Changes in sexual culture appear to be paralleled by changes in sexual behaviour and attitudes. Nonetheless, there are gender differences with regards to sexual behaviour and attitudes. Men have more permissive sexual attitudes (1), use more pornography (2) and report more masturbation compared to women (3). However, this may be a result of social stigma rather than actual gender differences. Furthermore, men are more negative towards homosexuals but not towards lesbians and men more strongly adhere to gender roles. Gender differences appear to decrease with time. The magnitude of gender differences for some sexual behaviours but not for sexual attitudes is moderated by gender empowerment in a nation. Countries with larger gender differences often hold a double standard and this may influence differences in reporting of sexual behaviours rather than actual differences. Furthermore, there are gender differences across ethnic groups which may be due to differences in power between males and females within that ethnic group. The gender empowerment measure (GEM) assesses the extent of gender equality in countries. According to the social structural theory, countries with higher scores on the GEM would have smaller gender differences in sexuality compared to countries with lower scores on the GEM. Data supports this hypothesis.There are several theories regarding gender differences:Evolutionary psychology (supported)This theory holds that gender differences in sexuality are the result of evolution (i.e. strategies between men and women for genetic success). Cognitive social learning theory (supported)This theory holds that learning takes place by observing others’ behaviours (e.g. through modelling). This implies that exposure to media (e.g. sexual behaviours in the media) influences sexuality.Social structural theory (supported)This theory holds that gender differences are a result of the division of labour by gender and gender disparity...
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“Eagly & Wood (2013). The nature-nurture debates: 25 years of challenges in understanding the psychology of gender.” – Article summary 
In the past, there was a strong focus on nurture when it comes to explaining gender differences. The rise of nature explanations can be explained by increasing possibilities to measure and understand the brain. This led to a focus on the brain and hormones. Explanations of gender differences often only consider nature or nurture rather than both.
Meta-analyses are a relatively new method to assess the gender differences in the population. It makes use of effect sizes, which can be used to assess stability versus variability in research. Most meta-analyses found small effect sizes for gender differences. However, there are some inconsistencies within the meta-analyses. Gender differences appear to be moderated by context (e.g. social context).
There appears to be a gender difference in temperament. Boys appear to have greater surgency (i.e. motor activity; impulsivity; experience of pleasure from high-intensity activities). Girls appear to have greater effortful control (i.e. self-regulatory skills). This may be due to genetic components or due to socialization (e.g. parents tend to encourage gender-typical behaviour and discourage gender-atypical behaviour).
Gender differences in mate preference may differ because of nature or nurture factors. Men value physical attractiveness more (i.e. young, attractive partner) while women value resource provision more (i.e. older, stable partner). However, these preferences may not be universal. Mate preferences may be a social construction, based on gender empowerment (i.e. females who are able to provide for themselves are less attracted to resource provision). Evidence from this comes from the fact that women are more likely to seek an older mate with resources in less gender-equal societies, demonstrating that societal power plays an important role. Nonetheless, this preference also occurred in societies with a higher parasite prevalence, indicating biological preferences. The majority of the evidence appears to indicate that people construct mate preferences within a particular division of labour and value partners with attributes that are useful for the gender roles in society.
However, both nature and nurture theories tend to fail in providing direct evidence for the causal factors underlying sex-typed behaviour. Gender differences likely are influenced by both nature and nurture factors. In interactive theories, it is important to take into account that gene influences often depend on the social environment.
The evoked culture model states that natural selection endowed humans with many cognitive modules that address specific adaptive problems that occurred frequently in the ancestral past. This implies that current environmental cues can evoke one or a set of these domain-specific, inherited behavioural strategies, producing variability in behaviour. This means that different behaviours are genetically coded and the current social and cultural context triggers this.
The biosocial constructionist model states that sociocultural factors shape the meanings that societies ascribe to men and women. These meanings rest on biological difference (e.g. different physique). The specific cognitive capacities of humans are a product of humans’ adaptation to variation itself rather than to environmental features. The sexes organize behaviour into patterns that are
.....read more “Hyde & Delamater (2017). Gender roles and stereotypes.” – Article summary Acculturation refers to the process of incorporating the beliefs and customs of a new culture. Socialization refers to the ways in which society conveys to the individual its norms or expectations for their behaviour.
Intersectionality refers to an approach that simultaneously considers the meaning and consequences of multiple categories of identity, differences and disadvantage. It states that the effects of gender roles should not be viewed in isolation. In the classic gender roles, heterosexuality appears to be central.
The comprehension goal states that people stereotype to better understand people. This can be both negative and positive. The self-enhancement goal states that people stereotype for self-enhancement purposes. This tends to be negative.
A gender binary refers to conceptualizing gender as having only two categories. Gender socialization comes from multiple sources (e.g. parents; media). Gendered parenting is mostly implicit.
Other gender differences are that men are more aggressive (1), more impulsive (2) and take more risks (3). They also differ on sensation seeking (1), risk-taking (2) and impulse control (3). Furthermore, girls tend to self-disclose more than boys and girls are better at decoding non-verbal cues and discerning others’ emotions. These differences may be the result of socialization.
Gender differences in sexuality may exist because men are taught to ignore risks (1), prefer more partners (2), women are warier of the environment (3) and are warier of the possibility of rape (4).
It is possible to measure sexual arousal objectively. This can be done using a penile strain gauge (males) or a vaginal photoplethysmograph (females). Both men and women are aroused by erotica but women are sometimes unaware of their physical arousal.
There are three explanation for gender differences:
There are four cultural explanations for gender differences in sexuality:
There are also several other explanations for gender differences:
“Petersen & Hyde (2010). A meta-analytic review of research on gender differences in sexuality, 1993 – 2007.” – Article summaryChanges in sexual culture appear to be paralleled by changes in sexual behaviour and attitudes. Nonetheless, there are gender differences with regards to sexual behaviour and attitudes. Men have more permissive sexual attitudes (1), use more pornography (2) and report more masturbation compared to women (3). However, this may be a result of social stigma rather than actual gender differences. Furthermore, men are more negative towards homosexuals but not towards lesbians and men more strongly adhere to gender roles.
Gender differences appear to decrease with time. The magnitude of gender differences for some sexual behaviours but not for sexual attitudes is moderated by gender empowerment in a nation. Countries with larger gender differences often hold a double standard and this may influence differences in reporting of sexual behaviours rather than actual differences. Furthermore, there are gender differences across ethnic groups which may be due to differences in power between males and females within that ethnic group.
The gender empowerment measure (GEM) assesses the extent of gender equality in countries. According to the social structural theory, countries with higher scores on the GEM would have smaller gender differences in sexuality compared to countries with lower scores on the GEM. Data supports this hypothesis.
There are several theories regarding gender differences:
The evolutionary psychology theory would predict that men are more likely to engage in casual sex (1), engage in extra-relational sexual behaviours (2), would be more accepting regarding attitudes requiring little sexual commitment (3) and that the desire for short-term mating decreases with age (4). The cognitive social learning theory would predict that women obtain more permissive attitudes towards sex as media exposure increases. Evidence from the gender similarities hypothesis comes from the fact that most gender differences are small or trivial
“Vanwesenbeeck (2009). Doing gender in sex and sex research.” – Article summary Masculinity is typically linked to lesbianism and femininity is linked to male-homosexuality in some contexts but not in all. There are ten major difficulties in the treatment of gender in sex research:
There are several perspectives about the body in relation to gender and sexuality:
According to the objectification theory, being vigilant and constantly aware of the outer body leaves the woman with fewer resources to be aware of the inner body experience (i.e. limited resources perspective). This means that girls’ sexual lives are influenced by self-objectification and hypervigilance of their own body as it requires awareness of the inner body experience.
There are several possible areas where gender differences could exist:
“Cretella, Rosik, & Howsepian (2019). Sex and gender are distinct variables critical to health: Comment on Hyde, Bigler, Joel, Tate, and van Anders (2019).” – Article summary Sex refers to how an organism is organized with respect to reproduction. This is an innate and binary trait not altered by psychological traits.
There are three reasons why sex is binary:
There are several reasons why it is important to adhere to sexual dimorphism:
“Davy (2015). The DSM-5 and the politics of diagnosing transpeople.” – Article summary The emphasis on distress in the diagnosis of gender dysphoria is problematic in two ways:
The true transsexual model referred to a person who required physical changes to their body to fully express their gender identity. However, many transpeople are not able to get these changes due to social, cultural or political reasons. Besides that, this model is focussed on the gender binary and neglects the true experience of transpeople.
It is difficult to call transpeople gender atypical as there is no clear cause for gender behaviour and there is no clear masculine or feminine behaviour. The DSM-5 criteria for gender dysphoria are derived from stereotypes applied in gender identity clinics serving transpeople.
Blanchard’s model states that there are two types of transsexuals:
This model strongly links gender dysphoria to homosexuality and cross-dressing and is heavily contested. For example, autogynephilic fantasies (i.e. imagining having sex as a female) are not specific to transwomen. This model is used in the DSM-5 as these subtypes are used for gender dysphoria. This needlessly sexualizes the diagnosis, which may exacerbate social discrimination and intensify the stigma.
Clinical encounters may not fully account for the multiple ways in which transpeople have lived their lives prior to accessing psychiatric assessment in a gender clinic. This may be because transpeople may be reluctant to relay anything to the gender clinic psychiatrists that may be viewed as different from the perceived ‘correct’ trans narrative. Transpeople tend to tailor their clinical narratives because they realize that psychiatrists have the power to stop their transitioning process. This leads transpeople to need to show distress to convince a psychiatrist.
Psychiatrists use a highly stereotyped notion of gender to provide a framework for assessing and treating transsexuals even though this stereotype may not be accurate. Psychiatrists fail to acknowledge the multiple ways for expressing and identifying with a particular gender (i.e. not necessarily only gender-conforming behaviour).
The heterosexual matrix refers to heterosexual gender roles being seen as natural rather than socially constructed. Intersex refers to the range of conditions affecting the chromosomal make-up (1), the reproductive system (2) and/or the sexual anatomy of a person (3).
The biological advocates of transsexuals state that gender identities are the product of biological dispositions. They claim that these dispositions are caused by hormonal influences in the foetus which produce feminized or masculinized neurological brain structure, which leads to a post-natal desire to transition. This, thus, claims that transsexualism is an innate, biological variation.
There are several things
.....read more “Hyde et al. (2019). The future of sex and gender in psychology: Five challenges to the gender binary.” – Article summaryThe gender binary assumes that one’s category membership is biologically determined (1), apparent at birth (2), stable over time (3), a powerful predictor of psychological variables (4) and salient and meaningful to the self (5). There is an idea that brains are gendered (i.e. male and female brains). In neuroscience requires two assumptions:
For a system to show dimorphism, each of its elements should be dimorphic. Furthermore, all the elements within an individual should be internally consistent (i.e. either all in the form typical of males or typical of females). The brain sex differences are context-dependent. However, it is unlikely that brains are internally consistent and dimorphic. Mosaicism (i.e. one typical female-part in the brain and one typical male-part in the brain) is most common in the human brain.
The idea of gender binary in behavioural neuroendocrinology involves two assumptions:
These assumptions do not hold as both men and women have testosterone and oestrogen. Furthermore, the average level of these hormones does not differ between men and women. The differences in levels of hormones vary across the lifespan. Thus, the gender binary cannot be completed based on androgens and oestrogens.
The reproductive glands are not fixed and innate as their levels vary widely within individuals. Hormones are influenced by social context. For example, testosterone decreases with supportive environments and increases with competitiveness. Furthermore, gendered expectations and lived experiences can shape hormones.
Gender binary in psychological research involves the assumption that there are only two discrete categories of people (i.e. males and females), implicitly stating that there is no overlap between the two categories.
People possess both feminine and masculine psychological characteristics. Internal consistency in personality traits (e.g. all masculine traits) is extremely rare. Stereotypes of men and women exist but individuals who consistently match these stereotypes are very rare. T
Transgender and non-binary people have largely been ignored in psychological research. Psychological research on transgender and non-binary people lead to three major challenges to the gender binary:
Gender identity is not invariably linked to sex category at birth. Gender could be seen as a bundle of separable constructs.
Being gender could be a precondition for doing gender in ways that are
.....read more “Kuyper & Wijsen (2013). Gender identities and gender dysphoria in the Netherlands.” – Article summaryThe prevalence of gender dysphoria is estimated by looking at health care services. However, individuals may be hesitant to seek medical care for gender dysphoria due to stigmatization. Furthermore, healthcare makes use of a dichotomous view of gender while people may be ambivalent about gender and do not desire treatment. This means that the prevalence of adult gender dysphoria may be underestimated.
Parent reports of child behaviour are used to assess the prevalence of gender dysphoria in children. This may lead to an overestimation of the prevalence of gender dysphoria as parents mostly look at cognitive and behavioural aspects and not at affective aspects of gender dysphoria.
Individuals with an ambivalent gender identity were more often men (1), more often had a lower education (2), were more often from a non-Western background (3) and were more often bisexual or homosexual (4). The sexuality aspect could be explained by the fact that people with a different sexuality from homosexuality are more often in scenes where binary gender identities are less common. This leads them to internalize the gender identity less, making it less incongruent.
Men want to transition more often than women. A dislike of one’s body is not always accompanied by a desire for medical treatment to transition. The low percentage of women disliking their body and desiring treatment could be explained by the fact that masculine women are more accepted in society than feminine men. This allows natal women to change their behaviour and gender more accordingly.
A diagnosis of gender dysphoria does not implicate the need for transition treatment and gender dysphoria should be viewed in a more dimensional way (i.e. different degrees of gender dysphoria).
“Reilly (2019). Gender can be a continuous variable, not just a categorical one: Comment on Hyde, Bigler, Joel, Tate, and van Anders (2019). – Article summarySex-role identification refers to the degree to which we develop stereotypical gender traits (1), interests (2) and beliefs (3). Androgyny refers to a healthy integration of both masculine and feminine traits. This affords a greater cognitive and behavioural flexibility and is linked to better psychological health.
There are four reasons why gender should be viewed as a continuous variable:
It appears as if femininity and masculinity are unrelated to sexual orientation. There is scientific evidence that gender identity and biological sex do not always align. This is not a pathology. The Hawthorne effect refers to people changing their answers on a questionnaire after they find out what the questionnaire is about.
“Zucker et al. (2013). Memo outlining evidence for change for gender identity disorder in the DSM-5.” – Article summaryThere were several changes from the DSM-4 to DSM-5 with regards to gender identity disorder:
The old introductory descriptor was a strong and persistent cross-gender identification. The A1 criterion refers to repeatedly stated a desire to be or insistence that one is the other sex. A polythetic form refers to the diagnostic criteria sharing a lot of symptoms among each other which are not essential for diagnosis.
There are several validators of gender dysphoria:
“Althof et al. (2017). Opinion paper: On the diagnosis/classification of sexual arousal concerns in women.” – Article summary In the earliest diagnostic manuals, only inhibited sexual excitement was used to denote psychosexual disorders. However, this was indicated by a lack of a physiological response. In later diagnostic manuals, the FSAD diagnosis was added. However, the subjective arousal subtype was removed from this diagnosis in the DSM-4. This was done to make sure that the male-female similarity in sexual dysfunctions diagnoses could be maintained. The FSAD diagnosis only represents genital arousal and sees subjective arousal and sexual desire as the same thing while it is not.
Desire refers to the motivation to engage in and/or be receptive to a sexual event for sexual or non-sexual gratification. Genital arousal refers to genital changes in response to sexual stimuli. These changes may be associated with other bodily reactions (e.g. increased heart rate). Subjective arousal refers to positive mental engagement and focus in respone to a sexual stimulus. This may include awareness of the presence or absence of genital changes or sensations during a sexual event (i.e. perceived arousal).
There is a close relation between desire and arousal problems. This implies that problems becoming aroused could diminish desire over time and vice versa. However, the correlation between desire and arousal does not account for all the variance. This implies that subjective arousal and desire are not the same variables. The frequency of desire can only explain a small part of the variance in subjective arousal frequency and the level of desire can only explain part of the variance in the level of subjective arousal. A lot of variance in subjective arousal is still unexplained by desire.
It can be expected that there is a low subjective arousal in women with low sexual desire if they are the same construct. However, women with low sexual desire do not necessarily have low subjective arousal. This implies that they are not the same construct.
This is important, as this implies the need to reintroduce the subjective arousal subtype in sexual dysfunction diagnoses. The diagnoses criteria have a major influence on how clinicians organize their thinking about sexual disorders (1, how clinical activity is coded for reimbursement (2), how populations are defined for clinical research (3) and how compounds or psychotherapeutic interventions are evaluated for the treatment of these disorders (4).
“Clinical Perspective on Today’s Issues – Lecture 1 (UNIVERSITY OF AMSTERDAM)” The biological model states that there are biological causes for the differences between men and women (e.g. hormones deeply affecting women but not men). The deficit model states that women are not equal to men with regards to capabilities.
The stereotypes of gender differences are that there are gender differences in:
However, these gender differences do not necessarily exist. The differences in math aptitudes are more culturally determined rather than determined by natal gender. Gender is not a good predictor of mathematics achievement while SES and mother’s education are highly predictive.
Depression is stereotypically seen as a female problem. More women than men reach the diagnostic criteria for depression, especially during adolescence. This difference was already present at age 12 and peaks at the ages 13 to 15 but declines in the 20s and remains stable afterwards.
This stereotype has several problems:
Theories on this gender difference typically focus on the emergence of the gender difference in depression in adolescence. However, the fact that this difference stabilizes in later life needs to taken into account when assessing or creating a theory.
There are several gender differences with medium effect sizes:
“Clinical Perspective on Today’s Issues – Lecture 2 (UNIVERSITY OF AMSTERDAM)” In the Netherlands, the prescribed mental healthcare is captured in quality standards. These standards include recommendations or prescriptions regarding proper treatment. There are several aspects of care:
Each step requires different decisions regarding care. The quality standards can help with the decisions in the treatment and recovery phase. A quality standard outlines what quality care looks like for clinicians and patients for particular conditions. A quality standard is developed independently in a workgroup (e.g. patients, relatives, health professionals). This workgroup collects all information about the subject and based on this, they attempt to reach consensus.
There are three types of information that is used in the workgroup:
There is no hierarchy in this information when it comes to creating quality standards. These quality standards are important because:
Every professional in healthcare should work according to professional standards. However, these standards can be deviated from. The comply or explain principle states that it is acceptable to deviate from this standard when the patient and professional both agree on it and the professional can argue for the decision.
Good quality care at an acceptable cost refers to care that is provided in the right place (1), by the right person (2), efficiently (3) and in good coherence around the patient and his next of kin (4). This requires self-direction (1), self-management (2) and equality of contact (3).
Professional proximity refers to real contact and this is important. Furthermore, it is important to use appropriate diagnostic labels as people do not derive their identity from their complaints (e.g. do not use the term schizophrenics). A counsellor should thus focus on the person and not solely on the diagnostic label. Treatment and support must always be available to enable patients to organize their lives as much as possible as they see fit. This can create independence as soon as possible.
Recovery is not only about the symptoms. It is about the continuation of life after mental health problems or dealing with mental health problems. Recovery involves:
There are several important elements of recovery processes:
“Balon & Clayton (2014). Female sexual interest/arousal disorder: A diagnosis out of thin air.” – Article summaryIn psychiatric illness, the criteria for establishing diagnostic validity are clinical description (1), laboratory studies (2), exclusion of or delineation from other disorders (3), a follow-up study (4) and a family study (5). These criteria are typically not fulfilled or psychiatric illnesses.
According to Balon and Clayton, the primary reason for the creation of the female sexual interest/arousal disorder (FSAID) was to get rid of the linear concept of the sexual response cycle in women and replace it with a circular model of sexual response. However, no diagnosis has been presented for this diagnosis. There are several things wrong with this diagnosis:
According to Balon and Clayton, the establishment of this diagnosis has the potential to inflict harm by excluding women who currently have an ‘old’ diagnosis (HSDD) and it is not clear what will happen with regard to treatment.
“Basson (2014). On the definition of female sexual interest/arousal disorder.” – Article summary The triggering of desire from competent sexual stimuli sometimes only occurs when sexual activity has begun for women. It is important to take the following things into account when describing a diagnosis:
There are five main problems with the FSIAD diagnosis in the DSM-5:
The context should be assessed to evaluate the role this plays in the woman’s sexual dysfunction in this disorder.
“Graham, Boyton, & Gould (2017). Challenging narratives of ‘dysfunction’. “ – Article summaryThe human sexual response cycle (HSRC) proposes a linear series of phases of sexual response. The phases are excitement (1), arousal (2), orgasm (3) and resolution (4). This model assumes that these phases are the same for men and women and the first sexual dysfunctions were based on this model. However, one model of sexual response does not fit all people.
In the DSM-5, duration and severity criteria were added to prevent overdiagnosis of sexual dysfunction. There is no empirical basis for the distinction between subjective arousal and desire. Symptoms must persist for 6 months and for all or almost all sexual encounters. To meet the criteria for a dysfunction, a woman needs to meet three of the following six criteria:
Flibanserin is the first medication to receive FDA approval for the treatment of HSDD. The drug has mixed effects on serotonergic and dopaminergic transmitter systems. Compared to the costs of using the drug, the benefits appear to be marginal.
The Even the Score campaign attempted to increase awareness of HSDD and push for treatment. This campaign claimed that men received more treatment for a similar disorder, although this claim is not true.
Many women seek or desire pharmaceutical treatment for FSD. They seek to return to the level of sexual desire they experienced earlier in the relationship and they claim that desire should remain unaffected by anything outside of the bedroom. This means that they believe that sexual desire is mainly influenced by physiological factors and not by psychological factors.
It is possible that the idea of normal (i.e. having sex frequently) causes distress and anxiety in women who do not live up to that ideal. This causes this behaviour to be pathologized. A focus on the relationship may thus be more effective than a focus on sexual desire.
In most research, there is no clear distinction between sex and desire. The lack of this definition of sex makes it difficult to address where the problems with desire/orgasm may exist. Furthermore, it perpetuates the idea that only vaginal sex equals to real sex. This leads to people who experience pleasure from non-PIV sex but not from PIV sex are categorized as dysfunctional while this is not necessarily the case.
Sex in research on FSD is represented in the following way:
“Graham, Brotto, & Zucker (2014). Response to Balon and Clayton (2014): Female sexual interest/arousal disorder is a diagnosis more on firm ground than thin air.” – Article summary There are gender differences in sexual response and there is widespread recognition for conceptualizing women’s sexual problems differently from those of men. In the FSIAD diagnosis, there is no differentiation between sexual desire and sexual arousal as there is no evidence that these are two different things in women. Many women who were diagnosed with HSDD or FSAD also met the diagnostic criteria for FSIAD.
It was criticized that the FSIAD diagnosis does not contain a lack of lubrication as an essential diagnostic criterion. However, this symptom is a different problem with a mainly biological basis. It should thus be treated by a gynaecologist rather than a psychologist. Besides that, the symptom of lack of lubrication is included in “absent/reduced genital sensations during sexual activity”. Therefore, a lack of lubrication may be a presenting problem but is not a sufficient or necessary one. Furthermore, measures of genital response do not differentiate between women who report sexual arousal problems from those who do not.
All in all, the critique of Balon and Clayton on the FSIAD diagnosis appears to be unfounded. The FSIAD is a move away from the outdated and unidimensional views of the nature of the sexual response.
“Hyde (2019). Kinds of sexual disorders.” – Article summaryA sexual disorder refers to a problem with the sexual response that causes a person mental distress. There is a continuum of sexual functioning rather than categories (i.e. dysfunctional and normal). At first, psychoanalysis was the only available treatment but this was expensive and not always feasible.
A lifelong sexual disorder refers to a sexual disorder that has been present ever since the person became sexual. An acquired sexual disorder refers to a sexual disorder that develops after a period of normal functioning.
Sexual desire refers to an interest in sexual activity, leading the individual to seek out sexual activity or be pleasurably receptive to it. Desire often begins before sexual activity and leads people to initiate sex. However, responsive desire is also possible. The problem in desire disorders is often the discrepancy between a person’s desire and the partner’s desire rather than the absolute level of desire.
There are different desire disorders:
There are also other sexual dysfunctions:
The female sexual interest/arousal disorder was merged from the female low sexual desire disorder (i.e. hypoactive desire disorder) and female arousal disorder (i.e. female sexual arousal disorder). During the menopause, oestrogen levels tend to decrease which, subsequently, leads to a decrease in vaginal lubrication. The prevalence of erectile disorder is less than 10% of men under 40 and 30% of men in their 60s. Psychological reactions to erectile dysfunction may be severe (e.g. shame).
“Toates (2017). Explaining desire: Multiple perspectives.” – Article summary One perspective regarding sexual desire and arousal states that any psychological changes correspond to changes in the brain. The sex hormones are released into the blood by glands and travel to the brain. Here, they sensitize particular regions. This makes these regions more responsive to sexual stimuli and thoughts. This implies that a biological event (e.g. loss of hormones) changes the activity of parts of the brain which is only experienced psychologically (e.g. loss of desire).
Psychological events can have effects throughout the body (e.g. anticipating a sexual encounter can increase levels of the hormone testosterone). A psychological change can precede biological changes. Events in the brain and mind are simultaneously biological and psychological.
Sexual transgression is often strongly socially disapproved and evokes blame. However, there may be a clear biological basis for this which needs to be taken into account without approving sexual transgression. Understanding the properties of the processes that help a person’s sense-making can give insight into how sexual desire, arousal and behaviour are organized.
Simple, self-regulation processes are built-in through evolution when there is a regular trigger to a straightforward action (e.g. reflex). This is because some reflexes may be inefficient if there was conscious control. However, novel problems require conscious processing and cannot be solved through reflexes.
Involuntary, unconscious processes exist alongside conscious processes that bring flexibility and creativity. These two types of processes integrate their control and behaviour is often based on a combination of them. There is behaviour that can be done automatically but also with full conscious control (e.g. brushing teeth0. The responsibility for a given task can move between automatic and controlled modes, depending on the circumstances.
In sexual desire and behaviour, learning plays a central role. Both classical and operant conditioning can play a role in learning of sexual desire and behaviour. A person’s awareness of the link between two events can influence the formation of an association between them (e.g. strengthening). Cues that have been paired with sexual activity acquire potency (incentive value) to trigger directed activity and searching (i.e. sexual arousal). For example, a person’s smell can be linked to attractiveness.
Dopamine systems are central to desires. There can be a strong craving and pleasure associated with its satiety in desires. Sex shares common features with feeding and drug/taking that the presence of the triggering stimulus causes the future to be devalued (e.g. hungry people prefer an immediate reward rather than a delayed bigger reward).
There are several commonalities between feeding and sex:
There are also several commonalities between drug-taking and sex:
“Toates (2017). Arousal.” – Article summary General arousal triggered by a range of non-sexual events can sometimes change into sexual arousal. There appears to be an optimal level of arousal although people differ in the level of optimal arousal. A lot of human behaviour can be explained as attempts to elevate a level of arousal.
Unpredictability (1), danger (2) and novelty (3) elevate arousal. Pleasant arousal is triggered by a range of desirable behaviour (e.g. sexual behaviour). Unpleasant arousal is characterized by fear and anxiety. The bodily states of pleasant and unpleasant arousal overlap considerably.
Negative emotions (e.g. fear) can be transformed into sexual desire. Sexual desire can also be heightened by things that are taboo or illegal. Sexual desire interacts with general excitement seeking. Seeking of arousal could amplify sexual desire. Breaking the boundaries of conventionalism could boost arousal (e.g. voyeurism) The forbidden aspect may be a crucial element in sexual attraction of some people.
Danger, negative emotions and sexual arousal all activate the sympathetic branch of the autonomic nervous system. They share bodily reactions (e.g. elevated heart rate). Emotion can thus enhance sexual arousal because the arousal of the autonomic nervous system becomes available to sexual arousal. Autonomic arousal does not immediately disappear when triggers are removed. This means that it can enhance later sexual attraction (e.g. people are aroused by a stimulus and by making the target of sexual attraction salient, they become more aroused due to the arousal by the neutral stimulus).
People tend to make sense of their bodily reaction by labelling it in terms of the most likely cause. In cases of ambiguity, people may misperceive the cause of their arousal. The time interval between the arousal trigger and the attribution process determines what the subjective arousal is attributed to. With a short time interval, there will be a correct attribution. However, with a longer time interval, it may be misperceived and misattributed (i.e. arousal by neutral stimulus attributed to sexual stimulus). With an even longer time interval, the arousal dissipates.
Arousal is interpreted in terms of available stimulus. This means that arousal induced by another factor than sexual arousal (e.g. negative emotion) makes an attractive partner more attractive and an unattractive partner more unattractive.
Perversion refers to people who celebrate and idealize humiliation (1), hostility (2), defiance (3), the forbidden (4), the furtive (5), the sinful (6) and the breaking of taboos (7). These people feel special for not being normal. These defiant attitudes are essential for the enjoyment of perversion. Physical pain can increase desire for some people but this depends on earlier experiences of pain. Individuals are more likely to exploit pain for sexual arousal in a society where a certain amount of pain is seen as integral to the sexual act.
There are three definitions of sexual arousal:
“Eagly & Wood (2013). The nature-nurture debates: 25 years of challenges in understanding the psychology of gender.” – Article summary In the past, there was a strong focus on nurture when it comes to explaining gender differences. The rise of nature explanations can be explained by increasing possibilities to measure and understand the brain. This led to a focus on the brain and hormones. Explanations of gender differences often only consider nature or nurture rather than both.
Meta-analyses are a relatively new method to assess the gender differences in the population. It makes use of effect sizes, which can be used to assess stability versus variability in research. Most meta-analyses found small effect sizes for gender differences. However, there are some inconsistencies within the meta-analyses. Gender differences appear to be moderated by context (e.g. social context).
There appears to be a gender difference in temperament. Boys appear to have greater surgency (i.e. motor activity; impulsivity; experience of pleasure from high-intensity activities). Girls appear to have greater effortful control (i.e. self-regulatory skills). This may be due to genetic components or due to socialization (e.g. parents tend to encourage gender-typical behaviour and discourage gender-atypical behaviour).
Gender differences in mate preference may differ because of nature or nurture factors. Men value physical attractiveness more (i.e. young, attractive partner) while women value resource provision more (i.e. older, stable partner). However, these preferences may not be universal. Mate preferences may be a social construction, based on gender empowerment (i.e. females who are able to provide for themselves are less attracted to resource provision). Evidence from this comes from the fact that women are more likely to seek an older mate with resources in less gender-equal societies, demonstrating that societal power plays an important role. Nonetheless, this preference also occurred in societies with a higher parasite prevalence, indicating biological preferences. The majority of the evidence appears to indicate that people construct mate preferences within a particular division of labour and value partners with attributes that are useful for the gender roles in society.
However, both nature and nurture theories tend to fail in providing direct evidence for the causal factors underlying sex-typed behaviour. Gender differences likely are influenced by both nature and nurture factors. In interactive theories, it is important to take into account that gene influences often depend on the social environment.
The evoked culture model states that natural selection endowed humans with many cognitive modules that address specific adaptive problems that occurred frequently in the ancestral past. This implies that current environmental cues can evoke one or a set of these domain-specific, inherited behavioural strategies, producing variability in behaviour. This means that different behaviours are genetically coded and the current social and cultural context triggers this.
The biosocial constructionist model states that sociocultural factors shape the meanings that societies ascribe to men and women. These meanings rest on biological difference (e.g. different physique). The specific cognitive capacities of humans are a product of humans’ adaptation to variation itself rather than to environmental features. The sexes organize behaviour into patterns that are
.....read more “Hyde & Delamater (2017). Gender roles and stereotypes.” – Article summary Acculturation refers to the process of incorporating the beliefs and customs of a new culture. Socialization refers to the ways in which society conveys to the individual its norms or expectations for their behaviour.
Intersectionality refers to an approach that simultaneously considers the meaning and consequences of multiple categories of identity, differences and disadvantage. It states that the effects of gender roles should not be viewed in isolation. In the classic gender roles, heterosexuality appears to be central.
The comprehension goal states that people stereotype to better understand people. This can be both negative and positive. The self-enhancement goal states that people stereotype for self-enhancement purposes. This tends to be negative.
A gender binary refers to conceptualizing gender as having only two categories. Gender socialization comes from multiple sources (e.g. parents; media). Gendered parenting is mostly implicit.
Other gender differences are that men are more aggressive (1), more impulsive (2) and take more risks (3). They also differ on sensation seeking (1), risk-taking (2) and impulse control (3). Furthermore, girls tend to self-disclose more than boys and girls are better at decoding non-verbal cues and discerning others’ emotions. These differences may be the result of socialization.
Gender differences in sexuality may exist because men are taught to ignore risks (1), prefer more partners (2), women are warier of the environment (3) and are warier of the possibility of rape (4).
It is possible to measure sexual arousal objectively. This can be done using a penile strain gauge (males) or a vaginal photoplethysmograph (females). Both men and women are aroused by erotica but women are sometimes unaware of their physical arousal.
There are three explanation for gender differences:
There are four cultural explanations for gender differences in sexuality:
There are also several other explanations for gender differences:
“Petersen & Hyde (2010). A meta-analytic review of research on gender differences in sexuality, 1993 – 2007.” – Article summaryChanges in sexual culture appear to be paralleled by changes in sexual behaviour and attitudes. Nonetheless, there are gender differences with regards to sexual behaviour and attitudes. Men have more permissive sexual attitudes (1), use more pornography (2) and report more masturbation compared to women (3). However, this may be a result of social stigma rather than actual gender differences. Furthermore, men are more negative towards homosexuals but not towards lesbians and men more strongly adhere to gender roles.
Gender differences appear to decrease with time. The magnitude of gender differences for some sexual behaviours but not for sexual attitudes is moderated by gender empowerment in a nation. Countries with larger gender differences often hold a double standard and this may influence differences in reporting of sexual behaviours rather than actual differences. Furthermore, there are gender differences across ethnic groups which may be due to differences in power between males and females within that ethnic group.
The gender empowerment measure (GEM) assesses the extent of gender equality in countries. According to the social structural theory, countries with higher scores on the GEM would have smaller gender differences in sexuality compared to countries with lower scores on the GEM. Data supports this hypothesis.
There are several theories regarding gender differences:
The evolutionary psychology theory would predict that men are more likely to engage in casual sex (1), engage in extra-relational sexual behaviours (2), would be more accepting regarding attitudes requiring little sexual commitment (3) and that the desire for short-term mating decreases with age (4). The cognitive social learning theory would predict that women obtain more permissive attitudes towards sex as media exposure increases. Evidence from the gender similarities hypothesis comes from the fact that most gender differences are small or trivial
“Vanwesenbeeck (2009). Doing gender in sex and sex research.” – Article summary Masculinity is typically linked to lesbianism and femininity is linked to male-homosexuality in some contexts but not in all. There are ten major difficulties in the treatment of gender in sex research:
There are several perspectives about the body in relation to gender and sexuality:
According to the objectification theory, being vigilant and constantly aware of the outer body leaves the woman with fewer resources to be aware of the inner body experience (i.e. limited resources perspective). This means that girls’ sexual lives are influenced by self-objectification and hypervigilance of their own body as it requires awareness of the inner body experience.
There are several possible areas where gender differences could exist:
“Cretella, Rosik, & Howsepian (2019). Sex and gender are distinct variables critical to health: Comment on Hyde, Bigler, Joel, Tate, and van Anders (2019).” – Article summary Sex refers to how an organism is organized with respect to reproduction. This is an innate and binary trait not altered by psychological traits.
There are three reasons why sex is binary:
There are several reasons why it is important to adhere to sexual dimorphism:
“Davy (2015). The DSM-5 and the politics of diagnosing transpeople.” – Article summary The emphasis on distress in the diagnosis of gender dysphoria is problematic in two ways:
The true transsexual model referred to a person who required physical changes to their body to fully express their gender identity. However, many transpeople are not able to get these changes due to social, cultural or political reasons. Besides that, this model is focussed on the gender binary and neglects the true experience of transpeople.
It is difficult to call transpeople gender atypical as there is no clear cause for gender behaviour and there is no clear masculine or feminine behaviour. The DSM-5 criteria for gender dysphoria are derived from stereotypes applied in gender identity clinics serving transpeople.
Blanchard’s model states that there are two types of transsexuals:
This model strongly links gender dysphoria to homosexuality and cross-dressing and is heavily contested. For example, autogynephilic fantasies (i.e. imagining having sex as a female) are not specific to transwomen. This model is used in the DSM-5 as these subtypes are used for gender dysphoria. This needlessly sexualizes the diagnosis, which may exacerbate social discrimination and intensify the stigma.
Clinical encounters may not fully account for the multiple ways in which transpeople have lived their lives prior to accessing psychiatric assessment in a gender clinic. This may be because transpeople may be reluctant to relay anything to the gender clinic psychiatrists that may be viewed as different from the perceived ‘correct’ trans narrative. Transpeople tend to tailor their clinical narratives because they realize that psychiatrists have the power to stop their transitioning process. This leads transpeople to need to show distress to convince a psychiatrist.
Psychiatrists use a highly stereotyped notion of gender to provide a framework for assessing and treating transsexuals even though this stereotype may not be accurate. Psychiatrists fail to acknowledge the multiple ways for expressing and identifying with a particular gender (i.e. not necessarily only gender-conforming behaviour).
The heterosexual matrix refers to heterosexual gender roles being seen as natural rather than socially constructed. Intersex refers to the range of conditions affecting the chromosomal make-up (1), the reproductive system (2) and/or the sexual anatomy of a person (3).
The biological advocates of transsexuals state that gender identities are the product of biological dispositions. They claim that these dispositions are caused by hormonal influences in the foetus which produce feminized or masculinized neurological brain structure, which leads to a post-natal desire to transition. This, thus, claims that transsexualism is an innate, biological variation.
There are several things
.....read more “Hyde et al. (2019). The future of sex and gender in psychology: Five challenges to the gender binary.” – Article summaryThe gender binary assumes that one’s category membership is biologically determined (1), apparent at birth (2), stable over time (3), a powerful predictor of psychological variables (4) and salient and meaningful to the self (5). There is an idea that brains are gendered (i.e. male and female brains). In neuroscience requires two assumptions:
For a system to show dimorphism, each of its elements should be dimorphic. Furthermore, all the elements within an individual should be internally consistent (i.e. either all in the form typical of males or typical of females). The brain sex differences are context-dependent. However, it is unlikely that brains are internally consistent and dimorphic. Mosaicism (i.e. one typical female-part in the brain and one typical male-part in the brain) is most common in the human brain.
The idea of gender binary in behavioural neuroendocrinology involves two assumptions:
These assumptions do not hold as both men and women have testosterone and oestrogen. Furthermore, the average level of these hormones does not differ between men and women. The differences in levels of hormones vary across the lifespan. Thus, the gender binary cannot be completed based on androgens and oestrogens.
The reproductive glands are not fixed and innate as their levels vary widely within individuals. Hormones are influenced by social context. For example, testosterone decreases with supportive environments and increases with competitiveness. Furthermore, gendered expectations and lived experiences can shape hormones.
Gender binary in psychological research involves the assumption that there are only two discrete categories of people (i.e. males and females), implicitly stating that there is no overlap between the two categories.
People possess both feminine and masculine psychological characteristics. Internal consistency in personality traits (e.g. all masculine traits) is extremely rare. Stereotypes of men and women exist but individuals who consistently match these stereotypes are very rare. T
Transgender and non-binary people have largely been ignored in psychological research. Psychological research on transgender and non-binary people lead to three major challenges to the gender binary:
Gender identity is not invariably linked to sex category at birth. Gender could be seen as a bundle of separable constructs.
Being gender could be a precondition for doing gender in ways that are
.....read more “Kuyper & Wijsen (2013). Gender identities and gender dysphoria in the Netherlands.” – Article summaryThe prevalence of gender dysphoria is estimated by looking at health care services. However, individuals may be hesitant to seek medical care for gender dysphoria due to stigmatization. Furthermore, healthcare makes use of a dichotomous view of gender while people may be ambivalent about gender and do not desire treatment. This means that the prevalence of adult gender dysphoria may be underestimated.
Parent reports of child behaviour are used to assess the prevalence of gender dysphoria in children. This may lead to an overestimation of the prevalence of gender dysphoria as parents mostly look at cognitive and behavioural aspects and not at affective aspects of gender dysphoria.
Individuals with an ambivalent gender identity were more often men (1), more often had a lower education (2), were more often from a non-Western background (3) and were more often bisexual or homosexual (4). The sexuality aspect could be explained by the fact that people with a different sexuality from homosexuality are more often in scenes where binary gender identities are less common. This leads them to internalize the gender identity less, making it less incongruent.
Men want to transition more often than women. A dislike of one’s body is not always accompanied by a desire for medical treatment to transition. The low percentage of women disliking their body and desiring treatment could be explained by the fact that masculine women are more accepted in society than feminine men. This allows natal women to change their behaviour and gender more accordingly.
A diagnosis of gender dysphoria does not implicate the need for transition treatment and gender dysphoria should be viewed in a more dimensional way (i.e. different degrees of gender dysphoria).
“Reilly (2019). Gender can be a continuous variable, not just a categorical one: Comment on Hyde, Bigler, Joel, Tate, and van Anders (2019). – Article summarySex-role identification refers to the degree to which we develop stereotypical gender traits (1), interests (2) and beliefs (3). Androgyny refers to a healthy integration of both masculine and feminine traits. This affords a greater cognitive and behavioural flexibility and is linked to better psychological health.
There are four reasons why gender should be viewed as a continuous variable:
It appears as if femininity and masculinity are unrelated to sexual orientation. There is scientific evidence that gender identity and biological sex do not always align. This is not a pathology. The Hawthorne effect refers to people changing their answers on a questionnaire after they find out what the questionnaire is about.
“Zucker et al. (2013). Memo outlining evidence for change for gender identity disorder in the DSM-5.” – Article summaryThere were several changes from the DSM-4 to DSM-5 with regards to gender identity disorder:
The old introductory descriptor was a strong and persistent cross-gender identification. The A1 criterion refers to repeatedly stated a desire to be or insistence that one is the other sex. A polythetic form refers to the diagnostic criteria sharing a lot of symptoms among each other which are not essential for diagnosis.
There are several validators of gender dysphoria:
“Althof et al. (2017). Opinion paper: On the diagnosis/classification of sexual arousal concerns in women.” – Article summary In the earliest diagnostic manuals, only inhibited sexual excitement was used to denote psychosexual disorders. However, this was indicated by a lack of a physiological response. In later diagnostic manuals, the FSAD diagnosis was added. However, the subjective arousal subtype was removed from this diagnosis in the DSM-4. This was done to make sure that the male-female similarity in sexual dysfunctions diagnoses could be maintained. The FSAD diagnosis only represents genital arousal and sees subjective arousal and sexual desire as the same thing while it is not.
Desire refers to the motivation to engage in and/or be receptive to a sexual event for sexual or non-sexual gratification. Genital arousal refers to genital changes in response to sexual stimuli. These changes may be associated with other bodily reactions (e.g. increased heart rate). Subjective arousal refers to positive mental engagement and focus in respone to a sexual stimulus. This may include awareness of the presence or absence of genital changes or sensations during a sexual event (i.e. perceived arousal).
There is a close relation between desire and arousal problems. This implies that problems becoming aroused could diminish desire over time and vice versa. However, the correlation between desire and arousal does not account for all the variance. This implies that subjective arousal and desire are not the same variables. The frequency of desire can only explain a small part of the variance in subjective arousal frequency and the level of desire can only explain part of the variance in the level of subjective arousal. A lot of variance in subjective arousal is still unexplained by desire.
It can be expected that there is a low subjective arousal in women with low sexual desire if they are the same construct. However, women with low sexual desire do not necessarily have low subjective arousal. This implies that they are not the same construct.
This is important, as this implies the need to reintroduce the subjective arousal subtype in sexual dysfunction diagnoses. The diagnoses criteria have a major influence on how clinicians organize their thinking about sexual disorders (1, how clinical activity is coded for reimbursement (2), how populations are defined for clinical research (3) and how compounds or psychotherapeutic interventions are evaluated for the treatment of these disorders (4).
“Clinical Perspective on Today’s Issues – Lecture 1 (UNIVERSITY OF AMSTERDAM)” The biological model states that there are biological causes for the differences between men and women (e.g. hormones deeply affecting women but not men). The deficit model states that women are not equal to men with regards to capabilities.
The stereotypes of gender differences are that there are gender differences in:
However, these gender differences do not necessarily exist. The differences in math aptitudes are more culturally determined rather than determined by natal gender. Gender is not a good predictor of mathematics achievement while SES and mother’s education are highly predictive.
Depression is stereotypically seen as a female problem. More women than men reach the diagnostic criteria for depression, especially during adolescence. This difference was already present at age 12 and peaks at the ages 13 to 15 but declines in the 20s and remains stable afterwards.
This stereotype has several problems:
Theories on this gender difference typically focus on the emergence of the gender difference in depression in adolescence. However, the fact that this difference stabilizes in later life needs to taken into account when assessing or creating a theory.
There are several gender differences with medium effect sizes:
“Clinical Perspective on Today’s Issues – Lecture 2 (UNIVERSITY OF AMSTERDAM)” In the Netherlands, the prescribed mental healthcare is captured in quality standards. These standards include recommendations or prescriptions regarding proper treatment. There are several aspects of care:
Each step requires different decisions regarding care. The quality standards can help with the decisions in the treatment and recovery phase. A quality standard outlines what quality care looks like for clinicians and patients for particular conditions. A quality standard is developed independently in a workgroup (e.g. patients, relatives, health professionals). This workgroup collects all information about the subject and based on this, they attempt to reach consensus.
There are three types of information that is used in the workgroup:
There is no hierarchy in this information when it comes to creating quality standards. These quality standards are important because:
Every professional in healthcare should work according to professional standards. However, these standards can be deviated from. The comply or explain principle states that it is acceptable to deviate from this standard when the patient and professional both agree on it and the professional can argue for the decision.
Good quality care at an acceptable cost refers to care that is provided in the right place (1), by the right person (2), efficiently (3) and in good coherence around the patient and his next of kin (4). This requires self-direction (1), self-management (2) and equality of contact (3).
Professional proximity refers to real contact and this is important. Furthermore, it is important to use appropriate diagnostic labels as people do not derive their identity from their complaints (e.g. do not use the term schizophrenics). A counsellor should thus focus on the person and not solely on the diagnostic label. Treatment and support must always be available to enable patients to organize their lives as much as possible as they see fit. This can create independence as soon as possible.
Recovery is not only about the symptoms. It is about the continuation of life after mental health problems or dealing with mental health problems. Recovery involves:
There are several important elements of recovery processes:
“Balon & Clayton (2014). Female sexual interest/arousal disorder: A diagnosis out of thin air.” – Article summaryIn psychiatric illness, the criteria for establishing diagnostic validity are clinical description (1), laboratory studies (2), exclusion of or delineation from other disorders (3), a follow-up study (4) and a family study (5). These criteria are typically not fulfilled or psychiatric illnesses.
According to Balon and Clayton, the primary reason for the creation of the female sexual interest/arousal disorder (FSAID) was to get rid of the linear concept of the sexual response cycle in women and replace it with a circular model of sexual response. However, no diagnosis has been presented for this diagnosis. There are several things wrong with this diagnosis:
According to Balon and Clayton, the establishment of this diagnosis has the potential to inflict harm by excluding women who currently have an ‘old’ diagnosis (HSDD) and it is not clear what will happen with regard to treatment.
“Basson (2014). On the definition of female sexual interest/arousal disorder.” – Article summary The triggering of desire from competent sexual stimuli sometimes only occurs when sexual activity has begun for women. It is important to take the following things into account when describing a diagnosis:
There are five main problems with the FSIAD diagnosis in the DSM-5:
The context should be assessed to evaluate the role this plays in the woman’s sexual dysfunction in this disorder.
“Graham, Boyton, & Gould (2017). Challenging narratives of ‘dysfunction’. “ – Article summaryThe human sexual response cycle (HSRC) proposes a linear series of phases of sexual response. The phases are excitement (1), arousal (2), orgasm (3) and resolution (4). This model assumes that these phases are the same for men and women and the first sexual dysfunctions were based on this model. However, one model of sexual response does not fit all people.
In the DSM-5, duration and severity criteria were added to prevent overdiagnosis of sexual dysfunction. There is no empirical basis for the distinction between subjective arousal and desire. Symptoms must persist for 6 months and for all or almost all sexual encounters. To meet the criteria for a dysfunction, a woman needs to meet three of the following six criteria:
Flibanserin is the first medication to receive FDA approval for the treatment of HSDD. The drug has mixed effects on serotonergic and dopaminergic transmitter systems. Compared to the costs of using the drug, the benefits appear to be marginal.
The Even the Score campaign attempted to increase awareness of HSDD and push for treatment. This campaign claimed that men received more treatment for a similar disorder, although this claim is not true.
Many women seek or desire pharmaceutical treatment for FSD. They seek to return to the level of sexual desire they experienced earlier in the relationship and they claim that desire should remain unaffected by anything outside of the bedroom. This means that they believe that sexual desire is mainly influenced by physiological factors and not by psychological factors.
It is possible that the idea of normal (i.e. having sex frequently) causes distress and anxiety in women who do not live up to that ideal. This causes this behaviour to be pathologized. A focus on the relationship may thus be more effective than a focus on sexual desire.
In most research, there is no clear distinction between sex and desire. The lack of this definition of sex makes it difficult to address where the problems with desire/orgasm may exist. Furthermore, it perpetuates the idea that only vaginal sex equals to real sex. This leads to people who experience pleasure from non-PIV sex but not from PIV sex are categorized as dysfunctional while this is not necessarily the case.
Sex in research on FSD is represented in the following way:
“Graham, Brotto, & Zucker (2014). Response to Balon and Clayton (2014): Female sexual interest/arousal disorder is a diagnosis more on firm ground than thin air.” – Article summary There are gender differences in sexual response and there is widespread recognition for conceptualizing women’s sexual problems differently from those of men. In the FSIAD diagnosis, there is no differentiation between sexual desire and sexual arousal as there is no evidence that these are two different things in women. Many women who were diagnosed with HSDD or FSAD also met the diagnostic criteria for FSIAD.
It was criticized that the FSIAD diagnosis does not contain a lack of lubrication as an essential diagnostic criterion. However, this symptom is a different problem with a mainly biological basis. It should thus be treated by a gynaecologist rather than a psychologist. Besides that, the symptom of lack of lubrication is included in “absent/reduced genital sensations during sexual activity”. Therefore, a lack of lubrication may be a presenting problem but is not a sufficient or necessary one. Furthermore, measures of genital response do not differentiate between women who report sexual arousal problems from those who do not.
All in all, the critique of Balon and Clayton on the FSIAD diagnosis appears to be unfounded. The FSIAD is a move away from the outdated and unidimensional views of the nature of the sexual response.
“Hyde (2019). Kinds of sexual disorders.” – Article summaryA sexual disorder refers to a problem with the sexual response that causes a person mental distress. There is a continuum of sexual functioning rather than categories (i.e. dysfunctional and normal). At first, psychoanalysis was the only available treatment but this was expensive and not always feasible.
A lifelong sexual disorder refers to a sexual disorder that has been present ever since the person became sexual. An acquired sexual disorder refers to a sexual disorder that develops after a period of normal functioning.
Sexual desire refers to an interest in sexual activity, leading the individual to seek out sexual activity or be pleasurably receptive to it. Desire often begins before sexual activity and leads people to initiate sex. However, responsive desire is also possible. The problem in desire disorders is often the discrepancy between a person’s desire and the partner’s desire rather than the absolute level of desire.
There are different desire disorders:
There are also other sexual dysfunctions:
The female sexual interest/arousal disorder was merged from the female low sexual desire disorder (i.e. hypoactive desire disorder) and female arousal disorder (i.e. female sexual arousal disorder). During the menopause, oestrogen levels tend to decrease which, subsequently, leads to a decrease in vaginal lubrication. The prevalence of erectile disorder is less than 10% of men under 40 and 30% of men in their 60s. Psychological reactions to erectile dysfunction may be severe (e.g. shame).
“Toates (2017). Explaining desire: Multiple perspectives.” – Article summary One perspective regarding sexual desire and arousal states that any psychological changes correspond to changes in the brain. The sex hormones are released into the blood by glands and travel to the brain. Here, they sensitize particular regions. This makes these regions more responsive to sexual stimuli and thoughts. This implies that a biological event (e.g. loss of hormones) changes the activity of parts of the brain which is only experienced psychologically (e.g. loss of desire).
Psychological events can have effects throughout the body (e.g. anticipating a sexual encounter can increase levels of the hormone testosterone). A psychological change can precede biological changes. Events in the brain and mind are simultaneously biological and psychological.
Sexual transgression is often strongly socially disapproved and evokes blame. However, there may be a clear biological basis for this which needs to be taken into account without approving sexual transgression. Understanding the properties of the processes that help a person’s sense-making can give insight into how sexual desire, arousal and behaviour are organized.
Simple, self-regulation processes are built-in through evolution when there is a regular trigger to a straightforward action (e.g. reflex). This is because some reflexes may be inefficient if there was conscious control. However, novel problems require conscious processing and cannot be solved through reflexes.
Involuntary, unconscious processes exist alongside conscious processes that bring flexibility and creativity. These two types of processes integrate their control and behaviour is often based on a combination of them. There is behaviour that can be done automatically but also with full conscious control (e.g. brushing teeth0. The responsibility for a given task can move between automatic and controlled modes, depending on the circumstances.
In sexual desire and behaviour, learning plays a central role. Both classical and operant conditioning can play a role in learning of sexual desire and behaviour. A person’s awareness of the link between two events can influence the formation of an association between them (e.g. strengthening). Cues that have been paired with sexual activity acquire potency (incentive value) to trigger directed activity and searching (i.e. sexual arousal). For example, a person’s smell can be linked to attractiveness.
Dopamine systems are central to desires. There can be a strong craving and pleasure associated with its satiety in desires. Sex shares common features with feeding and drug/taking that the presence of the triggering stimulus causes the future to be devalued (e.g. hungry people prefer an immediate reward rather than a delayed bigger reward).
There are several commonalities between feeding and sex:
There are also several commonalities between drug-taking and sex:
“Toates (2017). Arousal.” – Article summary General arousal triggered by a range of non-sexual events can sometimes change into sexual arousal. There appears to be an optimal level of arousal although people differ in the level of optimal arousal. A lot of human behaviour can be explained as attempts to elevate a level of arousal.
Unpredictability (1), danger (2) and novelty (3) elevate arousal. Pleasant arousal is triggered by a range of desirable behaviour (e.g. sexual behaviour). Unpleasant arousal is characterized by fear and anxiety. The bodily states of pleasant and unpleasant arousal overlap considerably.
Negative emotions (e.g. fear) can be transformed into sexual desire. Sexual desire can also be heightened by things that are taboo or illegal. Sexual desire interacts with general excitement seeking. Seeking of arousal could amplify sexual desire. Breaking the boundaries of conventionalism could boost arousal (e.g. voyeurism) The forbidden aspect may be a crucial element in sexual attraction of some people.
Danger, negative emotions and sexual arousal all activate the sympathetic branch of the autonomic nervous system. They share bodily reactions (e.g. elevated heart rate). Emotion can thus enhance sexual arousal because the arousal of the autonomic nervous system becomes available to sexual arousal. Autonomic arousal does not immediately disappear when triggers are removed. This means that it can enhance later sexual attraction (e.g. people are aroused by a stimulus and by making the target of sexual attraction salient, they become more aroused due to the arousal by the neutral stimulus).
People tend to make sense of their bodily reaction by labelling it in terms of the most likely cause. In cases of ambiguity, people may misperceive the cause of their arousal. The time interval between the arousal trigger and the attribution process determines what the subjective arousal is attributed to. With a short time interval, there will be a correct attribution. However, with a longer time interval, it may be misperceived and misattributed (i.e. arousal by neutral stimulus attributed to sexual stimulus). With an even longer time interval, the arousal dissipates.
Arousal is interpreted in terms of available stimulus. This means that arousal induced by another factor than sexual arousal (e.g. negative emotion) makes an attractive partner more attractive and an unattractive partner more unattractive.
Perversion refers to people who celebrate and idealize humiliation (1), hostility (2), defiance (3), the forbidden (4), the furtive (5), the sinful (6) and the breaking of taboos (7). These people feel special for not being normal. These defiant attitudes are essential for the enjoyment of perversion. Physical pain can increase desire for some people but this depends on earlier experiences of pain. Individuals are more likely to exploit pain for sexual arousal in a society where a certain amount of pain is seen as integral to the sexual act.
There are three definitions of sexual arousal:
“Brewin et al. (2009). Reformulating PTSD for DSM-V: Life after criterion A.” – Article summaryPost-traumatic stress disorder (PTSD) was introduced to have a single cause (i.e. traumatic event). This is unique as there is a clear, environmental cause rather than a complex interplay between environmental and genetic factors, such as in other disorders. However, not everyone who experiences trauma develops PTSD. This leads to three main criticisms towards PTSD:
The reaction to extreme stress is not necessarily time-limited and there is unique brain activation in PTSD compared to other people. This means that the first criticism does not fully hold. People have developed PTSD symptoms as a result of lower intensity traumas (e.g. learning about 9/11) due to genetic vulnerability. Furthermore, prolonged stress also leads to PTSD symptoms and indirect traumas (e.g. Halloween films) do not appear to lead to the full diagnostic criteria for PTSD.
It is undesirable to specify trigger events as an individual’s symptomatic profile will be shaped by their genetics (1), environmental history (2) and an interaction of the two (3). The A criterion only describes the usual context of PTSD without contributing to its diagnosis. It may thus be best to abolish the A criterion and refocus PTSD on a smaller set of core symptoms. It should be refocused around re-experiencing the event in the present in the form of intrusive multisensory images accompanied by a marked fear or horror. Refocusing the diagnosis of PTSD leads to a greater homogeneity of cases and reduced overlap with other disorders.
Proposed Diagnostic |
“Cacioppo et al. (2015). Loneliness: Clinical import and interventions.” – Article summary Loneliness refers to a discrepancy between an individual’s preferred and actual social relations. This discrepancy leads to the negative experience of feeling alone and the distress of feeling socially isolated. Feeling alone does not mean being alone and vice versa. An individual’s prior experiences (1), current attributions (2) and overall preference for social contact (3) influence an individual’s perception of the social environment and this influences loneliness.
There are three dimensions of loneliness:
The three dimensions correspond with the intimate space (1), social space (2) and public space (3).
Intimate loneliness corresponds to the inner core (i.e. intimate space). This can include up to five people. It comprises the people one relies on for emotional support during crises. Intimate partners tend to be a primary source of attachment (1), emotional connection (2) and emotional support (3). This indicates that a person’s marital status is an important predictor of intimate loneliness.
Relational loneliness corresponds to the sympathy group (i.e. social space). This can include anywhere between 15 to 50 people. It comprises core social partners whom one sees regularly and from whom one can obtain high-cost instrumental support. The frequency of contact with significant friends or family is the best predictor of relational loneliness. This plays a bigger role in the loneliness of women than that of men. The quality of friendship is more important than the number of friendships.
Collective loneliness corresponds to the active group (i.e. public space). This can include anywhere between 150 to 1500 people. It comprises individuals who can provide information through weak ties as well as low-cost support. This is a social space in which an individual can connect to similar others at a distance in a collective space. The number of voluntary groups one is part of is the best predictor of collective loneliness. This plays a bigger role in the loneliness of men than that of women.
People require the presence of significant others who they can trust and with whom they can plan (1), interact (2) and work together to survive and prosper (3). The physical presence of others in one’s social environment is not a sufficient condition. It is necessary that one feels connected to others. The perception of the friendly or hostile nature of one’s social environment is a characteristic of loneliness.
Loneliness and depression are not the same. Lonely people believe that all would be perfect if they were united with another longed-for person.
.....read more “DiTomasso, Brannen-McNulty, Ross, & Burgess (2003). Attachment styles, social skills and loneliness in young adults.” – Article summary Attachment provides the framework for how an individual perceives and interacts with the world. There is a heightened reliance on attachment relationships for adolescents when transitioning to adulthood. Bartholomew’s theory of attachment states that attachment should be explained in terms of how individuals perceive themselves and others in relationships. There are four attachment styles in adolescents and adults:
Transition is evaluated in the terms of the ease by which adolescents adjust to adulthood. This can be measured using indirect measures of psychosocial functioning (e.g. loneliness). An attachment style leads to attachment working models. This may provide the foundation for the development of social skills.
Attachment is associated with aspects of social competence (e.g. social support seeking; social adjustment). There is a relationship between attachment and social skills although it is not clear whether this mediates the effect of attachment on loneliness.
Riggio states that emotional and social skills are a set of interpersonal abilities that facilitate social interaction. There are several ways in which emotional and social skills are expressed:
These skills are associated with higher levels of self-esteem and this is an indicator of self-esteem. A balance may facilitate adolescents’ transition to adulthood and enhance psychosocial adjustment.
A secure attachment is associated with lower loneliness. A fearful attachment is associated with higher levels of loneliness. A dismissing attachment is associated with greater social
.....read more “DSM-5. Posttraumatic stress disorder.” – Article summary The clinical presentation of PTSD varies. It is not entirely clear what is seen as a traumatic event and what is not. A life-threatening illness or medical condition is not seen as trauma but medical incidents can qualify as traumatic events (e.g. waking up during surgery), same as a medical catastrophe in one’s child.
Intrusive recollection is not the same as depressive rumination. Intrusive recollection applies to involuntary and intrusive distressing memories. It can be short (e.g. flashback) but can lead to prolonged stress and heightened arousal.
In PTSD, there often is a heightened sensitivity to threats. Developmental regression (e.g. loss of language) may occur in children. PTSD can lead to difficulties in regulating emotions or maintaining stable interpersonal relationships.
The lifetime prevalence of PTSD is 8.7% in the United States and the twelve-month prevalence is 3.5%. These estimates are lower in many other countries (e.g. European countries). Different groups have different levels of exposure to traumatic events. The conditional probability of developing PTSD following a similar level of exposure may differ between groups.
Cultural syndromes (e.g. ataques de nervosia) may influence the expression of PTSD. The risk of onset of PTSD and severity may differ across cultural groups as a result of:
PTSD appears to be more severe if the traumatic event is interpersonal and intentional (e.g. torture). The highest PTSD rates are found among rape survivors (1), military combat and captivity survivors (2) and ethnically and politically-motivated internment and genocide survivors (3). Young children and older adults are less likely to show full-threshold PTSD.
The symptoms and relative predominance of symptoms may vary over time. Symptom recurrence and intensification may occur in response to reminders of the original trauma (1), ongoing life stressors (2) and newly experienced traumatic events (3). PTSD symptoms may exacerbate as result of declining health (1), worsening cognitive functioning (2) and social isolation (3).
Individuals who continue to experience PTSD into older adulthood may express fewer symptoms of hyperarousal (1), avoidance (2) and negative cognitions and moods (3) compared with younger adults. However, adults exposed to traumatic events during later life may display more avoidance (1), hyperarousal (2), sleep problems (3) and crying spells (4) than younger adults exposed to the same traumatic event.
There are several pre-trauma risk factors for the development of PTSD:
There are several peritraumatic
.....read more “Ozer, Lipsey, & Weiss (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis.” – Article summary There was no clear recognition of the chronic, long-term post-traumatic stress reactions before the diagnosis of PTSD. The amygdala (1), hippocampus (2) and HPA axis (3) are imperative in the development and maintenance of PTSD. The hippocampus and amygdala are involved in the registration of dangerous events and the formation of memories about this.
Memories formed under emotionally arousing situations behave differently from those that are not. Memory formation can be altered by the blocking effects of adrenalin. This means that the degree of arousal during or directly after a traumatic event has fundamental importance for the development of intrusive and hyperarousal symptoms.
Acute stress disorder (ASD) is a good predictor of PTSD but does not necessarily lead to the development of PTSD. The prevalence of PTSD is higher for women and minority groups, potentially due to their high exposure to traumatic events (e.g. sexual assault). The lifetime prevalence of exposure to a traumatic event is more than 50%.
There are several predictors of PTSD:
Peritraumatic dissociation is most strongly related to individuals seeking mental health services. This is only measurable after the trauma. It may occur because the trauma is so
.....read more “Pincus & Gurtman (2006). Interpersonal theory and the interpersonal circumplex.” – Article summary According to Sullivan, personality refers to the relatively enduring pattern of recurrent interpersonal situations which characterize a human life. This emphasizes the interpersonal situation. The interpersonal theory has two assumptions:
Integrating tendencies bring people together in mutual pursuit of satisfaction (1), security (2) and self-esteem (3). Dynamisms refers to the dynamic between the self and the interacting partner. This gives rise to long-lasting concepts of the self and the other.
Each situation ranges from rewarding to very anxious (i.e. on an anxiety gradient). Interpersonal learning of self-concept and social behaviour is based on an anxiety gradient. The interpersonal situation underlies genesis (1), development (2), maintenance (3) and mutability (4) of personality through the continuous patterning and repatterning of interpersonal experience in relation to the needs. Individual variation in personality occurs through interaction between a person’s level of cognitive maturation and characteristics of the interpersonal situation encountered. Abnormal personality is expressed via disturbed interpersonal relations.
The interpersonal circumplex refers to a system of personality. It is not necessarily a classification system. It assumes that behaviour could be understood when related to a dynamic theory of personality. However, the circumplex is not an operationalization of the interpersonal theory. It describes enduring patterns of interpersonal behaviour and can demonstrate behavioural rigidity.
Interpersonal mechanisms refer to the process variables of personality (i.e. personality in action). It reflects the interaction process between group members. The focus is on behaviour and the variables can be measured on a scale of behavioural intensity. The basic dimensions of the circumplex are latent variables. The circumplex states that normal and abnormal personality lie on a continuum.
Interpersonal traits refer to enduring tendencies of personality. A trait refers to how a person behaves in certain situations. Abnormality refers to rigid reliance on a limited class of interpersonal behaviours regardless of situational influences or norms. They are often enacted at inappropriate levels of intensity. Normality refers to the flexible and adaptive deployment of behaviours covering the entire circumplex within moderate ranges of intensity.
Extremity refers to a person’s deviance from a normative position on a particular dimension on the circumplex. This is likely to be undesirable and rarely situationally appropriate or successful. Rigidity refers to a summary of one’s limited repertoires across various interpersonal situations. This is a characteristic of a person.
Intraindividual variability in interpersonal behaviours may be an important and stable individual difference variable. However, traditional measures of interpersonal functioning involve assessments at a single point in time. Flux refers to the variability of an individual’s mean score on a particular interpersonal dimension (e.g. aggression). Spin refers to the variability of the person’s angular position across time. Pulse refers to the variability in vector length.
The inventory of interpersonal problems measures abnormal personality
.....read more “Schaver & Mikulincer (2011). An attachment-theory framework for conceptualizing interpersonal behaviour.” – Article summary Both Bowlby’s and Ainsworth’s attachment theory are used to conceptualize close interpersonal relationships. This theory states that people have core systems (i.e. attachments) and this is modifiable by experience.
Bowlby’s attachment theory states that humans have an innate attachment behavioural system. This motivates them to seek proximity to significant others (i.e. attachment figures). The main goal is to maintain adequate protection and support. Though the attachment system remains active over a lifespan, people become increasingly able to gain comfort from internal representations of attachment figures (i.e. attachment figure does not have to be physically present).
Attachment working models refer to the mental presentation of the self and others. These working models include procedural knowledge about how social interactions unfold and how one can best handle stress and distress;
An attachment style refers to a person’s chronic pattern of relational expectations (1), emotions (2) and behaviours (3) that results from attachment experiences. Attachment is crucial for maintaining emotional stability (1), developing positive attitudes towards the self and others (2) and forming satisfying close relationships (3).
Attachment insecurities interfere with prosocial attitudes and behaviour during interactions with people who are distressed or in need. A negative attachment is associated with more negative interactions (1), emotions (2) and less responsiveness to a partner’s needs (3).
Individual differences in attachment are the result of the availability (1), responsiveness (2) and supportiveness (3) of an attachment figure. The individual differences can be measured along avoidance and anxiety. Avoidance refers to the extent to which a person distrusts others’ goodwill and relies on deactivating strategies for coping with attachment insecurities. Anxiety refers to the degree to which a person worries that a relationship partner will be unavailable in times of need and relies on hyperactivation strategies. More avoidant people are less inclined to forgive and feel less grateful.
The individual differences in attachment shape cognitive-motivational predispositions and this biases the way people attend, interpret and respond to information that arises during a social interaction. Attachment-related patterns of social information processing predict interpersonal behaviour.
Personal predispositions (e.g. attitudes) are a part of a person’s attachment style. It is manifested in a person’s goal structure (i.e. goals in social interaction) and is demonstrated in a person’s declarative knowledge (1), procedural knowledge (2) and beliefs (3). This predisposition biases the acquisition and use of social information during an interaction via top-down
.....read more “Ehlers & Clark (2000). A cognitive model of posttraumatic stress disorder.” – Article summary Ehler and Clarke’s cognitive model of PTSD states that persistent PTSD only occurs if individuals process the traumatic event and/or consequences in a way which produces a sense of serious, current threat. People with persistent PTSD are unable to see the trauma as a time-limited event that does not have global implications for their future. There are two key processes that lead to this sense of threat:
The perception of current threat is accompanied by intrusions and other re-experiencing symptoms when activated. This motivates a series of behavioural and cognitive responses that are intended to reduce perceived threat and distress in the short-term but prevent cognitive change. This maintains the disorder.
There are several types of appraisal which can produce a sense of current threat:
The interpretation of one’s initial PTSD symptoms (1), other people’s reactions in the aftermath of the trauma (2) and the appraisal of the consequences of the trauma in other life domains (e.g. physical consequences) (3) are important and can produce a sense of current threat. Initial PTSD symptoms are normal after a traumatic event. If people appraise this as being an integral part of the self, then they may conclude that the trauma has permanently changed them.
These appraisals maintain PTSD by directly producing negative emotions and by encouraging individuals to engage in dysfunctional coping strategies. The nature of the emotional response in PTSD depends on the appraisal:
There are several characteristics of involuntary re-experiencing:
The cues for reexperiencing do not need to have a strong semantic relationship to the trauma (e.g. a similar smell may be enough). The pattern of retrieval and the intrusion characteristics may exist due
.....read more “Forest & Wood (2012). When social networking is not working: Individuals with low self-esteem recognize but do not reap the benefits of self-disclosure on Facebook.” – Article summary There is no difference between people with a high and a low self-esteem with regards to the desire for connection. However, compared to people with a high self-esteem, people with a low self-esteem have several characteristics.
One essential part of the development of intimacy is self-disclosure. However, people with a low self-esteem may be self-protective. They focus on avoiding revealing their flaws rather than focusing on their good qualities. This orientation guides a lot of the behaviours of people with low self-esteem and leads them to self-disclose less. Self-disclosure is positively associated with likability (1), relationship quality (2) and relationship stability (2).
Both people with a low and high self-esteem view Facebook as offering opportunities to express themselves. There are several characteristics of Facebook usage of people with low self-esteem:
People with lower self-esteem are liked less by strangers on Facebook due to the increased negativity. There is a greater social reward for more positive updates on Facebook for people with a low self-esteem but not for people with a high self-esteem. For people with a higher self-esteem, there is a greater social reward for more negative updates but not for people with a low self-esteem.
It is possible that disclosing negative personal information signals that the discloser trusts the person and desires connection. However, expressing negativity on Facebook may lack fostering intimacy and may lose its relationship-boosting effects when it is constant and indiscriminate (e.g. public post rather than a private message).
“Nadkarni & Hofmann (2012). Why do people use Facebook?” – Article summary Social networking sites (SNS) refer to internet-based services that give individuals three major capabilities:
The use of Facebook varies according to a user’s gender (1), ethnicity (2) and parental educational background (3). There are several characteristics of Facebook usage for people who score high on extraversion:
These characteristics may arise due to extraverted people’s need for a high level of stimulation and a large social network. Introverted people tend to transfer their socially inhibited behavioural style from offline to online. They have fewer Facebook friends but tend to spend more time on Facebook and have a more favourable attitude towards Facebook.
People who score high on neuroticism prefer the wall function and share more basic information. People who score low on neuroticism also share more basic information but not people with a moderate score. People with greater openness to experience use more features form the personal information section. People with high narcissism and low self-esteem tend to spend more time on Facebook. They are also more likely to post self-promotional photos enhanced by Photoshop.
The tendency to disclose and the need for popularity are predictors of information disclosure on Facebook. Facebook use is predicted by high levels of extraversion (1), neuroticism (2) and narcissism (3), low levels of self-esteem (4) and self-worth (5).
The dual-factor model of Facebook use states that Facebook use is primarily motivated by the need to belong and the need for self-presentation. The need to belong refers to the intrinsic drive to affiliate with others and gain social acceptance. The need for self-presentation refers to the continuous process of impression management.
Self-esteem and self-worth are closely associated with the need to belong. Self-esteem may play the role of monitoring one’s acceptability in the group (e.g. drop in self-esteem motivates steps to avoid rejection and improve standing of social hierarchy).
Exposure to information presented on one’s Facebook profile enhances self-esteem. This is especially the case when selectively self-presenting (e.g. editing information). Facebook use intensity reduces students’ perceived levels of loneliness. However, it is not clear whether Facebook use improves self-esteem as results are mixed.
Facebook use may facilitate relationship development and acceptance of peers. The association between Facebook use and self-esteem may be moderated by cultural and social factors. A general disconnection appears to motivate Facebook use and being connected appears to reward Facebook use.
The idealized-virtual identity hypothesis states that social media allows users to display their
.....read more “Van den Hout & Engelhard (2012). How does EMDR work?” – Article summary Eye movement desensitization and reprocessing (EMDR) is an effective treatment for alleviating PTSD symptoms. In EMDR, the patient recalls traumatic memories while simultaneously making horizontal eye movements. There are three hypotheses as to why and how EMDR works:
During recall, a memory becomes labile (i.e. events during recall influence how the memory is reconsolidated). The imagination inflation effect states that attempting to form a vivid and realistic image during recall influences the original memory. This makes the memory more vivid and realistic. The imagination deflation effect may occur by taxing the working memory while recalling the memory.
Eye movements thus tax working memory and make sure that the traumatic memory is reconsolidated less vividly (i.e. working memory theory). This can also reduce the impact of flashforwards and flashbacks. Other tasks that task the working memory are also effective (e.g. mental arithmetic). EMDR may be useful in treating other disorders as many disorders are activated by a negative event. However, the evidence for this is sparse.
There is an inverted U when it comes to the effectiveness of increasing working memory load. The competition between the recall of the traumatic memory and distracting tasks decreases the vividness and emotionality of the memory. This means that the tax on the working memory should not be too great. People who have a stronger delay on a reaction time task when they make eye movements improve more as a result of EMDR. This means that people with lower working memory capacity benefit more from EMDR.
Clinicians appear to increasingly use tones in the right and left ear instead of eye movements with EMDR. This is based on the interhemispheric communication hypothesis and patient preferences. However, there is no clear evidence as to whether this is effective. It is less effective than eye movements.
Mindfulness-based treatments may be effective for the treatment of PTSD. These treatments make use of mindful breathing. This taxes working memory to the same extent as eye movements, making it effective for the same reasons that
.....read more “Van Emmerik & Kamphuis (2015). Writing therapies for post-traumatic stress and post-traumatic stress disorder: A review of procedures and outcomes.” – Article summary For PTSD treatment, it is important to spend sufficient time on psychoeducation. The patient should understand the likely causes of their symptoms and how the treatment is supposed to alleviate these symptoms.
Writing therapy is effective for the treatment of PTSD and consists of three phases:
There are several guidelines for writing the letters:
Writing therapy is an effective alternative for people who do not benefit from TF-CBT or EMDR. It also appears to be effective in online settings (i.e. online writing). Writing may trigger specific processing mechanisms of the experience. One unique aspect is that it focused on social sharing. This may increase social support.
Imaginal exposure promotes the connection of previously unconnected traumatic memories into autobiographical memory. This reduces the probability that these memories are involuntarily activated. Furthermore, it may facilitate the retrieval of traumatic memories that are otherwise difficult to retrieve. This, in turn, can lead to modification of the appraisals of the event.
“Watkins et al. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions.” – Article summary Trauma-focused interventions refer to interventions that directly address memories of the traumatic event or thoughts and feelings related to the traumatic event (e.g. EMDR). Non-trauma focused interventions refer to interventions that do not directly address memories of the traumatic event or thoughts and feelings related to the traumatic event (e.g. stress inoculation training).
A combination of medication and psychotherapy is not recommended for the treatment of PTSD. Treatment of PTSD needs to focus on the focus of reexperiencing symptoms. This is the index trauma. Treatment drop-out appears to be lower in present-centred treatments than in trauma-specific treatments.
There are several strongly recommended treatments for PTSD:
The prolonged exposure treatment is based on the emotional processing theory. This theory states that fear is represented in memory as a cognitive structure that includes representations of the feared stimuli (1), the fear responses (2) and the meaning associated with the stimuli and responses to the stimuli (3). This fear structure can be dysfunctional when it does not represents a realistic threat anymore. This occurs when:
The cognitive processing theory assumes that people attempt to make sense of what happened after a traumatic event. This can lead to distorted cognitions of themselves, the world and others (e.g. “I am worthless).
Assimilation refers to when incoming information is altered to confirm prior beliefs. This could result in self-blame (e.g. “I was assaulted because I did not fight back”). Accommodation refers to altering beliefs to accommodate new learning (e.g. “I couldn’t have prevented what happened”). Over-accommodation refers to changing beliefs to prevent trauma from occurring in the future (e.g. “the world is a dangerous place”).
Cognitive restructuring
.....read more “Eagly & Wood (2013). The nature-nurture debates: 25 years of challenges in understanding the psychology of gender.” – Article summary In the past, there was a strong focus on nurture when it comes to explaining gender differences. The rise of nature explanations can be explained by increasing possibilities to measure and understand the brain. This led to a focus on the brain and hormones. Explanations of gender differences often only consider nature or nurture rather than both.
Meta-analyses are a relatively new method to assess the gender differences in the population. It makes use of effect sizes, which can be used to assess stability versus variability in research. Most meta-analyses found small effect sizes for gender differences. However, there are some inconsistencies within the meta-analyses. Gender differences appear to be moderated by context (e.g. social context).
There appears to be a gender difference in temperament. Boys appear to have greater surgency (i.e. motor activity; impulsivity; experience of pleasure from high-intensity activities). Girls appear to have greater effortful control (i.e. self-regulatory skills). This may be due to genetic components or due to socialization (e.g. parents tend to encourage gender-typical behaviour and discourage gender-atypical behaviour).
Gender differences in mate preference may differ because of nature or nurture factors. Men value physical attractiveness more (i.e. young, attractive partner) while women value resource provision more (i.e. older, stable partner). However, these preferences may not be universal. Mate preferences may be a social construction, based on gender empowerment (i.e. females who are able to provide for themselves are less attracted to resource provision). Evidence from this comes from the fact that women are more likely to seek an older mate with resources in less gender-equal societies, demonstrating that societal power plays an important role. Nonetheless, this preference also occurred in societies with a higher parasite prevalence, indicating biological preferences. The majority of the evidence appears to indicate that people construct mate preferences within a particular division of labour and value partners with attributes that are useful for the gender roles in society.
However, both nature and nurture theories tend to fail in providing direct evidence for the causal factors underlying sex-typed behaviour. Gender differences likely are influenced by both nature and nurture factors. In interactive theories, it is important to take into account that gene influences often depend on the social environment.
The evoked culture model states that natural selection endowed humans with many cognitive modules that address specific adaptive problems that occurred frequently in the ancestral past. This implies that current environmental cues can evoke one or a set of these domain-specific, inherited behavioural strategies, producing variability in behaviour. This means that different behaviours are genetically coded and the current social and cultural context triggers this.
The biosocial constructionist model states that sociocultural factors shape the meanings that societies ascribe to men and women. These meanings rest on biological difference (e.g. different physique). The specific cognitive capacities of humans are a product of humans’ adaptation to variation itself rather than to environmental features. The sexes organize behaviour into patterns that are
.....read more “Hyde & Delamater (2017). Gender roles and stereotypes.” – Article summary Acculturation refers to the process of incorporating the beliefs and customs of a new culture. Socialization refers to the ways in which society conveys to the individual its norms or expectations for their behaviour.
Intersectionality refers to an approach that simultaneously considers the meaning and consequences of multiple categories of identity, differences and disadvantage. It states that the effects of gender roles should not be viewed in isolation. In the classic gender roles, heterosexuality appears to be central.
The comprehension goal states that people stereotype to better understand people. This can be both negative and positive. The self-enhancement goal states that people stereotype for self-enhancement purposes. This tends to be negative.
A gender binary refers to conceptualizing gender as having only two categories. Gender socialization comes from multiple sources (e.g. parents; media). Gendered parenting is mostly implicit.
Other gender differences are that men are more aggressive (1), more impulsive (2) and take more risks (3). They also differ on sensation seeking (1), risk-taking (2) and impulse control (3). Furthermore, girls tend to self-disclose more than boys and girls are better at decoding non-verbal cues and discerning others’ emotions. These differences may be the result of socialization.
Gender differences in sexuality may exist because men are taught to ignore risks (1), prefer more partners (2), women are warier of the environment (3) and are warier of the possibility of rape (4).
It is possible to measure sexual arousal objectively. This can be done using a penile strain gauge (males) or a vaginal photoplethysmograph (females). Both men and women are aroused by erotica but women are sometimes unaware of their physical arousal.
There are three explanation for gender differences:
There are four cultural explanations for gender differences in sexuality:
There are also several other explanations for gender differences:
“Petersen & Hyde (2010). A meta-analytic review of research on gender differences in sexuality, 1993 – 2007.” – Article summaryChanges in sexual culture appear to be paralleled by changes in sexual behaviour and attitudes. Nonetheless, there are gender differences with regards to sexual behaviour and attitudes. Men have more permissive sexual attitudes (1), use more pornography (2) and report more masturbation compared to women (3). However, this may be a result of social stigma rather than actual gender differences. Furthermore, men are more negative towards homosexuals but not towards lesbians and men more strongly adhere to gender roles.
Gender differences appear to decrease with time. The magnitude of gender differences for some sexual behaviours but not for sexual attitudes is moderated by gender empowerment in a nation. Countries with larger gender differences often hold a double standard and this may influence differences in reporting of sexual behaviours rather than actual differences. Furthermore, there are gender differences across ethnic groups which may be due to differences in power between males and females within that ethnic group.
The gender empowerment measure (GEM) assesses the extent of gender equality in countries. According to the social structural theory, countries with higher scores on the GEM would have smaller gender differences in sexuality compared to countries with lower scores on the GEM. Data supports this hypothesis.
There are several theories regarding gender differences:
The evolutionary psychology theory would predict that men are more likely to engage in casual sex (1), engage in extra-relational sexual behaviours (2), would be more accepting regarding attitudes requiring little sexual commitment (3) and that the desire for short-term mating decreases with age (4). The cognitive social learning theory would predict that women obtain more permissive attitudes towards sex as media exposure increases. Evidence from the gender similarities hypothesis comes from the fact that most gender differences are small or trivial
“Vanwesenbeeck (2009). Doing gender in sex and sex research.” – Article summary Masculinity is typically linked to lesbianism and femininity is linked to male-homosexuality in some contexts but not in all. There are ten major difficulties in the treatment of gender in sex research:
There are several perspectives about the body in relation to gender and sexuality:
According to the objectification theory, being vigilant and constantly aware of the outer body leaves the woman with fewer resources to be aware of the inner body experience (i.e. limited resources perspective). This means that girls’ sexual lives are influenced by self-objectification and hypervigilance of their own body as it requires awareness of the inner body experience.
There are several possible areas where gender differences could exist:
“Cretella, Rosik, & Howsepian (2019). Sex and gender are distinct variables critical to health: Comment on Hyde, Bigler, Joel, Tate, and van Anders (2019).” – Article summary Sex refers to how an organism is organized with respect to reproduction. This is an innate and binary trait not altered by psychological traits.
There are three reasons why sex is binary:
There are several reasons why it is important to adhere to sexual dimorphism:
“Davy (2015). The DSM-5 and the politics of diagnosing transpeople.” – Article summary The emphasis on distress in the diagnosis of gender dysphoria is problematic in two ways:
The true transsexual model referred to a person who required physical changes to their body to fully express their gender identity. However, many transpeople are not able to get these changes due to social, cultural or political reasons. Besides that, this model is focussed on the gender binary and neglects the true experience of transpeople.
It is difficult to call transpeople gender atypical as there is no clear cause for gender behaviour and there is no clear masculine or feminine behaviour. The DSM-5 criteria for gender dysphoria are derived from stereotypes applied in gender identity clinics serving transpeople.
Blanchard’s model states that there are two types of transsexuals:
This model strongly links gender dysphoria to homosexuality and cross-dressing and is heavily contested. For example, autogynephilic fantasies (i.e. imagining having sex as a female) are not specific to transwomen. This model is used in the DSM-5 as these subtypes are used for gender dysphoria. This needlessly sexualizes the diagnosis, which may exacerbate social discrimination and intensify the stigma.
Clinical encounters may not fully account for the multiple ways in which transpeople have lived their lives prior to accessing psychiatric assessment in a gender clinic. This may be because transpeople may be reluctant to relay anything to the gender clinic psychiatrists that may be viewed as different from the perceived ‘correct’ trans narrative. Transpeople tend to tailor their clinical narratives because they realize that psychiatrists have the power to stop their transitioning process. This leads transpeople to need to show distress to convince a psychiatrist.
Psychiatrists use a highly stereotyped notion of gender to provide a framework for assessing and treating transsexuals even though this stereotype may not be accurate. Psychiatrists fail to acknowledge the multiple ways for expressing and identifying with a particular gender (i.e. not necessarily only gender-conforming behaviour).
The heterosexual matrix refers to heterosexual gender roles being seen as natural rather than socially constructed. Intersex refers to the range of conditions affecting the chromosomal make-up (1), the reproductive system (2) and/or the sexual anatomy of a person (3).
The biological advocates of transsexuals state that gender identities are the product of biological dispositions. They claim that these dispositions are caused by hormonal influences in the foetus which produce feminized or masculinized neurological brain structure, which leads to a post-natal desire to transition. This, thus, claims that transsexualism is an innate, biological variation.
There are several things
.....read more “Hyde et al. (2019). The future of sex and gender in psychology: Five challenges to the gender binary.” – Article summaryThe gender binary assumes that one’s category membership is biologically determined (1), apparent at birth (2), stable over time (3), a powerful predictor of psychological variables (4) and salient and meaningful to the self (5). There is an idea that brains are gendered (i.e. male and female brains). In neuroscience requires two assumptions:
For a system to show dimorphism, each of its elements should be dimorphic. Furthermore, all the elements within an individual should be internally consistent (i.e. either all in the form typical of males or typical of females). The brain sex differences are context-dependent. However, it is unlikely that brains are internally consistent and dimorphic. Mosaicism (i.e. one typical female-part in the brain and one typical male-part in the brain) is most common in the human brain.
The idea of gender binary in behavioural neuroendocrinology involves two assumptions:
These assumptions do not hold as both men and women have testosterone and oestrogen. Furthermore, the average level of these hormones does not differ between men and women. The differences in levels of hormones vary across the lifespan. Thus, the gender binary cannot be completed based on androgens and oestrogens.
The reproductive glands are not fixed and innate as their levels vary widely within individuals. Hormones are influenced by social context. For example, testosterone decreases with supportive environments and increases with competitiveness. Furthermore, gendered expectations and lived experiences can shape hormones.
Gender binary in psychological research involves the assumption that there are only two discrete categories of people (i.e. males and females), implicitly stating that there is no overlap between the two categories.
People possess both feminine and masculine psychological characteristics. Internal consistency in personality traits (e.g. all masculine traits) is extremely rare. Stereotypes of men and women exist but individuals who consistently match these stereotypes are very rare. T
Transgender and non-binary people have largely been ignored in psychological research. Psychological research on transgender and non-binary people lead to three major challenges to the gender binary:
Gender identity is not invariably linked to sex category at birth. Gender could be seen as a bundle of separable constructs.
Being gender could be a precondition for doing gender in ways that are
.....read more “Kuyper & Wijsen (2013). Gender identities and gender dysphoria in the Netherlands.” – Article summaryThe prevalence of gender dysphoria is estimated by looking at health care services. However, individuals may be hesitant to seek medical care for gender dysphoria due to stigmatization. Furthermore, healthcare makes use of a dichotomous view of gender while people may be ambivalent about gender and do not desire treatment. This means that the prevalence of adult gender dysphoria may be underestimated.
Parent reports of child behaviour are used to assess the prevalence of gender dysphoria in children. This may lead to an overestimation of the prevalence of gender dysphoria as parents mostly look at cognitive and behavioural aspects and not at affective aspects of gender dysphoria.
Individuals with an ambivalent gender identity were more often men (1), more often had a lower education (2), were more often from a non-Western background (3) and were more often bisexual or homosexual (4). The sexuality aspect could be explained by the fact that people with a different sexuality from homosexuality are more often in scenes where binary gender identities are less common. This leads them to internalize the gender identity less, making it less incongruent.
Men want to transition more often than women. A dislike of one’s body is not always accompanied by a desire for medical treatment to transition. The low percentage of women disliking their body and desiring treatment could be explained by the fact that masculine women are more accepted in society than feminine men. This allows natal women to change their behaviour and gender more accordingly.
A diagnosis of gender dysphoria does not implicate the need for transition treatment and gender dysphoria should be viewed in a more dimensional way (i.e. different degrees of gender dysphoria).
“Reilly (2019). Gender can be a continuous variable, not just a categorical one: Comment on Hyde, Bigler, Joel, Tate, and van Anders (2019). – Article summarySex-role identification refers to the degree to which we develop stereotypical gender traits (1), interests (2) and beliefs (3). Androgyny refers to a healthy integration of both masculine and feminine traits. This affords a greater cognitive and behavioural flexibility and is linked to better psychological health.
There are four reasons why gender should be viewed as a continuous variable:
It appears as if femininity and masculinity are unrelated to sexual orientation. There is scientific evidence that gender identity and biological sex do not always align. This is not a pathology. The Hawthorne effect refers to people changing their answers on a questionnaire after they find out what the questionnaire is about.
“Zucker et al. (2013). Memo outlining evidence for change for gender identity disorder in the DSM-5.” – Article summaryThere were several changes from the DSM-4 to DSM-5 with regards to gender identity disorder:
The old introductory descriptor was a strong and persistent cross-gender identification. The A1 criterion refers to repeatedly stated a desire to be or insistence that one is the other sex. A polythetic form refers to the diagnostic criteria sharing a lot of symptoms among each other which are not essential for diagnosis.
There are several validators of gender dysphoria:
“DSM-5. Posttraumatic stress disorder.” – Article summary The clinical presentation of PTSD varies. It is not entirely clear what is seen as a traumatic event and what is not. A life-threatening illness or medical condition is not seen as trauma but medical incidents can qualify as traumatic events (e.g. waking up during surgery), same as a medical catastrophe in one’s child.
Intrusive recollection is not the same as depressive rumination. Intrusive recollection applies to involuntary and intrusive distressing memories. It can be short (e.g. flashback) but can lead to prolonged stress and heightened arousal.
In PTSD, there often is a heightened sensitivity to threats. Developmental regression (e.g. loss of language) may occur in children. PTSD can lead to difficulties in regulating emotions or maintaining stable interpersonal relationships.
The lifetime prevalence of PTSD is 8.7% in the United States and the twelve-month prevalence is 3.5%. These estimates are lower in many other countries (e.g. European countries). Different groups have different levels of exposure to traumatic events. The conditional probability of developing PTSD following a similar level of exposure may differ between groups.
Cultural syndromes (e.g. ataques de nervosia) may influence the expression of PTSD. The risk of onset of PTSD and severity may differ across cultural groups as a result of:
PTSD appears to be more severe if the traumatic event is interpersonal and intentional (e.g. torture). The highest PTSD rates are found among rape survivors (1), military combat and captivity survivors (2) and ethnically and politically-motivated internment and genocide survivors (3). Young children and older adults are less likely to show full-threshold PTSD.
The symptoms and relative predominance of symptoms may vary over time. Symptom recurrence and intensification may occur in response to reminders of the original trauma (1), ongoing life stressors (2) and newly experienced traumatic events (3). PTSD symptoms may exacerbate as result of declining health (1), worsening cognitive functioning (2) and social isolation (3).
Individuals who continue to experience PTSD into older adulthood may express fewer symptoms of hyperarousal (1), avoidance (2) and negative cognitions and moods (3) compared with younger adults. However, adults exposed to traumatic events during later life may display more avoidance (1), hyperarousal (2), sleep problems (3) and crying spells (4) than younger adults exposed to the same traumatic event.
There are several pre-trauma risk factors for the development of PTSD:
There are several peritraumatic
.....read more “Althof et al. (2017). Opinion paper: On the diagnosis/classification of sexual arousal concerns in women.” – Article summary In the earliest diagnostic manuals, only inhibited sexual excitement was used to denote psychosexual disorders. However, this was indicated by a lack of a physiological response. In later diagnostic manuals, the FSAD diagnosis was added. However, the subjective arousal subtype was removed from this diagnosis in the DSM-4. This was done to make sure that the male-female similarity in sexual dysfunctions diagnoses could be maintained. The FSAD diagnosis only represents genital arousal and sees subjective arousal and sexual desire as the same thing while it is not.
Desire refers to the motivation to engage in and/or be receptive to a sexual event for sexual or non-sexual gratification. Genital arousal refers to genital changes in response to sexual stimuli. These changes may be associated with other bodily reactions (e.g. increased heart rate). Subjective arousal refers to positive mental engagement and focus in respone to a sexual stimulus. This may include awareness of the presence or absence of genital changes or sensations during a sexual event (i.e. perceived arousal).
There is a close relation between desire and arousal problems. This implies that problems becoming aroused could diminish desire over time and vice versa. However, the correlation between desire and arousal does not account for all the variance. This implies that subjective arousal and desire are not the same variables. The frequency of desire can only explain a small part of the variance in subjective arousal frequency and the level of desire can only explain part of the variance in the level of subjective arousal. A lot of variance in subjective arousal is still unexplained by desire.
It can be expected that there is a low subjective arousal in women with low sexual desire if they are the same construct. However, women with low sexual desire do not necessarily have low subjective arousal. This implies that they are not the same construct.
This is important, as this implies the need to reintroduce the subjective arousal subtype in sexual dysfunction diagnoses. The diagnoses criteria have a major influence on how clinicians organize their thinking about sexual disorders (1, how clinical activity is coded for reimbursement (2), how populations are defined for clinical research (3) and how compounds or psychotherapeutic interventions are evaluated for the treatment of these disorders (4).
“Balon & Clayton (2014). Female sexual interest/arousal disorder: A diagnosis out of thin air.” – Article summaryIn psychiatric illness, the criteria for establishing diagnostic validity are clinical description (1), laboratory studies (2), exclusion of or delineation from other disorders (3), a follow-up study (4) and a family study (5). These criteria are typically not fulfilled or psychiatric illnesses.
According to Balon and Clayton, the primary reason for the creation of the female sexual interest/arousal disorder (FSAID) was to get rid of the linear concept of the sexual response cycle in women and replace it with a circular model of sexual response. However, no diagnosis has been presented for this diagnosis. There are several things wrong with this diagnosis:
According to Balon and Clayton, the establishment of this diagnosis has the potential to inflict harm by excluding women who currently have an ‘old’ diagnosis (HSDD) and it is not clear what will happen with regard to treatment.
“Basson (2014). On the definition of female sexual interest/arousal disorder.” – Article summary The triggering of desire from competent sexual stimuli sometimes only occurs when sexual activity has begun for women. It is important to take the following things into account when describing a diagnosis:
There are five main problems with the FSIAD diagnosis in the DSM-5:
The context should be assessed to evaluate the role this plays in the woman’s sexual dysfunction in this disorder.
“Graham, Boyton, & Gould (2017). Challenging narratives of ‘dysfunction’. “ – Article summaryThe human sexual response cycle (HSRC) proposes a linear series of phases of sexual response. The phases are excitement (1), arousal (2), orgasm (3) and resolution (4). This model assumes that these phases are the same for men and women and the first sexual dysfunctions were based on this model. However, one model of sexual response does not fit all people.
In the DSM-5, duration and severity criteria were added to prevent overdiagnosis of sexual dysfunction. There is no empirical basis for the distinction between subjective arousal and desire. Symptoms must persist for 6 months and for all or almost all sexual encounters. To meet the criteria for a dysfunction, a woman needs to meet three of the following six criteria:
Flibanserin is the first medication to receive FDA approval for the treatment of HSDD. The drug has mixed effects on serotonergic and dopaminergic transmitter systems. Compared to the costs of using the drug, the benefits appear to be marginal.
The Even the Score campaign attempted to increase awareness of HSDD and push for treatment. This campaign claimed that men received more treatment for a similar disorder, although this claim is not true.
Many women seek or desire pharmaceutical treatment for FSD. They seek to return to the level of sexual desire they experienced earlier in the relationship and they claim that desire should remain unaffected by anything outside of the bedroom. This means that they believe that sexual desire is mainly influenced by physiological factors and not by psychological factors.
It is possible that the idea of normal (i.e. having sex frequently) causes distress and anxiety in women who do not live up to that ideal. This causes this behaviour to be pathologized. A focus on the relationship may thus be more effective than a focus on sexual desire.
In most research, there is no clear distinction between sex and desire. The lack of this definition of sex makes it difficult to address where the problems with desire/orgasm may exist. Furthermore, it perpetuates the idea that only vaginal sex equals to real sex. This leads to people who experience pleasure from non-PIV sex but not from PIV sex are categorized as dysfunctional while this is not necessarily the case.
Sex in research on FSD is represented in the following way:
“Graham, Brotto, & Zucker (2014). Response to Balon and Clayton (2014): Female sexual interest/arousal disorder is a diagnosis more on firm ground than thin air.” – Article summary There are gender differences in sexual response and there is widespread recognition for conceptualizing women’s sexual problems differently from those of men. In the FSIAD diagnosis, there is no differentiation between sexual desire and sexual arousal as there is no evidence that these are two different things in women. Many women who were diagnosed with HSDD or FSAD also met the diagnostic criteria for FSIAD.
It was criticized that the FSIAD diagnosis does not contain a lack of lubrication as an essential diagnostic criterion. However, this symptom is a different problem with a mainly biological basis. It should thus be treated by a gynaecologist rather than a psychologist. Besides that, the symptom of lack of lubrication is included in “absent/reduced genital sensations during sexual activity”. Therefore, a lack of lubrication may be a presenting problem but is not a sufficient or necessary one. Furthermore, measures of genital response do not differentiate between women who report sexual arousal problems from those who do not.
All in all, the critique of Balon and Clayton on the FSIAD diagnosis appears to be unfounded. The FSIAD is a move away from the outdated and unidimensional views of the nature of the sexual response.
“Hyde (2019). Kinds of sexual disorders.” – Article summaryA sexual disorder refers to a problem with the sexual response that causes a person mental distress. There is a continuum of sexual functioning rather than categories (i.e. dysfunctional and normal). At first, psychoanalysis was the only available treatment but this was expensive and not always feasible.
A lifelong sexual disorder refers to a sexual disorder that has been present ever since the person became sexual. An acquired sexual disorder refers to a sexual disorder that develops after a period of normal functioning.
Sexual desire refers to an interest in sexual activity, leading the individual to seek out sexual activity or be pleasurably receptive to it. Desire often begins before sexual activity and leads people to initiate sex. However, responsive desire is also possible. The problem in desire disorders is often the discrepancy between a person’s desire and the partner’s desire rather than the absolute level of desire.
There are different desire disorders:
There are also other sexual dysfunctions:
The female sexual interest/arousal disorder was merged from the female low sexual desire disorder (i.e. hypoactive desire disorder) and female arousal disorder (i.e. female sexual arousal disorder). During the menopause, oestrogen levels tend to decrease which, subsequently, leads to a decrease in vaginal lubrication. The prevalence of erectile disorder is less than 10% of men under 40 and 30% of men in their 60s. Psychological reactions to erectile dysfunction may be severe (e.g. shame).
“Toates (2017). Explaining desire: Multiple perspectives.” – Article summary One perspective regarding sexual desire and arousal states that any psychological changes correspond to changes in the brain. The sex hormones are released into the blood by glands and travel to the brain. Here, they sensitize particular regions. This makes these regions more responsive to sexual stimuli and thoughts. This implies that a biological event (e.g. loss of hormones) changes the activity of parts of the brain which is only experienced psychologically (e.g. loss of desire).
Psychological events can have effects throughout the body (e.g. anticipating a sexual encounter can increase levels of the hormone testosterone). A psychological change can precede biological changes. Events in the brain and mind are simultaneously biological and psychological.
Sexual transgression is often strongly socially disapproved and evokes blame. However, there may be a clear biological basis for this which needs to be taken into account without approving sexual transgression. Understanding the properties of the processes that help a person’s sense-making can give insight into how sexual desire, arousal and behaviour are organized.
Simple, self-regulation processes are built-in through evolution when there is a regular trigger to a straightforward action (e.g. reflex). This is because some reflexes may be inefficient if there was conscious control. However, novel problems require conscious processing and cannot be solved through reflexes.
Involuntary, unconscious processes exist alongside conscious processes that bring flexibility and creativity. These two types of processes integrate their control and behaviour is often based on a combination of them. There is behaviour that can be done automatically but also with full conscious control (e.g. brushing teeth0. The responsibility for a given task can move between automatic and controlled modes, depending on the circumstances.
In sexual desire and behaviour, learning plays a central role. Both classical and operant conditioning can play a role in learning of sexual desire and behaviour. A person’s awareness of the link between two events can influence the formation of an association between them (e.g. strengthening). Cues that have been paired with sexual activity acquire potency (incentive value) to trigger directed activity and searching (i.e. sexual arousal). For example, a person’s smell can be linked to attractiveness.
Dopamine systems are central to desires. There can be a strong craving and pleasure associated with its satiety in desires. Sex shares common features with feeding and drug/taking that the presence of the triggering stimulus causes the future to be devalued (e.g. hungry people prefer an immediate reward rather than a delayed bigger reward).
There are several commonalities between feeding and sex:
There are also several commonalities between drug-taking and sex:
“Toates (2017). Arousal.” – Article summary General arousal triggered by a range of non-sexual events can sometimes change into sexual arousal. There appears to be an optimal level of arousal although people differ in the level of optimal arousal. A lot of human behaviour can be explained as attempts to elevate a level of arousal.
Unpredictability (1), danger (2) and novelty (3) elevate arousal. Pleasant arousal is triggered by a range of desirable behaviour (e.g. sexual behaviour). Unpleasant arousal is characterized by fear and anxiety. The bodily states of pleasant and unpleasant arousal overlap considerably.
Negative emotions (e.g. fear) can be transformed into sexual desire. Sexual desire can also be heightened by things that are taboo or illegal. Sexual desire interacts with general excitement seeking. Seeking of arousal could amplify sexual desire. Breaking the boundaries of conventionalism could boost arousal (e.g. voyeurism) The forbidden aspect may be a crucial element in sexual attraction of some people.
Danger, negative emotions and sexual arousal all activate the sympathetic branch of the autonomic nervous system. They share bodily reactions (e.g. elevated heart rate). Emotion can thus enhance sexual arousal because the arousal of the autonomic nervous system becomes available to sexual arousal. Autonomic arousal does not immediately disappear when triggers are removed. This means that it can enhance later sexual attraction (e.g. people are aroused by a stimulus and by making the target of sexual attraction salient, they become more aroused due to the arousal by the neutral stimulus).
People tend to make sense of their bodily reaction by labelling it in terms of the most likely cause. In cases of ambiguity, people may misperceive the cause of their arousal. The time interval between the arousal trigger and the attribution process determines what the subjective arousal is attributed to. With a short time interval, there will be a correct attribution. However, with a longer time interval, it may be misperceived and misattributed (i.e. arousal by neutral stimulus attributed to sexual stimulus). With an even longer time interval, the arousal dissipates.
Arousal is interpreted in terms of available stimulus. This means that arousal induced by another factor than sexual arousal (e.g. negative emotion) makes an attractive partner more attractive and an unattractive partner more unattractive.
Perversion refers to people who celebrate and idealize humiliation (1), hostility (2), defiance (3), the forbidden (4), the furtive (5), the sinful (6) and the breaking of taboos (7). These people feel special for not being normal. These defiant attitudes are essential for the enjoyment of perversion. Physical pain can increase desire for some people but this depends on earlier experiences of pain. Individuals are more likely to exploit pain for sexual arousal in a society where a certain amount of pain is seen as integral to the sexual act.
There are three definitions of sexual arousal:
“Brewin et al. (2009). Reformulating PTSD for DSM-V: Life after criterion A.” – Article summaryPost-traumatic stress disorder (PTSD) was introduced to have a single cause (i.e. traumatic event). This is unique as there is a clear, environmental cause rather than a complex interplay between environmental and genetic factors, such as in other disorders. However, not everyone who experiences trauma develops PTSD. This leads to three main criticisms towards PTSD:
The reaction to extreme stress is not necessarily time-limited and there is unique brain activation in PTSD compared to other people. This means that the first criticism does not fully hold. People have developed PTSD symptoms as a result of lower intensity traumas (e.g. learning about 9/11) due to genetic vulnerability. Furthermore, prolonged stress also leads to PTSD symptoms and indirect traumas (e.g. Halloween films) do not appear to lead to the full diagnostic criteria for PTSD.
It is undesirable to specify trigger events as an individual’s symptomatic profile will be shaped by their genetics (1), environmental history (2) and an interaction of the two (3). The A criterion only describes the usual context of PTSD without contributing to its diagnosis. It may thus be best to abolish the A criterion and refocus PTSD on a smaller set of core symptoms. It should be refocused around re-experiencing the event in the present in the form of intrusive multisensory images accompanied by a marked fear or horror. Refocusing the diagnosis of PTSD leads to a greater homogeneity of cases and reduced overlap with other disorders.
Proposed Diagnostic |
“Cacioppo et al. (2015). Loneliness: Clinical import and interventions.” – Article summary Loneliness refers to a discrepancy between an individual’s preferred and actual social relations. This discrepancy leads to the negative experience of feeling alone and the distress of feeling socially isolated. Feeling alone does not mean being alone and vice versa. An individual’s prior experiences (1), current attributions (2) and overall preference for social contact (3) influence an individual’s perception of the social environment and this influences loneliness.
There are three dimensions of loneliness:
The three dimensions correspond with the intimate space (1), social space (2) and public space (3).
Intimate loneliness corresponds to the inner core (i.e. intimate space). This can include up to five people. It comprises the people one relies on for emotional support during crises. Intimate partners tend to be a primary source of attachment (1), emotional connection (2) and emotional support (3). This indicates that a person’s marital status is an important predictor of intimate loneliness.
Relational loneliness corresponds to the sympathy group (i.e. social space). This can include anywhere between 15 to 50 people. It comprises core social partners whom one sees regularly and from whom one can obtain high-cost instrumental support. The frequency of contact with significant friends or family is the best predictor of relational loneliness. This plays a bigger role in the loneliness of women than that of men. The quality of friendship is more important than the number of friendships.
Collective loneliness corresponds to the active group (i.e. public space). This can include anywhere between 150 to 1500 people. It comprises individuals who can provide information through weak ties as well as low-cost support. This is a social space in which an individual can connect to similar others at a distance in a collective space. The number of voluntary groups one is part of is the best predictor of collective loneliness. This plays a bigger role in the loneliness of men than that of women.
People require the presence of significant others who they can trust and with whom they can plan (1), interact (2) and work together to survive and prosper (3). The physical presence of others in one’s social environment is not a sufficient condition. It is necessary that one feels connected to others. The perception of the friendly or hostile nature of one’s social environment is a characteristic of loneliness.
Loneliness and depression are not the same. Lonely people believe that all would be perfect if they were united with another longed-for person.
.....read more “DiTomasso, Brannen-McNulty, Ross, & Burgess (2003). Attachment styles, social skills and loneliness in young adults.” – Article summary Attachment provides the framework for how an individual perceives and interacts with the world. There is a heightened reliance on attachment relationships for adolescents when transitioning to adulthood. Bartholomew’s theory of attachment states that attachment should be explained in terms of how individuals perceive themselves and others in relationships. There are four attachment styles in adolescents and adults:
Transition is evaluated in the terms of the ease by which adolescents adjust to adulthood. This can be measured using indirect measures of psychosocial functioning (e.g. loneliness). An attachment style leads to attachment working models. This may provide the foundation for the development of social skills.
Attachment is associated with aspects of social competence (e.g. social support seeking; social adjustment). There is a relationship between attachment and social skills although it is not clear whether this mediates the effect of attachment on loneliness.
Riggio states that emotional and social skills are a set of interpersonal abilities that facilitate social interaction. There are several ways in which emotional and social skills are expressed:
These skills are associated with higher levels of self-esteem and this is an indicator of self-esteem. A balance may facilitate adolescents’ transition to adulthood and enhance psychosocial adjustment.
A secure attachment is associated with lower loneliness. A fearful attachment is associated with higher levels of loneliness. A dismissing attachment is associated with greater social
.....read more “DSM-5. Posttraumatic stress disorder.” – Article summary The clinical presentation of PTSD varies. It is not entirely clear what is seen as a traumatic event and what is not. A life-threatening illness or medical condition is not seen as trauma but medical incidents can qualify as traumatic events (e.g. waking up during surgery), same as a medical catastrophe in one’s child.
Intrusive recollection is not the same as depressive rumination. Intrusive recollection applies to involuntary and intrusive distressing memories. It can be short (e.g. flashback) but can lead to prolonged stress and heightened arousal.
In PTSD, there often is a heightened sensitivity to threats. Developmental regression (e.g. loss of language) may occur in children. PTSD can lead to difficulties in regulating emotions or maintaining stable interpersonal relationships.
The lifetime prevalence of PTSD is 8.7% in the United States and the twelve-month prevalence is 3.5%. These estimates are lower in many other countries (e.g. European countries). Different groups have different levels of exposure to traumatic events. The conditional probability of developing PTSD following a similar level of exposure may differ between groups.
Cultural syndromes (e.g. ataques de nervosia) may influence the expression of PTSD. The risk of onset of PTSD and severity may differ across cultural groups as a result of:
PTSD appears to be more severe if the traumatic event is interpersonal and intentional (e.g. torture). The highest PTSD rates are found among rape survivors (1), military combat and captivity survivors (2) and ethnically and politically-motivated internment and genocide survivors (3). Young children and older adults are less likely to show full-threshold PTSD.
The symptoms and relative predominance of symptoms may vary over time. Symptom recurrence and intensification may occur in response to reminders of the original trauma (1), ongoing life stressors (2) and newly experienced traumatic events (3). PTSD symptoms may exacerbate as result of declining health (1), worsening cognitive functioning (2) and social isolation (3).
Individuals who continue to experience PTSD into older adulthood may express fewer symptoms of hyperarousal (1), avoidance (2) and negative cognitions and moods (3) compared with younger adults. However, adults exposed to traumatic events during later life may display more avoidance (1), hyperarousal (2), sleep problems (3) and crying spells (4) than younger adults exposed to the same traumatic event.
There are several pre-trauma risk factors for the development of PTSD:
There are several peritraumatic
.....read more “Ozer, Lipsey, & Weiss (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis.” – Article summary There was no clear recognition of the chronic, long-term post-traumatic stress reactions before the diagnosis of PTSD. The amygdala (1), hippocampus (2) and HPA axis (3) are imperative in the development and maintenance of PTSD. The hippocampus and amygdala are involved in the registration of dangerous events and the formation of memories about this.
Memories formed under emotionally arousing situations behave differently from those that are not. Memory formation can be altered by the blocking effects of adrenalin. This means that the degree of arousal during or directly after a traumatic event has fundamental importance for the development of intrusive and hyperarousal symptoms.
Acute stress disorder (ASD) is a good predictor of PTSD but does not necessarily lead to the development of PTSD. The prevalence of PTSD is higher for women and minority groups, potentially due to their high exposure to traumatic events (e.g. sexual assault). The lifetime prevalence of exposure to a traumatic event is more than 50%.
There are several predictors of PTSD:
Peritraumatic dissociation is most strongly related to individuals seeking mental health services. This is only measurable after the trauma. It may occur because the trauma is so
.....read more “Pincus & Gurtman (2006). Interpersonal theory and the interpersonal circumplex.” – Article summary According to Sullivan, personality refers to the relatively enduring pattern of recurrent interpersonal situations which characterize a human life. This emphasizes the interpersonal situation. The interpersonal theory has two assumptions:
Integrating tendencies bring people together in mutual pursuit of satisfaction (1), security (2) and self-esteem (3). Dynamisms refers to the dynamic between the self and the interacting partner. This gives rise to long-lasting concepts of the self and the other.
Each situation ranges from rewarding to very anxious (i.e. on an anxiety gradient). Interpersonal learning of self-concept and social behaviour is based on an anxiety gradient. The interpersonal situation underlies genesis (1), development (2), maintenance (3) and mutability (4) of personality through the continuous patterning and repatterning of interpersonal experience in relation to the needs. Individual variation in personality occurs through interaction between a person’s level of cognitive maturation and characteristics of the interpersonal situation encountered. Abnormal personality is expressed via disturbed interpersonal relations.
The interpersonal circumplex refers to a system of personality. It is not necessarily a classification system. It assumes that behaviour could be understood when related to a dynamic theory of personality. However, the circumplex is not an operationalization of the interpersonal theory. It describes enduring patterns of interpersonal behaviour and can demonstrate behavioural rigidity.
Interpersonal mechanisms refer to the process variables of personality (i.e. personality in action). It reflects the interaction process between group members. The focus is on behaviour and the variables can be measured on a scale of behavioural intensity. The basic dimensions of the circumplex are latent variables. The circumplex states that normal and abnormal personality lie on a continuum.
Interpersonal traits refer to enduring tendencies of personality. A trait refers to how a person behaves in certain situations. Abnormality refers to rigid reliance on a limited class of interpersonal behaviours regardless of situational influences or norms. They are often enacted at inappropriate levels of intensity. Normality refers to the flexible and adaptive deployment of behaviours covering the entire circumplex within moderate ranges of intensity.
Extremity refers to a person’s deviance from a normative position on a particular dimension on the circumplex. This is likely to be undesirable and rarely situationally appropriate or successful. Rigidity refers to a summary of one’s limited repertoires across various interpersonal situations. This is a characteristic of a person.
Intraindividual variability in interpersonal behaviours may be an important and stable individual difference variable. However, traditional measures of interpersonal functioning involve assessments at a single point in time. Flux refers to the variability of an individual’s mean score on a particular interpersonal dimension (e.g. aggression). Spin refers to the variability of the person’s angular position across time. Pulse refers to the variability in vector length.
The inventory of interpersonal problems measures abnormal personality
.....read more “Schaver & Mikulincer (2011). An attachment-theory framework for conceptualizing interpersonal behaviour.” – Article summary Both Bowlby’s and Ainsworth’s attachment theory are used to conceptualize close interpersonal relationships. This theory states that people have core systems (i.e. attachments) and this is modifiable by experience.
Bowlby’s attachment theory states that humans have an innate attachment behavioural system. This motivates them to seek proximity to significant others (i.e. attachment figures). The main goal is to maintain adequate protection and support. Though the attachment system remains active over a lifespan, people become increasingly able to gain comfort from internal representations of attachment figures (i.e. attachment figure does not have to be physically present).
Attachment working models refer to the mental presentation of the self and others. These working models include procedural knowledge about how social interactions unfold and how one can best handle stress and distress;
An attachment style refers to a person’s chronic pattern of relational expectations (1), emotions (2) and behaviours (3) that results from attachment experiences. Attachment is crucial for maintaining emotional stability (1), developing positive attitudes towards the self and others (2) and forming satisfying close relationships (3).
Attachment insecurities interfere with prosocial attitudes and behaviour during interactions with people who are distressed or in need. A negative attachment is associated with more negative interactions (1), emotions (2) and less responsiveness to a partner’s needs (3).
Individual differences in attachment are the result of the availability (1), responsiveness (2) and supportiveness (3) of an attachment figure. The individual differences can be measured along avoidance and anxiety. Avoidance refers to the extent to which a person distrusts others’ goodwill and relies on deactivating strategies for coping with attachment insecurities. Anxiety refers to the degree to which a person worries that a relationship partner will be unavailable in times of need and relies on hyperactivation strategies. More avoidant people are less inclined to forgive and feel less grateful.
The individual differences in attachment shape cognitive-motivational predispositions and this biases the way people attend, interpret and respond to information that arises during a social interaction. Attachment-related patterns of social information processing predict interpersonal behaviour.
Personal predispositions (e.g. attitudes) are a part of a person’s attachment style. It is manifested in a person’s goal structure (i.e. goals in social interaction) and is demonstrated in a person’s declarative knowledge (1), procedural knowledge (2) and beliefs (3). This predisposition biases the acquisition and use of social information during an interaction via top-down
.....read more “Ehlers & Clark (2000). A cognitive model of posttraumatic stress disorder.” – Article summary Ehler and Clarke’s cognitive model of PTSD states that persistent PTSD only occurs if individuals process the traumatic event and/or consequences in a way which produces a sense of serious, current threat. People with persistent PTSD are unable to see the trauma as a time-limited event that does not have global implications for their future. There are two key processes that lead to this sense of threat:
The perception of current threat is accompanied by intrusions and other re-experiencing symptoms when activated. This motivates a series of behavioural and cognitive responses that are intended to reduce perceived threat and distress in the short-term but prevent cognitive change. This maintains the disorder.
There are several types of appraisal which can produce a sense of current threat:
The interpretation of one’s initial PTSD symptoms (1), other people’s reactions in the aftermath of the trauma (2) and the appraisal of the consequences of the trauma in other life domains (e.g. physical consequences) (3) are important and can produce a sense of current threat. Initial PTSD symptoms are normal after a traumatic event. If people appraise this as being an integral part of the self, then they may conclude that the trauma has permanently changed them.
These appraisals maintain PTSD by directly producing negative emotions and by encouraging individuals to engage in dysfunctional coping strategies. The nature of the emotional response in PTSD depends on the appraisal:
There are several characteristics of involuntary re-experiencing:
The cues for reexperiencing do not need to have a strong semantic relationship to the trauma (e.g. a similar smell may be enough). The pattern of retrieval and the intrusion characteristics may exist due
.....read more “Forest & Wood (2012). When social networking is not working: Individuals with low self-esteem recognize but do not reap the benefits of self-disclosure on Facebook.” – Article summary There is no difference between people with a high and a low self-esteem with regards to the desire for connection. However, compared to people with a high self-esteem, people with a low self-esteem have several characteristics.
One essential part of the development of intimacy is self-disclosure. However, people with a low self-esteem may be self-protective. They focus on avoiding revealing their flaws rather than focusing on their good qualities. This orientation guides a lot of the behaviours of people with low self-esteem and leads them to self-disclose less. Self-disclosure is positively associated with likability (1), relationship quality (2) and relationship stability (2).
Both people with a low and high self-esteem view Facebook as offering opportunities to express themselves. There are several characteristics of Facebook usage of people with low self-esteem:
People with lower self-esteem are liked less by strangers on Facebook due to the increased negativity. There is a greater social reward for more positive updates on Facebook for people with a low self-esteem but not for people with a high self-esteem. For people with a higher self-esteem, there is a greater social reward for more negative updates but not for people with a low self-esteem.
It is possible that disclosing negative personal information signals that the discloser trusts the person and desires connection. However, expressing negativity on Facebook may lack fostering intimacy and may lose its relationship-boosting effects when it is constant and indiscriminate (e.g. public post rather than a private message).
“Nadkarni & Hofmann (2012). Why do people use Facebook?” – Article summary Social networking sites (SNS) refer to internet-based services that give individuals three major capabilities:
The use of Facebook varies according to a user’s gender (1), ethnicity (2) and parental educational background (3). There are several characteristics of Facebook usage for people who score high on extraversion:
These characteristics may arise due to extraverted people’s need for a high level of stimulation and a large social network. Introverted people tend to transfer their socially inhibited behavioural style from offline to online. They have fewer Facebook friends but tend to spend more time on Facebook and have a more favourable attitude towards Facebook.
People who score high on neuroticism prefer the wall function and share more basic information. People who score low on neuroticism also share more basic information but not people with a moderate score. People with greater openness to experience use more features form the personal information section. People with high narcissism and low self-esteem tend to spend more time on Facebook. They are also more likely to post self-promotional photos enhanced by Photoshop.
The tendency to disclose and the need for popularity are predictors of information disclosure on Facebook. Facebook use is predicted by high levels of extraversion (1), neuroticism (2) and narcissism (3), low levels of self-esteem (4) and self-worth (5).
The dual-factor model of Facebook use states that Facebook use is primarily motivated by the need to belong and the need for self-presentation. The need to belong refers to the intrinsic drive to affiliate with others and gain social acceptance. The need for self-presentation refers to the continuous process of impression management.
Self-esteem and self-worth are closely associated with the need to belong. Self-esteem may play the role of monitoring one’s acceptability in the group (e.g. drop in self-esteem motivates steps to avoid rejection and improve standing of social hierarchy).
Exposure to information presented on one’s Facebook profile enhances self-esteem. This is especially the case when selectively self-presenting (e.g. editing information). Facebook use intensity reduces students’ perceived levels of loneliness. However, it is not clear whether Facebook use improves self-esteem as results are mixed.
Facebook use may facilitate relationship development and acceptance of peers. The association between Facebook use and self-esteem may be moderated by cultural and social factors. A general disconnection appears to motivate Facebook use and being connected appears to reward Facebook use.
The idealized-virtual identity hypothesis states that social media allows users to display their
.....read more “Van den Hout & Engelhard (2012). How does EMDR work?” – Article summary Eye movement desensitization and reprocessing (EMDR) is an effective treatment for alleviating PTSD symptoms. In EMDR, the patient recalls traumatic memories while simultaneously making horizontal eye movements. There are three hypotheses as to why and how EMDR works:
During recall, a memory becomes labile (i.e. events during recall influence how the memory is reconsolidated). The imagination inflation effect states that attempting to form a vivid and realistic image during recall influences the original memory. This makes the memory more vivid and realistic. The imagination deflation effect may occur by taxing the working memory while recalling the memory.
Eye movements thus tax working memory and make sure that the traumatic memory is reconsolidated less vividly (i.e. working memory theory). This can also reduce the impact of flashforwards and flashbacks. Other tasks that task the working memory are also effective (e.g. mental arithmetic). EMDR may be useful in treating other disorders as many disorders are activated by a negative event. However, the evidence for this is sparse.
There is an inverted U when it comes to the effectiveness of increasing working memory load. The competition between the recall of the traumatic memory and distracting tasks decreases the vividness and emotionality of the memory. This means that the tax on the working memory should not be too great. People who have a stronger delay on a reaction time task when they make eye movements improve more as a result of EMDR. This means that people with lower working memory capacity benefit more from EMDR.
Clinicians appear to increasingly use tones in the right and left ear instead of eye movements with EMDR. This is based on the interhemispheric communication hypothesis and patient preferences. However, there is no clear evidence as to whether this is effective. It is less effective than eye movements.
Mindfulness-based treatments may be effective for the treatment of PTSD. These treatments make use of mindful breathing. This taxes working memory to the same extent as eye movements, making it effective for the same reasons that
.....read more “Van Emmerik & Kamphuis (2015). Writing therapies for post-traumatic stress and post-traumatic stress disorder: A review of procedures and outcomes.” – Article summary For PTSD treatment, it is important to spend sufficient time on psychoeducation. The patient should understand the likely causes of their symptoms and how the treatment is supposed to alleviate these symptoms.
Writing therapy is effective for the treatment of PTSD and consists of three phases:
There are several guidelines for writing the letters:
Writing therapy is an effective alternative for people who do not benefit from TF-CBT or EMDR. It also appears to be effective in online settings (i.e. online writing). Writing may trigger specific processing mechanisms of the experience. One unique aspect is that it focused on social sharing. This may increase social support.
Imaginal exposure promotes the connection of previously unconnected traumatic memories into autobiographical memory. This reduces the probability that these memories are involuntarily activated. Furthermore, it may facilitate the retrieval of traumatic memories that are otherwise difficult to retrieve. This, in turn, can lead to modification of the appraisals of the event.
“Watkins et al. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions.” – Article summary Trauma-focused interventions refer to interventions that directly address memories of the traumatic event or thoughts and feelings related to the traumatic event (e.g. EMDR). Non-trauma focused interventions refer to interventions that do not directly address memories of the traumatic event or thoughts and feelings related to the traumatic event (e.g. stress inoculation training).
A combination of medication and psychotherapy is not recommended for the treatment of PTSD. Treatment of PTSD needs to focus on the focus of reexperiencing symptoms. This is the index trauma. Treatment drop-out appears to be lower in present-centred treatments than in trauma-specific treatments.
There are several strongly recommended treatments for PTSD:
The prolonged exposure treatment is based on the emotional processing theory. This theory states that fear is represented in memory as a cognitive structure that includes representations of the feared stimuli (1), the fear responses (2) and the meaning associated with the stimuli and responses to the stimuli (3). This fear structure can be dysfunctional when it does not represents a realistic threat anymore. This occurs when:
The cognitive processing theory assumes that people attempt to make sense of what happened after a traumatic event. This can lead to distorted cognitions of themselves, the world and others (e.g. “I am worthless).
Assimilation refers to when incoming information is altered to confirm prior beliefs. This could result in self-blame (e.g. “I was assaulted because I did not fight back”). Accommodation refers to altering beliefs to accommodate new learning (e.g. “I couldn’t have prevented what happened”). Over-accommodation refers to changing beliefs to prevent trauma from occurring in the future (e.g. “the world is a dangerous place”).
Cognitive restructuring
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