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Chapter12 - Chapter 12 Chapter 12 Sexual Variants Abuse and...

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Unformatted text preview: Chapter 12 Chapter 12 Sexual Variants, Abuse, and Dysfunctions Sexual Variants, Abuse, and Dysfunctions 0. Sex and sexuality are important in life: 0. Freud: sex = live instinct; basic id drive 1. Darwin: sex is essential for procreation and survival of the species 1. Knowledge about subject limited due to: 2. Taboo character of topic 3. Level of controversy about subject 0. E.g. homosexuality, premarital sex Sexual Variants, Abuse, and Dysfunctions 2. Three areas to be covered: 4. Sexual variants: unusual sexual interests difficult to satisfy in a socially acceptable manner (“variant”, not “deviant”) 5. Sexual abuse: pressured, forced or inappropriate sexual contact 6. Sexual dysfunction: problems that interfere with satisfactory performance of sexual acts Sociocultural Influences on Sexual Practices and Standards 3. People tend to see the current sexual standards as right and are intolerant of sexual nonconformity 4. Sexual behavior that does not conform to current 4. standards is seen as sick or evil 0. Some aspects of sexuality are universal; others are quite variable (e.g. views of masturbation and homosexuality) Sociocultural Influences on Sexual Practices and Standards 1. View of masturbation: 2. Degeneracy (in the 1750s) and abstinence theory (in the 1830s) discouraged masturbation (caused weakness and insanity in men) 0. Eat graham crackers and kellog cornflakes as alternative 3. Today the American Medical Association considers masturbation “a normal part of adolescent sexual development” (1972) 4. Roman Catholic church continues to see masturbation as a sin Sociocultural Influences on Sexual Practices and Standards 7. Status of homosexuality: 8. Up to 1970, homosexuality was widely regarded as a sickness (DSM) 9. Current evidence shows that homosexuality is compatible with psychological normality 1. Kinsey's work; gay liberation; Am Psych. Assn 10. Homosexuality is no longer listed as a disorder in the DSM­IV­TR (although stress from lifestyle) 11. Factors contributing: genetics, prenatal hormones, 11. family dysfunction Sex­Typical and Sex­Atypical Behavior in Childhood Sexual and Gender Variants: The Paraphilias 12. The paraphilias are a group of persistent sexual behavior patterns in which unusual objects, rituals, or situations are required to fulfill sexual satisfaction 13. Distinguished by insistence and relative exclusivity of focus and acts 2. Current behavior; no distress; compulsive nature 14. Varies according to object & motive 3. Nonhuman; suffering & humiliation; children Sexual and Gender Variants: The Paraphilias (I) 5. The paraphilias include: 6. Fetishism: object is source of gratification 7. Recurrent sexually intense fantasies, urges and behaviors involving inanimate objects for sexual gratification (masturbate while experiencing object) Sexual and Gender Variants: The Paraphilias (II) 8. The paraphilias include: 9. Transvestic fetishism: cross dressing 9. 10.Recurrent sexually arousing fantasies, urges and behaviors that involve dressing as a female Sexual and Gender Variants: The Paraphilias (III) 11.The paraphilias include: 12.Voyeurism: peeping toms 13.Recurrent intense sexually arousing fantasies, urges or behaviors involving observation of unsuspecting female who is undressing or couples engaged in sexual activities Sexual and Gender Variants: The Paraphilias (IV) 14.The paraphilias include: 15.Exhibitionism: indecent exposure 16.Recurrent intense sexually arousing fantasies, urges or behaviors that involve exposing genitals to others in inappropriate settings without consent (in public places) 15. Not aggressive, but nonconsensual and upsetting Sexual and Gender Variants: The Paraphilias (V) 17.The paraphilias include: 5. Autogynephilia is a paraphelia characterized by a man’s sexual arousal at the thought of being a woman Sexual and Gender Variants: Sexual and Gender Variants: The Paraphilias (VI) 18.The paraphilias include: 19.Sadism: infliction of humiliation or pain 20.Recurrent intense sexually arousing fantasies, urges or behaviors that involve inflicting pain or humiliation on another 16. Whipping, biting, demeaning, burning 17. Serial killers are sometimes sexual sadists Sexual and Gender Variants: The Paraphilias (VII) 21.The paraphilias include: 22.Masochism: receipt of humiliation or pain 23.Recurrent intense sexually arousing fantasies, urges or behaviors that involve the act of being humiliated, beaten or hurt in a systematic pattern 18. Not done with a sadist Sexual and Gender Variants: The Paraphilias 24.Nearly all people with paraphilias are male (begins around puberty) 25.People with paraphilias often have more than one of the paraphilias 26.Other than sex offenders, most people with paraphilias do not seek treatment Sexual and Gender Variants: Sexual and Gender Variants: Gender Identity Disorders 27.Gender identity: sense of maleness or femaleness (corresponding w. biology) Sexual and Gender Variants: Gender Identity Disorders 28.Gender identity disorder is characterized by two components: 19. Cross­gender identification (belief that one's own sex is inappropriate) 20. Gender dysphoria– persistent discomfort about one’s biological sex or the sense that the gender role of that sex is inappropriate Sexual and Gender Variants: Gender Identity Disorders 29.The most common outcome of boys with gender identity disorder appears to be homosexuality (preoccupied with traditionally feminine activities) 30.There have been no prospective studies of girls with gender identity disorder (goes beyond ‘tomboy’ ) 31.Boys outnumber girls five to one Sexual and Gender Variants: Sexual and Gender Variants: Gender Identity Disorders 32.Gender dysphoria is typically treated psychodynamically (inner conflicts) 33.Transsexuals are adults with gender identity disorder (use surgical procedures to change) 34.Psychotherapy is usually not effective in helping adolescents or adults resolve their gender dysphoria (surgery may be only solution) Sexual and Gender Variants: Abuse and Dysfunctions Sexual and Gender Variants: Abuse and Dysfunctions 35.Sexual abuse: pressured, forced or inappropriate sexual contact 36.Sexual dysfunction: problems that interfere with satisfactory performance of sexual acts Sexual Abuse: Definition 37.Sexual contact that involves physical or psychological coercion to at least one individual who does not or reasonably cannot consent to the contact (e.g. child) 38.Includes pedophilia, incest and rape. Sexual Abuse: Prevalence and Sexual Abuse: Prevalence and Consequences 6. Depending on the definition (breadth) used, prevalence figures for child sexual abuse range from less than 5% to more than 30% 7. Short­term consequences may involve fears, post­ traumatic stress disorder, and sexual inappropriateness 8. Long­term consequences: Studies have found associations between reports of childhood abuse and adult psychopathology (personality, somatoform, dissociative, sexual problems) Sexual Abuse: Issues 39.Issues regarding child sexual abuse: 40.Children’s testimony 21. Issues of validity of testimony 22. Children being coached 41.Recovered memories of sexual abuse 23. ‘Repressed’ memories recovered in course of therapy 42.General problem of susceptibility to past event distortion Sexual Abuse: Pedophilia 43.Pedophilia: When an adult has recurrent, intense sexual urges or fantasies about sexual activity with a prepubescent child 24. Victims equally boys and girls 25. Multiple victims 44.Child molestation is defined by body maturity (not 44. age) of preferred partner 45.Typically begins in adolescence Sexual Abuse: Incest 46.Incest: culturally prohibited sexual relations between family members 26. Produces children with mental and physical problems due to shared recessive genes 27. Avoided by nonhuman animals 28. Brother/sister most common; father/daughter next most common 29. Incest usually involves one or two girls Sexual Abuse: Rape (Definition) 47.Rape: sexual activity that occurs under actual or threatened forcible coercion of one person by another 48.Statutory rape is sexual activity with a person who is legally defined to be under the age of consent (18) even if the underage person consents Sexual Abuse: Rape (Prevalence) 49.Depending on the definition used, prevalence figures run from 5% to 13% 30. Prevalence higher during & after wars 50.1 in 5 women will experience rape or attempted rape at some point in their lives Sexual Abuse: Rape (Motivation) 51.Rape is motivated by both sex and aggression (act 51. of violence) 31. Need to dominate, assert power, humiliate 52.Rape is correlated with any violence, bullying, or intrusive violation of another person’s integrity, selfhood or boundaries Sexual Abuse: Rape (Effects) 53.In addition to the physical trauma inflicted on the victim, the psychological trauma may also be severe often leading to post­traumatic stress disorder 54.The rape trauma syndrome is characterized by: severe sexual problems; pregnancy; STD's; PTSD Sexual Abuse: Rape (Pattern) 55.Rape tends to be a repetitive activity; mostly planned; typically near residence of rapist 32. One­third of rapes involve more than one rapist 56.Two­thirds of victims are acquainted with rapist 57.Often the victim is blamed for provoking the behavior and thus the rapist is not seen as ‘responsible’ for their act Sexual Abuse: Rape (Rapists) 58.Typical rapist: (60%) under 25 33. 34. 35. Are married (50%) Frequently lower SES Prior criminal record 59.Date rapists: middle to upper SES 59. 36. Promiscuous, hostile, detached, predatory, aroused by violence, aggressive 60.As the following slide shows, strangers commit only a small fraction of all rapes Relationship of Women Respondents to a Man Who Forced them to Do Something Sexual Sex Offenders: Recidivism 61.Recidivism rates for sex offenders are relatively low and decrease with age 62.However, sex offenders with deviant sexual preferences (e.g., those most attracted to children) have high rates of recidivism (includes also exhibitionists and severe sadists) Sex Offenders: Treatment 63.Therapies for sex offenders have at least one of the following four goals: 37. To modify patterns of sexual arousal 38. To modify cognitions and social skills to allow more appropriate sexual interactions with adult partners 39. To change habits and behavior that increase the chance of reoffending 40. To reduce sexual drive Sex Offenders: Treatment 64.Psychological therapies may include 41. 41. 42. 43. 44. 45. Aversion therapy (shock) Covert sensitization/assisted covert sensitization Satiation Cognitive restructuring Relapse prevention 65.Generally therapies are not very effective Sex Offenders: Treatment 66.Biological/surgical treatments include: 46. Physical or chemical castration (problems of relapse) (lower testosterone levels lower sex drive) 67.Combination programs of hormone therapy and cognitive­behavioral treatments 47. Goal is to withdraw hormones after individual has learned techniques for impulse control Sexual Dysfunctions: Definition 68.The term sexual dysfunction refers to impairment either in 48. 49. 50. The desire for sexual gratification The ability to achieve it May be physical, psychological, interpersonal 69.Problem typically adversely affects enjoyment of sex by both parties 51. Can occur in both heterosexual or homosexual couples Sexual Dysfunctions: Prevalence 70.Approximately 50% of women and one­third of 70. men in any 12 month period 71.Rate with age decreases for women and increases for men 72.Married and higher educated individuals have lower rate of dysfunctions Sexual Dysfunctions: Response Phases 73.The human sexual response has four phases: 52. Desire phase: fantasies about sexual activity 53. Excitement phase: subjective sense of pleasure and physiological changes 54. Orgasm: release of sexual tension 55. Resolution: relaxation and well­being 74.Phases are typically continuous and not discrete (although DSM divides them up) Sexual Dysfunctions: Desire 75.In hypoactive sexual desire disorder, a person shows little or no sex drive or interest (typically psychological) 56. (e.g. depression); partner dissatisfied w. freq. 76.With sexual aversion disorder, the person shows extreme aversion to, and avoidance of, all genital sexual contact with a partner Sexual Dysfunctions: Desire 77.Sexual desire disorder appears to be the most 77. common female sexual dysfunction 78.No basis for view that women do not desire sex as much as men 79.Women associate emotional intimacy with sex Sexual Dysfunctions: Arousal 80.Male erectile disorder (impotence) 57. Effects half the male population on at least a temporary basis (2/3 of men over 50) 58. Physiological causes: may be due to vascular disease in older men 59. Additionally: hypertension or diabetes associated with smoking, alcohol and obesity 60. Physiological dysfunction (hypertension etc) (treated by viagra ­ but sexual arousal must be present) Sexual Dysfunctions: Arousal 81.Male erectile disorder (impotence) 61. 62. 63. Psychological causes: Anxiety about sexual performance Cognitive distraction by negative thoughts Sexual Dysfunctions: Arousal 82.Female sexual arousal disorder (frigidity): the female counterpart of erectile disorder 64. Involves absence of feelings of sexual arousal and unresponsiveness to erotic stimulation 65. Failure to produce swelling and lubrication of vaginal tissues 66. Can be masked by lubricant and treated with viagra 66. 67. SSRI's sometimes effective Sexual Dysfunctions: Orgasmic 83.Premature ejaculation is the persistent and recurrent onset of ejaculation with minimal sexual stimulation 68. May occur before or shortly after penetration 69. Partner may be dissatisfied; male may be embarrassed 70. Arbitrary definition of prematurity Sexual Dysfunctions: Orgasmic 84.Male orgasmic disorder refers to the persistent inability to ejaculate during intercourse (retarded ejaculation) 71. Typically (85%) can ejaculate by other means 72. Treat by reducing anxiety (problem with SSRI's) Sexual Dysfunctions: Orgasmic 85.Female orgasmic disorder refers to persistent or recurrent delay in or absence of orgasm following a normal sexual excitement phase 73. Often related to relationship with partner 74. Identification complicated by subjective quality of female organism 75. May require direct stimulation of clitoris 76. May be due to psychological reasons ­ low self­ 76. esteem Sexual Dysfunctions: Pain 86.Vaginismus: an involuntary spasm of the muscles at the entrance of the vagina (not due to physical disorder) that prevents penetration and sexual intercourse 77. Often associated with sexual arousal disorder Sexual Dysfunctions: Pain 87.Painful coitus, or dyspareunia, can occur in men but is far more common in women 78. 79. 80. Could be due to infection, inflammation Could be due to conditioned psychological resp. Consider as a pain disorder, not sexual disorder Unresolved Issues 88.How harmful is childhood sexual abuse? End of Chapter 12 ...
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