• 'Stress and sex: a complicated relationship’ Declining sexual functioning as a predictor for attritional stress and fatigue (ASF), resilience injury and maladaptive behaviours in a sample of British Army soldiers

      Reeves, Andrew; Buxton, Christina; Prentice, Julie-Anne (University of Chester, 2021-10)
      With high-tempo work, frequent separation and operational commitments, military personnel are at greater risk than most of developing a broad range of mental health concerns. Whether at war or in peacetime, soldiers are trained to be ready for combat. Such conditioning is responsible for teaching soldiers how to override their flight or fight response; to run towards danger when human instinct seeks to run away. So, whether soldiers are engaged in combat or training for readiness, the destabilising impact of overriding innate biological functions can impact on how a soldier recognises and manages stress. Stress is known to contribute to a number of physical and psychological functions that impact on sexual desire and performance, offering sexual functioning as a potential marker for resilience injury and wider mental health concerns. Aims & Objectives Psychological support for intimate relationships is particularly vital for soldiers and their partners and may influence recovery rates from the unique mental demands of the military. This study sought to understand if declining sexual functioning could be an early predictor of problematic stress and maladaptive behaviours. It aimed to define clear at-risk groups for increased stress to help clinicians target assessment for those most susceptible to resilience overwhelm and mental health concerns. Research questions The study focused on 6 main research questions related to stress, sexual functioning, online sexual activity (OSA) and compulsive sexual behaviour (CSB). Results hoped to demonstrate the correlation between stress and sexual function and to define areas of additive stress that may impact on wellbeing. Clinical aims sought to highlight at-risk groups and protective factors to support psychoeducation, assessment protocols and treatment pathways. Method A mixed-methods approach allowed for the collection of quantitative statistical data via a scored and validated survey providing correlation information on the four main variables: stress, sexual functioning, online sexual activity and compulsive sexual behaviours. A qualitative component collected personal statements, observations and remarks to provide context for the statistical results. With equal priority, this created a snapshot of soldier experience in relation to stress and sex which could help the identification of those soldiers at greater risk of psychological distress. The study was primarily underpinned by the theoretical framework of Bancroft and Janssen’s Dual Control Model. This model centres on the balance between an individual’s inhibitory and excitatory processes in the central nervous system. With particular relevance to this study and soldier behaviour, the Dual Control Model considers how excitation and inhibition are impacted by stress and how individual response may impact on sexual behaviour. Where inhibition is elevated, some may experience difficulties with sexual interaction related to performance anxiety for example and where excitation is increased, individuals may feel less restricted and may be willing to take more sexual risks. Results Results demonstrated a clear link between increased stress and declining sexual function offering psychosexual assessment as a useful diagnostic tool for psychological distress. Through statistical analysis, 7 groups were identified as most at risk of resilience overwhelm and poor stress appraisal with declining sexual functioning. These groups included soldiers who lived alone, those who lived overseas with their partners, Other Ranks aged 26-30 years old, Non-Commissioned Officers aged 26-30 years old, Commissioned Officers aged over 40 years, soldiers that had served between 1-5 years and those personnel who had served over 20 years. Soldiers in more than one of these 7 groups were likely to experience the highest levels of stress and declining sexual functioning, with up to 83% of sexual function variance attributed to stress. Within this study, predictive factors were categorised from personal narratives. At-risk soldiers were identified as either being exposed to greater disconnection or isolation, currently experiencing a life stage transition or within a period of increased occupational demand. Soldiers currently at relationship pressure points such as starting or ending an intimate relationship did not demonstrate a significance correlation between elevated stress and declining sexual function. Over 85% of soldiers admit to using the internet for sexual activity; however, the majority were at levels that were considered to be low risk. Personnel reported preferring to seek out human connection. Increased OSA was not correlated with loss of desire but it was strongly associated with a decline in sexual satisfaction. Compulsive sexual behaviour was not generally problematic. Results demonstrated that soldiers in this study were more likely to have increased sexual inhibition resulting in sexual difficulties rather than elevated excitation leading to risk taking behaviour. There were marked differences between male and female soldiers including the experience of stress, sexual function and online sexual activity, suggesting that psychoeducation and healthcare assessment should be appropriately targeted with the consideration of sex-specific interventions. More research on the psychological and physiological differences between male and female soldiers is urged. Implications for practice Whilst poor sexual functioning can be influenced by many factors, this study has concluded that sexual difficulties are positively correlated with increased stress within the British Army. Therefore, questions on sexual functioning could offer an important measure of physical, cognitive and emotional health. Psychosexual training would enable those clinicians that support at-risk soldiers presenting with stress symptoms to explore sexual functioning and behaviour as part of their patient wellbeing assessment. Soldiers could benefit from greater awareness of how personal agency and control can diminish the harmful effects of stress, whilst leaders should continue to be mindful of their direct impact on soldier wellbeing. Relationships form part of systemic resilience and contribute to soldier wellbeing, happiness and key life decisions. Army policy makers should be aware of the implications of soldier overwhelm and relationship strain in relation to financial, operational and retention decisions