Sexuality and psychosis

Sexuality and sexual disorders of patients with psychoses are frequently neglected and under-investigated. The main purpose of the present study is to discuss the subjective experience of sexuality in patients with psychosis within the general psychodynamic and phenomenological understandings of psychotic states. The authors, both psychotherapists, dealing with patients with psychoses, reflected experiences from their clinical work with the help of the conceptual frameworks of psychodynamic and phenomenological psychiatry. Willingness and need of patients to talk about sexuality, non-specificity of frequencies and variety of sexual disorders in psychotic patients, difficulties in establishment of a stable (sexual) identity and the question of homosexuality, absence of sexual activities with others and feelings of guilt and inadequacy, masturbation with its functions, impulsive sexual acts or lack of sexual self-control, erotic delusions and erotic transference were the main findings, dominating the sexual sphere of these patients. All these manifestations of sexuality in patients with psychosis can be seen - as exposed in discussion - as consequences of a basic self-disorder (phenomenological perspective) or of difficulties in regulating closeness and distance (psychodynamic perspective). Reasons of avoidance of treatment of sexuality by the therapists of psychotic patients are discussed as well. Implications for dealing with sexuality issues in psychotherapy of patients with psychoses were drawn from the above findings in the last part of the article.