Sexuality in Psychiatric Disorders

Sexuality in Psychiatric Disorders

Risks for psychiatric disorders have evolved, and psychiatric disorders are manifestations of different evolved strategies for optimizing reproduction and survival, which may be undesirable but with the exception of severe cases, are adaptive. Different psychiatric disorders (with the exception of disorders that don’t largely affect overall personality and cognition, such as generalized anxiety disorder) therefore involve characteristic patterns of behavior, cognition, and emotionality related to sexuality and reproduction. This post will explore the evidence for what these patterns are in several psychiatric disorders.

Sociosexuality

Perhaps the broadest individual difference in sexuality in humans is sociosexuality, the degree to which an individual desires to have sexual experiences with people without needing to be in a long term relationship. Sociosexuality is strongly associated with overall sex drive [2], puberty timing (higher sociosexuality = earlier) [3], pornography use [4], reduced sexual disgust (and less conservative attitudes towards sexuality) [5], and paraphilic sexual interests [6]; sociosexuality and the mentioned traits make up a general broad factor of human sexuality. Sociosexuality (or the broad factor of sexuality) is increased several psychiatric disorders, including schizotypal, schizoid, borderline, antisocial, histrionic, narcissistic personality disorders [1], ADHD [7](except when accompanied by autistic traits), eating disorders [8](with the exception of a minority of cases of anorexia characterized by perfectionism and over conscientiousness [9]), and bipolar disorder [10]. Sociosexuality is decreased in autism [11], obsessive-compulsive personality disorder [12], and OCD (when characterized by perfectionism) [13].

Schizophrenia Spectrum

Sexuality in persons with schizophrenia spectrum disorders can be mistaken as being reduced from an outside perspective, however this is not the case. Persons with SSDs display an interpersonal pattern of severe social anxiety and exaggerated response to social stress (e.g., rejection) [14][15][16][19][20], and a need for independence (specifically, having independent beliefs and values, which makes intimacy impossible with others who will not accept their independent beliefs and values or force them to change) [17]. As a result, persons with SSDs often avoid expressing sexual thoughts and desires [18], tend not to pursue sexual partners due to fear of rejection [20], and rarely form intimate sexual relationships with others, despite having normal or above normal desire for them [19][21]. However, sexuality is not reduced, and persons with milder expressions of schizotypy and patients without severe negative symptoms tend to have more sexual partners than average, reduced sexual disgust, increased short term mating effort, reduced long term mating effort, and have earlier sexual intercourse [22][23][9][1]; these findings also apply to bipolar disorder, which is very closely related to SSDs. Persons with SSDs may use pornography and fantasy as a sexual outlet, and sometimes have unusual sexual interests [18][24][25][26]. 

Cluster B

All four cluster B personality disorders are characterized by high sociosexuality and the general factor of sexuality, however each have a unique sexual strategy. Histrionic personality disorder is a female-typical strategy characterized by preference for non-committed, short term sexual relationships, high effort invested into making ones self sexually appealing [17], inappropriate and sometimes deviant or coercive sexual behavior, grandiosity and social exhibitionism, and tendencies toward frequent or excessive flirting even without genuine interest [18]. Borderline personality disorder is characterized by mating effort, jealousy & sexual competitiveness [54], preoccupation with appearance [29], a high sex drive and sexual impulsivity [30], and sexual deviance [26][30]. Borderline personality is associated with body dysmorphia and eating disorders [29][54], and histrionic personality with eating disorders [54], particularly bulimia [31]. Antisocial personality is a male-typical strategy characterized by a preference for non-committed short term sexual relationships [32], risky and coercive sexual behavior [33][34][35], sexual deviance [26], and a high sex drive [36]. Narcissism is another male-typical strategy characterized by preference for non-committed, short term sexual relationships [37], sexual coercion [38], pursuit of high status sexual partners, high effort into enhancement of own attractiveness & status [8], and social exhibitionism. Vulnerable narcissism in particular is also associated with eating disorders [54].

Autism and OcPD

Autism and OcPD are closely related disorders [39], both characterized by reduced sociosexuality [11][12] and reduced general factor of sexuality. Autism involves delayed puberty timing [40][42], increased sexual disgust [47][45], reduced effort into forming relationships [41], reduced sex drive (particularly in women)[42][43][44][46], reduced sexual attraction [47] and a high frequency of asexual or demisexual orientations [46][47], and increased effort invested in maintaining long term relationships [11]. OcPD involves high sexual disgust [9], reduced desire for intimate relationships [48], low short term mating orientation, and increased effort into long term relationships [1]. Some cases of OCD involve increased sexual disgust, fears and obsessions around being sexually deviant or immoral, and increased bodily disgust sensitivity [8].

ADHD & EDs

Most cases of ADHD are characterized by increased sociosexuality and general factor of sexuality. ADHD involves sexual impulsivity and a high sex drive [7][49], earlier puberty timing [50], more & shorter romantic relationships, and risky sexual behavior [50]. Bulimia, most cases of anorexia, and most cases of body dysmorphia involve increased general factor of sexuality, early puberty timing, high mating effort, high sexual competitveness, risky sexual behavior, and excessive concern over one’s own physical attractiveness [52][53][54]. While the general factor of sexuality is increased in eating disorders and body dysmorphia, sociosexuality may be lower relative to other aspects (particularly in anorexia and body dysmorphia), as they are highly female-typical strategies [29], and sociosexuality is much lower in women than men [8].

1. Jonason et al. (2018) Love, Sex, and Personality Pathology: A Life History View of Personality Pathologies and Sociosexuality

2. Ostovich & Sabini (2004) How are Sociosexuality, Sex Drive, and Lifetime Number of Sexual Partners Related?

3. Ostovich & Sabini (2005) Timing of puberty and sexuality in men and women

4. Burtaverde et al. (2021) Why Do People Watch Porn? An Evolutionary Perspective on the Reasons for Pornography Consumption

5. Shea et al. (2019) Further evidence for associations between short-term mating strategy and sexual disgust

6. Dawson et al. (2016) Paraphilic Interests: An Examination of Sex Differences in a Nonclinical Sample

7. Soldati & Bolmont (2020) Sexuality in subjects who suffer from attention deficit/hyperactivity disorder

8. Rammsayer & Troche (2012) The Relationship Between Sociosexuality and Aspects of Body Image in Men and Women: A Structural Equation Modeling Approach

9. Del Giudice (2018) Evolutionary Psychopathology: A Unified Approach

10. Mazza et al. (2011) Sexual behavior in women with bipolar disorder

11. Del Giudice et al. (2010) The evolution of autistic-like and schizotypal traits: a sexual selection hypothesis

12. Hertler (2016) The Biology of Obsessive-Compulsive Personality Disorder Symptomatology: Identifying an Extremely K-Selected Life History Variant

13. Vulink et al. (2006) Sexual pleasure in women with obsessive-compulsive disorder?

14. Fogelson et al. (2008) Avoidant Personality Disorder is a Separable Schizophrenia Spectrum Personality Disorder even when Controlling for the Presence of Paranoid and Schizotypal Personality Disorders

15. Wuthrich & Bates (2006) Confirmatory Factor Analysis of the Three-Factor Structure of the Schizotypal Personality Questionnaire and Chapman Schizotypy Scales

16. Crespi (2016) Oxytocin, testosterone, and human social cognition

17. Stanghellini & Ballerini (2007) Values in persons with schizophrenia

18. Ahktar (1987) Schizoid personality disorder: a synthesis of developmental, dynamic, and descriptive features

19. Berry et al. (2007) Attachment styles, earlier interpersonal relationships and schizotypy in a non-clinical sample

20. Premkumar & Kumari (2022) Rejection sensitivity and its relationship to schizotypy and aggression: current status and future directions

21. Marten (2010) Schizoid personality disorder linked to unbearable and inescapable loneliness

22. Nettle & Clegg (2006) Schizotypy, creativity and mating success in humans

23. Negash et al. (2019) Risky sexual behaviors of schizophrenic patients: a single center study in Ethiopia, 2018

24. Meehl (1964) Manual for Schizotypic Checklist

25. McWilliams (2006) Some Thoughts about Schizoid Dynamics

26. Watts et al. (2017) Personality Disorder Features And Paraphilic Interests Among Undergraduates: Differential Relations And Potential Antecedents

27. Ferguson & Negy (2014) Development of a brief screening questionnaire for histrionic personality symptoms

28. French & Shrestha (2021) Histrionic Personality Disorder

29. Dinsdale et al. (2016) The ‘extreme female brain’: increased cognitive empathy as a dimension of psychopathology

30. Sansone & Sansone (2011) Sexual Behavior in Borderline Personality

31. Sansone et al. (2004) The prevalence of personality disorders among those with eating disorders

32. Ali & Chamorro-Premuzic (2010) The dark side of love and life satisfaction: Associations with intimate relationships, psychopathy and Machiavellianism

33. Munoz et al. (2010) Sexually coercive tactics used by university students: A clear role for primary psychopathy

34. Marcus & Norris (2014) A New Measure Of Attitudes Toward Sexually Predatory Tactics And Its Relation To The Triarchic Model Of Psychopathy

35. Fulton et al. (2014) Psychopathic Personality Traits, Risky Sexual Behavior, and Psychological Adjustment among College-Age Women

36. Hoffman & Verona (2019) Psychopathic traits, gender, and motivations for sex: Putative paths to sexual coercion

37. Schmidt et al. (2017) Narcissism and the strategic pursuit of short-term mating: Universal links across 11 world regions of the International Sexuality Description Project-2.

38. Blinkhorn et al. (2015) The ultimate femme fatale? Narcissism predicts serious and aggressive sexually coercive behaviour in females

39. Cloudfindings (2022) OcPD as an autism spectrum disorder

40. Whitehouse et al. (2011) Brief report: autistic-like traits in childhood predict later age at menarche in girls

41. Wainer et al. (2011) The structure and nature of the broader autism phenotype in a non-clinical sample

42. Ingudomnukul et al. (2007) Elevated rates of testosterone-related disorders in women with autism spectrum conditions

43. Bejerot & Eriksson (2014) Sexuality and Gender Role in Autism Spectrum Disorder: A Case Control Study

44. Pecora et al. (2019) Characterising the Sexuality and Sexual Experiences of Autistic Females

45. Strunz et al. (2016) Romantic Relationships and RelationshipSatisfaction Among Adults With Asperger Syndrome and High-Functioning Autism

46. George & Stokes (2018) Sexual Orientation in Autism Spectrum Disorder

47. Ekblad (2018) Asexuality : A possible background and how it relates to autism and neurodiversity

48. Griffin et al. (2016) Development and Examination of the Five-Factor Obsessive-Compulsive Inventory–Short Form

49. Bothe et al. (2019) Investigating the associations of adult ADHD symptoms, hypersexuality, and problematic pornography use among men and women on a largescale, non-clinical sample

50. Pai et al. (2022) New insights into precocious puberty and ADHD: a nationwide cohort study

51. Margherio et al. (2020) Romantic Relationships and Sexual Behavior Among Adolescents With ADHD

52. Allen (1999) An exploration of the association of level of eating disordered symptomatology and reproductive and mate attraction behaviors

53. Abed et al. (2012) Eating Disorders and Intrasexual Competition: Testing an Evolutionary Hypothesis among Young Women

54. Cloudfindings (2022) Latent Structure of Body Dysmorphia, Eating Disorder Symptoms, and Self Esteem Problems in Heterosexual Women, and Their Association with Cluster B Personality Trait