Abnormal Psychology Feb 25-Mar 2, 2010 Classes #12-13 Chapter 10: Changing views of Sexual Behavior Sexual Dysfunctions Paraphilias Gender identity Disorder Abnormal Psychology Feb 25-Mar 2, 2010 Classes #12-13

Changing views of Sexual Behavior The Generational Perspective: Ever-changing attitudes?

Generational Perspective Sexual behaviors once considered deviant in the U.S. include: Homosexuality Oral sex Masturbation

Sexual and Gender-Identity Disorders DSM-IV recognizes three main types of sexual disorders. Sexual dysfunctions Paraphilias Gender-identity disorders

Sexual Dysfunctions These are disorders that involve the absence or failure of the sexual response at some point during the sexual response cycle A loss or impairment of the ordinary physical responses of sexual function

Sexual Dysfunctions Sexual Desire Disorders Sexual Arousal Disorders Hypoactive Sexual Desire Sexual Aversion Disorder Sexual Arousal Disorders Female Sexual Arousal Disorder Male Erectile Disorder Orgasmic Disorders Female Orgasmic Disorder Male Orgasmic Disorder Premature Ejaculation Sexual Pain Disorders Dyspareunia Vaginismus

Sexual Desire Disorders Disorders in which the person lacks sexual interest or has an active distaste for sex Hypoactive sexual desire Lack of interest in sex Little or no sexual activity in these individuals Sexual Aversion Disorder Find sex unpleasant or repulsive

Sexual Arousal Disorders Inability to achieve or sustain arousal until the end of intercourse in a person who is capable of experiencing sexual desire Female sexual arousal disorder The inability of a woman to become sexually aroused or to reach orgasm Erectile disorder The inability of a man to achieve or maintain an erection

Orgasmic Disorders Inability to reach orgasm in a person able to experience sexual desire and maintain arousal Female Orgasmic Disorder Rarely reach orgasm Male Orgasmic Disorder Repeatedly cannot reach orgasm or its very delayed Premature ejaculation Inability of a man to inhibit orgasm as long as desired

Sexual Pain Disorders Vaginismus: Dyspareunia Involuntary muscle spasms in the outer part of the vagina that make intercourse impossible Dyspareunia Extreme pain felt in the genitals during sexual activity

Percentage of Sexual Problems in General Population of Adults (18-59) Men Women Lack of interest 15.7 33.4 Unable to climax 8.2 24.1 Climax too quickly 28.5 10.3 Physical pain 3.0 14.4 Not pleasurable 8.1 21.2 Anxiety 17.0 11.5 Arousal problem 10.4 18.8

Paraphilias The term Paraphilia means “abnormal or unnatural attraction” These are sexual disorders that revolve around abnormal means of achieving sexual arousal

General Qualities of Paraphilias The urges have an insistent, demanding or compulsory quality They vary in severity Almost exclusively male They generally replays the scene in sexual fantasies to stimulate arousal/masturbation They almost never come to treatment voluntarily

DSM-IV Criteria Over a period of at least 6 months, the patient experiences recurrent, intense sexually arousing fantasies, urges, or behaviors concerning these deviant acts Must cause marked distress or interpersonal difficulty

Types of Paraphilias Exhibitionism Fetishism Transvestic Fetishism Frotteurism Pedophilia Sexual Masochism Sexual Sadism Voyeurism

Exhibitionism This involves having fantasies about or actually exposing the genitals to an unsuspecting stranger A person repeatedly exposes his genitals to a stranger for the purpose of achieving sexual excitement

Demographics Onset: Usually before 18 Gender difference: Almost 100% males

Symptoms No sexual activity involved… They do not become violent They are usually very nervous Often expose themselves and then flee area before police arrive Most are married (around 60%) However, most unhappily married or single

Etiology Several theories have been proposed regarding the origins of exhibitionism However, none are considered conclusive

Behavioral Explanation Several studies have shown that emotional abuse in childhood and family dysfunction are both significant risk factors in the development of exhibitionism

Psychoanalytic Explanation It is thought that exhibitionists regard their mothers as rejecting them on the basis of their different genitals Therefore, they grow up with the desire to force women to accept them by making women look at their genitals Pure speculation

Physiological Explanation Hormones High levels of testosterone Head Trauma There are a small number of documented cases of men becoming exhibitionists following traumatic brain injury (TBI) without previous histories of sexual offenses. ADHD A childhood history of attention-deficit/hyperactivity disorder This research is in its infancy

Prognosis Poor It doesn’t appear they want to change They don’t get help unless arrested

Fetishism Inanimate object fetishists often collect the object of their favor, and may go to great lengths, including theft, to acquire just the "right" addition for their collection

Demographics Onset: Usually has origins in early to mid-childhood Fetishists rarely come to the attention of the criminal justice system

Fetishism In the majority of cases, the person with a fetish poses no danger to others and pursues the use of the fetish object in private Usually through masturbation Persons with a fetish rarely involve non-consenting partners Researchers have shown that in general fetishists: Have poorly developed social skills Are quite isolated in their lives Have a diminished capacity for establishing intimacy

Fetishism Explanations The causes of fetishism are not clearly understood… Some learning theorists believe that it develops from early childhood experiences An object was associated with a particularly powerful form of sexual arousal or gratification Psychoanalytical theories of causality focus on concepts of penis worship and castration anxiety

Prognosis The prognosis for eliminating a fetish is poor because most people with a fetish have no desire to change or eliminate it

Transvestic Fetishism Heterosexual males with this paraphilia dress in female clothes to produce or enhance sexual arousal This occurs in heterosexual males and is not part of Gender Identity Disorder Cross-dressing Usually without a real partner but with the fantasy that they are the female partner The fantasies, sexual urges, or behaviors must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Demographics Onset: Usually begins in childhood or early adolescence Gender difference: 100% males (DSM-IV criteria)

Transvestic Fetishism Some will wear a single item of female apparel under masculine clothing These heterosexual males may have very few sexual partners and have occasional homosexual relationships When not cross-dressing, they may behave in stereotypic male fashion but this behavior often turns quite feminine when wearing women's clothing

Etiology Very sketchy at best: Behavioral: Mother’s anger at men; wanted a girl Psychoanalytic: they engage in this behavior because it is enjoyable but the reasons for the enjoyment remain unconscious No evidence of genetic, hormonal or physiological abnormality in cross-dressers

Prognosis The prognosis for treatment of transvestic fetishism is poor, as most persons with this disorder do not desire to change

Frotteurism This Paraphilia is characterized by sexual fantasies, urges, or behaviors involving touching or rubbing one's genitals against the body of a non-consenting person The person generally tries to escape detection after touching the victim To be considered diagnosable, the fantasies, urges, or behaviors must cause significant distress in the individual or be disruptive to his or her everyday functioning

Demographics Onset: Gender difference: Most acts are performed by those between 15 to 25 years of age Gender difference: Almost all males Females are the most common victims

Etiology Most experts agree that there are underlying issues related to childhood which play a major role in the etiology

Prognosis The prognosis for eliminating frotteurism is poor as most frotteurs have no desire to change their behavior Since frotteurism involves nonconsenting partners and is against the law, the possibility of embarrassment may deter some individuals

Pedophilia According to the DSM-IV definition, pedophilia involves sexual activity by an adult with a prepubescent child Some individuals prefer females, usually 8- to 10-year-olds Those attracted to males usually prefers slightly older children Some prefer both sexes While some are sexually attracted only to children, others also are sometimes attracted to adults as well Gender difference: Pedophilia is almost always seen in males and is seldom diagnosed in females

Pedophilia Pedophiliac activity may involve undressing and looking at the child or more direct physical sex acts All these activities are psychologically harmful to the child, and some may be physically harmful Individuals with pedophilia often go to great lengths to obtain photos, films or pornographic publications that focus on sex with children These individuals commonly explain their activities with excuses or rationalizations that the activities

Pedophilia Why do they do it?

Treatment Pedophilia generally is treated with cognitive-behavioral therapy The therapy may be prescribed alone or in combination with medication Low levels of serotonin has been linked Selective serotonin reuptake inhibitors have been used with limited success

Prognosis Poor Even after intensive treatment, the course of the disorder usually is chronic and lifelong in most patients Which is the reason that most treatment programs emphasize a relapse-prevention model However, both the fantasies and the behaviors often lessen with advancing age in adults (burn-out)

Sexual Masochism The disorder is characterized by intense sexually arousing fantasies, urges, or behaviors in which the individual is humiliated, beaten, bound, or made to suffer in some way Person derives sexual pleasure from being abused or humiliated Sexually masochistic behaviors are typically evident by early adulthood, and often start with masochistic or sadistic play in childhood

Demographics Onset: Gender difference: Although masochistic sexual fantasies often begin in childhood, the onset of sexual masochism typically occurs during early adulthood Gender difference: Sexual masochism is slightly more prevalent in males than in females

Sexual Masochism These patterns of behavior are not only disruptive to social and occupational functioning, but they run the risk of threat to physical safety. Hypoxyphilia for example, involves the cutting off of oxygen supply for purposes of sexual stimulation

Etiology Unknown: There is no universally accepted cause or theory explaining the origin of sexual masochism

Prognosis Poor Chronic course; treatment not effective

Sexual Sadism Individuals with this Paraphilia use sexual fantasies, urges, or behaviors involving infliction of pain, suffering or humiliation of others to enhance or achieve their own sexual excitement For diagnosis: the person has acted on these urges with a nonconsenting person the sexual urges or fantasies cause marked distress or interpersonal difficulty

Demographics Onset: Gender difference: Although sadistic sexual fantasies often begin in the person's childhood, the onset of active sexual sadism typically occurs during early adult life Gender difference: When non-consenting partners are involved, the sadist is almost always a male

Etiology There has been no identified cause

Prognosis Poor Chronic course; treatment not effective

This is not currently in the DSM... Sadomasochism (S&M) Involves mutually gratifying sexual interactions between consenting partners There is a great variety in the intensity of these practices - some may become dangerous

Voyeurism This disorder is characterized by either intense sexually arousing fantasies, urges, or behaviors in which the individual observes an unsuspecting stranger who is naked, disrobing, or engaging in sexual activity To be considered diagnosable, the fantasies, urges, or behaviors must cause significant distress in the individual or be disruptive to his or her everyday functioning

Voyeurism Onset: Prevalence: Usually prior to the age of 15 years. No reliable statistics pertaining to the incidence of voyeurism in adulthood Prevalence: Unknown but expected to mainly men They are generally sexually inexperienced men who feel

Voyeurism They often put themselves in risky situations in which they will be caught or injured (roofs, fire escapes) The need for element of risk may be part of the arousal Most are nonviolent

Etiology There is no scientific consensus concerning the basis for voyeurism Most experts attribute the behavior to an initially random or accidental observation of an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity Successive repetitions of the act tend to reinforce and perpetuate the voyeuristic behavior

Prognosis Once voyeuristic activity is undertaken, it commonly does not stop. The prognosis for eliminating voyeurism is poor because most voyeurs have no desire to change their pattern of behavior Since voyeurism involves non-consenting partners and is against the law in many jurisdictions, the possibility of embarrassment may deter some individuals

DSM V: Sex Addiction??? Refers to a phenomenon in which individuals report being unable to manage their sexual behavior The existence of the condition is not universally accepted by sexologists and its etiology, nature, and validity have been debated

These guys apparently checked themselves into sex rehab

Pine Grove

Paris Hilton???

Our former President was accused of being a sex addict...

AIDS Patient Zero Gaetan Dugas Bragged about having 2500+ sexual partners 250 per year

Gender Identity Disorder Diagnostic Criteria A strong and persistent cross-gender identification Persistent discomfort with his/her sex or sense of inappropriateness in the gender role of that sex While this person may be male, he feels as if he is a female

Diagnostic Criteria An inconsistency between an individual’s physiological sex identification and his or her gender identity Persistent feelings of gender discomfort and inappropriateness of anatomic sex People with gender identity disorder act and present themselves as members of the opposite sex The disorder affects self-concept, the perception of an ideal partner, and the display of femininity or masculinity through mannerisms, behavior, and dress These feelings persist for at least 2 years

Case Study: Reneé Richards Richard Raskin had been an opthomologist and a moderately good professional tennis player In 1976 at age 52, she entered a women’s tennis tournament

Gender Identity Disorder: Types Specified Gender Identity Disorder/Transsexualism In both types: May occur in children or adults Rare disorders

Symptoms Cross-sex identification Individual wants to be, or claims to be the opposite sex Individual is uncomfortable about his/her sex Rejects traditional gender schemes, and believes that they will become the opposite sex

Gender Identity Disorder Doesn’t appear to be a choice for these people – they do not feel that they have a choice about their sexual identity While some of these people only suffer mild discomfort with their physiological sex, others may have a sense of actually belonging to the opposite sex

Explanations No support for any of except for physiological

Physiological Explanations Exposure to high levels of hormones associated with the opposite sex during the fetal period Girls exposed to androgens tend to be tom-boys, boys exposed to estrogen more feminine Prenatal exposure to anticonvulsant medications Phenobarbital, Dilantin

Hormone Therapy Some individuals take hormones consistent with their desired gender Men will take estrogens (female hormones) Females will take androgens (male hormones) They will usually develop the secondary sex characteristics of that sex after this treatment (development of breasts, etc.)

Sex Reassignment Surgery A more drastic option is to go through a sex-change operation Effective in making individuals look like members of the opposite sex Artificial vagina-like openings for the male-to-female change Orgasm is possible Female-to-male change is more difficult Penis can be attached Erections are not possible though Additionally, these individuals will usually go through the hormone therapy as well

Gender Identity Disorder Additionally, those suffering from this disorder should undergo the following types of therapy: Individual Counseling Family Counseling Couple Counseling

Gender Identity Disorder, not otherwise specified Transient cross-dressing behavior Persistent preoccupation with castration without a desire to acquire the sex characteristics of the other sex

Credits http://www.psych.uic.edu/education/courses/m2psypath/paraphilialecture2005.pdf http://www.minddisorders.com/ http://en.wikipedia.org/wiki/Sexual_addiction