When interviewing men with a combination of Major Depressive Disorder, Bipolar Disorder I and Male Hypoactive Sexual Desire Disorder with Male Erectile Disorder it is important to first rule out the possibility that there is an underlying physical cause creating one or more of the psychological problems. In the best possible scenario, the interviewer has full access to the patient’s medical history, and it includes hormonal work ups to eliminate these possibilities. For example, a patient with a hypoactive thyroid may suffer from mood swings, a loss of desire and associated erectile disorder, experiencing these symptoms on an ongoing basis could cause or exacerbate a depressive disorder. In a similar manner, medication for one or more of these disorders could effect, or cause the other disorders. A mood stabilizer like one of the lithium compounds is toxic to some individuals. Treatment with this medication could affect thyroid and other physical functions that would then cause the depression and hypoactive sexual desire disorder with male erectile disorder. Therefore, the first concern is to eliminate the possibility of these physical concerns early in the interview process,
The next concern is to determine if one of these psychological disorders is the cause of the other symptoms. Erectile dysfunction can cause mood swings, hypoactive sexual desire disorder and depression. In a like manner, depression can cause the sexual difficulties resulting in mood swings. Therefore, interviewer must explore not only the symptoms, but also the sequence in which they manifested.
Sexuality is a sensitive topic for anyone, this combination is usually particularly difficult for most men. Depending on the individual and his symptoms different interview approaches will prove to be effective. Some men will feel reassured if they know that their symptoms have an underlying physical cause, particularly if it is easily treatable. For example, knowing that his slow thyroid caused the other problems, and it can be successfully medicated could prove to be reassuring to many men. On the other hand, other individuals might feel threatened and “out of control” if they feel that their sexual identity is subject to such a seemingly unrelated cause such as a thyroid problem. The patients, attitude is a strong determining factor when the therapist considers the possible approaches and even the environment for the interview is conducted. A patient who is most comfortable with the idea that the cause may be physical is also likely to respond and relax in a clinical environment reminiscent of a medical doctor’s office. While the patient who feels threatened by the thought of a physical cause could benefit the most from a more relaxed, conversational approach and informal atmosphere.
References
Balon, M. R., Basson, M. B., Binik. Ph.D, Y., Both, P. S., Everaerd, P. W., Janata, P. J., et al. (2005). Handbook of Sexual Dysfunction. Boca Raton, FL, USA: Taylor & Francis.
Sexual Desire Disorders. (2009, 08 10). Retrieved 09 21, 2012, from MentalHelp.Net: http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=29697&cn=10
WebMD. (2012). Medications for Bipolar Disorder. Retrieved 09 21, 2012, from WebMD: http://www.webmd.com/bipolar-disorder/guide/medications-bipolar-disorder
