comer, abnormal psychology, 6th edition - school of ：来的人，心理异常，第六版-学院

Chapter 13,Sexual Disorders and Gender Identity Disorder,Categories of Sexual Disorders,Sexual DysfunctionsPeople who experience problems with their sexual responsesParaphiliasPeople with repeated intense sexual urges or fantasies in response to objects or situations that society deems inappropriateGender Identity DisorderA sex-related disorder in which people persistently feel that they have been assigned to the wrong sex and identify with the other gender,Sexual Dysfunctions,Sexual dysfunctions are disorders in which people cannot respond normally in key areas of sexual functioningAs many as 31% of men and 43% of women in the U.S. suffer from such a dysfunction during their livesSexual dysfunctions are typically very distressing, and often lead to sexual frustration, guilt, loss of self-esteem, and interpersonal problems,Sexual Dysfunctions,The human sexual response can be described as a cycle with four phases:DesireExcitementOrgasmResolutionSexual dysfunctions affect one or more of the first three phases,Sexual Dysfunctions,Some people struggle with sexual dysfunction their whole lives (labeled “lifelong type” in DSM-IV-TR)For others, normal sexual functioning preceded the disorder (labeled “acquired type”)In some cases the dysfunction is present during all sexual situations (labeled “generalized type”)In others it is tied to particular situations (labeled “situational type”),Disorders of Desire,The desire phase consists or an urge to have sex, sexual fantasies, and sexual attraction to othersHypoactive sexual desireA lack of interest in sex and a very low level of sexual activity Sexual AversionFinding sex distinctly unpleasant or repulsiveSexual advances may sicken, disgust, or frighten the personCan be an aversion or to a particular aspect of sex or generalized,Disorders of Desire,Biological causesA number of hormones interact to produce sexual desire and behaviorAbnormalities in their activity can lower sex drive These hormones include prolactin, testosterone, and estrogen for both men and womenSex drive can also be lowered by chronic illness, some medications, some psychotropic drugs, and a number of illegal drugs,Disorders of Desire,Psychological causesA general increase in anxiety or anger may reduce sexual desire in both women and menFears, attitudes, and memories may contribute to sexual dysfunctionCertain psychological disorders, including depression and obsessive-compulsive disorder, may lead to sexual desire disorders,Disorders of Excitement,Excitement phase of the sexual response cycleMarked by changes in the pelvic region, general physical arousal, and increases in heart rate, muscle tension, blood pressure, and rate of breathingIn men: erection of the penis In women: clitoral swelling and vaginal lubricationTwo dysfunctions affect this phase:Female sexual arousal disorder (formerly “frigidity”)Male erectile disorder (formerly “impotence”),Disorders of Excitement,Female Sexual Arousal DisorderWomen who are persistently unable to attain or maintain proper lubrication or genital swelling during sexual activityVery often comorbid with an orgasmic disorderMale Erectile DisorderMen who persistently fail to attain or maintain an adequate erection during sexual activityMost are over the age of 50Cases usually are the result from an interaction of biological, psychological, and sociocultural factors,Disorders of Excitement,Most cases of erectile disorder result from an interaction of biological, psychological, and sociocultural processesEven minor physical impairment of the erection response may make a man vulnerable to the effects of psychosocial factorsA violation of the typical male role ?,Disorders of Excitement,Biological causesThe same hormonal imbalances that can cause hypoactive sexual desire can also produce EDMost commonly, vascular problems are involvedED can also be caused by damage to the nervous system from various diseases, disorders, or injuriesThe use of certain medications and substances may interfere with erections,Disorders of Excitement,Psychological causesAny of the psychological causes of hypoactive sexual desire can also interfere with erectile functionFor example, as many as 90% of men with severe depression experience some degree of EDOne well-supported cognitive explanation for ED emphasizes performance anxiety and the spectator roleOnce a man begins to have erectile difficulties, he becomes fearful and worried during sexual encounters; instead of being a participant, he becomes a spectator and judge This can create a vicious cycle of sexual dysfunction where the original cause of the erectile failure becomes less important than the fear of failure,Disorders of Orgasm,Orgasm phase of the sexual response cycleSexual pleasure peaks and sexual tension is released as the muscles in the pelvic region contract rhythmically For men: semen is ejaculatedFor women: the outer third of the vaginal walls contractThere are three disorders of this phase:Premature ejaculationMale orgasmic disorder Female orgasmic disorder,Disorders of Orgasm,Premature ejaculationCharacterized by persistent reaching of orgasm and ejaculation with little sexual stimulationAbout 30% of men experience premature ejaculation at some timePsychological, particularly behavioral, explanations of this disorder have received more research support than other theoriesThe dysfunction seems to be typical of young, sexually inexperienced menIt may also be related to anxiety, hurried masturbation experiences, or poor recognition of arousal,Disorders of Orgasm,Male orgasmic disorderCharacterized by a repeated inability to reach orgasm or by a very delayed orgasm after normal sexual excitementOccurs in 8% of the male populationBiological causes include low testosterone, neurological disease, and head or spinal injuryMedications, including certain antidepressants (especially SSRIs) and drugs that slow down the CNS, can also affect ejaculation,Disorders of Orgasm,Female orgasmic disorderCharacterized by persistent delay in or absence of orgasm following normal sexual excitementAlmost 25% of women appear to have this problem10% or more have never reached orgasmAn additional 10% reach orgasm only rarelyWomen who are more sexually assertive and more comfortable with masturbation tend to have orgasms more regularlyFemale orgasmic disorder is more common in single women than in married or cohabiting women,Disorders of Orgasm,Female orgasmic disorder Biological causesA variety of physiological conditions can affect a womans arousal and orgasmThese conditions include diabetes and multiple sclerosisThe same medications and illegal substances that affect erection in men can affect arousal and orgasm in womenPostmenopausal changes may also be responsible,Disorders of Orgasm,Female orgasmic disorder Sociocultural causesFor decades, the leading sociocultural theory of female sexual dysfunction was that it resulted from sexually restrictive cultural messagesThis theory has been challenged because: Sexually restrictive histories are equally common in women with and without disordersCultural messages about female sexuality have been changing while the rate of female sexual dysfunction stays constant,Disorders of Sexual Pain,Two sexual dysfunctions do not fit neatly into a specific phase of the sexual response cycleThese are the sexual pain disorders:VaginismusDyspareunia,Disorders of Sexual Pain,VaginismusCharacterized by involuntary contractions of the muscles of the outer third of the vaginaSevere cases can prevent a woman from having intercoursePerhaps 20% of women occasionally have pain during intercourse, but less than 1% of all women have vaginismus,Disorders of Sexual Pain,VaginismusMost clinicians agree with the cognitive-behavioral theory that vaginismus is a learned fear responseA variety of factors can set the stage for this fear, including anxiety and ignorance about intercourse, trauma caused by an unskilled partner, and childhood sexual abuseSome women experience painful intercourse because of infection or disease, leading to “rational” vaginismusMost women with vaginismus also have other sexual disorders,Disorders of Sexual Pain,DyspareuniaCharacterized by severe pain in the genitals during sexual activityAffects almost 15% of women and about 3% of menDyspareunia in women usually has a physical cause, most commonly from injury sustained in childbirthAlthough relationship problems or psychological trauma from abuse may contribute to dyspareunia, psychosocial factors alone are rarely responsible,Treatments for Sexual Dysfunctions,Sex Therapy program developed by Masters and JohnsonGeneral FeaturesShort-term and instructive, typically lasting 15-20 sessionsCenters on specific sexual problemsCertain techniques are applied in almost all cases, regardless of the dysfunction,Treatments for Sexual Dysfunctions,1950s and 1960s: behavioral therapyBehavioral therapists attempted to reduce fear by applying relaxation training and systematic desensitizationHad moderate success, but failed to work in cases where the key problems were cognitive or psychoeducational,Treatments for Sexual Dysfunctions,1970: Human Sexual InadequacyThis book, written by William Masters and Virginia Johnson, revolutionized treatment of sexual dysfunctionsThis original “sex therapy” program has evolved into a complex, multidimensional approachIncludes techniques from cognitive, behavioral, couples, and family systems therapiesMore recently, biological interventions have also been incorporated,What Are the General Features of Sex Therapy?,Modern sex therapy includes:Assessing and conceptualizing the problemAssigning “mutual responsibility” for the problemEducation about sexualityAttitude changeElimination of performance anxiety and the spectator roleIncreasing sexual and general communication skillsChanging destructive lifestyles and marital interactionsAddressing physical and medical factors,What Techniques Are Applied to Particular Dysfunctions?,Hypoactive sexual desire and sexual aversion These disorders are among the most difficult to treat because of the many issues that feed into themTherapists typically apply a combination of techniques which may include:Affectual awareness, self-instruction training, behavioral techniques, insight-oriented exercises, and biological interventions such as hormone treatments,What Techniques Are Applied to Particular Dysfunctions?,Erectile disorderTreatments for ED focus on reducing a mans performance anxiety and/or increasing his stimulationMay include sensate-focus exercises such as the “tease technique”Biological approaches, used when the ED has biological causes, have gained great momentum with the recent approval of sildenafil (Viagra)Most other biological approaches have been around for decades and include gels, suppositories, penile injections, a vacuum erection device (VED), and penile implant surgery,What Techniques Are Applied to Particular Dysfunctions?,Male orgasmic disorderLike treatment for ED, therapies for this disorder include techniques to reduce performance anxiety and increase stimulationWhen the cause of the disorder is physical, treatment may include a drug to increase arousal of the nervous system,What Techniques Are Applied to Particular Dysfunctions?,Premature ejaculationPremature ejaculation has been successfully treated for years by behavioral procedures such as the “stop-start” or “pause” techniqueSome clinicians favor the use of fluoxetine (Prozac) and other serotonin-enhancing antidepressant drugsBecause these drugs often reduce sexual arousal or orgasm, they may be helpful in delaying premature ejaculationWhile some studies have reported positive findings, long-term outcome studies have yet to be conducted,What Techniques Are Applied to Particular Dysfunctions?,Female arousal and orgasmic disordersSpecific treatment techniques for these disorders include self-exploration, enhancement of body awareness, and directed masturbation trainingAgain, a lack of orgasm during intercourse is not necessarily a sexual dysfunction, provided the woman enjoys intercourse and is orgasmic through other meansFor this reason, some therapists believe that the wisest course of action is simply to educate women whose only concern is lack of orgasm through intercourse,What Techniques Are Applied to Particular Dysfunctions?,Vaginismus Specific treatment for vaginismus takes two approaches:Practice tightening and releasing the muscles of the vagina to gain more voluntary controlOvercome fear of intercourse through gradual behavioral exposure treatmentOver 75% of women treated for vaginismus using these methods eventually report pain-free intercourse,What Techniques Are Applied to Particular Dysfunctions?,Dyspareunia Determining the specific cause of dyspareunia is the first stage of treatmentGiven that most cases are caused by physical problems, medical intervention may be necessary,Paraphilias,These disorders are characterized by unusual fantasies and sexual urges or behaviors that are recurrent and sexually arousingOften involve:Humiliation of self or partnerChildrenNonconsenting peopleNonhuman objects,Paraphilias,According to the DSM-IV-TR, paraphilias should be diagnosed only when the urges, fantasies, or behaviors last at least 6 monthsFor most paraphilias, the urges, fantasies, or behaviors must also cause great distress or impairmentFor certain paraphilias, however, performance of the behavior itself is indicative of a disorderExample: sexual contact with children,Paraphilias,Some people with one kind of paraphilia display others as wellRelatively few people receive a formal diagnosis, but clinicians believe that the patterns may be quite commonAlthough theorists have proposed various explanations for paraphilias, there is little formal evidence to support the theoriesNone of the treatments applied to paraphilias have received much research or been proved clearly effectiveRecent work has focused on biological interventions,Fetishism,The key features of fetishism are recurrent intense sexual urges, sexually arousing fantasies, or behaviors that involve the use of a nonliving objectThe disorder usually begins in adolescenceAlmost anything can be a fetish objectWomens underwear, shoes, and boots are especially common,Fetishism,Behaviorists propose that fetishes are learned through classical conditioningFetishes are sometimes treated with aversion therapy, covert sensitization, or imaginal exposureAnother behavioral treatment is masturbatory satiation, in which clients masturbate to boredom while imagining the fetish objectAn additional behavioral treatment is orgasmic reorientation, a process which teaches individuals to respond to more appropriate sources of sexual stimulation,Transvestic Fetishism,Also known as transvestism or cross-dressingCharacterized by fantasies, urges, or behaviors involving dressing in the clothes of the opposite sex in order to achieve sexual arousal,Transvestic Fetishism,The typical person with transvestism is a heterosexual male who began cross-dressing in childhood or adolescenceTransvestism is often confused with gender identity disorder (transsexualism), but the two are separate patternsThe development of the disorder seems to follow the behavioral principles of operant conditioning,Exhibitionism,Characterized by arousal from the exposure of genitals in a public setting Also known as “flashing”Sexual contact is neither initiated nor desiredUsually begins before age 18 and is most common in malesTreatment generally includes aversion therapy and masturbatory satiationMay be combined with orgasmic reorientation, social skills training, or psychodynamic therapy,Voyeurism,Characterized by repeated and intense sexual desires to observe people in secret as they undress or to spy on couples having intercourse; may involve acting upon these desiresThe person may masturbate during the act of observing or while remembering it laterThe risk of discovery often adds to the excitement,Frotteurism,A person who develops frotteurism has fantasies, urges, or behaviors involving touching and rubbing against a nonconsenting personAlmost always male, the person fantasizes during the act that he is having a caring relationship with the victimUsually begins in the teenage years or earlierActs generally decrease and disappear after age 25,Pedophilia,Characterized by fantasies, urges, or behaviors involving sexual activity with a prepubescent child, usually 13 years of age or youngerSome people are satisfied with child pornographyOthers are driven to watching, fondling, or engaging in intercourse with childrenEvidence suggests that two-thirds of victims are female,Pedophilia,People with pedophilia develop the disorder in adolescenceSome were sexually abused as childrenMany were neglected, excessively punished, or deprived of close relationships in childhoodMost are immature, display faulty thinking, and have an additional psychological disorderSome theorists have proposed a related biochemical or brain structure abnormality,Pedophilia,Most people with pedophilia are imprisoned or forced into treatmentTreatments include aversion therapy, masturbatory satiation, and orgasmic reorientationCognitive-behavioral treatment involves relapse-prevention training, modeled after programs used for substance dependence,Sexual Masochism,Characterized by fantasies, urges, or behaviors involving the act or the thought of being humiliated, beaten, bound, or otherwise made to sufferMost masochistic fantasies begin in childhood and seem to develop through the behavioral process of classical conditioning,Sexual Sadism,A person with sexual sadism finds fantasies, urges, or behaviors involving the thought or act of psychological or physical suffering of a victim sexually excitingNamed for the infamous Marquis de SadePeople with sexual sadism imagine that they have total control over a sexual victim,Sexual Sadism,Sadistic fantasies may first appear in childhood Pattern is long-termA