Announcements

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Announcements

• Exam is Wednesday
• Q A session is tonight at 7
• My office hour is today at 3PM

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Eating, Sexual, and Gender Identity Disorders
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Etiology Eating Disorders

• Social
• Media influences
• Cultural standards
• Emotion regulation
• Psychological
• Gender role endorsement
• Ideal body internalization
• Body satisfaction

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Genetics
Kendler et al. (1991)
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Treatment of Eating Disorders

• Drugs ineffective for anorexia
• Anti-depressants are useful for Bulimia
• More effective than placebo
• Long-term effects minimal

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CBT

• CBT targets
• Restoring weight (anorexia)
• Ineffectiveness of purging and laxatives
• Dysfunctional thoughts

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CBT

• CBT drugs at 1, 6, and 10 yr follow-ups (Keel
  et al., 2002)
• Only 1/2 improve significantly 1/3 at 1 yr
  follow-up
• A lot of room for improvement
• Perhaps more focus on emotion
• Drugs CBT sometimes more effective

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Summary Conclusions

• Common among women
• Severe consequences
• Biological, Psychological, Social Causes
• Effective treatments available

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Sexual Functioning

• Whats normal? Abnormal?
• Gender identity disorders
• Sexual dysfunction
• Paraphilias

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Mens Sexual Experiences
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College Womens Sexual Experiences
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Gender Differences

• How do you think men and women differ?
• Masturbation frequency
• Attitudes toward casual sex
• Degree of sexual desire
• Emphasis on commitment

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Gender Differences

• Self-concept power and aggression
• Note Within-group variability

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Case Study Jessica

• What was your emotional experience during the
  video?
• Cognitive
• Subjective (feeling)
• Behavioral (or behavioral inclinations)
• Physiological
• Does Jessica have a disorder?

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Gender Identity Disorder

• Physical sex is inconsistent with identity
• Often cross-dress
• Experience teasing
• Very distressing

RuPaul
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GID Prevalence

• 1 in 30,000 males and 1 in 100,000-150,000
  females
• Controversial!

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Hypothesized Causes

• Excessive attention by opposite-sex parent?
• Lack of same-sex playmates during childhood?
• Reinforcement?
• High testosterone or estrogen during pregnancy?

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Psychosocial Treatment

• Change gender identity
• Behavioral techniques
• Effective in case studies
• Patient must be motivated

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Sex Reassignment Surgery

• Must live in opposite sex for 1 year
• Irreversible
• Outcomes
• 75 satisfaction rate
• 7 regret
• 2 attempt suicide

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Summary

• GID
• Uncommon
• Patients suffer
• Little is known about causes and treatment

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Sexual Functioning

• Sexual Response Cycle
• Appetitive phase
• Excitement phase
• Orgasm phase
• Resolution phase

Kaplan (1974) Masters Johnson (1970)
Abnormalities can occur at any phase
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Sexual Dysfunction Case Example

• What maladaptive cognitions does Clark have?
• How common do you think his problems are?
• How might you help him?

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Sexual Dysfunction

• Can occur at any stage

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Sexual Desire Disorders

• Hypoactive sexual desire disorder
• Disinterest
• Distress
• Sexual aversion disorder
• More extreme
• Avoidance

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Sexual Arousal Disorders

• Female Sexual Arousal Disorder
• Inability to maintain lubrication
• Male Erectile Disorder
• Difficulty forming/maintaining erection
• Man feels more impaired

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Male Erectile Disorder
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Orgasmic Disorders

• Male Orgasmic Disorder
• Female Orgasmic Disorder
• Premature Ejaculation

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Biological Causes

• Chronic illness
• Heart attacks
• Vascular diseases
• Medication/Drugs
• SSRIs
• Alcohol, cigarette smoking
• Hormonal influences
• Low testosterone, estrogen

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Environmental Causes

• Early traumatic experiences
• Laumann et al. (1999)
• Sexual abuse among girls doubles risk
• Increases risk for boys too

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Social Causes

• Deterioration in romantic relationship or other
  close relationships

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Psychological Causes

• Performance anxiety
• Negative thoughts
• Im going to make a fool of myself
• A real man doesnt have sexual problems

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Psychosocial Treatment

• William Johnson (1970) Human Sexual Inadequacy
• Goal Eliminate performance anxiety
• Nondemand pleasuring
• Nongenital pleasuring
• Genital pleasuring with ban on orgasm
• Eventually full sexual intercourse

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Psychosocial Treatment

• Close to 100 of premature ejaculation 60
  erectile dysfunction
• 60 to 70 positive outcome 2 years later

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Medical Treatment
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Medical Treatments

• Viagra
• 1998 wonder drug
• Levitra Cialis
• 50 to 80 benefit

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Medical Treatments

• Common side effects
• Headache
• Sneezing
• Flushing
• Blurry vision

• Rare side effects
• Stroke, heart attack
• Priapism
• Low blood pressure

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Paraphilias

• Deviations in sexual arousal targets
• At least 6 months
• Person has acted or experiences distress

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Paraphilias

• Pedophilia
• Scandal in Catholic Church
• 90 of abusers are male
• Incest is a subtype
• Many normal men (about 25) get aroused by
  erotic underage female pictures

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Hypothesized Causes

• Early inappropriate experiences
• Inappropriate sexual fantasies become reinforced
• Paradoxical effects of thought suppression
• Other psychiatric disorders
• 93.3 of pedophiles
• Biological influences unknown

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Treatment

• Covert sensitization
• Emotional description of negative consequences
• Imagine daily until arousal disappears

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Case Study
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Case Study with Follow-UP
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Treatment Outcomes
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Modern Treatment

• Orgasmic reconditioning
• Cognitive restructuring of rationalizations
• Role playing

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Paraphilias Summary

• Little is known about causes
• Can be treated

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Conclusions

• Sexual behavior is highly personal
• A wide range of normalcy
• Negative effects indicate pathology
• Many conditions are understudied