Paper2 mental health disorders. Dr.

Arun
21.6.21
Substance use continued
Family therapy for substance use disorders.
Two types of family therapy
Structural family therapy
And Functional family therapy

Strengthening the interpersonal relations. Cutting the unhealthy ties in the family .
Triangulation-mother and son turning against father. Unhealthy practice.
Only if these are also Solved, therapy can be effective.
Rehabilitation is important for substance use. Patients.
Rehabilitation and restructuring the relationship s.

Psycho sexual disorders

It can be because of many reasons, hormonal, blood circulation, injury to spine, psychological
factors.

Types of psycho sexual disorders

4 types
Sexual desire disorder
Sexual arousal disorder
Orgasmic disorders-
Sexual pain disorders.

All four categories are likely to seek counselling. Many family problems have their beginning in
sexual disorders.

Sexual desire disorders

Sexual desire is a basic instinct in all animals including man, basically for reproduction. Sex is a
procreational and recreational tool.
Sexual desire disorders are seen in both men and women.
Lack of sex hormones in the body is one reason.
Testosterone in men an d oestrogen in women. It may be less produced in the body from the
beginning.
It will have to be found using Physical examination as secondary sexual growth may be less.
Testing the hormonal levels and compensate.
It is purely medical not normally in the purview of the counsellor. But can identify and refer.
Due to accidents and injury. Trauma induced . Temporal lobe injured, spinal injury. Can lead to
this.
Again medical. Issue to be referred.
Common psychological factors- myths and beliefs about sex.
Mostly seen in females from conservative families.
• Sex is something that is terribly painful, it is only enjoyable for men, it may cause bleeding. At
a certain stage , these ideas lead to aversion to sex.
• History of traumatic sexual abuse in childhood, irrespective of gender. It has hurt them terribly
both physically and mentally .
• Depression can be an important factor that can cause this disorder.
Till a stage they were normal and then. Suddenly , they go uninterested.
• Anxiety also can lead to such a disorder.

Treatment modalities at a later stage.

Sexual arousal disorders. - they want to have sex but they are not aroused. there are signs
of arousal. In a man erection. In the women, wet in the clitoris, nipples get erect . These are
biological signs. They are interested in having sex but the arousal is not there.
Commonly in men .
Erectile dysfunction is the most common disorder.
• A condition in which the erection is not sufficient enough in time and strength to facilitate a
successful penetration.
There are different reasons.
• Vascular reasons- defect in blood flow. Lack of blood flow to the penis leading to erectile
dysfunction .
• Diabetes is one of the most common disease that leads to lack of blood flow. The small
blood vessels get affected first. Peripheral neuropathy, then erectile dysfunction, heart attack,
stroke, order of dysfunction because of blood flow lack.
If a diabetic patient gets erectile dysfunction they are likely to be patients of heart attack.
Erectile dysfunction is important as it may be an important sign for heart attack or stroke in
future,
If treated at the right time by controlling diabetes, can avoid all this.
Similarly smoking also can lead to blocking in blood vessels.
Nicotine gets deposited.

• Hormonal factors.
Lack of testosterone

• Injury to the spinal cord, can be caused falling down, may be from a tree, riding a bike over
rough road,
L5s1 area being affected can lead to erectile dysfunction.
• Psychological reasons also can be there.
If psychological reasons, suddenly the dysfunction happens.
Others., the dysfunction is normally slow.
Psychological reasons are all same as that in lack of Sexual desire disorder.
Misconceptions, anxiety,
In India now we are half westernised and involve in dating and involve in sexual life much before
marriage.
In the new normal after the pandemic the teenagers are more likely to be more experimental
in sexual activity. It may include same sex as well. They have been using a lot of cyber dating
apps and series and movies showing these kind of activities which seem to be of appeal to the
adolescent ages. It is likely that it will become common here too.

There are Stereo types in male sexuality. And sometimes they go to commercial sex workers. It
is under pressure situations, and because of the not comfortable state of mind and time factor,
it is possible to have erectile dysfunction.
they may have anxieties around it and may lead to psychological erectile dysfunction.
Both medical and psychological treatments are available.

• Orgasmic disorders

Orgasam is a heightened pleasure. Following a. Sexual act

Most commonly in men. Premature ejaculation is the most common disorder. A condition in
which ejaculation. Occurs within one minute of an erection occurs.
There are other ejaculation issues.
Delayed ejaculation, may be even hours.
Retrograde ejaculation .
The most common one is premature ejaculation.
There are treatments for these. Many are not comfortable speaking about these issues. All
these are mostly Psychological.
Retrograde ejaculation is mostly Medical and can be treated by a urologist. Others need to be
corrected by psychological treatment.

Sexual pain disorders.

Pain during intercourse and unable to complete.

Non organic vaginismus is a Common issue. Sudden onset of spasm of vaginal muscles
preventing sexual intercourse and associated pain in lower abdomen. This may be because of
psychological issues. Myths and misconceptions, exposure to visual media with violent and
dangerous sexual images. Easily accessible and creates strong impressions.
Dayspelunia is medical issue. pain due to infection, vaginal
Pain during sexual intercourse, as a result of infection or injury of the female reproductive
system.

How to approach the issue of psycho sexual disorders?

Give the problem as much importance as any other difficulty or disorder.
May be the client has a sexual life that is weird, but we must never be judgemental. We must be
receptive to whatever it is they are saying.
When we speak about it . Give simple explanations. This is a natural problem, there is no need for
any guilt or anything like that. No moral judgement or preconceived notions should interfere in
the treatment.

Medical treatment using medicines as they are all related to the neurotransmitters.
Schizophrenia -negative symptoms- lack of enjoyment. What is normally enjoyable becomes not
enjoyable. Can be treated by medicines.
Psychological treatment- sex therapy-
Sex therapy is to relieve a person from such disorders.

Masters and Johnson is the pioneers in this field. Vatsyan’s kamasutra is used as a reference
text.
Human sensibilities are most used. Sexology uses Kamasutra as reference
William Masters and Virginia Johnson introduced Dual sex therapy. Therapy to be given to a
couple who intent to have sex. Dimensions of sexuality has changed over the years.
In dual sex therapy both sex therapists and clients must be there.

Sensate focused technique.

This is a technique that can be used for all kinds of sexual disorders. Instead of giving much
importance to the act of intercourse , give importance to the experience of having Sex including
touches.
Steps- could be a question for exam.

• Non genital touch-touching areas other than genitals, taking turns, ten minutes and reverse.
After that. No touching genitals or breasts.
Texture awareness, when the pressure changes the touch changes and feed back to be
given.erogenous zones are there in the body, earlobe, neck, circum areoles region, big toes,
inside of the thighs are all areas that may have pleasurable. Feed back must be given which area
and what pressure .

• Touching including genitals and breasts.

No going into full sexual intercourse .

• Adding a lubricant- any lubricant. To be used,

• Mutual touch.

• Sexual intercourse.
Genital areas to be aroused by touch. Female on top , first and to be comfortable before going
to male on top position.

Treatment for premature ejaculation

• Start and stop technique.-the partner arouses the penis for erection and stops before
ejaculation on a signal from the man. Repeats four times before actual ejaculation.
• Squeeze technique.-give slight pressure and. Stop the ejaculation
Both are effective treatment for premature ejaculation

Vaginismus- Kegel’s exercises. Get the muscles of the vagina to tighten . sudden contraction of
the vaginal muscles followed by slow relaxation. Ten times every hour.
Dialatisation
Dilators used to dialate and relaxation
In many divorce cases start from vaginismus. And without being treated leads to more issues.

Homosexuality is a normal and not illegal. Must be empathetic towards sexual minorities.
Any activity. Involving two consenting adults within the privacy of their space /rooms is moral. Is
a definition by WHO
Rate of growth and development etc has to be assessed.