Author Andy Behrman, aka "Electroboy," discusses the stigma attached to living with bipolar disorder and how he dealt with it.

Personal Stories on Living with Bipolar Disorder

For years, I suffered with a mental disability. I still do - no one has found a cure for manic depression (bipolar disorder) yet. During those crisis years, though, nobody knew anything was really wrong with me. I was experiencing a wild roller coaster ride of frightening highs and lows that put my life in jeopardy, but my disability was completely invisible.

Granted, I was behaving rather erratically, flying from New York to Tokyo to Paris on business three or even four times a month, counterfeiting art and smuggling tens of thousands of dollars back into the United States. At the same time, I was drinking heavily and indulging in drugs (self-medicating my mental illness), engaging in sex with complete strangers that I would meet in bars and clubs, staying up for days on end, and in general living on the edge ...

but my disability was an invisible one.

Friends and family were convinced I was functioning just fine because I was efficient, productive and successful - who wouldn't be, working twenty-hour days? I had everybody fooled with my illness. While my manic depression remained undiagnosed, I secretly wished that my disability was a physical one - one that others would notice. Maybe people would be supportive and help me if I had diabetes or, God forbid, cancer. Maybe I needed to show up to the next family function in a wheelchair to get somebody's attention. I was helpless living with this invisible illness.

Once I was diagnosed, though, and given what I refer to as my "death sentence," things changed quickly. And no, my family and friends did not come rushing to my side to support me in battling against my illness - somehow I fantasized that this was going to happen.

All of a sudden I realized the stigma of having a mental illness - it hit me smack between the eyes. And the stigma was almost as bad as having to come to terms with the fact that I was mentally ill and needed treatment.

The stigma, I realize now, "started" with me. I initiated it. It was my own fault and a result of my own naive at age 28.

When the doctor diagnosed me and used the words "manic depression" and "bipolar," I had no idea what he was talking about. "Manic" sounded like "maniac" and "bipolar" sounded like "polar bear," so I was completely confused (in retrospect I should have aligned myself with the term "bipolar" then because of the "polar bear" association, but I didn't).

I was under the impression that the illness was degenerative and that I probably wouldn't live to see my next birthday. I asked the doctor how many other people there were like me - 2.5 million people in America alone.

He tried to calm me down and talk me through the diagnosis, but I was self-stigmatized by my new label. And then, of course, he had to remind me that I was now part of a category of people called "mentally ill." Oh, God. I was a lunatic, a freak, a psycho, a crack-up and a mental case.

When I left his office on the Upper East Side of Manhattan and walked home across Central Park that snowy morning, I imagined being forced to have electroshock therapy like Jack Nicholson in One Flew Over The Cuckoo's Nest. I persuaded myself that I was overreacting, taking this too far. That could never happen to me. But actually, I wasn't taking it too far. Less than three years later I found myself in the operating room of a psychiatric hospital in Manhattan, lying on a gurney with electrodes attached to my head and receiving electroshock treatments - 200 volts of electricity through my brain.

The stigma first hit me from the "outside world" with a little help from the written prescription my doctor gave me. It was filled out for medications thought to control my manic depression. The prejudice began then.

On seeing it, my own neighborhood pharmacist remarked, "Your doctor's putting you on all of this medication? - are you okay?" I didn't respond. I paid for my four prescription drugs and left the pharmacy wondering exactly what he meant by "all of this."

Was I some sort of "mental case" because I was now taking four different medications? Did the pharmacist know something about my condition that I didn't know? And did he have to say it in such a loud voice, just hours after my diagnosis? No, he didn't, that was unkind. It seemed that even the pharmacist had an issue with mentally ill patients, and trust me, mentally ill patients in Manhattan were the "bread and butter" of his business.

Next I had to tell people about the diagnosis. Scared to death, I waited a week until I got up the nerve to ask my parents to dinner.

I took them for a meal at one of their favorite restaurants. They seemed suspicious. Did I have something to tell them? They automatically assumed I was in some sort of trouble. It was written over both of their faces. Assuring them that I wasn't, but had some news that might surprise them, I just spilled the beans.

"Mom, Dad, I've been diagnosed as a manic depressive by a psychiatrist," I said. There was a long silence. It's as if I'd told them that I had two months to live (interestingly, the same reaction that I had when my doctor told me).

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They had a million questions. Are you sure? Where did it come from? What's going to happen to you? Although they didn't come out and say it, they seemed concerned that I was going to "lose my mind." Oh, God. Their son had a mental illness. Was I going to end up living with them for the rest of their lives? And of course, they wanted to know if it was genetic. My telling them that it was didn't exactly make for a pleasant conclusion to the dinner. Not only were they now faced with the stigma that their son had a mental illness, but the stigma that mental illness ran in the family.

With friends, it was easier to break the news of my mental illness.

They seemed to know more about manic depression and were supportive of my getting well and staying on a medication regime. But all hell broke loose when medication didn't manage my illness and I opted for the last resort - electroshock therapy.

My friends had had a really mentally ill friend who had to be hospitalized and "shocked" to maintain an even keel. This was too much for some to handle and those people simply disappeared. Nobody seemed to want a friend who was now officially a psychiatric patient and, after electroshock, a certifiable zombie.

In fact, everybody seemed frightened of me, including my neighbors, my landlord and shopkeepers who I had known for years. They all looked at me "funny" and tried to avoid making eye contact with me. I, however, was extremely up-front with them. I told them all about my illness and was able to explain my symptoms to them as well as my treatment. "Have faith - one day I'm going to be just fine," I seemed to cry out inside. "I'm still the same Andy. I've just slipped a bit."

As no one knew much about my mental illness, a lot of people had the attitude that I had the capability to "kick it" and get better instantly. This was the most frustrating attitude for me. My manic depression was ravaging my life, but because nobody could see it, many people thought it was a figment of my imagination. Soon I started thinking this too. But when the symptoms were out of control - the racing thoughts, the hallucinations and the sleepless nights - the fact that I really was ill was reassuring.

The guilt I felt for having a mental illness was horrible. I prayed for a broken bone that would heal in six weeks. But that never happened. I was cursed with an illness that nobody could see and nobody knew much about. Therefore, the assumption was that it was "all in my head," rendering me crazy and leaving me feeling hopeless that I'd never be able to "kick it."

But soon, I decided to cope with my illness like it was a cancer eating away at me and I fought back. I dealt with it like it was any old physical illness. I dumped the stigma and focused on recovery. I followed a medication regime, as well as my doctor's orders, and tried not to pay attention to the ignorant opinions from others about my illness. I fought it alone, one day at a time, and eventually, I won the battle.

About the author: Andy Behrman is the author of Electroboy: A Memoir of Mania, published by Random House. He maintains the website www.electroboy.com and is a mental health advocate and spokesman for Bristol-Myers Squibb. The film version of Electroboy is being produced by Tobey Maguire. Behrman is currently working on a sequel to Electroboy.

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The role of powerlessness in recovery is a wonderful paradox. At first glance, one might think that powerlessness suggests vulnerability or defenselessness. But in actuality, powerlessness is the better advantage.

As with all recovery tools, the secret is awareness. Powerlessness is an awareness of where the true power lies. Armed with this awareness, a recovering co-dependent is freed from the insanity of power and control games.

For example, I am powerless over a family member's addiction. I jeopardize my own sanity when I invest my own emotional time and energy into figuring out how to coerce, control, or threaten another person into giving up their addiction. I can best help that person with a professionally-guided intervention that keeps me out of the middle.

The same is true for separation, divorce, abuse, and any other relationship issue. I am powerless over the parties involved; however, I do have the power to help them get professional help. I have the power to let go and let God handle situations. I have the power to own my power when others try to exercise power and control over me.

I have the power to choose my responses to a given situation, rather than jumping in and getting enmeshed in someone else's stuff. I have the power to maintain my own serenity and sanity and take care of myself, with the help of my Higher Power.

Dear God, help me to see when I am powerless over people and situations and turn those people and situations over to You. Help me to own and exercise the power I have to care for myself, so I can be the best, whole person I can be. Help me to remember that knowing where the true power lies is a clean, healthy gift I can give others.

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next: Letting Go of Painful Situations

teenage sex

When it comes to teen pregnancy - why it happens and how to prevent it - teens get loads of advice from adults, but they aren't often asked to offer their own. The National Campaign to Prevent Teen Pregnancy set out to change this by asking teens directly what they would say to other teens about preventing pregnancy.

As so many of you have made clear, the teen years shouldn't be about pregnancy, parenting, midnight feedings, and diapers. I hope that you find these ideas useful - and perhaps see your own views and opinions reflected in them.

1. Thinking "it won't happen to me" is stupid; if you don't protect yourself, it probably will. Sex is serious. Make a plan.
2. Just because you think "everyone is doing it," doesn't mean they are. Some are, some aren't - and some are lying.
3. There are a lot of good reasons to say "no, not yet." Protecting your feelings is one of them.
4. You're in charge of your own life. Don't let anyone pressure you into having sex.
5. You can always say "no" - even if you've said "yes" before.
6. Carrying a condom is just being smart - it doesn't mean you're pushy or easy.
7. If you think birth control "ruins the mood," consider what a pregnancy test will do to it.
8. If you're drunk or high, you can't make good decisions about sex. Don't do something you might not remember or might really regret.
9. Sex won't make him yours, and a baby won't make him stay.
10. Not ready to be someone's father? It's simple: Use protection every time or don't have sex.

Next, let's talk about those nasty sexual diseases.

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next: Sexually Transmitted Diseases (You're Unfriendly STDs)

Mood Disorders

It is not uncommon that clients presenting with an eating disorder also have additional diagnosis concurrently. Depression is often seen accompanying a diagnosis of an eating disorder. Grubb, Sellers, & Waligroski (1993) reported a high percentage of depressive disorders among eating-disordered women and contend that often the depressive symptoms decrease after treatment of the eating disorder. Depression has been described as a prominent, though not the exclusive form of psychopathology in these disorders (Wexler & Cicchetti, 1992). Additionally, measures of depression are often influenced by the subject's current state or illness. It is not uncommon that depression, rather than eating disturbances, is the symptom for which women seek psychological counseling (Grubb, Sellers, & Waligroski, 1993; Schwartz & Cohn, 1996; Zerbe, 1995).

Deborah J. Kuehnel, LCSW, © 1998

Bi-polar Disorder

Kruger, Shugar, & Cooke (1996) addressed the comorbidity of binge eating disorder, partial binge eating syndrome, and bipolar disorder. The work of Kruger, Shugar, & Cooke (1996) was the first to describe and link the consistent occurrence of night binging syndrome between 2:00 and 4:00 a.m. This behavior was thought this to be of significance in the bipolar population because the early morning hours are also the time in which mood switches are reported to occur in subjects with bipolar disorder. Kruger, Shugarr, & Cooke (1996) encouraged along with others that there is a definite need for developing useful diagnostic categories by redefining the eating disorders not otherwise specified (de Zwaan, Nutzinger, & Schoenbeck, 1993; Devlin, Walsh, Spitzer, & Hasin, 1992; Fichter, Quadflieg, & Brandl, 1993).

Eating is more than just food intake; eating plays an important role in our social interactions, and it can also be used to alter emotional states, and even to influence brain function. Serotonin, or 5-hydroxytryptamine (5-HT ), is a neurotransmitter that plays an important role in the regulation of circadian and seasonal rhythms, the control of food intake, sexual behavior, pain, aggression, and the mediation of mood (Wallin & Rissanen, 1994). Dysfunction of the serotoninergic system has been found in a wide array of psychiatric disorders: Depression, anxiety, disorders of the sleep-wake cycle, obsessive-compulsive disorder, panic disorder, phobias, personality disorders, alcoholism, anorexia nervosa, bulimia nervosa, obesity, seasonal affective disorder, premenstrual syndrome, and even schizophrenia (van Praag, Asnis, & Kahn, 1990).

While the background of eating disorders is complex, the disorders probably involve dysregulation of several neurotransmitter systems. The involvement of impaired hypothalamic serotonin function in these disorders is well documented (Leibowitz, 1990; Kaye & Weltzin, 1991). There is good evidence from experimental and clinical studies to suggest that serotoninergic dysfunction creates vulnerability to recurrent episodes of large binge meals in bulimic patients (Walsh, 1991). There is also evidence that bulimic behavior has a mood-regulating function, (e.g., binging and purging are used by the patients to relieve psychic tension). However, bulimic behavior seems to have different functions for different subgroups (Steinberg, Tobin, & Johnson, 1990). Binging may be used to relieve anxiety, but it may result in an increase in guilt, shame, and depression (Elmore, De Castro, 1990).

Deborah J. Kuehnel, LCSW, © 1998

Obsessive-Compulsive Disorder

Obsessional personality traits and symptoms have been reported in between 3% to 83% of eating-disordered cases depending on the criteria used. Up to 30% of anorexia nervosa patients have been reported to have significant obsessional personality features at first presentation. Clinical similarities between obsessional personality and the dieting disorders have led to the contention that obsessional personality traits might predate the onset of the eating disorder (Fahy, 1991; Thornton & Russell, 1997). Thornton & Russell (1997) discovered that 21% of the eating disorder patients were found to have comorbid Obsessive-Compulsive Disorder (OCD) but even more significant was that 37% of anorexia nervosa patients had comorbid OCD. By contrast, individuals with bulimia nervosa had much lower rates of comorbidity for OCD (3%). Thornton & Russell (1997) stressed the likelihood that the impact of starvation exaggerates an already (premorbid) obsessional personality in those with eating disorders. When individuals with a premorbid obsessional personality and symptoms focus on food, weight, and shape issues, these may become enmeshed into their series of obsessions and compulsions. These obsessions and compulsions may result in feelings of guilt, shame, and a sense of "loss of control" for the individual (Fahy, 1991; Thornton et al, 1997).

Within these obsessions and compulsions, Andrews (1997) found one explanation for the concurrent occurrence of bodily shame with bulimic and anoretic symptomatology may be that the shame itself taps directly into a central component of the disorders - undue preoccupation with body shape and dread of getting too fat. Bodily shame was shown to have a significant association with disordered eating patterns but it was unclear whether shame was an antecedent concomitant or consequence of the eating disorder (Andrews, 1997; Thornton et al, 1997).

Deborah J. Kuehnel, LCSW, © 1998

Self-Mutilation

Yaryura-Tobias, Neziroglu, & Kaplan (1995) presented the relationship between OCD and self harm and explored this connection with respect to anorexia. Four observations were found:

First, there was a disturbance of the limbic system resulting in both self-mutilation and menstrual changes. Second, pain stimulation releases endogenous endorphins which produce a pleasant feeling, control dysphoria, and actively maintain the analgesia-pain-pleasure circuit. Third, 70% of their patients studied reported a history of sexual or physical abuse. Finally, the administration of fluoxetine, a selective serotonin reuptake blocker, has been successful in treating self-injurious behavior. (p. 36).

With these observations, Yaryura-Tobias, Neziroglu, & Kaplan (1995) encouraged clinicians treating OCD and eating disorders to be aware of the possibility of self-mutilation among their patients. Conversely, those treating self-mutilation may look for symptoms of OCD and eating disorders (Chu & Dill, 1990; Favazza & Conterio, 1989).

Deborah J. Kuehnel, LCSW, © 1998

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Many with ADHD have co-occurring Eating Disorders such as sugar craving, compulsive overeating, anorexia and bulimia. Find out why.

SELF-MEDICATING WITH FOOD

As human beings we find creative ways to decrease our emotional, physical, and spiritual pain. Some people use alcohol and other drugs to ease the pain and frustration of their ADD symptoms. Others use compulsive behaviors such as gambling, spending, or sexual addictions. Eating in ways that are not good for us, but temporarily make us feel better is also a form of self-medicating. Self-medicating is when we use substances and behaviors to change how we feel. The problem with self-medicating is that it initially works, but soon leads to a host of new problems.

Eating can temporarily calm ADD physical and mental restlessness. Eating can be grounding for some people with ADD, helping them focus better while reading, studying, watching television or movies. If your brain is not quick to contain your impulses, you may eat without thinking. Some compulsive overeaters are shocked to realize they have finished a carton of ice cream or a king-size tub of theater popcorn. They were not consciously aware of how much they were eating. Eating puts them into a pleasant trance like state that is a respite from their often active and chaotic ADD brain.

Although we don't think of food as a drug, it can be used as one. We have to eat, but eating too much or too little of certain types of food has consequences. Since there is no way to totally abstain from food, eating disorders are extremely hard to recover from. You may have to abstain from certain foods, perhaps those containing sugar, because they trigger a compulsion for more, yet everywhere you look you see and smell these foods.

WHY FOOD?

Food is legal. It is a culturally acceptable way to comfort ourselves. For some people with ADD, food is the first substance that helped them feel calm. Children with ADD will often seek out foods rich with sugar and refined carbohydrates such as candy, cookies, cakes, and pasta. People who compulsively overeat, binge, or binge and purge also eat these types of foods.

It is no accident that binge food is usually high in sugars and carbohydrates, especially when you take into consideration how the ADD brain is slow to absorb glucose. One of the Zametkin PET scan studies, results indicated that "Global cerebral glucose metabolism was 8.1 percent lower in the adults with hyperactivity than in the normal controls..."¹ Other research has also confirmed slower glucose metabolism in ADD adults with and without hyperactivity. This suggests that the binge eater is using these foods to change his or her neurochemistry.

SUGAR CRAVING AND HYPERACTIVITY

Researchers have searched for the connection between sugar and hyperactivity. Some studies have reported that sugar causes hyperactivity in children. When these studies have been duplicated, however, the results were not always consistent. The idea that sugar causes hyperactivity is relatively new in our culture, and has not been passed on from previous generations. This is why grandparents are often miffed when they are told not to give their grandchild any sugar. They haven't had the experience of sugar causing hyperactivity.

What if we have been looking at the question backward? What if ADD hyperactivity actually causes people to crave sweets? If the ADD brain is slower to absorb glucose, it would make sense the body would find a way to increase the supply of glucose to the brain as quickly as possible.

I have worked with many ADD adults who are addicted to sugar, especially chocolate which also contains caffeine. They find that eating sugar helps them stay alert, calm, and focused. Prior to ADD treatment many report drinking 6-12 sugar sodas, several cups of coffee with sugar, and constantly nibbling on candy and sweets throughout the day. It is impossible to sort out what is pure sugar craving when it is mixed with the stimulating effects of caffeine on the ADD brain.

THE SEROTONIN CONNECTION

Serotonin is a neurotransmitter that has been associated with symptoms of depression. Serotonin helps regulate sleep, sexual energy, mood, impulses and appetite. Low levels of serotonin can cause us to feel irritable, anxious, and depressed. One way to temporarily increase our serotonin level is to eat foods that are high in sugar and carbohydrates. Our attempts to change our neurochemistry are short lived, however, and we have to eat more and more to maintain feeling of well being. Medications such as Prozac, Paxil and Zoloft work to regulate serotonin. These medications are frequently helpful when used in combination with ADD and eating disorder treatment. Proper levels of serotonin can also help improve impulse control giving the person time to think before they eat.

COMPULSIVE OVEREATING

Most of us overeat at times. We may eat for sheer enjoyment even if we're not hungry, or we may eat more than we intend at a dinner party or celebration. But for some, overeating becomes a compulsion they cannot stop. Compulsive overeaters lose control of their ability to stop eating. They use food to alter their feelings rather than satisfy hunger. Compulsive overeaters tend to crave foods high in carbohydrates, sugars, and salt.

BINGE EATING and ADHD

Binge eating differs from compulsive overeating in that the binge eater enjoys the rush and stimulation of planning the binge. Buying the food and finding the time and place to binge in secret creates a level of risk and excitement that the ADHD brain craves. Large amounts of foods high in carbohydrates and sugars are rapidly consumed in a short period of time. The binge itself may only last fifteen to twenty minutes. Proper levels of serotonin and dopamine aid in impulse control problems that contribute to binge eating and Bulimia.

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BULIMIA

Bulimia is binge eating accompanied by purging. The bulimic experiences the rush of planning the binge, which can be very stimulating for the person with ADD. In addition, the bulimic may be stimulated by the satiation binging provides; then, he or she adds an additional dimension to the process: the relief of purging. Many bulimics report entering an altered state of consciousness, experiencing feelings of calmness and euphoria after they vomit. This cleansing provides relief which is short lived, and so the bulimic is soon binging again.

ANOREXIA

Our culture is obsessed with thinness. "Food is OK, but, don't gain weight." No wonder so many adolescent boys and girls, as well as women and men, become imprisoned in binge and purge cycles, chronic dieting, and anorexia nervosa. Anorexia can be deadly. Anorectics have lost their ability to eat in a healthy way. Self-starvation is characterized by loss of control. They are obsessed with thoughts of food, body image, and diet. Anorectics can also use laxatives, diuretics, enemas, and compulsive exercise to maintain their distorted image of thinness.

As we learn more about ADD, we discover that people manifest ADD traits differently. Obsessing on food, exercise, and thinness gives the anorectic a way to focus their chaotic ADD brains. They become over focused on thoughts and behaviors that related to food.

Frequently these people will only become aware of their high level of activity, distractibility, and impulsiveness after they have been in recovery for anorexia. Self starvation curtails hyperactivity.

Distractibility and spaceyness are characteristics of both anorexia and bulimia, whether or not they're accompanied by ADD. In each case the inability to concentrate or focus results because the brain is not being properly nourished. For people with ADD, however, there is a history of attention difficulties that predates the eating disorder. Their concentration, impulse problems, and activity level may not improve when their eating disorder is treated. As a matter of fact, their ADD traits can get worse once they are no longer self-medicating with food, or organizing their lives around food and exercise. If you are someone who has struggled with eating disorders, and suspect you may have ADD, it is important to get an evaluation. Both your eating disorders and your ADD must be treated.

COMPREHENSIVE TREATMENT

It is essential that both ADHD and eating disorders are treated. Too many people are struggling with their eating disorders because they have undiagnosed or untreated ADD. When ADD is properly treated the individual is better able to focus and follow through with treatment for their eating disorders. They also have greater control of their impulses, and less of a need to self-medicate their ADD symptoms.

Stimulant medications such as Dexedrine, Ritalin, Desoxyn, and Adderall that work with the neurotransmitter dopamine can be helpful in treating ADD restlessness, impulsiveness, attentional problems, and problems with obsessive thoughts. Medications such as Paxil, Prozac, and Zoloft are useful because they increase serotonin levels, thus helping with impulse control, obsessive thoughts, and decrease agitation.

The key to successful treatment lies in a comprehensive treatment program that address the medical, emotional, social, and physical aspects of both ADD and eating disorders. Recovering from eating disorders takes time, hard work and commitment. Recovering from eating disorders when you have ADD is even tougher. I encourage you to be patient. Put away the whip of contempt, and have compassion for yourself. You've been through a lot. Over the years I have seen many people who were once hopeless and despondent because they could not recover from their eating disorders chart solid courses of recovery once their ADD was treated.

¹. Zametkin, Nordahl, Gross, King, Semple, Rumsey, Hamburger, and Cohen, "Cerebral Glucose Metabolism in Adults with Hyperactivity of Childhood Onset," , 30 (1990).

About the author: Wendy Richardson, MA., LMFT, the author of The Link Between ADD And Addiction: Getting The Help You Deserve, is a licensed marriage, family, child therapist and Certified Addiction Specialist in private practice. She is also a consultant, trainer, and speaks at national and international ADD, chemical dependency, and learning disability conferences.

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Be aware of what can happen to the body as a product of starvation, nutrition deprivation and purging. It could help you begin to recognize symptoms of an eating disorder in your child.

• Hair can stop growing and even fall out.
• Severe fasting or exercising can cause muscles to deteriorate.
• Bone loss.
• The body can become abnormally cold, and in an effort to keep warm, fine hair can grow all over the body, even on the face and stomach.
• Reproductive functions can completely shut down, and periods can become irregular or stop altogether.
• Excessive vomiting or laxative abuse can lead to cardiac arrest.
• Purging causes chronic sore throats and eye vessels may burst.
• Research shows that 1,000 girls die every year from eating disorders.

Abigail Natenshon, author of When Your Child Has an Eating Disorder, says there are seven specific ways parents can help prevent eating disorders and help your daughters appreciate their bodies:

1. Minimize diet and weight talk. 
2. Connect during meal times with your child.
3. Don't equate thinness with happiness.
4. Praise your daughter for what she does, not how she looks.
5. Discourage extreme or obsessive behavior of any kind.
6. Ask your daughter to make a list of her positive attributes not related to her body or appearance.
7. Help her become a good problem solver.

next: What Causes Anorexia and Bulimia in Teens?
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Vitamin B3 aka Niacin lowers bad cholesterol (LDL) and fat levels in the blood. Learn about the usage, dosage, side-effects of Niacin.

Common Forms: Niacinamide, Nicotinic acid, Nicotinamide, Inositol hexaniacinate

• Overview
• Uses
• Dietary Sources
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Vitamin B3, also called niacin, is one of eight water-soluble B vitamins. All B vitamins help the body to convert carbohydrates into glucose (sugar), which is "burned" to produce energy. These B vitamins, often referred to as B complex vitamins, are essential in the breakdown of fats and protein. B complex vitamins also play an important role in maintaining muscle tone along the digestive tract and promoting the health of the nervous system, skin, hair, eyes, mouth, and liver.

Niacin plays an important role in ridding the body of toxic and harmful chemicals. It also helps the body make various sex and stress-related hormones in the adrenal glands and other parts of the body. Niacin is effective in improving circulation and reducing cholesterol levels in the blood. Niacin needs can be partially met by eating foods containing protein because the human body is able to convert tryptophan, an amino acid, into niacin.

Dietary deficiency of niacin tends to only occur in areas of the world where people eat corn as a staple and don't use lime in fertilization. Corn is the only grain that is low in niacin. Lime releases tryptophan which, again, can be converted to niacin in the body. Symptoms of mild deficiency include indigestion, fatigue, canker sores, vomiting, and depression. Severe deficiency of both niacin and tryptophan can cause a condition known as pellagra. Pellagra is characterized by cracked, scaly skin, dementia, and diarrhea. It is generally treated with a nutritionally balanced diet and niacin supplements. Niacin deficiency also results in burning in the mouth and a swollen, bright red tongue In the United States alcoholism is the prime cause of Vitamin B3 deficiency.

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Vitamin B3 Uses

Extremely high doses of niacin (available by prescription) have been shown to prevent and/or improve symptoms of the following conditions. Because of risk of toxicity people should always consult a knowledgeable health care provider before starting high doses of niacin.

High Cholesterol
Niacin is commonly used to lower elevated LDL ("bad") cholesterol and triglyceride (fat) levels in the blood and is more effective in increasing HDL ("good") levels than other cholesterol-lowering medications. However. High doses of niacin produce the side effects of flushing of the skin (which can be reduced by taking aspirin 30 minutes before the niacin), stomach upset (which usually subsides in a few weeks), headache, dizziness, blurred vision, and liver damage. Although the time-release form of niacin reduces flushing, long-term use is associated with liver damage.

Atherosclerosis
High doses of niacin medications are used to prevent development of atherosclerosis (plaque along the blood vessels that can cause blockage) and to reduce recurrent complications such as heart attack and peripheral vascular disease (atherosclerosis of the blood vessels in the legs that can cause pain with walking, called intermittent claudication) in those with the condition. According to a review of major clinical trials, the use of niacin for prevention and treatment of atherosclerosis and related conditions is "based on strong and consistent evidence" and appears to be as effective as certain medications for heart disease. Studies also suggest that high dose niacin may help relieve the symptoms of claudication - namely diminish the pain experienced with walking.

A recent study also found that the combination of niacin and a cholesterol-lowering drug called simvastatin (which belongs to a class known as HmG CoA reductase inhibitors or statins) may dramatically slow the progression of heart disease, reducing risk of heart attack, and even death.

Vitamin B3 and Diabetes
Because diabetes is often associated with atherosclerosis and heart disease, people with diabetes may benefit from nutrients that help manage elevated cholesterol levels and high blood pressure. Although niacin has been shown to boost HDL cholesterol and decrease triglyceride and LDL levels, there has been some concern that it may also raise blood sugar levels. In a recent study of 125 people with diabetes and 343 people without the condition, high doses of niacin (roughly 3000 mg/day), increased blood sugar in both groups, but hemoglobin A1C (considered a better measure of blood sugar over time) actually decreased in the diabetes group over a 60-week follow-up period. For this reason, if you have diabetes, niacin should only be used under the close monitoring of a qualified health care provider.

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Osteoarthritis
Some preliminary studies suggest that vitamin B3, as niacinamide, may improve arthritis symptoms, including increasing joint mobility and reducing the amount of anti-inflammatory medications needed. Researchers speculate that niacinamide may aid cartilage repair (damage to joint cartilage causes arthritis) and suggest that it may be used safely along with NSAIDs (non-steroidal anti-inflammatory medications) to reduce inflammation. Further research is needed to fully understand how vitamin B3 benefits people with OA and to determine whether the results apply to large numbers of people with the condition. It does appear, however, that niacinamide must be used for at least 3 weeks before the benefits described are seen. Experts also suggest that long-term use (1 to 3 years) may slow the progression of the disease.

Cataracts
Dietary vitamin B3, along with other nutrients is important for normal vision and prevention of cataracts (damage to the lens of the eye which can lead to cloudy vision.) One study including 2900 people living in Australia found that people who consumed the most protein, vitamin A, and vitamins B1 (thiamine), B2, and B3 (niacin) in their diets were significantly less likely to develop cataracts. A follow-up study also found that many supplemental B complex vitamins (including B12, B9, B3, B2, and B1) exert a protective effect against cataracts.

Burns
It is especially important for people who have sustained serious burns to obtain adequate amounts of nutrients in their daily diet. When skin is burned, a substantial percentage of micronutrients may be lost. This increases the risk for infection, slows the healing process, prolongs the hospital stay, and even increases the risk of death. Although it is unclear which micronutrients are most beneficial for people with burns, many studies suggest that a multivitamin including the B complex vitamins may aid in the recovery process.

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Other
An interesting area of research currently underway is the use of niacin skin care products as anti-aging agents, for treatment of acne, and, possibly, for prevention of skin cancer. Dermatologists expect that there will be information emerging about topical forms of niacin for these purposes over the next few years.

 

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Vitamin B3 Dietary Sources

The best dietary sources of vitamin B3 are found in beets, brewer's yeast, beef liver, beef kidney, pork, turkey, chicken, veal, fish, salmon, swordfish, tuna, sunflower seeds, and peanuts.

 

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Vitamin B3 Available Forms

Niacin is available in several different supplement forms: niacinamide, nicotinic acid, and inositol hexaniacinate. The form of niacin that is best tolerated with the least symptoms is inositol hexaniacinate. Niacin is available as a tablet or capsule in both regular and timed-release forms. The timed-release tablets and capsules may have fewer side effects than the regular niacin; however, the timed-release are more likely to cause liver damage and are therefore not recommended for long-term treatment. Regardless of the form of niacin being used, periodic checking of liver function tests is recommended when high-dose (2 - 6 gm per day) of niacin is used.

 

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How to Take Vitamin B3

Daily requirements for niacin may be higher for those who have cancer, those who are being treated with isoniazid (for tuberculosis), and people with protein deficiencies.

Daily recommendations for niacin from the diet for healthy individuals are listed below.

It is important to note, however, that only extremely high doses of niacin (in the range of 1,500 to 3,000 mg per day in divided doses) are helpful for most medical conditions. Such high doses are considered "pharmacologic" and must be prescribed by a qualified healthcare practitioner. The practitioner will instruct you on increasing the amount of niacin slowly, over the course of 4 to 6 weeks, and to take the medicine with meals to avoid stomach irritation.

Pediatric

• Infants birth to 6 months: 2 mg (adequate intake)
• Infants 7 months to 1 year: 4 mg (adequate intake)
• Children 1 to 3 years: 6 mg (RDA)
• Children 4 to 8 years: 8 mg (RDA)
• Children 9 to 13 years: 12 mg (RDA)
• Males 14 to 18 years: 16 mg (RDA)
• Females 14 to 18 years: 14 mg (RDA)

Adult

• Males 19 years and older: 16 mg (RDA)
• Females 19 years and older: 14 mg (RDA)
• Pregnant females: 18 mg (RDA)
• Breastfeeding females: 17 mg (RDA)

 

 

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Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

High doses (75 mg or more) of niacin can cause side effects. The most common side effect is called "niacin flush," which is a burning, tingling sensation in the face and chest, and red or "flushed" skin. Taking an aspirin 30 minutes prior to the niacin may help reduce this symptom.

At the very high doses used to lower cholesterol and the other conditions mentioned previously, liver damage and stomach ulcers can occur. When taking pharmacologic doses of niacin, your doctor or other healthcare practitioner will periodically check your liver function through a blood test. People with a history of liver disease or stomach ulcers should not take niacin supplements. Those with diabetes or gallbladder disease should do so only under the close supervision of a healthcare provider. Niacin should not be used if you have gout.

Taking any one of the B complex vitamins for a long period of time can result in an imbalance of other important B vitamins. For this reason, it is generally important to take a B complex vitamin with any single B vitamin.

 

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Possible Interactions

If you are currently being treated with any of the following medications, you should not use niacin without first talking to your healthcare provider.

Antibiotics, Tetracycline
Niacin should not be taken at the same time as the antibiotic tetracycline because it interferes with the absorption and effectiveness of this medication. Niacin either alone or in combination with other B vitamins should be taken at different times from tetracycline. (All vitamin B complex supplements act in this way and should therefore be taken at different times from tetracycline.)

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Aspirin
Taking aspirin before taking niacin may reduce flushing associated with this vitamin. This should only be done under the advice of a healthcare practitioner.

Blood Pressure Medications, Alpha-blockers
When niacin is taken with certain blood pressure medications known as alpha-blockers (such as prazosin, doxazosin, and guanabenz), the likelihood of side effects from these medications is increased.

Cholesterol-lowering Medications
Niacin binds bile-acid sequestrants (cholesterol-lowering medications such as colestipol, colesevelam, and cholestyramine) and may decrease their effectiveness. For this reason, niacin and these medications should be taken at different times of the day.

As described earlier, recent scientific evidence suggests that taking niacin with simvastatin (a drug that belongs to a class of cholesterol-lowering medications known as HMG-CoA reductase inhibitors or statins including atorvastatin and lovastatin as well), appears to slow down the progression of heart disease. However, the combination may also increases the likelihood for serious side effects, such as muscle inflammation or liver damage.

Diabetes Medications
People taking insulin, metformin, glyburide, glipizide, or other medications used to treat high blood sugar levels should monitor their blood sugar levels closely when taking niacin supplements.

Isoniazid (INH)
INH, a medication used to treat tuberculosis, may deplete levels of niacin and cause a deficiency.

Nicotine Patches

The use of nicotine patches with niacin may worsen or increase the risk of flushing reactions associated with this vitamin when used medicinally.

back to: Supplement-Vitamins Homepage

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Supporting Research

Adding vitamins to the mix: skin care products that can benefit the skin [press release]. American Academy of Dermatology; March 11, 2000.

Antoon AY, Donovan DK. Burn Injuries. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, Pa: W.B. Saunders Company; 2000:287-294.

Bays HE, Dujovne CA. Drug interactions of lipid-altering drugs. Drug Safety. 1998;19(5):355-371.

Brown BG, Zhao XQ, Chalt A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med. 2001;345(22):1583-1592.

Capuzzi DM, Guyton JR, Morgan JM, et al. Efficacy and safety of an extended-release niacin (Niaspan): a long-term study. Am J Cardiol. Dec 17, 1998;82:74U - 81U.

Cumming RG, Mitchell P, Smith W. Diet and cataract: the Blue Mountains Eye Study. Ophthalmology. 2000;107(3):450-456.

De-Souza DA, Greene LJ. Pharmacological nutrition after burn injury. J Nutr. 1998;128:797-803.

Ding RW, Kolbe K, Merz B, de Vries J, Weber E, Benet Z. Pharmacokinetics of nicotinic acid-salicylic acid interaction. Clin Pharmacol Ther. 1989;46(6):642-647.

Elam M, Hunninghake DB, Davis KB, et al. Effects of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease: the ADMIT study: a randomized trial. Arterial Disease Multiple Intervention Trial. JAMA. 2000;284:1263-1270.

Gaby AR. Natural treatments for osteoarthritis. Altern Med Rev. 1999;4(5):330-341.

Gardner SF, Marx MA, White LM, et al. Combination of low-dose niacin and pravastatin improves the lipid profile in diabetic patients without compromising glycemic control. Ann Pharmacother. 1997;31(6):677-682.

Gardner SF, Schneider EF, Granberry MC, Carter IR. Combination therapy with low-dose lovastatin and niacin is as effective as higher-dose lovastatin. Pharmacother. 1996;16:419 - 423.

Garg A. Lipid-lowering therapy and macrovascular disease in diabetes mellitus. Diabetes. 1992;41(Suppl 2):111-115.

Goldberg A, Alagona P, Capuzzi DM, et al. Multiple-dose efficacy and safety of an extended-release form of niacin in management of hyperlipidemia. Am J Cardiol. 2000;85:1100-1105.

Guyton JR. Effect of niacin on atherosclerotic cardiovascular disease. Am J Cardiol. Dec 17, 1998;82:18U - 23U.

Guyton JR, Capuzzi DM. Treatment of hyperlipidemia with combined niacin-statin regimens. Am J Cardiol. Dec 17, 1998;82:82U - 84U.

Jacques PF, Chylack LT Jr, Hankinson SE, et al. Long-term nutrient intake and early age related nuclear lens opacities. Arch Ophthalmol. 2001;119(7):1009-1019.

Jokubaitis LA. Fluvastatin in combination with other lipid-lowering agents. Br J ClinPract. 1996;77A(Suppl):28-32.

Jonas WB, Rapoza CP, Blair WF. The effect of niacinamide on osteoarthritis: A pilot study. Inflamm Res. 1996;45:330-334.

Kirschmann GJ, Kirschmann JD. Nutrition Almanac. 4th ed. New York: McGraw-Hill;1996:88-99.

Kuroki F, Iida M, Tominaga M, et al. Multiple vitamin status in Crohn's disease. Dig Dis Sci. 1993;38(9):1614-1618.

Kuzniarz M, Mitchell P, Cumming RG, Flood VM. Use of vitamin supplements and cataract: the Blue Mountains Eye Study. Am J Ophthalmol. 2001;132(1):19-26.

Matsui MS, Rozovski SJ. Drug-nutrient interaction. Clin Ther. 1982;4(6):423-440.

McCarty MF. Niacinamide therapy for osteoarthritis - does it inhibit nitric oxide synthase induction by interleukin-1 in chondrocytes? Med Hypotheses. 1999;53(4):350-360.

Meyer NA, Muller MJ, Herndon DN. Nutrient support of the healing wound. New Horizons. 1994;2(2):202-214.

Nutrients and Nutritional Agents. In: Kastrup EK, Hines Burnham T, Short RM, et al, eds. Drug Facts and Comparisons. St. Louis, Mo: Facts and Comparisons; 2000:4-5.

O'Hara J, Nicol CG. The therapeutic efficacy of inositol nicotinate (Hexopal) in intermittent claudication: a controlled trial. Br J Clin Prac. 1988;42(9):377-381.

Omray A. Evaluation of pharmacokinetic parameters of tetracylcine hydrochloride upon oral administration with vitamin C and vitamin B complex. Hindustan Antibiot Bull. 1981;23(VI):33-37.

Physicians' Desk Reference. 54th ed. Montvale, NJ: Medical Economics Co., Inc.: 2000:1519-1523.

Rockwell KA. Potential interaction between niacin and transdermal nicotine. Ann Pharmacother. 1993;27(10):1283-1288.

Torkos S. Drug-nutrient interactions: a focus on cholesterol-lowering agents. Int J Integrative Med. 2000;2(3):9-13.

Visalli N, Cavallo MG, Signore A, et al. A multi-centre randomized trial of two different doses of nicotinamide in patients with recent-onset type 1 diabetes (the IMDIAB VI). Diabetes Metab Res Rev. 1999;15(3):181-185.

Whelan AM, Price SO, Fowler SF, et al. The effect of aspirin on niacin-induced cutaneous reactions. J Fam Pract. 1992;34(2):165-168.

Yee HS, Fong NT, Atorvastatin in the treatment of primary hypercholesterolemia and mixed dyslipidemias. Ann Pharmacother. 1998 Oct;32(10):1030-1043.

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men and sex

Here's a list of all the articles in the Men and Sex section of my site:

1. Men and Sex Home

2. What Women Want: Intimacy First, Then Sex

3. Don't Push Me So Hard For Sex

4. Why Women and Men Have Different Sex Timeframes

5. The Changing Sexual Attitudes and Behaviors of Women

6. Men and Sexual Rejection

7. Male Sexual Assault

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continue story below

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back to: Psychology of Sex Sitemap

I'm Laura. Read my story of surviving domestic abuse, domestic violence. Maybe it will help you break free from an abusive marriage or relationship.

Oct. 1982 - Oct. 1983

We first met in October 1982, a couple of weeks before my birthday. I was working at a pizza delivery store as a cook. The kitchen had a huge picture window that we watched the world watch us spinning pizzas, just like on TV. He frequented the little beer-joint next door, and the first day I saw him is the ONLY time I ever dropped a pizza dough - and I dropped it on my head. I thought he was HOT! He didn't see my embarrassing moment, thank goodness!

Shortly thereafter, I quit working at the pizza place and started waiting tables at the beer-joint. We started talking and spending time together. He was SO nice; he'd buy me dinner and little gifts. On my birthday, he brought me a HUGE bouquet of flowers in a swan vase (I cherished that vase for many years). Before long, I asked him to move in with me, since he was then living with his sister and her family.

I was going to college and working part-time. He was working full-time, so we played house. At first, things were great. I'd come home and cook dinner, clean the house, work on my homework. He'd watch TV or go to visit his buddies, "to let me study." After a while, I noticed that it was getting later-and-later before he'd get home. He always had an explanation of why, so I didn't worry too much. Besides, I was busy trying to keep up my schoolwork.

We talked about getting married one day, but I told him not right now, let me finish school. Unfortunately, I was quickly losing interest in that. I guess, looking back, it was because I was more interested in what I could do for him, rather than what I could do for myself. So I eventually dropped out altogether.

Then, in September 1983, we found out I was pregnant.

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Oct. 1983 - May 1985

It was an uneventful pregnancy. We talked about getting married. I wanted to, he didn't. I guess I should have left it at that! But no, I continued to argue for it, and eventually, in March 1984, we did get married in the Judge's chambers; no family, no flowers, and only his friends in attendance. My "maid of honor" was his best friend's brother. I was seven months pregnant by then.

At one point, right before that, I found out from his boss's wife that a woman named Pat kept calling him at work. When I asked him who Pat was, he gave me some vague answer about she was a girl he went to school with. He said he ran into her in the course of his job, and that I shouldn't worry about it. No matter what I asked, he always said the same thing. To this day, I know he was lying, but can't prove it.

We didn't know if the baby was a boy or a girl and didn't want to know. I picked a name for a girl but never did settle on a boy's name, which was odd, because we did end up with a girl. She was beautiful. The joy of my life. She kept me very busy, as babies do, and for a while, life seemed almost perfect. Well, as perfect as having no money could be! But many couples have the same problem, so I didn't think much about it.

A major incident happened during this time. Of course, hindsight is 20/20, but at the time I didn't see it for what it was.

My parents had been on vacation and stopped into our town to see the baby, who was by then 8 months old and starting to walk. Since I was not working, and we had not yet been "back home" to show off the new baby, they invited me to drive back with them, and they'd send us back on a bus in a couple of days. (You need to know here, we had not been back home because every time I suggested it, he made some excuse not to go. Either he had to work, or the car wouldn't make it, or he didn't feel like driving the long drive, whatever.) He was at work, so I called him and asked if he would mind if I went. I felt like I was doing the right thing, to let him know I wanted to go since it wouldn't cost us anything. His only response was to become very sullen and say, "Do whatever you want to do." So I did. I went with them. Who wouldn't have? Silly me...

I had a wonderful time, seeing all of my family, showing off our little angel. I saw a few old friends, again very proud of the baby. We discovered that if I stayed two extra days, instead of the original four, I could fly back instead of taking the bus for the same price. So we set up the flight and I called him to tell him. I was glad that I would be able to stay two more days, and also that I wouldn't have to sit on the bus for hours. The flight would only take one hour.

When I called him, he simply said, "Fine," and hung up. Since I was enjoying being with my family, I thought nothing of it. I just assumed he was having a bad day and was tired. Boy, was I ever in for a surprise!

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When he picked me up at the airport, I was expecting a warm welcome: "Hi honey, I missed you and how's my angel?" etc. Not so. He never said a word to me or the baby. I was carrying her, her car seat, her diaper bag, my purse and my carry-on bag.

He just made sure I saw him, then turned and walked off, presumably towards the car. I called after him, but he ignored me. So I put the car seat on the floor, put her diaper bag and my carry-on in it, and started pushing it step-by-step with my foot. Some lady, bless her heart, saw what was going on and helped me carry the stuff to the car, where he was waiting. We got home, and he never said anything. For the next three days, I got the "silent treatment" in response to anything I said. He made his own meals, did his own laundry; but even worse, he ignored the baby. It was as if we didn't exist.

As it turns out, he had "found out" about some shuffling I had done with the money. Nothing more than anyone else would have done in our sad financial position, but he didn't see it that way. You know, "rob Peter to pay Paul." I would let the electric bill go late to pay the already late water bill, then pay half of the rent to pay the electric bill, etc. I'd tell him I needed more of his check than he was giving me to pay those bills, but he'd say "this is all there is," not realizing that I had become friends with the bookkeeper where he worked, and I knew that he was not telling me how much he REALLY made each week.

Bottom line is this: he was convinced I was stashing money in a savings account! No amount of pleading on my part would convince him otherwise. He just "knew" that I was planning something behind his back.

Looking back, that could have been one of the things that should have made me leave. But one of the characteristics of "co-dependence" is wanting to make things better AT ALL COSTS. That's what I wanted to do. I was determined to make him see the truth about any situation, not realizing that his truth was the only one he would ever see. Now I know that, but not then.

Well, after a few more months of living check-to-check, I knew I had to find a job in order to make ends meet. So I found a good sitter for the baby, who was 11-months by then, and got a really great job at a small loan company.

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May 1985 to Oct. 1990

Just a word of warning - this one is long.

The job I got was in a loan office. I was trained to do everything from taking applications over the phone, to processing the applications, to making the loan, to taking payments, to collection work when the payments weren't made. Within a month, I was making deposits of very large amounts of money, using the manager's car to take it to the bank. My husband didn't like me leaving to go to the bank, but I tried to tell him it was part of my job, and that it showed me I was trusted to do a good job.

I made $5/hour to start and it was my money. The people I worked for were very nice and took time to show me how to do what I needed to do. The baby was at a decent daycare. I would go home in the evenings, make dinner, clean the house, play with the baby, and I thought we were doing pretty good.

Then, little odd things began happening. No, I began to NOTICE them more, I think. He would come home an hour late and say he'd gotten stuck on a job. Or the phone would ring, and if I answered it, they'd hang up - and he would accuse me of having a boyfriend. I would call his work just to say hello and that I was thinking of him, and they'd say he was late again. If I asked him what took so long to get to work, he'd start a fight about me not being home to take care of the baby, and why in the hell was I checking up on him, etc.

Since he wouldn't really help with paying the bills, we still had no money and only one car (so I took the bus to work). No matter how much I made, when I would ask him for part of his check to help pay the bills, he "didn't have any leftover." When I would ask, "leftover from what," he would change the subject or start an argument over something he maintained was my fault; such as the laundry wasn't done or dinner wasn't ready early enough.

He eventually lost his job because he lost his temper one day and told off a customer. Then it seemed as though no job was good enough for him. It didn't matter to him that even flipping burgers would bring in $4.50 an hour and would help. Oh no, he wanted to be making the $7.00 an hour he was used to, or else he just wouldn't work. So we were living on my check.

Now, I've taken you through all this to get here: In February of 1987, my boss offered me a manager's position. The only catch was that we'd have to move from San Antonio to Killeen, 175 miles away. Since he wasn't working and we really had no family ties to where we lived, it didn't seem like a problem. I thought.

As part of my manager's training, I had to work in the military offices, since the new office was in a military town. I needed to get used to the ways of the military, the language, etc., so that I'd be better informed in the new office. Well, if he called the office and I wasn't there, he'd throw a FIT for them to track me down and call him. He even threatened one time to come to the office and "take care of the problem" himself, which to this day I'm not really sure what he meant, but he scared the dickens out of the poor girl that answered the phone.

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Basically, what I'd have to do is call him, tell him "I'm going to such-and-such office, I'm leaving right now." Then I'd call him the minute I got there. If it took longer than he thought it should, then he'd want to know where I stopped, who did I see, why didn't I tell him I was stopping, etc. He never would believe that traffic was bad. He even accused me of having an affair with my boss to get the promotion.

We finally moved to the new office. I got enough of a pay raise to afford a really nice BIG house; lots of room, a big yard for our little girl to play in. Unfortunately, his male ego was hurt because he couldn't find a "good job" in the little military town. Everyone hired family or military wives, which is usually what happens. The one job he did get, he lost because of his temper again - only this time he told off the boss's wife, who doubled as the bookkeeper, when (as he said) she screwed him out of three-hours pay. I never did get the whole story on that one. At any rate, he never did get a steady job.

My job was great - for me. He hated it. As the manager, I felt it was my job to open every day at 9am and stay til close at 6pm. He felt like I should be able to come and go as I pleased (or rather, as HE pleased), because that's what "all the other managers do." I also was more comfortable taking the deposits to the bank myself, but he even questioned that, going back to when I worked for the other office. He couldn't understand why I couldn't give that job to someone else, since it had been given to me (as a clerk) previously. He assumed I was lying about going to the bank before, therefore I must be lying about going now.

Let me note something here: throughout our marriage, I was constantly being accused of lying about one thing or the other. First of all, I was not raised that way. Secondly, I had more respect for our marriage vows than that. And most of all, I had no reason to lie to him - I wasn't hiding a boyfriend or a secret bank account, contrary to his constant accusations. Toward the end of the marriage, I began to be very secretive, but I'll get to that.

After we got settled, his ego was really getting the better of him. At one point, he decided that if he couldn't find a job in that town, he would go look elsewhere. He packed a backpack with some really strange items like a little duck I had given him, some pictures of the baby and me, warm clothes (since he was headed north) and took his dog and a handgun for protection. He set off walking, with me pleading with him not to go. Looking back, I know now that it was just more manipulation and control on his part. I was playing exactly the role I was supposed to be playing, the pleading, begging, sobbing wife. I carried a lot of anger with me over that one for a long time.

Anyway, he got arrested for vagrancy about 45 miles up the road. Unfortunately, he had an outstanding ticket in another county about 100 miles farther away, so they extradited him.

He called me to come get the dog and the backpack. This was on a Friday, and he said he'd be let go Monday night. Well, Sunday afternoon I get a phone call. It's him, and he's at a friend's house in San Antonio. Turns out, he "just couldn't take it," so he called them to pay off the ticket and come bail him out. He wanted me to drive to San Antonio to get him. He was also mad as hell that I didn't come "visit him" in jail!

I couldn't believe it. Our car was barely making it, our little girl was sick, it was raining the whole weekend, and he was mad that I didn't come play the little bereaved wife to him while he was in jail for three days. Now we owe this friend about $200 that we don't have, plus I have to drive to San Antonio to pick him up, taking off work to do so. I very nearly filed for divorce right then. By that time, I was beginning to realize that I would be just fine on my own. However, once I got to San Antonio, he turned on that Irish charm again, cried and pleaded, and I took him back.

We got home, things were fine for a long time. I now know that we were in what's commonly called the "honeymoon phase." That's when there's a huge blowout, then you make up, and things are wonderful. I thought he had changed, but not so. With physical abuse, this is the time where he promises not to "ever do it again." With us, he vowed to get a job, no matter what.

He had been hanging out at this one bar, where he met this woman who he claimed needed a ride to work and to get groceries. He would tell me these stories about her, about how she was so wild that she would show off her tattoos to anyone who asked - and they were on her breasts. He would laugh about it, and when I'd say "when can I meet her," he'd say, "oh, you don't have anything in common with her, she's a biker." I believe I did have something in common with her - my husband! But he always denied anything going on. What an idiot I was, right? But denial is a big part of this syndrome. And boy was I ever in denial!

Then I got pregnant with my son. And while he was, for the most part, an accident (we hadn't really talked about having anymore, but we weren't trying NOT to), he was very welcome. I thought maybe this will keep my husband at home. And when the baby came, it did. For about two days.

I had maternity leave coming, so since I was at home, he didn't feel obligated to stay home to baby-sit. I started going in to work, saying my employees were having trouble with the computer, just so he'd have to stay home with the baby and our daughter (who was by now 5-yrs old). He'd bring them both up to me at work, and say he had a job interview. I could keep them there, since we had a little break room in the back. He'd bring crayons and a coloring book and the playpen for the baby, then show up that evening to pick us up to go home. Curiously, with all those job interviews, he never did find a job. Hmm.

All this time, he was still accusing me of one thing or the other. If he called and I was at the bank (we could walk from the office), he'd be right there within minutes to check up on me. If I called the house and he was gone, it was none of my business where he went.

We had a joint checking account, because I had this dream of "life the way it should be," where it's not "your money" or "my money," but "our money." I thought if he saw that I trusted him with it, he'd respect that. So he always had access to the money. If I tried to save some money to go visit back home, he'd end up with it. (We went back to my hometown about once a year, only when the income tax refund came in.) Even our regular expenses became next to impossible to keep up with.

Eventually, I got to where I would pay the bills with money orders and put whatever was left in the bank for groceries. Sometimes, he'd beat me to the money, and we would have to really wing it for groceries. If I questioned him, or told him to stay out of the money at least until I got groceries, he would use that as an excuse to throw a fit and stomp out and get drunk. Then he'd come home, all apologetic. More than once, he overdrew the account, using the ATM card and going by the balance on the receipt, instead of the balance in the checkbook. He would say it was the bank's fault since they didn't put the real balance on the receipt.

This went on-and-on. He'd work odd jobs for two or three days, then quit. He tried to start a lawn care business, but the extent of his advertising was to put a sign in OUR yard, which looked like hell, that he'd do yards. He figured people driving by would see the sign and call him. I bought him some nice business cards. All he had to do was walk around and leave them on front doors or windshields. I found them dumped in the trash about three weeks later. He said he had passed them all out. When I showed him the full box, he said "oh no, those are the wrong ones" and that was it. No further explanation.

During the winter of 1990, I became pregnant with our third child. Once again, I was accused of lying, on two counts. One, I was accused of "deliberately getting pregnant," and two, although I didn't even know I was pregnant until I was eight weeks, he decided "I knew all along." Wrong to both counts! She is the joy of my life, but at the time I knew that the VERY LAST thing I needed was another baby.

He gave me a really hard time for awhile, saying it probably wasn't even his etc. Then he decided to leave it alone. In August 1990, Saddam Hussein attacked Kuwait, and Fort Hood emptied out. All the soldiers went to the Persian Gulf, and I was let go in October, due to "cutbacks." I was given a very healthy severance check due to a profit sharing plan in the company, and we moved back to San Antonio. We had been away for three-and-a-half years. I was seven-months pregnant.

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Oct. 1990 - Jan 1993

**Just a note here: on top of everything else, my dad was taken hostage by Saddam Hussein. So here I was, trying to deal with being without a job, very pregnant, and my dad was in the hands of a madman. He was released relatively unharmed right before Christmas.

I decided to stay home with the kids for awhile. My daughter was born in January 1991, and we lived off my severance pay and my part of the company profit-sharing plan. In April, he finally got a job. Things seemed to be going along okay, with me at home and he was working. I was the Girl Scout leader for my daughter's troop, and we seemed to be "normal." His mother moved in with us again, and his brother too (that didn't last too long, thank goodness - his brother moved on. His mom stayed with us, though.). My mother-in-law would help me with the babies and that was good. But with two women in one house, eventually tempers started flaring and patience wore thin. So I decided to go BACK to work.

I found a job as a substitute at the nearby school district where my oldest daughter was in first grade. I suddenly discovered that I absolutely loved to teach! I toyed with the idea of going back to school, but when I approached him with it, I was shot down. He would say, "I don't think you need to go to school. It's a waste of money." So I put it off.

The teachers at the school, however, encouraged me to look into college. They didn't know the situation at home. So what I did was actually apply for, and get accepted into, the four-year college there! Two days a week, when he thought I was working, I was really in school. Later, my financial aid fell through, so I had to quit.

But once I'd tasted it, boy did I ever want more! I told him outright that I was going, whether he liked it or not. Of course, that started many arguments. What I didn't know was that I had also started on my road to freedom....

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Jan. 1993 - Sept. 1995

This was truly the beginning of the end.

I got myself together, and applied to the local junior college, turned in my financial aid early, was accepted and approved, and took my first real classes the summer of 1993. (I took 3 classes a semester for the next three years, going almost every semester. I think I skipped two.) Things really started getting weird from then on.

He would always appear to be supportive of my going to school, but he would make little remarks about how I was neglecting my "wifely duties," which included house-cleaning, cooking, taking care of the kids, and, of course, sex. Fact was, his mother kept the house very neat, and she was a good sitter for the most part. I did the cooking, nobody ever went hungry.

As for sex, I simply was not interested in sex (this happens frequently - I thought I was tired - now I know I was becoming very dissatisfied with our relationship). However, I felt that it was my job, like maybe if I could GET interested again, things would be better.

He kind of realized the dilemma I was in and used it to make me feel guilty about everything. He tried to "guilt" me into doing things I didn't EVEN want to do. For example, he really put on the pressure to bring another woman into our bedroom for a menage-a-trois. Now that may be some people's idea of a good time, and that's fine for them, but I'm not even remotely interested in anything like that.

This pressuring went on for a couple of months and one night came to a screeching halt. We went for a drink at a bar that he frequented; a strip-joint. I decided that the way to make things right with us was to try life his way, to be more open to partying and going to bars. Well, he introduced me to this "friend" of his, a dancer, who just happened to be bi-sexual. This little fact was whispered in my ear, accompanied by "Does she turn you on?" I was disgusted and left. I started walking home, and he came after me, finally realizing by my extreme reaction that I was not interested. He said he only brought it up as a joke.

Around the end of October 1994, I discovered he had an affair with another woman. She called me to confess. She felt so very guilty because she was my friend. He managed to ruin a friendship. (I know, it takes two. But to this day, I think he did it because he was jealous of my friendship with her.) I asked him about it, and with his answer THE LIGHT WENT ON. He didn't deny it, he said, "She's just trying to drive us crazy." I know now THAT was the day that I began to really think about getting the hell away from him and that I didn't love him anymore.

You see, this man never lied to me. Ever. He would very skillfully OMIT and DANCE AROUND the truth. Example: one night he came home from work, showered, and left again. He was gone until 3 a.m. The next day, I asked "where were you?" His answer was, "I went over to Joe's."

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A couple of days later, I was talking to Joe's wife on the phone, and I laughingly apologized for him being over so late. She said, "oh no, he was only here about 45 minutes around 8 o'clock." Now, notice, he didn't lie. He did go "over to Joe's," he just left out all the rest of it.

From then on, I paid very close attention. I forgave the infidelity, telling myself "once is a mistake. He was drunk." But I watched very closely. If I asked him where he went, he would get very defensive and accuse me of checking up on him. And the only answer I would get was, "just driving around, thinking."

During this time, he made it so hard for me to have a "normal" life. I had friends, but if I went to their house, I was "meeting" someone. Or we were "plotting" against him. He actually told me these things! After all, why would I want to spend more time with my friends than my husband?

Needless to say, my friends never came to our house because he made them feel too uncomfortable. He'd sit and listen very attentively to our conversation, not contributing, just almost monitoring what we'd say. So they quit coming over. The same thing would happen if my folks came to town. We would hardly have a private moment. He was always "hovering" right there. He actually told me one time that he didn't want us talking about him while they were visiting. I laughed at him, saying they couldn't care less about HIM, they wanted to talk about the grandkids. But he was so paranoid.

When I went to the grocery store, if I was gone longer than he thought I should be, I was accused of being in the storeroom with the bagboy. Really! I can laugh at it now, but then it horrified me. I had to account for every minute and every penny, and most of the time I had to take at least one of the kids with me everywhere I went. The thing is, I wasn't doing anything. But in order to prove to him I was faithful, I had to abide by his rules. And that didn't even work. He still accused me of all kinds of evil plots and infidelities.

As far as school went, I was making straight A's, staying on the Dean's list. I do not know how I managed, but I did. He never said he was proud of me, never would offer to keep the kids busy so I could study. He would just remark that I cared more about school than our family, that school was the top priority in my life. He even went so far as to say that I must be sleeping with my professors to make such good grades. At one point, I informed him that two of my professors that semester were women, and he said, "So? It could happen."

He became literally OBSESSED with anything connected with sex, whether it was porn movies, magazines, peekaboo lingerie, whatever. He started staying home, but he would camp out in our bedroom, watching those movies. Then expect me to do the things he saw in them. I know now that not only was I subjected to verbal abuse, but I endured sexual abuse as well.

A little "fun" goes a long way. Sometimes, in a healthy relationship, you and your partner might want to experiment with new things, but in this instance it went way past playful. I don't even want to admit some of the things I let him do, but feel free to use your imagination. I was probably subjected to whatever you can come up with. And I did this all in the name of "fixing" the marriage.

I began to dread going to bed. I'd stay up past midnight, just to avoid the bedroom. I would wait til he fell asleep, then creep into bed, praying he wouldn't wake up. Sometimes, of course, he would just wait me out, then I had no way out.

Then, he fell at work, hurt his back, and was unable to work for a long time. IF I thought it was bad before, it started getting worse.

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Sept. 1995 - April 1997

Everything happened so fast at the end!

My dad passed away in August 1995 and you would have thought that I would have wanted to be close to my husband, but I didn't even want to be comforted by him. His hands on me just really made my skin crawl. I guess that's because of all the sick things he was making me do "because you are my wife." I know now that in a truly healthy relationship, those things are not forced on you. When he fell and hurt his back, in one way it was a blessing, but it also ended up making matters worse. Which I guess was a good thing, because it helped me along - but I'm getting ahead of myself here.

He couldn't work, so he was home ALL THE TIME. Once he got up and around, he followed me everywhere--to school, to work, he would even go with me to the grocery store and the library. He said since he had the chance, he wanted to get to know my life. Of course, I knew even then he was just trying to see if he could "catch me" doing something. Not that I was doing anything to catch, but he was trying!

The little time I had with my friends completely disappeared. He would even go with me to my study groups, saying he wanted to learn what I was learning. But when we'd leave, he'd say "I saw you looking at that guy" (or the guy was looking at me). Of course, I had no interest in a 20-year old living with his parents, but try to tell HIM that!

If I thought the drinking was bad, it became unbearable when he added his prescription painkillers to the mix. Up to that point, I was able to hide the arguing from my kids and keep them from hearing his hateful remarks. But the drugs and alcohol combination made it harder-and-harder to prevent them from direct exposure. It got to where I was calling the police at least once a week, just to get a moment's peace.

The first time I had him arrested, they put him in a cell with a phone, and he called me EVERY TWO MINUTES, ALL NIGHT. Like a dummy, I answered the phone, accepting the collect call. He'd say, "you'd BETTER come get me, right now." I'd tell him, "no, you are gonna stay right where you are." Then, I'd hang up and he'd call right back. That continued all night long.

In the morning, like a dummy, I went and picked him up from jail. All the way home he harassed me, in front of the kids, about did I enjoy my night with my boyfriend, and when did we plan on getting together again, so he could be better dressed for his night in jail. This was in front of our children. I could feel myself hating him more-and-more, but not knowing what to do.

This was around November. The semester before, in about April, I had read a book for a research paper that ended up showing me the way to get out from under him. The Verbally Abusive Relationship by Patricia Evans literally changed my life. I had been playing with some of the techniques she describes in the book, but not really seriously.

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At this point, due to his continuing drinking and now painkillers, he was completely out of hand, worse than I had ever seen him before. He was accusing me of seeing several men, accusing me of trying to turn our kids away from him, and accusing me of even trying to make him "hurt more" by taking away his pain medication. He was out of control. So I started really turning up the heat, using the techniques Ms. Evans recommends and it was making him nuts. If he accused me of something, I wouldn't DENY it, as I used to. I'd say "I do not have to listen to this." If he tried to change the subject from my question (diverting), I'd force him back to the issue.

Believe me, these things WORK!! Sadly, it became almost a game for me, to see how crazy I could make him. I got to where I was playing HIS head games, accusing HIM of seeing another woman, that he was hiding money from me, etc., just to see him squirm. This went on for a couple of months. Then, one night, I decided I had had ENOUGH. It was Feb. 28, 1996.

This was the turning point, the moment of truth. He had gone out, "driving around" again, and came home about 11:30 (the time is important). I was pretending to be asleep again, but he came in and yanked off the blankets. I pulled them back onto the bed. He threw them out the back door. By the time I gave up on having a blanket, five were in the backyard.

He was being so loud, he woke up my youngest daughter. She came and climbed up onto our bed and I figured he'd leave her blanket alone. Oh no, out the back door went that one. I put her back into her room and bed. As I was doing so, he came into the kids' room and started swearing at me, calling me names. I ignored him, continued comforting the kids (all three, were awake by now). He kept yelling at me, cussing, then he found the straw that broke the camel's back.

He called me the one name that did it. He called me a C***. I hope you can figure it out, because I refuse to even spell it out completely! I slapped him, right in front of my babies. It was almost a reflex action, without thought, to SHUT HIM UP! I ran into the living room, thinking, "OH GOD he's gonna hit me now!" But he didn't. He just came into the living room and started yelling again, that I'd hit him for no reason.

When I realized he wasn't going to hit me, I decided it was safe to call the police. Before I could dial the number, he jerked the phone out of the wall and stomped on it. Then, he went into the bedroom and got that one and killed it, too. So I decided to go down to the payphone at the corner and thought I'd better change out of my nightgown first. I pulled my gown over my head and was reaching for my jeans and t-shirt. He came into the bedroom, and said, "if you're going somewhere, then you're going just like that."

He then picked me up (bad back was all numb from alcohol & painkillers) and tried to put me out the front door, stark naked. I went limp and he dropped me. I got dressed, and had to leave in his car, because he had mine blocked in. I called the police, and they met me at the payphone, then followed me back to the house. They put him in handcuffs, so we could get some clothes together. His mother (still living with us) left with me and the kids. It was 1:45 a.m. when we headed for my brother's house. So the whole thing took about 2-hours. That's important.

All this was due to the mixture of alcohol and drugs. When I did get brave enough to try to talk to him, he only remembered about TEN MINUTES of all of the above! He didn't know why the phones were in pieces, or the blankets in the backyard. He did remember me slapping him, but not the reason why.

I still tried to make it work. We never moved back in, but I would go stay the night, hoping things would change if we just talked it over. But every time I'd think we were getting somewhere, it would go right back to awful again. He blamed the whole thing on me, saying if I would just give up my friends and school and just be his wife again, it would all be okay. We went back and forth like that for months. I finally realized that THERE WAS NOTHING I COULD DO TO MAKE IT WORK!!!! He was NOT going to change. He didn't want to. HE DIDN'T WANT TO.

I came to see that it wasn't my fault. I was not doing anything wrong by having friends, and enjoying school, and spending time at the library. That is perfectly normal behavior. It was HIS behavior that was messed up. HE was the one who needed help. And since he didn't want to get help, for us and for our marriage, I left and stayed away for good. It was the BEST decision I made for me and my kids.

He made it really hard on us, though. The year we were separated was rough. He made sure of that. He would call and harass me. If I wasn't home, he would leave long threatening messages on the answering machine. I kept the tapes for a long time, hoping to use them to have him committed. He would drive by our house at all hours, to see if I had my "boyfriend" there (of course, I didn't want anything to do with a man at that point!). He would come up to my second job at Wal-mart and just follow me around the store. He would call there, saying he was going to commit suicide if I didn't come back to him (at one point I asked him if he needed help doing it and he stopped using that threat).

He would call my day job at the elementary school and say he was coming up there if I didn't come to the phone. Finally, when I told him he was going to get me fired and then how would I feed the kids, he quit calling there. He would just come walking into my house like it was "ours," until I told him he had to knock like the rest of the world. Then, he wouldn't come over at all (to see the kids) saying he wasn't welcome. Oh yes, he made it very hard on us.

BUT! We were away from him, for the most part. And it was a wonderful feeling. I could go places without feeling guilty. I could have friends over and actually hold conversations. It was great. My money went to my kids, not his drinking. I was actually able to save a little each payday. Not much, but more than I ever had before!

In January 1997, I filed for divorce with my income tax refund check. It took almost all of it, but it was worth it. The divorce was final April 2, 1997 and I haven't seen him since. He has chosen not to see his kids or pay his child support. I do not say bad things about him to the kids because if, in the future, they decide to look for him, I want them to be able to say that any conclusions they draw about him are their own.

Now the good news - and it gets it's own chapter!!

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Happy Ending and a New Beginning

My divorce was final on April 2, 1997. But that's not the best part. I want you to know that even after all that unhappiness, all that insanity, all the bad "stuff," I am in a healthy relationship. A loving, normal relationship. I met a wonderful man with an adorable daughter (so now I have four kids! He loves me, loves my kids, and would never in a million years hurt any of us. He makes me laugh, and makes me feel loved every day.

We truly have a healthy relationship, both as adults and as good parents to our kids. That's important, because in my first marriage, the kids were see-sawed back-and-forth, not knowing who to listen to or who they could count on. Now they do. Now they follow rules, and have consequences if they break the rules, and they know we do it because we love them.

Our relationship, on an adult level, is wonderful. We discuss, we don't yell. If we disagree, we do it intelligently. At the end of the day, we spend a few minutes sharing our day with each other. We talk over any problems and they are usually resolved. We hold hands in public. We cuddle at night. All those things that loving, caring grownups should do. And it's wonderful. I said that, didn't I? I just can't tell you how awesome it feels to do it right!!

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Dr. Levin is our "ask-the-expert" here at Adders.org

Qualified at Pretoria University 1959 MB.ChB.

Married to Ethel, a nursery school teacher

4 sons, Paediatrician, General practitioner, Steel merchant, Electrical consultant to SHOCKPROOF.

Special interest: ADHD children (and adults) with learning and /or behaviour problems. (ATTENTIONAL DEFICIT HYPERACTIVITY DISORDER)

Lectured at many universities, schools and to medical profession.

Received nominations on 2 occasions from local branch of the South African Medical Association for national award (excelsior Prize)

Has had an official interview with a previous Minister of Education on diagnostic criteria and made suggestions that were accepted and published in Study guide no7 of 1991 from the Dept. Education and Culture from the House of Assembly.

Represented Medical Association on a governmental enquiry into use of Ritalin at Dept. of Health.

Written a chapter in a textbook on ADHD, on request of a professor at a university medical school and which is sold to students and doctors.

Researched, developed and modified a diagnostic rating scale of which he has evaluated over 1/4 million in aprox. 14,000 case studies over a period of 28 years. This rating scale is now used in many assessment centres through-out the country. Developed brain assessment and development charts as diagnostic tools for ADHD as well as remedial programs being used in many schools currently.

Has had his articles published in various teaching, medical and educational journals and internationally on the internet. Has been medical advisor to various remedial schools in the past and was instrumental in starting a remedial school and serving on its governing body for 8 years.

Has also been a lecturer to St Johns First Aid for 20 years, received a medal from them and mentioned in dispatches to her majesty Queen Elizabeth II.

Below is a photo taken of Dr Billy with Andrea from ADDISS at a Conference in Dublin in June 2005

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