Purely psychogenic (originating from the mind or psyche) erectile dysfunction probably accounts for only 10% of the cases of erectile dysfunction. Depression, anxiety, and stress may have an adverse effect on erectile function, and many of the medications used to treat these problems can cause erectile dysfunction and other forms of sexual dysfunction. However, in most situations, once erectile dysfunction occurs the man develops psychogenic components related to the anxieties that erectile dysfunction causes. Psychogenic causes of erectile dysfunction include:
- Performance anxiety
- Marital problems
- Dysfunctional attitude toward sex
- Sexual phobia
- Religious beliefs/inhibitions
- Prior traumatic sexual experience
The Psychological Types and Causes of ED
Your brain is your major sex organ, and detrimental thoughts, feelings, and experiences can cause ED.
Psychological System ED
Psychological system ED is caused by chronic psychological problems such as obsessive-compulsive disorder, chronic depression (dysthymia), generalized anxiety disorder, bipolar mood disorder (manic-depression), schizophrenia, a personality disorder (for example, avoidant personalitó disorder, dependent personality disorder, or borderline personality disorder), post-traumatic stress disorder (the aftereffects of witnessing tragedy or being victimized), or developmental disorders such as attention deficit/hyperactivity disorder; by the ongoing psychological effects of alcoholism or drug abuse; or by chronic, unresolved personal issues (especially those involving sexual guilt or shame).
While significant psychological problems can cause ED, scientific studies reveal that the vast majority of men with ED do not have a major psychological problem, nor do they share a common personality profile (Weeks and Gambescia 2000). This type of ED might not manifest in men in their twenties or thirties but usually does occur throughout the man’s life and in all sexual situations.
Psychological Distress ED
Psychological distress ED is caused by temporary psychological difficulties such as an adjustment disorder (for example, anxiety or depression in reaction to specific situations or events such as loss of job). Nearly 50 percent of the population will experience a psychological distress situation sometime in life (Amen 1998). Another factor, such as physical illness ED, can cause psychological distress because anxiety and stress distract from the sexual situation. Often it is difficult to determine whether the psychological features are the cause or result of ED. Psychological distress ED is acquired and usually occurs intermittently. It is more common and is easier to address and change than psychological system ED.
Men tend to underestimate the effect that psychological stress can have on their sexual functioning, assuming that when there is such a profound problem as ED, the cause must be profound as well. In fact, it does not take much psychological distress to disrupt sexual functioning. ED is more likely when the man has situational anxiety, reactive depression, loss of confidence, doubt, disappointment, irritation, remorse, embarrassment or negative feelings about his body, unrealistic expectations of sexual performance, or experiences internal conflicts such as between the roles of lover and father (Fagan 2002). In addition, losses (death of a parent, friend, loss of income), midlife adaptations, changing social status, parenting stresses, monotony, reaction to your partner’s distress, and even success can disrupt your psychological function.
Psychological distress not only may cause ED but is almost invariably an effect of ED. Most men with ED feel at least mild inadequacy, discouragement, self-doubt, or anxiety.
Psychosexual Skills Deficit ED
Psychosexual skills deficit ED results from absent or ineffective cognitive, emotional, or behavioral skills related to lovemaking. The man does not have accurate and sufficient knowledge about his body, his partner’s body, and sexual physiology (how sexual response works); has a number of distorted cognitions (thoughts or beliefs); has unreasonable expectations about sexual performance; and lacks essential sensual skills for arousal. Some men also lack interpersonal skills such as talking warmly of sex, making sex comfortable, and cooperating with a partner to achieve sexual satisfaction. This type of ED is lifelong but commonly does not occur with masturbation because the man feels more comfortable and less self-conscious when he masturbates.
The Cognitive-Behavioral-Emotional (CBE) Model
To help you understand the multiple dimensions of the psychosexual skills aspects of ED, we offer you a framework: the cogni-tive-behavioral’emotional (CBE) model. This will help you make sense of the otherwise confusing experience of ED and organize your approach to overcoming your ED.
The CBE model recognizes that each individual is composed of cognitions, or thoughts; behaviors, or actions; and emotions, or feelings. These experiences comprise the “core discussion” you have with yourself as well as your action plan to deal with the situation.
Cognitions or Thoughts
Cognitions involve ideas, beliefs, assumptions, observations, perceptions, interpretations, and expectations. These are unique to each person. Cognitions are beneficial or detrimental depending on their effect on your feelings and actions. Appreciate that your thoughts powerfully drive your feelings. Your thoughts about your sexuality – beliefs, standards, perceptions, expectations, and assumptions – are vital to your sexual response and satisfaction. This is why we are so careful to remind you that your sexual expectations must be solidly grounded on a reasonable view of your body, sexual response, and your sexual relationship. You want to reinforce reasonable and positive thoughts; don’t set yourself up for frustration and failure.
Behaviors or Actions
We choose to act (or not act) based upon our thoughts and feelings. Action is always a decision. The freedom to choose your behavior may be constrained by thoughts and feelings, but responsible and mature living mandates accountability for your behavior. Behaviors may be constructive or destructive depending on their effect on the individuals and the relationship.
Emotions or Feelings
Emotions are chemical-electrical “energy” events or experiences in your body. You label this energy according to how you experience these physical sensations: fear, sadness, loneliness, dread, satisfaction, resentment, worry, contentment, frustration, pleasure, irritability, excitement, anxiety, surprise, confusion, shame, guilt, comfort, embarrassment. Feelings are “motivators” that prompt, penalize, or reward action. Feelings are not themselves good or bad, right or wrong. Feelings influence the thoughts we have and the actions we take. Emotions are described as positive or negative depending on how you subjectively experience them and how they influence your behavior. You will need to understand and manage your feelings so they do not disrupt your efforts to change.
Thoughts, feelings, and behaviors interact in a complicated web of influences – thoughts influencing feelings, feelings influencing behaviors, and behaviors prompting thoughts and feelings. For example, you may expect (cognition) that you will “fail” (cognition) to get an erection, feel frustration (emotion), and anticipate (cognition) that your poor performance (behavior) will cause your partner’s disappointment (emotion). Making love with this predisposition, you will have difficulty focusing (cognition) on your pleasurable sensations; become preoccupied (cognition) with anticipating erectile failure; have difficulty relaxing (behavior) your body; lack awareness (cognition) of techniques (behavior) to facilitate erections; become preoccupied (cognition) by your partner’s body and reactions (behaviors); experience restricted, uneasy, or anxious sensuality (emotion); or entertain distorted thoughts (cognitions) such as I must have an erection or she will leave me.
While these features work against you in this example, recognize that you can make them work for you by replacing negative cognitions, behaviors, and emotions with realistic, beneficial ones. In the CBE model, each component is valued and is integral to promoting change. Understanding the cognitions, behaviors, and emotions that contribute to your ED will help you overcome the problem.
Relationship Distress ED
Complicated relationship dynamics (for example, failure to communicate, unresolved emotional conflicts, mistrust in response to infidelity) may cause ED, maintain ED caused by a different factor, or result from ED. The CBE model focuses on three fundamental dimensions of intimate relationship satisfaction: relationship identity, cooperation, and emotional intimacy.
Relationship identity refers to the composite cognitive life of your relationship – the beliefs, attributions, and expectations that each of you brings to your relationship; the relevance of your personal history; and what your relationship means to each of you. For example, how do you balance needs for individual autonomy and relationship cohesion? In healthy relationships, each individual benefits from the relationship, and the relationship benefits from the input of each individual.
Relationship cooperation refers to your composite behavioral interactions – how you communicate, work together in a balanced way, and solve problems in an effective and mutually agreeable manner. Your thoughts and feelings are hidden from each other unless you communicate them through a behavior, typically by discussing them. This is why communication is such an important part of couple sexual growth.
Relationship Emotional Intimacy
Relationship emotional intimacy refers to your relationship’s “environment” or quality of emotional bond. Intimacy includes the emotional, friendship, and sexual aspects of your relationship – feelings of affection, commitment, and closeness.
Deficits in these relationship features undermine the mutual emotional acceptance that is so important to healthy sexual functioning. Even when ED is caused by something other than relationship distress, it can cause considerable damage to your relationship. Relationship distress ED is acquired and limited to sex with your partner.