Hoorcolleges psychopathology
College 1 – Introduction + sexual dysfunction
Exam
Short essay questions
o Wat voor diagnoses komen in je op?
o Wat voor secondary diagnoses passen hierbij?
o Etc.
3 case scenarios
Open book exam DSM
What are sexual dysfunctions?
When the person feels distressed about their sexual life
o For approximately 6 months or more.
o A clinically significant disturbance in a person’s ability to respond sexually or to
experience sexual pleasure.
People give a different meaning of sex.
Sex is more then just penetration.
DSM is helpful but also problematic.
It is helpful for treatment, for research.
DSM 4 distinction between desire and arousal now combined together.
What can cause/maintain SD?
Coordinated by
o Neurological
o Vascular
o Endocrine
These 3 need to work together.
Individual sexuality incorporates
o Family
o Societal
o Religious
Beliefs
Experience
Sexual activity incorporates
o Inter-personal relationship
o Each partner (attitudes, needs, responses).
This changes with age, phase, state etc.
Causal factors in sexual dysfunction
,The bio-psycho-social assessment
Phases of sexual activity (Master and Johnson)
Excitement bloodflow, focus, tingling
Plateau
Orgasm
Resolution
Sexual response is not linear & uniform process – thus distinction between phases might be
artificial.
The majority of men endorsed the M&J model (48,5%) or the Kaplan model (38,3%; only
5,4% endorsed the Basson model, and 7,3% endorsed non of the models.
The sexual tipping point model
Features that make you excitated.
Features that inhibit you.
Specific sexual dysfunction
Delayed ejaculation (304.74)
Erectile disorder (302.72)
Female orgasmic disorder (302.73)
Female Sexual Interest/Arousal Disorder (302.73)
Genito-Pelvic Pain/Penetration Disorders (302.76)
Male Hypoactive Sexual Desire Disorder (302.71)
Premature (Early) Ejaculation (302.75)
Substance/medication-induced sexual dysfunction
, Other specified sexual dysfunction (302.79)
Unspecified sexual dysfunction (302.70)
Men’s sexual dysfunction
Delayed Ejaculation (DE)
o A marked difficulty of inability to achieve desired ejaculation.
o More common in men over 50… they need more visual and tactile information.
o Only 75% of men report always ejaculating during sexual activity.
o Many theories regarding the aetiology of DE but with little empirical data to support
any particular theory.
o 3 common factors associate with DE
Higher frequency of masturbation
Idiosyncratic masturbatory style
Disparity between the reality of es with his partner compared to his
preferred sexual fantasy during masturbation
DE is often mistakenly diagnosed as erectile disorder!
o In the clinical setting
DE is often mistakenly diagnosed as ED!
Focus on pleasure instead of function
Learn to focus attention on sexual stimuli
Cognitive restructuring
Suspend masturbatory activity temporarily
Use condoms during masturbation?
Check relationship
Erectile Disorder (ED)
o Failure to obtain or maintain erection during partnered sexual activities.
Marked decrease in erectile rigidity.
More common in men over 50.
o Most problems remit without professional intervention.
o Modern history:
Sildenafil (ViagraR) in 1996
European Edition in 1998
Managing expectations!
o Cobra study: ED onset occurred before Coronary Artery Disease (CAD) in 71% with a
mean time interval of 25 months.
Penis arteries are the smallest arteries in the body of a man.
o Medication and relational drugs with a negative impact on erectile function (e.g.
antihypertensives, antidepressants, recreational substances etc.)
o Assessment
Sexual development in childhood/adolescence
Masturbatory experience?
Rule out PE!
Hetero-bi-or homosexual orientation?
Chronic /permanent? Partner-/situation dependent?
Partner-/family-/business-/financial problems?
, Depressive symptoms?
ED existing with masturbatory activities?
General health conditions competing with sexual life?
MORNINGs?
Male Hypoactive Sexual Desire Disorder (MHSDD)
o Persistent deficient or absent sexual thoughts, fantasies or desires.
o 6% of younger 18-24 & 41% of older men 66-74 report problems with sexual desire;
persistent problem in only 1,8% of men.
o Many men are often treated for different sexual diagnoses while they are suffering
from HSDD.
o Sexual desire and sexual arousal are overlapping constructs since both depend on
the ability of an individual to process sexual information during sexual activity.
o HSDD limited to a single partner is not SD but a relationship problem.
o Erection and satisfaction are different things.
o Epidemiology of HSDD in men
Prevalence in men aged 16 to 59 years 14% to 17% - Greater in older men -
In all literature: 3-50%
Demographic survey in the US (1455 men aged 57 to 85 years) - 28% of men
reported a lack of desire for sex - 65% of affected men being bothered.
By the time that individuals reach middle and old age, there is a natural
decline in sexual desire, sexual capacity and the frequency of sexual
behaviour.
o Sufficient sexual stimulation is important for arousal to follow for women but also for
men. Eating the same food every day? No!
Sexual feelings diminished during repeated erotic stimulation, and increased
with the introduction of novel stimulation
o A side note on sexual pleasures in LT relationships
Sex play’s role in all phases of relationship (to start, to stay).
Sexual desire is important to relationships satisfaction and stability low
sexual desire source of relational distress.
Most prevalent complaint in LT relations is low sexual desire.
Important to focus on the process, same as food…. Let’s look at sexual
pleasure as flavour.
But ↘ in sexual desire --> ↘ in sexual frequency --> not necessarily ↘ in
relationship satisfaction.
o In longer relationships you get sexual boredom. You need to increase the
variation.
Premature Early Ejaculation
o Persistent or recurrent pattern of ejaculation during partnered sexual activity within
1 minute following penetration or before individual wishes.
o 20%-30% of men report concern about
ejaculation speed; 1%-3% have persistent
problem.
o What if rapid ejaculation is… natural?
In animals, sexual intercourse is
usually a brief episode.
In chimpanzees, for example, the
sequence of approach, penetration
and ejaculation lasts just six
seconds.
o There are a lot of techniques
College 1 – Introduction + sexual dysfunction
Exam
Short essay questions
o Wat voor diagnoses komen in je op?
o Wat voor secondary diagnoses passen hierbij?
o Etc.
3 case scenarios
Open book exam DSM
What are sexual dysfunctions?
When the person feels distressed about their sexual life
o For approximately 6 months or more.
o A clinically significant disturbance in a person’s ability to respond sexually or to
experience sexual pleasure.
People give a different meaning of sex.
Sex is more then just penetration.
DSM is helpful but also problematic.
It is helpful for treatment, for research.
DSM 4 distinction between desire and arousal now combined together.
What can cause/maintain SD?
Coordinated by
o Neurological
o Vascular
o Endocrine
These 3 need to work together.
Individual sexuality incorporates
o Family
o Societal
o Religious
Beliefs
Experience
Sexual activity incorporates
o Inter-personal relationship
o Each partner (attitudes, needs, responses).
This changes with age, phase, state etc.
Causal factors in sexual dysfunction
,The bio-psycho-social assessment
Phases of sexual activity (Master and Johnson)
Excitement bloodflow, focus, tingling
Plateau
Orgasm
Resolution
Sexual response is not linear & uniform process – thus distinction between phases might be
artificial.
The majority of men endorsed the M&J model (48,5%) or the Kaplan model (38,3%; only
5,4% endorsed the Basson model, and 7,3% endorsed non of the models.
The sexual tipping point model
Features that make you excitated.
Features that inhibit you.
Specific sexual dysfunction
Delayed ejaculation (304.74)
Erectile disorder (302.72)
Female orgasmic disorder (302.73)
Female Sexual Interest/Arousal Disorder (302.73)
Genito-Pelvic Pain/Penetration Disorders (302.76)
Male Hypoactive Sexual Desire Disorder (302.71)
Premature (Early) Ejaculation (302.75)
Substance/medication-induced sexual dysfunction
, Other specified sexual dysfunction (302.79)
Unspecified sexual dysfunction (302.70)
Men’s sexual dysfunction
Delayed Ejaculation (DE)
o A marked difficulty of inability to achieve desired ejaculation.
o More common in men over 50… they need more visual and tactile information.
o Only 75% of men report always ejaculating during sexual activity.
o Many theories regarding the aetiology of DE but with little empirical data to support
any particular theory.
o 3 common factors associate with DE
Higher frequency of masturbation
Idiosyncratic masturbatory style
Disparity between the reality of es with his partner compared to his
preferred sexual fantasy during masturbation
DE is often mistakenly diagnosed as erectile disorder!
o In the clinical setting
DE is often mistakenly diagnosed as ED!
Focus on pleasure instead of function
Learn to focus attention on sexual stimuli
Cognitive restructuring
Suspend masturbatory activity temporarily
Use condoms during masturbation?
Check relationship
Erectile Disorder (ED)
o Failure to obtain or maintain erection during partnered sexual activities.
Marked decrease in erectile rigidity.
More common in men over 50.
o Most problems remit without professional intervention.
o Modern history:
Sildenafil (ViagraR) in 1996
European Edition in 1998
Managing expectations!
o Cobra study: ED onset occurred before Coronary Artery Disease (CAD) in 71% with a
mean time interval of 25 months.
Penis arteries are the smallest arteries in the body of a man.
o Medication and relational drugs with a negative impact on erectile function (e.g.
antihypertensives, antidepressants, recreational substances etc.)
o Assessment
Sexual development in childhood/adolescence
Masturbatory experience?
Rule out PE!
Hetero-bi-or homosexual orientation?
Chronic /permanent? Partner-/situation dependent?
Partner-/family-/business-/financial problems?
, Depressive symptoms?
ED existing with masturbatory activities?
General health conditions competing with sexual life?
MORNINGs?
Male Hypoactive Sexual Desire Disorder (MHSDD)
o Persistent deficient or absent sexual thoughts, fantasies or desires.
o 6% of younger 18-24 & 41% of older men 66-74 report problems with sexual desire;
persistent problem in only 1,8% of men.
o Many men are often treated for different sexual diagnoses while they are suffering
from HSDD.
o Sexual desire and sexual arousal are overlapping constructs since both depend on
the ability of an individual to process sexual information during sexual activity.
o HSDD limited to a single partner is not SD but a relationship problem.
o Erection and satisfaction are different things.
o Epidemiology of HSDD in men
Prevalence in men aged 16 to 59 years 14% to 17% - Greater in older men -
In all literature: 3-50%
Demographic survey in the US (1455 men aged 57 to 85 years) - 28% of men
reported a lack of desire for sex - 65% of affected men being bothered.
By the time that individuals reach middle and old age, there is a natural
decline in sexual desire, sexual capacity and the frequency of sexual
behaviour.
o Sufficient sexual stimulation is important for arousal to follow for women but also for
men. Eating the same food every day? No!
Sexual feelings diminished during repeated erotic stimulation, and increased
with the introduction of novel stimulation
o A side note on sexual pleasures in LT relationships
Sex play’s role in all phases of relationship (to start, to stay).
Sexual desire is important to relationships satisfaction and stability low
sexual desire source of relational distress.
Most prevalent complaint in LT relations is low sexual desire.
Important to focus on the process, same as food…. Let’s look at sexual
pleasure as flavour.
But ↘ in sexual desire --> ↘ in sexual frequency --> not necessarily ↘ in
relationship satisfaction.
o In longer relationships you get sexual boredom. You need to increase the
variation.
Premature Early Ejaculation
o Persistent or recurrent pattern of ejaculation during partnered sexual activity within
1 minute following penetration or before individual wishes.
o 20%-30% of men report concern about
ejaculation speed; 1%-3% have persistent
problem.
o What if rapid ejaculation is… natural?
In animals, sexual intercourse is
usually a brief episode.
In chimpanzees, for example, the
sequence of approach, penetration
and ejaculation lasts just six
seconds.
o There are a lot of techniques
