It may not seem likely because it's
not widely discussed, but a majority of people will be affected by symptoms of
depression, anxiety and sexual dysfunction at some point in their lives. This
fact is at odds with the shame and discomfort surrounding these symptoms in our society.
Sexual dysfunction covers issues such as a lack of
sexual desire, an inability to become aroused or achieve orgasm, premature
ejaculation and erectile dysfunction. These problems are often not picked up by
doctors, and people hesitate to raise the issues themselves, maybe because they
feel embarrassed.
While depression, anxiety and sexual dysfunction can each
have a profound effect on quality of life, their impact is much worse when the symptoms co-occur.
In these combined cases, symptoms tend to be more severe
and last longer, and when not dealt with together, treatments tend to be less
effective. Indeed, people using ineffective approaches end up having worse
long-term outcomes, tend to drop out of treatment, and are less likely to return.
Fundamental
connectedness
We know depression, anxiety and sexual problems are
related, but there's very little research on how or why. Some studies show the
disorders tend to appear at the same time, or that
sexual dysfunction develops as a symptom of
depression and anxiety.
Others suggest sexual dysfunction creates a vulnerability to anxiety and depression. But
when we look at the body of research as a whole, the relationships appear to go
deeper than this.
We know depression, anxiety and sexual problems
co-occur at very high rates, and that they share multiple cognitive and
emotional characteristics. We also know they can all be treated
effectively using mindfulness and cognitive behavioural therapy.
These commonalities suggest they might all be part
of a
family of disorders called "internalising disorders"; one isn't causing another but they all share an underlying vulnerability. Preliminary research has supported this idea.
family of disorders called "internalising disorders"; one isn't causing another but they all share an underlying vulnerability. Preliminary research has supported this idea.
Lack of awareness
Given this close relationships
between the disorders, and the negative impact of not treating them together,
it's concerning that they're consistently treated separately. And that the manuals used
by mental health professionals and clinicians to diagnose disorders (the Diagnostic and Statistical Manual of Mental Disorders and
the International Classification of Diseases) don't recognise
the relationships between them.
Indeed, the separation in the way we diagnose and
treat these disorders is likely contributing to the low recognition rates of
sexual problems in primary care.
Studies have shown that most people with sexual problems
consider it appropriate to discuss their symptoms with their doctor, but very
few actively seek out help. People tend to expect their doctor to ask, and will not bring it up themselves.
Only 6 per cent of participants in a study of Australian adults aged between 40 and 80
had been asked about their sexual function during a routine medical exam in the
last three years. And those who were asked were more likely to seek help and
enter treatment.
Clearly, doctors should be screening for sexual problems, as people
aren't actively seeking the help they require.
Moving forward
together
If assessment of sexual problems were part of the
initial evaluation of depression and anxiety, and vice versa, the low recognition
rates of sexual dysfunction could be improved, and all symptoms could be
treated concurrently. This would improve effectiveness and be better for
patients.
Effective new treatment programs that target the common elements of multiple disorders have
already been developed for the shared aspects of depression and anxiety
disorders. The same types of programs could be developed using mindfulness and
cognitive behavioural therapy to treat sexual dysfunction, along with
depression and anxiety.
Taken together, what research we have suggests this
would improve the quality of life of people suffering from combinations of
these disorders.
At
the very least, doctors should be aware of the co-occurrence of the symptoms of
these disorders, and the fact that if a person is experiencing depression or
anxiety, that should act as a red flag to screen for sexual dysfunction.
It’s so bad that so many people do not have the courage to discuss these problems when they occur. The only way you can receive any kind of help is to actually ask for it. So what if you have a sexual dysfunction? Millions are just like you. Everything can be treated and it’s always much better to talk to someone about it then to keep it bottled up inside.
ReplyDeleteYes! Our minds and bodies are fundamentally connected. It makes sense that sexual dysfunction should be treated along with cognitive therapy for depression. Discussion with one's partner should also be encouraged. I think it's better to be open and honest than to cloak these feelings in secrecy and shame.
ReplyDeleteIf anxiety or depression consume a person, they don't feel worthy of anyone sometimes and then the stress part of the disorders mean they don't actually want sex at the time, it feels like another chore on an already overworked mind.
ReplyDelete