8-1 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd CHAPTER 8 SEXUAL AND RELATIONSHIP PROBLEMS

8-2 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Aims and Objectives Provide a description of the main relationship and sexual problems Review information regarding the aetiology and treatment approaches to these problems Discuss current challenges in each of these areas

8-3 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Sexual and relationship problems Sexual problems: sexual dysfunction The definition of sexual dysfunction Impairment or disturbance in 1 or more of the 3 stages of sexual functioning described by Kaplan (1979): desire, arousal and orgasm

8-4 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Sexual and relationship problems Sexual problems: sexual dysfunction DSM-IV-TR uses 3 dimensions to specify subtypes: Onset: lifelong or acquired Context: generalised or situational Aetiology: psychological factors or combined psychological and physiological factors Sexual desire disorders Sexual desire - interest one has in engaging in sexual activity alone or with a partner Two types of low sexual desire disorders in DSM-IV-TR Hypoactive sexual desire disorder – deficient or absent interest in sex Sexual aversion disorder – extreme aversion to or avoidance of sexual activity Estimated one-year prevalence of hypoactive sexual desire is up to 7% Prevalence increases with age Most common sexual dysfunction for women, with 33% experiencing this dysfunction

8-5 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Sexual and relationship problems Sexual problems: sexual dysfunction Sexual arousal disorders Sexual arousal refers to the physiological, cognitive, and emotional changes that prepare men and women for sexual activity Inadequate sexual arousal for men is labelled male erectile disorder The prevalence of erectile disorder is higher among men who smoke and who have medical conditions such as heart disease, diabetes, and hypertension Up to 50% of males will have erectile difficulties at some stage Female sexual disorder is difficulty attaining or maintaining adequate lubrication until the completion of the sexual act Less is known about prevalence of female sexual arousal disorder, however it has been estimated that 30-50% of women experience dysfunction in the desire, arousal, or orgasm phase of the sexual response cycle

8-6 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Sexual and relationship problems Sexual problems: sexual dysfunction Orgasmic disorders Male orgasmic disorder is diagnosed when the individual experiences a persistent difficulty to achieve orgasm, despite the apparent presence of adequate desire, arousal, and stimulation (prevalence between 0-3%) Premature ejaculation is ejaculation with minimal stimulation or before the man wishes it (prevalence about 5%) Female orgasmic disorder is defined as a delay or absence of orgasm following a normal sexual excitement period that causes the woman distress (prevalence is 24%) Sexual pain disorders Dyspareunia is a condition entailing pain or discomfort during intercourse that usually results in the avoidance of sexual activity For men prevalence estimates range from 0.2% - 8% (there were no available estimates for women)

8-7 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Sexual and relationship problems Sexual problems: sexual dysfunction The conceptualisation of sexual dysfunction Linear model assumes individuals progress through a sequence of stages from desire to arousal to orgasm. Dysfunctions of hypoactive sexual desire, sexual arousal and orgasmic disorder are based on these 3 stages Circular model (Basson, 2000) of arousal and desire is a more accurate description of sexual dysfunction in women. Desire may not be the first phase in the sequence. This model also emphasises the critical influence of contextual factors, not just sexual stimulation, on a women’s sexual arousal A final difference between the linear and circular models is that the occurrence of orgasm is not essential An equivalent model has not been developed for men Recent studies support circular notion of women’s sexual problems

8-8 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Sexual and relationship problems Sexual problems: sexual dysfunction The aetiology of sexual dysfunction Biological factors Aging process – sexual dysfunction increases with age, although large individual differences Medical conditions In men, sexual dysfunction can arise from conditions that cause decreased penile blood pressure Drugs have been implicated, such as antidepressant medications Psychological and social factors Developmental experiences, e.g., history of sexual abuse Current aspects of individual’s functioning Anxiety, e.g. performance anxiety, fear of success, fear of pleasure, and fear of injury Stress, e.g. financial difficulties, work stress, or stress that arises from illness Relationship factors, e.g., partner conflict, communication problems, lack of intimacy Cognitions – the meaning individuals give to sexual events

8-9 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Sexual and relationship problems Sexual problems: sexual dysfunction The treatment of sexual dysfunction Behaviour therapy Education, communication skills training Sensate focus exercises - focusing on pleasurable sensations in the absence of performance demand Cognitive behaviour therapy Challenge unrealistic beliefs contributing to sexual problems Medical treatments For males: Vacuum devices, penile injections or implants, oral medications For females: Hormonal (androgen and oestrogen) therapy and pharmacological treatments - largely unsuccessful Limitations of treatment research Treatment programs lack adequate research methodology Treatments are limited in their focus Few published treatment studies since the 1980s

8-10 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Sexual and relationship problems Sexual problems: the paraphilias The diagnosis of paraphilias The object that causes sexual excitement has a negative effect on others Causes distress or interferes with daily functioning The sexual behaviour is the person’s preferred or exclusive form of sexual gratification Exhibitionism – sexual gratification from exposing genitals to an involuntary observer Fetishism – use of non-living objects to obtain sexual gratification Frotteurism – sexual gratification from touching or rubbing against a non- consenting person Paedophilia – sexual activity with children of either sex Sexual masochism and sexual sadism – the experience of sexual stimulation through the infliction of pain or psychological degradation and humiliation on another person Transvestic fetishism – cross-dressing by a man into a woman’s clothing Voyeurism – looking at unsuspecting individuals as they are undressing, are in the act of sexual activity, or when they are naked

8-11 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Sexual and relationship problems Sexual problems: the paraphilias The aetiology of paraphilias Little data on the origins of paraphilias Generally believed that the causes originate in childhood or adolescence Psychoanalytic and learning explanations have been developed The treatment of paraphilias Biological treatments Chemical or surgical castration – effectiveness has been questioned recently Behaviour therapy Aversion therapy – unpleasant or painful stimulus is paired with inappropriate behaviour Exposure therapy – reduce anxiety associated with non-paraphilic situations Social skills training – teach people to interact with others in a comfortable way

8-12 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Sexual and relationship problems Relationship problems Historic and current approaches to relationship problems Early research in the 1940s focused on spouse personality characteristics In the 1950s, focus changed from individual factors to the interactional style In 1960s and 1970s, increased focus from behavioural observations to internal states, as well as on how power and power imbalances impacted on family dynamics In the 1980s and 1990s, research focused on interaction patterns and predictors of divorce More recent research has focused on complex processes E.g., depression may lead to greater negativity, which may in turn lead to relationship problems

8-13 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Sexual and relationship problems Relationship problems The aetiology of relationship problems Individual factors Biological factors – possible association between relationship problems and hormonal disturbances Personality – low levels of neuroticism and high levels of agreeableness, conscientiousness, and positive forms of expression related to partner satisfaction Cognitive factors - accuracy of individual’s perceptions of his/her partner’s qualities, attributions individual makes to explain the causes of his/her partner’s behaviour (e.g., internal or external, stable or unstable, global or specific) Relationship dynamics Communication – low levels of self-disclosure predict relationship problems Conflict – high levels of conflict lead to negative perceptions of the relationship Sexual functioning - association between sexual and relationship functioning

8-14 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Sexual and relationship problems Relationship problems The aetiology of relationship problems Contextual factors Becoming a parent is associated with high levels of relationship problems Negative social attitudes can place homosexual couples at risk for relationship problems Integrative models

8-15 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Sexual and relationship problems Relationship problems The treatment of relationship problems Behavioural and cognitive-behavioural couple therapy Behaviour exchange seeks to engage both partners in activities designed to enhance each other’s relationship satisfaction Communication training – each partner is taught skills to improve their roles as both the speaker (expressive skills) and the listener (receptive skills) Problem solving –set of skill to resolve areas of conflict within the relationship Challenging dysfunctional cognitions Limitations of current couple therapies Substantial proportion of individuals do not benefit Innovative approaches need to be developed, e.g., Integrative Behavioural Couple Therapy Expanding the focus of couple therapy - couple therapy can also help individuals experiencing psychological difficulties and medical problems

8-16 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Summary Sexual Problems Sexual Dysfunction Definition Conceptualisation Aetiology Treatment The Paraphilias Historical and Current Approaches Diagnosis Aetiology Treatment Relationship Problems Historical and Current Approaches Aetiology Treatment