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Briken P, Bőthe B, Carvalho J, Coleman E, Giraldi A, Kraus SW, Lew-Starowicz M, Pfaus JG. Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective. Sex Med Rev 2024; 12:355-370. [PMID: 38529667 PMCID: PMC11214846 DOI: 10.1093/sxmrev/qeae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior." OBJECTIVES To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them. METHODS A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues. RESULTS CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed. CONCLUSIONS Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.
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Affiliation(s)
- Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center, Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Beáta Bőthe
- Department of Psychology, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre de Recherche Interdisciplinaire Sur Les Problèmes Conjugaux Et Les Agressions Sexuelles, Montréal, QC H3C 3J7, Canada
| | - Joana Carvalho
- William James Center for Research, Department of Education and Psychology, University of Aveiro, Aveiro 3810-193, Portugal
| | - Eli Coleman
- Eli Coleman Institute for Sexual and Gender Health, University of Minnesota, Minneapolis, MN 55454, United States
| | - Annamaria Giraldi
- Sexological Clinic, Mental Health Center, Copenhagen University Hospital, Mental Health Services, Copenhagen CPH 2200, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Shane W Kraus
- Department of Psychology, University of Nevada Las Vegas, Las Vegas, NV 5030, United States
| | - Michał Lew-Starowicz
- Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw 01-809, Poland
| | - James G Pfaus
- Center for Sexual Health and Intervention, Czech National Institute of Mental Health, Klecany 25067, Czech Republic
- Department of Psychology and Life Sciences, Faculty of Humanities, Charles University, Prague 18200, Czech Republic
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2
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Weiss J, Steil R, Priebe K, Lindauer P, Kleindienst N, Fydrich T, Müller-Engelmann M. Sexual Dysfunctions in Women with Posttraumatic Stress Disorder Following Childhood Sexual Abuse: Prevalence Rates According to DSM-5 and Clinical Correlates. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3365-3378. [PMID: 37468726 PMCID: PMC10703738 DOI: 10.1007/s10508-023-02652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023]
Abstract
Many women with posttraumatic stress disorder (PTSD) after child sexual abuse (CSA) suffer from sexual problems. However, little is known about the frequency of female sexual dysfunctions (FSD) as defined by DSM-5 among women with PTSD due to CSA. Furthermore, factors related to FSD in this patient population are understudied. To assess prevalence rates and clinical correlates of FSD according to DSM-5 criteria in women with PTSD after CSA, a structured clinical interview for sexual dysfunctions according to DSM-5 criteria was administered in a sample of 137 women with PTSD after CSA. Participants also completed measures for PTSD, depression symptoms, and borderline personality disorder symptoms. The association between FSD, severity of abuse, PTSD-, depression-, borderline symptom severity, and age was examined. In a second step, the association between FSD and PTSD-clusters was assessed. Diagnostic criteria of female sexual interest/arousal disorder (FSIAD) were met by 2.6% of women in our sample. 5.2% met criteria of female orgasmic disorder (FOD), and 11.8% those of genito-pelvic pain/penetration disorder (GPPPD). PTSD symptom severity predicted number of fulfilled criteria of FSIAD and FOD, the cluster "negative alterations in cognition and mood," was associated with more fulfilled criteria in FSIAD and FOD. The majority of women reported sexual problems, but diagnostic criteria of FSD were met by only a small number of participants. PTSD symptoms, especially the cluster "negative alterations in cognition and mood," seem to be related to female sexual functioning after CSA.
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Affiliation(s)
- Judith Weiss
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Varrentrappstr. 40-42, 60486, Frankfurt Main, Germany.
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Varrentrappstr. 40-42, 60486, Frankfurt Main, Germany
| | - Kathlen Priebe
- Faculty of Life Sciences, Department of Psychology, Humboldt-University of Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Lindauer
- Psychology School, Hochschule Fresenius, Cologne, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Thomas Fydrich
- Faculty of Life Sciences, Department of Psychology, Humboldt-University of Berlin, Berlin, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt am Main, Varrentrappstr. 40-42, 60486, Frankfurt Main, Germany
- Faculty of Human Sciences, Department of Psychology, Medical School Hamburg, Hamburg, Germany
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3
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Nolan J, Mildred H, Broadbear JH, Knight T, Rao S. Are there underlying differences between sexually diverse and non-sexually diverse people diagnosed with Borderline Personality Disorder? PSYCHOLOGY & SEXUALITY 2022. [DOI: 10.1080/19419899.2022.2137057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | | | - S. Rao
- Spectrum, Eastern Health & Monash University
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4
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Elrassas H, Saad A, Fekry M, Elkholy H, Mansour O, Azzam L. Psychiatric comorbidity in a sample of Egyptian women with vaginismus. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00200-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Vaginismus is a female sexual dysfunction affecting the quality of women and the couple’s relationship. It is considered the main feminine cause of unconsummated marriage in Egypt. The study aims in assessment of comorbid psychiatric disorders, personality disorders, and levels of alexithymia among a sample of women with vaginismus. It is a case-control study where 30 women diagnosed with vaginismus following up in the psychosexual clinic in Ain Shams University Hospitals were enrolled in the study in comparison to 30 controls. Assessment was done based on the socio-demographic data, Toronto Alexithymia scale (TAS-20), Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I), and Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II).
Results
It was found that women having vaginismus had significant below university level of education (P = 0.026) together with their partners (P = 0.006). It was also found that women having vaginismus are showing high levels of alexithymia (p < 0.001), more than one anxiety and/or depressive disorder (P = 0.032) in comparison to the control group. Also, borderline personality disorder/traits and avoidant personality traits were significantly more frequent among cases (P = 0.026, P = 0.001, and P = 0.045 respectively). Moreover, it was found that having two or more of either of rigidity, perfectionism, dramatization, mood swings, and impulsivity was significantly more frequent among cases (P < 0.001) showing a unique personality pattern of women with vaginismus.
Conclusions
Women with vaginismus were having higher levels of alexithymia, more developing anxiety, and depressive disorders than controls and they have specific personality characteristics.
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Gewirtz-Meydan A, Opuda E. The Impact of Child Sexual Abuse on Men's Sexual Function: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:265-277. [PMID: 32691693 DOI: 10.1177/1524838020939134] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Child sexual abuse (CSA) is strongly associated with sexual dysfunction. However, research about male survivors' sexual functioning after CSA is lacking. The current systematic review searched for all studies that reported on CSA and sexual function among male survivors to answer the following questions: Do male survivors of CSA experience sexual dysfunctions, and if so, to what extent? Does CSA increase the risk of developing sexual dysfunctions in adulthood among men? Studies were identified by searching seven databases and sources of gray literature. The selection criteria included empirical studies involving a population of adult men who experienced CSA before the age of 18. Studies focused on sexual functioning and sexual development after the abuse. Twelve studies met the selection criteria. While some studies confirmed that CSA is a risk factor for sexual dysfunction in adult male survivors, including low sexual drive, problems with arousal, and difficulties with orgasm and pain, other studies failed to find a correlation between sexual dysfunction and CSA. The wide range in quality, methodology, and definitions of CSA and sexual function presented challenges to consistent analysis of the studies and to determine the impact of CSA. Further research is required to fully understand the effect of CSA on adult men's sexual function.
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Affiliation(s)
- Ateret Gewirtz-Meydan
- Sex and Couple Therapy Unit, Meir Medical Center, Kfar-Saba, Israel
- Crimes Against Children Research Center, University of New Hampshire, Durham, NH, USA
| | - Eugenia Opuda
- Health and Human Services Librarian, University of New Hampshire, Durham, NH, USA
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6
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Cabello-García MA, Del Río FJ, Sánchez-Sandoval Y. [Systematic review of personality disorders and sexual dysfunction]. Rev Int Androl 2019; 18:129-136. [PMID: 31444030 DOI: 10.1016/j.androl.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/12/2019] [Accepted: 03/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Personality disorders and sexual response are two closely related aspects, and knowledge of the relationship between both variables will serve to provide quality care to patients. METHODS The aim of the present study was to conduct a systematic review on the relationship between personality disorders and sexual dysfunctions. RESULTS Fourteen scientific articles published between 2006 and 2016 met the inclusion criteria to be part of this review. This work has allowed organizing the scarce information coming from scientific works referred to the existing relations between personality disorders and sexual dysfunctions. CONCLUSION It concludes with the need to carry out more research in this area.
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Affiliation(s)
| | - Francisco Javier Del Río
- Instituto Andaluz de Sexología y Psicología, Málaga, España; Departamento de Psicología, Facultad de Ciencias de la Educación, Universidad de Cádiz, Puerto Real, Cádiz, España
| | - Yolanda Sánchez-Sandoval
- Departamento de Psicología, Facultad de Ciencias de la Educación, Universidad de Cádiz, Puerto Real, Cádiz, España
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7
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Thompson KN, Betts J, Jovev M, Nyathi Y, McDougall E, Chanen AM. Sexuality and sexual health among female youth with borderline personality disorder pathology. Early Interv Psychiatry 2019; 13:502-508. [PMID: 29076247 DOI: 10.1111/eip.12510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/12/2017] [Accepted: 08/20/2017] [Indexed: 11/26/2022]
Abstract
AIM Borderline personality disorder (BPD) is a severe mental disorder that is characterized by unstable relationships, impulsive behaviours and identity disturbance. BPD usually has its onset between puberty and young adulthood and presents disproportionately among females in clinical settings. Taken together, this makes young women with BPD a particularly vulnerable group with regard to healthy psychosexual development. It was hypothesized that female youth with BPD pathology would be more likely to score worse on measures of sexual health and safety, and to show greater uncertainty in sexual identity formation. METHODS Fifty 15 to 24 yr-old females with 3 or more Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV) BPD criteria were compared with 204 females from a nationally representative sample. Both groups were interviewed using a comprehensive interview for sexual health and relationships. The patient group completed a structured diagnostic interview. RESULTS Young women with borderline personality pathology engaged in sexual relationships at a younger age, with more sexual partners in the previous year, in more casual relationships. They were more likely to practice unsafe sex for their first sexual experience, to be coerced into unwanted sexual activity, to be unclear about their sexual identity or their sexual attraction, and to report worse overall health status. CONCLUSIONS BPD pathology in youth is associated with poor sexual health and safety, and uncertainty in sexual identity formation. These findings support the need for assessment of the sexuality and sexual health of youth with BPD, along with the need for routine screening in sexual health services for BPD features among high-risk youth.
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Affiliation(s)
- Katherine N Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Martina Jovev
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
| | - Yolanda Nyathi
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Emma McDougall
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
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8
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de Aquino Ferreira LF, Queiroz Pereira FH, Neri Benevides AML, Aguiar Melo MC. Borderline personality disorder and sexual abuse: A systematic review. Psychiatry Res 2018; 262:70-77. [PMID: 29407572 DOI: 10.1016/j.psychres.2018.01.043] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 12/21/2017] [Accepted: 01/21/2018] [Indexed: 01/14/2023]
Abstract
Although sexual abuse (SA) is known to be frequent among borderline personality disorder (BPD) patients, few reviews evaluating that relationship have been published. This systematic review aimed to investigate SA (including adulthood) as a predictor of BPD diagnosis, clinical presentation and prognosis. Studies written in English or Portuguese from January 1997 until January 2017 were identified by searching the following keywords in three international databases: "borderline personality disorder" OR "borderline disorder" AND "sexual abuse" OR "sexual violence" OR "sexual victimization" OR "sexual assault" OR "rape". Forty articles met the eligibility criteria. Overall, SA was found to play a major role in BPD, particularly in women. Childhood sexual abuse (CSA) is an important risk factor for BPD. Adult sexual abuse (ASA) rates are significantly higher in BPD patients compared with other personality disorders (PDs). SA history predicts more severe clinical presentation and poorer prognosis. Suicidality has the strongest evidence, followed by self-mutilation, post-traumatic stress disorder (PTSD), dissociation and chronicity of BPD. Future research should study more ASA and include more males, milder BPD patients and documented or corroborated SA cases. The impact of other traumatic experiences (e.g., emotional abuse) on BPD must also be systematically reviewed.
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9
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Ciocca G, Ochoa S, Jannini EA. Epidemiology of Sexual Dysfunctions in Persons Suffering from Psychiatric Disorders. TRENDS IN ANDROLOGY AND SEXUAL MEDICINE 2018. [DOI: 10.1007/978-3-319-68306-5_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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10
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Collazzoni A, Laloyaux J, Larøi F. Examination of humiliation and past maladaptive family context in persecutory ideation: An exploratory study. Compr Psychiatry 2017; 78:19-24. [PMID: 28772187 DOI: 10.1016/j.comppsych.2017.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 06/22/2017] [Accepted: 06/28/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Previous studies have demonstrated that early interpersonal trauma is involved in the development of persecutory ideation. However, the specific influence of past and current social and familial variables has never been previously explored. Thus, the aim of the present study was to examine the potential role of current and past interpersonal humiliation events (e.g. to be cruelly criticized, submitted, bullied, insulted, scorned) and a negative family context on the development of persecutory ideation. METHODS Current and past interpersonal humiliation events (Humiliation Inventory), a negative family context (Risky Family Questionnaire) and degree of persecutory ideation (Peters et al. Delusions Inventory) were assessed in a sample of 175 non-clinical participants (range=18-62years, 81% women and 19% men) with the help of an online survey. RESULTS A pattern of significant correlations emerged, in particular, between persecutory ideation, the past and present interpersonal humiliation, and negative primary family context. Moreover, hierarchical multiple regression analysis revealed that, among the various variables, past interpersonal humiliation events and a negative family context significantly predicted higher levels of persecutory ideation. CONCLUSIONS For the first time in the literature, this study provides preliminary evidence that past interpersonal humiliation events and a negative family context are related to the development of persecutory ideation. In addition, we showed that past interpersonal humiliation events, but not the fear of current events, have an impact on the development of persecutory ideation. These results suggest that the amelioration of early familial and social contexts may help to prevent the development of persecutory ideation.
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Affiliation(s)
- Alberto Collazzoni
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Vetoio, Coppito II, 67100 L'Aquila, Italy.
| | - Julien Laloyaux
- Department of Biological and Medical Psychology, University of Bergen, Jonas Lies vei 91, BB-bygget, 5009 Bergen, Norway; NORMENT - Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Quartier Agora, Place des Orateurs 1, Trifacultaire (B33), 4000 Liège, Belgium
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Jonas Lies vei 91, BB-bygget, 5009 Bergen, Norway; NORMENT - Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Quartier Agora, Place des Orateurs 1, Trifacultaire (B33), 4000 Liège, Belgium
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11
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Petri-Kelvasa M, Schulte-Herbrüggen O. Disinhibited Exposing Behavior, Hypersexuality, and Erectile Dysfunction as a Consequence of Posttraumatic Stress in a 42-Year-Old Male Patient. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2197-2205. [PMID: 28484862 DOI: 10.1007/s10508-017-0985-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 03/25/2017] [Accepted: 03/26/2017] [Indexed: 06/07/2023]
Abstract
Research into sexual dysfunction and its explanations within a cognitive behavioral framework in patients with posttraumatic stress is sparse. In this report, we present the case of a 42-year-old male with severe posttraumatic stress symptoms who displayed apparent exhibitionistic behavior, hypersexual behavior in the form of excessive masturbation, and erectile dysfunction. Differential diagnostics showed that the presented exhibitionistic behavior could be more accurately classified as non-paraphilic disinhibited exposing behavior. Functional behavioral analysis of his sexual behavior suggested that disinhibited exposing and hypersexual behavior served as dysfunctional coping strategies for trauma-associated negative emotions. Erectile dysfunction seemed to be the result of trauma-associated hyperarousal and excessive masturbation. Within the context of operant learning processes, we propose that his sexual behaviors became highly automated and were used as the main strategies to regulate trauma-associated negative emotions. Implications for the diagnoses and suggestions for the conceptualization and incorporation into a cognitive behavioral therapy treatment of posttraumatic stress disorder are made.
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Affiliation(s)
- Mirja Petri-Kelvasa
- Department of Psychiatry and Psychotherapy, Charité-University Medicine, Charité Campus Mitte, Große Hamburger Straße 5-11, 10115, Berlin, Germany.
| | - Olaf Schulte-Herbrüggen
- Department of Psychiatry and Psychotherapy, Charité-University Medicine, Charité Campus Mitte, Große Hamburger Straße 5-11, 10115, Berlin, Germany
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12
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McMillan E, Adan Sanchez A, Bhaduri A, Pehlivan N, Monson K, Badcock P, Thompson K, Killackey E, Chanen A, O'Donoghue B. Sexual functioning and experiences in young people affected by mental health disorders. Psychiatry Res 2017; 253:249-255. [PMID: 28395230 DOI: 10.1016/j.psychres.2017.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 03/10/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Abstract
The majority of mental disorders have their onset in late adolescence and early adulthood and this coincides with important stages of sexual development. Although sexual dysfunction is highly prevalent among people with mental health disorders, little is known about this topic among youth. This study aimed to evaluate the sexual functioning and subjective experience of sex in young people aged between 15 and 26 years attending a youth mental health service. One hundred and three participants were assessed with the Sexual Health Questionnaire, Sexual Functioning Questionnaire, Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms and the Medication Adherence Rating Scale. There were 43 males, 52 females, and 8 transgender and gender diverse participants with a range of mental health disorders. Eighty (77.7%) had experienced consensual sexual intercourse. Ninety-nine (95.8%) endorsed at least one item of sexual dysfunction and clinical sexual dysfunction was present in 37 (38.9%) cases. Sexual dysfunction was associated with greater severity of general psychopathology, negative symptoms, antipsychotic use, lower antipsychotic medication adherence, and negative subjective experiences around sex. Addressing this sexual dysfunction in young people could lead to both an improvement in subjective experiences of sexual relationships and potentially improvement in adherence to treatment.
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Affiliation(s)
- Elizabeth McMillan
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Asiel Adan Sanchez
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Amit Bhaduri
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen Youth Health, Parkville, Melbourne, Australia
| | | | | | - Paul Badcock
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Katherine Thompson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Eoin Killackey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Andrew Chanen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen Youth Health, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen Youth Health, Parkville, Melbourne, Australia
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13
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Karan E, Niesten IJM, Frankenburg FR, Fitzmaurice GM, Zanarini MC. Prevalence and course of sexual relationship difficulties in recovered and non-recovered patients with borderline personality disorder over 16 years of prospective follow-up. Personal Ment Health 2016; 10:232-43. [PMID: 26864454 DOI: 10.1002/pmh.1327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 11/05/2022]
Abstract
Although borderline patients experience a wide range of sexual problems, including promiscuity, there is less evidence documenting their sexual relationship difficulties. This study had two aims. The first was to examine the prevalence of these difficulties (i.e. avoidance of sex and being symptomatic after sex) over 16 years of prospective follow-up among recovered and non-recovered patients with borderline personality disorder (BPD). The second was to determine time-to-remission, recurrence and new onset of these sexual relationship difficulties. The sexual relationship difficulties of 290 patients meeting both DIB-R and DSM-III-R criteria for BPD were assessed at baseline using the Abuse History Interview and reassessed every two years over eight waves of prospective follow-up. The prevalence of sexual relationship difficulties declined significantly over time for both groups of patients, while remaining significantly more common among non-recovered patients. By 16-year follow-up, over 95% of each group achieved remission for both types of difficulties. Recurrences of avoidance of sex were significantly more common in non-recovered patients. Non-recovered patients had higher rates of new onsets compared to recovered patients for each type of sexual relationship difficulty. Taken together, the results suggest that sexual relationship difficulties are not chronic for those with BPD regardless of recovery status. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Esen Karan
- McLean Hospital, Belmont, MA, USA.,Department of Psychology at City University of New York, New York, NY, USA
| | - Isabella J M Niesten
- McLean Hospital, Belmont, MA, USA.,Faculty of Clinical and Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Frances R Frankenburg
- McLean Hospital, Belmont, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | | | - Mary C Zanarini
- McLean Hospital, Belmont, MA, USA.,Harvard Medical School, Boston, MA, USA
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14
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Frías Á, Palma C, Farriols N, González L. Sexuality-related issues in borderline personality disorder: A comprehensive review. Personal Ment Health 2016; 10:216-31. [PMID: 26840032 DOI: 10.1002/pmh.1330] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/28/2015] [Accepted: 12/20/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sexuality is somewhat neglected in clinical research on borderline personality disorder (BPD). METHOD We performed a systematic review from 1980 to November 2014 through PubMed and PsycINFO. RESULTS Empirical evidence underscores that childhood sexual trauma may be considered a non-specific risk factor for BPD. Furthermore, individuals with BPD also display higher sexual identity disturbances and homosexual relationships than non-BPD individuals. Moreover, patients with BPD also exhibit higher sexual impulsivity than non-BPD. In addition, sexual risk behaviours among individuals with BPD are related to increased rates of sexually transmitted diseases, unwanted pregnancies, rape and commercial sexual relationships, especially among drug abusers. Although psychotherapy is widely recommended for BPD, there has been little systematic research on the effect of these treatments with respect to co-morbid post-traumatic symptoms related to childhood sexual trauma. CONCLUSIONS Sexuality-related issues represent a major clinical topic within this population. Findings are discussed concerning their methodological limitations and clinical implications. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Álvaro Frías
- FPCEE Blanquerna, Ramon-Llull University, Barcelona, Spain.,Consorci Sanitari del Maresme, Adult Outpatient Mental Health Center, Mataró, Spain
| | - Carol Palma
- FPCEE Blanquerna, Ramon-Llull University, Barcelona, Spain.,Consorci Sanitari del Maresme, Adult Outpatient Mental Health Center, Mataró, Spain
| | - Núria Farriols
- FPCEE Blanquerna, Ramon-Llull University, Barcelona, Spain.,Consorci Sanitari del Maresme, Adult Outpatient Mental Health Center, Mataró, Spain
| | - Laura González
- Consorci Sanitari del Maresme, Adult Outpatient Mental Health Center, Mataró, Spain
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Abstract
Sexual problems are highly prevalent among patients with psychiatric disorders. They may be caused by the psychopathology of the psychiatric disorder but also by its pharmacotherapy. Both positive symptoms (e.g., psychosis, hallucinations) as well as negative symptoms (e.g., anhedonia) of schizophrenia may negatively interfere with interpersonal and sexual relationships. Atypical antipsychotics have fewer sexual side-effects than the classic antipsychotics. Mood disorders may affect libido, sexual arousal, orgasm, and erectile function. With the exception of bupropion, agomelatine, mirtazapine, vortioxetine, amineptine, and moclobemide, all antidepressants cause sexual side-effects. Selective serotonin reuptake inhibitors (SSRIs) may particularly delay ejaculation and female orgasm, but also can cause decreased libido and erectile difficulties. SSRI-induced sexual side-effects are dose-dependent and reversible. Very rarely, their sexual side-effects persist after SSRI discontinuation. This is often preceded by genital anesthesia. Some personality characteristics are a risk factor for sexual dysfunction. Also patients with eating disorders may suffer from sexual difficulties. So far, research into psychotropic-induced sexual side-effects suffers from substantial methodologic limitations. Patients tend not to talk with their clinician about their sexual life. Psychiatrists and other doctors need to take the initiative to talk about the patient's sexual life in order to become informed about potential medication-induced sexual difficulties.
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Affiliation(s)
- Marcel D Waldinger
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of BetaSciences, Utrecht University, Utrecht, The Netherlands.
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16
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Brotto LA, Klein C. Psychological factors involved in women’s sexual dysfunctions. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.09.67] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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17
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Hafizi S. Sleep and borderline personality disorder: a review. Asian J Psychiatr 2013; 6:452-9. [PMID: 24309854 DOI: 10.1016/j.ajp.2013.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 06/24/2013] [Accepted: 06/28/2013] [Indexed: 12/17/2022]
Abstract
Sleep problems are very common among psychiatric patients. Borderline personality disorder, as a common and severe mental disorder, is associated with different types of sleep disturbances, such as disturbances of sleep continuity, altered REM sleep regulation and nightmares. These disturbances are the result of interaction of the personality traits, concomitant and comorbid diseases and environmental factors. Despite the high prevalence of sleep related disorders in BPD patients, this aspect of BPD is still neglected in clinical and research settings. To date there has been little agreement on sleep characteristics of BPD among different studies, and presence of some uncontrolled confounding factors, make interpretation of the results difficult. However, it seems that appropriate diagnosis and treatment of sleep disorders in BPD patients might lead to better outcome. This article aimed to review the current literature of sleep studies in BPD. Some recommendations and suggestions were made for future researches in this field.
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Affiliation(s)
- Sina Hafizi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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18
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Schulte-Herbrüggen O, Heinz A. Psychological trauma in soldiers-a challenge for the German Armed Forces (Bundeswehr). DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:557-8. [PMID: 23130088 DOI: 10.3238/arztebl.2012.0557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Singh D, McMain S, Zucker KJ. Gender identity and sexual orientation in women with borderline personality disorder. J Sex Med 2010; 8:447-54. [PMID: 21054794 DOI: 10.1111/j.1743-6109.2010.02086.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revision (DSM-IV-TR) (and earlier editions), a disturbance in "identity" is one of the defining features of borderline personality disorder (BPD). Gender identity, a person's sense of self as a male or a female, constitutes an important aspect of identity formation, but this construct has rarely been examined in patients with BPD. AIMS In the present study, the presence of gender identity disorder or confusion was examined in women diagnosed with BPD. MAIN OUTCOME MEASURES We used a validated dimensional measure of gender dysphoria. Recalled gender identity and gender role behavior from childhood was also assessed with a validated dimensional measure, and current sexual orientation was assessed by two self-report measures. METHODS A consecutive series of 100 clinic-referred women (mean age, 34 years) with BPD participated in the study. The women were diagnosed with BPD using the International Personality Disorder Exam-BPD Section. RESULTS None of the women with BPD met the criterion for caseness on the dimensional measure of gender dysphoria. Women who self-reported either a bisexual or a homosexual sexual orientation had a significantly higher score on the dimensional measure of gender dysphoria than the women who self-reported a heterosexual sexual orientation, and they also recalled significantly more cross-gender behavior during childhood. Results were compared with a previous study on a diagnostically heterogeneous group of women with other clinical problems. CONCLUSION The importance of psychosexual assessment in the clinical evaluation of patients with BPD is discussed.
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Affiliation(s)
- Devita Singh
- Gender Identity Service, Child, Youth, and Family Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
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20
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Matevosyan NR. Evaluation of Perceived Sexual Functioning in Women with Serious Mental Illnesses. SEXUALITY AND DISABILITY 2010. [DOI: 10.1007/s11195-010-9166-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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21
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