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29 Cards in this Set

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The field of sexual dysfunction has seen an increase in research with studies focused on what? (504
• Studies focus on functional magnetic resonance imaging (MRI)
• Cross cultural issues
• Qualitative methods
• Testing of herbal remedies
Sexual disorders are classified in the DSM-IV-TR into what 3 groups? (504)
1. Sexual dysfunctions which characterize sexual problems related to the sexual response cycle or pain
2. Paraphilias which are recurrent, sexually arousing fantasies, urges, or behaviors involving non-conventional or non-consenting person or objects
3. Gender Identity disorder which involves strong discomfort with one’s own sex and a desire to be the other sex
How are disorders of sexual dysfunction differentially classified in the DSM-IV-TR? (504)
According to problems in desire, arousal, orgasm, or pain.
What is the linear sequence of Masters & Johnson’s Human Sexual Response Cycle model of sexual stimulation? (504-505)
Excitement, plateau, orgasm, and resolution.
Specific sexual dysfunctions are divided into what 6 diagnoses in the DSM? (505)
• Sexual desire disorders
• sexual arousal disorders
• orgasmic disorders
• sexual pain disorders
• sexual dysfunction due to general medical condition
• sexual dysfunction NOS
What are the 3 specifiers of sexual dysfunction in the DSM (as paired like in the book)? (505-506)
1. lifelong vs. acquired
2. generalized versus situational
3. due to psychological factors or to combined psychological & biological factors
How is Hypoactive Sexual Desire Disorder defined by the APA? In what percent of men and women age 19-59 does this occur? How does Maurice (2005) operationalize how this presents in men? (508)
• persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity
• men 15%; women 30%
Maurice operationalized low sexual desire as:
1. Reduced thoughts, fantasies, & sexual dreams
2. Reduced sexual behavior w/ a partner
3. Reduced sexual behavior through masturbation
How is Sexual Aversion Disorder classified and defined? (509)
Classified as sexual desire disorder- persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital contact with a sexual partner.
List and give a brief definition of the Orgasmic disorders (511)
• Female Orgasmic Disorder is the persistent or recurrent inability of a woman to have an orgasm (climax or sexual release) after adequate sexual arousal and sexual stimulation.
• Male Orgasmic Disorder. The individual affected by male orgasmic disorder is unable to experience an orgasm following a normal sexual excitement phase. The affected man may regularly experience delays in orgasm, or may be unable to experience orgasm altogether.
• Premature ejaculation refers to the persistent or recurrent discharge of semen with minimal sexual stimulation before, on, or shortly after penetration, before the person wishes it, and earlier than he expects it.
How is Dyspareunia classified in the DSM-IV-TR? How is Vaginismus defined by the new definitions committee? (512)
• Dyspareunia: Recurrent or persistent genital pain associated with sexual intercourse
• Vaginismus: persistent or recurrent difficulties of the woman to allow vaginal entry of the penis, a finger and or any object, despite the woman’s expressed with to do so. There is often (phobic) avoidance and anticipation or fear of pain.
Clearly, there is a large degree of heterogeneity in what for sexual dysfunctions in men and women? What is thus essential for accurate diagnosis? (532)
• Large degree of heterogeneity in the diagnostic features, presumed etiologies, and treatments of the sexual dysfunctions in men and women
• Essential that a comprehensive biopsychosocial assessment of both partners—assessing all aspects of sexual response, satisfaction, and distress—be undertaken for accurate diagnosis and therefore optimal treatment to be decided upon
What is the current primary criteria for Gender Identity Disorder (GID) (535)
A strong and persistent cross-gender identification and persistent discomfort with one’s assigned sex. In addition, the individual cannot have a concomitant physical intersex condition such as congenital adrenal hyperplasia and the symptoms must cause clinically significant distress or impairment
Children must show 4 of what 5 characteristics to be considered be manifesting GID? (536)
1. Repeatedly stating a desire to be of the opposite sex or stating that one is of the opposite sex
2. Cross-dressing in clothing stereotypical of the opposite sex
3. Strong and persistent fantasies of being the opposite sex or preferences for cross-sex roles in make-believe play
4. A strong desire to participate in games and activities of the opposite sex
5. A strong preference for playmates of the opposite sex
Assessment and diagnosis of GID relies completely on what? (536)
Client’s self-report
In the past, intervention of clinicians working with those with GID focused on what? In contrast, current treatment, as outlined by the standards of care, includes three principal elements comprising “triadic therapy”—what do these elements include? (537)
• Past GID treatment focused on making the individual more like their biological sex. For example, past treatments have included various behavioral therapies targeted toward changing the individual’s social and sexual behaviors to be more stereotypically masculine or feminine, including behavioral modification of vocal characteristics, sexual fantasies, patterns of sexual arousal, and even movements and posture.
Current treatment includes three principal elements comprising a “triadic therapy”:
1. Living as the desired gender,
2. hormone therapy, and
3. sex reassignment surgery
The paraphilias, as defined by the DSM-IV-TR refer to sexual disorders of what? (538)
Paraphilias refers to sexual disorders of “recurrent, intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, or situations and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”
The paraphilias tend to fall into one of three types, involving what? (538)
The paraphilias tend to fall into one of three types:
• involving sexual arousal toward non-human objects,
• sexual arousal toward children or other non-consenting individuals,
• sexual arousal related to the suffering or humiliation of oneself or others.
Much research on paraphilias is based on samples of convicted sexual offenders, which leads to what three major confounds in understanding the paraphilias? (538)
• Many sexual offenders were never formally diagnosed
• The generalizability of these samples to all individuals with paraphilias is suspect, because it is likely that individuals convicted of a sexual offense represent the more severe end of the paraphilic spectrum
• The veracity of the self-reports by sexual offenders needs to be considered because these individuals often have high motivations to appear less “deviant” in their sexual interests and so may under- and overreport certain fantasies and experiences
What are the 9 paraphilias described in the chapter? Give a brief description of each (539-543)
Exhibitionism – recurrent and intense sexually arousing fantasies, sexual urges, or behaviors of exposing one’s genitals to an unsuspecting stranger over a period of at least 6 months, is the most commonly reported paraphilia.
Fetishism – recurrent sexual arousal (fantasies, urges, or behaviors) toward nonliving objects that are present for at least 6 months and are accompanied by clinically significant distress or impairment in at least one area of functioning.
Frotteurism – sexually arousal involving touching and rubbing against nonconsenting individuals that are present for at least 6 months and clinically significant distress or impairment is not a requirement for the diagnosis if the individual has acted on the urges.
Pedophilia – disorder involving sexual arousal toward a prepubescent child and must be recurrent over a period of at least 6 months, and the individual must either have experienced consequent distress or interpersonal difficulty or have acted on the urges.
Sexual Masochism – sexual arousal in response to being humiliated, bound, or beaten. The individual must experience this sexual arousal in the form of fantasies, urges, or behaviors over a minimum of 6 months and must suffer consequent distress or impairment in at least one important area of functioning.
Sexual Sadism – recurrent sexual arousal over a 6 month period in response to fantasies, urges, or behaviors involving the psychological or physical suffering of another. The urges or fantasies must have been carried out, must be distressing, or must cause interpersonal difficulty to meet diagnostic criteria.
Transvestic Fetishism – specific to heterosexual men, a disorder involving at least 6 months of recurrent sexual arousal associated with wearing women’s clothing (cross-dressing) and accompanied by significant distress or impairment.
Voyeurism – recurrent, intense sexual arousal, as demonstrated by fantasies, urges, or behaviors of seeing an unsuspecting person who is either naked, in the process of undressing, or engaging in sexual activity.
Paraphilia Not Otherwise Specified – given to those paraphilias that do not meet the criteria for any of the eight specified above. These include paraphilias such as necrophilia (sexual activity with corpses), zoophilia (sexual arousal involving activity with animals), coprophilia (sexual arousal involving activity with feces), klismaphelia (sexual arousal involving enemas), and urophilia (sexual arousal involving urination).
Name 3 of the self-report measures described in the chapter (546)
• Clarke Sexual History Questionnaire for Males
• Multiphasic Sex Inventory
• Wilson Sex Fantasy Questionnaire
Treatment of the paraphilias consists of a number of techniques, the most common of which are what? It is argued that even if treatment works merely as a placebo for reducing recidivism, it can have what other desirable effects? (550)
Common Approaches:
o Behavioral
o Cognitive
o Pharmacological
Other Desirable Effects:
o Teaching social skills
o Fostering honesty and openness
o Enhancing empathy for victims
LQ: What are the Major Divisions of the diagnostic categories for the Sexual Disorders? Give examples of each at various stages of the sexual response cycle (arousal, excitement, orgasm, resolution).
The DSM-IV makes a primary distinction between sexual dysfunctions and paraphilias (sexual deviations). Sexual Dysfunctions involve a primary impairment in the sexual response cycle, such as a Premature Ejaculation, or Female Orgasmic Disorder. The paraphilias involve a functional physiological sexual response which has been associated with an unnatural stimulus, such as seen in Voyerism, Rape, Pedophillia, and Frotteurism. DSM-IV described a large number of sexual disorders, particularly in the dysfunctions category and should be consulted for details on these conditions
LQ: What is Gender Identity Disorder?
The DSM-IV states that the major criteria for the diagnosis of gender identity disorder is a strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). It is stated to have no specific relationship to sexual orientation or to transsexualism.
LQ: Distinguish between Anorexia and Bullimia (provide both common and distinctive symptoms).
The diagnostic criteria for Anorexia involve a refusal to maintain minimal body weight for age and height, an intense fear of weight gain or becoming fat (even though under weight), and a disturbance in the way one's body shape or weight is experienced. In postmenarcheal females, amenorrheia is also seen. The three most common medical complications of people who are suffering from anorexia nervosa are loss of menses (amenorrhea), constipation, and hypotension. Although Anorexia and Bulimia share an intense fear of wight gain and a significant disturbance in the perception of one's shape or size, Bulimia is easily differentiated as it involves recurrent episodes of binge eating and inappropriate compensatory behavior in order to prevent weight gain (self-induced vomiting, laxative use, or over-exercise). Binging and compensatory behaviors both occur on average at least two times a week for three months. Bulimia and Anorexia can be comorbid.
LQ: What is the general organization of the Sleep Disorders as presented in DSM-IV-TR? Be able to give several examples of each type of disorder.
The DSM-IV presents the disorders of sleep under two general categories. The Dysomnias centrally involve a difficulty in initiating or maintaining sleep, being excessively sleepy, or finding sleep to be of poor quality (nonrestorative). The Parasomnias involve abnormal behavioral or physiological events occurring in association with sleep stages or the transitions between sleep stages. Examples of the former are Insomnia and Sleep Apnea and of the later, Sleep Terror Disorder, Sleepwalking, and Nightmare Disorder.
LQ: Describe the "other" category used for Impulsive Control Disorders.
The DSM-IV included a number of "habit" disorders in specific categories (e.g. Obsessive-Compulsive Disorder, Substance Dependence, and the Paraphilias). However, additional conditions not already presented are described in this small chapter, including Pathological Gambiling, Kleptomania, Intermittent-Explosive Disorder; and Trichotillomania.
LQ: Provide the name and a brief description for each of the types of Personality Disorder presented in the DSM-IV-TR.
Paranoid Personality Disorder- a pattern of distrust and suspiciousness such that other's motives are interpreted as malevolent

Schizoid Personality Disorder- disinterested in social relationships, socially apathetic

Schizotypal Personality Disorder- a pattern of acute discomfort in close relationships, cognitive/perceptual distortions, and behavioral eccentricities

Antisocial Personality Disorder- a pattern of disregard for, and violation of the right's of others

Borderline Personality Disorder- exhibits abrupt shifts in mood, have a poorly developed self-image, and demonstrate intense and unstable relationships

Histrionic Personality Disorder- a pattern of excessive emotionality and attention seeking

Narcissistic Personality Disorder- an inflated or grandiose sense of self, expect others to see them as specifically gifted

Avoidant Personality Disorder- so highly sensitive to criticism and rejection that they may refuse to enter into social relationships

Dependent Personality Disorder- a pattern of submissive and clinging behavior related to an excessive need to be taken care of

Obsessive Compulsive Personality Disorder- characteristics of orderliness perfectionism, and rigidity without true obsessions or compulsions
LQ: What is a V-code as used in DSM-IV-TR?
In the DSM-IV, clinically-relevant conditions which do not meet the criteria for a formal mental disorder may often be adequately described and communicated to others via a V-code diagnosis. A V-code indicates that the condition which is a focus, or even the primary focus, of clincial intervention is not attributable to mental disorder, Prominent examples include Partner-Relational Problem (used for marital conflict), Academic Problem, Malingering, Bereavement, and Occupational Problem.
What is an Adjustment disorder, as defined in the DSM-IV-TR?
According to the DSM-IV, an adjustment disorder is a psychological response to an identified stressor (nontraumatic) that results in the development of clinically significant emotional or behavioral symptoms. Symptoms must show onset within three montsh of the stressful event and resolve within six months, unless the stressor is ongoing in nature.