Abnormal Psychology

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Sexual Response Cycle

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Kinsey and Masters & Johnson’s mid-20th century research looking to find answers to human sexuality through interviews, direct observations

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What are the phases of the sexual response cycle?

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- Desire

- Excitement

- Orgasm

- Resolution

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Desire Phase

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Refers to sexualinterest or desire; sexually arousing fantasies and thoughts

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Excitement Phase

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Experiencing pleasure and increased flow of blood to the genitalia; result: Erection of penis for men, for women, enlargement of the breasts and increased lubrication of the vagina

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Orgasm Phase

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Sexual pleasure peaks: for men, ejaculation occurs (almost always); in women the outer walls of the vagina contract (rhythmic spasms)

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Resolution Phase

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Relaxation and a sense of well-being follows orgasm . For men, there is a “refractory period” (during which further erection is not possible for a time; length of this period varies with age, etc). Women are often able to respond almost at once without refractory period

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Sexual Dysfunctions

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These may cause various interpersonal problemsbetween couples (financial worries; incompatible sexual drives,illnesses, psychological issues, etc.)

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Male Hypoactive Sexual Desire Disorder

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Deficient sexual desires, or absent of same for at least 6 months

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Erectile Disorder

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75% of sexual occasions for six(6) months

(1) Inability to attain an erection

(2) Inability to maintain erection for completion ofsexual activity

(3) Marked decrease in erectile rigidity interferes withpenetration or pleasure.

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Female Sexual Interest/Arousal Disorder

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Diminished, absent or reduced frequency of at least three in the following 6 months

(1) Interest in sexual activity

(2) Erotic thoughts or fantasies

(3) Initiation of sexual activity & responsiveness to partner’s attempts to initiate

(4) Sexual excitement/pleasure during 75% of sexual encounters

(5) Sexual interest/arousal elicited by any internal or external cues

(6) Genital or nongenital sensations during 75% or sexual encounters.

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Female Orgasmic Disorder

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On at least 75% of sexual occasionsfor 6 months

(1) Marked delay, infrequency or absence of orgasm

(2) Markedly reduced intensity of orgasmic sensation

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Premature Ejaculation(Men)

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Tendency to ejaculate duringpartnered sexual activity within one (1) minute of sexualactivity on at least 75% of sexual occasion for six (6) months

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Delayed Ejaculation

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Marked delay, infrequency or absence oforgasm on at least 75% of sexual occasions for six (6) months

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Genito-Pelvic Pain/Penetration Disorder

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(1) Inability to have vaginal/penetration duringintercourse.

(2) Marked vulvovaginal or pelvic pain during vaginalpenetration or intercourse attempts.(Dyspareunia)

(3) Marked fear or anxiety about pain or penetration.

(4) Marked tensing of the pelvic floor muscles duringattempted vaginal penetration.(Vaginismus)

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Etiology of Sexual Dysfunctions

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“Spectator Role and Fears about Performance”

Religious Orthodoxy; Psychosexual Trauma; HomosexualInclination; Inadequate Counseling; Excessive Alcohol Use;Physiological Problems; Sociocultural Factors

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Treatments of Sexual Dysfunctions

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- Anxiety Reduction

Directed Masturbation

Change Attitudes and thoughts

Skills and Communication Training and Couples Therapy

Physical Treatment, and Medication

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Anxiety Reduction

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Psychoeducation about sexuality; SystematicDesensitization,Sexual skills training

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Directed Masturbation

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To enhance women’s comfort with andenjoyment of their sexuality (to identify various areas of herbody’s “erogenous zones.”)

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Change Attitudes & Thoughts

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Cognitive approach to focus on the pleasant sensations of sexual arousal; “Sensate Focus” therapies.

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Skills and Communication Training & Couples Therapy

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Improveskills; discuss good communications and openness betweenpartners

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Physical Treatment & Medications

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First of all, anyone with any sexual dysfunctions, should FIRST HAVE A REGULAR AND COMPLETE PHYSICAL Exam by family physician to rule out physical problems. Then focus on interpersonal problems for treating the specific disorders presented (premature ejaculation; erectile dysfunctions; female pain disorders)

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THE PARAPHILIC DISORDERS

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General definition: recurrent sexual attraction to unusual objects orsexual activities lasting at least (6) six months (Deviation fromnormal in what person is sexually attracted to).

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Types of Fetishistic Disorder

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- Nonliving or Nongenital

- Causes significant distress

- The sexually arousing objects

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Nonliving or Nongenital

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For at least six (6) months, recurrentand intense sexually arousing fantasies, urges and behaviors forthe above

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Causes significant distress

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Impairment in functioning

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The sexually arousing objects

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Not limited to articles of 61 clothing used in “cross-dressing”, or to devices designed to provide tactile genital stimulation (vibrator, etc)

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Pedophilic Disorder & Incest

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- Recurrent, Intense, sexually arousing

- Arousal is strong

- Person has acted

- Person is at least 18 yrs

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Recurrent, Intense, sexually arousing

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Fantasies, urges andbehaviors, involving sexual contact with a prepubescent child

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Arousal is strong

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Stronger for children than for adults

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Person has acted

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The urges and fantasies causeclinically significant distress or interpersonal problems

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Person is at least 18 yrs

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5 yrs older than the child

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Voyeuristic Disorder Symptoms

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- Recurrent and intense

- Person has acted

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Recurrent and intense

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Sexually arousing fantasies, urges and behaviors involving the observation of unsuspecting others who are naked, disrobing or engaged in sexual activity – for at least six (6) months

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Person has acted

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These urges with a nonconsenting person, or urges and fantasies cause marked distress or interpersonal problems.

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Exhibitionistic Disorder

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- Recurrent, intense and sexually

- Person has acted

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Recurrent, intense and sexually

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Arousing fantasies, urges orbehaviors involving showing one’s genitals to an unsuspectingperson

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Person has acted

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These urges to a nonconsenting person, or urges & fantasies cause significant distress & interpersonal problems

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Frotteuristic Disorder

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- Recurrent, intense and sexually

- Person has acted

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Recurrent, intense & sexually arousing fantasies

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Urges or behaviors involving touching or rubbing against a nonconsenting person

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Has acted on the above urges

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Nonconsenting person andor the urges/fantasies caused significant distress & problems

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Sexual Sadism Disorder

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(1) Desiring to inflict physical or psychologicalsuffering on another person.

(2) Actually causing the above to another person and thiscauses significant distress or impairment infunctioning or the person has acted on these urges witha nonconsenting (or consenting!) person.

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Sexual Masochism Disorder

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(1) Desiring to be humiliated, beaten, bound or made to suffer

(2) Acting upon the above, causes marked distress or impairment in functioning.

(3) NOT IN TEXT: Also there Coprofilia, Urolagnia, Bestiality, Necrofilia)

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Neurobiological Factors of Paraphilic Disorders

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Most paraphiliacs are men and there is speculation that hormones (testosterone) play a role. These hormones regulate sexual desire, and this appears to be high among those with (all) paraphilic disorders. Yet,such men do not appear to have high levels of testosterone or other androgens.

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Psychological Factors of Paraphilic Disorders

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(1) Classical Conditioning may have linked arousal withunusual or inappropriate stimuli.

(2) Operant Conditioning in cases of exhibitionism,pedophilia (or incest too?) is the result ofinadequate social skills. Substitution forconventional relationships (not learned?).

(3) Exposure of patients to physical and sexual abuse

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Treatments for the Paraphiliac Disorders

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Since many of the above disorders are illegal, many of the perpetrators are imprisoned and/or in court-ordered treatments. Research in this area is difficult since there cannot be control-groups used that receive no treatment at all vis-à-vis the treatment groups

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Strategies to Enhance Motivation for Paraphilic disorders

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(1) Empathize with the offenders’ reluctance to admit thathe/she is an offender and seek treatment to reducedefensiveness and hostility.(2) Point out that treatment might help control behavior.

(3) Emphasize the negative consequences of refusing (any)treatment and of offending again. (Stiffer penaltiesif accused).

(4) Explain that the psychophysiological assessment of thepatient’s sexual arousal will make it harder to denysexual proclivities to the authorities.

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Cognitive Behavioral Treatment for Paraphilic Disorders

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(1) Shock to hands for boot fetish etc.

(2) Drug that brought on nausea if acting on urges.

(3) Covert Sensitization=imagining such urge-situations and imagining becoming sick

(4) Change distorted thinking processes

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Biological Treatments for Paraphilic Disorders

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(1) Until hormonal treatment became available or successful, Castration, or Removal of Testes was used (however, cca. 3% of such patients were recidivists).

(2) Medications (especially for sexual offenders) as a supplement to psychological therapies, such as:

(a) Hormonal agents Medroxyprogesterone acetate

(b) Cyproterone acetate

(c) LHRH agents

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Efforts to Protect the Public (Megan’s Law)

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Special protection against pedophiles, child-rapists, etc. (Vigilantism also exists that causes other legal problems)