Mood Disorders
CHAPTER
11
L
aura and Mike have been married for a couple of years.
They generally get along well, but lately their relation-
ship has been strained. They both work long hours and
are tired when they get home. They spend weekends doing
household chores or zoning out in front of the television
or their computers. Laura and Mike aren’t spending much
quality time together, and their sex life has become non-
existent. They don’t even snuggle with each other in bed
anymore and rarely touch each other outside the bed. Their
relationship has changed so much since they fi rst started
dating, when they were attracted to each other and enjoyed
sexual relations. What went wrong, and what can they do
to improve their relationship?
By its very nature, human sexuality emerges from a confl uence
of neuropsychosocial factors. Neurologically, sexuality relies on
the actions of hormones and brain activity. Psychologically, sexual-
ity arises from the desire to be sexual with a particular person, in a
certain situation, at a specifi c moment. Fantasies and thoughts, body
image, the subjective sense of being male or female—all of these
factors and others influence sexuality. Similarly, concerns about
reproduction, infertility, or sexually transmitted diseases and past
experiences related to sex, such as sexual abuse or rape, also affect
an individual’s sexuality.
Woody Allen once commented that his favorite part of mastur-
bation was the cuddling afterward. This joke only serves to empha-
size that sexuality is ultimately social: It involves relationships. In
fact, even during solitary masturbation, someone’s thoughts and fan-
tasies usually involve other people. Sexuality is infl uenced by general
emotional satisfaction with a partner, how satisfi ed the partner has
been, the context of a particular sexual encounter, moral and reli-
gious teachings about sexuality, and cultural views of appropriate
sexual behavior (Malatesta & Adams, 2001). All of these conditions
and circumstances are ultimately rooted in social factors.
Abnormalities in sexuality and sexual behavior are also infl u-
enced by neuropsychosocial factors. For instance, an individual’s
brain (and, as a result, his or her body) may not respond to sexual
stimuli in the usual way or may respond sexually to stimuli that
are not generally considered to be sexual in nature (such as shoes).
Similarly, some individuals may have sexual fantasies that disturb
them, or they may have diffi culties with sexual functioning that leadChapter Outline
Gender Identity Disorder
What Is Gender Identity Disorder?
Criticisms of the DSM-IV-TR Defi nitionUnderstanding Gender Identity Disorder
Treating Gender Identity Disorder
Paraphilias
What Are Paraphilias?
Assessing Paraphilic Disorders
Criticisms of the DSM-IV-TR Paraphilias
Understanding Paraphilias
Treating Paraphilias
Sexual Dysfunctions
An Overview of Sexual Functioning and
Sexual Dysfunctions
Understanding Sexual Dysfunctions
Assessing Sexual Dysfunctions
Treating Sexual Dysfunctions473Gender and Sexual Disorders
Stephen Tunney