Goldstein Psychopathology - Chapters 10-14

What is important to consider in defining "normal" vs. "abnormal" sexual behavior?

Normative(i.e. common, average) facts and statistics; cultural considerations; gender differences in sexual behavior and attitudes

True or False: More women report ever masturbating than men.

False! 72% of men report ever masturbating, whilst 42% of women do

What are some reasons for the discrepancy in statistics for male and female masturbation?

Male masturbation may be easier, physical gratification more emphasized for men

What are sexual self-schemas?

Beliefs about one's own sexuality

True or False: Women are more likely to value experience of passionate and romantic feelings.

True!

True or False: About half of women hold embarrassed, conservative, or self-conscious views towards sex

False--a minority of women feel this way

Men have fewer negative core beliefs about sex. What are they more likely to emphasize?

Dominance and aggression

What is involved in sexual dysfunctions?

Desire, arousal, orgasm, or pain

How long must sexual dysfunction symptoms be present for in order to make a diagnosis?

6+ months

In order to be considered a disorder, what must sexual dysfunction symptoms lead to?

Impairment or distress

In unsure cases of sexual dysfunction (e.g. caused by a medication), under what rationale should you diagnose?

Diagnoses are not always black and white--remember the benefits of a diagnosis(healthcare, comfort of the individual, etc.). Just because something may be a side effect of medication or otherwise typically disqualifies an individual for a diagnosis, if it is still causing clinically significant distress and whatnot then the benefits of a diagnosis would mean one may still be necessary

What phase does the human sexual response cycle usually start with?

The desire phase

Human Sexual Response Cycle: What is the desire phase?

Sexual urges occur in response to sexual cues

Human Sexual Response Cycle: What is the arousal stage?

A subjective sense of sexual pleasure and physiological signs of sexual arousal

What are the physiological signs of sexual arousal in males?

Penile tumescence(increased flow of blood into the penis)

What are the physiological signs of sexual arousal in females?

Vasocongestion(blood pools in the pelvic area) leading to vaginal lubrication, breast tumescence(erect nipples)

Human Sexual Response Cycle: What is the plateau phase?

Brief period occurs before orgasm

Human Sexual Response Cycle: What is the orgasm phase in males?

Feelings of the inevitability of ejaculation, followed by ejaculation

Human Sexual Response Cycle: What is the orgasm phase in females?

Contractions of the walls of the lower third of the vagina

Human Sexual Response Cycle: What is the resolution phase?

Decrease in arousal occurs after orgasm(particularly in men)

What is the difference between lifelong and acquired sexual dysfunctions?

When the disturbance began!

Lifelong: Been present since individual became sexually active

Acquired: Began after a period of relatively normal sexual function

What is the difference between generalized and situational sexual dysfunctions?

The types of stimulation they are/aren't limited to

Generalized: Not limited to certain types of stimulation, situations, or partners

Situational: Only occurs with certain types of stimulation, situations, or partners

Sexual dysfunctions can be classified by whether they are caused by psychological factors alone or psychological factors combined with medical conditions. Why isn't there classification of causation by medical conditions alone?

Because then it wouldn't be a sexual dysfunction disorder--it'd be an entirely different diagnosis! (i.e. the medical condition in question)

**IMPORTANT: it is important to consider that comorbodities are always a possibility! Someone with depression and sexual dysfunction because of it isn't just experiencing depression symptoms, it could absolutely be a sexual dysfunction disorder comorbidity as a result of the depression

What treatment is usually administered for sexual dysfunction disorders?

It depends on the specific type of dysfunction, but foundations of CBT are typically used first. Psychoeducation may also be used

What is the best practice for sexual function/gender identity disorders?

ACT(Acceptance and Commitment Therapy)

What diagnosis accounts for about half of all patients at sexuality clinics?

Specific sexual dysfunction disorders

What is male hypoactive sexual desire disorder?

Little or no interest in any type of sexual activity, including masturbation and fantasies

What is female sexual interest/arousal disorder?

Reduced sexual interest, reduced sexual activity, fewer sexual thoughts, reduced arousal to sexual cues, reduced pleasure or sensations during almost all sexual encounters

There are diagnoses for hyPOsexual function. Why not for hyPERsexual function?

Hypersexual behavior is usually a symptom of a bigger challenge like mania or a mood disorder

What is the most common sexual problem for which men seek treatment?

Erectile disorder

What is erectile disorder?

Difficulty achieving or maintaining an erection despite (usually) intact sexual desire

True or False: Prevalence of erectile disorder increases with age.

True

What is the most prevalent sexual dysfunction in adult males?

Premature ejaculation (affects 21% of all adult males)

What is premature ejaculation?

Ejaculation occurring within ~1 minute of penetration and before it is desired

What population of males is premature ejaculation most common in?

Younger, inexperienced males

**Goldstein thinks the use of the word "inexperienced" here is funny

True or False: Treatment is highly sought out for delayed ejaculation.

False--it is rarely sought

What is female orgasmic disorder?

Marked delay, absence, or decreased intensity of orgasm in almost all sexual encounters

What causes must be ruled out in order for a diagnosis of female orgasmic disorder?

Relationship distress or other significant stressors

**ex. if you don't like your partner, of course you probably won't enjoy sex with them

What is genito-pelvic pain/penetration disorder?

In females, difficulty with vaginal penetration during intercourse, associated with one or more criteria

What are the criteria associated with penetration difficulty for genito-pelvic pain/penetration disorder?

Pain during intercourse or penetration attempts, fear/anxiety about pain during sexual activity, tensing of pelvic floor muscles in anticipation of sexual activity

What processes are involved in assessing sexual behavior?

Detailed interviews, medical evaluation, and psychophysiological assessment

What may be assessed in a medical evaluation for sexual behavior?

Medication side effects and physical conditions

Psychophysiological Assessment of Sexual Behavior: What is being measured?

Sexual arousal in response to erotic material

Psychophysiological Assessment of Sexual Behavior: What is used to take measurements of arousal in males? What does it measure?

Penile strain gauge; measures erection

Psychophysiological Assessment of Sexual Behavior: What is used to take measurements of arousal in females? What does it measure?

Vaginal photoplethysmograph; measures blood flow to vagina

(NOT A CARD) feel free to check out lecture #12 slide 15, it has some possible questions that may be asked in a sexual interview! Note that Goldstein in particular said he copy and pasted from the textbook and would never personally use the word "rape," as it is triggering for the victim and may limit the effectiveness of the interview

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What are biological causes of sexual dysfunctions?

Physical disease, chronic illness, prescription medications(e.g. antihypertensive medication), alcohol and drugs

True or False: People with sexual dysfunction are less likely to experience anxiety and negative thoughts about sexual encounters, as their sexual desire is usually intact despite the dysfunction.

False--people with sexual dysfunction are more likely to experience anxiety and negative thoughts about sexual encounters

What are some psychological causes of sexual dysfunctions?

Anxiety and negative thoughts about sexual encounters, active avoidance of awareness of sexual cues, traumatic experiences

What are some social and cultural combinations of sexual dysfunctions?

Erotophobia, unpleasant or traumatic sexual experiences, poor interpersonal relationships, lack fo communication

What is erotophobia?

Association of sexuality with negative feelings, anxiety, or threat

(NOT A CARD)feel free to check out slide 18 of lecture #12! Includes a model of functional and dysfunctional sexual arousal that further explains the positive and negative feedback loops involved

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What is Masters and Johnson's psychosocial intervention?

Education about sexual response, foreplay, etc. with sensate focus and nondemand pleasuring

What is sensate focus and nondemand pleasuring in psychoeducation for sexual dysfunction?

Sexual activity with the goal of focusing on sensations without trying to achieve orgasm in order to ultimately decrease performance anxiety

What medical treatment may be administered for erectile dysfunction?

Viagra/similar medications, injection of vasodilating drugs into the penis, testosterone, penile prosthesis or implants, vascular surgery, vacuum device therapy

**you probably don't have to know all of these lol

True or False: Few medical procedures exist for female sexual dysfunction.

True

What are paraphilic disorders?

Misplaced sexual attraction and arousal focused on inappropriate people or objects

What do paraphilic disorders have a high comodbidity with?

Anxiety, mood, and substance use disorders

A paraphilia is not a disorder unless...

...it is associated with distress and impairment or harm or the threat of harm to others

What is frotteuristic disorder?

Persistent pattern of seeking sexual gratification by causing friction against unwilling others

**seen more in eastern cultures

What is fetishistic disorder?

Sexual attraction to nonhuman objects

What is voyeuristic disorder?

Observing an unsuspecting individual undressing, naked or engaged in sexual activity for sexual gratification

What is exhibitionistic disorder?

Exposure of genitals to unsuspecting strangers for sexual gratification

What is sexual sadism disorder?

Inflicting pain or humiliation to attain sexual gratification

What is sexual masochism disorder?

Suffering pain or humiliation to attain sexual gratification

What is transvestic disorder?

Sexual arousal associated with the act of wearing clothing of the opposite sex

**from goldstein: this obviously has nothing to do with drag queens or ur average cross dresser and instead is generally associated with closeted old men who don't understand (or want to admit to) their feelings

What is pedophilia?

Sexual attraction to prepubescent children

What gender are the vast majority of pedophiles?

Males

True or False: Incestuous males may be aroused by adult women.

True (why is this in the pedophilia slide under associated features? ASK GOLDSTEIN)

True or False: Male pedophiles are usually also aroused by adult women.

False--they are usually not aroused by adult women

True or False: Some pedophiles rationalize the behavior.

True--pedophilia is above all else a mental disorder and rationalizing the behavior to comfort oneself if the thoughts are distressing and/or known to be wrong is something people may do to cope or get out of punishment(as there are a lot of negative outcomes)

What does treatment for paraphilic disorders target?

Problematic sexual associations

Paraphilic Disorder Treatment: What is covert sensitization?

Imagining averse consequences to form negative associations with the unacceptable behavior

Paraphilic Disorder Treatment: What is orgasmic reconditioning?

Masturbation to appropriate stimuli

Paraphilic Disorder Treatment: Which populations may be prescribed medications that reduce testosterone?

Convicted sex offenders, among others

**generally just criminals but not best practice anymore--not test important

What is gender identity?

Essence of feelings toward being a man, a woman, genderfluid, or nonbinary or toward having other experiences

When is gender identity usually formed?

Between 18-36 months of age

True or False: Gender identity is related to transvestic disorder and same sex attraction.

False

When is gender dysphoria diagnosed?

When there is a marked incongruence between one's experienced/expressed gender and assigned gender and there is clinically significant distress or impairment as a result

How common is gender dysphoria?

Relatively rare

Which gender is gender dysphoria more common in?

Males

**b/t 5-14 per thousand vs. 2-3 per thousand in females

True or False: Gender dysphoria rates are different across cultures, as some revere individuals with nontraditional gender experience

False--whilst some cultures do revere individuals with nontraditional gender experience, rates are still similar across cultures

Is there a biological cause for gender dysphoria? What about a genetic one?

No clear biological causes identified, but there is a likely genetic component

**60-70% of variance in gender expression is explained by genetics according to studies! Exposure to hormones in utero may play a role

What are ways to support transgender individuals?

Hormonal therapy, gender affirming surgery, treatment of gender nonconformity in children

Supporting Transgender Individuals: What is hormonal therapy?

Administration of hormones to bring about secondary sex characteristics consistent with identity

Supporting Transgender Individuals: What is required for gender affirming surgery to be an option?

Must be psychologically/socially stable and live as desired gender first

True or False: Most transgender individuals report satisfaction with surgical results.

True--an overwhelming majority!

True or False: Treatment of gender nonconformity in children is very controversial.

True

Supporting Transgender Individuals: What options are available for treating gender nonconformity in children?

Actively discouraging it, watchful waiting, supporting the transgender identity, hormone(puberty) blockers

(This is just the range of treatments! Treatment is very controversial, hence why discouraging it is listed--though not encouraged! It's like naming treatments for children questioning their sexuality and listing conversion therapy)

What is substance use?

Taking moderate amounts of a substance in a way that doesn't interfere with functioning

What is substance intoxication?

Physical reaction to a substance

What two things are substance dependence defined by?

Tolerance and withdrawal

What is tolerance?

Needing more of a substance to get the same effect or a reduced effects from the same amount

What is withdrawal?

Physical response when substance is discontinued after regular use

Generally, what is a substance-use disorder?

A pattern of substance use leading to significant impairment and distress

**it's a long list so I won't include it in the quizlet but L13 slide 9 has a list of symptoms :)

How many symptoms must be experienced within what time period to qualify for a substance-use disorder?

Two or more within a year

Categories of Substances: What do depressants result in?

Behavioral sedation

Categories of Substances: What do stimulants do?

Increase alertness and elevate mood

Categories of Substances: What do opiates do?

Produce analgesia(no pain) and euphoria

Categories of Substances: What do hallucinogens do?

Alter sensory perception