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Expression of one's sexuality is a fundamental mental health need of all individuals, regardless of age and gender. While the popularity and widespread use of Viagra and similar medications for male erectile dysfunction have helped many individuals, it has also reinforced a more male dominated view of sexuality-one that focuses more on genital function, and less on the relationship and issues of intimacy and meaning. Highlighting important issues and recent trends, the paper provides an overview of the diagnosis, description, etiology, assessment and treatment of women's sexual problems. A broad perspective on sexuality is emphasized, along with an understanding of the sexual response cycle. A selected review of the literature on older women and sexual dysfunction shows wide variability and the important role of biomedical, health and relational factors. In working with the sexual needs of older women, any therapeutic intervention should be based upon a solid understanding of the myths and realities of the sexual aging process, a keen understanding of the sexual challenges faced by older women, and a respect for the continuity of one's sexual lifestyle. [ABSTRACT FROM AUTHOR]

Women are the primary consumers of mental health services. Ironically, research addressing their unique needs lags behind that of men's issues. The aging process introduces an important variable that accentuates the relative lack of information and specific treatment guidelines for older women who are confronted by mental health problems. This volume offers a comprehensive overview for the health professional who is seeking a greater depth of understanding with respect to the study of mental health problems in general, and how these issues pertain specifically to women and the aging process. A second goal of this project is to provide the practicing therapist and counselor with a research update and a broad clinical perspective offered by seasoned clinicians. Using current psychiatric diagnosis as a framework, the contributions address the range of mental health problems, including dementia and cognitive impairment, schizophrenia, alcohol abuse, mood and anxiety disorders, traumatic and dissociative conditions, sexual and eating disorders, and personality disorders. It is hoped that this book will inform, inspire and encourage students and health professionals in their work with middle aged and older women who are facing mental health challenges. [ABSTRACT FROM AUTHOR]

Background: The present study examined a group of patients who have obsessive compulsive disorder (OCD) and certain comorbid personality disorders to provide data on types of clinical problems that complicate treatment. Data are presented on patient response to a comprehensive behavior therapy., Method: Forty-one consecutively referred, adult, nonpsychotic patients with OCD were evaluated independently by their attending psychiatrist and a consulting psychologist for presence of DSM-III-R personality disorder. Thirty-one of these patients, for whom there was 100% agreement on presence or absence of a comorbid personality disorder, participated in a course of comprehensive behavior therapy. OCD patients with comorbid personality disorder (OCD+PD) were compared with a group of OCD patients without comorbid personality disorder (nonPD OCD) on pretreatment and treatment-related variables., Results: There was significantly high interrater reliability between psychiatrist and psychologist on diagnosis of personality disorder (p < .001). OCD+PD patients demonstrated poorer response to prior psychiatric treatments and greater psychosocial and psychiatric impairment at pretreatment than did nonPD OCD patients. The OCD+PD patients demonstrated a moderate response to comprehensive behavior therapy, but below that of nonPD OCD patients. OCD+PD patients were also rated as more difficult to treat, required more psychiatric hospitalizations during treatment, and were more likely to terminate behavior therapy prematurely than were nonPD OCD patients., Conclusion: In modest samples of OCD+PD patients (N = 26), and nonPD OCD patients (N = 5), this study found that OCD patients with personality disorder had greater psychopathology, fewer coping and living skills, and were more resistant to psychiatric treatment than the nonPD OCD patients. In addition, when treated with a comprehensive behavior therapy that focuses on other clinical problems in addition to the OCD symptoms, the OCD+PD patients had an enhanced response to treatment.

The threshold for the dark interval between two flashes was used to examine differences in stimulus persistence in 72 subjects aged 20 to 79 years. The data were then combined with results from two previous studies involving children and adolescents; thus, a cross sectional, adult, life-span view of differences in the dark-interval threshold was presented. Results showed that during childhood and adolescence there is a decline in stimulus persistence as a result of decreased receptor sensitivity. In adulthood, however, the dark-interval threshold remains fairly stable until the 70s where it increases significantly. Two possible explanations for this increase in stimulus persistence in old age are discussed.

Behavior therapy has been underutilized in the private psychiatric hospital setting. A recent survey of member hospitals of the National Association of Private Psychiatric Hospitals (NAPPH) found that fewer than 25 percent of those surveyed provided behavior-therapy consultation for inpatients and fewer than 40 percent had a behavior therapist on staff (1). This situation is unfortunate because behavior therapy has made significant contributions to the mental health field, and the approach offers a research-based system of accountability and cost-efficiency. Moreover, behavior therapy is applicable to a wide range of psychiatric problems, and its methods and procedures provide a practical and effective complement or alternative to a patient's pharmacotherapy and insight-oriented psychotherapy. Clearly, behavior therapy has much to offer the private psychiatric hospital, and this contribution is gradually being recognized. This paper describes the development and growth of a behavioral-consultation and treatment program in a private psychiatric hospital.

This case study presents the first application of behavioral techniques in the management of psychological reactions associated with respiratory weaning. A forty-eight-year-old woman, with a history of brain stem dysfunction and repeated respiratory arrests participated in a four-week behavioral treatment program designed to 1) eliminate suffocation fear and depression, 2) promote respiratory self-sufficiency, and 3) facilitate successful ventilatory weaning. At one year follow-up, the patient continued to display no evidence of respiratory difficulty, depressive symptomatology, or agitated mood states.

In an attempt to evaluate how widows of various ages adapt sexually to loss of a marital partner, 100 relatively healthy, community-dwelling widows between the ages of 40 and 89 completed a reliable 101-item questionnaire which evaluated three major areas: 1) barriers to sexual expression posed by age-related changes in body image, mood state and environmental context; 2) degree of unhappiness associated with loss of various marriage-oriented activities; and 3) perceived utility of various activities which indirectly might satisfy sexual and affectional needs. Controlling for income, education, heterosocial involvement, and family contact, and using level of morale and depression as corroborative measures, results showed specific age differences across variables assessed. In particular, younger widows, when compared with their older counterparts, viewed changes in body image, the dearth of unattached men, and limited financial resources for social activities as representing significant sexual barriers. Increasing age of the widow was associated with lower unhappiness ratings with loss of marriage-related activities. For the sample as a whole, greater unhappiness was expressed with the loss of nonsexual, heterosocial activity (e.g., conversation with a man, going places with a man). Results also indicated that, regardless of the widow's age, activities pertaining to her children and grandchildren, wearing attractive clothing, and expressing her spirituality are all effective in meeting affectional and sexual needs. Results are discussed within the context of older female sexuality, affectional adaptation to widowhood, and therapeutic implications directed at this neglected group.