We Admitted We Were Powerless

The very first step of every 12-Step program begins with these words – an admission of powerlessness. For many people, that very first step makes participation in a 12-Step program very difficult and with good reason: powerlessness is an uncomfortable feeling and not one that most people seek out or admit to.

In fact, most of us spend a great deal of energy, time, and effort attempting to try to control things and other people in our lives. We work hard to try to create a life of happiness, as we should. However, these efforts often involve trying to gain control over something we don’t have control of, like an addiction. Other times, the efforts involve trying to change or control other people who are in our lives. And understandably, because the people in our lives – their choices and behaviors – affect us; sometimes profoundly.

But when we stop and look at how effective our efforts are to bend others’ actions to our will – when we really examine how well our efforts to control things go – we find that, in fact, we cannot figure out a way to make others be or do what we want. We discover that using all of our efforts to control someone so they don’t cause us pain doesn’t, in fact, protect us. As the program of Alanon says: we don’t cause the behavior of others, we can’t control it, and we can’t “fix” it. Trying to do so simply makes our life feel unmanageable and increases our unhappiness.

Acknowledging that we are powerless is not about acknowledging that we are weak. Instead it acknowledges what is true, and allows us to focus on the things that we can control and the person who we can help: ourselves. Acknowledging the ways we are powerless also allows us to be more accepting of others, and to find a more peaceful way of being in the world and in relationships.

Security is mostly a superstition. It does not exist in nature, nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or nothing. Helen Keller

Enjoy Your Life

Sometimes change is simple, even if it’s not easy

Enjoy your life and be happy. Being happy is of the utmost importance. Success in anything is through happiness. More support of nature comes from being happy. Under all circumstances be happy, even if you have to force it a bit to change some long standing habits.

Just think of any negativity that comes at you as a raindrop falling into the ocean of your bliss. You may not always have an ocean of bliss, but think that way anyway and it will help it come. Doubting is not blissful and does not create happiness. Be happy, healthy and let all that love flow through your heart.

— Maharishi Mahesh Yogi

 

To many, this quote by Maharishi Mahesh Yogi may seem trite, or overly simplistic. And indeed, there are times when we need more than this to create happiness—we may to make changes in our lives or our behaviors, we may need insight and/or healing. We may need transformation through meditation, psychotherapy, or relationship before we can apply new ways of thinking effectively.

However, there is a basic truth to the above quote, as evidenced by Cognitive Behavioral Therapy (CBT); a psychotherapeutic approach that addresses dysfunctional emotions, behaviors, and cognitions through a goal-oriented, systemic process. It is also evidenced through programs such as the 12-Step programs, which helps its members transform, in part, through addressing habits of thought. Programs such as this address a basic truth in the same way Maharishi does: habits of thought create an experience in life, and sometimes we have to consciously change those habits in order to create a different experience, one of happiness.

The Right of Every Child

Recently, in anticipation of National Child’s Mental Health Awareness Week, the Directors of Pathways Institute interviewed a colleague who has a daughter with learning and attention differences.  Pathways Institute works therapeutically with people who have learning and attention differences and their families, and helps them to navigate the system to get services.

When did you notice your daughter’s learning differences? 

I was lucky: when my daughter was quite young – a little over one year old – I noticed she didn’t have hand dominance.  I remembered reading an article about hand dominance as a possible early indicator of learning disabilities while I was in graduate school.  At that point I started to pay closer attention to the how she was developing.

What happened next?

In preschool they did a “ready for kindergarten” screening and the occupational therapist conducting the screening noticed a couple of things.  She noticed the lack of hand dominance and the inability to cross the midline, meaning she would start drawing on the left side of the paper with her left hand get to the middle and switch to her right hand.  She alerted us that we might want to have her assessed.  We set that up and discovered a couple of things that surprised us: our daughter had weak core strength and no hand dominance.  The recommendation was she do occupational therapy.  We started it and it was helpful.  She spent two years in OT and at the end was able to cross the midline and the OT felt she chose to be right handed.  At this point she is still quite ambidextrous.

How did she do when she started kindergarten?

This was the beginning of a very difficult time for her and us.  She had a great deal of difficulty learning to write her letters and she was already identified as a child that was unable to pick up the first pieces of reading.  It was recommended to us she do some afterschool work with her kindergarten teacher on phonics.  We signed her up and she did two rounds of 6 weeks.  At the end very little progress was made and when we asked the teacher, who had a masters level degree as a reading specialist, if she thought we were dealing with dyslexia, she wouldn’t answer the question.  I learned later that she wasn’t allowed by the school district to answer.  This will remain forever immoral and unconscionable to me.  Here we had a child who needed help and they refused to tell us, for political reasons.  But in spite of this lack of information, I knew that learning disabilities are genetic, and I have a sister who is dyslexic, so I was now “on the case,” so to speak.

Was the school supportive?

We had to push and push for testing, and finally at the end of second grade she was tested.  But she still somehow managed to fall in the low, low averages which would not qualify her as learning disabled.  The testing showed just a couple areas of significant deficit: in particular, she scored at 2% for short term visual memory processing.  Because she was strong in other areas, she didn’t qualify.

There is an undeniable conflict of interest if the same institutions that have to provide the services are doing the testing.  I know most parents with dyslexic kids are shocked to discover – and the generable public should also know – that the acceptable averages to qualify as learning disabled are so low that kids have to be several grades behind in school before they qualify for services in California.  And even then some don’t.  My kid didn’t.  Most kids that fall that far behind experience depression and anxiety.  This should be unacceptable and people should be outraged.  In essence we didn’t get anywhere with the school district, we had incredible problems trying to get help for our daughter, but that’s a story for another day.  Suffice it to say that sadly schools and educational administrators don’t appear to be interested in why a child isn’t learning.  This should be the mission and mandate of special education, not “does a child simply qualify.”  It is a broken system where everyone ends up demoralized.

What was it like for you to be denied services for your daughter?

Traumatic.  My wife and I were incredibly confused, distraught and angry.  We really didn’t know where to turn or what to do.  And we were both well-educated professionals.   We couldn’t understand why no one seemed to want to talk to us or how could it be that all these education professionals, who must have evaluated hundreds of kids, were acting like they didn’t have clue?  Our daughter’s principle told us, “Why don’t you take her to one of the private schools that specialize in learning disabilities?”  It is hard to know if she was asking us to leave or telling us she couldn’t help or both.

Luckily we had a friend who told us about an amazing organization: Parents Education Network (PEN).  We were introduced to several PEN members, and talking with them was like walking out into the sunlight after being in the dark for years.  They told us to stop talking to parents of kids without learning disorders, stop talking to educators who don’t care or aren’t interested or able to think about your child, and surround yourselves with supportive friends, family and the parents of LD kids who are a few steps ahead, join PEN and get more information and education.  Finally, they said be prepared to sacrifice and invest in your child.  We were lucky that it was possible for us. It isn’t for most people and that is one of the great educational crimes of our time.  PEN saved our sanity and in ways ultimately our family.

What was it like for your daughter?

It’s very painful to recall.  During her K-3 years in school she just went down, down, down emotionally.  Every day she went to school and was frustrated and failing in making the kind of progress her peers were making.  She was a good kid and so she never acted-out in school, although some kids do.  But at home she was angry and in a dark place.  She hated school and didn’t want to be there but went anyway.  She was an incredible trooper as we were intervening with reading specialists and math tutors.  She’d go to school all day and then 4 days a week go to tutoring; she was exhausted.  She was sad.  She wasn’t well received socially; she did have a few friends but I think because she was so insecure and frankly exhausted she could be controlling and inflexible.  It was hard on her friends and hard on her.  Her insecurity stemmed from living in body with neurophysiology that was failing her in school.  I think she was riddled with fear and quite anxious.

What help and treatment did you seek?

We went to a very wise child psychologist, who told us to get her out the school, change her environment and put her in a school that specialized teaching kids who are dyslexic.  He told us this wasn’t a parenting problem – we had been told it was a parenting problem at different points by school administrators and unkind people who saw an unhappy kid and blamed us, the parents. He recommended we get her neuropsychological testing which was informative and verified what we knew in our gut: that our daughter had learning and attention disorders, although they failed to give her a diagnosis of dyslexia.  Once she was at the new school with experts they all said, “Your kid is dyslexic”.  As an aside, we were so glad to learn that finally, in the upcoming DSM-V, dyslexia will be included with an understandable and researched-based criteria.  You have no idea how relieving this will be for us and millions of parents and kids who are dyslexic.  An actual criteria worked on by the Shaywitzs, the leading researchers and experts in the field.

Did you feel relief after the neuropsychological evaluation and diagnosis? 

Recently, I saw a clip of an interview with James Redford about his new movie, The D Word.  It is about his son’s journey with dyslexia.  He was asked the same thing.  His answer was something like, “No I wasn’t relieved once there was a diagnosis, my son was functionally illiterate and I was still caught in the fear of wondering how this kid is going to make it in life.”  I nearly broke down in tears when I heard that clip – another parent, a father, that really understands.  I wasn’t relieved either.  I didn’t know how my daughter was going to do.  Would she ever get to a place of acceptance, would she learn to read, would she have the chance to go to college?  Would she plateau at a very low level, would she ever feel secure?  A child’s world and job is school, and when they start out failing the psychological impact is huge.  I knew that kids with LD and ADHD are at high risk for dropping out of school, drugs and other impulse disorders.  I wasn’t relieved I was still terrified.

You have seen a change in your daughter over the past few years.  What’s different now since she has been at the school these last 4 years?

My sister is a psychoanalystand I remember talking to her about my daughter when my daughter was about 7-years-old.  She said, “You know, some day she will need to tell you what is was really like for her.”  I was puzzled, I didn’t really get it because I thought I knew what it was like since I has been through it with her.  My sister said, “She will need to tell you how painful it has been and likely how angry she has been at you, because she is dyslexic and in that way different from you and Lori (my wife).  You and Lori didn’t struggle in school and you don’t struggle with learning now.”  At that time, my daughter would just express anger and shut-down, she never was able to talk about what was happening.  She was obviously young so I couldn’t expect it but was this ever going to happen, this kind of conversation with my daughter?

Even after going to the new school my daughter struggled at first – she saw it as a school for losers.  She was projecting her own insecurity and lack of acceptance on the school and kids.  Gratefully, we were referred to a truly gifted child psychologist who worked with her.  This psychologist really understands LD kids and is so incredibly patient, sensitive to and interested in their amazing minds.  She has helped my daughter accept being dyslexic.  It wasn’t quick, and it wasn’t cheap, but the therapy and the education has been worth every penny, miles of carpool, and thousands of hours of time.

I always hoped the day would come as my sister suggested it might, that my daughter would be able to say to me and my wife the truth about her experience.  That day came about a month ago.  It happened when my daughter was having a brown out (unable to recall from memory knowledge she had the day before) and struggling with homework.  She was tired and frustrated and then just began to weep.  She said to me, “You don’t understand what it’s like.  I have to work so hard and sometimes I just can’t remember or find things in my mind.  And you aren’t dyslexic.  You and mom never have these kinds of problems and you’ll never know what it is like.”  I knew then that she had really begun to develop a place of deep acceptance of herself and that she could now tell me what was so painful, that things were easier for me, that she was different than her mom and me.  It was a deep expression of psychological security and healing.

I still get anxious – currently I worry about next steps as we begin to look at high schools – but I am not as scared.  And when I can sit back and just see what she has accomplished I am filled with the deepest respect and love for her.  I have to keep working on having faith so my own fears don’t get in her way.  I now believe that she is going to have an amazing future.  She is the strongest person I have ever known.

How does your daughter feel about herself today?

Well you’d really have to ask her.  What I see is that my daughter is learning, she values her unique out-of-the-box thinking mind, she wants to be a scientist, she has learned to be quite flexible, and has a full social life of friends.  She is able to laugh and recently just happened to say how she doesn’t feel angry any more.  We owe a great debt to all those who have supported her and us.  Both my wife and I feel that educational advocacy for this population of people will be our life’s work.  Every child and family should have this kind of success, whether they have money or not.  It is the right of every child to learn and grow to their fullest potential.

Schwartzenagger, a child out of wedlock & another celebrity scandal: choosing not to follow the story

When celebrities confess sexual betrayal it can trigger painful feelings and memories for the partners of sex addicts.  It is hard to look away when it’s all over the news, radio and internet.  You may want to ask yourself a few questions:

Does it help or hurt me to give my attention to this latest scandal or story?  Do I need anymore evidence that sex addiction, betrayal and loss of trust exist and damage relationships?  Would it be better for me to do something affirming for myself and my healing process?  Can I take a media vacation today and not get into any gossip sessions with co-workers, family and friends?  Can I be honest with my partner and those I am close to and tell them the current story triggered painful and angry feelings and I need love and support and understanding?  

Take a break, take a deep breathe and think about how you can have a better day.  

“We either make ourselves happy or miserable. The amount of work is the same.” – Carlos Castaneda

Elizabeth Corsale, MA, MFT

Addiction and harm reduction: come as you are

In the world of addiction, moderation has traditionally been a dirty word.  Harm reduction has started to change that. Harm reduction is a philosophy that approaches change compassionately.  The aim is to reduce negative consequences associated with the behavior in question and celebrate any positive change, no matter how small.  The motto “Come as you are,” captures harm reduction’s foundation in humanistic and client-centered approaches.

Moderation management for alcohol and drug abuse has gained awareness as an alternative intervention to abstinence, however clinicians who treat process addictions, such as compulsive sexual behavior and kleptomania, have been doing harm reduction by default. For example, most patients who seek sex addiction treatment aren’t looking to abstain from sexual behaviors or activity, but rather to develop healthy sexual behaviors.  Likewise, patients in compulsive shoplifting treatment programs aren’t told to restrict themselves to online shopping, but instead learn why they behave impulsively and create alternative, healthy coping strategies. Furthermore, Harm Reduction Psychotherapy, which addresses both the compulsive behavior and underlying mood or personality disorders, fits process addiction treatment like a custom knit glove. So many patients with process addictions act impulsively as a means of self-medicating depression, anxiety and trauma, much like someone who misuses drugs or alcohol as a way of coping.

So what does this mean for the future of process addiction treatment? If we utilize a harm reduction approach to treatment, we can help the patient reduce negative consequences, increase their self-efficacy and motivation to change.  We do this by celebrating small successes, helping them understand the meaning of their impulsive behavior with the use of integrated psychodynamic, cognitive-behavioral and attachment theories, and reduce the paralyzing shame and guilt that encumbers initiation in treatment by encouraging patients to come as they are.

Jennifer Fernandez, MA

We may be human, but we are also animals

Cognitive Behavioral Therapy (CBT) has been around for a long time and has shown significant success in use for the treatment of difficult to treat disorders such as depression, impulse disorders, addictions, obsessive-compulsive disorder, anxiety, and others.  That said, for those of us who are deep thinkers – who are always asking “But why?” – the idea of changing our lives for the better by simply changing the way we think or behave feels superficial, overly simplistic, or even distasteful.

In truth, there are values to all types of therapy, and because of this many therapists who consider themselves to be psychodynamic and relationship-focused have incorporated techniques that involve CBT – especially the “cognitive” part that addresses reflexive thinking.  But research continues to demonstrate that behavioral modification techniques can help a great deal – for people of all ages.  In spite of wanting to use our capacity for insight, thought, and reasoning to place ourselves above our fellow animals, it turns out we are also subject to the same basic behavioral conditioning that teaches a dog to “sit” using a treat, or training a cat to stay off the dining room table by using a squirt gun.

An example of this was demonstrated in recent research published in Psychological Science.  University of Amsterdam experimental psychologist Reinout W. Wiers and his associates had alcoholics practice “pushing away” images of alcohol with a joystick when they appeared.  When studied originally, those addicted to alcohol had an immediate impulse to “pull” these images towards them when they appeared.  Through the very simple practice, that impulse was re-trained as one that would reflexively push the image away.  They were then given the standard abstinence-based, cognitive behavioral three month program with everyone else.

During the follow-up study it was found that there were expected relapses by all groups.  However, the group with the cognitive-bias modification (CBM) or “pushing away” technique had significantly lower incidents of relapse. One still-abstinent patient told a story illustrating how the technique had worked for him. At a party, looking for a soda, the man opened the refrigerator, but found it full of beer. “Immediately, he made the push movement” — he closed the door.  Certainly, in the moments following he would have to think about whether or not he wants to take a drink and will have a decision to make.  But it appears that this CBM technique enabled people to reverse their initial impulse, giving them the time to think and make the choice not to drink.

This reversal of impulse has tremendous implications in the treatment of other addictions and impulse disorders.  This study will not be news for those who treat sex offenders and have used aversive techniques for years.  However, it does open the door for those who suffer from addictions to drugs and alcohol, or process addictions such as gambling or stealing.  These simple techniques might help, in the moment, to give people who suffer from these impulses the time they need to make a better choice.

Samantha Smithstein, Psy.D.

Charlie Sheen’s addictions: not making his life part of ours

The recent news has been full of articles about celebrity Charlie Sheen’s drinking and womanizing with various women sex workers and porn film actors.  Many media outlets will ignore this story, understanding it is not news; but other media will cover it. Comedians and late night hosts will use it as nightly comedic material, celebrity media outlets will speak with well-known addictions experts for their spin on Mr. Sheen’s situation and condition.  This maelstrom of media will blow over in a few weeks but during that time it can often be extremely triggering for sex/love addicts and their partners.  Often times those triggered will feel embarrassed, anxious about if the other is paying attention to the stories, wonder why they aren’t talking about it, and in some cases obsessively look for more stories.

If you are feeling vulnerable and anxious when these kind of stories hit the news here are a few suggestions:

1) Talk to someone.  If you are in therapy talk to your therapist, if you attend 12-step meetings talk to your 12-step group, or just talk to someone you trust about the feelings, thoughts, memories and fantasies this story arouses inside of you.

2) Be honest with yourself and support system if you are feeling triggered to “act out” in your
addiction if you are a sex/love addict or in your Unhealthy Relationship Patterns (URP) if you are a partner.  URP can be snooping, constantly looking for more stories about the celebrity, controlling behaviors, obsessive fear based thoughts, and not taking care of yourself.

3) Talk to your partner with non-defensive communication.  The following are some examples of how someone who struggles with sex/love addiction or their partner could bring up feelings that may have surfaced.

Partner Example
I noticed the celebrity story has made me feel anxious and brought up painful memories.  I don’t need to rehash that with you, I just want you to know I am feeling anxious and could really use some comfort right now.  Have you had any feelings about this story?

or

Sex/Love Addict Example
I have had feelings of shame every time a comedian makes a joke or someone in the media tells me sex addiction is just an “excuse” for bad behavior.  I have been working hard  on my recovery and can see that I have more work to do since someone elses (the celebrity) problems bring up feelings of shame in me.

When sex/love addiction hits the news it is a time when sex/love addicts and their partners need to have as much abstinence as possible from this kind of media blitz and engage in meaningful communication with their therapists, 12-step sponsors and each other to discuss honestly the feelings and thoughts about their own addiction experience.

Elizabeth Corsale, MA, MFT

Sometimes what you need is hard to swallow

Frequently when a therapist suggests that his or her patient might be helped by psychotropic medication the suggestion is met with concern, doubt, or even anger. This is even the case when a patient has been suffering for years from mood, impulse, or attention-related issues. Additionally, often patients try medication, experience relief, and then decide abruptly to stop taking medication without consultation with their therapist and psychiatrist; often while simultaneously self-medicating with illegal drugs, alcohol, or unhealthy behaviors. This can be especially true during the holidays, when the pressure to be happy is intense, the feelings of depression are frequent, and the availability of unhealthy behaviors is high.

No doubt prescribed psychiatric medication is not a perfect science: there are side-effects and sadly medication doesn’t always work and provide the relief of symptoms and quality of life improvement sought by the patient. However, all too often side effects and/or the efficacy of the medication are not the reasons people stop taking helpful medication. Instead, the reason expressed is more likely to be “I just don’t want to be on medication (for the rest of my life).” Why?

Unfortunately, in large part this is because there remains serious stigma, shame and fear of psychiatric medication and psychological treatment. According to NARSAD, the Mental Health Research Association, one in five Americans suffer from mental illness in a given year but only one-third seek treatment. In San Francisco it is estimated that close to ten percent of the population suffers from a serious mental illness. In a recent study, psychiatry residents – those doctors learning to help people with mental illness – acknowledged that while they would tell others about being in psychotherapy, they had not admitted to anyone that they were taking psychotropic medication because of the perceived stigma even amongst their peers and superiors. In a study earlier this year, it was found that even the drug companies that market psychotropic medications to doctors were perpetuating rather than breaking-down the stigma attached to mental health problems.

Of course, the ads from the medication companies and fears of the psychiatry residents are simply a reflection of the societal stigma that still exists. And yet medications have given so many people a chance at living a happier, more fulfilled life. Rather than a weakness, character flaw, or sign of a mental deficiency, a psychiatric condition is a medical condition that needs to be treated. Without a doubt, there are many ways to approach psychological problems without medication. This can range from psychotherapy, to meditation and/or yoga, to exercise, to lifestyle interventions, or some combination these interventions. But in some cases, just as with any medical issue, medication can make a tremendous difference. For example, medication can make a profound change in a patient who has been in psychotherapy for years and has made tremendous progress psychologically, emotionally, and in making healthy lifestyle choices, but remains unable to shake a pervasive negativity about herself that makes it very difficult for her to achieve satisfying, intimate relationships. Once on a low dose of anti-depressants, she may find that the negativity has lifted and she is much more healthy psychologically and capable of relationships than she imagined.

Part of the resistance to medication is due to a societal backlash. Pharmaceutical companies make a profit from selling medication and our culture has a tendency to look for the easy answer to problems, sometimes in a pill. Many have turned to medication inappropriately – over-medicating our children or those struggling with mental illness. It has become clear through these experiences and in research that medication is not always the answer and most often not enough as a solution. However, it is also clear that in some cases medication is one tool in the toolbox of interventions that can make a tremendous difference.

Samantha Smithstein, Psy.D. and Elizabeth Corsale, MA, MFT

Pleasure vs. stress

Often people turn to pleasurable activities when feeling stressed, and we tend think of this as being an “escape” or an unhealthy coping mechanism. This is especially true when the pleasurable activity is unhealthy for us and/or our relationships with others. But recent research at the University of Cincinnati has demonstrated that pleasurable activity such as food or sex actually reduces stress via brain pathways by inhibiting anxiety responses in the brain.

The researchers found that even small amounts of yummy food can reduce stress for a week – and that it was the taste that made the difference rather than the content or the quantity. Additionally, access to a sexual partner also had a similar effect. This helps to explain why seeking such activities continues during stressful times, even when it is a behavior that is unwanted, such as overeating or sexual acting-out.

But these findings are not simply important because they explain issues related to obesity or sexual addiction, although certainly that is important. These findings also point us towards finding a solution – alternatives to behaviors that someone desires to change. In other words, if it is true that a small taste of something delicious or pleasurable sexual activity can reduce stress, then it would follow that other pleasurable activities can reduce stress as well.

Furthermore, we know from prior research that there are activities that the body and mind can find deeply pleasurable and highly effective in reducing stress, even if intellectually we may not think of them as enjoyable. For example, exercise is an effective stress reduction activity (and pleasurable for the body), even if the person exercising imagines it to be a chore or tiresome. Similarly, people complain that they wouldn’t be able to find time to mediate or think of it as a waste of time, when techniques such as Transcendental Meditation have been found not only to be pleasurable for the mind and body but also highly effective stress-reduction techniques.

The link between stress reduction and pleasure is becoming clearer, and adds to the list of explanations as to why some people may engage in activities that aren’t necessarily good for them during periods of stress. But this link also provides us with alternatives that can bring about the (ultimately) same desired result in a better way. This is especially important in the weeks ahead, as we head towards the holidays. Holidays often bring a combination of both stress and the availability of unhealthy pleasurable activities. Becoming conscious of the link between the two can help us choose the option for pleasure that not only helps us to relieve the stress but makes us healthier in the long run.

Samantha Smithstein, Psy.D.

Diagnostic conundrum part 2: compulsive behavior as an anxiety disorder

In a previous article, “process addictions” such as addiction to sex, stealing, food, etc. were explored as legitimate disorders and inclusion was called for in the diagnostic manual. One possibility explored in that article was that it be included in the category of “Substance-Related Disorders,” since the experiences of people who feel compelled to repeat these behaviors are often highly similar to the description of the experiences of people dependent on substances (the diagnostic criteria).

There is, however, another category of diagnoses under which process addictions could potentially be included: that of Anxiety Disorders such as Obsessive-Compulsive Disorder. A person with Obsessive-Compulsive Disorder has recurrent and persistent disturbing, intrusive and inappropriate thoughts or impulses that they cannot ignore or suppress. This person then feels driven to perform a behavior in order to reduce the thoughts or impulses. The behavior is either not realistically connected to the thought or is excessive.

Most traditionally, obsessions are related to fears (getting ill) and compulsions are related to simple, common acts such as hand washing, ordering, checking, counting, or repeating words silently. The person may even rationally know that the behavior won’t make the fear/thought go away, but they still feel compelled to action, over and over again.

However, it is possible that some people attempt to quash the intrusive thoughts or fears  by behaviors such as shopping, eating, or masturbating, and that the person feels driven to this behavior in spite of knowing that it will not, ultimately, solve their problems. Often people describe an experience of feeling anxious, alone, or generally “uncomfortable.” They seek out a behavior in an effort to feel better, even as they are aware that when they are done, they will feel even worse.  Sometimes they find themselves repeating the behavior over and over, such as masturbating for hours even after it ceases to feel pleasurable.

This way of thinking about compulsive or “addictive” behaviors is a less common way of conceptualizing it, but for some, it may be exactly what ails them.  And, as in the case of substance dependence, inclusion in the new diagnostic manual could get them the help (and medical coverage) they need.

Samantha Smithstein, Psy.D.

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