comerabnormalpsychology7theditiondes来的人心理异常第七版des

《comerabnormalpsychology7theditiondes来的人心理异常第七版des》由会员分享，可在线阅读，更多相关《comerabnormalpsychology7theditiondes来的人心理异常第七版des（82页珍藏版）》请在装配图网上搜索。

1、Slides&Handouts by Karen Clay Rhines,Ph.D.Northampton Community CollegeSexual Disorders and Gender Identity DisorderChapter 131Sexual Disorders and Gender Identity DisorderSexual behavior is a major focus of both our private thoughts and public discussionsExperts recognize two general categories of

2、sexual disorders:Sexual dysfunctions problems with sexual responsesParaphilias repeated and intense sexual urges and fantasies in response to socially inappropriate objects or situations2Sexual Disorders and Gender Identity DisorderDSM-IV-TR also includes a diagnosis of gender identity disorder,a se

3、x-related pattern in which people feel that they have been assigned to the wrong sexRelatively little is known about racial and other cultural differences in sexualitySex therapists and sex researchers have only recently begun to attend systematically to the importance of culture and race3Sexual Dys

4、functionsSexual dysfunctions are disorders in which people cannot respond normally in key areas of sexual functioningAs many as 31%of men and 43%of women in the U.S.suffer from such a dysfunction during their livesSexual dysfunctions are typically very distressing,and often lead to sexual frustratio

5、n,guilt,loss of self-esteem,and interpersonal problemsOften these dysfunctions are interrelated;many patients with one dysfunction experience another as well4Sexual DysfunctionsThe human sexual response can be described as a cycle with four phases:DesireExcitementOrgasmResolutionSexual dysfunctions

6、affect one or more of the first three phases567Sexual DysfunctionsSome people struggle with sexual dysfunction their whole lives(labeled“lifelong type”in DSM-IV-TR)For others,normal sexual functioning preceded the disorder(labeled“acquired type”)In some cases the dysfunction is present during all se

7、xual situations(labeled“generalized type”)In others it is tied to particular situations(labeled“situational type”)8Disorders of DesireDesire phase of the sexual response cycleConsists of an urge to have sex,sexual fantasies,and sexual attraction to othersTwo dysfunctions affect this phase:Hypoactive

8、 sexual desire disorderSexual aversion disorder9Disorders of DesireHypoactive sexual desire disorderCharacterized by a lack of interest in sex and little sexual activityPhysical responses may be normalPrevalent in about 16%of men and 33%of womenDSM-IV-TR refers to“deficient”sexual interest/activity

9、but provides no definition of“deficient”In reality,this criterion is difficult to define10Disorders of DesireSexual aversion disorderCharacterized by a total aversion to(disgust of)sexSexual advances may sicken,repulse,or frightenThis disorder seems to be rare in men and more common in women11Disord

10、ers of DesireA persons sex drive is determined by a combination of biological,psychological,and sociocultural factors,and any of these may reduce sexual desireMost cases of low sexual desire or sexual aversion are caused primarily by sociocultural and psychological factors,but biological conditions

11、can also lower sex drive significantly12Disorders of DesireBiological causesA number of hormones interact to produce sexual desire and behaviorAbnormalities in their activity can lower sex drive These hormones include prolactin,testosterone,and estrogen for both men and womenSex drive can also be lo

12、wered by chronic illness,some medications(including birth control pills),some psychotropic drugs,and a number of illegal drugs13Disorders of DesirePsychological causesA general increase in anxiety,depression,or anger may reduce sexual desire in both women and menFears,attitudes,and memories may cont

13、ribute to sexual dysfunctionCertain psychological disorders,including depression and obsessive-compulsive disorder,may lead to sexual desire disorders14Disorders of DesireSociocultural causesAttitudes,fears,and psychological disorders that contribute to sexual desire disorders occur within a social

14、contextMany sufferers of desire disorders are feeling situational pressuresExamples:divorce,death,job stress,infertility,and/or relationship difficultiesCultural standards can impact the development of these disordersThe trauma of sexual molestation or assault is also likely to produce sexual dysfun

15、ction15Disorders of ExcitementExcitement phase of the sexual response cycleMarked by changes in the pelvic region,general physical arousal,and increases in heart rate,muscle tension,blood pressure,and rate of breathingIn men:erection of the penis In women:swelling of the clitoris and labia and vagin

16、al lubricationTwo dysfunctions affect this phase:Female sexual arousal disorder(formerly“frigidity”)Male erectile disorder(formerly“impotence”)16Disorders of ExcitementFemale sexual arousal disorderCharacterized by repeated inability to maintain proper lubrication or genital swelling during sexual a

17、ctivityMany with this disorder also have desire or orgasmic disordersIt is estimated that more than 10%of women experience this disorderBecause this disorder is so often tied to an orgasmic disorder,researchers usually study the two together;causes of the two disorders will be examined together17Dis

18、orders of ExcitementMale erectile disorder(ED)Characterized by repeated inability to attain or maintain an adequate erection during sexual activityAn estimated 10%of men experience this disorderAccording to surveys,half of all adult men have erectile difficulty during intercourse at least some of th

19、e time18Disorders of ExcitementMost cases of erectile disorder result from an interaction of biological,psychological,and sociocultural processesEven minor physical impairment of the erection response may make a man vulnerable to the effects of psychosocial factors19Disorders of ExcitementBiological

20、 causesThe same hormonal imbalances that can cause hypoactive sexual desire can also produce EDMost commonly,vascular problems are involvedED can also be caused by damage to the nervous system from various diseases,disorders,or injuriesThe use of certain medications and substances may interfere with

21、 erections 20Disorders of ExcitementBiological causesMedical devices have been developed for diagnosing biological causes of EDOne strategy involves measuring nocturnal penile tumescence(NPT)Men typically have erections during REM sleep;abnormal or absent nighttime erections usually indicate a physi

22、cal basis for erectile failure21Disorders of ExcitementPsychological causesAny of the psychological causes of hypoactive sexual desire can also interfere with arousal and lead to erectile dysfunctionFor example,as many as 90%of men with severe depression experience some degree of EDOne well-supporte

23、d cognitive explanation for ED emphasizes performance anxiety and the spectator roleOnce a man begins to have erectile difficulties,he becomes fearful and worried during sexual encounters;instead of being a participant,he becomes a spectator and judge This can create a vicious cycle of sexual dysfun

24、ction where the original cause of the erectile failure becomes less important than the fear of failure22Disorders of ExcitementSociocultural causesEach of the sociocultural factors tied to hypoactive sexual desire has also been linked to EDJob and marital distress are particularly relevant23Disorder

25、s of OrgasmOrgasm phase of the sexual response cycleSexual pleasure peaks and sexual tension is released as the muscles in the pelvic region contract rhythmically For men:semen is ejaculatedFor women:the outer third of the vaginal walls contractThere are three disorders of this phase:Rapid or Premat

26、ure ejaculationMale orgasmic disorder Female orgasmic disorder24Disorders of OrgasmRapid or Premature ejaculationCharacterized by persistent reaching of orgasm and ejaculation with little sexual stimulationAbout 30%of men experience rapid ejaculation at some timePsychological,particularly behavioral

27、,explanations of this disorder have received more research support than other explanationsThe dysfunction seems to be typical of young,sexually inexperienced menIt may also be related to anxiety,hurried masturbation experiences,or poor recognition of arousal25Disorders of OrgasmRapid or Premature ej

28、aculationThere is a growing belief among many clinical theorists that biological factors may also play a key role in many cases of this disorderOne theory states that some men are born with a genetic predispositionA second theory argues that the brains of men with rapid ejaculation contain certain s

29、erotonin receptors that are overactive and others that are underactiveA third explanation holds that men with this dysfunction experience greater sensitivity or nerve conduction in the area of their penis26Disorders of OrgasmMale orgasmic disorderCharacterized by a repeated inability to reach orgasm

30、 or by a very delayed orgasm after normal sexual excitementOccurs in 8%of the male populationBiological causes include low testosterone,neurological disease,and head or spinal cord injuryMedications,including certain antidepressants(especially SSRIs)and drugs that slow down the central nervous syste

31、m(CNS),can also affect ejaculation27Disorders of OrgasmMale orgasmic disorderA leading psychological cause appears to be performance anxiety and the spectator role,the cognitive factors involved in ED28Disorders of OrgasmFemale orgasmic disorderCharacterized by persistent delay in or absence of orga

32、sm following normal sexual excitementAlmost 25%of women appear to have this problem10%or more have never reached orgasmAn additional 10%reach orgasm only rarelyWomen who are more sexually assertive and more comfortable with masturbation tend to have orgasms more regularlyFemale orgasmic disorder is

33、more common in single women than in married or cohabiting women29Disorders of OrgasmFemale orgasmic disorderMost clinicians agree that orgasm during intercourse is not mandatory for normal sexual functioningEarly psychoanalytic theory used to consider lack of orgasm during intercourse to be patholog

34、icalTypically linked to female sexual arousal disorder The two disorders tend to be studied and treated togetherOnce again,biological,psychological,and sociocultural factors may combine to produce these disorders30Disorders of OrgasmFemale orgasmic disorder Biological causesA variety of physiologica

35、l conditions can affect a womans arousal and orgasmThese conditions include diabetes and multiple sclerosisThe same medications and illegal substances that affect erection in men can affect arousal and orgasm in womenPostmenopausal changes may also be responsible31Disorders of OrgasmFemale orgasmic

36、disorder Psychological causesThe psychological causes of hypoactive sexual desire and sexual aversion,including depression,may also lead to female arousal and orgasmic disordersMemories of childhood trauma and relationship distress may also be related32Disorders of OrgasmFemale orgasmic disorder Soc

37、iocultural causesFor decades,the leading sociocultural theory of female sexual dysfunction was that it resulted from sexually restrictive cultural messagesThis theory has been challenged because:Sexually restrictive histories are equally common in women with and without disordersCultural messages ab

38、out female sexuality have been changing while the rate of female sexual dysfunction stays constant33Disorders of OrgasmFemale orgasmic disorder Sociocultural causesResearchers suggest that unusually stressful events,traumas,or relationships may produce the fears,memories,and attitudes that character

39、ize these dysfunctionsResearch has also linked certain qualities in a womans intimate relationships(such as emotional intimacy)to orgasmic behavior34Disorders of Sexual PainTwo sexual dysfunctions do not fit neatly into a specific phase of the sexual response cycleThese are the sexual pain disorders

40、:VaginismusDyspareunia35Disorders of Sexual PainVaginismusCharacterized by involuntary contractions of the muscles of the outer third of the vaginaSevere cases can prevent a woman from having intercoursePerhaps 20%of women occasionally have pain during intercourse,but less than 1%of all women have v

41、aginismus36Disorders of Sexual PainVaginismusMost clinicians agree with the cognitive-behavioral theory that vaginismus is a learned fear responseA variety of factors can set the stage for this fear,including anxiety and ignorance about intercourse,trauma caused by an unskilled partner,and childhood

42、 sexual abuseSome women experience painful intercourse because of infection or disease,leading to“rational”vaginismusMost women with vaginismus also have other sexual disorders37Disorders of Sexual PainDyspareuniaCharacterized by severe pain in the genitals during sexual activityAs almost 14%of wome

43、n and about 3%of menDyspareunia in women usually has a physical cause,most commonly from injury sustained in childbirthAlthough relationship problems or psychological trauma from abuse may contribute to dyspareunia,psychosocial factors alone are rarely responsible38Treatments for Sexual Dysfunctions

44、The last 35 years have brought major changes in the treatment of sexual dysfunctionEarly 20th century:psychodynamic therapyBelieved that sexual dysfunction was caused by a failure to negotiate the stages of psychosexual developmentTherapy focused on gaining insight and making broad personality chang

45、es;was generally unhelpful391950s and 1960s:behavioral therapyBehavioral therapists attempted to reduce fear by applying relaxation training and systematic desensitizationHad moderate success,but failed to work in cases where the key problems included misinformation,negative attitudes,and lack of ef

46、fective sexual techniquesTreatments for Sexual Dysfunctions401970:Human Sexual InadequacyThis book,written by William Masters and Virginia Johnson,revolutionized treatment of sexual dysfunctionsThis original“sex therapy”program has evolved into a complex,multidimensional approachIncludes techniques

47、from cognitive,behavioral,couples,and family systems therapies,along with a number of sex-specific techniquesMore recently,biological interventions have also been incorporatedTreatments for Sexual Dysfunctions41What Are the General Features of Sex Therapy?Modern sex therapy is short-term and instruc

48、tiveTherapy typically lasts 15 to 20 sessionsIt is centered on specific sexual problems rather than on broad personality issues42What Are the General Features of Sex Therapy?Modern sex therapy includes:Assessing and conceptualizing the problemAssigning“mutual responsibility”for the problemEducation

49、about sexualityAttitude changeElimination of performance anxiety and the spectator roleIncreasing sexual and general communication skillsChanging destructive lifestyles and marital interactionsAddressing physical and medical factors43What Techniques Are Applied to Particular Dysfunctions?In addition

50、 to the universal components of sex therapy,specific techniques can help in each of the sexual dysfunctions44What Techniques Are Applied to Particular Dysfunctions?Hypoactive sexual desire and sexual aversion These disorders are among the most difficult to treat because of the many issues that feed

51、into themTherapists typically apply a combination of techniques,which may include:Affectual awareness,self-instruction training,behavioral techniques,insight-oriented exercises,and biological interventions such as hormone treatments45What Techniques Are Applied to Particular Dysfunctions?Erectile di

52、sorderTreatments for ED focus on reducing a mans performance anxiety and/or increasing his stimulationMay include sensate-focus exercises such as the“tease technique”46What Techniques Are Applied to Particular Dysfunctions?Erectile disorderBiological approaches,used when the ED has biological causes

53、,have gained great momentum with the development of sildenafil(Viagra)and other erectile dysfunction drugsMost other biological approaches have been around for decades and include gels,suppositories,penile injections,and a vacuum erection device(VED)These procedures are now viewed as“second-line”tre

54、atmentAnother biological approach penile implant surgery is performed only rarely47What Techniques Are Applied to Particular Dysfunctions?Male orgasmic disorderLike treatment for ED,therapies for this disorder include techniques to reduce performance anxiety and increase stimulationWhen the cause of

55、 the disorder is physical,treatment may include a drug to increase arousal of the sympathetic nervous system48What Techniques Are Applied to Particular Dysfunctions?Rapid or Premature ejaculationPremature ejaculation has been successfully treated for years by behavioral procedures such as the“stop-s

56、tart”or“pause”procedure and the“squeeze”techniqueSome clinicians favor the use of fluoxetine(Prozac)and other serotonin-enhancing antidepressant drugsBecause these drugs often reduce sexual arousal or orgasm,they may be helpful in delaying premature ejaculationMany studies have reported positive res

57、ults with this approach49What Techniques Are Applied to Particular Dysfunctions?Female arousal and orgasmic disordersSpecific treatments for these disorders include cognitive-behavioral techniques,self-exploration,enhancement of body awareness,and directed masturbation trainingBiological treatments,

58、including hormone therapy or the use of sildenafil(Viagra),have also been tried,but research has not found such interventions to be consistently helpful50What Techniques Are Applied to Particular Dysfunctions?Female arousal and orgasmic disordersAgain,a lack of orgasm during intercourse is not neces

59、sarily a sexual dysfunction,provided the woman enjoys intercourse and is orgasmic through other meansFor this reason,some therapists believe that the wisest course of action is simply to educate women whose only concern is lack of orgasm through intercourse51What Techniques Are Applied to Particular

60、 Dysfunctions?Vaginismus Specific treatment for vaginismus takes two approaches:Practice tightening and releasing the muscles of the vagina to gain more voluntary controlOvercome fear of intercourse through gradual behavioral exposure treatmentMost women treated for vaginismus using these methods ev

61、entually report pain-free intercourse52What Techniques Are Applied to Particular Dysfunctions?Dyspareunia Determining the specific cause of dyspareunia is the first stage of treatmentGiven that most cases are caused by physical problems,medical intervention may be necessary53What Are the Current Tre

62、nds in Sex Therapy?Over the past 30 years,sex therapists have moved beyond the approach first developed by Masters and JohnsonTherapists now treat unmarried couples,those with other psychological disorders,couples with severe marital discord,the elderly,the medically ill,the physically handicapped,c

63、lients with a homosexual orientation,and clients with no long-term sex partner54What Are the Current Trends in Sex Therapy?Therapists are paying more attention to excessive sexuality,which is sometimes called hypersexuality or sexual addictionThe use of medications to treat sexual dysfunction is tro

64、ubling to many therapistsThey are concerned that therapists will choose biological interventions rather than a more integrated approach55ParaphiliasThese disorders are characterized by unusual fantasies and sexual urges or behaviors that are recurrent and sexually arousingOften involve:NonhumansChil

65、drenNonconsenting adults Humiliation of self or partner56ParaphiliasAccording to the DSM-IV-TR,paraphilias should be diagnosed only when the urges,fantasies,or behaviors last at least 6 monthsFor most paraphilias,the urges,fantasies,or behaviors must also cause great distress or impairmentFor certai

66、n paraphilias,however,performance of the behavior itself is indicative of a disorder,even if the individual experiences no distress or impairmentExample:sexual contact with children57ParaphiliasSome people with one kind of paraphilia display others as wellRelatively few people receive a formal diagnosis,but clinicians believe that the patterns may be quite common58ParaphiliasSome experts argue that,with the exception of nonconsensual paraphilias,paraphilic activities should be considered a disor