Événements de vie et anxiété chez les hommes souffrant de ...

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CLINICAL SEXOLOGY M. VINCENT ; M. BONIERBALE ; R. PORTO ; M.H. COLSON ; C. LANÇON SUMMARY : The aim of this research was to study the role of an individual’s recent experience in the onset of erection disorders. Our hypothesis was that the subjects were more vulnerable to anxiety causing difficulties for them in adapting to outside events. Our sample was a group of 26 patients suffering from secondary erection disorders and a group of 20 control subjects. We used the Life-Events Questionnaire developed by F. Amiel-Lebigre (1986) to make a list of events experienced during the five years prior to the onset of erection disorders for the patients, and during the five years prior to the date at which the questionnaire was filled in for the control subjects. The subjects were all asked to give a score between 0 and 100 to each event according to its emotional impact on them. We also measured the subjects’ anxiety scores using the State-Trait Anxiety Inventory or STAI (Spielberger, 1983). Our hypothesis was to use the State-Trait score to reflect long-standing anxiety specific to each subject. The results show that there had been a much greater number of life events during the year prior to the onset of erection disorders for the patients than for the control subjects. A detailed analysis of this peak of events revealed that the most common events were those of an emotional nature and those involving a loss, or bereavement. We also noted that the patients often assigned a high emotional impact score to this type of event. In addition, the results did not show any higher state-anxiety and/or trait-anxiety scores for patients than for control subjects. KEY WORDS: • Erection disorders • Life-events • Anxiety VINCENT M. et al. (2004) Europ. J. of Sexol ; Sexologies ; (XIII), 48 : 11-12 Life events and anxiety in male subjects suffering from erectile disorders How important are life events recently experienced by individuals in the onset of erection disorders? We also investigate the role of anxiety as a factor that could not only potentially reduce the individual’s capacity to cope with outside events, but also with regard to the performance anxiety model first described by Masters and Johnson (1971) and often used since in contemporary models. Life events A specific methodology has been developed to study the effect of life events on an individual’s experience. The leaders on the subject of life-event methodology are Holmes and Rahe. In 1967 they developed the Schedule of Recent Experience, the very first questionnaire on life events to be validated. In the past thirty years, a complex approach has developed to the relationship between events and disease, leading to the appearance of various different event questionnaires. Questionnaires as a clinical tool have enabled the long-suspected role of the emotional impact of life events on the onset or deterioration of somatic or psychological disorders to be clearly evidenced. Aharonian et coll. (1991) applied the event-based methodology to erectile disorders. According to the results they obtained, there would appear to be two decisive factors: the concept of a quantitative accumulation of highimpact events during a brief lapse of time, and the main type of events taking place during this lapse of time. This led us to formulate the following hypotheses: H1: Men suffering from an erection disorder have experienced a significantly higher number of high-impact life events during the year before the onset of the disorder. H2: There might be a type of event that is conducive to the onset of erection disorders, i.e. emotional events or events related to a loss. ■ Methodology The sample comprises a “patient” group including 26 subjects who consulted for a secondary erection disorder, and a control group of 20 subjects. Using the Life-events questionnaire developed by F. Amiel-Lebigre (1986), we listed the events experienced by the subjects during the five years prior to the onset of their erection disorder (t0) for the patients, and during the five years prior to the date at which the questionnaire was being filled in (t0) for the control subjects. The events experienced are identified by means of the date of onset (year), the area they concern (professional, financial, social, emotional, family and health), their type (gain or loss), and an impact score given by the subjects themselves on a scale of 0 to 100 (with 100 being the maximum impact). - VOL.XIII, N°49 11
12 Anxiety We studied the general and stable form of anxiety experienced by individuals that defines the way in which they cope with outside events. According to the model developed by Rahe (1976), psychologically-strong individuals experience events for a shorter period of time than more fragile individuals, thereby avoiding the accumulated impact of successive events. We also investigated performance anxiety, often mentioned by the authors as a factor that could lead to erectile disorders. Masters and Johnson (1971) suggested a possible mechanism of cognitive interference, often referred to as the “vicious circle of anxiety”, where the fear of failure accumulates with the anxiety, to establish the erectile disorder. Some research conducted by Hartmann (1998) evidenced the role of performance anxiety in the onset of erectile disorders. The author identified three main factors in patients, which he suggests should be considered as a continuum: - Immediate factors represented by the performance anxiety, - Life events in the patient’s recent past, - Constitutional vulnerability acquired in childhood. We therefore formulated the following hypothesis: H3: individuals suffering from erectile disorders have significantly high anxiety levels. ■ Methodology We used the State-Trait Anxiety Inventory or STAI developed by Spielberger (1983). This tool provides an independent assessment of the anxiety trait which makes reference to stable and specific characteristics of the state of anxiety related to a situation, or an event. We therefore wanted to make a more specific assessment of the general state of anxiety using the traitanxiety scale and performance anxiety using the state-anxiety scale. Results ■ Distribution of life events There was an accumulation of life - VOL.XIII, N°49 events during the year prior to the onset of the erection disorder. This peak of events was also observed in the control subjects, but to a lesser extent (Figure 1/see french version). In the patients, there was a 200% increase in events experienced during the year prior to t0, compared to only 69 % for the control subjects (Table 1/french version). And yet, the patients did not give a significantly higher impact score to the events they experienced during the year prior to the onset of erectile disorders than to the events they had experienced previously (Table 2/french version). ■ The areas concerned by the life events Most of the events represented belong to the emotional field. (Figure 2, Table 3/french version). In addition, the patients gave a high impact score to 80.8% of the “emotional” type events they experienced (Table 4/french version). ■ Type of life events The results show that the patients reported more events representing a loss (84.5%) than the controls (72.8%), and vice versa, the controls reported more events representing a gain (27.1%) than the patients (15.4) (Figure 3, Table 5/french version). Furthermore, both the patients and the controls reported a stronger impact for events representing a loss than those representing a gain (Table 6/french version). ■ Anxiety As far as anxiety is concerned, no significant differences can be seen between the anxiety scores obtained by the patients and those obtained by the anxiety controls. (Table 7/french version). Conclusion The results obtained would seem to confirm hypothesis 1. As stated by Aharonian et coll. (1991) in their research, it would appear that the accumulation of events is an important factor in the role played by life events in the pathogenesis of erectile disorders. Furthermore, it would appear that even if the events are not judged to have a particularly strong impact on the subject, they nevertheless have an accumulated effect. Concerning hypothesis 2, it would appear in fact that there is a type of event which plays in favour of the onset of erectile disorders, i.e. events of an emotional nature and events representing a loss for the subject. The event most commonly mentioned is “separation/divorce”. This observation gives us an indication of the important role played by the relationship within a couple and the consequences of modifications to the balance in the couple in the onset of an erectile disorder. The results obtained from the anxiety questionnaire do not point in the same direction as those obtained by Hartmann (1998) since we did not observe a high anxiety level in the patient group. We are therefore unable to evidence the presence of performance anxiety in men suffering from erectile dysfunctions; hypothesis 3 has not been evidenced. However, it is possible that the STAI (Spielberger, 1983) is not a good tool to measure vulnerability to outside events, or even performance anxiety. There are other measurement scales, coping scales which could provide better results. In addition, the fear of failure could be assessed by measuring self-esteem. Adresse pour correspondance : M. Bonierbale CHU Ste-Marguerite, Service du Pr C. Lançon, 13274 Marseille Cedex 9.
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