Objectives: According to the DSM-5, in men, the inability to achieve or sustain an erection for satisfactory sexual activity can be of organic or psychological nature. The risk factors for Psychogenic Erectile Dysfunction (PED) include exposure to episodic, acute or chronic stressors, dysfunctional lifestyle factors and relationship patterns, anxiety, mood and personality disorders, neurotic or submissive temperamental traits. We hypothesized that worsening socioeconomic condition may lead to PED, and that depression and temperament (harm avoidance) may act as mediators or moderators of this relationship. Methods: Eighty-four patients with psychogenic erectile dysfunction and fifty healthy control subjects participated in a retrospective study that investigated stressful events (e.g., lifestyle factors) potentially associated with PED and our hypothesized mechanism linking stress, depression, temperament, and erectile dysfunction. Results: In our clinical sample, loss of economic resources was a risk factor for PED and its effects were statistically mediated by depression, especially among individuals who scored high in harm avoidance. Conclusions: Our findings are consistent with the rank theory of depression and emphasize the importance of an evolutionary approach to understanding clinical conditions such as psychogenic erectile dysfunction.
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