Romantic relations, sexuality and intimacy among young adults and adolescents with severe mental illness, intellectual disability and Down syndrome: a review of the literature

Abstract

Abstract Background Although sexual health and well-being have gained recognition as vital parts of a person’s overall well-being despite possible conditions of disability, individuals with severe mental illness, as well as people with intellectual disability and Down syndrome, especially adolescents and young adults, often face stigma and human rights violations which, in association with the specific nature of their clinical condition, impacting their self-esteem and the ability to form meaningful relationships and express their own sexuality. Methods Prioritizing the perspective of young people themselves with diagnoses of severe mental illness (schizophrenic spectrum disorders and psychosis), intellectual disability and Down syndrome, electronic databases were consulted and articles published in English concerning sexuality, intimacy and romantic relations were included. The only exception is a study in Spanish included due to its consistent relevance with the aim of the review. The reference sections of the relevant articles were reviewed for additional pertinent publications. Results A total of 32 studies were included and analyzed, showing that sexual and reproductive health of individuals with severe mental illness, intellectual disability and Down syndrome, particularly adolescents and young adults, is notably poorer compared to the general population. In the case of severe mental illness and mild intellectual disability, this disparity leads to increased vulnerability, including gender-based violence, risky sexual behavior, and exploitation, compounded by self-stigmatization, social isolation, and cognitive deficits inherent these disorders, impacting emotional and sexual well-being. Similarly, individuals with severe intellectual disability, including Down syndrome, exhibit greater interest in social interactions struggling to understand social boundaries facing risks of exploitation and victimization, due to the lack of appropriate sex education. Conclusions Despite the contemporary advancements in treatment modalities and increased understanding, individuals with severe mental illness, intellectual disabilities and Down syndrome, face significant challenges in their sexual lives. Societal misconceptions perpetuate the denial of appropriate sex education and reproductive choices, leaving those individuals vulnerable to victimization. Addressing these needs through comprehensive education and support is crucial to mitigate risks and improve overall well-being.