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Chapter 10

Abnormal Psychology CHAPTER 10 NOTES - I got a 4.0 in the course

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PSY 240
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Chapter 10: Sexual and Gender Identity Disorders What Is Normal Sexuality? • In gender identity disorder, there is psychological dissatisfaction with one’s biological sex. The disorder is not specifically sexual but rather a disturbance in the person’s sense of identity as a male or a female • Sexual dysfunction find it difficult to function adequately while having sex • Paraphilia includes disorders in which sexual arousal occurs primarily in the context of inappropriate objects or individuals • Paraphilic arousal patterns tend to be focused rather narrowly, often precluding mutually consenting adult partners, even if desired • For adolescents, 5% of male teenagers and 11% of female teenagers report some homosexual behavior, but this is mostly in addition to hetero behavior, and most of these teens identify as hetero • 50% of men and 36% of women age 75 to 79 were sexually active • Decreases in sexual activity are mostly correlated with decreases in general mobility ad various disease processes and consequent medication, which may reduce arousal. Gender Differences: • Much higher percentage of men than women report that they masturbate • One traditional view accounting for differences in masturbatory behavior is that women have been taught to associate sex with romance and emotional intimacy, whereas men are more interested in physical gratification • Amore likely reason is anatomical. Because of the nature of the erectile response in men and their relative ease in providing sufficient stimulation to reach orgasm, masturbation may simply be more convenient for men • Number of studies suggest that no gender differences are currently apparent in attitudes about homosexuality, the experience of sexual satisfaction, or attitudes toward masturbation • In the late 1900s and after 2000, investigators have notices a decrease in the number of sexual partners and a tendency to delay sex among adolescent boys, perhaps due to a fear of AIDS • Men are more specific and narrow in their patterns of arousal: hetero men are aroused by female sexual stimuli but not male sexual stimuli. For gay men, it’s the opposite • Females on the other hand, whether hetero or lesbian, experience arousal to both male and female sexual stimuli, demonstrating a broader, more general pattern of arousal • These core beliefs about sexuality are referred to as “sexual self-schemas” • Women tend to report the experience of passionate and romantic feelings as an integral part of their sexuality, as well as openness to sexual experience.Asubstantial number of women also hold an embarrassed, self-conscious schema that sometimes conflicts with more positive aspects of their sexual attitudes • Men on the other hand, evidence a strong component of feeling powerful, independent, and aggressive as part of their sexuality, in addition to being passionate, loving, and open to experience • Peplau summaries research to date on gender differences in human sexuality as highlighting four themes: 1. Men show more sexual desire and arousal than women 2. Women emphasize committed relationships as a context for sex more than men 3. Men’s sexual self-concept, unlike women’s is characterized partly by power and aggression 4. Women’s sexual beliefs are more shaped by cultural, social, and situational factors • The overwhelming majority of individuals engage in heterosexual, vaginal intercourse in the context of a relationship with one partner Cultural Differences: • The Sambia in Papua New Guinea have all young boys in the tribe, starting at age 7, become semen recipients by engaging exclusively in homo oral sex with teenage boys. Only oral sexual practices are permitted. The boys switch roles early in adolescence, and become semen providers to younger boys • Acceptable perceived ages for both men and women were significantly younger in Sweden • 73.7% of Swedish women and only 56.7% ofAmerican women used some form of contraception during their first sexual intercourse The Development of Sexual Orientation: • Homosexual orientation was shared in approximately 50% of identical twins, compared with 16-22% of fraternal twins • In men, genes account for aprox 34% of the cause, and in women 18%, with the remained accounted for by environmental influences • Other reports indicate that homo and also gender atypical behavior during childhood is associated with differential exposure to hormones, particularly atypical androgen levels in utero and that the structure of the brain might be diff in individuals with homo as compared to hetero arousal patterns • May be many pathways to the development of heterosexuality or homo and that no one factor can predict the outcome • Study found that each additional older brother increased the odds of being gay by 1/3. This finding is referred to as the fraternal birth order hypothesis.And may suggest the importance of environmental influences Gender Identity Disorder: • Is present if a person’s physical gender is not consistent with the person’s sense of identity • Primary goal is not sexual gratification but rather the desire to live life openly in a manner consistent with that of the other gender • Autogynephilia- gender identity disorder begins with a strong and specific sexual attraction to a fantasy of oneself as a female. This fantasy then progresses to a more comprehensive identity of a female. • Individuals in this subgroup of biological males were not effeminate as boys, but became sexually aroused while cross-dressing and to fantasies of themselves as women. Over time these fantasies progress to becoming a woman Causes: • Research has yet to uncover any specific biological contributions to GID, although it seems likely that a biological predisposition will be discovered • Early research suggested that, as with sexual orientation, slightly higher levels of testosterone or estrogen at certain critical periods of development might masculinize a female fetus or vice versa • At least some evidence suggests that gender identity firms up between 18 months and 3 years of age and is relatively fixed after that • Gender nonconformity- Boys who behave in feminine ways and girls who behave in masculine ways • Girls with gender nonconforming behavior are seldom studied, because their behavior attracts much less attention in Western societies Treatment: • Treatment is available for GID in a few specialty clinics around the world, although much controversy surrounds treatment • The most common decision is to alter the anatomy physically to be consistent with the identity through sex reassignment surgery Sex reassignment surgery: o Individuals must live in the opposite sex role for one to two years so that they can be sure they want to change sex o Hormones are administered to promote the growth of breasts and the development of other secondary sex characteristics o An artificial penis is constructed through plastic surgery and breasts are surgically removed o Those who undergo female-to-male conversions are generally adjusted better than those who make male-to-female transitions o As many as 2% attempt suicide after surgery (a number much higher than the rate for the general population) Treatment of Intersexuality: o Health professionals may want to examine closely the precise nature of the intersex condition and consider surgery only as a last resort o Otherwise, psychological treatments to help individuals adapt to their particular sexual anatomy, or their emerging gender identity, might be more appropriate An Overview of Sexual Dysfunctions: • The three stages of the sexual response cycle are desire, arousal, and orgasm/ each are associated with specific sexual dysfunctions. In addition, pain can become associated with sexual functioning, which leads to additional dysfunctions • Two disorders are sex specific: premature ejaculation and vaginismus (painful contractions or spasm of the vagina during attempted penetration) • Disorders can either be generalized (every time having sex) or situational (with certain partners or times) • Sexual dysfunctions are further specified as 1) due to psychological factors or 2) due to psychological factors combined with a general medical condition Sexual Desire and Arousal Disorders: • Disorders of arousal are called male erectile disorder and female sexual arousal disorder. The problem here is not desire. • Their problem is in becoming physically aroused: a male has difficulty achieving or maintaining an erection, and a female cannot achieve or maintain adequate lubrication • In women, arousal and lubrication may decrease at any time, but, as in men, such problems tend to accompany aging • It is unusual for a man to be completely unable to achieve an erection. More typical is a situation where full erections are possible during masturbation and partial erections occur during attempted intercourse, but with insufficient rigidity to allow penetration • The prevalence of female arousal disorders is somewhat more difficult to estimate because many women still do not consider absence or arousal to be a problem, let alone a disorder • Two disorders reflect problems with the desire phase of the sexual response cycle: Male Hypoactive Sexual Desire Disorder: o Has little or no interest in any type of sexual activity o Problems of hypoactive SDD used to be presented as marital rather than sexual difficulties o The US survey confirmed that 22% of women and 5% of men suffer from HSD o For men, the prevalence increases with age, for women, it decreases o Patients rarely have sexual fantasies, seldom masturbate, and attempt intercourse once a month or less Female Sexual Interest/Arousal Disorder: o No or reduced interest in sex, no or few erotic thoughts or fantasies o Does not respond to external erotic cues o No to little pleasure during sex Orgasm Disorders: Female Orgasmic Disorder: o An inability to achieve an orgasm despite adequate sexual desire and arousal is commonly seen in women but is relatively rare in men o In diagnosing this problem, it is necessary to determine that the women never or almost never reach orgasm. This distinction is important because only approx. 20% of all women reliably experience regular orgasms during sex Premature Ejaculation: o Afar more common male orgasmic disorder is premature ejaculation which occurs well before the man and his partner wish it to o In the US survey, 21% of all men met criteria for premature ejaculation, making it the most common male sexual dysfunction o Aperceived lack of control over orgasm, however, may be the more important psychological determinant of PE o Appears to occur primarily in inexperienced men with less education about sex Delayed Ejaculation: o Ejaculation is absent, infrequent, or greatly delayed o Some men who are unable to ejaculate with their partners can obtain an erection and ejaculate during masturbation. In the most usual pattern, ejaculation is delayed; this is called retarded ejaculation o Occasionally men suffer from retrograde ejaculation in which ejaculatory fluids travel backward into the bladder rather than forward Sexual Pain Disorders: • Intercourse is associated with marked pain. For some men and women, sexual desire is resent and arousal and orgasm are easily attained, but the pain is so severe that sexual behavior is disrupted. • This subtype is named dyspareunia and is diagnosed only if no medical reasons for pain can be found Genito-Pelvic Pain/Penetration Disorder • Amore common problem is vaginismus, in which the pelvic muscles in the outer third of the vagina undergo involuntarily spasms when intercourse is attempted • The spasm reaction may occur during any attempted penetration, including a doctor exam or insertion of a tampon. Women report sensations of ripping, burning or tearing during attempted intercourse • The prevalence of this condition in cultures with conservative views of sexuality may be as high as 42% in at least two clinic samples • Results from the US survey indicate that approx. 7% of women suffer from one or the other type of sexual pain disorder, with higher proportions of younger and less educated women reporting this problem Assessing Sexual Behavior: Interviews: • Clinicians must demonstrate to the patient through their actions and interviewing style that they are comfortable talking about these issues • The clinician also covers nonsexual relationship issues and physical health and screens for the presence of additional psychological disorders • Patients may volunteer in writing some info they are not ready to talk about, so they are usually given a variety of questionnaires that help reveal sexual activity and attitudes Medical Examination: • Avariety of drugs, including some commonly prescribed for hypertension, anxiety, and depression, often disrupt sexual arousal and functioning • These specialists may check levels of sexual hormones necessary for adequate sexual functioning and, in the case of males, evaluate vascular functioning necessary for an erectile response PsychophysiologicalAssessment: • Many clinicians assess the ability of individuals to become sexually aroused under a variety of conditions by taking psychophysiological measurements while the patient is either awake or asleep • In men, penile erection is measured using a penile strain gauge.As the penis expands, the strain gauge picks up the changes and records them on a polygraph • Penile rigidity is also important to measure in cases of erectile dysfunction, because large erections with insufficient rigidity will not be adequate for intercourse • Women use a vaginal photoplethysmograph which is smaller than a tampon. It is inserted into the vagina and a light source at the tip of the instrument and two light sensitive photoreceptors on the sides, measure the amount of light reflected back fro the vaginal walls. Because blood flows to the vaginal walls during arousal, the amount of light passing through them decreases with increasing arousal • Individuals listen to an erotic audiotape or watch an erotic film and their arousal is measured using these instruments. Patients also report subjectively the amount of arousal that they experience Causes and Treatment of Sexual Dysfunction: Causes of Sexual Dysfunction: • Usually a patient referred to a sexuality clinic complains of a wide assortment of sexual problems, although one may be of most concern Biological Contributions: o Neurological diseases and other conditions that affect the nervous system, such as diabetes and kidney disease, may directly interfere with sexual functioning by reducing sensitivity in the genital area o Vascular disease is a major cause of sexual dysfunction, because erections in men and vaginal engorgement in women depend on adequate blood flow. The two relevant vascular problems in men are arterial insufficiency (constricted arteries), which makes it difficult for blood to reach the penis, and venous leakage (blood flows out too quickly for an erection to be maintained) o Chronic illness can also indirectly affect sexual functioning. It is not uncommon for individuals who have had heart attacks to be wary of the physical exercise involved in sexual activity to the point of preoccupation o It is now recommended that men presenting with erectile dysfunction should be screened for cardiovascular disease o Drugs for high blood pressure, called antihypertensive medications, in the class known as beta blockers, may contribute to sexual dysfunction. SSRIs also may interfere with sexual desire and arousal in both men and women o Drugs such as alcohol, cocaine, nicotine, and heroin, also produce widespread sexual dysfunction in frequent users and abusers o Physically alcohol is a CNS suppressant, and for men to achieve erection and women to achieve lubrication is more difficult when the CNS is suppressed. Chronic alcohol abuse may cause permanent damage and decrease testosterone levels and cause fertility problems Psychological Contributions: o For years most sex researchers and therapists though the prin
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