Download Rieger Chapter Summaries PowerPoint 08

CHAPTER 8
SEXUAL AND RELATIONSHIP
PROBLEMS
8-1
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Aims and Objectives

Provide a description of the main relationship and sexual
problems

Review information regarding the aetiology and treatment
approaches to these problems

Discuss current challenges in each of these areas
8-2
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Sexual and relationship problems

Sexual problems: sexual dysfunction

The definition of sexual dysfunction

Impairment or disturbance in 1 or more of the 3 stages of sexual
functioning described by Kaplan (1979): desire, arousal and
orgasm
8-3
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Sexual and relationship problems

Sexual problems: sexual dysfunction

DSM-IV-TR uses 3 dimensions to specify subtypes:




Onset: lifelong or acquired
Context: generalised or situational
Aetiology: psychological factors or combined psychological and
physiological factors
Sexual desire disorders

Sexual desire - interest one has in engaging in sexual activity alone or
with a partner

Two types of low sexual desire disorders in DSM-IV-TR
 Hypoactive sexual desire disorder – deficient or absent interest in sex

Sexual aversion disorder – extreme aversion to or avoidance of sexual activity

Estimated one-year prevalence of hypoactive sexual desire is up to 7%

Prevalence increases with age

Most common sexual dysfunction for women, with 33% experiencing this
dysfunction
8-4
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Sexual and relationship problems

Sexual problems: sexual dysfunction

Sexual arousal disorders

Sexual arousal refers to the physiological, cognitive, and emotional
changes that prepare men and women for sexual activity

Inadequate sexual arousal for men is labelled male erectile disorder


The prevalence of erectile disorder is higher among men who smoke and who
have medical conditions such as heart disease, diabetes, and hypertension

Up to 50% of males will have erectile difficulties at some stage
Female sexual disorder is difficulty attaining or maintaining adequate
lubrication until the completion of the sexual act

Less is known about prevalence of female sexual arousal disorder, however it
has been estimated that 30-50% of women experience dysfunction in the
desire, arousal, or orgasm phase of the sexual response cycle
8-5
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Sexual and relationship problems

Sexual problems: sexual dysfunction


Orgasmic disorders

Male orgasmic disorder is diagnosed when the individual experiences
a persistent difficulty to achieve orgasm, despite the apparent
presence of adequate desire, arousal, and stimulation (prevalence
between 0-3%)

Premature ejaculation is ejaculation with minimal stimulation or before
the man wishes it (prevalence about 5%)

Female orgasmic disorder is defined as a delay or absence of orgasm
following a normal sexual excitement period that causes the woman
distress (prevalence is 24%)
Sexual pain disorders

Dyspareunia is a condition entailing pain or discomfort during
intercourse that usually results in the avoidance of sexual activity

For men prevalence estimates range from 0.2% - 8% (there were no
available estimates for women)
8-6
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Sexual and relationship problems

Sexual problems: sexual dysfunction

The conceptualisation of sexual dysfunction

Linear model assumes individuals progress through a sequence of
stages from desire to arousal to orgasm.


Dysfunctions of hypoactive sexual desire, sexual arousal and orgasmic
disorder are based on these 3 stages
Circular model (Basson, 2000) of arousal and desire is a more
accurate description of sexual dysfunction in women. Desire may not
be the first phase in the sequence.

This model also emphasises the critical influence of contextual factors, not
just sexual stimulation, on a women’s sexual arousal

A final difference between the linear and circular models is that the
occurrence of orgasm is not essential

An equivalent model has not been developed for men

Recent studies support circular notion of women’s sexual problems
8-7
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Sexual and relationship problems

Sexual problems: sexual dysfunction

The aetiology of sexual dysfunction

Biological factors


Aging process – sexual dysfunction increases with age, although large
individual differences
Medical conditions



In men, sexual dysfunction can arise from conditions that cause decreased
penile blood pressure
Drugs have been implicated, such as antidepressant medications
Psychological and social factors

Developmental experiences, e.g., history of sexual abuse

Current aspects of individual’s functioning



Anxiety, e.g. performance anxiety, fear of success, fear of pleasure, and fear of
injury

Stress, e.g. financial difficulties, work stress, or stress that arises from illness
Relationship factors, e.g., partner conflict, communication problems, lack of
intimacy
Cognitions – the meaning individuals give to sexual events
8-8
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Sexual and relationship problems

Sexual problems: sexual dysfunction

The treatment of sexual dysfunction


Behaviour therapy

Education, communication skills training

Sensate focus exercises - focusing on pleasurable sensations in the
absence of performance demand
Cognitive behaviour therapy



Challenge unrealistic beliefs contributing to sexual problems
Medical treatments

For males: Vacuum devices, penile injections or implants, oral medications

For females: Hormonal (androgen and oestrogen) therapy and
pharmacological treatments - largely unsuccessful
Limitations of treatment research

Treatment programs lack adequate research methodology

Treatments are limited in their focus

Few published treatment studies since the 1980s
8-9
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Sexual and relationship problems

Sexual problems: the paraphilias

The diagnosis of paraphilias

The object that causes sexual excitement has a negative effect on
others

Causes distress or interferes with daily functioning

The sexual behaviour is the person’s preferred or exclusive form of
sexual gratification







Exhibitionism – sexual gratification from exposing genitals to an involuntary
observer
Fetishism – use of non-living objects to obtain sexual gratification
Frotteurism – sexual gratification from touching or rubbing against a nonconsenting person
Paedophilia – sexual activity with children of either sex
Sexual masochism and sexual sadism – the experience of sexual stimulation
through the infliction of pain or psychological degradation and humiliation on
another person
Transvestic fetishism – cross-dressing by a man into a woman’s clothing
Voyeurism – looking at unsuspecting individuals as they are undressing, are
in the act of sexual activity, or when they are naked
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
8-10
Sexual and relationship problems

Sexual problems: the paraphilias


The aetiology of paraphilias

Little data on the origins of paraphilias

Generally believed that the causes originate in childhood or adolescence

Psychoanalytic and learning explanations have been developed
The treatment of paraphilias

Biological treatments


Chemical or surgical castration – effectiveness has been questioned recently
Behaviour therapy



Aversion therapy – unpleasant or painful stimulus is paired with inappropriate
behaviour
Exposure therapy – reduce anxiety associated with non-paraphilic situations
Social skills training – teach people to interact with others in a comfortable
way
8-11
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Sexual and relationship problems

Relationship problems

Historic and current approaches to relationship problems

Early research in the 1940s focused on spouse personality
characteristics

In the 1950s, focus changed from individual factors to the interactional
style

In 1960s and 1970s, increased focus from behavioural observations to
internal states, as well as on how power and power imbalances
impacted on family dynamics

In the 1980s and 1990s, research focused on interaction patterns and
predictors of divorce

More recent research has focused on complex processes

E.g., depression may lead to greater negativity, which may in turn lead to
relationship problems
8-12
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Sexual and relationship problems

Relationship problems

The aetiology of relationship problems

Individual factors




Biological factors – possible association between relationship problems and
hormonal disturbances
Personality – low levels of neuroticism and high levels of agreeableness,
conscientiousness, and positive forms of expression related to partner
satisfaction
Cognitive factors - accuracy of individual’s perceptions of his/her partner’s
qualities, attributions individual makes to explain the causes of his/her
partner’s behaviour (e.g., internal or external, stable or unstable, global or
specific)
Relationship dynamics



Communication – low levels of self-disclosure predict relationship problems
Conflict – high levels of conflict lead to negative perceptions of the
relationship
Sexual functioning - association between sexual and relationship functioning
8-13
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Sexual and relationship problems

Relationship problems

The aetiology of relationship problems


Contextual factors

Becoming a parent is associated with high levels of relationship problems

Negative social attitudes can place homosexual couples at risk for relationship
problems
Integrative models
8-14
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Sexual and relationship problems

Relationship problems

The treatment of relationship problems

Behavioural and cognitive-behavioural couple therapy




Behaviour exchange seeks to engage both partners in activities designed to
enhance each other’s relationship satisfaction
Communication training – each partner is taught skills to improve their roles as
both the speaker (expressive skills) and the listener (receptive skills)

Problem solving –set of skill to resolve areas of conflict within the relationship

Challenging dysfunctional cognitions
Limitations of current couple therapies

Substantial proportion of individuals do not benefit

Innovative approaches need to be developed, e.g., Integrative Behavioural
Couple Therapy
Expanding the focus of couple therapy - couple therapy can also help
individuals experiencing psychological difficulties and medical problems
8-15
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Summary

Sexual Problems



Sexual Dysfunction

Definition

Conceptualisation

Aetiology

Treatment
The Paraphilias

Historical and Current Approaches

Diagnosis

Aetiology

Treatment
Relationship Problems



Historical and Current Approaches
Aetiology
Treatment
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
8-16