Abstract
Little is known about the ability of persons with severe mental disorders to give consent to sexual activity. A possible reason
for this shortcoming is the absence of specific criteria and tools to measure sexual consent in psychiatric clinical settings.
We developed a clinician oriented semi-structured interview, the Sexual Consent Assessment Scale (SCAS), and investigated
sexual consent capacity in a sample of hospitalized patients with bipolar disorder (n = 54, M
age = 38.1 years, 48% males) and schizophrenic spectrum disorders (n = 31, M
age = 38.4 years, 29% males). The SCAS items were derived from the criteria proposed by Kennedy and Niederbuhl (Am J Ment Retard,
106:503–510, 2001). The full scale and a shorter scale comprising 10 items (SCAS-10) achieved good initial validity. Patients with schizophrenic
spectrum disorders had worse sexual consent capacity than patients with bipolar disorder. This difference was unexpectedly
independent from patients’ symptomatology, as measured by the Brief Psychiatric Rating Scale. Conversely, poor cognitive functioning
measured by the Raven’s Standard Progressive matrices was associated with reduced capacity to give sexual consent in both
groups. Subjects in the schizophrenic spectrum disorders group were more frequently judged incapable in basic knowledge of birth
control methods and in domains underlying metacognitive abilities. Principal component analysis revealed two SCAS-10 interpretable
factors: “appropriateness-recognition” and “consequences-metacognition.” Our study suggests that patients with severe psychiatric
disorders, especially those with cognitive dysfunction, might be at risk of incapacity to give valid sexual consent.
for this shortcoming is the absence of specific criteria and tools to measure sexual consent in psychiatric clinical settings.
We developed a clinician oriented semi-structured interview, the Sexual Consent Assessment Scale (SCAS), and investigated
sexual consent capacity in a sample of hospitalized patients with bipolar disorder (n = 54, M
age = 38.1 years, 48% males) and schizophrenic spectrum disorders (n = 31, M
age = 38.4 years, 29% males). The SCAS items were derived from the criteria proposed by Kennedy and Niederbuhl (Am J Ment Retard,
106:503–510, 2001). The full scale and a shorter scale comprising 10 items (SCAS-10) achieved good initial validity. Patients with schizophrenic
spectrum disorders had worse sexual consent capacity than patients with bipolar disorder. This difference was unexpectedly
independent from patients’ symptomatology, as measured by the Brief Psychiatric Rating Scale. Conversely, poor cognitive functioning
measured by the Raven’s Standard Progressive matrices was associated with reduced capacity to give sexual consent in both
groups. Subjects in the schizophrenic spectrum disorders group were more frequently judged incapable in basic knowledge of birth
control methods and in domains underlying metacognitive abilities. Principal component analysis revealed two SCAS-10 interpretable
factors: “appropriateness-recognition” and “consequences-metacognition.” Our study suggests that patients with severe psychiatric
disorders, especially those with cognitive dysfunction, might be at risk of incapacity to give valid sexual consent.
- Content Type Journal Article
- Category Original Paper
- Pages 1-9
- DOI 10.1007/s10508-011-9840-3
- Authors
- Gabriele Mandarelli, Department of Neurosciences, Mental Health and Sensory Organs, University of Rome “Sapienza”, Faculty of Medicine and Psychology, Via di Grottarossa 1035, 00189 Rome, Italy
- Stefania Zangaro, Department of Neurosciences, Mental Health and Sensory Organs, University of Rome “Sapienza”, Faculty of Medicine and Psychology, Via di Grottarossa 1035, 00189 Rome, Italy
- Michele Raja, Servizio Psichiatrico di Diagnosi e Cura, Santo Spirito Hospital, Rome, Italy
- Antonella Azzoni, Servizio Psichiatrico di Diagnosi e Cura, Santo Spirito Hospital, Rome, Italy
- Roberto Tatarelli, Department of Neurosciences, Mental Health and Sensory Organs, University of Rome “Sapienza”, Faculty of Medicine and Psychology, Via di Grottarossa 1035, 00189 Rome, Italy
- Stefano Ferracuti, Department of Neurosciences, Mental Health and Sensory Organs, University of Rome “Sapienza”, Faculty of Medicine and Psychology, Via di Grottarossa 1035, 00189 Rome, Italy
- Journal Archives of Sexual Behavior
- Online ISSN 1573-2800
- Print ISSN 0004-0002