Let’s talk about sexuality and intimacy in people with severe mental illness

Jose de Jager

Research output: ThesisDoctoral thesis 1 (Research UU / Graduation UU)

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Abstract

The topic of sexuality and intimacy is beginning to receive more attention within the
current recovery-oriented framework in mental health, but the experiences of sexuality and
intimacy among people with SMI have not been extensively researched yet. This lack of
attention can be found in clinical practice as well. Even though some people with SMI
report (temporarily) decreased needs in the field of sexuality and intimacy due to mental
health problems, most have the same desires when it comes to sexuality and intimacy as
the general population. However, the amount of unmet needs in these fields seems to be
much higher. The research described in this dissertation focusses on the experience of sexuality,
intimacy among people with severe mental illnesses, and thus entails studies that enhance knowledge on the barriers that people with SMI encounter when navigating their sexual and romantic lives.
Personal stories, examples, experiences and views of those encountering these barriers have helped deepen the understanding of these factors. The most important conclusions are:
• People with SMI have sexuality and intimacy needs that are largely similar to those
observed in the general population.
• However, people with SMI experience barriers for sexuality and intimacy, some of
which were (indirectly) related to having a SMI.
• These barriers are: self-stigma, sexual trauma, diminished social skills, lower (sexual)
self-esteem, symptoms and psychotropic side-effects.
• In some, these barriers lead to a need for care. Childhood sexual abuse is associated
with higher needs for care concerning sexuality and intimacy in adulthood.
• Needs for care concerning sexuality and intimacy are rarely met.
• Most clients welcome a conversation about sexuality and intimacy.
• Group interventions focused on sharing experiences and learning from each other are
valuable, especially in young adults.
• Further quantitative explorations showed that intimacy is mainly associated with selfstigma.
Sexual disfunctioning is associated with sexual self-esteem and psychotropic
side effects, while sexual autonomy is associated with sexual trauma and sexual selfesteem.
• Sexual trauma may increase the risk of having a sexual dysfunction. It is unclear if an
additional PTSD further increases this risk.
Original languageEnglish
Awarding Institution
  • University Medical Center (UMC) Utrecht
Supervisors/Advisors
  • van Os, Jim, Primary supervisor
  • Nugter, Annet, Co-supervisor
Award date19 Oct 2021
Publisher
Print ISBNs978 90 393 7388 0
DOIs
Publication statusPublished - 19 Oct 2021

Keywords

  • Sexuality
  • intimacy
  • psychosis
  • schizophrenia
  • SMI
  • romantic relationships
  • sexual trauma
  • Stigma

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