Abnormal Psych Ch. 10 Sexuality/Gender

Rape

Forced sexual intercourse with a nonconsenting person. Note that the legal definition of rape varies from state to state. Rape survivors often experience a range of health problems, both psychological and physical. They report eating problems, cystitis, headaches, irritability, mood changes, anxiety and depression, and menstrual irregularity. Survivors may become withdrawn, sullen, and mistrustful.

Erectile disorder (ED)

(Disorder of Interest/Arousal) A sexual dysfunction in males characterized by difficulty in achieving or maintaining erection during sexual activity.

Delayed ejaculation

(Orgasm disorder) A marked delay in reaching ejaculation (in men), or an infrequency or absence of ejaculation.

Premature ejaculation

(Orgasm disorder) A type of sexual dysfunction characterized by a recurrent pattern of ejaculation occurring within about one minute of vaginal penetration and before the man desires it.

Female orgasmic disorder

(Orgasm disorder) A type of sexual dysfunction involving marked delay in reaching orgasm (in women) or an infrequency or absence of orgasm. The DSM-5 expanded the criteria to include cases in which women experience a sharp reduction in the intensity of orgasmic sensations.

Vaginismus

A condition in which the muscles surrounding the vagina involuntarily contract whenever vaginal penetration is attempted, making sexual intercourse painful or impossible. The pain cannot be explained by an underlying medical condition, and so is believed to have a psychological component.

Genito-pelvic pain/penetration disorder

A disorder that applies to women who experience sexual pain and/or difficulty engaging in vaginal intercourse or penetration.

Treatment of Paraphilias

A major problem with treating paraphilias is that many people who engage in these behaviors are not motivated to change. They may not want to alter their behavior unless they believe that treatment will relieve them from serious punishment, such as imprisonment or loss of a family life. Consequently, they don't typically seek treatment on their own.

Transvestism

A paraphilia (also called transvestic fetishism) in which individuals have recurrent and powerful urges, fantasies, or behaviors related to cross-dressing and are sexually aroused by cross-dressing. Although other men with fetishes can be satisfied by handling objects such as women's clothing while they masturbate, transvestite men want to wear them. They may wear full feminine attire and makeup or favor one particular article of clothing, such as women's stockings.

Hypoxyphilia

A paraphilia in which a person seeks sexual gratification by being deprived of oxygen by means of using a noose, plastic bag, chemical, or pressure on the chest.

Effects of Sexual Abuse on Children

A recent international study showed that nearly 8% of adult males and nearly 20% of adult females reported some form of sexual abuse before the age of 18. The typical abuser is not the proverbial stranger lurking in the shadows, but a relative or step-relative of the child, a family friend, or a neighbor—someone who has held and then abused the child's trust. Sexual abuse can inflict great psychological harm, whether it is perpetrated by a family member, acquaintance, or stranger. A study in the UK showed children of sexual abuse were between 6 and 10 times more likely to engage in suicidal behavior. Younger children sometimes react with tantrums or aggressive or antisocial behavior. Older children often develop substance abuse problems. Abused children may become prematurely sexually active or promiscuous in adolescence and adulthood. Psychological problems may continue into adolescence and adulthood in the form of posttraumatic stress disorder, anxiety, depression, substance abuse, and relationship problems.

Sexual masochism

A type of paraphilia characterized by strong and recurrent sexual urges, fantasies, or behaviors in which the person becomes sexually aroused by being humiliated, bound, flogged, or made to suffer in other ways.

Fetishism

A type of paraphilia charactertized by recurrent, powerful sexual urges, fantasies, or behaviors involving inanimate objects, such as an article of clothing.

Pedophilia

A type of paraphilia involving recurrent and powerful sexual urges or fantasies or behaviors involving sexual activity with children (typically 13 years old or younger). To be diagnosed with pedophilia, the person must be at least 16 years of age and at least 5 years older than the child or children toward whom the person is sexually attracted or has victimized. In some cases of pedophilia, the person is attracted only to children. In other cases, the person is attracted to adults as well. The word pedophilia derives from the Greek paidos, meaning "child."

Frotteurism

A type of paraphilia involving recurrent, powerful sexual urges, fantasies, or behaviors in which the person becomes sexually aroused by rubbing against or touching a nonconsenting person. Frotteurism, also called "mashing," often occurs in crowded places, such as subway cars, buses, or elevators. The rubbing or touching, not the coercive aspect of the act, sexually arouses the man. The French word frottage refers to the artistic technique of making a drawing by rubbing against a raised object.

Voyeurism

A type of paraphilia involving strong and recurrent sexual urges, fantasies, or behaviors in which the person becomes sexually aroused by watching unsuspecting people, generally strangers, who are naked, disrobing, or engaging in sexual activity. The voyeur usually masturbates while watching or while fantasizing about watching. Peeping may be the voyeur's only sexual outlet. Some people engage in voyeuristic acts in which they place themselves in risky situations. The prospects of being discovered or injured apparently heighten their excitement.

Sexual sadism

A type of paraphilia or sexual deviation characterized by recurrent, powerful sexual urges, fantasies, or behaviors in which the person becomes sexually aroused by inflicting physical or psychological suffering or humiliation on another person.

Gender Dysphoria

A type of psychological disorder in which people experience significant personal distress or impaired functioning as a result of a conflict between their anatomic sex and their gender identity. Not all people with transgender identity have gender dysphoria or any other diagnosable disorder. Although the prevalence rate of gender dysphoria is unknown, the disorder is certainly uncommon. It is believed to often begin in childhood. GID takes many paths. It can end by adolescence, with the child's becoming more accepting of her or his gender identity, or it may persist into adolescence or adulthood.

Biological Perspectives on Sexual Dysfunction

Biological factors such as low testosterone levels and disease can dampen sexual desire and reduce responsiveness. The male sex hormone testosterone plays a pivotal role in energizing sexual desire and sexual activity in both men and women. The adrenal glands and ovaries are the sites where testosterone is produced in women. Cardiovascular problems involving impaired blood flow both to and through the penis can cause erectile disorder—a problem that becomes more common as men age. Erectile disorder may share common risk factors with cardiovascular disorders (heart and artery diseases) which should alert physicians that erectile dysfunction may be a sign of underlying cardiovascular disorders that need to be medically evaluated. Erectile dysfunction is also more common in obese men (as are cardiovascular problems). Men with diabetes mellitus also stand an increased risk of ED. Erectile disorder and delayed ejaculation may also result from multiple sclerosis (MS), a disease in which nerve cells lose the protective coatings that facilitate the smooth transmission of nerve impulses. Chronic kidney disease, hypertension, cancer, and emphysema can also impair erectile response, as can endocrine disorders that suppress testosterone production. Depressant drugs such as alcohol, heroin, and morphine can reduce sexual desire and impair sexual arousal. Narcotics, such as heroin, also depress testosterone production, which can diminish sexual desire and lead to erectile failure.

Cognitive-Behavioral Therapy of Sexual Disorder

Cognitive-behavioral therapy is briefer and focuses directly on changing problem behavior. Cognitive-behavioral therapy includes a number of specific techniques, such as aversion therapy, covert sensitization, and social skills training, to help eliminate paraphiliac behaviors and strengthen appropriate sexual behaviors. In many cases a combination of methods is used. The goal of aversion therapy is to induce a negative emotional response to paraphiliac stimuli or fantasies.

Biological Treatments of Sexual Dysfunction

Erectile disorder frequently has organic causes, so it is not surprising that treatment is becoming increasingly medicalized. Drugs that increase blood flow to the penis, such as Viagra, are successful in producing erections in a majority of men suffering from erectile disorder. Surgery may be effective in rare cases in which blocked blood vessels prevent blood flow to the penis, or in which the penis is structurally defective.

Biological Perspectives in Fetish

Investigators find evidence of higher-than-average sex drives in men with paraphilias, as evidenced by a higher frequency of sexual fantasies and urges and a shorter refractory period after orgasm by masturbation (i.e., length of time needed to become rearoused). Some professionals refer to the heightened sex drive that may apply to some cases of paraphilia as hypersexual arousal disorder—the opposite of hypoactive sexual desire disorder. Other investigators find differences between paraphilic men and male control subjects in brain wave patterns in response to paraphilic (fetishistic and sadomasochistic) images and control images (nude women, genital intercourse, oral sex).

Telephone scatologia

Making obscene phone calls

Gender identity

One's psychological sense of being female or being male.

Sex Reassignment Surgery

People who undergo sex-reassignment surgery can participate in sexual activity and even reach orgasm, but they cannot conceive or bear children because they lack the internal reproductive organs of their newly reconstructed sex. Investigators generally find positive postoperative adjustment of transsexuals. Men seeking sex-reassignment outnumber women by perhaps 3 to 1.

Sexual dysfunctions

Persistent or recurrent problems with sexual interest, arousal, or response. (lifetime vs. acquired; situational vs. generalized) Cases of sexual dysfunction that have existed for the individual's lifetime are called lifetime dysfunctions. In situational dysfunctions, the problems occur in some situations (for example, with one's spouse), but not in others (for example, with a lover or when masturbating), or at some times but not others.

Psychological Perspectives on Sexual Dysfunction

Physically or psychologically traumatic sexual experiences may lead the person to respond to sexual contact with anxiety rather than arousal or pleasure. Conditioned anxiety resulting from a history of sexual trauma or rape may lead to problems with sexual arousal or achieving orgasm or lead to pain in women during penetration. Women with problems becoming sexually aroused may harbor deep-seated anger and resentment toward their partners. Other psychologically based causes of sexual arousal disorder, especially in women, include guilt about sex and ineffective stimulation by the partner. Sexual trauma early in life may make it difficult for men or women to respond sexually when they develop intimate relationships. Other psychological problems, such as depression and anxiety, can also result in sexual dysfunctions involving impaired sexual interest, arousal, or response. Another principal form of anxiety in sexual dysfunctions is performance anxiety, which represents an excessive concern about the ability to perform successfully. Relationship problems can also contribute to sexual dysfunctions, especially when they involve long-simmering resentments and conflicts. Cognitive theorists, such as Albert Ellis (1977b), point out that underlying irrational beliefs and attitudes can contribute to sexual dysfunctions. Consider two such irrational beliefs: (a) we must have the approval at all times of everyone who is important to us; and (b) we must be thoroughly competent at everything we do. If we cannot accept the occasional disappointment of others, we may catastrophize the significance of a single frustrating sexual episode. If we insist that every sexual experience be perfect, we set the stage for inevitable failure.

Psychoanalysis of Sexual Disorder

Psychoanalysts attempt to bring childhood sexual conflicts (typically of an Oedipal nature) into awareness so they can be resolved in the light of the individual's adult personality. Favorable results from individual case studies appear in the literature from time to time, but there is a dearth of controlled investigations to support the efficacy of psychodynamic treatment of paraphilias.

Theoretical Perspectives on Transgender Identity

Psychodynamic theorists point to extremely close mother-son relationships, empty relationships with parents, and fathers who were absent or detached. These family circumstances may foster strong identification with the mother in young males, leading to a reversal of expected gender roles and identity. Girls with weak, ineffectual mothers and strong masculine fathers may overly identify with their fathers and develop a psychological sense of themselves as "little men." Learning theorists similarly point to father absence in the case of boys—to the unavailability of a strong male role model. The development of transgender identity may result from the effects of male sexual hormones on the developing brain during prenatal development. A combination of genetic and hormonal influences may create a disposition that interacts with early life experiences in leading to the development of transgender identity.

Psychological Perspectives of Fetish

Psychodynamic theorists see many of the paraphilias as defenses against leftover castration anxiety from the phallic period of psychosexual development. In Freudian theory, the young boy develops a sexual desire for his mother and perceives his father as a rival. Castration anxiety—the unconscious fear that the father will retaliate by removing the organ that has become associated with sexual pleasure through masturbation—motivates the boy to give up his incestuous yearnings for his mother and identify with the aggressor, his father. Learning theorists explain paraphilias in terms of conditioning and observational learning. Some object or activity becomes inadvertently associated with sexual arousal. The object or activity then gains the capacity to elicit sexual arousal. For example, sex researcher June Reinisch (1990) speculates that the earliest awareness of sexual arousal or response (such as erection) may have been connected with rubber pants or diapers.

Sadomasochism

Refers to a practice of mutually gratifying sexual interactions between partners involving both sadistic and masochistic acts. The clinical diagnosis of sexual masochism or sadism is not brought to bear unless such people become distressed by their behavior or fantasies, or these urges and fantasies lead to problems with other people.

Low Sexual Drive or Desire

Sex therapists may try to help people with low sexual desire kindle their sexual appetite through the use of self-stimulation (masturbation) exercises together with erotic fantasies. When working with couples, therapists prescribe mutual pleasuring exercises the couple can perform at home or encourage them to expand their sexual repertoire to add novelty and excitement to their sex life. The use of a testosterone gel patch attached to the skin for administering the hormone can increase sexual desire and improve sexual function in men with abnormally low levels of testosterone.

Disorders of Sexual Arousal

Sexual arousal results in the pooling of blood in the genital region, causing erection in the male and vaginal lubrication in the female. These changes in blood flow occur as a reflexive response to sexual stimulation; they cannot be willed. Women who have difficulty becoming sexually aroused and men with erectile problems are first educated to the fact that they need not "do" anything to become aroused.

Types of Sexual Dysfunction

Sexual dysfunctions affect 40% to 45% of adult women and 20% to 30% of adult men at some point in their lives (Lewis et al., 2010). We can group sexual dysfunctions within three general categories: 1. Problems with sexual interest, desire, or arousal. 2. Problems with orgasmic response. 3. Problems involving pain during sexual intercourse or penetration (in women).

Zoophilia

Sexual urges or fantasies involving contact with animals

Necrophilia

Sexual urges or fantasies involving contact with corpses

Partialism

Sole focus on part of the body, such as the breasts

Types of paraphilias

Some paraphilias are relatively harmless and victimless. Among these are fetishism and transvestic fetishism. Others, such as exhibitionism, pedophilia, and voyeurism have unwilling victims. The most harmful paraphilia is sexual sadism when acted out with a nonconsenting partner.

Exhibitionism

Strong and recurrent urges, fantasies, or behaviors of exposing of one's genitals to unsuspecting individuals for the purpose of sexual arousal. Typically, the person seeks to surprise, shock, or sexually arouse the victim. The person may masturbate while fantasizing about or actually exposing himself (almost all cases involve men). The victims are almost always women.

Types of Rape

The main types of rape include stranger rape, acquaintance rape, marital rape, and male rape. Stranger rape is committed by an assailant (or assailants) who is not acquainted with the victim. Acquaintance rapes - rapes committed by people known by the victim. Date rape is a kind of acquaintance rape. Investigators report that 10% to 14% of married women suffer marital rape.

Transgender identity

The psychological sense of belonging to one gender while possessing the sexual organs of the other.

Disorders of Interest and Arousal

These disorders involve deficiencies in either sexual interest or arousal. These disorders involve deficiencies in either sexual interest or arousal. Men with male hypoactive sexual desire disorder. (MHSDD) persistently have little, if any, desire for sexual activity or may lack sexual or erotic thoughts or fantasies. Women with female sexual interest/arousal disorder (FSIAD) experience either a lack of, or greatly reduced level of, sexual interest, drive, or arousal. Clinicians do not necessarily agree on criteria for determining the level of sexual desire considered "normal." Sex researchers continue to debate how to define sexual dysfunctions, especially in women. For example, some researchers argue that labeling a lack of sexual desire in women as a dysfunction imposes on women a male model of what should be normal. Problems with sexual arousal in men typically takes the form of failure to achieve or maintain an erection sufficient to engage in sexual activity through completion.

Genital Pain Disorders

Treatment of painful intercourse generally requires medical intervention to determine and treat any underlying physical problems, such as urinary tract infections, that might be causing pain. Vaginismus is a conditioned reflex involving the involuntary constriction of the vaginal opening and represents a psychologically based fear of penetration, rather than a medical problem. Treatment for vaginismus may include a combination of behavioral methods, including relaxation techniques and the gradual exposure method to desensitize the vaginal musculature to penetration by having the woman over the course of a few weeks insert fingers or plastic dilators of increasing sizes into the vagina while she remains relaxed.

Treatment of Sexual Dysfunctions

Until the groundbreaking research of the famed sex researchers William Masters and Virginia Johnson in the 1960s, there was no effective treatment for most sexual dysfunctions. Psychoanalytic therapy approached sexual dysfunctions indirectly. It was assumed that sexual dysfunctions represented underlying conflicts, so treatment focused on resolving those conflicts through psychoanalysis. Most contemporary sex therapists assume sexual dysfunctions can be treated by directly modifying the couple's sexual interactions. Pioneered by Masters and Johnson (1970), sex therapy uses cognitive-behavioral techniques in a brief therapy format to help individuals enhance their sexual competencies (sexual knowledge and skills) and relieve performance anxiety. When feasible, both partners are involved in therapy. In some cases, however, individual therapy may be preferable, as we shall see. Sexual problems are often embedded in a context of troubled relationships. Therapists may also use couple therapy to help couples share power in their relationships, improve communication skills, and negotiate differences. Significant changes have occurred in the treatment of sexual dysfunctions in the past 25 years. Today, there is greater emphasis on biological or organic factors in the development of sexual problems and the use of medical treatments, such as the drug sildenafil (Viagra), to treat male erectile dysfunction.

Paraphilias

Unusual or atypical patterns of sexual attraction that involve sexual arousal in response to atypical stimuli. These atypical patterns of sexual arousal may be labeled by others as deviant, bizarre, or "kinky". The range of atypical stimuli include nonhuman objects such as underwear, shoes, leather, or silk, to humiliation or experience of pain in oneself or one's partner, or children and other persons who do not or cannot grant consent. The DSM-5 includes a class of mental disorders called paraphilic disorders. For a paraphilic disorder to be diagnosed, the paraphilia must cause personal distress or impairment in important areas of daily functioning, or involve behaviors presently or in the past in which satisfaction of the sexual urge involved harm, or risk of harm, to other people.

Sociocultural Perspectives on Sexual Dysfunction

Women who harbor stereotypical attitudes toward female sexuality are unlikely to become aware of their own sexual potential. Sexual anxieties may transform negative expectations into self-fulfilling prophecies. Sexual dysfunctions in men, too, may be linked to extremely strict sociocultural beliefs and sexual taboos. In India, cultural beliefs that link the loss of semen to a draining of the man's life energy underlie the development of Dhat syndrome, an irrational fear of loss of semen.

Disorders of Orgasm

Women with orgasmic disorder often harbor underlying beliefs that sex is dirty or sinful. They may have been taught not to touch themselves. They feel anxious about sex and have not learned, through trial and error, what kinds of sexual stimulation will arouse them and help them reach orgasm. Masters and Johnson preferred working with the couple in cases of female orgasmic dysfunction, but other sex therapists prefer to work with the woman individually by directing her to practice masturbation in private. Directed masturbation provides women opportunities to learn about their own bodies at their own pace and has a success rate of 70% to 90%. It frees women of the need to rely on or please partners. Once women can reliably masturbate to orgasm, couple-oriented treatment may facilitate transfer of training to orgasm with a partner. Delayed ejaculation has received little attention in the clinical literature, but may involve psychological factors such as fear, anxiety, hostility, and relationship difficulties. The standard treatment, barring underlying organic problems, focuses on increasing sexual stimulation and reducing performance anxiety. The most widely used behavioral approach to treating premature (early) ejaculation is called the stop-start or stop-and-go technique.

Biomedical Therapies of Sexual Disorder

sSRIs are often helpful in treating obsessive-compulsive disorder, a psychological disorder characterized by recurrent obsessions and compulsions. People with paraphilias often experience obsessive thoughts or images of the paraphilic object or stimulus and many also feel compelled to repeatedly carry out the paraphilic acts. Antiandrogen drugs reduce levels of testosterone in the bloodstream. Antiandrogens do not completely eliminate paraphiliac urges, nor do they change the types of erotic stimuli to which the man is attracted.