Intimacy, Romance, and Sexuality in Early Psychosis: A Mixed-Methods Investigation of Needs, Barriers, and Associations with Psychiatric and Cognitive Symptoms

Abstract

People experiencing psychosis identify intimate relationships as integral to their well-being and recovery. However, psychiatric symptoms, cognitive deficits, and stigma experienced in early psychosis may disrupt the formation and maintenance of these relationships. Although early psychosis intervention (EPI) programs are effective at improving symptomatic and functional outcomes, issues related to intimacy and sexuality are often overlooked, receiving little clinical or academic focus. The objective of the current dissertation was to explore how functioning in intimate, sexual, and romantic relationships are related to symptoms and impairment experienced in early psychosis, and how these areas of life are conceptualized as part of recovery. In Chapter 2, data from qualitative interviews highlight how people with early psychosis navigate and derive meaning in areas relating to intimacy, romance, and sexuality in their lives. Across four themes, participants described their experiences and aspirations, and reflect on the value of addressing these topics in EPI programs as important aspects of recovery. Chapter 3 presents data examining differences between early psychosis and control participants on measures related to intimacy, romance, and sexuality. Results demonstrate that individuals with early psychosis report more negative outcomes related to social, romantic, and sexual functioning, and that these areas are often insufficiently addressed in healthcare settings. Chapter 4, data are presented that show that individuals with psychosis demonstrate greater impairment on a novel task assessing social cognition specific to sexual and romantic interactions. Performance on this novel task was associated with romantic and sexual functioning above and beyond the effects of psychiatric symptoms, cognition, or traditional measures of social cognition. These findings inform a sparse literature base on intimacy, romance, and sexuality in early psychosis, highlight the value of addressing these topics in EPI programs, and support their role in recovery from psychosis.