Tag Archives: sexual dysfunction

Comparing PTSD and Somatization Disorder


Comparing PTSD and Somatization Disorder shows that there are some similarities in the symptoms but for the most part they are different.  Somatization Disorder has a lot more physical symptoms while PTSD has more symptoms leaning toward emotional.  The symptoms the two disorders have in common are headaches and stomachaches.  In both cases symptoms can be so severe and last so long that it completely disrupts the person’s life.

Do you have medically unexplained physical, or somatic, symptoms?

Somatization disorder can cause a person towards an emotional reaction such as depression or even suicide because they feel so much pain and can never get a diagnosis for it.  The symptoms often lead to substance abuse.  Thereby leaving them to feel hopeless, as if they will never get the help they need.  Somatization disorder has a wide range of physical symptoms.  A person with this disorder will report many different symptoms over a period of time with no real medical explanation.  These symptoms are often pain throughout the body, but not usually all at the same time.  Pain in the form of headaches, stomach ache, joint or muscle pain.  It could also be internal, such as vomiting, or it could come about as a sexual or menstrual problem.  Neurological symptoms are also common, often occurring as problems with balance or vision and even paralysis.

Generally for a patient to be diagnosed they will have experienced a minimum of eight symptoms.  There will be a minimum number of symptoms from a given category.  An example of this is that a patient will experience four or more symptoms from the pain category, two or more symptoms from the gastrointestinal category, one or more symptoms from the sexual symptoms category, and one or more symptoms from the pseudoneurological symptoms.  When a person is showing signs of these symptoms they will be unexplainable and a medical diagnosis is not usually possible.  Generally the person will explain the pain they are having in a fashion that makes it seem as if they are in more pain than you think they should be in, as if they are over exaggerating the symptoms.

Somatization Disorder lasts for a very long time which is one thing this disorder has in common with PTSD.  PTSD symptoms can last anywhere from months to years.   Most PTSD symptoms are different from Somatization Disorder because they come from more of a psychological background than a physical background.  PTSD symptoms are generally geared more towards an emotional aspect, some examples are worry over dying, acting younger than the chronological age, having an impaired memory or obsessiveness.  It seems that PTSD actually transforms a person’s behavior instead of changing them physically.  This is because when traumatic experiences occur, the feelings they experience, such as shock, nervousness or fear continue on for a length of time and gradually get stronger.  The stronger they get the less of a normal life the person is able to lead.

These increased symptoms can include nightmares or night terrors, hypervigilance, panic attacks, hypersensitivity, low self-esteem and shattered self-confidence or a physical or mental paralysis.  There are three categories often used by clinicians in order to type or group people who are diagnosed with PTSD.  The categories used are re-living, avoiding, and increased arousal.  The people in the re-living group are people who suffer from living through the trauma they have been through over and over again.  This can happen through a flashback or a hallucination or just by being reminded even in small ways.  The people in the avoiding group tend to try to stay away from people, places or things that can remind them of the event.  Unfortunately the person can start to isolate themselves and eventually can turn completely inward from detachment.  The people in the increased arousal group lean towards either having difficulty showing their emotions or on the other end of the spectrum showing overly exaggerated emotions.  This group is also the group who has some physical symptoms such as higher blood pressure, muscle tension and nausea.

In conclusion, it has become very apparent to me that while there are some similarities between PTSD and Somatization Disorder, there are a lot more differences.  It has also become very apparent to me that the people who suffer from these disorders are dealing with a lot of pain, and whether it is physical or emotional, this pain can cause the person suffering from it to shut down and disable them from enjoying the life they were meant to lead.

References

Netherton, S.D., Holmes, D., Walker, C.E. (1999). Child and Adolescent Psychological Disorders.   New York, NY: Oxford University Press.

Blaney, P.H., Millon, T. (2009). Oxford Textbook of Psychopathology.

New York, NY: Oxford University Press.

(2009, February 9). Anxiety & Panic Disorders Guide. WebMD.com. Retrieved October 5, 2009, from http://www.webmd.com/anxiety-panic/guide/post-traumatic-stress-disorder

(Retrieved 2009, October 5). Somatization Disorder. Intelihealth.com.  http://www.intelihealth.com/IH/ihtPrint/W/8271/25759/187986.html?d=dmtHealthAZ&hide=t&k=base

(Retrieved 2009, October 5). Posttraumatic Stress Disorder. American Academy of Child & Adolescent Psychiatry. AACAP.org

http://www.aacap.org/cs/root/facts_for_families/posttraumatic_stress_disorder_ptsd

(Retrieved 2009, October 5). Somatization Disorder. PsychNet-UK.

http://www.psychnet-uk.com/dsm_iv/somatization_disorder.htm

Kinchin, D. (2005). Post Traumatic Stress Disorder The Invisible Injury.

Didcot, Oxfordshire OX11 9YS, UK.  Retrieved October 5, 2009, from http://www.successunlimited.co.uk/books/ptsympt.htm

 

Sexual Disorder and Sexual Dysfunction, Is There A Difference?


The use of the words sexual dysfunction and sexual disorder when searched often brings up articles defining sexual disorder as sexual dysfunction. The usage, of course, is incorrect because these two subjects are so vastly different.

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Sexual dysfunction is actually an occurrence during the act of sex that has become problematic for one or both partners. These are things such as low libido or stamina, erectile dysfunction, or vaginal dryness. If any of these things occur and neither of the partners has a real problem with it, it is actually not considered a dysfunction.

When someone has a problem with their sexual function it can have a negative effect on more areas than just the area of sex. It can affect a person’s mood and can seep into other relationships because of the emotional pain and embarrassment which flows through attitudes and outlook unknowingly.

Sexual dysfunction has a number of causes both in the emotional and physical realm. It could also be caused by a combination of factors instead of just one thing. Sometimes a medical condition can have an effect on a person’s sexual function but because the person doesn’t realize the problem is medically related it affects them mentally; which can create a kind of negative unending circle. Some medical conditions which are examples of this are cardiovascular disease, diabetes, and depression.

When looking at cardiovascular disease in connection with sexual dysfunction we can see that both men and women can be affected this way because the blood vessels change in such a way that they are unable to effectively supply extremities with necessary blood. When this happens the genital area, either male or female, does not have the blood flow it needs to operate properly.

Diabetes affects a person in a similar fashion, but diabetes actually affects the nerves in the tissue of the genital area.

Depression affects people on a whole other spectrum of the body. Because the chemicals in the brain are not working properly they cause a person’s sex drive or libido to suffer. This is generally backed up by the inability to really feel any type of pleasure. This can in turn cause a loss of self confidence. Self confidence is highly important when recovering from depression, this can cause the same negative circle mentioned earlier.

Sexual dysfunction does have similar effects for men and women in some instances, but there are other things involved in sexual dysfunction that affect each person differently.

In men for example, there are some differing psychological aspects to be considered when looking at sexual dysfunction, these are concern for how they are performing sexually, marital difficulties, and feelings of guilt.

In women hormones and emotional/psychological issues seem to cause a lot of problems in this area. Things that cause a flux in the level of a woman’s hormones are having a baby or moving into menopause. Other things that can lead to sexual dysfunction in women are not having a desire for sex, or losing arousal during sex, being unable to have an orgasm or feeling pain during sex. A women’s emotional well being can have a lot to do with her ability to function sexually. If she is under a great deal of stress or anxiety, having conflicts with her partner or having issues with her body image can also become problematic.

There seem to be a lot of treatments for sexual dysfunction, but sometimes a health problem has to be treated first. Sometimes the treatment for the health problem is the cause of the sexual dysfunction and patients have to have treatment as a side effect of their medication. One way to avoid this would be to adjust the medication. This would be most ideal solution. When that doesn’t work other options are given to the patient, they can include medications for impotence or strengthening of the genitals.

Sexual disorder is completely different when compared to sexual dysfunction. Sexual disorder includes acts or behaviors that are described as sexual deviancy. These sexual acts or desires include a variety of preferences. These can include animals, various objects or different kinds of materials. Other preferences can include children or pain, either to themselves or others.

There are many categories under the sexual disorder heading and quite a few subcategories as well. In fact there are far too many to explain all of them in this short article.

Disorders under the paraphilias heading include exhibitionism, fetishism, frotteurism, transvestism, and voyeurism. These are only a few disorders under this heading. Exhibitionists have a propensity to display their genitalia to people they don’t know. They go through cycles where this action feels completely necessary.

Fetishists have an object they need to have involved in sex acts. Usually if the object is not there the person will either have difficulty with orgasm, or, will not be able to orgasm at all. Objects are generally anything from a certain type of material to a garment.

Frotteurism is a need to rub a person’s body parts against another person and generally ahs the same type of cycles as an exhibitionist does, where this action feels completely necessary, it is a compulsion.

Transvestism is when a man feels a need to either imagine himself in women’s or actually does dress in women’s clothing in order to become aroused.

Voyeurism is when a person watches other people get undressed, usually unbeknownst to the person undressing.

There are many more disorders that involve things that the general population would consider weird or sinister.  In fact many sexual disorders if uncontrolled will cause the person with the disorder to end up in jail, unfortunately there does not seem to be a cure for sexual disorders and thus the patient must depend on their own self control.

Sexual dysfunction and sexual disorder have similar names and are often intertwined when being described, but I feel that I have shown just how different they really are.

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Sexual Dysfunction vs. Sexual Disorder


A “dysfunction” is literally defined as an abnormality or disturbance of function.  (Colman, 2009, p. 232)  It may also be defined as abnormal or unhealthy interpersonal behavior or interactions.  (Merriam-Webster Online Dictionary [MWOD], 2010)  Specifically, sexual dysfunctions are defined as “conditions that impair the desire or ability to achieve sexual satisfaction.”  (Blaney & Millon, 2009, p. 399)  With and within the DSM-IV-TR, the term sexual dysfunction is conceptualized as an umbrella category that encompasses a wide variety of sex related conditions, some of which may or may not “belong” in a manual that is intended to cover and contain “mental disorders.”  This essay will give a brief overview of what are currently considered under the broad title of Sexual Dysfunctions, and provide some subjective thought on efficacy of continued inclusion as we move toward the newest revision of the “psychiatric bible,” the DSM-V.

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Under the rubric set forth by the current DSM, the DSM-IV-TR, the following disorders are considered under the broader category of Sexual Dysfunctions: Sexual Desire Disorders (i.e., Hypoactive Sexual Desire Disorder, Sexual Aversion Disorder), Sexual Arousal Disorders (i.e., Female Sexual Arousal Disorder, Male Erectile Disorder), and Orgasmic Disorders (i.e., Female Orgasmic Disorder, Male Orgasmic Disorder, and Premature Ejaculation), Sexual Pain Disorders (i.e., Dyspareunia, Vaginismus), Sexual Dysfunction Due to a General Medical Condition, Substance-Induced Sexual Dysfunction, and Sexual Dysfunction Not Otherwise Specified (NOS).  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 535)  Comparatively speaking, a “disorder” is literally defined as an abnormal physical or mental condition.  (MWOD, 2010)  In the DSM-IV-TR, sexual dysfunctions are differentiated from Paraphilias and Gender Identity Disorders (GIDs).  The essential features of a Paraphilia are arousing fantasies, sexual urges, or behaviors generally involving non-hum, the suffering or humiliation of oneself or one’s partner, or children or other non-consenting persons.  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 566)  Paraphilias include Exhibitionism, Fetishism, Frotteurism, Pedophilia, Sexual Sadism, Transvestic Fetishism, Voyeurism, and Paraphilia NOS.  Conversely, GID is characterized by strong and persistent cross-gender identification coupled with a persistent discomfort about one’s assigned sex and/or gender role.  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 576)

Among those disorders, there are some that appear to fit better than others.  Take the Sexual Desire Disorders (i.e., Hypoactive Sexual Desire Disorder, Sexual Aversion Disorder) for example… what is considered normal libido?  Is there any objective way to quantify or qualify the need or desire to have sexual relations?  Honestly, I don’t think there is.  What is normal sexual activity to me and my partner may be too much or too little for another.  Like most disorders, one of the key diagnostic criterions of the DSM-IV-TR sexual dysfunctions is “marked distress or interpersonal difficulty.”  As a result, it’s not a problem unless the potential client makes it one, regardless of the presence of desire to engage in sexual activity.  Furthermore, it’s not a disorder unless a deficiency is detected and deemed appropriate by the clinician, thereby inserting another level of subjectivity.  It should come as no surprise that inter-rater reliability is lacking, and epidemiological data is mixed based on the definition of the disorder.

Another example is Sexual Arousal Disorders (i.e., Female Sexual Arousal Disorder, Male Erectile Disorder).  Although at the core, there may be some genetic or psychological factors at play, I am not sure I could consider it a disorder if someone simply isn’t attracted to their potential partner?  There are so many variables at play in Female Sexual Arousal Disorder that it may be increasing difficult to identify specific etiology.  Perhaps her partner is less than skilled.  Perhaps there is a developmental basis for the lack of lubrication (menopause).  Perhaps there are underlying biological causes in the form of circulatory problems that contribute to an inability to attain sufficient swelling response during periods of sexual arousal.  All of these situations are in fact treatable, but should we consider them “mental disorders?”  In some cases yes, where psychological factors are at play… however, there are an abundance of situations where psychological factors have little relevance in the diagnosis and treatment of Sexual Arousal Disorders.

Orgasmic Disorders (i.e., Female Orgasmic Disorder, Male Orgasmic Disorder, and Premature Ejaculation) may be propagated by psychological factors, and subsequently appropriate for inclusion in the DSM-V.  Conversely, there are a whole host of “combined factors,” including a very wide variability in type or intensity of stimulation that can trigger organism, that are likely less than “psychological” in nature.  Take premature ejaculation for example.  I think we would be hard pressed to find men who don’t want to last longer… and that inability may be a significant cause of duress for some men.  But as currently envisioned, there is no baseline as to what constitutes a threshold between a disorder, and simply being “excitable.”

Paraphilias are a hot topic in the psychological community because the presence of “mental disorders” like pedophilia seems to justify the behavior.  It would appear to me that any suggestion that paraphilias are in fact a mental disorder would present the opportunity to present a legal argument that “he or she is mentally ill, and as a result, can’t be considered liable for these actions.  In my opinion, simply having a legal option like that is counterintuitive and reprehensible.

We have addressed what is present; however, there is one glaring absence in the current nosology.  Where is the diagnostic category of “sexual dysfunction due to mental disorder?”  One possible solution is to redefine sexual dysfunction due to substance abuse as a dysfunction due to mental disorder “with onset during intoxication.”  (Segraves & Balon, 2007)  Including such a category would be intuitive in my opinion, despite the fact that our meanings of the words disorder and dysfunction have become rather convoluted in their practical application.  It seems to meet the definition of “abnormal or unhealthy,” more so than some of what we currently consider to be dysfunctions.  Without, there is a great deal of work that needs to be done in terms of clarification and codification as we approach the watershed appearance of the latest version of the DSM.

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References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

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

Colman, A. M. (2009). Oxford dictionary of psychology (3rd ed.). Oxford, NY: Oxford University Press.

Merriam-Webster Online Dictionary. (2010). disorder. Retrieved May 23, 2010, from http://www.merriam-webster.com/dictionary/disorder

Merriam-Webster Online Dictionary. (2010). dysfunction. Retrieved May 23, 2010, from http://www.merriam-webster.com/dictionary/dysfunction

Segraves, R. T., & Balon, R. (2007, Aug). Toward an improved nosology of sexual dysfunctions in DSM-V. Psychiatric Times, 24(9), 44. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1313390581&Fmt=2&clientId=4683&RQT=309&VName=PQD

Sexual Dysfunctions


Sexual dysfunctions are conditions that impair sexual satisfaction.  This can manifest as reduced desire to initiate or sustain sexual activity, or lack of ability to achieve sexual satisfaction.  Epidemiological data suggests that the prevalence rate for all sexual disorders is approximately 31% for men and 43% for women.  (Blaney & Millon, 2009, p. 399)  That rate is given to fluctuate, however, depending on the definition of what a “dysfunction” actually entails.  The reality, for Blaney & Millon, is that any particular label or operational definition is imperfect and subject to alterative interpretations.  The key consideration for the therapist is that we must been seen as nonjudgmental.

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I am not overly surprised by the suggestion that Americans have never learned to be comfortable talking about things sexual.  “Even couples who have been together for many years, and experienced physical intimacy hundreds of times, are still often most reluctant to reveal their sexual desires, fears, and concerns to each other.”  (Blaney & Millon, 2009, p. 400)  This is the 21st Century; it’s perfectly acceptable (even desirable)… this is foreign to me.

“Rewarding sexual activity requires the adequate functioning of at least three organ systems: cardiovascular, hormonal, and neurological.”  (Blaney & Millon, 2009, p. 401)  These systems can be adversely affected by medications, particularly SSRI Antidepressants.  Virtually any medical condition that affects those systems; including illnesses, treatments, procedures, and changes- could also serve as precipitating factors.  Finally, culture and psychosocial variables weigh in as contributing factors, although “many people with sexual dysfunctions report none of these factors and many with one or more of these risk factors report satisfying and functional sexual lives.”  (Blaney & Millon, 2009, p. 402)

If a regular partner is a variable, it is preferable to have them present and willing to participate in the process.  “The involvement of the partner of the symptomatic client in treatment is widely believed to play an important (even critical) facilitative role in sex therapy.”  (Blaney & Millon, 2009, p. 404)  Even if the partner is unwilling or unable to be present for the office visits, partner cooperation and participation (along with sensitivity to partner issues on the part of the therapist) are “good enough” to make reasonable progress.

Knowing what is at stake is a key consideration for therapists to measure or ascertain.  What if they therapy fails?  Will the relationship end or will it continue?  “Having more at stake in treatment (i.e., the continuation of the relationship) can sometimes serve as an important motivator for one or both partners.”  (Blaney & Millon, 2009, p. 404)  However, this presents negative aspects as well… primarily because it is an outward indication that there is serious dissatisfaction with the relationship.

Sexual pain disorders are another dimension of sexual dysfunctions that are often neglected.  Recurrent or persistent genital pain in a female, typed dyspareunia, often causes marked distress.  Vulvodynia, characterized by chronic vulvar discomfort or pain, is also not uncommon.  The third common complaint is involuntary contractions or spasms of the outer third of the vaginal barrel, called vaginismus.  This condition makes intercourse painful or impossible.

Treatment of sexual pain disorders always begins with a careful and comprehensive gynecological exam.  “Among the many medical treatments that have been used, with at least some success, are the following:  topical creams, oral medications, biofeedback, physical therapy, cognitive behavioral sex therapy, pain management, local anesthetic agents, topical estrogen, electrical stimulation of the vestibular area, and surgery.”  (Blaney & Millon, 2009, p. 422)

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Reference

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