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Summary Case 3
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Case 3 of the course sexuality. the course is given in the 2nd year of the Bachelor Health Sciences. I got an 8 myself for the exam
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Taak 31. Het verband tussen angst en depressie en seksuele problemen
- Depression, anxiety, and sexual dysfunction in the DSM-IV
o With such a strong link between sexual dysfunction and depression or anxiety
respectively, it is perhaps surprising that there are few direct diagnostic links between
these disorders in the current version of the DSM-IV
o In relation to mood disorders, sexual functioning is mentioned only briefly in two
locations in the DSM-IV, with one statement claiming “In some individuals, there is a
significant reduction from previous levels of sexual interest or desire” , and another
stating “There may be… difficulties in sexual functioning” , going on to mention
anorgasmia in women and erectile dysfunction in men
o In the sections on anxiety disorders, few references to sexuality can be found other
than that specific phobia related to sexual contact should be classified as a sexual
aversion disorder rather than a specific phobia, and that posttraumatic stress disorder
may be accompanied by reduced ability to feel emotions related to intimacy or
sexuality
o the prevalence of sexual dysfunction in people with anxiety disorders is high. This
may be because the relationship between anxiety and sexual dysfunction is not always
clear, with sexual dysfunction primarily related to the cognitive rather than the
physiological aspects of anxious arousal, or that anxiety is sometimes associated with
an increase in sexual arousal rather than a decrease. If sexual dysfunction proves to be
related conclusively to anxiety, then a dimensional approach to understanding the link
between them would most likely have implications for diagnosis and treatment of both
anxiety and sexual dysfunction disorders.
Depression and sexual dysfunction
- sexual desire disorders
o Loss of libido is perhaps the most common aspect of sexual functioning that is
affected by depression or depressive symptoms. It should be noted, however, that loss
of sexual desire is not always the case, at least in men
o Although many studies relating depression to loss of libido do not take into account
the use of antidepressant medication, some research has specifically focused on the
connection between sexual functioning and depression in non-medicated populations,
in order to rule out potential confounds. This showed still a decrease of sexual desire
o women with depressive symptoms reported a greater desire for solitary sexual activity
than non-depressed women, and that these same women were significantly more
likely to have masturbated in the last month.
- Sexual arousal disorders
o Sexual arousal disorders, particularly erectile dysfunction (ED) are common in men
with depression. In women, there is also some evidence of decreased arousal in
depression
o these studies show that up to 50% of men who have ED are depressed or show
depressive symptoms and that depression is 2-3 times more likely in men with ED
than men with no sexual arousal disorder
o it is generally thought that depression in women leads to difficulty in sexual arousal.
sexual symptoms comorbid with depression do not easily disappear, even when the
depression is in remission
o negative thoughts or affect that are experienced before sexual activity commences can
decrease sexual responding, even when positive affect is introduced later. Conversely,
positive affect may increase sexual responding, providing resilience against later
negative thought
- orgasm and pain disorders
o Very little systematic research has linked orgasm and pain disorders to depression,
although this may reflect a lack of research interest rather than a lack of a connection
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, - Sexual pleasure and satisfaction
o Because there are no disorders associated with reduced enjoyment of sexual activities,
no specific statistics are reported here. It is worth noting that several of the studies
listed above report rates of sexual satisfaction or pleasure in depressed and control
populations. Rates of satisfaction and enjoyment are, in almost all cases, lower in
depressed populations than in control populations. Because satisfaction and pleasure
with one's sexual relationships are an important part of overall well-being and
presumably contribute to normal sexual function, this is an important topic to be
addressed in any future research.
- Conclusion
o All phases of the sexual response cycle, with the possible exception of resolution, are
associated with depression. In addition, pain disorders are also found often in
depressed people, although this finding applies more often to women than to men, and
is an aspect of sexuality that is not as often researched in the context of depression.
Sexual desire disorders are common in up to 50% of people who are depressed, with
the likelihood of a sexual desire disorder sometimes more than 5 times as likely in
depressed than non-depressed people. Disorders of arousal are also common in
women and men. This has been assessed by both subjective self-report measures and
by objective measures. None of this work has clearly established whether sexual
dysfunction is caused by depression or if depression is caused by sexual dysfunction.
Rather than one causing the other, it seems likely that there are reciprocal and
bidirectional effects of each type of dysfunction upon the other, or that they often
appear together and are not easily separable. High rates of comorbidity, coupled with
the lack of a clear causal link between sexual dysfunction and depression, suggest that
each might be a symptom of the other, with depressive symptoms one of the main
problems found in those with sexual dysfunction, and sexual dysfunction found in
those who are depressed
Anxiety and sexual dysfunction
- anxiety has nonetheless been associated with sexual dysfunction in several studies, including
studies that experimentally manipulated anxiety.
- Generalized anxiety disorder and dimensional measures of anxiety
o anxiety is common in people with sexual dysfunction, but that the nature and level of
the anxiety might show large individual differences. t anxiety is a major factor in the
etiology of sexual dysfunction
o measures of worry showed small but significant correlations with both sexual aversion
and hypoactive sexual desire. By explicating the relationship between worry and
anxiety, Katz and Jardine concluded that anxiety was related to a lack of sexual desire
and to sexual disgust
o certain types of cognitive interference can reduce arousal in sexually functional men,
but can actually increase arousal in men with secondary erectile dysfunction,
presumably by distracting them from worries about their sexual functioning. It was
also concluded that in healthy men, anxiety that is not cognitively distracting can have
an enhancing effect on sexual arousal
- obsessive compulsive disorder
o In addition, there was a trend for the women with OCD to score higher on vaginismus,
sexual non-communication, and dissatisfaction subscales. women with OCD scored
higher than a control group on measures of sexual disgust, and scored lower on
measures of sexual desire, arousal, and satisfaction with orgasm
- Panic disorder
o mixed reports about sexual dysfunction in panic disorder
o sexual symptoms might be presenting symptoms of depression rather than of panic
disorder
- social phobia
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, o premature ejaculation was associated with a 2.5 times higher chance of also having
comorbid social phobia
o men: y harder to become aroused, had a lower frequency of orgasm during sex,
enjoyed sex with their partner less, and were less satisfied with their own sexual
functioning
o Social phobic women had a lower frequency of sexual thoughts and desire for sex,
less coital lubrication, more difficulty with arousal, less frequent sex, less sexual
satisfaction, more painful sex, and higher loss of desire during sex
- Post-traumatic stress disorder
o treated with selective serotonin reuptake inhibitors or received no medication had
significantly poorer scores across all aspects of sexual functioning that were measured
(desire, arousal, orgasm, activity and satisfaction). They concluded that PTSD is
associated with pervasive sexual dysfunction
o women who were raped had significantly more sexual aversion and genital pain. Other
studies also suggest that a relationship between PTSD and sexual dysfunction may
present in people who have experienced sexual trauma, although rates for co-
occurrence of these disorders is not always described
- conclusion
o A strong relationship exists between anxiety and sexual dysfunction, although this
relationship is not as clear as in depression. Generalized anxiety disorder appears to be
associated with all phases of the sexual response cycle, although there are conflicting
reports. Bradford and Meston used their finding that women who scored in the
moderate range on state anxiety were higher in physiological arousal than those who
scored low or high in state anxiety to explain why some studies find experimentally
induced anxiety increases arousal while others find arousal decreased. They also
pointed out the generally weak correlations between objective and subjective
measures of arousal in the literature, concluding that different methodologies can
return different findings depending on the focus of the research.
o Obsessive compulsive disorder and panic disorder seem to be primarily associated
with lowered sexual desire and sexual aversion, although lower arousal, pain, and
reduced satisfaction have also been noted.
o Social phobia also appears to be related to lower sexual desire, but in one study, it was
also related to most phases of the sexual response cycle in men and women. This
disorder also seems to be strongly related to premature ejaculation, although the
findings are somewhat mixed.
o Posttraumatic stress disorder has been related to sexual aversion as well, but also to
pain, erectile difficulties, and problems with premature ejaculation. In addition, sexual
abuse viewed within a posttraumatic stress disorder framework has linked
posttraumatic stress to depression, anxiety, and sexual dysfunction
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