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									Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

                                                                                Sexual and Gender Identity Disorders: An Overview

                                                                             Ÿ What Is “Normal” vs. “Abnormal” Sexual Behavior?
                                                                               § Normative facts and statistics
                                                                                 § Cultural considerations
                               Chapter 10                                        § Gender differences in sexual behavior and attitudes
                                                                             Ÿ Development of Sexual Orientation
                                                                               § Complex interaction of bio-psycho-social influences
              Sexual and Gender Identity Disorders
                                                                               § The example of homosexuality
                                                                             Ÿ DSM-IV-TR Sexual and Gender Identity Disorders
                                                                                 § Gender identity disorder
                                                                                 § Sexual dysfunctions
                                                                                 § Paraphilias




Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

             The Nature of Gender Identity Disorder                                          Sexual Dysfunctions: An Overview

Ÿ Clinical Overview                                                          Ÿ Sexual Dysfunctions
   § Person feels trapped in the body of the wrong sex                         § Affect desire, arousal, and/or orgasm
   § Assume identity of the desired sex                                        § Pain associated with sex can lead to additional dysfunction
   § The goal is not sexual                                                  Ÿ Males and Females
Ÿ Causes are Unclear                                                             § Experience parallel versions of most sexual dysfunctions
   § Gender identity develops early – 18 and 36 months/age                       § Affects about 43% of all females and 31% of males
Ÿ Sex-Reassignment Surgery
                                                                                 § Most prevalent class of disorder in the United States
   § Who is a candidate? – Basic prerequisites before surgery
                                                                             Ÿ Classification of Sexual Dysfunctions
   § 75% report satisfaction with new identity
                                                                               § Lifelong v s. acquired
   § Adjustment is better for Female-to-male conversions
Ÿ Psychosocial Treatment of Gender Identity Disorder                             § Generalized v s. specific
   § Realign psychological gender with biological sex                            § Psychological factors alone
   § Few Large Scale Studies                                                     § Psychological factors combined with medical conditions




Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

                                                                                          Sexual Desire Disorders: An Overview

                                                                                   Ÿ Hypoactive Sexual Desire Disorder
                                                                                     § Little or no interest in any type of sexual activity
                                                                                     § Masturbation, sexual fantasies, and intercourse are
                                                                                       rare
                                                                                     § Accounts for half of all complaints at sexuality clinics
                                                                                     § Affects 22% of women and 5% of men
                                                                                   Ÿ Sexual Aversion Disorder
                                                                                     § Little interest in sex
                                                                                     § Physical / sexual contact – Extreme fear, panic,
                                                                                       disgust
                                                                                     § 10% of males report panic attacks during sexual
                                                                                       activity

Figure 10.3 The human sexual response cycle.




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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

            Sexual Arousal Disorders: An Overview                                              Orgasm Disorders: An Overview

                                                                             Ÿ Inhibited Orgasm: Female and Male Orgasmic Disorder
      Ÿ Male Erectile Disorder                                                  § Have adequate desire and arousal
         § Difficulty achieving and maintaining an erection                     § Unable to achieve orgasm
      Ÿ Female Sexual Arousal Disorder                                          § Rare condition in adult males
         § Difficulty achieving and maintaining adequate                        § Most common complaint of adult females
           lubrication                                                          § 25% of adult females report difficulty reaching orgasm
      Ÿ Associated Features of Sexual Arousal Disorders                         § 50% of adult females report experiencing regular orgasms
         § Problem is arousal, not desire                                    Ÿ Premature Ejaculation
         § Affects about 5% of males, 14% of females                            § Ejaculation before the man or partner wishes it to
         § Males are more troubled by the problem than                          § 21% of all adult males meet diagnostic criteria
           females
                                                                                § Most prevalent sexual dysfunction in adult males
         § Erectile problems are the main reason males seek
                                                                                § Common in younger, inexperienced males
           help
                                                                                § Problem declines with age




Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

               Sexual Pain Disorders: An Overview                                     Sexual Pain Disorders: An Overview (cont.)

      Ÿ Defining Feature                                                           Ÿ Vaginismus
        § Marked pain during intercourse                                                § Limited to females
      Ÿ Dyspareunia                                                                     § Outer third of the vagina undergoes involuntary
        § Extreme pain during intercourse                                                 spasms
           § Adequate sexual desire, arousal, and ability to attain                     § Complaints include feeling of ripping, burning, or
             orgasm                                                                       tearing
           § Must rule out medical reasons for pain                                     § Affects over 5% of women seeking treatment in the
           § Affects 1% to 5% of men and about 10% to 15% of                              U.S.
             women                                                                      § Prevalence rates are higher in more conservative
                                                                                          groups




Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

   Assessing Sexual Behavior and Sexual Dysfunction
                                                                                                                    Clark

      Ÿ Comprehensive Interview
           § History of sexual behavior, lifestyle, and associated
             factors
      Ÿ Medical Examination
        § Must rule out medical causes of sexual dysfunction
      Ÿ Psychophysiological Evaluation
           § Exposure to erotic material
           § Determine extent and pattern of sexual arousal
           § Males – Penile strain gauge
           § Females – Vaginal photoplethysmograph




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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

                   Causes of Sexual Dysfunctions

Ÿ Biological Contributions
  § Physical disease and medical illness
  § Prescription medications
  § Use and abuse of alcohol and other drugs
Ÿ Psychological Contributions
  § The role of “anxiety ” vs. “distraction”
  § The nature and components of performance anxiety
  § Psychological profiles associated with sexual dysfunction
Ÿ Social and Cultural Contributions
  § Negative scripts about sexuality
  § Erotophobia – Learned negative attitudes about sexuality
  § Negative or traumatic sexual experiences
  § Poor interpersonal relationships, lack of communication
                                                                             Figure 10.6 A model of functional and dysfunctional sexual arousal.




Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

       Psychosocial Treatment of Sexual Dysfunction                                      Medical Treatment of Sexual Dysfunction


      Ÿ Education alone                                                            Ÿ Erectile Dysfunction
        § Surprisingly effective                                                     § Viagra – Is it really the wonder drug?
      Ÿ Masters and Johnson’s Psychosocial Intervention                                 § Injection of vasodilating drugs into the penis
        § Education                                                                     § Penile prosthesis or implants
        § Eliminate performance anxiety – Sensate focus
          and nondemand pleasuring                                                      § Vascular surgery
      Ÿ Additional Psychosocial Procedures                                              § Vacuum device therapy
        § Squeeze technique – Premature ejaculation                                Ÿ Few Medical Procedures for Female Sexual
        § Masturbatory training – Female orgasm disorder                             Dysfunction
        § Use of dilators – Vaginismus
        § Exposure to erotic material – Low sexual desire
          problems




Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

                                                                                                    Paraphilias: An Overview
                                Viagra Failures
                                                                             Ÿ Nature of Paraphilias
                                                                               § Sexual attraction and arousal
                                                                               § Focused on inappropriate people and/or objects
                                                                               § Often multiple paraphilic patterns of arousal
                                                                               § High comorbidity – Anxiety, mood, and substance abuse
                                                                             Ÿ Main Types of Paraphilias
                                                                               § Fetishism
                                                                               § Voyeurism
                                                                               § Exhibitionism
                                                                               § Transvestic fetishism
                                                                               § Sexual sadism and masochism
                                                                               § Pedophilia




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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

                                    Fetishism                                                    Voyeurism and Exhibitionism

      Ÿ Fetishism
                                                                                   Ÿ Voyeurism
         § Sexual attraction – Nonliving objects
                                                                                     § Observing an unsuspecting individual undressing or
           § Objects can be inanimate and/or tactile                                   naked
           § Examples include rubber, hair
                                                                                        § Risk associated with “peeping” is necessary for
           § Usually many objects of fetishistic arousal, fantasy,                        arousal
             urges
                                                                                   Ÿ Exhibitionism
                                                                                     § Exposure of genitals to unsuspecting strangers
                                                                                        § Element of thrill and risk are necessary for sexual
                                                                                          arousal




Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

                          Transvestic Fetishism                                           Sexual Sadism and Sexual Masochism


      Ÿ Transvestic Fetishism                                                      Ÿ Sexual Sadism
         § Sexual arousal with the act of cross-dressing                             § Inflicting pain or humiliation to attain sexual
                                                                                       gratification
           § Males may show highly masculine compensatory                          Ÿ Sexual Masochism
             behaviors
                                                                                     § Suffer pain or humiliation to attain sexual
           § Most do not show compensatory behaviors                                   gratification
           § Many are married and the behavior is known to                         Ÿ Relation Between Sadism and Rape
             spouse                                                                  § Some rapists are sadists
                                                                                     § Most rapists do not show paraphilic patterns of
                                                                                       arousal
                                                                                     § Sexual arousal to violent sexual and non-sexual
                                                                                       material




Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

                                   Pedophilia                                              Paraphilias: Causes and Assessment

      Ÿ Overview
                                                                                   Ÿ Causes of Paraphilia
        § Pedophiles – Sexual attraction to young children
                                                                                     § Associated with sexual and social problems and
        § Incest – Sexual attraction to one’s own children
                                                                                       deficits
        § Victims are typically children or young adolescents
                                                                                        § Inappropriate arousal / fantasy learned early in life
        § Pedophilia is rare, but not unheard of, in females
                                                                                        § High sex drive plus suppression of urges / drive
      Ÿ Associated Features
        § Most pedophiles and incest perpetrators are male                         Ÿ Psychophysiological Assessment of Paraphilias
        § Incestuous males may be aroused to adult women                             § Deviant patterns of sexual arousal
        § Pedophiles are not aroused by adult women                                     § Desired sexual arousal to adult content
        § Most rationalize the behavior                                                 § Docial skills and the ability to form relationships
        § Engage in other moral compensatory behavior
          (church)




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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

                                    Paraphilia                                             Paraphilias: Psychosocial Treatment
                                                                             Ÿ Psychosocial Interventions
                                                                               § Most are behavioral
                                                                               § Target deviant and inappropriate sexual associations
                                                                               § Covert sensitization – Imagining aversive consequences
                                                                               § Orgasmic reconditioning – Masturbation + appropriate
                                                                                  stimuli
                                                                               § Family/marital therapy – Address interpersonal problems
                                                                               § Coping & relapse prevention – Self -control, risk
                                                                                  management
                                                                             Ÿ Efficacy of Psychosocial Interventions
                                                                               § About 70% to 100% of cases show improvement
                                                                               § Poorest outcomes – Rapists / Multiple paraphilias
Figure 10.9 A model of the                                                     § Most paraphilias run a chronic course
development of paraphilia.                                                     § Relapse rates are high




Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

                   Pedophilia: Medical Treatment                                 Summary of Sexual and Gender Identity Disorders

Ÿ Medications: The Equivalent of Chemical Castration
   § Often used for dangerous sexual offenders
                                                                             Ÿ Gender Identity and Gender Identity Disorder
Ÿ Types of Available Medications
                                                                                 § Problem is not sexual
   § Cyproterone acetate – Anti-androgen, reduces
     testosterone, sexual urges and fantasy                                      § The problem is feeling trapped in body of wrong sex
   § Medroxyprogesterone acetate – Depo-provera, also                        Ÿ Sexual Dysfunctions are Common in Men and Women
     reduces testosterone                                                      § Problems with desire, arousal, and/or orgasm
   § Triptoretin – A newer more effective drug that inhibits                 Ÿ Paraphilias Represent Inappropriate Sexual Attraction
     gonadtropin secretion
                                                                               § Desire, arousal, and orgasm gone awry
Ÿ Efficacy of Medication Treatments
                                                                             Ÿ Available Psychosocial and Medical Treatment Options are
   § Drugs greatly reduce sexual desire, fantasy, arousal
                                                                               Generally Efficacious
   § Relapse rates are high with medication discontinuation
                                                                               § Comprehensive assessment and treatment approaches




Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

               Exploring Gender Identity Disorders                                                 Exploring Sexual Disorders




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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow   Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders                             Chapter 10: Sexual and Gender Identity Disorders

                      Exploring Sexual Disorders                                                   Exploring Sexual Disorders




Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow
Chapter 10: Sexual and Gender Identity Disorders

                      Exploring Sexual Disorders




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