While the terms “pedophile” and “child molester” are often used interchangeably, they do not mean the same thing. A pedophile is a person who is attracted to children, but not all people with pedophilia molest children. Many individuals who are attracted to children never act on their attraction, and some seek help in order to keep from harming children.

Pedophilia is considered by some to be one of the most difficult social problems to understand. The 5th edition of the Diagnostic and Statistical Manual classifies pedophilia as a paraphilia, distinguishing it from pedophilic disorder: It is diagnosable as a mental health condition when it causes distress to the affected individual or to someone who is unwilling or unable to consent. Thus, according to this classification, having an attraction to children and not acting on it does not indicate a mental condition.

New research shows that pedophilic disorder may be neurological in nature, lending further support to the position that an attraction to children is not a choice. Some may find this difficult to accept, as those who do act on their desires and molest children have the potential to cause serious and lasting harm to many children. They may repeat their crime over and over until stopped by the criminal justice system. Many people may believe that, once caught, people who molest children deserve to spend the rest of their lives in prison, but the reality is that many of these individuals will eventually be released.

Upon release from prison, offenders are often required to enter rehabilitation programs, which are meant to redirect pedophilic urges and help a person refrain from harming children. These programs are often viewed with skepticism, as many believe that a person who molests children cannot be rehabilitated and that pedophilic urges will always lead to the sexual abuse of a child. However, there are several perspectives on the issue.

The Difference Between Pedophilia and Child Molestation

Psychological perspectives on child molestation vary greatly, but experts agree that most people who molest children fall into one of four categories:

1. Children or teenagers under the age of 16 who are sexually curious and may experiment with younger children.
2. Adults who have a brain condition, intellectual disability, or other mental health issue.
3. Individuals who have an antisocial personality and may use children sexually but have no particular sexual desire for children.
4. Individuals who are older than 16 and experience ongoing sexual desire for children. Sexual desire for children, or pedophilia, can be identified and treated or controlled with therapy and medication.

Ninety-five percent of all known instances of child molestation are committed by people with pedophilia. Other individuals may molest children for the above reasons, out of sexual frustration, or in order to maintain power or exert control.

Though nearly all those who molest children have pedophilia, many people with pedophilia will never molest a child, and some work to eliminate their attraction to children through various forms of treatment and therapy.

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Non-Offenders

Dan Savage, who frequently writes on the topic of human sexuality, has published several accounts of people who, despite their attraction to young children, avoid being alone around children and are able refrain from committing acts of molestation. It is generally acknowledged that it may take a significant amount of self-control to avoid offending and that pedophiliac inclinations typically mean a person with pedophilia will find it difficult to have a healthy sexual relationship.

In several European countries, Savage points out, people experiencing a sexual attraction to children are often able to seek treatment confidentially. In the United States, however, an individual who discloses pedophilic tendencies may be arrested, as therapists and physicians are required by law to report anyone who poses a threat to children. This law, in addition to the stigma surrounding pedophilia and the limited number of resources available to those seeking help in the U.S., is likely to discourage non-offenders from seeking professional help, help that may enable them to continue to keep from offending.

Free and confidential prevention and treatment programs–such as Germany’s Prevention Project Dunkelfeld–may help those who are attracted to children refrain from acting on their desires. Some European countries do have lower child molestation rates than the United States, and this fact may be connected to the availability of treatment.

Many people who are attracted to children are horrified and frightened by their preferences and attempt to do everything they can to keep from harming a child. They may wish to attend therapy, explore ways to curb their desires, or take medication. Making treatment available and accessible to individuals before they offend may reduce instances of child molestation.

Chemical Castration

Chemical castration is one method that may keep child molesters from reoffending. Many states in the U.S. offer voluntary chemical castration in exchange for earlier release. Some states, such as California, mandate castration for offenders with multiple convictions as a condition of release. The treatment has been shown to greatly reduce sexual desire in men who are attracted to children and to lower rates of recidivism.

Those who have not yet harmed a child and who are committed to avoiding doing so may find relief from their desires through chemical castration. In some cases, an antidepressant, which may have the effect of further limiting one’s sex drive, is also prescribed.

Sexual desire cannot be completely eliminated by castration, a fact that leads many individuals to question the efficacy of the treatment and the risk of releasing offenders who may still experience some sexual desire for children. Another objection stems from the fact that the person undergoing treatment must be relied on to take their medication regularly. However, chemical castration has been shown to be effective for many individuals and thus is likely to protect many children who would potentially be victims of sexual abuse.

Group Therapy

Many therapists use group therapy as a type of treatment for people with pedophilic tendencies. Groups can provide a safe environment to discuss inappropriate and harmful urges, and the support of a group of individuals facing similar challenges may give some people the strength to avoid offending or reoffending.

However, when someone is involuntarily enrolled into group therapy and has no particular desire to stop offending, a support group can become a different environment. Other members may, knowingly or unknowingly, support a high-risk offender’s further attempts at molestation. But because mandated group therapy may be of benefit to some convicted offenders or those who are at risk for offending, group leaders may not wish to withhold a potentially helpful treatment from anyone. They may, however, choose to carefully screen participants prior to program entry and during treatment.

Aversion Therapy

Aversion therapy pairs an unpleasant stimulus such as an electric shock, pinch, or flick along with a pleasant stimulus. Sex offenders may use aversion therapy to attempt to eliminate their attractions to children. While this therapy can be effective, it often poses ethical problems, as therapists cannot shock their patients. It can also be difficult to maintain consistency with this type of treatment. Further, when aversion therapy does work, it is unlikely to do more than eliminate the attraction to children. It likely will not help people develop an attraction to age-appropriate adults if they do not already experience such an attraction.

Fake Porn

Psychologists have still not reached an agreement about whether pedophilia is a sexual orientation or a mental illness. Those who believe it is a sexual orientation may advocate the use of fake porn, depicting animated or CGI children, as a way for those with pedophilic tendencies to achieve sexual release. Some therapists have reported that this method has been successfully used to reduce an individual’s desire to molest a child.

However, other therapists point to studies demonstrating the effect pornography can have on sexual desire and express concern that such pornography may actually create or increase a desire to sexually abuse children. Many also question the ethics of making such pornography, even when it does not involve actual children.

References:

1. Early Diagnosis and Effective Treatment. (n.d.). Retrieved from http://www.childmolestationprevention.org/pages/focus_on_the_cause.html
2. Goode, S. D. (2010). Understanding and addressing adult sexual attraction to children: A study
   of paedophiles in contemporary society. New York, NY: Routledge.
3. Jenkins, P. (2004). Moral panic changing concepts of the child molester in modern
   America. New Haven, CT: Yale Univ Press.
4. Kaplan, M. (2014, October 5). Pedophilia: A Disorder, Not a Crime. Retrieved from http://www.nytimes.com/2014/10/06/opinion/pedophilia-a-disorder-not-a-crime.html?_r=0
5. Kincaid, J. R. (1998). Erotic innocence: The culture of child molesting. Durham, NC: Duke
   University Press.
6. Nanos, J. (2014, March 1). Can Chemical Castration Help Pedophiles Tame the Beast Within? Retrieved from http://www.bostonmagazine.com/news/article/2014/02/25/chemical-castration
7. Schwartz, C. (2011, December 7). What Science Reveals about Pedophilia. Retrieved from http://www.thedailybeast.com/articles/2011/12/06/what-science-reveals-about-pedophilia.html
8. Seto, M. C. (2008). Pedophilia and sexual offending against children: Theory, assessment, and
   intervention. Washington, DC: American Psychological Association.

Everyone occasionally has a bad case of the Mondays, but that can also go away once you start joking around with coworkers. However, what happens when you’re surrounded by negativity, people who gossip and constantly complain? If positivity is lacking in the workplace, it can be a major mood drainer. Luckily, experts do have some suggestions for conquering situations with negative coworkers. These are just some possible solutions to a negativity problem, but feel free to experiment and add your own personalized touch.

Cheryl Palmer, a certified career coach and the owner of Call to Career, said when people are placed in a negative environment, it can start to rub off on them if they don’t consciously fight against it. However, she does have a couple of tips to help workers stay positive in a potentially negative work environment:

1)    Whenever possible, surround yourself with positive people. If any of your coworkers have a positive attitude, associate yourself with them. If there are no positive people at work, then make sure you surround yourself with positive people outside of work.
2)    Physically take yourself out of that environment whenever feasible. For example, you don’t have a choice when it comes to being around negative people when you are in the office, but you can use your lunch break to get out of the office and take a breather. Going for a brief walk during your lunch break can be rejuvenating.

Workers can even attempt to bring positivity to negative coworkers, especially if they appear to be more open to changing their ways. Here are two tips for helping coworkers see their jobs in a more positive light:

1)    Focus on the positive aspects of the job and/or organization. You can usually find something positive if you look for the positive.
2)    Another way to help coworkers is to focus the conversation on positive things outside of the workplace. Instead of talking about work all the time and how bad things are, you can talk with coworkers about their families and outside interests.

Tina Tessina, a psychotherapist and author of It Ends With You: Grow Up and Out of Dysfunction, said in an email that overall negatively, especially in the workplace, can lead to worse issues.

“Negativity increases anxiety and despondency, which in turn increase stress,” Tessina said. “There are many studies that show how deleterious stress is to your health.  A negative outlook also ‘programs’ your subconscious to look for more negative things, and can easily make the situation seem gloomier than it really is.”

“When you’re complaining about what’s wrong, you’re not looking for ways to improve your situation or circumstances,” she added. “You wind up not being able to see the positive options that are there. A negative attitude can also increase the likelihood that your coworkers won’t get along. Once people start on the fault-finding path, they wind up also being negative toward each other, which creates an unpleasant, edgy atmosphere.”

She has a couple suggestions for being more positive in the workplace.

1)    Be the different voice—find something positive to say about whatever they’re complaining about; or else just ignore the negative conversation. You are not required to join in when the discussion is going downhill.
2)    No one responds well to being told what or how they should think or talk. What you can do is be the ‘Pollyanna’ in the group, searching for the positive possibilities and being a creative thinker. If you don’t follow the herd, the herd may wind up following you.

Tessina said people need to realize they have the power to take charge of their own thoughts and feelings, or they could get out of hand. This is one aspect to consider if you start giving in to negative talk at work or hear other coworkers complaining.

“Your thoughts affect your mood, and how you relate to yourself can either lift or dampen your spirits,” Tessina said. “Neuronal activity in the brain activates hormones which are synonymous with feelings. Constant self-criticism results in a ‘what’s the use’ attitude, which leads to depression. Continuous free-floating thoughts of impending doom lead to anxiety attacks. Negative self-talk creates stress.”

If you’re constantly stressed and prone to negativity, it might be a good idea to look at what types of relationships you’ve built with others, because chances are you’ve surrounded yourself with negativity and relationships that are prone to stress. It’s also beneficial to do some soul-searching and come to terms with what you want to do with your life, so that’s one less thing to become stressed about.

“What I do to help clients become aware of self-inflicted stress is first, to ask them to become aware of what they’re saying to themselves—if there is a constant stream of negativity, it will create stress—just as being followed around by someone who’s constantly carping on you would be stressful,” Tessina said.

April Ricchuito, a yoga/MST therapist, gave her suggestions in an email for combating negativity in the workplace:

1)    “Avoid taking anything personally. This was never about you; it’s about them. Set good, clear boundaries.”
2)    “Learn to meditate. Take three deep breaths and smile before responding, especially when you are irritated.”
3)    “Watch a few funny YouTube videos if you can. Share them with your coworkers.”
4)    “Look up a few office/desk yoga exercises you can do quickly and effortlessly to get grounded and relaxed.”
5)    “If you do choose to speak to coworkers about their outlooks, speak to them privately. Use ‘I’ statements to avoid sounding like you are attacking. Offer to help them: ‘Hey, I noticed you don’t seem as positive as usual. Is anything going on that I can help you with?’”

Denise Altman, the president of the Altman Initiative Group, Inc., said it’s important to find a job that you can look forward to and have passion for – work doesn’t have to be a place you drag yourself to. She also offers the following advice: “Start the day with a positive thought or mantra—post it on your screen saver or Post-it to your computer and think on that when others say negative things.”

Kathi Elster, an executive coach and business strategist at K Squared Enterprises, and coauthor of books like Working With You is Killing Me: Freeing Yourself From Emotional Traps At Work, gave a different suggestion to stay positive, even when you’re surrounded by negativity in the workplace. “Do whatever you need to in order to keep your positive mood in check. It might be talking to a friend that makes you laugh, keeping uplifting music on, surrounding yourself with the things that remind you how good life can be—photos, your favorite scents, humorous reminders, cartoons, jokes, etc.”

When assessing a patient for major depressive disorder (MDD) and choosing the most appropriate course of treatment, personality type is a major consideration. Research has demonstrated that people with high levels of neuroticism and/or low levels of extraversion often respond less well to treatment and have higher relapse rates. Briefly, neuroticism is a personality trait that includes a tendency toward negative emotions and emotional instability. Extraversion, on the other hand, describes a tendency toward positive feelings, including but not limited to higher levels of socialization and self-confidence. A recent study published in the Archives of General Psychiatry examined the links between personality type, cognitive therapy, and the antidepressant medication Paxil (paroxetine).

In multiple studies of the drug Paxil, participants who showed significant improvement in their depression also reported greater feelings of confidence and liveliness. The authors of these studies generally describe these personality changes as effects of the overall improving mood of the patients. A more recent study ponders whether selective serotonin reuptake inhibitors (SSRI) medications, Paxil in this case, do in fact work to change personality states resulting in a lessening of depressive symptoms. The study was broken into three groups: a placebo group, a therapy group, and a group receiving Paxil. Depression and personality ratings were gathered from each participant at regular intervals throughout the 16-week study.

As many previous studies have shown, even people receiving placebo showed noteworthy improvement in their depression. However, the personality trait scores underlined a potentially significant fact. Neuroticism and extraversion were both relatively unchanged in the placebo group, while those receiving Paxil or cognitive therapy showed improvement in both of these key areas. This suggests that Paxil may work to alter personality traits on the molecular level. Cognitive therapy also led to decreased neuroticism and increased extraversion, but the reasons for these changes are not as clear. What is clear is that these personality changes predict a better long-term outcome for patients and a lower chance of relapse.

The lesson from this research is that clinicians should be mindful of specific personality traits when treating an individual with MDD. Paxil, and possibly all of the SSRI medications, may work to improve depression on a more fundamental level than anyone realized. The data has always been there, in a sense, but perhaps the interpretation was lacking. As researchers unlock the mysterious relationship between moods and chemical neurotransmitters, more specifically targeted drugs will be developed. Furthermore, as the early warning signs of depression—neuroticism, low extraversion—are better identified, interventions will be possible to prevent this debilitating mental health condition before it occurs.

References

1. Depression (major depression) – MayoClinic.com. (n.d.). Mayo Clinic. Retrieved March 8, 2012, from http://www.mayoclinic.com/health/depression/DS00175
2. Tang, T.Z., DeRubeis, R.J., Hollon, S.D., Amsterdam, J., Shelton, R., & Schalet, B. (2009). A placebo-controlled test of the effects of paroxetine and cognitive therapy on personality risk factors in depression. Archives of General Psychiatry, 66, (12), 1322-1330.

Never underestimate the power of talking with someone who really listens.

Our culture doesn’t encourage people to talk about their emotional pain. Our culture teaches people to suppress their feelings. People tell each other not to “whine” about problems or not to “dwell” on them. People are told to “get over it” and to “be strong,” meaning “don’t feel anything—and if you do, don’t talk about it or show it.”

One example of this is when only certain emotions are deemed “appropriate.” Anger, especially for men, is more acceptable than sadness or anything vulnerable. So, for many men, emotions like sadness, loneliness, disappointment, anxiety, guilt, and shame get funneled into expressions that look like anger. Unhealthy coping mechanisms—such as using alcohol, other substances, or addictive activities—are taken up in order to push the genuine feelings down. These provide some temporary relief but, ultimately, undermine a person’s strength, health, and functionality.

Most people, when they feel upset, benefit by talking to someone who listens patiently, nonjudgmentally, empathically, and who shows that he/she understands at a deep level. There is something basic in the way human beings react when receiving this simple, but skillful, response to talking about their emotional pain.

Depression is no different from any other emotional pain, in this sense. [fat_widget_right]If everyone who felt depressed was comfortable talking about it to a good listener, we would have far fewer depressed people—possibly even fewer people on antidepressants.

Recently, a psychiatrist who was treating a friend of mine said that few people truly have a chemical imbalance causing their depression. Maybe this is why some research shows that antidepressants work about as well as placebos. Maybe the placebo works because the patients get some caring human contact before taking the pill. Human contact goes hand-in-hand with talking. We all need to see people smile at us, be warm toward us, perhaps even touch us in a friendly, appropriate way. Warm, caring human contact is essential for us to live and thrive.

Ideally, we would all have this in our lives without having to pay someone to get it. We would all have friends, relatives, spiritual leaders, mentors, teachers, or healers around to listen and care when we are upset. Yet our culture no longer supports this basic need. We are too busy. Many of us come from families who have abused us, or from whom we are separated. We often live alone, or have only our immediate family around. We are not connected to a church or community where this kind of talking may have been more available in the past. Instead we put value on the rational, over the emotional, to the extreme. As a result, many people end up trying to hide their tears and vulnerability, thus creating more alienation and isolation. Ironically, suppressing our feelings and being deprived of warm contact actually makes us more susceptible to depression, making people think they have even more to hide.

So if you are feeling depressed or in emotional pain, try to find someone you can talk to—someone who will listen deeply and without judgement. Talk to him/her about everything that’s seriously bothering you, and keep talking until you feel relief (even if you have to go through several people to have as much time talking as you need). If there’s no one in your life like this, and you don’t think you can find anyone, find a good therapist. It will help to do your talking with a highly trained, skilled, and naturally intuitive professional. You owe it to yourself to do whatever it takes to prevent depression, or deeper depression. It’s really so simple (though not always easy), yet so important.

We all manage the impressions other people have of us. We think about what we might wear to an event or a job interview, we consider how free we can be with “expletive deleted” words in a given social situation, we may carefully choose what information we reveal about where or if we went to college or what kind of work we do. When it is appropriate, impression management helps us get what we want. However, when we manage other peoples’ impressions of us in most of our interactions, we run the risk of interfering with our identity by impeding the development of our sense of self.

Excessive impression management involves overly focusing on creating a particular view of who we are and controlling how people think and feel about us. When so much of our attention and energy is placed on controlling how we are perceived, there is little room for us to think about, be interested in, or develop our real selves. Typically, when we are overly invested in impression management, our sense of self has little substance. In trying to become the person we believe people want us to be, we become chameleons, changing our shape and form, altering our ideas. Sometimes, we may not even notice our own ideas (or be interested in developing them), because we are so intent on being seen as the impressive person we have assessed this particular situation requires.

Why would it be a problem if we are successful in creating the impressions we desire? Why does it matter if today we determine that it would be good to be viewed as creative and funky, and tomorrow we know we have to come across as smart and conservative?

My experience as a therapist has allowed me to witness the damage that can result from constant attention to impression management. People who have practiced impression management excessively for years (some quite successfully) often find that they begin to experience a vague sense of something being wrong with their lives. Many have had difficulties in relationships or in forming lasting relationships. When they come to therapy, they have difficulty finding words to explain an emptiness or tired dissatisfaction with life. It’s as if a false structure of self collapses and leaves little underneath to hold the person upright. What becomes apparent by talking in therapy are the underlying feelings that have been pushed aside in the process of creating false impressions. As these clients talk in therapy, they begin to uncover shame, a lack of self-confidence, anxiety about failure, self-hate, and many other feelings they’d defended against.

Lily, a 31 year-old client, is a successful executive in a publishing firm. She makes an excellent salary and has steadily risen in her profession. She is  active socially and is often the life of the party at the many events to which she is invited. When she came for her first appointment, directly from work, Lily was conservatively dressed in an expensive suit and carried a designer handbag. In our first session, she reported feeling depressed and had a difficult time trying to explain a feeling of unease about herself and her life. She told me “I don’t know exactly what I am feeling or what the problem is. I should be happy. I have a great job. I am always going out and having fun. But I guess I’m not really having fun. I don’t know. Maybe I’m beginning to feel I should be thinking about some kind of relationship. I go out on a lot of dates, but I haven’t wanted to be in a relationship. I just don’t know what the problem is. I shouldn’t be feeling this way, even though I guess I really am not sure what I am feeling.”

Lily and I began to work together, and in the fourth month of our work, she came to her appointment on a day that she didn’t go into her office. She wore torn jeans, a short cropped top and had a pink streak in her hair that hung loose instead of her usual bun. She also had a small ring in her nose. It took a moment for me to realize who she was! It wasn’t just her change of wardrobe that I was responding to. Somehow it felt as if I were in the presence of a totally different person than the one I was beginning to know. As she sat down, I said, “Wow, you look really different today.” Then I asked  if she could talk about her two very different looks. What Lily described to me illustrated excessive impression management.

Lily said she was going to meet some old friends she knew from college. She hadn’t seen them for five years, although she stayed in contact, mostly by email several times a year. She had already told me that she had been popular in college but hadn’t mentioned that she was a drama major and hung out with a group who were generally outsiders on the campus. She also hadn’t made it clear that while she was popular within her group, that wasn’t the case in general. She said, “I might not have been popular with everyone, but I did keep them intrigued by how I looked and by my in-your-face style. I had dyed pink, green, or striped hair; I smoked a lot of weed and was usually the one to buy for the rest. We were a very tight bunch. We kinda slept around inside the group. It was a great time in my life.”

I asked Lily whether her choice of dress was related to this meeting with her old friends or whether she usually dressed this way with friends when she wasn’t at work. “Oh no,” Lily said, “I would never dress this way with my friends today. I guess I have a whole variety of clothes that I wear, depending on who I’m with. For instance, I would never wear my designer stuff with the girls I go out for drinks with on most Wednesday nights. They don’t know I make so much money, and I would feel funny around them. I also have other clothes I wear with family. I can’t be too funky or too fancy with them. They would be really critical if I looked like that. They don’t really get what I do now, the same as they never knew much about me in college. I’m really selective with what kind of information I reveal to people. I’m really worried about how to dress today because I’m not sure where everyone is at. I didn’t think the corporate look or the way I dress with my Wednesday group would make the right impression, so I thought this would be a good compromise.” With what sounded like great pride, Lily continued, “I suppose I am a woman for all seasons. I can be whatever I think people want me to be.”

As Lily and I continued to work in therapy, she began to recognize that as a “woman for all seasons” she didn’t have a sense of what kind of a woman she really was. While we all have many different parts of ourselves, and it’s not so unusual to be different with different people, Lily had no sense of a core self. She began to understand that her unease and empty feelings were related to the absence of knowing who she was and what she wanted. This awareness motivated her to commit to work in therapy. Over time, she discovered how she got to be without a strong self, what parts of herself were there but not attended to, and what feelings she had trouble tolerating. Most of all, Lily developed an identity. She became aware of her own desires, feelings, and dreams.

If you haven’t read the novel yet, you might be 50 shades of curious about why Fifty Shades of Grey is the most-talked-about tale in print currently.

A quick search will reveal that the romance between the main characters, Mr. Grey and Miss Steele, revolves around bondage, discipline, dominance, submission, sadism, and masochism (BDSM). In fact, Christian Grey appears to really only get satisfaction from sex when it involves inflicting pain or dominance over his partner, which, following criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) used by mental health professionals to make diagnoses, could be considered a mental disorder called sexual sadism.

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The DSM IV-TR states that “sexual sadism involves acts (real, not simulated) in which the individual derives sexual excitement from the psychological or physical suffering (including humiliation) of the victim.” In order to officially be diagnosed with sexual sadism, individuals must meet the following criteria:

1)    “Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.”
2)    “The person has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.”

In the first novel of the series, Christian Grey appears to engage in sexual sadism only with consenting participants (like Anastasia Steele, the main female character), but he openly admits to being abused (including sexual abuse) as a child and teenager and appears to be at least somewhat distressed by the fact that it’s difficult for him to have a “normal” relationship. He even explains to the character Anastasia Steele at one point that this is just the way he is, almost with sorrow. And although he does have “normal” or “vanilla” sex with Anastasia, he makes it obvious that he prefers sex that involves pain and pleasure at the same time, always with him dominating.

Anastasia also admits to herself that there is something unusual about Christian and his sexual preferences, but she lets her desire for him take over, and she hopes that she can make him want a “normal” relationship with her. She herself has issues with low self-esteem and confidence, which is perhaps why she is so drawn to the seemingly overly confident Christian. Both characters appear to function as well as the average person in their fictional world, but both have issues that could potentially need to be addressed by a professional if they lived in the real world.

So it appears that one of the main characters of Fifty Shades of Grey may have a diagnosable disorder related to sexuality, or at least has abnormal sexual preferences and a traumatic past that hasn’t been resolved yet. He has major difficulties maintaining any lasting romantic relationship, and yet the relationship between Christian and Anastasia seems to have been received in a somewhat positive light, considering the large following of readers.

The Experts Weigh In
Several mental health experts have offered their insight into the unusual relationship found in Fifty Shades of Grey (and the two other novels in the series). Reef Karim, a board-certified psychiatrist, the founder and medical director of the Control Center for Addictions, and author of Why Does He Do That? Why Does She Do That? and host of the new show Broken Minds on the Discovery channel, said that the novel is definitely making people think about normal and abnormal sexuality and possibly changing some people’s minds.

He said in an e-mail that the main question people are wondering is, “What is normal and abnormal sexual behavior, and when is aberrant sexual experimentation and behavior considered a mental health diagnosis?” “The really interesting part of psychiatric diagnoses is that many are based on a behavioral spectrum where the interruption of an individual’s social, relational, occupational, and functional life is a key factor in making the diagnosis,” Karim said. “This book has become a literary piece of pop culture that is challenging many to review their thoughts on normative and ‘out of the box’ sexual behaviors.”

He said that there could be concerns about a link between sadomasochism (S&M) and childhood abuse as well, since that is mentioned in the novel. “There is definitely a connection, but many people with no psychiatric or psychological history report enjoying BDSM primarily as a novel and alternative way to connect with each other,” Karim said.

Despite (or because of) the unusual relationship involving pain and pleasure (and emotional issues), many women appear to be captivated by the novels. Karim suggests this is because women enjoy having sexual fantasies, but that doesn’t necessarily mean they want the type of relationship found in the novel to become more than a fantasy. If anything, women might be more prone to sexually experiment during or after reading the novels.

However, he doesn’t think the novel is capable of completely changing sexual norms, so sexual sadism and sexual masochism will most likely still be considered mental disorders according to the DSM in the future. “I believe the novel opens up the conversation of BDSM, kink and sexual norms, but it’s much more in the curiosity range than actually changing research-driven professional medicine,” Karim said. “Expecting an increase in sex shop purchases is different than changing a clinical manual.”

Karim explains further why the novel is so appealing to women (and men), even with the dysfunctional (and sometimes even depressing) personalities of the characters. “In regards to sexual research, many women fantasize about submission, and many men fantasize about dominance,” he said. “Even though men and women are more equal than ever in regards to occupation and finances, we are still very different sexes, and definitive gender and role-based fantasies do exist,” he added. “Many people in our society have hidden (or not so hidden) fantasies involving kink, S&M, or altered sexual behavior. 50 Shades of Grey has opened up the conversation of previously hidden sexual desires and fantasies of many women.”

He said the novel could help couples become more creative in their sex lives, but going to any extremes is generally not beneficial. “The introduction of BDSM can add to a couple’s sexual tool box, but occasionally it can get out of control,” Karim said. “When extreme behavior leaves the bedroom or involves extremes in the bedroom, it can negatively impact the relationship. I’ve treated couples who use BDSM as a novel, fun experience in a healthy and intimate way, and I’ve treated other couples or individuals who became obsessed with the act or re-created a previous abuse history with a lot of painful markings.”

Overall, the BDSM series is encouraging men and women to discuss sexuality more openly with each other. “The book mentions childhood abuse and difficulties with self-esteem that contribute to the psychological make-up of these characters, but it has also found a way to tap into the S&M lifestyle curiosity shared by many men and women,” Karim said. “It may actually normalize the behavior, when done in moderation, as not something strange but perhaps just another form of sexual expression. Life isn’t always black and white; sometimes it’s fun to live with a little grey.”

Kari Tabag, a licensed clinical social worker, works with adolescents and college-age men and women and has read the series. She said the novel has passages that hint at mental health issues like posttraumatic stress, codependency, BDSM, and alcoholism.

Although she agrees that the novel can improve people’s sex lives through fantasy, role play, and experimentation, the sexual expectations people might have after reading the series might be set too high, leading to disappointment. Also, she emphasizes that the actual relationship depicted in the series is very unhealthy in many ways. “Christian and Anastasia’s relationship is not a healthy one. They are codependent and are too enmeshed with each other,” Tabag said. “A lot of women are codependent and are what I call ‘daddy hungry.’ This novel depicts two people who have abandonment along with trust issues.”
There are even more unhealthy aspects of the fictional relationship, according to Tabag:

• When Anastasia finds out that Christian only dates women with brown hair, it is a dead giveaway of his childhood abuse and abandonment. In fact, Anastasia refers to him as her “boy,” which is not healthy.
• Anastasia repeatedly feels that she is not worthy of Christian and vice versa.
• Christian is obsessed with Anastasia and even follows her to another state when she visits with her mother.
• They both are looking for someone to take care of rather than focusing on healing themselves. A healthier relationship involves two people who have their own separate, independent personas, making them well-established, well-rounded, self-reliant individuals.
• Christian wants Anastasia to give in to him and give up all control, and he lavishes her with gifts as a reward.

Although the relationship in the novel is not healthy, BDSM is not necessarily as terrible as it’s made out to be. Tabag suggests our society is not necessarily mature when it comes to accepting and understanding sexual preferences outside of ‘man on top.’”

Viewpoint From a Submissive
Kasi Alexander, the author of several books and short stories about alternative lifestyles, such as Becoming Sage and Saving Sunni, has herself been involved in the lifestyles of polyamory, BDSM, and power exchange. She currently identifies herself as a “slave,” and the partner in her polyamorous relationship is the “master”; she could also be referred to as a submissive. She said in an email that the relationship between Christian and Anastasia is not necessarily a model of the typical BDSM or power exchange relationship. The characters themselves are also not typical. For example, Christian Grey was abused as a child and became involved in BDSM at 15, and he now avoids “vanilla” sex and relationships.

“Very few people in the lifestyle immerse themselves so deeply that they have no desire for a relationship outside the parameters of power exchange,” Alexander said. “The ones who do are using the lifestyle to mask other personality defects, not the other way around. Accepting your dominant or submissive tendencies does not kill the desire for intimacy, closeness, or connection.” Also, the character of Anastasia Steele is low in self-esteem, self-worth, and confidence, which is not usual for submissives, Alexander said.

“Many people assume that submissives give up all responsibility for themselves, are doormats that cannot stand up for themselves, and so are taken advantage of by predatory dominants,” Alexander said. “That couldn’t be further from the truth. Submissives are stereotypically extremely strong, capable people. Many of them crave submission as a way to temporarily escape the huge responsibilities they take on in their “vanilla” lives.”

Alexander adds that the BDSM lifestyle can even be considered therapeutic in different ways. “In my own relationship, we have used our power exchange to work on my self-image and body issues, increase my self-confidence, and achieve many goals, including writing and publishing three books (so far),” she said. “Other kinky people that we know use sensation play as therapy or catharsis to work through feelings of inadequacy, childhood abuse issues, and various kinds of mental health issues.”

The BDSM element of 50 Shades of Grey just takes the typical romance/erotic novel a little further. “Women have a genetic inclination toward alpha males, so we love our fictional heroes to be large, powerful, and a little scary—someone who has the ability to hurt us but doesn’t,” Alexander said. “And almost all BDSM play is based on the intensification of physical experiences. So the fantasy of the physical ‘danger’ (intensity of experience) goes along with the mental domination of having a strong alpha male taking over your life. It’s erotic, even if it’s not what we want in our actual day-to-day lives.”

She said BDSM and power exchange have the potential to make relationships more sexually fulfilling, but just like in any relationships, it’s a matter of communicating wants and desires. And just like in other bad relationships, abuse and manipulation can happen, but that is a matter of individual personalities and relationships, not a characteristic of BDSM as a whole. She said it’s important to make a distinction between mental conditions and different sexual preferences and alternative lifestyles. “The most important aspect of the mental disorder consideration is the difference between true sadism and kinky sadism,” Alexander said. “A vast majority of ‘sadists’ in the BDSM community derive no pleasure from inflicting pain unless the recipient is enjoying the experience, whereas a true sadist is not concerned with the benefit of the other person.”

She believes that people will eventually become more accepting of these types of lifestyles and realize that they can be beneficial to people who can learn how to make them work.

“More education is needed to show people that polyamory is not cheating, BDSM is not abuse, and power exchange is not manipulation,” Alexander said. “The important thing to keep in mind is the benefit for the people involved. BDSM and power exchange can be done badly and for the wrong reasons, but they can also be used for personal, professional, and spiritual growth and for the enhancement of relationships.”

Related articles:
What Do Your Sexual Fantasies Mean?
The Good and Bad Sides of Porn
Exploring Alternative Lifestyles in Your Relationship

As an illegal psychostimulant drug, cocaine has ravaging effects both on the individual user and on society as a whole. The addictive qualities of cocaine are well-documented, and users often persist in their abuse despite one negative consequence after another. The search for effective, reliable treatments for cocaine addiction is ongoing. Recently, the antipsychotic drug Abilify (aripiprazole) has shown some potential as a treatment both for those currently addicted to the drug and those in the recovery stages. A pair of experiments with mice demonstrated that Abilify blocks some of the positive, rewarding effects of stimulant drugs while also reducing the odds of relapse.

In the earlier mouse study, Abilify reduced “self-administration” of cocaine in mice. As the dosage of Abilify was increased, the effect was more pronounced. At the same time, the mice did not seem to “overcome” the effects of Abilify by administering higher doses of cocaine. Researchers believe that part of this medication’s action on the cellular level actually negates the action of cocaine and possibly other stimulants. Another positive aspect of Abilify is that it seems to lack any obvious rewarding qualities of its own. The mice did not self-administer more Abilify in lieu of cocaine, an important quality that enhances its potential as a treatment for drug-addicted humans.

A later study examined whether Abilify could reduce relapse of cocaine addiction. In this experiment, mice were presented with the opportunity to self-administer cocaine after a 2-week period of withdrawal from the drug. Mice that had been given scheduled doses of Abilify showed far less potential for relapse. Apparently, the medication establishes a kind of “blockade” around the receptor sites to which cocaine typically attaches. This revelation is important for those who work directly with individuals in the field of drug addiction.

Addiction to cocaine and other stimulants continues to be a public health epidemic. Researchers are on a quest to discover effective pharmaceutical treatments for addiction. Because of repeated successful trials, low incidence of side effects, and generally high tolerability, Abilify has been identified as a potentially very useful tool in the battle against psychostimulant addiction. Abilify both reduces the immediate reward effects of cocaine and reduces the odds of relapse during the recovery phase. As a supplement to group counseling or talk therapy, treatment with Abilify may give recovering addicts a powerful advantage in their struggle to restore normalcy in their lives.

 References

• Feltenstein, M. W., Do, P. H., See, R. E. (2009). Repeated aripiprazole administration attenuates cocaine seeking in a rat model of relapse. Psychopharmacology, 207, 401-411.
• Sorensen, G., Sager, T. N., Petersen, J. H., Brennum, L. T., Thogersen, P., Bengtsen, C. H., Thomson, M., … Woldbye, D. P. D. (2008). Aripiprazole blocks acute self-administration of cocaine and is not self-administered in mice. Psychopharmacology, 199, 37-46.

George W. Bush created the Healthy Marriage Initiative based on research showing that healthy, strong marriages make a positive contribution to communities. The program, funded by the federal government, was designed to help unwed parents living in socioeconomically deprived neighborhoods reap the benefits of marriage. Most of the targeted families were minorities and faced challenges with keeping and maintaining employment, adequate housing, and earning enough income to supply the basic needs of their families. They also dealt with crime and safety issues. The government believed that this vulnerable group was the most in need of programs designed to help couples develop healthy marriages. The program was implemented during Bush’s administration and fully supported by Obama when he became President.

It is only recently, however, that the results of this program are coming to light and being fully analyzed. And, as outlined in a recent article, they are not encouraging. According to data gathered by Matthew D. Johnson, an associate professor of psychology at Binghamton University, the programs were based on scant research from higher income, nonminority couples. Johnson reviewed assessments from thousands of couples who participated in the program and discovered that the framework, which was based on individuals from different socioeconomic environments with fewer challenges, did not provide a relevant foundation from which minority couples could build a strong marriage. The couples that need the Healthy Marriage Initiative most do not consider marriage more important than finding employment, meeting basic needs, and ensuring the safety of their families. “When faced with a myriad of social issues, building intimate relationships is just not high on their priority lists,” says Johnson.

The Healthy Marriage Initiative costs slightly more than $9,000 per couple to implement and has become more of a burden, both economically and socially, to the very communities that it was designed to help. Johnson believes that the intention behind the program was the right one but that the whole initiative needs to be restructured in order to achieve positive results. Specifically, Johnson believes that the program should be fully examined and reformatted based on accurate research, and if it still cannot meet target goals, it should be eliminated altogether.

Adults who have survived childhood abuse are more likely to experience mental health problems than those who were not abused during their youth. Depression, anxiety, panic, posttraumatic stress, eating and food issues, and substance abuse are just some of the psychological conditions that these survivors face. Another consequence of childhood abuse is diminished physical health. Research has shown that negative psychological well-being decreases physical health and can lead to serious health problems, including hypertension and heart disease. But few studies have examined how specific types of childhood abuse affect physical health directly.

To address this gap in research, Cathy Spatz Widom, Ph.D., of the Psychology Department at John Jay College at the City University of New York recently conducted a study that sought to determine the link between three individual types of abuse and later physical health problems. Widom analyzed data from adults who had been abused prior to their 12th birthday. The average age of the participants was 41. Each participant underwent a complete physical examination and blood test in adulthood. Based on documented reports of the abuse, Widom compared how sexual abuse, neglect/maltreatment, and physical abuse in childhood affected the participants’ health in adulthood.

She found that the adults who had experienced neglect and maltreatment had poorer oral and visual health as well as impaired airflow and increased risk for diabetes. The adult survivors of sexual abuse were more likely than the other participants to develop oral health issues and hepatitis C. They also had higher rates of HIV and malnutrition. Those who had survived physical abuse were also at increased risk for malnutrition and diabetes. Although some of these conditions could be attributed to maladaptive coping techniques, such as smoking, drug or alcohol use, and poor nutrition, the findings clearly show that adults who have survived childhood abuse are still at increased risk for significant physical health problems. Widom believes that these findings have strong clinical implications. She said, “Understanding the mechanisms that place abused and neglected children at higher risk for these adult physical health outcomes will help focus these efforts.”

Reference:
Widom, C. S., Czaja, S. J., Bentley, T., Johnson, M. S. (2012). A prospective investigation of physical health outcomes in abused and neglected children: New findings from a 30-year follow-up. American Journal of Public Health, 102.6, 1135-1144.

I am frequently asked what the best complementary or alternative therapies for kids are. This is a broad and potentially complex question, with appropriate courses of treatment depending on both on the child’s struggles and the balance of safety and efficacy of the therapy being considered. Eventually, many parents eventually find a complementary or alternative medicine (CAM) therapy that feels right for their child.

The most recent data from the National Center for Complementary and Alternative Medicine (NCCAM) found that 12% of the 9,000 children surveyed in 2007 had used some form of CAM during the previous year. CAM use typically ranges from providing remedies in lieu of medical treatments—such as using a homeopathic flu remedy instead of a prescription—to using CAM in conjunction with conventional remedies. The latter can be as simple as giving a child a zinc lozenge or tea with honey in addition to the antibiotics a doctor prescribes when a child has a sore throat or throat infection. Another example is when a child has been diagnosed with attention deficit hyperactivity disorder (ADHD), and his or her parents employ dietary changes even if the child is also receiving medication or psychotherapy. CAM therapies are often used to help children manage symptoms of chronic pain conditions or notable anxiety, ideally in combination with psychotherapy (and appropriate medical care, if this is indicated).

Remembering Developmental Differences

A point NCCAM emphasizes is that children are not merely smaller versions of adults. Similarly, more studies have been conducted regarding the effects of many CAM therapies on adults, although there is a growing body of research on CAM with children. Thus, what may be considered an appropriate CAM therapy or dose of therapy for an adult is not necessarily what we can recommend for a child.

That being said, there are a number of treatments that are considered generally safe for children, particularly when provided or informed by appropriately trained professionals. My favorites are listed here. I chose to emphasize non-oral intake therapies, although at times these may also be appropriate.

1. Guided imagery or self-hypnosis can be helpful for managing mood symptoms, pain and itching, sleep difficulties, and nausea.
2. Mindfulness or other types of meditation can aid in improving mood, pain, itching, sleep, nausea, and concentration.
3. Aromatherapy can help reduce anxiety and enhance feelings of calm, especially when paired with other therapies, including cognitive behavioral therapy, meditation, imagery/hypnosis, or massage.
4. Movement therapies, such as yoga, dance therapy, or tai chi can increase a child’s feelings of mastery, discharge excess physical tension, provide focus, and improve mood.
5. Massage  decreases muscle tension or soreness and increases relaxation.
6. Energy therapies, such as Reiki or therapeutic touch, may help increase calmness and decrease stress. These may also help with some physical discomforts.
7. Art therapy can help children cope with change, shed light on emotions and concerns that they may have trouble verbalizing, and reinforce healing images created during guided imagery and hypnosis.
8. Homeopathy is gently calming and is reported to help with fears, anxiety, and tantrums. There is less data on this therapy, but it is generally considered to be safe.
9. Diluted ginger tea can help with upset stomach/nausea.
10. Dietary changes, which may include eliminating processed foods, caffeine, or sugar and emphasizing whole grains, fruits, vegetables, legumes, and healthy sources of protein, are health-supportive overall, and some parents report improved mood, sleep, and concentration when processed foods are limited or eliminated.

One common theme that runs through most of the therapies listed above is that they help children to feel calmer. Some of the approaches provide children with tools to help them directly impact how they feel via what they do (movement therapies, imagery/hypnosis, meditation, art), which enhances children’s feelings of mastery and control. All of these approaches require at least initial participation and monitoring from parents—a key ingredient in helping children to feel safe, loved, and supported.

As always, it is essential to keep healthcare providers in the loop when using CAM therapies with children, particularly with those who have a medical or psychological illness.

Modeling Emotional Intelligence

Finally, if I were to add a number 11 to the list, it would be to emphasize that children pick up on and are undoubtedly affected by their parents’ moods. It is essential for parents dealing with anxiety, depression, or other psychological challenges to obtain appropriate treatment. Doing so helps parents feel better, enhances their ability to cope with the many demands of parenting, and teaches children about the value of self-care. Furthermore, emotionally healthy parents tend to parent more effectively, which also reduces children’s feelings of anxiety and depression.

Resources:

• National Center for Complementary and Alternative Medicine: CAM Use and Children
• Columbia University’s Integrative Therapies Program for Children with Cancer: A leading program that emphasizes both research and clinical practice. Their website contains a wealth of information about a variety of therapies, as well as helpful links.
• This article details an integrative (CAM) treatment of pediatric pain and itch (pruritus) with a seven year-old girl:
  • Stein, T. R., Sonty, N., and Saroyan, J. M. (2012). “Scratching” beneath the surface: An integrative psychosocial approach to pediatric pruritus and pain. Child Clinical Psychology and Psychiatry, 17(1), 33-47.

Psychiatric nurses who work at inpatient mental health facilities interact with many different types of clients. Some may be relatively subdued and withdrawn while others may be more outgoing. Facilities designed to address the needs of the severely mentally incapacitated treat individuals with extreme cognitive and behavioral problems, and constant supervision and precaution are necessary to ensure the safety of both the clinicians and the clients. Nursing stations within these facilities are designed to provide maximum accessibility and supervision while also providing safety and security to the staff members. Some stations are designed with glass barriers and locked doors and others are built with no walls or windows, allowing both the staff members and clients open access.

Kelly Southard, the Quality Outcomes Coordinator at the Cone Behavioral Health Hospital in Greensboro, North Carolina, recently conducted a study to determine how each type of nursing station design affected therapeutic outcomes. For her study, Southard assessed 25 nurses and 81 clients in an acute psychiatric unit of a hospital before the nursing station was renovated and after. Prior to renovation, the nursing station was closed and had window and door barriers. The nursing station was only modestly renovated with new paint and countertops and removal of the window and door.

Southard found no significant differences in the perceptions of the ward environment after the renovation compared to before the renovation. The staff members and the clients did not report an increase in therapeutic ambiance as a result of having an open nursing station. However, many clients did comment that they felt that that the nurses were more accessible in the open station. Another interesting finding and one that is of concern to staff members charged with the care of high-risk clients was that the open station did not increase the level of aggression or violence on the ward. In contrast, the staff members discovered that the clients actually exhibited less aggression and anger after the renovations. Southard added, “Although more research is needed, these desired trends could be related to nursing staff being more readily available to better meet patients’ needs.”

Reference:
Southard, K., Jarrell, A., Shattell, M. M., McCoy, T. P., Bartlett, R. (2012). Enclosed versus open nursing stations in adult acute care psychiatric settings: Does the design affect the therapeutic milieu? Journal of Psychosocial Nursing & Mental Health Services, 50.5, 28-34.

Did you know that most individuals who have experienced sex addiction and have taken their recovery process very seriously and remain committed to it for life can be some of the healthiest individuals, despite their past challenges?

Relationships in general take a lot of hard work, but many people are not willing to engage in the hard stuff to make their relationships easier down the road. If people do not feel that they have an addiction or struggle with any kind of sexual integrity issue, it is more challenging for them to understand the need to have boundaries around their relationship to protect it from anything that can cause it to weaken.

Here are THREE REASONS individuals need not be afraid to date someone who has recovered from or is in active recovery from a sex addiction:

STRONG BOUNDARIES: Most individuals recovering from sex addiction who have worked hard in a program, such as outpatient therapy, along with being a part of a support group or in-patient program with a solid outpatient support system know the importance of having strong boundaries to first protect themselves from relapse or slipping back into old habits. For example, a person who has abused alcohol needs to stay away from bars and heavy drinking venues to avoid temptation. The same goes for people with sex addiction; they have certain places they cannot visit, movies they cannot watch, and websites to stay clear of, and even conversations with other individuals that may trigger certain thoughts or feelings.

Therefore, people who have recovered from sex addiction and have moved toward a healthy outlook in life will more than likely be very respectful and aware of situations that may be uncomfortable for their partner, such as noticing attractive people in the partner’s presence or even while alone or putting themselves in a position that could be cause for concern, such as eating lunch alone with a coworker of the opposite sex.

INTEGRITY: Most people recovering from sex addiction have learned the benefits and the importance of having integrity in their life. It is essential that they share their feelings appropriately and be truthful with themselves and that they avoid anything that would cause even a hint of suspicion by others. One way that you will know that your dating partner is someone who values integrity is to watch him or her. Does this person’s behavior coincide with his or her belief system? Is he open about his life’s journey while using discernment? Does she show consistency in making decisions with integrity in all areas of her life (i.e., financial, family, work), not just in relationships?

SELF-CARE: When people who have struggled with sex addiction have worked hard on their personal recovery, one of the tools they learn is the importance of self-care. What that means is their ability to recognize that they first must take care of themselves in a healthy way before they have anything to offer anyone else. They are good at keeping things in their lives that bring value, and they do not expect someone else to fill all their needs. These individuals will have introduced specific behaviors/patterns in their life that support their recovery and reduce the temptations they will face, such as computer filters, accountability partners, continued self-improvement choices, and consistent activities that not only grow who they are but also have a positive impact on others. Most important, where their recovery plan may change along the way, they never let their guard down to say they have arrived, and they stay in the continuous mode of healthy self-care in some fashion. This not only assists them in being the person of integrity they want to be but also prepares them to be real, genuine, honest, and transparent in future relationships.

As you can see, while some may shy away from the idea of dating an individual who has recovered from sexual addiction, there are numerous reasons this can actually be a very positive experience. Keep in mind, it is not your responsibility to keep this person on track in his or her recovery, and if the person is truly taking care of himself, he will not want or expect you to do this. You actually get the benefits of being with an individual who has come face to face with a very challenging addiction and decided that he or she is worth doing the hard work to overcome it and live a life of integrity. The end result is someone who can share compassion, understanding, and love in a deeper, healthier way in relationships because that person made it a point to have tough love for him- or herself first.

Related articles:
Three Ways to Avoid Sex Addiction Relapse
Sex Addiction: Can Trust Be Restored?