Romantic relations, sexuality and intimacy among young adults and adolescents with severe mental illness: A review of the literature

Background Individuals with severe mental illness (SMI), including schizophrenia and psychotic disorders, often face significant challenges in developing and maintaining romantic and intimate relationships. Despite a strong desire for companionship and sexual expression, these individuals frequently encounter barriers such as social stigma, cognitive issues, and psychiatric symptoms affecting social functioning. Existing research primarily focuses on general social engagement rather than the specific complexities of romantic and sexual relationships. This narrative review synthesizes recent literature (2017–2023) to explore the intersection of SMI with sexuality, intimacy, and romantic relationships among adolescents and young adults. Methods A narrative review approach was used to examine studies published in English between January 2017 and December 2023. Literature searches were conducted using Web of Science and Scopus, with Boolean operators applied to keywords related to severe mental illness, adolescence and young adulthood, sexuality, and romantic relationships. Inclusion criteria focused on studies addressing intimacy, romantic relationships, and sexuality among individuals diagnosed with schizophrenia or psychosis. Studies that primarily discussed medical, forensic, or legal aspects without addressing relational or psychological dimensions were excluded. The selected literature was analyzed thematically. Results Five key themes emerged: (1) Sexual risk-taking behaviors, highlighting increased vulnerability to unprotected sex, sexually transmitted infections (STIs), and exploitation; (2) Sexual dysfunctions, often related to psychiatric symptoms and medication side effects; (3) Personal and relational resources, including the role of self-esteem, social cognition, and relationship quality in supporting romantic engagement; (4) Social stigma, which impacts self-perception, desirability, and access to relationships; and (5) Sexual orientation and gender identity, emphasizing the unique challenges faced by LGBTQ + individuals with SMI, who experience compounded stigma and relational difficulties. Conclusions This review highlights the unmet needs for intimacy, love, and sexual expression among individuals diagnosed with SMI and the significant barriers they face. Findings suggest that psychosocial interventions, comprehensive sexual education, and stigma reduction strategies are essential for improving relationship opportunities and overall well-being. Future research should focus on lived experiences and explore tailored interventions to support romantic and sexual relationships in this population.