PSYCHO SEXUAL DISORDERS:-

Human sexuality is complex phenomenon that

includes the biological, psychological, social and
cultural aspects.
Psycho sexual disorders are the sexual problems
that are psychological in origin and occur in the
absence of any pathological disease.
Normal Sexual Response cycle:-
CLASSIFICATION OF SEXUAL DISORDERS:-
Sexual disorders may be divided into three broad categories.
1. Sexual Dysfunction
Any impairment in normal sexual response cycle.
2. Disorder of sexual preference (paraphilias)
Unusual or deviant sexual behaviour
3. Gender identity disorder
Persistent identification with opposite sex and discomfort
in own sex.
PSYCHOPASTHOLOGY (PSYCHODYNAMICS) SEXUAL
DISORDERS:-
Exact cause of sexual disorders is not known.
● Psychodynamic theory :- It states that maladaptive sexual
behavior of a person is associated with the early
childhood trauma or fixation in the oedipus stage id
psychosexual development.
● Psychosocial and cultural factors:- Poor parenting,
misinformation, negative role modeling , conflict of values
, fears and trauma, issues of trust and conflict among
partners.
● Genetic Factors:- Abnormalities in limbic system and
temporal lobe.

● Hormonal : Abnormalities in the production of sex hormones

such as androgen

● Organic factors:- Medical illness such as diabetes mellitus,

thyroid disorders, spinal cord injury, central nervous system
(CNS), syphilis, etc.

● Psychoactive substances and drugs:- Antidepressants,alcohol

and other substances.
SEXUAL DYSFUNCTIONS:-
Sexual dysfunctions refer to important of normal sexual
interest, enjoyment and /or performance. Impairment can
occur at one or more points of the normal sexual response
cycle- desire, arousal (or excitement)and orgasm. There
are different types of disorders of sexual dysfunction
CLASSIFICATION OF SEXUAL DYSFUNCTIONS:-
● Appetitive dysfunction
● Impaired genital response
● Orgasmic dysfunction
● Pain during sex
● Hypoactive sexual desire disorder
● Sexual aversion disorder
● Female sexual arousal disorder
● Male erectile disorder (impotence)
Inhibited female orgasm (anorgasmia)
Inhibited male orgasm(retarded ejaculation)
Premature ejaculation
Vaginismus (female)
Dyspareunia (both female and male)
ETIOLOGY :-
PSYCHOSOCIAL AND CULTURAL FACTORS:-
Ignorance and misinformation:- Many parents and schools fail to provide
even basic sex education.
Conflict of values:- Normal recurring sexual feelings are perceived as guilt
because it is portrayed as shamed, dirty or sinful.
Fear and trauma:- Sexual abuse, rape and premarital pregnancy occurred
in the past.
Psychodynamic theory:- Dissociated memories of early sexual trauma or
castration anxiety.
Relationship Factors:-
Issues of trust, conflict among partners, anger, difficulties with
communication and commitment problems.
Organic Factors:- Variety of drugs and medical illness such as diabetes
mellitus, thyroid disorders, spinal cord injury, CNS, syphilis, etc. may cause
disturbances of the sexual response.
Psychoactive Substances Drugs:-
● Side effects of drugs used to treat diabetes or hypertension.
● Other drugs including antidepressants.
● Alcohol and other substances.
CLINICAL ASSESSMENT
Careful and detailed sexual history should be elicited from
both the patient and ideally from the partner as well.
SPECIFIC DISORDERS SEXUAL DYSFUNCTION:-
Sexual Arousal (Desire)Disorder are two types (DSM-5). It is
characterized by the persistent problems in sexual activities
which lasting more than six months.
1.Female Sexual Interest/ Arousal Disorder:-
Absent or reduced interest in sexual activity, thoughts or
fantasies, excitement or pleasure and arousal.
2.Male Hypoactive Sexual Desire Disorder:-
Reduced or absent of sexual thoughts or fantasies and desire
for sexual activity.
Orgasmic Disorders:-
Orgasmic disorder now referred to as female orgasmic disorder. It is
characterized by the difficulty or inability of a woman to reach
orgasm during sexual stimulation. The diagnosis or delayed
ejaculation. The symptoms must be present for a minimum duration
of 6 months without any organic pathology.
Sexual Aversion Disorder:-
It refers to a near total avoidance of sexual activity and may be
associated with extreme fear, anxiety or contempt. Lack of libido is a
common symptom of psychiatric disorders especially.
Male Erectile Dysfunction (impotence):-
It is characterized by the inability of a person to get an erection
during sexual activity, inability to maintain an erection long
enough to finish a sexual act and inability to get an erection that
is as rigid as previously experienced.

Premature Ejaculation:-
Ejaculation occurs during sexual activity within one minute
after vaginal penetration and before the individual wishes it.
Most common cause of premature ejaculation is anxiety.
Inhibited Male orgasm:-
Person fails to ejaculation following an adequate phase of
sexual excitement or activity.
Vaginismus:-
There is involuntary spastic(abnormal muscle tightness due to
prolonged muscle contraction) contraction near the vagianl
entrance. It is conditioned response of the muscles around the
introitus. (opening of the vagina, which leads to the vaginal
canal).
 DISORDERS OF SEXUAL PREFERENCE
(PARAPHILIAS )HAS HOMOSEXUALITY:-
Paraphilias are characterized by an excitement stage of
sexual activity, fantasies that are associated with sexual
objects, stimulus or orientations. The stimulus may be a
woman’s shoe, a child , animals, instruments of torture or
incidents of aggression.
DEFINITION:-
Sexually fantasies, urges or behaviors that are recurrent,
intense, occur over a period of at least six months, and
cause significant distress or interfere with important areas of
functioning.’
 ETIOLOGY:-
● Early relationship problems.
● Disrupted development of sexuality.
● Repressed unacceptable heterosexual (sexually attracted to people
of the opposite sex)feelings.
● Excessive shyness or harboring fears about relationship with the
opposite sex.
● Learning theory:- Stated that sexual arousal in this way is a learn
behavior and conditioned response.
● Psychoanalytic theory:- Stated that it is symbolic presentation of
repressed homosexuality or oedipal conflicts
Classification of Disorders of sexual preference:-
Disorders of paraphilias or sexual preference can be
categorized into two.
Abnormal Preference of sexual objects:
Fetishism: Sexual arousal occurs with a non- living object
which is usually intimately associated with the human
body. The fetish object which is usually intimately
associated with the human body. The fetish object may
include bras, underpants, shoes, gloves, etc.
Abnormal Preference of sexual objects:-
Fetishism: Sexual arousal occurs with a non- living object which is usually
intimately associated with the human body. The fetish object which is usually
intimately associated with the human body. The fetish object may include bras,
underpants, shoes, gloves, etc.

Transvestism:- Sexual arousal occurs by wearing clothes of the opposite sex.

Sexual sadism:- The person is sexually aroused by physical and psychological

humiliation, suffering or injury of the sexual partner.

Sexual masochism:- Here the person is sexually aroused by physical or

psychological humiliation or injury inflicted on self by others.
Exhibitionism:- The person is sexually aroused by the exposure of
one’s genitalia to an unsuspecting stranger.
Voyeurism: This is persistent or recurrent tendency to observe
unsuspecting persons naked (usually of the other sex) and engaged in
sexual activity.
Frotteurism:- This is a persistent or recurrent involvement in the act of
touching and rubbing against an unsuspecting, non consenting person
Pedophilia :- It is charcterized by persistent or recurrent involvement of
an adult in sexual activity with prebubertal children.
Zoophilia(Beastiality):- involving in sexual activity with animals.
Other paraphilias:- Sexual arousal occurs with urine, feces, enemas,
etc
TREATMENT OF DISORDERS OF SEXUAL PREFERENCE:-
Psychotherapy:
The focus is to help the person to recognize and oppose
rationalizations about his/ her behavior.
Behavior therapy:-
Covert sensitization can be useful where pairing an undesirable
image /thought with the abnormal sexual images is done to
suppress the abnormal sexual images.
Medications:-
Antiandrogens or oestrogens are used to suppress the
production of testosterone that helps to reduce the
frequency or intensity of sexual desire.
Other medications:- Selective serotonin reuptake
inhibitors (SSRIs) is also effective in decreasing the
sexual obsessiveness and urges.
GENDER IDENTITY DISORDERS (GENDER DYSPHORIA):-
DEFINITION:- Gender identity disorders as a group whose common
feature is a strong, persistent preference for living as a person of the
other sex.
CLASSIFICATION:-

1.Gender Identity Disorders(ICD-10):-

Transsexualism :- Desire to live and be accepted as a member of the
opposite sex, usually accompanied by the wish ro make one’s body as
congruent as possible with one’s preferred sex through surgery and
hormonal treatment.
2.Dual -role transvestism:- Wearing clothes of the opposite sex in
order to experience temporarily membership of the opposite sex in
the absence of any sexual motivation for the cross- dressing and
any desire to change permanently into the opposite sex.

3.Gender identity disorder of childhood:-

For females:- Persistent and intense distress about being a girl and
a stated desire to be a boy.
For males:- Persistent and intense distress about being a boy and
an intense desire to be a girl.
EPIDEMIOLOGY:- Prevalence gender identity disorder is 1 in 30,000 men and 1
in 100,000 women.

ETIOLOGY:-
1. Biological theory:- Sex steroids influence the expression of sexual behavior
in mature men/ women.
2. Psychosexual theory:- Sigmund Freud believed that gender identity
problems resulted from conflicts experienced by children within the oedipal
triangle.

CLINICAL FEATURES:-
● Repeatedly stating intense desire to be of the opposite gender.
● Insistence that one is of the opposite gender.
● Cross- dressing.
● Fantasies of being of the opposite gender.
● Strong desire to participate in the games of the opposite
gender.

HOMOSEXUALITY:-
Definition:-
Homosexuality refers to sexual attraction toward persons of the
same sex.
EPEDIMIOLOGY:-Male homosexuality is more common than in female.
ETIOLOGY:-
● Theexact cause unknown. Both biological and psychosocial factors
probably play a role.
● People with homosexuality found to have problems in relationship
with the parent of the same sex during childhood.
● Emotionally cold and distant parents.
TREATMENT:-

BEhavior therapy:- Modifying the sexual behavior of patients experiencing

adjustment problems.E,g covert sensitization or aversion therapy can be
used in treating those who are strongly motivated.
NURSING MANAGEMENT OF SEXUAL DISORDERS:-
Evaluate the degree to which the patient believes he/ she is ‘in control’
of his/ her own behavior.
Assess the patient’s feelings of comfort and content with his/ her own
performance.
Evaluate recent variations in the patient’s behavior.
Evaluate the extent to which the patient feels loved and respected by
others.
Assess how competent patients feel about their ability to perform and
carry out their own and others expectations
EATING DISORDERS:-
Eating disorders are serious, the conditions related to persistent eating
behaviors that negatively impact person’s health, emotions and ability
to function in important areas of life.

ANOREXIA NERVOSA :-

Definition:-
Anorexia nervosa is characterized by excessive food restriction,
irrational fear of gaining weight and a distorted body self- perception
which leads to excessive weight loss.
ETIOLOGY:-
Genetic:- It is assumed that some people may have genes (chromosomes 1.2
and 13) that increase their risk of developing anorexia. Monozygotic twins
have higher risk of developing the disorder as compared to dizygotic twins.
Biological factors:- This involves the changes in brain neurotransmitters
such as norepinephrine, serotonin.
Endocrine abnormalities:- Abnormality or dysfunction of hypothalamus is
found to be associated with the disorder
Psychological factors:- Personality traits such as perfectionism, obsessive
compulsiveness, neuroticism negative emotionality and low self-esteem
seems to be associated with the eating disorders.
Socio cultural influences:-

Social acceptance of thinness.

Mass media such as television, magazines and advertising influences.

CLINICAL FEATURE:-

Intense fear of gaining weight or becoming fat, even when underweight.

Refuse to keep weight at what is considered normal for her age and height.

Have a distorted (inaccurate) body image that is focused on body weight or

shape.

Person refuses to admit the seriousness of weight loss.

May have purging behavior such as self -induced vomiting, or the misuse of
laxatives, diuretics or enemas etc.
OTHER SYMPTOMS:-
● Blotchy or yellow dry skin and covered with fine hair.
● Confusion, poor memory and judgment.
● Dry mouth, dehydration and constipation.
● Low blood pressure and cardiac arrhythmias.
● Extreme sensitivity to cold (wearing several layers of clothing to stay
warm).
● Loss of bone strength and osteoporosis.
● Wasting away of muscle and loss of body fat.
TREATMENT:-
No medication has been proven to decrease the desire to lose weight.
1. Antidepressants (selective serotonin reuptake inhibitors) antipsychotics
(olanzapine) and mood stabilizers may be helpful in some cases.
PSYCHOLOGICAL THERAPIES:-
Cognitive behavioral therapy:- To correct the cognitive distortion of body
image and fear of gaining weight.
Group therapy:- To encourage them to eat in a healthier way.
Family therapy:- Used for treating younger patients.
Support groups:- Patients and families meet and share what they’ve
been through.

BULIMIA NERVOSA:-
DEFINITION:-

Bulimia nervosa is characterized by frequent episodes of binge ( over

eat) eating followed by bahavior that compensates for the overeating
such as forced vomiting, excessive use of laxatives or diuretics, fasting,
excessive exercise or a combination of these behaviors. The illness was
first distinguished from anorexia nervosa in 1979
 BINGE AND PURGE CYCLE:-

Strict dieting Tension and

craving

Binge
eating

Shame and disgust

Purging to
avoid weight
gain
Strict dieting:-Dieting triggers bulimia’s destructive cycle of bringing
(overeating) and purging (removal).

Craving:- The strict and rigid dieting for a longer time leads powerful cravings
for food.

Binge eating:- Strong craving triggers a phase of binge eating, where patient
overeat.

Purging:- Overeating leads to a phase purging where patient tries to

compensate overeating by doing efforts to remove the food from the body
(forced vomiting, excessive use of laxatives or diuretics, fasting, excessive
exercise.)

Shame and disgust:- This behavior triggers shame and disgust that finally
leads to strict dieting and restart the cycle.
CLINICAL FEATURES :-
BINGE EATING:-
● Lack of control over eating inability to stop eating and eating until the
point of physical discomfort and pain.

● Eating unusually the large amounts of food with no obvious change in

weight.

● Alternating between overeating and fasting;rarely eats normal meals. It is

all or nothing when it comes to food.
PURGING:-
● Frequently disappears after meals or takes a trip to the bathroom to
throw up.
● Using laxatives, diuretics or enemas after eating
● Excessive exercise;works out strenuously , especially after eating.

PHYSICAL SIGNS AND SYMPTOMS:-

● Calluses or scars on the knuckles or hands from sticking fingers
down the throat to induce vomiting.
● Puffy’ chipmunk’ cheeks caused by repeated vomiting.
● Discolored teeth from exposure to stomach acid when throwing up.
ETIOLOGY OF BULIMIA NERVOSA:-
Genetics factors:- There may be a genetic predisposition for the
disorder.Incidence is higher among first - and second- degree relatives of
individuals with bulimia nervosa.
Biological factors: Abnormalities of central nervous system neurotransmitters
especially serotonin and norepinephrine.
Psychological and personality factors:- Personality traits such as perfectionism,
impaired self -concept, affective instability and poor impulse control.
Developmental factors :- Absence of adaptive functioning to maturational tasks
an developmental stressors(e.g puberty, peer and parental relationships,
sexuality, marriage and pregnancy).
 DIFFERENCE BETWEEN ANOREXIA AND BULIMIA NERVOSA:-
Anorexia nervosa Bulimia nervosa

Weight Significantly underweight Normal weight or overweight

Eating Eat little food/ few Eat large amount of food, then purges
habit calories by vomiting and/ or using laxatives

Body Too concern on weight and

image
appearance. Too concern on weight and
Dangerously thin but has appearance
false image that the body is
still fat.
Medical
Weakness, fatigue,Nutritional Weakness, fatigue. Dehydration.
symptoms
deficiencies.Low blood pressure
TREATMENT:-
MEDICATION:- Fluoxetine and other antidepressants may reduce binge -eating episodes
and help lessen depression.

Cognitive- behavioral therapy:- Targets the unhealthy eating behaviors and the
unrealistic negative thoughts.

Breaking the binge and purge cycle:- Here patient is taught the skills to monitor eating
habits, avoid situations that trigger binges, cope with stress.

Changing unhealthy thoughts and patterns:-Focuses on identifying and changing

dysfunctional beliefs about weight , dieting and blood shape.

Individual therapy:- Focuses on relationship issues, underlying anxiety and depression,

low self esteem, and feelings of isolation and loneliness
PICA DISORDER:-

Pica is characterized by an appetite for substance largely non- nutritive

(such as clay or chalk). For these actions to be considered pica,
symptoms must persist for >1 month at an age. These are different
variations of pica, as it can be from a cultural tradition, acquired taste
or a neurological mechanism such as an iron deficiency or chemical
imbalance.

Important consideration:- This pattern of eating should last at least

1 month to make the diagnosis of pica
COMPLICATIONS:-
Intoxication, impairment in both physical and mental development.
Surgical emergencies due to an intestinal obstruction.
Nutritional deficiencies.

HIGH TIP:-
Stressors such as maternal deprivation, family issues,
parental neglect, pregnancy, poverty, and a disorganized
family structure are strongly linked to pica.
COMMON FORM OF PICA:-
● Amylophagia (consumption of starch).
● Coprophagy (consumption of feces- animal feces).
● Geophagy (consumption of soil, clay, or chalk).
● Hyalophagia (consumption of glass).
● Consumption of dust or sand has been reported among
iron deficient patients.
● Mucophagia (consumption of mucus).
Odowa:- (Soft stones eaten by pregnant women in kenya).

Treatment:-
● Psychosocial, environmental and family guidance iron
deficiency).
● Treating any mineral deficiencies or other comorbid
conditions.
● Positive reinforcement.
● Discrimination training between edible and inedible items,
with negative consequences.
● Aversive therapy , oral taste (e.g., lemon), smell sensation
(e.g.,ammonia)and physical sensation (e.g.,water mist in face).

● Physical restraint and behavior modificatio:-.

1. Self -protection devices that prohibit placement of objects in the mouth.
2. Time -out contingent on pica being attempted
3. Overcorrection, with attempted pica resulting in required washing of
self, disposal of nonedible objects and chore -based punishment.
4. Negative practice (nonedible object held against patient’s mouth without
allowing ingestion)