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Part 2- L1.docx

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Gareth Treharne

Part 2- Lecture 1 Disorders as learning of aberrant behaviour The roots of behaviour therapy lie in the theories of classical and operant conditioning developed in the early to mid-twentieth century by Pavlov ([1927] 1960) and Skinner (1953) - behaviour is determined by external events past learning experiences drive present - behaviour behavioural change can be achieved through direct manipulation of external events; there is no need to explore or change the individual’s ‘psyche’ or ‘inner world’ the - Principles of learning are subject to scientific exploration and hold across all species: studies in rats inform our understanding of human behaviour. Normative behaviour - 20-39 year old males o 95% have had vaginal sex before o 7.3 median partners in life time o 71% have had 1 sexual partner in the last year o 23% have had 20+ partners in lifetime o 3.7- median frequency of vaginal intercourse o 2% have had homosexual activity in last 10 years o 1% exclusively homosexual - Normal sexual functioning o An absence of dysfunction o Significant interpersonal variability and malleability (change- ability) of response over time o Significant sociocultural variability in normal sexual functioning  Problem that it is all generalised  This was used to classify sexual dysfunction  Same problems as the three stage model  Kaplans (1979) 3 stage model × Desire  Physiological and psychological aspects of libido  Under limbic and hormonal control  Centrally mediated × Excitement  Peripherally mediated × Orgasm × Peripherally mediated  The 3 stage model was in DSM 3 and 4 but not 5. Sexual Dysfunctions - Involve a problem in sexual response - Delayed ejaculation - Female interest/arousal disorder - Female orgasmic disorder o Inhibits orgasm - Genito-pelvic pain/ penetration disorder o Spasm disorder o Vaginismis, dyspareunia o recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina o Prevents sexual intercourse o Less than 1% o Results from  Psychoanalytic × unresolved psychosexual conflicts in early childhood  behavioural × phobic reaction to actual or imagines negative experience or penetration o treatment  sensate focus, gradual regression to genital touching - Male hypoactive sexual desire disorder - Premature ejaculation - Substance/education induces sexual dysfunction - Erectile disorder o persistent or recurrent inability to gain or maintain an adequate erection until completion of sexual activity o results in marked distress or interpersonal difficulties o reported a 7 per cent prevalence among men aged 18 – 29, 9 per cent for men aged 30 – 39, 11 per cent for those aged 40 – 49 and 18 per cent for those aged 50 – 59 o Caused by high blood pressure, and the long-term effects of drugs such as alcohol, heroin, marijuana and cigarettes o results from an oedipal conflict constellation involving fear of castration or incest, uncertainties in sexual identity, incestuous object choices, latent homosexual tendencies and fear of aggressive-phallic impulses o Anxiety adversely affects sexual performance as a result of cognitive and perceptual factors. o Men’s sexual excitement depends on balance between excitatory and inhibitory mechanisms. o Key inhibitory processes  Anxiety  fear of negative outcomes o failure to achieve firm erection which is the key element of every sexual encounter o Treatment  Anxiety reduction and desensitization  Cognitive techniques  Interpersonal interventions  Medical approaches Paraphilc disorders - Involve repeated and intense sexual urges, behaviour or fantasies in response to objects or situations that society deems inappropriate - Exhibitionistic disorder o Exposing genitals to unsuspecting stranger - Fetististic disorder o The use of non-living objects o Specific focus on items - Frotteuristic disorder o Touching, rubbing against non-consenting other - Paedophilic disorder o Prepubescent child - Sexual masochism disorder o Being mad or suffer during sex - Sexual sadism disorder o Psychological or physical suffering of others - Transvestic disorder o Cross dressing - Voyeuristic disorder o Observing unsuspecting others Changing definitions of disorders - DSM o Sociopathic personality disturbances - DSM2 o Personality disorders and certain other non-psychotic mental disorders o Sexual deviation o Includes homosexuality - DMS3, DSM3R, DSM4 o Psycho sexual disorders o Gender identity disorders o Paraphilia’s o Psychosexual dysfunctions o Other psychosexual disorders o (ego-dystonic homosexuality) - BDSM o Bondage, discipline, dominance, submission, sadism, masochism o Statistically abnormal but pathologically ‘neutral’ o Historically DS has been marginalising certain subgroups of the population  Particularly women and sexual minorities o Most psychological theories are biased towards the preservation of prevalent social morals o BDSM activities are by themselves evidence of psychopathology Fetishism - Predominantly male - Almost never diagnosed in females - About 8% of paraphilia patients have fetishism - About 3.5% sexual offenders - Course and features o Onset typically in childhood or adolescence o Chronic, life long o Fluctuating frequency of acts o Fluctuation of urges o 65% of those with fetishism have more than one fetish object o The presenting problem is not usually the fetish o 70% of those with fetishism disorder have stable partner relationships o Fetish object  60% is clothing  20% is rubber items  15% is parts of the body  15% is footwear o Behaviours with object  45% Wear
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