7/3/2013 ABNORMAL PSYCHOLOGY SEVENTH EDITION CHAPTER TWELVE CHAPTER OUTLINE. Sexual and Gender Identity Disorders. Oltmanns and Emery

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1 ABNORMAL PSYCHOLOGY SEVENTH EDITION Oltmanns and Emery PowerPoint Presentations Prepared by: Ashlea R. Smith, Ph.D. This multimedia and its contents are protected under copyright law. The following are prohibited by law: any public performance or displays, including transmission of any image over a network, preparation of any derivative work, including the extraction, in whole or in part, of any images, any rental, lease, or lending of the program. CHAPTER TWELVE Sexual and Gender Identity Disorders CHAPTER OUTLINE Sexual Dysfunctions Paraphilias Gender Identity Disorders 1

2 OVERVIEW Masters and Johnson described human sexual response cycle in terms of a sequence of overlapping phases: Excitement Orgasm Resolution Sexual dysfunctions can involve disruption of any stage of the sexual response cycle. The classification of sexual disorders was revised dramatically in the U.S. and Western Europe in the twentieth century. BRIEF HISTORICAL PERSPECTIVE Early approaches to sexual behavior were influenced by religion and culture. Purpose of sexual behavior was biological reproduction anything from that was considered psychopathology. In there were changes in societal views of sexual behavior. Alfred Kinsey ( ) National Health and Social Life Survey (NHLS) Asked about masturbation, and four basic techniques involving partners: vaginal intercourse, fellatio, cunnilingus, and intercourse. Masturbation is relatively common. Most heterosexual intercourse is vaginal. Most sexual activity is monogamous. 2

3 FIGURE 12-1 Sexual Response in Primary Partnership During Previous Year FIGURE 12 2 Sexual Satisfaction in Primary Partnership During the Previous Year SEXUAL DYSFUNCTIONS Symptoms Diagnosis DSM-IV-TR divides sexual dysfunctions into several types. Diagnostic criteria less specific There must be demonstration that the problem leads to marked distress or interpersonal difficulties. 3

4 SEXUAL DYSFUNCTION HYPOACTIVE SEXUAL DESIRE DISORDER Lack of interest in sex must be persistent and pervasive Most males and females seeking treatment for hypoactive sexual desire report other forms of sexual dysfunction SEXUAL AVERSION DISORDER Some people develop an active aversion to sexual stimuli and begin to avoid sexual situations altogether Stronger than a simple lack of interest SEXUAL DYSFUNCTION MALE ERECTILE DISORDER Difficulties in obtaining or maintaining an erection May feel subjectively aroused, but the vascular mechanisms fail Can be transient or chronic FEMALE SEXUAL AROUSAL DISORDER When the female cannot achieve or maintain genital response Desire is present, but physiological responses are inhibited (Meston & Bradford, 2007) SEXUAL DYSFUNCTION PREMATURE EJACULATION Referred to as early ejaculation Among men suffering from lifelong premature ejaculation, 90% ejaculate within 1 minute after insertion of the penis into the vagina (Waldinger, 2009) FEMALE ORGASMIC DISORDER May have strong desire, find great pleasure in sexual foreplay, and show signs of arousal, but cannot reach orgasm. Generalized or situational difficulties 4

5 SEXUAL DYSFUNCTION PAIN DURING SEX Dyspareunia can occur in men or women Mild to searing pain Many women develop a lack of interest or aversion to sex Vaginismus HYPERSEXUAL DISORDER No diagnosis in the DSM-IV-TR; excessive sexual drive categorized in the ICD-10 Obsessive thoughts about sexual encounters, guilt, reckless behaviors SEXUAL DYSFUNCTION Frequency Some forms of sexual dysfunction are relatively common (Christensen et al., 2011). Obvious gender differences: Men: primarily premature ejaculation Women: all other forms of sexual dysfunction reported more often by women FIGURE 12 3 Prevalence of Sexual Dysfunctions 5

6 SEXUAL DYSFUNCTIONS SEXUAL BEHAVIOR ACROSS THE LIFE SPAN Sexual activity changes with age Rates of inactivity decreases significantly for women Differences between young and older people is a matter of degree CROSS-CULTURAL COMPARISONS Cultural and ethnic differences have been reported for sexual practices, beliefs about sexuality, and patterns of sexual decision-making Cross-cultural studies of prevalence rates for specific sexual dysfunctions have not been reported SEXUAL DYSFUNCTIONS BIOLOGICAL FACTORS Sexual desire is influenced by sex hormones for both men and women. Testosterone: important for male sexual desire Many cases of erectile dysfunction related to neurological, vascular or hormonal impairment BIOLOGICAL FACTORS Various types of neurological disorders, pelvic disease, and hormonal dysfunction can interfere with the process of vaginal swelling and lubrication Alcohol and drugs can inhibit orgasm SEXUAL DYSFUNCTIONS PSYCHOLOGICAL FACTORS Sexual desire and arousal are determined, in part, by mental scripts learned throughout childhood and adolescence Personal meaning Beliefs toward sexuality PSYCHOLOGICAL FACTORS Culturally determined attitudes can have a dramatic impact on women s ability to become sexually aroused Couples that have communication problems, power conflicts, absence of intimacy and trust may have difficulties 6

7 What are the primary targets of psychological approaches to treating sexual dysfunction? Sensate focus Education and cognitive restructuring Communication training SEXUAL DYSFUNCTIONS BIOLOGICAL TREATMENTS Primarily medications Erectile dysfunction: Viagra, Cialis, Levitra Penile implants BIOLOGICAL TREATMENTS Medications for women being developed to increase sexual desire: Intrisia Symptoms DSM-IV-TR requires that: The erotic preoccupation must have lasted at least six months The person s paraphilic urges lead to clinically significant distress or impairment Urges have become compulsory Urges produce sexual dysfunction Urges require the participation of nonconsenting persons 7

8 TABLE 12 2 Other Types of Paraphilias FETISHISM The association of sexual arousal with nonliving objects. Wide range of objects, but most are for women s underwear, shoes, rubber, or leather TRANSVESTIC FETISHIM Cross-dressing for the purpose of sexual arousal Primarily among heterosexual men; should not be confused with drag queens SEXUAL MASOCHISM Recurrent, intense sexually arousing fantasies, urges, or impulses involving being humiliated, beaten, bound, or otherwise made to suffer (Hucker, 2008; Krueger, 2010) People may act on these impulses by themselves or with a partner SEXUAL SADISM Intense, sexually arousing fantasies, urges, or behaviors that involve the psycho-logical or physical suffering of a victim Fantasies often involve asserting dominance over the victim; the experience of power and control may be as important as inflicting pain (Hucker,

9 EXHIBITIONISM About half of these men have erections while exposing themselves, and some masturbate at the time; others usually masturbate shortly after the experience while fantasizing about the victim s reaction Usually involves a desire to shock the observer, but sometimes they harbor fantasies that the involuntary observer will become sexually aroused VOYEURISM The act of observing an unsuspecting person, usually a stranger, who is naked, in the process of disrobing, or engaging in sexual activity (Metzl, 2004) The process of peeping is arousing in its own right FROTTERURISM Becoming sexually aroused by touching or rubbing his genitals against other, nonconsenting people PEDOPHILIA Persistently engaging in sexual activities with children Over 100,000 children are referred to child-protective services because of suspected child abuse Includes a great variety of behaviors and sexual preference (Cohen & Galynker, 2002; Fagan et al., 2002) RAPE AND SEXUAL ASSAULT Acts involving nonconsensual sexual penetration obtained by physical force, by threat of bodily harm, or when the victim is incapable of giving consent by virtue of mental illness, mental retardation, or intoxication (Goodman, Koss, & Russo, 1993) RAPE AND SEXUAL ASSAULT Nation Victim Center (1992) reported 14% of adult women have been raped Acquaintance rapes Types of rapists Sadistic Nonsadistic Vindictive Opportunistic 9

10 FIGURE 12 4 Forced Sex Relationships of Perpetrator to Victim FIGURE 12 5 Overlap Among Three Major Types of Paraphilias BIOLOGICAL FACTORS Some focus on the endocrine system Elevated levels of testosterone Neurological abnormalities in the limbic system Pedophiles and exhibitionists show subtle dysfunction in the left temporal lobe SOCIAL FACTORS Distortions in the normal mating process courtship disorders Likely to be problems in social relationships and impaired inter-personal skills 10

11 AVERSION THERAPY The rationale is to create a new association with the inappropriate stimulus so that the stimulus will no longer elicit sexual arousal Some positive effects Recently fallen into disfavor COGNITIVE BEHAVIORAL TREATMENT Belief that paraphilias are based on a variety of cognitive and social deficits Programs focused on education, social skills, and relapse prevention procedures does not lead to obviously better outcomes than a routine period of incarceration HORMONES AND MEDICATION Drugs to reduce testosterone Cyproterone acetate Triptorelin Antidepressants and antianxiety drugs Legal issues Community notification laws FIGURE 12 6 Outcome of Psychological Treatment for Sex Offenders 11

12 GENDER IDENTITY DISORDERS Symptoms DSM-IV-TR categorizes the sense of discomfort with one s anatomical sex as gender identity disorder. Also been called transsexualism or gender dysphoria. People with gender identity disturbances do not literally believe that they are members of the other gender. Rather, they feel that, with the exception of their physical anatomy, they are more like the other gender. GENDER IDENTITY DISORDERS Frequency Gender identity disorders are rare in comparison to most of the other disorders that we have considered in this book. Male-to-female transsexuals are apparently more common than female-to-male transsexuals. Estimated prevalence figures are one person with gender identity disorder for every 12,000 males and 30,000 females (Olsson & Moller, 2003). GENDER IDENTITY DISORDERS Causes The etiology of gender identity disorder is poorly understood. Belief that it is strongly influenced by sex hormones based on studies of pseudohermaphroditism 12

13 GENDER IDENTITY DISORDERS Treatment Various forms of psychotherapy have been used in an effort to alter gender identity, but the results have been fairly negative. One alternative to psychological treatment is sexreassignment surgery, in which the person s genitals are changed to match the gender identity (Sohn & Bosinski, 2007). 13