Abnormal Psychology: Sexual and Relationship Problems

Sexual Dysfunction

  • Sexual dysfunction involves a disturbance in desire, arousal, or orgasm (Kaplan, 1979).
  • DSM-5 includes diagnoses for both males and females, as well as genito-pelvic pain/penetration disorder for women.

DSM-5 Classification of Sexual Dysfunction

The DSM-5 classification of sexual dysfunctions includes:

  • Males
    • Desire: Male hypoactive sexual desire disorder
    • Arousal: Erectile disorder
    • Orgasm: Delayed ejaculation, Premature ejaculation
  • Females
    • Desire/Arousal: Female sexual interest/arousal disorder
    • Orgasm: Female orgasmic disorder
    • Pain: Genito-pelvic pain/penetration disorder

Sexual Desire Disorder

  • Involves diminished interest in sexual activity.
  • Hypoactive sexual desire disorder (males). Female sexual interest/arousal disorder (females).
  • Prevalence increases with age.
  • Statistics:
    • 8% of men
    • 55% of women may experience desire problems.

Sexual Arousal Disorder

  • Males: Erectile disorder is the inability to attain or maintain an erection.
  • Females: Difficulty in attaining or maintaining adequate lubrication.
  • Statistics:
    • 50% of men may experience erectile difficulties.
    • Risk factors: smoking, medical conditions.
    • Australian study (2009): 52% of women experienced arousal problems.

Orgasmic Disorders

  • Males:
    • Delayed ejaculation
    • Premature ejaculation
    • Statistics (2013 study):
      • Delayed ejaculation: 4% of men
      • Premature ejaculation: 8% of men
  • Females:
    • Female orgasmic disorder: marked delay or absence of orgasm, or reduced intensity.
    • Statistics (2009 Australian study): 51% prevalence.
  • Genito-pelvic pain/penetration disorder:
    • Pain or discomfort during intercourse.
    • Affects up to 4% of women.

Aetiology of Sexual Dysfunction

Biological Factors
  • Increases with age (erectile and sexual desire problems).
  • Associated with comorbid medical conditions.
  • Medications (e.g., antidepressants).
Psychological and Social Factors
  • Developmental, individual, and relationship factors (McCabe, 1991).

Treatment of Sexual Dysfunction

Behaviour Therapy
  • Education
  • Communication skills training
  • Sensate focus exercises
  • Cognitive behaviour therapy: challenges unrealistic beliefs.
  • Internet-based treatment approaches.
Medications
  • Various medications for men and women.
  • Limitations of treatment programs: inadequate research, narrow approach, lack of empirical testing.

Paraphilic Disorders

  • Atypical sexual activities involving:
    • Non-human objects
    • Non-consenting adults
    • Suffering or humiliation
    • Children
  • A 2011 study found that 62.4% of men reported sexual arousal to either a fantasy or experience of paraphilic situations.

Paraphilia vs. Paraphilic Disorder

  • Paraphilia is a necessary but not sufficient condition for having a paraphilic disorder.
  • Paraphilic Disorder: causes distress or impairment to the individual, or satisfaction has entailed personal harm, or risk of harm, to others (APA, 2013).
  • A paraphilia by itself does not necessarily justify or require clinical intervention.

Types of Paraphilic Disorders

  • Voyeuristic Disorder
  • Exhibitionistic Disorder
  • Frotteuristic Disorder
  • Sexual Masochism Disorder
  • Sexual Sadism Disorder
  • Pedophilic Disorder
  • Fetishistic Disorder
  • Transvestic Disorder

General Diagnostic Criteria

  • Specific details of the paraphilic disorder.
  • 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.

Criterion A of Pedophilic Disorder

  • Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviours involving sexual activity with a prepubescent child or children (generally age 13 years or younger).

Criterion A of Other Paraphilic Disorders

  • Voyeuristic Disorder: Recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors (over at least 6 months).
  • Exhibitionistic Disorder: Recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors (over at least 6 months).
  • Frotteuristic Disorder: Recurrent and intense sexual arousal from touching or rubbing against a non-consenting person, as manifested by fantasies, urges, or behaviors (over at least 6 months).
  • Sexual Masochism Disorder: Recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviors (over at least 6 months).
  • Sexual Sadism Disorder: Recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors (over at least 6 months).
  • Fetishistic Disorder: Recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s), as manifested by fantasies, urges, or behaviors (over at least 6 months). Must cause distress to self or others.
  • Transvestic Disorder: Recurrent and intense sexual arousal from crossdressing, as manifested by fantasies, urges, or behaviors (over at least 6 months). Must cause distress to self or others.

Fetishism Controversy

  • Some argue 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.
  • Question: If the condition causes clinically significant distress or impairment…?