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Sexual response in obsessive–compulsive disorder: the role of obsessive beliefs

Published online by Cambridge University Press:  15 July 2020

Andrea Pozza ,
Donatella Marazziti Open the ORCID record for Donatella Marazziti [Opens in a new window] ,
Federico Mucci Open the ORCID record for Federico Mucci [Opens in a new window] ,
Nicole L. Angelo ,
Davide Prestia  and
Davide Dèttore
Andrea Pozza
Affiliation:
Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
Donatella Marazziti*
Affiliation:
Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
Federico Mucci
Affiliation:
Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
Nicole L. Angelo
Affiliation:
School of Psychology, University of Florence, Florence, Italy
Davide Prestia
Affiliation:
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Infant-Maternal Science, Section of Psychiatry, University of Genoa, Genoa, Italy IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Davide Dèttore
Affiliation:
Department of Health Sciences, University of Florence, Florence, Italy
*
Author for correspondence: Donatella Marazziti Email: [email protected]
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Abstract

Background

Sexual response in obsessive–compulsive disorder (OCD) research and practice is overlooked. According to the Dual Control Model, satisfactory sexual response is based upon a balance of sexual excitation and inhibition. The assessment of sexual response in OCD may have clinical implications, such as the integration of sex therapy in psychotherapeutic intervention. The present study was aimed at comparing sexual excitation and inhibition levels between OCD patients and matched control subjects, and investigating whether obsessive beliefs might predict sexual excitation/inhibition.

Methods

Seventy-two OCD patients (mean age ± standard deviation [SD]: 34.50 ± 10.39 years) and 72 matched control subjects (mean age ± SD: 34.25 ± 10.18) were included (62.50% men and 37.50% women in both groups). The Obsessive Compulsive Inventory-Revised (OCI-R), the Obsessive Beliefs Questionnaire-46 (OBQ-46), and the Sexual Inhibition/Sexual Excitation Scales (SIS/SES) were administered.

Results

Patients with OCD showed significantly higher levels of sexual excitation, inhibition due to threat of performance failure, and inhibition due to threat of performance consequences than the controls. In addition, the patients with more severe symptoms showed lower excitation than those with less severe symptoms, and those with higher perfectionism had stronger inhibition due to threat of performance failure than those with lower perfectionism.

Conclusions

This is the first study exploring sexual response in OCD according to the Dual Control Model. Sexual response is an impaired quality of life outcome in OCD that should be assessed in routine clinical practice. These findings support the importance of addressing specific obsessive beliefs to improve sexuality in OCD patients.

Keywords

Sexual responseObsessive–compulsive disorderobsessive beliefsexcitationinhibitionsexual arousalperfectionism
Type
Original Research
Information
CNS Spectrums , Volume 26 , Issue 5 , October 2021 , pp. 528 - 537
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Albert, U, Maina, G, Bogetto, F, Chiarle, A, Mataix-Cols, D. Clinical predictors of health-related quality of life in obsessive-compulsive disorder. Compr Psychiatry. 2010;51(2):193–200.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed.. Washington, DC: American Psychiatric Association; 2013.Google Scholar
Coluccia, A, Fagiolini, A, Ferretti, F, et al. Obsessive-compulsive disorder and quality of life outcomes: protocol for a systematic review and meta-analysis of cross-sectional case-control studies. Epidemiol Biostat Public Health. 2015;12(2). doi: 10.2427/10037.Google Scholar
Huppert, JD, Simpson, HB, Nissenson, KJ, Liebowitz, MR, Foa, EB. Quality of life and functional impairment in obsessive-compulsive disorder: a comparison of patients with and without comorbidity, patients in remission, and healthy controls. Depress Anxiety. 2009;26(1):39–45. doi: 10.1002/da.20506.CrossRefGoogle Scholar
Pozza, A, Lochner, C, Ferretti, F, Cuomo, A, Coluccia, A. Does higher severity really correlate with a worse quality of life in obsessive-compulsive disorder? A meta-regression. Neuropsychiatr Dis Treat. 2018;14:1013–1023. doi: 10.2147/NDT.S157125.CrossRefGoogle ScholarPubMed
Rachman, S. A cognitive theory of obsessions. Behav Res Ther. 1997;35(9):793–802.CrossRefGoogle ScholarPubMed
Salkovskis, PM. Obsessional-compulsive problems: a cognitive-behavioural analysis. Behav Res Ther. 1985;23(5):571–583.CrossRefGoogle ScholarPubMed
Obsessive Compulsive Cognitions Working Group. Cognitive assessment of obsessive-compulsive disorder. Behav Res Ther. 1997;35(7):667–681.CrossRefGoogle Scholar
Obsessive Compulsive Cognitions Working Group. Psychometric validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory: part I. Behav Res Ther. 2003;41(8):863–878.CrossRefGoogle Scholar
Coradeschi, D, Pozza, A, Mannelli, E, et al. Obsessive belief changes in patients with resistant OCD treated daily with prolonged exposure and response prevention. Psicoterapia Cognitiva e Comportamentale. 2013;18(3):23–37.Google Scholar
Grotte, T, Solem, S, Vogel, PA, Cüneyt Güzey, I, Hansen, B, Myers, SG. Metacognition, responsibility, and perfectionism in obsessive-compulsive disorder. Cog Ther Res. 2015;39:41–50. doi: 10.1007/s10608-014-9635-7.CrossRefGoogle Scholar
Hezel, DM, McNally, RJ. A Theoretical review of cognitive biases and deficits in obsessive-compulsive disorder. Biol Psychol. 2016;121(Pt B):221–232.doi: 10.1016/j.biopsycho.2015.10.012.CrossRefGoogle ScholarPubMed
Pozza, A, Dèttore, D. Are inflated responsibility beliefs specific to OCD? Meta-analysis of the relations of responsibility to OCD, anxiety disorders, and depression symptoms. Clin Neuropsych. 2014;11(6):170–181.Google Scholar
Pozza, A, Coradeschi, D, Dèttore, D. Do dysfunctional beliefs moderate the negative influence of comorbid severe depression on outcome of residential treatment for refractory OCD? A pilot study. Clin Neuropsych. 2013;10(3):72–83.Google Scholar
Pozza, A, Albert, U, Dèttore, D. Perfectionism and intolerance of uncertainty are predictors of OCD symptoms in children and early adolescents: a prospective, cohort, one-year, follow-up study. Clin Neuropsych. 2019;16:53–61.Google Scholar
Tolin, DF, Worhunsky, P, Maltby, N. Are "obsessive" beliefs specific to OCD?: a comparison across anxiety disorders. Behav Res Ther. 2006;44(4):469–480.doi: 10.1016/j.brat.2005.03.007.CrossRefGoogle ScholarPubMed
Tumkaya, S, Karadag, F, Kalkan Oguzhanoglu, N. Relationship between obsessive beliefs and symptoms in patients with obsessive compulsive disorder. Noro Psikiyatr Ars. 2015;52(1):54–58. doi: 10.5152/npa.2015.7015.CrossRefGoogle ScholarPubMed
Bouvard, M, Fournet, N, Denis, A, Sixdenier, A, Clark, D. Intrusive thoughts in patients with obsessive compulsive disorder and non-clinical participants: a comparison using the international intrusive thought interview schedule. Cogn Behav Ther. 2017;46(4):287–299. doi: 10.1080/16506073.2016.1262894.CrossRefGoogle ScholarPubMed
Miegel, F, Jelinek, L, Moritz, S. Dysfunctional beliefs in patients with obsessive-compulsive disorder and depression as assessed with the Beliefs Questionnaire (BQ). Psychiatry Res. 2019; 272:265–274. doi: 10.1016/j.psychres.2018.12.070.CrossRefGoogle Scholar
Marazziti, D, Dell'Osso, B, Catena Dell'Osso, M, et al. Romantic attachment in patients with mood and anxiety disorders. CNS Spectr. 2007;12(10):751–756.CrossRefGoogle ScholarPubMed
Kumar, A, Sharma, MP, Kandavel, T, Reddy, YJ. Cognitive appraisals and quality of life in patients with obsessive–compulsive disorder. J Obsessive–Compuls Relat Disord. 2012;1(4):301–305.CrossRefGoogle Scholar
Davison, SL, Bell, RJ, LaChina, M, Holden, SL, Davis, SR. The relationship between self-reported sexual satisfaction and general well-being in women. J Sex Med. 2009;6(10):2690–2697. doi: 10.1111/j.1743-6109.2009.01406.x.CrossRefGoogle ScholarPubMed
Stephenson, KR, Meston, CM. The conditional importance of sex: exploring the association between sexual well-being and life satisfaction. J Sex Marital Ther. 2015;41(1):25–38. doi: 10.1080/0092623X.2013.811450.CrossRefGoogle ScholarPubMed
Pozza, A, Veale, D, Marazziti, D, et al. Sexual dysfunction and satisfaction in obsessive compulsive disorder: protocol for a systematic review and meta-analysis. Syst Rev. 2020;9(1), 1–13. doi: 10.1186/s13643-019-1262-7.CrossRefGoogle ScholarPubMed
Norberg, MM, Calamari, JE, Cohen, RJ, Riemann, BC. Quality of life in obsessive-compulsive disorder: an evaluation of impairment and a preliminary analysis of the ameliorating effects of treatment. Depress Anxiety. 2008;25(3):248–259. doi: 10.1002/da.20298.CrossRefGoogle Scholar
Ghassemzadeh, H, Raisi, F, Firoozikhojastefar, R, et al. A Study on sexual function in obsessive-compulsive disorder (OCD) patients with and without depressive symptoms. Perspect Psychiatr Care. 2017;53(3):208–213. doi: 10.1111/ppc.12160.CrossRefGoogle Scholar
Real, E, Montejo, A, Alonso, P, Mencho, JM. Sexuality and obsessive-compulsive disorder: the hidden affair. Neuropsychiatry. 2013;3:23–31.CrossRefGoogle Scholar
Vulink, NC, Denys, D, Bus, L, Westenberg, HG. Sexual pleasure in women with obsessive-compulsive disorder? J Affect Disord. 2006;91(1):19–25. doi: 10.1016/j.jad.2005.12.006.CrossRefGoogle ScholarPubMed
McCabe, MP, Sharlip, ID, Lewis, R, et al. Incidence and prevalence of sexual dysfunction in women and men: a consensus statement from the fourth international consultation on sexual medicine 2015. J Sex Med. 2016;13(2):144–152. doi: 10.1016/j.jsxm.2015.12.034.CrossRefGoogle ScholarPubMed
Fontenelle, LF, de Souza, WF, de Menezes, GB, et al. Sexual function and dysfunction in Brazilian patients with obsessive-compulsive disorder and social anxiety disorder. J Nerv Ment Dis. 2007;195(3):254–257. doi: 10.1097/01.nmd.0000243823.94086.6f.CrossRefGoogle ScholarPubMed
Basson, R, Gilks, T. Women's sexual dysfunction associated with psychiatric disorders and their treatment. Womens Health (Lond). 2018;14:1745506518762664. doi: 10.1177/1745506518762664.Google ScholarPubMed
Pahwa, PK, Foley, SM. Biopsychosocial evaluation of sexual dysfunctions. In Ishak, WW, ed. The Textbook of Clinical Sexual Medicine. Switzerland: Springer; 2017:79–94.CrossRefGoogle Scholar
Habke, AM, Hewitt, PL, Flett, GL. Perfectionism and sexual satisfaction in intimate relationships. J Psychopathol Behav Assess. 1999;21(4):307–322.CrossRefGoogle Scholar
Quadland, MC. Private self-consciousness, attribution of responsibility, and perfectionistic thinking in secondary erecticle dysfunction. J Sex Marital Ther. 1980;6(1):47–55. doi: 10.1080/00926238008404245.CrossRefGoogle ScholarPubMed
Stoeber, J, Harvey, LN. Multidimensional sexual perfectionism and female sexual function: a longitudinal investigation. Arch Sex Behav. 2016;45(8):2003–2014. doi: 10.1007/s10508-016-0721-7.CrossRefGoogle ScholarPubMed
Janssen, E, Vorst, H, Finn, P, Bancroft, J. The sexual inhibition (SIS) and sexual excitation (SES) scales: I. Measuring sexual inhibition and excitation proneness in men. J Sex Res. 2002;39(2):114–126. doi: 10.1080/00224490209552130.CrossRefGoogle ScholarPubMed
Brakoulias, V, Starcevic, V, Belloch, A, et al. International prescribing practices in obsessive-compulsive disorder (OCD). Hum Psychopharmacol. 2016;31(4):319–324. doi: 10.1002/hup.2541.CrossRefGoogle Scholar
Mazzi, F, Morosini, P, De Girolamo, G, Lussetti, M, Guaraldi, GP. SCID-I—Structured Clinical Interview for DSM-IV Axis I Disorders (Italian Edition). Florence: Giunti OS; 2000.Google Scholar
Goodman, WK, Price, LH, Rasmussen, SA, et al. The yale-brown obsessive compulsive scale. II. Validity. Arch Gen Psychiatry. 1989;46(11):1012–1016.CrossRefGoogle ScholarPubMed
Foa, EB, Kozak, MJ, Salkovskis, PM, Coles, ME, Amir, N. The validation of a new obsessive-compulsive disorder scale: the obsessive-compulsive inventory. Psychol Assess. 1998;10(3):206–214. doi: 10.1037/1040-3590.10.3.206.CrossRefGoogle Scholar
Foa, EB, Huppert, JD, Leiberg, S, et al. The obsessive-compulsive inventory: development and validation of a short version. Psychol Assess. 2002;14(4):485–496.CrossRefGoogle ScholarPubMed
Sica, C, Ghisi, M, Altoe, G, et al. The italian version of the obsessive compulsive inventory: its psychometric properties on community and clinical samples. J Anxiety Disord. 2009;23(2):204–211. doi: 10.1016/j.janxdis.2008.07.001.CrossRefGoogle ScholarPubMed
Dorz, S, Novara, C, Pastore, M, Sica, C, Sanavio, E. Presentazione della versione italiana dell’obsessive beliefs questionnaire (OBQ): struttura fattoriale e analisi di attendibilità (parte I). Psicoterapia Cognitiva e Comportamentale. 2009;15:139–170.Google Scholar
Novara, C, Dorz, S, Pastore, M, Sica, C, Sanavio, E. Presentazione della versione italiana dell’obsessive beliefs questionnaire (parte II). validità convergente e specificità dei costrutti in un campione clinico. Psicoterapia Cognitiva e Comportamentale. 2011;17:157–172.Google Scholar
Panzeri, M, Dèttore, D, Altoe, G, Zanella, F, Baldetti, M, Janssen, E. T01-O-14 factor structure of the italian sexual inhibition/excitation (SIS/SES) scales. Sexologies. 2008;17:S54Google Scholar
Cohen, J. Statistical Power Analysis for the Behavioral Sciences. New York, NY: Routledge; 1998.Google Scholar
IBM. Statistics for Windows, Version 24.0 [Computer Software]. Armonk, NY: IBM Corp; 2016.Google Scholar
Bancroft, J, Janssen, E. The dual control model of male sexual response: a theoretical approach to centrally mediated erectile dysfunction. Neurosci Biobehav Rev. 2000;24(5):571–579.CrossRefGoogle ScholarPubMed
Purdon, C. Empirical investigations of thought suppression in OCD. J Behav Ther Exp Psychiatry. 2004;35(2):121–136. doi: 10.1016/j.jbtep.2004.04.004.CrossRefGoogle ScholarPubMed
Pozza, A, Ferretti, F, Coluccia, A. Perceived physical health in obsessive-compulsive disorder: a protocol for a systematic review and meta-analysis. BMJ Open 2019;9(6):e026261. doi: 10.1136/bmjopen-2018-026261.CrossRefGoogle ScholarPubMed
Bankier, B, Aigner, M, Bach, M. Alexithymia in DSM-IV disorder: comparative evaluation of somatoform disorder, panic disorder, obsessive-compulsive disorder, and depression. Psychosomatics. 2001;42(3):235–240. doi: 10.1176/appi.psy.42.3.235.CrossRefGoogle ScholarPubMed
Pulverman, CS. A review of "Come as You Are". J Sex Marital Ther. 2015;42(1):94–96. doi: 10.1080/0092623x.2015.1106768.CrossRefGoogle Scholar
McNally, RJ, Mair, P, Mugno, BL, Riemann, BC. Co-morbid obsessive-compulsive disorder and depression: a Bayesian network approach. Psychol Med. 2017;47(7):1204–1214. doi: 10.1017/S0033291716003287.CrossRefGoogle ScholarPubMed
Bancroft, J, Vukadinovic, Z. Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model. J Sex Res. 2004;41(3):225–234. doi: 10.1080/00224490409552230.CrossRefGoogle ScholarPubMed
Zillman, D. Transfer of excitation in emotional behavior. In Cacioppo, JT, Petty, RE, eds. Social Psychophysiology: A Sourcebook. New York, NY: Guilford Press; 1983:215–240.Google Scholar
Warwick, HM, Salkovskis, PM. Hypochondriasis. Behav Res Ther. 1990;28(2):105–117.CrossRefGoogle ScholarPubMed
Kabat-Zinn, J. Mindfulness-based interventions in context: past, present, and future. Clin Psychol: Sci Pr. 2006;10(2):144–156. doi: 10.1093/clipsy.bpg016.Google Scholar
Wells, A. Metacognitive Therapy for Anxiety and Depression. Abingdon, UK: Routledge; 2016.Google Scholar
Pozza, A, Dettore, D. Drop-out and efficacy of group versus individual cognitive behavioural therapy: what works best for obsessive-compulsive disorder? A systematic review and meta-analysis of direct comparisons. Psychiatry Res. 2017;258(12):24–36. doi: 10.1016/j.psychres.2017.09.056.CrossRefGoogle ScholarPubMed
Strosahl, KD, Hayes, SC, Wilson, KG, Gifford, EV. An ACT primer. In: Hayes, SC, Strosahl, KD, eds. A Practical Guide to Acceptance and Commitment Therapy. Boston, MA: Springer; 2004: 31–58.CrossRefGoogle Scholar
Velten, J. The dual control model of sexual response: Relevance of sexual excitation and sexual inhibition for sexual function. Curr Sex Health Rep. 2017;9(2):90–97. doi: 10.1007/s11930-017-0108-3.CrossRefGoogle Scholar