Obsessive compulsive disorder is a mental disorder that is characterized by the presence of obsessions (mental images, thoughts or impulses that generate discomfort or anxiety) and compulsions (behaviors or repeated mental acts in order to reduce or eliminate the emotional discomfort associated with obsessions).
The DOC is a chronic psychopathological framework that concerns 1-3% of the world population and brings great harmful effects on the functioning of the individual who is affected. A fundamental aspect of the subjective functioning of DOC patients which has been poorly investigated is that relating to the sex life.
Some studies (e.g., Aksaray et al., 2001; Klimowicz et al., 2017) indicate a high comorbility between DOC and sexual sphere disorders. Rats are between 54% and 73% with sexual dissatisfaction, the absence of desire, drop in excitement and anorgasmia. It is evident both on a clinical level and literature, and the DOC patients we have a little satisfaction of their intimate and sexual life.
Causes of sexual difficulties in the DOC
The patient’s intimate and sexual operation can be compromised by a series of variables relating to the disorder or the care of the disorder.
The effects of drugs on sexuality
The last group includes the sexual dysfunctionities induced by the drugs prescribed in the treatment of obsessive symptoms. In particular, we know that some categories of antidepressants (e.g., SSRI) used in the treatment of obsessive symptoms, may have worse effects on sexual health, with drop in libido and erection and ejaculation disorders.
Even the use of certain classes of antipsychotics, producing an increase in prolactin, can induce sexual function problems. These dysfunctions in turn can lead the patient to be less adherent to the pharmacological prescription, precisely because of the subjective suffering associated with these side effects.
The effects of sexual and aggressive obsessions on sexuality
There are also to consider that sometimes the same content of the obsessions It can create an obstacle to the quality of intimate and sexual life.
The sexual obsessions are made up of a series of unacceptable and unwanted thoughts with a sexual content experienced as selfish and painful for the subject. Examples of these obsessions are the obsessive doubts of being able to be homosexual, pedophile or sexually aggressive towards the partner.
Patients afflicted by these mental intrusions often try to reassure each other through continuous controls and automonitoraggi that inevitably conflict with the possibility of living their sexuality serenely. Often, also, due to their fears, they implement real avoidance of situations of sexual intimacy.
Other obsessions and sexual difficulties
There are studies that provide preliminary data on the presence of dysfunctions in the sexual life of patients with other types of obsessions. For example fears related to dirt and contamination (eg, fear or disgust for body secretions) or obsessive doubts about the relationship and the partner (e.g., doubts of not being quite involved in the relationship or not having chosen the “right” partner for themselves).
So far, however, very few research data of are aimed at investigating the role of the emotional dimensions of the doc (guilt and disgust) in the compromise of the functioning and perceived quality of one’s sex life.
Disgust in obsessive-compulsive disorder
Disgust is a universal emotion with the evolutionary function of pushing the individual and avoiding the contact or ingestion of potentially harmful substances (Rozin & Fallon, 1987).
Disgust plays a fundamental role in the psychopathology of obsessive-compulsive disorder, above all-but not only!-In the DOC with fear of contamination (eg, McKay, 2006).
Research on the disgust in Doc has explored its role in the etiology and phenomenology of obsessive symptoms of contamination. The propensity to disgust is significantly correlated to the cleaning/washing rituals (among other studies, Olatunji et al., 2010; back them et al., 2003).
In addition, the propensity for disgust It seems to be a significant predictor both of the obsessive symptoms from contamination and, to a lesser extent, of those of control and order and symmetry (Mancini et al., 2001; Olatunji et al., 2004). Finally, there are data in support of a direct linear association between the DP construct and the fear of contamination in obsessive patients (eg, Moretz & McKay, 2008).
There Sensitivity to disgust (Disgust Sensibility, DS) was investigated in a lower number of research on the DOC. The available data indicate a high correlation of this construct with contamination symptoms (Knowles et al., 2018) and with those characterized by pure obsessions and unacceptable thoughts (Pozza et al., 2016).
Role of disgust on the sexual functioning of subjects with obsessive symptoms
There propensity and sensitivity to disgust There are also associated with other psychopathological disorders other than DOC (eg, phobias) and playing a significant role also in sexual problems due to high sexual inhibition.
This last dimension, in the theoretical perspective of the Dual Control Model of Janessen & Bancroft (2006), is positively related to the presence of sexual dysfunctions.
There propensity and sensitivity to disgustfacilitating this inhibitory response, would contribute to the avoidance and refusal of certain sexual stimuli (Knowles et al., 2018). But also to the decrease in excitement, desire and sexual response (Andrews et al., 2015).
A recent study
A very recent study (Pozza, Angelo, Prestia and Dèttore, 2019) has explored the association between propensity and sensitivity to disgust and the dimension of sexual inhibition in subjects with a diagnosis of obsessive-compulsive disorder.
In particular, the authors compared a clinical sample with a control group. They hypothesized that DOC patients presented marked levels of sexual inhibition (vs. excitement). They also expected that, as the levels increase propensity and sensitivity to disgustsymptoms from contamination and unacceptable thoughts/pure obsessions, corresponded an increase in the variable sex inhibition and a decrease in sexual excitement.
Study results
The results confirm that in obsessive subjects a greater level of sexual inhibition was present than the control group.
Against expectations, the excitement levels were also high in the clinical group. This data led the authors to hypothesize that the avoidance of relationships (as a secondary effect of the distress generated by the symptoms) produces a increase both in the inhibition and in sexual excitement.
Other authors have also proposed that the paradox of the greatest sexual arousal found in some mental disorders related to inhibition/retreat (e.g., depression) can be explained how a coping strategy compared to the feelings of solitude and isolation.
Furthermore, in subjects with DIGNOSIS OF DOCas the sensitivity to disgust (but not propensity!) increases and of contamination symptoms corresponded to an increase in sexual inhibition.
On the contrary, the trend of sexual excitement was not predicted by any of the variables investigated, if not a significant decrease to worsen the general intensity of the symptoms. In fact, it is quite understandable as more compromised patients on the symptomatological level can have reduced sexual excitement than those who have milder symptoms.
Conclusions
This interesting study is the first that systematically analyzes the relationship between the constructs of excitement and sexual inhibition (rather than the categories of the various sexual dysfunctions) with some central and emotional dimensions in the obsessive-compulsive disorder. Constitutes an important stimulus for the research vein on issues still so little investigated despite the huge impact of sexual problems in the functioning of such patients.
Bibliographic notes
- Aksaray et al., (2001). Sexuality in Women with compulsive obsessive disorder. Journal of Sex and Marital Therapy, 27: 273-277.
- Ghassemzadeh et al. (2017). A Study On Sexual Function in OCD Patient With and With Without Symptoms. Perspective in Psychiatric Care, 208-213.
- Klimowicz et al. (2017). Sex and Chronic Psychiatric Illness. In Ishak (ed.). The Textbook of Clinical Sexual Medicine (p.507-524). Springer Interioral.
- Pozza, Angelo, Prestia, Dèttore (2019). The Role of Disgust Propensity and Sensititivity on sexual Excitation and Inhibition in compulsive obsessive disorder. Research in Psychotherapy: Psychopathology, precess and outcome, 22,447-457.
- Real, Montejo, Alonso & Menchon (2013) .Sexuality and Ocd: The Hidden Affair Neuropsychiatry, 3 (1), 23-31.
