Resolving the sexual intimacy paradox: a developmental model for the treatment of sexual desire disorders

Although relationship factors are an important component in the evaluation and treatment of hypoactive sexual desire (HSD) disorders, a sexual intimacy paradox often occurs wherein many couples increase the intimacy in their relationship while their sexual desire continues to decline. To resolve the apparent paradox and to further our understanding of the relationship between intimacy and eroticism, we offer a developmental model of sexual intimacy as a guide to treating the interpersonal aspects of HSD and other sexual dysfunctions. This model expands Erikson's developmental phase of intimacy into five elements: conflagration, merger, fusion, differentiation, and integration. The model is described and case examples are presented as illustrations of the therapeutic issues and resolutions within each element.