal problems—but in a highly nondirective manner. -In behavioral therapy, the client is taught how to monitor her food intake, is reinforced for introducing avoided foods into her diet, and is taught coping techniques for avoiding bingeing. -the cognitive-behavioral and interpersonal therapy clients showed the greatest and most enduring improvements. -CBT is significantly more effective than IPT in treating bulimia and works more quickly, with substantial improvement being shown by 3 to 6 weeks into treatment with CBT ( -For binge-eating disorder, cognitive-behavioral therapy has been shown to be more effective than other psychotherapies or antidepressant medications

Anorexia STATS

-Community-based studies in the United States and Europe find that the lifetime prevalence of anorexia nervosa is 0.9 percent in adult women -0.3 percent in adolescent girls - rate among males is 0.3 percent in the U.S. - In the United States, Caucasians are more likely than African Americans and Hispanic Americans to develop the disorder -Long-term studies suggest that the median number of years from onset to remission of the disorder is 7 years for women and 3 years for men, even among patients in treatment -Ten to 15 years after onset of the diagnosis, about 70 percent of patients no longer qualify for a diagnosis, but many continue to have eating-related problems or other psychopathology, particularly depression -ndividuals with the binge/purge type of anorexia nervosa tend to have more comorbid psychopathology than people with the restricting type, particularly impulsive, suicidal, and self-harming behaviors, and a more chronic course of the disorder -a death rate of 5 to 9 percent -In addition, the suicide rate among people with anorexia nervosa is 31 times the rate in the general population

AN Treatments

-During hospitalization, the therapist will try to engage the client in facing and solving the psychological issues causing her to starve herself. -CBT: can lead to weight gains and reductions in symptoms, although a substantial percentage of patients drop out of therapy or return to anorexic behaviors over time -In family therapy, the person with anorexia and her family are treated as a unit. Parents are coached to take control of their child's eating and weight. As the therapy progresses, the child's autonomy is linked explicitly to the resolution of the eating disorder.

Binge Eating Behaviors

-Eating an unusually large amount of food (1200-4000 calories in 2 hours) -Lack of control -Typically dessert/snack foods -Most likely at home, alone, at night, or after unstructured activity -Often in a negative mood

treatment for elderly SA

-Elders are treated along with people their same age in a supportive, nonconfrontational approach. -Negative emotional states (such as depression and loneliness) and their relationship to the substance abuse are a focus of the intervention. Social skills and social networks are rebuilt. Staff members are respectful and are interested in working with older adults. -Linkages are made with medical facilities and community resources (such as housing services). -Due to increasing longevity and the size of the baby-boomer generation, the proportion of the population that is above age 65 will increase dramatically over the next few decades (King & Markus, 2000). In addition, older Americans will become much more ethnically diverse in the future. ---Although 85 percent of Americans over age 65 in 1995 were non-Hispanic whites, this proportion is expected to decrease to 66 percent by 2030 (Whitbourne, 2000). -In turn, the proportion of older people who are of Hispanic and Asian descent will increase. Much more research is needed on the psychological health needs of older people, particularly older people in ethnic and racial minority groups with substance use disorders. -A large, multi-site clinical trial called Project MATCH compared three interventions designed to help people Page 420with alcohol use disorder: cognitive-behavioral intervention, motivational interviewing and enhancement, and a 12-step program based on the AA model but led by professional counselors ALL EQUALLY EFFECTIVE -Project COMBINE, indicated that combining psychosocial intervention with medications did not yield better outcomes than individual therapies -Only about 25 percent of people with alcohol use disorder seek treatment (Dawson et al., 2005). -About 25 percent may recover on their own, often due to maturation or positive changes in their environment (e.g., getting a good job or marrying a supportive person) that motivate them to control their drinking -In the United States, young adults between 18 and 24 have the highest rates of alcohol consumption and make up the largest proportion of problem drinkers of any age group. - In general, however, prevention programs designed to stop drinking have had limited success. - harm reduction model harm reduction model approach to treating substance use disorders that views alcohol use as normative behavior and focuses education on the immediate risks of the excessive use of alcohol (such as alcohol-related accidents) and on the payoffs of moderation (such as avoidance of hangovers)

Major NCD STATs

-Estimated prevalence of most common type of major NCD - Alzheimer's disease - is 5 to 10% of people over age 65 30% of individuals age 85+ are living with major NCD -Some degree of cognitive decline is NORMAL in healthy aging - NOT ALL older adults develop dementia

Sociocultural factors in SD

-For example, both the traditional Chinese medical system and the Ayurvedic medical system, which is native to India, teach that loss of semen is detrimental to a man's health (Dewaraja & Sasaki, 1991). Masturbation is strongly discouraged because it results in semen loss without the possibility of conception. - in a sexual clinic in India found that 77 percent of the male patients reported difficulties with premature ejaculation and 71 percent were concerned about nocturnal emissions associated with erotic dreams - depersonalization syndrome known as Koro;This syndrome involves an acute anxiety state, characterized by a feeling of panic and impending death, and a delusion that the penis is shrinking into the body and disappearing US: -People in lower educational and income groups may have more sexual dysfunctions because they are under more psychological stress, because their physical health is worse, or because they have not had the benefit of educational programs that teach people about their bodies and about healthy social relationships. - In addition, people from cultural backgrounds that teach negative attitudes toward sex are more likely to develop sexual dysfunctions resulting from these attitudes

Gender Dysphoria Prevalence

-Gender dysphoria in children is a rare condition in which a child persistently rejects his or her anatomic sex and strongly desires to be or insists he or she is a member of the opposite sex. -Girls with this disorder seek masculine-type activities and male peer groups to a degree far Page 383 beyond that of a tomboy. -Sometimes, these girls express the belief that they will eventually grow a penis. -Boys with the disorder seek feminine-type activities and female peer groups and tend to begin cross-dressing in girls' clothes at a very early age (Zucker & Wood, 2011). -They express disgust with their penis and wish it would disappear. The onset of these behaviors typically is in the preschool years. Boys are referred more often than girls for concerns regarding gender dysphoria. -Gender dysphoria is rare, with an estimated prevalence of 1 in 12,900 for male to female gender dysphoria and 1 in 33,800 for female to male gender dysphoria

sex positive

-Having positive attitudes about sex and feeling comfortable about your own sexual identity as well as with the sexual behavior of others. Sex positive people are open to learning about sex. They try to learn about their own bodies as well as their partner's bodies.

Caffeine Stimulants

-High doses: agitation, seizures, respiratory problems -Withdrawal: flu-like, headache, fatigue, down mood

Substance Use Disorder

-Impaired control: Use more than planned Cravings/ desire to reduce use -Social impairment: Not meeting responsibilities/ doing activities Social difficulties -Risky use: Use despite danger or physical/ psychological problems -Physical addiction: Tolerance Withdrawal

The Effects of Cocaine

-Initially, cocaine produces an instant rush of intense euphoria, followed by heightened self-esteem, alertness, energy, and feelings of competence and creativity. Users crave increasing amounts of the substance, for both its physiological and its psychological effects -When taken repeatedly or at high doses, however, it leads to grandiosity, impulsiveness, hypersexuality, compulsive behavior, agitation, and anxiety reaching the point of panic and paranoia. Stopping cocaine use can induce exhaustion and depression. -Cocaine activates those areas of the brain that register reward and pleasure. -Cocaine blocks the reuptake of dopamine into the transmitting neuron, causing it to accumulate in the synapse and maintaining the pleasurable feeling . The rapid, strong effects of cocaine on the brain's reward centers make this substance more likely than most to lead to a stimulant use disorder. -Cocaine's effects wear off quickly, and the dependent person must take frequent doses to maintain a high. Tolerance also can develop, and the individual must obtain larger and larger amounts to experience a high -People with cocaine-related stimulant use disorder spend huge amounts of money on the substance and may engage in theft, prostitution, or drug dealing to obtain enough money to purchase it. -Other frequent medical complications of cocaine use are heart rhythm disturbances and heart attacks; respiratory failure; neurological effects, including strokes, seizures, and headaches; and gastrointestinal complications, including abdominal pain and nausea. -Physical symptoms include chest pain, blurred vision, fever, muscle spasms, convulsions, and coma -Among U.S. college students, 5.5 percent report ever having used cocaine, whereas 12 percent of 18- to 22-year-olds not in college report ever having used cocaine; among high school students, about 3.5 percent report ever having used cocaine

PCP

-Intoxication: similar to hallucinogens -High dose: violent, amnesia, coma, psychosis

Hallucinogens

-Intoxication: synesthesia, mood shifts, hallucinations -Bad response: anxiety, paranoia, psychosis requiring hospitalization

alcohol stats

-Large nationwide studies in the United States find that about 7 percent of adults are heavy drinkers, and 17 to 23 percent of adults report binge drinking at least once in the last month -35 percent of college students report binge drinking in the past month, compared to 32 percent of 18- to 22-year-olds not in college . Binge drinking is especially common among members of fraternities and sororities, with 75 percent of members saying they binge drink - men are more likely to drink alcohol than are women, and also are more likely to drink heavily or binge drink - Similarly, across all age groups, males are much more likely to develop alcohol use disorders than are females -Similarly, the gender gap is greater among U.S. ethnic minority groups that more widely accept traditional gender roles, such as Hispanics and recent Asian immigrants, than among European Americans, due largely to high percentages of minority women who completely abstain from alcohol. -alcohol use disorders decline with age. -First, with age the liver metabolizes alcohol at a slower rate, and the lower percentage of body water increases the absorption of alcohol. As a result, older people become intoxicated faster and experience the negative effects of alcohol more severely and more quickly. Second, as people grow older, they may become more mature in their choices, including choices about drinking alcohol to excess. Third, older people have grown up under stronger prohibitions against alcohol use and abuse than have younger people. Fourth, people who have used alcohol excessively for many years may die from alcohol-related diseases before they reach old age -Consumption in the Russian Federation is high among both men and women, and the rates of negative health consequences due to alcohol are highest in this and surrounding countries (Rehm et al., 2009). Page 398 -Low rates of consumption in some African and middle eastern countries are tied to Islam's prohibitions against alcohol. -One group at high risk for alcohol-related problems is Native Americans, 43 percent of whom meet the criteria for alcohol abuse or alcohol dependence at some time in their life . Deaths related to alcohol are as much as five times more common among Native Americans than in the general U.S. population

Individual differences and NCD

-Lower edu associated with lower SES poorer access to good health care/nutrition ----> Greater rates of NCDs in individuals with lower levels of education -Higher rates of hypertension and cardiovascular disease in African Americans --->Greater rates of NCDs in African Americans compared to European Americans -Asian and Latino families have more positive view of caring for sick, older family members -->Greater rates of institutionalization of European Americans compared to Asian & Latino individuals

Substance withdrawal

-Maladaptive behavioral and psychological problems -Due to cessation/reduction of use

Substance Intoxication

-Maladaptive behavioral and psychological problems -Due to effect of drug on central nervous system

biological causes- BN

-Many people with bulimia show abnormalities in the systems regulating the neurotransmitter serotonin -Deficiencies in serotonin might lead the body to crave carbohydrates, and people with bulimia often binge on high-carbohydrate foods.

Maintaining factors : ED

-Negative Self-image--> over-evaluation of weight, shape, eating--> strict dieting, weight control behaviors-->low weight, hunger-->Binge -->Guilt, fear of gaining weight-->Compensatory behavior-->Relief ( which negatively reinforces the process) -compesnatory behaviors--> made her hungrier

Alzehimers is due to:

-Neurofibrillary tangles: Made of protein called tau that impede nutrients and other essential supplies from moving through cells causing them to die -Plaques: Deposits of a protein called beta-amyloid; these plaques are Neurotoxic and accumulate in the spaces between the cells of the cerebral cortex, hippocampus, and amygdala -Extensive cell death in the cortex that shrinks the cortex and enlarges the ventricles of the brain -Cells lose many of their dendrites, the branches that link one cell to other cells Apolipoprotein E gene ApoE -Certain variants of ApoE lead to reduced cortex and hippocampus volume as early as childhood etiology: Cell death causes shrinkage of the cerebral cortex in advanced alzheimer's

Psychotherapy for SD

-One technique is individual psychotherapy, in which individuals explore the thoughts and previous experiences that impede them from enjoying a positive sexual life. Couples therapy often helps couples develop more satisfying sexual relationships. -A therapist begins treatment by assessing the attitudes, beliefs, and personal history of an individual client or of both members of a couple in order to discover experiences, thoughts, and feelings that might be contributing to sexual problems. -Cognitive-behavioral interventions often are used to address attitudes and beliefs that interfere with sexual functioning -Similarly, a woman who has low sexual desire because she was taught by her parents that sex is dirty would learn to challenge this belief and to adopt a more accepting attitude toward sex. - The therapist may use role playing during therapy sessions to observe how the couple discusses sex and how the partners perceive each other's role in their sexual encounters -A therapist may encourage a couple to set aside enough time to engage in seduction rituals and satisfying sexual encounters -. In general, therapists help partners understand what each wants and needs from sexual interactions and helps them negotiate mutually acceptable and satisfying repertoires of sexual exchange. -Cognitive-behavioral therapies are used most commonly, although some therapists use psychodynamic interventions and some use interventions based on family systems therapy. Cognitive-behavioral therapies have been researched more than other types of therapy and have been shown to be effective for several types of sexual dysfunction -Whether a therapist uses a cognitive-behavioral or some other therapeutic approach to address the psychological issues involved in a sexual dysfunction, direct sex therapy using behavioral techniques may be a part of the therapy. When a sexual dysfunction seems to be due, at least in part, to inadequate sexual skill on the part of the client and his or her partner, sex therapy that focuses on practicing skills can be useful. -Studies show that more than 80 percent of anorgasmic women are able to have an orgasm when they learn to masturbate and that 20 to 60 percent are able to have an orgasm with their partner after learning to masturbate - sensate focus therapy treatment for sexual dysfunction in which partners alternate between giving and receiving stimulation in a relaxed, openly communicative atmosphere in order to reduce performance anxiety and concern over achieving orgasm by learning each partner's sexual fulfillment needs

Effects of Opiods

-Opioids can suppress the respiratory and cardiovascular systems to the point of death. -The drugs are especially dangerous when combined with depressants, such as alcohol or sedatives. -Withdrawal symptoms include dysphoria, an achy feeling in the back and legs, increased sensitivity to pain, and a craving for more opioids. The person may experience nausea, vomiting, profuse sweating and goose bumps, diarrhea, and fever -These symptoms usually appear within 8 to 16 hours of last use and peak within 36 to 72 hours. -In chronic or heavy users, they may continue in strong form for 5 to 8 days and in a milder form for weeks to months. -In some areas of the United States, up to 60 percent of chronic heroin users are infected with HIV. -One-third of middle-aged adults in the United States report having used these drugs for nonmedical purposes sometime in their life. -Thirteen percent of 12th-graders, 12 percent of college students, and 18 percent of 18- to 22-year-olds not in college report having ever used these drugs for nonmedical purposes

Techniques for treating pelvic muscle tightening

-Pelvic muscle tightening is often treated by deconditioning the woman's automatic tightening of her vaginal muscles (Leiblum, 2000). She is taught about the muscular tension at the opening of her vagina and the need to learn to relax those muscles. In a safe setting, she is instructed to insert her fingers into her vagina.

Binge eating disorder STATS

-People with binge-eating disorder often are significantly overweight and say they are disgusted with their body and ashamed of their bingeing -As many as 30 percent of people currently in weight-loss programs may have binge-eating disorder -In contrast, approximately 2 to 3.5 percent of the general population have the disorder -Binge-eating disorder is somewhat more common in women than in men, -People with this disorder also have high rates of depression and anxiety and possibly a higher incidence of alcohol abuse and personality disorders -Binge-eating disorder tends to be chronic; one retrospective study found the mean duration of the disorder to be 8 years , and another study found a mean duration of 14.4 years.

psych factors : cognitive ED

-Primary proposed cognitive vulnerability: -overevaluation of shape or weight -internalization of thin ideal - perfectionism -Low self-esteem -additional cognitive vulnerabilities

Obesity STATS

-Rates have continued to climb, and currently it is estimated that over one-third of American adults and 17 percent of American children are obese -African Americans have the highest obesity rate, followed by Hispanic and non-Hispanic whites -Obesity is associated with an increased risk of coronary heart disease, hypertension and stroke, type 2 diabetes, and some kinds of cancer -In the United States, 5 to 7 percent of all health care costs are due to the effects of obesity. - People with obesity suffer not only more physical illnesses but also a lower quality of life and more emotional problems, due in part to the stigmatization of obese people - Obese people show less activity in certain reward areas of the brain than do lean people when they actually consume such food, however, suggesting that changes in the brain similar to those seen in drug addicts occur after chronic exposure to ultraprocessed foods -Genes affect the number of fat cells and the likelihood of fat storage, the tendency to overeat, and the activity level in the brain in response to food.

Rates of Female sexual interest

-Rates of low sexual desire increase to 26 percent in postmenopausal women (Leiblum et al., 2006). -Women with low sexual desire are more likely than men to report anxiety, depression, and life stress. -About 20 percent of women report difficulties with lubrication or arousal during sexual activity -Some women who experience problems with arousal and desire are not distressed by this

Trauma that leads to sexual disorders

-Reductions in sexual desire and functioning often follow personal trauma, such as the loss of a loved one, the loss of a job, or the diagnosis of severe illness in one's child. Unemployment may contribute -Trauma can also cause a person to experience a depression that includes a loss of interest in most pleasurable activities, including sex. -One type of personal trauma often associated with sexual desire disorders in women is sexual assault or sexual abuse -male partners of women who have been sexually assaulted sometimes cannot cope with the trauma and withdraw from sexual encounters with the sexual assault survivor. Survivors then may feel victimized yet again, and their interest in sex may decline even further.

Interpersonal Factors in SD

-Relationship problems also can be the direct cause of sexual dysfunctions -One partner may want to engage in a type of sexual activity that the other partner is uncomfortable with, or one partner may want to engage in sexual activity much more often than the other partner. -Anorgasmia (lack of orgasm) characteristic of female orgasmic disorder may be tied to lack of communication between a woman and her partner about what the woman needs to reach orgasm - In sexual encounters between men and women, men still are more likely to decide when to initiate sex, how long to engage in foreplay, when to penetrate, and what position to use during intercourse. -Conflicts between partners that are not directly related to their sexual activity can affect their sexual relationship as well (McCarthy & Thestrup, 2008; Rosen & Leiblum, 1995). -Anger, distrust, and lack of respect for one's partner can greatly interfere with sexual desire and functioning. STATS: -women are more likely than men to report problems in their marital relationship, other stressful events in their life, and higher levels of psychological distress (Meston & Bradford, 2007). -Men seeking treatment are more likely than women to be experiencing other types of sexual dysfunction in addition to low sexual desire, such as erectile dysfunction.

Circles of sexuality

-Sensuality: involves our level of awareness, acceptance, and enjoyment of your own and others' bodies -ex: Skin hunger, body image, fantasy, sexual response cycle -sexualization: involves how we use our sexuality and may include manipulating and controlling others. -ex:flirting, media messages, sexual assault, incest, withholding sex, seduction, sexual harassment -sexual health and reproduction: relates to attitudes and behaviors toward our health and consequences of sexual activity. -ex:sexual behavior, anatomy/physiology, reproduction, -sexual identity:how we perceive ourselves as a sexual being. ex. : Biological gender, gender identity, gender role, sexual orientation -intimacy : the degree of which we express and have a need for closeness with another person. -ex:caring/sharing, loving/liking, risk taking, vulnerability, trust, self disclosure

Medications that lower sexual desire

-Several prescription drugs can diminish sexual drive and arousal and interfere with orgasm (Clayton, 2007). These include antihypertensive drugs taken by people with high blood pressure, antipsychotic drugs, antidepressants, lithium, and tranquilizers. -Indeed, sexual dysfunction is one of the most common side effects of the widely used selective serotonin reuptake inhibitors -creational drugs, including marijuana, cocaine, amphetamines, and nicotine, can impair sexual functioning -alcohol

Psychological factors SA

-Social learning theories (see the chapter "Theories and Treatment of Abnormality") suggest that children and adolescents may learn substance use behaviors from the modeling of their parents and important others in their culture. -Because alcohol-related problems are more common among males than females, most of the adults modeling inappropriate use of alcohol are male. In turn, because children are more likely to learn from adults who are similar to themselves, male children and adolescents may be more likely to learn these behaviors than female children and adolescents. -

Anorexia Symptoms

-Some of the most serious consequences of anorexia are cardiovascular complications, including bradycardia (extreme slowing of heart rate), arrhythmia (irregular heart beat), and heart failure. -Another potentially serious complication of anorexia is acute expansion of the stomach, to the point of rupturing. -Bone strength is an issue for women who have amenorrhea, presumably because low estrogen levels reduce bone strength. -Kidney damage has been seen in some people with anorexia, and impaired immune system functioning may make people with anorexia more vulnerable to medical illnesses.

Gender differences SA

-Substance use, particularly alcohol use, is more acceptable for men than for women in many societies (Hughes et al., 2010). Heavy drinking is part of what "masculine" men do and is modeled by heroes and cultural icons. In contrast, until recently heavy drinking signified that a woman was "not a lady." -Women tend to be less likely than men to carry risk factors for substance use disorders (Nolen-Hoeksema, 2004). They appear less likely to have personality traits associated with substance use disorder (behavioral undercontrol, sensation seeking). They also appear less motivated to use alcohol to reduce distress and less likely to expect drug consumption to have a positive outcome -Women suffer alcohol-related physical illnesses at lower levels of exposure to alcohol than men do (Fillmore et al., 1997). In addition, heavy alcohol use is associated with reproductive problems in women. Page 414Women may be more likely to experience greater cognitive and motor impairment due to alcohol than do men and to suffer physical harm and sexual assault following alcohol use -When they do use alcohol, women may notice that they feel intoxicated much sooner than do men, and they may be more likely to find these effects aversive or frightening, leading them to limit their consumption -Men tend to begin using substances in the context of socializing with male friends, while women most often are initiated by family members, partners, or lovers (McCrady et al., 2009). -One study found that 70 percent of female crack users were living with men who also were substance users, and many were living with multiple people who were abusers (Inciardi, Lockwood, & Pottieger, 1993). -Perhaps because women's drug use is more closely tied to their intimate relationships, studies have found that treatments that include their partners tend to be more effective in reducing substance use disorders in women

Alcoholics Anonymous (AA)

-Support Group -Disease model -Must abstain completely -12 step program -Admit dependence -Reliance on a higher power -Seek forgiveness

LSD

-Symptoms included severe anxiety, paranoia, and loss of control. -Some people on bad trips would walk off a roof or jump out a window, believing they could fly, or walk into the sea, believing they were "one with the universe." -For some, the anxiety and hallucinations were severe enough to produce psychosis requiring hospitalization and long-term treatment. Some people reexperience their psychedelic experiences, especially visual disturbances, long after the drug has worn off and may develop a distressing or impairing hallucinogen persisting perception disorder.

Sexual Disorders : Biological causes

-The DSM-5 specifies that to receive a diagnosis of any sexual dysfunction, the dysfunction cannot be caused exclusively by a medical condition. -One of the most common contributors to sexual dysfunction is diabetes, which can lower sexual drive, arousal, enjoyment, and satisfaction, especially in men -Other diseases that are common causes of sexual dysfunction, particularly in men, are cardiovascular disease, multiple sclerosis, kidney failure, vascular disease, spinal cord injury, and injury to the autonomic nervous system due to surgery or radiation (Lewis et al., 2010). -As many as 40 percent of cases of erectile disorder are caused by one of these medical conditions -abnormally low levels of the androgen hormones, especially testosterone, or high levels of the hormones estrogen and prolactin can cause sexual dysfunction (Hackett, 2008). -In women, levels of both androgens and estrogens may play a role in sexual dysfunction, although less consistently so than in men ( -Estrogen problems in women may result in low arousal due to reduced vaginal lubrication. Levels of estrogen drop greatly at menopause; thus, postmenopausal women often complain of lowered sexual desire and arousal. -which removes the main source of estrogen, the ovaries -

Theories of SA : biological

-The brain appears to have its own "pleasure pathway" that affects our experience of reward. This pathway begins in the ventral tegmental area in the midbrain, then progresses through an area of the limbic system called the nucleus accumbens and on to the frontal cortex. -It is particularly rich in neurons sensitive to the neurotransmitter dopamine -Some drugs, such as amphetamines and cocaine, directly increase the availability of dopamine in this pathway, producing a strong sense of reward or a "high." -Cocaine clears out of the brain more rapidly than do amphetamines, which explains why users on a binge need to use cocaine much more frequently to maintain a high than do those using amphetamines (Koob & Volkow, 2010). -Snorting, smoking, or injecting drugs delivers them to the brain much faster than taking them orally and thus produces a quicker, more intense reaction. -Other drugs increase the availability of dopamine more indirectly. - For example, the neurons in the ventral tegmental area are inhibited from continuously firing by GABA neurons, so the firing of GABA neurons reduces the high caused by activity in the dopamine neurons. -The opiate drugs inhibit GABA, which stops the GABA neurons from inhibiting dopamine, making dopamine available in the reward center -Other areas of the frontal cortex, including the orbitofrontal cortex, the dorsolateral frontal cortex, and the inferior frontal gyrus, play important roles in controlling the urge to drink alcohol or use drugs (Bechara, 2005; Goldstein & Volkow, 2002). -Individuals whose reward network overpowers their control network may be more likely to use substances -The chronic use of psychoactive substances alters the reward centers, creating a craving for these substances (Robinson & Berridge, 1993). -The repeated use of substances such as cocaine, heroin, and amphetamines causes the brain to reduce its production of dopamine, with the result that dopamine receptors in the brain become less sensitive. -As the brain produces less dopamine, more of the drug is needed to produce the desired effects. -If the individual stops taking the drug, the brain does not immediately compensate for the loss of dopamine, and withdrawal symptoms occur. --- -Also, because the brain is not producing its typical amount of dopamine, the person may feel sad and unmotivated and may have difficulty experiencing pleasure from other sources, such as food or happy events. Craving for the drug sets in because only the drug can produce pleasure -Psychoactive drugs also affect a number of other biochemical (including glutamate) and brain systems. -Alcohol produces sedative and antianxiety effects largely by enhancing the activity of the neurotransmitter GABA in the septal/hippocampal system. -Alcohol also affects serotonin systems, which are associated with changes in mood -Although individuals who have used a substance for an extended period experience decreased sensitivity to the rewarding aspects of the substance, they become more sensitive to cues associated with their substance use, such as the locations where they typically use the substance or the paraphernalia associated with it. These conditioned responses to drug cues can induce powerful cravings that can lead to relapse -Stress also activates reward systems, creating cravings. In addition, chronic use of drugs seems to lead to disrupted activity in frontal regions of the brain involved in impulse control, making it even more difficult for individuals to resist cravings. -about 50 percent of the variation in risk for substance use disorders attributable to genetic factors (see reviews by Urbanoski & Kelly, 2012; Young-Wolff, Kendler, Ericson, & Prescott, 2011). There seems to be a common underlying genetic vulnerability to substance use disorders in general, rather than to use of specific substances, perhaps accounting for the fact that individuals who use one substance are likely to use several. -Genetic variation in the dopamine receptor gene (labeled DRD2) and the dopamine transporter gene (labeled SLC6A3) influences how the brain processes dopamine, thereby affecting how reinforcing a person finds substances such as nicotine (Nemoda, Szekely, & Sasvari-Szekely, 2011). In addition, the genes that control GABA have also been implicated in substance use disorders, particularly alcohol use disorders.

Cognitive theories : SA

-The cognitive theories of alcohol use disorders have focused on people's expectations of alcohol's effects and their beliefs about the appropriateness of using it to cope with stress (Marlatt, Baer, Donovan, & Kivlahan, 1988). ' -People who expect alcohol to reduce their distress and who do not have more adaptive means of coping (e.g., problem-solving skills or supportive friends or family) are more likely than others to drink alcohol when they are upset and to have social problems related to drinking (Cooper et al., 1992). -One personality characteristic consistently related to an increased risk of substance use disorders is behavioral undercontrol, or the tendency to be impulsive, sensation-seeking, and prone to antisocial behaviors such as violating laws.

Substance abuse

-The diagnosis of substance abuse was given when a person's recurrent use of a substance resulted in significant harmful consequences comprising four categories. First, the individual fails to fulfill important obligations at work, school, or home. -Second, the individual repeatedly uses the substance in situations in which it is physically hazardous to do so, such as while driving. Third, the individual repeatedly has legal problems as a result of substance use, such as arrests for drunk driving or for the possession of illegal substances. Fourth, the individual continues to use the substance despite repeated social or legal problems as a result of use. The DSM-IV diagnosis of substance abuse required that the person show repeated problems in at least one of these categories within a 12-month period.

SA facts

-The environment can also influence how maladaptive the intoxication is. People who drink alcohol only at home may be less likely to cause harm to themselves or others than are people who drink at bars and drive home under the influence of alcohol.

Alcohol stages

-The first, which usually begins within a few hours after drinking has been stopped or sharply curtailed, includes tremulousness (the "shakes"), weakness, and profuse perspiration. The person may complain of anxiety (the "jitters"), headache, nausea, and abdominal cramps and may retch and vomit. -The second stage includes convulsive seizures, which may begin as soon as 12 hours after drinking stops but more often appear during the second or third day. - The third stage of withdrawal is characterized by delirium tremens, or DTs. Auditory, visual, and tactile hallucinations occur. -The person also may develop bizarre, terrifying delusions, such as the belief that monsters are attacking. He or she may sleep little and may become agitated and disoriented. Fever, profuse perspiration, and an irregular heartbeat may develop. -Delirium tremens is fatal in approximately 10 percent of cases. Death may occur from hyperthermia (extremely high body temperature) or the collapse of the peripheral vascular system. -Fortunately, only about 11 percent of individuals with severe alcohol use disorder ever experience seizures or DTs (

biological causes- AN

-The hypothalamus plays a central role in regulating eating - Disordered eating behavior might be caused by imbalances in or dysregulation of any of the neurochemicals involved in this system or by structural or functional problems in the hypothalamus. -People with anorexia nervosa show lowered functioning of the hypothalamus and abnormalities in the levels of several hormones important to its functioning, including serotonin and dopamine -people with anorexia continue to show abnormalities in hypothalamic and hormonal functioning and neurotransmitter levels after they gain some weight, whereas other studies have found that these abnormalities disappear with weight gain

BN Stats

-The lifetime prevalence of bulimia nervosa is estimated to be 0.5 percent in adults -0.9 percent in adolescents -more common in females than in males -In the United States, it is more common in Caucasians than in African Americans -onset of bulimia nervosa most often occurs in adolescence -Although the death rate among people with bulimia is not as high as among people with anorexia, bulimia also has serious medical complications and a death rate nearly double that in the general population -One of the most serious complications is an electrolyte imbalance, which results from fluid loss following excessive and chronic vomiting, laxative abuse, and diuretic abuse. Imbalances in electrolytes can lead to heart failure. -suicide rate among people with bulimia nervosa is 7.5 times higher than in the general population -A long-term study of people seeking treatment found that 15 years after the disorder about 50 percent showed remission of their symptoms but the other 50 percent still had symptoms qualifying for a diagnosis

sociocultural factors SA

-The reinforcing effects of substances—the highs produced by stimulants, the calming and "zoning out" effects of the depressants and the opioids—can be more attractive to people under chronic stress. -Thus, rates of substance use disorders are higher among people living in poverty, women in abusive relationships, and adolescents whose parents fight frequently and violently -Alcohol-related disorders are less common in these societies than in societies with few restrictions, either legal or cultural, on alcohol use

Biological treatments

-The selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (trade name Prozac), have been the focus of much research on biological treatments for bulimia nervosa. These drugs appear to reduce binge-eating and purging behaviors, but often they fail to restore the individual to normal eating habits - Adding cognitive-behavioral therapy to antidepressant treatment increases rates of recovery -Antidepressants are often used to treat anorexia nervosa, and they result in reduction of symptoms in half the studies conducted -Olanzapine, an atypical antipsychotic, leads to increases in weight in people with anorexia nervosa

sexual rituals in sadism and masochism disorders

-The sexual rituals in sadism and masochism disorders are of four types: physical restriction, which involves the use of bondage, chains, or handcuffs as part of sex; the administration of pain, in which one partner inflicts pain or harm on the other with beatings, whippings, electrical shock, burning, cutting, stabbing, strangulation, torture, mutilation, or even death; hypermasculinity practices, including the aggressive use of enemas, fists, and dildos in the sexual act; and humiliation, in which one partner verbally and physically humiliates the other during sex

transgender

-The term transgender more broadly refers to individuals with varying degrees of cross-gender identity, including transsexuals but also individuals who cross-dress and people with transvestic fetishes (see Lawrence, 2008). -The DSM-5 defines transgender as the broad spectrum of individuals who transiently or persistently identify with a gender different from their natal gender.

Cognitive treatments SA

-Therapists also help clients learn to handle stressful situations in adaptive ways, such as seeking the help of others or engaging in active problem solving. -Therapists work with clients to challenge these expectations by reviewing alcohol's negative effects on the clients' behavior. -The therapist helps the client evaluate the effectiveness of each option and anticipate any negative consequences. -In most cases, therapists using cognitive-behavioral approaches encourage their clients to abstain from alcohol, especially when they have a history of frequent relapses into abuse. -When a client's goal is to learn to drink socially and the therapist believes the client can achieve this goal, therapy may focus on teaching the client to engage in social, or controlled, drinking. -Studies have shown that cognitive-behavioral approaches are effective in treating abuse and dependence on alcohol, cannabis, nicotine, heroin, amphetamines, and cocaine - motivational interviewing motivational interviewing intervention for sufferers of substance use disorders to elicit and solidify individuals' motivation and commitment to changing their substance use; rather than confronting the user, the motivational interviewer adopts an empathic interaction style, drawing out the user's own statements of desire, ability, reasons, need, and, ultimately, commitment to change - abstinence violation effect abstinence violation effect what happens when a person attempting to abstain from alcohol use ingests alcohol and then endures conflict and guilt by making an internal attribution to explain why he or she drank, thereby making him or her more likely to continue drinking in order to cope with the self-blame and guilt -Relapse prevention programs relapse prevention programs treatments that seek to offset continued alcohol use by identifying high-risk situations for those attempting to stop or cut down on drinking and teaching them either to avoid those situations or to use assertiveness skills when in them, while viewing setbacks as temporary - A study of people with alcohol and other substance use disorders showed that adding mindfulness meditation training to the usual treatment led to significant reductions in craving and relapse during the follow-up period -Alcoholics Anonymous (AA) Alcoholics Anonymous (AA) an organization created by and for people with alcoholism involving a 12-step treatment program -meta-analyses and reviews of studies of AA's effectiveness have produced mixed results, with some analyses suggesting that AA is effective and others suggesting that it is worse than no treatment ( -Approximately 2 percent of people over age 65 can be diagnosed with an alcohol use disorder, and about 10 percent can be considered heavy drinkers (Helzer, Burnam, & McEvoy, 1991; Merrick et al., 2008). -One-third to one-half of abusers of alcohol first develop problems after age 65 (Liberto, Oslin, & Ruskin, 1996). - Moreover, the abuse of and dependence on prescription drugs (e.g., sedative, hypnotic, or anxiolytic use disorders) is a substantial problem among the elderly. -Although only 13 percent of the U.S. population is over age 65, this group accounts for one-third of all prescription drug expenditures (NIDA, 2008b). The most commonly prescribed drugs are diuretics, cardiovascular drugs, and sedatives. -

cognitive theories: Paraphilia

-These distortions may have been learned from parents' deviant messages about sexual behavior. They are used to justify the person's victimization of others. -Several lines of evidence suggest that alterations in the development of the brain and hormonal systems may contribute to pedophilia (Seto, 2008). - Men with pedophilia are more likely to have had a Page 381 head injury before age 13, to have cognitive and memory deficits, to have lower intelligence, and to have differences in brain structure volume (Cantor et al., 2008). -In addition, some small studies suggest that men with pedophilia have dysfunctions in the frontal areas of the brain involved in regulating impulsive and aggressive behavior and in testosterone levels

Partial-syndrome eating STATS

-Those diagnosed with partial-syndrome eating disorders also had lower self-esteem, poorer social relationships, poorer physical health, and lower levels of life satisfaction than those with no signs of an eating disorder. They were less likely to have earned a bachelor's degree and more likely to be unemployed. -these problems included anxiety disorders, substance abuse, depression, and attempted suicide. Almost 90 percent had a diagnosable psychiatric disorder when they were in their early 20s.

emotion regulation ED

-Thus, women who show bulimic symptoms unconsciously organize their perceptions of the world around body size more so than do women who do not show significant bulimic symptoms. --Women with the depressive subtype of disordered eating patterns suffer greater social and psychological consequences over time than do women with the dieting subtype -Over an 8-year follow-up, 80 percent of the women with the depressive subtype developed major depression. Among those women who suffered both elevated depressive symptoms and body dissatisfaction, 43 percent developed a diagnosable eating disorder -One important task of adolescence is separation and individuation from one's family. Bruch argues that girls from overcontrolling families deeply fear separation because they have not developed the ability to act and think independently of their family. -What may distinguish families in which anorexia nervosa or Page 352 bulimia nervosa develops is that the mothers in these families believe their daughters should lose more weight, criticize their daughters' weight, and are themselves more likely to show disordered eating patterns -Studies of adult women with binge-eating disorder suggest that the combination of low parental warmth and high parental demands or control seems to distinguish girls and women who develop binge-eating disorder from those who develop other forms of psychopathology -Another family characteristic that distinguishes people with binge-eating disorder from individuals with other mental disorders is a history of binge eating among other family members (

Biological Treatments for Paraphilias

-Treatment is often forced on those who are arrested after engaging in illegal acts including voyeurism, exhibitionism, frotteurism, or pedophilia. Simple incarceration does little to change these behaviors, and convicted sex offenders are likely to become repeat offenders Biological:Surgical castration, which removes the testes and thereby almost completely eliminates the production of androgens, lowers repeat offense rates among sex offenders - although it is rarely used today -Sex offenders can also be treated by chemical castration, in which they are given antiandrogen drugs that suppress the production of testosterone and thereby reduce the sex drive. These drugs typically are used in conjunction with psychotherapy and can be useful for hypersexual men who are motivated to change their behavior -Follow-up studies have shown that people with a paraphilia treated with antiandrogen drugs show reductions in their paraphilic behavior, although the results are mixed -The selective serotonin reuptake inhibitors (SSRIs) have been used to reduce sexual drive and paraphilic behavior. Some studies find that these drugs have positive effects on sexual drive and impulse control (e.g., Greenberg, Bradford, Curry, & O'Rourke, 1996), although the effects are not totally consistent across studies

SA DSM-5 facts

-Users may continue to take the substance to relieve or avoid withdrawal symptoms. Physiological dependence (evidence of tolerance or withdrawal) was not required for a diagnosis of substance dependence in the DSM-IV, however. -The diagnosis of substance dependence preempted the diagnosis of substance abuse. Some individuals abused substances for years, severely disrupting their lives, without qualifying for a diagnosis of substance dependence. -The DSM-5 combined substance abuse and dependence into one diagnosis, substance use disorder, because of difficulties in distinguishing between abuse and dependence in clinical and research settings and because of the low reliability of the diagnosis of substance abuse -Clinicians also rate the severity of the substance use disorder as mild (two or three of the criteria are met), moderate (four or five criteria are met), or severe (six or more criteria are met).

Biological causes of pain in women SD

-Vaginal dryness or irritation, which causes pain during sex and therefore lowers sexual desire and arousal, can be caused by antihistamines, douches, tampons, vaginal contraceptives, radiation therapy, endometriosis, and infections such as vaginitis or pelvic inflammatory disease (Meston & Bradford, 2007). -Injuries during childbirth that have healed poorly, such as a poorly repaired episiotomy, can cause sexual pain in women (Masters, Johnson, & Kolodny, 1993). -Women who have had gynecological cancers sometimes report pain, changes in the vaginal anatomy, and problems with their body image or sexual self-concept

Minnesota Starvation Experiment

-WW-II: 36 conscientious objectors - During semi-starvation: - Men purposely starving themselves - food Rituals - Depressed and anhedonia during re-feeding: - Binge eating - insatiable hunger Fasting can cause a lot of symptoms in AN and BN

Obesity Medications

-Weight-loss drugs, such as sibutramine (Meridia), orlistat (Xenical), and rimonabant (Acomplia), suppress appetite and can help people lose weight. -All these medications have side effects, including gastrointestinal upset (orlistat), increased blood pressure and heart rate (sibutramine), and negative mood changes (rimonabant). -For obese people with a BMI between 30 and 39, low-calorie diets (900 to 1,200 calories per day), often using prepackaged, portion-controlled servings (such as SlimFast shakes), are recommended -For extremely obese people with a BMI of 40 or over who have at least one severe health problem (e.g., diabetes), bariatric surgery is an option.

Trends across lifespans SD

-While sexual activity is greater among younger adults than among older adults, many adults remain sexually active well into old age -both men and women need adequate levels of testosterone to maintain sexual desire. Testosterone levels begin to decline in a person's 50s and continue to decrease steadily throughout the rest of the person's life. -Lower testosterone levels are associated with increased difficulty in achieving and maintaining an erection (Agronin, 2009). -Diminished estrogen levels in postmenopausal women can lead to vaginal dryness and lack of lubrication and thus to a reduction in sexual responsivity -sexual dysfunction in older adults, the cause is not age itself but rather medical conditions, which are more common in older age. -For both older men and older women, the loss of a lifelong spouse, losses of other family members and friends, health concerns, and discomfort with one's own aging can contribute to sexual problems

EDNOS Stats

-about 5 percent of the general population experiences EDNOS (Fairburn et al., 2007; Wade et al., 2006). EDNOS tends to be as severe and persistent as bulimia nervosa or anorexia nervosa (Fairburn et al., 2007).

PCP

-also known as angel dust, PeaCePill, Hog, and Tranq—is manufactured as a powder to be snorted or smoked. -Although PCP is not classified as a hallucinogen, it has many of the same effects. -At lower doses, it produces a sense of intoxication, euphoria or affective dulling, talkativeness, lack of concern, slowed reaction time, vertigo, eye twitching, mild hypertension, abnormal involuntary movements, and weakness. -At intermediate doses, it leads to disorganized thinking, distortions of body image (e.g., feeling that one's arms are not part of one's body), depersonalization, and feelings of unreality. -A user may become hostile, belligerent, and even violent (Morrison, 1998). -At higher doses, PCP produces amnesia and coma, analgesia sufficient to allow surgery, seizures, severe respiratory problems, hypothermia, and hyperthermia. -Symptoms of severe intoxication can persist for several days; people with PCP intoxication may be misdiagnosed as having a psychotic disorder unrelated to substance use -Phencyclidine or other hallucinogen use disorder is diagnosed when individuals repeatedly fail to fulfill major role obligations at school, work, or home due to intoxication with these drugs. - They may use the drugs in dangerous situations, such as while driving a car, and they may have legal troubles due to their possession of the drugs. Because the drugs can cause paranoia or aggressive behavior, frequent users may find their work and social relationships affected. -About 11 percent of the U.S. population reports having tried a hallucinogen or PCP, but only 0.4 percent report having used it in the past month (Johnston et al., 2012; SAMHSA, 2002). -Use is higher among teenagers and young adults, however, with 5.8 percent of 12th-graders, 4.1 percent of college students, and 6.4 percent of 18- to 22-year-olds not in college reporting use of a hallucinogen in the past year

The dementias

-alzehimers -vascular disease -lewy body disease - Frontotemporal lobar degeneration

Sociocultural influences SA

-chronic stress -social values around use and intoxications: country, age group -gender norms: more acceptable for males

Neurocogn. disorders are broken down into 3 categories:

-delirium -mild neurocognitive disorder - major neurocognitive disorder

Treatments for SA: biological

-eta-analyses and reviews of existing treatments suggest that, as a whole, they help only about 17 to 35 percent of people with substance use disorders abstain for up to 1 year -For people dependent on alcohol, a benzodiazepine, which has depressant effects similar to those of alcohol, can reduce tremors and anxiety, decrease pulse and respiration rate, and stabilize blood pressure (Ntais, Pakos, Kyzas, & Ioannidis, 2005). The dosage is decreased each day so that a patient withdraws from the alcohol slowly but does not become dependent on the benzodiazepine. -Antidepressant drugs sometimes are used to treat individuals with substance dependence who are depressed, but their efficacy in treating either alcohol or other drug problems or depression without psychotherapy has not been consistently supported (Nunes & Levine, 2004). People have widely different responses to the SSRIs. -Antagonist drugs block or change the effects of the addictive drug, reducing the desire for it. Naltrexone and naloxone are opioid antagonists—they block the effects of opioids such as heroin. -Naltrexone has also proven useful in treating alcohol dependents and abusers, possibly because it blocks the effects of endorphins during drinking. -The drug acamprosate affects glutamate and GABA receptors in the brain, which are involved in the craving for alcohol -A drug that can make alcohol actually punishing is disulfiram, commonly called Antabuse (Carroll, 2001). Just one alcoholic drink can make people taking disulfiram feel sick and dizzy and can make them vomit, blush, and even faint. -Most common is nicotine replacement therapy—the use of nicotine gum or a nicotine patch, nasal spray, or inhaler to prevent withdrawal effects. I -One drug approved for this use is the antidepressant Page 415bupropion (marketed for smoking cessation as Zyban). A drug called varenicline (Chantix), which binds to and partially stimulates nicotine receptors, also has been shown to reduce cravings for nicotine products and decrease their pleasurable effects -Gradual withdrawal from heroin can be achieved with methadone. This drug is itself an opioid, but it has less potent and less long-lasting effects than heroin when taken orally. The person dependent on heroin takes methadone to reduce extreme negative withdrawal symptoms.

Psych Theories: Cognitions SA

-expectancies -get in the mood -less tense -more fun

Psychosocial theories: gender dysphoria

-focus on the role parents play in shaping their children's gender identity. Parents encourage children to identify with one sex or the other by reinforcing "gender-appropriate" behavior and punishing "gender-inappropriate" behavior. -a large sample of boys with gender dysphoria found that their parents were less likely than the parents of boys without gender dysphoria to discourage cross-gender behaviors (Green, 1986). That is, these boys were not punished, either subtly or overtly, for engaging in feminine behavior such as playing with dolls or wearing dresses as much as were boys who did not have gender dysphoria. Further, boys who were highly feminine (although not necessarily with gender dysphoria) tended to have mothers who had wanted a girl rather than a boy, saw their baby sons as girls, and dressed their baby sons as girls. When the boys were older, their mothers tended to prohibit rough-and-tumble play, and the boys had few opportunities to have male playmates -About one-third of these boys had no father in the home, and those who did have a father in the home tended to be very close to their mother. In general, however, the evidence in support of psychological contributors to gender dysphoria has been weak

Heritability- ED

-found a heritability of 56 percent for anorexia nervosa -binge-eating disorder found a heritability of 41 percent -Genes appear to carry a general risk for eating disorders rather than a specific risk for one type of eating disorder -genetic risk for developing eating disorders appears to interact with the biological changes of puberty to contribute to the onset of eating disorders in girls, but not in boys

Biological FActors ED

-genetic risk AN heritability: 56% Binge ED heritable: 41% -neural coorelates: altered in BN- low serotonin cravings (sends messages) altered in AN - altered dopamine--> change in reward -Fasting is rewarding -hypothalmus: regulates eating; receives messages -reduced functioning in AN

rohypnol

-goes by the slang names Roofies, Rophies, Roche, and the Forget-Me-Not Pill. -It is a benzodiazepine and has sedative and hypnotic effects (NIDA, 2008a). -Users may experience a high, as well as muscle relaxation, drowsiness, impaired judgment, blackouts, hallucinations, dizziness, and confusion. -----Rohypnol tablets can easily be crushed and slipped into someone's drink. -Rohypnol is odorless, colorless, and tasteless, so victims often don't notice that their drink has been altered. -Side effects can include headaches, muscle pain, and seizures. In combination with alcohol or other depressants, rohypnol can be fatal (NIDA, 2008a).

Biological Therapies for Sexual Dysfunctions

-if medications are contributing to a sexual dysfunction, adjusting the dosage or switching to a different type of medication can relieve sexual difficulties. Also, getting a person to stop using recreational drugs such as marijuana can often cure sexual dysfunction. Erectile disorder: -The drug that has received the most media attention in recent years is sildenafil (trade name Viagra) - also Cialis and Levitra, have similar positive effects. These drugs do have side effects, though, including headaches, flushing, and stomach irritation, -injections -vacuum pump -prosthesis -inflatable device -Some antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs), can cause sexual dysfunctions. One drug that has proven helpful in this regard is bupropion, which goes by the trade names Wellbutrin and Zyban. Bupropion appears to reduce the sexual side effects of the SSRIs and can itself be effective as an antidepressant Premature ejaculation: -some antidepressants can be helpful, including fluoxetine (Prozac), clomipramine (Anafranil), and sertraline (Zoloft). Several studies suggest that these drugs significantly reduce the frequency of premature ejaculation -Hormone replacement therapy can be very effective for men whose low levels of sexual desire or arousal are linked to low levels of testosterone; they are not effective for men whose low sexual desire or arousal is not linked to low levels of testosterone (Segraves, 2003). For women, the effects of testosterone therapy are mixed -find that high levels of testosterone increase sexual desire and arousal in women but also run the risk of significant side effects, including masculinization (e.g., chest hair, voice changes) -Bupropion has proven helpful in treating some women with hypoactive sexual desire -Large controlled studies investigating the effects of sildenafil for women with sexual dysfunctions also report mixed results

Substance dependence

-in the DSM-IV was closest to what people often refer to as drug addiction. People who are dependent on, or addicted to, a substance often show tolerance -tolerance—they experience diminished effects from the same dose of a substance and need more and more of it to achieve intoxication.

Cannabis

-intoxications -Low doses: feeling of wellbeing, relaxation, sleepy, forgetfulness, impaired motor functioning -High doses: perceptual distortions, depersonalization, paranoia -withdrawal

Cognitive Factors-ED

-omen who feel they need a perfect body, are dissatisfied with their body, and have low self-esteem will engage in maladaptive strategies to control their weight, including excessive dieting and purging. -People with eating disorders tend to have a dichotomous thinking style, judging things as either all good or all bad -Thus, women who show bulimic symptoms unconsciously organize their perceptions of the world around body size more so than do women who do not show significant bulimic symptoms.-

Body image disturbance ED

-overestimate actual body size -unrealistic low ideal body size -social comparison -body dissatisfaction

Medication Treatments SA

-reduce withdrawal: Benzodiazepines (alcohol), Antidepressants -Antagonists = block effects: Naltrexone,Naloxone -Aversive conditioning: antabuse - maintenance: methadone

sociocultural factors ED

-thinner beauty ideal : magazines, movies, TV -friends attitudes -athelete; in a sport where weight matters

depressive subtype

. Women with this subtype also are concerned about their weight and body size, but they are plagued by feelings of depression and low self-esteem and often eat to quell these feelings.

Low sexual desire or arousal...

.. is among the most common problems for which people seek treatment

techniques for treating early ejaculation

1. stop-start technique sex therapy technique used for premature ejaculation; the man or his partner stimulates his penis until he is about to ejaculate; the man then relaxes and concentrates on the sensations in his body until his level of arousal declines; the goal of this technique is for the man to learn to identify the point of ejaculatory inevitability and to control his arousal level at that point -If a man is engaging in this exercise with a female partner, they are instructed not to engage in intercourse until he has sufficient control over his ejaculations during her manual stimulation of him. 2.squeeze technique squeeze technique sex therapy technique used for premature ejaculation; the man's partner stimulates him to an erection, and then when he signals that ejaculation is imminent, the partner applies a firm but gentle squeeze to his penis, either at the glans or at the base, for 3 or 4 seconds; the goal of this technique is for the man to learn to identify the point of ejaculatory inevitability and to control his arousal level at that point

Example situations

1. Benzos: seems like she is drunk 2. Kevin has been addicted for years, starts vomiting and shaking in withdrawal : alcohol 3. Yael is withdrawing , she feells like she has the flu, nauseas , and had diarrhea: opiods 4. Cam took drug to feel relaxed, took too much and is paranoid: cannabis Carl smokes this everyday, feels euphoric and fills him with energy,clenches teeth, and quickly crashes: methamphetamines

hypoxyphilia

A particularly dangerous activity is hypoxyphilia, which involves sexual arousal by means of oxygen deprivation, obtained by placing a rope around the neck, putting a plastic bag or mask over the head, or exerting severe chest compression

Delirium

A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and orientation to the environment and awareness (reduced orientation to the environment). B. The disturbance develops over a short period of time (usually hours to a few days), and represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day. C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception). D. The disturbances in Criteria A and C are not better explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma. E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal, or exposure to a toxin, or due to multiple etiologies. - Delirium is a state of fluctuating confusion, marked by significant inattention, altered perception (illusions and hallucinations) and psychomotor overactivity (agitation, tremor, insomnia) and autonomic over activity (racing heart,, profuse sweating, hypertension, and hyperthermia). -After recovery, patients are typically amnestic to the episode. -There is evidence of a direct physiological cause; it is typically reversible if the underlying cause is treated

Gender Dysphoria DSM-5

A. A marked incongruence between one's experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by at least two of the following: A marked incongruence between one's experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics) A strong desire to be rid of one's primary and/or secondary sex characteristics because of a marked incongruence with one's experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics) A strong desire for the primary and/or secondary sex characteristics of the other gender A strong desire to be of the other gender (or some alternative gender different from one's assigned gender) A strong desire to be treated as the other gender (or some alternative gender different from one's assigned gender) A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one's assigned gender) B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.

DSM-5 Major Neurocognitive Disorder

A. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on: Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment. B. The cognitive deficits interfere with independence in everyday activities (i.e., at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications). C. The cognitive deficits do not occur exclusively in the context of delirium. D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia). -Disorders with onset later in life (50+ years of age) - though not always! -Core symptom of these disorders is cognitive impairment, though other symptoms (e.g., mood disturbance, sleep difficulties, hallucinations) are also common -Unlike many other disorders we've discussed, the underlying pathology and etiology for these can often be determined. -Several NCDs frequently co-occur (e.g., mixed Alzheimer's disease-vascular pathology) -Many of these disorders are often referred to as types of "dementia" DSM-5: -a. This cognitive decline has to be evidence by two things 1- can be family; loss of insight 2 - objective evidence of decline b. Significant impairment in functioning (subjective experience of decline, objective experience of decline) ---- "Previous level" - distinguished neurocognitive disorders from neurodevelopmental disorders Instrumental activities of daily living are things like paying bills or managing medications

Bulimia Nervosa DSM-5

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time under similar circumstances. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once per week for 3 months. D. Self-evaluation is unduly influenced by body shape and weight. E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Binge-eating disorder: DSM-5

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. The binge-eating episodes are associated with three (or more) of the following: Eating much more rapidly than normal. Eating until feeling uncomfortably full. Eating large amounts of food when not feeling physically hungry. Eating alone because of feeling embarrassed by how much one is eating. Feeling disgusted with oneself, depressed, or very guilty afterward. C. Marked distress regarding binge eating is present. D. The binge eating occurs, on average, at least once a week for 3 months. E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

DSM-5 Anorexia Nervosa

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. B. Intense fear of gaining weight or of becoming fat, or of persistent behavior that interferes with weight gain, even though at a significantly low weight. C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. Specify current subtype: Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). Weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise. Binge-Eating/Purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

Medications SSRIs -ED

AN: No better than placebo BN: Reduce binge/purge But still abnormal eating habits SSRI + CBT may have better outcome

Abstinence vs. Harm Reduction SA

Abstinence: Focus on no use Harm reduction: -use safely -use in moderation -focus on reducing harmful consequences -US : normal to drink - higher substance use disorders -environmental factors are also imortant : cause if in good enviornment rats reduce use of rats

sex offenders and out of control sexual behavior

Addressing denial Accepting responsibility Developing a personalized plan Identifying triggering situations Developing healthy sexual attitudes and behaviors Exploring patterns of behavior and past abuse Harm reduction model Sex addiction vs. Out of control sexual behavior Case example: Donald Case example: Kevin

transsexuals

Adults who might be diagnosed with gender dysphoria sometimes are called transsexuals transsexuals people who experience chronic discomfort with their gender and genitals as well as a desire to be rid of their genitals and to live as a member of the opposite sex

Other Stimulants

Amphetamines: -Prescription pills -Snorted (crank) or smoked (crystal meth) -Affects release and reuptake of dopamine and norepinephrine -Intoxication and withdrawal similar to cocaine - Norepinephrine: increases energy, muscle tone

AN

Anorexia Nervosa Restriction of energy intake relative to requirements leading to significantly low weight AND Intense fear of gaining weight or behaviors to avoid weight gain Disturbance in perception of weight or influence of weight on self-evaluation Types Restricting type Binge/purge type

Purging behaviors

Attempts to compensate for binge eating or prevent weight gain Fasting Self-induced vomiting Laxative misuse Diuretics Excessive exercise Enemas Chewing/spitting out food -Any effort to do a different diet that is not normal is compensatory behavior

Treatment for Behavior: Paraphilia

Behavior: Aversion therapy aversion therapy treatment that involves the pairing of unpleasant stimuli with deviant or maladaptive sources of pleasure in order to induce an aversive reaction to the formerly pleasurable stimulus -Desensitization procedures may be used to reduce the person's anxiety about engaging in normal sexual encounters with other adults. For example, people with a paraphilia might be taught relaxation exercises, which they then use to control their anxiety as they gradually build up fantasies of interacting sexually with other adults in ways that are fulfilling to them and to their partners - effective in the treatment of nonpredatory paraphilias such as fetishism

Cognitive-Behavioral SA

Behavioral: Aversive classical conditioning (if highly motivated) Contingency management Cognitive: -Identification of situations that trigger use -Cognitive restructuring - challenge expectations about use -Problem-solving

Binge Eating Disorder

Binge Eating Disorder Binges without purging, fasting

Spectrum chart of ED

Binging Low High Restriciton/ compensatory Binge ED behav. AN BN Key features: -Body Image Disturbance -Impairment/Distress

Bulimia Nervosa

Bulimia Nervosa Binges with lack of control Behaviors to prevent weight gain Purging Fasting Occurs at least once a week Self-evaluation unduly influenced by body shape and weight - - Efforts to avoid weight gain - They consumed more calories than they retained, they threw up most of them - Regardless how much you binge you retain a lot of those calories, so it doesn't do much for weight - Can develop other illnesses like GERD

CBT for AN

Cognitive: Psycho-education Cognitive restructuring Overvaluation of shape and weight Perfectionism Body image Behavorial: -Meal planning and eating goals -Rewards contingent on weight gain

Treatment for female sexual dysfunction

Creams Vaginal Dilators Nerve blocks Anti-Depressants Ruling out medical causes Couples' Tx Behavioral Treatments (sensate focus, vibrators) Trauma work Psycho-Education PLISSIT Masturbation Pelvic Floor Tx

DSM-5 Criteria for Gambling Disorder

DSM-5 Criteria for Gambling Disorder Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period: Needs to gamble with increasing amounts of money in order to achieve the desired excitement. Is restless or irritable when attempting to cut down or stop gambling. Has made repeated unsuccessful efforts to control, cut back, or stop gambling. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble). Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed). After losing money gambling, often returns another day to get even ("chasing" one's losses). Lies to conceal the extent of involvement with gambling. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling. Relies on others to provide money to relieve desperate financial situations caused by gambling. The gambling behavior is not better explained by a manic episode. Specify if: Episodic: Meeting diagnostic criteria at more than one time point, with symptoms subsiding between periods of gambling for at least several months. Persistent: Continuous symptoms for multiple years. Current Severity: Mild (4-5 criteria met); Moderate (6-7 criteria met); Severe (8-9 criteria met). -

Depressants

Depressants slow the central nervous system. In moderate doses, they make people relaxed and somewhat sleepy, reduce concentration, and impair thinking, judgment, and motor skills. In heavy doses, they can induce stupor or even death

psych factors:emotions

Depression symptoms ---> Eating disorder Types of binge eating patterns Dieting subtype: Attempts to lose weight Depressive subtype: attempts to regulate emotions ; poorer prognosis

Early Stages of Treatment SA

Detox Inpatient treatment Medications Motivation Motivational Interviewing Goal: increase motivation and commitment to change Focus on: ambivalence and cognitive dissonance

DSM-5 Mild NCD

Difference: cognitive deficits do not interfere with capacity for independence -modest cognitive decline from a previous level of performance - the cognitive deficits dont occur exclusively in context of a delirium, and are not better explained by another disorder -Primary distinctions between major and mild NCDs: Severity of cognitive impairment Degree of interference with instrumental activities of daily living -Clinical, epidemiological, radiological and biomarker research data suggest it's a "valid clinical entity " -Modest rates of progression from mild NCD to dementia/major NCD Rates of progression from mild NCD to Alzheimer's disease about 12-15% per year.

Are ED a culture bound disorder?

Differences across time: -Increased rates in those born after 1945 than before 1945 Different incidence across countries: -Higher rates in "westernized" countries US and Netherlands vs. Curacao -Curacao Differences by Race No cases in majority black population All cases were in minority white population most had been abroad to US or Netherlands

Dyspareunia Vulvodynia

Dyspareunia-pain at sexual entry or with any penetration. Vaginismus-the persistent involuntary spasm of the muscles in the outer third of the vagina that interferes with sexual intercourse. Vulvodynia-chronic vulvar pain without an identifiable cause.

Ecstasy

Ecstasy has the stimulant effects of an amphetamine along with occasional hallucinogenic properties - It is fairly popular with young adults; -6.8 percent of college students and 13.0 percent of 18- to 22-year-olds not in college report having used ecstasy at some time (Johnston et al., 2012). -Users experience heightened energy and restlessness and claim that their social inhibitions decrease and their affection for others increases. -Even short-term use can have long-term negative effects on cognition and health, however. -People who use ecstasy score lower on tests related to attention, memory, learning, and general intelligence than do people who do not use the drug. -The euphoric effects of ecstasy, and some of the brain damage, may be due to alterations in the functioning of serotonin in the brain—serotonin levels in ecstasy users are half those in people who are not users (Gold, Tabrah, & Frost-Pineda, 2001). -Long-term users risk several cardiac problems and liver failure and show increased rates of anxiety, depression, psychotic symptoms, and paranoia (Gold et al., 2001) -Another effect of ecstasy is teeth-grinding; some users suck a baby pacifier at parties to relieve this effect.

Treatments for Male sexual disorders

Erectile enhancement drugs, such as Viagra. Sensate focus Pleasure oriented vs Goal oriented Squeeze technique Trauma work Partnered and non-partnered masturbation PLISSIT

Family factors ED

Family dynamics: -conflict and control -messages to lose weight Daughter: -perfictionistic -focused on pleasing others Maternal eating pathology: -body dissatisfaction -internalization of thin-ideal -dietary restraint -eating disorder symptoms

psychotherapy for AN -Family Based

Family-Based Therapy for adolescents Observe family meals Parent becomes therapist Strict expectations for eating Privileges linked to eating After weight gain Transfer control back to adolescent *treatments need to increase motivation for change

Feeding Disorder - Otherwise Specified

Feeding Disorder - Otherwise Specified Most common Symptoms of AN or BN but not enough for either diagnosis Clinically significant impairment/distress

GHB

GHB is a central nervous system depressant approved for the treatment of the sleep disorder narcolepsy -At low doses, it can relieve anxiety and promote relaxation. At higher doses, it can result in sleep, coma, or death. - In the 1980s, GHB was widely used by bodybuilders and athletes to lose fat and build muscle and was available over the counter in health food stores. -In 1990, it was banned except under the supervision of a physician due to reports of severe side effects, including high blood pressure, wide mood swings, liver tumors, and violent behavior. -Other side effects include sweating, headache, decreased heart rate, nausea, vomiting, impaired breathing, loss of reflexes, and tremors -GHB is also considered a date-rape drug because it has been associated with sexual assaults (NIDA, 2008a). It goes by the street names Grievous Bodily Harm, G., Liquid Ecstasy, and Georgia Home Boy.

Gay, lesbian, and bisexual people

Gay, lesbian, and bisexual people experience sexual dysfunctions for the same reasons as heterosexual people, such as medical disorders, medications, aging, or conflicts with partners. Gay, lesbian, and bisexual people face additional stressors related to their sexuality due to continuing stigma and discrimination against them

Gender Dysphoria

Gender dysphoria gender dysphoria condition in which a person believes that he or she was born with the wrong sex's genitals and is fundamentally a person of the opposite sex - DSM-5's Page 382 gender dysphoria is diagnosed when there is a discrepancy between individuals' gender identity (i.e., sense of themselves as male or female) and their biological sex

Biological theories SA

Genetic Vulnerability: Heritable ~60% Family and twin studies Dopamine genes Reward sensitivity/impulsivity -ppl that find substances more rewarding are more likely to use them - The faster the reinforcement the more likely the behavior repeats - Immediate positive reinforcemnt; but immediately after negative reinforcement occurs so you don't want to go through withdrawal again

substance/medication-induced sexual dysfunction

If individuals do have a sexual dysfunction caused by a substance (such as chronic alcohol abuse) or a medication (such as an antidepressant), they may be diagnosed with substance/medication-induced sexual dysfunction. -In reality, these dysfunctions overlap significantly, and many people who seek treatment for a sexual problem have more than one nonsexual dysfunction.

SA DSM-5

Impaired centre control The substance is taken in increasingly larger amounts or over a longer period of time than originally intended. The substance user craves the use of the substance. The substance user feels an ongoing desire to cut down or control substance abuse. Much time is spent in obtaining, using, or recovering from the substance. Social impairment The ongoing use of the substance often results in an inability to meet responsibilities at home, work, or school. Important social, work-related, or recreational activities are abandoned or cut back because of substance use. Ongoing substance use despite recurring social or relationship difficulties caused or made worse by the effects of the substance. Risky use Ongoing substance use in physically dangerous situations such as driving a car or operating machinery. Substance use continues despite the awareness of ongoing physical or psychological problems that have likely arisen or been made worse by the substance. Pharmacological criteria Changes in the substances user's tolerance of the substance is indicated by the need for increased amounts of the substance to achieve the desired effect or by a diminished experience of intoxication over time with the same amount of the substance. Withdrawal is demonstrated by the characteristic withdrawal syndrome of the substance and/or taking the same or similar substance to relieve withdrawal symptoms.

acquired male hypoactive sexual desire disorder

In most cases, the man used to enjoy sex but has lost interest in it, a condition diagnosed as acquired male hypoactive sexual desire disorder. -Between 5 and 13 percent of men report frequent problems involving hypoactive sexual desire, with higher rates among older men than among younger men

lifelong male hypoactive sexual desire disorder

In some rare cases, men report never having had much interest in sex, either with other people or privately (e.g., viewing of erotic films, masturbation, or fantasy). These men are diagnosed with lifelong male hypoactive sexual desire disorder, as the disturbance has always been present.

common causes of delirium

Infection : encephalitis, meningitis, sepsis Withdrawal: alcohol, sedatives, analegesics Acute metabolic: electrolyte, renal-hepatic failure, acidosis, alkalosis trauma: pst-surgical, hypo or hyperthermia CNS PAthology: hemorrhage, hydrocephalus,seizure, tumor, vasculitis Hypoxia: carbon monoxide poisioning, hypotension, cardiac arrest Deficiencies: B12, thiamin, severe nutritonal deficiency Endocrinopathies: hyper or hypoadrenocorticism, hyper or hypoglycemia Acute Vacular: hypertension, occlusive stroke Toxins or drugs: medication reaction/change/overdose, toxic exposure Heavy metals: managanese, mercury

Opiods

Intoxication: -Rush of euphoria -Followed by lethargy, slurred speech, cognitive slowing -Severe: coma, seizure, respiratory suppression Withdrawal: -Dysphoria, achiness, nausea, sweating, diarrhea, fever, insomnia --overdoeses can be fatal

Ketamine

Ketamine is a rapid-acting anesthetic that produces hallucinogenic effects ranging from rapture to paranoia to boredom -Ketamine can elicit an out-of-body or near-death experience. It also can render the user comatose. -It has effects similar to those of PCP, including numbness, loss of coordination, a sense of invulnerability, muscle rigidity, Page 411aggressive or violent behavior, slurred or blocked speech, an exaggerated sense of strength, and a blank stare. -Because ketamine is an anesthetic, users feel no pain, which can lead them to injure themselves (NIDA, 2008a). -A ketamine high usually lasts 1 hour but can last as long as 4 to 6 hours, and it takes 24 to 48 hours for users to feel normal again. -Large doses can produce vomiting and convulsions and may lead to oxygen starvation in the brain and muscles. -One gram can cause death. - Ketamine is another date-rape drug used to anesthetize victims (

Biological theories SA

Major neurotransmitter: Dopamine -Indirect effect: Inhibit GABA -GABA inhibits dopamine -Inhibiting GABA → less inhibition of dopamine → more dopamine

Sociocultural factors : Gender ED

Males comprise 10% - 25% of those with AN or BN 10x risk in gay or bisexual men BN more likely Excessive exercise most common compensatory strategy Muscle Dysphoria = preoccupation with muscle size/body mass Form of Body Dysmorphic Disorder = preoccupation with certain parts of the body; perceive parts as irregular or unattractive Commonly co-occurs with eating disordered behavior

symptoms of major NCD

Memory impairment Poor attention Sustained, divided, and selective Perceptual-motor difficulties Executive function impairment - difficulties with planning, initiating and monitoring behavior, abstract reasoning -ex: Driving, cooking, paying bills Aphasia - impairment in production and comprehension of language;Word-finding difficulties Non-fluent & effortful speech; increasing phonological & grammatical errors Apraxia - impaired ability to execute common actions (e.g., putting on a shirt, waving goodbye); NOT a motor or comprehension deficit; deficit in planning motor action Agnosia - difficulties recognizing objects/people

delayed ejaculation

Men with delayed ejaculation experience a marked delay in or the absence of orgasm following the excitement phase of the sexual response cycle in at least 75 percent of sexual encounters. -it is estimated that less than 3 percent of men could be diagnosed with delayed ejaculation

Tests to determine sexual disorders

Men: -to determine whether a man is capable of attaining an erection, clinicians can do a psychophysiological assessment with devices that directly measure men's erections. In a laboratory, strain gauges can be attached to the base and glans of a man's penis to record the magnitude, duration, and pattern of arousal while he watches erotic films or listens to erotic audio recordings Women: , the physical ability to become aroused can be measured with a vaginal photoplethysmograph, a tampon-shaped device inserted into a woman's vagina that records the changes accompanying vasocongestion, the rush of blood to the vagina during arousal

How are Major NCDs Diagnosed?

Most common way: neuropsychological evaluation -Extensive clinical interview -Paper-and-pencil tests that assess learning and memory, language, visuospatial skills, attention, executive function, motor skills, and pre-morbid functioning -Integrate medical history, results from neuroimaging if available, informant reports of behavior -Exceptions to this: huntington's

blackout

Once sober, they may have amnesia, known as a blackout, for the events that occurred while they were intoxicated

nicotine

One of the most addictive substances known, however, is fully legal for use by adults and readily available to adolescents—nicotine nicotine alkaloid found in tobacco; operates on both the central and peripheral nervous systems, resulting in the release of biochemicals, including dopamine, norepinephrine, serotonin, and the endogenous opioids -70 percent of people over age 12 have smoked cigarettes at some time in their life, and about 28 percent currently are smokers -Rates of cigarette use are much higher in Europe and many developing nations -Over two-thirds of people who begin smoking become dependent on nicotine, a rate much higher than is found with most other psychoactive substances

Our bodies produce natural...

Our bodies produce natural opioids, including endorphins and enkephalins, to cope with pain. -Doctors also may prescribe synthetic opioids, such as hydrocodone (Lorcet, Lortab, Vicodin) or oxycodone (Percodan, Percocet, OxyContin) for pain. -The initial symptom of opioid intoxication often is euphoria (see Table 5). People describe a sensation in the abdomen like a sexual orgasm, referring to it as a thrill, kick, or flash. -They may have a tingling sensation and a pervasive sense of warmth. They pass into a state of drowsiness, during which they are lethargic, their speech is slurred, and their mind may be clouded. -They may experience periods of light sleep with vivid dreams. Pain is reduced (Ruiz et al., 2007). A person in this state is referred to as being on the nod.

Paraphilia

Paraphilia-a mental disorder characterized by recurrent intense sexually arousing fantasies, sexual urges, or sexual behaviors lasting at least 6 months involving(1) nonhuman objects, (2) the suffering or humiliation of oneself or one's partner, or (3) children or other non-consenting people Consent, non consent, contact with others, no contact with others.

Psych Theories SA: Behavioral

Positive Reinforcement: Use is rewarding Negative Reinforcement: -Using to stop withdrawal -Using to cope with negative emotions/stress modeling behaviors: how family was

Ppl with ED

Ppl w/ ED: have a lower ideal body weight PPl w/o ED: having a higher ideal body weight

Dementia with Lewy Bodies

Prevalence & Onset: -12-27% of diagnosed dementias -Onset between age 50 and 70 Symptoms: -Fluctuating cognition/consciousness -Rigidity and decreased spontaneous movements (parkinsonism) -Visual hallucinations -Impaired attention -Executive dysfunction -Visuoconstructional deficits Risk factors: -Older age -Other NCDs (e.g., Parkinson's disease; AD) Etiology/Neuropathology: -Accumulation of Lewy bodies, alpha-synuclein protein, in the nuclei of neurons Lewy bodies are abnormal deposits of a protein called alpha-synuclein in the brain that affect the brain's chemistry and cause cognitive impairment and neurodegeneration The fluctuation in mental status can be seen as temporary confusion and disoriented. DLB is diagnosed among individuals in whom neuropsychological deficits present concurrently with motor symptoms or within one year, while dementia associated with PD has been diagnosed among individuals whom present with prominent motor features without prominent neuropsychological deficits.

Vascular Dementia

Prevalence & Onset: -2nd most common cause of dementia -Onset typically between ages 60 and 75 Risk factors: -Hx of stroke -Atherosclerosis (clogged arteries) -Hypertension, high cholesterol -Smoking cigarettes -Obesity -Male -Older age Symptoms: -Slow processing speed -Attention deficits -Executive dysfunction -Psychomotor slowing -Visuoconstructional deficits -Various neuro. symptoms based on site of stroke and penumbra -Depression, anxiety, disinhibition Etiology/Neuropathology: -Cerebrovascular disease & stroke! -Neuroanatomical damage varies depending upon vascular etiology Vascular dementia - dementia due to Cerebrovascular disease --- occurs when the blood supply to areas of the brain is blocked, causing tissue damage in the brain. Neuroimaging techniques, such as PET and MRI, can detect areas of tissue damage and reduced blood flow in the brain, confirming cerebrovascular disease. Sometimes there are neurological signs and symptoms, which can be minimal or severe (e.g., gait and balance problems, abnormal reflex responses, rigidity, visual field deficits, clonus, etc.). not consistent across patients because there based on the site of stoke Pt - symbol search - disinihibition -Cerebrovascular disease occurs when the blood supply to areas of the brain is blocked, causing tissue damage in the brain. Neuroimaging techniques, such as PET and MRI, can detect areas of tissue damage and reduced blood flow in the brain, confirming cerebrovascular disease.

Frontotemporal Dementia

Prevalence & Onset: -4th most common (5-9% of cases) -Among those under 60, 1st or 2nd most common -Onset between ages 50 to 60 Symptoms: -Personality changes -Deficits in language -Executive dysfunction -Semantic knowledge impairments* -Agnosia* Risk factors: -Family hx of dementia -Older age Etiology/Neuropathology: --Degeneration of frontal and/or temporal lobes Changes in personality and social behaviors (e.g., poor social judgment, silliness/ jocularity, impulsivity, disinhibition, decreased hygiene, and/or impersistence). The initial personality changes may present with increasing activity, disinhibition, impulsivity, lack of empathy and reduced regard for others. Alternatively, patients may present as "bored" or "depressed" and exhibit behavioral apathy, motor, iimpersistence, amotivation, and emotionally blunting. FTD has one of the strongest genetic links.

Alzeheimer's disease

Prevalence & Onset: -50% of all dementia cases are pure or "mixed" AD -Onset typically after age 65; prevalence increases with age -When onset before 65, often strong genetic link Symptoms: -Memory impairment -Word-finding difficulties -Visuoconstructional deficits -Social withdrawal -Agitation, confusion* -Emotional blunting* Risk factors: -Older age -Female -Lower edu. level -Apoe4 gene -Down syndrome -Many other factors! Etiology/Neuropathology: -Amyloid plaques and neurofibrillary tangles -Begin in medial temporal lobes (e.g., hippocampi)

treatment and prevention of NCDS

Prevention: Physical & mental activity Avoid risk factors for stroke slowing decline: Cholinesterase inhibitors (e.g., Aricept) NMDA receptor antagonist (e.g., Namenda) symptom management: Antidepressants Antipsychotics Behavioral therapy

sex and aging

Reproductive bias We are sexual from the day we are born till the day we die Sexual dysfunction vs normal aging Ethical Issues: Dementia and consent, sexual policies in nursing homes. Recognizing your own bias and potential ageism.

causes of sexual disorder

Sexual Trauma Restricted Sexual Scripts Health Problems Medication side effects Poor communication Aging Issues within the relationship Mental health Body Image Performance anxiety Narrow view of the definition of sex

sexual sadism disorder

Sexual sadism sexual sadism disorder disorder characterized by obtaining sexual gratification through inflicting pain and humiliation on one's partner -in sexual sadism disorder, a person's sexual fantasies, urges, or behaviors involve inflicting pain and humiliation on his or her sex partner. Further, for the diagnosis to be given, the urges must cause the person significant distress or impairment in functioning or the person must have acted on these urges with a nonconsenting person.

autogynephilia.

Some men with transvestic disorder are sexually aroused by thoughts of being a woman—having a woman's physical traits or functions (for example, breasts or menstruation) or engaging in traditionally feminine tasks, such as sewing. This accompanying arousal is called autogynephilia.

paraphillic disorder

The DSM-5 attempted to tighten the definition of a paraphilic disorder by specifying that the presence of a paraphilia does not constitute a disorder and that a diagnosis can be given only when the behaviors cause the person distress or impairment or cause others harm. -These controversies are difficult to resolve because they involve moral judgments and powerful social norms.

BN -Behaviors

The behaviors people with bulimia use to control their weight include self-induced vomiting; the abuse of laxatives, diuretics, or other purging medications; fasting; and excessive exercise. -Whereas a woman with anorexia nervosa who is absolutely emaciated looks in the mirror and sees herself as obese, a woman with bulimia nervosa has a more realistic perception of her actual body shape and weight.

Sexual Disorders DSM-5

The sexual dysfunction disorders can be roughly divided into disorders of sexual desire and arousal and disorders of orgasm and sexual pain. If a sexual dysfunction is caused by a substance (e.g., alcohol) or medication, it is given the diagnosis substance/medication-induced sexual dysfunction. All sexual dysfunctions (except substance/medication-induced sexual dysfunction) require a minimum duration of approximately 6 months. Disorders of Sexual Interest/Desire or Arousal Female sexual interest/arousal disorder: Persistent lack of, or significantly reduced, interest in sexual activity and/or lack of arousal in response to sexual activity. Male hypoactive desire disorder: Persistently absent or deficient sexual/erotic thoughts or fantasies, or desire for sexual activity. Erectile disorder Recurrent inability to attain or maintain an erection or a marked decrease in erectile rigidity. Disorders of Orgasm or Sexual Pain Female orgasmic disorder: Reduced intensity, or recurrent delay or absence of orgasm during sexual activity Early ejaculation: Recurrent ejaculation within 1 minute of initiation of partnered sexual activity when not desired Delayed ejaculation: Marked delay, infrequency, or absence of ejaculation during sexual encounters Genito-pelvic pain/penetration disorder: Marked difficulties having vaginal penetration; pain or tightening of pelvic floor muscles during penetration

Voyeurism

Voyeurism, as a form of sexual arousal, involves watching another person undress, do things in the nude, or have sex. Voyeurism is probably the most common illegal paraphilia - voyeuristic disorder to be made, the voyeuristic behavior must be repeated over 6 months and must be compulsive. Further, for a diagnosis to be given, the urges must cause the person significant distress or impairment in functioning or the voyeur must have acted on these urges with a nonconsenting person.

female orgasmic disorder

Women with female orgasmic disorder, or anorgasmia, experience markedly reduced intensity of orgasms, or delay or absence of orgasm, after having reached the excitement phase of the sexual response cycle in at least 75 percent of sexual encounters. -Female orgasmic disorder can be either lifelong or acquired. -4.7 percent can be diagnosed with orgasmic disorder -The problem is greater among postmenopausal women, with about one in three reporting some problem reaching orgasm during sexual stimulation

dieting subtype

Women with this dieting subtype are greatly concerned about their body shape and size and try their best to maintain a strict low-calorie diet, but they frequently abandon their regimen and engage in binge eating.

Stimulants

activate the central nervous system, causing feelings of energy, happiness, and power; a decreased desire for sleep; and a diminished appetite -Cocaine and the amphetamines (including the related methamphetamines) are the two types of stimulants associated with severe substance use disorders. -They cause dangerous increases in blood pressure and heart rate, alter the rhythm and electrical activity of the heart, and constrict the blood vessels, which can lead to heart attacks, respiratory arrest, and seizures -In the United States, toxic reactions to cocaine and the amphetamines account for more than a third of drug-related emergency room visits -Prescription stimulants, including Dexedrine and Ritalin, are used to treat asthma and other respiratory problems, obesity, neurological disorders, attention-deficit/hyperactivity disorder -Caffeine and nicotine also are stimulants, and although their psychological effects are not as severe as those of cocaine and amphetamines, these drugs—particularly nicotine—can have long-term negative effect

night eating disorder

an eating disorder characterized by the regular intake of excessive amounts of food after dinner and into the night -People with night eating disorder feel an overwhelming desire to eat at night most nights of the week and are highly distressed that they cannot control their eating behavior. They experience frequent insomnia and may believe they need to eat in order to fall asleep. They typically are not hungry in the morning and skip breakfast - Night eating disorder most often begins in early adulthood and tends to be long-lasting -People with this disorder often are overweight and suffer from depression. Night eating disorder differs from sleep-eating, which can occur in some sleep disorders in that people with night eating disorder are awake and aware when they are eating while people who sleep-eat are not.

Cocaine cocaine

central nervous system stimulant that causes a rush of positive feelings initially but that can lead to impulsiveness, agitation, and anxiety and can cause withdrawal symptoms of exhaustion and depression -crack is a form of freebase cocaine boiled down into tiny chunks, or rocks, and usually smoked.

amenorrhea

cessation of the menses

Caffeine

chemical compound with stimulant effects -with 75 percent of it ingested in coffee (Chou, 1992). A cup of brewed coffee has about 100 milligrams of caffeine, and the average U.S. adult drinks about two cups per day. Other sources include tea (about 40 milligrams of caffeine per 6 ounces), caffeinated soda (45 milligrams per 12 ounces), over-the-counter analgesics and cold remedies (25 to 50 milligrams per tablet), weight-loss drugs (75 to 200 milligrams per tablet), and chocolate and cocoa (5 milligrams per bar) -Caffeine stimulates the central nervous system, increasing the levels of dopamine, norepinephrine, and serotonin. It also increases metabolism, body temperature, and blood pressure. -The DSM-5 specifies that a diagnosis of caffeine intoxication should be given only if an individual experiences significant distress or impairment in functioning as a result of the symptoms. Someone who drinks too much coffee for several days in a row during exam week, for example, might be so agitated that she cannot sit through her exams and so shaky that she cannot drive a car; such a person could be given a diagnosis of caffeine intoxication.

Biological theories SA

chronic use--> alters reward pathways: Reduced DA production DA receptors less sensitive --> need more drugs: Cravings Withdrawal Low mood -negatively reinforces chronic use

Cognitive and CBT: Treatments for paraphilia

cognitive: -may be combined with behavioral interventions designed to help people learn more socially acceptable ways to approach and interact with people they find attractive - Role playing might be used to give the person with a paraphilia practice in approaching another person and eventually negotiating a positive sexual encounter with him or her. -Also, group therapy in which people with paraphilias support one another through changes in their behavior can be helpful. -Multiple studies find that these combined cognitive-behavioral treatments can effectively treat nonpredatory paraphilias in individuals motivated to change -Cognitive-behavioral therapy also has been used to help people with a predatory paraphilia (e.g., pedophilia, exhibitionism, voyeurism) identify and challenge thoughts and situations that trigger their behaviors and serve as justifications for the behaviors (Maletzky, 1998; McConaghy, 1998). -Unfortunately, randomized clinical trials of cognitive-behavioral therapy for sex offenders have found no significant differences in the recidivism rate between men who received the therapy and those who did not

CBT for BN

cognitive: Psycho-education Cognitive restructuring Monitor cognitions behavioral: -Meal planning and eating goals Exposure Forbidden foods Negative emotions Feeling full

male hypoactive sexual desire disorder

condition in which a man's desire for sex is diminished to the point that it causes him significant distress or interpersonal difficulties and is not due to transient life circumstances or

Obesity

condition of being significantly overweight, defined by the Centers for Disease Control as a body mass index (BMI) of 30 or over, where BMI is calculated as weight in pounds multiplied by 703, then divided by the square of height in inches

atypical anorexia nervosa

disorder characterized by all the criteria for anorexia nervosa except that despite significant weight loss, the weight of the affected individual remains within or above the normal range

Benzodiazepines barbiturates

drugs that reduce anxiety and insomnia (such as Xanax, Valium, Halcion, Librium, and Klonopin) drugs used to treat anxiety and insomnia that work by suppressing the central nervous system and decreasing the activity level of certain neurons ((such as Seconal) -depress the central nervous system. Intoxication with and withdrawal from these substances are similar to alcohol intoxication and withdrawal. Users may initially feel euphoric and become disinhibited but then experience depressed moods, lethargy, perceptual distortions, loss of coordination, and other signs of central nervous system depression. -approximately 90 percent of people hospitalized for medical care or surgery are prescribed sedatives -Nationwide studies find that about 9 percent of adults, 9.6 percent of college students, and close to 5 percent of teenagers report using prescription sedatives or tranquilizers in the last year for nonmedical purposes -DSM-5 classifies problematic misuse of these drugs as sedative, hypnotic, or anxiolytic use disorders -Barbiturates and benzodiazepines cause decreases in blood pressure, respiratory rate, and heart rate. -In overdose, they can be extremely dangerous and even cause death from respiratory arrest or cardiovascular collapse. - Overdose is especially likely when people take these substances (particularly benzodiazepines) with alcohol.

Binge-eating disorder binge-eating disorder

eating disorder in which people compulsively overeat either continuously or on discrete binges but do not behave in ways to compensate for the overeating -People with binge-eating disorder may eat continuously throughout the day, with no planned mealtimes . Others engage in discrete binges of large amounts of food, often in response to stress and to feelings of anxiety or depression

bulimia nervosa of low frequency and/or limited duration

eating disorder in which people engage in bingeing and behave in ways to prevent weight gain from the binges, such as self-induced vomiting, excessive exercise, and abuse of purging drugs (such as laxatives) -except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months

anorexia nervosa

eating disorder in which people fail to maintain body weights that are normal for their age and height and have fears of becoming fat, distorted body images, and amenorrhea

ego-dystonic homosexuality

ego-dystonic homosexuality (which meant that the person did not want to be homosexual), as a mental disorder. Gay men, lesbians, and bisexual people argue that their sexual orientation is a natural part of themselves.

exhibitionism

exhibitionism obtains sexual gratification by exposing his or her genitals to involuntary observers, who usually are strangers. -individuals must have acted on their urges to engage in the behavior, or the behavior must cause significant distress or impairment. Most exhibitionists are men, and their targets tend to be women, children, or adolescents -His behavior often is compulsive and impulsive—he feels a sense of excitement, fear, restlessness, and sexual arousal and then feels compelled to find Page 379 relief by exhibiting himself

frotteuristic disorder

frotteuristic disorder frotteuristic disorder disorder characterized by obtainment of sexual gratification by rubbing one's genitals against or fondling the body parts of a non consenting person -individuals must have acted on their urges to engage in the behavior, or the urges must be causing significant distress or impairment. Most people who engage in frotteurism are males, and the onset of the disorder most often is in early adulthood

Erectile disorder

in men, recurrent inability to attain or maintain an erection until the completion of sexual activity -Men with the lifelong form of erectile disorder have never been able to sustain an erection for a desired period of time. -Men with the acquired form of the disorder were able to sustain an erection in the past but no longer can. - criteria for erectile disorder specify that a man must fail to achieve or maintain an erection until completion of sexual activity on all or almost all (75 to 100 percent) occasions over a period of approximately 6 months. -The prevalence of erectile dysfunction increased dramatically with age, with over 77 percent of men over age 75 affected by it

female sexual interest/arousal disorder

in women, recurrent inability to attain or maintain the swelling-lubrication response of sexual excitement -In order to receive this diagnosis, a woman must, for at least 6 months, report at least three of the following symptoms: absent or significantly reduced interest in sexual activity, in sexual or erotic thoughts or fantasies, in initiation of sex or receptiveness to sex, in excitement or pleasure in most sexual encounters, in sexual responsiveness to erotic cues, or in genital or nongenital responses to sexual activity. -In addition, sexual interest or desire and sexual arousal seem to be more intimately connected with each other in women than in men. In some women, sexual interest precedes arousal, while in others it follows it. *It is important to note that female sexual interest/arousal disorder should not be diagnosed simply when there is a difference of interest between sexual partners, and that "most" in the criteria refers to having absent or significantly reduced excitement or pleasure in approximately 75-100% of sexual encounters. *CAN be lifelong or acquired

Fetishistic disorder

involves the use of nonliving objects or nongenital body parts for sexual arousal or gratification. Commonly eroticized body parts include feet, toes, and hair. Soft fetishes are objects that are soft, furry, or lacy, such as frilly lingerie, stockings, and garters. Hard fetishes are objects that are smooth, harsh, or black, such as spike-heeled shoes, black gloves, and garments made of leather or rubber - For the person with a fetish, the desire is for the object itself -Fetishistic disorder is almost exclusively reported in males in clinical samples. Although many men may engage in fetishistic behavior, perhaps less than 1 percent would be diagnosed with a disorder, because their behavior does not cause significant distress or impairment

bulimia nervosa

is uncontrolled eating, or bingeing, followed by behaviors designed to prevent weight gain from the binges -Mild presentations of bulimia include an average of 1-3 episodes of inappropriate compensatory behavior per week, while more extreme forms involve an average of 14 or more episodes per week.

opioids opioids

opioids opioids substances, including morphine and heroin, that produce euphoria followed by a tranquil state; in severe intoxication, can lead to unconsciousness, coma, and seizures; can cause withdrawal symptoms of emotional distress, severe nausea, sweating, diarrhea, and fever -Morphine, heroin, codeine, and methadone

paraphilic disorder

paraphilic disorder paraphilic disorder disorder characterized by atypical sexual activity that involves one of the following: (1) nonhuman objects, (2) nonconsenting adults, (3) the suffering or humiliation of oneself or one's partner, or (4) children -The DSM-5 specifies that paraphilias are not in and of themselves mental disorders, and cannot be diagnosed as a paraphilic disorder. A paraphilic disorder is a paraphilia that is currently Page 376 causing the individual significant distress or impairment, or entails personal harm or risk of harm to others.

pedophilic disorder

pedophilic disorder pedophilic disorder disorder characterized by adult obtainment of sexual gratification by engaging in sexual activities with young children -. To be diagnosed with pedophilic disorder, the individual must have acted on the urges, or the urges must have caused significant distress or impairment. Most people with pedophilic disorder are heterosexual men attracted to young girls (Seto, 2008). Homosexual men with pedophilia typically are attracted to young boys. -DSM-5 recognizes that pedophilic disorder can be exclusive (i.e., attracted only to children) or nonexclusive. -This is especially true in incestuous relationships, in which people with pedophilic disorder may see themselves as simply being good, loving parents. They believe that what they do to the child is not sexual but loving -About two-thirds of victimized children show significant recovery from their symptoms within 12 to 18 months following cessation of the abuse, but significant numbers of abused children continue to experience psychological problems even into adulthood

other specified feeding or eating disorder (EDNOS)

presentations of an eating disorder that cause clinically significant distress or impairment but do not meet the full diagnostic criteria for any of the eating disorders otherwise identified

sexual dysfunctions sexual dysfunctions

problems in experiencing sexual arousal or carrying through with sexual acts to the point of sexual arousal -To qualify for a diagnosis of a sexual dysfunction, the difficulty must be more than occasional or transient, and must cause significant distress or interpersonal difficulty. -The DSM-5 recognizes seven distinct sexual dysfunction disorders, which can roughly be divided into disorders of desire and arousal and disorders of orgasm and sexual pain

performance anxiety

r performance anxiety performance anxiety anxiety over sexual performance that interferes with sexual functioning

early or premature ejaculation early ejaculation

recurrent ejaculation within 1 minute of initiation of partnered sexual activity when not desired, on 75 percent of occasions over a period of at least 6 months. It can be either lifelong or acquired. The DSM-5 also notes that early ejaculation may be applied to nonvaginal sexual activities, -The most common form of orgasmic disorder in males -Men with this disorder persistently ejaculate with minimal Page 365 sexual stimulation before they wish to ejaculate -When the one-minute criterion is applied, the prevalence of men who meet the criteria for the disorder falls to 1-3%

sadomasochism

sadomasochism sadomasochism pattern of sexual rituals between a sexually sadistic "giver" and a sexually masochistic "receiver" -Men are much more likely than women to enjoy sadomasochistic sex, in the roles of both sadist and masochist (Sandnabba et al., 2002). Some women find such activities exciting, but many consent to them only to please their partners or because they are paid to do so, and some are nonconsenting victims of sadistic men.

sexual masochism disorder

sexual masochism sexual masochism disorder disorder characterized by obtaining sexual gratification through experiencing pain and humiliation at the hands of one's partner -In sexual masochism disorder, a person's sexual fantasies, urges, or behaviors involve suffering pain or humiliation during sex, and they must cause the person significant distress or impairment in functioning. In both disorders, distress may manifest as guilt, shame, loneliness, or intense sexual frustration.

Inhalants inhalants

solvents, such as gasoline, glue, or paint thinner, that one inhales to produce a high and that can cause permanent central nervous system damage as well as liver and kidney disease - One group of inhalants is solvents, including gasoline, glue, paint thinners, and spray paints. -The chemicals rapidly reach the lungs, bloodstream, and brain. Another group of inhalants is medical anesthetic gases, such as nitrous oxide ("laughing gas"), which also can be found in whipped cream dispensers and products that boost octane levels. -Nitrites, another class of inhalants, dilate blood vessels and relax muscles and are used as sex enhancers. Illegally packaged nitrites are called "poppers" or "snappers" on the street -In diagnosing an inhalant use disorder, DSM-5 recommends specifying the particular substance involved when possible (e.g., solvent use disorder). - less than 2 percent reported ever having used inhalants, with about 75 percent of users being male (Howard et al., 2010).Page 410 Adolescents report higher levels of use, with about 10 percent of teenagers reporting ever having used inhalants -Chronic users of inhalants may have a variety of respiratory irritations and rashes. -Inhalants can cause permanent damage to the central nervous system, including degeneration and lesions of the brain; this damage can lead to cognitive deficits, including severe dementia. -Recurrent use can also cause hepatitis and other liver and kidney disease. Death can occur from depression of the respiratory or cardiovascular system. -Sudden sniffing death is due to acute heartbeat irregularities or loss of oxygen. -Users sometimes suffocate when they fall unconscious with an inhalant-filled plastic bag over their nose and mouth. -Users also can die or be seriously injured when the inhalants induce the delusion that they can do fantastic things, such as fly, and they then jump off a cliff or a tall building to test their perceived ability

spectatoring

spectatoring: They anxiously attend to reactions and performance during sex as if they were spectators rather than participants

Masters and johnsons sexual response cycle

starts with desire-->arousal-->plateau-->orgasm--> resolution

cannabis

substance that causes feelings of well-being, perceptual distortions, and paranoid thinking -Cannabis is the most commonly used illegal drug, with 42 percent of adults in the United States and 23 percent of Europeans having used the drug - About half of older adolescents and young adults say they have used cannabis at some time in their life, and about 20 percent have used it in the last year -Intoxication usually begins with a "high" feeling of well-being, relaxation, and tranquility (see Table 7). -Users may feel dizzy, sleepy, or dreamy. They may become more aware of their environment, and everything may seem funny. -They may become grandiose or lethargic. People who already are very anxious, depressed, or angry may become more so (Ruiz et al., 2007). -The symptoms of cannabis intoxication may develop within minutes if the drug is smoked but may take a few hours to develop if it is taken orally. -The acute symptoms last 3 to 4 hours, but some symptoms may linger or recur for 12 to 24 hours. -Although people often view cannabis as a benign or safe drug, it can significantly affect cognitive and motor functioning. -People taking cannabis may believe they are thinking profound thoughts, but their short-term memory is impaired to the point that they cannot remember thoughts long enough to express them in sentences. - Motor performance also is impaired. People's reaction times are slower and their concentration and judgment are deficient, putting them at risk for accidents. -The cognitive impairments caused by cannabis can last up to a week after heavy use stops (Pope et al., 2001). These effects appear to be greater in women than in men (Pope et al., 1997). -The physiological symptoms of cannabis intoxication include increased or irregular heartbeat, increased appetite, and dry mouth. - Cannabis smoke is irritating and increases the risk of chronic cough, sinusitis, bronchitis, and emphysema. -It contains even larger amounts of known carcinogens than does tobacco and thus creates a high risk of cancer. -The chronic use of cannabis lowers sperm count in men and may cause irregular ovulation in women (Ruiz et al., 2007). At moderate to large doses, cannabis users experience perceptual distortions, feelings of depersonalization, and paranoid thinking. -Several studies have found that cannabis use significantly increases the risk of developing a psychotic disorder -Physical tolerance to cannabis can develop, with users needing greater amounts to avoid the symptoms of withdrawal, which include loss of appetite, hot flashes, runny nose, sweating, diarrhea, and hiccups (Kouri & Pope, 2000). -Seven to 10 percent of the U.S. population would qualify for a diagnosis of cannabis use disorder

substance-induced sexual dysfunction

substance-induced sexual dysfunction substance-induced sexual dysfunction problems in sexual functioning caused by substance use

hallucinogens

substances, including PCP, LSD and MDMA (ecstasy), that produce perceptual illusions and distortions even in small doses

synesthesia & psychedelic

synesthesia, the overflow from one sensory modality to another. People say they hear colors and see sounds. They feel at one with their surroundings, and time seems to pass very slowly. -Others feel a sense of detachment and a great sensitivity for art, music, and feelings. These experiences lent the drugs the label psychedelic

Treatments: Gender Dysphoria

three principal treatments for gender dysphoria: (1) cross-sex hormone therapy, (2) full-time real-life experience in the desired gender role, and (3) sex reassignment surgery, which provides the genitalia and secondary sex characteristics (e.g., breasts) of the gender with which the individual identifies -Estrogens are used in feminizing hormone therapy for male-to-female individuals with gender dysphoria. -Testosterone Page 385 is used to induce masculinization in female-to-male individuals with gender dysphoria. -Hormone therapy may be given to individuals regardless of whether they wish to undergo sex reassignment surgery. -Before undergoing sex reassignment surgery, individuals spend up to a year or more living full-time in the gender role they seek. Some choose to live full-time in their desired gender role even if they do not undertake sex reassignment surgery or hormone therapy -Follow-up studies suggest that the outcome tends to be positive when patients are carefully selected for gender reassignment procedures based on their motivation for change and their overall psychological health and are given psychological counseling to help them through the change Children: -Treatment of children and adolescents with gender dysphoria focuses primarily on psychotherapy to help them clarify their gender identity and deal with interpersonal and psychological issues created by that identity. Most clinicians consider hormone therapies and surgeries unacceptable for children and adolescents because they cannot give fully informed consent for such procedures

binge/purge type of anorexia nervosa binge/purge type of anorexia nervosa

type of anorexia nervosa in which periodic bingeing or purging behaviors occur along with behaviors that meet the criteria for anorexia nervosa -This disorder is different from bulimia nervosa in that people with the binge/purge type of anorexia nervosa continue to be substantially below a healthy body weight, whereas people with bulimia nervosa typically are at normal weight or somewhat overweight.

restricting type of anorexia nervosa restricting type of anorexia nervosa

type of anorexia nervosa in which weight gain is prevented by refusal to eat

partial-syndrome eating disorders

—syndromes that don't meet the full criteria for anorexia nervosa or bulimia nervosa -Adolescents with partial-syndrome eating disorders may binge a couple of times a month but not every week. They may be underweight but not severely so. They tend to be highly concerned with their weight and judge themselves on the basis of their weight, but their symptoms don't add up to a full-blown eating disorder.

Defining Abnormal Drinking

• All depends on context • Alcoholic hepatitis: 20-30s die of it, drink a lot liver gets inflammed and die M F Heavy drinking 2+/day 1+/day Binge Drinking 5+/hrs 4+/hrs Rates in US: -Binge drinking in frats the highest (70%) - Binge drinking college campus (35%) -Binge drink monthly (20%) -heavy drinkers (10%)