What are the possible reasons for losing interest in sex and what to do to help

 
Have you gone off sex?

Many people go off sex for a while - especially during times of stress or after childbirth. But what if you don't regain your desire? Psychosexual therapist Paula Hall looks at the causes and solutions.

Losing interest

If you're single, or have made a conscious decision to be celibate, you may be quite happy without having sex for a while. But if you're in a relationship and you've just gone off it, not only are you missing out on the fun and intimacy sex can provide, but so is your partner. This can lead to powerful feelings of rejection and loss that can soon turn to resentment. Both partners can begin to doubt their sexuality and attractiveness.

Going off sex can be particularly disturbing for men. It's a common myth that men are always dying for it, so if you're not, both you and your partner maybe feeling left confused.

Common causes

Low sexual desire is rapidly becoming the most common issue treated in psychosexual therapy. There are a number of reasons why someone may initially go off sex, but often what happens is that even when the original cause has long gone, couples may find it very difficult to restart their sexual relationship.

In some cases, going off sex may start as a symptom of another sexual problem. For example: difficulty reaching orgasm, impotence or painful intercourse. If this maybe the cause, read the information on those conditions too.

For a few, the problem may be physical. But in the majority of cases it's the result of negative thoughts or feelings. The most common ones are:

• Poor self-esteem. If you don't feel good about yourself you'll find it difficult to see yourself as a sexual person. Your partner will be seeing a very private side of you and that takes confidence.
• Relationship issues. If you're feeling angry, upset or in any way insecure about your relationship, you need to address these issues before you can expect to feel sexual towards your partner. Try talking things through with them or going for couple counseling. Some couples struggle to feel desire for their partner because they say they feel too close. The relationship feels too much like brother and sister and sex may feel inappropriate. Sex therapy can help these couples see each other in a new light.
• Partner problems. It's a sensitive subject, but a common cause of going off sex is a partner who turns you off. It might be a physical or hygiene issue, perhaps they have a habit that makes you switch off or they're not a very skilled lover. Honesty is the only way to get round this. (See I'd like you to... for some tips.)
• Bad experiences. An inhibited childhood or a particular traumatic experience might have left you with negative feelings about sex.
• Fears. There may be powerful fears of pregnancy or getting an infection. Talking through these things with your partner or a counselor may help.

Other possible reasons

Any illness, disability or change in your lifestyle that leaves you tired, in pain or feeling low about yourself will have an indirect affect on your sex drive. The following have a direct effect:

• depression
• childbirth
• alcohol and drug abuse
• illness or damage to testes or ovaries, which can affect hormone production
• illnesses such as some pituitary conditions, hypothyroidism, cirrhosis or stress certain prescription drugs

You may find it useful to see your GP if any of the above apply.

Tips for increasing desire

• Relax. This is the most important thing you can do. Have a bath, use deep-breathing techniques or buy a relaxation tape.
• Check your environment. Be sure there are no distractions to you becoming aroused and that the atmosphere suits your mood.
• Exercise your pelvic floor. This will increase the blood flow to your genital area and make you more conscious of any sensations of physical arousal.
• Try using fantasy. Get yourself in the mood by slipping into a favorite fantasy.
• Enjoy being sensual before you're sexual. Take your time and allow your body focus on the pleasurable sensations of touch.
• Change your view. Get sex into the forefront of your mind by reading or watching something more raunchy than you'd normally choose.
• Focus on positives. If there's something about your partner or yourself you don't like, don't think about it. Force yourself to look at and think about the positives, instead.
• Stimulate your sympathetic nervous system. Exercise, watch a scary movie, go on a roller coaster - anything that will speed up your heart rate. Research suggests that 15 to 30 minutes later your body is more sexually responsive.

See the practical exercises section for more information.

Further help

If none of the self-help techniques work for you, you might want to ask your GP for advice. Alternatively, the support and guidance of a psychosexual therapist may help.

Books

The Sex Starved Marriage, Michele Weiner Davis (Simon and Schuster UK)

Rekindling Desire: A Step by Step Program to Help Low-Sex and No-Sex Marriages

Rekindling Desire: A Step by Step Program to Help Low-Sex and No-Sex Marriages Barry McCarthy, Emily McCarthy (Brunner Routledge)

Related Information:

• Difficulty Reaching Orgasm
• Orgasms
• Sex Therapy

next: Difficulty Reaching Orgasm

Recognizing the problem in anorexia nervosa

In anorexia nervosa, family members are often the first to notice that something is wrong. They notice that you are thin and continuing to lose weight. They become worried, and may be alarmed by your weight loss. You will probably continue to think that you are over-weight and will want to lose more weight. You may find yourself lying to other people about the amount you are eating, and the weight you are losing. If you have bulimia nervosa, you will probably feel guilty and ashamed of your behavior. You will try to hide it, even if it affects your work and makes it difficult to lead an active social life. People with bulimia often find that they finally admit to the problem when their life changes, perhaps a new relationship, or starting to live with other people. It can be a huge relief when this happens.

Getting the right help for anorexia

Your general practitioner can refer you to a counsellor, psychiatrist or psychologist who has experience with these problems. Some people choose private therapists, self-help groups or clinics, but it is still safest to let your GP know what is happening. You will need to have a regular physical health check.

Assessment

The psychiatrist or psychologist will first want to talk with you to find out when the problem started and how it developed. You will need to talk frankly about your life and feelings. You will be weighed and, depending on how much weight you've lost, you may need a physical examination and blood tests. With your permission, the psychiatrist will probably want to talk with your family, (and perhaps a friend), to see what light they can shed on the problem. However.. if you do not want other members of the family involved, even very young patients have a right to confidentiality. This may sometimes be appropriate because of abuse or stress in the family.

Self-help for anorexia and bulimia

• Bulimia can sometimes be tackled using a self-help manual with occasional guidance from a therapist.
• Anorexia usually needs more organized help from a clinic or therapist. It is still worth getting as much anorexia information as you can about the options so that you can make the best choices for yourself.

Things to do

Stick to regular mealtimes - breakfast, lunch and dinner. If your weight is too low, have morning, afternoon and night-time snacks.

• If you can't manage this, try to think of one small step you could take towards a more healthy way of eating. For instance, you may be unable to eat breakfast. To start with, get into the routine of sitting at the table for a few minutes at breakfast time, and perhaps drink a glass of water. When you have got used to doing this, try having just a little to eat, even half a slice of toast - but do it every day.
• Keep a diary of what you eat, when you eat it, and what your thoughts and feelings have been every day. You can use your diary to see if there seems to be any connection between how you feel, what you are thinking about, and how you eat
• Try to be honest about what you are or are not eating, both with yourself and with other people.
• Remind yourself that you don't have to be achieving things all the time- let yourself off the hook sometimes. Remind yourself that, if you lose more weight, you will feel more anxious and depressed.
• Make two lists - one of what your eating disorder has given you, one of what you have lost by it. A self-help book can help you to do this.
• Try to be kind to your body, don't punish it.
• Make sure you know what a reasonable weight is for you, and that you understand why.
• Read about stories of other people's experiences of recovery. You can find these in self-help books or on the internet.
• Think about joining a self-help group. Your GP may be able to recommend one or you can contact the Eating Disorders Association (see overleaf).

Things NOT to do

• Don't weigh yourself more than once a week.
• Don't spend time checking your body and looking at yourself in the mirror. Nobody is perfect. The longer you look at yourself, the more likely you are to find something you don't like. Constant checking can make the most attractive person unhappy with the way they look.

• Don't cut yourself off from family and friends. You may want to because they think you are too thin, but they can be a lifeline.

• Avoid websites that encourage you to lose weight and stay at a very low body weight. They encourage you to damage your health, but won't do anything to help when you fall ill.

What if I don't have any help or don't change my eating habits?

Most people with a serious eating disorder will end up having some sort of eating disorder treatment, so it is not clear what will happen if nothing is done. However, it looks as though most people with an established eating disorder will continue with it. Some sufferers will die, but this is less likely if you do not vomit, use laxatives or drink alcohol.

Professional help Anorexia

You need to get back to somewhere near a normal weight. To help with this, you and your family will first need information. What is a 'normal' weight for you? How many calories are needed each day to get there? You may ask, "How can I make sure that I don't become fat again ?" and "How can I be sure that I will be able to control my eating?" At first, you probably won't want to think about getting back to a normal weight, but you will want to feel better.

• If you are still living at home, your parents may get the job of checking what food you are eating, at least at first. This involves making sure that you have regular meals with the rest of the family, and that you get enough calories. Mounds of lettuce can be very deceptive! You will see a therapist regularly, both to check your weight and for support.
• Dealing with this problem can be stressful for everyone concerned and your family may need support to cope with an eating disorder. This doesn't necessarily mean that the whole family has to come to therapy sessions together (although this can be very helpful for younger patients). It does mean that your family may need help to understand and cope with the anorexia.

• It will be important to discuss anything that may be upsetting you, such as how to get on with the opposite sex, school, self-consciousness, or any family problems. Although it is important to be able to talk things over confidentially, sometimes a therapist may need to discuss things with you and your family together.

Psychotherapy or counseling

• This involves spending time regularly, probably about one hour every week, with a therapist to talk about your thoughts and feelings. It can help you to understand how your problem started, and then how you can change some of the ways you think about things. You can talk about the present, the past, and your hopes for the future. It can be upsetting to talk about some things, but a good therapist will help you to do this in a way which helps you to feel better about yourself.
• Sometimes it can be done in a small group of people with similar problems, in sessions lasting around 90 minutes.
• Other members of your family can be included, with your permission. They may also be seen separately for sessions to help them understand what has happened to you, how they can work together with you, and how they can cope with the situation.
• Treatment of this sort can last for months or years.
• Only if these simple steps do not work, or if you are dangerously underweight, will the doctor suggest admission to hospital.

Hospital treatment

This consists of much the same combination of controlling eating and talking about problems, only in a more supervised and concentrated way.

Physical health

• Blood tests will be done to check whether you have become so under-nourished that you are anaemic or at risk of infection.
• Your weight will be regularly checked to make sure that you are slowly getting back to a healthy weight.

Advice and help with eating

• A dietician may meet with you to discuss healthy eating - about how much you eat and whether you are getting all the nutrients you need to stay healthy.
• You can only get back to a healthy weight by eating more, and this may be very difficult at first. You will be encouraged to eat regularly, but also helped to deal with the anxiety this causes you. Staff will help you to set targets and to deal with the fear of losing control of your eating.
• Gaining weight is not the same thing as recovery - but you can't recover without first gaining weight. If you are starved, you won't be able to think clearly or concentrate properly.

Compulsory treatment

This is unusual. It is only done if someone has become so unwell that he or she:

• cannot make proper decisions for themselves
• needs to be protected from serious harm. In anorexia, this can happen if your weight is so low that your health (or life) is in danger and your thinking has been severely affected by the weight loss.

How effective is the treatment?

More than half of sufferers make a recovery, although they will on average be ill for five to six years. Full recovery can happen even after 20 years of severe anorexia nervosa. .Past studies of the most severe cases admitted to hospital have suggested that one in five of these may die. With up-to-date care, the death rate is much lower if the person stays in touch with medical care. .As long as the heart and other vital organs have not been damaged, most of the complications of starvation (even bone and fertility problems) seem to recover slowly, once a person is eating enough.

Bulimia:

Psychotherapy

Two kinds of psychotherapy have been shown to be effective in bulimia nervosa. They are both given in weekly sessions over about 20 weeks.

Cognitive Behavioural Therapy (CBT)

This is usually done with an individual therapist, but can be done with a self-help book, group sessions or even self-help CD-ROMs.CBT helps you to look at your thoughts and feelings in detail. You may need to keep a diary of your eating habits to help find out what triggers your binges. You can then work out better ways of thinking about, and dealing with these situations or feelings.

Interpersonal Therapy (IPT)

This is also usually done with an individual therapist, but concentrates more on your relationships with other people. You may have lost a friend, a loved one may have died, or you may have been through a big change in your life. It will help you to rebuild supportive relationships that can meet your emotional needs better than eating.

Eating advice

The aim is for you to get back to eating regularly, so you can maintain a steady weight without starving or vomiting. You may need to see a dietician for advice about a healthy, balanced diet. A guide such as "Getting Better BITE by BITE" (see references) can be helpful.

Medication

Even if you are not depressed, SSRI antidepressants can reduce the urge to binge eat. This can reduce your symptoms in 2-3 weeks, and provide a "kick start" to psychotherapy. Unfortunately, without the other forms of help, the benefits wear off after a while. Medication is useful, but not a complete or lasting answer.

How effective is the treatment?

• About half of sufferers recover, cutting their binge eating and purging by half. This is not a complete cure, but can enable someone to get back some control of their life, with less interference from their eating problem.
• The outcome is worse if you also have problems with drugs, alcohol or harming yourself.
• CBT and IPT work just as effectively over a year, although CBT seems to start to work a bit sooner.
• There is some evidence that a combination of medication and psychotherapy is more effective than either treatment on its own. .Recovery usually takes place slowly over a few months, or even years.
• Long-term complications include damaged teeth, heart burn, and indigestion. A small number of people will have epileptic fits.

The Royal College of Psychiatrists also produces mental health information for patients, carers and professionals including: Alcohol and Depression, Anxiety and Phobias, Bereavement, Depression, Depression in Older Adults, Manic Depression, Memory and Dementia, Men Behaving Sadly, Physical Illness and Mental Health, Postnatal Depression, Schizophrenia, Social Phobias, Surviving Adolescence and Tiredness.

The College also produces factsheets on treatments in psychiatry such as Antidepressants, and Cognitive Behavioural Therapy. All these can be downloaded from this website. For a catalogue of our materials for the general public, contact the Leaflets Department, Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG. Tel: 020 7235 2351 ext.259; Fax: 020 7235 1935; E-mail: leaflets@rcpsych.ac.uk.

Organisations that can help

Eating Disorders Association, 103 Prince of Wales Road, Norwich NR1 1DW Helpline: 01603-621-414; Monday to Friday, 9.00 am to 6.30 pm Youth Helpline: 01603-765-050; Monday to Friday, 4.00 pm to 6.00 pm www.edauk.com. Provides information and help on all aspects of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating and related eating disorders.

NHS Direct 0845 4647 www.nhsdirect.nhs.uk. Provides information and advice on all health topics.

Patient UK. www.patient.co.uk. Provides information on leaflets, support groups, and a directory of UK websites on all aspects of health and disease.

Young Minds, 102 - 108 Clerkenwell Rd, London EC1M 5SA; Parents Information Line: 0800 018 2138; www.youngminds.org.uk. Provides information and advice on child mental health issues.

Anorexia Nervosa and Related Eating Disorders, inc www.anred.com/slf_hlp.html. Website with information on eating disorders. 17

Books

Breaking free from Anorexia Nervosa: A Survival Guide for Families, Friends and Sufferers, Janet Treasure (Psychology Press)

Overcoming Anorexia Nervosa: A self-help guide using Cognitive Behavioural Techniques, Christopher Freeman and Peter Cooper (Constable & Robinson)

Bulimia Nervosa and Binge-eating: A guide to recovery, Peter Cooper and Christopher Fairburn (Constable & Robinson)

Overcoming Binge Eating, Christopher G Fairburn (Guildford Press)

Getting Better BITE by BITE: A Survival Kit for Sufferers of Bulimia Nervosa and Binge Eating Disorders, Ulrike Schmidt and Janet Treasure (Psychology Press)

References

Agras, W. S., Walsh, B.T., Fairburn, C. G., et al (2000) A multicentre comparison of cognitive-behavioural therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry, 57, 459-466.

Bacaltchuk J., Hay P., Trefiglio R. Antidepressants versus psychological treatments and their combination for bulimia nervosa (Cochrane Review). In: The Cochrane Library, Issue 2 2003.

Eisler, I., Dare, C., Russell, G. F. M., et al (1997) Family and individual therapy in anorexia nervosa. Archives of General Psychiatry, 54, 1025-1030.

Eisler, I., Dare, C., Hodes, M., et al (2000) Family therapy for anorexia nervosa in adolescents: the results of a controlled comparison of two family interventions. Journal of Child Psychology and Psychiatry, 41,727-736.

Fairburn, C. G., Norman, P.A., Welch, S. L., et al (1995) A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments. Archives of General Psychiatry, 52, 304-312.

Hay, P. J., & Bacaltchuk, J. (2001) Psychotherapy for bulimia nervosa and bingeing (Cochrane Review) In The Cochrane Library Issue 1.

Lowe, B., Zipfel, S., Buchholz, C., Dupont, Y., Reas D.L. & Herzog W. (2001). Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study. Psychological Medicine, 31, 881-890.

Theander, S. (1985) Outcome and prognosis in anorexia nervosa and bulimia. Some results of previous investigations compared with those of a Swedish long-term study. Journal of Psychiatric Research 19, 493-508.

next: Medical Management Of Anorexia Nervosa And Bulimia Nervosa
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What happens to anorexic teenagers when they become anorexic young women?

In their twenties many fall in love, get married and try to build a life with their husbands just like other young women. The difference is that the anorexic young woman has anorexic thinking and feeling influencing every decision and action in her life. She is often very afraid.

Most people in their mid-twenties go through a kind of developmental shock as they are confronted by new and different kinds of personal challenges in their lives. The woman is only recently no longer a young girl. There are new responsibilities to understand and shoulder. She discovers that she and others people are placing new and often quite reasonable expectations on her.

Whether she accepts those expectations or not, she still has to deal with them. This is a stressful time for any young woman, but particularly so for an anorexic young woman. She can feel angry, frightened and overwhelmed.

An anorexic who for years has been doing a 'good job' at being anorexic is hiding in plain sight all the time. She's thin, but not skeletal. According to fashion dictates, she is elegantly lean in a most feminine way.

When friends and family see her, they often see an attractive, dainty and feminine young woman who, in their eyes, might be a lovely model. She is a bit on the nervous side and does overreact to a few things, they think, but, they continue to themselves, she's still young. She'll outgrow it soon.

However, she knows she has begun to build an adult life based precariously on an image of herself that is unsupported by her inner world.

Inside, the anorexic young woman is wracked with anxiety. Because her outer appearance is so different from her inner experience she has problems expressing her fears. If she makes a reference to her anxieties she is often ignored or discounted. She may even be accused of being stupid for being nervous because she appears to have a good life. She may have what appears to others to be a better life than they, and so her pain is even more difficult to accept or understand.

This makes her, already an isolated person, even more isolated. Grief, despair and anxiety become her constant companions.

If someone does see a bit through her facade, suggests that she has a mental problem and that it might be a good idea to seek psychotherapy she will often panic. The classic paradoxical thought comes through. "I don't need a psychotherapist. I just need someone to talk to honestly who will listen to me."

She yearns for genuine understanding, but that means she would have to reveal herself. This would, in her perception, destroy the adult life she is attempting to build. She knows her foundations for that life are flimsy. She is so good at creating a correct and lovely appearances that few people appreciate just how flimsy her foundations are. And, in keeping with her isolationist beliefs, she can think of no one who could listen to her. She is trapped in a bind created by her own mind.

Because she needs desperately to have people think well of her and because she thinks her appearance is the way to control other people's perceptions she strives valiantly to maintain a specific look and image.

If she publicly acknowledges her tormented inner world, she is terrified of what people will think of her. Her fear drives her to create an image of even greater perfection as she withholds her real feelings from others. She draws the anorexic trap tighter around herself.

Often, she knows she is doing this and her terror terrifies her as well. Her intelligence may tell her that this kind of thinking and behavior doesn't make sense, but it seems more powerful than any healing action she might dare.

Many anorexic women find benefits to being riddled with anxiety. Anxiety can be a powerful experience that overwhelms the possibility of feeling anything else. In the anorexic anxiety can eliminate any recognition of hunger for food. It's easier to starve. But then they can panic over that too. Too much starvation might affect their appearance so that others know something is wrong.

An anorexic can feel hunger. But her anxiety is greater than her hunger. Her fear is that is she eats a tiny bit or eats the wrong thing her hunger will overwhelm her and she won't be able to stop eating. That fear creates an overwhelming state of anxiety that floods her inner world. The flood of anxiety overwhelms her need to nourish herself and she continues living in starvation mode.

Often the anorexic woman knows she is in some kind of cycle where she recognizes a pattern to her feelings of weakness and flooding anxiety. She doesn't know what is causing it. She can't tell if it's coming from the outside world or from her inner life. If she gets more close to exploring her inner life than she can bear, she often will feel a strong burning sensation in her abdomen.

This is like a danger signal, a warning not to know more about herself. Also, since that burning sensation will prevent her from eating food, she may experience that pain as a kind of familiar protection. She may also experience it as a betrayal and become even more frightened.

The anorexic young woman wants relief from this anguish. She says she wants a normal life, but she doesn't really know what that is. She hopes there is help, but she can't imagine it. Help involves moving into exactly what she fears most, letting someone see her real inner life. It means experiencing exactly what she wants to avoid.

She is not a teenager now. She is a young woman attempting to build a life. She may have made promises to her husband, made commitments to an advanced educational program, be on a career track where others depend on her. After all, she looks good and knows how to control her appearance and what others perceive at least for a while longer.

Healing may mean that her flimsy structure will collapse. She cannot imagine the life that would remain in the debris. Despite her fear and pain she is clutching to the life she has. She tries to keep her fear and pain away from her awareness through starving, controlling her appearance and trying to control other people's behavior and perceptions. She is certain that if she surrenders control she is doomed to unimaginable horrors.

It's difficult to convey to a woman who is anorexic that the healing process does not have to be dramatic and extreme. Healing is a gradual process where each level of experience unfolds when the person is ready for it. That's one of the many reasons a mental health professional who understands eating disorders is so helpful. Healing is painful. So is being anorexic and living with hidden pain.

One kind of pain is endless. The other is in the service of healing and living that healthy life she so years for.

The biggest and most important step in healing is that first step...making the commitment to your own healing regardless of fear and regardless of what people think. The young adult anorexic woman knows that building a life on false appearances with no solid base just makes the structure she is creating more apt to topple on its own. The consequences will impact her and people who depend on her presence.

This adds to her anxiety. But this thought can also lead her to make a decisive move toward genuine healing and a genuine life.

There are ways to recover and people to help.

U.S. Sources of Help

More help is available in urban areas than rural areas, but more resources are continually developing around the country. Specific, personal, in depth and confidential attention is available through private practice licensed psychotherapists. This is often more costly than what is available through clinics which often offer treatment at low fee by therapists in training who are supervised by licensed professionals or by HMO programs which limit number of sessions and access to psychotherapy. Some hospitals have excellent in patient and out patient treatment programs for people with eating disorders.

Twelve step programs can be a great support. Plus the people you meet at local meetings may be able to provide good local referrals to public and private resources that may be helpful to you.

Referrals are available online for therapists, out patient and residential programs around the world.

See:

EDAP (Eating Disorder Awareness and Prevention)

The Something Fishy website offers a treatment finder section.

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sexual problems

Almost everyone, at one time in their lives, will have been attracted to a person of the same gender, but not necessarily felt sexual attraction. We all have idols, heroes or heroines during our growing years, and for many, that is where it ends. But for about 10-15% of the adult population, the feelings of attraction to a person of the same gender persist.

Trying to identify your true sexual orientation may be difficult for some, who might be distressed at the feelings of sexual attraction, and experience behavioral changes, like withdrawal, unwillingness to go out socially, mood swings, eating difficulties, and problems with concentration.

The question 'Am I gay or lesbian?' can be a cause of great pain and turmoil to many women and men alike. In particular, those who have had a strict religious upbringing can suffer very much if they find themselves attracted to a person of the same gender.

Many people suppress their true feelings and form heterosexual relationships, leading to marriage or longterm partnerships in an attempt to be 'normal' or acceptable to family, friends and society. Others suppress their feelings with alcohol, drugs, or even overwork. Sadly, a number of gifted, talented people have committed suicide, rather than face the disapproval or judgment of family members. People do not choose to be gay, they either are or are not, although to date there is no proof that it is either 'in the genes' or determined by experiences in early life.

It can be very helpful to openly discuss these feelings and attractions with someone non-judgmental and supportive, who can help you to discover who you really are.

next: Male Erection: Penis Erection Problems

sexual problems

Men don't like to admit to sexual problems, especially their own.

Women are much more ready to admit ignorance, to find fault with their own behavior, and to look for ways of making things better. Compare women's magazines with men's. The women's magazines have articles on improving sex and fixing problems in virtually every issue. Playboy and Penthouse almost never have such articles. Since so much rides on a man's being good, or at least adequate, in sex, it's very difficult for men to hear they have a problem in this area.

A lot of these differences are things that both sexes have taken heat about. Women are often criticized by partners for their relative lack of interest, not initiating enough, wanting too much foreplay, and taking too long to get aroused or to orgasm. Men have been scolded for every single item on the list. I think the criticism is unfortunate and gets us nowhere. In a sense, everyone is doing what comes naturally, whether naturally be defined as what's built in or what's been learned over the years.

While it is true that we have to learn to accommodate to each other, I don't think blame and accusations or feeling guilty is going to help. We have to feel good about ourselves to have decent relationships and sex. A man should not have to feel guilty for looking at or fantasizing about younger women, for desiring sex without love, or anything else that he is or feels. But neither, on the other hand, should he denigrate his partner. It's fine if you have fantasies about the college girl next door, but it's something else if you make comments about her in front of your lover that imply your lover is inadequate. It's fine if you sometimes want a quickie -- perhaps you can arrange it with your partner -- but it is not fair to complain that you can't have them all the time or that she takes too long to turn on.

The male ways of expressing love and sex are really OK. And so are the female ways. The better we understand and feel about ourselves and each other, the more likely we will be able to make the changes we desire in our sex lives and elsewhere.

From "The New Male Sexuality" by Bernie Zilbergeld, PhD. Copyright © 1992 by Bernie Zilbergeld.

next: Four Perspectives on Sex Problems

men and sex

Not many people talk about male rape and sexual assault. However, I discovered that outside of child abuse and the prison population, the gay community deals with that a lot. I would imagine that men, like women who are sexually victimized, wonder whether what happened was rape and whether they were to blame.

Rape and sexual assault can happen to anyone, including men, regardless of their race, class, age, size, appearance, or sexual orientation.

"I picked up this guy at a bar and took him home with me. He made me have a kind of sex that I didn't want. I was too scared to fight back or refuse. Is that sexual assault?"

Yes. Rape and sexual assault include any unwanted sexual acts. Even if you agree to have sex with someone, you have the right to say "no" at any time, and to say "no" to any sex acts. Rapists sometimes use threats or weapons to force a person to cooperate. It is important to remember that cooperation does not mean consent. Sometimes cooperating with a rapist is necessary to survive the situation. If you are sexually assaulted or raped, it is never your fault - you are not responsible for the actions of others.

What are rape and sexual assault?

A sexual assault is any time either a stranger, or someone you know, touches any parts of your body in a sexual way, directly or through clothing, when you do not want it. Sexual assault includes situations when you cannot say no because you are drunk, high, unconscious, or have a disability.

Rape is any kind of sexual assault that involves the forced penetration of the anus or mouth, by a penis or other object.

Rape and sexual assault are not sex, they are violent crimes. Rape and sexual assault, like any other forms of violence, are used to exert power and control over another person.

Can men be sexually assaulted or raped by other men?

Yes. Rape and sexual assault can happen to anyone, including men. Thousands of men are sexually assaulted and raped every year, and it has nothing to do with their race, class, age, religion, sexual orientation, size, appearance, or strength. A man can be sexually assaulted by a stranger, a family member, or someone he knows and trusts. Experts estimate that 1 in 6 men are sexually assaulted during their lifetime. Even though male sexual assault remains vastly underreported, the united States Department of Justice documents more than 13,000 cases of male rape every year.

"I was walking down the street late one night and three guys jumped me and dragged me into an alley. They called me a "faggot" and a "bitch", threatened to beat me up, and forced me to give them all blow jobs. It this what I get for being gay?"

No. What you experienced was a sexual assault, a crime of violence, not sex. Attackers frequently use verbal harassment and name-calling during a sexual assault. Sexual assault has nothing to do with the sexual orientation of the attacker or the survivor. While rapists can be bisexual or gay, most of the men who rape and sexually assault other men are heterosexual. Sometimes heterosexual men use rape and sexual assault to target, humiliate, and hurt other men for being gay. A sexual assault does not make you gay, bisexual, or heterosexual.

What are typical reactions during or after a rape or sexual assault?

Sexual assault or rape is almost always a traumatic experience. Sometimes a man who is sexually assaulted or raped has an involuntary or forced erection or ejaculation. Also, muscles in the anus often relax when a man is raped. This does not mean that the survivor wanted to be raped or sexually assaulted. Involuntary erections and ejaculations are normal reactions to trauma.

Although, everyone reacts differently to surviving such an assault, there are some common symptoms and reactions.

Common Physical Symptoms:

• tears in the lining of the rectum
• swelling and abrasion of the anus
• anal warts or lesions
• stiff or sore limbs
• loss of memory and/or concentration
• loss of appetite
• nausea
• changes in sleep patterns
• stomachaches
• and headaches

Sometimes a survivor can contract a sexually transmitted disease during the assault, but not have symptoms until months later.

Common Psychological Reactions:

• denial
• shame
• humiliation
• feeling of loss of control
• fear
• mood swings
• flashbacks to the attack
• depression
• loss of self-respect
• anger
• anxiety
• guilt
• retaliation fantasies
• nervous or compulsive habits
• change in sexual activity
• suicidal thoughts and behavior
• withdrawal from relationships or support networks.

"My boyfriend and I were having lots of problems. He was going out a lot and having sex and not using a condom. One night he got angry, hit me, stormed out of the house, and came back hours later, stinking drunk. He forced me into bed, fucked me, and refused to wear a condom. I was always careful about having safe sex, now I'm afraid of getting HIV."

Many people are concerned about HIV infection after surviving a sexual assault, and it is important to know the facts. Any contact between your bodily fluids (including blood and semen) and the bodily fluids of an HIV-positive person puts you at risk of contracting HIV. However, repeated contact with HIV is usually necessary for infection.

What should I do if I am raped or sexually assaulted?

Get medical attention as soon as possible.

Go to the nearest hospital emergency room that has a rape crisis program. Although you may feel embarrassed about your injuries, it is important to receive medical assistance. Hospital staff frequently see such injuries to the penis, anus and other body parts, not all caused by rape or sexual assault.

Even if you do not seem to be injured, it is important to get medical attention. Sometimes injuries that seem minor at first can get worse. Also you may have been infected with a sexually transmitted disease, which may take weeks or months to appear, but may be easily treated with an early diagnosis.

If you are living with HIV/AIDS, especially if you are symptomatic, medical attention is particularly important. Exposure to another persons bodily fluids can further compromise your immune system, or trigger an opportunistic infection.

Going to the hospital can be frightening, especially after surviving a traumatic experience. Ask a friend to go with you, or call the Anti-Violence Project.

Consider talking to a sexual assault/rape crisis counselor.

Counseling is an important way to regain a sense of control over your life after surviving a rape or sexual assault. Counseling can help you cope with both the physical and emotional reactions to the sexual assault and any previous sexual assaults, as well as provide you with the information about hospital and criminal justice system procedures. A counselor can provide you with information and support necessary to help you decide whether or not you want to tell friends and family members about the assault, or report the assault to the police.

Consider reporting to the police and/or pursuing a criminal case.

Sexual assault is a serious crime. As a sexual assault survivor, you have the right to report the crime to the police. If you think you can identify the perpetrator, you have the right to look at mug shots and ride in a patrol car to look for the perpetrator.

Because police are not always sensitive to male sexual assault survivors, it is important to have a friend or advocate accompany you to the precinct to report the crime.

If you are concerned about HIV infection, it is important to talk to a counselor about the possibility of exposure and the need for testing.

next: The Basics of Sex Therapy Homepage

Discover how to deal with the pressure to have sex and why many teens are choosing abstinence.

More and more teenagers are choosing abstinence now because they want to be 100% sure of avoiding STD's (sexually transmitted diseases) and pregnancy. Even teens who have had sex before are making a commitment to be abstinent. Read on to find out more about how to deal with the pressure of having sex, whether it's still possible to get STD's, and why many teens are choosing abstinence over sex.

What exactly is abstinence anyway?

Abstinence means that you are not having sexual intercourse. Sexual intercourse means that you are having "sex" with a partner. Sex can be vaginal, oral or anal. So if someone is abstinent, it means they are not having sexual relations with anyone.

Why are teens choosing to be abstinent?

Many teens choose abstinence because they know that it is the best protection against STD's, and it is 100% effective in preventing pregnancy. Others choose abstinence because of religious beliefs or because of their own values.

Do most teens who have had sex wish they waited?

Yes! In fact 3 out of 4 girls who have had sex wish they had waited longer before having sexual intercourse.

What should I say if I feel pressured to have sex?

A good relationship is about good communication. Talk to the person you're dating and be clear about your values and what you really want. Don't be shy about what you don't feel comfortable doing. The fact is you don't really need to tell anyone why you don't want to have sex. It's good to be honest with the person you are dating early on that you plan to be abstinent. This way there will be no expectations and you both can avoid situations that could make abstinence difficult, such as going to a party where there's alcohol or being alone in an empty house.

My partner keeps telling me. "If you love me, you'd have sex with me."

Don't be fooled by this line! Loving someone doesn't just give them permission for sex. Changing your mind and having sex when you really don't want to is letting yourself down, and it doesn't guarantee that your partner will stay with you either. In the long run, if someone wants to break up with you just because you won't have sex, they really are not worth it.

How can I talk to my parents about sex?

You may think that your parents would be last on your list of people that you would talk to about sex but remember they were teenagers once too and probably faced a lot of similar issues that you are facing now. In fact, your values are based on your parent's attitude about things. Talking to a parent may help you understand your feelings. You might want to start a conversation with your parent(s) about peer pressure. You could mention that you think there's a lot of pressure on teens to have sex. Then you might ask them their feelings about sex before marriage. Parents know that growing up isn't easy. If given the chance, parents can be very helpful and supportive. The important thing to remember is to talk about your feelings with an adult or friend you feel comfortable with—someone you can trust.

Is it possible to get and STD or become pregnant without vaginal intercourse?

It is possible to get pregnant without having sexual intercourse if a male ejaculates near your vagina, since sperm can still get inside of you. If you don't have vaginal, anal, or oral sex, you can't get and STD. You should know that some STD's are spread from oral sex.

Are there any other risks involved with having sex?

Yes. Besides running the risk of getting an STD or becoming pregnant, having sex when you're not ready can cause you to feel bad about yourself and also make you question your relationship.

How will I be able to tell if I'm ready to have sex?

Knowing when you are ready to have sex can be tricky because your body may feel like you are ready. You may feel very romantic with your partner and have the urge to have sex. This is perfectly normal but you should also listen to your thoughts and beliefs to help you decide when the time is right. If you're nervous or not sure, wait until you can make a choice that you are sure of. Remind yourself that abstinence is the only 100% way to avoid pregnancy and STD's. One thing for sure to remember is: "you should never feel pressured or pushed into having sex."

Most teenagers will agree that saying "no" to sex can be hard but having sex is a serious decision that has consequences. You can make a choice to say "no" to sex and still be close with your partner. When you choose to be abstinent, it means you want to wait to have sex until the time is right for you! Talking with someone you trust will help you follow your feelings and values and stick to your decision.

South Korea Women Starving, Victims of Fashion

Thirty miles south of the border with starving North Korea, young women in the South Korean capital are starving themselves, victims not of famine but of fashion.

Dr. Si Hyung Lee has seen this dark side of affluence and modernity. He remembers best the patient who died of respiratory failure: "She was a pediatrician's daughter," said Lee, director of the Korea Institute of Social Psychiatry at Koryo General Hospital in Seoul. "Her father and mother were both doctors."

But her parents failed to realize that their teen-ager suffered from anorexia nervosa -- a disease almost unheard of in Korea a decade ago -- until it was too late to save her.

If Asia is a reliable indicator, eating disorders are going global.

Anorexia -- a psychiatric disorder once known as "Golden Girl syndrome" because it struck primarily rich, white, well-educated young Western women -- was first documented in Japan in the 1960s. Eating disorders are now estimated to afflict one in 100 young Japanese women, almost the same incidence as in the United States, according to retired Tokyo University epidemiologist Hiroyuki Suematsu.

Over the past five years, the self-starvation syndrome has spread to women of all socioeconomic and ethnic backgrounds in Seoul, Hong Kong and Singapore, Asian psychiatrists say. Cases also have been reported -- though at much lower rates -- in Taipei, Beijing and Shanghai. Anorexia has even surfaced among the affluent elite in countries where hunger remains a problem, including the Philippines, India and Pakistan.

Doctors in Japan and South Korea say they also have noticed a marked increase in bulimia, the "binge-purge syndrome" in which patients gorge themselves, then vomit or use laxatives to try to keep from gaining weight, sometimes with lethal consequences.

Experts debate whether these problems are caused by Western pathologies that have infected their cultures via the globalized fashion, music and entertainment media, or are a generic ailment of affluence, modernization and the conflicting demands now placed on young women. Either way, the effects are unmistakable.

"Appearance and figure has become very important in the minds of young people," said Dr. Ken Ung of National University Hospital in Singapore. "Thin is in, fat is out. This is interesting, because Asians are usually thinner and smaller-framed than Caucasians, but their aim now is to become even thinner."

A weight-loss craze has swept the developed countries of Asia, sending women of all ages -- as well as some men -- scurrying to exercise studios and slimming salons.

Liposuction surgeons have popped up in Seoul, as have diet powders and pills, cellulite creams, weight-loss teas and other herbal concoctions "guaranteed" to melt away the pounds.

In Hong Kong, 20 to 30 types of diet pills are in common use, including variations on the "fen-phen" combination of fenfluramine and phentermine that was banned in the United States last month for causing heart damage, said Dr. Sing Lee, a psychiatrist at the Chinese University of Hong Kong who has written extensively on eating disorders. Though the Health Ministry has asked pharmaceutical companies to withdraw the offending drugs, "I'm sure new ones will be coming out right away," Lee said.

In Singapore, where the anorexia death of a 21-year-old, 70-pound student at the prestigious National University made headlines last year, dieting itself has become a fashion statement. On Orchard Road, the city's toniest shopping district, a hot-selling T-shirt designed by "essence" bears this stream-of- consciousness essay on modern female angst:

"I've got to get into that dress. It's easy. Don't eat ... I'm hungry. Can't eat breakfast. But I ought to ... I like breakfast. I like that dress ... Still too big for that dress. Hmm. Life can be cruel."

In Japan, where dieting is less a trend than a way of life for many young women, the principle that thinner is better is now being applied to facial beauty. A recent subway flier for a young women's magazine pictured an attractive model complaining, "My face is too fat!"

Drugstores and beauty salons offer face-reducing seaweed creams, massage, steam and vibration treatments and even Darth Vader-like facial masks designed to promote sweating.

The Takano Yuri Beauty Clinic chain, for example, now offers a 70-minute 'facial slimming treatment course' for $157 at 160 salons across Japan, and reports business is booming.

South Korea is perhaps the most interesting case study since, until the 1970s, full-figured women were seen as more sexually attractive -- and more likely to produce healthy sons, said Lee. "When I was a kid, plumper-than-average women were considered more desirable, they could be a first son's wife in a good house," he said.

But standards of beauty have changed dramatically in the 1990s with democratization, as South Korea's government decontrolled TV and newspapers, allowing in a flood of foreign and foreign-influenced programming, information and advertising.

"The 'be slim' trend starts earlier now, even in elementary school," said the institute's Dr. Kim Cho Il. "They shun overweight boys and girls -- especially girls -- as their friends."

Dieting by growing teen-agers often leads to inadequate calcium intake and weaker bones. Kim is worried about an increase in osteoporosis cases when this generation of girls reaches menopause.

"The dieting will also result in weaker physiques and lessened resistance against disease," she said.

South Korean psychiatrist Dr. Kim Joon Ki, who spent a year in Japan studying eating disorders, said the increase in eating pathologies over the past few years has been phenomenal. "Before I went to Japan in 1991, I had seen only one anorexia patient," Kim said. "In Japan they told me, 'Korea will be next, so you should study this now.' And sure enough, they were right."

Kim said he has seen more than 200 patients, about half of whom were anorexic and half bulimic, in the 2 years since he opened a private eating-disorder treatment clinic. "Lately I have so many calls that I can't even give them all appointments," he said.

But Kim said his new book on eating problems, "I Want to Eat But I Want to Lose Weight," is selling poorly. "Readers' attention is still focused on dieting, not on eating disorders," he said.

Dieting is not only trendy, it's a necessity for many South Korean women who want to fit into the most fashionable clothes _ some of which are only made in one small size which is the equivalent of an American size 4, said Park Sung Hye, 27, a fashion editor at Ceci, a popular monthly style magazine for 18- to 25-year-old women.

"They make just one size so only skinny girls will wear it and it will look good," Park said. "They think, 'We don't want fatty girls wearing our clothes because it will look bad and our image will go down."'

As a result, "If you're a little bit fatty girl, you cannot buy clothes," she said. "All of society pushes women to be thin. America and Korea and Japan all emphasize dieting."

Park said eating disorders are increasing but still are relatively rare. "If, say, 100 people are dieting, maybe two or three have bulimia or anorexia so it's not enough to worry about," she said. But in the articles she writes on how to diet, she cautions readers against excess, warning, "A model's body is abnormal, not normal."

Park said young Koreans' attitudes toward food differ from those of their elders, who remember hunger after World War II and the old greeting, "Have you eaten?" and fat as a sign of prosperity. "Now skinny (means you are) more wealthy, since everyone can eat three times a day," Park said.

Young women interviewed in Seoul's swanky Lotte department store said dieting was a necessary evil.

"Boys don't like plump girls," said Chung Sung Hee, 19, who at 5 feet and 95 pounds considers herself overweight. "I don't know whether they are serious or not but sometimes they say I'm plump.... So I try to lose weight. I go without food, and my friends use milk diets or juice diets, but we don't last that long."

Han Soon Nam, 29, an advertising company employee, said of dieting: "I don't think it's good but it is the fashion. Everything has a price. You lose your health to get skinnier."

next: Eating Disorders: The Cultural Idea of Thinness
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The stress of raising a child with ADHD can be tremendous. Families with an ADHD child have higher incidences of verbal and physical abuse, along with substance abuse.

The Stress of Raising an ADHD Child

Living in families, and raising children can be difficult under the best of circumstances. Many of us had a hard time living in the families that we grew up in. It may be difficult today, living together in the families that we have created. We may feel guilty for not giving our children or partner what we feel they deserve. We may feel painfully aware of how we are not taking care of our own needs. This is especially true if a member, or several members of our family have Attention Deficit Disorder.

As our knowledge of Attention Deficit Disorder grows, we are learning that ADD is not simply a disorder of childhood. ADD is life long condition. Children with ADD grow up to be adults with ADD. People with ADD do not live and grow in a vacuum. They have relationships, children, and create families with people who may or may not have ADD. Therefore, it is essential to help not only the person directly affected by ADD, but the entire family. Attention Deficit Disorder, similar to addictions affects every member in the family. Families do not cause ADD, and yet families need help to live and thrive in spite of the impact of ADD.

We now know that ADD runs in families. It has been estimated that there is a 30% chance that a child with ADD has at least one parent who has ADD. It has also been estimate that there is a 30% chance that that same child will have a sibling with ADD. I frequently work with families where one or both parents have ADD, and one or two of their children also have the condition. Living in a family with ADD can be like living in a five ring circus. There is always someone or something that demands attention.

As parents we want the best for our children, and are often willing to sacrifice our needs for theirs. But what is the impact on the family if one of the parents has untreated Attention Deficit Disorder? Too many times, I hear caring parents say, "Please help my son or daughter. I've dealt with this all my life and can continue to." The problem with this is that it can be incredibly difficult to provide consistent parenting for any child, let alone a child with ADD, if you as the parent have untreated ADD. There is a reason why the airlines request that adults put their oxygen mask on first, so that they are then able to help the children.

Families with ADD have higher incidents of physical, and verbal abuse. Substances such as alcohol, food and drugs are often used to self-medicate the pain and frustration of family ADD. Some parents of children with ADD suffer from Post-traumatic Stress Disorder (PTSD). PTSD is a condition that occurs when people are subjected to extreme, ongoing stress that is beyond the realm of normal experience. PTSD symptoms include depression, anxiety, sleep disturbances, hyper-vigilance, and re-experiencing of the trauma.

For the for mention reasons, it is imperative that ADD is viewed in the context of the family, or persons environment. Relationship therapy that is specific to addressing the impact of ADD is essential. Family therapy which includes parents and siblings with and without ADD is critical. So often the non-ADD siblings are left out, or feel that they have to somehow make up for the difficulties that their ADD sibling(s) are causing. Educating and treating all members of the family system promotes family wellness.

We have learned from the evolution of the chemical dependency field over that past two decades that treating alcoholics and addicts outside of the context of their relationships is less than helpful. We have also learned that family members of the chemically dependent person also need treatment, so that they too can recover. The same is true with Attention Deficit Disorder. Let us continue to be quick learners as our knowledge of ADD expands. ADD is not caused by poor parenting, or dysfunctional families, and yet the entire family deserves treatment. No one in the family is immune from the impact of Attention Deficit Disorder.

About the author: Wendy Richardson M.A., LMFCC specializes in the treatment of ADD and co-related substance abuse. She provides education and therapy for couples and families where ADD is present. She is a writer who speaks nationally and provides workshops and trainings on Attention Deficit Disorder.

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Analysis of benefits and risks of ADHD medications plus side-effects of medications for ADHD. And why using medications to treat ADHD is controversial.

Important Points

• Medications are NOT the only treatment for ADHD.
• The decision to use medications for treatment of ADHD requires knowledge and consideration.
• Other interventions (such as psychotherapy, educational accommodations, etc.) should always accompany the use of medications for ADHD.
• Periodic re-evaluation of ADHD medication use is essential, as a person's response and need can change over time.

What is ADD / ADHD?

Attention-Deficit/Hyperactivity Disorder (AD/HD, or ADHD) is characterized by two or more of the following:

• poor attention
• impulsivity
• hyperactivity.

The condition may take different forms: either inattentive or hyperactive/impulsive. Children are more often the ones diagnosed with ADHD, but many adults also maintain the attention impairments (ADD).

It is currently believed that ADHD is a neurobiological condition caused by genetics, conditions in utero, or possibly by relational trauma.

Why are medications often used for the treatment of ADHD?

Although the causes of ADHD are somewhat speculative, the source is generally believed to be a problem with either the structure or functioning of the brain. The most common view is that ADHD is a biochemical problem, related to an imbalance of the neurotransmitters in the brain. Thus, the use of medications is to regulate this presumed imbalance. Stimulants are the most frequently utilized type of medications for ADHD. Gabor Maté, M.D., author of Scattered: How Attention Deficit Disorder Originates and What You Can Do About It, offers this explanation and analogy:

• Even though ADHD individuals are generally hyperactive, their brain waves are slower at a time when they would be expected to be faster (when reading or other tasks are attempted).
• The brain's prefrontal cortex is supposed to sort out and organize sensations and impulses coming from the body and the environment, and to inhibit those that are not useful in a given situation. When this task is successful, there is order, as with a policeman directing traffic at a busy intersection.
• In an ADHD person, the prefrontal cortex is underactive, like a policeman asleep on the job, thus not prioritizing and selecting or inhibiting input. The result is a flood of data bits that keep the mind and body unfocused and in turmoil. Traffic is gridlocked.
• Stimulant medications wake the policeman and allow the prefrontal cortex to perform traffic direction more efficiently.

What are the medications for treating ADHD?

Stimulants

The most common medications for treating ADHD are stimulants. Stimulants have been the longest in use for treatment of ADHD, and have the most research studies on their effects. Although some have been used on children as young as age 3, most are recommended for age 6 or older. Long-term studies on the use of stimulants for the treatment of ADHD lean toward the discontinuation during adolescence, due to possible growth inhibition.

Stimulants for the treatment of ADHD may be shorter or longer acting formulations. Short/intermediate acting stimulants require dosages 2-3 times a day, while long acting stimulants last 8-12 hours, and can be taken once a day, thus not requiring a dose at school.

There are four main types of stimulants used for treatment of ADHD:

• amphetamines (Adderall)
• methylphenidate (Ritalin, Concerta, Metadate)
• dextroamphetamine (Dexedrine, Dextrostat)
• pemoline (Cylert - less commonly prescribed because can cause liver damage)

Non-stimulant

The newest medication for treatment of ADHD is Strattera. This medication is a reuptake inhibitor that acts on the neurotransmitter norepinephrine (which affects blood pressure and blood flow) in the same way that antidepressants act on the neurotransmitter seratonin, allowing the natural chemical to remain longer in the brain before being drawn back up. Because it is a non-stimulant, it may be less objectionable to some families. Nevertheless, it has similar side effects as other medications used for ADHD.

Antidepressants and anti-anxiety medications

In some cases, Antidepressants or anti-anxiety medications may be prescribed either in addition to or instead of stimulants for the treatment of ADHD. Most often, this determination is based on other symptoms, beyond those typical of ADHD alone. Antidepressants most commonly affect the neurotransmitters seratonin or norepinephrine. (the FDA advises that anyone on antidepressants should be watched for increases in suicidal thoughts and behaviors. Monitoring is especially important if this is the child or adult's first time on depression medication or if the dose has recently been changed. If the depression appears to be getting worse, an evaluation by a mental health professional should be scheduled as soon as possible).

Antipsychotic or mood-stabilizing medications

For certain conditions that include symptoms of ADHD, other medications may be prescribed. With a few exceptions for seizure disorders, antipsychotic medications are not prescribed for children and most mood stabilizers are not recommended for children or adolescents.

What are the side effects of medications for ADHD?

Persistent and negative side effects of stimulants have been documented, including sleep disturbances, reduced appetite, and suppressed growth, which might have important health implications for the millions of children who are currently taking medication for ADHD. Source: Centers for Disease Control and Prevention

Side effects most commonly include:

• decreased appetite or weight loss
• headaches
• upset stomach, nausea or vomiting
• insomnia or sleep difficulties
• jitteriness, nervousness, or irritability
• lethargy, dizziness, or drowsiness
• social withdrawal

All medications have side effects, and sometimes a change in dosage, brand or type of medication will allow for the usefulness of the medication while reducing the side effects. One problem with medications for ADHD is that they are most often prescribed for young children, who usually will not be able to accurately report side effects. This is one of the concerns about prescribing any medications for children.

Why is the use of medications for ADHD controversial?

The introduction of medications for the treatment of ADHD initially seemed like a miracle cure. Many believe that the benefits in terms of academic achievement and social behavior warrant the possible risks. However, there are also many concerns about the use of medications for ADHD, and as studies continue to monitor their effects, the controversy grows. Some of the most often-expressed concerns are:

Overuse

As cultures become more fast-paced with increasing time pressures on parents, children, and teachers, the use of ADHD medications seems a fast fix for a complex problem. Long-range effects on the developing brain are not known. Even when medications are advised, they should never be used as the exclusive treatment for ADHD. Additional interventions (such as behavior management, parenting skills, and classroom accommodations) must also be incorporated.

Age of children

Originally, ADHD medications were prescribed for school-age children, and use was generally discontinued at adolescence. In recent years, these medications have been prescribed at younger ages, and have been extended through adolescence and into adulthood. In some cases, doctors are diagnosing ADHD and prescribing medications for children as young as age 2, even though the controlled studies on these medications were not done on pre-school children. Understanding of normal child development and family behavioral management skills might be a more appropriate intervention for such young children.

Misdiagnosis of ADHD

ADHD is defined by behavioral symptoms. There is no specific test for ADHD. Behaviors that are common to ADHD may be caused by a variety of other sources, such as domestic violence, alcoholism in the family, inadequate parenting, ineffective behavior management, poor attachment to a stable caregiver, or a number of other medical conditions. The symptoms of ADHD are on a continuum that could be interpreted differently by any particular parent, teacher or physician. What one person would consider normally active for a child might be seen by someone else as hyperactive. What one adult can tolerate or handle might be seen by another adult as impossible behavior.

Sources:

• DSM-IV-TR, The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.
• ADHD, Wikipedia
• Attention Deficit Hyperactivity Disorder publication by NIMH, June 2006.
• FDA Warning on Antidepressants
• The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit hyperactivity disorder (ADHD). Archives of General Psychiatry, 1999;56:1073-1086.

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