Sexual Dysfunctions and Paraphilic Disorders Sexual Disorders Introduction DSM5 classification Sexual dysfunctions Paraphilias Previous DSM classification systems used Masters and Johnsons ID: 280588
Download Presentation The PPT/PDF document "Chapter 15" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Chapter 15
Sexual Dysfunctions
and
Paraphilic DisordersSlide2
Sexual Disorders: Introduction
DSM-5
classification
Sexual dysfunctions
Paraphilias
Previous
DSM
classification systems used
Masters and Johnson’s
four-stage human sexual response cycle
Major criticisms were related to the linear conceptualization of this model
New
view system
Disorders
of sexual dysfunction
are now listed in alphabetical order in that no underlying model of sexual response has been agreed-uponSlide3
DSM-5
Diagnoses of Sexual Dysfunction
Delayed ejaculation
Erectile disorder
Female orgasmic disorder
Female sexual interest/arousal disorder
Genito-pelvic pain/penetration disorder
Male hypoactive sexual desire disorder
Premature (early) ejaculation
Substance-/medication-induced
sexual dysfunction
Other specified;
unspecifiedSlide4
Diagnostic Considerations
Each sexual dysfunction disorder may be specified as being
lifelong versus acquired
and
general versus
s
ituational
DSM-5
also lists
five
associated features
Partner factors
Relationship factors
Individual vulnerability factors
Cultural/religious factors
Medical factors
DSM-5
has added a minimum duration
(Criterion
B) of
6
months to decrease diagnosis of temporary conditions Slide5
Epidemiology
The National Health and Social Life Survey
Total
prevalence for sexual
difficulties
43
% in women and 31% in
men
F
igures may be inflated
because
distress was not studied
African American
women
reported
lower levels of sexual desire and pleasure than
did Caucasian women
Caucasian women
reported
more sexual pain than
did African American women
B
oth
Caucasian and African American women
had higher rates of sexual difficulty than
did Hispanic womenSlide6
Epidemiology cont.
Being married and having higher education were each associated with lower rates of dysfunction
Emotional
or stress-related problems were strongly associated with sexual
difficulties
Physical
health-related problems were more predictive of sexual dysfunction in men
only
A
decline in social status was related to an increased risk for all types of sexual difficulty for
women,
but only with erectile disorder in
men
Quality
of life significantly predicted sexual difficulties, particularly for
womenSlide7
Epidemiology cont.
Some prevalence rates based on the NHSLS data:
Low desire in 15
% of
men and 30
% of
women
ED in 7
% of
men aged
18 to 29
; 18
% in those
aged
50 to 59
Female sexual arousal disorder (
DSM-IV
) ranged from 11% to 31%
Premature ejaculation affects approximately 30% men
18 to 59
(most prevalent male dysfunction)
Delayed ejaculation is much less prevalent (
2–8
%)
Methodological
concerns—
“medicalization”Slide8
Psychological and Biological Assessment
Is the
problem
related
to a psychological versus a biological/organic
etiology,
or
both?
Clinical interview
Mood
and general psychiatric
status
M
edications
and medical
comorbidities
P
sychosexual history
P
ersonal
historySlide9
Etiology
All of the
sexual dysfunctions are considered to be biopsychosocial in their
etiology
Specifiers
“due to psychological factors” and “due to combined factors” have been eliminated from
DSM-5
27% to 62
% of women with low desire also meet criteria for a depressive disorder
Cultural influences
Lower levels of desire in women from
E
ast
Asian heritage compared to women from European descent
“Sex
guilt” may be a mediating factor in cultural differences
Hormonal imbalances
Performance anxiety
Genetic factors
Alcohol usageSlide10
Treatment
Much
research attention
has been focused
on finding effective pharmacological treatments for the most prevalent sexual complaints
(i.e., low
desire in women, erectile and ejaculation difficulties in men
)
As a result, there is a paucity of
randomized controlled trials of psychological
treatments
Typically, treatment can include:
Medications
Hormonal therapy
PsychotherapySlide11
Paraphilias: Introduction
Paraphilias, as defined in the
DSM-5
,
refer
to
“any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners”
Term
paraphilia
translates into love (
philia
) beyond the usual (
para
)
Two main types:
Anomalous activity preferences
Anomalous target preferencesSlide12
Paraphilias: Introduction cont.
Paraphilias and sexual offending are not mutually exclusive, but do not necessarily co-occur
Much
of the research on paraphilias has been based on samples of convicted sexual
offenders
Confounds
M
any
sexual offenders were never formally diagnosed with a
paraphilia
G
eneralizability (more severe end of spectrum)
Veracity
of
self-reports (want to look less deviant)Slide13
DSM-5 Diagnoses
Exhibitionistic
disorder
Fetishistic
disorder
Frotteuristic
disorder
Pedophilic
disorder
Sexual
masochism
d
isorder
Sexual
sadism
d
isorder
Transvestic
disorder
Voyeuristic
disorder
Otherwise
specified/unspecifiedSlide14
Diagnostic Considerations
Paraphilias and
paraphilic
disorders are not the same thing; paraphilia is a necessary but not sufficient for
diagnosis,
may not cause distress or require clinical intervention
DSM-5
specifiers added: In a controlled environment and
in
full remission
Paraphilias
must be
distinguished from:
Nonpathological
sexual
interests
Other paraphilias (transvestic and
fetishistic)
Comorbidity of
paraphilias
is high
Paraphilias
need to be distinguished from other
nonparaphilic disorders (transvestic disorder and gender dysphoria)Slide15
Epidemiology
The incidence and prevalence of the paraphilias is unknown due to their secretive and often illegal
nature
Frequency
estimates are generally based on small,
nonrepresentative samples
(often
involving convicted sexual
offenders)
Exhibitionism is one of the the most common paraphilias and may be the most common sexual offense
(
one-third
to two-thirds
sexual offenses in Canada,
United States,
and Europe)
Fetishism is a rare condition (0.8%)
Frotteurism may be more common than once believedSlide16
Epidemiology cont.
Pedophilia prevalence is unknown
Upper limit has been extrapolated to be about 5% (3-9% of men in a convenience sample self-reported fantasies or sexual contact involving prepubescent children)
5% to 10% of the population has engaged in some form of masochistic activity; less than 1% on a regular basis
In sexual offenders, rates of masochism range from
2% to 5
%; sexual sadism ranged from
4% to 9
%
In nonclinical samples, 5% of men and 2% of women
admitt
ed
becoming sexually aroused to inflicting pain on others
Voyeurism is also common and is a common sexual offenseSlide17
Psychological and Biological Assessment
Assessment strategies
include:
Self-report measures (Clark Sexual History
Questionnaire;
Multiphasic Sex Inventory; Wilson Sex
Fantasy Questionnaire)
Phallometric assessment
Polygraph
Measures
of visual reaction
time
Challenges in assessment include:
Privacy
StigmaSlide18
Etiology
Numerous theories have been proposed to explain how the paraphilias develop; however, empirical evidence is either lacking or
contradictory
Neuroanatomy/neurobiology
Learning, modeling, and life events
Cognitive influencesSlide19
Course, Prognosis, and Treatment
Course is typically chronic
Severity of sexual sadism tends to increase over time
There is a lack of
empirical
support that
treatment for sexual offenders is superior to
a placebo
Treatment with non-offending
individuals
focuses on health, safety, overcoming impairment