1. 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

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

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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

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

13. 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

14. 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

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

16. 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

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

18. 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

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

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

21. 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

22. 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

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

24. 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

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

26. 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

27. 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

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

29. 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

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

31. 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

32. 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

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

34. 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

35. 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

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

37. 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

38. 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

39. 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

40. Pedophilia
Why do they do it?

41. 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

42. 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)

43. 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

44. 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

45. 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

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

47. Prognosis
Poor
Chronic course; treatment not effective

48. 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

49. 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

50. Etiology
There has been no identified cause

51. Prognosis
Poor
Chronic course; treatment not effective

52. 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

53. 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

54. 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

55. 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

56. 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

57. 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

58. 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

59. These guys apparently checked themselves into sex rehab

60. Pine Grove

61. Paris Hilton???

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

63. AIDS Patient Zero Gaetan Dugas
Bragged about having sexual partners
250 per year

64. 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

65. 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

66. 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

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

68. 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

69. 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

70. Explanations
No support for any of except for physiological

71. 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

72. 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.)

73. 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

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

75. 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

76. Credits