Abstract
Sexual arousal is often impaired in patients with obsessive–compulsive disorder (OCD). However, little is known about the factors related to this impairment: no study focused on the role of gender-based effects of attachment styles and contamination symptoms. The Dual Control Model assumes three processes driving sexual arousal: sexual excitation (SE), sexual inhibition (SI) due to threat of performance failure, and SI due to threat of performance consequences (e.g., getting contaminated with sexually transmitted diseases). In a group of OCD patients, we hypothesized that (a) women report lower SE and higher SI than men; (b) patients with insecure (both anxious and avoidant) attachment styles show lower SE and higher SI; (c) attachment styles moderate the relation between gender and sexual arousal (respectively, for women, higher attachment anxiety, and for men higher attachment avoidance were related to impaired sexual arousal (higher SE and SI) controlling for OCD severity); and (d) contamination symptoms moderate the relation between gender and sexual impairment (women with contamination symptoms show impaired sexual arousal). Seventy-two OCD patients (37.50% women) completed the Obsessive–Compulsive Inventory-Revised, Attachment Styles Questionnaire and Sexual Inhibition/Sexual Excitation Scales. In contrast with our hypotheses, women reported higher SE and lower SI due to threat of performance consequences than men. Patients with higher attachment avoidance (discomfort with intimacy) but also confidence in self and others had higher SE. Women with attachment avoidance (i.e., discomfort with intimacy) had lower SE, while women with attachment anxiety (i.e., preoccupations with relationships) had higher SI due to negative performance consequences. Women with contamination symptoms had higher SI due to performance failure but lower SI due to performance consequences. The present preliminary findings suggest that sexual arousal impairment should be evaluated during the assessment of OCD patients, and gender-based effects of attachment styles and contamination symptoms should be considered during personalized treatment planning.
Highlights
Sexual Arousal in Obsessive–Compulsive Disorder: The Role of Gender According to the Dual Control ModelObsessive–compulsive disorder (OCD) is a psychiatric condition characterized by obsessions and compulsions that cause significant distress and disability in various aspects of quality of life [1, 2]
Based on the literature data about gender differences in attachment styles, contamination symptoms and sexual arousal processes [e.g., [35,36,37,38,39, 55,56,57,58]], we hypothesized that (a) female patients report lower sexual excitation (SE) and higher sexual inhibition (SI) than male ones; (b) obsessive–compulsive disorder (OCD) patients with more anxious and avoidant attachment styles show lower SE and higher SI; (c) attachment styles moderate the relation between gender and sexual response after controlling for general OCD severity, i.e., respectively, for female patients higher attachment anxiety and for male patients, higher attachment avoidance are related to impaired sexual response; and (d) contamination symptoms moderate the relation between gender and sexual response, i.e., for female patients, the presence of contamination symptoms is related to impaired sexual response
The results of the non-parametric tests suggested an association between gender and contamination symptoms: the number of women with contamination symptoms was significantly higher than the number of men
Summary
Sexual Arousal in Obsessive–Compulsive Disorder: The Role of Gender According to the Dual Control ModelObsessive–compulsive disorder (OCD) is a psychiatric condition characterized by obsessions and compulsions that cause significant distress and disability in various aspects of quality of life [1, 2]. It is not surprising that sexual functioning, significantly contributing to quality of life, may be altered in this clinical population, since this type of patients more frequently present sexual dysfunctions such as less sexual desire and arousal, and orgasmic difficulties than people of the general population [3,4,5]. Some data showed that patients with OCD report more frequent and more intense sexual dysfunctions even than other clinical groups such as patients with anxiety disorders [6]. Impaired sexual functioning in OCD patients may be influenced by serotonergic antidepressant medication, commonly prescribed at high dosages as the first-line psychopharmacological intervention, which can induce some sexual dysfunctions both in men and women [7]. Not all data supported this evidence, and some papers suggested that OCD patients may have sexual dysfunctions independently of serotonergic medications [8]. Data from meta-analyses and from empirical studies indicated that the female gender would be related to a worse intimate and interpersonal quality of life [9] and more frequent sexual dysfunctions than the male gender [10, 11]
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