52-year-old man • erectile dysfunction • insomnia • migraine headaches • disclosure of infidelity

,; ,

doi:doi: 10.12788/jfp.0438

Case Reports

52-year-old man • erectile dysfunction • insomnia • migraine headaches • disclosure of infidelity

J Fam Pract. 2022 July;71(6):265-268 | doi: 10.12788/jfp.0438

PDF Download

References

1. Blumstein P, Schwartz P. American Couples: Money, Work, Sex. William Morrow; 1983.

2. Blow A, Hartnett K. Infidelity in committed relationships I: a methodological review. J Marital Fam Ther. 2005;31:183-216. doi: 10.1111/j.1752-0606.2005.tb01555.x

3. Glass S, Wright TL. Sex differences in type of extramarital involvement and marital dissatisfaction. Sex Roles. 1985;12:1101-1120.

4. Thompson AP. Emotional and sexual components of extramarital relations. J Marriage Fam. 1984;46:35-42. doi: 10.2307/351861

5. Laumann EO, Gagnon JH, Michael RT, et al. The Social Organization of Sexuality: Sexual Practices in the United States. University of Chicago Press; 1994.

6. Oliver MB, Hyde JS. Gender differences in sexuality: a meta-analysis. Psychol Bull. 1993;114:29-51. doi: 10.1037/0033-2909.114.1.29

7. Glass SP, Wright TL. Justifications for extramarital relationships: the association between attitudes, behaviors, and gender. J Sex Res. 1992;29:361-387. doi: 10.1080/00224499209551654

8. Spanier GB, Margolis RL. Marital separation and extramarital sexual behavior. J Sex Res. 1983;19:23-48.

9. Atkins DC, Baucom DH, Jacobson NS. Understanding infidelity: correlates in a national random sample. J Fam Psychol. 2001;15:735-749. doi: 10.1037//0893-3200.15.4.735

10. Treas J, Giesen D. Sexual infidelity among married and cohabitating Americans. J Marriage Fam. 2000;62:48-60. doi: 10.1111/j.1741-3737.2000.00048.x

11. Glass SP. Not ‘Just Friends’: Protect Your Relationship From Infidelity and Heal the Trauma of Betrayal. Free Press; 2002.

12. Blow A, Hartnet K. Infidelity in committed relationships II: a substantive review. J Marital Fam Ther. 2005;31:2. doi: 10.1111/j.1752-0606.2005.tb01556.x

13. Buunk B. Conditions that promote breakups as a consequence of extradyadic involvements. J Soc Clin Psychol. 1987;5:271-284. doi: 10.1521/jscp.1987.5.3.271

14. Charn IW, Parnass S. The impact of extramarital relationships on the continuation of marriages. J Sex Marital Therapy. 1995;21:100-115. doi: 10.1080/00926239508404389

15. Schneider JP, Irons RR, Corley MD. Disclosure of extramarital sexual activities by sexually exploitative professionals and other persons with addictive or compulsive sexual disorders. J Sex Edu Therapy. 1999;24:277-287. doi: 10.1080/01614576.1999.11074316

16. Atkins DC, Eldridge KA, Baucom DH, et al. Infidelity and behavioral couple therapy: optimism in the face of betrayal. J Consult Clin Psychol. 2005;73:144-150. doi: 10.1037/0022-006X.73.1.144

17. Johnson SM, Makinen J, Millikin J. Attachment injuries in couple relationships: a new perspective on impasses in emotionally focused marital therapy. J Marital Fam Therapy. 2001;27:145-155. doi: 10.1111/j.1752-0606.2001.tb01152.x

The impact of infidelity on couples varies due to factors such as the pre-morbid health of the marriage,¹³ the depth of involvement with the affair partner,¹⁴ and pre-existing attitudes about infidelity.¹³

Infidelity is a common cause of divorce in America. However, in a sample, Schneider et al¹⁵ found that despite initial threats to leave the marriage after infidelity, less than one-quarter of partners divorced. Other studies have found that disclosure of the infidelity and a commitment to work on the marriage may be an essential component of healing.¹⁶

One study found that 25% of married men and 15% of married women admitted to having had extramarital sex at least once during their relationship.

Emotionally focused couples therapy, with its emphasis on attachment and bonding, may hold promise for helping couples successfully work through the trauma brought on by extramarital relationships.¹⁷ Psychologist and infidelity researcher Shirley Glass found that of the two-thirds of couples who chose to stay together after an affair, 80% of them reported a better marriage after treatment.¹¹

Initial steps to take, and questions to ask

Both male and female patients need to feel comfortable surfacing sexual concerns with their clinicians. In this case, the concerns of the husband are interwoven with broader marital issues, which are the source of emotional and psychosomatic distress. His decision regarding his affair carried with it potentially life-altering consequences for his wife, 3 children, and affair partner and her family. It also raised ethical issues for the FP, who was providing care to both the husband and the wife. Appropriate care requires that a physician in this situation

demonstrate a nonjudgmental approach
clarify personal ethics in response to patient behaviors
maintain confidentiality
apply an ethical framework to resolve value dilemmas
avoid actions that would be harmful to patients.

Interviewing can help to elicit information that may be clarifying not only to the physician but also to the patient. When interviewing a patient such as the one in this case, it would be wise to ask:

How long has the affair been going on?
Why is the patient engaging in the affair?
Is abuse (emotional or physical) a factor in the marriage?
Does the patient still have feelings for their spouse? Does the patient want to work on the marriage?
Has the patient talked to a friend or therapist about the situation?
Would the patient be willing to talk to a therapist?

Continue to: Ethical and legal considerations