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Normophillic sexual disorders in private practice: diagnostic changes, prevalence & treatment
Sexual Disorders defined by DSM-4
Normophilic sexual activities conform to the dictates of custom, religion, and law. These include Sexual Behavior with Consenting Adults, Masturbation, Pornography, Cybersex, Telephone Sex, Strip Clubs. Normophillic sexual behaviors represent one of the core avenues for human satisfaction, however in excess these behaviours can of course lead to harm. DSM-4 accounted for excesses of Normophillic behaviours under the category Sexual Disorder Not Otherwise Specified (NOS). See table over page. Paraphillic sexual activities by contrast do NOT conform to the dictates of custom, religion, and law and generally include sexually deviant types of behavior. See table over page for Paraphillic disorders.
Sexual and Gender Identity Disorders in DSM 4. The sexual disorders are further subdivided into 4 categories
DSM-IV Sexual Disorder Categories 1. Sexual Dysfunctions Broad Description Examples
disturbance in sexual desire and in the psychophysiological changes that constitute the sexual response cycle.
Low Sexual Desire Disorders (Hypoactive Sexual Desire Disorder and Sexual Aversion Disorder), Sexual Arousal Disorders (Female Sexual Arousal Disorder and Male Erectile Disorder), Orgasmic Disorders (Female Orgasmic Disorder, Male Orgasmic Disorder, and Premature Ejaculation), Sexual Pain Disorders (Dyspareunia-painful intercourse, Vaginismus-vaginal spasm during penetration). Secondary and Other Sexual Dysfunctions, which include Sexual Dysfunction Due to a General Medical Condition, Substance-Induced Sexual Dysfunction
2. Paraphillic disorders,
recurrent, intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, or situations that occur over a period of at least six months and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Paraphilias are commonly associated with increased sexual activity, often with compulsive and/or impulsive features
strong and persistent cross-gender identification accompanied by persistent discomfort with one's assigned sex disorders of sexual functioning that are not classifiable in any of the specific categories
"Distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used" (DSM-IV . 638). This diagnosis has historically been the most common one to be used for patients identified as sexual addicts.
Sexual fantasies, urges or behaviours may relate to: Masturbation Pornography Sexual Behavior with Consenting Adults Cybersex Telephone Sex Strip Clubs.
Presentation Using internet porn streaming videos & photo galleries as a self-soothing habit. Partner found evidence on his PC and demanded he address the issue. Marital breakdown. Porn usage was one factor. He used at work and at home to manage stress. His step daughter followed a URL address to porn site told her mother who confronted him. His wife answered late night call from unknown woman. Confronted partner who confessed he had met woman online in sex chat line and agreed to meet for liaison. Daughter revealed that father had touched her. When confronted he confessed masturbating in front of daughter. Presented with homicidal and suicidal ideation.CATT team called. Post hospitalization adopted BDSM as a stress management technique. Depressed. Grieving over having autistic son 4yrs old. Intimacy breakdown with wife. Using porn late at night when he cant sleep. He was concerned that he only wanted to watch 1980s simulated rape domination videos. Stress in marriage.flirting and chasing women. Compelled to have sex as a stress reliever rather than addressing his primary relationship problems. Frequent casual sex as a self soother for loneliness. Also as a defense against seeking men who treat her wellfear of being abandoned again. Struggling with parenting and marriage. Staying up late online chat and cyber sex.
Background Issues Extremely strict religious upbringing. Taboos about nudity and intimacy. Anxiety about having sex, never confident. Pressure from partner to have children. He came from very enmeshed family of origin, lacked adult confidence. Very devout Christian. Lacked confidence with women used porn from teens. Bullied, social anxiety teens. Fell into to gaming as an escape. Enjoyed going onto sex chat lines pretending to be older or different gender. Long history of being socially anxious, using internet porn. Had early sexual experiences aged 9 initiated by 12 yr old girl. Extremely devout Christian. Broke up from wife has 5 kids under 12. Significant drug user. Borderline PD. History of passionate relationship with more mature woman when he was 16. Then had partner into BDSM preferred aggressive sex. Current wife more sexually conservative. His own mother had extramarital affair and left his father when he was 8. Extreme work pressure, business owner, no work-life balance Sexually assaulted as a child. Borderline features. Recently abandoned by her husband of 1 yr. History of sexual abuse as a child, 2 failed marriages.
Andrew 44 Jo L 38 Mary 48