Case Discussion

Joyce's symptoms meet the DSM-IV-TR criteria for sexual aversion, evidencing persistent and recurrent avoidance of sexual genital contact with her husband, which causes marked personal and interpersonal distress and which is not better accounted for by another psychiatric disorder. Joyce also meets the Consensus Panel criteria that emphasize personal rather than partner distress as the relevant feature. Her symptoms are clearly related to the acquisition of fear and subsequent avoidance. Joyce did not evidence or report particular fear or avoidance of sexual interactions until sexual behavior was paired with abuse and victimization. She retained sexual drive and desire even while she felt pressured into sex in each of her relationships after her childhood sexual abuse. In each case, including her marriage, sexual interactions after the early relationship phase (limerance) became negatively conditioned. Joyce acquired an aversion response which then was maintained by sexual avoidance.

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