Hello people, welcome back to the blog! Last week, we finished with the Cluster B personality disorders, borderline, histrionic, and narcissistic personality disorders. This week, we’ll complete the entire series with the Cluster C “anxious and fearful” disorders: avoidant personality disorder, dependent personality disorder and obsessive compulsive personality disorder, not to be confused with obsessive compulsive disorder OCD.
Avoidant Personality Disorder
AvPD or APD is characterized by extreme shyness, feelings of inadequacy, and extreme sensitivity to criticism. The key word here is avoid. People with AvPD are often unwilling to get involved with other people unless they’re certain they’ll be liked, otherwise, they’re not going to take the chance of being rejected. They’ll sooner avoid all social interaction than risk being ridiculed, humiliated, or disliked. They’re constantly preoccupied with how they’re being perceived, are hypervigilant of criticism, and may view themselves as not being good enough or socially inept. They typically avoid new activities or meeting strangers like the plague. For many of them, just the thought of something as simple as asking a stranger for the time is inconceivable. As a result of these constant fears, they’re extremely restrained, even in their intimate relationships. They can appear very socially awkward, not only due to lack of experience, but also because they tend to excessively monitor internal reactions, their own and everyone else’s, and this keeps them from engaging naturally in social situations. As with many personality disorders, a vicious cycle can take over in which the more they monitor their internal reactions, the more inept they feel; and the more inept they feel, the more they monitor their internal reactions.
Signs and symptoms of AvPD may include:
-Anhedonia, lack of pleasure in activities
-Severe anxiety in social situations
-Avoiding conflict, being a “people-pleaser”
-Avoidance of social interaction despite a strong desire for intimacy
-Avoiding interaction in work settings or turning down promotions
-Avoiding making decisions
-Avoiding situations due to fear of rejection
-Easily hurt by criticism or disapproval
-Extreme self-consciousness, lack of assertiveness
-Fearful and tense demeanor, lack of trust in others
-Constant worry about being ridiculed, shamed, or ‘found out’ and rejected
-Feeling inadequate, inferior, or unattractive
-Misinterpreting neutral situations as negative
-No close friends/lacking a social network
-Unwilling to take risks or try new things
AvPD affects about 2.5 percent of the population, with roughly equal numbers of men and women being afflicted. As you can probably guess, AvPD is strongly associated with anxiety disorders, especially social anxiety, and can be associated with actual or felt rejection by parents or peers in childhood. In fact, childhood emotional neglect and peer group rejection are risk factors for development of AvPD, but it can occur without any notable abuse or neglect history. Generally speaking, people with the diagnosis are typically very shy as children, but Captain Obvious says that not every child who is shy goes on to develop the disorder, and not every adult who is shy has it. We all have people, places, and things we don’t like, or which make us anxious, that we’d like to avoid. The difference lies in how the person experiences them. With AvPD, even just the fear of rejection or disapproval can be an extremely painful experience, and this makes them struggle to maintain relationships in their personal and professional lives.
Dependent Personality Disorder
DPD is characterized by an inability to be alone. People with DPD rely on other people for comfort, reassurance, advice, and support regarding all areas of their lives. They develop symptoms of anxiety when they’re lacking these outside sources of guidance. They fear separation, and are most often described as clingy or needy. They are submissive and passive by nature, and allow others to direct their lives because they are unable to do so themselves. They tend to be indecisive and unable to take the initiative, allowing other people such as spouses or parents to make all the major life decisions, including where to live, what type of career to pursue, and where to work. They have difficulty initiating projects or doing things on their own due to a lack of self-confidence in judgment or abilities, as opposed to a lack of motivation or energy. Because of their reliance on others, they may not learn the skills of independent living, and this perpetuates their dependency. Being often preoccupied with the thought of being left to fend for themselves, if they ever do disagree with any decision made for them, they would rarely express it; they would simply adjust their opinion to match that of their champion for fear of abandonment. In fact, the idea of being alone may cause such discomfort that some will go to considerable lengths to secure and maintain relationships. As you can imagine, this can be a big problem if they get roped in with an individual who doesn’t have their best interests in mind. This can be a very dangerous and destructive situation, especially when they believe that they are under the protection of someone who they idealize as competent and powerful, someone who’s their hero champion, and towards whom they behave in a self-effacing and ingratiating manner. People with DPD often end up with people with a cluster B personality disorder, as the latter feed on the unconditional regard in which the former holds them. I’ve had many patients that have coupled up in this manner, and it can be an unholy nightmare to untangle. Generally speaking, people with DPD maintain a naïve perspective, and have limited insight into themselves, and certainly even less into others. This entrenches and perpetuates their dependency, leaving them vulnerable to abuse and exploitation.
Signs and symptoms of DPD may include:
-Difficulty making everyday decisions
-Requiring others to assume responsibility for most major areas of his or her life
-True fear of having to provide self-care or fend for themselves if left alone
-Submissive or clingy behavior
-Tendency for naiveté
-Lack of self-confidence, requiring excessive advice and reassurance from others
-Instinctively agree with others for fear of disapproval
-Going to excessive lengths to obtain support from others, even if it includes unpleasant tasks
-Tolerance of poor or abusive treatment, even when other options are available
-Feeling uncomfortable, anxious, bored, or helpless when alone
-Difficulty doing projects due to lack of confidence in abilities
-Urgent need to start a new relationship when a close one has ended
People with DPD normally first show signs in early to mid-adulthood, and males and females are generally equally diagnosed. True DPD is somewhat rare, with an estimated prevalence ranging from 0.49 to 0.6 percent. People with DPD are very prone to separation anxiety, and can become devastated when relationships and friendships are severed. When alone, a person with DPD may experience severe anxiety, panic attacks, and hopeless despondence. Clearly, some of these symptoms are the same for people with anxiety disorders, but people with medical conditions such as depression or even menopause may also experience some of these symptoms. Some factors that might contribute to the development of this disorder include having a history of a neglectful or an abusive upbringing, having overprotective or authoritarian parents, and
having a family history of anxiety disorders.
In addition, having a diagnosis of separation anxiety disorder or a history of chronic illness during childhood can increase the risk of developing DPD. Most people deal with feelings of insecurity at some point in their lives. It’s natural and perfectly normal to need other people to care for us or give us reassurance at times. The difference is that people with DPD require reassurance from others to simply function in their daily lives. A healthy balance involves being able to both depend on others as well as being independent enough to fend for oneself.
Obsessive Compulsive Personality Disorder
Aka Anankastic Personality Disorder
OCPD is characterized by a preoccupation with orderliness, perfectionism, and mental and interpersonal control, even at the expense of efficiency. People with OCPD have an obsessive need to follow rules and regulations, and they have a strict moral and ethical code from which they will not deviate… they’re always right. They often have such a level of perfectionism that they cannot finish tasks because they become too fixated on the details. They generally have an unwillingness to delegate or share tasks, unless the person they’re working with agrees to perform them exactly as they ask. They may be so preoccupied with details and order that the major point of the activity is lost. The rigidity that accompanies having OCPD often interferes with the person’s ability to relate to others and vice versa. While they can often improve their quality of life if they seek treatment, they rarely perceive that there’s a problem, so the condition tends to go untreated. As you can imagine, people with OCPD can be extremely difficult to work with or have a relationship with because they typically only see things their way. They believe that their approaches are the best way, and usually cannot understand another person’s point of view. They are often excessively devoted to work and productivity, to the exclusion of leisure activities and friendships. They generally have a miserly spending style toward both themself and others; money is something to be hoarded for future catastrophes. They are often unable to discard worn-out or worthless objects, even when they have no sentimental value. OCPD should not be confused with OCD, obsessive compulsive disorder. While some mannerisms and compulsions are similar, there is a BIG difference: people with OCD are aware that their compulsions are illogical, while people with OCPD are not. In fact, in their way of thinking, their thinking is logical, and if other people followed their rules, everything in their life would be fine. Just ask them, they’ll tell you… sometimes you don’t even have to ask! The problem comes in especially when rules and procedures don’t dictate the correct answer; decision making can become a painful, time-consuming process. In this case, the person with OCPD may have such difficulty deciding which tasks take priority or what’s the best way of doing a certain task, that they may never get started on anything, let alone finish. They’re prone to anger in situations in which they’re unable to maintain control of their physical environment, although they don’t typically express it directly. They’ll often find a more passive aggressive way to express it; for example, leaving a poor tip at a restaurant instead of speaking to management. When anger is expressed, it’s usually done with righteous indignation, often over a seemingly minor matter.
Signs and symptoms of OCPD may include:
-Overwhelming need for order and perfection, such that it interferes with task completion
-Fixation on organization, detailed schedules, list making
-An overwhelming need to be punctual
-Strict personal moral and ethical codes
-Excessive devotion to work at the expense of family or social relationships
-Often seen as ungenerous or frugal
-Display hoarding behaviors, such as refusing to throw things away
-Significant rigidity and stubbornness
-Inability to share or delegate work due to fear it won’t be done right
-Often feel righteous, indignant, and angry
-Stiff, formal, or rigid mannerisms
In relationships, people with OCPD are very aware of their relative status, and they tend to display excessive deference to an authority they respect, and excessive resistance to an authority they don’t. When they express affection, it’s done in a very controlled manner, and they’re very uncomfortable when they’re around other people who are emotionally expressive. Their everyday relationships have a formal quality to them, and they’re usually very stiff in situations where most others are smiling and happy. They’re often so preoccupied with logic and intellect, they tend to carefully hold themselves back in conversations until they’re sure that whatever they say will be the perfect thing.
As with most personality disorders, the intensity of OCPD symptoms will decrease with age, and the most extreme symptoms have usually nearly ceased by the time the majority of people are in their 40s or 50s. OCPD is approximately twice as prevalent in males than females, and occurs in between 2.1 and 7.9 percent of the general population, making it the most prevalent personality disorder. A childhood with very controlling or protective parents or caregivers, or one in which they were often unavailable, may increase the risk of developing OCPD. But Captain Obvious says a person may have OCPD without any of the above factors as causes. In some case studies, adults can recall experiencing OCPD from a very early age. They may have felt that they needed to be a perfect or perfectly obedient child. This need to be good and follow the rules then carries over into adulthood. People with OCPD often experience anxiety that occurs with depression; and OCPD is generally seen as a coping mechanism, a way for the person to establish order in their lives and deal with their feelings. People experiencing OCPD often don’t recognize that their behavior is problematic, so they generally take some convincing before they agree to seek treatment. This can be very overwhelming to family members, especially if they’re dealing with constant criticism. The good news is that with time and treatment, many people with OCPD can find the motivation to change.
Personality Disorder not otherwise specified
Each person is an individual and behaves in unique ways, so not everyone fits neatly into the personality disorders I’ve discussed. If a person doesn’t have enough symptoms to fully meet the criteria of a specific type, PD-NOS is the diagnosis used in this case. This may also be known as personality disorder trait specified PD-TS. These names can sound like opposites, but they both focus on the fact that the person has some personality disorder traits, but not enough of one specific type to fit in the box.
And as for personality disorders, in the words of Porky Pig… that’s all folks!
I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon.
Thank you and be well people!
Hello people, I hope everyone had a great holiday weekend! Did everyone set off a bunch of fireworks? Did you grill some burgers or dogs, have some baked beans, and a scoop of potato salad? Top it off with some apple pie? Me neither. Can I just ask, why do people shoot off fireworks on Saturday day, like before the sun sets? Are they testing them to see if they’re loud enough? Just wondering. Maybe they can’t wait. Anyhoo, last week, we talked about Antisocial Personality Disorder, the first Cluster B personality disorder, the dramatic and erratic disorders. If you recall, ASPD is the official diagnostic term for the colloquial terms sociopathy and psychopathy. That’s the big takeaway. So this week, we’ll be continuing with the Cluster B’s with Borderline Personality Disorder.
Borderline Personality Disorder
BPD is also sometimes called Emotionally Unstable Personality Disorder, or EUPD, but I prefer Borderline. It always reminds me of that 80’s song. BPD is the most commonly diagnosed personality disorder, and was so called, because it was thought to lie on the “borderline” between neurotic disorders (meaning anxiety disorders) and psychotic disorders, such as schizophrenia and bipolar disorder. BPD is characterized by difficulties in regulating emotion. People with BPD experience big mood swings, and they feel a great sense of instability and insecurity. They feel emotions very intensely, often for extended periods of time, and it’s generally harder for them to return to a stable baseline after an emotionally triggering event. This difficulty can lead to impulsivity, poor self-image, and intense emotional responses to stressors. Struggling with self regulation and having a poor self-image essentially equates to a lack of a sense of self, and as a result, they often experience feelings of emptiness and extreme fears of abandonment, whether these are real or just perceived. They generally have a pattern of instability in their relationships, and there can be violence involved, especially in response to criticism. These unstable personal relationships often involve “splitting,” where the person alternates between idealization “I’m so in love!” and devaluation “I hate him!” Suicidal threats and acts of self-harm are common, and this is how and why many people with BPD frequently come to medical attention. Extreme stress responses can lead to dissociative feelings, meaning they feel disconnected from their thoughts or themselves, have “out of body” type feelings, potentially even psychotic episodes. They basically check out, and may not remember these events well afterwards.
BPD signs and symptoms may include:
-Impulsive behaviors that can have dangerous outcomes, such as excessive spending, unsafe sex, reckless driving, gambling, overuse of substances, and binge eating
-Distorted and unstable self-image affecting moods, values, opinions, goals, and relationships
-Wide mood swings, often as a reaction to interpersonal stress
-Unstable and intense relationships
-Suicidal behavior or threats of self-injury
-Intense fear of being alone or abandoned, may be real or imagined
-Periods of intense depressed mood, irritability, or anxiety lasting a few hours to a few days
-Ongoing feelings of emptiness
-Frequent, intense displays of anger, often followed by shame and guilt
-Stress-related paranoia that comes and goes; when stress is severe, it can lead to brief psychotic episodes
It has been suggested that BPD often results from childhood sexual abuse, and that it is more common in women, in part because women are more likely to suffer sexual abuse. However, some argue that BPD is more common in women simply because women presenting with angry and promiscuous behavior tend to be labeled with it, whereas men presenting with similar behaviors tend instead to be labeled with ASPD, Antisocial PD. More recent research seems to back this up. Women are more likely to receive the diagnosis, because it is commonly thought of as a “female” disorder, even though there’s no such thing. In fact, of the estimated 1.4 percent of the adult U.S. population with BPD, nearly 75 percent of them are women.
Histrionic Personality Disorder
HPD is characterized by a pattern of excessive emotion and attention seeking. People with HPD generally like to be the center of attention at all times, and may actually be uncomfortable when they’re not. They often use physical appearance to draw attention to themselves, are often flirtatious, and can employ exaggerated or rapidly shifting emotions as a means to reach this goal. The surprise is that they usually lack a sense of self-worth, and they depend on attracting this attention to seek the approval of others in order to boost their wellbeing. They often seem to be dramatizing or playing a part in a bid to be seen and heard. The word “histrionic” is derived from the Latin histrionicus, meaning “pertaining to the actor.” People with HPD may take great care of their appearance, and behave in a manner that is overly charming or inappropriately seductive. Because they crave excitement, they tend to act on impulse and are easily suggestible, and they may place themselves at risk of an accident, or fall prey to exploitation. Their dealings with others often seem insincere or superficial, and in the long term, this can adversely impact their social and romantic relationships. They find this to be especially distressing, as they are very sensitive to criticism and rejection, and they react very poorly to loss or failure. It can result in a vicious cycle in which the more rejected they feel, the more histrionic they become, and the more histrionic they become, the more rejected they feel. Achieving any emotional or sexual intimacy may be difficult, and they may play a victim role, potentially without being aware of it. They may also try to control their partner using seduction or emotional manipulation, while becoming very dependent on them. They tend to be too trusting, especially of authority figures who they think may be able to solve all their problems. They often think relationships are closer and more intimate than they really are. They crave novelty and tend to bore easily, so they may change jobs and friends frequently. Delayed gratification is very frustrating to them, so their actions are often motivated by obtaining immediate satisfaction.
HPD signs and symptoms may include:
-Constantly seeking attention
-Into instant gratification
-Excessively emotional, dramatic, or sexually provocative to gain attention
-Excessive concern with physical appearance
-Speaks dramatically with strong opinions, but few facts or details to back them up
-Makes rash decisions
-Easily influenced by others
-Shallow, rapidly changing emotions
-Believes relationships with others are closer than they really are
-Gullible and easily influenced by others
-Excessively sensitive to criticism or disapproval
-Low tolerance for frustration, easily bored by routine, often beginning projects without finishing them or skipping from one event to another
-Self-centered, rarely showing concern for others
-Good social skills, but use them to manipulate others, to be the center of attention
The estimated prevalence of HPD is less than 2 percent of the general population. It is usually evident by early adulthood, and is diagnosed more often in women than in men, but this may simply reflect the higher prevalence of women in clinical settings. There is a clear tendency for HPD to run in families, which suggests a genetic susceptibility, but the child of a parent with the disorder might simply be repeating learned behavior. Other environmental factors that might be involved include a lack of criticism or punishment as a child, and unpredictable attention given to a child by his or her parent(s), which tends to lead to confusion about what types of behavior earn parental approval.
Narcissistic Personality Disorder
NPD is characterized by an extreme feeling of self-importance, a sense of entitlement, and a need to be admired. The person is envious of others, and expects them to be the same of him. They typically lack empathy, and readily lie, exploit, or take advantage of others to achieve aims. To others, they may seem self-absorbed, controlling, intolerant, selfish, and/ or insensitive. If they feel ridiculed or obstructed, they can become very angry and even vengeful. Fueled by a belief that they’re special, and more important than others, they can have a reaction called “narcissistic rage,” which can have disastrous consequences for all involved. It’s human nature to be aware of and express our own needs, as well as want others to be aware of our abilities and achievements. These aren’t bad things, but people with NPD take this to the extreme. At the heart of it, they have fragile self-esteem, so they rely on others to recognize their worth and their needs. They are generally unhappy and disappointed when they’re not given the praise or special favors they believe they deserve. This can cause problems in all areas of life, work
school, and relationships. People with NPD usually put themselves on a pedestal, where they can look down on others and direct them, as they believe they are better than. They exaggerate their own talents and accomplishments, while downplaying those of others. They are usually preoccupied by power, success, and beauty, and may engage in impulsive behaviors, such as risky sex and gambling, in their pursuits of these goals.
NPD signs and symptoms may include:
-Fantasies about power, success, and attractiveness
-Entitled, conceited, snobby
-Exaggeration of achievements or talents
-Expectation of constant praise and admiration
-Exaggeration of intimacy with others, especially those with wealth or VIP status
-React negatively to criticism
-Show great charm but quickly become irritated or angry
-Talking at length about their own concerns but lacking interest in those of others
-Show aggression when faced with a threat to their ego
-Resent the successes of other people
-Arrogant, dismissive, or unaware of other people’s needs
-Perceived superiority that covers a deep seated insecurity
-Unreasonable expectations of favors and advantages
-Envy of others accompanies belief that others envy them
-Unfulfilling relationships; become unhappy, angry, and confused when things don’t go their way
-Typically have ongoing issues with work, school, relationships, finances, alcohol, substances
Research indicates that NPD affects 6.2 percent of the U.S. population, and is much more common in men than women, affecting 7.7 percent of men and 4.7 percent of women. There may be cultural influences associated with NPD, but this may be a stereotype. Diagnosing NPD specifically can be challenging, as the features tend to have so much overlap with other disorders. In addition, a person with NPD may not recognize that problems in their life stem from their own behavior, and they may blame others instead. Narcissists can be especially difficult to deal with. I’ve done a lot of family counseling for it, but the person with the diagnosis must accept it to make headway. Some NPD traits may appear similar to confidence, but healthy confidence and NPD aren’t the same thing. People who have healthy self-esteem are usually humble, while people with NPD, by definition, never are. It takes a lot of work on the patient’s part to modify behavior, but it can be done with sufficient motivation.
That’s the end of Cluster B Personality Disorders. Next week, we’ll tackle Cluster C disorders.
I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon.
Thank you and be well people!
Hello people, welcome back to the blog, people! I hope everyone had a fantastic father’s day. Last week, we started getting into the signs and symptoms of personality disorders. We talked about the Cluster A odd and eccentric disorders: paranoid, schizoid, and schizotypal personality disorders. This week, we’ll be getting into Cluster B disorders, the dramatic and erratic disorders.
Cluster B disorders are characterized by overly emotional or unpredictable thinking or behavior, and include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. People with these disorders typically have difficulty regulating their emotions, as well as maintaining relationships, as others often see their behaviors as threatening or disturbing. Treating any personality disorder is challenging, but Cluster B has some of the most difficult to treat disorders for a variety of reasons, not the least of which is the stigma associated with the diagnosis. Another factor has to do with the affected person’s propensity to give an inaccurate account of signs and symptoms. These can be especially true for antisocial personality disorder or ASPD.
Antisocial personality disorder is characterized by a pervasive pattern of disregard for the rights of others. People with this disorder consistently show no regard for right and wrong, and ignore the feelings of the other people around them. This generally begins in childhood or early adolescence and continues into adulthood. After treating many people with ASPD, I can tell you that they can be the most charming, entertaining, witty, and fun to be around people you’ll ever meet. But in severe cases, they can live to exploit others in something akin to sport. ASPD makes people uncaring. They can act rashly, unsafely, and destructively, without an ounce of guilt when their actions hurt other people. That may even be the goal. They tend to be callous, cynical, and contemptuous of the feelings of others. They can be very manipulative, and due to these tendencies, it’s often difficult to tell whether they’re lying or telling the truth.
Speaking of, let me correct a myth. Two common terms affiliated with ASPD are psychopath and sociopath, but these terms are not interchangeable. Neither psychopath or sociopath are actual diagnoses in the world of psychiatry. They are colloquial terms to describe people with impulsive or reckless personalities who lack empathy for others. A psychopath is someone whose actions more tend to reflect calculation, manipulation, and cunning. They are deceptively charismatic and charming, and tend to mimic rather than experience emotions. They can do so with ease, as this is their stock in trade. By contrast, sociopaths are more able to form attachments to others, but they still tend to act insensitively, or in an unfeeling manner, and generally disregard social rules. They are also more easily agitated, and have a tendency to be more impulsive. Psychopaths are usually thought of as more deviant and violent, and less likely to blend into society than sociopaths. Everyone has their own definitions of the words psycopathy and sociopathy, and they probably come from movies and television. In reality, in the world of psychiatry, both carry a diagnosis of ASPD, and psycopathy is just a very severe form of ASPD. These are the individuals I was referring to that can be the most charming. Believe me, they make it easy to want to lower your guard, but with some, you may do so at your peril.
ASPD signs and symptoms may include:
-Disregard for right and wrong
-Persistent lying or deceit to exploit others
-Callous, cynical, and disrespectful of others
-Applying charm or wit to manipulate others for personal pleasure
-Arrogance, a sense of superiority, extremely opinionated
-Lack of compassion and empathy for others
-Unremorseful when confronted with wrongdoing
-Inability to admit mistakes
-Bullying demeanor, use threats to deal with personal conflict
-Impulsiveness or failure to plan ahead
-Unnecessary risk-taking or dangerous behavior
-No regard for the safety of self or others
-Instability when it comes to work and home life
-Hostility, irritability, agitation, aggression, intimidation, violence
-Consistently irresponsible and repeatedly fail to fulfill work or financial obligations
-Mental health issues, may include talk of suicide or threatening suicide
ASPD affects approximately 2 to 4 percent of the population, often occurs alongside problems with drugs and alcohol, and is much more common in men. Some research has suggested when ASPD does develop in women, the condition may become more severe; and women with ASPD are even more likely to abuse substances than men. That said, research also indicates antisocial behavior may persist longer in men, and men with ASPD have an increased risk of early death. People with ASPD frequently fail to consider the negative consequences of their behavior, and they don’t generally learn from them either. In addition, they often violate the law, and behave violently or impulsively, becoming criminals. They are commonly unable to fulfill daily responsibilities related to family, school, or work. For all of these reasons, the highest prevalence of ASPD- 70 percent- is found among males who are in jails, prisons, or similar institutions.
The risk factors associated with ASPD have been better studied than some of the other personality disorders. The genetic component applies, especially family history of ASPD or another personality disorder. But of note, adults with ASPD typically show symptoms of another disorder in childhood called conduct disorder, before the age of 15. Signs and symptoms of conduct disorder include serious, persistent behavioral problems, such as aggression toward people and animals, serious violation of rules, destruction of property, lying, cheating, and theft. Although ASPD is considered lifelong, in some people, there are certain symptoms- especially destructive and/ or criminal behavior- that may decrease over time. It’s not very clear on whether this is due to aging, or an increased awareness of the consequences of their behavior. Speaking of, some of the complications associated with ASPD can include homicidal or suicidal behaviors, low social and economic status, homelessness, and premature death, usually as a result of violence. Behaviors have consequences, that’s the lesson many people with ASPD fail to learn.
Like anything else, symptoms occur on a spectrum, and vary in severity. ASPD doesn’t have to mean a person is violent or evil. The stigma associated with personality disorders in general, and ASPD in particular, may make it even more difficult for people who want to improve to get the help they need. More than 90 percent of people diagnosed with ASPD also live with another mental health issue, most often depression and/ or anxiety. Early intervention may be the key to treatment, so the ability of caregivers and educators to spot childhood conduct disorder is important. Negative attitudes toward “delinquents” may reinforce ideas such as, “I’m bad,” “I’ll never amount to anything,” or “No one cares what happens to me,” and these play a role in the development of ASPD.
When people with ASPD do enter treatment, it’s more often to get help for a co-occurring condition, or because a legal authority or family member has required to do so. Among those who do get help, many drop out of treatment early. Negative attitudes and ineffective treatment methods can contribute to this. It’s important for people with ASPD to work with therapists who are willing to try a range of approaches to find the most effective treatment. A key factor in successful therapy is recognizing individual fault. People with ASPD who can’t admit or accept that their actions are harmful may not be able to improve. Exploring state of mind, including emotions, desires, and feelings toward others is critical for progress. Once the person better understands their thoughts, they can use this understanding to address their impulses, and potentially help control them. Research has shown treatment can help improve many of the behaviors associated with ASPD, with the strict caveat that the person is willing to work toward change. When successful, treatment not only improves the quality of life for the person with ASPD, it also has a positive impact on the people in their lives.
Next week, we’ll continue with cluster B disorders, starting with borderline personality disorder.
I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!
Please feel free to share the love! Share blogs and YouTube videos with family and friends.
Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too!
And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them!
As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon.
Thank you and be well people!
Personality Disorders, part 3
Hello, people! In last week’s blog, we talked about the cause of personality disorders, sort of the nature versus nurture debate, and how both genetics and environment play a role in developing these disorders. We also discussed some of the requirements for diagnosis: how the maladaptive behaviors or personality traits must be relatively stable over time and consistent across situations; that they must cause significant impairment in self and interpersonal functioning; and that they cannot be a result of the direct effects of a substance or general medical condition. Each of the ten disorders has its own set of diagnostic criteria based on the various signs and symptoms typically exhibited. And that’s what we’ll be getting into today- the signs and symptoms of personality disorders.
As I mentioned before, the DSM-5 allocates each of the ten personality disorders to one of three groups or clusters, A, B, or C, based on similar characteristics and symptoms. Many people with one personality disorder also have signs and symptoms of at least one additional personality disorder, and it is usually within the same cluster. I should note that it’s not necessary to exhibit all the signs and symptoms listed for a disorder to be diagnosed. So let’s get started on the first cluster.
Cluster A Personality Disorders
These are characterized by odd, eccentric thinking or behavior. They include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.
Paranoid Personality Disorder
PPD is defined by mistrust and suspicion so intense that it permeates thought patterns and behavior, interfering with daily functioning. A person with PPD feels very wary of others, believing that they want to harm them. They are always on guard for signs that someone is trying to threaten, mistreat, or deceive them. No matter how unfounded their beliefs, they may repeatedly question the faithfulness, honesty, or trustworthiness of the people around them, whether they are friends, family, spouse, and/ or lovers. They may be defensive or sarcastic, which may elicit a hostile response from others. This response, in turn, then seems to confirm their original suspicions, reinforcing their beliefs. When they perceive they’re being persecuted, rejected, or slighted, they’re likely to respond with hostility, angry outbursts, and/ or controlling behavior; and they often deflect any blame onto others. Their fearful and distrustful perceptions make forming and maintaining close relationships very difficult. In addition, they’re often able to find and exaggerate the negative aspects of any situation or conversation, which also strains relationships. These qualities affect their ability to function at home, work, and school. Because of these symptoms, the condition often results in social withdrawal, tenseness, irritability, and lack of emotion.
Common PPD symptoms include:
-Suspecting, without justification, that others are trying to exploit, harm, or deceive them.
-Doubting or obsessing on the lack of loyalty or trustworthiness of family, friends, and acquaintances.
-Refusing to confide in people for fear that any information they divulge will be used against them.
-Becoming detached or socially isolated
-Interpreting hidden, malicious, demeaning, or threatening subtext or meanings in innocent gestures, events, or conversations.
-Having trouble working with others, being argumentative and defensive.
-Being overly sensitive to perceived insults, criticism, or slights.
-Quickly feeling anger, snapping to judgment, and holding grudges.
-Responding to imagined attacks on their character with anger, hostility, or controlling behavior.
-Repeatedly suspecting, without basis, their romantic partner or spouse of infidelity.
-Having trouble relaxing due to an inability to let their guard down.
PPD affects approximately 1 to 5 percent of people worldwide, though I’ve seen estimates of up to 10 percent. It often first appears in early adulthood, and is more common in men than women. Research suggests it may be most prevalent in those with a family history of schizophrenia. Despite being one of the most common personality disorders, PPD can be difficult to detect until symptoms progress from mild to more severe. This is because most people behave in mistrustful, suspicious, or hostile ways at some point in their lives without warranting a diagnosis of PPD. Spotting the signs can be further complicated as it often occurs with another mental health problem, such as an anxiety disorder, obsessive-compulsive disorder (OCD), substance abuse, or depression. When people with PPD have other diagnoses, it can compound their PPD symptoms. For example, depression and anxiety affect mood, and shifts in mood can make someone with PPD more likely to feel paranoid and isolated.
Professional treatment can help someone with PPD manage symptoms and improve their daily functioning. But due to the very nature of the disorder, most people with PPD don’t seek help, as they don’t see their suspicious behavior as unusual or unwarranted. Rather, they see it as rational. They are defending themselves against the bad intentions and deceptive, untrustworthy activities of those around them. As far as they’re concerned, their fears are justified, and any attempts to change how they think only confirms their suspicions that people are “out to get them” in some way. In addition, their intense suspicion and mistrust of others often includes mental health professionals. They question their motives in trying to help, and it can take a fair amount of time to build enough trust so they feel comfortable confiding in them and following their advice.
Schizoid Personality Disorder
The term “schizoid” indicates a natural tendency to direct attention toward one’s inner life and away from the external world. Please note that while their names sound alike, and they might have some similar symptoms, schizoid personality disorder is not the same thing as schizophrenia. People with schizoid PD tend to be distant, detached, aloof, and more prone to introspection. They often choose to be alone, and have little to no desire for social or sexual relationships. In addition to being indifferent to other people, they are also indifferent to social norms and conventions. They seem to not care about external praise or criticism, and commonly demonstrate a lack of emotional response. They are generally “loners” who prefer solitary activities. Many people with schizoid personality disorder are able to function fairly well, although they tend to choose jobs that allow them to work alone, such as night security officers, library, or lab workers.
A competing theory about people with schizoid PD is that they are in fact highly sensitive with a rich inner fantasy life. That they experience a deep longing for intimacy, but find initiating and maintaining close relationships too difficult or distressing, and as a result, choose to retreat into their inner world, which they create with vivid detail.
Common Schizoid PD symptoms include:
-Lack of interest in social or personal relationships, preferring to be alone
-Limited range of emotional expression
-Inability to take pleasure in most activities
-Inability to pick up normal social cues
-Difficulty relating to others
-Appearance of being cold or indifferent to others
-Little or no interest in intimacy or in having sex with another person
-May commonly daydream and/or create vivid fantasies of complex inner lives.
-Often reclusive, organize life to avoid contact with other people
Available statistics suggest that between 3 to 4 percent of the general population has schizoid PD, though it’s very difficult to accurately assess the prevalence, because people with schizoid PD rarely present for medical attention. This is because they generally function so well, and their preferences have few or no negative legal or societal consequences. Schizoid PD usually begins in late adolescence or early adulthood, affects men more often than women, and is more common in people who have close relatives with schizophrenia.
Schizotypal Personality Disorder
STPD is characterized by oddities of appearance, behavior, and speech, unusual perceptual experiences, and anomalies of thinking similar to those seen in schizophrenia. People with STPD have a higher than average probability of developing schizophrenia, and the condition used to be called “latent schizophrenia.” Their anomalies of thinking can include odd beliefs, suspiciousness, obsessive ruminations, and magical thinking, which is being overly superstitious or thinking of themselves as psychically powerful. An example may be believing that they have a “sixth sense” or thinking that speaking of the devil can make him appear. This may lead them to develop what are called ideas of reference- the false belief or intuition that occurrences, events, or details in the world relate or refer directly to themselves. People with STPD generally don’t understand how relationships form, or the impact of their behavior on others. They may react oddly in conversations, not respond, or talk to themselves. They have difficulty with responding appropriately to social cues, often misinterpret people’s motivations and behaviors, and develop significant distrust of others. This can cause excessive social anxiety, and can lead them to fear social interaction, thinking that other people are harmful. While people with STPD and people with schizoid PD both avoid social interaction, people with STPD do so because they fear others, whereas people with schizoid PD do so simply because they have no desire to interact with others, or find interacting with them too difficult.
Schizotypal personality disorder typically includes five or more of these signs and symptoms:
-Being a loner and lacking close friends outside of the immediate family
-Limited or inappropriate emotional responses, “flat emotions”
-Persistent and excessive social anxiety, tendency to be stiff and awkward when relating to others
-Very uncomfortable with intimacy
-Commonly misinterpret events, ie feeling that something has a direct personal offensive meaning, when it is actually harmless or inoffensive
-Distorted perceptions or odd perceptual experiences, ie mistaking noises for voices, hearing a voice whisper their name, or sensing an absent person’s presence
-Peculiar, eccentric, or unusual thinking, beliefs, or mannerisms
-Suspicious or paranoid thoughts and constant doubts about the loyalty of others
-Belief in special powers, such as mental telepathy or superstitions
-Dressing in peculiar ways, such as wearing oddly matched clothes or appearing unkempt
-Peculiar style of speech: highly variable, this may include unusual patterns of speaking, rambling oddly during conversations, vague speech, or speaking in excessive detail, in metaphors, or in an overly elaborate manner.
The prevalence of STPD ranges from approximately 1 to 4 percent of the population, and is more common in men than in women. STPD occurs more often in relatives of patients with schizophrenia or another Cluster A personality disorder. In fact, people that have an immediate family member with STPD can be as much as 50 percent more likely to develop it, as compared to people without that family history. People with STPD typically disagree with the suggestion their thoughts and behavior are disordered, and seek medical attention for depression or anxiety as opposed to the disorder. While it is typically diagnosed in early adulthood, some signs and symptoms, such as increased interest in solitary activities, or a high level of social anxiety, may be seen in the teen years. These children may also underperform in school, or appear socially out of step with peers, and this may result in teasing or bullying. STPD is likely to endure across the entire lifespan, though treatment, such as medications and therapy, can improve symptoms. Without treatment, individuals with STPD are at high risk for having major difficulty with work and relationships.
That’s the end of Cluster A personality disorders. Next week, we’ll cover Cluster B.
I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!
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Thank you and be well people!
Welcome back to the blog, people. Last week we started a new series on personality disorders, which are one of the most common of the severe mental disorders. A personality disorder is marked by rigid patterns of thoughts and behaviors that cause significant life impairment, and deviate from what is generally expected, or considered “normal” by society. There are four core defining features that are common to all personality disorders. They are distorted thinking patterns, problematic emotional responses, impulse control issues, and interpersonal difficulties. In order for a diagnosis to be made, a person must demonstrate significant and lasting difficulties in at least two of those four areas. We’ll talk more about diagnosis later; first let’s talk about what causes personality disorders.
As we talked about last week, personality is the combination of thoughts, emotions and behaviors that makes you unique. It’s the way you view, understand, and relate to the outside world, as well as how you perceive yourself. Your personality forms during childhood, and it’s shaped through an interaction of your genetics and your environment, often referred to as nature and nurture. Have you ever been told ‘You remind me of Uncle Jimmy, the way you do xyz.’ This may be because certain personality traits can be passed on to you by your parents through inherited genes. That is to say, these natural traits may be heritable. The nurture refers to your environment, the surroundings you grew up in, the events that occurred, and your relationships with family members and others.
The exact cause of personality disorders isn’t known. Just as personalities are shaped by genetics and environment, personality disorders are thought to be caused by a combination of these genetic and environmental influences. It’s thought that your genetics may make you prone to developing a personality disorder, and then something in your environment- some life situation- may trigger the actual development. In other words, the tendency to develop a personality disorder can be inherited, but not the disorder itself. The disorder only arises if/when something interferes with the development of the healthy personality. For most personality disorders, levels of heritability are about 50 percent, which is similar to, or even higher than, that of many other major psychiatric disorders. There’s no clear reason why some people develop the feelings and behaviors associated with personality disorders, while other people don’t. The social circumstances we grow up in and the quality of the care we receive greatly affect the way our personality develops, so they seem to be part of the equation.
The nurture side of the coin carries a lot of weight in developing personality disorders. Most of the patients I’ve diagnosed had something happen during their childhood. They may have had a chaotic family life, too little parental support, or a history of traumatic event(s). Trauma doesn’t have to mean emotional, physical, or sexual abuse; it may be the loss of a parent, or extreme poverty or neglect. Captain Obvious says that not everyone who experiences a traumatic situation will develop a personality disorder, and not everyone who develops a personality disorder will have had a traumatic experience. People have unique reactions, and develop different coping methods to deal with the situation they’re presented with. That’s often the core of the issue in the way personality disorders can develop; the strategies needed for coping with pain, fear, and anxiety as a child aren’t ones that are helpful or appropriate in adult life, and may in fact be harmful. That should sound familiar, no… perhaps maladaptive?
Although we can’t label a precise cause, we know that there are certain factors that seem to increase the risk of developing or triggering the condition. In addition to an abusive, unstable, or chaotic family life during childhood, other risk factors seem to include a diagnosis of childhood conduct disorder, and variations in brain chemistry and structure. A family history of personality disorders or other mental illness is another risk factor. We know of some specific links; for example, a family history of depression may increase the risk of developing borderline personality disorder and/ or obsessive-compulsive personality disorder.
Diagnosing Personality Disorders
This can be a difficult diagnosis to make, and it never happens quickly. It involves a thorough medical and social history and multiple assessments, often over an extended length of time. Each of the ten personality disorders have criteria that must be met to qualify for diagnosis. Generally speaking, it requires finding a persistent, inflexible pattern of maladaptive traits across many life circumstances. They must also cause significant distress and impairment in at least two of the four aforementioned core areas: the way you perceive and interpret yourself, other people and events; the appropriateness of your emotional responses; how well you function when dealing with other people and in relationships; and whether you can control your impulses.
It’s important to remember that everyone can exhibit maladaptive behavior from time to time. In order to meet the diagnostic requirement of a personality disorder, these traits must cause functional impairment and/or subjective distress, and they must be persistent and inflexible; meaning they can be repeatedly observed without regard to time, place, or circumstance. Other considerations are age of onset and the exclusion of other possible causes, like other mental health disorders, substance use, or history of head trauma.
Next week, we’ll start taking a closer look at the ten personality disorders; we’ll talk about the signs and symptoms for cluster A, the “Odd and Eccentric” disorders: paranoid, schizoid, and schizotypal personality disorder.
I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!
Please feel free to share the love! Share blogs and YouTube videos with family and friends.
Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too!
And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them!
As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon.
Thank you and be well people!
The Cult of Personality… Disorders
Hello, people! Last week, we talked about thyroid disease and mental health, how they may exist together, and how some of the symptoms overlap. It’s definitely something to keep in mind when you’re looking for a diagnosis, and even once you’ve been diagnosed with one, as it doesn’t eliminate the other. And that brought the thyroid series to a close. If you remember nothing else, it should be that since the thyroid regulates metabolism- how every cell in the body uses energy from food to do its thing- its function controls literally everything in the body. So when it’s not working properly, the symptoms can vary widely. It may seem subtle at first, but eventually, you’re going to know about it, so the sooner you pick up on it, the better.
Now moving on to our next topic, personality disorders. What are they? Disorder is fairly straightforward, so let’s talk about personality. Our personality is the collection of thoughts, feelings, and behaviors that makes each one of us the individuals we are. The traits of our personalities represent our patterns of thinking, perceiving, reacting, and relating to people, places, and things in our world. We don’t always think, feel, and behave in exactly the same way- that depends on the situation we’re in, the people we’re with, and all sorts of other interconnecting factors. We’re meant to be flexible to a point, but our personality traits remain relatively stable over time. Are you very talkative or very quiet? Are you constantly moving or are you a couch potato? A social butterfly or a bookworm? Are you a worry wart, always anxious, or laid back and unconcerned? These fundamental patterns make up our personality traits, and they imply consistency and stability.
Personality disorders exist when these traits become so pronounced, rigid, and maladaptive that they impair interpersonal function. Maladaptive is such a great shrinky word. It just means more harmful than helpful, as opposed to adaptive, more helpful than harmful. Fun fact: every living organism, from bacteria to humans, displays maladaptive and adaptive traits, though they don’t pertain to behavior or personality in every case. In this case, maladaptations are patterns of behavior that are detrimental or counterproductive, that interfere with life. As applied to personality disorders, these maladaptive patterns of behavior deviate from what is considered “normal” or expected by society. Put it all together, and what is a personality disorder? It’s a type of mental disorder marked by rigid and enduring patterns of thoughts and behaviors that deviate from the expectations of society, and cause significant impairment in many areas of a person’s life.
According to the shrink bible, the DSM-5, personality disorders are primarily problems with self identity and interpersonal functioning. That’s a shrinky way of saying people with personality disorders have problems with how they perceive themselves and how they interact with others. This affects how they form and maintain relationships with employers, family, friends, and intimate partners. They generally have poor coping skills, and tend to repeat patterns of behavior which are often volatile, confusing, and difficult. Maladaptive behavior may have consequences, and can cause significant problems in relationships, social activities, work, school, and potentially every facet of life. Some disorders may be so problematic that people actually avoid relationships whenever possible. These problems lead to distress, not only to the person with the disorder, but to those around them. Unlike people with anxiety or mood disorders- who know they have a problem but are unable to control it- people with personality disorders are often not aware that they have a problem, and as a result, will not seek treatment on their own. If they do, it’s the distress caused by the consequences of the maladaptive behaviors that lead them to seek treatment, rather than any discomfort with their own intrinsic thoughts and feelings. In my experience, when they do seek treatment, the chief complaint is often of depression or anxiety rather than the actual manifestations of the personality disorder.
Personality disorders are among the most common of the severe mental disorders, and often occur along with other mental illnesses, such as substance abuse disorders, anxiety disorders, and mood disorders, like depression and bipolar disorder. It’s estimated that 10 percent to 13 percent of the world’s population suffer from some form of personality disorder, and it’s thought to be underdiagnosed. While signs are sometimes apparent during childhood, most personality disorders start to become evident during the teenage years, as the personality further develops and matures. As a result, almost all diagnoses occur after the age of 18. As far as prevalence, there are no clear distinctions in terms of ethnicity. Regarding gender, most differences exist in the manifestation of symptoms within each disorder, as opposed to prevalence of diagnosis among the ten disorders, with three exceptions: antisocial personality disorder is far more common in men, while borderline and histrionic personality disorders are more common in women. Though they’re considered chronic or enduring, more recent studies indicate that some types of personality disorders may become less severe over time.
Personality Disorders: Ten Types
The DSM-5 allocates each of the ten personality disorders to one of three groups or clusters: A, B, or C. Each disorder rarely appears in its “textbook” form, they often blur into one another. Their division into clusters is intended to reflect this tendency, with any given personality disorder most likely to blur with others within its cluster. Many people diagnosed with one personality disorder also have signs and symptoms of at least one other, typically within the same cluster.
Cluster A personality disorders are characterized by odd, eccentric thinking or behavior. They include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.
Cluster B personality disorders are characterized by dramatic, overly emotional, erratic or unpredictable thinking or behavior. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.
Cluster C personality disorders are characterized by anxious, fearful thinking or behavior. They include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. Please note this is not the same as obsessive-compulsive disorder, OCD.
Our understanding of personality disorders and what it means to experience them is constantly evolving. It can be a controversial diagnosis, especially in regard to terminology.
Incidence and prevalence statistics ultimately depend on where clinicians draw the line between a “normal” personality and one that leads to significant impairment. Diagnosing personality disorders reliably is difficult. Why? How far from “normal” must personality traits deviate before they can be counted as disordered? How significant is “significant impairment”? And how is “impairment” to be defined? Next week, we’ll continue with personality disorders, though I won’t be answering those questions… those are just food for thought.
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Hello, welcome back to the blog, people! We’re continuing our look at thyroid disease. Last week, we took a pretty deep dive into diagnosis, especially lab tests. I mentioned that the TSH (thyroid stimulating hormone) test is considered by most practitioners as the gold standard test, as it regulates the release, and therefore balance, of the thyroid hormones T4 and T3. A T4 (thyroxine) test is commonly ordered with the TSH, as together, they offer a good snapshot of overall function, as well as suggest a cause for an abnormality. A T3 (triiodothyronine) test is usually only ordered to support a diagnosis of hyperthyroidism, as it’s not very helpful in hypothyroidism, since it’s the last hormone to be affected. Thyroid antibody tests can also be run to help identify different types of autoimmune thyroid conditions, such as Hashimoto’s hypothyroidism and Graves’ Disease hyperthyroidism.
There are different recommendations on how to screen for abnormal thyroid hormone levels, and your health insurance may “help” determine what tests are done and when. In most US states, and probably elsewhere as well, you can order your own thyroid tests on the interwebs, and this may be a more affordable way to have them done. You can find plenty of analyzers there too, so you can enter your results if you’re confused about what they mean.
A TSH alone can be a sufficient screening test for abnormalities, and it can be followed by a T4 and/or T3 should any be found.
Generally speaking, an elevated TSH, with or without low T4 or T3, is associated with hypothyroidism, and a low TSH with high T4 and/or high T3 is associated with hyperthyroidism. I should note that in order to receive a diagnosis of hyperthyroidism, lab tests must demonstrate that one or both thyroid hormones are elevated, so there must be a high T3 and/ or T4.
In addition to lab tests, diagnosis of thyroid disease generally involves a review of signs and symptoms, physical examination of the neck to feel for masses or nodules, while noting the condition of hair, nails, and eyes, with imaging and ultrasound tests to further evaluate findings if needed. A primary care physician can make the diagnosis and formulate an effective treatment plan, but a physician who specializes in the thyroid, an endocrinologist, is very helpful, and may be required in some cases.
Once diagnosed, treatment is aimed at correcting the imbalance and returning thyroid hormone levels to normal, in order to alleviate the symptoms the person is experiencing. This can be done in a variety of ways, depending on the cause, and whether the imbalance has resulted in a hyper- or hypothyroid condition.
Several treatments for hyperthyroidism exist. The best approach depends on your age, personal preference, physical condition, and the underlying cause and severity of your disorder.
Taken by mouth, radioactive iodine is given to a large percentage of adults with hyperthyroidism, as it effectively destroys the cells of your thyroid, preventing it from making high levels of thyroid hormones. It also causes the gland to shrink, which may make it a good choice in cases of goiter. Symptoms usually subside within several months, and excess radioactive iodine disappears from the body in weeks to months after treatment is discontinued. This treatment may cause thyroid activity to slow enough to actually be considered underactive, meaning that it may result in secondary hypothyroidism; so you may eventually need to take medication every day to replace thyroxine. Common side effects include dry mouth, dry eyes, sore throat, and changes in taste. Precautions may need to be taken for a short time after treatment to limit or prevent radiation exposure to others.
Medications like methimazole (aka Tapazole) and propylthiouracil gradually reduce symptoms of hyperthyroidism by preventing your thyroid gland from producing excess amounts of hormones. Symptoms usually begin to improve within several weeks to months, but treatment typically continues for at least one year, and often longer. For some people, this clears up the problem permanently, but other people may experience a relapse. These drugs can be pretty gnarly. If you’re allergic, you can develop skin rashes, hives, fever, or joint pain. They can make you more susceptible to infection, and can cause serious liver damage, sometimes even leading to death. Because propylthiouracil has caused far more cases of liver damage, it should really only be used when you can’t tolerate methimazole.
Beta blockers such as propranolol and Inderal are usually used to treat high blood pressure. They don’t affect thyroid levels, but they can ease some symptoms, such as tremor, sweating, rapid heart rate, and palpitations. For this reason, your physician may prescribe them to alleviate symptoms until your thyroid levels are closer to normal. For patients with temporary forms of hyperthyroidism, ie thyroiditis, inflammation of the thyroid gland, beta blockers may be the only treatment required. Once the thyroiditis resolves, they can be discontinued. These medications are generally well tolerated, but aren’t recommended for people who have asthma, and side effects may include fatigue and sexual dysfunction.
In a thyroidectomy, most of your thyroid gland is permanently removed. If you’re pregnant, can’t tolerate antithyroid drugs, and don’t want or can’t have radioactive iodine therapy, you may be a candidate for thyroid surgery- although this is usually an option of last resort, as it is permanent. Risks of this surgery include damage to your vocal cords and parathyroid glands, those four tiny glands situated on the back of your thyroid gland that help control the level of calcium in your blood. Postoperatively, you’ll need lifelong treatment with synthetic hormone to supply your body with normal amounts of thyroid hormone. If your parathyroid glands are also removed, you’ll need medication to keep your calcium levels normal as well.
If you have hypothyroidism, low levels of thyroid hormones, the main treatment option is to replace the hormone. Daily use of the synthetic form of thyroid hormone thyroxine, called levothyroxine, ie Levo-T and Synthroid, restores adequate hormone levels, and reverses the signs and symptoms of hypothyroidism. Determining proper dosage may take time, but you should start to feel better soon after you start treatment. To determine the proper initial dosage, your physician may check your TSH level after six to eight weeks. With a proper diet, the medication will gradually lower cholesterol levels elevated by the disease, and may also reverse any weight gain. Treatment with levothyroxine will be lifelong, but because the dosage you need may change, your physician should check your TSH levels periodically as needed. If you have coronary artery disease or severe hypothyroidism, your physician may start treatment with a smaller dose and increase it gradually. This progressive replacement allows your heart to adjust to the increase in metabolism.
Having excessive amounts of this hormone can cause side effects, such as increased appetite, insomnia, heart palpitations, and tremor or shakiness. It causes virtually no side effects when used in the appropriate dose and is relatively inexpensive, but try to stick to the same brand, as there can be some variances in dosing. Don’t skip doses or stop taking it because you’re feeling better; if you do, your symptoms will return. Food hinders absorption of levothyroxine, so it should be taken on an empty stomach at the same time every day. Ideally, you take it in the morning and wait one hour before eating or taking other medications. If you take it at bedtime, wait four hours after your last meal or snack. Certain medications, supplements, and even some foods may seriously affect your ability to absorb it. Tell your physician if you eat large amounts of soy products or a high fiber diet, or you take other medications, such as iron supplements or multivitamins that contain iron, aluminum hydroxide, which is commonly found in antacids, and calcium supplements.
Thyroid Disease: Prognosis
Generally speaking, even if you have a thyroid disease, you can usually live a normal life without many restrictions, as long as you have appropriate treatment. The overall prognosis varies depending on your diagnosis. With hypothyroidism, your levels and overall symptoms may improve with medication, but it’s a condition you’ll be treating for the rest of your life. You’ll take medication daily, and your physician will likely monitor you to make adjustments over time if needed. But this is not necessarily the case with hyperthyroidism. If antithyroid medications work, then your thyroid hormone levels will most likely return to normal without any further issues. That said, once you have any form of thyroid disease, your physician may need to monitor your condition with occasional blood tests to make sure your thyroid hormones are at optimal levels.
Thyroid Disease: Complications
As with any disease, early diagnosis and treatment of symptoms improves the long term outlook. The complications of undiagnosed, uncontrolled, and/or inadequately controlled thyroid disease can lead to a number of health problems that can affect your long term quality of life, and in some cases, can even be life threatening.
Even if you are under treatment or have received treatment for thyroid disease, if you start to notice signs of any of the following issues, see your physician to check your thyroid levels, or seek emergency treatment when appropriate.
Some of the most serious complications of hyperthyroidism involve the heart. These include a rapid heart rate, a heart rhythm disorder called atrial fibrillation, which increases your risk of stroke, and congestive heart failure, a condition in which your heart can’t circulate enough blood to meet your body’s needs.
Excess thyroid hormone interferes with your body’s ability to incorporate calcium into your bones, so untreated hyperthyroidism can lead to weak, brittle bones and osteoporosis.
People with Graves’ Disease can develop eye problems, including bulging, red or swollen eyes, sensitivity to light, and blurry or double vision. When left untreated, severe eye problems can lead to vision loss.
Red, swollen skin
People with Graves’ disease can develop Graves’ dermopathy. This affects the skin, causing redness and swelling, often on the shins and feet.
Thyroid storm, aka thyrotoxic crisis, is a life threatening hypermetabolic state induced by excessive release of thyroid hormones, resulting in a sudden worsening of symptoms. An individual’s heart rate, blood pressure, and body temperature can reach dangerously high levels, causing delirium. This requires urgent medical attention, as without prompt, aggressive treatment, thyroid storm is often fatal.
Constant stimulation of your thyroid to release more hormones may cause the gland to become larger, a condition called goiter. Although it’s generally not painful, a large goiter can affect your appearance and may interfere with swallowing or breathing.
Hypothyroidism puts you at greater risk for heart disease and heart failure, and can raise your levels of LDL, low-density lipoprotein or “bad” cholesterol.
Mental health issues
Hypothyroidism can cause depression that becomes more severe over time. You may notice decreased interest in activities you used to enjoy. It can also cause slowed mental functioning, and memory or concentration lapses.
Long term uncontrolled hypothyroidism can cause damage to your peripheral nerves that carry information from your brain and spinal cord to the rest of your body. Peripheral neuropathy causes pain, numbness, and tingling in affected areas, most often the legs and feet.
Uncontrolled hypothyroidism can cause you to have aches and pains in your joints and muscles, as well as tendonitis.
Low levels of thyroid hormone can interfere with ovulation, which greatly impairs fertility. In addition, some autoimmune causes of hypothyroidism can also impair fertility.
Myxedema is a life threatening condition that can result from undiagnosed hypothyroidism. The term “myxedema” can be used to mean severely advanced hypothyroidism. But it’s also used to describe skin changes in someone with severely advanced hypothyroidism. The classic skin changes include swelling of your face, including lips, eyelids, and tongue, and/ or the swelling and thickening of skin anywhere on your body, but especially on your lower legs. Signs and symptoms include intense cold intolerance and drowsiness, followed by profound lethargy and unconsciousness. In people with severe hypothyroidism, trauma, infection, exposure to the cold, and certain medications can trigger a life threatening condition called myxedema coma, which causes a loss of consciousness and hypothermia, extremely low body temperature. If you have signs or symptoms of myxedema, you need immediate emergency medical treatment.
That’s all for this week, folks. Next week will be devoted to thyroid disease and mental health issues.
Please feel free to share the love! Share blogs and YouTube videos with family and friends.
Thank you and be well people!
Welcome back, people! Last week I introduced a new topic- the thyroid- and hopefully you remember that it’s a butterfly shaped endocrine gland that wraps around the windpipe in the forward aspect of the middle throat. It plays a major role in regulating the body’s metabolism, growth, and development by production and release of thyroid hormones, called T3 and T4, into the bloodstream. When it doesn’t work properly, it can have a huge impact on multiple systems throughout the entire body. We also talked about how all of the functions of the endocrine glands are interlinked, and that the thyroid works especially closely with the pituitary gland located in the brain. In order to make the right amount of T3 and T4, the thyroid gland needs the help of the pituitary, to “tell” it- through its own hormone called thyroid stimulating hormone, TSH- when to produce and release more or less hormones into the bloodstream. And we left off with an introduction on the two basic states that result from thyroid disease or dysfunction: hyperthyroidism, when you make too much thyroid hormone, and hypothyroidism, when you make too little.
This week, we’ll get deeper into thyroid disease and talk about the various symptoms of thyroid imbalance. But I should remind that the endocrine system and the thyroid are very dynamic and can change temporarily in response to normal natural processes other than disease. If and when the body needs more energy in certain situations- if it’s during a growth spurt, time in a very cold environment, or during pregnancy for example- the thyroid gland may temporarily produce more hormones. That increase in T3 and T4 increases the basal metabolic rate, so all of the cells in the body work harder. That causes a faster pulse and stronger heartbeat, a rise in body temperature, and activation of the nervous system and then other systems needed to accomplish whatever the situation may call for. Because the cells are working harder, they need more energy, so energy stored in the liver and body is broken down and utilized faster, and food is used up more quickly as well. When the situation has ended- say the growth phase is over, or mom has the baby- the demand is lessened, the thyroid will produce less T3 and T4, the basal metabolic rate will slow, and energy requirements will reduce to previous levels. Ultimately, the thyroid and entire endocrine system will return to their previous functional levels, ready to respond next time.
Thyroid Disease by the Numbers
Thyroid disorders are very common, and very commonly run in families, and affect more than 12 percent of Americans, or an estimated 20 million people. They can occur in anyone- men, women, teens, children, or infants- at any time, meaning they can be present at birth or may develop later. Hypothyroidism is much more common than hyperthyroidism, though the latter is easier to diagnose. About one in 20 people has some kind of thyroid disorder, which may be temporary or permanent, and up to 60 percent of people with thyroid disease are unaware of their condition. While they can occur in anyone, thyroid disease affects 5 to 8 times more women than men, so one woman in 8 will develop some type of thyroid disease at some point in her life.
When the thyroid is properly balanced, it produces and replaces just the right amount of hormones to keep your metabolism working at the proper rate. When the thyroid makes too much hormone, as in hyperthyroidism, that’s sometimes also called overactive thyroid. And the flip-side of this, when your thyroid makes too little hormone, in hypothyroidism, that’s sometimes called underactive thyroid. These conditions can be standalone or caused by other diseases and conditions that impact the way the thyroid gland works, including genetic and inherited disease.
Hyperthyroidism Causes and Conditions
There are several conditions that can cause overactive thyroid, or hyperthyroidism. The most common cause is an inherited autoimmune disorder that affects 1% of the general population, called Graves’ disease. This causes immune cells attack the thyroid gland, which responds by enlarging and secreting excess thyroid hormone. Immune cells may also go on to attack the muscles and connective tissue of the eyes, causing them to bulge, a state known as exophthalmos, and this eye condition is usually then referred to as thyroid eye disease or Graves’ eye disease.
Thyroid nodules, which are small, round, usually benign masses present within the thyroid gland tissue, can also cause thyroid overactivity. There may be a single autonomously functioning nodule or a condition called toxic multinodular goiter, where there are multiple nodules within the thyroid which produce too much hormone. As the nodules increase in size and/ or number, it can cause a large, externally obvious swelling called a goiter in the neck.
Having excess iodine in your body can also stimulate the thyroid to make more hormone than it needs, since iodine is the mineral used to make T3 and T4. Excessive iodine can be found in some cough syrups and other medications like amiodarone, a heart medication.
An inflammatory process of the thyroid called thyroiditis may also cause hyperthyroidism. The person may or may not be aware of it, as it can be painful or not felt at all. In early stages of some types of thyroiditis, the thyroid may release or leak hormones that were stored there, and this hyperthyroid state can last for a few weeks or months. If it continues, the inflammation will eventually impair the production of thyroid hormone, and this will result in hypothyroidism.
Hypothyroidism Causes and Conditions
Some of the conditions associated with underactive thyroid, or hypothyroidism, include other types of thyroiditis, where the swelling of the thyroid gland impairs hormone production. Hashimoto’s thyroiditis is the most common cause of hypothyroidism. This is an inherited autoimmune disorder whereby the body’s own immune cells attack the thyroid, causing inflammation and damage to the tissue that inhibits or halts production of hormone.
Postpartum thyroiditis is a usually temporary condition that occurs in 5% to 9% of women after childbirth, whereby the thyroid is temporarily inflamed and underactive as a result.
An iodine deficiency is a common cause of underactive thyroid, or hypothyroidism, outside of the US. When the body is deficient in iodine, it simply doesn’t have enough to produce a sufficient amount of T3 and T4 hormone. Even today, iodine deficiency affects several million people around the world.
Sometimes, the thyroid gland simply doesn’t work correctly from birth, and for obvious reasons, this can have severe implications. This condition affects about 1 in 4,000 newborns. If left untreated, the child can have both physical and mental issues in the future. Because of the potential consequences, all newborns are given a screening blood test in the hospital to check their thyroid function.
Thyroid Disease Risk Factors
The causes of thyroid dysfunction are largely unknown, but there are several factors that can place you at a higher risk of developing a thyroid disease. The first and most obvious is if you have a family history of thyroid disease, as it is commonly familial. Also, if you have had treatment for a past thyroid condition, such as a partial thyroidectomy, or cancer treatment such as radiation, you are more likely to have thyroid issues later. If you are Caucasian or Asian your risk is slightly higher. If you have prematurely graying hair, your risk for developing thyroid disease is higher. In addition, if you have certain other medical conditions like Down Syndrome, Turner syndrome, and bipolar disorder, it increases your risk. If you have autoimmune or related disorders, you are at especially increased risk: lupus, rheumatoid arthritis, pernicious anemia, celiac disease, type 1 diabetes, primary adrenal insufficiency, Sjögren’s syndrome, Addison’s disease, or vitiligo. If you take a medication that’s high in iodine, such as amiodarone, this excess iodine increases the risk for developing hyperthyroidism. And if you are over 60 years old, your risk increases. This is especially true in women, as their risk is already so much greater than men.
Thyroid Disease Symptoms
Because there are such a variety of symptoms associated with thyroid disease, many can be very similar to the signs and symptoms of other medical conditions, as well as general stages of life changes. This can make it difficult to know if your symptoms are related to a thyroid issue or something else entirely.
Symptoms of Hyperthyroidism
Because the thyroid is overactive, it speeds cellular activity and generally causes the body processes to move faster. This causes the body to use energy too quickly, so people with hyperthyroidism usually have increased appetite, and may feel weak unless they consume more food to keep up with energy demands; and even if they do, they may still lose weight unintentionally. In addition, it may cause them to have trouble sleeping and sleep disturbances, confounding the fatigue they feel. Hyperthyroidism also tends to cause increased heart rate, stronger heart beat, tremors, heat sensitivity, itching, and increased sweating. It often results in feelings of anxiety, irritability, and nervousness, and causes racing thoughts, and difficulty focusing on one task. It may cause an enlarged thyroid gland to the point of goiter, where it is visible externally, as well as problems with vision or eye irritation, including protruding or bulging eyes called exophthalmos. Women with hyperthyroidism will typically have light and irregular menstrual periods. And rarely, men with hyperthyroidism can see some breast development. Be aware that if someone experiences symptoms like irregular heart rate, dizziness, shortness of breath, and/ or loss of consciousness, that requires immediate medical attention. Hyperthyroidism can cause atrial fibrillation, which is a dangerous arrhythmia that can lead to strokes as well as congestive heart failure. This is an extreme medical emergency.
Symptoms of Hypothyroidism
When the thyroid is underactive, body processes move more slowly, and this causes people to feel extremely tired and fatigued. Because cellular processes move more slowly, less energy is required, so less stored energy is utilized. Because the metabolism is sluggish, less food is required and more is stored, so having hypothyroidism makes someone much more likely to gain weight. Mentally, people commonly experience depression, mental slowness, and forgetfulness. Physically, they commonly experience constipation, puffy face, muscle cramps, dry skin, brittle nails, dry and coarse hair, hair loss, hoarse voice, and intolerance to cold temperatures. They may experience fatigue and shortness of breath with exercise. They are likely to have joint pain, stiffness, and swelling, and even carpal tunnel syndrome. Women with hypothyroidism are likely to have frequent and heavy menstrual periods.
Kids and teens with hypothyroidism can have all of the signs above, but may also have delays in sexual maturity or puberty, growth delays and shorter stature, slow mental development, and slower development of permanent teeth.
Infants and babies with hypothyroidism may have no symptoms at all. But if symptoms do present, they can include cold hands and feet, constipation, extreme sleepiness, weak or hoarse cry, little or no growth, poor feeding habits, puffy face, stomach bloating, swollen tongue, and umbilical hernia. In addition, you may notice low muscle tone, sometimes called floppy baby, as well as persistent jaundice, which is yellowing of the skin and whites of the eyes. These symptoms require immediate medical attention.
I think we’ll pick up there next week, with complications and prognosis.
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Welcome back, people! Last week we continued our foray into all things Xanax and talked about dependence and use disorder. The next step in the chain- withdrawal- can be a special kind of beastie, definitely deserving of its own blog, so this week will be all about Xanax withdrawal.
As I mentioned last week, some folks can take their bit of Xanax a couple of times a day as directed for umpteen years, and never develop a tolerance or pathological dependence. Others start out taking it as directed, but develop a tolerance and maybe start to abuse it- take too much too often- and then begin to develop a more pathological dependency. Others may abuse it recreationally on occasion, to netflix and chill, find they really like it, then develop a severe addiction. It may not sound like these people have much in common, but they do. When they stop taking it, they’re all going to go through withdrawal.
They won’t do so alone, though. In 2017, doctors wrote nearly 45 million prescriptions for Xanax, so it’s no surprise that these prescribing practices have contributed to thousands of cases of abuse and dependence. With those numbers, there has been all sorts of research and stats examined on benzos, and I read that in 2018, an estimated 5.4 million people over the age of 12 misused prescription benzodiazepines like Xanax. That’s a lot of people, people.
To many patients that take their Xanax exactly as prescribed, it seems to come as a surprise that they’re facing a withdrawal experience, but Xanax doesn’t discriminate- so anyone taking enough of it for more than a few weeks will develop a physical dependence. Once you have become physiologically dependent on a drug, you will experience withdrawal symptoms when you stop or reduce your dose. Simple as that.
Withdrawal is different for everyone. Depending on the dose and how often you’ve been using it, the withdrawal experience typically ranges from uncomfortable to very unpleasant, but it can also be medically dangerous. The only safe way to quit is to slowly taper down the dose under the direction of a physician, or in an in-patient treatment center setting, depending on the situation. If you’ve been taking high doses of Xanax several times a day, then quitting is going to take a great deal of time, patience, and determination. Please note that quitting cold turkey can cause extremely dangerous withdrawal symptoms. This can include delirium, which is a state characterized by abrupt, temporary cognitive changes that affect behavior; so you can be irrational, agitated, and disoriented- not a good combo. Sudden withdrawal can also cause potentially lethal grand mal (aka tonic-clonic) seizures. These are like electrical storms in the brain, where you lose consciousness and have violent muscular contractions throughout the body. It’s not a risk you want to take, people- so don’t do this on your own! Even if you’ve been taking Xanax illicitly, that doesn’t mean you have to go it alone. Just fess up to a physician and tell them exactly how much you’ve been taking so they can design a taper schedule for you, or help you find a treatment center. There is a lot of help available if you make the effort.
Tapering your dose is the best course of action for managing withdrawal symptoms, but that doesn’t mean it’s a picnic in the shade. While you taper down the dose, you’ll likely experience varying degrees of physical and mental discomfort. You may feel surges of anxiety, agitation, and restlessness, along with some unusual physical sensations, like feeling as though your skin is tingling or you’re crawling out of your skin. But keep in mind that these are all temporary.
Signs and Symptoms
The major signs and symptoms of Xanax withdrawal vary from person to person. Research indicates that roughly 40% of people taking benzodiazepines for more than six months will experience moderate to severe withdrawal symptoms, while the remaining 60% can expect milder symptoms. It’s very common to feel nervous, jumpy, and on edge during your taper. And because Xanax induces a sedative effect, when the dose is reduced, most people will experience a brief increase in their anxiety levels. Depending on the severity of your symptoms, you may experience a level of anxiety that’s actually worse than your pre-treatment level. Support from mental health professionals can be very beneficial during and after withdrawal, as therapy and counseling may help you control and manage the emotional symptoms of benzo withdrawal.
Physical Withdrawal Symptoms
As a central nervous system depressant, Xanax serves to slow down heart rate, blood pressure, and temperature in the body- in addition to minimizing anxiety, stress, and panic. Xanax may also help to reduce the risk of epileptic seizures. Once the brain becomes used to this drug slowing all of these functions down on a regular basis, when it is suddenly removed, these CNS functions generally rebound quickly, and that is the basis for most withdrawal symptoms. Symptoms can start within hours of the last dose, and they can peak in severity within 1 to 4 days. The physical signs of Xanax withdrawal can include: headache, blurred vision, muscle aches, tension in the jaw and/ or teeth pain, tremors, nausea, vomiting, diarrhea, numbness of fingers, tingling in arms and legs, sensitivity to light and sound, alteration in sense of smell, loss of appetite, insomnia, cramps, heart palpitations, hypertension, sweating, fever, delirium, and seizures.
Psychological Withdrawal Symptoms
Xanax, as a benzodiazepine, acts on the reward and motivation regions of the brain, and when a dependency is formed, these parts of the brain will be affected as well. When an individual dependent on Xanax then tries to quit taking the drug, the brain needs some time to return to normal levels of functioning. Captain Obvious says that whenever you stop a benzo, because it acts as an anxiolytic, you’re going to experience a sudden increase in anxiety levels. While there are degrees of everything, the psychological symptoms of Xanax withdrawal can be significant, as the lack of Xanax during withdrawal causes the opposite of a Xanax calm, which is to say something akin to panic. At the very least, that can make you overly sensitive, and less able to deal with any adverse or undesired feelings. Withdrawal can leave people feeling generally out of sorts, irritable, and jumpy, while some individuals have also reported feeling deeply depressed. Unpredictable shifts in mood have been reported as well, such as quickly going from elation to being depressed. Feelings of paranoia can also be associated with Xanax withdrawal.
Nightmares are often reported as a side effect of withdrawal. I included insomnia in physical symptoms, but trouble sleeping can also be a psychological symptom, as it is both mentally and physically taxing. People can be overtaken by anxiety and stress during withdrawal, and that may cause this trouble sleeping at night, which then contributes to feelings of anxiety and agitation, so it’s a cycle that can be tough to break free of. Difficulty concentrating is also reported, and research has found that people can have cognitive problems for weeks after stopping Xanax. Ditto for memory problems. Research shows that long-term Xanax abuse can lead to dementia and memory problems in the short-term, although this is typically restored within a few months of the initial withdrawal. Hallucinations, while rare, are sometimes reported when people suddenly stop using Xanax as well. Suicidal ideation is sometimes reported, as the anxiety, stress, and excessive nervousness that can occur during withdrawal can lead to, or coexist with suicidal thoughts. Finally, though rare, psychosis may occur when a person stops using Xanax cold turkey, rather than being weaned off of it.
Xanax Withdrawal Timeline
Xanax is used so commonly for anxiety and panic disorders because it works quickly, but that also means it stops working quickly and leaves the body quickly. Xanax is considered a short-acting benzodiazepine, with an average half-life of 11 hours. As soon as the drug stops being active in the plasma, usually 6 to 12 hours after the last dose, withdrawal symptoms can start. Withdrawal is generally at its worst on the second day, and improves by the fourth or fifth day, but some symptoms can last significantly longer. If you go cold turkey and don’t taper your dose, your withdrawal symptoms will grow increasingly intense, and there really is no way to predict how bad they may get, or how you’ll be affected.
Unfortunately, five days doesn’t signal the end of withdrawal for some people, as some may experience protracted withdrawal. Estimates suggest that about 10% to 25% of long-term benzodiazepine users experience protracted withdrawal, which is essentially a prolonged withdrawal experience marked by drug cravings and waves of psychological symptoms that come and go. Protracted withdrawal can last for several weeks, months, or even years if not addressed by a mental health professional. In fact, these lasting symptoms may lead to relapse if not addressed with continued treatment, such as regular therapy.
Factors Affecting Withdrawal
Withdrawal is different for each individual, and the withdrawal timeline may be affected by several different factors. The more dependent the body and brain are to Xanax, the longer and more intense withdrawal is likely to be. Regular dose, way of ingestion, combination with other drugs or alcohol, age at first use, genetics, and length of time using or abusing Xanax can all contribute to how quickly a dependence is formed and how strong it may be. High stress levels, family or prior history of addiction, mental health issues, underlying medical complications, and environmental factors can also make a difference in how long withdrawal may last for a particular individual and how many side effects are present.
Coping with Xanax Withdrawal
The best way to avoid a difficult and potentially dangerous withdrawal is to slowly taper down your dose of Xanax, meaning to take progressively smaller doses over the course of up to several weeks. By keeping a small amount of a benzo in the bloodstream, drug cravings and withdrawal may be controlled for a period of time until the drug is weaned out of the system completely. It may sound like designing a taper would be a no-brainer, but it’s definitely not recommended to taper without a physician’s guidance. Why? Because Xanax is a short-acting drug, your body metabolizes it very quickly. Controlling that is challenging because the amount of drug in your system goes up and down with its metabolism. To help you avoid these peaks and valleys, doctors often switch you from Xanax to a longer acting benzo during withdrawal, as it may make the process easier. And believe me, that’s what you want. If the physician goes this switch route, once you’ve stabilized on that med, you’ll slowly taper down from that a little bit at a time, just as you would with Xanax.
Another reason not to play doctor on this one is if you start to have breakthrough withdrawal symptoms when your dose is reduced, your physician can pause or stretch out your taper. It’s up to him or her, through discussion with you, to design the best tapering schedule for your individual needs. Sometimes it’s a fluid and changing beastie.
In addition, adjunct medications like antidepressants, beta-blockers, or other pharmaceuticals/ nutraceuticals may be effective in treating specific symptoms of Xanax withdrawal, and you’ll need a physician to recommend and/ or prescribe those as well.
Alleviating Symptoms of Withdrawal
An individual may notice a change in appetite and weight loss during Xanax withdrawal, so it’s important to make every attempt to eat healthy and balanced meals during this time. It may sound obvious, but a multivitamin including vitamin B6, thiamine, and folic acid is especially helpful, as these are often depleted in addiction and withdrawal. There are some herbal remedies that may be helpful during withdrawal, such as valerian root and chamomile for sleep. Meditation and mindfulness are very useful for managing blood pressure and anxiety during withdrawal, so be sure to check out my March 15 blog for more on mindfulness. Considering the insomnia and fatigue that may occur during withdrawal, it may seem counterintuitive to commit to exercise, but it has been shown to have positive effects on mitigating withdrawal symptoms and decreasing cravings. Exercise stimulates the same pleasure and reward systems in the brain, so it stands to reason that it can also help to lift feelings of depression or anxiety that may accompany physical withdrawal symptoms.
Xanax Withdrawal Safety
Some of the things I’ve mentioned are so important they bear repeating. Xanax should not be stopped suddenly, or cold turkey, and vital signs like blood pressure, heart rate, respiration, and temperature need to be closely monitored during withdrawal. This is because these may all go up rapidly during this time, and this can contribute to seizures that can lead to coma and even death.
People with a history of complicated withdrawal syndromes and people with underlying health issues should work very closely with their physician during withdrawal, as should the elderly and people with cognitive issues, as there can be unique risks involved. If you have acquired your Xanax illicitly, you can still work with a doctor to taper down your dose. Start by visiting a primary care physician or urgent care center and tell them that you are in, or are planning to be in, benzodiazepine withdrawal. If you don’t have insurance, visit a community health center. If you plan to or have become pregnant, you will need to discuss your options with your prescribing physician and OB/GYN about the risks and benefits of continuing versus tapering Xanax or other benzos. Some women continue taking them throughout their pregnancy, while others follow a dose tapering schedule.
The key to achieving the goal of getting off of Xanax is to follow the tapering schedule to the very end. By the end of your taper, you might be cutting pills into halves or quarters. Note that some individuals may be better suited for a harm reduction approach, in which the taper leads to a maintenance dose rather than abstinence. If you’re very concerned about the risks involved in Xanax tapering for any reason, discuss these concerns with your physician, because you may be better suited for inpatient detoxification. While this is more expensive, it is covered by many insurance plans.
No matter how you slice it, quitting Xanax takes time, patience, and determination. If you’ve been using it for longer than a few months, quitting can be hard, and there will be days where you want to give up and give in. But with medical supervision and support, you can be successful, and in the long-term, the health benefits are considerable. Withdrawal isn’t a picnic, but if Xanax is both the alternative to it, and a problem for you, it beats that alternative hands down.
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Alprazolam Use Disorder
Helll-ooo people! I hope everyone had a great holiday weekend, maybe bit the head off a big bunny- a chocolate one of course. We’ve been talking about alprazolam, trade name Xanax. Last week I warned you about the dangers of buying it off of the street. If you’ve forgotten why it’s dangerous, it’s because it’s nearly always counterfeit crap made in some moron’s basement with fentanyl and heaven knows what else, and you don’t want that. If you think I have a pretty clear opinion on fake Xanax, or any fake pharmaceutical for that matter, Captain Obvious says you’d be right.
If you read the first blog in this series a couple of weeks ago, you already know that Xanax, generic name alprazolam, is a member of the class of anxiolytic drugs called benzodiazepines, and very commonly prescribed for anxiety and panic disorders- mainly because it’s very effective and works quickly. But it also has serious addiction potential and is a common drug of abuse, and this is something that patients and their families must be aware of up front. With that in mind, this week’s blog will focus on the signs and symptoms of Xanax abuse, and how that progresses to the diagnosis of sedative use disorder, or more specifically Xanax use disorder.
Some people who are prescribed Xanax for anxiety or panic disorders can take their prescribed dose twice a day for years and never experience an issue, unless or until they stop taking it. They become dependent upon it, but only in that their body becomes used to having the drug in their system- it’s not a pathological dependence. Upon stopping it, they’ll still experience withdrawal symptoms, but they don’t develop Xanax use disorder, because their use is quite literally not disordered. Incidentally, I’ll be focusing on withdrawal from Xanax next week. In contrast, far too many people develop a pathological dependence upon Xanax. Even if they have a genuine anxiety disorder and start out taking it only as prescribed, they begin to abuse it by taking too much and/ or too often, and they develop a use disorder, which progresses to what we colloquially call an addiction.
This is a process that generally starts because they begin to develop a tolerance to the drug and require more of it to achieve the desired effect, whether that is to quell their symptoms of anxiety, or to get high. Tolerance is a phenomenon that occurs with many drugs, but it is especially dangerous in a drug like Xanax, as it’s a closed circuit- the more you need, the more you take, and the more you take, the more you need. Ideally, a patient informs their prescribing physician if they feel that their current dose is no longer adequate. But that doesn’t always happen, and patients may choose to increase the dose on their own; and at that point, they’re abusing the drug.
Some of the most common physical signs and symptoms of Xanax abuse include slurred speech, poor motor coordination, confusion, blurred vision, drowsiness, dizziness, difficulty breathing, loss of consciousness, and an inability to reduce intake without symptoms of withdrawal. Beyond the physical symptoms, when a person begins to abuse Xanax, there will likely be noticeable changes in their behavior as well. Some of the most common behavioral signs of Xanax abuse include the following:
-Taking risks in order to buy Xanax: some people may do things they wouldn’t have previously considered in order to obtain it. For instance, they may steal, often from loved ones, in order to pay for Xanax.
-Losing interest in normal activities: as Xanax abuse takes a firmer hold in a person’s life, they commonly lose interest in activities they formerly enjoyed.
-Risk-taking behaviors: as Xanax abuse continues, the person may become more comfortable taking big risks, such as driving while on Xanax.
-Maintaining stashes of Xanax: to ensure that they will not have to go without Xanax, they will attempt to stockpile it.
-Relationship problems: Xanax abuse invariably leads to interpersonal problems and social issues, but this often isn’t enough to motivate the person to stop.
-Obsessive thoughts and actions: the person will spend an inordinate amount of time and energy obtaining and using Xanax. This may include activities like doctor shopping or looking for alternate sources of it, or asking friends, family, and/ or colleagues for it.
-Legal issues: this can be related to illegally obtaining Xanax, being arrested/ incarcerated for drugged driving, or for other disturbances as a consequence of use.
-Solitude and secrecy: when abusing Xanax, it’s very common for people to withdraw from friends and family to protect their use.
-Financial difficulties: to pay for Xanax, a person may drain their financial resources and/ or those of family and friends.
-Denial: this includes setting aside valid concerns about Xanax abuse to protect ongoing use of the drug. For example, minimizing or refusing to recognize the dangers of buying it on the street.
As Xanax abuse progresses, it reaches what most people would term an addiction. But the actual diagnosis recognized in the psych nerd’s bible, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) is termed use disorder. If the person is using Xanax, we call it sedative use disorder or Xanax use disorder, but there is opioid use disorder as well- essentially anything that is abused can fill in the blank. In order for a person to be diagnosed with a sedative use disorder, they must exhibit a certain number of signs and symptoms within a one year period. The more symptoms that are present, the higher the grading the sedative use disorder will receive, and this places the severity of the disorder on a continuum, be it mild, moderate, or severe.
Paraphrased versions of the assessed symptoms of Xanax use disorder are as follows:
-Repeated problems in meeting obligations in the areas of family, work, or school because of Xanax use.
-Spending a significant amount of time acquiring Xanax, using it, or recovering from side effects of use.
-Continued Xanax use despite hazardous circumstances.
-Continued Xanax use despite the complications it causes with social interactions and interpersonal relationships.
-Continued Xanax use despite experiencing one or more negative personal outcomes.
-Using more Xanax or using it for longer than recommended or intended.
-An inability to stop using Xanax despite an ongoing desire to do so.
-Obsessive craving for Xanax.
-Ceasing or reducing participation in work, social, or family affairs due to Xanax use.
-Building tolerance over time, necessitating the use of increasing amounts of Xanax to achieve desired effect.
-Experiencing withdrawal symptoms upon decreasing the dose of Xanax.
These last two signs- building tolerance that requires continual dosage increases, and experiencing withdrawal symptoms when dosage is decreased- are indicative of physical dependence and ultimately addiction. These are natural body processes that occur when the brain and body habituate to drug use over time. Once the body becomes accustomed to having the drug, a sort of new normal is established in its presence. Thereafter, when the drug use stops, the body will issue its demand for more of the drug in the form of withdrawal symptoms. And that’s exactly where we’ll pick up next week.
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Counterfeit Drugs: Fake Xanax
For this week’s alprazolam blog, I want to know if I can fake you out. We’re going to talk about fake Xanax. Look at the picture above. Can you tell which Xanax are fake? Are you certain? Enough to roll the dice with your life on the pass line? Because, make no mistake- if you get your Xanax from anywhere other than a licensed pharmacy, you are absolutely, positively doing so every single time you take it. By the end of this blog, you’ll definitely know the answer to the first question. As to the second, I’d hope you already know the answer, because even Captain Obvious won’t bother with that one, people.
When you think of counterfeit drugs, you may not be too concerned if you consider them to be just weakened copycat versions of the real thing, made with a bunch of essentially harmless junk. Probably the worst that could happen is it won’t work, right? Wrong! Obviously, the main problem with counterfeit drugs in general is that they’re clearly illegal and therefore unregulated, so you don’t know what you’re getting. I mean, with counterfeit drugs, there’s no truth in advertising. And helll-ooo, they’re produced in somebody’s gnarly basement, so there sure as hell isn’t any quality control. While they can be cut with innocuous things like baking soda or baby powder, they can also be laced with extremely harmful substances, things like rat poison, bleach, and formaldehyde. Unfortunately, many drug users don’t know, or don’t care, how dangerous it is to ingest substances like these. But there are cases where counterfeit drugs are especially dangerous, and fake or counterfeit Xanax is at the top of that list. In late 2015, the entire country learned this lesson the hard way when in three months, there were nine documented cases where people in San Francisco suddenly overdosed from “Xanax.” To be clear, it wasn’t Xanax at all. That number included a baby, who had picked a tab of it up off the floor and put it in their mouth. It also included one person who didn’t even get to live to regret it. I think we got off pretty easily in that singular event, but obviously more have followed.
By the Numbers… Without Numbers (?)
Again, since production and sale of fake Xanax is illegal, underground, and unregulated, there aren’t national or global databases to collect information or statistics as there are with other drugs. But I found some reports from various global sources that were interesting. And by that I mean frightening. Some highlight snippets include a report citing that 25% of 2018 drug overdose deaths in Northern Ireland were caused by counterfeit Xanax. Another report from U.S. Customs and Border Protection stated that in the first four months of 2020, during unspecified smuggling attempts, their CBP officers seized 27 shipments of fake Xanax, totalling over 35 pounds. I also listened to part of a podcast on the subject that featured an officer from Portland, Oregon talking about a spate of teenage overdoses on fake Xanax, and the subsequent investigation. They apparently did a round up of all the street dealers they could find, and busted down doors and did everything they could to clean up the area. The goal was to get every Xanax pill off the street, and he stated that of all the “Xanax” pills they recovered, not a single one was legit. He didn’t say exactly how many that was, but it seemed like a lot. Every pill in the area was fake. That’s huge. And very scary.
Fake Xanax: Beyond the Obvious
“Good” counterfeit Xanax pills look exactly like the real thing. And clearly, by “good” I don’t mean that in the traditional sense. That means they have the same color, size, shape, and pharmaceutical markings, aka imprints, on the pills as the bonafide prescription versions do. While the difference isn’t obvious to the naked eye, there is one huge difference between real and fake Xanax that makes it especially scary: the latter usually contains fentanyl, an extremely potent opioid that is responsible for countless accidental overdoses in numerous counterfeit and legal preparations. In fact, it’s estimated that many thousands of U.S. citizens ingest a deadly dose of each year without ever even realizing it. How horribly tragic and senseless is that?
Fentanyl is a schedule II synthetic opioid that is 50 to 100 times stronger than heroin and morphine, respectively. It is typically prescribed by a specialized physician strictly for patients struggling with severe or chronic pain, and it is such a potent and dangerous drug that the DEA has advised officials to take extra protective precautions, like gloves, even just when handling it, to avoid accidental death. This is because it is easily absorbed through the skin, and takes so little to be lethal. While other opiate doses are measured in milligrams, fentanyl is dosed in micrograms, and an amount equal to two grains of salt is lethal to nearly all individuals. Clearly, a drug that is 100 times stronger than morphine is no joke, and it officially now kills more Americans annually than any drug in history.
People who take fentanyl accidentally will be unaware of what they have taken, or how much, so they face an even higher risk of an opioid overdose. In the case of fake Xanax exposure, if or when a person does overdose on it, in the unlikely event that they’re lucky enough to make it to a hospital, it presents a unique problem. As a physician, I can tell you that when a person’s symptoms present differently from what is expected, it delays treatment, and Xanax overdose and fentanyl overdose present very differently. So when it’s reported that a person took “Xanax,” or some pills are found on their person, but their symptoms don’t look like a benzodiazepine overdose, those few minutes a medic or doc takes to assess the situation may be the few that end up costing them their lives. But that can be the case fake percocet or oxycodone as well, because fentanyl is commonly used in producing counterfeit versions of all of those. Even cocaine- maybe especially so because of the cost differential- fentanyl is so much cheaper that it’s very commonly used to cut it. And talk about presenting differently: cocaine and fentanyl overdose are not even remotely similar to one another. Even if users are aware that fentanyl is in the product, and aren’t that concerned about it, there’s still no way to know how much fentanyl is in it, or exactly how potent that fentanyl is. As a result, it is extremely easy to overdose after consuming any counterfeit product.
Since the pills look exactly like the real thing, it’s nearly impossible to tell the difference. But, if someone consumes counterfeit Xanax made with fentanyl, there will be noticeable symptoms and side effects that wouldn’t ordinarily be present with genuine Xanax. The side effects of fentanyl include excessive itching, slowed breathing, nausea and vomiting, flushed skin, and constricted pupils. These can quickly progress to overdose, and those signs and symptoms are progressively shallow breathing, usually followed by gurgling or choking sounds, or sounds like “snoring,” pale, blue, cold, or clammy skin, limp body or unresponsiveness, and finally suppressed breathing. People often report that they didn’t recognize that someone was overdosing, even though they literally sat there watching it. They usually think they’ve nodded out and are snoring, and then just stop snoring. In reality, they’re really choking, then their breathing is severely suppressed, and when they stop making noise, they’ve simply stopped breathing. Fentanyl also yields some dangerous psychological effects, such as depression, hallucinations, difficulty sleeping, and nightmares. These are all signs to be aware of if you ever take a drug from a questionable source.
Fake Xanax: How it’s Done
Counterfeit Xanax is made using a pill press, which is exactly what it sounds like: it’s a device that is used to press powders together with a binding agent, to make the substance into a solid pill form. Pill pressing devices can be smaller than the size of a person’s palm, or large enough to need a small room for storage. Pill molds are added to the pill press to press the pills into certain sizes and to make markings or indentations. Sometimes they’re called “stamps,” and manufacturers use these to customize the appearance of the pill and mimic the exact imprint used by the legit pharmaceutical company. Currently, it’s not illegal to own a pill press, and in fact, some people use them to make their own vitamins or supplements at home. But it is illegal to own a pill mold that is used in a pill press. As a result, counterfeit pill molds are usually designed in other countries and sold to the U.S. as “spare parts” or “equipment.” This allows street dealers and manufacturers to purchase their supplies without gaining attention from the police, and continue to make fake drugs in their gnarly basements.
Fake Xanax: Why it’s Done
Helll-oooo! People who sell drugs don’t do so because they enjoy it, they do it to earn a profit. It behooves them to find a way to make their drugs cheaper and more potent, because that’s the best way to generate more profit from a smaller amount of product- that’s just common business sense. Believe it or not, many street-level dealers can get their hands on fentanyl very cheaply, either through theft, or through overseas production of cheap, sketchy fentanyl look-a-likes, so they commonly use it to cut their drugs, and this actually makes their products cheaper and more potent. To be clear, these fake products may not even contain the actual primary component. But in cases of fake Xanax, if it does contain actual alprazolam, the combination makes it even more dangerous- but the fentanyl alone can just as easily provide or mimic the effects the user is looking for. The result is a product that looks and feels pretty much like real Xanax, but is infinitely more dangerous; sold at a fraction of the price, as compared to the real thing, brought to you by your friendly neighborhood street thug.
Fake Xanax: How to Avoid It
Clearly, the easiest way to avoid purchasing fake Xanax is to never purchase the drug on the streets in the first place. In fact, the only reason anyone should ever take Xanax in the first place is if they have a prescription for it and are instructed to by their doctor. Unfortunately, some people who are prescribed the medication seek out cheaper ways to fill their prescription, such as purchasing it from shady online pharmacies or from overseas stores. But you’d be surprised how enterprising some dealers are, and a “pharmacy” selling counterfeit drugs is certainly not unheard of. So kids, the take home lesson is that if you have a Xanax prescription, you should always get it filled at a licensed pharmacy.
Fentanyl: The Masked Killer
As a final word of caution, I just wanted to include a short synopsis of three stories I read about counterfeit drugs containing fentanyl. None of them have happy endings.
A 28-year-old smoked “a powdery substance” at his mother’s home, where he was living at the time. His mother found him unresponsive in the living room, and having no idea of what had happened, called 911. He was pronounced dead on arrival. The death investigation determined that the substance had been given to him by a friend, who stated they both thought it was cocaine. Toxicology confirmed that while he had a non-lethal level of cocaine in his system at the time of death, the cause of death was acute fentanyl intoxication- he died of a fentanyl overdose.
A 20-year-old college student suffering from undiagnosed anxiety was panicking about a test the following day, so consumed a single oxycodone pill he had obtained illegally before going to bed. His roommates found him dead the next morning. Toxicology confirmed that he died from a fentanyl overdose.
A 19-year-old purchased two Percocet from a friend. He consumed both pills and subsequently died from an overdose. His friend confirmed the purchase, but then toxicology showed the presence of lethal levels of fentanyl. His friend swore he didn’t know they were fake and was very distraught. That friend was also later found dead of an overdose. It was confirmed that it was also due to fentanyl, but it wasn’t clear if it was suicide or accidental.
These are cases where four individuals died of fentanyl overdose, with all of them consuming a different drug, and three of them never even realizing they were consuming fentanyl. On that note, have you decided which group of Xanax in the picture were fake? I’ll tell you now: both are fake. Guess it’s a good thing you couldn’t actually choose. Get my point?
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When Home Becomes Work: Challenges of Working Remotely
Captain Obvious says that while coronavirus is responsible for thrusting us (with IT people kicking and screaming) into working remotely as a necessity, it was already a fairly common practice BR (before ‘rona). In fact, a statistic I read indicated an overall global trend toward remote work long BR, with a global increase of 159% between 2005 and 2017. As far as US stats on remote work go, 17% of US employees report that they worked from home five days or more per week BR, but that jumped to 44% DR (during ‘rona). As for the future, polls indicate that totally AR (after ‘rona) a minimum of 16% of American people who had previously worked outside the home BR will switch to working remotely from home at least two days per week AR. In addition, more than one-third of US firms that had employees switch to remote work DR believe that it will remain more common at their company AR. Globally, polls now predict that 25% to 30% of the earth’s workforce will work remotely multiple days per week by the end of 2021. In short, the genie is out of the bottle, and it’s not likely to go back in.
Many employers and business leaders think that going remote is as simple as sending an employee away from the office with a laptop and a to-do list, but unfortunately, it’s not that simple. In truth, there are real life consequences associated with working remotely. It may sound like a dream come true, but from where I’m sitting, it’s become more like a nightmare. A lot of people have gone back to their outside offices now, but many are still working from home. This is either because they- or their employers- are still too reluctant to make the switch and return, or have found it beneficial enough that it behooves them to continue remote operations. Regardless of why you may find yourself doing so, working remotely does present its own set of challenges, not the least of which is that companies were essentially forced into it overnight, without benefit of true preparedness and system checks.
But in any event, if you are still working remotely at this point, you may find yourself continuing to do so indefinitely. I find that most of my patients enjoy lounging in their pajamas all day as they work from home, never leaving their house because it’s such an effort to get dressed; though they fail to understand why they’re so anxious, irritable, and depressed. The good news is that there is a way to do this work from home deal effectivelyand happily, and even excel at it, while still having a personal life and functioning appropriately. The bad news is there are some not-so-nice ramifications and consequences associated with the routine, and a lot of people are starting to recognize this after far too long being “trapped” at home. Spoiler alert: most people actually are not. The bottom line is that your whole world doesn’t have to change just because you’ve eliminated a commute. Out of necessity DR, it did change for a time, but at this point, it’s time to get out and reclaim some normalcy. Some of the issues that come up with working remotely are more rooted in the personal realm, and deal with basic self care and psychological health, while others center more on professional matters. But don’t kid yourself, there’s a lot of overlap and cross reactivity betwixt and between them. So this blog marks the beginning of a series dedicated to identifying the issues surrounding working remotely, and discussion on how to address them appropriately, with some tips and tricks and coping methods thrown in for good measure.
Today’s blog will deal with some problems that I’ve noted in video calls and appointments with my patients. I sometimes call them “duh!!” issues, because a lot of you are going to be like, “Duh, Dr. Agresti, we all know that!” Well, what some people know and what they do are two very different things. If you’re depressed, and you haven’t brushed your hair or gotten dressed for a week straight, then you might hear me say, “Duh, go brush your hair and get dressed, you’ll feel better.” I suppose you could also call them “helll-ooo!!” issues, as in, “Helll-ooo… you really need to take a shower!!” That’s a real thing, people. Not all of the things I’ll discuss are quite that extreme, but my list of remote work must-do’s includes some personal care requirements that must become- and remain- second nature to you; they must be part of a regular routine, regardless of the fact that you may be all alone, with nobody even there to see (or smell) you. So that’s where we’re starting; with just some very basic, very simple recommendations for a better life and more success in a remote work situation. Most of these you probably already know, but you may not be doing them. Allow this to be your kick in the can if that’s the case.
-Sleep in your bed, but then get out of said bed when you get up in the morning. Don’t just wake up and roll over to reach for your laptop to start your day. I cannot tell you how many patients I talk to while they’re working in bed; they’re literally in bed 24/7. Get out of bed!
-Create a dedicated office, preferably with a door you can close to keep things quiet and help you avoid distractions. If you don’t have a spare room, then at least create a dedicated work space. Even a corner of a room will do if that’s all you can spare. You really just need room for a table or desk large enough to hold a computer and whatever supplies you need, and a chair. Try to make it as comfortable- and functional- as possible.
-Make a schedule and stick to it. And be sure to keep an accurate account of the hours you work. I’ll be discussing supervisory micromanaging in the next blog, but if you keep a regular schedule and good records of your hours, you’ll have all the info you need if you are questioned by a micromanaging supervisor.
-Now that you aren’t commuting to and from the office, you’re going to be physically moving a lot less. So you must make time each day for exercise. So many of my patients that have switched to working remotely have gained a fair bit of weight and almost all of them have lost serious muscle tone. When you’re working from home, it’s easy to get comfortable and complacent, and turn into a flabby flaccid couch potato. Do something to move your muscles every day.
-Eat three square meals each day, and no more 24/7 snack attacks. Just because your refrigerator is mere steps away doesn’t mean you should make the trip every 30 minutes. A small midmorning, midafternoon, or late night snack is okay, but that’s it. Note my word choice: or not and. Three decent meals and one small snack each day is acceptable- just try not to go too crazy- and try to make it reasonably healthy, maybe a yogurt, cottage cheese, or piece of fruit. Like, a box of girl scout cookies is not a snack, people.
-Because you aren’t commuting to and from the office, you’re also rarely going to be required to go outside. So you must make a special point to go outside every day, even if it’s just for 15 minutes after lunch. Human bodies require vitamin D, and nothing’s a better source than sunlight. Try taking a walk around your neighborhood after you have lunch, just something where you’re exposed to the sun.
-A lot of my patients are complaining of decreased intimacy and a lack of sexual energy since they started working remotely. So my next suggestion is to do whatever you can to be close to your partner. Emotional and physical intimacy are important, so have sex, but maybe don’t combine this suggestion with the one above it, unless you have an excellent privacy fence.
-When work is over, stop working. It can be tempting to work more hours when you’re at home. This may sound counterintuitive, but it’s true. To avoid this trap, work the same schedule and number of hours each day at home as you would if you were commuting to an office. Don’t try to cram jam in four16 hour days days a week in order to take a 3 day weekend, unless it’s an unavoidable situation, and/ or you receive permission or clearance from a supervisor if applicable.
-Make sure to get adequate sleep. Go to bed at a reasonable time, get up at a reasonable time, and try to stick to a sleep schedule. And remember to avoid blue light exposure for at least two to three hours before you go to bed, otherwise you’ll have a hard time falling asleep.
-Keep your regular grooming routine- you’ll feel better about yourself. If you didn’t get the hint, shower every day. Brush your hair, and your teeth. Shave and put on makeup if you’re about that life. Work is not a pajama party, so get dressed in appropriate clothing. You don’t have to wear a suit or heels, but make an effort to be presentable, even if there’s no one to present yourself to.
This isn’t rocket science, people. Basically, you should follow the same routine you always have, and do everything you would do if you were going to an actual outside office or workplace: go to bed at a reasonable and regular time on work nights, get up at a reasonable and regular time each morning, and resist the urge to hit snooze 97 times. Shower, shave, get dressed in decent clothing, and eat breakfast. Then go to work in your in-house office space, just as you would if you were going to commute to an office. Avoid distractions and get your work done. Take a one hour lunch break maximum, and make sure to actually eat something reasonable, but avoid eating at your desk. Think about taking lunch outside for some fresh air, vitamin D, and a change of scenery, and you can kill multiple birds with a single stone. After lunch time is not nap time- and it hasn’t been since kindergarten- so after lunch, go back to work until it’s time to stop at the end of the day. Make sure to put in a full day’s work, while also being careful not to overwork. Behave as if you owned the company and were paying employee salaries. Supervisors will be less likely to micromanage you to death if you give them no reason to mistrust you or doubt your motivations.
No Nearly Naked Zooming
Captain Obvious says that videoconferencing has become a big part of our lives DR, and will continue to be long AR. Here’s a fun fact for you, Zoom saw phenomenal growth in 2020, and ended the third quarter of 2020 with an astounding report of 367% year-over-year revenue growth. If you had stock in Zoom Video Communications BR, which I did not, that’s a very fun fact for you. And get this… Zoom hosted an average of 300 million meeting participants per day throughout 2020. That’s 300 million people that don’t need to see you in your underwear, people. Same goes for gnarly, used-to-be-white, ripped t-shirts with yellow pit stains. Get it? If you didn’t, here’s the simple concept: put on a shirt. One with at least two buttons at the top.
Drinks, not Zinks
Even if you dress appropriately for video conferencing calls, there’s really no replacement for real deal interaction, because shockingly, humans are hardwired for human connection. Even Captain Obvious wouldn’t bother with that one. It’s just not possible to simply erase our evolutionary zeitgeist and replace millions of years of in-the-flesh interactions with technologically mediated virtual communications. While Zoom and its brethren have helped us in our attempts to recreate a certain degree of face-to-face experiences, that’s really as much thanks to the power of human imagination as it is to technology; and nothing stifles human creativity and imagination like isolation and loneliness. As a society, we spend a lot of time creating tech to replicate real-life experiences, but it’s a cheap substitute. In most situations, we’re better off spending a larger portion of that time experiencing real-life personal experiences. If you live alone and work from home, you could literally spend days without any human contact. You should make an effort to socialize, but remember to do so responsibly and wear your mask, people. Call a friend and suggest you meet for dinner, coffee, or lunch, or go on a date night. Drinks are hands down better than Zinks, so arrange to meet a friend IRL.
Loneliness or isolation is one of the most commonly reported issues that remote workers and digital nomads face, along with anxiety, stress, and depression. Next week, in part deux of this remote work blog, I’ll talk more about those, as well as some professional issues that can come into play when working remotely, and I’ll make some suggestions on how to deal with them. Then in part three, I’ll talk about some specific anxiety and stress busting techniques you can incorporate into your routine during the day, as you need them, and they won’t complicate or derail your work schedule, or negatively affect your productivity. In fact, they’ll do just the opposite.
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Personality and Behavior: DISC Model
Wikipedia defines personality as the “characteristic set of behaviors, cognitions, and emotional patterns that evolve from biological and environmental factors.” I’m sure they probably go on to list those factors in the third through fifth paragraphs, so this short definition seems neat and tidy without really committing to much. But as we all know, when you’re dealing with humans, things aren’t ever simple. In reality, there’s no formal or universal definition, but that’s okay, because it gives psych nerds something to argue about. Because there’s no universally accepted meaning, all definitions are essentially theories, most of which center somewhere around an individual’s psychological motivations and resulting interactions with their environment. Alternatively, people can refer to it as character, temperament, or disposition, but in my opinion, no matter what you call it, the bottom line is that each person has a unique combination of characteristics or qualities that form a distinctive set, and these govern their perspectives, motivations, and behaviors.
Now, before I really get into this week’s topic, this is a good place for me to add a disclaimer: When addressing concepts like personalities and behaviors with a large group of people, I have to simplify and generalize, because these are nuanced subjects with far too many influential and individual factors than I could ever address in a blog. So if there are any psych police out there on patrol, please don’t write me a ticket for simplifications and generalizations.
Now that that’s out of the way, I’ll start with a question: have you ever noticed at times how different the judgement and behaviors of your family and friends can be from your own? My profession means that I literally spend the majority of my life examining what someone does, their behavior(s), and why they do it, their motivation(s). I’m sure you’ve been in many situations where you’ve asked yourself, “Why did he/ she dothat?” or “What were they thinking?” While sometimes it can be frustrating to have a difference of opinion with people, the truth is that life would be boring if we all thought and acted the same way.
So how do you understand and reconcile these differences? Believe it or not, the starting point of understanding people is actually pretty simple; accept just one fact: that while I’m sure you’re fabulous, everyone is not like you. In point of fact, everyone is not like everyone else, either. If you search for a definition of the word personality, you’ll invariably find the words “characteristic” and “unique” included, along with other synonyms. These are all evidence of, and pretty words to convey, one fact: that we’re all different. We all carry our life experiences and opinions with us, and we filter everything we see, hear, and experience through them, so they color our perceptions and motivations; and these in turn influence our behaviors. I believe the saying goes something like “different isn’t bad, it’s just different,” and I can roll with that. Each of us is unique; we think differently, and therefore behave differently. It’s really a good thing; far, far better than the alternative.
But behavior and personality can be easily misunderstood, and if that becomes chronic, these repeated misunderstandings tend to become areas of stress that affect a person’s happiness, which in turn affects motivation and productivity in every aspect of life. If you’ve ever been in a situation where you felt like you couldn’t “get along” with someone, on some fundamental level, you probably just don’t understand them. A lack of understanding and acceptance of differences can lead to tension, disappointment, and miscommunication. When issues like these go unresolved, they tend to build, and ultimately, can lead to resentment. Resentments can be notoriously difficult to untangle, so in the end, it’s far better to avoid the original problem if you can. Admittedly, that’s often easier said than done, especially if you don’t have a clue what on earth is going on inside the mind of another person. I’ll shed some light on that, so that hopefully by the end of this blog, you’ll have more insight on what that may be.
If the problem is associated with misunderstanding(s), then it only follows that the solution to that problem probably has a lot to do with understanding. When I say that, I’m not talking about holding hands and singing kumbaya with everybody… I’m saying that accepting that people have different opinions from yours, and then making reasonable attempts at understanding where they’re coming from, will serve you better than being obstinate and absolutely refusing to do so. That said, the success of nearly every solution is in its application, so how exactly do we better understand people? There is a relatively simple visual model that can serve as a key to understanding the basics on how people behave. It’s called The DISC Model of Human Behavior, aka DISC model. It can be applied to loosely categorize a person’s personality traits and extrapolate their motivating factors and behavioral styles. More on that later.
Before I get into the DISC model, time for another disclaimer: Because personality and behavior are such diverse and nuanced human attributes, and since the DISC model is a theoretical one, it isn’t used for diagnostic or clinical applications. In other words, when you come into my office and tell me your life story, I’m not running through it in my head looking to categorize you as one of four types. People are complex and DISC is by nature more simple and general; and rarely, if ever, does anyone fall perfectly into any one type. That said, I’m covering this model today in blog form because I think it’s an interesting and practical way for everyday non-clinical people to better understand themselves and others, and to apply that in an effort to communicate more effectively with people who have differing perspectives… which is basically everyone!
Why Personality Traits and Behavior Matter
Why should you care to learn about behavior and personality or the DISC model? Believe it or not, personality and people skills are important aspects of life: personal, social, and workplace. If you can’t work in cooperation with other people, it can be really tough to make it in this world. It can affect your ability to keep a job or advance your position, to make friends, and to keep peace with partners, family, and friends. We’re all familiar with IQ, our intelligence quotient, and we spend years in school developing and learning how to effectively use our minds. But developing your personality to effectively use behavior is also vital to successful living. Studies have shown that technical skill, beginning with intelligence and developed through education and experience, accounts for only 15% of success in the workplace; the other 85% has been shown to actually come from people skills. These skills are developed through learning better ways to behave, communicate, and interact with others. The DISC model is commonly applied as a tool to increase your ability to understand yourself and others, and communicate more effectively with everyone.
History of the DISC Model
Even if it sounds like one, this isn’t a new age, hippy-dippy-trippy idea. Au contraire. Let’s get in the waaay-back-machineand go to Greece, around about 300 B.C.-ish. Why? To see Hippocrates. Whenever I hear his name I can’t help but smile despite myself, because it always makes me think of Bill & Ted’s Excellent Adventure. When they met Hippocrates, they mispronounced his name like the murderous mammal + crates, pronounced like it rhymed with plates, and in their characteristic burner dude affectations. And now the memory of that movie quote is inextricably linked to his name in my mind.. I hear them say it every time. Anyway, back to the topic at hand. Hippocrates was a physician, but also a rebel! And thankfully so. At a time when most of his fellow Greeks were attributing sickness to The Fates, superstition, and the wrath of the gods, Hippocrates espoused the firm belief that all forms of illness had a natural cause. Which, believe me, is a far better alternative than worrying about appeasing The Fates, the witches, and the gods. At any rate, perhaps in pondering the natural basis of illness, or maybe ways to prove his theory to his colleagues, Hippocrates began to recognize that the behaviors of individuals seemed to follow distinct patterns, and he began to loosely categorize the differences in these behaviors.
While Hippocrates had the original notions on behavioral patterns, many psychologists and scientists continued to explore and expand on his theory. In 1928, Dr. William Marston wrote The Emotions of Normal People, in which he theorized that people are motivated by four intrinsic characteristics or factors that direct predictable behavioral patterns, and described these four factors as personality types. He then created a visual model that utilized a circle divided into quadrants to represent these four personality types. In his original work, he labelled them as D, I, S, C: Dominance, Inducement, Submission, and Compliance. And poof… the DISC model was born.
From what I’ve read, Marston was kind of a freaky guy, and the slightly(?) deviant undertones of his word choices “dominance, inducement, submission, and compliance” seem to confirm this. Even though he was a well respected psychologist by day, he was also a surprisingly successful comic book author by night, and is in fact credited for creating the comic book character “Wonder Woman.” She’s an Amazonian, a race of female warriors from an island where men were not allowed. This actually isn’t too much of a stretch, because Marston was also a champion of women’s rights. Despite this, he seemed to have had more than his fair share of female-centric scandal in his life. I found several references that said that he invented the first lie detector test, but also found some that credit someone else with this feat. Regardless, apparently he wasn’t exactly always on a first name basis with the truth, because he lied to the public about being a bigamist. Evidently, after he married his second wife (who was also a former student) and she moved in with him and his first wife, he told the public she was just a relative staying with them… and they fell for it. So during his bigamist marriage, they all lived together in a ménage à trois, and he actually fathered children with both women. But in spite of the scandal he caused with his colorful private life, Marston’s theories of human behavior are still widely accepted today.
What is DISC Used For?
The DISC model is applied as a personal assessment tool designed to ascertain a person’s personality traits and behavioral styles. It’s essentially a series of questions that evaluate human behavior in various situations. For example, it looks at how you respond to challenges, rules, and procedures, how you influence others, and what your preferred pace is.
While Marston’s theories and DISC model were generally well received, some organizations later modified it and created a negative tool used by organizations and employers to weed out undesirables. But in later years, to reflect a change in attitudes, it has since seen several iterations. Now all existing forms of it are used exclusively as positive tools of inclusion rather than being negative and judgemental. DISC assessments are used to foster understanding and respect, improve people skills, build better teams, increase productivity, reduce conflict, and relate and communicate with others more effectively; all of this is meant to translate to increased cooperation and the creation of better working relationships. In fact, the DISC model is widely accepted in the business community; so much so that many organizations and employers incorporate it into all associate training programs, but it is especially used in fields and positions related to sales, marketing, customer service, and management.
I was surprised to learn that DISC assessments have confirmed use in 70% of the Fortune 500 companies, including Exxon/Mobile, General Electric, Chevron, and Walmart. Pretty impressive, as these are strong companies with good management; and according to what I read, that’s where most of them focus their DISC utilization.
But you can also apply the model to your personal life, to learn more about yourself and grow as a person, increase people skills, illuminate your own motivations, and uncover your strengths and blind spots, some of which you may not even be aware of. As a bonus, you’ll then be better prepared to answer certain questions that may come up in life; for example, when a prospective employer asks “What would you say your strengths are?” or even better, when your spouse or partner looks at you exasperatedly and asks, “Why the *bleep* do you do that?” Wouldn’t it be nice to have a handy answer to that one?!
In the end, despite its generalizations, the model is sort of like “personalities for dummies”- not that I’m saying you’re dummies- I’m just saying it’s a simple and useful way for non-clinical people to better understand themselves and their own motivations, and apply that knowledge to relationships and everyday interactions, both in and out of the workplace.
DISC Terminology: Four Behavioral Patterns
Since Marston’s time, while the general concept surrounding the DISC model has remained the same, some of the terminology has changed several times. Some publishers and reference models use a lowercase i in DISC as a way of distinguishing between different models and for trademarking assessments and reports (read: as a way of making money). DISC with a capital I can’t be trademarked, so I’ve used that form for our purposes. The terms used to convey the DISC personality/ behavioral types have also changed for several reasons: to reflect a change in attitudes and more positivity, as a way of distinguishing between different models, and for trademarking purposes; so now there are a few different versions that vary slightly. Different companies and publishers determine and apply their various terms, and I’ve listed the most popular ones, in an order with the ones that I find most applicable first and Marston’s being last.
D: Dominant / Dominance
I: Inspiring / Interactive / Inducement
S: Supportive / Steadiness / Submission
C: Cautious/ Conscientious / Compliance
No matter what term is used, the basic traits and behavioral styles are essentially the same; I’ll cover those later.
I should note that now some publishers have apparently modified assessments to further extrapolate personality traits and behavioral styles; I’ve seen some that will describe up to twelve types, and even an article that referenced exactly 41 personality types. I didn’t fact-check or verify that, but just wanted to mention it as kind of an outlier.
This model is based on two fundamental observations about what drives people to behave the way they do, which are essentially their motivators. I want to emphasize something to keep in mind: as you look at fundamental behaviors, you’re looking at tendencies, not absolutes. Most people will tend to behave more one way than the other, but will behave both ways, to greater and lesser degrees, depending on the situation they find themselves in. Also, behaviors are fluid; they can and do change over time and vary by situation.
DISC: Two Fundamental Observations
(Internal) Motor and (External) Focus
-Some people are more outgoing, while others are more reserved. This is each person’s “pace,” or “internal motor.” It is sometimes simply referred to as the “motor” drive. Some people engage quickly and always seem ready to go, and these are considered outgoing types. Others engage more slowly or more cautiously, and these are considered reserved types.
-Some people are more task-oriented, while others are more people-oriented. This is each person’s “external focus” or “priority” that guides them; sometimes simply referred to as “focus.” Some people are more focused on getting things done, and these are considered task-oriented types. Others are more attuned to the people around them and their feelings, and these are considered to be people-oriented types.
Visualizing the DISC Model
As I mentioned, DISC is a visual model, and it utilizes a circle to represent the range of “normal” human behaviors. You can imagine it as a clock face.
To illustrate the application of the first fundamental observation, aka motor drive, imagine you divide a circle in half horizontally, as from 9 o’clock to 3 o’clock on a clock face. The upper half then represents Outgoing (or fast-paced) people, while the lower half represents Reserved (or slower-paced) people.
To illustrate the application of the second fundamental observation, aka focus drive, imagine you divide a circle in half vertically, as from 12 o’clock to 6 o’clock on a clock face. The left half then represents Task-Oriented people, while the right half represents those who are more People-Oriented.
When the two motor and focus circles are superimposed to combine them, you end up with four behavioral tendencies to help characterize people: Outgoing, Reserved, Task-Oriented, and People-Oriented. The balance of these four tendencies shapes the way each person sees life and those around them.
To illustrate the incorporation of the two drives (motor and focus) you can imagine one clock face with two divisions (horizontal and vertical) and therefore in four quadrants. Starting at 12 o’ clock and moving clockwise, you would then see Outgoing at 12 o’clock, People-Oriented at 3 o’clock, Reserved at 6 o’clock, and Task-Oriented at 9 o’clock.
By combining the two drives, you now have four total behavioral tendencies: from the upper left quadrant, moving clockwise, those tendencies are then:
Outgoing and Task-Oriented (upper left quadrant)
Outgoing and People-Oriented (upper right quadrant)
Reserved and People-Oriented (lower right quadrant)
Reserved and Task-Oriented (lower left quadrant).
Then to further define and describe these four behavioral tendencies, the DISC terms are added, one letter per quadrant: Dominant, Inspiring, Supportive, and Cautious.
Illustratively, these are added to each of the four corners of the diagram, again starting with the upper left quadrant and moving in a clockwise direction: Dominant in upper left quadrant, Inspiring in upper right quadrant, Supportive in lower right quadrant, and Cautious in lower left quadrant.
Once added, starting with the upper left quadrant and moving in a clockwise direction, each DISC term correlates with the four behavioral tendencies such that:
Dominant types are Outgoing and Task-Oriented (upper left quadrant)
Inspiring types are Outgoing and People-Oriented (upper right quadrant)
Supportive types are Reserved and People-Oriented (lower right quadrant)
Cautious types are Reserved and Task-Oriented (lower left quadrant).
What emerges is the full graphical description of the complete DISC model.
To make the quadrants easier to discuss, we typically call each quadrant a behavioral style or type, though some people use the phrase personality type. I’ll spare you the specifics as to why, but technically speaking, it’s not really accurate to use the word “personality” type or style with the DISC model, because it’s actually a behavioral model. While I tend to refer to it as a behavioral style, either term- personality or behavior- is generally acceptable for a colloquial discussion or a blog.
DISCussion: Four Primary Behavioral Styles
While DISC refers to placement within four primary behavioral styles, always keep in mind that each individual person can, and usually will, display some of all four behavioral styles depending on the situation. The resultant blending of behavioral tendencies is often called a style blend, and each individual’s style blend will have more of some traits and less of others.
The Dominant “D” Style
An outgoing, task-oriented individual will be focused on getting things done, solving problems, making things happen, and getting to the bottom line, usually as quickly as possible. They can sometimes be blunt, outspoken, and somewhat demanding. The key insights in understanding and developing a relationship with this type of person are respect and results.
The Inspiring “I” Style
An outgoing, people-oriented individual is generally enthusiastic, optimistic, open, and trusting. They thrive on interaction and love to socialize and have fun. This person places emphasis on persuading others and is usually focused more on what others may think of them. The key insights in understanding and developing a relationship with this type of person are admiration and recognition.
The Supportive “S” Style
A reserved, people-oriented individual will place an emphasis on cooperation, sincerity, loyalty, and dependability. They enjoy working together as a team and thrive on helping or supporting others. They usually focus on creating and/ or preserving relationships and on maintaining peace and harmony. The key insights in understanding and developing a relationship with this type of person are friendliness and sincere appreciation.
The Cautious “C” Style
A reserved, task-oriented individual enjoys independence, and often fears being wrong. They will seek value, consistency, and quality information, and will usually focus on details, facts, rules, accuracy, and being correct. The key insights in understanding and developing a relationship with this type of person are trust and integrity.
I should also note that some organizations use a shortcut in discussing the different behavioral types, where the dominant type is also known as High D, the inspiring type is also known as High I, the supportive type is also known as High S, and the cautious type is also known as High C.
Behavioral Styles: Elevator Test
As you’ll see, this is a pun meant to give you an idea of your own behavioral style and to help you identify others. Captain Obvious says it’s not meant to be scientifically or clinically valid, people, it’s just to illustrate the four behavioral styles in a relatable, “everyday situation” kind of way.
The doors are about to close on a person who is eager to get on an elevator, which already has four people inside. One of the four people already inside glances at their watch, because they’re in a hurry and would prefer not to wait. But also inside is the bubbly, smiling, energetic second passenger who actually holds the door open while encouraging the newcomer to climb aboard. The third rider doesn’t mind if the new person gets on, and they simply step back to make room while patiently waiting for them to do so. The fourth passenger barely looks at the new guy, as they’re busily calculating the sum of everyone’s weight in their head while also looking around to estimate the age of the elevator.
Did you see yourself in this scenario? Did you recognize the behavioral styles of the other elevator passengers? Read on to find out if you’ve got it.
This scenario demonstrates behavior of the Dominant (outgoing / task-oriented) person who wouldn’t really mind if the elevator door closes before the new guy can get on, because they’re just focused on getting where they need to be as quickly as possible. But that possibility is dashed by the Inspiring (outgoing / people-oriented) person who feels energized by the addition of yet another positive interaction to their day. The Supportive (reserved / people-oriented) person just calmly steps back to make room for the new guy because they empathize with him and are willing to be accommodating. All of this while the Cautious (reserved / task-oriented) person almost can’t help but make sure the added person doesn’t exceed the weight limit of the old elevator and potentially cause them all to get stuck… or worse.
Notice that there were four different people who responded to the same exact event in very different ways? People are motivated differently, and therefore think differently, so they behave differently.
Every individual person has a unique combination of characteristics and qualities that form a distinctive set, and these govern their perspectives, motivations, and behaviors.
The DISC model developed by Marston is used as the basis for varying assessments of personality traits and behavioral styles.
While it is simplified and generalized, it can be an effective and empowering tool to examine motivating factors, to uncover and address blind spots, and to identify, highlight, and articulate strengths.
It can be used by people to better understand themselves and others, and to apply that understanding in an effort to improve people skills and to communicate more effectively with people who have differing perspectives.
It is commonly used in the professional arena, especially in Fortune 500 companies. Employers often use it for determining placement of new employees, to build better teams, increase productivity and communication, reduce and resolve conflict, and foster acceptance and understanding.
Each person has a unique blend of all of the major personality traits and behavioral styles to a greater or lesser extent.
Behavioral patterns are fluid and dynamic, and can change over time or as a person adapts to his or her environment.
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Thank you and be well people!
Kratom: Panacea or Poison?
What is Kratom?
Kratom (scientific name: Mitragyna speciosa) is a tropical evergreen tree in the coffee family that is native to the jungles of Southeast Asia; specifically found in Thailand, Myanmar, and Malaysia. It is also found in Papua New Guinea. Other names for kratom include thang, kakuam, thom, ketum, and biak. Whatever it’s called and wherever it may be found, this tree, or at least the leaves on it, has been causing quite a commotion in recent years.
The Scientific Scoop
Mitragyna speciosa leaves contain multiple active components, referred to as alkaloids, with properties ranging from stimulant-like energizing and uplifting to opiate-like drowsiness and euphoria, so this makes it difficult to characterize kratom as one particular type of drug, i.e. as “stimulant” or “opiate.” Kratom’s two main alkaloids are mitragynine and its active metabolite, 7-hydroxymitragynine, which has strong activity at the µ-opioid receptors (where µ is pronounced like ‘you’ but with an m: mu). This is the main opioid receptor, the same one that is the primary binding target of opioids like heroin and oxycodone. Why is this so important? Why do we need to know exactly where kratom binds and what effect that has? Well, so we know how it may be used. Here in America, the government isn’t so good with just accepting that this ancient Asian secret does xyz just because they said so. Because kratom binds to µ-opioid receptors just like heroin etc, opponents say that it must be categorized as a narcotic and therefore, it must be addictive just like heroin etc. But Narcan/ naloxone is also categorized the same way, and obviously it’s not addictive; in fact, it’s used to save people in cases of opioid overdose.
There is a great deal of supportive scientific evidence from many independent laboratory studies using mouse models and multiple human cell lines that confirms that kratom’s alkaloid metabolite 7-Hydroxymitragynine is in fact a key mediator of the analgesic effects of kratom, through its agonistic binding to the µ-opioid receptor. This has also been confirmed by the finding that in the presence of the opioid receptor antagonist naloxone, the pharmacological blockade of the analgesic effect will occur. In plain language: they’ve clearly shown that kratom binds specifically to the µ-opioid receptor in human cell lines, and demonstrated that this binding produces analgesic effects by giving it to a specific type of live mouse that essentially models the human system. So after the mice were given kratom, they exhibited analgesic effects from it– through previously established and accepted behaviors that I’m totally not going into here– just trust people. And then, as if that’s not enough, to further prove that this analgesic effect the mice were having was definitely the result of kratom’s binding to the µ-opioid receptor, they then gave the kratom-dosed mice Narcan, aka naloxone, which is a µ-opioid receptor antagonist. What does that mean? Think of it this way: the Narcan “antagonizes” the µ-opioid receptor; it basically bullies anything already bound to that µ-opioid receptor, pushes it off, and then it binds to it and blocks it so that as long as it’s parked there, nothing’s getting by it to bind to those µ-opioid receptors. That’s how and why Narcan saves people from overdose: it pushes all the opioids off all of the µ-opioid receptors and then sits on them, and hopefully that happens soon enough that the person survives the overdose. If they do, and if they then ingest more opioids for several hours after being given the Narcan, they won’t feel the effects of the drugs for as long as the Narcan is present there on those receptors, because the drug’s opioids won’t be able to bind to the µ-opioid receptors, as the Narcan will be sitting there. So there’s been a lot of work done in various labs all over the globe to elucidate kratom’s form and function. But despite all of this work, there’s much more to be done! I’ll talk more about that later.
None of kratom’s uses are clinically proven, as it has not been studied in the human clinical trials that the FDA requires to allow a drug compound to be legally available on the open market. Clinical studies are very important for the development of new drugs, as they help to identify consistently harmful effects, harmful interactions with other drugs, and dosages that are effective, yet not dangerous. That said, there have been many legitimate published laboratory studies with clear demonstrable findings in mouse models and human cell lines that do allow us to at least extrapolate the effects of kratom in humans with some accuracy and relative safety. Most findings have been positive, and there is a large vocal community of kratom supporters with numerous anecdotal testimonials of kratom’s effectiveness in treating various conditions. But despite this, because treatment practices using kratom have not been rigorously studied as either safe or effective, the DEA staunchly maintains that it has no valid medical uses or benefits. In fact, several years ago, the FDA threatened to make kratom a Schedule 1 narcotic, meaning it would be grouped with marijuana, LSD, and ecstasy, among others, and this elicited a huge backlash… tens of thousands of kratom proponents complained vociferously, signed endless petitions and all that yada yada, and the FDA caved, dropping the issue, at least for the time being. But that’s not going to be the end of that story people… not when the government’s involved. So for now, kratom’s status should be listed as “to be continued.”
What is Kratom Used For?
In its native regions of Southeast Asia, kratom has been known to be used as a traditional medicine for more than a century, but has likely been used for multiple centuries. There in Southeast Asia, the leaves of the kratom tree are typically chewed directly from the tree or consumed as a tea, and they induce stimulant and opioid-like analgesic effects, depending on the amount used. This is because the effects felt from ingesting kratom have been found to be dose-dependent: at low doses, which is generally considered 1 to 5 grams, kratom has been reported to work like a stimulant, imparting feelings of being more energetic, more alert, and more sociable. At higher doses, considered to be 10 to 15 grams, kratom has been reported as being more sedating, dulling emotions and sensations while producing euphoric effects. Anything over 15 grams is considered risky.
The stimulant type effects have traditionally made kratom popular among Southeast Asian agricultural workers especially, who use it to aid them in their long hours of hard labor. But for generations there, kratom has also been used successfully in its native regions for several other purposes: as an aphrodisiac to increase sexual desire, as an energy booster, to ameliorate withdrawal symptoms following cessation of opioid use, and for treating cough, diarrhea, and chronic pain. More recently, here in the US, there has been an uptick in the use of kratom by people who are self-treating chronic pain and managing acute withdrawal from opiates, while seeking alternatives to prescription medications. While some people claim to have success using kratom to treat depression and anxiety, and others say that kratom can also be used to treat muscle aches, fatigue, high blood pressure, diarrhea, and post-traumatic stress disorder (PTSD). Some studies report that kratom possesses anti-inflammatory, immunity-enhancing, and appetite-suppressing properties, but obviously more research is needed to confirm these benefits.
Kratom: Processing and Forms
The psychoactive compound referred to as kratom is found in the leaves of Mitragyna speciosa, and the processing seems pretty straightforward: after the plant’s large dark green leaves are harvested, they can be prepared in several ways: fresh leaf, dried leaf that is pulverized and powdered, dried leaf that is simply crushed, and concentrated liquid leaf extract. Kratom can typically be purchased in multiple forms, including paste, capsule, tablet, gum, tincture, and extract. In certain forms it is often combined with added sweetener to overcome its harsh bitterness. Kratom can be brewed into a tea as well, a form that is offered in kratom tea houses present in a few US states. Kratom can also be smoked or vaporized, though this is not very common.
While the use of Mitragyna speciosa is certainly not new, the alkaloid extraction and refinement methods to turn the alkaloids from the plant into kratom has certainly evolved, and now purity is said to be higher. I’ve read that now there are also fortified kratom powders available, and these contain extracts from other plants in a nod to the nutraceutical angle. In the United States, kratom is usually marketed as an alternative medicine, and often found in stores that sell supplements. Kratom can also be found in gas stations and paraphernalia shops in most parts of the US, except in the handful of states and cities that have banned it. Many people purchase kratom over the Internet, where it may be sold for “soap-making and aromatherapy,” a lot like what happened with synthetic marijuana or spice; that’s in an effort to circumvent the FDA’s 2014 ruling that made it illegal to import or manufacture kratom as a dietary supplement in the US.
Is Kratom Legal?
Although kratom is technically legal at the federal level, some US states and municipalities have chosen to ban it, making it illegal to sell, possess, grow, or use it. Other states have imposed age restrictions. In the states of Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin, kratom is illegal to buy, sell, possess or use. There are special cases in some states: while kratom is legal in California, it is banned in San Diego. While it’s legal in Colorado, in Denver it’s considered illegal for human consumption. Kratom is legal in Florida, except for Sarasota Country, where it’s banned. Kratom is legal in Illinois for those over the age of 18, except in the city of Jerseyville, where it is banned. Kratom is legal to use in Mississippi, except in Union County, where it’s banned. In New Hampshire, kratom is only legal for those over the age of 18. Please don’t quote me on these people- make sure to double check if you’re wanting to purchase- not that I’m encouraging that or even saying it’s acceptable btw.
As far as countries around the globe go, kratom is illegal in: Australia, Denmark, Finland, Israel, Japan, Latvia, Lithuania, Myanmar, Malaysia, New Zealand (unless prescribed by a doctor), Poland, Romania, Russia, Singapore, South Korea, Sweden, Thailand, and Vietnam. Note that most places where native Mitragyna speciosa grows, it’s illegal… funny! Speaking of that, the country of Thailand has recently reconsidered the status of some illegal substances, so kratom might not remain illegal there.
In countries like Ireland, Italy, and the United Kingdom, the rules may vary from one city to the next. It’s also important to note that the status of kratom legality isn’t widely known for some countries. For example, it isn’t clear whether it is legal in China, or in many of the African nations. However, as the drug kratom becomes more widely known, countries, counties, and cities that don’t currently ban kratom may choose to do so at any point.
Is Kratom Safe?
Proponents say kratom is an amazing compound, a game-changer and lifesaver. Opponents, like the FDA, say it has no viable medicinal properties. How the US DEA, medical professionals, and millions of regular kratom users can have such divergent views of the same plant is hard to fathom. The overarching “company line” seems to answer this question “No!!” They state that kratom is considered addictive, that people can develop a physical dependence on it, and that in and of itself indicates that it’s not safe. There are some anecdotal reports of people becoming dependent on kratom, but there are more reports of people successfully using it to recover from opioid addiction; not to mention successfully treating chronic pain, fibromyalgia, anxiety, depression, on and on. So in my book, the jury’s out people.
The question of kratom’s safety comes down to two factors: the lack of regulation and the interactions with other drugs or substances, whether endogenous or exogenous.
Lack of Regulation
Any time a substance, including herbal supplements, isn’t regulated by the FDA, there are potential safety hazards. This is because there is no standardization when a substance isn’t regulated. That means that companies, particularly if they’re operating online, can market the product however they want. There are no official drug warning labels for kratom, and people may take it without knowing what other substances it contains. A buyer never knows what level of potency a kratom product could have or whether it’s pure. In addition, the active ingredient in kratom varies widely by plant species. As with marijuana strains, different kratom strains have slightly different effects; there are multiple species of the tree, so this makes kratom’s effects unpredictable. This unpredictable nature leads to a risk of overdose and other serious side-effects, including seizures, hallucinations, chills, vomiting, liver damage, or even death.
Because there is little research currently available on how kratom interacts with other substances, the breadth and severity of effects are yet unknown. This unpredictability adds to the dangers of using kratom in combination with something else, because you’ll have little idea what it could do to you. Potentially negative effects can be even more severe when kratom is combined with other drugs and prescription medicines. Some of the kratom chemicals have been shown to interact with how the liver metabolizes other drugs, which can lead to dangerous interactions. Another risk is presented when people buy commercial versions of kratom that have been combined with other drugs or substances, especially if they too work on the same opioid receptors. The potential consequences of many drug interactions can range from seizures to liver damage.
Various Points on the Kratom Controversy
Depending on what you read and who you believe, kratom is a dangerous, addictive drug with no medical utility and severely deleterious side effects that include overdose and death, or it is an accessible pathway out of undertreated chronic pain and opiate withdrawal, as well as being useful in treating many other health issues. There are great physicians and impressive institutions with interesting facts on both sides of this issue.
Recent increased kratom use in the United States, combined with concerns that kratom represents an uncontrolled drug with abuse potential, has highlighted the need for more careful study of its pharmacological activity. The major active alkaloid found in kratom, mitragynine, has been reported to have opioid agonist and analgesic activity in vitro and in animal models that are consistent with the purported effects of kratom leaf in humans. However, preliminary research has provided some evidence that mitragynine and related compounds may act as atypical opioid agonists, meaning they induce their therapeutic effects like analgesia, while also limiting the negative side effects that often accompany classical opioids. One such side effect that is absent in kratom is constipation. A chronic pain medication like kratom that doesn’t cause constipation like current opioids all do sounds like a good thing, but as I said before, it’s a long way from here to there, especially considering the FDA’s current opinion. And something tells me they won’t be changing their collective mind any time soon.
As it stands now, there is little to no control or reliable information on growth, processing, packaging, and/ or labeling of the kratom currently sold in the US; and all of this adds to the already considerable uncertainty of its health risks. In 2018, the FDA instituted a mandatory recall of all kratom containing compounds over concerns about Salmonella contamination in these products. More recently, the DEA placed kratom on its “Drugs and Chemicals of Concern” list, but as I mentioned before, it has not yet labeled it as a controlled substance, though not for lack of trying. Time will tell how long that lasts.
Kratom can be addictive due to its opiate-like qualities, and a small minority of users may end up requiring addiction treatment. The CDC claims that between 2016 and 2017, there were 91 deaths due to kratom; but this claim should be met with healthy skepticism, as all but seven of these casualties had other drugs in their system at the time of their deaths, and that makes it totally impossible to uniquely implicate kratom.
A patient wishing to use kratom to treat chronic pain or to mitigate opioid withdrawal symptoms could expect to encounter several problems with doing so, not all of which even have anything to do with the intrinsic properties of the kratom itself.
A patient that wants to use kratom to treat a legitimate illness or condition will likely face four problems for the foreseeable future:
-The first problem is that the DEA still occasionally threatens to make it a Schedule 1 controlled substance, along with drugs like heroin and ecstasy. This would make kratom very difficult to access, and would likely make the supply as a whole even more dangerous than it is now. Generally, it’s not a good idea to use something to treat chronic pain or addiction that may soon become less available and less safe: you want to know it’s going to be readily available, and that as a cure, it won’t cause more problems than the illness it’s being used to treat!
-The second problem is that the complete lack of oversight and quality control in the production and sale of kratom makes its use potentially dangerous.
-The third problem is that kratom has not been well studied for any of the uses its proponents claim it has an affinity in treating! Maybe the FDA hasn’t heard the saying that goes, “Absence of evidence of benefit isn’t evidence of absence of benefit.”
-The fourth and final problem is that kratom doesn’t show up on drug screens. I like kratom’s potential, but I can argue that adding another potentially addictive opiate-like substance while an opiate epidemic is already going on may not be the best course of action.
Is there a sensible path forward with kratom?
I’m not sure that anyone has the answer to that question, but at a bare minimum, the safety of kratom could be improved through:
-Regulation: it would be safer if people knew the exact dosage of kratom they were truly consuming, and that it was totally free of contamination.
-Education: educated consumers who know all of the potential benefits and dangers of the compound they are consuming are far less vulnerable to misleading claims.
-Research: if kratom does in fact have the benefits that have been demonstrated in the laboratory for treating either addiction or chronic pain, we should absolutely know it and make it known: accurately defining the risks of using kratom is critical, as is making all medical personnel and laypersons informed.
If all four of these points could somehow be accomplished by scientists and public health specialists, without: overdue distortion from corporate interests, anti-drug ideology, and romanticism by kratom enthusiasts, then we should have enough clarity to answer the basic questions about kratom, including the most important question of all…is it harmful or helpful?
Effects of Kratom: Good, Bad, Ugly
Recall that the expected effects from kratom are dose-dependent: that smaller doses will produce a stimulant-like effect, while larger doses will produce sedative or opioid-like effects.
A small dose of kratom to produce stimulant effects would be up to just a few grams, and these effects would be felt within 10 minutes after ingestion and can last up to 90 minutes. These expected stimulant effects include increased energy, alertness, and sociability, increased sex drive, decreased appetite, and giddiness.
A larger dose of kratom, between 10 and 25 grams, can have a sedative effect, imparting feelings of sedation, calmness, euphoria, pain reduction, and cough suppression, which last for much longer periods of time, potentially up to six hours.
Potential unsafe and negative effects of regular kratom use, even at low doses, can include: agitation, tachycardia, drowsiness, vomiting, confusion, anxiety, tremors, itching, sweating, insomnia, lack of appetite, tremor, coordination problems, and withdrawal symptoms.
There can also be negative effects of high dose kratom, including: addiction, nausea, itching, constipation, and withdrawal symptoms of tremor and sweating.
There can be negative side effects of taking any dose of kratom at irregular times or random intervals as well. Many users of kratom have reported something called “The Kratom Hangover” the day after taking it, the symptoms of which can include irritability, anxiety, nausea, and headaches.
Because kratom can cause problems with coordination and sleepiness, it’s dangerous to drive or operate machinery while using it. For this same reason, pregnant women are also advised never to use kratom.
There can be grave side effects from taking kratom, which can include seizures and respiratory and/ or cardiac arrest.
If a person takes a high dose of kratom and falls asleep, they may vomit and choke while asleep.
There are numerous calls into the CDC poison centers for kratom overdose every year.
The risk of overdose increases when kratom is taken with another substance, especially opioids.
Recent studies have found evidence of fatal kratom-only overdoses involving severe and negative side effects that can occur when someone takes too much. Some of the symptoms of taking too much kratom can include: impaired motor skills, lethargy, slurred speech, either shallow or very heavy breathing, tremors, listlessness, aggression, delusions, and hallucinations.
Long-term and heavy use of kratom can lead to liver problems, as kratom tends to make it more difficult for the liver and kidneys to process and filter toxins out, contributing to the potential for this type of organ damage.
Signs of liver damage include dark-colored urine and yellow skin and eyes.
Kratom: Necessary Evil or Just Plain Evil?
Kratom is currently considered a dietary supplement, as it is not approved nor regulated by the US FDA. That said, there are anecdotal reports of beneficial effects of kratom use, though there is no clinical evidence yet to support them. In the future, with the proper supporting research, kratom may indeed have proven potential.
But without this research, there are a lot of unknowns with kratom, such as effective and safe dosage, possible interactions, and possible harmful effects, including death. These are all things that you should weigh before taking any drug, but for kratom, they’re all question marks. In the final analysis, going by laboratory findings, kratom holds great potential. But if you’re thinking about using kratom to treat chronic pain or opioid addiction, or anything else… exercise extreme caution people.
I hope you enjoyed this blog and found it to be interesting and educational. Sharing means caring, so please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon.
Thank you and be well people!
Since it’s pretty clear you people really like reading about all things tangential to sex, I don’t mind indulging your secret freaky sides every once in a while. Hey, far be it from me to deny you! So in that spirit, this week’s topic is….
wait for it….
The Oxford Dictionary has this to say:[sey-doh-mas-uh-kiz-uhm]
interaction, especially in sexual activity, in which a person enjoys or derives pleasure from inflicting or receiving physical or mental suffering upon or from another person.
Abbreviation: S&M, S and M
The shrinky dink version from the American Psychological Association Dictionary version:
1. sexual activity between consenting partners in which one partner enjoys inflicting pain (see sexual sadism) and the other enjoys experiencing pain (see sexual masochism).
2. a paraphilia in which a person is both sadistic and masochistic, deriving sexual arousal from both giving and receiving pain. —sadomasochist n. —sadomasochistic adj.
The Mark G. Agresti version:
deriving pleasure or gratification from inflicting or experiencing pain.
It’s important to note that both the pain and pleasure given and/ or received in sadomasochism can be physical, emotional, or both. In addition, when it exists in the strictest definition, it is considered a mental illness, but there are all sorts of conditions and considerations- and controversy- that go along with that. I’ll elaborate a little on that later. No matter who you listen to or what you believe, sadomasochism tends to be a rather delicate topic, and strictly speaking, not exactly one you’d discuss in “polite society.” Whatevs. I’m all about taking deep dives into that kind of stuff- it’s actually one of my missions in life- and in fact, my entire profession centers on helping people with delicate issues that aren’t talked about in “polite society.” Despite not being coffee talk, there’s a lot to be said about sadomasochism… including the fact that many people exhibit sadomasochistic tendencies, which is not to say they regularly wear black leather gear or want to tie their partners up and beat them btw. I’d even venture to say that most people, eapecially when in romantic love relationships, exhibit characteristics of sadomasochists. How does that grab you? If you’re thinking Ineed my head examined right about now, then keep reading about the psychology of sadomasochism.
But first, I have to get into where the term sadomasochism comes from, break it down (pun intended), look at its nominal derivation, and how it’s been viewed and analyzed throughout the ages. Let’s just say that shrinky dinks have had a lot to say on the subject.
Captain Obvious says that sadomasochism is the mashup of sadism and masochism, terms coined in the late 1800’s by an Austrian psychiatrist dude named Richard von Krafft-Ebing, who believed that the natural tendency of the male was toward sadism, while the natural tendency of the female bent toward masochism. What!Everrr! In reality, studies show that sadistic fantasies are just as likely to occur in females as they are males, though the masochistic bend definitely develop earlier in males. We now know that, like many things, sadomasochism knows no gender. When you break it down, sadism is defined as pleasure or gratification gained from the infliction of pain and suffering upon another person, while the counterpart, masochism, is the pleasure or gratification of having pain or suffering inflicted upon the self. At the simplest, most basic level, you could say that sadists get off on dishing it out and masochists on taking it. Now, how often are things that simple? Like never, people. And believe me, that’s the case here. But this generalization works just in terms of remembering which is which. That said, there are no clear lines dividing the two, and in practice, they’re often interchangeable and may even coexist in the same individual at different times.
Krafft-Ebing named sadism after the 18th century Marquis de Sade, a French nobleman, revolutionary politician, philosopher, and writer. He is most famous for his libertine sexuality, and he ‘graced the world’ with novels, short stories, plays, and dialogues, including Justine, which is basically about a woman with the same name who travels around the world getting the crap beaten out of her as she goes, and Les prospérités du vice, which roughly translates to something like the pleasures of vice, in which he said:
How delightful are the pleasures of the imagination! In those delectable moments, the whole world is ours; not a single creature resists us, we devastate the world, we repopulate it with new objects which, in turn, we immolate. The means to every crime is ours, and we employ them all, we multiply the horror a hundredfold.
Two of his most commonly annotated quotes:
“It is always by way of pain one arrives at pleasure.“
“I’ve already told you: the only way to a woman’s heart is along the path of torment. I know none other as sure.“
Sounds like a great guy, right? Evidently, his current day ancestors have been very busy trying to rehabilitate their great great great whatever’s image by creating a line of gourmand treats: wine, pâté, cheeses and such; and supposedly had pitched a Sade line of lingerie to Victoria’s Secret. Another fun fact, the film Quills, starring Geoffrey Rush, Kate Winslet, and Michael Caine, is inspired by the story of Sade.
Krafft-Ebing was a busy guy, naming masochism for a contemporary of his, 19th century Austrian nobleman, writer, and journalist Leopold von Sacher-Masoch, who gained renown for his romantic stories of Galician life. He also authored Venus in Furs, in which he wrote:
Man is the one who desires, woman the one who is desired. This is woman’s entire but decisive advantage. Through man’s passions, nature has given man into woman’s hands, and the woman who does not know how to make him her subject, her slave, her toy, and how to betray him with a smile in the end is not wise.
Interestingly, evidently Masoch did not approve of this use of his name. Bummer that somebody names something after you and you don’t approve of it. My suspicion is that it’s more likely that he didn’t approve what it was used for, as Krafft-Ebing essentially outed the guy as a masochist. Sadly, no word on a lingerie line for Sacher-Masoch, but I’ll keep you posted.
Sadomasochism as a mashup term was actually coined by none other than Freud, the mother-loving, father-hating Austrian neurologist and psychologist who is widely regarded as the father of psychoanalysis, a therapeutic process designed to make the subconscious conscious by releasing repressed emotions and experiences.
Even The Kama Sutra, which dates back to second century India, includes an entire chapter devoted to “blows and cries.” According to the Hindu text, “sexual relations can be conceived as a kind of combat… For successful intercourse, a show of cruelty is essential.” Seriously?
Now that you’re good to go for the daily double on historical literary references to sadomasochism…
Most of the time, for obvious reasons, we think of sadomasochism and it’s nominal components in terms of sexual behavior only, but they can have broader applications, and this is especially the case in sadism. The quality of being sadistic is most applicable to some notable autocrats of the past and present, and these are actually the first thing that comes to mind when I hear the word. When no other single word could possibly encompass the horror of their being, sadist just works. Think Stalin, Pol Pot, Hitler, Saddam Hussein, and the Kims. I was surprised to even see our 45th President’s name included while looking up a statistic. Hmmm… wonder who submitted that? (Dr. Mark Agresti is not making a statement about any person’s sexual inclination or mental status and is not claiming any political affiliation; this advertisement is brought to you by the equal opportunity offender party.)
Okay, I have no clue how that dude got in here, but you get the idea about sadism. On the other hand, masochists enjoy receiving pain, which, again, may or may not be sexual. Strangely (?) I couldn’t find much in terms of famous or known masochists. The best I could do was a British artist I actually remember from some required art “appreciation” class freshman year, a painter named Keith Vaughan. Evidently, he purpose built some kind of gizmo contraption to electrocute his own genitals. They definitely didn’t cover that part in my class though, I’m pretty sure I’d remember that.
Sexual sadism and masochism can actually be considered to be psychological disorders, as each are categorized by the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) as paraphilias, which are sexual disorders that are characterized by socially unacceptable preoccupations or behaviors. Some other examples of paraphilias include voyeurism, exhibitionism, and fetishism, to name just a few. There’s a great deal of controversy on this topic, and at first glance, I generally think of sexual sadism and masochism as quasi-disorders at best. Proponents of the ‘disorder theory’ claim that because sadism involves causing physical or psychological pain or suffering to another human being, anyone who enjoys it is mentally ill. Opponents say that it doesn’t involve pain or suffering in the ‘classic sense,’ (say whaaat??) and that as long as it occurs with a consenting partner, it should be argued that it is not a psychological disorder.
I say that there are many factors to take into account, but that it should definitely be considered a psychological disorder in certain cases: if and/ or when it causes anxiety or depression to that individual, causes problems that interfere with work, social setting, or family, and obviously when it poses, or is likely to pose, a potential danger to another individual person or group. And in fact, more recent versions of the DSM back me up, asserting that it must “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” in order for sexual sadism or masochism to be considered a disorder. I’ll spare you the markers that must be considered to establish that distinction. And you’re welcome for that.
When applied to sexual relationships, sadomasochism is generally termed BDSM, or Bondage and Discipline, Dominance and Submission, and Sadism and Masochism. BDSM is generally considered to be an “alternate” sexual preference that includes a variety of sexual identities and activities. Mainstream culture often represents it as reckless, dangerous, and unhealthy; a dark, non-normal kind of sexual preference which typically forces its players to retreat into carefully curated communities alienated from the majority of society. If you actually paid attention to Fifty Shades of Grey, you might have understood that Christian Grey’s reasons for enjoying kink stem from a childhood filled with abuse. Television crime dramas often portray fetishists as seedy, unethical lawbreakers, and that’s probably as a result of the psychological disorder theory more than anything else. Participants or “kinks” often make the argument that dominance and submission are more a power dynamic than a punisher-punishee relationship; and they usually identify themselves in one of three main ways: dominant, submissive, and switch, though the identities are fluid and continuous, and can change depending on the participants’ mood or partner. But if you consider the fact that the terms sadism, masochism, and sadomasochism were coined in the late 1800’s, pop culture wasn’t responsible for making kink the latest fad… it seems some humans have long had a penchant for adventurous sex. Even way back in 1956, when the Kinsey Institute was in its heyday, a study revealed that 50% of men and 55% of women enjoyed erotic biting, evidently as racy as they got when describing kinky sex. Considering all of the historical evidence taken together, I can only surmise that we’re not necessarily having more kinky sex than we always were, but we’re just talking about it- or admitting it- more than before.
Bondage: A form of restricting a sexual player’s movement, ie by ropes or handcuffs, to increase pleasure.
Discipline: A series of rules and punishments typically used by a dominant partner to exert control over their submissive partner.
Dominance: The act of dominating a sexual partner, during or outside of sex. This can include dictating sexual behavior, food habits, and even sleep patterns.
Submission: The act of a submissive partner following a dominant’s actions or dictates.
Consensual sadomasochism should not be confused with acts of sexual aggression. While sadomasochists do seek out pain in the context of love and sex, they do not do so in other situations, and typically abhor uninvited aggression or abuse as much as the next person. Generally speaking, sadomasochists are not psychopaths, and thankfully, the opposite is usually true as well. Also contrary to popular belief, evidently submissives have just as much control over deciding what happens to them as their dominant partner does, and sometimes even more so. Communication between the dominant and submissive is of utmost importance, as that’s where boundaries are set, desires are shared, and permission is given. Consent, in the form of a formal contract, a verbal agreement, or a casual conversation, is the key to healthy expression of BDSM and sadomasochism. There is typically an understanding between all partners that activity could stop at any moment should they be uncomfortable with the intensity of play; this can be done through the use of previously agreed upon safe words that signal others to stop when uttered. I’ve seen references to layers of safe words that are like a traffic light: green means good to go, yellow means proceed with caution, and red means get the hell away from me. That’s sure different than the “red light-green light” we played as kids.
Speaking of games….
Maybe you think that this sort of stuff only applies to a small number of “deviants,” but the truth is that many people, if not most, do actually harbor sadomasochistic tendencies. For example, many casual, “normal” behaviors, like infantilizing, tickling, and love-biting, could be considered as containing traces and elements of sadomasochism. In addition, sadomasochism can play out on a more psychological level- sadomasochism on the DL if you will. Consider the fact that in almost every relationship, one partner is more attached than the other. This phenomenon is just accepted as fact without much discourse, so commonly that it has even been the subject of poetry and philosophy, with the more attached partner being referred to as “the one who waits.”
In 1977, A Lover’s Discourse: Fragments philosopher Roland Barthes writes:
Am I in love? —yes, since I am waiting. The other one never waits. Sometimes I want to play the part of the one who doesn’t wait; I try to busy myself elsewhere, to arrive late; but I always lose at this game. Whatever I do, I find myself there, with nothing to do, punctual, even ahead of time. The lover’s fatal identity is precisely this: I am the one who waits.
When this asymmetry is examined, the less attached partner (A) grows dominant, while the more attached partner (B) becomes infantilized and submissive in a bid to please, coax, and seduce them. Sooner or later, (A) feels stifled and distances themselves, but if he or she moves too far away, (B) feels threatened and may go cold or give up. That in turn prompts (A) to flip and, for a while, to become the more enthusiastic of the two. But the original dynamic soon re-establishes itself, until it is upset again, and so on, ad nauseum. Domination and submission are elements of every relationship (or nearly so) but that does not mean that they are not tedious, sterile, and immature, as Freud points out…endlessly I might add.
Rather than playing cat and mouse, couples need to have the confidence and the courage to rise above the game playing. True love is about trusting, respecting, nurturing, and (healthy) enabling, but not everyone has the capacity and maturity for this kind of love. I see this domination-submission phenoma nd game playing a lot…like a lot a lot, and it can be quite the mess to rectify, as people get comfortable in their roles, whetjer they’re conscious of them or not.
Sadomasochism, BDSM, kink…they aren’t really my thing. Then again, neither is sociopathy, but I can still effectively diagnose and treat patients with it. That said, sadomasochism as a practice is definitely harder to understand than just grasping it as a general concept. I classify it as one of those great mysteries of the human condition that give me a headache when I try to completely untangle them. I’ve of course had patients into all kinds of kink and BDSM, and then again, I’ve also had some who are more “classic” practicing sadomasochists, who can be more challenging to treat. Everybody’s got a backstory that I may or may not be privy to, so I don’t judge and I think I do a pretty good job of treating everybody fairly. I figure that understanding, or at least the most earnest attempt at it, is the best way to deal with anything we may not ascribe to, even as we wish to respect the person who does. Along that same vein, if you’re curious about BDSM and kink, there are websites galore with tips and tricks, even online “academies” where you can learn to be a dom or a sub, or BDSM groups for the over 50 set…you name it, it’s there for your perusal. If you do decide to partake, I can only suggest to communicate, communicate, communicate; be safe, establish a safe word and safe boundaries, and have fun people.
Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and remember… sharing means caring! Please feel free to share the love! Share blogs and YouTube videos with family and friends.
And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them. As always, my book, Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon.
Thank you and be well people!
MGA here. I’m writing this closing after finishing today’s blog, but it’s weird that I’m sticking it at the top of it, but there’s a method to my madness. I’m switching things up today and talking to you first because I might just have an announcement! And maybe even a favor to ask of all of you. So please read on.
I think you guys have liked these sex toy blogs, no? Well, I have to tell you, this series has been a lot of work, but really great fun, too. So even though today’s sex toy blog is the last in the series (wahn waaahnn waaahhhhnnnnn) I don’t want you to be sad.
Months ago, when I stumbled across some health benefits of orgasms that I didn’t know or hadn’t thought about, I started thinking that if I didn’t know or think about these things, maybe some of you didn’t either. Once I started looking at all the material online about orgasms, that led me directly to the point (underlined in bold letters) that they’re not the automatic foregone conclusion to any and every sexual event that all the movies and all the… propaganda is really the only accurate word… makes them out to be. In fact, nothing could be further from the truth. Especially for women. This singular fact- that there is more bs and shame shrouding the real reality of sex and orgasm- made me want to expose it. And of course do so in my very own unique (maybe slightly weird and slightly more irreverent) way. My shrinky senses were on alert, and the rest of it, the sex toys and all, was just a natural progression. I had a mission. Present all of it in an approachable way, no shame, no bs, no flinching.
There’s sooo much material on the great interwebs on all things sex, orgasm, toys, and sex psych… it’s actually overwhelming. I knew that I couldn’t possibly do the subject any justice in one blog, so I decided to do the series. And while I was researching and reading, I saw so much evidence that made it crystal clear that sex, orgasm, and sexual health and wellness are such huge and integral components of the human condition, yet… Shhhh!Keep your voice down! What is wrong with you?! Why do you have to talk about this stuff anyway? Helll-ooo… such huge and integral components of the human condition, yet WE DON’T TALK ABOUT THEM!!
Because the fact that we don’t talk about it is just patently dumb. Look, I’m all for discretion, though you couldn’t be blamed if you’re having a hard time believing that, rolling your eyes right about now and thinking “seriously?” Yep. Seriously. I understand that it’s not an easy topic, but the fact that there’s so much shame and confusion and bs obscuring the topic of sex, all things that do real damage to real people in real life, I knew that propagating those things by continuing to not talk about it just wasn’t going to happen.
Once I had put up the first sex toy blog, a patient asked me what the hell was I… ‘a psychiatrist of all people, doing writing about sex (very quietly) and dildos (almost whispered, as though she was concerned that the morality police were hiding behind my desk waiting to bust her) and how some people can and some people… can’t… be… satisfied?‘ she almost spit it out, she was so happy to have found the word, any word. Then she quickly added, ‘It’s just too… too personal!‘ she said with a shake of her head and a tsk tsk expression. For any of you that are thinking ‘Yeah, riiight? Exactly!’ right now, my answer to why is pretty simple: I am a psychiatrist, so people come to me seeking help for their problems. Right? I’m dealing with their minds and all the things that happen in them and to them. So any and every “thing” that creates a barrier to their happiness- to the point that they’re sitting in my office- is fair game. And many times, the tallest, widest, and strongest barrier I see in that office is shame. And shame is shame, no matter what it arises from, and so it is my sworn enemy, and I like to make it a point to wipe it out where it lives at every opportunity. And the fact that this patient who wanted to know why I was doing these blogs had to barely whisper the word dildos as it stuck in her throat, and because I could literally see her search frantically for any word to say butorgasm is exactly why I was doing them. How’s that for irony?
I don’t claim to be a sex therapist, so it doesn’t fall to me to cleanly and concisely educate about it in an academic way, every impact that sexual health and wellness has on people’s lives. That’s not why I wanted to do it. Do I want you to learn something? Definitely. By the time you’ve read these blogs, do I want you to be able to recite the six principles of sexual health and explain the genesis of their inclusion? No. In fact, I don’t even go over all of that technical stuff, because that’s not what this is about. What this is all about is just getting the real deal info out there. Relax the stigma. Show that the subject is not too taboo, which was why I made that the subtitle of the first sex toy blog.
So during the countless hours I spent putting these last three blogs together, I had an epiphany. Okay, maybe it was part epiphany, part hallucination brought on by a lack of sleep, but the end result remained the same: with all of the things that have to be brought to the light, these were going to be some really. long. blogs. people. In fact, I could totally fill an entire book with this stuff. So I’m going to. That’s the announcement: I’m doing another book…my third. But it’s going to be very different from my first two, and not just because of the subject matter. It’s going to be different because I’m writing with a co-author, something I’ve never done. Her name is Dawn, and she’s kind of got degrees like a thermometer: biology, molecular biology, chemistry, microbio… there could be more, but my point is that she’s not a moron at all, yet despite that, she doesn’t take herself too seriously, and I think you’ll like her writing style, because I do… and it’s a lot like mine to be honest. I think that having both the male and female perspectives will make it a better, more balanced book. It’s going to be good, people!
Which brings me to my next point. Actually, my next question. And it’s for you. Yes… you. And you. All of you! I need a favor. Well, we- Dawn and I- need one. We need you to help us. Will you help us write this book? I promise it’ll be super easy. Here’s the scoop: given the general topic of sex and orgasm, we’re going to be doing a simple, anonymous sex survey in the not-too-distant future, and we’re hoping that you’ll agree to participate in it. And in order to get a statistically significant sample size (say that five times fast) and draw conclusions from the survey, it’s got to get into the hands of a lot of people. So I’m asking everyone to please share this blog with at least five people, but if you can share it with more than that, even better! So I guess that’s two favors I’m asking: one, that all of you will agree to be contacted to take the survey, and two: that each of you will share this blog to pass that same request on to at least five others. I really appreciate it people!
For you to agree to be contacted to take the survey, you just have to leave a comment on the blog saying so. If you’re familiar with the site, at the end of each blog there’s a little blue link that says “LEARN MORE” Click on that and it’ll take you directly to a reply box. Type in “Contact me to take the survey” fill in your info, check save my info for future, check if you wish to get notifications and submit. Voila!
If you’re like me, you like to ‘copy paste edit’ to save time, so here’s a message you can do that with to send along with the blog to explain everything to your people, people! FYI: I assumed that the people you send to won’t be familiar with the blog, so the instructions on how to leave a comment that I give in the following pre-fab message are different than those I gave you above- they’re faster, as they don’t require they read the whole blog to see the “learn more” link located at the end of each blog. They can just click on the small grey comment link just before the blog.
Feel free to ‘copy paste edit’ this paragraph to send when you share the blog. Thanks!
Dr. Mark Agresti, a psychiatrist I know, has a weekly blog https://dragresti.com/blog/ and he just mentioned that he will be doing a simple anonymous sex survey sometime in the not-too-distant future, and in order to get a statistically significant sample size of completed surveys to draw conclusions from, he’s requesting that people agree to be contacted to take the survey, and that we please pass that same request on to at least five other people. So great news… you’re one of my people! So please click on the link https://dragresti.com/blog/ and you’ll be able to see and read all of his weekly blogs anytime. To agree to be contacted to take the survey, you have to leave a comment saying so. There are lots of places to do that, but the fastest is to look where it announces that week’s blog title and in small grey letters you’ll see the authorship, date, category and a [> 1 comment] link. Click on that little comment link and it’ll take you directly to a reply box. Please type in “contact for survey” then fill in your details, check the box that says ‘Save my name, etc for next time’ and if you wish to receive future notifications and submit. Voila! And please feel free to pass the request along to as many people as you’d like. Dr. Agresti appreciates it and so do I!
Housekeeping is almost done here people.
I hope you’ll enjoy this final blog in the three part sex toy series: The Future of Sex Toys
Please don’t forget to leave a “Contact for survey” comment and share the blog to pass it along to as many people as possible. The more people that take the survey, the more meaningful the data gathered from it will be- and the better the book based on that will be!
I really appreciate it.
And if you have other comments about any of my blogs, if you like what you’re reading or you have suggestions, please leave those too. I’m always down for comments!
Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, share, and comment on those vids too! And my book Tales from the Couchhas more educational topics and patient stories, and it’s available in the office and on Amazon.
Thank you and be well people!
Now without further ado, this week’s blog…
Part Trois du Trois:
The Future of Sex Toys
Throughout the course of history, humans have experimented with numerous ways to derive sexual satisfaction: ancient dildos, Ben Wa Balls, Cleopatra’s bee vibrator… We’ve already explored how our ancestors got off in the history of sex toys, so now we’ll look ahead. What does the future of sex toys hold?
Imagine a world where you can strap on your VR headset, crank up your smart bodysuit, and have virtual sex with someone on the other side of the globe. It sounds like the setting for a sci-fi porn flick, but fully remote VR sex is closer than you think.
The marriage of sex and innovative technologies is known today as “sex tech.” And just like every innovative business linked to sex, it’s BIG business: the sex tech industry is currently valued at more than $30 billion dollars. But unlike some businesses linked to sex, the sex tech market specifically is set to explode, and this value is predicted to climax at over $124 billion by 2024… quadruple in four years people! I can’t think of another industry that has, or ever could, accomplish this growth rate expectation.
Remember that total geek that sat in front of you in eighth grade math class? The guy with the pocket protector and ultra thick glasses that couldn’t get a human date so he was really into robots? Yeah, him. This is what he grew up to do: sex tech. And just fyi… he’s a billionaire now.
From Sex Industry to Sex Tech
While sex toys in their primitive form have existed for literally ages, the last few decades have allowed civilization to explore an unprecedented level of freedom in the sexual health and wellness arena, and this has led to a proliferation of sophisticated technology and innovation in sex tech. A perfect example of this is the novel intersection of sex and Artificial Intelligence (AI), a pairing that was once thought to be inconceivable, but now holds great promise for the most immersive sex experiences ever possible.
Sex Tech Defined
As defined by FutureofSex.net: “Sex tech is technology and technology-driven ventures designed to enhance, innovate, and disrupt in every area of human sexuality and human sexual experience. Sex tech is important because sex and sexuality lie at the heart of everything we are and everything we do.”
Now that we’ve cleared that up…
What Will Sex Toys Look Like In The Future?
Where do you currently keep your sex toys? In the sock drawer? A dedicated goodie box?
Let’s explore some data:
The world’s largest masturbation study (yup, that’s a real thing) published that 78 percent of adults in the world masturbate, including: 96 percent of British men, 93 percent of German men, and 92 percent of American men; and 78 percent of British women, 76 percent of German women, and 76 percent of American women.
A survey from UK sex toy creator Lovehoney found that three in four Americans own at least one dildo. That means roughly 70 percent of Americans have a dildo in their homes (or cars, or cubicles… no judgement) While the majority, 78 percent, are women, 64 percent of men that answered also said they own a “phallic sex toy;” guess they couldn’t say d i l – d o… dildo.
One safe conclusion we can draw from this data is that there are a lot of dildos floating around out there people. If we round down the current US population to 328 million, and assume that each respondent has just one dildo (which would be highly unusual- most people that use them definitely have more) that means there are more than 229 million dildos in the US. And given that number, as compared to the number of people that freely talk about using them or admit to it, we can also see clear evidence that many people still feel embarrassment and/ or shame to admit to masturbating, much less using toys. So even though the tech has advanced, it’s pretty clear that society’s acceptance has not come nearly far enough. It’s especially true in the non-male founded sex tech companies. There is a definitive double standard, so read on for details on that.
In 2017, one sex tech company self-named by its founder, Lora DiCarlo introduced the Osé, a dual massager for blended orgasms that introduced the world to “sex tech inspired by human movement.” For the very first time, a “smart toy” employed very complex mechanics and robotics that spoke to actual female anatomy and vaginal physiology. This founder and her company actually did a ton of work to develop this. They took countless measurements and made molds of thousands of vaginas to create a natural feeling toy with robotics that perfectly mimicked human movement, specifically a “come hither” motion for G-spot massage. The end result was apparently worth it- it was so unique and the movement so human and life-like that it actually won a highly coveted robotics innovation award from the Consumer Technology Association (CTA) in that same year.
But then, when the CTA considered that the company was founded by a woman, they actually rescinded the award! Apparently because in their estimation, a female engineer/ founder creating robotic tech ‘inspired by human movement’ for the purposes of creating ‘a dual massager with come hither G-spot massage and clitoral stimulation’ for the specific purpose of ‘achieving a blended orgasm’ was lewd, and as such, the CTA could not be associated with the device in any way; which btw in their policies, that made it comparable to hard core pornography. That means they were actually saying that a woman creating robotic tech to theoretically pleasure herself and other women is pornographic. Saaay whaaat?! I’m a guy, so I don’t even have a horse in this race, but I’m still offended! They made it quite evident that if it had been developed by a man, it would have been a different story. A male founder of the product would have kept the award. Can you believe that bullshit, people? And PS, they also refused to let her company, and all other female founded sex tech companies, to even attend the event in the future!
As you can imagine, Lora DiCarlo was mad as hell, but not surprised at all. She and all of the other female sex techies were used to having Facebook and other social media platforms censor them, PayPal refuse to offer their payment platform for their websites, or to be associated with them in any way. They got nothing but doors slammed in their collective faces. Just another Tuesday.
Well, Captain Obvious says that Ms. Lora DiCarlo had some things to say to the CTA about that. She started a critical public conversation about gender equity in tech, demanded that CTA issue a public apology and re-award her the award that she earned, and publicly demanded that any and all female-founded sex tech companies be invited to all future CTA events. And CTA in fact got smart and capitulated to her demands. Since that time, Lora DiCarlo and her company have continued to champion the cause of women’s sexual health in as open and public a way as possible. In addition, she and her fellow female techies have also formed Women of Sex Tech, which the New York Times said is “a tech-savvy and female-led women’s sexuality movement that has made its home in New York, instead of, say, Silicon Valley. Women, many of them under 40, are updating sex toys and related products with their own needs in mind, and leading the companies that sell them.”
And in fact, there are many more female founded sex tech co’s than male- it’s not even close, and Facebook and some other social platforms still censor them, so some specifically create vanilla campaigns to slip past the censors to be allowed on them. I don’t know about PayPal, but any person or company with three brain cells to spark off each other should be rolling out the red carpet to welcome these previously wrongly censored companies. I can feel her pain with Facebook… they refuse to boost my blog ever since I said that social media was problematic because devotees spent too much time in their artificial, anti-social social media platform. They need to get with the times and realize that just because they don’t appreciate a product or comment or statement, that doesn’t automatically invalidate it.
Anyway, the moral of that story is that today, women are kicking butt and leading the charge in the women’s sexual wellness arena and the robotics and AI that go with it…a fact that offends the nerdy guys in their Silicone (Valley) Prisms.
Back to the Future… of Sex Toys
We all know what yesterday’s dildos look like- mostly veiny, flesh-toned, realistic penis replicas (designed by men- I can believe that) or brightly colored carnival-prize-looking things that apparently didn’t excel in form or function. Both of those are relegated to under the bed to gather dust and dog hair (eeeww) or under the socks in the top drawer.
Now contrast that to an insta-worthy living room with a coffee table proudly displaying an artsy magazine, a glass succulent cactus terrarium, and a beautiful, artisanal, teal-colored dildo…
According to sexperts, advances in sex tech will continue to be accompanied by a more open and accepting attitude towards sexuality. As a result, sex toy designs are moving away from products that need to be hidden away under a bed or in a drawer like a dirty secret. Now designers are embracing sleek and aesthetically pleasing designs that are meant to be noticed and begging to be on display in (almost) every home in the country. Ornamental dildos? Sure, why not?!
More Options, More Orgasms
As society becomes more open-minded and accepting of trans, non-binary people, and just all people, we can expect to see more gender neutral toys in a range of sizes, colors, and designs. In fact, as you’ll read later, this is already the case.
Alexa… Oh Yeah, Right There Alexa!
The future isn’t just about high tech gadgets, it’s about having greater control over them. Imagine a vibrator with a range of personalized settings: slow and sensual or a hit it and quit it quickie for lunch breaks. Voice recognition and AI technology will play an increasing role in realizing this future. Voice activated toys that respond when asked to change strength, speed, or force will make Alexa look like a boring prude by comparison. And in fact, this is another example of ‘the future is now’ deal, as Vibease, the company that introduced the world’s first app controlled vibrator has now developed the world’s first AI integrated, voice activated vibrator. And it actually looks like a designer lipstick, so they clearly created it with an eye toward it going with when the user heads out to work or play. As Vibease says, their “goal is simple: bring out your inner glow…” Pretty catchy, huh people? Right now, I believe the AI enabled voice activated lipstick vibrator (say that four times fast) is actually available on Kickstarter for half price; they’re evidently selling it at a discount as a means of funding future techie toys. If anybody maybe needs a handy excuse for buying and trying…
How about sex toys that become integrated into our bodies? The founder of media and research company Future of Sex believes that in 30 years we might not even see sex toys as separate entities. I don’t know about that exactly, but it’s quite a concept, and as you’ll read later, Elon Musk is already working on what I might categorize as similar tech. A male sex techie named Rich Lee has developed the LoveTron9000. How stereotypical does that sound? I can hear some dulcet baritone celeb like Morgan Freeman or James Earl Jones, or best yet, Barry White, voicing the commercial… “The LoooveTronnn9thouusaaannd… Oh yeaaahhh, you neeeeddd thiiss, mennn.” So what is it? It’s an implant that’s embedded behind the pubic bone, and it vibrates so that it makes the penis vibrate. If you’re into that, then the good news is that innovation in bio-hacking and body modification means that similar tech innovations will become more common. Just had a thought: is Barry White dead? If he is, sorry and may he RIP, baaabbbyyyy.
If vibrating penises aren’t your thing, how about a smart bed that can hug you, whisper sweet nothings in your ear, and stimulate your nether regions… all at the same time. That tech is on the not-too-distant horizon too, people.
VR and LDR
If you’re in a long distance relationship and/ or living in The Time of Corona, futuristic sex toys could bring you closer together, even if you’re social distancing. VR, sex robots, and teledildonics (sex toys controlled remotely over an internet connection via apps) are combined to allow your sex doll to be controlled remotely by your partner while you’re wearing a VR headset, with… say, Fiji as the 3D backdrop. The tech is coming soon, people. Teledildonics has already been around long enough to be slightly goosed by the newer competition. While it’s not obsolete by any means, there have been tech advancements that necessitated a new and equally advanced term: cyberdildonics. While some references seem to mistakenly use the two terms interchangeably, cyberdildonics is actually distinctively different. Both are technologies for participants to have remote sex via electronic data link and/ or smart applications, but cyberdildonics is tech in which tactile sensations (which is also called haptic tech) specifically are also able to be communicated between the participants via a data link and/ or smart applications.
Here’s how cyberdildonics work. The dildo lover/ female/ pronoun of your choosing/ yourself/ them: they have a high-tech dildo embedded with touch sensors. The person who enjoys penis attention has an advanced penis sleeve that’s capable of pulsating and contracting. First step: the two lovers connect their sex toys to the interfacing app. Second step: both then connect to a video call, which can be through the same toy interface app (some companies have this ability included) or through another exogenous app like FaceTime, What’s App, or Duo. Third step: have some fun! When they stroke or suck or insert the dildo into themselves, the other sees it on the video call screen and in response, their sleeve pulses and squeezes, delivering sensations that are said to be remarkably close to actual sex.
And/ or… switch ’em up! For the person who would usually be enjoying the sleeve’s pulsations on their penis, give them a smart vagina, replete with vulva and clitoris and embedded with touch sensors. Then give their lover an app-enabled vibrator. As one strokes or licks the smart vagina, their lover’s vibrator will react so they can feel their touch with every move made. With tech advances, new smart toy types have been, and will be continued to be, released. So if variety is the spice of life, get the vibrating cock ring, butt plug, vibrator egg, or whatever strikes your fancy and eat it up!
Teledildonics, Cyberdildonics, Digisexuality… Oh My!
Here’s a neologism for ya: digisexuality. What is it? A digisexual is a person who is sexually attracted to robots or other forms of sexuality that are technologically-mediated. Like the geek in my eighth grade math class with his thick glasses and pocket protector… the one who’s bound to be a billionaire by now. He’s a digisexual for sure. But whatever floats your boats people. No judgement, just saying.
No Partner? No Problem!
According to sexperts, it’s just a matter of time before celebrities hop on the digisexual and cyberdildonic bandwagon and license the use of their faces for sex dolls or VR scenes, so one day soon, you’ll be able to have a simulated sexperience with your favorite celebrity! Honestly, this one rates kinda high on my creep-o-meter people.
Sick of People? Date a Robot!
Wouldn’t it be great if you could program your boyfriend and/ or girlfriend to do and say whatever you wanted? Well, sex robots are not a sci-fi fantasy anymore: they’re already among us. Harmony 3.0 (and by now maybe even 4.0 and 5.0) is a lifesize doll which can be programmed via the Realbotix app. And of course it comes with 18 personality types, 42 nipple designs, and 14 dishwasher-friendly labias to choose from, don’tcha know. These AI drive sex toys are transforming the way people view- and feel- sex. One benefit associated with them would be that if you wish to fulfill any sexual fetish that a regular human partner might not want to engage in, you can access various quick sex scenarios on your bot partner and indulge in the experience that way. And Captain Obvious says that another benefit of utilizing this technology is that the risk of STD is completely eliminated. Remember Ryan Gosling in the movie Lars and the Real Girl? I mentioned it in a previous blog. If you’re into this, dolls and bots can be programmed to tell jokes and recite poetry, whatever you’re willing to teach them, they’re willing to learn. Just think: she will always remember your birthday. And never bitch when you leave the toilet seat up. Now that is technology I can get behind people!
If bionic penises are more your speed, sexbot company RealDoll also has a fully customizable male doll… Though it looks like they literally have one, while the rest of their site is absolutely overrun with different female versions: classic, petite, and wicked, in dizzying arrays of features, along with interchangeable heads and toros too, for the Jeffrey Dahmer set I suppose. And if you like penises but could care less what it’s attached to… or if it’s actually attached to anything, they also sell the RealPenis, which at first glance is shockingly realistic. And it may also be at second glance too, but I couldn’t look again.
The Future of Sex Toy Tech is Coming… Are You?
The expiration of the original teledildonics patent a few years ago is the driving force behind the rapid expansion in the field of smart sex toys. That’s why we’ve come so far in such a short period of time and have an array of smart toys. It’s been a wild ride, but we haven’t even hit the loop de loops yet! Where there once were only app controlled panty vibes where you turned control over to your partner so they could zing you out of the clear blue sky just to say hi, now there are teledildonic couple toy sets: an app controlled toy for vaginal/ G-spot/ clitoral stimulation is sold in a set with a vibrating penis sleeve, or vibrating butt plug, or vibrating cock ring. They’re meant to be used simultaneously via app control by your partner.
There are a few really unique smart app controlled vibrating toys that are worth an honorable mention. If you can’t sleep unless you can hear and/ or feel the beat of your partner’s heart, Little Riot’s Pillow Talk might be the ticket. It lets you hear the heartbeat of your loved one in real time via a mobile app, wristband, and speaker, as if you have laid your head on their chest, even when they’re on the other side of the world. And haptic touch advancements in combination with VR have also made smart toy prototypes that make virtual hugs and even remote kissing possible. Now I don’t know about you, but I’m going to have to see that to believe people.
What could possibly go wrong? Well, since you asked… as anyone who’s argued helplessly with Alexa or Siri about just turning on a damn light has discovered, the reality of an ‘Internet of Things’ is sometimes closer to an ‘Internet of Shit.’ If you think it’s irritating when your own doorbell decides you’re an intruder because you’re wearing your favorite Batman shirt, wait until tech companies start using your genitals to beta-test their cutting edge tech. And the quality of your sexual experience in using these is based on the quality of internet connections and the app/ software interface between the devices. But I imagine the up-side is that time will only lead to better connectivity. Regardless, this tech is not without risk. In reality, it’s possible that people can be hurt, technologically and maybe even physically by this tech. Companies could possibly leak data that identifies users, even without malicious intent mind you. Remember the Ashley Madison hack in 2015? When “The Impact Team” stole the user data of Ashley Madison, the commercial website that billed itself as an enabler of extramarital affairs? At least two suicides are directly attributed to having been identified in that data breach.
Breaches of that order happen all the time. I got a letter from an e-commerce, or “shopping cart” company about a year ago. They’re basically responsible for presenting you an online store’s stuff, enabling you to select the stuff you want and put it in your cart, write reviews, seek faq’s, make modifications, and eventually pay for your crap in order to receive it. Well, the letter informed me that this gigantic e-commerce site had a security breach, and that my card information was among the data that was extracted. The kicker? The breach had taken place like 16 months before! Yet this was the first I’d heard of it. I don’t know if they dragged their feet during an investigation and that’s why they didn’t inform me sooner, or if maybe they didn’t even know about the breach until long after it was done. Frankly both are disturbing. They say that cyber thieves or their network rings usually just hold on to the data they steal for a while, lulling you into believing that your info must be safe, because surely they would’ve robbed me blind by now, right? Right? Anyway, you see the issue. If you’re employing an app to facilitate intimacy, use protection… and I don’t mean condoms.
Poor security could also allow malicious hackers to view the GPS coordinates of users, or take control of devices remotely. We’ve known for years that cars can be hacked, as can heart implants and webcams. Similar invasions could possibly be coming soon to your erogenous zones, too. But I have noted that some sex techs are very serious about security, as Bluetooth can also be hacked. And the almighty cloud. In an attempt to thwart this, I know that sex tech co Vibease allows only one linked device to control the toy at any given time so that any hacker will just be impotent. You set it up with your partner with a password and they also suggest a fingerprint-required complete phone lock to keep pick-pocketing smartphone thieves from availing themselves of your partner’s pleasure. Maybe the sex toy app itself should require a penis or nipple print as a unique identifier to access it too.
While there are always cons against pretty much anything in life, the same goes for pros. In addition to providing a viable outlet for sexual intimacy in long distance relationships, as well as the same during A Time of Corona, there are some other fascinating opportunities. For example, sex tech can provide people with an anonymized and untraceable alternative to a physical encounter in countries where gay sex is against the law. In a situation like that, teledildonics could provide physical pleasure with far less risk than what would be involved with an actual encounter. And as we’re already seeing with cyberdildonics, as sex tech advances, it will continue to incorporate other emerging technologies. Combining VR is on the not-too-distant horizon, so in combining VR and toys, you’re more fully immersed in the sexual experience, since you can see it, hear it, feel it, and get physical stimulation based on what you’re seeing in the chosen scene. Morning sex in Maui, a nooner floating along on the Nile, and for delicious dessert, go to Dubai.
Another cool thing about sex tech is the definitive opportunities to create hardware for disabled people to have sex. Historically, most toy controllers have been touch-based. There hasn’t been a lot of time and/ or effort dedicated to voice interfaces or eye tracking capabilities that would allow people who can’t reliably manipulate a phone to control toys. Through hands free utilization, tactile capabilities, and voice recognition AI, sex tech can be developed as a more sexually gratifying experience for people with disabilities. Also, for those people, or any people who may find it difficult to reach orgasm, many tech toys already can, or will be able to “learn” what gets their user off, so that the patterns and combinations that are the E ticket ride can be recalled, accessed, and re-played anytime.
Whether you consider yourself to be a visionary on the cutting edge or a total dinosaur in technology adoption, one thing is for sure… sex tech literally moves at cyberspeed. A report from Future of Sex offers insightful information and predictions on technological transformation in 5 areas:
#1: Remote Long Distance Sex
Internet of thing (IoT) system that enables the safe connection of device(s) to the Internet. Obvi this technology of teledildonics and cyberdildonics is already here and expanding, and there doesn’t seem to be an end in sight.
#2: Virtual Sex, Cybersex
Virtual sex or cybersex would entail the electronic transmission of sexually explicit or obscene messages via text, voice, or video. Historically, cybersex has utilized chatroom(s) and/ or online games, but believe it or not, good old fashioned phone sex and sexting are some of the most common forms of virtual sex.
Virtual sex via online games allow fantasies to run wild. Online multiplayer virtual games allow users to adopt different roles to see what they like best. The game Red Light Center allows you to design your own avatar to experience virtual interactions and even sex with other players in real time. The role playing, customization of avatars, and the virtual environment allows fantasies that are erotic and outrageous, and everything in-between. Some 3D sex games even support virtual reality headsets and interactive sex toys, all of which can deeply intensify the immersive cybersex experience.
#3: Robot Sex
Robots aid humans in various tasks; robotics are actually integrated into so many everyday objects that we take them for granted… we don’t even think about them. But sex tech robots are designed to be noticed; and many “online adult forums” utilize erotic chatbots to help moderate and facilitate racey group chats or private room activities. So it should come as no surprise that sex robots have been a popular sex tech trend, and they’re getting better all the time, as I mentioned near the beginning of this blog. Sexbots are basically very expensive and very lifelike, fully customizable silicone dolls. Tech advancements give them increasingly sophisticated movement and features to make them look, feel, and act like real girls. As they do closely mimic human movement and behavior, when you consider the potential to learn constantly, get smarter in communication on every topic (humor, speech, friend’s preferences/ likes/ dislikes) and with every interaction their human friend has with them, they offer very realistic and responsive experiences when it comes to sex and intimacy. Different doll techies/ creators offer multiple dolls with varying levels of virtual reality, artificial intelligence, physical characteristics, capabilities, and external feature realism, such as skin qualities: how it feels to the touch, it’s warmth, and the presence of responsive touch sensors.
#4: Immersive Entertainment
In order to have an immersive experience and heighten the end user’s intimacy, it is common to see many adult entertainment providers embrace and incorporate virtual reality (VR) technology with teledildonics and cyberdildonics. For example, CAM4VR offers live streaming with a VR sex camera and voice capability, so users can engage directly with adult performers. Put it all together and it makes for a very up-close and personal experience. Meanwhile, CamSoda includes 3D holograms to explore and even incorporates a release of various scents through a sensory mask in order to provide a multi-sensory play.
Aside from the adult industry, VR is utilized in an immersive sex education experience in an effort to create a safer environment for people to learn about their sexuality. Emory University and Georgia Tech plan to develop a high-engagement VR sex education program focusing on safer sex practices for young women to minimize instances of STD infection and transmission, HIV infection and transmission, and unintended pregnancy. VR is also utilized in therapeutic applications as well. BaDoinkVR is one example of such a program; their complementary VR tool is provided to singles and couples to help them discover their own sexual pleasure preferences and those of their partner, as well as methods to enhance both sexual pleasure and performance in real world sexual intimacy. And what’s coming soon may have you doing the same… on the not too distant horizon, VR will be applied to haptic (touch sensation) tech for users to indulge in thoroughly immersive acts of sexual intimacy.
Human augmentation typically refers to the notion of improving on or building upon the capabilities of the human body. But being human, we’re constantly wanting more and better, so augmentation also refers to theoretical methodologies to push the envelope on the human body’s capabilities and use methods that could, would, or will (!) include augmented reality through implantables or wearables.
The future is now, and many recent medical breakthroughs have demonstrated marked success in human augmentation; these have opened our eyes to many possibilities we once believed impossible.
Some success stories include: the first US penis transplant in 2016. A penile cancer patient required an amputation of his penis in order to have a chance of survival. Following this at a later date, his surgeons at Massachusetts General Hospital successfully completed the 15 hour transplant operation using a complete organ taken from a deceased donor. The operation was ultimately deemed a success after the 64-year-old man regained sexual function and the ability to urinate normally once again. This procedure has been adapted and procedure time significantly decreased to apply the surgical technology to US soldiers who sustained severe bodily damage and amputations from bombs and IED explosions during overseas wars, and thus far with great success, as they have regained sexual function and the ability to urinate normally post-operatively.
Another example of augmentation success as Swedish doctor Mats Brannstrom completed the world’s first “womb” transplant, which I assume they mean is a uterine or total vaginal transplant. Since then, many procedures involving varying iterations of vaginal transplants have been successful in countries around the globe, some of which were reproductively successful with patients carrying pregnancies to full term and delivering normally with the transplanted organs.
Yet another example of successful human augmentation was made possible by doctors at Wake Forest Baptist Medical Center when they succeeded in building and implanting a lab-grown vagina derived from the patient’s own cells, ultimately allowing her to resume normal vaginal function. The same group was also responsible for bio-engineering penile erectile tissue followed by successful implantation on laboratory rabbits.
Augmentation methodology has been used to overcome sexual dysfunction and/ or injury through the re-engineering of human tissues and organs which are then transplanted to help restore normal function. Moreover, this technology offers the potential for future body modification and customization in an effort for humans to enhance their individual sexual aesthetic and increase their enjoyment of sexual intimacy.
Clearly, augmentation is yet another technology where the future is now, as it has already been successfully employed numerous times around the world to repair the body and its organs after the ravages of disease and war. But what if feelings of orgasmic pleasure or heroin-like bliss were accessible through augmentation and made available to you as easily as you could push a button? Would you push it?
Elon Musk is betting you will. His company Neuralink has recently made quite a stir with the claim that their products can directly stimulate the pleasure centers in the brain. The company is dedicated to creating “Brain Computer Interfaces” (BCIs) which are devices that communicate directly with the brain at the synapse level. Basically, they want to put microchips inside people’s skulls, people… microchips that would elicit a chemical release as a response to their communication with the brain.
Musk has introduced a pig named Gertrude to the world, and she has a coin-sized chip implanted in her brain. Interesting timing, as the BBC states that Neuralink applied for approval to begin human testing on their BCI microchips last year.
So what is this brain chip anyway? Musk calls it a “digital superintelligence layer” that mediates communication between the limbic system and the brain’s cortex. The limbic system mainly deals with emotions, how we feel about things, while the cortex is more involved with the experiences of consciousness, perception, and thought which are far more important to human homeostasis.
Musk has stated that the initial use of BCIs will be aimed at brain-related diseases, claiming that neurological conditions like Obsessive Compulsive Disorder (OCD), Amyotrophic Lateral Sclerosis (ALS), and autism could all potentially be “solved’ or cured with Neuralink’s microchip. Basically, brain signals release chemicals, and those chemicals make us feel the way we do about things. So if Musk’s chip can tap into our sexual pleasure centers, it can cause a release of chemicals that make us feel an orgasm without the physical actions and scenarios that we would usually undertake in order to reach it. In a nutshell, he says that the chip will allow the wearer to bypass the requisite physical activity and get straight to the reward. I’m going to use the example of Tourette Syndrome, which is a disorder whereby affected people are compelled to make repetitive disruptive noises and sudden movements called tics. Like OCD, Tourette Syndrome is a neurological disorder that is totally out of a person’s conscious control; if they make attempts to deny the tics or hold them back for any length of time, eventually they will literally explode with tics, to the point where they are unable to function until the tics are expressed, which then sort of puts them back at baseline, almost like they’ve been reset. Affected people say that the mental feeling of needing to tic is like the need to scratch an itch, and that the feeling will build and multiply until they must finally “scratch it,” meaning they express the tics. This causes them to expel the tics that have built up in a sort of fit, after which the “itch” is vanquished… for a short time. It will build again and the whole cycle starts over. This feeling of being purged of tics must be mediated by the release of a chemical in the brain…. Just as the all-encompassing feeling of ‘I need to tic, I must tic’ is mediated by a chemical released by the brain when affected people resist their tics. That bit is basic science people, it’s like a for-sure deal that different chemicals released by the brain are what tells the person’s nervous system ‘hey, you haven’t tic’d, you can’t deny me, you must tic now now now…’ And also after having tics, then ‘hey, it’s okay, chill out, you’re good… for now.’
Musk didn’t mention my example, but I think it’s the perfect model for explaining the potential of a chip with this technology, assuming it actually does interface with the brain in the way it’s described and that it does elicit the chemical response as it’s described to do. But please understand that those are big assumptions for now.
If this BCI chip causes the release of chemicals in the brain that mediate how we feel about something without having to physically enact the behavior(s) that would usually cause their release, then it should work well in Tourette Syndrome or tic disorder, along with other neurological disorders with the same sort of altered or skewed reward system, where you could get the chemical release without acting out the potentially maladaptive or undesirable behavior of tics or checking and re-checking the locks in OCD, or self-injurious behaviors (like head baging) often exhibited in autism. I can also see the potential for use in psych patients who are cutters: they have an irresistible need or urge to deeply incise the skin and/ or release blood and/ or feel pain. If they could have that insatiable desire quenched chemically in the brain without having to act out the physical cutting action, that’s it… problem solved, cutting cured. That’s pretty incredible to imagine. The potential benefit in ALS patients is a little more complex, so I won’t bother with that here, but on first glance, Musk’s BCI chip has the potential to be a total game changer in treating some of the most difficult neurological and neuropsych disorders on the face of the planet in my opinion. It could hold great promise for disorders where the reward system is somehow perverted or held for ransom by the brain.
Musk says that the advent of his BCI chip will not necessitate the automatic elimination of physical activity, and that the chip’s presence would not override independent human thoughts of performing physical activities as we’re all used to doing now. And dare I add the single qualifier “before…” to the end of that statement? Because when you’re monkeying around with the reward center, the release of chemicals, and the brain, bad things can happen from the jump or they can develop over time. The brain is a powerful organ people, just ask an addict. That said, to me, Musk’s pre-qualifying comment at this very early stage of the game sort of smacks of his intentionally plugging a pacifier into our collective mouths before we even start whimpering about its absence. In any case, Neuralink’s human studies could prove to be an interesting bit of theater. But Musk generally gets what he wants, and he wants this technology- at least the ownership of it. Because I’m pretty dang sure he won’t be getting one of those chips in his skull anytime soon. Still lots to be determined. Stay tuned.
I do see benefits of the chip in the sexual wellness category. For people who are unable to physically engage in sexual activity due to illness and/ or injury, people who are simply anorgasmic, or people that can perform acts of sexual intimacy, but not to a point of orgasmic release, I see great potential. These are all genuine issues with real life implications. The chip could allow for the stimulation of pleasure centers to heighten arousal and increase the potential for an orgasmic sexual response. Then it could essentially capture and record the pleasure responses of one person and those can be read by some technology within the chip or even some of the independent biofeedback type sex tech devices, and then transmitted (for lack of a better word) to that person’s partner, which would let that partner know what the first person’s sexual pleasure feels like, and that could integrate that desire into their partner’s intimate experience. And also, if there is a specific set of circumstances that arouses someone and makes them more likely to achieve the end goal of reaching orgasm, they could share that feeling with their partner. Say if they like the excitement from the risk of being caught having sex in a public place, or they like the completed idea of getting away with it, the chip could capture what that risky feeling feels like to them and those feelings could then be overlaid onto the partner’s chip or through some other type of independent sex tech, so that the partner also feels the rush or excitement from that risk, and therefore automatically incorporates it into their feelings during the sexual experience. Almost like dimming the lights to set a mood, except this would be setting a mental mood, so that the sexual experience would have a specific mental context that may make both halves of the couple more likely to reach orgasm. That’s a win – win scenario.
Sounds interesting, right? Well, need I say there are risks? Actually, there are RISKS people. I mean, Captain Obvious reminds us that we are talking about having a chip implanted in or near the brain… an electronic component interfacing directly with brain tissue, or at least interacting with another electrical system, which the human brain is. But even if we throw those trivial matters aside, hell, I’ve had my computer hacked- what happens if some homicidal freak hijacks people’s chips? Would they be able to remotely control someone to do their dirty work? Yikes, people! And what about all the data collected from chips? All the random thoughts and/ or feelings, the ‘side data’ if you will. If a private interest group got access and/ or control over everyone’s data and used it to advance a candidate in an election, or influence the government, or squash or advance legislation or alter bill introduction or the passing of laws or affect the governing actions of all of the above? Any group that had access to all that information would basically rule the world- they could control everyone and everything with relative impunity.
But this I know: people could potentially be seriously harmed by overstimulating the brain globally, and overstimulating the pleasure centers of the brain specifically. Helll-ooo… aaa-ddic-cc-tion! If people can have “orgasmic pleasure” or “heroin-like bliss” freely available to them as easily as pushing a button, will they be able to continue functioning everyday without constantly pushing that button? They would be bombarding their neurons with pleasure chemicals… and usually, too much of a good thing… is a really bad thing.
We’ve all seen sci-fi movies where AI (artificial intelligence) enslaves the entire human race. But Musk has an answer for that too. Sort of. He claims that Neuralink’s devices are actually the very things that will protect us humans from this situation, should it ever arise: that BCIs would give us virtually instant access to information in a way analogous to completely automated systems, which intimates that we would somehow “know” or “understand” everything, even when we’re being tampered with or manipulated. Not so sure about that.
Generally speaking, I like Elon Musk. And admittedly, some of this sounds cool. But I don’t trust his abilities over mine to be certain of potential medical, psychological, and behavioral ramifications of brain neurochemistry. But I assume he’s put the right people in the right places. I have to say that as a psychiatrist, if there was a cure for some of the most destructive and currently incurable neuropsych disorders in existence, that would be amazing. But… in my experience, where Mother Nature or God or a higher power or whatever you believe in puts a check…there’s a balance somewhere, usually in a place you don’t see until it’s too late. Couple that with the potential for addiction issues, the possibility of chip hijacking, and honestly, Musk’s (kinda lame) assertion/ pseudo explanation not to worry, that we would know and/ or anticipate everything would keep us safe, that feels a little too tenuous for moi to step out on… So let’s just say that I won’t be beta testing these BCIs. But, I will follow this issue and read with great interest all about the people who do.
Embracing Sex Tech: Problems & Solutions
As far as existing sex tech and products coming in the relatively near future, most fall squarely into the “adult entertainment” and “sexual health and wellness” arenas, and I think the latter have been, and will continue to be, better received. It seems that innovations in teledildonics and cyberdildonics aim to improve intimacy and sexual pleasure, and they hold great potential to resolve the age-old problems that revolve around physical, emotional, and geographical constraints of romantic love relationships. I know that with coronavirus, some couples that had to temporarily split for months at a time had difficulty doing so successfully. Long distance relationships are another excellent example. If you’re a young newlywed bride from Great Grits Georgia and your soldier husband is called to serve in some hellhole on the other side of the globe for a year, that’s a real problem- the kind that breeds misery, introversion, distrust, communication issues, and physical/ emotional intimacy problems in both partners- problems that can potentially pave a road to divorce where one never existed before. So if sex tech and couple toys or similar interactive devices allow couples to continue- or even advance- their sexual intimacy, while forging ahead with a difficult situation, then only good healthy things are likely to come of it.
…Very Different from Embracing Sexbots!
AI-driven sex tech robots are relatively new and their aim is to apply advanced concepts of machine learning to transforming our sexual experience. Thanks to the sensors in the defined “sensitive” zones of the bots’ bodies, these sex robots can experience pleasure and, in turn, reciprocate the favor. Also, they can learn from previous experiences. For example, your habits and moods or what turns you on.
I was surprised to read a recent survey that said that 1 out of 5 men said they are open to the idea of having sex with a doll. This number is likely to increase when sex dolls become more humanlike and way less expensive. In fact, human/doll (or bot) sexual intercourse might overtake human/human sexual intercourse way faster than we think.
Issues: Sex Dolls and Bots
However, major concerns are arising, not the least of which involve the concept of men having sex with child type sex dolls. With sex dolls, the romance and chit-chat typical of a normal relationship are eliminated, and maybe more importantly, these relationships happen in a strictly private environment. It’s not like you bring your bot ball and chain with you when you go to a buddy’s house to watch the game. So really we’re left to just speculate about the psychological ramifications of a continual and purposeful romantic love relationship with a non-human entity. And boy do we speculate…
Monetary Costs of Sex Dolls and Bots
Currently, these things are freaking E for expensive people. A Realbotix head alone costs about $10,000, but you’ll shell out another $25,000 to $65,000 if you want a body to put it on. And speaking of that body, features such as skin-like materials, self-warming orifices, full-body detailing, and a texturized canal with internal pulsations are only the tip of the iceberg. If a human tells their doll/ bot what they enjoy sexually, they can evidently learn from it; then when it’s applied during physical intimacy, the patterns can be recorded or “remembered” by the doll or bot; I can only assume that they can then be recalled, essentially repeating the exact same experience. This would only be in the most advanced models I’m sure. Doll/ Bot companies claim that today’s most futuristic dolls can learn whatever names you give them, when your birthday is, how to read poetry, and even hold their own during erotic conversations. Plus, they don’t require cab fare when you’re done or a romantic dinner before you even get started.
In comparison, the “busted up bargain bots” as I lovingly call them only range from $4,000 to $12,000. But with continued advances in technology, the price across the bot board is certain to drop, making this tech more accessible to the average person, which will undoubtedly lead to more dolls and bots, but probably the same scant amount of information about the psychological ramifications of a purposeful romantic love relationship with a non-human entity.
And this was a new one on moi…
Enter the Slutbot Sexting Tutors
Supposedly, these were developed in response to the controversy that has obviously sprung up around the invention of such high-functioning sex bots, with people arguing that such machines will make interpersonal interactions a thing of the past. But the world’s first Slutbot Sexting Tutor has entered the scene and it’s definitely making the conversation more interesting- in more ways than one. This intuitive robot helps users express their sexy, seductive side in a more efficient and flirty way, which serves as not only a relationship booster, but also a terrific add-on to any interactive sex toy you might already own and utilize. So its reason for existence is basically to transform lonely -cis men into slutbox sexters? Alllrrrightyyy thennn…
The True Future of Sex Toys Is Non-Binary
When sex toys became popular in the ‘70s, they were made “by men” and “for women” so it’s no great wonder that they looked like giant towering examples of realistic penises, complete with veins and perfectly sculpted heads, often with an attached set of perfectly sculpted balls, neatly placed where they would be in an anatomy schematic but never in real life. They were typically flesh toned and the focus was placed on the penetrative aspect as opposed to being concerned with stimulation. In short, they missed the mark, and that really set them up to continue to miss it for a very long time. Why? Because that’s what the industry execs assumed women wanted to use. And so began a long enduring disconnect. But fast forward to today, when the sex tech industry is finally focused on inclusion, and actually does include some non-binary-led companies amongst the many powerful female-led companies, all of them seeing that the future of sex tech is truly and unapologetically non-binary.
Gone are the days of “one size dildo fits all vulvas.” Gone are the days when hot pink phallic contraptions had to be appreciated, just because it was amazing to even have a choice. It’s a good thing that those days are in the rearview mirror. But let’s face it, there’s still a huge amount of phobia surrounding sex in general, no matter the labels or qualifiers. But it’s magnified and multiplied when it’s non-cis, non-hetero sex. Thankfully, more and more companies are working hard to do away with that phobia.
When it comes to sex toys, we now recognize that sexual interests and tastes can be as unique and singular as the bodies that contain them. While there’s nothing wrong with wanting a rainbow glitter dick, lipstick vibrator, or hyper-realistic flesh-colored dildo, many of these products can be alienating to individuals who may identify as gender nonbinary, or people who feel put off by the gender essentialism of toys created “for men” or “for women.” So, in light of the increased cultural awareness of non-binary gender identities, innovative sex toy designs are making pleasure more accessible for everyone. One company striving to make the sex toy industry more inclusive is Wild Flower, a nonbinary sex toy retailer and digital community dedicated to providing sex education to those who have been overlooked by the adult industry.
What makes purchasing a sex toy so difficult for some individuals are the ideas and labels that automatically come attached to them like baggage. Gender, sex, and bodies are complex topics… acknowledge this and counter it by totally eliminating gender in marketing. While this might make things like search engine optimization difficult, the upside is that newly unlabeled and unlimited genderfluid-friendly toys can open minds and new worlds of sexual expression for everyone, regardless of how they identify, or if they even do at all. Free the toys!
A Victorian Take on Remote Sex
Today’s blog has been all about the future of sex tech, which at its heart centers around smart sex toys designed for remote sex in one of many forms. But really, remote sex is nothing new. Ever since the dawn of literacy, lovers separated by distance or circumstance have touched each other remotely through erotic letters held and read in one hand… while doing something else with the other. If you’ve got some time, there are many examples of “Victorian sexting” during the civil war era online. Some of it is hilarious and some is pretty mind blowing… but let’s take a quick “wow break” to check out a couple of excerpts from letters between none other than General George Armstrong Custer and his wife Elizabeth “Libbie” Bacon Custer, who was said to be “hotter than a $2 pistol.” We’ll see how they implemented remote sex.
Far from the prudish stereotype of the Victorian woman, Libbie clearly delighted in creative euphemism and double-entendre. In one letter to her husband, she wrote of “a soft place upon somebody’s carpet” and of her desire to “sit Tomboy” (as in astride) for “just one… ride” as they were fond of asking for “just one” which appears to be a reference to an orgasm. Scandalous.
Custer wrote in reply “Oh, I do want one so badly. I know where I would kiss somebody if I was with her tonight.” Shocking.
Nothing could dampen Custer’s ardor for Libbie. During one of his campaigns, he sent her the 19th Century equivalent of a dick pic:
“Good morning my Rosebud. ‘John’ has been making constant and earnest inquiries for his bunkey for a long time, and this morning he seems more persistent than ever, probably due to the fact that he knows he is homeward bound.”
And in one letter to her BFF, Libby told her that she and Custer had had a threesome, and it seems like she wants her to stay!
She said “Custer, as I, devoted most of our attention … to the selection of a pretty girl… This pretty girl … was held by both of us, and would do more toward furnishing and beautifying our army quarters than any amount of speechless bric-abrac.”
That Libby was really freaky. And the great General Custer was into it. Who knew?
Now moving away from the Victorian age and through the 20th century, remote sex migrated to the telephone, when even Dear Abby approved of- and even recommended- phone sex for long distance lovers. Of course, any form of remote sex is not the “real thing,” but the body’s sexiest organ is the mind, and remote sex talk excites it just as much now as it did in years past. Teledildonics and cyberdildonics basically combine these excited and sexy thoughts, and therefore the minds, of each half of a couple that are separated, bringing them together virtually, and that extends the potential excitement more than ever before.
Potential Real World Ramifications of Sex Tech
Teledildonics Biggest Winners: Sex Workers
No doubt some long-distance lovers will embrace teledildonics and have big juicy fun. But the largest market for Web-enabled sex devices appears to be sex work. The Web already contains a surfeit of sites whose female (and gay male) employees show their assets, touch themselves, and exhort remote users to masturbate, all in an effort to earn a buck.
Teledildonics not only makes remote sex work more lifelike, it’s also more personal. The phone-Web interface is more one on one, allowing consumers to feel closer to providers. In addition, teledildonics allows sex workers to earn extra money by fulfilling requests. Men can tip to see the sex worker fellate a dildo while they physically feel it by utilizing a device. Tipping is almost too easy: just tap your phone, and voila… the fee is charged to your credit card. No fuss, no muss, no exchange of fluids.
Many sex workers prefer remote sex to the real thing. And why not? The hours are flexible. They can work in the privacy of their homes. And compared to the alternatives: street-walking, massage parlors, hotel calls, and brothels, remote sex is safer… no violent customers, poor hygiene, or sexually transmitted diseases, and no risk of arrest. Police generally focus on street level sex work; they really couldn’t care less what people do on the phone behind closed doors. Teledildonics is also safer for men who regularly pay for sex as well, and for all the same reasons.
Teledildonics’ Biggest Losers: Women Who Abhor Porn and Snoops
While teledildonics may be a boon to long distance lovers, it’s bound to cause consternation among women who feel threatened by their men masturbating to porn. Except instead of the man stroking himself to some random video image, now teledildonics allows him to look at a real live woman who’s stroking, licking, and using a Web-enabled sex toy. Many men are likely to find that more compelling than porn. And I suspect that their wives will not exactly be thrilled about all that.
By some estimates, as many as 25 percent of coupled individuals have peeked into their partners’ devices looking for evidence of porn use or affairs. I hear about this from patients all the time. They complain that their partner tracks them, or steals their phone to snoop. Some put a screen lock on, but their partners know that sometimes the photos they might be looking for would be on the micro card, so they snag it and plug it into their phone to snoop. Anyway, the evolution of sex tech means that from now until who knows when, jealous and insecure partners will continue to snoop and should now be expected to check for teledildonics apps- after scouring the phone for texts and calls with random women, and tossing the closets and drawers looking for web-enabled sex toys.
As teledildonics and cyberdildonics become more established, I think the news media will treat it breathlessly, with sympathetic profiles of long distance couples who “really enjoy it” followed by hand-wringing from those who consider it a threat. Personally, I find that sex sells… people love to read about it and speculate on it, and app-enabled sex toys are a fascinating new wrinkle in the oldest quest of all time: the search for erotic satisfaction. Especially in my profession, where that search is often tied into self worth. I’m not terribly concerned with what it all means for civilization, since it’s not like commercial phone sex services have led us to the ruins of Sodom and Gomorrah in previous years. We’ll survive. Necessity may be the mother of invention, but lust is often the father of necessity… because don’t forget that a hard prick has no conscience.
Sex Tech Psychology
The End of the World as We Know It?
If the sexbots are already here, what’s next? Will everyone start marrying dolls and sever connections with other human beings? If we get used to programming our partner, how could we ever go back to human beings with free choice? Panic rules the streets!
I’ve read articles and comments online that point to concerns that sexbots and VR pornography could dehumanize sex and warp our perception of consensual relationships, but I’m not convinced of that at all. Even if that’s a possibility in the future, it’s certainly not the case yet, because I think sex robots have yet to seem ‘real’ enough to appeal to a large audience. Until the last couple of years, designers have been very bad at making human-like robots, as technology hasn’t been all that well suited to it, and our brains can easily pick out points where human-like things don’t look like humans, and that’s a buzzkill in every way imaginable. And until recently, after advancements in skin technology to add warmth and feel and the addition of more realistic facial features and movements, sex robots have really just been immobile sex dolls glorified with some animatronics and chat capabilities built in, and I think it’s going to stay niche as long as that’s the case, and that makes it a non-starter in the problem department. I don’t think they treat these dolls like real people.
But some vehemently disagree, claiming that owners become deeply bonded to bots, but also add that even if their use of sex dolls appears to dehumanize real (meaning actually human) women or promotes misogyny, that in reality, bot-owners actually “cherish” their dolls and treat them with respect. That’s a ‘Hmmm maybe’ for moi people. I’m sure that for some people that find it hard to make connections and sustain romantic relationships, sex dolls could be an incredibly useful way to combat loneliness. But I can’t imagine a way that any man could ever convince himself that he is in a real relationship with a doll. Just doesn’t compute for me. But I guess the fact is that it doesn’t have to! In the meantime, it’s an interesting theoretical, but I don’t think I’ll be spending much time worrying about it.
The Future of Sex Toys: For Better or Worse? Utopia or Dystopia?
Should we be excited about all this new technology, or terrified of what the future holds? Are sex robots a threat to human relationships, or a niche invention which can help the lonely without affecting anyone else?
With all of the questions swirling around the future of sex, I think that the answers have everything to do with being human, and little to nothing to do with technology. No matter what “toys” you add, it still comes down to a person’s brain, as that’s what’s ultimately in control. As for the future, I’m just hoping for one that is more open, with less judgement and shame, and more acceptance and equality. I think that’s something we can all get behind. However it goes, the future of sex tech promises to be exciting, and all we can do is wait for it to be revealed and see what it’s about.
Thanks- be well, people!
Sex Toys: Not Too Taboo
Usually I write my blogs and record my vids right off the top of my head with basically zero preparation required. Today’s topic is a little outside my usual scope, but I’m man enough to admit that I did some research- and believe me when I tell you that there is a freaking metric ton of info on sex toys out there! As a physician, I’ve seen more than my fair share of kink and way-out-there sex practices in hospital ER’s all over this great country, but I found that toys these days go from “wow…now that sounds interesting” to “they want you to put that there?” to “dammit, why the hell didn’t I think of that??” Some of it is totally blush-worthy, but set aside your hang-ups and preconceived notions, open your minds, and get ready to get really up close and personal here, people! And fair warning: prepare for plenty of innuendo and double entendre – and any time you read something and think to yourself ‘oh wow, did Dr. Agresti realize what he wrote there, what that word choice kinda sounds like in a blog about sex?’ The answer is yes and yes…I did and I do. So I hope you like it and share it.
Sex toys are clearly no longer the taboo subject of generations past, as ever increasing numbers of men and women, cis and trans, L, G, B, and Q, individually, and in couples and fill-in-the-blank-somes, are incorporating toys into their sex lives. As a result, it’s no surprise that the sex toy business is banging. Not a shock if you recall my wildly popular orgasm blog and some of the not-so-fun facts I had to reveal:
-10% to 15% of all women are anorgasmic, meaning they cannot or do not orgasm…like at all. Bummer days people.
-75% of women will never (Hey, you hear that? Never…ever…ever…ver…ver…err…errr) reach orgasm from straight up intercourse alone, without a toy. Like wow people.
-Captain Obvious says that means that only 25% of women will reach orgasm from vanilla sexual intercourse alone, ie without a toy.
-Only 29% of women regularly reach orgasm with their partner, while 75% of men will always reach orgasm with their partner (“yeah, or a hole in the wall” as added by someone who will remain nameless that’s giving me the stink eye at this very moment because for some reason she thinks that when I’m typing on my laptop I somehow magically become blind to everything else.) Anyway, the moral of this story is that women are far more likely to orgasm when they’re all by themselves than when they’re with a partner. Ouch people.
So…why should you care, you ask? Well, numero uno is that you might have a vagina. Duh. And if you’re an owner of said vagina, you are statistically much more likely to be among that 75% that can’t orgasm from vanilla intercourse, or the 71% that don’t orgasm with your partner at all! Or you could even be both. Or, maybe you have a penis, but you care about someone that has a vagina…like you really care, to the point where you want to have sex with them and please them…both at the same time I mean. This would be good intel then, no? Because then you could even introduce a sex toy (surprise, honey!) and explain that you got it just because you’re so concerned that she may be a member of the “no orgasm club.” But don’t call it that- use big words and quote the statistics in an effort to make yourself sound smart- they’ll appreciate that. Oh, and because you’re a giver. Throw that one in there too. No… really, in all seriousness, emotional intimacy and pleasure from physical intimacy are truly very important parts of a love relationship. And emotional intimacy is at its best when everybody involved derives pleasure from engaging in physical intimacy. To simplify: make your partner’s orgasm at least as important as yours. They’ll be much more inclined to like you and give you more opportunities to make their orgasm at least as important as yours… it’s a positive feedback loop.
There are a lot of myths surrounding sex toys, and one of the most ridiculous is that they’re unnatural and unhealthy. In reality, that couldn’t be farther from the truth. Sex is one of the most natural things a body does; it’s a gross comparison, but sex is right up there with peeing and pooping. Anything that promotes sex and pleasure is absolutely natural and completely healthy! In fact, people who abstain tend to have more instances of anxiety and depression. Facts people. Women that use sex toys report greatly increased levels of sexual desire, much more frequent orgasms, far greater sexual satisfaction, and happer, better, and more complete intimate relationships. I can’t find a negative in any of that.
Why are sex toy sales on the rise?
While they were once seen as depraved and belonging to a certain line of work, these days they are totally socially acceptable. Now there are even more sex toy parties than Tupperware parties, and women enthusiastically compare notes about the latest sex toys in their collection. The hype surrounding the film Fifty Shades of Grey has played a part in this, along with the fact that today’s women are no longer ashamed about satisfying themselves. On the contrary, self-assured modern women are open about their sexuality, and this includes the fact that they don’t necessarily need a man to be sexually satisfied. That said, couples are also incorporating sex toys into their activities at an ever increasing rate. In particular, couples in long-term relationships are using sex toys to spice up their love lives, allowing them to explore new sexual experiences together. I’ll be talking all about this in part three of this sex toy series, and you don’t want to miss it- it is hot stuff people!
But before we get that deep, today I’m going to start with the basics on sex toys: what they are, how they started, and what they’re all about. Then next week in part two, I’ll talk about who’s using sex toys and what you should consider if you decide to join them. As I said before, part three will be about partner toys and ways to spice up long-term relationships. And at the end, I’m going to paste some links to articles and sites where you can find more information about different types of toys, how to choose a first toy, and where you can find and purchase any and every toy you could ever want. Look, if you’re into playing fingerpuppet five-on-one or downstairs DJ and it works for you, I certainly have no objections your honor, but some new toys could put a new smile on your face; so keep reading my blogs and if anything strikes your fancy… be adventurous and go for it!
What are sex toys?
As if you don’t know… Sex toys, aka adult toys, aka “marital aids”… all are terms for objects that people use to have more pleasure during partner sex or masturbation. Sometimes sex toys can also have medical uses, as in cases of sexual dysfunction, although that seems to be something of a point of contention. There are many different types of sex toys, and people use them for any of many different reasons, but the general idea and end goal is basically the same for everyone across the board: to get off. I’m pretty sure that’s the technical term.
Here’s a quick overview of some of the most common categories of sex toys:
AKA vibes or buzzers
AKA “personal massagers” (yeah…riiiight)
-Objects that vibrate or buzz to stimulate internal and/ or external genitals.
-Most commonly used on the clitoris and/ or other parts of the vulva and vagina, especially the G-spot.
-Can also stimulate the penis, scrotum, testicles, nipples, anus, and the male P-spot.
-Come in endless shapes and sizes, waterproof or not, for inside the body and/ or out, and for all genders.
-Objects that go inside a vagina, anus, or mouth.
-Come in many shapes and sizes, but they’re often shaped similarly to a penis.
-Some look realistic, others more abstract.
-Can be slightly curved to help stimulate G-spot or prostate, the P-spot.
-Can be made out of lots of different materials: silicone, rubber, plastic, metal, or
glass (freaking yikes – not for butterfingers!)
-Dildo Fun Fact #1: Ever wonder where the term dildo came from? Constantly, right? Let’s get in the Wayback Machine to find out!
-Turns out, like so many words, dildo is thought to be a bastardization of terms taken from other languages.
-IMO, the winner is diletto, taken from the Italian which means ‘a woman’s delight.’ This seems a very likely place where the word we know and love today got its start, however there are a couple of other contenders.
-My next personal choice would be dill-doll, which is the ye olde English translation for the old Norse word ‘dilla,’ a verb meaning ‘to soothe.’ So literally, a dill-doll would be a soothing doll, as in…a penis! Of course! Or an intimidating giant rubbery effigy of one, anyway.
-Dildo Fun fact #2: Did you know that there’s an actual place called Dildo? I heard that’s where Waldo was… Waldo in Dildo. But seriously, there’s a town in the maritime province of Canada called Dildo, and Dildo Island is located just offshore don’tcha know. The tourism marketing folks there are fighting one hell of an uphill battle. Check out these tags that I came up with:
‘Dildo~ The Weather is Here…Wish You Were Beautiful!’
‘Come to Dildo…See the Sights!’
‘The Isle of Dildo…Get On It!’
-Captain Obvious says these are toys made specifically to stimulate the anus.
-Includes plugs (aka butt plugs), anal beads, prostate massagers, and wide base/ flared dildos. Yeah people…pay special attention to that wide base/ flared part- if you don’t, these suckers are prone to take an accidental detour waaay up the hershey highway, and then you’ve got to go to an ER to have it pulled out, and that’s not embarassing at all. I’ve seen this all up-close-and-personal-like more times in the ER than my poor brain can block people.
-You must use lube to use anal toys (especially anal toys) safely. An overarching theme on these toy sites is basically this: lube is cheap, so use lots and lots of lube when you play with toys.
-AKA masturbation sleeves
-AKA penis sleeves
-Soft tubes designed to put the penis into.
-Come in all shapes and sizes, and with different textures on the inside for more sensation.
-Some feature vibration or suction.
-These are cool because there are strokers specially designed for a larger clitoris or smaller penis, particularly for intersex or trans people.
AKA cock rings
AKA erectile dysfunction rings
AKA constriction rings
-Shockingly, these are rings that go around your scrotum and/ or penis (must be prior to arousal people!)
-Work by slowing the blood flow out of the penis once it’s erect, thereby increasing sensation and/ or making the erection harder and longer-lasting.
-The safest penis rings are made from soft, flexible materials that can be easily removed in case of emergency: silicone, rubber, or leather with snaps for the biker set.
-Some penis rings have little vibrators on them to stimulate the wearer and/ or their partner during intercourse.
-Penis rings restrict blood flow, so don’t wear one for longer than 10 to 30 minutes, and take it off right away if it becomes even slightly painful: kind of defeats the purpose.
-Talk to a nurse or doctor before using penis rings if you have a bleeding disorder or are on blood-thinning medicine. See, just the fact that they mention that leads me to believe that there could be blood shed associated with using this toy…so for me, this is a pass and a no freaking way, people!
AKA penis pumps
AKA vacuum pumps
AKA vacuum erection pumps
-Vacuum-like devices that use a hand or battery-powered pump to create suction around the penis, clitoris, vulva, or nipples. -Pumps drive blood flow to the area, which helps increase sensitivity and sensation. -Penis pumps can help you get an erection, but they won’t make your penis permanently bigger. Sorry people.
-Some pumps are designed to help treat erectile dysfunction, genital arousal disorder, and orgasm disorder.
-For more information about these pumps, contact a nurse or doctor. You can also go to your local Planned Parenthood health center. -Most of the pumps you buy in sex stores or adult shops are not medical devices, they’re just meant to enhance pleasure during sex and masturbation.
-Make sure to follow the instructions on the packaging, and don’t pump for longer than the instructions dictate.
-Once again, talk to your doctor before using a pump if you have a blood disorder, or are on blood-thinning medication.
Ben Wa Balls
AKA Kegel balls
AKA Kegel trainers
AKA Vagina balls
AKA Orgasm balls
-I’m sure you’ll all be shocked to learn this first part: that these are round objects; but maybe a little more surprised by the second part: that they’re designed to be inserted inside the vagina, and definitely shocked by the last part: some women keep them in for an entire day. Like on purpose. Whoa people. Don’t mind me, I’ll just be crying in the fetal position over in the corner.
-They can assist in exercises that tone and strengthen the Kegel muscles.
-Kegel balls are usually weighted so that the vagina must be squeezed to keep them inside the body, strengthening the pelvic floor muscles.
-You don’t need these balls to do Kegel exercises, and not everyone uses them for that purpose; many women just like the way they feel inside the vagina.
-Fun Ben Wa Balls fact: female prisoners could use these to enlarge their “God purse,” which is what they call their vaginal cavities, especially when they hide illegal items from cops and/ or smuggle contraband into jails and prisons. Wonder if a female inmate came up with them… after all, necessity is the mother of invention.
-Some are hollow with smaller balls inside that roll and bounce when you move, making a jiggling sensation. And probably a jingling noise too, right? Can you imagine that? I’ll do it for you: you’re a man in an elevator, you’ve just pushed the button for eleven, and just as the doors are about to close, you hear the familiar sound of jingle bells getting louder as you see a woman is running to catch the elevator, and as she jumps inside at the last second and lands in her spot, there’s one final loud jingle as she smiles and says “five please,” then silence. Internal thoughts as you push five: Hmmm, those were bells. Like jingle bells? Huh. But kind of… quiet-ish… almost muffled (? you ponder this as you clean your right ear with a pinky finger). Funny, it’s May, not December. I don’t see any bells tied to her stilettos. Odd. Well, maybe she’s one of those people that keep that holiday spirit all year long. Freaks. Ugh so annoying! Or, she’s got ’em in that purse. It’s really small; didn’t see that on her other shoulder before. That’s it. They’re in that purse. Gotta be. Mystery solved. Good job.
Meanwhile, her internal thoughts after you pushed five: Sheese…this ass monkey moron heard my bell balls. Ha! He’s trying to figure it out right now…I can see the gears working overtime in his pea brain. Can practically smell the burning as he’s inspecting me. No moron, they’re not tied to my Manolo’s…what am I, four? Doesn’t he- oh, he just saw my purse. Yep, he thinks I’ve got them in there. Oh yeah, he thinks he’s got it all figured out…he looks so proud of himself. Little does he know this silly little purse won’t even hold my bell balls! But my God purse does…juuust fine. Later loser.
Right after his mental pat on the back, the elevator stops, the door opens, and she’s gone… jingle all the way.
-These are garment systems that hold a packer, dildo, or other sex toy against the body.
-Some can be worn like underwear or jock straps, while others can go around other parts of the body, such as the thigh.
People still have a hard time talking about sex and orgasm, but make no mistake: these are integral components of life, and even the ancients knew it. The desire for a good, satisfying, old-fashioned orgasm is timeless. Our ancestors, while they were making hair combs out of bone and forming and firing clay pots, they didn’t neglect their sexual needs… quite the opposite actually. Need proof? To date, the oldest dildo recovered is a big curved stone phallus found in Germany. How old was it? 28,000 years old people!
Turns out, historical men (and women, maybe even more so) were light-years ahead of us in the pleasure department; we have proof positive of this, thanks to their inventions, all of which are still used today. Here are the backstories on some of the most recognized sex toys and paraphernalia that’s still out there in one form or another.
-Invented in 1904
-“Lady substitutes” are recorded as far back as the seventeenth century, when French sailors devised the Dame de Voyage: a collection of curvaceous rags (say whaaat?) that could only ever resemble a woman to a very homesick and horny Frenchman. But it wasn’t until some time after vulcanized rubber was patented that the more familiar model came about, which was in 1904. Boy, that must’ve been a Goodyear… and a good year! At that time, they marketed them as “inflatable dolls for discerning gentlemen.” Would’ve been a hell of a lot easier than marketing tourism to Dildo.
-Less than four years later, German sexologist Iwan Bloch was marvelling over mass-manufactured versions that could ‘imitate ejaculation’ for sale in Parisian catalogues. Rating super creepy was a firm that offered a custom doll resembling “Any actual person, living or dead,” which has to be the single most disturbing tagline in the history of marketing and advertising. Except maybe of course for ‘The Isle of Dildo…Get On It!’
-Now they make those “real life girls” which are waaay too (sur)real for me, but devotees talk to them, eat with them, and live with them like they’re real humans. Some medical show I saw followed these men that preferred these dolls, and one guy had four of them, and he actually detailed conversations between himself and the “girls,” including arguments between them about how they would get jealous when he chose to “spend time” with someone other than them. And I’ll never forget when they filmed him opening a door with a smile and saying something like “Yeah, the girls hate to be put in the closet,” and the camera focuses on the closet and there are his three other girls all sprawled out haphazardly. Here he was explaining how he loved each of them, combed and styled their hair, shopped for hot outfits for them, and here they were, all crumpled up in some dingy little closet, waiting for their next date with him or whatever. It was patently ridiculous while absolutely hilarious! There was a movie on this same storyline, I think it was called Lars and the Real Girl. I’m sure you could find it if you were so motivated.
-Invented in 1892
-An English dude named Frank E. Young was a man with a vision, and that vision evidently involved things being inserted up other people’s rectums. Because that happens everyday, right?
-Developed in 1892, but not marketed until the turn of the century, his ‘Rectal Dilator’ was a terrifying 4 1/2-inches of pain, designed to go not just where the sun don’t shine, but where the sun can’t, and won’t ever, shine. At the time, it was billed as a cure for piles, a gussied-up term for hemorrhoids.
-The devices were hawked to doctors and even advertised in respected journals. And people might well have gone on believing they were medical devices too, were it not for the ridiculously suggestive instruction manual included with each order.
-For forty years, these Victorian butt plugs managed to jump the pond to be sold all across the US of A, before they fell afoul of the 1938 Federal Food, Drugs, and Cosmetics Act, which banned them for “false advertising.” Given that it looks like it does, I don’t see how that’s possible, but we are talking about our federal government here.
-Invented in 1869
-That date is the officially accepted one, but legend has it that Cleopatra actually developed the first version of a vibrator. She was said to keep a jar of live bees on her bedside table, and when she was needing some personal attention, she had her servants fill a hollowed-out gourd with them. She then pressed that against her lower Mesopotamia, using the angry vibrations emanating through the gourd to pleasure herself.
-She had to stimulate her own self after all four of her husbands died… I guess a girl’s gotta do what a girl’s gotta do. And evidently she did, quite regularly.
-Back to the Victorian vibrators of 1869… this period was a different time… a time when “robots” were steam-powered and doctors treated hysterical women by masturbating them to climax. Of course. I also covered this in my orgasm blog.
-Female hysteria was supposedly a genuine illness, and its treatment involved a qualified medical professional rubbing the female patient’s private parts until orgasm was achieved. Because nothing about this practice could be logical, doctors often complained of boredom and pain-in-the-wrist, probably the very first cases of repetitive motion injury.
-One of said qualified medical professionals, George Taylor, came to the rescue and invented the first steam-powered vibrator. Because what could possibly go wrong with that… a metal device powered by steam… which is hella hot people!
-Although (shock of shocks) that version failed to catch on, J. Granville’s 1880 ‘electrochemical’ design really did, much to the delight of housewives everywhere, as they went bonkers for them.
-Even Good Housekeeping magazine started running monthly reviews of these marvelous wonders. So what happened? Well, society accepted the ‘massager’ as long as devotees could tell themselves that it was a medical device, rather than a sexual aid. Yeah, riiight…whatever gets ‘ya through the night people.
-Now, I should note something I learned while doing research for this blog: that supposedly, while this practice of medical professionals using a vibrator to bring women to climax was common, it was not done for a female hysteria diagnosis, as there supposedly was no such animal. So there ‘ya go, now ‘ya know.
-After these vibrators made their debut in the earliest porn films, husbands soon realized what their wives were up to all the time, and they put a stop to it. Of course they did! Because as every man of that era knew, the last thing you wanted was a sexually satisfied wife… total bullshit.
-Trust me people, I’m a doctor: a partner that’s satisfied in every aspect of life is actually the thing you should want more than anything else in the history of things in the whole wide world. If you’re wondering why, (re-)read my orgasm blog.
-Depends on whose history books you read, but the accepted invention date was around 1560-ish.
-Going by a strictly modern definition, the first reliable record of condom use doesn’t appear until 1564.
-Regardless, in Japan and China, ‘condoms’ made from various animal membranes were in use before the 15th century. I use ‘quotes’ because there’s really no telling what they were called.
-Japan favored tortoiseshell, but then later thin leather, to make them. In China they were made out of oiled paper or lamb intestines. Neither differed much from condoms in later centuries that were made out of linen or animal intestine.
-They were typically one-size-fits-all – sorry “Magnum” men – and they had to be dipped in water before use to make them pliable. Hmmm… pleasure fit.
-In the 16th century, condoms were used primarily to prevent STD’s like syphilis, as it was typically fatal. So whatever they called them, they may have saved some lives. That is until… Duhn Dun Duuuhhhnnn!!!
-The discovery of spermatozoa in the 17th century changed everything forevermore. -The Church became outraged over the use of any barrier that could impede the progress of men’s little swimmers as they attempted to reach and fertilize a golden egg.
-As a result, by the 18th century, the condom’s reputation amongst medical professionals had been firmly cemented as a tool for philanderers, prostitutes, and the immoral.
-Despite this condom condemnation, they actually proved to be quite popular among the upper and middle classes of the day. The beleaguered working classes finally gained access to them after the vulcanization of rubber, round about 1839… another Goodyear and good year. And also what undoubtedly led to the ubiquitous term recognized ’round the world… ‘rubbers.’
Penis (Cock) Rings
-Invented in China in about 1200 A.D.
-These have undergone few changes or innovations in their history. If it ain’t broke…
-Evidently, being ancient Chinese nobility was not an easy job. Not only did you have to put up with assassination plots and Mongol invaders, you were also expected to service your wife, mistresses, and concubines… all on a regular basis.
-While it sounds like fun and games, there was an urgent reason behind it: if you didn’t produce an heir, you could be pretty sure some obscure prince was going to step up to take his shot at a coup.
-In stressful circumstances, performing can become… well… difficult, people!
-But have no fear – penis rings are here! -First made from the upper and lower eyelid rings of a goat, with the eyelashes still attached (freaking ouch!) it helped the wearer get on with the business of impregnation for hours on end, even if he was secretly crying on the inside. And I’ll bet he was.
-While primarily made for purposes of sexual enhancement, they were later made from carved ivory and jade to also be worn for aesthetic adornment. No matter how pretty it is, I betcha they still hurt like hell.
-For a brief period inspired by sexual repression, these rings were also designed specifically for the purpose of preventingerections and sexual exploits by inflicting pain with constriction or spikes.
-This is interesting, because it really demonstrates the clear link between pleasure and pain, even waaay back in dynastic China… tres 50 Shades. Interesting though it may be, I’ll take a hard pass on the pain part of that equation, thank you very much people. Debbie and I have no Christian and Anastasia tendencies at all.
-In reality, the basic form and function of these rings have remained quite unchanged, though they are now made in softer, less painful materials and in adjustable models as well.
-AKAs: Ben Wa Balls, Burmese Balls
-Origins are uncertain and incomplete
-What we know: they appeared in the Orient sometime around A.D. 500 and were originally used to pleasure men.
-Women soon (somehow) caught on to the benefits (?) of the device, and the balls went supernova.
-Recorded across most Asian cultures, Geisha Balls were the “Rabbit” of their day: a toy that could heighten pleasure during sex, or simply facilitate some good old-fashioned self-pleasure.
-Popularized in Third Century A.D.
-The Kamasutra was many things: a manual for living, a treatise on sex, and likely the earliest recorded scam. Why? I’m glad you asked: because in it, they describe a method for making a penis larger. How? I’m glad you asked: by catching wasps, and- stingers and all- rubbing them all over the penis, being very careful not to crush and kill them before they angrily sting the entire shaft and head of the penis. Or, some people say you could also simply grasp each wasp and apply its stinger to the skin of the penis- and then repeat that action until you’ve managed to cover it completely. Does it work? I’m glad you asked: technically, yes… but the enlargement you get would only be courtesy of the swelling caused by the poison stinger, and I’m quite sure that using the penis for intercourse in that condition would be painful as hell, certainly sufficient enough to prevent you from doing so. In reality, the efficacy of this “treatment” in making the penis larger is questionable at best, and lethal at worst, if that’s how one discovers they happen to have a severe anaphylactic reaction to wasp stings, and would be very temporary in any case… So it would only work about as well as the tub o’ enlargement cream that Junior High boys buy online after sneaking dad’s credit card.
-There is an alternative of sorts, to increase the girth of a penis. What is it? I’m glad you asked: Apadravyas. What the hell are those? I’m glad you asked: apadravyas are a type of deep penis shaft piercing. *Warning: cross your legs, penis people!* These piercings pass through the penile shaft at certain specific points and apparently function to make the penis feel larger as it enters the vagina – or so devotees claim.
-These girth piercings come in other forms based on where they are placed through the shaft.
-In addition to apadravyas, other forms of these piercings are called ‘deeply placed ampallangs’ and ‘reverse shaft Prince Alberts.’ Well hell, that clears it right up… not!
-These deep penis shaft piercings are fairly rare piercings due to (helll-ooo!!) their associated pain, difficulty, bleeding, and long healing times.
-Common placement is directly behind the head of the penis, but they can be placed farther back if the (completely batshit crazy) man so desires.
-In the interest of research (heh heh) I had to ask Debbie if she would have intercourse with a dude with an apadravyas. I can’t describe the look she gave me, because words just can’t go there, and I can’t tell you exactly what she said… but it sounded a lot like “what the muck is a applegravys and what does it have to do with mucking some dude?!” After I enlightened her, I repeated my question: “…so would you have intercourse with a dude with an apadravyas?” I can’t tell you what she said, because she didn’t say anything… she just set her face in an ‘ewww, what the hell stinks?’ expression and shivered… an impressive, full body-length shiver, starting from the blonde hairs on the very top of her pretty head and carrying down to the very tips of her perfectly manicured pink toenails. After this shiver response, she started to turn and walk away, but then turned back to add “Just to be clear… I would never (word that sounds like muck) a dude with an applegravys in his (word that sounds like lick) – not even after a tetanus shot! I love my wife, so it’s my duty to keep her on her toes, however I find it fit to do so. That’s how I see it anyway… can I get an amen?! Anyway, so it was for her own good that I asked (read: yelled after her as she left) in my very best Austin Powers voice “…so you’re saying it really turns you on, huh baby?” And what did I get for all of my concern? A Debbie triple: an eye roll-tongue tisk-whut-everrr! As you can imagine, it’s a classic at my house.
-Sometime and somewhere – evidently, actually everywhere in Ancient Greece.
-Given their reputed penchant for orifices that don’t naturally lubricate, it should come as no surprise that the Greeks were into lube.
-While no record exists of its earliest use, we do know that by 350 B.C., olive oil was big business… and it wasn’t just for salads, o-kaaay?
-Aristotle makes a passing reference to this olive oil love in his History of the Animals, implying that smoother sex was best because it made pregnancy less likely. Suurre…
-Two centuries later, physician Soranus echoed Aristotle’s views on olive oil as lube. Seriously?! A Greek dude named Sore-anusthat’s into olive oil lube? Duh! This has got to be a joke. Albeit a hilarious one!
-Sore-anus’ friends- Herodotus, Plutarch, and Ovid- evidently agreed wholeheartedly, and all maintained that Athens got its name because the goddess Athena herself gifted its founders with an olive tree… that’s how much they loved olive oil.
-Greeks were clearly keen on material innovations. In an effort to upgrade from hard (not to mention dangerous and so very uncomfortable) materials like stone, dried tar, and wood, the Greeks developed olisbokollikes- these were essentially dildos baked out of bread. They basically made breadsticks, people. Breadstick dildos…a whole new take on “food porn.”
-I don’t know why, but whenever I think about Greeks, I automatically think Romans, so I don’t want to leave them out… the Romans were innovators as well during this time. They’re actually known for creating the double-ended dildo, which was regularly used between partners and friends, but was also even used during certain public ceremonies. Roman exhibitionists… that’s amore, people!
….And speaking of dildos
-Archaeologists discovered an eight inch stone behemoth in Germany, dated at 28,000 years old, people!
-The dildo may well be humanity’s most durable invention, as only fire, weapons, clothing, and beads appear to have been around longer.
-Evidently, archaeologists find dildos on digs all the time: it’s almost as if people in the prehistoric era found sex to be a natural and enjoyable thing that they didn’t have to be ashamed of. No shame in their game people.
…And speaking of no shame: Pornography
-Years ago, archaeologists uncovered a decidedly pervy prehistoric statue carved from a mammoth tusk. Who knew that archeology could be so titillating?
-It was basically a female torso with… hmmm- how to put this… ‘exaggerated’ sexual parts on top and bottom.
-It was a toy- a sex toy- and it was also functional pornography! A two-fer people!
-The exact age of it is uncertain, but the best guess places it at over 35,000 years old.
-That means it may even pre-date religion. That’s big, people.
-Obviously, the history of religion is essentially educated guesswork, so lots of eggheads argue about it, but if you assume it’s true- that this pervy porno sex toy pre-dates religion- can you understand the implication of that?
-In case you can’t, I’ll help you out: that would mean that before humans bothered with their ‘trivial’ thoughts on the meaning and creation of life, they had already figured out all the things that turned them on and got them off, and were producing toys and paraphernalia to make it easier and more gratifying to do so. Talk about priorities, people.
Clearly, human beings have been exploring sexuality since the dawn of time, and as it turns out, sex toys and sex paraphernalia have been around for just as long. The above glimpse at their design histories offers a strange and often hilarious look at humans’ constant quest for innovation and better…. connection, let’s say.
Okay people, this blog has been a long one, but you hung in there (hahaha I’m on a roll here!!) and I like to reward good behavior. So, speaking of hilarious, I found a page from a UK-based global sex toy company called Lovehoney (Lovehoney.co.uk) where they sell stuff that might blow your mind…but the following will sooner bust your gut: it’s their list of the 101 funniest Lovehoney site searches (look for occasional commentary from me, MGA people!)
101 Funniest Searches on our Sex Toy Site
Quoted from Lovehoney page:
There have been 6.9 million unique searches on Lovehoney.co.uk in the year to date. Most of the words that are typed into the search box at the top of our site are pretty straightforward: cock rings, vibrators, and all the other types of sex toys we sell. And when customers type in a phrase, we try to present them with the product or page they’re looking for. Simple. But!!! Some of the searches are not quite what you’d expect…
Ummm… Sorry, no page for that!
Or any of the below, which are just 101 of the funniest, weirdest, and ‘whoops you’re on the wrong website’ searches we’ve found!
Typos and epic auto-correct fails…
1. make your duck longer
2. election enhancer (MGA: we’ll all need this come November people!)
3. cockfosters extension
4. pension extender (MGA: where can I sign up for this?)
5. masterbakers for male
6. master storyteller sleeves
7. prostate lasagne (MGA: not what your Italian grandma serves for Sunday supper, thank you God)
8. blowtorch stroker
9. extra quiet clitoris
10. quiet rabbi
11. g spotify
12. large g snot rabbit
13. vibe eating butt plug
14. king clock dildo
15. breaded dildo (MGA: ditto last comment)
16. jelly bilbaos
17. rubber dodos (MGA: and scientists claim they went extinct)
18. nipped pasty
19. nipple gardening cream
20. or gasman creams
21. pies for woman to get horny (MGA: we need to introduce this lady to Mr. 5 ^)
22. parents ribbed and dotted
23. bondage ape (MGA: our ASPCA would never allow those here)
24. lego restraints (MGA: I remember looking for that set. People really snapped ’em up at Christmas time!)
25. clint clamp
26. sexist enhancer (MGA: ‘Ah-hem, I’m afraid I couldn’t purchase these again for you, Mr. President’)
27. £3 sex tits (MGA: that’s only $3.75 USD…can’t be very BIGsex tits)
Somebody’s got the sex toy blues…
28. argue dildo
29. be warned balls
30. begging set
31. bitterly kiss
32. bleak lace lingerie
33. blue worthless knickers
34. fifty shades of greed
35. cock extinction
36. fleshlight insults
38. hate based lubricant
39. male sick vibrator
40. male wasterbators (MGA: masturbating stoner guys)
41. vaginal fighting cream
42. ben war balls
43. very berating pants
44. misery bundle
45. pensive sleeve
46. performance kills
47. remorse egg
48. repent rabbit
49. undead wear
50. ruthless panties
51. sorry panties
52. worthless dispenser panties
We do NOT sell these…
53. bishop vibrator
54. barman vibrator
55. cricket vibe
56. turnip vibrator (MGA: for the very strict vegan)
57. parsnip vibrator (MGA: okay, somebody clearly thinks they’re a comedian. I make the jokes here, people!)
58. vibrators with noodles
59. bike saddle dildo
60. pogo stick dildo
61. glasses with testicals snaped to them
62. Darth vader condom
63. extra sting condoms
64. pickled onion condoms
65. chicken tikka masala condoms (MGA: it’s past somebody’s dinnertime)
66. lovehoney wine
67. extra wine vibrator
68. make-up sperm coconut
69. paperami lube
70. Love twiglets
71. family guy sex doll
72. Japanese dancing pants
73. loyal pyjamas
74. machine guns
Going somewhere? You’re on the wrong site… (MGA: if I had captioned this, it would’ve been: “Sorry – we’re all about coming, not going…”)
75. gloucestershire bus timetables
76. london to whitehaven train times
77. meeting point in bangkok airport
78. walking trails in east falmouth
79. bike rack inside caravan
80. staying in a hotel in alton towers
81. is drinking allowed on coaches
82. parrot sale in india
83. North Korea (MGA: there’s a Kim dynasty joke in there somewhere)
Nope, we’re not a grocery store…
84. andrex supreme quilted toilet roll tissue paper
85. fairy non bio pods sensitive skin washing capsules
86. gaviscon double action mint tablets
87. roasted cauliflower with parmesan cheese
88. serrano ham
Just plain weird…
91. Peter from gravesend – timewaster
92. hide your drink in bra
93. mild penis
94. mild vagina
95. outpouring vegan
96. room of priests
97. scrotal parachute (MGA: I know they stretch as we age, but wow…that’s gotta be impressive)
98. the loo of love (MGA: must’ve missed that position in the Kamasutra)
And finally this person, who clearly knows exactly what they want…
101. a silicone butt plug for beginer one my wife can leave in her ass n get on with housework shaped without risk of it falling out
(MGA: alert the media people… I’m speechless!!)
That’s some of the history and background on sex toys. In the next couple of weeks, I’ll be covering more interesting details and specifics on sex toys that you won’t want to miss, so be sure to come on back for more, people.
I hope you really enjoyed this blog and maybe even found it to be slightly more titillating than the usual fare. If so, please feel free to spread the love and share it with family and friends…. and lovers of course! And be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more fabulously educational topics and patient stories, and is available in office and on Amazon.
Thank you and be well people!
Opioids: History, Use, Abuse, Addiction
How Did We Get Here?
Anchored in the history, culture, religion, mythology, biology, genetics, and psychology of the earliest civilizations to the societies of present day, humans have long tried to balance the positive medicinal properties of opioids with the euphoric effects that have so often led to their use and abuse.
Before we get into their history, first a quick fyi lesson in the semantics of the terms opiates vs opioids vs narcotics. While the terms are often used interchangeably, they are technically different things.
The term opiate refers to any drug that is derived from a naturally occurring substance, ie from opium alkaloid compounds found in the poppy plant. Types of opiate drugs include opium, codeine, and morphine. The term opioid is broader, and refers to any synthetic or partially synthetic drug created from an opiate. Examples of opioid drugs include heroin, methadone, oxycodone, and hydrocodone. Narcotics is an older term that originally referred to any mind altering compound with sleep-inducing properties.
For the general public, only the term opioid is really necessary, as it includes all opi- substances. In my practice and in my blogs, I sometimes make a distiction between the terms, but if you’re looking for a safe bet, or maybe a trivia win, the term opioid is the best and most accurate choice. Regardless of the word used, one is not any safer than the other; any opiate or opioid has the potential to treat pain, to be abused, and to cause dependence.
Following are some of the most common opioids and their generic names, listed in order of increasing strength.
Hydrocodone (Vicodin, Hycodan)
Morphine (MS Contin, Kadian)
Oxycodone (Oxycontin, Percocet)
History of Opiates
A long, long time ago, opiate use began with Papaver somniferum, otherwise known as the opium poppy. Native to the Mediterranean, it grew well in subtropical and tropical regions fairly easily, a fact that contributed to its historical popularity. Unripe poppy seed pods were cut, and the milky fluid that seeped from the cuts was scraped off, air-dried, and treated to produce opium.
In case you’re wondering… today, legal growing of opium poppies for medicinal use primarily takes place in India, Turkey, and Australia. Two thousand tons of opium are produced annually, and this supplies the entire world with the raw material needed to make the medicinal components. Papaver somniferum plants grow from the very same legal and widely available poppy seeds found in today’s many seed catalogues. But, planting these seeds is less legal, with the DEA classifying them as a Schedule II drug, meaning that technically, they can press charges against anyone growing this poppy variety in their backyard. You can ask this one dude in North Carolina about it, as he was busted for having one acre of these big blooming beauties behind his house. At about 9 feet tall and topped with big red blooms, they’re not exactly inconspicuous. Another grow was discovered after an Oregon state patrol officer stopped to look at a field of beautiful “wildflowers,” wanting to cut a bouquet for his wife… a story that I personally find totally hilarious. Evidently, when he cut the first one, he was surprised by the sap that got all over his hands, so instead of taking some home to his wife, he took one to a fellow cop friend that was big on horticulture, and she enlightened him on what it was. Good thing too, because he had even thought about how cool it would be to dry the “wildflowers” to seed and plant them in his side yard! You just can’t make this stuff up.
Archaeologists have found 8,000 year-old Sumerian clay tablets that were really the earliest “prescriptions” for opium. The Sumerians called the opium poppy “Hul Gil,” meaning the “Joy Plant,” which was regularly smoked in opium dens. Around 460-357 B.C. Hippocrates, known as the “Father of Medicine” acknowledged opium’s usefulness as a narcotic, and prescribed drinking the juice of the poppy mixed with nettle seed. Alexander the Great took opium with him as he expanded his empire- it’s surprising that he was so great, because some accounts seem to suggest that he was a raging addict. Arabs, Greeks, and Romans commonly used opium as a sedative, presumably for treating psychiatric disorders. In the 15th and 16th centuries, Arabic traders brought opium to the Far East. From there, opium made its way to Europe, where it was used as a panacea for every malady under the sun, from physical ailments to a wide variety of psych issues. Biblical and literary references, and opium’s use by known and respected writers, leaders, and thinkers throughout history, including Homer, Franklin, Napoleon, Coleridge, Poe, Shelly, Quincy, and many more, made opium use perfectly acceptable, even fashionable.
19th Century Opiates to Opioids
There was a lot of unrest and violence around the globe throughout the 1800’s. Wounded soldiers from the American Civil War, British Crimean War, and the Prussian French War were basically allowed to abuse opium. And sure enough, beginning in the 1830’s, one-third of all lethal poisoning cases were due to opium and its opiate derivatives, and this really marked the first time that a “medicinal” substance was recognized as a social evil. Yet, most places around the world still really turned a blind eye to opium and opiate use. But, so many soldiers developed a dependency on opiates that the post-war addiction state was commonly known as “soldier’s disease.”
In 1806, German alkaloid chemist Friedrich Wilhelm Adam Sertürner isolated a substance from opium that he named “morphine,” after the god of dreams, Morpheus. The prevailing wisdom for creating morphine was to maintain the useful medicinal properties of opium while also reducing its addictive properties. Uh huh, sure. In the United States, morphine soon became the mainstay of doctors for treating pain, anxiety, and respiratory problems, as well as consumption and “female ailments,”
(that’s old-timey for tuberculosis and menstrual moodiness/ cramps) In 1853, the hypodermic needle was invented, upon which point morphine began to be used in minor surgical procedures to treat neuralgia (old timey for nerve pain). The combination of morphine and hypodermic needles gave rise to the medicalization of opiates.
Well, morphine turned out to be more addictive than opium, wouldn’t ya know it. So, as with the opium before it, the morphine problem was “solved” by a novel “non-addictive” substitute. Of course… I mean, what could possibly go wrong? Your first clue is that this novel compound was the first opioid, and was called heroin. See where this is going? First manufactured in 1898 by the Bayer Pharmaceutical Company of Germany, heroin was marketed as a cough suppressant, a treatment for tuberculosis, and a remedy for morphine addiction. Well, as you can probably guess, that worked great, until heroin proved to be far more addictive than morphine ever thought of being. So what to do? Hmmm… what…to…do… I know! Let’s make a “non-addictive” substitute for the heroin! That’s the best plan, definitely.
20th Century: Opiates to Opioids
By the dawning of the 20th century, the United States focused on ending the non-medicinal use of opium. In 1909, Congress finally passed the “Opium Exclusion Act” which barred the importation of opium for purposes of smoking. This legislation is considered by many to be the original and official start of the war on drugs in the United States. Take that, Nancy Reagan! In a similar manner, the “Harrison Narcotics Tax Act of 1914” placed a nominal tax on opiates and required physician and pharmacist registration for its distribution. Effectively, this was a de-facto prohibition of the drug, the first of its kind.
In 1916, a few years after Bayer stopped the mass production of heroin due to the dependence it created, German scientists at the University of Frankfurt developed oxycodone with the hope that it would retain the analgesic effects of morphine and heroin, but with less physical dependence. Of course they did, because this worked out so swimmingly before. What could possibly go wrong?
Well, we know how this story turns out.
First developed in 1937 by German scientists searching for a surgical painkiller, what we know today as methadone was exported to the U.S. and given the trade name “Dolophine” in 1947. Later renamed methadone, the drug was soon being widely used as a treatment for heroin addiction. But shocker… unfortunately, it too proved to be even more addictive than its predecessor heroin. Captain Obvious says he’s sensing a trend here.
In the 1990’s, pharmaceutical companies developed some new and especially powerful prescription opioid pain relievers. They then created some equally powerful marketing campaigns that assured the medical community that patients would not become addicted to these drugs. Gleefully, docs started writing for them, and as a result, this class of medications quickly became the most prescribed class in the United States- even exceeding antibiotics and heart medications- an astounding statistic. Well, we now know that the pharma co’s were full of crap: opioids were (and still are) the most addictive class of pharmaceuticals on the planet… and so in the late 90’s, the opioid crisis was born.
Opioids: True and Freaky Facts
The real fact is that 20% to 30% of all patients who were/ are prescribed opioids for chronic pain will misuse them. Further, studies on heroin addicts report that 80% of them actually began their addiction by first misusing prescription opioids. That’s a big number people, but I think it’s actually higher. Food for thought for all the pill poppers out there saying ‘I’ll never use a street drug like heroin.’ And speaking of that, by the turn of the 21st century, the mortality rate of heroin addicts was estimated to be as high as twenty times greater than the rest of the population. Twenty times, people.
Opioid Addiction and Overdose
Opioids produce a sense of wellbeing or euphoria that can be addictive to some people. Opioids are often regularly and legitimately prescribed by excellent, well-meaning physicians when treating patients for severe pain. The problem is that even when taken properly, many people develop tolerance to these opioids, meaning they need more and more to get the same effect and relieve their pain. That’s just one factor that makes them so insidious. In addition, we cannot predict who will go down this tolerance and potential addiction path, because it can happen to anyone who takes opioids. However, there are some factors that make people more susceptible to addiction, such as the presence/ prevalence of mood disorder(s) and especially a genetic/ familial history of addiction, which contributes to nearly 50% of abuse cases.
When people become addicted to opioids, they begin to obsessively think about ways they can obtain more, and in some cases they engage in illegal activities, such as doctor shopping, stealing prescriptions from friends and family, and/ or procuring them on the street.
Another insidious facet of tolerance is that the tolerance to the euphoric effect of opioids develops faster than the tolerance to the dangerous physical effects of taking them. This often leads people to accidentally overdose as they chase the high they once felt. In this attempt to get high, they take too much and overdose, dying of cardiac or respiratory arrest. Drug overdose is the leading cause of accidental death in the United States, and there are more drug overdose deaths in America every year than deaths due to guns and car accidents combined. According to the CDC, 2019 drug overdose deaths in the United States went up 4.6% from the previous year, with a total of 70,980 overdose deaths, 50,042 of which were due to opioids.
There’s a kahuna in Opioidland that’s so big and so bad that it bears a special mention… fentanyl. Referencing the above statistics, of the more than 50,000 opioid overdoses, fentanyl is specifically indicated in more than 20,000 of those fatalities. Again, I think it’s way higher than that. Regardless, I think we can all agree that it’s deadly. Fentanyl is so crazy dangerous because it is 50 to 100 times more potent than morphine, so it takes the teeny tiniest amount to overdose. A lethal dose of fentanyl for adults is about two milligrams- that’s the equivalent of six or seven grains of salt people!
Obvi, there are tons of chilling statistics about fentanyl, but here’s another one for you: in one-third of fentanyl overdoses, the individual died within seconds of taking it. Get this- they died so quickly that their body didn’t have enough time to even begin to metabolize the drug, so no metabolites of fentanyl were found on toxicology screens at the time of autopsy. The moment you ingest or inject any drug/ pharmaceutical, the body immediately begins to break it down into components called metabolites. After a certain period of time (which varies according to many different factors) the drug is completely metabolized by the body, so a toxicology screen will pick up those metabolites rather than the complete molecule(s) of the drug. Every drug has a known rate of metabolism, so tox tests can tell how long ago a drug was used or ingested. This data is saying that in one-third (33%) of fentanyl overdose deaths, tox screens pick up zero metabolites, because the body had no time to even begin to start the process of making them. The screens detected the presence of the full complete molecule(s), but no breakdown products. It’s a very significant and scary hallmark of fentanyl use/ abuse/ overdose: the fact that you may not live long enough to regret using it.
How did fentanyl become such a big part of the opioid epidemic? Around 2010, docs were getting smart to the use and abuse of opioids and the ensuing crisis, and many stopped prescribing them. This left a lot of addicted people, including many who legitimately required relief from pain, unable to get prescriptions and SOL. At the same time, buying prescription drugs on the street was crazy expensive due to increased demand and decreased supply. But also, heroin had became so abundant that it suddenly became cheaper than most other drugs, so addicts started to switch to heroin. In one survey, 94% of people in treatment for opioid addiction said they used heroin only because prescription opioids became much more expensive and harder to obtain.
Next, to make things exponentially worse, drug cartels discovered how to make fentanyl very cheaply, so huge quantities of fentanyl started flooding the market. Because fentanyl is easier to make, more powerful, and more addictive than heroin, drug dealers recognized the opportunity, and began to lace their heroin with fentanyl. People taking fentanyl-laced heroin are more likely to overdose, because they often don’t know they’re taking a much more powerful drug. Fentanyl can be manufactured in powder or liquid forms, and it can be found in many illicit drugs, including cocaine, crack, and methamphetamine. And let’s face it folks, the people making this garbage aren’t exactly rocket scientists, so all of these drugs can (and usually do) contain toxic contaminants and/ or have different levels of fentanyl in each batch, or even varying levels within the same batch. These facts just add to the lethal potential of this stuff.
Now fentanyl has found its way onto the street in yet another form: pills. When fentanyl pills are created for the street, they’re pressed and dyed to look like oxycodone. Talk about insidious! If you go looking to buy oxy’s on the street and the dealer is selling them dirt cheap because they don’t know any better, or care is probably more accurate, you’ll probably think ‘Wow- these oxy’s are cheap! Let me get those!’ If your body is accustomed to using real oxy’s and you unknowingly take fentanyl, you will absolutely overdose. Like see ya later, bye overdose.
But believe it or not, it gets worse… A new variation of fentanyl is finding its way into the drug trade. Carfentanil is 100 times stronger than fenatanyl, which makes it 10,000 times more potent than morphine. While it was originally developed as an elephant tranquilizer (hel-looo??!!) the powdered form of carfentanil is now commonly used as a cutting agent in illicit drugs like heroin, cocaine, and methamphetamine.
Opioid withdrawal can be extremely uncomfortable. But an important thing to remember is that opioid withdrawal is not generally life threatening if you are withdrawing only from opioids and not a combination of drugs. This is because each drug class is pharmacologically different, so withdrawal is different for each one. FYI, the most dangerous withdrawls are from benzodiazepines (Valium, Xanax, etc) and alcohol, even though alcohol isn’t technically a drug, it reacts, is metabolized, and physically withdraws from the body like any drug. Individually, either can be lethal in withdrawl and require medical supervision.
Opioid Withdrawal Symptoms
Withdrawal typically includes the following symptoms to varying degrees:
Hot and cold sweats
Muscle aches and pains
Stages of Opioid Withdrawal
-The first phase (called acute withdrawal) begins about 12 hours after the last opioid use. It peaks at around 3 – 5 days, and lasts for approximately 1 – 4 weeks. This acute stage has mostly physical symptoms.
-The second phase (post-acute withdrawal) can last for a long time, with some references documenting up to two years. The symptoms during this phase are mostly emotional, and while they are considered less severe, they last longer.
Symptoms include mood swings, anxiety, variable energy, low enthusiasm, variable concentration, and disturbed sleep.
But, don’t let concern over withdrawl symptoms keep you from getting off of opioids. There are medications that can significantly decrease all of these. Two of the most common are methadone and buprenorphine. Being that drug detox is one of my specialties, in next week’s blog, I’ll outline both of these and tell you my reccommendations.
Now that we’ve covered the history and background on opioids, if you think you might have an opioid addiction, I have a separate quiz that will bring some clarity to you on that question. I will upload a more detailed assessment as a separate blog, but for now, here’s a short generalized screen to take first.
Do You Have an Opioid Addiction?
Answer yes or no to each of the following questions. If you answer yes to at least three of these questions, then you are likely addicted to opioids and should definitely take the detailed addiction self-assessment test which follows. I also suggest that you print the assessment and answers and take them with you for a professional evaluation.
Addiction: Basic Screen1) Has your use of opioids increased over time?2) Do you experience withdrawal symptoms when you stop using?3) Do you use more than you would like, or more than is prescribed?4) Have you experienced negative consequences to your using?5) Have you put off doing things because of your drug use?6) Do you find yourself thinking obsessively about getting or using your drug?7) Have you made unsuccessful attempts at cutting down your drug use?
Again, if you answered yes to at least three of these questions, then you are likely addicted to opioids and should take the detailed addiction self-assessment test which follows as a separate blog. Be sure to print both with you for a professional evaluation.
I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon.
Thank you and be well people!
Postpartum Depression: o
Signs, Symptoms, New Treatment?
Last week, we talked about sex and orgasms, so it seems only fitting that this week, I talk about the potential ‘homework’ that may come after the sex and orgasms: pregnancy… and the postpartum depression that may accompany it.
It is one of life’s greatest joys, and for me personally, the proudest moment of my entire life: the birth of a child. But no matter how much you love that baby or how you’ve looked forward to its arrival, having a baby is stressful on both parents for many reasons. However, there are specific reasons that make it more physically and emotionally taxing on mom. Captain Obvious says that there are many physical, emotional, and chemical changes in a woman’s body that allow them to (help) create, carry, and birth these little miracles. And add to that the onset of new responsibilities, sleep deprivation, and lack of time for any personal care, it’s not a big shock that lots of new moms get overwhelmed and feel like they’re on an emotional rollercoaster from hell. In fact, the mild depression and mood swings that are so common in new mothers have earned them a name, “the baby blues.” But how do you know if what mom is feeling goes beyond the blues? What should you look for, and when should you seek help?
The majority of women experience at least some symptoms of the baby blues immediately after childbirth. Why? It’s all down to female hormones: specifically, progesterone and estrogen, the big kahunas in the female hormone universe.
Progesterone’s role in pregnancy is so vital that it’s referred to as the “pregnancy hormone.” Actually, progesterone comes into play long before pregnancy, as it is one of the hormones secreted by the ovaries that governs ovulation and menstruation in post-pubescent women. Then upon conception, it gets the uterus ready to accept, implant, and maintain a fertilized egg, and it also prevents the uterine muscle contractions that would otherwise cause a woman’s body to reject it. During fetal gestation, it helps create an environment that nurtures the developing baby. It makes it sound like progesterone is in there painting, hanging curtains, and fluffing pillows, but its role goes way beyond that. The placenta, which is the structure inside the uterus that provides oxygen and nutrients to a developing baby, will itself begin to produce progesterone after about 8 to 10 weeks of pregnancy. At this point, the placenta increases progesterone production to a much higher rate than the ovaries ever thought about making. Those high levels of progesterone throughout the pregnancy cause the mom’s body to stop producing more eggs, as well as prepare her breasts to produce milk.
Also produced by the ovaries when not pregnant, and then later by the placenta during pregnancy, estrogen helps the uterus grow, maintains the uterine lining where the budding baby is nestled, steps up blood circulation, and activates and regulates the production of other key hormones. In early pregnancy, it also helps mom develop her milk-making machinery. And baby benefits too, as estrogen triggers the development of those teeny tiny organs and regulates bone density in those cute little developing arms that wave and legs that kick.
The increased levels of progesterone and estrogen during pregnancy actually make mom feel good and feel bonded to baby, even though she may be crying her eyes out for virtually no reason (sorry ladies) in the beginning. Levels of both hormones continue to increase as the pregnancy advances, and mom’s body actually gets used to these high levels. Then when the baby is born, there’s no more placenta, so mom’s progesterone and estrogen levels drop suddenly and precipitously, in a matter of hours. So mom goes essentially cold turkey from high hormone levels to comparatively no hormone levels. Sudden hormonal change + stress + isolation + sleep deprivation + fatigue = tearful + overwhelmed + emotionally fragile mom. Generally, these feelings can start within just the first day or so after delivery, peak at around one week, and taper off by the end of the second, third, or maybe up to the fourth week postpartum; that’s if it’s the baby blues.
These baby blues are perfectly normal, but if symptoms are extreme, don’t go away after a month, or get worse, mom may be suffering from postpartum depression and likely needs help.
Postpartum Signs & Symptoms
Though they share some symptoms, postpartum depression is a much more serious problem than the baby blues, and should never be ignored. Shared symptoms of the two include mood swings, crying jags, sadness, insomnia, and irritability.
Postpartum depression is the most common complication of childbearing, and it occurs in 10% to 20% of all moms after delivery. It is different from the baby blues in that the symptoms are more severe and longer lasting. It is an issue that can’t be blown off or underestimated, because it begins at a critical time, when mom is caring for a helpless infant and needs to be bonding with them.
Symptoms of postpartum depression can include suicidal thoughts, an inability to care for the newborn child, and in extreme cases, even thoughts of harming the baby. Postpartum can be extremely debilitating, and certain signs can put the lives of mom and/ or baby in jeopardy.
Beyond the Blues
Common Red Flags for Postpartum:
-Mom withdraws from partner
-Mom’s unable to bond well with baby
-Mom’s anxiety gets out of control, preventing ability to sleep and/ or eat
-Mom feels guilty, worthless, useless, overwhelmed
-Mom seems preoccupied with death or wishing she were no longer alive
There’s no single reason why some new moms develop postpartum depression and others don’t, but a number of interrelated causes and risk factors are generally at play.
Postpartum Causes/ Triggers
Hormonal changes after childbirth cause fatigue and depression:
-Progesterone/ estrogen levels drop
-Thyroid levels can drop
-Changes in blood pressure, immune system functioning, metabolism
Numerous physical/ emotional changes after delivery:
-Physical delivery pain
-Difficulty losing baby weight
-Insecurity, especially in physical/ sexual attractiveness
Significant stress of caring for a newborn:
-Mom is sleep deprived
-Mom is overwhelmed/ anxious about her abilities to properly care for baby
-Mom has difficulty adjusting
All of the above factors are especially true in first time moms, as they must also get used to an entirely new identity at the same time.
Postpartum Risk Factors
Several factors can predispose a mom to suffer from postpartum depression:
-History of postpartum depression
A prior episode can increase the chances of a repeat episode by 30% to 50%.
-History of non-pregnancy related depression and/ or family history of mood disturbances
-Social stressors, including lack of emotional support, abusive relationship, and/ or financial uncertainty
-Significantly increased risk in women who discontinue medications abruptly for purposes of pregnancy.
Postpartum psychosis is an even more rare, and more extremely serious disorder that can also develop after childbirth. Characterized by a loss of contact with reality, postpartum psychosis poses an extremely high risk for suicide or infanticide, and hospitalization is nearly always required to keep both mom and baby safe. Postpartum psychosis develops suddenly, usually within the first two weeks after delivery, and sometimes within a matter of 48 hours.
Postpartum Psychosis Symptoms
Postpartum psychosis is considered a medical emergency requiring immediate medical attention.
-Hallucinations: seeing things and/ or hearing voices that aren’t real
-Delusions: paranoid, irrational beliefs
-Extreme agitation and anxiety
-Suicidal thoughts or actions
-Confusion and disorientation
-Rapid mood swings
-Inability or refusal to eat or sleep
-Thoughts of harming or killing baby
There is a screening tool that can be used to detect postpartum depression, called the Edinburgh Postnatal Depression Scale. I will put the questions and explain the scoring of this scale at the conclusion of this blog. It can be helpful if mom or partner isn’t quite sure if symptoms are the baby blues or true postpartum depression.
Coping with Postpartum Depression
Four Tips for Moms:
1) Create a secure attachment with baby.
The emotional bonding process between mom and child, known as attachment, is the most important task of infancy. The success of this wordless relationship enables a child to feel secure enough to develop fully, and affects how he or she will interact, communicate, and form relationships throughout their entire lives.
A secure attachment is formed when moms respond warmly and consistently to baby’s physical and emotional needs. When baby cries, quickly soothe them. If baby laughs or smiles, respond in kind. In essence, the goal is for mom and baby to be in synch, and to be able to recognize and respond to each other’s emotional signals.
Postpartum depression can interrupt this bonding. Depressed moms can be loving and attentive at times, but at other times may react negatively or not respond at all. Moms with postpartum depression are generally inconsistent in their care, and tend to interact less with their babies; they are also less likely to breastfeed, play with, and read to them. Postpartum is sinister in this way, as learning to bond with baby not only benefits the child, it also benefits mom by releasing endorphins that make mom feel happier and more confident. By its very presence, postpartum makes the bonding process difficult, and therefore mom is less likely to produce those endorphins that would make her feel better. It’s a vicious cycle.
If mom didn’t experience a secure attachment as an infant, she may not know how to create a secure attachment as a mom. However, this can be learned, as human brains are definitively primed for this kind of nonverbal emotional connection that creates so much pleasure for both mom and baby.
2) Lean on others for help and support.
Human beings are social creatures. Positive social contact relieves stress faster and more efficiently than any other means of stress reduction. Historically, and from an evolutionary perspective, new moms have typically received help from those around them after childbirth. In today’s world, new moms often find themselves alone, exhausted, and lonely for supportive adult contact.
Ideas to better connect with others:
-Make relationships a priority. When feeling depressed and vulnerable, it’s more important than ever to stay connected to family and friends, even if you’d rather be alone. Isolating will only make the situation feel even bleaker, so make adult relationships a priority. Let loved ones know your needs and how you wish to be supported.
-Don’t hide feelings. In addition to the practical help that friends and family can provide, they can also serve as a much-needed emotional outlet. Share experiences- good, bad, and ugly- with at least one other person, and preferably face to face. It doesn’t matter who mom talks to, so long as that person is willing to listen without judgment and offer reassurance and support.
-Be a joiner. Even if mom has supportive friends, she may want to consider seeking out other women who are dealing with the same transition into motherhood. It’s very reassuring to hear other mothers share the same worries, insecurities, and feelings. Good places to meet other new moms include support groups for new parents or organizations such as ‘Mommy and Me.’ Pediatricians can also be excellent neighborhood resources.
3) Take care of yourself. One of the best things moms can do to relieve or avoid postpartum depression is to take care of themselves. The more moms care for their mental and physical well-being, the better they’ll feel.
Simple lifestyle changes can go a long way toward helping moms feel more like themselves again.
-Skip the housework. Make yourself and baby the priority, and give yourself the permission to concentrate on just that. Remember that being a 24/7 mom is far more work than holding down a traditional full-time job.
-Ease back into exercise. Studies show that exercise may be just as effective as medication when it comes to treating depression, so the sooner moms get back up and moving, the better. No need to overdo it: a 30-minute walk each day will work wonders. Stretching exercises, like those found in yoga, have shown to be especially effective.
-Practice mindfulness meditation. Research supports the effectiveness of mindfulness for making moms feel calmer and more energized. It can also help moms become more aware of what they feel and need.
-Don’t skimp on sleep. A full eight hours may seem like an unattainable luxury when dealing with a newborn, but poor sleep makes depression worse. Moms must do whatever they can to get plenty of rest- from enlisting the help of the partner or family members, to catching naps at every opportunity.
-Set aside quality time for yourself to relax and take a break from mom duties. Find small ways to pamper yourself, like taking a bubble bath, savoring a hot cup of tea, lighting scented candles, or getting a massage at a day spa, or even calling a masseuse to come to you.
-Make meals a priority. Nutrition often suffers during depression. What mom eats has an impact on her mood, and also the quality of breast milk the baby requires, so always make the best effort to establish and maintain healthy eating habits, for yourself and baby.
-Get out in the sunshine. Sunlight lifts the mood, so try to get at least 10 to 15 minutes of sun each day.
4) Make time for your relationship with your partner. More than half of all divorces take place after the birth of a child. For many men and women, the relationship with their partner is their primary source of emotional expression and social connection. The demands and needs of a new baby can get in the way and fracture this relationship, unless couples put time, energy, and thought into preserving their bond.
-Don’t scapegoat. The stress from nights of no sleep and new or expanded responsibilities can leave parents feeling overwhelmed and exhausted. It’s all too easy to play the blame game and turn frustrations onto your partner. Instead of finger pointing, remember that you’re in this together. If you tackle parenting challenges as a team, you’ll find that you’ll become an even stronger unit.
-Keep the lines of communication open. Many things change following the birth of a baby, including roles and expectations. For many couples, a key source of strain is the post-baby division of household and childcare responsibilities. It’s important to talk about these issues, rather than letting them fester. Don’t assume your partner has a crystal ball or knows how you feel or what you need, because you’re bound to feel perpetually disappointed and frustrated if you do.
-Carve out couple time. It’s essential to make time for just the two of you when you can reconnect. But don’t put pressure on yourself to be romantic or adventurous, unless you’ve discussed it and found you’re both game. And you don’t need to go out on a date to enjoy each other’s company. Just spending even 15 or 20 minutes together, undistracted and focused on each other, can make a big difference in how close you feel to each other.
Treatment for Postpartum Depression
If, despite self-help and the support of family, mom is still struggling with postpartum depression, it’s best to seek professional treatment.
-Individual therapy/ marriage counseling A good therapist can help moms deal better with the adjustments of motherhood. If moms or partners are experiencing marital difficulties or are feeling unsupported at home, marriage counseling can also be very beneficial.
-Antidepressants. In postpartum cases where mom’s ability to function adequately for herself or baby is compromised, antidepressants may be an option, though they are more effective when accompanied with psychotherapy. Obviously, medication must be closely monitored by a physician.
-Hormone therapy: Estrogen replacement therapy can sometimes be helpful in combating postpartum depression, and is often used in combination with an antidepressant. There are risks that go along with hormone therapy, so moms must be sure to talk to their doctor about what may be best, and safest, for them.
Helping New Moms with Postpartum
If your loved one is a mom experiencing postpartum depression, the best thing you can do is to offer support, give her a break from her childcare duties, provide a listening ear, and always be patient and understanding. But, be sure to take care of yourself too. Dealing with the needs of a new baby is hard for the partner as well as mom. And if your significant other is depressed, that means you are dealing with two major stressors.
Tips for Partners:
-Encourage mom to talk about her feelings. Listen without judgement and without making demands. Instead of trying to ‘just fix’ things, simply be there for mom to lean on.
-Offer help around the house. Chip in with the housework and childcare responsibilities, and don’t wait for mom to ask… trust me on this one!
-Make sure mom takes time for herself. Rest and relaxation are even more important after a new edition. Encourage her to take breaks, hire a babysitter, or schedule some date nights.
-Be patient if she’s not ready for sex. Depression affects sex drive, so it may be a while before mom’s in the mood. Offer her physical affection, but don’t push it if she’s not up for anything beyond that.
-Getting exercise can make a big dent in depression, but it’s hard for moms to get motivated when they’re feeling low. So do something simple, like going going for a walk with mom. Better yet, make walks a daily ritual for just the two of you, or for the whole family.
There is a fairly new breakthrough drug called Zulresso (brexanolone). Approved in 2019, Zulresso is a neuropathic drug, and first in its class. So what is it? Basically, it’s an aqueous (water-based) solution of progesterone products. They have taken the component product of progesterone and put it into solution; it is then administered to a new mom with postpartum depression. And then a miracle happens… seriously! This lifts postpartum depression like a kid does candy. It is a scientific breakthrough; never before have we had a drug that treats postpartum depression faster than any drug for any type of depression, ever. That’s the good news, but guess what comes next… the bad. While we know it works, very well and very quickly, there are some major disadvantages of this drug. The first one is that it can only be administered by IV infusion. So that means that you have to place an IV map into mom’s vein and drip the drug in with IV fluid. That brings me to the next big disadvantage: it can only be administered in a hospital setting. Why is that? Well, studies show that during administration, which takes place over about 60 hours, two and a half days, some moms can become very dizzy and faint, can lose consciousness, and can even stop breathing. For all of these reasons, moms must be medically monitored with an oximeter and telemetry for two and a half days, during which time they must be checked on every two hours. And they cannot be in charge of baby during this hospital stay, because they may be in and out of consciousness and/ or have severe respiratory issues. While that’s no bueno, the last disadvantage is muy loco, people. Are you ready? The drug costs $34,000. Yep. But wait, it gets better, which in this case, actually means worse. That little $34K is just for the drug! The hospitalization and monitoring costs more… a lot more. And to add insult to injury, you have to shell out the cash to pay for a sitter to watch baby, as mom could potentially be very busy losing consciousness and going into respiratory distress.
Needless to say, Zulresso is not used very much, even though it is an amazing breakthrough product, essentially curing the notoriously difficult-to-treat postpartum depression in a mere 60 hours. There are some other anti-depressants that work pretty well. Effexor (venlafaxine, desvenlafaxine) and Wellbutrin (bupropion) with antipsychotics like Abilify help to speed up the treatment process generally show some progress in about a week.
So while I’m very impressed with Zulresso as a novel, first-in-class drug, you can see my practical issues with it. Although, I suppose that everything is relative: if my wife were suffering from serious postpartum depression, to the point that she was suicidal, or the baby’s life was in danger, and it was refractory, meaning all other treatment options had been tried and failed, I would find a way to get the Zulresso treatment; I’d make it happen, by contacting the manufacturer for patient support options. Or maybe by selling a kidney. Whatever it took.
Edinburgh Postnatal Depression Scale
This 10-question self-rating scale has proven to be an efficient way of identifying patients at risk for “perinatal” or postpartum depression. While this test was specifically designed to be administered by a medical professional, to a woman who is pregnant or has just had a baby, it can be used as an effective at-home guide to determine if you or someone you care about has postpartum depression. Just make sure to follow all of your score’s corresponding action(s).
For each of the 10 questions, please check mark the answer that comes closest to how you have felt in the past 7 days. Scoring is explained after the questions.1) I have been able to laugh and see the funny side of things.
____ As much as I always could
____ Not quite so much now
____ Definitely not so much now
____ Not at all2) I have looked forward with enjoyment to things.
____ As much as I ever did
____ Rather less than I used to
____ Definitely less than I used to
____ Hardly at all3) I have blamed myself unnecessarily when things went wrong.
____ Yes, most of the time
____ Yes, some of the time
____ Not very often
____ No, never4) I have been anxious or worried for no good reason.
____ No not at all
____ Hardly ever
____ Yes, sometimes
____ Yes, very often5) I have felt scared or panicky for no very good reason.
____ Yes, quite a lot
____ Yes, sometimes
____ No, not much
____ No, not at all6) Things have been getting on top of me.
____ Yes, most of the time I haven’t been able to cope at all
____ Yes, sometimes I haven’t been coping as well as usual
____ No, most of the time I have coped quite well
____ No, I have been coping as well as ever7) I have been so unhappy that I have had difficulty sleeping.
____ Yes, most of the time
____ Yes, sometimes
____ Not very often
____ No, not at all8) I have felt sad or miserable.
____ Yes, most of the time
____ Yes, sometimes
____ Not very often
____ No, not at all9) I have been so unhappy that I have been crying.
____ Yes, most of the time
____ Yes, quite often
____ Only occasionally
____ No, never10) The thought of harming myself has occurred to me.
____ Yes, quite often
____ Hardly ever
SCORING VALUES AND GUIDE
Grade each of your checked answers with the specifically stated score, then add the scores together. Take that sum and apply to the interpretation/ action scale and follow the stated suggestion.1) I have been able to laugh and see the funny side of things
0 As much as I always could
1 Not quite so much now
2 Definitely not so much now
3 Not at all 2) I have looked forward with enjoyment to things
0 As much as I ever did
1 Rather less than I used to
2 Definitely less than I used to
3 Hardly at all 3) I have blamed myself unnecessarily when things went wrong
3 Yes, most of the time
2 Yes, some of the time
1 Not very often
0 No, never 4) I have been anxious or worried for no good reason
0 No, not at all
1 Hardly ever
2 Yes, sometimes
3 Yes, very often 5) I have felt scared or panicky for no very good reason
3 Yes, quite a lot
2 Yes, sometimes
1 No, not much
0 No, not at all 6) Things have been getting on top of me
3 Yes, most of the time I haven’t been able to cope
2 Yes, sometimes I haven’t been coping as well as usual
1 No, most of the time I have coped quite well
0 No, I have been coping as well as ever 7) I have been so unhappy that I have had difficulty sleeping
3 Yes, most of the time
2 Yes, sometimes
1 Not very often
0 No, not at all8) I have felt sad or miserable
3 Yes, most of the time
2 Yes, quite often
1 Not very often
0 No, not at all 9) I have been so unhappy that I have been crying
3 Yes, most of the time
2 Yes, quite often
1 Only occasionally
0 No, never 10) The thought of harming myself has occurred to me
3 Yes, quite often
1 Hardly ever
EPDS Score Interpretation/ Action
Score of 8 or less: depression not likely, but continue to seek support.
Score of 9 to 11: depression is possible, continue seeking support and re-screen in 2 to 4 weeks. Seriously consider appointment with primary care provider or established mental health professional.
Score of 12 to 13: fairly high possibility
of depression. Continue to monitor and seek support. Make appointment to see primary care provider or established mental health professional.
Score of 14 and higher: this is a positive screen for probable postpartum depression. Diagnostic assessment is required to determine appropriate treatment. See mental health specialist or primary care provider for referral to same.
Note: if there is any positive score (a rating of 1, 2, or 3) on question 10 (suicidality risk) definite immediate discussion and possible emergency management is required. Refer to primary care provider, mental health specialist, or emergency resource for further assessment and intervention as appropriate. The urgency of the referral will depend on several factors, including: whether suicidal ideation is accompanied by a plan, whether there has been a history of suicide attempt(s), whether symptoms of a psychotic disorder are present, and/ or if there is concern about harm to the baby.
So that’s all the news on postpartum depression. If you liked this, please share with friends and family. Look for new blogs here every Monday, and check out my book, Tales from the Couch, for more education and patient stories, available on Amazon.com. See my YouTube channel for new lectures- I post them all the time. And I’d appreciate it if you hit that subscribe button, people! Thanks everybody, be well.
Double your Pleasure: the Health Benefits of the Magical Mystical Orgasm
Once a topic strictly relegated to hushed conversations, research has taken the orgasm from bedroom to clinic, elucidating the many positive benefits of these happy endings. Great news, right? But before I get into that, I want to talk about the definition and history of the orgasm. What you don’t know might surprise you.
Because it’s hilarious, my favorite clinical description of orgasm is ‘a temporary state of neuromuscular euphoria and paroxysmal climax, often accompanied by vocalization, and generally with the ejaculation of semen in the male and vaginal contractions in the female.’
If you’ve ever wondered, the sensation of an orgasm is basically the same for men and women. This is because the penis and clitoris are homologous organs, meaning they arise from the same tissue in a developing embryo. Whichever part you have is connected to the spinal cord, and hence the brain, through a pair of nerves called the pudendal nerves. It’s a horrible name for the same nerves in males and females, so it makes perfect sense that we have the same perfect sensations of pleasure.
From fascination to repulsion and everything in between, orgasm has been the subject of speculation and debate since the Big Bang. Aristotle actually wrote about orgasm and female ejaculation in the first-century BC… and you thought he was just into philosophy! By the way, that’s not a typo: women can ejaculate, though research estimates that only 10% to 50% of women do; actually a small number considering that the woman must reach orgasm in the first place in order to ejaculate. The moral of that story? Don’t let the pornos fool you- it’s a pretty rare event whose presence or absence says nothing of a male’s or female’s sexual prowess.
In ancient times in Western Europe, women could be medically diagnosed with a disorder called “female hysteria,” during which they exhibited symptoms of nervousness, insomnia, irritability, loss of appetite for food/ sex, and “a tendency to cause trouble.” (this elicited a what-ever! and an eye roll from my wife Debbie) Women diagnosed with the condition would sometimes undergo the proscribed treatment of “pelvic massage” by a medical professional until they experienced “hysterical paroxysm,” which immediately, but not permanently, “cured” them. Captain Obvious says that this diagnosis is no longer recognized as a medical condition. In the early 1900’s, the first electric vibrators hit the market- a decade before vacuum cleaners and electric clothes irons! Evidently, women had gotten their priorities straight. And the rest, as they say, is history.
Thankfully, we’ve clearly come a long way in narrowing the orgasm perception gap. But questions persist: how long does it last, does a woman need one to get pregnant, can all women have them, can men/ women have multiples, what’s the G-spot, where’s the G-spot, do women fake it and how to tell??? Time for answers.
I’ll just get the less pleasant news out of the way first. 10% to 15% of all women are anorgasmic, meaning they cannot orgasm… at all. It can be global, meaning there is no means by which she can orgasm, or it can be situational, meaning she can only orgasm under certain circumstances. In some cases, age and circumstance are factors in the ability to orgasm for both women and men. (Un)Fun fact: Marilyn Monroe was actually anorgasmic until the age of 36, when she reported to her psychiatrist that she had finally had her first orgasm. A sadly ironic circumstance for America’s biggest sex symbol was that her first orgasm, and possibly last, had been just months before her death. In men, anorgasmia typically manifests in an inability to ejaculate, called anejaculation, and usually occurs as part of erectile dysfunction, which can be organic or a side effect of medication.
Fast facts from peer-reviewed studies:
-75% of women never reach orgasm from intercourse alone.
-75% of men and 29% of women always reach orgasm with their partner.
-Women are far more likely to orgasm alone than with a partner. Ouch.
Are orgasms like potato chips? Experts say that if women can have one, they can have more than one. In fact, studies have shown that most women are not only capable of multiples, but they are actually capable of two different types of multiples: sequential and serial multiples. Sequential multiples are a series of orgasms that come fairly close together. Usually from 2 to 10 minutes apart, sequential orgasms have a drop-off in arousal in between; they’re like a roller coaster, with a dip after the first hill before a climb back up the next. According to studies, women report that the most common scenario for sequential multiples is an oral sex orgasm followed by another orgasm during intercourse. In contrast, serial multiples are orgasms that come one after another and are separated by just seconds; with no interruption in arousal, serial orgasms are more like a set of waves breaking on a beach. It’s a different story for men, who have what’s called a refractory period. This is the time needed for a break- and sometimes a nap- between orgasms, but given the right amount of time, male multiples aren’t entirely unusual.
The average length of a man’s orgasm is approximately 10 seconds, though it is possible for them to last up to 30 seconds. A woman’s orgasm may last slightly longer or much longer than a man’s, with an average length of 20 seconds, but possibly up to 30 seconds or more. There is a very rare and misunderstood disorder called Persistent Genital Arousal Disorder (PGAD) found in women. PGAD is spontaneous, persistent, unwanted, and uncontrollable genital arousal in the absence of sexual stimulation or sexual desire, and which is typically not relieved by orgasm. Women with this disorder report feeling constantly and uncomfortably on the brink of orgasm for weeks or months at a time. If you’re thinking that would be cool, you’re wrong; for the sufferer, it is a very debilitating and embarrassing disorder with no cure and little potential for future therapeutic intervention. There is concern that the word ‘arousal’ in the title may be misleading, because it connotes pleasure, and having PGAD is the polar opposite of pleasure. Though vastly more common in women, PGAD is considered an analogous version of priapism, and is called such; this is when men have persistent and often painful erections for various reasons, the most well known being a side effect of the ‘little purple pill’ Viagra.
According to a published study, straight women only have orgasms 62% of the time they have sex, while lesbians orgasm 75% of the time they have sex. I guess there’s something to be said about being familiar with the tools you’re working with.
G-whiz! There’s much ado about the female G-spot, and most people don’t even have a clue what the G in G-spot stands for. The Gräfenberg Spot was named for German gynecologist Ernst Gräfenberg, who unknowingly started a furor when he characterized an erogenous area of the vagina that, when stimulated, can lead to strong sexual arousal, powerful orgasms, and potential female ejaculation. While some people think the G-spot is as real as a unicorn, most say that every woman has one, but that it’s not necessarily the magical button of fable and lore. So for reals, what is it? The G-spot is a quarter-sized area in the vagina that swells with blood when women are aroused, and some “experts” say it is directly connected to the ‘orgasm center’ in the brain. For the record, I call bullshit on this ‘orgasm center’ stuff- it sounds like it comes from a Cosmo article. Being board certified in psychiatry and neurology, I know a few things about the brain, and there isn’t an ‘orgasm center.’ In reality, orgasms are not localized, discrete events. Researchers have used PET-scans and functional-MRI’s to show that up to 30 major brain systems are activated during orgasm, so it’s more like a wave that washes over the brain in a global manner. There is an analogous male G-spot called the P-spot, where P stands for prostate. This organ is located internally, between the base of the penis and the rectum, and produces pleasant sensations on stimulation.
Though an orgasm isn’t strictly necessary to feel pleasure, most people will admit that reaching the big “O” with a partner or ‘Han Solo’ is a great added bonus. But beyond just feeling great, an orgasm also brings with it a host of unexpected health benefits, from lowering stress levels and heart attack risk to giving skin a fabulous natural glow. Read on to learn all the good stuff that comes from the fun stuff.
Several hormones are released during orgasm in both males and females, including oxytocin and DHEA. Studies suggest that these hormones could have protective qualities against cancers and heart disease. Oxytocin and other endorphins released during male and female orgasm have also been found to work as relaxants, in both a physical sense and psychological sense, as a mood elevator. Oxytocin is the bonding and cuddling chemical, aka the ‘tend and befriend’ chemical, and makes both sexes feel a desire to be closer to their partner during and after sex. Women actually release four times the normal amount of oxytocin on orgasm. In fact, evidence shows that the bonding and cuddling mechanism is so reliable and predictable that if a woman doesn’t feel cuddly after sex, it is strongly suggestive that she faked her orgasm. Whoa, people.
Orgasms can help lower the risk of prostate cancer in older men. Ward off prostate cancer by having sex? True story! A decade-long and well-reviewed study demonstrated that regular and frequent ejaculation (defined as at least four times per week) in men over age 50 can lower the risk for prostate cancer by up to 30%. One of the authors of the study said, “We know that having sex and orgasms is beneficial for every aspect of male health. The male reproductive system fares best with regular use, and the prostate belongs to that system. The more ejaculations, the better off he’ll be.” Hey, no argument here.
Orgasms can help regulate the female menstrual cycle, even during times when women are not actively on their periods. According to a published and peer-reviewed scientific journal, the mechanism is linked to the apparent circadian rhythm of ovaries and their response to inflammation. Regular orgasms in females lower inflammation, improving immune health, mental health, and circadian health, which fosters regular cycles.
Orgasms can also help boost female fertility.
Regular sexual activity triggers physiological changes in the body that increase a woman’s chances of getting pregnant, even outside the window of ovulation, meaning that orgasms bring benefits at any and all points in the fertility cycle.
An associated concept is that female orgasm appears to improve the odds of conception. Now, I’ve been surprised and frightened by the prevailing ignorance on this topic, so let me be clear here: a female orgasm is not required for a woman to get pregnant; all that is required is the male’s sperm (part of the ejaculate) to meet the female’s egg(s), which is/ are released automatically and independently each month during ovulation. The basic premise of orgasm improving the odds of conception centers on the vaginal and cervical contractions during orgasm. It is believed that the ligaments involved in the muscular pulsations and contractions from the female orgasm cause the cervix to dip down and pull in any semen pooled in the vagina. That brings in more sperm, and more sperm means it’s more likely for one or more of those wiley guys to win the race to any unsuspecting egg that may be hanging out up there. This is all borne out by findings in women who have had intercourse with orgasm having more sperm in their cervical mucus than women who have had intercourse without orgasm. The moral of this story is that orgasmic pulsations are some next-level shit, and those baby-making parts have minds of their own, grabbing around in the dark to continue the genetic line. Science, people!
Orgasms as the next homeopathic treatment for colds and flu? Consider going to the bedroom instead of the drugstore. Orgasms are killer for your immune system, no pun intended. A small German study found that immediately after sexual arousal and masturbation to climax, men showed increased levels of leukocytes, which are the white blood cells that help protect the body from illness and infectious disease. But the ladies haven’t been left out here. Another study demonstrated a correlation between female sexual activity, and therefore female orgasm, and levels of Helper T cells, which help to activate the cells the body needs to fight off foreign invaders that cause disease and illness. In addition, orgasm in both males and females releases those feel-good hormones called endorphins, and these are known to reduce general inflammation, the arch enemy of the immune system and other biological pathways. Reduction of inflammation, wherever it may be, does a body good.
In both men and women, orgasm is shown to help alleviate pain and increase one’s threshold for pain. This is also due to the release of those feel-good endorphins and their ability to reduce inflammation. Studies have shown a direct link between sexual activity and migraines, with 60% of participants reporting some improvement of their migraine attack, and 70% reporting moderate to complete relief. It is believed that orgasm impacts perceived pain through the down-regulation of pain sensitization pathways and by modulating the immune system to reduce levels of inflammation, thus reducing pain levels. Orgasm as an anti-inflammatory once again… O-lieve?
Evidently, orgasm is also useful for relieving the pain of menstrual cramps. In addition to the reduction of inflammation for general pain relief, the pleasurable muscular pulsations and contractions of the female orgasm also use up specific lipid compounds called prostaglandins, which are the cause of menstrual cramps. Lower concentrations of free prostaglandins translates to less cramping-type muscle pain, which is a very good thing.
Orgasms can help keep your brain sharp. The flood of hormones released in both male and female orgasm sends a ton of messages throughout the body, increasing brain activity. This is particularly true in women. An imaging study of brain function and orgasm showed that while masturbating and upon orgasm, women’s brains light up with activity in the cortical, subcortical, and brainstem regions. The researchers stated that these benefits are more powerful than doing challenging crossword puzzles. Hmmm… Sunday New York Times puzzle, roll in the hay; New York Times, roll in the hay… Frustration, satiation… Duh- this one’s what you call a no-brainer. At least, that’s the technical term.
Orgasm reduces levels of stress and anxiety in males and females. Though an orgasm initially releases a flood of stress hormones, studies have shown that the end-game effect is stress reduction. Experts have long agreed that the post-coital payoff in terms of anxiety reduction is also major, as during an orgasm, the parts of the brain that process fear shut down. All of this is thanks to our friend oxytocin, the bonding, snuggling, tend and befriend chemical.
What makes for a happy heart can also make for a healthy heart. Since any sort of physical activity helps your heart pump more efficiently, it’s no surprise that sex can too. But published studies indicate that regular sexual activity seriously benefits heart health, helping to lower cardiovascular risk in older men and women. More specifically, they demonstrated that frequent sex and orgasms reduced instances of cardiovascular disease, hypertension, and rapid heart rate among those over age 65, especially in comparison to those that don’t have frequent sex and orgasms. This study didn’t define “frequent,” so take away from that what you will. Or what you can get away with.
Orgasm as the mystical fountain of youth? That radiant flushed look is post-coital glow; it’s for reals, and all thanks to the increased blood flow from your orgasm. The skin is the body’s largest organ, and also the biggest tell. If you’re under stress, it shows by way of a sallow, stressed out complexion. But when men and women climax, blood vessels throughout the body open up, allowing them to carry greater quantities of blood, which is the source of the flushed and blushed look. The increased blood flow also helps to stimulate the production of collagen, a protein that keeps skin looking plumped and youthful, which is why orgasms may be the quickest- and cheapest- way to gorgeous skin. Some British shrink did a survey of 3,500 people, including both men and women, and determined that regular orgasms were the second most common factor/ cause for people looking younger, the first being regular exercise. Nobody called me, so I don’t know who appointed this guy the chief judge of orgasm and youngness, but it is what it is.
Orgasms can help boost your self-esteem and well-being. When your desires are being satiated, it makes sense that you would feel better about yourself, but it turns out that there’s a proven and demonstrable link between sexual health and self-esteem. So say researchers at Johns Hopkins (well…la tee da) as they found that sexual pleasure among young adults (ages 18-26, both male and female) is linked to healthy psychological and social development. They specifically looked at measures of self-esteem, autonomy, and empathy, and found that sexual pleasure increased all three of these measures in both males and females. However, they also found that the level of increase was not uniform: measures of self-esteem increased the most in young women particularly, while young men showed higher levels of empathy. The explanatory hypotheses for these findings are similar: that the effect of a female’s orgasm on self-esteem is circular, so the ability to easily achieve orgasm increases a woman’s self-esteem, which, in turn, better facilitates her achieving orgasm, which again feeds her self-esteem, and so on. In an analogous way, empathetic males are more responsive to their partner’s needs, and this initiates a positive feedback cycle: being more responsive to their partner’s needs increases the male partner’s ability to reach orgasm, which feeds the male’s empathetic nature and makes them more responsive to their partner’s needs, and so on… Now, I can’t say that I’m calling bullshit on this, but it seems to me that this is back-asswards: while I totally buy that orgasm in both men and women would lead to increases in all three measures, I would think that levels of self-esteem would be more increased in men, resulting from a sort of evolutionary caveman pride ‘look what I can do’ kind of thing. And I would think that greater empathy levels would be higher in women, because of the super intensive release of oxytocin that results in the huggy cuddly ‘oh how I love this person’ feelings. Then again, maybe it’s that women have a higher increase in self-esteem because their orgasm assures them that they are sexually attractive, and men have a higher increase in empathy because their partner has had a simultaneous orgasm? I’m not sure, and you probably don’t care, so we’ll just step away from this one for now.
Orgasms can help you live longer, so say some experts. Additionally, the health benefits of orgasm increase with age, and extend throughout a person’s life. Some Brits studied men between the ages of 45 and 59, and found that those with “high orgasmic frequency” lowered their mortality risk by as much as 50%. The men that had two or more orgasms a week died at a rate that was half the rate of the men who had orgasms less than once a month; in other (less confusing) words, the men that had fewer than one orgasm per month died twice as fast as the men that had eight or more orgasms per month. Like wow, people! These findings prove that sexual activity and orgasm have a protective effect on men’s health. As for the ladies: over the course of an eight-decade study on married, heterosexual couples, researchers found a demonstrable link between orgasms, health, and longevity: specifically, results indicated that women who orgasmed frequently lived longer than their female counterparts who didn’t, though they did not disclose a longevity estimation or definitive ratio of the number of orgasms required to attain greater longevity.
Orgasms aren’t exactly a miraculous method for weight loss, but getting there might be a different story. Sex is an aerobic activity; it gets your heart rate up, and there’s no better way to burn calories than when your heart is pumping. Beats a treadmill, stairclimber, or pilates any day of the week. Researchers have attempted to measure the number of calories burned during sex for many years and on numerous occasions, but the results have varied wildly. Accepted averages indicate that most people burn about 150 to 200 calories each time they have sex, but there are some really fun ways to set that number on fi’ya… a heated make-out session can burn as many as 85 calories per hour in a 150-pound person, while 15 minutes of heavy foreplay will burn about 25 calories. So, figure you make-out for 15 minutes, then another 15 minutes of foreplay, followed by intercourse, will burn about 250 calories- that’s the same number burned in a 30-minute run, but it’s way more fun than a run. If that’s not enough burn for you, add in a sensual and arousing massage at a burn rate of 80 calories per hour. Or, employ the magic of multiples: reaching a second orgasm can burn an additional 60 to 100 calories, depending on the amount of work required to get there; and since it’s a bonus score, why stop after just one? The ultimate formula for burning more calories during sex is fairly simple: just pour on more heat and more passion for a longer period of time.
You have probably always known that orgasms are awesome, but now you know the why and how of everything orgasmic, and are all set to impress and amaze your friends with your dazzling sexual intellect at the next cocktail party.
And even though I wrote this blog on the benefits of orgasm, I don’t want to contribute to society’s historical relationship with sex and orgasm: typically seen as goal-based, a skill to be practiced and reward to be achieved, rather than something to explore, experience and enjoy. So go forth, explore, experience, enjoy, orgasm, and spread the word, people!
But first, google ‘Dr. Mark Agresti YouTube’ to check out my videos, leave comments, like, and subscribe to my YouTube channel. As always, you can find tons of content and patient stories in my book, Tales from the Couch, available in office or on Amazon. Thanks people.Learn More