Can a person live an entire lifetime without sexual desire, sexual fantasies, or ever falling in love?

Otto Kernberg in his book Treatment of Severe Personality Disorders: Resolution of Aggression and Recovery of Eroticism, describes cases of total absence of sexual activity, fantasy, and relations, possibly affecting a patient's social life to the extent that there may be no social life at all. According to Kernberg, these cases involved here requiring a careful differential diagnosis:

First, there is a syndrome that includes the most severe cases of borderline personality organization, but without a narcissistic personality proper, in which a primary, total inhibition of all erotic potential has taken place. It is the case of such severely temperamentally negative predisposition, and overwhelmingly negative affect activation in the context of a traumatizing environment, that the erotization of the body surface and the erotically stimulating aspects of normal attachment have not taken place. Negative, particularly aggressive affects, override the possibility of primary erotic stimulation. 

A second type of patient with practically total loss of the capacity for erotic response is the patient with narcissistic personality who, after many years of sexual promiscuity, has lost his or her capacity for temporary infatuations and sexual involvements and whose sexual life gradually has become practically extinguished. Here, the analysis of the narcissistic personality structure should reactivate the patient's erotic potential in terms of the capacity for sexual arousal, excitement, and orgasm.

A third case is that of the "dead mother" syndrome, patients with a severely narcissistic personality structure in which the dismantling of all internalized object relations, including the concept of self, has become so dominant that their internal capability for emotional relationships seems to be erased.

Kernberg points to another particularly important observation. 

Under all these circumstances, in cases of obliteration of sexuality of the kind mentioned, there may develop an absence of erotic elements in the therapist's countertransference as well, a tendency to abandon all thoughts and feelings of erotic implications relating to that patient.

The therapist should be alert to the problem of total absence of any erotic feature to his or her reaction to the patient and make use of it to explore with the patient the correspondent deficit in his or her life as a major issue to be resolved, if possible. This is as important as the patient's relationship to work and profession and to friendship and social life.

In such cases, it is essential to maintain alertness to any, even the vaguest, manifestation of an erotic activation that potentially may emerge. Again, this emergence may only occur in the context of the activation of severely sadomasochistic features that already represent an advantage in this situation.

Otto Kernberg's perspective invites us to look differently at clinical presentations that may appear to be "asexuality" or simply a lack of interest in intimate relationships. Beneath these superficially similar manifestations may lie fundamentally different psychological processes, each requiring a different clinical approach and carrying a different therapeutic prognosis.

This is why, for Kernberg, the exploration of sexuality is not a secondary topic but one of the central pathways to understanding personality structure and its potential for change.

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(c) Yuliia Holopiorova,

Ukrainian Association of Transference-Focused Psychotherapy