Sexual Expression and It’s Determinants, in People Diagnosed with Psychotic Disorders

Abstract

This qualitative study aims to explore the difficulties people with a psychotic disorder have in sexual expression, and associated determinants. Twenty-eight semi-structured interviews were conducted and analyzed using the Grounded Theory method. Almost all participants experienced unfulfilled needs in sexual expression. These unfulfilled needs were associated with a range of factors, including antipsychotic medication, psychotic symptoms, sexual abuse, social skills and stigma, all of which may converge on a pathway involving (sexual) self-esteem. Further research is required to better understand the role of self-esteem in relation to sexual needs and expression in people with psychotic disorders.

Full text

Vol:.(1234567890)
Community Mental Health Journal (2018) 54:1082–1088
https://doi.org/10.1007/s10597-018-0285-1
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ORIGINAL PAPER
Sexual Expression andIt’s Determinants, inPeople Diagnosed
withPsychotic Disorders
JosédeJager1 · RoosvanGreevenbroek1· AnnetNugter1· JimvanOs1
Received: 9 August 2017 / Accepted: 8 May 2018 / Published online: 18 May 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract
This qualitative study aims to explore the difficulties people with a psychotic disorder have in sexual expression, and asso-
ciated determinants. Twenty-eight semi-structured interviews were conducted and analyzed using the Grounded Theory
method. Almost all participants experienced unfulfilled needs in sexual expression. These unfulfilled needs were associated
with a range of factors, including antipsychotic medication, psychotic symptoms, sexual abuse, social skills and stigma, all
of which may converge on a pathway involving (sexual) self-esteem. Further research is required to better understand the
role of self-esteem in relation to sexual needs and expression in people with psychotic disorders.
Keywords Sexuality· Sexual expression· Sexual functioning· Psychosis· Schizophrenia· Recovery
Introduction
In surveys, around 15% of the general population indicates
dissatisfaction with his or her sex life (Mulhall etal. 2008).
This percentage is as high as 64% in people with a mental
disorder diagnosed in the realm of psychosis (Östman 2014).
Despite the fact that 83% experiences sexual feelings, peo-
ple with a psychotic disorder often report not being able to
express their sexuality (Peitl etal. 2009; McCann 2010).
Sexual expression describes the way a person experiences
sexuality and communicates sexuality with others. Express-
ing sexuality includes three factors: sexual behavior, sexual
communication and sexual identity (Harvey etal. 2004).
Sexual expression plays an important role in self-definition,
as expressing sexuality can confirm the sense of being a man
or woman, which is important for self-esteem and identity
(Volman and Landeen 2007). It is influenced by biological,
psychological and social factors (Denman 2004). Therefore,
a bio-psycho-social approach may shed more light on the
difficulties people diagnosed with a psychotic disorder face
in the field of sexuality and their sexual expression.
Patients who have had psychotic symptoms often suffer
from deficit symptoms. These symptoms as well as the use
of antipsychotic drugs have impact on their sexual expres-
sion. Lack of motivation or desire, arousal and orgasm are
common problems (Harley etal. 2010; Van Sant etal. 2012).
Sexual dysfunctions caused by the side-effects of medica-
tion play an important role in the observed high rates of
non-adherence among people diagnosed with a psychotic
disorder (Malik etal. 2010). Further, the body image is
often perceived negatively by weight gain as a side-effect
of antipsychotic drugs (Volman and Landeen 2007; Östman
and Björkman 2013).
Usually, the onset of a psychosis occurs in adolescence or
young adulthood, a phase during which sexuality and psy-
chosocial skills also develop (Whisman etal. 2014). A psy-
chotic episode may lead to a later onset or absence of sexual
experience, less knowledge and fewer skills to develop
sexual roles and to connect to others in a sexual fashion
(Volman and Landeen 2007). Fears and doubts about sexual
orientation (Skodlar and Nagy 2009), low sexual confidence
and feelings of sexual incompetence may develop (Peitl etal.
2009; Kelly and Conley 2004).
Social factors concern the limitations in social skills and
social insight that people with a psychotic disorder may
experience (Peitl etal. 2009; Savla etal. 2013). Several stud-
ies show that this may impede the ability to start or maintain
sexual relations (Pinkham etal. 2007; Lysaker etal. 2007;
Van Sant etal. 2012). Östman and Björkman (2013) indicate
that patients and partners hardly communicate about issues
related to their sexual relationship. Earlier literature shows
* José de Jager
j.dejager@ggz-nhn.nl
1 GGZ Noord-Holland-Noord, Postbus 18, 1850BAHeiloo,
TheNetherlands
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