MIDTERM: PSM107 - Increased anxiety

Chapter 5: Somatic Symptom Related Disorders and - Faulty interpretation of physical sensations
Dissociative Disorders - Intensified focus on sensations
Characteristics
Soma - means body - Severe anxiety over physical problems that are
Somatic symptom disorder (Briquet’s Syndrome) medically undetectable
Characteristics - Affects women and men equally
- reports of multiple physical symptoms without - May emerge at any age.
medical basis - Evident in diverse cultures
- Runs in family; probably heritable basis Treatment
- Rare—most prevalent among unmarried women in - Psychotherapy to challenge illness perceptions
low socioeconomic groups - Counseling and/or support groups to provide
- Onset usually in adolescence; often persists on old age reassurance
Causes DSM 5 Criteria:
- Eventual social isolation
- Continual development of new symptoms
- Immediate sympathy and attention
Treatment
- Cognitive-behavioral therapy (CBT) to provide
reassurance, reduce stress, and minimize help-seeking
behaviors
DSM 5 CRITERIA:

B. Conversion Disorder
Characteristics
- Severe physical dysfunctioning (e.g., paralysis and
blindness) without corresponding physical pathology -
Affected people are genuinely unaware that they can
function normally
- May coincide with other problems, especially somatic
symptom disorder
- Most prevalent in low socioeconomic groups, women,
and men under extreme stress (e.g., soldiers)
II. Disorders related to Somatic Symptoms Disorders Causes
A. Illness Anxiety Disorder - Social influences (symptoms learned from observing
Causes real illness or injury)
- life stresses or psychological conflict
- reduced by incapacitating symptoms
Treatment
- Same as for somatic symptom disorder, with emphasis
on resolving life stress or conflict and reducing help-
seeking behaviors
DSM 5 CRITERIA:
C. Factitious Disorder (Munchausen’s)
- Intentionally produced symptoms/faking illness
Munchausen syndrome by proxy - 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
disorder imposed on another.
Anna O – experienced some form of Conversion
disorder and factitious disorder
Symptoms:
- fabricated or exaggerated physical symptoms
- self-inflicted wounds or illnesses
- poorly explained symptoms that do not fit a specific
medical diagnosis
Causes:
- psychological factors, such as a desire for attention or
sympathy
- history of childhood abuse or neglect, medical
profession exposure
Treatment options:
- Psychotherapy, particularly cognitive-behavioral
therapy
- Addressing underlying psychological issues,
Hospitalization in severe cases
DSM 5 CRITERIA:
D. Dissociative disorders
- Characterized by detachment from the self
(depersonalization) and objective reality (derealization)
Causes
- Similar etiology to posttraumatic stress disorder
- Severe abuse during childhood
> Fantasy life is the only “escape”
> Process becomes automatic and then involuntary
- High suggestibility a possible trait
- Interacts with biological vulnerability
1. Dissociative Identity Disorder (DID)
Characteristics
- Affected person adopts new identities, or alters, that
coexist simultaneously; the alters may be complete
and distinct personalities or only partly independent
- Average number of alters is 15
- Childhood onset; affects more women than men
- Patients often suffer from other psychological
disorders simultaneously
- Rare outside of Western cultures
Treatment
- Long-term psychotherapy may reintegrate separate
personalities in 25% of patients
- Treatment of associated trauma similar to
posttraumatic stress disorder; lifelong condition
without treatment
2. Depersonalization-Derealization Disorder
Characteristics
- Severe and frightening feelings of detachment
dominate the person’s life
- Affected person feels like an outside observer of his - If needed, therapy focuses on retrieving lost
or her own mental or body processes information
- Causes significant distress or impairment in DSM 5 CRITERIA
functioning especially emotional expression and
deficits in perception
- Some symptoms are similar to those of panic
disorder
- Rare; onset usually in adolescence
Treatment
- Psychological treatments similar to those for panic
disorder may be helpful
- Stresses associated with onset of disorder should be
addressed; tends to be lifelong
DSM 5 CRITERIA:

4. Dissociative Trance
Characteristics
- Sudden changes in personality accompany a
trance or “possession”
- Causes significant distress/impairment in
functioning
- Often associated with stress or trauma
- Prevalent worldwide, usually in a religious context;
rarely seen in Western cultures
- More common in women than in me
Treatment (Little is known)
3. Dissociative Amnesia
Characteristics
CHAPTER 6: MOOD DISORDERS AND SUICIDE
- Generalized: Inability to remember anything,
People with mood disorders experience one or both of
including identity; comparatively rare
the following:
- Localized: inability to remember specific events
Mania: A frantic “high” with extreme overcondence and
(usually traumatic); frequently occurs in war
energy, often leading to reckless behavior
- More common than general amnesia
Depression: A devastating “low” with extreme lack of
- Usually adult onset for both types
energy, interest, confidence, and enjoyment of life
- Dissociative Fugue: memory loss is accompanied by
Causes of Mood Disorders:
purposeful travel or bewildered wandering (subtype)
1. Biological Influences
Treatment
- Inherited vulnerability
- Usually self-correcting when current life stress is
- Altered neurotransmitters and neurohormonal
resolved
systems
- Sleep deprivation
 - Circadian rhythm disturbances Hypomanic episode - Less severe and less disruptive
2. Behavioral Influences version of a manic episode that is one of the criteria for
Depression several mood disorders.
- General slowing down
- Neglect of responsibilities and appearance Types of Mood Disorders
- Irritability; complaints about matters that used to be 1. Depressive
taken in stride Major Depressive Disorder
Mania Symptoms of major depressive disorder:
- Hyperactivity - sudden, often triggered by a crisis, change, or loss
- Reckless or otherwise unusual behavior - extremely severe, interfering with normal functioning
3. Emotional and Cognitive Influences - can be long term, lasting months or years if untreated
Depression Some people have only one episode, but the pattern
- Emotional flatness or emptiness usually.
- Inability to feel pleasure DMS 5 CRITERIA:
- Poor memory
- Inability to concentrate
- Hopelessness and/or learned helplessness
- Loss of sexual desire
- Loss of warm feelings for family and friends
- Exaggerated self-blame or guilt
- Overgeneralization
- Loss of self-esteem
- Suicidal thoughts or actions
Mania
- Exaggerated feelings of euphoria and excitement
4. Social Influences
- Women and minorities—social inequality and
oppression and a diminished sense of control
- Social support can reduce symptoms
- Lack of social support can aggravate symptoms
Triggers:
- Negative or positive life changes (death of a loved one,
promotion, etc.)
- Physical illness
Major Depressive Episodes
- Extreme depression
- 2 weeks
- Cognitive symptoms Persistent Depressive Disorder (PDD) (Dysthymia)
- Physical dysfunction Symptoms of PDD (Dysthymia):
- Anhedonia – reduced ability to feel pleasure - Long-term unchanging symptoms of mild depression,
- Duration—4 to 9 months, untreated sometimes lasting 20-30 years if untreated. Daily
Manic episode functioning not severely affected, but over time
- Exaggerated elation, joy, euphoria impairment is cumulative.
- 1 week, or less
- Cognitive symptoms DSM 5 CRITERIA:
- Duration—3 to 4 months, untreated
 - Severe mood disorder typified by major depressive
Table 7.4 episodes superimposed over a background of persistent
Diagnostic Criteria for Persistent Depressive dysthymic mood. Also called “Persistent depressive
Disorder (Dysthymia) disorder with intermittent major depressive episodes.”
A. Depressed mood for most of the day, for more days
than not, as indicated by either subjective account or Other Depressive Disorder
observation by others, for at least 2 years.
Note: In children and adolescents, mood can be irritable Premenstrual Dysphoric Disorder (PMDD)
and duration must be at least 1 year. - Clinically significant emotional problems that can
B. Presence, while depressed, of two (or more) of the
following: occur during the premenstrual phase of the
1. Poor appetite or overeating reproductive cycle of a woman.
2. Insomnia or hypersomnia
3. Low energy or fatigue - 2- 5% of women meet criteria
4. Low self-esteem
5. Poor concentration or difficulty making decisions
Disruptive Mood Dysregulation Disorder
6. Feelings of hopelessness C. During the 2-year period - Condition in which a child has chronic negative moods
(1 year for children or adolescents) of the disturbance,
the person has never been without the symptoms in
such as anger and irritability without any accompanying
criteria A and B for more than 2 months at a time. mania.
D. Criteria for major depressive disorder may be - Children have increased diagnosis for bipolar 40%
continuously present for 2 years.
E. There has never been a manic episode or a between 1995 and 2005
hypomanic episode, and criteria have never been met Bipolar (NOS)
for cyclothymic disorder.
F. The disturbance is not better explained by a
persistent schizoaffective disorder, schizophrenia, Additional Defining Criteria for Depressive Disorders
delusional disorder, or other specified or unspecified
schizophrenia spectrum and other psychotic disorder. Symptom Specifiers
G. The symptoms are not attributable to the ■ Psychotic features
physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition (e.g., - Hallucinations
hypothyroidism).
- Delusions
H. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important ■ Anxious distress
areas of functioning.
Specify if: - Comorbid disorders or anxiety symptoms
Current severity: Mild, moderate, severe ■ Mixed features
With anxious distress
With mixed features - At least 3 symptoms of mania
With melancholic features ■ Melancholic
With atypical features
With mood-congruent psychotic features - Severe somatic symptoms
With mood-incongruent psychotic features
■ Atypical features
With peripartum onset
Early onset: If onset is before age 21 years - Oversleeping and overeating
Late onset: If onset is at age 21 years or older
Specify (for most recent 2 years of dysthymic disorder): ■ Catatonic features
With pure dysthymic syndrome: if full criteria for a major - Catalepsy (trance or seizure loss of sensation and
depressive episode have not been met in at least the
preceding 2 years consciousness)
With persistent major depressive episode: if full criteria
for a major depressive episode have been met
throughout the preceding 2-year period Bipolar
With intermittent major depressive episodes, with
current episode: if full criteria for a major depressive
- people live on an unending emotional roller coaster.
episode are currently met, but there have been periods Types of Bipolar Disorders
of at least 8 weeks in at least the preceding 2 years with
symptoms below the threshold for a full major Bipolar I
depressive episode - major depression and full mania
With intermittent major depressive episodes, without
current episode: if full criteria for a major depressive - Recurrent (Symptom-free for 2 months)
episode are not currently met, but there has been one
or more major depressive episodes in at least the
Bipolar II
preceding 2 years In full remission, in partial remission - Alternation of major depressive episodes with
hypomanic episodes (not full manic episodes).
Double Depression
DSM 5 CRITERIA:
Symptoms of Double Depression:
 An Integrative Theory
- Shared biological vulnerability
- Psychological vulnerability
- Exposure to Stress
- Social and interpersonal relationships

Treatment of Mood Disorders: Medication

Antidepressant Medication
- Tricyclics (Tofranil, Elavil)
- Monamine oxidase inhibitors (MAO inhibitors): (Nardil,
Parnate); MAO inhibitors can have severe side effects,
especially when combined with certain foods or over-
Cyclothymia
the-counter medications
- mild depression + mild mania, chronic and long-term
- Selective-serotonin reuptake inhibitors or SSRIs
(Prozac, Zoloft) are newer and cause fewer side effects
than tricyclics or MAO inhibitors
Antimanics Medication
- Lithium is the preferred drug for bipolar disorder; side
effects can be serious; and dosage must be carefully
regulated
- Other antimania drugs: Carbamazepine and Valproate
Electroconvulsive Therapy
- Brief electrical current and with temporary seizures
- 6 to 10 treatments with high efficacy
> Severe depression
§ Few side effects
§ Relapse is common
Transcranial Magnetic Stimulation
- Localized electromagnetic pulse
- Fewer side effects and efficacy is likely good
- More studies needed
- Vagus nerve stimulation
Treatment of Mood Disorders: Psychological
Depression and Bipolar
Cognitive and Behavioral Therapy
- learn to replace negative depressive thoughts and
attributions with more positive ones
- develop more effecting coping behaviors and skills
Interpersonal
Bipolar
- Management of interpersonal problems
- Increase medication compliance
- Interpersonal and Social Rhythm Therapy
- Family-focused treatment
Suicide
Population specific
- Caucasians and Native Americans
Increasing rates
- Adolescents and Elderly
Gender differences
Indices
- Attempts, Plans, and Ideations
Types of suicide (Durkheim)
a. Altruistic - individual who brought dishonor to
himself or his family kill himself
b. Egoistic - loss of social supports
c. Anomic - result of marked disruptions (loss of job)
d. Fatalistic - loss of control over one’s own destiny
Risk factors
- Family history and Neurobiology
- Preexisting disorder or Alcohol
- Stressful life event
- Shameful/humiliating stressor
- Suicide publicity and media coverage
Treatment
Importance of assessment
- Suicidal desire – Ideation
- Suicidal capability – Past attempts
- Suicidal intent – Plan
- No-suicide contract
Hospitalization: Complete or partial
Cognitive-Behavioral Therapy (CBT)
CHAPTER 7: EATING AND SLEEP-WAKE DISORDERS
Individuals with eating disorders:
- Feel a relentless, all-encompassing drive to be thin
- Are mostly young females from middle- to upper-class
families, who live in socially competitive environment
- Lived only in Western countries until recently
Causes of Eating Disorders:
Psychological Influences
- Diminished sense of personal control and self-
confidence, causing low self-esteem
- Distorted body image
Social Influences
- Cultural and social emphasis on slender ideal, leading
to body dissatisfaction and preoccupation with food
and eating
Biological Influences
- Possible genetic tendency to poor impulse control,
emotional instability and perfectionistic traits
Types of Eating Disorders
Bulimia Nervosa (Binges and Purging)
- Out-of-control consumption of excessive amounts of
mostly non-nutritious food within a short time
Purging - Elimination of food through self-induced
vomiting and/or abuse of laxatives or diuretics
Non-Purging - To compensate for binges, some
bulimics exercise excessively or fast between binges
- Vomiting may enlarge salivary glands (causing a
chubby face), erode dental enamel, and cause
electrolyte imbalance resulting in cardiac failure or
kidney problems
- Weight usually within 10% of normal
- Age of onset is typically 18 to 21 years of age,
although it can be as early as 10
Associated psychological disorders
- Anxiety (80.6%)
- Mood disorders (50-70%)
- Substance abuse (36.8%)
Treatment for Bulimia Nervosa:
- Drug treatment, such as antidepressants
- Short-term cognitive-behavioral therapy (CBT) to
address behavior and attitudes on eating and body
shape
- Interpersonal psychotherapy (IPT) to improve
interpersonal functioning
DSM 5 CRITERIA:
Anorexia Nervosa
- Intense fear of obesity and persistent pursuit of
thinness; perpetual dissatisfaction with weight loss
Restricting - Severe caloric restriction, often with
excessive exercise and sometimes with purging, to the
point of semi-starvation
Binge-eating disorder
Binge-eating-purging – another subtype
- Similar to bulimia with out-of-control food binges, but
- Severely limiting caloric intake may cause amenorrhea,
no attempt to purge the food (vomiting, laxatives,
downy hair on limbs and cheeks, dry skin, brittle hair or
diuretics) or compensate for excessive intake
nails, sensitivity to cold, and danger of acute cardiac or
- Marked physical and emotional stress; some sufferers
kidney failure, electrolyte imbalance
binge to alleviate bad moods
- Weight at least 15% below normal
- Binge eaters share some concerns about weight and
- Average age of onset is between 18 and 21 years of
body shape as individuals with anorexia and bulimia
age, with younger cases tending to begin at 15
- Tends to affect more older people than either bulimia
Associated features
or anorexia
- Body image disturbance
Associated Features
- Pride in diet and control
- Many are obese and older
- Rarely seek treatment
- More psychopathology vs. non-binging obese
Associated psychological disorders
- Concerned about shape and weight
- Anxiety: OCD
Treatment for Binge-eating disorder
- Mood disorders (71%)
- Short-term CBT to address behavior and attitudes on
- Substance abuse
eating and body shape
- Suicide
- Interpersonal Therapy (IPT) to improve interpersonal
Treatment for Anorexia Nervosa:
functioning
- Hospitalization (at 75% below normal weight)
- Drug treatments that reduce feelings of hunger
- Outpatient treatment to restore weight and correct
- Self-help approach
dysfunctional attitudes on eating and body shape
DSM 5 CRITERIA:
- Family therapy
- Tends to be chronic if left untreated; more resistant to
treatment than bulimia
DSM 5 CRITERIA:
 Diagnosing Sleep–Wake Disorders
- A polysomnographic (PSG) evaluation assesses an
individual’s sleep habits with various electronic tests to
measure airflow, brain activity, eye movement, muscles
movements, and heart activity. Results are weighed
with a measure of sleep efficiency (SE), the percentage
of time spent asleep.

Types of Sleep-Wake Disorders

Dysommnias - disturbances in the timing, amount, or
quality of sleep
■ Insomnia Disorder
- difficulty initiating sleep, maintaining sleep or non-
restorative sleep.
Causes:
- pain, insufficient exercise, drug use, environmental
influences.
- anxiety, respiratory problems and biological
vulnerability.
Treatment
- medical (benzodiazepines)
- psychological (anxiety reduction, improved sleep
Obesity hygiene) - combined approach is usually most effective.
- Up to 70% of U.S. adults are overweight, and over 35% DSM 5 CRITERIA:
are obese
- Worldwide problem; increased risk in urban rather
than rural settings
- Two forms of maladaptive eating patterns associated
with obesity— binge eating and night eating syndrome
Cross-Cultural Considerations
- North American minority populations
- Immigrants to western cultures
- Increase in eating disorders
- Increase in obesity
- Cultural values
- Standards for body image
Developmental Considerations
- Adolescent onset
- Weight gain
- Interaction with social ideals

SLEEP–WAKE DISORDERS
- Characterized by extreme disruption in the everyday
lives of affected individuals, and are important factor in
many psychological disorders.
■ Hypersomnolence Disorder
- Characteristics include abnormally excessive sleep and
sleepiness, and involuntary daytime sleeping.
- classified disorder is subjectively disruptive
Causes: genetic link and/or excess serotonin.
Treatment: medical (stimulant drugs).
DSM 5 CRITERIA:
■ Narcolepsy
- sudden daytime onset of REM sleep combined with
cataplexy, a rapid loss of muscle tone that can be quite
mild or result in complete collapse.
- Often accompanied by sleep paralysis and/or
hypnagogic hallucinations.
Cause: likely to be genetic.
Treatment: medical (stimulant drugs).
DSM 5 CRITERIA:
TABLE 8.6
Diagnostic Criteria for Narcolepsy
A. Recurrent periods of irrepressible need to sleep,
lapsing into sleep, or napping occurring within the
same day. These must have been occurring at least
three times per week over the past 3 months.
B. The presence of at least one of the following:
1. Episodes of cataplexy defined as either (a) or (b),
occurring at least a few times per month:
(a) In individuals with long standing disease, brief
(seconds to minutes) episodes of sudden bilateral
loss of muscle tone with maintained, consciousness,
precipitated by laughter or joking.
(b) In children or in individuals within 6 months of
onset, spontaneous grimaces or jaw-opening
episodes with tongue thrusting or a global
hypotonia, without any obvious emotional triggers.
2. Hypocretin deficiency, as measured using
cerebrospinal fluid (CSF) hypocretin-1
immunoreactivity values (less than or equal to one
third of values obtained in healthy subjects tested
using the same assay or less than or equal to 110
pg/ml). Low CSF levels of hypocretin-1 must not be
observed in the context of acute brain injury,
inflammation or infection.
3. Nocturnal sleep polysomnography showing rapid
eye movement (REM) sleep latency less than or
equal to 15 minutes, or a multiple sleep latency test
showing a mean sleep latency less than or equal to 8
minutes and two or more sleep onset REM periods.
Specify current severity:
Mild: Infrequent cataplexy (less than once per week),
need for naps only once or twice per day, and less
disturbed nocturnal sleep
Moderate: Cataplexy once daily or every few days,
disturbed nocturnal sleep, and need for multiple
naps daily
Severe: Drug-resistant cataplexy with multiple
attacks daily, nearly constant sleepiness, and
disturbed nocturnal sleep (i.e., movements,
insomnia, and vivid dreaming)
■ Breathing-Related Sleep Disorders
- breathing is interrupted during their sleep often
experience numerous brief arousals throughout the
night and do not feel rested even after 8-9 hours asleep
Treatment:
- continuous positive air pressure (CPAP) machines is
the gold standard
- weight loss is also often prescribed.
Types of Breathing-Related Sleep Disorders
Sleep apnea – suspended breathing
■ Subtypes of sleep apnea dioxide (CO2) levels, because insufficient air is
- Obstructive Sleep Apnea hypopnea syndrome (OSA) exchanged with the environment.
- occurs when airflow stops despite continued activity DSM 5 CRITERIA:
by the respiratory system
- sometimes associated with obesity, as is increasing age
DSM 5 CRITERIA:

Circadian Rhythm Sleep Disorder

- characterized by disturbed sleep (either insomnia or
excessive sleepiness during the day)
Causes:
- inability to synchronize sleep patterns with current
pattern of day and night
- Central Sleep Apnea (CSA) - jet lag, shift work, delayed sleep, or advanced sleep
(going to bed earlier than normal bedtime)
- complete cessation of respiratory activity for brief
DSM 5 CRITERIA:
periods and is often associated with certain central
nervous system disorders such as cerebral vascular
disease, head trauma, and degenerative disorders
- wake up frequently during the night but they tend not
to report excessive daytime sleepiness
DSM 5 CRITERIA:

Parasomnias - abnormal behaviors that occur during

sleep
Types of Parasomia Disorders
- Sleep-related hypoventilation
Nightmare Disorder
- labored breathing
- occur during REM or dream sleep
- is a decrease in airflow without a complete pause in
breathing. This tends to cause an increase in carbon
- Nightmares qualify as nightmare disorder when they - adult sleepwalking is usually associated with other
are stressful enough to impair normal functioning. psychological disorders; genetic link.
- Causes are unknown, tend to decrease with age. Related Conditions
Treatment: Antidepressants and Relaxation training - Nocturnal eating syndrome
DSM 5 CRITERIA: - Person eats while asleep
DSM 5 CRITERIA:

DISORDER OF AROUSAL
- includes a number of motor movements and behaviors
during NREM sleep

Types of Non-Rapid Eye Movement Sleep Behavior

Disorder
■ Sleep terrors
- Occur during non-REM (non-dreaming) sleep, most
commonly affect children
- Child screams, cries, sweats, sometimes walks, has
rapid heartbeat, and cannot easily be awakened or
comforted.
- More common in boys than girls, and possible genetic
link since they tend to run in families. May subside with
time

■ Sleepwalking (Somnambulism)
- Occurs at least once during non-REM sleep in 15% to
30% of children under age 15.
Causes:
- extreme fatigue, sleep deprivation, sedative or
hypnotic drugs, and stress
CHAPTER 8: Sexual Dysfunctions, Paraphilic Disorders,
and Gender Dysphoria
ABNORMAL SEXUAL BEHAVIOR
- it is associated with one of three kinds of impair ed
functioning—gender dysphoria, sexual dysfunction, or
paraphilic disorders.
Gender Differences
■ Masturbatio: M = 81% F = 45%
■ Casual premarital sex
- Men are more permissive, gap is shrinking
■ Elements of satisfaction
Women = demonstrations of love, intimacy
Men = focus on arousal
■ No differences in several domains
- Acceptability of homosexuality
- Acceptability of masturbation
- Experience of satisfaction
■ Sexual self-schemas - cognitive generalizations
regarding sexual aspects of the self
■ Core beliefs about sexual aspects of one’s self
Females - Higher conflict
- Experience of passionate and romantic feelings
- Openness to sexual experience
- Embarrassed, conservative, or self-conscious
Males—no negative core beliefs
Summary of sexuality differences
Men
- Show more sexual desire and arousal
- Self-concept includes power, independence and
aggression
Women
- Emphasize context of committed relationship
- Sexual beliefs are shaped by cultural, situational, and
social factors
THE DEVELOPMENT OF SEXUAL ORIENTATION
- Genetic/familial component
- Homosexuality in twins
Identical = 50%
Fraternal = 16-22%
- No specific genes
- Biology interacts with environment
AN OVERVIEW OF SEXUAL DYSFUNCTIONS
The human sexual response cycle
1. Desire phase- Sexual urges occur in response to
sexual cues or fantasies
2. Arousal stage - A subjective sense of sexual pleasure
and physiological signs of sexual arousal. Males: penile
tumescence. Females, vasocongestion (blood pools in
the pelvic area) leading to vaginal lubrication and breast
tumescence (erect nipples).
3. Plateau phase - Brief period occurs before orgasm.
4. Orgasm phase – Males: feelings of the inevitability of
ejaculation, followed by ejaculation; Females:
contractions of the walls of the lower third of the
vagina.
5. Resolution phase Decrease in arousal occurs after
orgasm (particularly in men).
Causes of Sexual Dysfunction
Biological
- Physical disease & Medical illness
- Prescription medications & Alcohol and drugs
Psychological
- “Anxiety” vs. “distraction”
- Performance anxiety
- Arousal
- Cognitive processes
- Negative affect
Social and Cultural
- Erotophobia (fear of sex/erotic feelings)
- Negative or traumatic experiences
- Poor interpersonal relationships
- Lack of communication
Classification of Sexual Dysfunction
Lifelong - refers to a chronic condition that is present
during a person’s entire sexual life
Acquired - refers to a disorder that begins after sexual
activity has been relatively normal
Generalized- occurring every time the individual
attempts sex
Situational - occurring with some partners or at certain
times but not with other partners or at other times
Categories of Sexual Dysfunction among Men and
Women
Sexual Desire Disorders
Men: hypoactive sexual desire disorder (little or no
desire to have sex)
DSM 5 CRITERIA Sexual Arousal Disorders
Men: Erectile disorder (difficulty attaining or
maintaining erections)
Women: Sexual interest/arousal disorder (little or no
desire to have sex)
Orgasm Disorders
Men: Delayed ejaculation; premature (early)
ejaculation
DSM 5 CRITERIA

Women: sexual interest/arousal disorder (little or no

desire to have sex)
DSM 5CRITERIA:

Women: Female orgasmic disorder

DSM 5 CRITERIA:
 Combined with CBT
- Vasodilating drug injection - Papaverine or
prostaglandin
Penile prosthesis or implants - Vacuum device therapy

PARAPHILIC DISORDERS
Sexual Pain Disorders - Sexual arousal occurs almost exclusively in the context
Men: / of inappropriate objects or individuals.
Women: Genito-pelvic pain/penetration disorder (pain, Types of Paraphilic Disorders
anxiety, and tension associated with sexual activity; Frotteuristic disorder - unwanted touching in public
vaginismus, i.e., muscle spasms in the vagina that DSM 5 CRITERIA
interfere with penetration)
DSM 5 CRITERIA

Fetishistic disorder - sexual attract. to nonliving objects

DSM 5 CRITERIA:

Treatment of Sexual Dysfunction

Education - Highly effective Voyeuristic disorder - sexual arousal achieved by
Psychosocial intervention (Masters and Johnson) viewing unsuspecting person undressing or naked
- Education Exhibitionistic disorder - sexual arousal & gratification
- Eliminate performance anxiety by exposing genitals to unsuspecting strangers
- Sensate focus DSM 5 CRITERIA:
- Non-demand pleasuring
Psychosocial Treatments
- Premature ejaculation - Squeeze technique
- Female orgasm disorder - Masturbatory training
- Vaginismus - Use of dilators
- Hypoactive sexual desire - Exposure to erotic material
Medical Treatment
- Erectile dysfunction - Viagra, Levitra and Cialis
 DSM 5 CRITERIA

Transvestic disorder - sexual arousal associated with

the act dressing in clothes of the opposite sex

Incest - sexual attraction to family member

A model of the development of paraphilia

Sexual Sadism – arousal associated with either inflicting

pain or humiliation
Sexual Masochism – arousal associated with suffering
pain or humiliation
DSM 5 CRITERIA

Causes of Paraphilic Disorders

Pedophilic disorder - sexual attraction to children ■ Preexisting deficiencies
 - In levels of arousal with consensual adults
- In consensual adult social skills
■ Treatment received from adults during childhood
■ Early sexual fantasies reinforced by masturbation
■ Extremely strong sex drive combined with
uncontrollable thought processes
Treatment for Paraphillic Disorders
Covert sensitization: Repeated mental reviewing of
aversive consequences to establish negative
associations with behavior
Relapse prevention: Therapeutic preparation for coping
with future situations
Orgasmic reconditioning: Pairing appropriate stimuli
with masturbation to create positive arousal patterns
Medical: Drugs that reduce testosterone to suppress
sexual desire; fantasies and arousal return when drugs
are stopped
GENDER DYSPHORIA
- present when a person feels trapped in a body that is
the “wrong” sex that does not match his or her innate
sense of personal identity. (Gender identity is
independent of sexual arousal patterns.) Relatively rare.
Causes of Gender Dysohoria:
Biological Influences
■ Not yet confirmed: prenatal exposure to hormone
- Hormonal variations may be natural or result from
medication
Psychological Influences
■ Gender identity develops between 11/2 and 3 years
of age
- “Masculine” behaviors in girls and “feminine”
behaviors in boys evoke different responses in different
families
Treatment
■ Sex reassignment surgery: removal of breasts or
penis; genital reconstruction
- Requires rigorous psychological preparation,
financial and social stability.
■ Psychosocial intervention to change gender identity
- Usually unsuccessful except as temporary relief until
surgery
DSM 5 CRITERIA
TABLE 10.13
Criteria for Gender Dysphoria
In Children:
A. A marked incongruence between one’s
experienced/expressed gender and assigned gender, of at
least 6 months’ duration, as manifested by at least six of
the following (one of which must be Criterion A1)
1. A strong desire to be of the other gender or an
insistence that one is the other gender (or some
alternative gender different from one’s assigned gender).
2. In boys (assigned gender), a strong preference for cross-
dressing or simulating female attire; or in girls (assigned
gender), a strong preference for wearing only typical
masculine clothing and a strong resistance to the wearing
of typical feminine clothing.
3. A strong preference for cross-gender roles in make-
believe play or fantasy play.
4. A strong preference for the toys, games, or activities
stereotypically used or engaged in by the other gender.
5. A strong preference for playmates of the other gender.
6. In boys (assigned gender), a strong rejection of typically
masculine toys, games, and activities and a strong
avoidance of rough-and-tumble play or in girls (assigned
gender), a strong rejection of typically feminine toys,
games, and activities.
7. A strong dislike of one’s sexual anatomy.
8. A strong desire for the primary and/or secondary sex
characteristics that match one’s experienced gender.
B. The condition is associated with clinically significant
distress or impairment in social, school, or other important
areas of functioning.
In Adolescents and Adults:
A. A marked incongruence between one’s
experienced/expressed gender and assigned gender, of at
least 6 months’ duration, as manifested by at leas two of
the following:
1. A marked incongruence between one’s
experienced/expressed gender and primary and/or
secondary sex characteristics (or in young adolescents, the
anticipated secondary sex characteristics).
2. A strong desire to be rid of one’s primary and/or
secondary sex characteristics because of a marked
incongruence with one’s experienced/expressed gender
(or in young adolescents, a desire to prevent the
development of the anticipated secondary sex
characteristics).
3. A strong desire for the primary and/or secondary sex
characteristics of the other gender.
4. A strong desire to be of the other gender (or some
alternative gender different from one’s assigned gender).
5. A strong desire to be treated as the other gender (or
some alternative gender different from one’s assigned
gender).
6. A strong conviction that one has the typical feelings and
reactions of the other gender (or some alternative gender
different from one’s assigned gender).
B. The condition is associated with clinically significant
distress or impairment in social, school, or other important
areas of functioning.
Treatment of Disorders of Sex Development
(Intersexuality)
Five sex theory by Anne Fausto-Sterling
■ Males
■ Females
■ Herms - hermaphrodites, or people born with both
testes and ovaries;
■ Merms - anomatically more male than female but
possess some aspect of female genitalia
■ Ferms - who have ovaries but possess some aspect of
male genitalia
Prevalence = 1.7%
Treatment
Psychosocial over surgical: Increase adaptation
CHAPTER 9: SUBSTANCE-RELATED AND ADDICTIVE
DISORDERS
Causes:
Trigger: Social Influences
- Exposure to drugs—through media, peers, parents, or
lack of parental monitoring—versus no exposure to
drugs
- Social expectations and cultural norms for use
- Family/culture/society and peers (all or some)
supportive versus unsupportive of drug use
Drug Use and Drug Abuse: Biological Influences
■ Inherited genetic vulnerability affects:
- Body's sensitivity to drug (ADH gene)
- Body's ability metabolize drug (presence of specific
enzymes in liver)
■ Drugs activate natural reward center ("pleasure
pathway") in brain
■ Neuroplasticity increases drug-seeking and relapse
Psychological Influences
Not to use:
■ Fear of effects of drug use
■ Decision not to use drugs
■ Feeling of confidence and self-esteem without drug
use
To use:
■ Drug use for pleasure; association with "feeling good"
(positive reinforcement)
■ Drug use to avoid pain and escape unpleasantness by
"numbing out" (negative reinforcement)
■ Feeling of being in control
■ Positive expectations/urges about what drug use will
be like
■ Avoidance of withdrawal symptoms
■ Presence of other psychological disorders: mood
anxiety, etc.
Substance-related and addictive disorders – which are
associated with the abuse of drugs and other
substances people take to alter the way they think, feel
and behave.
Psychoactive substances - alter mood, behavior /both
Levels of involvement
1. Substance use – indigestion of psychoactive
substances in moderate amounts does not affect
functioning.
2. Substance intoxication – reaction to indigested
substances (drunkenness or getting high)
3. Substance abuse – problematic amount of indigested
substance
4. Substance dependence - “drug-seeking behaviors.”
The repeated use of a drug, a desperate need to ingest
more of the substance
TYPES OF SUBSTANCES
Depressants - alcohol, barbiturates (sedatives: Amytal,
Seconal, Nembutal), benzodiazepines (antianxiety:
Valium, Xanax, Halcion)
Effects:
■ Decreased central nervous system activity
■ Reduced levels of body arousal
■ Relaxation
Stimulants - Amphetamines, cocaine, nicotine, caffeine
Effects:
■ Increased physical arousal
■ User feels more alert and energetic
Opiates - Heroin, morphine, codeine
Effects:
■ Narcotic—reduce pain and induce sleep and
euphoria by mirroring opiates in the brain
(endorphins, etc.)
Hallucinogens - Cannabis, LSD, Ecstasy
Effects:
■ Altered mental and emotional perception
■ Distortion (sometimes dramatic) of sensory
perceptions
Substance Abuse-Related Disorders
A. Sedative, Hypnotic, or Anxiolytic Related Disorders - activates the natural opioid system of our bodies
Drugs: Barbiturates and Benzodiazepines - withdrawal: excessive yawning, nausea and vomiting,
- include maladaptive behavioral changes such as chills, muscle aches, diarrhea, and insomnia
inappropriate sexual or aggressive behavior, variable
moods, impaired judgment, impaired social or Cannabis-Related Disorders
occupational functioning, slurred speech, motor Drugs: Cannabis (Marijuana)
coordination problems, and unsteady gait. - causes altered perception of the world
- affect the brain by influencing the GABA - mood swings, dream-like states, heightened sensory
neurotransmitter system experiences, seeing vivid colors, or appreciating the
- dangerous when combined with alcohol subtleties of music
- cannabis use disorder: impairments of memory,
B. Stimulant-Related Disorders
concentration, relationships with others, and
Drug: Amphetamines
employment are negative outcomes of long-term use
- can induce feelings of elation and vigor and can reduce
fatigue. You feel “up.” Then came the “crash,” feeling
Hallucinogen-Related Disorders
depressed or tired.
Drugs: LSD (d-lysergic acid diethylamide) “acid”
- can lead to hallucinations and delusions
- psilocybin (found in certain species of mushrooms),
(Schizophrenia)
lysergic acid amide (found in the seeds of the morning
Drug: Cocaine
glory plant), dimethyltryptamine (DMT) (found in the
- increases alert ness, produces euphoria, increases
bark of the Virola tree, which grows in South and
blood pressure and pulse, and causes insomnia and loss
Central America); and mescaline (found in the peyote
of appetite.
cactus plant). Phencyclidine (or PCP) is snorted,
- cocaine-induced paranoia
smoked, or injected intravenously, and it causes
- withdrawal causes apathy and boredom
impulsivity and aggressiveness
- subjective intensification of perceptions,
C. Tobacco-Related Disorders
depersonalization, and hallucinations, blurred vision
Drug: Nicotine
- hallucinogen-use disorder: lose effectiveness from
- stimulate (nAChRs) (the dopamine system responsible
long term use
for feelings of euphoria)
- Smoking: depression, anxiety, and anger
Inhalant Drugs-Related Disorder
- Relapse: depression and anxiety, higher to women
Drugs: hair spray/paint, paint thinner, gasoline, amyl
nitrate, nitrous oxide (“laughing gas”), nail polish etc.
D. Caffeine-Related Disorders
Intoxication: dizziness, slurred speech, lack of
Drug: Caffeine (gentle-stimulant)
coordination, euphoria, and lethargy
- least harmful of all addictive drugs, caffeine can still
Withdrawal: sleep disturbance, tremors, irritability, and
lead to problems similar to that of other drugs
nausea—up to 2-5 days.
- plays an important role on the release of dopamine
- can also increase aggressive and antisocial behavior,
and glutamate in the striatum, which may explain the
and long-term use can damage bone marrow, kidneys,
elation and increased energy
liver, lung, nervous system, and the brain
- causes jittery, insomnia

Alcohol
Opioid-Related Disorders
- Withdrawal: Delirium tremens - produce frightening
Drug: morphine, codeine, and heroin.
hallucinations and body tremors.
- opiate: the natural chemicals in the opium poppy that
- Dementia
have a narcotic effect (they relieve pain and induce
sleep)
- Wernicke-Korsakoff disorder - confusion, loss of
muscle coordination, and unintelligible speech.
Gambling Disorder
- Needs to gamble with increasing amounts of money in
order to achieve the desired excitement.
- Is restless or irritable when attempting to cut down or
stop gambling.
Treatments for Substance-Abuse Related Disorders
Psychosocial Treatments
Aversion therapy—to create negative associations with
drug use (shocks with drinking, imagining nausea with
cocaine use)
Contingency management to change behaviors by
rewarding chosen behaviors
Alcoholics Anonymous and its variations
Inpatient hospital treatment (can be expensive)
Controlled use and Community reinforcement
Relapse prevention
Biological Treatments
Agonist substitution – Replacing one drug with a similar
one (methadone for heroin, nicotine gum and patches
for cigarettes)
Antagonist substitution - Blocking one drug's effect
with another drug (naltrexone for opiates and alcohol)
Aversive treatments - Making taking drug very
unpleasant (using Antabuse, which causes nausea and
vomiting when mixed with alcohol, to treat alcoholism)
Drugs to help recovering person deal with withdrawal
symptoms (clonidine for opiate withdrawal, sedatives
for alcohol, etc.)
Treatment: Cognitive-behavioral interventions (helping
person identify and avoid triggers for aggressive
outbursts) and approaches modeled after drug
treatments appear most effective.
Kleptomania
- Recurring failure to resist urges to steal unneeded
items
- Feeling tense just before stealing, followed by feelings
of pleasure or relief when committing the theft
- High comorbidity with mood dis orders and, to a
lesser degree, with substance abuse/dependence
Treatment: Behavioral interventions or antidepressant
medication
Pyromania
- Irresistible urge to set fires
- feeling aroused prior to setting fire then a sense of
gratification or relief while the fire burns
- Rare: diagnosed in less than 4% of arsonists
Treatment:
Cognitive-Behavioral Therapy (CBT) - interventions
(helping person identify signals triggering urges, and
teaching coping strategies to resist
- Little etiological and treatment research

IMPULSE-CONTROL DISORDERS
- Characterized by inability to resist acting on a drive or
temptation. Sufferers often perceived by society as
having a problem simply due to a lack of "will."

Types of Impulse-Control Disorders

Intermittent Explosive
- Acting on aggressive impulses that result in assaults or
destruction of property
- Current research is focused on how neurotransmitters
and testosterone levels interact with psychosocial
influences (stress, parenting styles)