Acquired Generative Imagery Deficit as a Core Feature of Post-SSRI Sexual Dysfunction

This paper proposes that Post-SSRI Sexual Dysfunction (PSSD) fundamentally involves an acquired deficit in generative capacity, defined as the ability to internally produce mental images, felt bodily states, inner speech, and interoceptive awareness. Sexual dysfunction represents the most salient downstream consequence because desire depends on generating anticipatory representations of wanted states. A preliminary survey of 21 individuals with self-reported PSSD found that 90% reported vivid mental imagery prior to SSRI exposure, while 74% now experience impaired or absent imagery. This framework integrates previously disparate observations, including documented small fiber neuropathy and GPCR autoantibodies, into a coherent mechanistic model. Preprint of manuscript under peer review.