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
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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
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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
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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
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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
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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
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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
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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:
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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
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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
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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
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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
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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
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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:
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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
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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
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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
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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
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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
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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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