Article

Impaired Sexual Function in Patients with Borderline Personality Disorder is Determined by History of Sexual Abuse

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Abstract

Patients suffering from a Borderline Personality Disorder (BPD) display altered sexual behavior, such as sexual avoidance or sexual impulsivity, which has repeatedly been linked to the sexual traumatization that occurs in a high percentage of BPD patients. Until now, no empirical data exists on whether these patients concomitantly suffer from sexual dysfunction. This study investigates sexual function and the impact of sexual traumatization on this issue in women with BPD as compared to healthy women. Sexual function was measured using the Female Sexual Function Index. Additionally, diagnoses were made with SCID II Interviews for Axis II and with the Mini International Neuropsychiatric Interview for Axis I disorders. The Post-traumatic Stress Diagnostic Scale for trauma evaluation was used. Sexual orientation was assessed by self-evaluation. Forty-five women with BPD as diagnosed according to DSM-IV criteria and 30 healthy women completed questionnaires on sexual function and sexual abuse history, as well as interviews on axis I and II disorders and psychotropic medication. The BPD group showed a significantly higher prevalence of sexual dysfunction. Subgroup analyses revealed that BPD with concomitant sexual traumatization, and not BPD alone, best explains impaired sexual function. Sexual inactivity was mainly related to current major depression or use of SSRI medication. In sexually active participants, medication and symptoms of depression had no significant impact on sexual function. Not BPD alone, but concomitant sexual traumatization, predicts significantly impaired sexual function. This may have a therapeutic impact on BPD patients reporting sexual traumatization.

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... Findings on the prevalence of homosexuality among women with versus without a BPD diagnosis are mixed. On the one hand, similar rates of homosexual or bisexual orientation as that reported by Reich and Zanarini [197] [205]. Moreover, Singh et al. [177] stated that the rate of homosexual or bisexual orientation in each of these studies was higher than the rate for women in the general population[1.4%] ...
... On the other hand, Dulit et al. [203] found no significant difference in rates of heterosexuality in consecutive female psychiatric inpatients with[73%] versus without[89%] DSM-III BPD and found a rate of homosexuality among those with BPD similar to the rate of homosexuality among women in the general population[1-2%] [200]. In addition, in Schulte-Herbrüggen et al. [205], a larger proportion of the healthy female controls[13.3%] reported homosexual orientation than the female psychiatric inpatients with DSM-IV BPD[6.7%], ...
... Reich and Zanarini [197] found that a reported family history of homosexual or bisexual orientation was significantly associated with homosexual or bisexual orientation and/or same-sex relationships among such patients. Some researchers have suggested that higher rates of homosexual behavior among people with BPD may be due to impulsivity paired with identity disturbance [181] and that a trend for a higher rate of bisexual orientation in female psychiatric inpatients with DSM-IV BPD may reflect identity disturbance [205]. ...
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Background: In recent years, there have been significant advancements in understanding the etiology, assessment, and treatment of borderline personality disorder (BPD). However, the influence of culture has not been carefully considered. The present review is an attempt to identify cultural factors that may change the presentation, assessment, and response to treatment among adults and adolescents with BPD. Discussion: We discuss the relevance of examining the BPD diagnosis across cultures, define culture, and review studies on the prevalence of BPD across sociocultural groups. Conclusion: We provide a comprehensive list of assessments developed to capture BPD and the cultural adaptations and validations attempted thus far. We also summarize the evidence base for culturally sensitive treatments for BPD. Finally, we present suggestions for future research and clinical implications for our findings.
... They are more likely to be coerced into having sex (Sansone & Sansone, 2011a), and to have impaired sexual function (Schulte-Herbruggen, Ahlers, Kronsbein, et al., 2009). Sexual health is further adversely impacted by a diagnosis of BPD and co-occurring substance use disorder, as indicated by even higher rates of STIs (Chen, Brown, Lo, & Linehan, 2007) and unprotected sex (Harned, Pantalone, Ward-Ciesielski, Lynch, & Linehan, 2011). ...
... An additional consideration is that many individuals will experience subsequent sexual relationship difficulties (Zanarini et al., 2003) and for some, engaging in a sexual relationship will provoke trauma-related symptoms (Sansone, Lam, et al., 2011). This might eventually lead women with BPD to avoid sexual relationships (Sansone, Lam, et al., 2011;Schulte-Herbruggen et al., 2009). ...
Article
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.
... There is little empirical research on other forms of sexual psychopathology in BPD. One study of 45 women with BPD found that reduced sexual desire as measured by the Female Sexual Function Index was associated with comorbid depression rather than BPD traits (Schulte-Herbrüggen et al., 2009). ...
... In addition, there should also be detailed research into the sexual side-effects (e.g. inhibited sexual desire) of psychotropic medication (antidepressants) to determine their impact on treatment adherence in patients with BPD (Schulte-Herbrüggen et al., 2009). Overall, the heterogeneity of BPD samplessome consisted of individuals with a confirmed clinical diagnosis of BPD, others of individuals who self-reported personality traits associated with BPDmade it difficult to compare the results of different studies and prevented us drawing firm conclusions. ...
Article
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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.
... In the BPD group (and, to a lesser extent, the PD group), the percentage who self-identified as either bisexual or homosexual was substantially higher than the rates reported on in epidemiological survey studies (e.g., [16][17][18][19][20]). In another recent study, Schulte-Herbrüggen et al. [21] reported that 30.1% of 45 women with BPD, treated as inpatients, self-identified as bisexual or homosexual, compared with 20% of 30 healthy control women, a nonsignificant difference at P = 0.11. ...
... In our sample of BPD women, 27% selfidentified as either bisexual or lesbian, and this metric of sexual orientation correlated quite strongly with our self-reported continuous metric of sexual attraction. The percentage of women who self-identified as either bisexual or lesbian was virtually identical to the percentage reported on by Reich and Zanarini [12] and similar to that of Schulte-Herbrüggen et al. [21]. Given that these percentages are quite elevated when compared with population baserates of a self-reported bisexual or lesbian sexual orientation [17], how might this finding be interpreted? ...
Article
Full-text available
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. In the present study, the presence of gender identity disorder or confusion was examined in women diagnosed with BPD. 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. 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. 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. The importance of psychosexual assessment in the clinical evaluation of patients with BPD is discussed.
... Psychiatry Research 253 (2017) 249-255 relationship between sexual dysfunction and previous sexual trauma (Schulte-Herbruggen et al., 2009;Turchik and Hassija, 2014), positive smoking status (Kupelian et al., 2007), antidepressant use (Montgomery et al., 2002), or mood stabilizer use (Grover et al., 2014). However, these findings have to be considered within the limitations of the small sub-group in the mood clinic and the small number prescribed mood stabilizers. ...
... The present study examined subjective experiences after sexual activity in young people but further research is needed to evaluate feelings before intercourse, as well as expectations and motivations for engaging in sex. This might be particularly important to assess in young people with borderline personality disorder, as this group has been found to have a complex connection to sexual identity, intercourse and relationships (Sansone et al., 2008;Schulte-Herbruggen et al., 2009). Additionally, as young people today often have private access to the internet, future research might focus on the use of, and attitudes towards, resources such as online pornography and social media platforms for selecting sexual partners. ...
Article
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.
... Die Vermengung von privatem Befinden, psychischer Gesundheit und beruflicher Einsetzbarkeit stellt aber auch in zivilen Bereichen eine dauerhafte Herausforderung für Arbeits-und Betriebsmediziner dar, insbesondere wenn das Äußern psychischer Belastung stigmatisiert oder schambesetzt ist. Psychische Traumatisierung hat neben der häufig diskutierten Symptomatik, zu der Hyperarousal, Intrusionen und Vermeidungsverhalten zählen, häufig auch einen negativen Einfluss auf das partnerschaftliche Erleben und die Sexualität (7). Dabei zeigen Studien auch bei nicht-sexualisierter Gewalterfahrung, dass viele Menschen nach dem Kriegseinsatz an sexueller Dysfunktion leiden, und zwar unabhängig von der Ausbildung einer PTBS-Symptomatik (8). ...
Article
Editorial zu den Beiträgen: "Traumatische Ereignisse und posttraumatische Belastungs -störungen bei im Ausland eingesetzten Soldaten – Wie hoch ist die Dunkelziffer? von Wittchen und Schönfeld et al. sowie "Einsatz bedingte Belastungen bei Soldaten der Bundeswehr – Inanspruchnahme psychiatrisch-psychothera -peutischer Behandlung" von Kowalski et al. auf den folgenden Seiten mend der Aufgabe an, sich den Fragen zum ange-messenen Umgang mit im Einsatz traumatisierten Soldaten zu stellen. Neben traumatherapeutischen Behandlungskonzepten stellt aufgrund der besonde-ren Konstellation im Bundeswehreinsatz die Primär-und Sekundärprävention eine besondere Herausfor-derung dar. Nirgendwo sonst sind Schulungs-und Behandlungsabläufe so planbar wie bei militärischen Einsätzen. Einsatzbedingte Belastungen bei Soldaten Nach früheren Studien ausländischer Armeen stellen in dieser Ausgabe des Deutschen Ärzteblattes Hans-Ulrich Wittchen und Sabine Schönfeld et al. (3) so-wie Jens Kowalski et al. (4) erstmals Daten der Bundeswehr zu einsatzbedingten Belastungen vor. Demnach leiden – bezogen auf 10 000 Soldaten – nach einem durchschnittlich viermonatigen Einsatz 291 Soldaten unter einer PTBS. Das höchste Risiko, an einer PTBS zu erkranken, besteht offenbar bei Einsätzen in Kundus (Afghanistan) und expliziten Kampfeinsätzen. Die sich daraus ergebende Präva-lenz von 2,9 Prozent posttraumatischer Belastungs-störungen ist allerdings deutlich niedriger als bei an-deren Armeen im selben Einsatzgebiet (5, 6). Es scheint, dass sich edukative Programme, kürze-re Einsatzzeiten im Vergleich zu anderen Armeen und somit wahrscheinlich eine niedrigere kumulative Dosis an traumatisierenden Ereignissen positiv für die Betroffenen auswirken. In diesem Zusammen-hang ist aber anzumerken, dass in der Arbeit von Wittchen und Schönfeld et al. nur die PTBS als Trau-mafolgestörung untersucht wurde, es gibt also keine expliziten Angaben zu weiteren Erkrankungen wie Angststörungen sowie affektiven und substanzge-bundenen Störungen, die ein komplexeres Bild erge-ben können. Weiterhin gibt die Studie Hinweise darauf, dass die Zahl der unerkannten oder unbehandelten PTBS-Fälle mit 45 % erheblich ist. Auch die im Vergleich niedrige Neuerkrankungsrate von PTBS bei Soldaten darf nicht darüber hinwegtäuschen, dass qualifizierte störungsspezifische Behandlungsplätze bisher trotz der steigenden Anzahl von Auslandseinsätzen fehlen. Die breite öffentliche Diskussion und psychoeduka-tive Maßnahmen bei der Bundeswehr führten nach den Daten von Kowalski et al. im Zeitraum Januar E in psychisches Trauma stellt nach der ICD-10 eine Situation dar, die "ein belastendes Ereignis oder eine Situation kürzerer oder längerer Dauer, mit außergewöhnlicher Bedrohung oder katastrophenar-tigem Ausmaß, die bei fast jedem eine tiefe Ver-zweiflung hervorrufen würde" beinhaltet. Sogenann-te Traumafolgestörungen – wie zum Beispiel die akute Belastungsstörung, die posttraumatische Be-lastungsstörung (PTBS) und affektive Erkrankungen – sind im psychiatrisch-psychotherapeutischen, aber auch im gesamtgesellschaftlichen Kontext in den vergangenen Jahren zunehmend ins Zentrum der Diskussion gerückt.
... According to the several studies' findings, the history of childhood abuse can increase the risk of BPD in adulthood (Elzy, 2011;Fossati et al., 1999;Igarashi et al., 2010;Tyrka et al., 2009;Widom et al., 2009;Wolke et al., 2012). It can also predict suicidal and self-harm behaviors, sexual dysfunctions and dissociative symptoms in BPD patients (Carballo et al., 2008;Schulte-Herbrü ggen et al., 2009;Watson et al., 2006;Weierich and Nock, 2008;Zanarini et al., 2011) and lead to neuro-cognitive dysfunction (Minzenberg et al., 2010). Many studies have investigated the association of childhood abuse and sleep disturbances (Chen et al., 2010;Glod et al., 1997;Greenfield et al., 2011;Gregory and Barclay, 2009;Heitkemper et al., 2011;Noll et al., 2006;Paolucci et al., 2001;Poon and Knight, 2011) and have shown positive relationship between them. ...
Article
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.
... Mustafa denied any prior serious medical diagnoses, treatment, surgeries, or head injuries. In line with research suggesting that sexual dysfunction may be determined by previous traumatic life events (Schulte-Herbrüggen et al., 2009), however, he reported to have never before experienced traumatic events in his life. He did and does not consume drugs, alcohol, or nicotine. ...
Article
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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.
... In particular, a case-control study of a female population showed that BPD concomitant with sexual traumatization significantly increased the presence of female sexual dysfunction. 56 Moreover, in general, the relation between childhood sexual abuse and BPD has been well documented with dramatic consequences in adult life, such as suicidal attempts, sexual risk behavior, sexually transmitted infections, and substance abuse. 57 Interestingly, the behavioral differences between suicidal BPD and opiate-dependent BPD were examined. ...
Article
Abstract Introduction Personality disorders impair several aspects of intrapsychic and interpersonal life. In particular, mating strategies and sexual functioning could manifest in different and/or dysfunctional ways in people with personality disorders. Aim To describe, through a comprehensive review of the literature, the mating strategies and sexual functioning in patients with personality disorders. Methods We listed and discussed the principal studies on the relation between mating strategies and sexual functioning in personality disorders. The search strategy used search terms in PubMed for the main studies published from January 2000 to December 2016. Main Outcome Measures We considered two main sections for our selection according to the aim of the present review: mating and sexuality. Results Interesting evidence on mating strategies in personality disorders was found. In particular, the major items were found in the dramatic-unpredictable cluster, with borderline personality disorder being the most studied. In contrast, the bizarre-eccentric cluster had fewer items, with the schizoid personality disorder being the least studied. For sexual behavior, borderline personality seems to be the unique disorder sufficiently studied, with evidence of major histories of child sexual abuse, the presence of sexual dysfunctions, and paraphilic interests. Conclusion A large spectrum of mating strategies characterizes different personality disorders, although an inconsistent knowledge about the relation between sexual function and personality disorders emerged from our analysis of the literature. Hence, we invite clinicians and researchers to integrate psychodiagnostic and sexual assessments in psychiatric disciplines for people with personality disorders.
... It is important to mention that not every child who has lived in a maladaptive family and experienced interpersonal past humiliation events will develop persecutory ideation. For example, some individuals may develop no symptoms at all, while others may experience psychological difficulties such as post-traumatic stress disorder [23,24] or borderline personality disorder [25,26] with or without persecutory ideation. We have no clear explanation for why certain individuals specifically develop persecutory ideation but the variety of possible outcomes suggests the influence of other factors such as a preexisting vulnerability (which is related to several factors including genetic liability) and cognitive (e.g., cognitive bias) and affective factors (e.g., emotions regulation strategies). ...
Article
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 = 18–62 years, 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.
... Neben sexueller Vermeidung und Dissoziation, Selbstverletzen und Suizidalität im Zusammenhang mit Sexualität ( Zanarini et al., 2003) kann es im Rahmen der Borderline­ Störung zu sexuellem Risikover­ halten ( Sansone et al., 2011) und sexuellen Funktionsstörungen (Er­ regungs­, Lubrikations­, Orgasmus­ störungen, verringerte sexuelle Be­ friedigung, mehr Schmerzen beim Sex) kommen ( Schulte­Herbrüggen et al., 2009). ...
... Women with borderline personality disorder have shown similar sexual outcomes to those with histrionic personality in that, despite sexual depression and dissatisfaction, there were higher rates of sexual esteem and sexual assertiveness compared with controls [76]. In a study of 45 women with borderline personality who completed brief questionnaire measures of sexual response, the impairment in several domains of sexual functioning was found to be associated with sexual abuse history and not exclusively to the personality traits, per se [77]. This was also borne out in other research that found higher rates of sexual abuse in dating relationships (i.e., date rape) and an earlier debut of sexual activity among women with borderline personality [78]. ...
Article
Full-text available
Compared with research on men's sexual dysfunction, far less is known about the precise etiology of and effective treatments for sexual dysfunction in women. The lack of any pharmacologically approved treatment for women's sexual complaints has been attributed, in part, to the complexity of psychosocial and interpersonal factors involved. The aim of this article is to review some of the major psychological aspects of women's sexual dysfunction, focusing on the role of Axis I and Axis II disorders, individual vulnerability factors and interpersonal influences. Implications for treatment, where relevant, are discussed throughout.
... The interplay of personal wellbeing, mental health, and professional deployability is a challenge for occupational health physicians in civilian companies too, especially if verbalizing psychological stress is associated with stigmatization or shame. In addition to the oft-discussed symptoms, which include hyperarousal, intrusions, and avoidance behaviors, psychological trauma often has a negative influence on personal relationships and sexuality (7). Studies have shown that even after experiences of violence that is non-sexual that many people are affected by sexual dysfunction after military deployments to war zones, and that this is independent of the development of PTSD (8). ...
... • Borderline-Persönlichkeitsstörung (BPS): Sexuelle Vermeidung, Dissoziation, Selbstverletzen und Suizidalität im Zusammenhang mit Sexualität ( Zanarini et al., 2003) treten bei BPS ebenso vermehrt auf wie sexuelles Risikoverhalten (Sansone & Sansone, 2011) und sexuelle Funktionsstörungen wie Probleme mit der Erregung, der Lubrikation, dem Orgasmus, der Befriedigung oder Schmerzen beim Sex ( Schulte- Herbrüggen et al., 2009). Auch Unsicherheiten bezüglich der eigenen sexuellen Orientierung sowie der sexuellen, teils aber auch der geschlechtlichen Identität (Genderdyshorie/Geschlechtsinkongruenz) sind bei BPS besonders häufig ( Frías et al., 2016). ...
Article
Für viele Menschen, die sexuelle Gewalt erlebt haben, ist die Sexualität ein „Ort der Verletzung“. Selbst Jahre nach einem Missbrauch oder einer Vergewaltigung hat ein bedeutender Teil der Betroffenen noch immer mit schweren Traumafolgen zu kämpfen, die sich störend auf die Sexualität auswirken und nicht nur Selbstschädigungen, Partnerschaftsprobleme oder Beziehungslosigkeit, sondern auch seelische Krisen und ernste körperliche Erkrankungen nach sich ziehen können. Mit dem 2018 erfolgten Beschluss des Deutschen Ärztetags, eine Zusatz-Weiterbildung „Sexualmedizin“ zu schaffen, rücken die traumaassoziierten sexuellen Störungen nun in das Interesse von Ärzten, Psychotherapeuten und Sexualtherapeuten. Der Beitrag gibt einen Überblick über typische Beschwerdekonstellationen und stellt ein klinisch erprobtes Behandlungskonzept vor.
... Anteil der Personen mit Borderline-Störung, bei denen zusätzlich eine PTBS vorliegt (Frías 2014) in der Bevölkerung in klinischen Stichproben 30 -70 % (Frías 2014) 33 -79 % (Frías 2014) Anteil der Personen mit Borderline-Störung, bei denen zusätzlich eine komplexe posttraumatische Belastungsstörung vorliegt in klinischen Stichproben 34 % (Barnow et al. 2005) bzw. 80 % (Sauer 2013) (Dulz 2009;Frías et al. 2016;Lohmer & Wernz 2009;SignerskiKrieger et al. 2015;SchulteHerbrüggen et al. 2009;Wiederman & Sansone 2009;Zanarini et al. 2003 ...
Article
PTT - Persönlichkeitsstörungen: Theorie und Therapie. 2019; 23: 87 – 100. Traumatisierungen spielen nicht nur bei der Entstehung von Borderline-Persönlichkeitsstörungen eine wichtige Rolle, sie können sich auch auf die Sexualität auswirken. Einige klinische und wissenschaftliche Beobachtungen deuten außerdem darauf hin, dass bestimmte sexuelle Probleme, über die Borderline-Patienten typischerweise berichten, wahrscheinlich mit traumatischen Erfahrungen in Verbindung stehen. Traumaassoziierte sexuelle Störungen können sehr vielgestaltig sein und ziehen nicht selten schwere Selbstschädigungen, Reviktimisierungen, Partnerschaftsprobleme, Beziehungslosigkeit und krisenhafte Einbrüche nach sich. Traumamodifizierte Behandlungsansätze können Betroffenen helfen, einen selbstfürsorglicheren und selbstbestimmteren Umgang mit ihrer Sexualität zu entwickeln.
... Al analizar el impacto de algún trauma de carácter sexual o bien de cualquier otra naturaleza sobre la personalidad y la respuesta sexual, se encuentra que los trastornos de personalidad en general se asocian con las disfunciones sexuales, tanto en hombres como en mujeres 50,51 , y que específicamente en el caso de las mujeres, las que presentan un trastorno límite de la personalidad presentan de forma significativa mayor prevalencia de disfunciones sexuales 52 . ...
Article
Resumen Introducción Los trastornos de la personalidad y la respuesta sexual son dos aspectos íntimamente relacionados, y el conocimiento de la relación entre ambas variables servirá para proporcionar una atención de calidad a los pacientes. Método El objetivo del presente estudio fue realizar una revisión sistemática sobre la relación entre trastornos de la personalidad y disfunciones sexuales. Resultados Catorce artículos científicos publicados entre 2006 y 2016 cumplieron los criterios de inclusión para formar parte de esta revisión. Este trabajo ha permitido organizar la escasa información proveniente de trabajos científicos referida a las relaciones existentes entre trastornos de la personalidad y disfunciones sexuales. Conclusión Se concluye con la necesidad de realizar más investigación en esta área.
... While there is a large body of research linking CSA and sexual dysfunction, most of the information is based on samples of women survivors of CSA (e.g., Bartoi & Kinder, 1998;Bird et al., 2014;Brotto et al., 2012;Buehler, 2008;Kilimnik & Meston, 2016;Kristensen & Lau, 2011;Lacelle et al., 2012;Leclerc et al., 2010;Leonard et al., 2008;Lorenz et al., 2015;Meston & Heiman, 2000;Meston et al., 2006;Mullen et al., 1994;Noll et al., 2003;Pulverman et al., 2017;Rellini et al., 2011;Sarwer & Durlak, 1996;Schloredt & Heiman, 2003;Schulte-Herbrüggen et al., 2009;Seehuus et al., 2015;Staples et al., 2012;Stephenson et al., 2014;Zollman et al., 2013;Zwickl & Merriman, 2011). In addition, two reviews describing the sexual functioning of women survivors of CSA (Leonard & Follette, 2002;Pulverman et al., 2018) have been published. ...
Article
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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The waiting room of a busy oncology practitioner’s office will include women patients who may also have sexual health concerns [1–7]. In many cases, the sexual health problems of these oncologic patients will be highly associated with their female oncologic health care problems and/or the treatments for their oncologic condition [8–12]. In the vast majority of cases, however, while great attention is provided to the oncologic concern, there is only limited attention given to their sexual health problems. KeywordsArousal-Engorgement-Lubrication-Neurotransmitters-Androgens-Hormones
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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. © 2015 Elsevier B.V. All rights reserved.
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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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Background and objective: The question of the psychopathological consequences of early sexual abuse has been a nuclear topic in psychoanalytic studies, but has received little attention in clinical psychiatry until recent years. On one side, the literature stresses the pathogenic value of early sexual abuse in different psychiatric disorders and their course, on the other side, the description of the False Memory Syndrome raises the issue of the low reliability of some of the memories of early sexual abuse that emerge frequently in the course of acute psychoses or dissociative states. Method: From July 2008 to September 2010 the Authors have interviewed all female patients consequently admitted in a unit for acute inpatients or in emergency settings, asking them if they had been sexually abused in childhood or adolescence. The patients who referred to be abused were evaluated with an ad hoc Questionnaire to establish the main details of the abuse and the reliability of their report. Some criteria to classify the abuse as True, Possible or Unlikely were defined. Then the patients were assigned to a DSM-IV category using the SCID-I and the SCID-II. Some patients were interviewed again during subsequent admissions. Results: In about 2 years, 46 patients (mean age 41.3) were identified. Most reports (27) were considered "True", 11 "Possible", 9 "Unlikely" (one patient had both "True" and "Unlikely" evaluations). The types of sexual abuse were highly heterogeneous, spanning from repeated incest to incest attempts to more ephemeral experiences, but all had a traumatic quality and were well fixed in patient's memory. However, 30% of patients refered a long period of amnesia and the revelation of the episodes very often is simultaneous with the first or subsequent episodes of the mental disorder. The patients were assigned mainly to Mood Disorders and Borderline Personality Disorders categories, but most of the "Unlikely" statements had delusional qualities and emerged during psychotic episodes or relapses. Some patients fulfil criteria for Anxiety Disorders and those of the so called "False Memory Syndrome". The degree of certainty may change in some cases in following interviews. Conclusions: The issue of the pathogenic value of the abuse statements cannot be answered definitively due to the lack of a comparision with non patients. From a psychopathological and clinical point of view, these experiences have a high subjective impact: "True" abuses can be considered non-specific pathogenic factor, "Possible" abuses may constitute a frequently recurring theme under the form of doubt of traumatic experiences in the course of acute relapses of the different disorders, while "Unlikely" abuses represent a more or less structured theme that is created ex novo by the pathologic state. However the differentiation of these sub-categories is often arbitrary or unsatisfying. The hypothesis of a "psychopathological continuum" in the degree of truthfulness of early sexual abuse more exactly describes their clinical manifestations. Most patients show sexual disorders and high instability in their sexual relationships, hence the emergence of these themes may be considered as a sexual conflict index.
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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
Article
Contemporary object-relation theory of personality postulates that the level of severity of personality organization parallels the nature and extent of problems in the patient’s sexual life. The study aims at exploring the relationship between dimensions of Borderline Personality Organization (BPO) (as assessed according to Otto Kernberg’s model), sexual functioning, quality of sexual life and paraphilias in a community sample of men. One-hundred thirty-six healthy men were asked to complete a set of questionnaires including the Inventory of Personality Organization (IPO), the International Index of Erectile Function, the Sexual Quality of Life Questionnaire, and a checklist to assess the prevalence of paraphilias. High scores on IPO subscales were significantly associated with low overall satisfaction in sexual functioning, low quality of sexual life, and the presence of paraphilias. Results expand previous findings on the relationship between features of BPO and core components of sexual life and support the need for an assessment of personality functioning in subjects reporting sexual problems.
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Personality disorders are pervasive and stable patterns of behavior and inner experiences that start during adolescence or young adult life and have negative effects on functioning of the person or produces distress. Personality disorders are grouped into three clusters. Cluster A, defined as bizarre and weird, is formed by paranoid, schizoid, and schizotypal characteristics. Cluster B, defined as impulsive and extraverted, is formed by borderline, narcissistic, antisocial, and histrionic personality disorder. Finally, cluster C, defined as anxious and introverted, is formed by avoidant, dependent, and obsessive-compulsive personality disorder. People with personality disorders have great problems with intimacy as their personality traits negatively influence their capacity to form dyadic relationships and their capacity for empathy. People with different clusters of personality disorders will have different mating strategies and different ways of forming intimate relations. There is not much research on specific sexual dysfunctions in specific personality disorders. Paranoid personalities are more prone to homophobia, while schizoid personality disorder is correlated with asexuality. Treatment of people with personality problems who at the same time have sexual problems should be directed toward psychoeducation (about their personality disorder) and better partner communication with emphasis on learning empathy.
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Quando sia l’esperienza interiore sia il comportamento stesso si allontanano marcatamente rispetto alle aspettative del milieu culturale dell’individuo in modo pervasivo e inflessibile, magari fin dall’età delle scoperte sessuali dell’adolescenza o della prima età adulta, determinando disagio o menomazione, si parla di disturbo della personalità, assai sovente rappresentato e visibile proprio nei comportamenti sessuali e affettivi. Il clinico non psichiatra e non psicologo che fa diagnosi e terapia dei disturbi del comportamento sessuale deve quindi essere attrezzato a riconoscere il sospetto diagnostico, utilizzando eventualmente la risorsa specialistica nei casi sospetti. Troppo spesso infatti il fallimento dell’intervento scaturisce dal mancato riconoscimento di un disturbo della personalità in grado di impedire la restitutio ad integrum della sessuopatia. (Ed.)
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The prevalence of sexual dysfunctions is higher in persons suffering from mental illnesses. Anxiety, depression, and mood disorders are considered important comorbidity factors for sexual dysfunction in males and females. However, a part of literature is dedicated to assessing sexuality in psychotic patients. In this severe mental illness, both the psychopathology and its pharmacological treatment drastically impact on sexual functioning. In this regard, the prevalence of sexual dysfunction is very high in these patients. On the contrary, less evidence exists about the epidemiology of sexual problems among people with personality and eating disorders, above all in males.
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Introduction: Personality disorder patients suffer from their poor interpersonal life, influenced by their strict personality characteristics. The latter could also influence their sexual life, because the personality characteristics could increase sexual difficulties and dysfunctions. However the connection between specific personality disorders and sexual dysfunction has not been expanded in literature. The aim of this chapter is to highlight the state of the art concerning the connection between personality disorders and sexual dysfunctions.
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A satisfactory sexual relationship cannot be warranted without a good general relationship and requires appropriate physiological sexual responses, healthy psychological states of each partner, and both partners to be responsive to each other’s needs. For these reasons, sexual satisfaction requires the well-being of both the relationship and each partner. Social and cultural issues, globalization, religion, moral values, expectations, communication and problem-solving skills of partners, general relationship issues, psychology, physiology, sexual functions, and distresses of each partner have profound effects on the quality of the sexual relationship. There are quite several different risk factors that can cause difficulties in sexual relationships, yet surprisingly people having adequate sexual relationships take it for granted.
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The aim of this chapter is to describe a wider perspective of the so-called hypersexuality including compulsive sexual behavior disorder as defined in the ICD-11 with its common features and therapeutic interventions but also other etiologies and clinical manifestations of “out-of-control sexual behaviors” that physicians and psychologists may be confronted with. We elaborate on clinical features labeled as problematic sexual behavior, including such various manifestations as problematic pornography use, compulsive masturbation, impulsive/compulsive sexual contacts with casual partners, cybersex, and others, and describe mechanisms leading to the loss of control over sexual behavior. Three descriptive cases of hypersexual behaviors of different etiologies are presented. The chapter ends with a comprehensive guidance into clinical management of the out-of-control sexual behavior.
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Introduction: The literature shows a discrepancy in the association between child sexual abuse (CSA) and adult sexual function. One of the proposed explanations for this discrepancy is the different ways in which CSA is assessed. While some studies explicitly ask potential participants whether they are sexual abuse survivors, others ask whether participants experienced specific unwanted sexual behaviors. Aim: This study investigated the differences between women who self-identified as CSA survivors, women who experienced similar unwanted sexual experiences but did not identify as CSA survivors (NSA), and women with no history of sexual abuse (control). CSA was defined as unwanted touching or penetration of the genitals before the age of 16. Methods: A sample of 699 college students anonymously completed a battery of questionnaires on sexuality and sexual abuse history. Main outcome measures: Sexual function was measured with the Female Sexual Function Index (FSFI), and sexual satisfaction was measured with the Sexual Satisfaction Scale-Women. History of CSA was measured with a modified version of Carlin and Ward's childhood abuse items. Results: Differences emerged between women who experienced sexual abuse before age 16 and women who never experienced sexual abuse (control) on the personal distress subscale of the Sexual Satisfaction Scale. The CSA group (N = 89) reported greater sexual distress compared to the NSA (N = 98) group, and the NSA group reported more distress than the control group (N = 512). No significant group differences were observed in the FSFI. Characteristics of the abuse that predicted whether women identified as CSA survivors included vaginal penetration, fear at the time of the abuse, familial relationship with the perpetrator, and chronic frequency of the abuse. These abuse characteristics were associated with sexual satisfaction but not with sexual function. Conclusions: Differences in levels of sexual satisfaction between women with and without a history of CSA were associated with the type of CSA definition adopted. It remains unexplained why the CSA group showed more personal distress about their sexuality but not more sexual dysfunction.
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This paper examines the diagnostic category called Borderline Personality Disorder (BPD) and its relationship to gay people. It discusses the psychoanalytic definition of borderline personalities, and to it adds a cultural definition. In the light of these cultural variables, the diagnosis is defined as a metaphor for the complexities and confusions of modern life. These confusions are important in the lives of gay people, who, it is suggested, are currently more prone to be diagnosed as BPD. Through the life study of a gay man, both the psychoanalytic and cultural variables are identified, then generalized to the problems of gay people in our transitional society.
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Many lay persons and professionals believe that child sexual abuse (CSA) causes intense harm, regardless of gender, pervasively in the general population. The authors examined this belief by reviewing 59 studies based on college samples. Meta-analyses revealed that students with CSA were, on average, slightly less well adjusted than controls. However, this poorer adjustment could not be attributed to CSA because family environment (FE) was consistently confounded with CSA, FE explained considerably more adjustment variance than CSA, and CSA-adjustment relations generally became nonsignificant when studies controlled for FE. Self-reported reactions to and effects from CSA indicated that negative effects were neither pervasive nor typically intense, and that men reacted much less negatively than women. The college data were completely consistent with data from national samples. Basic beliefs about CSA in the general population were not supported.
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This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.
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A meta-analysis of the published research on the effects of child sexual abuse (CSA) was undertaken for 6 outcomes: posttraumatic stress disorder (PTSD), depression, suicide, sexual promiscuity, victim-perpetrator cycle, and poor academic performance. Thirty-seven studies published between 1981 and 1995 involving 25,367 people were included. Many of the studies were published in 1994 (24; 65%), and most were done in the United States (22; 59%). All six dependent variables were coded, and effect sizes (d) were computed for each outcome. Average unweighted and weighted ds for each of the respective outcome variables were .50 and .40 for PTSD, .63 and .44 for depression, .64 and .44 for suicide, .59 and .29 for sexual promiscuity, .41 and .16 for victim-perpetrator cycle, and .24 and .19 for academic performance. A file drawer analysis indicated that 277 studies with null ds would be required to negate the present findings. The analyses provide clear evidence confirming the link between CSA and subsequent negative short- and long-term effects on development. There were no statistically significant differences on ds when various potentially mediating variables such as gender, socioeconomic status, type of abuse, age when abused, relationship to perpetrator, and number of abuse incidents were assessed. The results of the present meta-analysis support the multifaceted model of traumatization rather than a specific sexual abuse syndrome of CSA.
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Major depression is frequently associated with sexual dysfunction (over 70% of patients), and the antidepressant medications used to treat the illness may exacerbate pre-existing sexual dysfunction, or induce sexual dysfunction not present on diagnosis. In women, sex hormones that change across the life cycle, menstrual cycle, and diurnally have direct effects on sexual functioning, and indirect effects via modulation of neurotransmitter systems. These complex neuroendocrine effects lead to the sexual dysfunction seen with antidepressants. Strategies to manage these effects have had some success. They include switching to antidepressants with minimal sexual side effects, addition of hormones and/or antidotes, and lowering the dose of medication. Emerging data on the pathophysiology of sexual function and dysfunction, and new treatment options may lead to improved quality of life for women diagnosed with depression.
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The Female Sexual Function Index (FSFI) is a brief multidimensional scale for assessing sexual function in women. The scale has received initial psychometric evaluation, including studies of reliability, convergent validity, and discriminant validity (Meston, 2003; Rosen et al., 2000). The present study was designed to crossvalidate the FSFI in several samples of women with mixed sexual dysfunctions (N = 568) and to develop diagnostic cut-off scores for potential classification of women's sexual dysfunction. Some of these samples were drawn from our previous validation studies (N = 414), and some were added for purposes of the present study (N = 154). The combined data set consisted of multiple samples of women with sexual dysfunction diagnoses (N = 307), including female sexual arousal disorder (FSAD), hypoactive sexual desire disorder (HSDD), female sexual orgasm disorder (FSOD), dyspareunia/vaginismus (pain), and multiple sexual dysfunctions, in addition to a large sample of nondysfunctional controls (n = 261). We conducted analyses on the individual and combined samples, including replicating the original factor structure using principal components analysis with varimax rotation. We assessed Cronbach's alpha (internal reliability) and interdomain correlations and tested discriminant validity by means of a MANOVA (multivariate analysis of variance; dysfunction diagnosis x FSFI domain), with Bonferroni-corrected post hoc comparisons. We developed diagnostic cut off scores by means of standard receiver operating characteristics-curves and the CART (Classification and Regression Trees) procedure. Principal components analysis replicated the original five-factor structure, including desire/arousal, lubrication, orgasm, pain, and satisfaction. We found the internal reliability for the total FSFI and six domain scores to be good to excellent, with Cronbach alpha's >0.9 for the combined sample and above 0.8 for the sexually dysfunctional and nondysfunctional samples, independently. Discriminant validity testing confirmed the ability of both total and domain scores to differentiate between functional and nondysfunctional women. On the basis of sensitivity and specificity analyses and the CART procedure, we found an FSFI total score of 26.55 to be the optimal cut score for differentiating women with and without sexual dysfunction. On the basis of this cut-off we found 70.7% of women with sexual dysfunction and 88.1% of the sexually functional women in the cross-validation sample to be correctly classified. Addition of the lubrication score in the model resulted in slightly improved specificity (from .707 to .772) at a slight cost of sensitivity (from .881 to .854) for identifying women without sexual dysfunction. We discuss the results in terms of potential strengths and weaknesses of the FSFI, as well in terms of further clinical and research implications.
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This study examined self-reported adult sexual functioning in individuals reporting a history of childhood sexual abuse (CSA) in a representative sample of the Australian population. A sample of 1793 persons, aged 18-59 years, were randomly selected from the electoral roll for Australian states and territories in April 2000. Respondents were interviewed about their health status and sexual experiences, including unwanted sexual experiences before the age of 16 years. More than one-third of women and approximately one-sixth of men reported a history of CSA. Women were more likely than men to report both non-penetrative and penetrative experiences of CSA. For both sexes, there was a significant association between CSA and symptoms of sexual dysfunction. In assessing the specific nature of the relationship between sexual abuse and sexual dysfunction, statistically significant associations were, in general, evident for women only. CSA was not associated with the level of physical or emotional satisfaction respondents experienced with their sexual activity. The total number of lifetime sexual partners was significantly and positively associated with CSA for females, but not for males; however, the number of sexual partners in the last year was not related to CSA. CSA in the Australian population is common and contributes to significant impairment in the sexual functioning of adults, especially women. These consequences appear not to extend to the other areas of sexual activity considered in this study.
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On the basis of literature that suggests that child sexual abuse (CSA) survivors with post traumatic stress disorder (PTSD) have higher baseline sympathetic nervous system (SNS) activity than healthy controls and research that suggests that the SNS plays a critical role in female physiological sexual arousal, we examined the impact of SNS activation through intense exercise on sexual arousal in women with CSA and PTSD. We measured physiological and subjective sexual arousal in women with CSA (n = 8), women with CSA and PTSD (n = 10), and healthy controls (n = 10) during exposure to nonerotic and erotic videos. After exercise, women with CSA and women with CSA and PTSD showed no significant differences in the physiological sexual response compared with no exercise, which was different from the increased physiological sexual response after exercise observed in control women.
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To present nationally representative findings on prevalence, sociodemographic correlates, disability, and comorbidity of narcissistic personality disorder (NPD) among men and women. Face-to-face interviews with 34,653 adults participating in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions conducted between 2004 and 2005 in the United States. Prevalence of lifetime NPD was 6.2%, with rates greater for men (7.7%) than for women (4.8%). NPD was significantly more prevalent among black men and women and Hispanic women, younger adults, and separated/divorced/widowed and never married adults. NPD was associated with mental disability among men but not women. High co-occurrence rates of substance use, mood, and anxiety disorders and other personality disorders were observed. With additional comorbidity controlled for, associations with bipolar I disorder, post-traumatic stress disorder, and schizotypal and borderline personality disorders remained significant, but weakened, among men and women. Similar associations were observed between NPD and specific phobia, generalized anxiety disorder, and bipolar II disorder among women and between NPD and alcohol abuse, alcohol dependence, drug dependence, and histrionic and obsessive-compulsive personality disorders among men. Dysthymic disorder was significantly and negatively associated with NPD. NPD is a prevalent personality disorder in the general U.S. population and is associated with considerable disability among men, whose rates exceed those of women. NPD may not be as stable as previously recognized or described in the DSM-IV. The results highlight the need for further research from numerous perspectives to identify the unique and common genetic and environmental factors underlying the disorder-specific associations with NPD observed in this study.
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According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, borderline personality disorder (BPD) is an Axis II phenomenon that is characterized by impulsivity, including sexual impulsivity. However, little empirical research has been undertaken to confirm and/or define the nature of sexual impulsivity in patients with BPD, which is the focus of the present study. Using a cross-sectional approach and sample of convenience, we surveyed 76 women who were being seen as outpatients in an internal medicine clinic regarding: a) borderline personality symptoms using two measures (i.e., the borderline personality scale of the Personality Diagnostic Questionnaire-4, McLean Screening Inventory for Borderline Personality Disorder); and b) their sexual histories. We found two statistically significant differences--those with borderline personality symptomatology were more likely to have an earlier onset of sexual intercourse as well as to report date rape. Individuals with borderline personality symptomatology report earlier sexual exposure as well as date rape, but not other aspects of sexual impulsivity such a greater number of sexual partners, more frequent treatment for sexually transmitted diseases, etc.
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Background: Female sexual dysfunction has a high prevalence. However, there is a general lack of diagnostic tools in German speaking countries. The FSFI is an easy to use 19-item English questionnaire that was published in the US. It was validated for problems with sexual arousal, hypoactive sexual desire and orgasm difficulties. We performed a semantic-cultural validation and confirmatory factor analysis in 1243 women. Methods: Semantic-cultural validation was performed by two independent translations, a comparison of the versions and the creation a single version by agreement between the translators. This was re-translated into English by a third translator and checked for semantic differences. These were corrected. The final version was put up on an internet site specified for sexual dysfunction. Factor analysis und reliability analysis were performed confirming the factor structure of the original questionnaire. Results: Re-translation into English led in two items to different phrases, none of which proved to have a different meaning than the original version. The internet validation tool was readily accepted. It was completely filled in by 1243 women within 9 months. Confirmatory analysis confirmed a six factor model which explained 78.43% of the variance (Cronbach's α being 0.75-0.95). Conclusion: With the semantic-cultural validation and confirmatory factor analysis of the German version of the Female Sexual Function Index (FSFI-d) a useful diagnostic tool for clinical and epidemiological research is now available. Further research will lead to abbreviated versions and will make it possible to create tools more suitable for the clinician.
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The authors investigated gender differences in 137 inpatients with DSM-III borderline personality disorder. Male borderlines were more likely to be homosexual and to receive multiple DSM-III substance use diagnoses. especially of combinations of alcohol, cocaine, and stimulants.
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The Structured Clinical Interview for DSM-III-R [Diagnostic and Statistical Manual, Revised] (SCID) is a semistructured interview for making the major Axis I and Axis II diagnoses. It is administered by a clinician or trained mental health professional who is familiar with the DSM-III-R classification and diagnostic criteria (1). The subjects may be either psychiatric or general medical patients or individuals who do not identify themselves as patients, such as subjects in a community survey of mental illness or family members of psychiatric patients. The language and diagnostic coverage make the SCID most appropriate for use with adults (age 18 or over), but with slight modification, it may be used with adolescents. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Introduction. Homosexuality is a topic that needs to be integrated into the knowledge base of the practitioner of sexual medicine. Aim. To present to the reader a summary of the current literature on homosexuality and sexual orientation and address specifically issues that pertain to the relationship sexual orientation and sexual medicine practice. Main Outcome Measures. The information is presented in a continued medical education format, with a series of evaluation questions at the end of the activity. Methods. A review of the literature is presented and organized according to the authors' judgment of the value of the information as to provide the reader with an inclusive panorama of the issues covered. Results. Current concepts, debates, and need for further research are presented. Conclusions. The professional of sexual medicine needs to be aware of the various topics reviewed in this article as his or her involvement in the area of sexuality can create the expectation on the part of the patients of knowingness of all aspects of human sexuality. Sexual orientation is a complex area but considerable understanding has fortunately been achieved in many issues in reference to homosexuality and heterosexuality. Rubio-Aurioles E, and Wylie K. Sexual orientation matters in sexual medicine. J Sex Med 2008;5:1521–1533.
Article
Introduction. As many as 20–30% of women report an inability to orgasm during sexual intercourse. Some female sexual problems have been reported to cluster with psychological and social problems. Underlying personality type may play a role in the development or maintenance of such problems. Aim. The aim of this study was to investigate whether certain domains of personality are associated with female coital orgasmic infrequency. To our knowledge this is the first such study in a large unselected population. Methods. A total of 2632 women (mean age 51) from the TwinsUK registry completed questionnaires relating to personality and sexual behavior. Personality domains were assessed using the validated Ten-Item Personality Index (TIPI). Coital orgasmic frequency was measured using a seven-point Likert scale. Main Outcome Measures. Using logistic regression, we investigated whether variations in five domains of personality are associated with female coital orgasmic infrequency. Discordant twin analysis was used to verify findings. Results. Introversion (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.7–3.7), emotional instability (OR 2.0, 95% CI 1.3–3.1), and not being open to new experience (OR 2.4, 95% CI 1.6–3.6) were significantly associated with orgasmic infrequency, whereas indices of agreeableness and conscientiousness were not significantly associated with orgasm frequency. Conclusion. Specific personality subtypes appear to be significant risk factors for orgasmic infrequency. Consideration of these behavioral risk factors may need to be incorporated into research into female orgasmic disorder, and possible approaches to its treatment. Harris JM, Cherkas LF, Kato BS, Heiman JR, and Spector TD. Normal variations in personality are associated with coital orgasmic infrequency in heterosexual women: A population-based study. J Sex Med 2008;5:1177–1183.
Article
To present nationally representative findings on the prevalence, correlates, and comorbidity of and disability associated with DSM-IV schizotypal personality disorder (SPD). This study used the 2004-2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, which targeted a nationally representative sample of the adult civilian population of the United States aged 18 years and older and residing in households and group quarters. In Wave 2, attempts were made to conduct face-to-face reinterviews with all respondents to the Wave 1 interview. Lifetime prevalence of SPD was 3.9%, with significantly greater rates among men (4.2%) than women (3.7%) (p < .01). Odds for SPD were significantly greater among black women, individuals with lower incomes, and those who were separated, divorced, or widowed; odds were significantly lower among Asian men (all p < .01). Schizotypal personality disorder was associated with substantial mental disability in both sexes. Co-occurrence rates of Axis I and other Axis II disorders among respondents with SPD were much higher than rates of co-occurrence of SPD among respondents with other disorders. After adjustment for sociodemographic characteristics and additional comorbidity, associations remained significant in both sexes between SPD and 12-month and lifetime bipolar I disorder, social and specific phobias, and posttraumatic stress disorder, as well as 12-month bipolar II disorder, lifetime generalized anxiety disorder, and borderline and narcissistic personality disorders (all p < .01). Common and unique factors may underlie associations of SPD with narcissistic and borderline personality disorders, whereas much of the comorbidity between SPD and most mood and anxiety disorders appears to reflect factors common to these disorders. Some of the associations with SPD were sex specific. Schizotypal personality disorder and dependent, avoidant, and borderline personality disorders were associated with the occurrence of schizophrenia or psychotic episode. Schizotypal personality disorder is a prevalent, fairly stable, highly disabling disorder in the general population. Sex differences in associations of SPD with other specific Axis I and II disorders can inform more focused, hypothesis-driven investigations of factors underlying the comorbid relationships. Schizotypal as well as borderline, dependent, and avoidant personality disorders may be components of the schizophrenia spectrum.
Article
The purpose of this study was to assess the prevalence of homosexuality/ bisexuality and same-sex relationships in a sample of 362 hospitalized subjects, 290 with borderline personality disorder (BPD) and 72 comparison subjects with other personality disorders. At baseline and at five contiguous 2-year follow-up intervals, subjects meeting DIB-R and DSM-III-R criteria for BPD or at least one other personality disorder were interviewed using a semi-structured interview about their sexual orientation and the gender of intimate partners. Subjects with BPD were significantly more likely than comparison subjects to report homosexual or bisexual orientation and intimate same-sex relationships. There were no significant differences between male and female borderline subjects in prevalence of reported homosexual or bisexual orientation or in prevalence of reported same-sex relationships. Subjects with BPD were significantly more likely than comparison subjects to report changing the gender of intimate partners, but not sexual orientation, at some point during the follow-up period. A reported family history of homosexual or bisexual orientation was a significant predictor of an aggregate outcome variable assessing homosexual/bisexual orientation and/or same sex relationship in borderline subjects. Results of this study suggest that same-gender attraction and/or intimate relationship choice may be an important interpersonal issue for approximately one-third of both men and women with BPD.
Article
In the last decade, a great deal of research has been accomplished in the study of borderline personality, but the literature is yet to systematically examine the intimate relationships of individuals with this particular personality disorder. In doing so, this study compared a sample of female borderlines with an adequately matched sample of non-personality disorders (aged 23-33 years) using the following measures: the Hurlbert Index of Sexual Assertiveness, the Sexual Opinion Survey, the Sexuality Scale, and the Index of Sexual Satisfaction. In the borderline sample, about 50% of the women reported a childhood history of physical or sexual abuse, as compared to about 15% in the control group. Also, borderline women were found to have significantly higher sexual assertiveness, greater erotophilic attitudes, and higher sexual esteem. Despite these findings, the borderline group evidenced significantly greater sexual preoccupation, sexual depression, and sexual dissatisfaction. Implications for these findings and treatment issues are discussed.
Article
The existing literature on the long-term sequelae of child sexual abuse is reviewed. The evidence suggests that sexual abuse is an important problem with serious long-term sequelae; but the specific effects of sexual abuse, independent of force, threat of force, or such family variables as parental psychopathology, are still to be clarified. Adult women with a history of childhood sexual abuse show greater evidence of sexual disturbance or dysfunction, homosexual experiences in adolescence or adulthood, depression, and are more likely than nonabused women to be revictimized. Anxiety, fear, and suicidal ideas and behavior have also been associated with a history of childhood sexual abuse but force and threat of force may be a necessary concomitant. As yet, there is insufficient evidence to confirm a relation between a history of childhood sexual abuse and a postsexual abuse syndrome and multiple or borderline personality disorder. Male victims of child sexual abuse show disturbed adult sexual functioning. The relation between age of onset of abuse and outcome is still equivocal. Greater long-term harm is associated with abuse involving a father or stepfather and abuse involving penetration. Longer duration is associated with greater impact, and the use of force or threat of force is associated with greater harm.
Article
This is the first of a two-part report that critically evaluates empirical studies on the short- and long-term effects of child sexual abuse. With the exception of sexualized behavior, the majority of short-term effects noted in the literature are symptoms that characterize child clinical samples in general. Among adolescents, commonly reported sequelae include sexual dissatisfaction, promiscuity, homosexuality, and an increased risk for revictimization. Depression and suicidal ideation or behavior also appear to be more common among victims of sexual abuse compared to normal and psychiatric nonabused controls. Frequency and duration of abuse, abuse involving penetration, force, or violence, and a close relationship to the perpetrator appear to be the most harmful in terms of long-lasting effects on the child. The high prevalence of marital breakdown and psychopathology among parents of children who are sexually abused makes it difficult to determine the specific impact of sexual abuse over and above the effects of a disturbed home environment. Given the broad range of outcome among sexual abuse victims, as well as the methodological weaknesses present in many of the studies reviewed, it is not possible at this time to postulate the existence of a "post-sexual-abuse-syndrome" with a specific course or outcome.
Article
The authors found that 12 (57%) of 21 consecutive male patients with borderline personality disorder who presented for psychiatric treatment at two distant geographic sites were homosexual. They then obtained the sexual histories of 80 patients who met standardized criteria for borderline disorder and found that 17 (21%) of these patients were homosexual, four (5%) were bisexual, and nine (11%) had diagnoses of paraphilias. Ten (53%) of the 19 men with borderline disorder were homosexual, compared with seven (11%) of the 61 women. Homosexuality was 10 times more common among the men and six times more common among the women with borderline personality disorder than in the general population or in a depressed control group.
Article
Researchers determining the prevalence of homosexuality in nationally representative samples have focused upon determining the prevalence of homosexual behavior, ignoring those individuals whose sexual attraction to the same sex had not resulted in sexual behavior. We examine the use of sexual attraction as well as sexual behavior to estimate the prevalence of homosexuality in the United States, the United Kingdom, and France using the Project HOPE International Survey of AIDS-Risk Behaviors. We find that 8.7, 7.9, and 8.5% of males and 11.1, 8.6, and 11.7% of females in the United States, the United Kingdom, and France, respectively, report some homosexual attraction but no homosexual behavior since age 15. Further, considering homosexual behavior and homosexual attraction as different but overlapping dimensions of homosexuality, we find 20.8, 16.3, and 18.5% of males, and 17.8, 18.6, and 18.5% of females in the United States, the United Kingdom, and France report either homosexual behavior or homosexual attraction since age 15. Examination of homosexual behavior separately finds that 6.2, 4.5, and 10.7% of males and 3.6, 2.1, and 3.3% of females in the United States, the United Kingdom, and France, respectively, report having had sexual contact with someone of the same sex in the previous 5 years. Our findings highlight the importance of using more than just homosexual behavior to examine the prevalence of homosexuality.
Patients with borderline personality disorder provide an ideal sample for a study of impulsive sexual behavior and factors related to it in psychiatrically ill women. Even though impulsive sexual behavior is one of the DSM-III-R criteria for borderline personality disorder, not all patients with the disorder manifest such behavior. While controlling for diagnosis, we identified factors related to sexual impulsivity of these patients. Our results suggest that impulsive sexual behavior is common in some women with borderline personality disorder. Forty-six percent of the women in our sample reported that they had impulsively entered into sexual relationships with partners they did not know well. Al though many axis I conditions that could contribute to impaired judgment were present, only alcohol abuse correlated with sexual impulsivity. Patients with impulsive sexual behavior were more likely to receive a comorbid axis II diagnosis of histrionic personality disorder, were more likely to have general problems with impulsivity, were more extraverted, and suffered less from anxiety. They appeared to be very different from another group women with borderline personality disorder who complained of severe anxiety and chronic emptiness and boredom and who were likely to exhibit symptoms of anorexia and selfmutilation. For the practicing clinician, one implication of these findings is that exposure to HIV through sexual contact may be a pressing concern with only some patients with borderline personality disorder. Our findings suggest that practitioners should be especially concerned with more extraverted, histrionic patients who experience low levels of anxiety and who abuse alcohol. Other patients with borderline personality disorder who are more anxious and who have symptoms of anorexia and self-mutilation may be at lower risk for infection. One limitation of this study is the difficulty of reliably assessing what is essentially private and unobserved behavior. Subjects are likely to deny behaviors, including sexual practices, that they feel are socially unacceptable. Future research should investigate whether the impulsive sexual behavior these patients exhibit is also unsafe sexual behavior that is likely to put them at risk for HIV infection. Also of importance will be studies of HIV seroprevalence among patients with borderline personality disorder, although as Coyle and associates (10) have pointed out, rates of seropositivity do not accurately measure risk behavior.
Article
The impact of substance abuse on patients with borderline personality disorder was investigated. Substance abuse was common. Female patients preferred alcohol and sedatives. Male patients preferred stimulants. Substance abuse was associated with poor school performance, unemployment, and promiscuity. Depersonalization-derealization was common in nonsubstance using and alcohol-sedative using patients, but was rarely found in stimulant users. Substance abuse appears to be a devastating complication in the patient with borderline personality disorder.
Article
The empirical literature that addresses the association between childhood sexual abuse (CSA) and the interpersonal functioning of female survivors within their adult family context is critically examined. Specifically, research on relationship difficulties, problems in attachment, marital conflict and divorce, secondary traumatization, sexual dysfunction, maternal attitudes and functioning, and the heightened risk for having children who themselves are sexually abused is reviewed. There is converging evidence in both clinical and community samples that, compared to other women, female CSA survivors do experience more relationship problems and more problems in sexual functioning. Based on community samples, there is an indication that CSA survivors experience problems in marital functioning and attachment. Beyond this, little sound research has addressed the issues of secondary traumatization, maternal attitudes, maternal functioning, or intergenerational patterns of abuse. The use of specificity designs, improved sampling strategies, and standardized, psychometrically strong measures in future research would greatly improve the quality of our knowledge on the interpersonal and family functioning of CSA survivors.
Article
A subset of research exploring the long-term impact of child sexual abuse (CSA) has examined the adult interpersonal functioning of female survivors. The present review discusses empirical findings and critical methodological issues related to this important but often overlooked aspect of adult adjustment. Though characterized by several methodological limitations, this literature, as a whole, suggests that early sexual abuse represents a risk factor for a range of interpersonal dysfunction among female survivors, including problems with intimate partner relations, disturbed sexual functioning, and difficulties in the parental role. Suggested methodological improvements for future research include new approaches to the measurement of CSA and interpersonal variables, the need for comprehensive assessment of significant third variables, and the use of more representative sampling strategies.
Article
This study was conducted to investigate the association between psychiatric disorders and high-risk sexual behavior among adolescent primary care patients. Interviews assessing anxiety, conduct, depressive, eating, substance use, and personality disorders (PDs), as well as histories of sexual behavior were administered to 119 male and 284 female adolescent primary care patients. Results indicated that, after co-occurring psychiatric disorders were controlled statistically, adolescents with elevated PD symptom levels were more likely than adolescents without elevated PD symptom levels to report a high number of sexual partners during the past year and during their lifetime. Adolescents with a history of conduct disorder were more likely than adolescents without such a history to report a high number of lifetime unsafe sexual partners. Elevated antisocial, dependent, and paranoid PD symptom levels were associated with high-risk sexual behavior after co-occurring psychiatric disorders were controlled. Further, certain specific antisocial, borderline, dependent, histrionic, narcissistic, obsessive-compulsive, paranoid, and schizotypal PD symptoms were independently associated with high-risk sexual behavior after co-occurring psychiatric disorders and overall PD symptom levels were controlled. The association between overall PD symptom levels and the number of sexual partners was significantly stronger among the females than among the males in the sample. Increased recognition and treatment of PDs, coupled with increased recognition of high-risk sexual behavior may facilitate the prevention of sexually transmitted diseases and teenage pregnancy among adolescents.
Article
Sexual problems in women with a history of child sexual abuse (CSA) are relatively common but only a few studies have attempted to explain the mechanisms of these problems. Given the potential for a variety of factors associated with sexual problems in CSA survivors, the field needs a theoretical model to explain these difficulties. The main aim of this article was to illustrate a theoretical model to understand sexual problems in CSA survivors. Sexual problems are here grouped into hyposexual and hypersexual. A review of empirical studies that support this model is presented. A second aim was to discuss the definition of CSA adopted in research projects. Results from studies targeting psychophysiologic, affective, and cognitive sexual responses are discussed. Vaginal photoplethismography, sexual self-schemas, and implicit sexual associations to sexual stimuli were the focus of the studies reviewed. These studies showed that during the exposure to sexual stimuli, CSA survivors experienced more inhibitory responses and less excitatory responses than women in the comparison groups. On the other hand, in situations when sexual stimuli were not present, CSA survivors showed a greater excitation of sexual responses than women in the comparison groups. Additionally, CSA survivors showed a potential difficulty inhibiting intrusive sexual thoughts. The model shows promising qualities to adequately explain the hypo- and hypersexuality of CSA survivors. The advantages of this model over others include the ability to guide the selection of cognitive and behavioral interventions for patients presenting for treatment.
Article
Depressive and schizophrenic patients frequently suffer from sexual dysfunctions. Antidepressants and antipsychotics can aggravate them leading to discontinuation of the treatment. The strategy to decrease these dysfunctions is the following: 1) reducing the dose of medication; 2) changing antidepressant: replace SSRI by moclobemid, trazodone, bupropion, mirtazpine, which do not delay ejaculation; switching to another antipsychotic: quietiapine, olanzapine, aripripazol, which do not increase serum prolactin; 3) taking a drug holiday for two or three days and 4) adding another drug such as sildenafil if impotence, or a dopaminergic agonist (aripripazol, a partial agonist) or cabergoline, in case of hyperprolactinaemia.
Article
Through reviewing what is known about the nature, course, and heritability of borderline personality disorder (BPD), we argue for a reconceptualization of this disorder that would lead to its placement on Axis I. Borderline personality disorder is a prevalent and disabling condition, and yet the empirical research into its nature and treatment has not been commensurate with the seriousness of the illness. We not only review empirical evidence about the etiology, phenomenology, and course of the disorder in BPD but we also address fundamental misconceptions about BPD that we believe have contributed to misunderstanding and stigmatization of the disease. Finally, we suggest future directions for research that might permit the identification of core features of this disorder, with a focus on the importance of naturalistic assessments and of assessments through the course of development.
Association between dissociation and cortisol response during states of heightened physiological sexual arousal in women with a history of child sexual abuse. International Society for the Study of Women's Sexual Health
  • A Rellini
  • L D Hamilton
  • Y Delville
  • C Meston
Rellini A, Hamilton LD, Delville Y, Meston C. Association between dissociation and cortisol response during states of heightened physiological sexual arousal in women with a history of child sexual abuse. International Society for the Study of Women's Sexual Health 2007.
Implicit and explicit cognitive processes and sexual arousal in survivors of child sexual abuse. Meeting of the International Society for the Study of Women's Sexual Health
  • A Rellini
  • D Ing
  • C Meston
Rellini A, Ing D, Meston C. Implicit and explicit cognitive processes and sexual arousal in survivors of child sexual abuse. Meeting of the International Society for the Study of Women's Sexual Health 2006.