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

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.