Pandemic Affective Disorder (PAD): Seasonal Affective Disorder On Steroids
Late fall and early winter are a busy time in my clinical practice. The combination of cold temperatures and shorter days often bring on feelings of social isolation and despair. My patients are not alone. According to the scientific data, over 66 million people suffer from some form of winter dysphoria and over 6 million experience depressive symptoms so severe they are unable to function in their daily lives. Many of these individuals are suffering from what the psychiatric literature refers to as Seasonal Affective Disorder (SAD).
Symptoms of SAD typically start out mild in the fall and gradually become more severe as the winter approaches. This syndrome is often referred to as the "winter blues” because it is triggered by the lack of day light and the cold weather. Like other forms of depression, people who have SAD can be overwhelmed with feelings of guilt, anxiety and despair. They can feel like the energy in their body has been zapped resulting in sluggishness, poor concentration and little motivation to do activities that they once found to be pleasurable. Due to intrusive negative thoughts, they can easily become agitated. This high degree of irritability can make it hard to fall asleep and stay asleep, resulting in exhaustion and mood swings. One's appetite is often affected and accompanied by either weight gain or loss. Many people who have SAD suffer from low self-esteem.
There are many explanations for this negative shift in mood. In the colder months, people tend to exercise less, stay in more, socially isolate, drink more alcohol excessively and eat more sugar and carbohydrates. Some of the factors that seem to play a role in the onset of SAD is a change in circadian rhythm. The research suggests the reduction in sunlight disrupts the body's internal clock and throws off one's sense of well-being. Not having enough sunlight can also cause of drop in serotonin, a neurotransmitter, that when lowered results in mood changes associated with depression and anxiety. The change in seasons can also disrupt the body's level of melatonin. Melatonin plays an important role in sleep patterns, affect and energy level. Low or high sugar levels and diminished amounts of vitamin D can all lead to biologically induced mood instability.
This season, however, my practice has become busier than usual. With the onset of the pandemic, the increase in depression has become dramatic. It is like Seasonal Affective Disorder on steroids. The people I treat this year are suffering from a syndrome I have coined Pandemic Affective Disorder (PAD). As winter approaches, these individuals with PAD are suffering from severe social isolation, anxiety associated with political unrest, financial insecurity including unemployment, and fear of getting ill. Some may not be able to go in to work or school. Many are not able to be with family members, an additional hardship around the holidays. Some may not be able to be with an ailing family member or had to experience the death of a loved one remotely. My patients are not alone in their sense of dread and hopelessness. The American Psychological Association reports that over 80 percent of all Americans say they are experiencing some form of severe stress due to the coronavirus. The Center For Disease Control and Prevention (CDC) indicates that the level of depression amongst Americans since the outbreak of COVID-19 has gone up over 300 percent. During these trying times, being overwhelmed with depression and anxiety is no longer identified as a disorder, but rather, the current order of our everyday lives. Being overwhelmed with depression and anxiety can now be seen as a rational response during these horrific times of the coronavirus and the effects of political unrest.
There are many things people can do to help themselves during these dark and cold days of COVID-19. Try to be outside in the sun as much as possible. Exercise regularly, be it walks, yoga or exercise videos, or indoor exercise equipment. Develop bubbles of friends and family who you feel comfortable with, who have been socially distancing and have tested negative for the virus. Be creative with small outside gatherings, utilizing heat lamps, fire pits or warm blankets. Use technology to meet with friends and family on a regular basis via video conferencing or phone calls. Avoid over watching negative news on the TV and try to have more family movie nights. Buy a sun lamp and sit under it for a few hours a day. During the day try to sit by a sunny window as much as possible. Make an appointment with a psychologist and continue to see them on a weekly basis. Most psychologists are offering some form of video conferencing. Possibly talk with your psychiatrist or primary care doctor about taking medications to treat your situational depression and anxiety. Avoid alcohol. While alcohol can temporarily make you feel less anxious and numb, it may intensify feelings of depression and anger. Keep a daily activity journal so you can track of any mood swings, so you can remember the good times when you are feeling down. Perhaps even plan social events in the future so you have something to look forward to. Most importantly, keep things in perspective, for like the seasons, these dark times of the pandemic will pass.
Below is a link to an Interview with Dr. Klein about Seasonal Affective Disorder and the Pandemic.
Dr. Klein is a clinical psychologist who specializes in the treatment of depression and Seasonal Affective Disorder. He has offices in Westport, Stamford and Fairfield. During these difficult times, he is serving the greater Connecticut region via video conferencing.
To many parents a liberal arts education is no longer considered a realistic option for their children. Successful parents want successful children and as such expect them to go to highly competitive schools and study subjects deemed necessary to accelerate economic advancement.
The external pressures to get into a competitive school, however, can be overwhelming to a child. Admission into a “good school” has become harder and more complicated. The world of higher education has changed dramatically over the past decade. Being a good student is no longer enough. In addition to good grades and high test scores, you now need to demonstrate that you participate in sports, extra curricula activities, do volunteer work and have completed several advanced placement courses. Even the college essay has become a monumental task, requiring professional assistance.
In the “old” days students would apply to a handful of schools but now with the advent of the common application, a high school student can now send applications to 900 different colleges with a single click of a mouse. The common application has increased the pool of applicants at each college significantly, resulting is much greater competition.
The college application process has become so complicated that it requires sophisticated strategies and the aid of a dedicated college coach with a specialized software program to develop a personalized strategic plan. Do you apply early decision, early admission, regular admission, how may schools should you apply to, how many safety schools, how many should be reach schools? You can now sit in front of a computer program and see how your child statistically stacks up to past applicants who applied to each respective school based upon grades, test scores etc.
The severity of competition is even more intense for those kids who live in highly educated and affluent areas. It is difficult for a child to stand out from their peers when they live in a town where their cohorts all have grades and test scores two standard deviations above the norm. Being from a northeast suburb can also be a disadvantage when applying to colleges that desire student bodies that are geographically, ethnically and economically diverse.
While many students are academically strong, some lack the emotional aptitude required to handle the intensity of the application process. The pressure from parents, peers and one’s self can be overwhelming to the child. Many kids I see in my practice suffer from low self-esteem. They fear that if they don’t get into a good school they will let down their parent or perhaps be ostracized by their peers. Going to classes each day, while your classmates flaunt their early admission acceptances on Facebook or by wearing collegial emblems on their clothing can bring up feelings of inadequacy.
Overwhelmed by all this pressure, it is understandable why a senior in high school might become overridden with anxiety and exhibit symptoms such as an inability to relax, always feeling on edge, irrational fears of impending doom, restlessness, feeling tense and having difficulty concentrating. Sometimes general anxiety can manifest somatically as stomach pain, panic attacks, muscular tension, headaches or insomnia.
Some kids try to overcome their fears by irrational thoughts or ritualistic behaviors. They become obsessed with the college application process and cannot think of anything else. They cannot control these intrusive thoughts and they find it difficult to relax or even perform chores. In many instances, the child’s academic performance begins to deteriorate due to an inability to focus. Some kids develop compulsive behaviors as a means of avoiding these negative thoughts. They watch television excessively, play endless video games, constantly surfing the internet, spend significant amounts of time on social media, or even watch hours of pornography. Many even turn to alcohol and drugs for temporary relief.
High school students can also be plagued by depression. In children, depression can manifest in many different ways. For example, some kids with depression might feel sad, hopeless, have difficulty concentrating, sleep poorly, have little appetite or an inability to experience pleasure. Others can experience depression in how they interact with others. They can be socially withdrawn, avoid responsibilities, procrastinate, or become emotionally sensitive.
Some kids manifest their depression by exhibiting oppositional behaviors. They can become agitated, aggressive or even antisocial. Kids who have been well behaved can suddenly become deviant. It is common for students to feel embarrassed, ashamed, or over ridden with guilt about failing to live up to expectations. Many kids, as well as their parents, have separation anxiety and get nervous even with the idea of the child going off to college is mentioned.
Many high school students feel alone and isolated in their suffering. They feel like they have no one to turn to who can understand their pain and give unbiased advice. They fear rejection by their parents, teachers and friends.
Kids are often relieved to finally have someone who they can talk to confidentially, in an open manner, without the fear of criticism or judgement. Many can finally admit that the issues that are bothering them have been around for a long time. They can explore their family dynamics in a safe environment and begin work through the age-specific developmental issues of separation and self-identity, which can be overwhelming and confusing to a child at this age.
Who are they? What do they they want to be when they grow up? How do they get their needs met? How do they become that person they want to be? What is the path they should pursue that will make them happy? And most importantly, what college do they want to go to and what subjects should they study?
Surprisingly some kids feel a sense of relief when they discover they will be going to one of their safety schools. Safety, especially to a child, is not always a bad thing, and often times a welcomed surprise.
Dr. Martin Klein Is a clinical psychologist who practices in Fairfield, Westport and Stamford CT. During these stressful times, he is currently offering video conferencing to all students and families across the state of Connecticut. He specializes in working with high school students who struggle with issues of anxiety, stress, depression, low self-esteem and addictions. He works closely with students and their families who are going through the college application process.
For the adult survivor of childhood abuse, what is most frightening about the therapeutic process is its demand for verbal communication and intimacy. Many victims are unaware of their past history of abuse or find it too difficult to speak openly about their painful memories, especially to a therapist.
Victims of abuse are conflicted about how they should relate to a therapist. They desire their therapist’s understanding and care, but fear if they let down their defenses they might become vulnerable once again to possible abuse.
Childhood abuse rarely appears as the presenting problem. To diagnose a victim of abuse, the therapist must learn to read between the lines of what the person is saying or even not saying. It is within the silence that victims express their suffering and need for help. The abuse victim communicates less with speech, and more with the symbolic language of the body.
There they sit facing the therapist, scared, frightened, hyper vigilant, numb, looking away from the therapist’s eyes in order to avoid what they perceive as their therapists’ piercing and critical gaze.
As a perceived parental figure, therapists can easily become screens for the victim’s projections. The individual may experience the therapist as if he or she is an abuser and the therapeutic session an abusive situation. If this occurs, the conflicts and struggles the adult had as a child may be acted out within the realm of the therapeutic relationship.
It is understandable why even a seasoned therapist might be disturbed by the victim’s inappropriate and situationally dystonic behaviors and actions. To cope with their own level of anxiety, some therapists might choose to relate to the patient in a defensive manner.
The most common form of defense used by therapists to create distance between themselves and the acting out patient is the diagnostic procedure. By labeling a person with a diagnosis, the patient as subject is transformed into an object that can then be defined, manipulated and controlled.
Because of their hyper vigilance, victims are sensitive to how others perceive them. If they feel the therapist is relating to them as an object rather than as a fellow subject, their acting out tendencies will escalate.
The feeling of being objectified by the therapist will serve as a catalyst for the victim to re-experience and reenact the past abusive situation within the present therapeutic relationship. In other words, the defensive therapist will be perceived by the victim as being manipulative and controlling and as a result will react in a defense fashion against what they perceive to be a threat.
The goal of treatment is not for the therapist to diagnose the victim, but rather for the victim to begin to learn how to identify and understand their patterns of thoughts, emotions and behaviors. By organizing their experiences into language, their victim will develop the psychological distance and personal integrity required to gain a sense of mastery and control.
Over and against the victim’s negative projections, the therapist must relate to the victim with unconditional compassion and support. For it only by developing a safe and highly structured milieu that the victim will be able to let down his or her defenses and begin to work through the issues related to the abuse.
It is understandable why the victim’s defense mechanisms might be interpreted by both the therapist and patient as maladaptive character traits. No one would dispute the negative effects these defense mechanisms have in terms of sabotaging and resisting the therapeutic process. However, to continue to view the victim’s defense mechanisms as a form of “resistance” will have a negative effect upon treatment. To critically confront the defenses can make the victim feel as defective and helpless as he or she felt at the time of the abuse.
By recontexualizing these defenses mechanisms, from within the horizon of a developmental/ historical perspective, the victim will begin to realize the important role these personality traits played in terms of their survival. Defense mechanisms are, in fact, coping strategies that, in the past, helped the victim adapt to a maladaptive environment.
By reinterpreting these defense mechanisms as coping strategies, the patient will begin to develop more positive self-image and begin to fell more integrated and in control. In time, they will realize that these maladaptive defenses mechanisms are no longer appropriate or needed.
In addition to basic trust, self doubt is a problem that also plagues victims of childhood abuse. The victim does not trust his or her own thoughts and perceptions – especially past memories associated with the abuse. In fact, many victims are unsure if their memories are fantasy or reality.
To help the victim overcome self-doubt, it is important for the therapist to validate his or her memories. What matters is not the historical facticity of the memories, but rather what psychological significance these memories have in terms of the person’s current experience.
To accomplish this goal, the therapist, must keep in mind that the victim’s recollections of the past are based upon a child’s perspective – a viewpoint that is very different from how we as adults perceive ourselves, others and the world. For example, children tend to perceive adults as being bigger than life and also do not have a proper understanding of sexuality, aggression, or even a clear demarcation of self and other. From this vantage point, it is understandable why the victim’s memories might have a limited or distorted child-like quality to their narrative.
Working through the defenses, learning to trust oneself and the therapist, reconnecting thoughts with feelings, and beginning to integrate the past with the present is both a frightening and exciting process.
What is most frightening about the process is that it requires the subject to face the unknown, What is most rewarding about the process is that if offers the subject the freedom for personal expansion and growth.
Dr. Klein is a clinical psychologist who practices in Fairfield and Westport CT. He specializes in the treatment of trauma, Post Traumatic Stress Disorders (PTSD) and adults survivors of emotional, physical and sexual childhood abuse.
Alcohol is legal and socially acceptable. It plays an important role in our culture and daily lives. To make a toast on a special occasion or engage with your associates at a happy hour is considered to be normal and even proper etiquette. While low dosages of alcohol might reduce social inhibitions or improve cardiac health, it has long been known that excessive drinking is detrimental to most of the organs in your body and in fact can be deadly if done to excess.
Over the long-term, heavy alcohol consumption can cause severe illness such as liver and brain damage and increase risk of cancer. A recent study concluded that drinking as little as 10-14 glasses of wine or beer a week can reduce one's life expectancy by several years. While alcohol may not be seen by society as a deadly drug, in our country over 15 million people are reported to have some sort of alcohol use disorder, and over 88,000 people die from alcoholism on an annual basis. Alcohol is a highly addictive substance. In fact, trying to detox off of alcohol without medical assistant can have dire physiological consequences. It is no wonder that alcoholism is viewed as a chronic and sometimes fatal disease.
However, alcoholism has not always been considered to be a disease. Prior to the twentieth century, a person's inability to "hold their liquor" was seen more as a personal weakness. Alcoholics were identified as "drunks," with flawed character and low morals. It was not until the 1930s that the medical community began to define alcoholism as a disease and Alcoholics Anonymous (AA) was founded and embraced the disease model as a core principle. The disease model allowed the medical profession to begin to treat addicts as victims of their illness rather than derelicts who should be punished for their sins.
The disease model has its merits -- it offered alcoholics the opportunity for recovery rather than social scorn. However, it also had an intrinsic flaw -- it did not address the underlying psychological issues that caused the substance abuse in the first place.
Many people who abuse alcohol suffer from some sort of underlying anxiety disorder. In an attempt to self-medicate their underlying psychological issues, the alcoholic develops an addiction. The alcoholic now has dual presenting problems -- 1. anxiety and 2. alcohol dependence. It is my clinical view that to achieve sustained sobriety, the alcohol abuse and the underlying anxiety dysfunctions must be concurrently treated. In fact, between 20 to 50 percent of people do relapse right after the completion of disease model treatment program and nearly 90 percent of people relapse within 4 years of completing an alcohol rehabilitation program.
Being human is not a easy feat. We don't have control over many variables in our lives and we must all face possibilities that tragedies can happen at anytime, including one's own mortality. For most of us, however, we adapt to our existential condition. We learn how to put things out of our heads so we can function in the world and limit our fears. Anxiety is a normal part of life and in many instances it arises for good reason. For example, if a lion is chasing you in the jungle, anxiety and fear are not only appropriate, they are essential to one's survival instinct.
Alcoholics tend to be individuals that did not grow-up in ideal family settings. They did not develop a basic sense of security or trust and thus never felt safe with others or even natural in their own skin. They tend to be overwhelmed by irrational anxieties and uncontrollable fears even in situations that don't justify these feelings. Their high degree of anxieties can manifest in different ways. Some individuals suffer from general anxiety; constant worrisome thoughts and unnecessary fears about routine events and everyday activities. Others have social anxieties; fear of being scrutinized by others, humiliated or embarrassed in public. Many are plagued by obsessions or compulsions; paralyzed by the "should've could've," find it difficult to make decisions, stop ruminations or unwanted behaviors. Many cannot slow down their thought processes and suffer from an inability to relax or insomnia. Others have phobias; public speaking, going in an elevator or meeting a stranger can result in a feeling of panic, chest pain, tightness in the throat and shortness of breath. A history of trauma or past abusive can result in the avoidance of intimacy, low self-esteem, intrusive thoughts and self-destructive behaviors.
Alcoholics can have have one or more of the types of anxiety disorders described above. To achieve sobriety and avoid relapse, a person has to do more than stop drinking, they have to learn better coping mechanisms to handle their underlining anxieties that are at the root of their substance abuse problem.
AA meetings can play a significant role in helping the alcoholic address their anxieties. More than just focusing on alcohol as a disease, there is a significant psycho-social component to the AA group meetings that address the alcoholic's anxieties head on. AA group meetings can be viewed as a form of exposure therapy; whereby the alcoholic faces its irrational fears and learns more adoptive interpersonal modalities of functioning. AA offers a type of re-parenting experience; a safe environment of unconditional support that promotes basic trust and a sense of social well being. Attending meetings and sharing with others in an open and honest manner is self empowering; it reinforces that one is okay for who they are. By surrendering to a high power, the alcoholic comes to terms with the reality that many existential fears are not in their control. By bonding with a sponsor, honesty and intimacy is achieved perhaps for the first time. By taking one step at a time, the person stops ruminating about future and past decisions. By having to attend groups and speak in front of others, irrational interpersonal and social fears are called into question.
However, for many AA meetings are not the right mileu to address their psychological issues. They need more individualistic and intensive psychotherapy to work though their childhood and family issues and learn more adaptive ways to improve self-esteem communication, interpersonal relationships and abilities to handle existential issues as they arise. Existential psychotherapy can help you learn how to differentiate between appropriate anxieties, the fear one feels when a lion is chasing you in the jungle, and irrational anxieties, the fears of low self-esteem, being around others or being a failure.
Dr. Martin Klein, Ph.D. is a clinical psychologist who practices in Fairfield and Westport CT. He specializes in alcoholism, addictions and anxiety disorders. He is trained in existential psychoanalysis and psychotherapy.
Westport addiction psychologist -- alcohol and drug abuse
Fairfield addiction psychologist -- alcohol and drug abuse
Everything that irritates us about others can lead us to an understanding of ourselves.
Couples therapy is more complex than individual psychotherapy. In individual therapy you are working with one person. In couples therapy you are dealing with a minimum of two. Not only are there twice as many people in the room, but each individual brings his or her own set of psychological issues to the relationship. These psychological issues are not static, but rather are dynamic and intertwine between the couple in a myriad of complex configurations and interpersonal entanglements.
Relationships can take on an ominous life of its own. When left unmanaged, it can throw couples into a whirlwind of interpersonal conflict and distress. Many couples become overcome by the negative patterns of their relationship. They feel beaten down and hopeless — victimized by how the dynamics of the relationship brings out the worst in each other. It is difficult to grasp how two individuals who at one point in time were in love now feel only contempt toward each other. How attraction can transform into repulsion so quickly is beyond all that seems rational.
What complicates couples therapy even more is how each person in the relationships carries within him or herself a vast array of influential voices that have been incorporated into their own sense of self. These voices shapes the ways each partner interacts with the other. Voices from the past, present and even future can be heard within the couple’s narrative — learned beliefs, views, even politics of parents, grandparents, siblings, children, previous relationships, colleagues or friends. In some ways couples counseling is more like group therapy than individual counseling.
To be successful, the psychologist must listen, comprehend, and map out all that is being said within, outside and between the two partners. It is the psychologist’s job to start the initial couples counseling sessions with a comprehensive psychosocial assessment. This is necessary in order to learn all that is being said and not said by each participant, who is being influenced by who, and how all these different voices interact and affect the dynamics of the relationship.
Couples counseling can sometimes feel like a tennis match. Couples arguing back and forth, volleying for their point of view. A therapist, however, is not a referee. It is not the job of the psychologist to determine who is right or wrong or resolve a dispute by compromise. Conflict resolution is the technique used in mediation where an arbiter assists the couple to negotiate the terms of a settlement. A settlement is something that is acceptable when you are getting a divorce, not when you are planning to stay together. To settle and sacrifice your needs for the sake of the relationship can only lead to further resentment, conflict and contempt. It is counterproductive. To stick with the tennis analogy, couples counseling does not lead to “Love” just because the participants both agree to being “at fault.”
Taking sides in couples counseling is a big mistake. What is important in couples counseling is for the psychologist to assist both partners to develop the ego strength to see outside their own personal assumptions and begin to understand the perspective of the other and how it relates to the dynamics of the relationship. A seasoned therapist knows the focus in working with a couple must be on insight and transformation, not on who is right or wrong.
I help couples pinpoint and understand the sources of their conflicts. I will work with you to achieve a better understanding of the external influences and family dynamics that play a role in shaping your relationship and cause dysfunctional interactions. I will assist you in developing new strategies to solidify your relationship and regain trust and intimacy. The work will include learning how to openly communicate, problem solve and develop new productive ways to discuss, understand and accept individual differences.
The goal of couples therapy is to learn to see your significant other in a new light, based upon insight and knowledge and not the blind subconscious forces we sometimes mistake for attraction and love.
Dr. Martin Klein is a clinical psychologist who practices in Westport and Fairfield CT. He specializes in couples therapy and marital counseling.
Westport marital therapist
Fairfield marital therapist
Dr. Martin Klein, Ph.D. psychologist specializes in the treatment of anxiety utilizing a combination of hypnosis, mindfulness techniques and psychotherapy. He practices in Westport and Fairfield CT.
Westport hypnosis and hypnotherapy
Fairfield hypnosis and hypnotherapy
Baby, sweet baby, you're my drug
Come on and let me taste your stuff
Baby, sweet baby, bring me your gift
What surprise you gonna hit me with
I am waiting here for more
I am waiting by your door
I am waiting on your back steps
I am waiting in my car
I am waiting at this bar
I am waiting for your essence
Baby, sweet baby, whisper my name
Shoot your love into my vein
What Is Sex Addiction?
In my practice I often get phone calls asking if I treat sex addiction. It is my experience the term means different things to different people. The majority of calls come from men. Often it involves an individual who has had extra martial affairs, is obsessed with internet pornography, put himself in a sexually compromising and/or illegal position, cannot stop sexual urges or fantasies, or suffers from excessive masturbation. All of these behaviors interfere with daily responsibilities and put strain on relationships, resulting in psychological distress to themselves and their families. In some instances, it is the spouse that demands their partner seek profession help or face consequences such as separation or divorce.
The History Of Sex Addiction
Different names have been used to characterize individuals who engage in excessive and at times deviant sexual activities. Labels such as Don Juanism, nymphomania, satyriasis, erotomania, hypersexuality, impulsive disorder, overactive sex drive has been around for along time. The term “sex addiction,“ however, did not arise on the scene until the 1970s. It was originally coined by members of Alcoholics Anonymous who set out to apply their 12 step principles toward sexual recovery. In a similar vein as alcoholics, they identified those who suffered from excessive and disruptive sexual activities as being physiologically dependent. Based upon the AA paradigm, they believed that sex addicts cannot be cured; but rather their disease can only be controlled by complete abstinence. To suppress their sexual dependence, members must acknowledge the disease is greater than themselves, surrender to a higher power, participate in group meetings in order to muster up the collective power to battle the disease one day at a time. With the popularity of the 12 step movement, numerous organizations formed that follow the AA doctrine - - Sex Addicts Anonymous, Sexaholics Anonymous, Sex and Love Addicts Anonymous, Sexual Compulsive Anonymous and Sexual Recovery to name a few.
Is Sex Addiction A True Addiction?
As these organizations expanded and continued to help many people, its fundamental premise has been called into question by many in the mental health communities. Neither the American Psychiatric Association, the American Psychological Association nor the American Medical Association recognize “sex addiction” as a valid diagnosis. According to the American Medical Association, there is no clear evidence that “sex addiction” is a biological disease that leads to physiological dependence and withdrawal. While past editions of the American Diagnostic And Statistical Manual of Mental Disorders had a category called Sexual Disorders Not Otherwise Classified, the latest version does not. After reviewing the empirical evidence, it decided not to include the diagnosis of “hypersexual Disorder” in it’s current manual. Despite its absence, mental health professionals have found the following disregarded criteria for Hypersexual Disorder to be of diagnostic value:
For a period of at least six months:
Compulsion Or Impulse Control?
The World Health Organization’s (WHO) manual does includes the diagnosis “excessive sexual drive.” In their manual, this diagnosis is classified as a compulsive behavior and/or impulse control disorder and not an addiction. There is extensive research that suggests hypersexual disorders are of a psycho-social nature. For example, people who identify themselves as “sex addicts” often come from dysfunctional families and have a history of being abused. One study found that 82 percent of sex addicts reported being sexually abused as children. Sex addicts often describe their parents as rigid, distant, uncaring and critical. Many parents of sex addicts have similar tendencies and were also abused as children. Many of these families, including the addicts themselves, are more likely to be substance abusers.
There continues to be great disparity as to the etiological and diagnostic criteria for hypersexual disorders. Is “sex addiction” a true addiction? Is it an obsessive compulsive disorder, impulse disorder, or perhaps not even a disorder at all? Where the responsibility falls - - the addiction, the learned character traits, or the individual’s bad choices - - has significant repercussions in terms of diagnosis, treatment and how society views and treats these individuals.
The answer to these questions are not so clear cut. Perhaps individuals struggle with sexual dysfunctions for different reasons or a complex array of multiple reasons. Even if the evidence suggests sex addiction is not an addiction, this does not rule out the possibility that physiological factors can still play an important role in its constitution. The existence of a strong correlation between hypersexuality and anxiety and mood disorders has been well documented in the literature. In fact, it has been shown that the same neurological transmitters that are involved in anxiety and depression appear to play a role in obsessive and compulsive behaviors.
Like many obsessions and compulsions - - be it video games, the internet, gambling, sports, the stock market or even watching TV - - sexual compulsions can only provide temporary relief from unwanted emotions. The moment the compulsive activity stops the unwanted thoughts and feelings do return with vengeance. Individuals who identify themselves as “sex addicts” tend to act out to mask or avoid unwanted emotions such as sadness, shame, loneliness, guilt, anger and fear. Many “sex addicts” also suffer from low self-esteem, impaired occupational, educational, social, family or relationship issues.
Empathy, Acceptance And Self-Responsibility
It is important to have empathy for individuals who suffers from hypersexual disorders. One must have an appreciation of the depth of their suffering, conflicts and daily struggles, be it of a physiological, psychological or self-inflicted nature. You must be aware of their personal histories, family dynamics, current stressors, sense of self, and underlying psychiatric issues such as mood, anxiety or character weaknesses.
To overcome hypersexual tendencies, one must accept and take self-responsibility for their own limitations, dysfunctional tendencies and past discretions in order to harness their inner strength and move forward in a productive manner. In addition to the support of family, friends and
organizational groups, having a seasoned clinical psychologist as your guide on this difficult journey is important to the healing process.
Dr. Klein is a clinical psychologist who practices in Westport CT. He specializes in the treatment of sex and porn addictions as well as substance addictions.
It Was Meant To Be
People often repeat proverbs as explanations as to why certain events have occurred in their lives. One saying I commonly hear is: "it was meant to be." People use this expression to account for both positive and negative events in their lives. For example, "It was meant to be that I met the man of my dreams" or "the promotion at work that I did not get was not meant to be."
This saying implies that what has happened in a person's life occurred because of an external omnipotent force. These expression are stated in past tense, and is never said prior to an event as a premonition.
It Happened For A Reason
The proverb implies a sense of destiny -- the belief one's actions are predetermined and must have happened for a reason. In fact, some people actually say "it must have happened for a reason" rather than "it was meant to be" -- but both expressions have similar connotations.
In a predetermined world, one is no longer responsible for his or her decisions. One might think she is making a choice, but in actuality she is doing what is dictated by destiny. To use an an analogy, in a world where destiny rules, one's experience of having free will is like the child's experience of being the captain of the ship on a carnival ride where the toy steering wheel has no real control of the boat that in reality travels on a fixed circular track. In other words, free will and choice are illusory.
The Abandon Of Free Will
Why would someone want to accept a worldview that undermines their right to self determination? Isn't personal freedom what we all strive for? From an early age are we not taught the goal of life is to achieve as much freedom as possible, be it financially, socially, at work or in one's relationships? Why would a person want their freedom taken away or diminished by some sort of authoritarian force or being? Is it possible that personal freedom is not all that it is cracked up to be?
The Anxiety Of Choice
Some people have a hard time making decisions. Decisions are not always easy, be it what college to go to, who to marry, where to live, how to invest, should I have kids, take this job, divorce or retire? While you often hear personal freedom is a wonderful privilege, when faced with actual choices, individuals often become psychologically paralyzed. Fear of making the wrong decision can lead to overwhelming anxiety and despair. Once the choice has been made, many individuals often doubt their decision and experience the dread associated with regret. This regret sometimes manifests itself in an obsessive like rumination: "should have" -- "could have" --"what if." Other times, it is defended against by denying the the personal responsibility for the decision. It was not my fault, or I could not have choose otherwise because it was beyond by control -- "it was meant to be."
Paradoxically, to some individuals freedom can be experience as a limitation. To choose "A" means you did not choose "B". Decisions can be perceived as an act of eliminating options. Contrary to the popular saying, for these individuals, every time a door opens another door is closed. A closed door symbolizes one's finitude. Alexander Graham Bell said it so nicely: "When one door closes, another opens; but we often look so long and so regretfully upon the closed door that we do not see the one which has opened for us."
Should Have Could Have
Personal freedom can cause anxiety on many different levels. First, there is the fear of making the wrong decision. This anxiety manifests in obsessive thoughts, thinking over and over again about the pros and cons of each decision. Ironically, while it may feel like not choosing keeps open possibilities, in reality no decision is itself a choice, one that is nonproductive or forward-moving. Second, there is the anxiety associated with regret. This anxiety manifests in ruminative thoughts, the "should have" -- "could have."
Coping Mechanisms and Regret
Both types of anxiety are very painful and can result in despair. Many individuals develop coping mechanisms to avoid these intense negative feelings. For example, some might develop compulsions. -- repetitive rituals as a means of trying to gain a sense of control over fear of the unknown. Others might avoid the decision altogether -- perhaps alcohol or drug abuse as a means of not dealing with the question at hand. Several might deny there is even a choice -- if life is ruled by destiny -- "it was meant to be " you are not responsible for decisions, thus cannot have regrets.
From experience we all know that these coping mechanisms -- be it obsessions, compulsions, avoidance or denial -- have limited abilities to defend against these fears and anxieties associated with the responsibility and pressure of self determination.
Claustrophobia, Panic Attacks And The Fear of Death
There is one more level of anxiety worth mentioning that is intertwined with both the fear to decide and the regret of past decisions. This anxiety is much deeper and more cumbersome than the anxieties discussed above. For the fear of limitation when pushed to its root origin brings one to the fear of one's finitude. Perhaps the claustrophobia or panic associated with a closed door is intrinsically the fear of one's mortality. The existential psychologist refer to this ultimate cause of angst as "death anxiety." But the fairy tale of "happily ever after" is perhaps a topic for another blog.
Dr. Martin Klein is a clinical psychologist who specializes in the treatment of anxiety. He has offices in Westport and Fairfield CT.
Copyright November 2016, Martin Klein, Ph.D.
CT Viewpoints -- CTMirror June 17, 2020
As a child my parents considered themselves to be political independents. With their thick blue collar Brooklyn accents they always told me you should “vote for the person not the party.” Sometimes they voted democratic and at other times they voted republican. My dad was proud to have voted for both the democrat Edward Koch and the republican Rudolph Giuliani for Mayor of New York City. On some occasions, my parents did not always vote for the same person. I remember in the 1984 presidential election, my mother voted for Walter Mondale and my dad voted for Ronald Regan. While their political views were not always aligned, they always had mutual respect for their divergent opinions.
They valued their freedom and especially took the 15th Amendment, their right to vote, very seriously. They knew the importance of expressing one’s voice; a privilege their parents did not have prior to coming to the United States. My parents felt it was patriotic to stand up for what was right. During the 1960s, I remember being with my mother as we participated in numerous peaceful demonstrations. Voting and speaking out for human rights made them feel proud to be an American. They believed that their vote, their freedom to voice their political views and demonstrate for what they perceived to be human rights and justice, would create a better world for their children.
In the past century, the two-party political system has always been viewed as a crucial aspect of our great democracy. The parties’ ideological differences were seen as a check and balance mechanism that led to compromise; the coming together of best practices, thus resulting in historic progress.
As I raise my own children, however, I find myself in a country that is very different from when I grew up. Both parties have become extremely polarized, the Democrats to the left and the Republicans to the extreme right. There is no debate. There is no compromise. There is no coming together somewhere in the middle. Everybody is shouting and no one is listening. Our leaders are acting like 8-year-old children holding their hands over their ears, jumping up and down and calling people derogatory names.
And then it happened. A pandemic. A “lynching in broad daylight.” Protests and rioting in the streets. Peaceful protesters being shot with rubber bullets and tear gas. Is this Washington D.C. or is it Tienanmen Square? Photo opportunities reminiscent of Marie-Antoinette “let them eat cake.” Large corporations getting bigger and stronger while the working class and small businesses are unemployed or going bankrupt. The stock market is going up, while the poor have no food to eat.
The country is exhausted. Enough is enough. We are all feeling vulnerable, anxious and isolated. Despite the pandemic, the country has taken to the street. There is anger in the air. It is time for change. We have reach a tipping point. It is no longer about Democrat versus Republican. It is now beyond politics. It is about the very principles that define us as a country. It is about equality verses racism. It is about democracy versus fascism. It is about environmental survival versus financial profits, science versus mythology, women’s rights verses chauvinism and sexual harassment. It is about compassion verses brutality. It is about being decent, morale, honest and having the psychological capacity to have empathy for others. It is now about good versus evil.
As a country we need hope, we need leadership. We need a grownup to tell us it is all going to be okay. We need to be on the right side of history before it is too late. We all need to vote, even if we have to wear masks.
Martin H. Klein, Ph.D. is a clinical psychologist based in Fairfield and Westport. He is currently offering tele-conferencing sessions.
Dr. Martin Klein is a clinical psychologist who practices in Westport, Stamford and Fairfield CT. He works with children, adults and couples.