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PSYC 3140
Stephen Fleming

PSYC3140 Exam 2 Chapter 8: Eating and Sleeping Disorders Eating disorders: Overview Increase during 1950s and early 1960s Bulimia nervosa: out of control eating episodes , or binges, followed by self-induced vomiting, excessive use of laxatives or other attempts to “purge” Anorexia nervosa: person eats nothing beyond minimal amounts of food o Characterized by overwhelming, all-encompassing drive to be thin o Highest mortality rate of any disorder Rates for bulimia rose dramatically near late 1970s, may relate to increased prevalence of dieting & preoccupation w/ body amongst young women & social pressure toward consumption, food availability William Gull: first used term anorexia nervosa: 1872 st Bulimia described in 1970s, when eating were included for 1 time as separate group in DSM-IV o Previously classified in infancy, child & adolescence disorders Increase tends to be culturally specific ( young females , but evidence suggests is now global Bulimia Nervosa The hallmark of bulimia is eating a larger amt of food (mostly junk) than most ppl would eat under similar circumstances As important as amount of food eaten is fact that eating is experienced as out of control Another criterion: person attempts to compensate for binge eating by purging techniques o Self-induced vomiting immediately after o Laxatives (women who use more impulsive than those who do not) o Diuretics (greatly increase frequency of urination) o Prolonged fasting o Excessive exercise Subtyped in DSM-IV into purging and non-purging type (rare) Those who purged developed disorder @ younger age, higher rates of comorbid depression, anxiety disorder, alcohol abuse Medical consequences: o Salivary gland enlargement due to repeated vomiting o Continued vomiting=>chemical imbalance of bodily fluids e.g. sodium & potassium levels=electrolyte imbalance o Cardiac arrhythmia, renal and kidney failure o Intestinal problems e.g. severe constipation/ colon damage Associated psychological disorder 1 PSYC3140 Exam 2 o Anxiety disorders. E.g. Social phobia, generalized anxiety disorder o Mood disorders, esp depression (follows bulimia and may be reaction to it), borderline personality disorder, substance abuse (nicotine dependence common), impulse control Anorexia Nervosa Major difference b/w this and bulimia is whether individual is successful @ losing weight Ppl w. AN are proud of weight loss accomplishments and extraordinary control, unlike ppl w/ BN who are ashamed of problem and LACK of control BN more common than AN, but great overlap Decreased body weight most notable feature of AN, but not core of disorder Ppl w/ AN have intense fear of obesity and relentlessly pursue thinness Caroline Davis: severe, almost punishing exercise common in AN DSM IV: 2 subtypes of AN: 1. Restricting type: where ppl diet to limit calorie intake 2. Binge-eating/purging type: binge on small amts of food and purge excessively and consistently Person w/ AN never satisfied w/ weight loss, average=25-30% below normal body weight Key criterion in AN=marked disturbance in body image: way person sees and feels abt body Some show increased interest in cooking & food Medical consequences: o Cessation of menstruation o Dry skin, brittle hair/nails, sensitivity to or intolerance of cold temperatures o Lanugo: downy hair on limbs and cheeks]vomiting=> electrolyte problems, cardiac and kidney problems Associated psyc disorders o Anxiety and mood disorders o E.g. Obssesive and compulsive disorder (individual engages in senseless. Ritualistic behaviour to rid herself of unpleasant feeling of gaining weight) o Substance abuse, suicide Binge-eating disorder (BED) Experience marked distress due to binge eating but do not engage in extreme compensatory behaviours 2 PSYC3140 Exam 2 Currently, BED in DSM-IV as potential new disorder, will be classified as separate disorder in DSM 5 BED associated w/ more severe obesity About half try dieting before bingeing and half binge then diet Stats BN only recognized as distinct disease in 1970s About 95%=women, middle-upper class, same with AN Age of onset-16-19 yrs Immigrants to Western countries also develop Men rated their actual size, ideal size and size most attractive to females as approx. equal Women rated current figures as much heavier than ideal Friendships contribute heavily to formation of body image concerns and eating habits Strong relationship b/w dieting and bingeing “false-hope syndrome”: ppl’s false hopes abt self-change attempts initially strongly reinforced, positive feelings and sense of control that ppl feel with initial success lead them to continue pursuing unrealistic or impossible goals for weight loss Evidence suggests strong genetic contribution to body size Those w/ eating disorder display strong preoccupation w/ food, chronic dieters seem to remember info better when it pertains to food Typical anorexic’s family tends to be successful, hard-driving, concerned about external appearances, eager to maintain harmony Mothers of anorexic girls tend to be “society’s messengers” reinforce social expectations, less satisfied with families and family cohesion Biological dimensions Eating disorders run in families, genetic component Relatives of such patients are 4 or 5 times more likely to develop Important study by Walter and Kendler: bulimia occurs in 23% identical twins, as compared to 9% fraternal twins Symptoms of eating disorders have partially genetic basis, body mass 57% heritable, purging 42%, concern for overeating 20% Hypothalamus plays important role: low levels of serotonin activity associated with impulsivity in general and bingeing specifically Role of exercise in maintaining AN: “activity anorexia” where excessive physical activity can cause a loss of appetite Psyc’l dimensions 3 PSYC3140 Exam 2 Many women w/ disorders have diminished sense of personal control and confidence in their abilities and talents Perfectionist attitude affects but only w/ prerequisite that ppl must consider themselves overweight and manifest low self-esteem, among women that were dissatisfied w/ their bodies Substantial anxiety before and during snacks, state of relief caused by purging acts as reinforcer Integrative model No one factor sufficient to cause Ppl w/ eating disorders may have some of same biological vulnerabilities as ppl w/ anxiety disorders Social and cultural pressures to be thin motivate restriction of eating Treatment At present, drugs founds to be largely ineffective Antipsychotic medication olanzapine may be helpful in treatment of AN in children (side effect of weight gain) Drugs generally most effective for bulimia same antidepressant meds for mood and anxiety Antidepressants not found to be long-lasting effective for BN Psychosocial treatment o Until recently, were directed at low-esteem and identity disorder Bulimia Nervosa o 1 stage is to teach patients physical consequences of bingeing and purging and ineffectiveness of vomiting and laxative abuse for weight control o Patients scheduled to eat small smalls 5 or 6 times per day o Later stages, cognitive therapy focuses on altering dysfunctional thoughts and attitudes about body shape, weight, eating o Short term cognitive therapy proved to be effective 3 different treatments: a) Cognitive behavioural therapy (CBT): focused on changing eating habits and attitudes about weight and shape -bingeing and purging declined by more than 90% b) Behaviour therapy (BT) focused only on changing eating habits c) Interpersonal psychotherapy (IPT) focused on improving interpersonal functioning, did as well as CBT after 1 yr follow-up Variant of CBT=psychoeducation for BN, main goal is to help ppl normalize eating habits and reduce body image disturbance by providing them w/ useful information and strategies e.g. meal planning, problem solving and self-monitoring 4 PSYC3140 Exam 2 CBT superior and remains preferred treatment for bulimia Binge-eating disorder Preliminary result of CBT treatment for binge-eating disorder look promising (after 1 year, reduced by 64%) Self-help procedures may also be helpful Anorexia Nervosa Most important initial goal is to restore the patient’s weight to normal/low-normal range, which is easiest stage of treatment But difficult part is to tackle the underlying dysfunctional attitudes about body shape Focus ten shifts to their marked anxiety over becoming obese Effective treatment similar to BN Research highlights importance of assessing clients’ readiness for change, interventions are ebing developed to enhance patients’ motivation to change Family therapy included (seems to be effective): 2 goals o Negative and dysfunctional communication regarding food and eating must be eliminated, meals made more structured and reinforcing o Attitudes toward body shape and image distortion discussed at length Prevention Early concern of overweight most powerful predictor of eating disorders, need to tackle Prevention program developed to emphasize normality of weight gain after puberty, and restriction causes increased gain BUT..intervention program had little effect overall, (Killen) most effective way is to screen for 11-12 yr olds at high risk for developing disorders and apply program Sleep Disorders Common myth that all ppl need 24 hrs of sleep to function properly The ideal amt of sleep actually varies from person to person Sleep patterns change as we age (for infants 16=hours, early adulthood=7 to 8 hours, 50+ 6 hours or less) Some chronic health problems linked to insomnia: migraines, circulatory problems, digestive and respiratory disease Why? Because immune functioning is reduced with the loss of even a few hours of sleep Sleep problems interact with psychological factors Sleep can be divided into 2 broad states: 1. Slow-wave state in which person sleeps deeply 5 PSYC3140 Exam 2 2. Rapid-eye movement (REM) state in which brain appears as if it is awake and in which sleeper experiences dreams. Between the 2 are transition stages Stage 1: person transitions thru wakefulness into drowsiness and then sleep (during 1, person drifts in and out of consciousness) Stage 2: person is truly sleeping, but lightly (can be easily aroused) Stage 3: moderately deep sleep Stage 4: very deep sleep (when awoken, person may seem disoriented) Throughout night, we show a 90 min. cycle of sleep, from lighter to deeper sleep then back to light sleep and ending with REM sleep Normal sleepers spend 20% of sleep time in deep sleep, 30% dreaming, 50% in light sleep Sleep disorders are divided into 2 major categories: 1. Dyssomnias: difficulties getting enough sleep and complaints about quality of sleep 2. Parasomnias: abnormal events that occur during sleep, e.g. nightmares and sleep- walking Most comprehensive evaluation of sleep can be determined only by a polysomnographic evaluation (PSG) o Patient sleeps 1 or more nights in a sleep laboratory, monitored on: o Respiration, leg movements, brainwave activity (EEG) o Eye movements (EOG) o Muscle movements (EMG) o Heart activity (ECG) Alternative is actigraph, wristwatch device that measures arm movements Also helpful for clinicians to find out average # of hours person sleeps each day, taking into acct sleep efficiency (% of time actually spent asleep, not just lying in bed) o Amt of time sleeping/amt of time in bed Another way to determine sleep problems is to observe daytime sequelae: behaviour while awake o E.g. if it takes a person 90 min. to fall asleep and they are not bothered, feel rested during the day, they do not have a sleep problem Dyssomnias Primary insomnia Insomnia one of the most common sleep disorders, means “not sleeping” BUT…not possible to go completely w/o sleep, after 40 hours w/o sleep, person begins having microsleeps (which last several seconds or longer) Exception: fatal familial insomnia (degenerative brain disorder) where total lack of sleep leads to death 6 PSYC3140 Exam 2 Ppl considered to have insomnia of they have trouble falling asleep (initiating), wake up too early and can’t go back to sleep (maintaining) and if they sleep reasonable # of hours but are still not rested during the day (non-restorative sleep) Clinical description o Primary insomnia : indicates that complaint is not related to other medical or psychiatric disorders o Some have trouble initiating and maintaining sleep, while others sleep all night but still feel unrested Stats: o About 1 third of populations reports some symptoms of insomnia any year o Nearly ¼ of Cdns report insomnia o Several psyc disorders associated: total sleep time decreases with depression, substance abuse, anxiety disorders, dementia, alcohol abuse o Women report insomnia twice as often as men o **Note: sleep problem only a disorder if you experience discomfort about it o Complaints of insomnia differ in frequency among ppl of different ages Causes o Sometimes related to problems with biological clock and control of temperature o Light exposure causes an acute increase in human body temperature, which falls during night o Ppl who have insomnia may have a delayed temperature rhythm: body temp doesn’t drop and they don’t fall asleep until later o Drug use and change in environmental factors e.g. light, noise or temp o Various psyc’l stresses o Sutton and colleagues: found that having a very stressful life was 1 of 3 strongest predictors of insomnia for Cdns o Morin and colleagues: ppl with insomnia may have unrealistic expectation about how much sleep they need and how disruptive disturbed sleep will be  **illuminates role of cognition in insomnia o Learned behaviour? Ppl associate the bedroom and bed with the frustration and anxiety that go w/ insomnia so that arrival of bedtime may cause anxiety o Biological and psyc factors reciprocally related  Children with sleep problems had more difficult temperaments, personality, sleep difficulties and parental reaction all interact o Cultural factors (eg. North American norms that discourage co-sleeping may cause anxiety for children when sleeping) o Ppl may be biologically vulnerable: e.g. a person may be a light sleeper or have a family history of insomnia, narcolepsy or obstructed breathing Integrative model 7 PSYC3140 Exam 2 o Biological vulnerability and sleep stress influence each other o Extrinsic influences such as poor sleep hygiene (daily activities affecting how we sleep) can affect physiological activity of sleep e.g. jet lag o Ppl take sleeping pills but are not aware that rebound insomnia may occur when meds are drawn, rebound leads ppl to think they still have problem, re-take meds, cycle repeats, problem is perpetuated o Naps that alleviate fatigue can disrupt sleep during night o anxiety also extends problem Primary hypersomnia problem of “sleeping too much” DSM-4 criteria for hypersomnia includes not only sleeping too much but subjective impression of this problem. Ppl w/ hyper sleep thru night and appear rested but still complain of being excessively tired during the day Sleep apnea can also cause excessive sleepiness: ppl snore loudly, pause between breaths and complain of dry mouth and headache in morning When diagnosing hypersomnia, need to rule out insomnia, sleep apnea and other reasons Narcolepsy In addition to daytime sleepiness, ppl also experience cataplexy: a sudden loss of muscle tone Occurs while person is awake, can range from slight weakness to complete collapse Appears to result from sudden onset of REM sleep Two other characteristics: 1. Sleep paralysis: brief period after awakening when person can`t move or speak 2. Hypnagogic hallucinations: vivid experiences that begin at the start of sleep and said to be unbelievably realistic: involves touch, hearing and body movements **may serve to explain UFO experiences Breathing-related disorders Problems w/ breathing while asleep Ppl experience brief arousals throughout night and do not feel rested even after reasonable hours of sleep May experience hypoventilation: where breathing is constricted a great deal and becomes laboured Sleep apnea: when person stops breathing altogether for short periods of time o Other signs: heavy sweating, headache during day, sleep attacks (episodes of falling asleep during day) 3 types of apnea: 8 PSYC3140 Exam 2 1. Obstructive: when airflow stops despite activity by respiratory system 2. Central: complete cessation of respiratory activity, associated with CNS disorders 3. Mixed: combination of previous 2 Circadian-rhythm disorders Characterized by disturbed sleep brought on by brain’s inability to synchronize its sleep patterns with current patterns of day and night Human biological clock in the suprachiasmatic nucleus in the hypothalamus o Connected is a pathway from eyes. The light in morning and decreasing light at night signal brain to reset the biological clock each day Several types: 1. Jet lag type: caused by rapidly crossing multiple time zones 2. Shift-work type: associated with work schedules, problems of working unusual times can cause heart disease, ulcers and cancer 3. Delayed phase type : arises from within the person, sleep delayed later than normal Melatonin (hormone produced by pineal gland) contributes to the setting of biological clocks that tell us when to sleep, also called “Dracula hormone” b/c production stimulated by darkness and ceased in the daytime Both light and melatonin helps set biological clock Treatment of dyssomnias Most common are medical Popular meds are benzodiazepines e.g. Halcion, Dalmane Short-acting drugs preferred because long-term drugs don’t wear off by daytime, ppl report more daytime sleepiness Long-acting drugs preferred when negative effects e.g. daytime anxiety observed Several drawbacks to meds: o Can cause excessive sleepiness o Dependence and misuse o Meant for short-term treatment, not recommended for longer than 4 weeks o Longer use can cause rebound insomnia o May cause increase in sleepwalking To treat narcolepsy or hypersomnia, stimulants used Cataplexy can be treated with antidepressants, GHB Treatment of breathing related disorders focus on helping person breathe better o May mean weight loss 9 PSYC3140 Exam 2 o Tricyclic antidepressants to stimulate airways o Gold standard for treating obstructive sleep=use of mechanical device (continuous positive air pressure machine or CPAP) that improves breathing o Treatment for mild apnea involves digeroo: wind instrument) Environmental treatments General principle for treating circadian rhythm disorders=phase delays (moving bedtime later) or phase advances (moving bedtime earlier) Phase delays proved more effective, drawback=ppl need to take daytime naps Bright light therapy Psyc’l treatments Progressive relaxation or sleep hygiene Treatment involving CBT showed best outcomes Prevention of sleep disorders Can be prevented with practice of sleep hygiene (changes in lifestyle that promote sleep) Sleep hygiene relies on allowing brain’s normal drive to take over and replacing restrictions on activities prior to bedtime that interfere w/ sleep E.g. avoid caffeine, regular sleep schedule Parasomnias Abnormal events that occur during sleep or during twilight time b/w sleeping and waking 2 types: 1. Those that occur during REM sleep  Nightmares, to qualify in DSM 4, must be so severe that it affects normal function 2. Those that occur during non-REM sleep  Sleep terrors, commonly afflict children  Begins w/ scream, occur during NREM sleep, sweating, panting  Treatment involves careful monitoring and scheduled awakenings  Sleep-walking (somnambulism) occurs during NREM, may be due to extreme fatigue, sleep deprivation, stress, sedative or hypnotic drugs 10 PSYC3140 Exam 2 Chapter 10: Sexual disorders and gender identity disorders Gender and cultural differences There are some dramatic gender differences in patterns of sexual behaviour and relationships Men express far more permissive attitudes towards casual sex and premarital sex than women do Differences in basic or core beliefs about sexual aspects of self o Women report experience of passionate and romantic feelings as part of sexual experience, more conservative, self-conscious schema while men evidence feelings of power, independence and aggression as part of sexuality What is normal in 1 cultural not necessarily normal in another Development of sexual orientation Reports suggest homosexuality runs in families Concordance rates for homosexuality more common among monozygotic twins than dizygotic twins or siblings Associated with differences in hormonal exposure early in life and actual brain structure This general biological vulnerability then interacts w/ various environmental conditions, personality traits etc to determine behavioural patterns Bem’s “exotic becomes erotic” model o Person inherits biological variables which cause child-hood temperaments (e.g. aggressive, activity level) o Then develops sex-typical or atypical activity and playmate preferences (e.g. less feminine boys play with more aggressive boys, aggressive boys attracted to feminine girls) o Feeling different from opposite or same-sex peers o Generalized attraction, autonomic arousal to opposite or same-sex peers o Erotic or romantic attraction to opposite or same-sex persons Gender identity disorder Essence of masculinity or femininity is a deep-seated personal sense called gender identity Gender identity disorder: present if a person’s physical gender is inconsistent w/ that person’s sense of identity, ppl feel “trapped in wrong body” GID (or transexualism) must be distinguished from transvetic fetishism (where person aroused by dressing up as opposite sex) In case of GID, primary goal is not sexual but desire to live openly in manner of opposite gender 11 PSYC3140 Exam 2 Must be distinguished from intersex individuals (hermaphrodites), ppl who are born w/ genitalia of both sexes and are assigned a sex Also different from same-sex arousal patterns of feminine male or woman who has masculine mannerisms ***Note: in DSM 4, gender identity is independent from sexual arousal patterns Autogynephilia (where GID begins w/ strong and specific sexual attraction to fantasy of oneself as a female, then progress to becoming a woman GID occurs 3x more frequently in males than in females Causes Coolidge: genetics contributed about 62% to creating biological vulnerability to experience GID Research suggests higher levels of testosterone or estrogen at critical periods in development might masculinize a female fetus or feminize a male fetus Intersex condition CAH: brains of these chromosomal females flooded w/ male hormones (androgens) which produce masculine genitalia Some evidence suggests gender identity firms up b/w 18 months and 3 yrs of age Parental preference for children’s sex may influence how child is raised via encouragement or discouragement of gender-typical/stereotypic behaviours Excessive attention and physical contact from mother may play role in forming effeminate boys Treatment Presently most common treatment is sex reassignment surgery o To qualify, patient must live in opposite sex role for 1-2 yrs o Must be stable financially, socially, psychologically o In male-to female, hormone administered to promote gynecomastia (breast growth) and other secondary sex characteristics o If patient satisfied w/ trial, genitals removed and vagina constructed o In female-to-male, penis is artificially constructed, breasts removed o Controversy around whether this should be publicly funded procedure, until 1998, was funded w/ taxpayer money, now private-human rights concerns Surgery and hormonal replacement therapy been the standard treatment for intersex Psychosocial treatment: focuses on making adjustments Sexual dysfunctions Three stages of the sexual response cycle, desire, arousal, orgasm, each associated w/specific sexual dysfuctions 12 PSYC3140 Exam 2 Can be life-long (present throughout entire sexual life) or acquired (begins after sexual activity has been relatively normal) Sexual desire disorders Hypoactive sexual desire disorder: o Little or no interest in any sexual activity, requires great deal of clinical judgment taking into acct age, context o Used to be presented as marital problem o Most frequent presenting complaint of women o For men, prevalence increases with age, for women, decreases with age Sexual aversion disorder o Where even the thought of sex or brief casual touch might evoke fear, panic or disgust, sometimes principle problem may be panic disorder or b/c sex triggers traumatic memories Sexual arousal disorder o Male erectile disorder: has difficulty achieving or maintaining erection (formerly impotence) o Female sexual arousal disorder: cannot achieve or maintain adequate lubrication (formerly frigidity) o Man typically feels more impaired by problem than woman as inability to achieve erection makes intercourse nearly impossible Orgasm disorders Inhibited orgasm o Inability to achieve orgasm despite adequate sexual desire and arousal o More common in women, rare in men o Female orgasmic disorder: most common complaint among women who seek sex therapy o Equally present in all age groups, unmarried women 1.5x more likely to experience than married o Retarded ejaculation (where its delayed) and retrograde ejaculation (where semen travel backward) not to be confused w/ male orgasmic disorder Premature ejaculation: o Ejaculation that occurs well before it’s desired o Most frequent male sexual dysfuction o Perception of lack of control over orgasm may be most important psychological component o Grenier: has 3 components:  Behavioural: regularity of rapid ejaculation 13 PSYC3140 Exam 2  Emotional: worry or concern about it  Efficiency: perceiving they have little control over timing Sexual pain disorders Intercourse associated with marked pain so severe that it is disrupted A.k.a dyspareunia, diagnosed only is no medical reasons for pain can be found Degree of dyspareunia in women associated with depressive and anxiety symptoms, marital adjustment, hostility, psychotic symptoms Vaginismus: pelvic muscles in the vagina undergo involuntary spasms when intercourse attempted Assessing sexual behaviour 3 major aspects of assessments: 1. Interviews: supported by numerous questionnaires b/c patients may provide more info on paper than verbal interview 2. Thorough medical exam: rules out variety of medical conditions that can contribute to sexual problems 3. Psychophysiological assessment: direct measurements taken while patients wake or asleep to gauge their physiological aspects of sexual arousal  Penile strain gauge: as penis expands, stain gauge picks up changes and records them on a polygraph  Vaginal photoplethysmograph: arousal assessed by amt of blood flow  Nocturnal penile tumescense (NPT) used before, but determined to be a crude and inaccurate method Causes of sexual dysfunction Biological contributors Physical and medical conditions Neurological diseases and conditions which affect the NS e.g. diabetes and kidney disease directly interfere w/ sexual functioning by reducing sensitivity in that area Vascular disease: arterial insufficiency and venous leakage (blood flows out too quickly for erection to be maintained) Prescription meds: o Anti-hypertension drugs, beta blockers o Selective-serotonin reuptake inhibitors (SSRI) antidepressant meds and other anxiety drugs Substance abuse: 14 PSYC3140 Exam 2 o Alcohol: acts as CNS suppressant, makes it difficult to achieve erection and lubrication, chronic alcohol use may cause permanent neurological damage and eliminate sexual response cycle altogether, fertility problems o Smoking Psychological contributions Environmental factors (e.g. insufficient sexual context) Depression Perceptions that emotional intimacy was lacking Performance anxiety made up of 1) arousal 2) cognitive processes 3) negative affect Ppl who are dysfunctional tend to expect the work and find situation to be most unpleasant, they avoid sexual cues As a result, person who focuses on negative thoughts finds it almost impossible to become sexually aroused Negative affect-attentional focus on consequences of not performing-increased autonomic arousal-increasingly efficient attn. on consequences of not performing- dysfunctional performance-avoidance Social and cultural contributions Erotophobia: where person develops negative cognitive set about sexuality, and their responses reflect these beliefs Sexual victimization and abuse, traumatic sexual acts Marked deterioration in close interpersonal relationships (e.g growing dislike for partner or finds partner no longer attractive) Poor sexual skills European women significantly more knowledgeable and liberal towards sex, higher rates of desire, arousal, sexual pleasure than Asian women Negative self-schema ** remember interaction of psyc’l and physical factors: no one biological or physical factors is responsible Socially transmitted negative attitudes about sex may interact w/ person’s relationship difficulties and predispositions to develop performance anxiety and lead to sexual dysfunction Treatment of sexual dysfunction Education is vital: ignorance about sexual response cycle and intercourse often leads to long-lasting dysfunctions Psychosocial treatments 15 PSYC3140 Exam 2 Masters and Johnson: primary goal is to eliminate psychologically based performance anxiety Introduced sensate focus and nondemand pleasuring: o Couples are to refrain from intercourse or genital caressing o 1 phase consists of non-genital pleasuring o Then genital pleasuring but no orgasm o Then intercourse, where depth of penetration gradually built-up, pleasuring and touching continue, finally full intercourse and thrusting accomplished o High recovery rates after 2 weeks, about 60-70% for erectile dysfunction Premature ejaculation: o Squeeze technique: penis is stimulated to near full erection o Partner then squeezes the penis near top of head, which reduces arousal o Steps repeated until penis inserted into vagina w/o thrusting o Man can develop sense of control over arousal and ejaculation o Up to 90 benefit Lifelong female orgasmic disorder may be treated w/ explicit training in masturbatory procedures, about 70-90% benefit To treat vaginismus, woman and partner gradually insert dilator increasing in size carried out in context of genital and non-genital pleasuring so as to retain arousal, 2 subtypes of: o Involves a phobia of penetration for which CBT developed for fear reduction most appropriate o Involves genital pain for which psychosocial techiniques developed for treatment of chronic pain most appropriate Treatment for low sexual desire are standard re-education and communication phases of traditional sex therapy with addition of masturbatory training and exposure to erotic material, 50-70% benefit Medical treatments Variety of pharmacological and surgical techniques developed, mostly focusing on male erectile disorder, e.g. Viagara, Levitra and Cialis 4 popular procedures: 1. Oral meds **Note: it is importance to combine any medical treatment w/ comprehensive educational and sex therapy program to ensure max benefit Viagara, by 2003 had become most common treatment for erectile dysfunction (E.D.) Yohimbine and testosterone have been used to treat E.D. for some time, but results have been negligible UWO researchers reported that testosterone may alleviate hypoactive desire in women 16 PSYC3140 Exam 2 2. Injection of vasoactive substances directly into penis Vasodilating drugs such as papvarine or prostaglandin can be injected directly into penis when intercourse desired, this is to allow blood to flow to the penis and thereby produce an erection, not very popular among patients b/c of side effects Topical application of papaverine externally to women’s genitalia also produces vasocongestion and arousal 3. Surgery Penile prosthesis or implants, various versions, can involves semirigid silicone rod implanted into penis, or pumping fluid into inflatable cyclinder or inflatable rod with internal pumping device 4. Vacuum device therapy External vacuum draws blood which is trapped by specially designed ring Paraphilia psychosexual disorders characterized by sexual fantasies, feelings, or activities involving a nonhuman object, a nonconsenting partner such as a child, or pain or humiliation of oneself or one's partner. Most of these have to happen over a period of at least 6 months and cause significant impairment to functioning and distress Fetishism person is sexually attracted to non-living objects, women’s undergarments are very popular arousal is associated w/ 2 different classes of onjects: 1. inanimate objects 2. a source of specific tactile stimulation (e.g. rubber) Voyeurism and Exhibitionism voyeurism: the practice of observing an unsuspecting individual undressing or naked in order to become aroused exhibitionism: achieving sexual arousal and gratification by exposing one’s genitals to unsuspecting strangers o to qualify for diagnosis, behaviour must occur repeatedly and be compulsive or out of control Transvetic fetishism sexual arousal strongly associated with act of cross dressing, dressing in clothes of the opposite sex 17 PSYC3140 Exam 2 Kurt Freund CAMH: suggests that this is indistinguishable from other forms of fetishism in most respects Sexual sadism and sexual masochism Both associated with either inflicting pain or humiliation on others (sadism) or suffering pain and humiliation (masochism) Closely related condition is hypoxiphilia : involves self-strangulation to reduce flow of oxygen to the brain and enhance the sensation of orgasm Sadistic rape: Not exactly classified as a paraphilia b/c most instances of rape are better characterized as an assault, but certain rapists do fit definitions of paraphilia closely and are better described as sadists Pedophilia and incest Pedophilia: sexual attraction to children, could be male children, female or both Incest: sexual attraction to person’s relatives, victims tend to be girls who are beginning to mature physically Paraphilia in women Paraphilia seldom seen Exception: sadomasochistic practices 5-10% of all sexual offenders are women Causes of paraphilia Often occur in context of other sexual and social problems Deficiencies in levels of “desired arousal” Marshall: inability to develop adequate social relationships associated with developing inappropriate sexual outlets Disordered relationships in childhood and adolescence with resulting deficits in healthy sexual development Nature of person’s sexual fantasies: sexual arousal could become associated with neutral object repeatedly present during sexual arousal One of most powerful engines for development of unwanted sexual arousal may be early sexual fantasies that are repeatedly reinforced thru very strong sexual pleasure associated w/ masturbation Incredibly strong sex drive Very act of trying to suppress unwanted emotionally charged thoughts and fantasies seem to increase their frequency and intensity 18 PSYC3140 Exam 2 Assessing and treating paraphilia Assessment not limited to presence of deviant arousal but also for levels of appropriate arousal to adults, for social skills and for ability to form relationships Psychosocial treatment Most are behaviour therapy methods aimed at changing associations and context from arousing to neutral Covert desensitization: sexually arousing images are associated with the direct consequences that happen as a result of the paraphilic behaviour o Therapist narrates undesirables scenarios, and patient is instructed to imagine them every day until all arousal disappears Orgasmic reconditioning: patients instructed to masturbate to usual fantasies to retain positive arousal patterns Relapse prevention: taught to recognize early signs of temptation and institute a variety of self-control measures Although most of these methods successful, rapists have lowest success rate of ppl w/ single disorder and ppl w/ multiple paraphilia conditions have lowest success rate of any group Drug treatments Involve antiandrogens and agents which reduce testosterone levels, thereby eliminating sexual desire and fantasy “chemical castration” 19 PSYC3140 Exam 2 Chapter 12: Personality Disorders (abbre. PDs) Overview Personality disorders: perceiving, relating to, thinking about environment and one self that are inflexible and maladaptive, persist in variety of situations, cause impairment in functioning or distress Person may not feel any subjective distress, it may be felt by others b/c of the actions of that person esp. ppl w/ antisocial personality disorder DSM-4 lists 10 specific personality disorders, which are listed On Axis II b/c they are distinct Researchers advocate for a dimensional model rather than categorical model: one which sees PDs as extreme variants of normal personality traits in five-factor model b/c sometimes PDs not some clear-cut (reframe issue as one of degree rather than kind) DSM 5 likely to incorporate aspects of dimensional approach to PDs 3 clusters: o Cluster A: “Odd or eccentric”: includes paranoid, schizoid, schizotypal PDs o Cluster B: “dramatic, emotional, or erratic: includes antisocial, borderline, histrionic, and narcissistic PDs o Cluster C: “anxious of fearful”: includes avoidant, dependent, OCD PDs Pds found in 0.5-2.5% of general population (US) Originate in childhood or adolescence, continue into adult years, difficult to pinpoint onset Criticism that several PDs including histrionic PD and borderline have diagnostic criteria that are biased against females b/c disorder may simply be embodiment of extremely “feminine traits” Ppl diagnosed w/ PDs have high comorbidity rates, multiple PDs at once Cluster A Disorders Paranoid PD Ppl w/ this disorder are characterized as being excessively mistrustful and suspicious of others, without any justification Assume others are out to harm or trick them, tend not to confide in others Clinical description o Defined by pervasive unjustified mistrust of others o Are suspicious in situations where most ppl agree suspicion is unfounded o May be argumentative, complain a lot, or quiet, but are obviously hostile towards others o Often appear tense and “ready to pounce” on others o Very sensitive to criticism and have an excessive need for autonomy 20 PSYC3140 Exam 2 o Bears relationship to 1) paranoid type of schizophrenia and 2) delusional disorder o However, their suspiciousness does not reach delusional proportions or hallucinations Causes o No apparent biological contributions o Ppl w/ schizophrenic relatives seem more susceptible o Strong genetic influence proven o Psyc’l contributions not strong, 1 view is that patients hold some basic flawed assumptions about the world (e.g. ppl are vicious and malevolent, deceptive) o Cultural factors: ppl who lived thru harsh experiences: e.g. prisoners, refugees, hearing impaired, elderly Treatment o Patients unlikely to seek professional help b/c of mistrust o Therapists try to provide environment conducive to trust o Cognitive therapy used to change person’s mistaken beliefs o To date, no confirmed demonstration that paranoid PD can be treated successfully w/ any method Schizoid PD Show a pattern of detachment from social relationships and very limited range of emotions in interpersona
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