Daily Archives: September 20, 2010

Sexual disorders


Sexual disorders are divided into two categories; paraphilias and gender identity disorders (GIDs).  Most paraphilias occur more frequently in males when compared to females, but GIDs are more evenly distributed.  “The term paraphilia denotes any powerful and persistent sexual interest other than sexual interest in copulatory or precopulatory behavior with phenol-typically normal, consenting human partners.”  (Blaney & Millon, 2009, p. 527)

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I was wholly unaware that hebephilia (the preference for pubescent age partners) was different from pedophilia (sexual interest in prepubescent children).  Even though pedophilia is more widely discussed, hebephilia may be the greater of the two in terms of being a problem.  Typical behaviors of pedophiles (and hebephiles) consist of touching breasts, buttocks, or genitalia of the child… or, by inducing the child to touch or fellate the offender.  (Blaney & Millon, 2009, p. 528)  Makes me sick just writing about it, that’s the honest truth.

Fetishism comes in many different forms.  Fetishism in general denotes sexual interest focused on classes of objects or features of objects other than the external reproductive organs of people, applying specifically to instances where objects are the central feature rather than a supporting element in sexual activity.  Stuff fetishism refers to the erotic interest in specific materials such as rubber, leather, or fur.  Clothing fetishism is stuff fetishism, but more centrally focused on clothing (generally emblematic of gender).  I found the following statement to be revealing… “If I buy the kind of shoes I prefer and ask a woman I know to wear them for me, it doesn’t have the same appeal as if they were her own shoes.  I guess this is because they don’t seem to be as much a part of her.”  (Blaney & Millon, 2009, p. 529)

The concept of autoeroticism is fascinating… suggesting that that the fantasies of people whom suffer from erotic identity disorder pertain less to any sexual partners and more to their transformed images of themselves.  (Blaney & Millon, 2009, p. 531)  This transformed self image may be of the opposite gender, of a different age (specifically children, as in infantilism), or even of being an amputee apotemnophilia).  It has been suggested that these conditions are in fact “erotic target location errors,” and that they may in fact represent autoerotic forms of other conditions (infantilism as an autoerotic form of pedophilia, for example).

Sadism refers to the erotic interest in inflicting fear, humiliation, and/or suffering.  It is the pain the carries the erotic value, differentiating them from people whom suffer from biastophilia.  There also exist individuals who seek to inflict pain or humiliation, but only on willing partners… this has been called the “hyperdominance pattern” of sexual behavior.  (Blaney & Millon, 2009, p. 532)

I was particularly interested in telephone scatalogia, mostly because we periodically get a call like that.  This condition refers to the erotic interest in using a telephone to expose unsuspecting persons to vulgar or sexual language, or, to elicit it from them.  (Blaney & Millon, 2009, p. 534)  Our caller is the “shock caller” variety.  Ole’ boy will call up out of the blue and say some of the nuttiest stuff I have ever heard… and then just hang up.  Then he’ll lay low for 6-8 months, rinse and repeat.  It’s almost entertaining to be honest.

“Gender identity disorders are a heterogeneous class of syndromes characterized, in adults, by the persistent idea that one is, or should have been, a member of the opposite sex and, in children, by pervasive patterns of behavior consistent with such a belief.”  (Blaney & Millon, 2009, p. 540)  I’m not sure that the latter is confined to children, and for that reason, I am not sure that’s the best working definition I have ever heard.  GIDs come in homosexual and non-homosexual varieties, and are marked by the individual believing that “on the inside, they really are member of the opposite sex.”  As a result, oftentimes, these individuals will not identify themselves as gay or homosexual… instead referring to themselves as transgender.

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Reference

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.

Sleep/Wake Disorders


Historically, sleep disorders have long been commonly recognized within the context of other psychopathological conditions, but they have been frequently minimized or otherwise ignored as distinct entities or stand-alone psychopathological situations.  Research supporting the current DSM-IV-TR classification system is extremely limited, despite the common sense approach (in my opinion) of grouping sleep disorders primarily on the basis of underlying constellation of symptoms.

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Primary insomnia is the hallmark diagnosis in this category.  It is “characterized by chronic difficulty initiating and/or maintaining sleep or persistent poor-quality sleep.”  (Blaney & Millon, 2009, p. 508)  Individually commonly suffer from mild anxiety, mood disturbances, concentration/memory dysfunction, somatic concerns, and general malaise… but these conditions are generally viewed as symptoms rather than causes.  Insomnia prevalence increases with age, in contrast with sleep onset difficulties are more common in young adults.  It has also been suggested that, generally speak, women are more susceptible than men.  Societal prevalence is between 1% and 2%.  (Blaney & Millon, 2009, p. 508)

I was intrigued by the statement that “the majority of insomnia sufferers tend to overestimate the time it takes them to fall asleep and to underestimate the time they actually sleep to some degree.”  (Blaney & Millon, 2009, p. 510)  This might give some basis to a cognitive-behavioral approach if we can reset those expectations.  A stated by the text, the main problem is that most clinicians don’t have access to the raw data to confirm or refute this subjective complaint.  My question… is it out of the realm of possibility for us to send a client home with a measurement device so we can accumulate that data?

Narcolepsy is characterized by recurrent, irresistible day time sleep episodes.  The “classic tetrad” indicative of narcolepsy includes excessive daytime sleepiness and unintended sleep episodes during situations where most persons could stay awake, abrupt and reversible decrease or loss of muscle tome (without loss of consciousness, also known as cataplexy), and/or awakening from nocturnal or diurnal sleep with an inability to move (sleep paralysis), and finally vivid images and dreams that are evoked just as sleep develops (hypnagogic hallucinations).  (Blaney & Millon, 2009, p. 510)  Narcolepsy generally first appears during adolescence or young adulthood, and is believed to be genetically predisposed.   Life events may precipitate the onsite of this disorder… although it is not clear to me whether they are causes or effects?

Breathing related sleep disorders encompass what is widely known as sleep apnea.  This condition manifests as loud snorting, pauses in breathing, gasping for breath during sleep, headaches on wake, and automatic behaviors during wakefulness or excessive daytime sleepiness.  The headaches on waking part turned my head because I get that all the time… although I haven’t really noticed any other signs or symptoms.  Odd…

Circadian Rhythm Sleep Disorders (CRSDs) represent a mismatch between natural sleep/wake rhythms and the schedule imposed by occupational or social demands.  (Blaney & Millon, 2009, p. 512)  Individuals typically report insomnia at certain times of the day (generally when they want to be sleeping) and excessive sleepiness at other times (generally when they should be awake).

Parasomnias encompass nightmares, night terrors, and sleepwalking.  Nightmare disorder is characterized by repeated awakenings by disturbing dreams.  Sleepwalking and Night Terrors both occur early in the sleep period and appear to represent incomplete arousals from the deepest states of sleep (states 3-4), known as slow wave sleep (SWS).  All of the above are more prevalent in children when compared with adults, and more common in males than in females. (I honestly would have expected it to be more common in females?)

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Reference

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.