Rashin DʼAngelo. Pacifica Graduate Institute. Ph.D. Clinical Psychology

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Agnes Houston
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1 ! RUNNING HEAD: Sexual Aversion Disorder Rashin DʼAngelo Pacifica Graduate Institute Ph.D. Clinical Psychology

2 ! Healthy sexuality appears to be an important contributor to mental health. Its absence often signifies a lack, an emotional block, causing distress for the individual. The hidden meanings behind sex seem to define oneʼs sense of self. The ability to please oneʼs partner, to orgasm at the appropriate time, and the unspoken pressure for the ʻrightʼ amount of eroticism, can bring on symptoms of anxiety for the person. The quest for intimacy, promoted as a panacea to consumers by clinicians, (Schnarch, 1991, p. 89) further exacerbates the issue of performance, highlighting oneʼs sexual potential as the crucible of personal growth.! Intimacy itself derives from the Latin word intimus, meaning inner or inmost (Schnarch, 1991). Keifer (1977) defined intimacy as the experiencing of the essence of oneʼs self in intense intellectual, physical and/or emotional communion with another human being (p. 276). Hatfield (1984) defined it as a process in which we attempt to get close to another, to explore similarities and differences in the ways we think, feel, and behave (Schnarch, 1991). True intimacy is a process of self-disclosure, based on our capacity for self-other distinction, a product of oneʼs relationship with oneself (Schnarch, 1997).! Sexuality is the vessel of intimacy in relationships. It is where two partners are at their most vulnerable state. In cases of most sexual disorders, in particular Sexual Aversion Disorder, therapy must not only be sensate focused, but look at the underlying core beliefs about intimacy. DSM-IV describes Sexual Aversion Disorder as follows:! The essential feature of Sexual Aversion Disorder is the aversion to and active! avoidance of genital sexual contact with a partner. The disturbance must cause! marked distress or interpersonal difficulty. The dysfunction is not better

3 ! accounted for by another Axis I disorder. The individual reports anxiety, fear, or! disgust when confronted by a sexual opportunity with a partner. The intensity of! the individualʼs reaction when exposed to the aversive stimulus may range from! moderate anxiety and lack of pleasure to extreme psychological distress.!!!!!!!!!! (APA, p.541)! Symptoms of Sexual Aversion Disorder include avoidance of sexual opportunity, extreme anxiety, panic attacks, feelings of terror, faintness, nausea, palpitations, dizziness, and breathing difficulties. There may be markedly impaired interpersonal relations, with individuals using covert strategies, such as traveling, going to sleep early, being over-involved in work, to avoid potential sexual partners (APA, 2000). The lack of craving and excitement for sex, combined with intense anxiety and fear, often create tension and conflict with a partner, as well as with oneself.! The etiology of Sexual Aversion Disorder could be hormonal regulation, and a medical condition should always be ruled out prior to looking at a psychological origin. Some evidence does suggest that relationship issues and/or sexual trauma in childhood may play a role in the development of this disorder (APA, 2000). For the purpose of this paper, Schnarchʼs differentiation model will be used to view Sexual Aversion Disorder, its etiology and treatment.! In Passionate Marriage, David Schnarch describes differentiation as the ability to maintain a sense of self when in close emotional and physical proximity to others, especially as they become increasingly significant (1997). Balancing individuality and togetherness, the differentiated individual is solid but permeable (p.68). While differentiation allows for space within an intimate relationship, it also makes available

4 true togetherness. Emotional fusion is the opposite of differentiation, it is connection without individuality. (Schnarch, 1997, p.57) It is dependence and enmeshment, an invisible but tenacious emotional connection. (p. 57) Differentiation is the ability to stay in connection without being consumed, but fusion is turning towards the engulfing connection because of its tremendous impact. In reality, fusion creates more alienation and separateness for two partners than being apart.! Schnarch further elaborates on the differentiating personʼs abilities for selfsoothing and emotional regulation in the face of deprivation and anxiety; tolerating ambiguity and ambivalence; and being able to maintain a sense of self in intimate relationships (1997). Shaw states in the face of emotional fusion, abandonment issues, and engulfment fears, anxiety remains necessary for emotional growth. (1994, p. 47) Learning to tolerate and use high levels of anxiety can serve personal growth.! If Sexual Aversion Disorder is situated within a framework of differentiation, one could view it as an aversion to emotional fusion. For a pseudo-differentiated individual with early sexual trauma or insecure attachment patterns, intimacy could be interpreted as engulfment. The fear and anxiety of an intimate encounter could be so intense to create an avoidance pattern, justified by indirect means such as over involvement with work, financial obligations, and family, or covertly through substance abuse, poor hygiene, and not taking care of oneʼs health.! Differentiation is vital to those who physically and psychologically do not allow sexual intimacy. The onset of panic attacks at the possibility of a sexual encounter, coupled with implicit means of keeping potential intimate partners at a distance, point toward a fear of emotional fusion, mistakenly understood as attachment. In this context,

5 treatment cannot be focused solely on behavioral intervention, for technique and expectation without considering emotional maturation and differentiation needs exacerbates the anxiety, thus increasing the sexual aversion and accompanying defenses.! An alternative treatment approach, focusing on the individualʼs sense of self and looking at underlying core issues, advances personal growth and healing. In a sexual relationship without appropriate psychological separateness, self-other boundaries are not defined and the fear of engulfment remains the unspoken word. The nonverbal approach to creating safety and alleviating enmeshment anxiety is the avoidance of intimacy. Sexual Aversion Disorder is not a pathology, rather an attempt by the self to form a safe container, a boundary of I-thou separateness. The symptom is a symbolic description of oneʼs need to maintain a sense of self, a self-determination of differentiation gone unrecognized. Shifting the focus from the pathology to the reparative function of the symptom can begin the process of differentiation, a necessary task for self-validated intimacy in relationship.

6 References American Psychiatric Association: (2000). Diagnostic and Statistical Manual of Mental! Disorders (4th ed., text revision) Washington, DC: American Psychiatric! Association. Schnarch, D. M. (1991). Constructing the sexual crucible: An integration of sexual! marital therapy. New York: W. W. Norton & Company. Schnarch, D. M. (1997). Passionate marriage. New York: W. W. Norton & Company. Shaw, J. (1994). Treatment of primary vaginismus: A new perspective. Journal of Sex &! Marital Therapy, 20.

Sexual Aversion. PP7501: Adult Psychopathology

Sexual Aversion. PP7501: Adult Psychopathology Sexual Aversion PP7501: Adult Psychopathology What is Sexual Aversion? The individual reports anxiety, fear, or disgust when confronted by sexual opportunity. What is Sexual Aversion NOT? Loss of desire