Evaluation of Alexithymia, Anger and Temperament Features in Insomnia Patients with Sexual Dysfunction

Abstract

Aim: One of the most common sleep disorders is insomnia, and it is also an independent risk factor related to sexual dysfunction (SD). The aim of the present study was to investigate the anger parameters, temperament parameters, and alexithymia in insomnia patients with SD. Material and Methods: The study group consisted of 92 patients diagnosed with insomnia according to the third edition of the International Classification of Sleep Disorders. The sociodemographic data form, Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire (TEMPS-A), Insomnia Severity Index (ISI), Toronto Structured Interview for Alexithymia (TSIA), Arizona Sexual Experiences Scale (ASEX), Pittsburgh Sleep Quality Index (PSQI), State-Trait Anger Expression Inventory (STAXI) were applied to the patients. Results: While 62 patients had SD, 30 patients had no SD. ISI, PSQI, anger in score were significantly higher in patients with SD (p=0.048, p=0.007, p=0.032, respectively). While depressive and anxious temperament was significantly higher in patients with SD (p=0.026, p=0.008, respectively), hyperthymic temperament was significantly higher in patients without SD (p=0.013). ISI score, depressive, and anxious temperament were significantly correlated with the ASEX score (r=0.214, p=0.041; r=0.261, p=0.012; r=0.286, p=0.007, respectively). Linear regression revealed that depressive, cyclothymic, and irritable temperaments were predictors of ISI (p=0.001). According to logistic regression, hyperthymic temperament was an independent predictor of SD (p=0.001). Conclusion: Psychological factors should also be considered in studies conducted on the relationship between insomnia and SD. Further research is needed on temperament characteristics, alexithymia and anger issues. Thus, patients can be approached more comprehensively.

Keywords

• sexual dysfunction
• insomnia
• temperament

Cinsel İşlev Bozukluğu Olan İnsomni Hastalarında Aleksitimi, Öfke ve Mizaç Özelliklerinin Değerlendirilmesi

Abstract

Amaç: İnsomni en yaygın uyku bozukluklarından biridir ve cinsel işlev bozukluğu (CİB) ile ilişkili bağımsız bir risk faktörüdür. Bu çalışmanın amacı CİB olan insomni hastalarında öfke parametrelerini, mizaç parametrelerini ve aleksitimiyi araştırmaktır. Gereç ve Yöntemler: Çalışmaya uluslararası uyku bozuklukları sınıflandırması üçüncü versiyonuna göre insomni tanısı alan 92 hasta dahil edildi. Hastalara sosyodemografik veri formu, Memphis, Pisa, Paris and San Diego mizaç değerlendirme ölçeği (Temperament Evaluation of Memphis, Pisa, Paris, San Diego Auto-questionnaire, TEMPS-A), insomni şiddet ölçeği (Insomnia Severity Index, ISI), Toronto aleksitimi ölçeği (Toronto Structured Interview for Alexithymia, TSIA), Pittsburgh uyku kalitesi ölçeği (Pittsburgh Sleep Quality Index, PSQI), Arizona cinsel yaşantılar ölçeği (Arizona Sexual Experiences Scale, ASEX) ve durumluk-sürekli öfke ifade ölçeği (State-Trait Anger Expression Inventory, STAXI) uygulandı. Bulgular: 62 hastada CİB varken, 30 hastada CİB yoktu. CİB olan hastalarda ISI, PSQI ve öfke içeri skoru anlamlı olarak yüksekti (sırasıyla p=0,048, p=0,007, p=0,032). CİB olan hastalarda depresif ve anksiyöz mizaç anlamlı derecede yüksek iken (sırasıyla p=0,026, p=0,008), hipertimik mizaç CİB olmayan hastalarda anlamlı olarak daha yüksekti (p=0,013). ISI skoru, depresif ve anksiyöz mizaç ile ASEX skoru arasında anlamlı korelasyon saptandı (sırasıyla r=0,214, p=0,041; r=0,261, p=0,012; r=0,286, p=0,007). Lineer regresyon analizi depresif, siklotimik ve irritabl mizacın ISI'nın ön gördürücüleri olduğunu ortaya koymuştur (p=0,001). Lojistik regresyon analizine göre hipertimik mizaç, CİB’in bağımsız bir ön gördürücüsüdür (p=0,001). Sonuç: İnsomni ve CİB ilişkisine dair yürütülen çalışmalarda psikolojik faktörler de göz önünde bulundurulmalıdır. Mizaç özellikleri, aleksitimi ve öfke konularının daha fazla araştırılması gerekmektedir. Böylece hastalara daha kapsamlı yaklaşılabilir.

Keywords

• cinsel işlev bozukluğu
• insomni
• mizaç

References

1. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97-111.
2. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.
3. Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD, Laumann EO, Moreira ED Jr, et al. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med. 2010;7(4 Pt 2):1598-607.
4. Kalmbach DA, Arnedt JT, Pillai V, Ciesla JA. The impact of sleep on female sexual response and behavior: a pilot study. J Sex Med. 2015;12(5):1221-32.
5. Rajkumar RP, Kumaran AK. Depression and anxiety in men with sexual dysfunction: a retrospective study. Compr Psychiatry. 2015;60:114-8.
6. Moyano N, Sierra JC. Relationships between personality traits and positive/negative sexual cognitions. Int J Clin Health Psychol. 2013;13(3):189-96.
7. Wiegel M, Scepkowski LA, Barlow DH. Cognitive-affective processes in sexual arousal and sexual dysfunction. In: Janssen E, editor. The psychophysiology of sex. Bloomington: Indiana University Press; 2007. p.143-65.
8. Lindholm T, Lehtinen V, Hyyppä MT, Puukka P. Alexithymic features in relation to the dexamethasone suppression test in a Finnish population sample. Am J Psychiatry. 1990;147(9):1216-9.

9. Michetti PM, Rossi R, Bonanno D, Tiesi A, Simonelli C. Male sexuality and regulation of emotions: a study on the association between alexithymia and erectile dysfunction (ED). Int J Impot Res. 2006;18(2):170-4.
10. Madioni F, Mammana LA. Toronto Alexithymia Scale in outpatients with sexual disorders. Psychopathology. 2001;34(2):95-8.
11. Michetti PM, Rossi R, Bonanno D, De Dominicis C, Iori F, Simonelli C. Dysregulation of emotions and premature ejaculation (PE): alexithymia in 100 outpatients. J Sex Med. 2007;4(5):1462-7.
12. Costa RM, Oliveira G, Pestana J, Costa D, Oliveira RF. Do psychosocial factors moderate the relation between testosterone and female sexual desire? The role of interoception, alexithymia, defense mechanisms, and relationship status. Adapt Hum Behav Physiol. 2019;5(1):13-30.
13. Scimeca G, Bruno A, Pandolfo G, Micò U, Romeo VM, Abenavoli E, et al. Alexithymia, negative emotions, and sexual behavior in heterosexual university students from Italy. Arch Sex Behav. 2013;42(1):117-27.
14. Brody S, Laan E, van Lunsen RH. Concordance between women's physiological and subjective sexual arousal is associated with consistency of orgasm during intercourse but not other sexual behavior. J Sex Marital Ther. 2003;29(1):15-23.
15. Bozman AW, Beck JG. Covariation of sexual desire and sexual arousal: the effects of anger and anxiety. Arch Sex Behav. 1991;20(1):47-60.
16. Pompili M, Girardi P, Tatarelli R, Iliceto P, De Pisa E, Tondo L, et al. TEMPS-A (Rome): Psychometric validation of affective temperaments in clinically well subjects in mid- and south Italy. J Affect Disord. 2008;107(1-3):63-75.
17. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297-307.
18. Yücel Ağargün M, Kara H, Anlar Ö. The validity and reliability of the Pittsburgh Sleep Quality Index. Turk Psikiyatri Derg. 1996;7(2):107-15.
19. Sayar K, Güleç H, Ak I. [Reliability and validity study of Toronto alexithymia scale]. İstanbul: 37th National Congress of Psychiatry, Scientific Studies Abstract Book; 2001. p.130. Turkish.
20. Zhang B, Wing YK. Sex differences in insomnia: a meta-analysis. Sleep 2006;29(1):85-93.
21. Barsky AJ, Peekna HM, Borus JF. Somatic symptom reporting in women and men. J Gen Intern Med. 2001;16(4):266-75.
22. Liu Y, Zhang J, Lam SP, Yu MW, Li SX, Zhou J, et al. Help seeking behaviors for insomnia in Hong Kong Chinese: a community-based study. Sleep Med. 2016;21:106-13.
23. Morin CM, LeBlanc M, Daley M, Gregoire JP, Mérette C. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med. 2006;7(2):123-30.
24. Benbir G, Demir AU, Aksu M, Ardic S, Firat H, Itil O, et al. Prevalence of insomnia and its clinical correlates in a general population in Turkey. Psychiatry Clin Neurosci. 2015;69(9):543-52.
25. Xiang YT, Ma X, Cai ZJ, Li SR, Xiang YQ, Guo HL, et al. The prevalence of insomnia, its sociodemographic and clinical correlates, and treatment in rural and urban regions of Beijing, China: a general population-based survey. Sleep. 2008;31(12):1655-62.
26. He J, Luan QM, Xie CG, Du CY, Cheng YR. Quality of life and mental state of those retired. Chin Ment Health J. 2002;16(3):177-8. Chinese.
27. Allaert FA, Urbinelli R. Sociodemographic profile of insomniac patients across national surveys. CNS Drugs. 2004;18(Suppl 1):3-7; discussion 41,43-5.
28. Kaneita Y, Ohida T, Osaki Y, Tanihata T, Minowa M, Suzuki K, et al. Insomnia among Japanese adolescents: a nationwide representative survey. Sleep. 2006;29(12):1543-50.
29. Jefferson CD, Drake CL, Scofield HM, Myers E, McClure T, Roehrs T, et al. Sleep hygiene practices in a population-based sample of insomniacs. Sleep. 2005;28(5):611-5.
30. İrer B, Çelikhisar A, Çelikhisar H, Bozkurt O, Demir Ö. Evaluation of sexual dysfunction, lower urinary tract symptoms and quality of life in men with obstructive sleep apnea syndrome and the efficacy of continuous positive airway pressure therapy. Urology. 2018;121:86-92.
31. Kalmbach DA, Arnedt JT, Pillai V, Ciesla JA. The impact of sleep on female sexual response and behavior: a pilot study. J Sex Med. 2015;12(5):1221-32.
32. Lewis RW, Fugl-Meyer KS, Bosch R, Fugl-Meyer AR, Laumann EO, Lizza E, et al. Definitions, classification, and epidemiology of sexual dysfunction. In: Lue TF, Basson R, Rosen R, Giuliano F, Khoury S, Montorsi F, editors. Sexual medicine: sexual dysfunction in men and women. United Kingdom: Health Publications; 2004. p.1-36.
33. Turan Ş, Usta Sağlam NG, Bakay H, Gökler ME. Levels of depression and anxiety, sexual functions, and affective temperaments in women with lifelong vaginismus and their male partners. J Sex Med. 2020;17(12):2434-45.
34. Rózsa S, Rihmer Z, Gonda X, Szili I, Rihmer A, Ko N, et al. A study of affective temperaments in Hungary: internal consistency and concurrent validity of the TEMPS-A against the TCI and NEO-PI-R. J Affect Disord. 2008;106(1-2):45-53.
35. Karam EG, Salamoun MM, Yeretzian JS, Mneimneh ZN, Karam AN, Fayyad J, et al. The role of anxious and hyperthymic temperaments in mental disorders: a national epidemiologic study. World Psychiatry. 2010;9(2):103-10.
36. Hisli Şahin N, Durak Batıgün A, Alkan Pazvantoğlu E. [The role of interpersonal style, self perception and anger in sexual dysfunction]. Turk Psikiyatri Derg. 2012;23(1):18-25. Turkish.
37. Araujo AB, Johannes CB, Feldman HA, Derby CA, McKinlay JB. Relation between psychosocial risk factors and incident erectile dysfunction: prospective results from the Massachusetts Male Aging Study. Am J Epidemiol. 2000;152(6):533-41.
38. Muscatello MR, Bruno A, Scimeca G, Pandolfo G, Paduano R, Mico U, et al. The relationship between anger and heterosexual behavior. An investigation in a nonclinical sample of urban Italian undergraduates. J Sex Med. 2010;7(12):3899-908.
39. Iannuzzo G, Pandolfo G, Bonadonna A, Lorusso S, Crucitti M, Lanza G, et al. The relationship between anger and sexual behavior: a review of theories and research. Mediterr J Clin Psychol. 2014;2(1):1-29.
40. Berenguer C, Rebôlo C, Costa RM. Interoceptive awareness, alexithymia, and sexual function. J Sex Marital Ther. 2019;45(8):729-38.