3009PSY.docx

3009PSY ABNORMAL PSYCHOLOGY Final Abnormal Exam Content Examinable content – Modules 7 to 11 Module 7 – Eating Disorders Introduction Food is part of all our lives.  It is part of our culture and our everyday experience.  For some people eating, and perceptions of body shape/weight become preocc...

3009PSY ABNORMAL PSYCHOLOGY Final Abnormal Exam Content Examinable content – Modules 7 to 11 Module 7 – Eating Disorders Introduction Food is part of all our lives.  It is part of our culture and our everyday experience.  For some people eating, and perceptions of body shape/weight become preoccupations, and impact significantly on their psychological and physical health.  This module will introduce you to the eating disorders, focusing on anorexia nervosa and bulimia. Please ensure that you have read the relevant chapter of the course textbook (Rieger, 2017) before proceeding with this module:   Chapter 9. Eating Disorders – READING NEED TO DO Module 7 MINI LECTURE 1- ANOREXIA NERVOSA Overview of mini lecture The diagnostic criteria Epidemiology Other characteristics Mortality Cognitive behavioural conceptualisation Treatment outcome Anorexia Nervosa: Definition Eating disorder in which the individual is significantly below a body weight that is normal for his/her age and height and suffers from a fear of gaining weight and from body image disturbance. Diagnostic criteria Refusal to maintain weight of at least 85% of expected weight Intense fear of gaining weight, though underweight Disturbance in body image perception * A criterion of a BMI <17.5 is often also used as a part of a cut-off for anorexia The presence of amenorrhea (included in the DSM) is increasingly recognised as neither useful or relevant in diagnosis of AN. Amenorrhea (uh-men-o-REE-uh) is the absence of menstruation, often defined as missing one or more menstrual periods. Prevalence Low – 0.5% lifetime prevalence in females 10x more common in females in males Course Onset in adolescents – mid to late Highly variable The Body Mass Index BMI= kg/ M^2 (height) Common AN Characteristics: AN is often complicated by other traits and psychopathology that complicate the picture Depression and anxiety symptoms Obsessional features Perfectionism Low self-esteem Social withdrawal Physical complications Lack of insight into/ acceptance of need for treatment Mortality in AN mortality rates for AN range between 0% and 20% estimate rates of 0.56% per year Mortality for females age 15-24 = 0.0045% per year Mortality for female psychiatric inpatients = 0.021% per year Suicide rate in general population = 0.00002% per year Severity of alcohol use and substance use were correlated with mortality Predictors of mortality in AN (Keel et al., 2003) Severity of alcohol use and substance use were correlated with mortality A regression model incorporating Duration of Illness, Affective Disorder During Hospitalization, Suicidality, and Severity of Alcohol Abuse was significant in predicting mortality CBT Conceptualisation of AN 1980s – Becks CT early application Individuals with AN have overvalued ideas of body weight connection with perfectionism Show increased need or desire to exert control Success in dieting reinforces sense of control CBT theory of AN Onset Need for self-control in context of low – self-esteem, perfectionism, and sense of ineffectiveness. Control overeating focused of success / control Controlling eating has a strong effect on those in the environment, which may already be clouded with dysfunctional relationships (Impact on family) Controlling eating provides a mechanism of arresting or reversing puberty changes Western society values dieting to control body weight or shape. CBT theory of AN Maintenance Dietary restriction enhances the sense of being control Aspects of starvation encourages further dietary restriction (increased hunger – threat, impaired concentration) Extreme concerns about shape and weight encourage dietary restriction (western society) The Thin Commandments – pro AN movement – AN thought If you aren't thin you aren't attractive. Being thin is more important than being healthy. You must buy clothes, cut your hair, take laxatives, starve yourself, do anything to make yourself look thinner. Thou shall not eat without feeling guilty. Thou shall not eat fattening food without punishing oneself afterwards. Thou shall count calories and restrict intake accordingly. What the scale says is the most important thing. Losing weight is good/gaining weight is bad. (dichotomous thinking ) You can never be too thin. Being thin and not eating are signs of true will power and success. Outcome of treatment of AN – Steinhausen ( 2002) Metanalysis 119 patient cohorts, Total 559- patients Different treatment methods Mean dropout rate of 12.3% across studies Predictors of Outcomes Factors unrelated to outcome / with inconsistent findings: Weight loss at presentation Hyperactivity Dieting Obsessive Compulsive Disorder Socioeconomic status Predictors of Good Outcome: Short duration of symptoms Good parent-child relationship Histrionic Personality features Predictors of Poor Outcome: Vomiting Bulimia Purgatory behaviour Premorbid developmental abnormalities Eating disorders in childhood Chronicity Obsessive Compulsive Personality Disorder Module 7 MINI LECTURE 2 - BULIMIA NERVOSA Overview of mini lecture Diagnostic Criteria Cognitive behavioural models of Bulimia Treatment outcome bulimia nervosa Eating disorder in which the individual engages in recurrent binge eating episodes and compensatory behaviours (such as self-induced vomiting, abuse of laxatives and excessive exercise) designed to prevent weight gain. Bulimia Nervosa Recurrent episodes of binge eating: Involves eating a large amount of food in one setting Perception of lack of control overeating Recurrent inappropriate compensatory behaviour Occurring at least twice per week over three-month period Self-perception body weight Not occurring exclusively in context to AN Prevalence 1-3% lifetime prevalence 10x more common in females than males Course Onset typically in late adolescence or early adulthood. Chronic and intermittent courses seen CBT Conceptualisation – BN Psychosocial influences Current cultural milieu - correlation between cultural pressure to be thin and ED prevalence, across and within cultural groups (Hsu, 1990). Family factors Vulnerability factors (Fairburn et al., 1997) Some authors have argued similarity between BN and OCD (see Rubenstein, 1995) BN patients show higher levels of obsessional traits than normal controls. CBT Model of BN The role of Dieting in BN Dieting behaviour is a risk factor for BN. In 15-year-old schoolgirls, those who diet were 8 times more likely to develop an eating disorder within a one-year period than those who did not restrict food intake. But dieting was not a sufficient factor alone in BN. Only 20% of those dieting went on to develop an ED. (Patton et al., 1990) Patients consistently report the onset of binge eating behaviour following a period of dieting. Cognitive Model of BN Treatment outcome of Bn Whittal, Agras, & Gould (1999) Meta analysis of 26 studies evaluating CBT with BN. (N=460) Found effect sizes of 1.22 to 1.35 of CBT on (Effect sizes above 0.8 is thought to be a large effect) – addressed Binge eating, Purging, Depression symptoms, Eating attitudes Hay & Bacaltchuk (2000) Cochrane Review Identified 21 controlled studies of BN Compared CBT vs no treatment, delayed treatment, alternative psychotherapy, self-help CBT. CBT found to be superior to no treatment or delayed treatment CBT approached significance in comparison to other psychotherapies BN is the eating disorder with the most research into treatment outcome, and treatment outcome studies of the highest quality. Response rates are generally reported at around 50% (Wilson, Fairburn & Agras, 1997) Cognitions must be addressed in addition to behavioural techniques to prevent relapse (Cooper & Steere, 1995) Anderson & Maloney (2001) were critical of the use of bingeing and purging behaviour as the only outcome measure and reported variable findings of the impact of CBT on core cognitive symptoms. TUTORIAL NOTES - EATING DISORDERS Eating disorders Prevalence 90% of the population are a risk to develop it more common in females high risk for physical symptoms - laxatives effects, teeth effects with purging , malnutrition severe as death diagnosed - higher risk of suicide 6x higher APS collaborated with Medicare - created practices for treatment Medicare offers 40 rebated session each year with a clinical psychologist 20 rebated dietitian sessions Bulimia nervosa repeated episodes on binge eating disorder followed by compensatory behaviours (purging etc..)once per week excessive amount on body weight and shape on self-evaluation binge eating disorder similar to BN but does not have the compensatory behaviours eating large amount of food with in a relatively short period of time loss of control of eating anorexia nervosa restrictive energy intake a fear of gaining weight disturbed body image (see themselves 2x larger than what they actually are) DSM - use BMI - less than 17 then diagnosed can be due to another conditions origins not really clear - media maybe, societal impacts maybe biological factors, insulin resistance LOWER PREVALENCE LESS THAT 1% pica appetite for substances that are non-nutritive har paper soil paint metal soil glass more in children and adolescents outside of spiritual rumination a person brings back food and rechews partially digested food Avoidant/ restrictive disorder some type of problem in children difficulty digesting food avoiding certain foods lectures eating only small portions having no appetite being afraid to eat after choking episod READING NOTES - EATING DISORDERS Module 8 – Personality Disorders Introduction We all have a personality and the idea of labelling someone as having a personality that is disordered is controversial. At the end of the module you will have learnt about how Personality Disorders are categorised and some of the controversies around diagnosis. You will be introduced to each of the three clusters of Personality Disorder and the key characteristics of each.  Module 8 MINI LECTURE 1- Components of Personality disorder + Diagnosis Overview Understand what is considered a personality disorder Understand how Personality Disorders are Diagnosed Definition of Personality A persistent pattern of thinking and feeling and behaving that is pervasive across situations and enduring over time Five Factor model identifies five essential traits: Neuroticism Extraversion Openness to experience Conscientiousness Agreeableness 3 key core factors that differentiate disordered personality from normal- range problematic behaviours: Million (1981) identified three core features Functional inflexibility – don’t adapt to changes (one strategy they use in all situations) Self – defeating behaviour patterns (adopt anger or self defeating behaviour even when they don’t want to , self-sabotage) Tenuous stability under stress and marked instability in mood, thinking and behaviour during difficult life events. (when things don’t go right they find it difficult to cope, instability in mood, struggle to adapt and cope with stress, not suited to highs tress situations) The Diagnosis of Personality Disorder DSM-5 defines personality disorders as enduring patterns of perceiving, relating to and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts These patterns must differ from the individual’s cultural group and cause significant personal distress and impairment in functioning The Impacts of Diagnosis As in all forms of psychopathology, a diagnosis can carry serious consequences for the individual. This is particularly important for PD Perception of poor prognosis Perception of ‘difficulty’ Aversion of clinicians to working with PD Particularly important given diagnostic unreliability Misuse of the Diagnosis A diagnosis of Personality Disorder can sometimes be made for the wrong reasons For a client that the therapist is not having success in treating For a client who challenges the expertise or opinion of the therapist “Resistant” clients Comorbidity – High Personality disorders show high levels of comorbidity with mood disorders Mood Disorder: 61.3% at a single timepoint Depression: 39% at a single timepoint Depression: 74% lifetime prevalence Substance Abuse Anxiety Disorders Some features can tap into features of other disorders BPD: shares dissociation/unstable sense of self with DID Social anxiety vs Avoidant PD? Possible Indications of a Personality Disorder Does the presenting problem include aspects that are not typical of the presentation of other disorders? Are there previous multiple inconsistent psychiatric or psychological diagnoses? Is the person chaotic or excessively emotionally responsive? Does the person have problems in relationships with others? Does the person not respond to effective treatments for presenting problems? How does the therapist react to being with the person Module 8 MINI LECTURE 2- Three Clusters of PD and the Key characteristics of each. Overview of mini lecture 3 clusters of PD The key characteristics of the different Personality Disorders DSM-5 includes 10 distinct personality disorders categorised into one of three clusters: Cluster A—odd or eccentric traits and behaviours Cluster B—dramatic, emotional, erratic traits Cluster C—anxious and fearful traits Cluster A – Odd or eccentric traits and behaviours : Paranoid – Worried others are trying to hurt them, hypervigilance to threat. Less bizarre or delusional that a psychotic disorder. Schizoid – Low desire for connection with others, indifference to others’ opinions. Schizotypal – Discomfort with close relationships, odd ideas (e.g., belief that they are clairvoyant). Cluster B – Dramatic, Emotional, erratic traits: Anti-Social Personality Disorder – Offending behaviour, lack of guilt/remorse, impulsiveness. (problem with everyone else not them mentality) , comorbidity is depression, and substance use disorder) Borderline Personality Disorder – Unstable identify and personal relationships that are often love/hate (different to Bipolar Disorder that is mood based) Histrionic Personality Disorder – A pattern of attention seeking, their behaviour is superficial. Narcissistic Personality Disorder – Arrogant, other people exist only as witnesses to their greatness. (comorbidity with depression - other don’t see them as great like they thing they are) Borderline personality Disorder – continued : Aetiology of borderline personality disorder: The importance of genetics is unclear Psychosocial factors, e.g. childhood trauma, are strongly associated with borderline personality disorder Biological influences are also likely Treatment of borderline personality disorder: People with BPD often seek help Psychological intervention is recognised as the first-line treatment CBT, meditation, mindfulness Cluster C – Anxious and fearful traits: Avoidant Personality Disorder – fear of negative evaluation means they feel inferior and avoid contact. Dependant Personality Disorder – strong need to be taken care of and anxiety about being alone. Obsessive Compulsive Personality Disorder – rigid, moralistic and perfectionistic. Summary Weak 12 Tut notes - Abnormal Psychology test questions AN is more likely to develop in individuals who A – low self esteem According to cog theorists, the most important cog aspect of dysfunctional thinking in people with AN is Dysfunctional self-evaluation, with over emphasis on their shape and weight Cluster A personality disorder are defined in terms of A personality with odd or eccentric traits Cluster B personality is defined in terms of A personality with dynamic, acting out or flamboyant behaviours Cluster C A personality with anxious and fearful traits and behaviours Substance use disorder cluster in families because D - Genetic component, role modelling, individuals’ relatives’ relationships – genetic Which answer best describes factitious disorder C - an individual deliberately feigns illness for no obvious gain. According to the iatrogenic theory, dissociative identity disorder is the product of : D therapy of the popular media. – medications Which is not a paraphilia? E – homosexuality disorder Transvestic disorder Sexually aroused by cross dressing – need to be clinical stressing – diagnosed if they try to stop but they can’t and that if they do it all the time when they should not be Cognitive Behaviour therapy for sexual dysfunction focuses on Challenging unrealistic beliefs that may contribute to sexual problems Changing their cognitions CASE STUDY In exam we will have 20 case studies Module 9 – Additive Disorders Introduction Addictive disorders can cause significant distress and problems for our Society. Here we will look at diagnosis and treatment options. There is a great deal of positive news. Alcohol use has generally fallen in Australia over the last thirty years, although still too many people are negatively impacted by alcohol and treatment resources for those in need are sparse. I have included some long YouTube clips here that might be of interest if you have time. If you are short of time feel free to skip them. Mini lecture 9A – Substance use disorder Overview of mini lecture The diagnostic criteria of substance use disorders Co-morbity Treatment of substance use disorders Historic Portrayal of gin in history painting (alcohol addiction) Beer – was good and portrayed well but not Gin Society has often have an ambivalent relationship with alcohol substances Diagnosis – where we diagnose a substance use problem? To be diagnosed with a substance use disorder an individual must show at least 2 symptoms within a 12-month period which have resulted in clinically significant distress or impairment. These include the following: Larger amounts of the substance are consumed Unsuccessful attempts at reducing substance use A large amount of time is spent obtaining, using and recovering from the substance Strong desires or cravings to use the substance The individual fails to fulfil role because of substance use Continued use even though it causes interpersonal difficulties Interferes with social and occupational activities Occurs in situations that are hazardous (e.g., drunk driving) Continued use even though the person knows it is causing problems Tolerance is evident by either: A) a need for increased amounts of the substance to achieve same effect, or B) diminished effect for the same amount of substance Withdrawal is evident by either: A) a range of symptoms that emerge after cessation in use, or B) taking a substance in order to alleviate these symptoms Comorbidity Comorbidity of substance use disorders and other mental disorders is a major challenge of treatment In Australia approximately 35 per cent of those with a substance use disorder also have other mental disorders Those with a comorbid condition have worse outcomes on a range of measures Epidemiology Substance use disorders are associated with increased physical problems and heightened mortality Older people face risks: they are more susceptible to the effects of alcohol which can lead to increased mortality from falls, motor vehicle accidents and suicide Substance misuse extends beyond the individual. One 2010 study reports almost 75 per cent of Australian adults had been affected by the drinking of others The prevalence of harmful alcohol use among Indigenous Australians is estimated to be twice that of non-Indigenous Australians Biological Factors Adoption and twin studies suggest a strong genetic component in the development of substance use disorder The genetic basis of substance use disorder is thought to be non-specific Substances that can lead to dependence act on the brain’s reward system The major reward systems are the dopaminergic system and the endogenous opioid system The inhibition dysregulation theory argues that addictions are the result of a failure of an inhibitory system Psychological factors – Behavioural Factors Traditional behavior theories focus on learning and conditioning as the basis for acquiring substance use disorders Both classical conditioning and operant conditioning have been used to explain addictive behaviors Incentive-sensitization theory proposes that drugs of addiction change the areas of the brain responsible for the incentive to use the drugs Psychological factors – Cognitive Theories Outcome expectancy theory is a cognitive theory of addiction which states that an individual’s expectation of positive consequences from substance use increases propensity to use Relapse prevention theory is a cognitive-behavioral theory of substance use that argues individuals in high-risk situations will use substances if: They do not have appropriate coping strategies They have positive expectations relating to the effects of the substance They have a low degree of self-efficacy Single relapse full relapse = abstinence violation effect The TREATMENT of substance use disorder Set up goals—e.g., abstinence or controlled use Detoxification—as a useful first step Use of medications—but compliance may be an issue Motivational interviewing Brief interventions are generally considered to be most useful for those whose substance use is not yet severe Cognitive behavior training in a range of skills, including relapse prevention, has been associated with a good outcome There is some evidence for the utility of internet-based interventions Recovery models recognize that people start at different points, have different goals, and these goals may differ from family or society more broadly Mini lecture 9B – Gambling disorder Overview of Mini lecture Diagnosis gambling disorder Treatment Gambling Disorder Gambling Disorder: Historical Approaches Gaming and gambling have existed in almost every culture since antiquity Their social acceptability differs across cultures Gambling is an integral part of the Australian cultural ethos There are numerous anecdotal case histories of problem gambling Diagnosis DSM-5 gambling disorder is defined as persistent and recurrent problematic gambling behaviour leading to impairment and distress Criteria include a need to gamble with increasing amounts of money, repeated unsuccessful attempts to control gambling, preoccupation with gambling and irritability when trying to cut back on gambling The need to gamble with increasing amounts of money is akin to the tolerance criteria for substance use disorder The restlessness experienced when attempting to cut down gambling is like the withdrawal criteria for substance use disorder Gambling is conceptualized as an addiction on the basis that individuals repeatedly engage in a behavior to achieve a euphoric state Epidemiology of Gambling Disorder Approx. 5 per cent of adolescents meet the criteria for pathological gambling—2–5 times the rate for adults Adolescent and adult males gamble more frequently and intensely than adolescent and adult females The ratio of male to female problem gamblers seeking treatment is 3:2 Females are motivated by dealing with negative emotional states Males are motivated by winning, excitement and chasing losses 90 per cent of problem gamblers begin before 20 years The aetiology of Gambling Disorder Serotonin, dopamine and noradrenaline are implicated in inhibitory control, reward mechanisms and arousal in impulsive and addictive disorders Certain personality factors such as impulsivity are associated with problem gambling Both classical and operant conditioning are important in the aetiology and maintenance of problem gambling Cognitive models emphasis cognitive errors that are hypothesized to result in problem gambling Parental modelling and early negative childhood experiences can contribute to the development of problem gambling Cultural attitudes towards gambling and the availability of opportunities to gamble are influential Integrated pathways model Includes behaviorally conditioned, emotionally vulnerable, and biologically based problem gamblers The Treatment of Gambling Disorder Psychoanalytic and psychodynamic approaches Primal addiction Gamblers Anonymous Emphasis on shared common experiences Behavioural and cognitive interventions Gambling as a learned maladaptive behaviour Challenge dysfunctional beliefs that lead to the behaviour Pharmacological interventions SSRIs, opioid antagonists, mood stabilisers Public health model External societal determinants of gambling Consumer protection approach Tutorial Notes Addictive Disorders The Current (Draft) NHMRC Alcohol Use Guidelines A Personal AUDIT of Alcohol Use NEED TO GO OVER TUT NOTES + READINGS FOR 9,10,11 Module 10 – Somatic Symptoms and Dissociative Disorders Mini lecture 10A – Somatic Symptoms and Related Disorders Overview Somatic Symptom disorder Conversion disorder Illness anxiety disorder Factitious Disorder and Factitious disorder Imposed on Another There are many things we don’t know with physical and mental symptoms Somatic Symptom Disorder The experience of one or more debilitating somatic symptoms Symptoms are accompanied by abnormal thoughts, feelings and behaviours These abnormal reactions include disproportionate and persistent thoughts about the seriousness of symptoms; persistently high anxiety about one’s health or symptoms; and spending excessive time and energy over health concerns (e.g., excessive healthcare utilisation) There is a somatic symptom present but there is a huge amount on anxiety about that Conversion Disorder Disturbance in motor or sensory functioning Not consistent with any recognized medical condition Causes significant distress and/or impairment Epidemics of conversion disorder, ‘mass hysteria’, occur periodically One person becomes sick and the experience of symptoms, beliefs about the cause of symptoms, and anxiety about the symptoms generalizes to others Example , people thought they were exposed to chemical weapons, they weren’t , developed symptoms like they were Illness Anxiety Disorder Illness anxiety disorder: Preoccupation with having or getting a serious illness Somatic symptoms not prominent High levels of health anxiety and excessive health-related behaviours The individual may worry about a particular disease/illness, or a number of different types If a medical condition is present, the level of preoccupation is excessive The Treatment of Somatic Symptom and Related Disorders Cognitive Behavioural Model Factitious Disorder and Factitious Disorder Imposed on Another (Munchausen’s syndrome by proxy) Factitious disorder imposed on another (previously called Munchausen syndrome by proxy) is when someone falsely claims that another person has physical or psychological signs or symptoms of illness, or causes injury or disease in another person with the intention of deceiving others. Factitious disorder, imposed on the self: Fabrication of psychological or medical symptoms May involve induction of injury or disease in oneself or others and presenting of oneself or others as ill This behavior does not appear to have any obvious external reward Has been known as ‘Munchausen’s syndrome’ Factitious disorder, imposed on another: An individual induces illness in another Has been known as ‘Munchausen’s by proxy’ Makes someone else ill, or pretends someone else is ill Mini lecture 10B – Dissociative Disorders Overview Hypnosis and Dissociation Depersonalisation Disorder Derealisation Disorder Dissociative Amnesia Dissociative Identity Disorder Hypnosis Controversial When someone is under the control of someone else – dissociation contact with one’s unconscious Induction procedure – to imagine a situation, think of …. , to make them relaxed and less tense “The human plank“ “ human pain tolerance” – ice example – hypnosis better group at carrying out task compared to control group Dissociative Disorder DSM-5 dissociative disorders include: Depersonalisation/derealisation disorder Dissociative amnesia—may also occur with dissociative fugue Dissociative identity disorder. For all disorders the disturbance causes significant distress or impairment of functioning and is not better explained by another medical or mental disorder Depersonalization disorder involves a persistent feeling of being detached from one’s self Derealization disorder involves experiencing one’s surroundings as being unreal Dissociative amnesia involves loss of memory for significant personal information. May occur with a fugue state which involves travel away from home or work, with inability to recall the past DID Dissociative identity disorder (DID) involves the presence of two or more distinct identity or personality states that recurrently take control of the person’s behaviour. Individuals with DID also experience all other dissociative phenomena, plus posttraumatic stress symptoms and auditory hallucinations Iatrogenesis of Dissociative identity Disorder Iatrogenesis is the creation of an illness through the intervention of medical / health professionals Some suggest that DID is an iatrogenic illness Expectancies of therapists Expectancies of patients / clients Suggestibility of patient / clients Aetiology of Dissociative Disorder Most dissociative disorders are believed to be stress/trauma related Depersonalisation/derealisation disorder has been associated with childhood abuse Common precipitants are extreme stress, depression, anxiety and substance abuse Dissociative amnesia Biological explanations focus on the effects of stress on different brain systems Psychological explanations focus on motivations for forgetting Treatment of Dissociative Disorder Depersonalisation/derealisation disorder: Partial support for the use of medication and cognitive behaviour therapy Dissociative amnesia: Most cases spontaneously remit Dissociative Identity Disorder: Support for teaching coping skills, exposure-based techniques and integrating different identities Module 11 – Sexual Disorders Mini lecture 11A – Sexual Disorders in the DSM5 + Paraphilias Overview The different types of sexual dysfunction for males and females and the range of treatments for these disorders The diagnostic criteria for the paraphilic disorders outlined in the DSM-5 and describe current understandings regarding the aetiology and treatment of these disorders Sexual dysfunction Sexual dysfunction consists of a disturbance in one or more of the three stages of sexual functioning described by Kaplan (1979): desire, arousal and orgasm The DSM-5 includes four male and two female sexual dysfunctions and also includes genito-pelvic pain/penetration disorder for women Sexual Desire Disorder Sexual desire is the interest one has in engaging in sexual activity either alone or with a partner In the DSM-5 hypoactive sexual desire disorder is a dysfunction in which an individual’s desire for sex is severely diminished causing great distress Hypoactive sexual desire disorder is a classification for males, but is combined with sexual arousal disorder for females Prevalence increases with age 8 per cent of men and 55 per cent of women may experience desire problems Sexual Arousal Disorder For men the inability to attain or maintain an erection sufficient for intercourse: referred to as male erectile disorder Female sexual arousal disorder is experienced as difficulty in attaining or maintaining adequate lubrication until the completion of the sexual act As many as 50 per cent of men will experience erectile difficulties at some stage in their life There is a higher risk for men who smoke or who have a range of medical conditions A 2009 Australian study found that 52 per cent of women experienced arousal problems Orgasmic Disorders Men The DSM-5 identifies two types of orgasmic disorders in men: Delayed ejaculation Premature ejaculation A 2013 study found that delayed ejaculation was experienced by 4 per cent of a community sample of men, and premature ejaculation was experienced by 8 per cent of men Female Female orgasmic disorder is defined by the DSM-5 as a marked delay or absence of orgasm or reduced intensity of orgasmic sensations, accompanied by significant distress A 2009 Australian study reported prevalence to be 51 per cent Genito-pelvic pain/penetration disorder involves pain or discomfort during intercourse and affects up to 4 per cent of women The Aetiology of sexual Dysfunction Biological Factors Sexual dysfunction increases with age particularly for erectile and sexual desire problems Sexual dysfunction is associated with comorbid medical conditions Medications such as antidepressants have been implicated in sexual dysfunction Psychological and social factors: McCabe (1991) includes developmental, individual and relationship factors as contributing to the aetiology of sexual dysfunction The Treatment of Sexual Dysfunction Behaviour therapy uses a combination of techniques to alleviate sexual difficulties including: Education Communication skills training Sensate focus exercises Cognitive behaviour therapy challenges unrealistic beliefs contributing to sexual dysfunction Internet-based treatment approaches show promising results – seen with paedophilic desires Various medications are used for both men and women Many treatment programs for sexual dysfunction have lacked adequate research methodology, many have been too narrow in their approach, and many have not been tested empirically at all Paraphilic Disorder Paraphilic disorders are atypical sexual activities that involve one of the following: Non-human Non-consenting adult The suffering or humiliation of oneself or one’s partner Children A 2011 study found that 62.4 per cent of men reported sexual arousal to either a fantasy or experience of paraphilic situations—indicating that such experiences are common and not necessarily a disorder Paraphilia Vs Paraphilic Disorder Paraphilic Disorder “A paraphilic disorder is a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others. A paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not necessarily justify or require clinical intervention.” Paraphilic Disorders : Voyeuristic Disorder Exhibitionistic Disorder Frotteuristic Disorder Sexual Masochism Disorder Sexual Sadism Disorder Pedophilic Disorder Fetishistic Disorder Transvestic Disorder DEFINITIONS Voyeuristic Disorder: Voyeuristic disorder involves a pattern of sexual arousal primarily from observing others undressing or engaging in sexual activity without their consent or knowledge. Exhibitionistic Disorder: Exhibitionistic disorder is characterized by recurrent and intense sexual arousal achieved by exposing one's genitals to non-consenting individuals, typically in public settings. Frotteuristic Disorder: Frotteuristic disorder pertains to obtaining sexual gratification through non-consensual touching or rubbing one's genitals against a non-consenting person in crowded places. Sexual Masochism Disorder: Sexual masochism disorder involves experiencing sexual arousal or satisfaction from being humiliated, beaten, bound, or otherwise made to suffer physically or psychologically. Sexual Sadism Disorder: Sexual sadism disorder refers to deriving sexual pleasure from inflicting pain, humiliation, or suffering on others, often without their consent. Pedophilic Disorder: Pedophilic disorder is characterized by sexual attraction to prepubescent children and engaging in sexual behaviors with them. It's important to note that having a sexual attraction to children is not the same as acting on those attractions, and not all individuals with pedophilic disorder engage in abusive behavior. Fetishistic Disorder: Fetishistic disorder involves sexual arousal or gratification primarily through nonliving objects or specific body parts (e.g., shoes, feet, or undergarments) to the extent that it causes significant distress or impairment. Transvestic Disorder: Transvestic disorder, which is now considered a paraphilic disorder only if it causes significant distress or impairment, involves recurrent cross-dressing by heterosexual males for sexual arousal or satisfaction. General Diagnostic Criteria for Paraphilic Disorder Specific details of the paraphilic disorder The individual has acted on these sexual urges with a non-consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (This is very important) The individual experiencing the arousal and/or acting on the urges is at least 18 years of age. Key points The individual has acted on these sexual urges with a non-consenting person, the sexual urges or fantasies cause clinically significant distress or impairment The individual experiencing the arousal and/or acting on the urges is at least 18 years of age. Paedophilia Criterion A Paraphilic Disorders Criterion A Fetishism Controversy Some authors have argued that Fetishism should not be considered a clinical disorder Individual arousal in response to stimulus is a “private matter” As defined in DSM, Fetishism does not involve anyone other than the individual But If the condition causes clinically significant distress or impairment…? THINGS TO DO Go over tutorial notes Go over notes Print them out Monday do readings Quizlet Online Ai test maker using these notes