Abnormal Psychology, the science and treatment of psychological disorders by A. M. Kring, S. L. Johnson, G. C. Davison and J. M. Neale (thirteenth edition) – Chapter 12

Sexual fantasies begin to qualify as abnormal when they begin to affect us or others in unwanted or harmful ways. Sexual dysfunctions are persistent disruptions in the ability to experience sexual arousal, desire, or orgasm, or as pain associated with intercourse. Paraphilic disorders are defined as persistent and troubling attractions to unusual sexual activities or objects. Sexual norms and behaviour change with time and culture. Gender dysphoria refers to the idea that one should be the opposite gender.

Men report thinking about sex, masturbating and desiring sex more often as well as desiring more sexual partners and having more partners. Women tend to be ashamed of any flaws in their appearance and this shame can interfere with sexual satisfaction. Sexuality is more closely tied to relationship status for women than for men. Men are more likely to think of their sexuality in terms of power.

Women are more likely to report symptoms of sexual dysfunction, but men are more likely to meet diagnostic criteria for paraphilic disorder. The sexual response cycle consists of four phases:

1. Desire phase
   Sexual interest or desire.
2. Excitement phase
   Increased blood flow to the genitalia.
3. Orgasm phase
   Sexual pleasure peaks and orgasm occurs.
4. Resolution phase
   Relaxation and a sense of well-being that follows an orgasm.

For women, there is a difference between biological arousal and subjective excitement.

SEXUAL DYSFUNCTIONS
There are three types of sexual dysfunctions. Sexual dysfunctions involving sexual desire, arousal and interest (1), orgasmic disorders (2) and a disorder involving sexual pain (3). All sexual dysfunction disorders must last at least 6 months. Sexual concerns that arise as a consequence of severe relationship distress (e.g: partner abuse) should not be diagnosed as sexual dysfunctions.

Clinical profile female sexual interest/arousal disorder:

Clinical profile male hypoactive sexual desire disorder:

Clinical profile erectile disorder:

Clinical profile female orgasmic disorder:

Clinical profile premature ejaculation:

Clinical profile delayed ejaculation:

Women are more likely than men to report at least occasional concerns about their level of sexual desire. Occasional symptoms of erectile disorder are the most common sexual concern among men. The prevalence of this is 13% - 28%. The prevalence of erectile disorder increases greatly with age. The prevalence of premature ejaculation is less than 3%. The prevalence of delayed ejaculation is less than 1%.

Clinical profile Genito-pelvic pain/penetration disorder:

Vaginismus refers to involuntary muscle spasms of the outer third of the vagina to a degree that makes intercourse impossible. This is common in women with Genito-pelvic pain/penetration disorder.

ETIOLOGY OF SEXUAL DYSFUNCTIONS
There are two immediate causes for sexual dysfunction: fear about performance (1) and the adoption of a spectator role (2). A spectator role refers to begin an observer, rather than a participant in a sexual experience.

A sexual dysfunction disorder diagnosis can only be made in the absence of a medical illness. If heavy alcohol use before intercourse is present, it can also not be labelled a sexual dysfunction disorder. Sexual dysfunction can be caused by either low levels of testosterone or Estrogen or by the high levels induced by supplements.

Psychological factors of sexual dysfunction include rape or sexual abuse. Positive experiences are important. Relationship problems also often interfere with sexual arousal and pleasure. Depression and anxiety increase the risk of sexual dysfunction. Anxiety and depression are comorbid with sexual pain and with female sexual desire/arousal disorder. Stress and exhaustion impede sexual functioning. Negative cognitions also interfere with sexual functioning. People that blame themselves for decreased sexual performance will be more likely to develop recurrent sexual problems. Many negative cognitions about sex are learned through social and cultural surroundings.

TREATMENTS OF SEXUAL DYSFUNCTIONS
 

PARAPHILIC DISORDERS
Most people with paraphilic disorders are male and heterosexual. Onset of paraphilic disorders typically begins during adolescence. The onset of sexual sadism disorder and sexual masochism disorder tends to occur by early adulthood. Paraphilic disorders are highly comorbid with mood disorders, anxiety and substance use disorders.

Clinical profile fetishistic disorder:

A fetish refers to the object of these sexual urges. The attraction in fetishistic disorder is experiences as involuntary and irresistible.

Clinical profile pedophilic disorder:

Overt physical force is seldom used in pedophilic disorder. About half of the children who are exposed to childhood sexual abuse will develop symptoms, such as depression, low self-esteem or other disorders. The odds that childhood sexual abuse will produce clinically significant symptoms are increased when a perpetrator threatens the child, the child blames himself or when the family is unsupportive. Negative outcomes are also more pronounced when there is sexual intercourse. Symptoms are also more likely if the victim is younger.

Incest is a subtype of pedophilic disorder. Incest refers to sexual relations between close relatives for whom marriage is forbidden.

Clinical profile voyeuristic disorder:

More men than women are diagnosed with voyeuristic disorder.

Clinical profile exhibitionistic disorder:

Clinical profile frotteuristic disorder:

Clinical profile sexual sadism disorder:

Clinical profile sexual masochism disorder:

Asphyxiophilia refers to sexual arousal by restricting breathing.

ETIOLOGY OF PARAPHILIC DISORDERS
Androgens are a neurotransmitter that regulate sexual desire. It is hypothesized that androgens play a role. The majority of people with paraphilic disorders have a history of childhood sexual abuse. Incidents with the paraphilic disorders often occurs with alcohol use, as it makes people act more impulsively. Negative moods may also play a role, because the act of the disorder may be a mean to escape the negative affect. Cognitive distortions and attitudes also play a role in the paraphilic disorders. People diagnosed with paedophilia have a lower IQ and higher rates of neurocognitive problems than the general population.

TREATMENTS OF PARAPHILIC DISORDERS