Skip to main content
SpringerLink
Log in

Are Sexual Problems a Form of Internalizing Psychopathology? A Structural Equation Modeling Analysis

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Sexual dysfunctions, depression, and anxiety disorders have high rates of comorbidity. The aim of this study was to empirically evaluate an expanded model of internalizing psychopathology (Krueger, 1999) that includes sexual problems, based on these patterns of comorbidity. Responses to an online survey from a sexually active community sample (n = 563) were analyzed using structural equation modeling to compare the fit of four alternative models for males and females. An expanded model of the internalizing spectrum that included sexual problems was a good fit for the pattern of interrelationships in the female data. However, the weak relationships between the observed variables in the male data meant that none of the models provided an adequate fit for men. This study offers preliminary evidence for the utility of a model of the internalizing spectrum that includes sexual problems for women, which could facilitate a better understanding of the role of common underlying psychopathological processes between disorders and offer a first step towards effective diagnosis and treatment. Future research should focus on clinical and representative samples, using other measurement methods.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. In the present study, symptoms of sexual dysfunction are referred to as “sexual problems,” as no diagnosis has been made (Lutfey et al., 2009).

References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

  • American Psychiatric Association. (2010). DSM-5 development. Retrieved 22 Feb 2010 from www.dsm-5.org.

  • Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103, 411–423.

    Article  Google Scholar 

  • Angst, J. (1998). Sexual problems in healthy and depressed persons. International Clinical Psychopharmacology, 13(Suppl. 6), S1–S4.

    Article  PubMed  Google Scholar 

  • Arbuckle, J. L. (2009). Amos 18 user’s guide. Crawfordville, FL: Amos Development Corporation.

    Google Scholar 

  • Balon, R. (2006). Mood, anxiety, and physical illness: Body and mind, or mind and body. Depression and Anxiety, 23, 377–387.

    Article  PubMed  Google Scholar 

  • Bancroft, J., Janssen, E., Strong, D., Carnes, L., Vukadinovic, Z., & Long, J. S. (2003). The relation between mood and sexuality in heterosexual men. Archives of Sexual Behavior, 32, 217–320.

    Article  PubMed  Google Scholar 

  • Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54, 140–148.

    Article  PubMed  Google Scholar 

  • Basson, R. (2000). The female sexual response: A different model. Journal of Sex and Marital Therapy, 26, 51–65.

    Article  PubMed  Google Scholar 

  • Basson, R. (2003). Biopsychosocial models of women’s sexual response: Applications to management of ‘desire disorders’. Sexual and Relationship Therapy, 18, 107–115.

    Article  Google Scholar 

  • Boisseau, C. L., Farchione, T. J., Fairholme, C. P., Ellard, K. K., & Barlow, D. H. (2010). The development of the unified protocol for the transdiagnostic treatment of emotional disorders: A case study. Cognitive and Behavioral Practice, 17, 102–113.

    Article  Google Scholar 

  • Brown, C., Schulberg, H. C., Madonia, M. J., Shear, M. K., & Houck, P. R. (1996). Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders. American Journal of Psychiatry, 153, 1293–1300.

    PubMed  Google Scholar 

  • Chambless, D. L., Caputo, G. C., Bright, P., & Gallagher, R. (1984). Assessment of “fear of fear” in agoraphobics: The Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090–1097.

    Article  PubMed  Google Scholar 

  • Clark, L. A., Watson, D., & Reynolds, S. (1995). Diagnosis and classification of psychopathology: Challenges to the current system and future directions. Annual Review of Psychology, 46, 121–153.

    Article  PubMed  Google Scholar 

  • Connor, K. M., Davidson, J. R. T., Churchill, L. E., Sherwood, A., Foa, E., & Weisler, R. H. (2000). Psychometric properties of the Social Phobia Inventory. British Journal of Psychiatry, 176, 379–386.

    Article  PubMed  Google Scholar 

  • Derogatis, L. R., Meyer, J. K., & King, K. M. (1981). Psychopathology in individuals with sexual dysfunction. American Journal of Psychiatry, 138, 757–763.

    PubMed  Google Scholar 

  • Donahey, K. M., & Carroll, R. A. (1993). Gender differences in factors associated with hypoactive sexual desire. Journal of Sex and Marital Therapy, 19, 25–40.

    Article  PubMed  Google Scholar 

  • Dunn, K. M., Croft, P. R., & Hackett, G. I. (1998). Sexual problems: A study of the prevalence and need for health care in the general population. Family Practice, 15, 519–524.

    Article  PubMed  Google Scholar 

  • Dunn, K. M., Croft, P. R., & Hackett, G. I. (1999). Association of sexual problems with social, psychological, and physical problems in men and women: A cross sectional population survey. Journal of Epidemiology and Community Health, 53, 144–148.

    Article  PubMed  Google Scholar 

  • Edwards, A. L. (1976). Introduction to linear regression and correlation. San Francisco: W. H. Freeman and Co.

    Google Scholar 

  • Elliot, A. N., & O’Donohue, W. T. (1997). The effects of anxiety and distraction on sexual arousal in a nonclinical sample of heterosexual women. Archives of Sexual Behavior, 26, 607–624.

    Article  Google Scholar 

  • Field, A. (2009). Discovering statistics using SPSS (3rd ed.). London: Sage.

    Google Scholar 

  • Figueira, I., Possidente, E., Marques, C., & Hayes, K. (2001). Sexual dysfunction: A neglected complication of panic disorder and social phobia. Archives of Sexual Behavior, 30, 369–377.

    Article  PubMed  Google Scholar 

  • Goldberg, D. P., Krueger, R. F., Andrews, G., & Hobbs, M. J. (2009). Emotional disorders: Cluster 4 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine, 39, 2043–2059.

    Article  PubMed  Google Scholar 

  • Gorman, J. M. (1997). Comorbid depression and anxiety spectrum disorders. Depression and Anxiety, 4, 160–168.

    Article  Google Scholar 

  • Graziottin, A. (1998). The biological basis of female sexuality. International Clinical Psychopharmacology, 13(Suppl. 6), S15–S22.

    Article  PubMed  Google Scholar 

  • Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239.

    Article  PubMed  Google Scholar 

  • Hoyer, J., Uhmann, S., Rambow, J., & Jacobi, F. (2009). Reduction of sexual dysfunction: By-product of cognitive-behavioural therapy for psychological disorders? Sexual and Relationship Therapy, 24, 64–73.

    Article  Google Scholar 

  • Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.

    Article  Google Scholar 

  • Jackson, D. L., Gillaspy, J. A., & Purc-Stephenson, R. (2009). Reporting practices in confirmatory factor analysis: An overview and some recommendations. Psychological Methods, 14, 6–23.

    Article  PubMed  Google Scholar 

  • James, L. M., & Taylor, J. (2008). Revisiting the structure of mental disorders: Borderline personality disorder and the internalizing/externalizing spectra. British Journal of Clinical Psychology, 47, 361–380.

    Article  PubMed  Google Scholar 

  • Kendler, K. S., Prescott, C. A., Myers, J., & Neale, M. C. (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry, 60, 929–937.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 617–627.

    Article  PubMed  Google Scholar 

  • Kline, R. B. (2005). Principles and practice of structural equation modeling. New York: Guilford Press.

    Google Scholar 

  • Kontula, O., & Haavio-Mannila, E. (2009). The impact of aging on human sexual activity and sexual desire. Journal of Sex Research, 46, 46–56.

    Article  PubMed  Google Scholar 

  • Kotov, R., Chang, S. W., Fochtmann, L. J., Mojtabai, R., Carlson, G. A., Sedler, M. J., et al. (2010). Schizophrenia in the internalizing–externalizing framework: A third dimension. Schizophrenia Bulletin, 37, 1168–1178.

    Article  PubMed  Google Scholar 

  • Kramer, M. D., Krueger, R. F., & Hicks, B. M. (2008). The role of internalizing and externalizing liability factors in accounting for gender differences in the prevalence of common psychopathological syndromes. Psychological Medicine, 38, 51–61.

    Article  PubMed  Google Scholar 

  • Krueger, R. F. (1999). The structure of common mental disorders. Archives of General Psychiatry, 56, 921–926.

    Article  PubMed  Google Scholar 

  • Krueger, R. F., Chentsova-Dutton, Y. E., Markon, K. E., Goldberg, D., & Ormel, J. (2003). A cross-cultural study of the structure of comorbidity among common psychopathological syndromes in the general health care setting. Journal of Abnormal Psychology, 112, 437–447.

    Article  PubMed  Google Scholar 

  • Krueger, R. F., & Markon, K. E. (2006). Reinterpreting comorbidity: A model-based approach to understanding and classifying pathology. Annual Review of Clinical Psychology, 2, 111–133.

    Article  PubMed  Google Scholar 

  • Krueger, R. F., & Piasecki, T. M. (2002). Toward a dimensional and psychometrically-informed approach to conceptualizing psychopathology. Behaviour Research and Therapy, 40, 485–499.

    Article  PubMed  Google Scholar 

  • Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States: Prevalence and predictors. American Medical Association, 281, 537–541.

    Article  Google Scholar 

  • Laurent, S. M., & Simons, A. D. (2009). Sexual dysfunction in depression and anxiety: Conceptualizing sexual dysfunction as part of an internalizing dimension. Clinical Psychology Review, 29, 573–585.

    Article  PubMed  Google Scholar 

  • Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress scales. Sydney: Psychology Foundation.

    Google Scholar 

  • Lutfey, K. E., Link, C. L., Rosen, R. C., Wiegel, M., & McKinlay, J. B. (2009). Prevalence and correlates of sexual activity and function in women: Results from the Boston Area Community Health (BACH) Survey. Archives of Sexual Behavior, 38, 514–527.

    Article  PubMed  Google Scholar 

  • Lykins, A. D., Janssen, E., & Graham, C. A. (2006). The relationship between negative mood and sexuality in heterosexual college women and men. Journal of Sex Research, 43, 136–143.

    Article  PubMed  Google Scholar 

  • Markon, K. E. (2010). Modeling psychopathology structure: a symptom-level analysis of Axis I and II disorders. Psychological Medicine, 40, 273–288.

    Article  PubMed  Google Scholar 

  • Marsh, H. W., Hau, K. T., & Wen, Z. (2004). In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s (1999) findings. Structural Equation Modeling, 11, 320–341.

    Article  Google Scholar 

  • Meston, C. M., & Buss, D. M. (2007). Why humans have sex. Archives of Sexual Behavior, 36, 477–507.

    Article  PubMed  Google Scholar 

  • Michael, A., & O’Keane, V. (2000). Sexual dysfunction in depression. Human Psychopharmacology: Clinical and Experimental, 15, 337–345.

    Article  Google Scholar 

  • Nobre, P. J., & Pinto-Gouveia, J. (2009). Cognitive schemas associated with negative sexual events: A comparison of men and women with and without sexual dysfunction. Archives of Sexual Behavior, 38, 842–851.

    Article  PubMed  Google Scholar 

  • Richters, J., Grulich, A. E., de Visser, R. O., Smith, A. M. A., & Rissel, C. E. (2003). Sex in Australia: Sexual difficulties in a representative sample of adults. Australian and New Zealand Journal of Public Health, 27, 164–170.

    Article  PubMed  Google Scholar 

  • Rosen, R. C. (2000). Prevalence and risk factors of sexual dysfunction in men and women. Current Psychiatry Reports, 2, 189–195.

    Article  PubMed  Google Scholar 

  • Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., & Shabsig, R. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex and Marital Therapy, 26, 191–208.

    Article  PubMed  Google Scholar 

  • Rosen, R. C., Cappelleri, J. C., & Gendrano, N. (2002). The International Index of Erectile Function (IIEF): A state-of-the-science review. International Journal of Impotence Research, 14, 226–244.

    Article  PubMed  Google Scholar 

  • Rosen, R. C., Riley, A., Wagner, G., Osterloh, I. H., Kirkpatrick, J., & Mishra, A. (1997). The International Index of Erectile Dysfunction (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology, 49, 822–830.

    Article  PubMed  Google Scholar 

  • Schumacker, R. E., & Lomax, R. G. (2004). A beginner’s guide to structural equation modeling. Oxford, England: Routledge.

    Google Scholar 

  • Slade, T., & Watson, D. (2006). The structure of common DSM-IV and IDC-10 mental disorders in the Australian general population. Psychological Medicine, 36, 1593–1600.

    Article  PubMed  Google Scholar 

  • Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092–1097.

    Article  PubMed  Google Scholar 

  • Strand, J., Wise, T. N., Fagan, P. J., & Schmidt, C. W. (2002). Erectile dysfunction and depression: Category or dimension? Journal of Sex and Marital Therapy, 28, 175–181.

    PubMed  Google Scholar 

  • ter Kuile, M. M., Both, S., & van Lankveld, J. J. D. M. (2010). Cognitive behavioral therapy for sexual dysfunctions in women. Psychiatric Clinics of North America, 33, 595–610.

    Article  PubMed  Google Scholar 

  • Tignol, J., Martin-Guehl, C., Aouizerate, B., Grabot, D., & Auriacombe, M. (2006). Social phobia and premature ejaculation: A case-controlled study. Depression and Anxiety, 23, 153–157.

    Article  PubMed  Google Scholar 

  • Trudel, G., Landry, L., & Larose, Y. (1997). Low sexual desire: The role of anxiety, depression and marital adjustment. Sexual and Marital Therapy, 12, 95–99.

    Article  Google Scholar 

  • van Lankveld, J. J. D. M., & Grotjohann, Y. (2000). Psychiatric comorbidity in heterosexual couples with sexual dysfunction assessed with the Composite International Diagnostic Interview. Archives of Sexual Behavior, 29, 479–498.

    Article  PubMed  Google Scholar 

  • van Minnen, A., & Kampman, M. (2000). The interaction between anxiety and sexual function: A controlled study of sexual functioning in women with anxiety disorders. Sexual and Relationship Therapy, 15, 47–57.

    Article  Google Scholar 

  • Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology, 114, 522–536.

    Article  PubMed  Google Scholar 

  • Widiger, T. A., & Sankis, L. M. (2000). Adult psychopathology: Issues and controversies. Annual Review of Psychology, 51, 377–404.

    Article  PubMed  Google Scholar 

  • Widiger, T. A., & Trull, T. J. (2007). Plate tectonics in the classification of personality disorder. American Psychologist, 62, 71–83.

    Article  PubMed  Google Scholar 

  • Wiegel, M., Meston, C., & Rosen, R. (2005). The Female Sexual Function Index (FSFI): Cross-validation and development of clinical cutoff scores. Journal of Sex and Marital Therapy, 31, 1–20.

    Article  PubMed  Google Scholar 

  • Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford, CA: Stanford University Press.

    Google Scholar 

Download references

Acknowledgments

We would like to thank Dr. Alan Taylor, who assisted with statistical analyses.

Author information

Authors and Affiliations

  1. Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia

    Miriam K. Forbes & Carolyn A. Schniering

Authors
  1. Miriam K. Forbes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carolyn A. Schniering
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miriam K. Forbes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Forbes, M.K., Schniering, C.A. Are Sexual Problems a Form of Internalizing Psychopathology? A Structural Equation Modeling Analysis. Arch Sex Behav 42, 23–34 (2013). https://doi.org/10.1007/s10508-012-9948-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-012-9948-0

Keywords

Search

Navigation