Human Sexuality Sexual Disorders: Dysfunction,
Description: Human Sexuality Sexual Disorders: Dysfunction, Dysphoria, and Paraphilia Sexual Myths and Realities Pre-1966 Masters Johnsons Human Sexual Response; The Science of Sexuality Accepted beliefs about Human Sexuality: Masturbation is rare
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slide1. Human Sexuality Sexual Disorders: Dysfunction, Dysphoria, and Paraphilia<br>
slide2. Sexual Myths and Realities Pre-1966/ Masters & Johnson’s “Human Sexual Response”; The Science of Sexuality
Accepted beliefs about Human Sexuality:
Masturbation is rare and causes disease in men
Women never masturbate
Homosexuality is abnormal
Most couples have exclusively missionary sex
Women are not sexual and rarely have orgasms
Premarital sex is rare; so is extramarital sex<br>
slide3. What is “Normal” Sexual Behavior? Normal Sexual Behavior: Wide range; research is recent and evolving
Difficult to determine what is normal
Example: people report tremendous variation in frequency of sexual outlet or release
Influenced by cultural norms and values
Kinsey: “The only unnatural sex act is that which you cannot perform”
Definitions of sexual disorders are inexact<br>
slide4. Defining Sexual Behavior as a Mental Disorder Controversy surrounding definition of deviant sexual behavior
Current Def: Only deviant if it threatens society, causes distress to participants, or impairs social or occupational functioning
Is gender dysphoria a psychiatric disorder?
Is Sex Addiction a disorder?
Is hyposexuality a disorder if there is no distress?<br>
slide5. The Sexual Response Cycle Appetitive/Excitement phase
Characterized by person’s interest in sexual activity
Arousal/Plateau phase
May follow or precede the appetitive phase
Heightened when specific, direct sexual stimulation occurs
Various physical changes occur
Example: increased blood flow to penis in males<br>
slide6. The Sexual Response Cycle (cont’d.) Orgasm phase
Characterized by involuntary muscular contractions throughout the body and eventual release of sexual tension
Resolution phase
Characterized by relaxation of the body after orgasm
Heart rate, blood pressure, and respiration return to normal<br>
slide7. Human Sexual Response Cycle<br>
slide8. Sexual Dysfunctions Recurrent and persistent disruption of any part of the normal sexual response cycle
DSM-5 requires that symptoms be present for at least six months and be accompanied by significant distress
Types of dysfunctions
Lifelong – onset since beginning of sexual behavior
Acquired – after a period of normal sexual behavior
Generalized – across situations, partners, all stimulation
Situational – specific to certain situations, partners, stim<br>
slide9. Sexual Dysfunction Dx DSM-5 diagnosis for sexual dysfunction not made if better explained by another disorder (i.e., depr)
Sexual Dysfunction can be comorbid with relational difficulties and psychological disorders
Example: Loss of Sexual Arousal Drive subsequent to relationship conflict; poor body image; grief<br>
slide10. Lifetime Prevalence of Sexual Disorders in the United States (40–80 Age Range)<br>
slide11. Sexual Interest/Arousal Disorders Problems with initial phase of sex: little interest in sex but capable of orgasm
What is normal frequency? 2-3x wk? year?
Male hypoactive sexual desire disorder
Little or no interest in sexual activities
Female sexual interest/arousal disorder
Little or no interest, or diminished arousal to sexual cues
Most common in women – 33%
40-50% of all sexual difficulties involve deficits in interest<br>
slide12. Orgasmic Disorders Female orgasmic disorder (prevalence 10-40%)
Persistent delay or inability to achieve orgasm despite receiving adequate sexual stimulation
Marked reduced intensity of orgasmic sensation
Not dx if orgasm is possible with stimulation
Delayed ejaculation – (worsens with age)
Persistent delay or absence of ejaculation after excitement phase is reached
Lifelong type can occur
Rule out Medical Cause: surgical injury to lumbar nerves; nerve supply to genitals<br>
slide13. Orgasmic Disorders Premature Ejaculation
Recurrent pattern of having an orgasm with minimal sexual stimulation before, during, or after vaginal penetration
Must occur within one minute of penetration
Most common sexual dysfunction for young men
Affects 21-33 percent of men<br>
slide14. Orgasmic Disorders Pain Penetration Disorders: Involves physical pain or discomfort associated with intercourse/penetration
Dyspareunia
Pain in the pelvic region during intercourse
Vaginismus
Involuntary spasm of the outer third of the vaginal wall
Prevents or interferes with sexual intercourse<br>
slide15. Arousal Disorders: Aging Sexual Changes across Lifespan:
Female drop in estrogen: Interest drop; Thinning of vaginal walls; lower lubrication
Male drop in Testosterone – drop in arousal & ED
Delayed Ejaculation/Absence
Erectile Dysfunction: inability to form penile erection
Psychological cause: may experience Nocturnal erections
Medical Cause: Poor circulation/heart disease
Prostate Discomforts<br>
slide16. Etiology of Sexual Dysfunctions<br>
slide17. Etiology of Sexual Dysfunctions Biological dimension
Levels of testosterone (low) or estrogens (low) linked to lower sexual interest in men and women, and erectile difficulties in men
Medications used to treat medical conditions affect sex drive
Many antidepressant and antihypertensive medications
Alcohol as leading cause of disorders – ejaculation/ed issues
Illnesses and other physiological factors (heart disease; diabetes; )<br>
slide18. Etiology of Sexual Dysfunctions (cont’d.) Psychological dimension
History of Sexual Trauma; Emotional Abuse
Increase of Stress; Poor Coping
Anxiety disorder: poor performance
Depression: anhedonia
Performance anxiety and spectator role
Cultural/Religious beliefs about sexuality/body (prohibitions)
Poor Self-Image: Negative thoughts and dysfunctional beliefs<br>
slide19. Etiology of Sexual Dysfunctions (cont’d.) Social dimension
Social relationships: positive sexual experiences
Current sexual relationship: communication/sexual compatibility; partner violence/abuse
Early sexual experiences
Traumatic sexual experiences
Relationship dynamics predictive of sexual disorders
Marital satisfaction associated with greater sexual frequency<br>
slide20. Etiology of Sexual Dysfunctions (cont’d.) Sociocultural dimension: Rigid Scripts
cultural scripts: defines roles, allowable behaviors, pleasures, sexual play script
Examples of sociocultural aspects
People in Asian countries consistently report lowest frequency of sexual intercourse
Cultural scripts for men in the United States
Sexual potency as a sign of masculinity
Homophobia toward lesbians or gays<br>
slide21. Treatment of Sexual Dysfunctions Biological interventions
Hormone replacement – testosterone, estrogen, etc.
Mechanical means to improve functioning
Vacuum pumps, suppositories, penile implants
For ED, injecting medication into penis
Oral medications (Viagra, Levitra, Cialis)
Psychological boost may lead to feelings of enhanced pleasure<br>
slide22. Psychological Treatment Approaches Education
Replace myths and misconceptions with facts
Anxiety reduction
Desensitization or graded approaches
Changing negative thoughts and beliefs about sex
Structured behavioral exercises
Tasks that gradually increase amount of sexual interaction
Sexual Communication training – relationship focused<br>
slide23. Gender Dysphoria Previously called gender identity disorder (GID) or transsexualism
Marked incongruence (mismatch) between one’s experienced or expressed gender and biologically assigned gender
Not the same as sexual orientation
Diagnosed when there is significant distress or impairment – High Suicidality Risk
Childhood – some don’t persist into adulthood
Adolescent/Adult onset - many persist into adulthood<br>
slide24. Etiology of Gender Dysphoria Etiology is unclear
Research has focused on other sexual disorders
Likely an interaction of multiple variables
Most transgender children have normal hormone levels
No specific neurological explanation
Brain alterations associated with psychosocial distress and social exclusion<br>
slide25. Psychological and Social Influences Explanations must be viewed with caution
Hypothesis –
Do Childhood experiences influence development of gender dysphoria? Mediating role?
Parent encouragement of feminine behavior, overprotection, lack of male role models, etc.
Psychosocial stressors
Stigma and lack of societal acceptance play a role in distress and impairment associated with gender dysphoria<br>
slide26. Treatment of Gender Dysphoria Gender reassignment therapies
Changing physical characteristics through hormone therapy or surgery
Many involve reconstructing genital organs
Some insurance beginning to include coverage for transgender individuals
Studies show positive outcomes<br>
slide27. Paraphilic Disorders DSM-V definition
Sexual arousal in objects, body parts, or abnormal targets (feet, lingerie, hair, voyeurism, porn, etc.)
May involve unusual erotic behavior
Diagnosed only when paraphilia harms, or risks harming others and is acted on
Or causes the individual to experience distress or impairment in social functioning<br>
slide28. Paraphilic Disorders<br>
slide29. Paraphilic Disorders Involving Nonhuman Objects Fetishistic disorder – predominantly men
Extremely strong sexual attraction and fantasies involving inanimate objects
Examples: shoes or undergarments
Person is often sexually aroused to the point of erection in the presence of the fetish item
Person may choose sexual partners on the basis of having that item (e.g., bound feet)
Must cause significant distress or harm to others<br>
slide30. Transvestic Disorder Intense sexual arousal associated with cross-dressing (wearing clothes appropriate to the opposite gender)
Do not confuse with gender dysphoria
Most people who cross-dress are exclusively heterosexual
Incidence higher among men than women
Men may become sexually aroused by thoughts of themselves as female<br>
slide31. Paraphilic Disorders Involving Nonconsenting Persons Exhibitionistic disorder
Urges, acts, or fantasies of exposing one’s genitals to strangers, intent to shock
Voyeuristic disorder
Urges, acts, or fantasies involving observation of an unsuspecting person disrobing or engaging in sex activity
Diagnosed only in those age 18 or older
Individual must be distressed by or have acted on the voyeuristic urges<br>
slide32. Frotteuristic Disorder Recurrent/intense sexual urges, acts, or fantasies of touching or rubbing against a nonconsenting person
For diagnosis, person must be markedly distressed by urges or have acted on them
Prevalence is difficult to determine
Behavior may go unnoticed or presumed to be accidental<br>
slide33. Pedophilic Disorder Adult relates to children as erotic objects
Sexual abuse of children is common
Estimated 1/4 of girls and 1/5 of boys
Most people who act on pedophilic urges are friends, relatives, or acquaintances of their victims
Effects of sexual abuse can be lifelong<br>
slide34. Paraphilic Disorders Involving Pain or Humiliation Sexual masochism disorder
Sexual urges, fantasies, or acts that involve being humiliated, bound, or made to suffer
Individual does not seek harm or injury
Finds sensation of helplessness appealing
Sexual sadism disorder
Sexual urges, fantasies, or acts that involve inflicting physical or psychological suffering on others<br>
slide35. Etiology and Treatment of Paraphilic Disorders We still have much to learn
Some research findings conflict with each other
Some men may be biologically predisposed to pedophilic disorder
Psychological factors also contribute
Paraphilias may result from accidental associations between certain situations and sexual arousal<br>
slide36. Behavioral Approaches to Treatment Extinction or aversive conditioning: punishment or elimination of behavior
Acquiring or strengthening sexually appropriate behaviors: learning healthy sexuality
Developing appropriate social skills
Legal Consequences to inappropriate sexual interest<br>
slide37. Rape Sexual aggression that involves sexual activity performed against a person’s will through the use of force, argument, pressure, alcohol or drugs, or consent
Not considered a psychological disorder
Number of rapes in the U.S. has risen dramatically
One in five adult women has been raped
One in 71 men<br>
slide38. Characteristics of Male Rapists Create situations in which sexual encounters may occur
Misinterpret friendliness as provocation and protests as insincerity
Manipulate women into sexual encounters with alcohol (70%) or other drugs
Attribute failed attempts at sexual encounters to perceived negative features of the woman<br>
slide39. More Characteristics of Male Rapists Come from environments of parental neglect or physical or sexual abuse
Experience Sex earlier in life than men who are not sexually aggressive
Have more sexual partners than non-sexually aggressive men<br>
slide40. Date Rape Many Reluctant to Report
Between eight and 25 percent of female college students report having “unwanted sexual intercourse”
Many universities conducting workshops to encourage understanding that intercourse without consent is rape<br>
slide41. Effects of Rape Rape trauma syndrome symptoms
Include psychological distress, phobic reactions, post-traumatic stress symptoms, and sexual dysfunction
Phases in rape trauma syndrome
Acute phase: disorganization; PTSD Sx
Feelings of self-blame, fear, or depression
Long-term phase: reorganization
Survivors deal directly with feelings and attempt to reorganize their lives<br>
slide42. Etiology of rape Power rapist: 55 percent of rapists
Compensate for feelings of personal/sexual inadequacy by trying to intimidate victims
Anger rapist: 40 percent of rapists
Angry at women in general
Sadistic rapist: 5 percent of rapists
Derives satisfaction from inflicting pain
May torture or mutilate victims<br>
slide43. Etiology of Rape (cont’d.) Rape has more to do with power, aggression, and violence than sex
Sexual motivation also plays a role in rape
Most rape survivors are in their teens or 20s
Vulnerable age group
Most rapists name sexual motivation as primary reason for actions
Many rapists have multiple paraphilias (immature sexuality)<br>
slide44. Etiology of Rape (cont’d.) Why is the rate of rape increasing in US?
Effects of pornography and media portrayals of violent sex may affect rape prevalence
“Cultural spillover” theory
Rape is high in environments that encourage violence
United States has highest rape rate among countries reporting rape statistics<br>
slide45. Treatment for Rapists Many believe sex offenders are not good candidates for treatment
Most common penalty is imprisonment
High recidivism rates
When intervention occurs, it usually incorporates behavioral techniques
Some treatment techniques show success with exhibitionists
Outcomes tend to be poor for rapists<br>
slide46. Contemporary Trends and Future Directions Trends in Defining Abnormality:
New Def: “Normal” if no harm to self or others?
Exp: Is a fetish normal if not harmful??
Gender dysphoria may eventually be removed as a psychiatric diagnosis
Sweden has removed transvestism, fetishism, and sadomasochism from list of mental illnesses<br>
slide47. Review What are normal sexual behaviors?
What do we know about normal sexual responses and sexual dysfunction?
What causes gender dysphoria, and how is it treated?
What are paraphilic disorders, what causes them, and how are they treated?
Is rape an act of sex or aggression?<br>
slide48. Group Work: Case Analysis Each group will work together on each case, evaluate each case, form a diagnosis and develop a rationale for the decision.
Total of 4 cases representing different sexual disorders
Class Discussion
Please turn in group work at end of class<br>
slide2. Sexual Myths and Realities Pre-1966/ Masters & Johnson’s “Human Sexual Response”; The Science of Sexuality
Accepted beliefs about Human Sexuality:
Masturbation is rare and causes disease in men
Women never masturbate
Homosexuality is abnormal
Most couples have exclusively missionary sex
Women are not sexual and rarely have orgasms
Premarital sex is rare; so is extramarital sex<br>
slide3. What is “Normal” Sexual Behavior? Normal Sexual Behavior: Wide range; research is recent and evolving
Difficult to determine what is normal
Example: people report tremendous variation in frequency of sexual outlet or release
Influenced by cultural norms and values
Kinsey: “The only unnatural sex act is that which you cannot perform”
Definitions of sexual disorders are inexact<br>
slide4. Defining Sexual Behavior as a Mental Disorder Controversy surrounding definition of deviant sexual behavior
Current Def: Only deviant if it threatens society, causes distress to participants, or impairs social or occupational functioning
Is gender dysphoria a psychiatric disorder?
Is Sex Addiction a disorder?
Is hyposexuality a disorder if there is no distress?<br>
slide5. The Sexual Response Cycle Appetitive/Excitement phase
Characterized by person’s interest in sexual activity
Arousal/Plateau phase
May follow or precede the appetitive phase
Heightened when specific, direct sexual stimulation occurs
Various physical changes occur
Example: increased blood flow to penis in males<br>
slide6. The Sexual Response Cycle (cont’d.) Orgasm phase
Characterized by involuntary muscular contractions throughout the body and eventual release of sexual tension
Resolution phase
Characterized by relaxation of the body after orgasm
Heart rate, blood pressure, and respiration return to normal<br>
slide7. Human Sexual Response Cycle<br>
slide8. Sexual Dysfunctions Recurrent and persistent disruption of any part of the normal sexual response cycle
DSM-5 requires that symptoms be present for at least six months and be accompanied by significant distress
Types of dysfunctions
Lifelong – onset since beginning of sexual behavior
Acquired – after a period of normal sexual behavior
Generalized – across situations, partners, all stimulation
Situational – specific to certain situations, partners, stim<br>
slide9. Sexual Dysfunction Dx DSM-5 diagnosis for sexual dysfunction not made if better explained by another disorder (i.e., depr)
Sexual Dysfunction can be comorbid with relational difficulties and psychological disorders
Example: Loss of Sexual Arousal Drive subsequent to relationship conflict; poor body image; grief<br>
slide10. Lifetime Prevalence of Sexual Disorders in the United States (40–80 Age Range)<br>
slide11. Sexual Interest/Arousal Disorders Problems with initial phase of sex: little interest in sex but capable of orgasm
What is normal frequency? 2-3x wk? year?
Male hypoactive sexual desire disorder
Little or no interest in sexual activities
Female sexual interest/arousal disorder
Little or no interest, or diminished arousal to sexual cues
Most common in women – 33%
40-50% of all sexual difficulties involve deficits in interest<br>
slide12. Orgasmic Disorders Female orgasmic disorder (prevalence 10-40%)
Persistent delay or inability to achieve orgasm despite receiving adequate sexual stimulation
Marked reduced intensity of orgasmic sensation
Not dx if orgasm is possible with stimulation
Delayed ejaculation – (worsens with age)
Persistent delay or absence of ejaculation after excitement phase is reached
Lifelong type can occur
Rule out Medical Cause: surgical injury to lumbar nerves; nerve supply to genitals<br>
slide13. Orgasmic Disorders Premature Ejaculation
Recurrent pattern of having an orgasm with minimal sexual stimulation before, during, or after vaginal penetration
Must occur within one minute of penetration
Most common sexual dysfunction for young men
Affects 21-33 percent of men<br>
slide14. Orgasmic Disorders Pain Penetration Disorders: Involves physical pain or discomfort associated with intercourse/penetration
Dyspareunia
Pain in the pelvic region during intercourse
Vaginismus
Involuntary spasm of the outer third of the vaginal wall
Prevents or interferes with sexual intercourse<br>
slide15. Arousal Disorders: Aging Sexual Changes across Lifespan:
Female drop in estrogen: Interest drop; Thinning of vaginal walls; lower lubrication
Male drop in Testosterone – drop in arousal & ED
Delayed Ejaculation/Absence
Erectile Dysfunction: inability to form penile erection
Psychological cause: may experience Nocturnal erections
Medical Cause: Poor circulation/heart disease
Prostate Discomforts<br>
slide16. Etiology of Sexual Dysfunctions<br>
slide17. Etiology of Sexual Dysfunctions Biological dimension
Levels of testosterone (low) or estrogens (low) linked to lower sexual interest in men and women, and erectile difficulties in men
Medications used to treat medical conditions affect sex drive
Many antidepressant and antihypertensive medications
Alcohol as leading cause of disorders – ejaculation/ed issues
Illnesses and other physiological factors (heart disease; diabetes; )<br>
slide18. Etiology of Sexual Dysfunctions (cont’d.) Psychological dimension
History of Sexual Trauma; Emotional Abuse
Increase of Stress; Poor Coping
Anxiety disorder: poor performance
Depression: anhedonia
Performance anxiety and spectator role
Cultural/Religious beliefs about sexuality/body (prohibitions)
Poor Self-Image: Negative thoughts and dysfunctional beliefs<br>
slide19. Etiology of Sexual Dysfunctions (cont’d.) Social dimension
Social relationships: positive sexual experiences
Current sexual relationship: communication/sexual compatibility; partner violence/abuse
Early sexual experiences
Traumatic sexual experiences
Relationship dynamics predictive of sexual disorders
Marital satisfaction associated with greater sexual frequency<br>
slide20. Etiology of Sexual Dysfunctions (cont’d.) Sociocultural dimension: Rigid Scripts
cultural scripts: defines roles, allowable behaviors, pleasures, sexual play script
Examples of sociocultural aspects
People in Asian countries consistently report lowest frequency of sexual intercourse
Cultural scripts for men in the United States
Sexual potency as a sign of masculinity
Homophobia toward lesbians or gays<br>
slide21. Treatment of Sexual Dysfunctions Biological interventions
Hormone replacement – testosterone, estrogen, etc.
Mechanical means to improve functioning
Vacuum pumps, suppositories, penile implants
For ED, injecting medication into penis
Oral medications (Viagra, Levitra, Cialis)
Psychological boost may lead to feelings of enhanced pleasure<br>
slide22. Psychological Treatment Approaches Education
Replace myths and misconceptions with facts
Anxiety reduction
Desensitization or graded approaches
Changing negative thoughts and beliefs about sex
Structured behavioral exercises
Tasks that gradually increase amount of sexual interaction
Sexual Communication training – relationship focused<br>
slide23. Gender Dysphoria Previously called gender identity disorder (GID) or transsexualism
Marked incongruence (mismatch) between one’s experienced or expressed gender and biologically assigned gender
Not the same as sexual orientation
Diagnosed when there is significant distress or impairment – High Suicidality Risk
Childhood – some don’t persist into adulthood
Adolescent/Adult onset - many persist into adulthood<br>
slide24. Etiology of Gender Dysphoria Etiology is unclear
Research has focused on other sexual disorders
Likely an interaction of multiple variables
Most transgender children have normal hormone levels
No specific neurological explanation
Brain alterations associated with psychosocial distress and social exclusion<br>
slide25. Psychological and Social Influences Explanations must be viewed with caution
Hypothesis –
Do Childhood experiences influence development of gender dysphoria? Mediating role?
Parent encouragement of feminine behavior, overprotection, lack of male role models, etc.
Psychosocial stressors
Stigma and lack of societal acceptance play a role in distress and impairment associated with gender dysphoria<br>
slide26. Treatment of Gender Dysphoria Gender reassignment therapies
Changing physical characteristics through hormone therapy or surgery
Many involve reconstructing genital organs
Some insurance beginning to include coverage for transgender individuals
Studies show positive outcomes<br>
slide27. Paraphilic Disorders DSM-V definition
Sexual arousal in objects, body parts, or abnormal targets (feet, lingerie, hair, voyeurism, porn, etc.)
May involve unusual erotic behavior
Diagnosed only when paraphilia harms, or risks harming others and is acted on
Or causes the individual to experience distress or impairment in social functioning<br>
slide28. Paraphilic Disorders<br>
slide29. Paraphilic Disorders Involving Nonhuman Objects Fetishistic disorder – predominantly men
Extremely strong sexual attraction and fantasies involving inanimate objects
Examples: shoes or undergarments
Person is often sexually aroused to the point of erection in the presence of the fetish item
Person may choose sexual partners on the basis of having that item (e.g., bound feet)
Must cause significant distress or harm to others<br>
slide30. Transvestic Disorder Intense sexual arousal associated with cross-dressing (wearing clothes appropriate to the opposite gender)
Do not confuse with gender dysphoria
Most people who cross-dress are exclusively heterosexual
Incidence higher among men than women
Men may become sexually aroused by thoughts of themselves as female<br>
slide31. Paraphilic Disorders Involving Nonconsenting Persons Exhibitionistic disorder
Urges, acts, or fantasies of exposing one’s genitals to strangers, intent to shock
Voyeuristic disorder
Urges, acts, or fantasies involving observation of an unsuspecting person disrobing or engaging in sex activity
Diagnosed only in those age 18 or older
Individual must be distressed by or have acted on the voyeuristic urges<br>
slide32. Frotteuristic Disorder Recurrent/intense sexual urges, acts, or fantasies of touching or rubbing against a nonconsenting person
For diagnosis, person must be markedly distressed by urges or have acted on them
Prevalence is difficult to determine
Behavior may go unnoticed or presumed to be accidental<br>
slide33. Pedophilic Disorder Adult relates to children as erotic objects
Sexual abuse of children is common
Estimated 1/4 of girls and 1/5 of boys
Most people who act on pedophilic urges are friends, relatives, or acquaintances of their victims
Effects of sexual abuse can be lifelong<br>
slide34. Paraphilic Disorders Involving Pain or Humiliation Sexual masochism disorder
Sexual urges, fantasies, or acts that involve being humiliated, bound, or made to suffer
Individual does not seek harm or injury
Finds sensation of helplessness appealing
Sexual sadism disorder
Sexual urges, fantasies, or acts that involve inflicting physical or psychological suffering on others<br>
slide35. Etiology and Treatment of Paraphilic Disorders We still have much to learn
Some research findings conflict with each other
Some men may be biologically predisposed to pedophilic disorder
Psychological factors also contribute
Paraphilias may result from accidental associations between certain situations and sexual arousal<br>
slide36. Behavioral Approaches to Treatment Extinction or aversive conditioning: punishment or elimination of behavior
Acquiring or strengthening sexually appropriate behaviors: learning healthy sexuality
Developing appropriate social skills
Legal Consequences to inappropriate sexual interest<br>
slide37. Rape Sexual aggression that involves sexual activity performed against a person’s will through the use of force, argument, pressure, alcohol or drugs, or consent
Not considered a psychological disorder
Number of rapes in the U.S. has risen dramatically
One in five adult women has been raped
One in 71 men<br>
slide38. Characteristics of Male Rapists Create situations in which sexual encounters may occur
Misinterpret friendliness as provocation and protests as insincerity
Manipulate women into sexual encounters with alcohol (70%) or other drugs
Attribute failed attempts at sexual encounters to perceived negative features of the woman<br>
slide39. More Characteristics of Male Rapists Come from environments of parental neglect or physical or sexual abuse
Experience Sex earlier in life than men who are not sexually aggressive
Have more sexual partners than non-sexually aggressive men<br>
slide40. Date Rape Many Reluctant to Report
Between eight and 25 percent of female college students report having “unwanted sexual intercourse”
Many universities conducting workshops to encourage understanding that intercourse without consent is rape<br>
slide41. Effects of Rape Rape trauma syndrome symptoms
Include psychological distress, phobic reactions, post-traumatic stress symptoms, and sexual dysfunction
Phases in rape trauma syndrome
Acute phase: disorganization; PTSD Sx
Feelings of self-blame, fear, or depression
Long-term phase: reorganization
Survivors deal directly with feelings and attempt to reorganize their lives<br>
slide42. Etiology of rape Power rapist: 55 percent of rapists
Compensate for feelings of personal/sexual inadequacy by trying to intimidate victims
Anger rapist: 40 percent of rapists
Angry at women in general
Sadistic rapist: 5 percent of rapists
Derives satisfaction from inflicting pain
May torture or mutilate victims<br>
slide43. Etiology of Rape (cont’d.) Rape has more to do with power, aggression, and violence than sex
Sexual motivation also plays a role in rape
Most rape survivors are in their teens or 20s
Vulnerable age group
Most rapists name sexual motivation as primary reason for actions
Many rapists have multiple paraphilias (immature sexuality)<br>
slide44. Etiology of Rape (cont’d.) Why is the rate of rape increasing in US?
Effects of pornography and media portrayals of violent sex may affect rape prevalence
“Cultural spillover” theory
Rape is high in environments that encourage violence
United States has highest rape rate among countries reporting rape statistics<br>
slide45. Treatment for Rapists Many believe sex offenders are not good candidates for treatment
Most common penalty is imprisonment
High recidivism rates
When intervention occurs, it usually incorporates behavioral techniques
Some treatment techniques show success with exhibitionists
Outcomes tend to be poor for rapists<br>
slide46. Contemporary Trends and Future Directions Trends in Defining Abnormality:
New Def: “Normal” if no harm to self or others?
Exp: Is a fetish normal if not harmful??
Gender dysphoria may eventually be removed as a psychiatric diagnosis
Sweden has removed transvestism, fetishism, and sadomasochism from list of mental illnesses<br>
slide47. Review What are normal sexual behaviors?
What do we know about normal sexual responses and sexual dysfunction?
What causes gender dysphoria, and how is it treated?
What are paraphilic disorders, what causes them, and how are they treated?
Is rape an act of sex or aggression?<br>
slide48. Group Work: Case Analysis Each group will work together on each case, evaluate each case, form a diagnosis and develop a rationale for the decision.
Total of 4 cases representing different sexual disorders
Class Discussion
Please turn in group work at end of class<br>