Dissociative Experiences During Sexual Behavior Among a Sample of Adults Living with HIV Infection and a History of Childhood Sexual Abuse

Abstract

Little attention has been given to the occurrence of dissociative symptoms during sexual behavior in adults who have experienced childhood sexual abuse (CSA). For this study, 57 adults living with HIV infection who had experienced CSA and were entering a treatment study for traumatic stress completed study assessments and clinical interviews, including a 15-item scale of Dissociative Experiences during Sexual Behavior. Predictor variables included DSM-IV-TR diagnoses of PTSD and Dissociative Disorders, Rape by an Intimate Partner, Duration of CSA, Number of Perpetrators of CSA, and Current Sexual Satisfaction. A multiple regression analysis was conducted to identify significant associations between predictors and dissociation during sex. Mean differences by clinical diagnosis were also examined. Results indicated that PTSD, Dissociative Disorders, Rape by an Intimate Partner, Duration of CSA, and Number of Perpetrators of CSA were associated with increased dissociation during sexual behavior. Dissociation during sex likely increases vulnerability to sexual revictimization and risky sexual behavior. Standard behavioral prevention interventions may be ineffective for sexual situations when dissociation occurs, and prevention efforts should be integrated with mental health care for those who have experienced CSA.

Sexual Health and Dissociative Experiences among Abused Women

“…This study is important because the research examining the intersection of dissociation and sexual behaviors is very limited. Most recently, Hansen et al (2012) examined dissociative experiences during sexual behavior in a sample of adults with a history of child sexual abuse (CSA). Unlike this study that used the published version of the DES, Hansen et al (2012) adapted the DES specifically to examine dissociative experiences during sexual activity.…”

“…Women are disproportionately affected by STIs, with the rate of infection among women almost three times higher than the rate among men (CDC, 2012d). For women, untreated and undertreated STIs are associated with pelvic inflammatory disease (PID), chronic pelvic pain, infertility, spontaneous abortion, preterm labor and preterm delivery (Hathaway, Mucci, Silverman, Brooks, Mathews, & Pavlos, 2000;Letourneau, Holmes, & Dissociation Women with a history of trauma from IPV experience higher rates of depression, posttraumatic stress disorder, and dissociative symptoms than other women (Cohen et al, 2000;Hansen, Brown, Tsatkin, Zelgowski, & Nightingale, 2012;Iverson et al, 2013;Laughon et al, 2007;Lindgren & Renck, 2008;Maman, Campbell, Sweat, & Gielen, 2000). Researchers have suggested that dissociative symptoms, in particular, may inhibit a woman from engaging in protective sexual health behaviors and may play an important role in women's ability to practice safer sex (Malow, Devieux, & Lucenko, 2006;Myers et al, 2006).…”

“…Researchers have proposed investigating dissociation as a possible psychological mechanism interfering with riskreducing behaviors and HIV counseling messages in women who have experienced trauma, including IPV (Hamberger et al, 2004;Hansen et al, 2012;Messman-Moore & Long, 2003), but few have actually measured dissociation. The study reported here is a step towards understanding the role of dissociative experiences and sexual health behaviors among women exposed to IPV.…”

Associação entre estados afetivos negativos e comportamentos sexuais de risco

“…Adicionalmente, os investigadores verificaram que os sintomas de PSPT se encontram associados com o aumento de processos dissociativos na atividade sexual, o que aumenta a vulnerabilidade para o comportamento sexual de risco (Hansen, Brown, Tsatkin, Zelgowski, & Nightingale, 2012). Por fim, a investigação revela que pessoas com sintomas de PSPT possuem maior vulnerabilidade de serem coagidas ou forçadas a ter relações sexuais, ou podem-se sentir incapazes de negociar práticas sexuais seguras (El-Bassel, Gilbert, Rajah, Foleno, & Frye, 2000).…”

Sexuelle Dysfunktionen bei Frauen mit Posttraumatischer Belastungsstörung - ein Übersichtsartikel

“…Ängste nach physischer Gewalterfahrung davor, dass bestimmte Körper-teile berührt werden, intrusiv beeinflusste Schmerzen nach einem traumatischen Verkehrsunfall oder nach Kriegserfahrungen [Tran et al, 2015]. Starke emotionale Reaktionen können zudem zu dissoziativen Zuständen führen [Schauer und Elbert, 2010], die dann wiederum die Angst vor Sexualität aufrechterhalten, unter anderem auch, weil keine korrigierenden Erfahrungen gemacht werden können oder keine Diskrimination zur Traumasituation vorgenommen werden kann [van Berlo und Ensink, 2000;Hansen et al, 2012]. Es gibt sogar Befunde, die zeigen, dass sich bei Frauen, die anhaltendem sexuellem Kindesmissbrauch ausgesetzt waren, kortikale Veränderungen in der Repräsentation genital-somatosensorischer Felder ergeben, die zunächst auf die sensorische Verarbeitung des Missbrauchs abschwächend wirken, im Verlauf jedoch aufgrund der geringeren Repräsentation genital-somatosensorischer Felder zu sexuellen Dysfunktionen im Erwachsenenalter füh-ren [Heim et al, 2013].…”