Dottorato in PSICOLOGIA DINAMICA E CLINICA

Titolo della tesi: Advancing Knowledge on Predictors, Correlates, and Underlying Mechanisms of Perceived Sexual Desire Discrepancy

INTRODUCTION. Sexual desire discrepancy (SDD) stands out as a prominent facet within the realm of sexual desire, serving as a primary catalyst prompting individuals and couples to seek therapeutic intervention. The European Society for Sexual Medicine (ESSM) recommends treatment options directed towards improving dyadic communication and exploring emotional needs. However, as highlighted by the expert opinion itself, these treatment recommendations are speculative and primarily based on clinical experience rather than research. In fact, despite its prevalence, affecting a substantial percentage of couples (25-30%), and the historical emergence of the concept in scientific literature, a significant global gap persists, namely the absence of research-informed and evidence-based clinical guidelines to manage and treat SDD. To address this gap, the ESSM urges the scientific community to advance research on predictors, correlates, and underlying mechanisms of SDD, focusing attention on aspects of individual and relational functioning that have been insufficiently explored to date (e.g., communication, emotional regulation, dyadic empathy, romantic attachment) or have yielded contrasting results (e.g., sexual satisfaction). Furthermore, given that SDD is inherently a dyadic phenomenon, expert opinion strongly advocates examining SDD by considering the couple as the unit of analysis and intervention. This approach underscores a shift from singularly concentrating on individual partners to directing attention towards the couple as a unified entity. However, in specific instances, a scenario may unfold wherein only one partner manifests a willingness to partake in therapeutic intervention for SDD. In such circumstances, the ESSM advocates for the adoption of an individual approach centered on the individual's experience and the personally perceived partner's experience. As a result, exploring both the individual perspective and that related to the partner in understanding SDD can provide a broader insight into its manifestation and the necessary strategies for management, both at the individual and couple levels. AIM. In accordance with the recommendations provided by the ESSM, the current doctoral research project has focused on investigating predictors, correlates, and underlying mechanisms of perceived SDD, directing attention to aspects of individual and relational functioning that are currently unexplored or yield conflicting results. The exploration was conducted initially at the individual level and subsequently in dyadic interaction, also examining partner effects. METHODS. Two cross-sectional studies were designed. Respectively, in the first (individual-centered) and second (couple-centered) studies, individuals engaged in romantic relationships (N = 369) and couples (N = 94) completed an online protocol in which sexual satisfaction, dyadic sexual communication, difficulty in emotion regulation, dyadic empathy, and romantic attachment were evaluated for the degree of involvement in the current degree of perceived SDD. MAIN OUTCOME MEASURES. For the first study (individual-centered), hierarchical multiple regression analyses and mediation analyses using a bootstrapping procedure were conducted. Hierarchical multiple regression analyses were performed to assess the ability of variables of interest (i.e., sexual satisfaction, dyadic sexual communication, difficulty in emotion regulation, dyadic empathy, and romantic attachment) to predict the degree of perceived SDD, and to determine whether their effect was significant over and above the influence of the most widely used covariates in sexual desire and SDD research (i.e., gender, age, sexual orientation, relationship duration, having a child/children, desire to have a child/children, and social desirability bias). Mediation analyses were conducted to examine the underlying mediation mechanisms of perceived SDD, focusing on the main predictors identified in the final regression analysis (i.e., dyadic sexual communication and sexual satisfaction). In particular, it was assessed whether the quality of dyadic sexual communication plays a key role in increasing or diminishing the degree of perceived SDD through sexual satisfaction and whether the effect was significant over and above the influence of the selected covariates. For the second study (couple-centered), an Actor-Partner Interdependence Mediation Model (APIMeM) using multilevel modeling was employed to specifically estimate actor’s and partner’s associations between difficulty to access to emotion regulation strategies and sexual satisfaction, using the actor’s and partner’s degree of perceived SDD as a potential mediator. Relationship duration was used as a covariate. RESULTS. As expected, results from the first study highlighted that higher sexual satisfaction, better-perceived quality of dyadic sexual communication, lower difficulty in the regulation of emotions, higher dyadic empathy, and more positive attachment relationships were associated with a lower degree of perceived SDD. Furthermore, sexual satisfaction and quality of dyadic sexual communication emerged as the most robust predictors of the degree of perceived SDD, revealing that better quality of dyadic sexual communication was associated with a lower degree of perceived SDD through higher sexual satisfaction. Importantly, these effects were significant even after accounting for covariates. Results from the second study showed a significant and negative total effect of actor’s difficulty to access to emotion regulation on sexual satisfaction, indicating that higher actor’s difficulty to access to emotion regulation was associated with lower actor’s sexual satisfaction. The same was not found for the partner’s difficulty to access to emotion regulation. Furthermore, indirect effects showed that the effect of actor’s difficulty to access to emotion regulation strategies on the actor’s sexual satisfaction passes through actor’s degree of perceived SDD, and that the effect of the partner’s difficulty to access to emotion regulation strategies on the actor’s sexual satisfaction passes through the actor’s degree of perceived SDD. These effects were significant even after accounting for relationship duration as a covariate. The effect of actor’s difficulty to access to emotion regulation strategies on partner’s sexual satisfaction through the actor’s degree of perceived SDD, and the effect of partner’s difficulty to access to emotion regulation strategies on partner’s sexual satisfaction through the actor’s perceived SDD were not significant. CONCLUSIONS. Overall, this research showed the importance of developing and testing interventions directed towards the exploration and management of aspects related to individual and relational functioning, such as sexual satisfaction, dyadic empathy, and romantic attachment, with a particular focus on the enhancement of the quality of dyadic sexual communication and the cultivation of effective emotion regulation strategies. Importantly, the effects held significant over and above the effect of the relevant covariates. This research project contributes valuable insights for professionals and researchers within the fields of sexual and relational health, representing a significant stride toward a more nuanced comprehension of the factors and dynamics underlying perceived SDD at both the individual level and in dyadic interaction. To the best of the author's knowledge, this would constitute the first investigation to have proffered preliminary empirical substantiation for the opinion-based recommendations put forth by the ESSM, which advocated directing treatment efforts towards facets such as communication and emotions.