Profiles of distress related to sexual function, psychological distress, and sexual pleasure: a person-centered analysis of early maladaptive schemas and psychological inflexibility

Abstract

Background: Sexual distress and sexual pleasure are two clinically distinct parameters used to evaluate sexual dysfunction, alongside psychological distress. Various psychological processes and problems have been implicated in the etiology and maintenance of sexual dysfunction. Two transdiagnostic processes, Early Maladaptive Schemas (EMS) and Psychological Inflexibility (PI), have been associated with psychopathology. However, knowledge about their effects on sexual health outcomes, namely distress and pleasure, is lacking.

Aim: This cross -sectional study investigates whether different profiles related to sexual dysfunction—defined by distress related to sexual function, sexual pleasure, and psychological distress—show distinct patterns of EMS and PI and how these patterns may inform targeted interventions.

Methods: Data from 612 participants [M age = 37.95 years, 77.0% identified as women (n = 471)] were included in our analysis. A latent profile analysis (LPA) was conducted to identify distinct profiles of distress related to sexual function, sexual pleasure, and psychological distress. Later, Bolck–Croon–Hagenaars procedures were employed to identify in-between profile differences across EMS and PI.

Outcomes: The outcomes of our study were EMS and PI scores across profiles.

Results: Our analysis yielded 3 distinct profiles: Low Distress/High Pleasure, High Distress/Low Pleasure, and Deeply Affected Pleasure profiles, with the latter presenting with greater symptom severity. Sexual pleasure is the indicator that best discriminates the latter profile from the former two. There is a significant increase in various EMS from the Low Distress/High Pleasure to the High Distress/Low Pleasure profile, specifically in those belonging to the domains of Disconnection and Rejection and Impaired Autonomy and Performance. The early maladaptive schema that differs in the Deeply Affected Pleasure profile (when comparing with the High Distress/Low Pleasure profile) is Emotional Deprivation. Psychological Inflexibility differs in these profiles and is more significant in the Deeply Affected Pleasure cluster.

Clinical Implications: Sexual pleasure emerges as a relevant factor to consider in clinical evaluation and intervention. Also, targeting EMS and PI might prove beneficial in patients presenting with increased distress related to sexual function and/or diminished sexual pleasure.

Strengths and Limitations: This article incorporates both negative (ie, sexual distress) and positive (ie, sexual pleasure) sexual outcomes as components of a sexual dysfunction and our results put sexual pleasure at the center of clinical conceptualization. Various limitations restrict our findings, namely, the characteristics of the sample (mostly highly educated women), the study design (cross -sectional), the non-inclusion of gender, sexual orientation and relational configuration diversity, and the non-inclusion of other determinants of sexual health (eg, relational factors, chronic disease).

Conclusion: EMS and PI are associated with distress related to sexual function, sexual pleasure, and psychological distress, as per the profiles presented. Specifically, the Emotional Deprivation schema might be of importance in patients with diminished sexual pleasure.