Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

IJIR publishes special/guest-edited issues and topical collections. The peer review process for articles included in topical collections/special issues is the same as the peer review process of the journal in general. Additionally, if the Guest Editors author an article in their topical collection/special issue, they will not handle the peer review process.​

Personality and psychiatric disorders in chronic pain male affected by erectile dysfunction: prospective and observational study


The prevalence of personality disorders (PDs) and sexual dysfunction in chronic pain patients is higher than in general population. Our main objective was to analyse the influence of PD in patients with erectile dysfunction and chronic non-cancer pain and their response to andrological treatment. One-hundred one patients were included along 30 months. Pain intensity, quality of life, sexual life quality, anxiety and depression were analysed together with opioid dose. Erectile functioning was measured with the International Index of Erectile Function (IIEF) and PDs with Millon Clinical Multiaxial Inventory (MCMI-III). The mean age was 57 ± 12 years old, with moderate to severe pain, 70% were sexually active and presented moderate to severe ED. PDs were very frequent (31%, cut-off 85 and 84% cut-off 75 scores) mostly anxiety, compulsive, though disorder, somatoform and narcissistic. Self-defeating feature presence was significantly correlated (r = −0.4, 95% CI = −0.605 to −0.145, p = 0.002) with a more severe baseline ED and narcissistic, and a better response to andrological treatment (p = 0.010, d = 1.082). Patients with dysthymia features required significantly higher opioid doses vs. control (238 vs. 102 mg/day, respectively). These findings underline the importance of diagnosing PDs to rigorously treat patients with chronic pain and ED.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3


  1. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA. 1993;270:83–90.

  2. Özkorumak E, Karkucak M, Civil F, Tiryaki A, Özden G. Sexual function in male patients with ankylosing spondylitis. Int J Impot Res. 2011;23:262–7.

    Article  Google Scholar 

  3. Bal S, Bal K, Turan Y, Deniz G, Gurgan A, Berkit IK, et al. Sexual functions in ankylosing spondylitis. Rheumatol Int. 2011;31:889–94.

    Article  Google Scholar 

  4. Pirildar T, Muezzinoglu T, Pirildar S. Sexual function in ankylosing spondylitis: a study of 65 men. J Urol. 2004;171:1598–600.

    Article  Google Scholar 

  5. Shen B, Zhang A, Liu J, Da Z, Xu X, Gu Z. A primary analysis of sexual problems in Chinese patients with ankylosing spondylitis. Rheumatol Int. 2013;33:1429–35.

    Article  Google Scholar 

  6. SED Sociedad Española del Dolor. Manual de Medicina del Dolor Fundamentos, evaluación y tratamiento. Madrid: Editorial Médica Panamericana; 2016. p. 542.

  7. Samolsky Dekel BG, Ghedini S, Gori A, Vasarri A, Di Nino G, Melotti RM. Lasting prolonged-release tapentadol for moderate/severe non-cancer musculoskeletal chronic pain. Pain Ther. 2015;4:107–17.

    Article  Google Scholar 

  8. Varrassi G, Muller-Schwefe G, Pergolizzi J, Oronska A, Morlion B, Mavrocordatos P, et al. Pharmacological treatment of chronic pain—the need for CHANGE. Curr Med Res Opin. 2010;26:1231–45.

    Article  CAS  Google Scholar 

  9. Pergolizzi J, Ahlbeck K, Aldington D, Alon E, Coluzzi F, Dahan A, et al. The development of chronic pain: physiological CHANGE necessitates a multidisciplinary approach to treatment. Curr Med Res Opin. 2013;29:1127–35.

    Article  Google Scholar 

  10. Ajo R, Segura A, Inda MD, Planelles B, Martinez L, Ferrandez G, et al. Opioids increase sexual dysfunction in patients with non-cancer pain. J Sex Med. 2016;13:1377–86.

    Article  Google Scholar 

  11. Ajo R, Segura A, Inda MD, Margarit C, Ballester P, Martinez E, et al. Erectile dysfunction in patients with chronic pain treated with opioids. Disfunción eréctil en pacientes con dolor crónico tratados con opioides. Med Clin (Barc). 2017;149:49–54.

  12. Kimball AB, Jacobson C, Weiss S, Vreeland MG, Wu Y. The psychosocial burden of psoriasis. Am J Clin Dermatol. 2005;6:383–92.

    Article  Google Scholar 

  13. Palijan TZ, Kovacevic D, Koic E, Ruzic K, Dervinja F. The impact of psoriasis on the quality of life and psychological characteristics of persons suffering from psoriasis. Coll Antropol. 2011;35:81–5.

    PubMed  Google Scholar 

  14. Ajo R, Segura A, Mira L, Inda MD, Alfayate R, Sanchez-Barbie A, et al. The relationship of salivary testosterone and male sexual dysfunction in opioid-associated androgen deficiency (OPIAD). Aging Male. 2017;20:1–8.

    Article  CAS  Google Scholar 

  15. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Publishing; 2013.

  16. Millon T. Classifying personality disorders: an evolution-based alternative to an evidence-based approach. J Personal Disord. 2011;25:279–304.

    Article  Google Scholar 

  17. Millon T, Grossman SD, Lenzenweger M, Clarkin J. Personology: a theory based on evolutionary concepts. In: Clarkin J, Lenzenweger M (eds). Major theories of personality disorder (2nd ed.). New York: Guilford; 2005. pp. 282–331.

  18. Pergolizzi J, Boger RH, Budd K, Dahan A, Erdine S, Hans G, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract. 2008;8:287–313.

    Article  Google Scholar 

  19. Cardenal V, Sánchez M, Ortiz-Tallo M. Adaptación y baremación al español del Inventario Clínico Multiaxial de Millon-III (MCMI-III). Madrid: TEA Ediciones. 2007.

  20. Rossi G, Derksen J. International adaptations of the Millon Clinical Multiaxial Inventory: construct validity and clinical applications. J Personal Assess. 2015;97:572–90.

    Article  Google Scholar 

  21. Exner J, Exner J, Levy A, Exner J, Groth-Marnat G, Wood J, et al. The Rorschach: a comprehensive system. Basic foundations and principles of interpretation (4th ed., Vol. 1). Hoboken, NJ: John Wiley & Sons, New York; 2008.

  22. Herdman M, Badía X, Berra S. El EuroQol-5D: una alternativa sencilla para la medición de la calidad de vida relacionada con la salud en atención primaria. Aten Prim. 2001;28:425–9.

    Article  CAS  Google Scholar 

  23. Snaith RP. The hospital anxiety and depression scale. Health Qual Life Outcomes. 2003;1:29.

    Article  Google Scholar 

  24. Rosen RC, Cappelleri J, Gendrano N. The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res. 2002;14:226.

    Article  CAS  Google Scholar 

  25. Woodward JM, Hass SL, Woodward PJ. Reliability and validity of the sexual life quality questionnaire (SLQQ). Qual Life Res. 2002;11:365–77.

    Article  Google Scholar 

  26. Conrad R, Schilling G, Bausch C, Nadstawek J, Wartenberg HC, Wegener I, et al. Temperament and character personality profiles and personality disorders in chronic pain patients. Pain. 2007;133:197–209.

    Article  Google Scholar 

  27. Fischer-Kern M, Kapusta ND, Doering S, Horz S, Mikutta C, Aigner M. The relationship between personality organization and psychiatric classification in chronic pain patients. Psychopathology. 2011;44:21–6.

    Article  Google Scholar 

  28. Goldstein RB, Dawson DA, Chou SP, Grant BF. Sex differences in prevalence and comorbidity of alcohol and drug use disorders: results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Stud Alcohol Drugs. 2012;73:938–50.

    Article  Google Scholar 

  29. Trull TJ, Jahng S, Tomko RL, Wood PK, Sher KJ. Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Personal Disord. 2010;24:412–26.

    Article  Google Scholar 

  30. Litwin MS, Nied RJ, Dhanani N. Health‐related quality of life in men with erectile dysfunction. J Gen Intern Med. 1998;13:159–66.

    Article  CAS  Google Scholar 

  31. Burri A, Spector T. Recent and lifelong sexual dysfunction in a female UK population sample: prevalence and risk factors. J Sex Med. 2011;8:2420–30.

    Article  Google Scholar 

  32. McMahon CG, Jannini E, Waldinger M, Rowland D. Standard operating procedures in the disorders of orgasm and ejaculation. J Sex Med. 2013;10:204–29.

    Article  Google Scholar 

  33. Angstman KB, Seshadri A, Marcelin A, Gonzalez CA, Garrison GM, Allen JS. Personality disorders in primary care: impact on depression outcomes within collaborative care. J Prim Care Community Health. 2017;8:233–8.

    Article  Google Scholar 

  34. French L, Turner K, Dawson S, Moran P. Psychological treatment of depression and anxiety in patients with co‐morbid personality disorder: a scoping study of trial evidence. Personal Ment Health. 2017;11:101–17.

    Article  CAS  Google Scholar 

  35. Dixon-Gordon KL, Berghoff CR, McDermott MJ. Borderline personality disorder symptoms and pain in college students: the role of emotional suppression. J Personal Disord. 2018;32:277–88.

  36. Sternbach RA, Wolf S, Murphy R, Akeson W. Traits of pain patients: the low-back “loser”. Psychosomatics. 1973;14:226–9.

    Article  CAS  Google Scholar 

  37. Kalmbach DA, Ciesla JA, Janata JW, Kingsberg SA. Specificity of anhedonic depression and anxious arousal with sexual problems among sexually healthy young adults. J Sex Med. 2012;9:505–13.

    Article  Google Scholar 

  38. Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol. 2010;146:891–5.

    PubMed  PubMed Central  Google Scholar 

  39. Chang M-C, Chen P-F, Lung F-W. Personality disparity in chronic regional and widespread pain. Psychiatry Res. 2017;254:284–9.

    Article  Google Scholar 

  40. Lavan H, Johnson JG. The association between axis I and II psychiatric symptoms and high-risk sexual behavior during adolescence. J Personal Disord. 2002;16:73–94.

    Article  Google Scholar 

  41. Langas AM, Malt UF, Opjordsmoen S. In-depth study of personality disorders in first-admission patients with substance use disorders. BMC Psychiatry. 2012;12:180.

    Article  Google Scholar 

  42. Zikos E, Gill KJ, Charney DA. Personality disorders among alcoholic outpatients: prevalence and course in treatment. Can J Psychiatry. 2010;55:65–73.

    Article  Google Scholar 

  43. Payer DE, Park MTM, Kish SJ, Kolla NJ, Lerch JP, Boileau I, et al. Personality disorder symptomatology is associated with anomalies in striatal and prefrontal morphology. Front Hum Neurosci. 2015;9:472. Published 2015 Aug 31.

Download references


We acknowledge the help received from Dr Olga Alda (pain clinical coordinator), Ms Raquel Martín (pain health care assistant), Ms Emi Martínez (biology fellow) and Mr Carlos García-Navas (pharmacy fellow).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ana M. Peiró.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ajo, R., Inda, MdM., Mateu, M. et al. Personality and psychiatric disorders in chronic pain male affected by erectile dysfunction: prospective and observational study. Int J Impot Res 33, 339–347 (2021).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links