The development of a cohesive sense of self is a task of childhood. Similarly, the capacity to tolerate frustration and adaptively regulate affects is acquired (or not) during childhood. Early childhood is a sensitive phase for the development of adequate patterns of attachment (1). These may influence interpersonal relationships throughout life. The vicissitudes of these relationships, both sexual and nonsexual in turn, may influence the etiology of many psychiatric disorders (major depressive disorder, for example) and also the capacity to cope with them.
One of the most subtle and most complex, yet important, conceptual integrations that clinicians must make is to formulate the relationship between three domains of behavior—childhood attachments; the onset of painful/negative emotions including anxiety, depression, and anger; and the experience and expression of sexuality. Connecting the past to the present may seem counterintuitive to clinicians, particularly if the patient does not do so. Also counterintuitive is the conceptual connection between emotions that may seem completely unrelated to each other. Sexual desire, for example, is associated with sexual feelings that are qualitatively different from other feelings. The notion that these may be condensed with feelings of depression, anxiety, and anger, for example, in such a way as to motivate a person to engage in certain types of sexual activities may seem improbable to some practitioners. Our clinical experience, however, and that of others suggests that mental scenarios that are influenced by disordered attachment patterns and fueled by mixed emotions may be constructed during childhood. These may repetitively motivate sexual activities (particularly problematic activities) throughout life and influence the manifestations of many psychiatric disorders.