PANCE Blueprint Psychiatry (6%)

Human sexuality (PEARLS)

Human sexuality
Exhibitionistic disorder Sexual gratification attained by exposing genitals to unsuspecting strangers
Female sexual interest/arousal disorder A female dysfunction marked by a persistent reduction or lack of interest in sex and low sexual activity, as well as, in some cases, limited excitement and few sexual sensations during sexual activity
Fetishistic disorder A paraphilic disorder consisting of recurrent and intense sexual urges, fantasies, or behaviors that involve the use of a nonliving object or nongenital part, often to the exclusion of all other stimuli, accompanied by clinically significant distress or impairment
Male hypoactive sexual desire disorder A male dysfunction marked by a persistent reduction or lack of interest in sex and hence a low level of sexual activity
Pedophilic disorder A paraphilic disorder in which a person has repeated and intense sexual urges or fantasies about watching, touching, or engaging in sexual acts with children, and either acts on these urges or experiences clinically significant distress or impairment
Sexual masochism disorder A paraphilic disorder characterized by repeated and intense sexual urges, fantasies, or behaviors that involve being humiliated, beaten, bound, or otherwise made to suffer.
Voyeuristic disorder A paraphilic disorder in which sexual arousal is derived from observing unsuspecting individuals undressing or naked
Exhibitionistic disorder
Patient will present as → a 23-year-old male who goes to city park during the summer months in an overcoat. He enjoys walking around the park exposing his genitals to strangers. He then runs away so as to avoid getting caught.

Over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors.

  • The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Female sexual interest/arousal disorder
Patient will present as → a 33-year-old woman with a chief complaint of trouble having intercourse. She is completely disinterested in sex and she is not receptive to her partner’s attempts to initiate foreplay. She reports that when they do have sex she never achieves orgasm. This is affecting her current relationship with her boyfriend.

Requires absence/reduced of 3 of the following for 6 months that causes distress.

  • Interest in sexual activity
  • Sexual/erotic thoughts or fantasies
  • Initiation of sexual activity/not receptive
  • Excitement/pleasure
  • Sexual interest/arousal in response to internal or external stimuli
  • Genital or nongenital sensations

Must rule out other medical disorders prior to making the diagnosis.

Fetishistic disorder
Patient will present as → a female brings her 29-year-old boyfriend to a couples therapist because she is uncomfortable with his behavior. She found him clutching her feet during intercourse, and noticed that he insists on being able to see her feet while they engage in sexual acts.

Sexual arousal obtained from specific objects.

  • Over a period of at least 6 months, recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s), as manifested by fantasies, urges, or behaviors.
Male hypoactive sexual desire disorder
Patient will present as → a 53-year-old male complaining of a lack of desire for sex with his wife causing him marked distress for the past year. His wife has been very hurt by his lack of response to her advances and he reports that this is having a significant strain on their relationship. Prior to this, he was interested in sex and he and his wife would have intercourse 1-2x per month. He is very active and continues to compete in triathlons. He has no significant past medical history.

Characterized as a lack or absence of sexual fantasies and desire for sexual activity.

  • For this to be regarded as a disorder, it must cause marked distress or interpersonal difficulties and not be better accounted for by another mental disorder, a drug (legal or illegal), some other medical condition, or asexuality.
  • The symptoms have persisted for a minimum duration of approximately 6 months.
Pedophilic disorder
Patient will present as → a 33-year-old male gymnastics teacher insists that all his students take a shower after class. He supervises the children showering and becomes sexually aroused.

Sexual arousal by prepubescent children (generally 13 years or younger)

  1. Over a period of at least 6 months.
  2. The individual has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.
Sexual masochism disorder

 

Patient will present as → a 23-year-old male who concerned that his behavior has resulted in his inability to maintain a relationship. He reveals that he requires his partners to strangle him and humiliate him in order for him to achieve and maintain an erection.

Arousal from being threatened or hurt during sexual activities

  • Over a period of at least 6 months.
  • The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in functioning.
Voyeuristic disorder
Patient will present as → a 20-year-old male college student was reported by others for spying through the windows of his fellow female dormmates. 

Recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity.

  • Over a period of at least 6 months.
  • The individual has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress.
Feeding and eating disorders (Lecture + ReelDx) (Prev Lesson)
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