Erectile dysfunction (ED) has an intricate pathogenesis, with organic and psychosocial factors contributing to the shaping of its clinical manifestations and functional impairment. ED disrupts not only an individual’s sexual life but may also contribute to impairments of self-esteem, social functioning, quality of life, overall well-being, mood, etc. The assessment process and therapeutic interventions should be adequate to the specific profile of each patient, therefore an interdisciplinary approach is usually recommended, in order to find the vulnerability factors, recent triggers, psychiatric and organic comorbidities or causes, and elements that contribute to maintaining the sexual dysfunction, such as lifestyle factors, interpersonal conflicts, or inadequate sexual education. This narrative review explores the evidence-based approaches to structured psychiatric, psychological, and therapeutical assessment in patients with ED, and the most validated psychosocial treatments available. The results support the use of recognized diagnostic criteria within DSM-5TR and ICD-11, together with structured instruments (scales, questionnaires, and inventories), in a multidisciplinary approach. The cognitive model and cognitive-emotional model of ED support the initiation of cognitive-behavioral therapy in these patients. Other interventions, like the PLISSIT model, sexual therapy, couple therapy, and sexual-focused psychoeducation are also supported by evidence. In conclusion, ED requires a combined, psychiatric, psychologic, psychotherapeutic, and organic-oriented assessment, with the purpose of tailoring the treatment to the patient’s particularities.
Background: Behavioral addictions (BAs), including gambling disorder, gaming disorder, problematic pornography use, compulsive sexual behavior, and problematic internet use, have received increasing attention because of their potential impact on mental health, occupational functioning, and military readiness. Objectives: To identify military-specific risk factors, clinical and operational consequences, barriers to detection and treatment, and gaps in prevention strategies related to BAs among active-duty personnel and veterans, and to propose a framework for prevention and early intervention. Methods: A narrative evidence synthesis was conducted using studies evaluating BAs in military and veteran populations, and data were extracted regarding prevalence, risk factors, psychiatric comorbidities, functional outcomes, help-seeking barriers, and intervention approaches. Findings were analyzed thematically to identify common patterns across different BAs and to inform the development of a military-specific prevention framework. Results: Evidence consistently indicated that military personnel and veterans are at increased risk of confronting multiple vulnerability factors for BAs, including trauma exposure, deployment-related stress, social isolation, boredom, sleep disruption, risk- taking tendencies, and barriers to help-seeking. Gambling disorder and problematic gaming were the most extensively studied conditions and were associated with depression, anxiety, posttraumatic stress disorder, substance use disorders, suicidality, impaired occupational functioning, financial difficulties, and reduced operational readiness. Also, emerging evidence suggests similar associations for problematic pornography use, compulsive sexual behavior, and problematic internet use. Across studies, stigma, concerns about career repercussions, and limited awareness of available services represented important obstacles to treatment engagement. Conclusions: BAs represent an under-recognized challenge to military health and force readiness, while the available evidence supports implementing integrated prevention strategies that include routine screening, psychoeducation, commander training, confidential referral pathways, and early intervention programs. A comprehensive military-specific framework targeting behavioral addictions may improve individual well-being while reducing operational and organizational consequences.
