title: The impact of disrupted childhood attachment on the presentation of psychogenic erectile dysfunction: an exploratory study.
abstract: BACKGROUND
  Erectile dysfunction (ED) is a common form of male sexual dysfunction. Psychological factors play an important role in the onset and persistence of ED. Disturbed childhood attachment is a biologically and psychologically plausible predisposing factor for psychogenic ED that has not been systematically studied to date.
  
  
  OBJECTIVE
  This study aims to assess the frequency and correlates of events associated with parental separation (actual or threatened) and loss in men with a diagnosis of psychogenic ED.
  
  
  METHODS
  The case records of 46 men who presented to a clinic for psychosexual disorders in the period 2012-2013, and were diagnosed with psychogenic ED using a semi-structured interview schedule, were reviewed.
  
  
  RESULTS
  Events causing actual or potential disturbed attachment (DA) in childhood were reported by 20 of 46 men with psychogenic ED (43.5%). This group of men (DA+) had an earlier age at onset of ED (median 25 vs. 29 years, P = 0.005), were more likely to be single (15/20 vs. 5/26 (χ(2)  = 14.307, P < 0.001), reported sexual performance anxiety more frequently (12/20 vs. 7/26, χ(2)  = 5.101, P = 0.024), and were more likely to develop ED in the absence of a proximate stressor (4/20 vs. 15/26, P = 0.015). They also showed a trend toward being more likely to report guilt over early sexual experiences as a contributory factor (5/20 vs. 1/26, P = 0.072). In a binary logistic regression analysis, the presence of performance anxiety (B = 2.01, P = 0.023) and marital status (B = -2.85, P = 0.001) were significantly associated with events causing DA.
  
  
  CONCLUSIONS
  Disrupted childhood attachment was common in our sample of men with ED and is associated with significant differences in their clinical profile, particularly an earlier onset, a lower likelihood of being married, and higher rates of performance anxiety. This study highlights the need to consider early childhood experiences, particularly using an attachment theory framework, when examining the origins of psychogenic erectile dysfunction.
authors.affiliation: Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Rajkumar
mesh_terms: D000328:Adult; D007172:Erectile Dysfunction / Q000209:etiology / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D009769:Object Attachment; D010287:Parent-Child Relations; D011569:Psychiatric Status Rating Scales; D011582:Psychological Theory; D012725:Sexual Behavior / Q000523:psychology*
keywords: Anxiety; Attachment Theory; Erectile Dysfunction