You know the cliche: a woman is so uninterested in sex that she makes a shopping list while making love. Jennifer and Laura Berman see such women all the time, and it's frustration -- not boredom -- that brings them to the Bermans' clinic at UCLA.

"I was talking to a woman earlier today about her low libido, which was a result of the fact that she can't reach orgasm," says psychologist Laura Berman, Ph.D., who with her sister, urologist Jennifer Berman, M.D., is a founder and co-director of the Center for Women's Urology and Sexual Medicine clinic. "Because she can't reach orgasm, sex is frustrating. She feels a hopeless, fatalistic complacency about her sex life. When she's having sex, her partner picks up on that and feels rejected and angry, or notices she's withdrawing. Then intimacy starts to break down. Her partner feels less intimate because there's less sex, and she feels less sexual because there's less intimacy. The whole thing starts to break down."

Acknowledgment of sexual dysfunction in America is booming. But with all the attention on Viagra and prostate problems in men, most people would probably never guess that more women than men suffer from sexual dysfunction. According to an article in the Journal of the American Medical Association, as many as 43 percent of women have some form of difficulty in their sexual function, as opposed to 31 percent of men.

And yet female sexuality has taken a back seat to the penis. Before Viagra, medicine was doing everything from penile injections to wire and balloon implants to raise flagging erections, while female sexual dysfunction was almost exclusively treated as a mental problem. "Women were often told it was all in their head, and they just needed to relax," says Laura.

The Bermans want to change that. They are at the forefront of forging a mind-body perspective of female sexuality. The Bermans want the medical community and the public to recognize that female sexual dysfunction (FSD) is a problem that may have physical as well as emotional components. To spread their message, they have appeared twice on Oprah, have made numerous appearances on Good Morning America and have written a book, For Women Only.

"Female sexual dysfunction is a problem that can affect your sense of well-being," explains Jennifer. "And for years people have been working in a vacuum in the sex and psychotherapy realms and the medical community. Now we are putting it all together."

No single problem makes up female sexual dysfunction. An article in the Journal of Urology defined FSD as including such varied troubles as a lack of sexual desire so great that it causes personal distress, an inability of the genitals to become adequately lubricated, difficulty in reaching orgasm even after sufficient stimulation and a persistent genital pain associated with intercourse. "We see women ranging from their early twenties to their mid-seventies with all types of problems," Laura says, "most of which have both medical and emotional bases to them." The physical causes of FSD can range from having too little testosterone or estrogen in the blood to severed nerves as a result of pelvic surgery to taking such medications as antihistamines or serotonin reuptake inhibitors, such as Prozac (Fluoxetine). The psychological factors, Laura says, can include sexual history issues, relationship problems and depression.

The Bermans codirected the Women's Sexual Health Clinic at Boston University Medical Center for three years before starting the UCLA clinic in 2001. At present, they can see only eight patients a day, but each one receives a full consultation the first day. Laura gives an extensive evaluation to assess the psychological component of each woman's sexuality.

"Basically, it's a sex history," Laura says. "We talk about the presenting problem, its history, what she's done to address it in her relationship, how she's coped with it, how it has impacted the way she feels about herself. We also address earlier sexual development, unresolved sexual abuse or trauma, values around sexuality, body image, self-stimulation, whether the problem is situational or across the board, whether it's lifelong or acquired." After the evaluation, Laura recommends possible solutions. "There is some psycho-education in there, where I'll work with her around vibrators or videos or things to try, and talk about addressing sex therapy."

Afterward, the patient is given a physiological evaluation. Different probes are used to determine vaginal pH balance, the degree of clitoral and labial sensation and the amount of vaginal elasticity. "Then we give the patient a pair of 3-D goggles with surround sound and a vibrator and ask them to watch an erotic video and stimulate themselves to measure lubrication and pelvic blood flow," Jennifer says.

he identification of FSD (female sexual dysfunction) has been called everything from the final frontier of the women's movement to an attempt by the patriarchy to shackle women's sexuality. But given the success that drugs such as Viagra have had in reversing male sexual dysfunction, the Bermans found an unexpected amount of criticism from their peers. "The resistance we got from the rest of the medical community early on was surprising to us," Laura says, explaining that the urological field, in particular, has been dominated by men.

Clearly, the Bermans will need hard data to win over their critics. Their UCLA facility is enabling the Bermans to conduct some of the first systematic psychological and physiological research on the factors that inhibit female sexual function. One of their first studies suggests that the pharmaco-sexual revolution that helped some men overcome their sexual dysfunction may prove less effective for women. Their initial study of the effects of on women found that Viagra did increase blood flow to the genitalia and thereby facilitate sex, but women who took the drug said it provided little in the way of arousal. In short, subjects' bodies might have been ready, but their minds were not.

"Viagra worked half as often in the women with an unresolved sexual abuse history as in those without it," Laura says. "So it's just not going to work alone. Women experience sexuality in a context, and no amount of medication is going to mask psychologically rooted, or emotionally or relationally rooted sexual problems." Laura believes the results of the Viagra study counter those who contend that FSD is simply a tool of pharmaceutical companies to "medicalize" female sexuality.

"I'm less concerned about it, because I'm aware that it won't work," she says. "And in some respects, pharmaceutical companies are closing the divide between the mind and body camps of FSD. Clinical trials of new drugs for FSD are requiring psychologists to screen participants, and that is an acknowledgment that an accurate assessment of a drug's efficacy requires a consideration of the test subjects' feelings about sex. So these physicians who may not be motivated to bring on a sex therapist are now motivated to participate in a clinical trial, and then that model becomes the norm."

Currently, the sisters are working on MRI studies of the brain's response to sexual arousal, the place where mind and body meet. And although there is a lot more research to be done on FSD, identifying it as a problem has already made a significant impact on how women perceive their sexuality. "Women now feel more comfortable going to their doctors, and they're not taking no for an answer, not being told to just go home and have a glass of wine," explains Laura. "They feel more entitled to their sexual function."

READ MORE ABOUT IT: For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life Jennifer Berman, M.D., and Laura Berman, Ph.D. (Henry Holt & Co., 2001)

Body Language and Boundaries

When it comes to sex, "guesswork" on the part of both partners about what the other partner is thinking and body language are often misinterpreted. Setting boundaries ahead of time is a good idea. You owe it to yourself and your partner to establish clear-minded communication from the start.

The Five Basic Steps to Good Communication:

1. Know what you want and do not want sexually.
2. Communicate clearly to your partner what is OK and what is not OK.
3. Listen carefully to what your partner is saying and expect the same in return.
4. Be assertive in defining your personal space.
5. If you feel uncomfortable in any situation, even slightly, find a place of safety.

Medications for schizoaffective disorder are a vital part of treatment. The right medication can reduce schizoaffective disorder symptoms to make someone more comfortable in the moment. It can also increase someone’s level of functioning, which in turn increases the quality of life. Schizoaffective disorder medications can lead to better outcomes for people living with this illness.

Schizoaffective disorder is a psychotic disorder with features of a mood disorder. Accordingly, doctors frequently prescribe a combination of medications that target both psychosis and mood.

Schizoaffective disorder medications include three classes of drugs: atypical antipsychotics, mood stabilizers, and antidepressants.

Schizoaffective Disorder Medications: Atypical Antipsychotics

Atypical antipsychotics work within the circuitry of the brain to improve things like perception (hallucinations, delusions) and cognitive functions (disorganized thinking). Atypical antipsychotics (also simply called antipsychotics) are used no matter what type of schizoaffective disorder someone has.

The only medication specifically for schizoaffective disorder approved by the FDA is paliperidone (Invega), although other atypical antipsychotics are prescribed, too, to target all the psychotic symptoms of the disorder (Mayo Clinic).

The following antipsychotics are often prescribed to people living with schizoaffective disorder (brand names are in parentheses):

• Aripiprazole (Abilify)
• Asenapine (Saphis)
• Cariprazine (Vraylar)
• Clozapine (Clozaril, Fazaclo)
• Haloperidol (Haldol)
• Iloperidonoe (Fanapt)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Paliperidone (Invega, Invega Sustenna)
• Quetiapine (Seroquel)
• Risperidone (Risperdal, Risperdal Consta)
• Ziprasidone (Geodon)

While antipsychotic medications are effective, they usually can’t stand alone. Other schizoaffective disorder drugs are necessary to treat the mood aspects of the illness.

Schizoaffective Disorder Medications: Mood Stabilizers

Medications for schizoaffective disorder bipolar type include both antipsychotics and mood stabilizers. Mood stabilizers are particularly effective to calm the manic symptoms of schizoaffective disorder.

Sometimes, doctors prescribe anticonvulsants for mania because they work like mood stabilizers. In the below list, lithium is a mood stabilizer, while the other three are anticonvulsants.

• Lithobid (Lithium)
• Carbamazepine (Tegretol, Carbatrol, Epitol, Equetro)
• Oxcarbazepine (Trileptal, Oxtellar XR)
• Valproic Acid (Depakote, Depakene, Depacon, Stavzor)

Schizoaffective Disorder Medications: Antidepressants

When someone has been diagnosed with the depressive type of schizoaffective disorder, her doctor will likely prescribe antipsychotics and antidepressants.

The most common class of antidepressants used in treating schizoaffective disorder is the selective serotonin reuptake inhibitors (SSRIs). These include:

• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Fluoxetine (Prozac, Sarafem)
• Fluvoxamine (Lovox)
• Parixetine (Paxil, Pexeva)
• Sertraline (Zoloft)

Less commonly prescribed but effective in treating the depressive symptoms of schizoaffective disorder are the serotonin and norepinephrine reuptake inhibitors (SNRIs). Among them:

• Venlafaxine (Effexor, Effexor XR)
• Duloxetine (Cymbalta, DermacinRX DPN Pak, Irenka)

Finally, to treat depression, doctors sometimes prescribe an aminoketone medication that works differently than the SSRIs and SNRIs:

• Bupropion (Wellbutrin, Wellbutrin XL)

Medication is the best treatment for schizoaffective disorder. Unfortunately, though, medication can come with side effects.

Schizoaffective Disorder Medications: Side Effects

The following lists delineate the major side effects of the medications for schizoaffective disorder. Not every medication within a drug class has the exact same side effects. Further, the same medication doesn’t carry identical side effects for everyone who takes it. These are general lists of side effects within each category and can act as a tool for discussion with your doctor or pharmacist.

Antipsychotic side effects:

• Blurred vision
• Constipation
• Dizziness
• Drowsiness
• Dry mouth
• Menstrual problems
• Muscle spasms or tremors
• Rapid heartbeat
• Rash
• Restlessness
• Weight gain (42% of people taking antipsychotics are overweight or obese, leading to other health problems; World of Psychiatry)

Antipsychotic side effects that are rare but serious/dangerous

• Cataracts
• Diabetes (Type 2)
• Heart problems (ventricular arrhythmia, myocarditis)
• High cholesterol
• Tardive Dyskinesia and other drug-induced movement disorders known as extrapyramidal side effects (these involve involuntary, random, uncontrollable muscle movement (in tardive dyskinesia, these movements involve the face, tongue, and jaw), tremors, ringer tapping, rocking, etc.)

Mood stabilizer side effects:

• Blackouts
• Excessive thirst
• Frequent urination
• hallucinations
• Heartbeat issues (fast, slow, irregular, pounding)
• Itching
• Nausea/vomiting
• Rash
• Slurred speech
• Tremors in hands
• Vision changes

Mood stabilizer side effects that are rare but serious/dangerous

• Kidney problems
• Seizures
• Thyroid problems

Antidepressant side effects:

• Agitation
• Anxiety
• Diarrhea
• Headache
• Nausea/vomiting
• Panic attacks
• Restlessness
• Sleep problems
• Sexual problems

Antidepressant side effects that are rare but serious/dangerous

• Acting on dangerous impulses
• Aggression/anger/violence
• Increased depression
• Mania
• Serotonin syndrome (a life-threatening illness involving fever, blood pressure changes, agitation, hallucinations)
• Suicidal thoughts and/or attempts

Can Schizoaffective Disorder be Treated without Medication?

Schizoaffective disorder medication side effects lists can be intimidating and alarming. Many people wonder if conditions like schizoaffective disorder can be treated without medication.

There are indeed treatments for this disorder that don’t involve medication; however, they usually won’t work until someone is steadied with medication. Medication is needed to stabilize the brain in this brain-based illness.

Schizoaffective disorder medications help increase quality of life, and that often outweighs the side effects. Ultimately, though, whether to take medication is a personal choice that is best made in consultation with your doctor.

article references

Symptoms of schizoaffective disorder fit into multiple categories. This illness is a single mental disorder that has features of psychotic disorders and mood disorders. It can be hard to understand and even harder to live with. Multiple types of symptoms team up and present quite a challenge for those living with schizoaffective disorder.

In the DSM-5, symptoms of schizoaffective disorder are stated as the primary category (Criterion A) of symptoms of schizophrenia as well as symptoms of a major mood episode. This description can be a bit vague, though, when you’re trying to figure out just what you or a loved one is experiencing. Here’s an in-depth look at the symptoms of schizoaffective disorder.

General Schizoaffective Disorder Signs and Symptoms

Schizoaffective disorder includes these categories of symptoms and signs:

• Psychotic
• Manic
• Depressive mood and other symptoms of depression
• Cognitive

The way someone experiences each of these is highly individualized because within these general categories, there are numerous symptoms.

How the symptoms behave is as important as the symptoms themselves.

• The symptoms of a mood disorder and symptoms of a psychotic disorder can occur together or separately
• Symptoms tend to occur in cycles
• Symptom severity is important and will be used to guide treatment
• Delusions or hallucinations must occur for at least two consecutive weeks without a mood disorder (this disorder is at its essence a psychotic disorder)
• Other than the required minimum two-week absence, mood symptoms must be present the majority of the time during the course of the illness

Psychotic Symptoms of Schizoaffective Disorder

Schizoaffective disorder includes the first set of requirements for schizophrenia

• Delusions (false beliefs)
• Hallucinations (sensing things that aren’t there; especially auditory in the form of voices)
• Disorganized thinking (evident in talking with someone and having difficulty following the erratic flow of ideas)
• Grossly disorganized or abnormal motor behavior (problems with goal-directed behavior, acting unpredictably, catatonia in which some doesn’t react to the world)
• Negative symptoms (things taken away from the person, like speech or emotional expression)

Except for those symptoms that mimic depression, negative symptoms aren’t as common in schizoaffective disorder as they are in schizophrenia.

Like schizophrenia, schizoaffective disorder involves cognitive symptoms; however, cognitive symptoms in schizoaffective disorder aren’t as pronounced as they are in schizophrenia. Cognitive symptoms include experiences such as memory problems, difficulty with abstract thinking, problems with advanced planning, and attention deficits.

Someone with schizoaffective disorder can have any of the above psychotic signs and symptoms, with delusions and auditory hallucinations among the most common. This is only part of what the symptoms of schizoaffective disorder are, though. Mood symptoms are prominent, too.

Symptoms of Schizoaffective Disorder Bipolar Type

The bipolar type of schizoaffective disorder involves mania. To be diagnosed with this type, someone must have experienced a manic episode. Depressive episodes may occur but aren’t necessary for a diagnosis of schizoaffective disorder bipolar type.

Mania refers to a noticeably elevated, expansive, or irritable mood. During a period of mania, someone channels much energy into goal-directed behavior.

Whatever she has made her goal, she will hyperfocus on it to the detriment of other areas of her life, including other goals and relationships.

Other signs and symptoms of mania that can be part of schizoaffective disorder include:

• Inflated self-esteem
• Reduced need for sleep
• Pressure to talk
• Racing thoughts or flight of ideas (jumping from one thought to the next)
• Distractibility
• Psychomotor agitation that appears like a sense of purposelessness
• Risky behavior (excessive spending, sexual promiscuity, substance abuse, etc.)

To be diagnosed as having the bipolar type of schizoaffective disorder, someone must have at least three of the above signs and symptoms.

Someone with the bipolar type might also experience symptoms of depression at times, or he might not develop them at all. When someone only experiences depressive symptoms with the psychotic symptoms, he instead has schizoaffective disorder depressive type.

Symptoms of Schizoaffective Disorder Depressive Type

The primary mood symptom in the depressive type is depressed mood. Living with a depressed mood most of every day, feeling sad, hopeless, and empty, is what sets this type of schizoaffective disorder apart from schizophrenia.

Other signs and symptoms that are part of the depressive type of schizoaffective disorder are

• Decreased interest in activities
• Loss of a sense of pleasure (anhedonia)
• Unintentional weight gain or loss
• Frequent headaches
• Chest pains
• Fatigue, exhaustion
• Physical aches and pains
• Digestive problems
• Back pain
• Sexual dysfunction
• Agitation
• Slowing down of movement
• Feelings of worthlessness or excessive guilt
• Difficulty thinking, concentrating and making decisions
• Persistent thoughts of death, suicidal ideation

Use the above lists as a schizoaffective disorder symptom checklist to keep track of your psychotic and mood signs and symptoms and to make it easier to talk with your doctor.

article references

Part psychotic disorder, part mood disorder, schizoaffective disorder is baffling. What causes schizoaffective disorder? It’s a question that people living with this complex disorder and their loved ones commonly ask. Researchers and other mental health professionals ask it, too. So far, the answer remains elusive.

The causes of schizoaffective disorder are still largely unknown. This mental illness is unique. The combination of psychosis and mania and/or depression makes it difficult to fully comprehend. Researchers are seeking answers, including a definitive cause. While they can’t say with absolute certainty what causes this mental illness, they do have solid theories. Hopefully, one day, this will lead to better schizoaffective disorder treatments.

For now, based on what is known about related disorders, such as schizophrenia, bipolar disorder, and major depressive disorders, and on commonalities among people with schizoaffective disorder, researchers and neuroscientists are discovering possible causes. They’re also identifying likely risk factors and triggers.

Possible Causes of Schizoaffective Disorder

While it’s still unknown what causes schizoaffective disorder, these factors have been identified as potential origins of the disorder:

• Genetics: There is quite possibly a biological component to schizoaffective disorder, with certain genes coded for things like mental illness, including psychotic disorders.
• Brain: Differences in brain chemistry and brain structure have been found in people with schizoaffective disorder compared to non-affected people. Neuroimaging studies have shown brain malformations and/or smaller brain volume in people with this mental illness.
• Birth defect: Problems during birth that cause reduced oxygen to the baby can cause mental illnesses later in life, and it seems that may include schizoaffective disorder too.
• Exposure to toxins or viruses in the womb: Babies whose mothers smoked, drank alcohol, were exposed to other environmental toxins, or came in contact with certain viruses may be at increased risk in adolescence or adulthood for illnesses such as schizoaffective disorder.
• Substances: Certain drugs, psychoactive, mind-altering drugs like LSD, PCP, psychedelic mushrooms, and others, seem to have the potential to cause psychotic and other disorders.

Currently, no difference in cause has been found between the two types of schizoaffective disorder. One thing researchers are trying to discover is why one person with schizoaffective disorder will have bipolar type and another person has depressive type. While it’s possible that each type has a unique cause, current knowledge says that the causes are the same no matter the type.

Risk Factors and Triggers for Developing Schizoaffective Disorder

Risk factors and triggers have a role to play in the development of schizoaffective disorder (or anything else, for that matter). One or more of the elements that causes the disorder must be present, and risk factors and triggers can “activate” those causal factors to spur the development of the illness.

Risk factors are conditions that exist or actions someone is taking, while triggers are things in the environment that have a negative impact on someone. Risk factors and triggers that are at work in the development of schizoaffective disorder are such things as:

• Family history of mental illness, especially schizoaffective disorder, schizophrenia, and bipolar disorder
• Developmental delays in childhood linked to structural differences in the brain
• Extreme and/or chronic stress
• Substance use or abuse
• Having been a victim of abuse or neglect
• Trauma

Neuroscientists have made progress in understanding the cause of schizoaffective disorder. It’s important that research continues, for insight into cause can lead to significant prevention efforts.

article references

Summary of Bipolar Psychosis special section on HealthyPlace.com

Can you believe how much you know about bipolar psychosis? You now have the information needed to assess your (or your loved one's) possible psychotic symptoms so that you can get the correct medical treatment. It's a good idea to really examine your past and current bipolar symptoms to see if they include psychosis. Bipolar psychosis doesn't have to be a mystery. It's simply another symptom of a complex, but ultimately treatable illness.

Many people want to know, “Can you manage bipolar disorder without medication?” The answer to this is both simple and complex. Managing bipolar disorder without medication is possible for a few, but not many. Read below about possible options for managing bipolar without medications (Do Real, Natural Bipolar Medications Even Exist?).

(Note that if you’re cycling, any type of antidepressant, pharmacological or not, can be dangerous. But if you’re dealing with a prolonged bipolar depression, then these options might be right for you.)

Options for Managing Bipolar Depression Without Medication

Mood stabilizers are the primary treatment for bipolar disorder, but even with them, and certainly without them, bipolar depression can be hard to manage. However, there are options that act as antidepressants that are not pharmacological in nature.

According to Jim Phelps, MD, a noted bipolar specialist, these include:

• Bipolar-specific psychotherapy – many psychotherapies have been shown to be useful in bipolar disorder treatment. These include:
  • Prodrome detection therapy – seeing the signs of a bipolar mood before it is full-blown
  • Psychoeducation – becoming educated about bipolar disorder
  • Cognitive therapy – involves multiple areas of therapy, including building a support team and coping with depression
  • Interpersonal and social rhythm therapy – involves improving personal interactions and creating a routine to help with bipolar disorder
  • Family-focused therapy – involves multiple types of therapy, including psychoeducation and diagnosis acceptance. This therapy also gets the family involved with the person with bipolar disorder.

• Exercise – this is very difficult for most people in a depression to do. Nevertheless, it has been shown that aerobic exercise does create an antidepressant effect. Of course, there are many other benefits to exercise as well such as improved heart health and weight loss.
• Light manipulation – this includes controlling the hours of light and darkness per day as well as when it occurs. Control of blue light (such as the light from electronics) is particularly important. Light manipulation may also work to stabilize mania as well.
• Omega-3 fatty acids (sometimes just called “fish oil”) – research shows that omega-3 supplements do work as antidepressants, but it has a small effect and it takes a long time to work. Also note an omega-3 supplement must:
  • Be highly concentrated so you can get to 1,000 mg (1 gram) of eicosapentaenoic (EPA) per day in two or three pills each day
  • Be at least 60% EPA

• N-acetylcysteine (NAC) – an over-the-counter amino acid that may work to treat bipolar depression but likely is subject to tolerance, like most medications. (Tolerance is when the medication works but then spontaneously becomes ineffective.)
• Thyroid hormone – getting one’s thyroid hormone in an optimal range for bipolar disorder can reduce symptoms. While this does require testing and a prescription, the medication is not psychopharmacological in nature.

Options for Managing Bipolar Mania Without Medication

There are few options for the management of bipolar mania without medications. The following are those with some evidence:

• Magnesium – there is some evidence that magnesium, when combined with a mood stabilizer, effectively treats manic or rapid-cycling states. However, magnesium has been used as an injection; there is no evidence for oral monotherapy use.
• Select amino acids – there is preliminary evidence that leucine, isoleucine, and valine may provide improvement in people with acute mania. See here for more information.
• Phosphatidylcholine (choline) – may reduce the severity of mania and/or depression.
• Proprietary multi-nutrient formula – there is some very early evidence that a proprietary formula containing 36 separate constituents, including chelated minerals, vitamins, and trace elements, may reduce symptoms of mania, depressed mood, and psychosis in bipolar patients.
• Reserpine – an herb that may treat bipolar mania but probably only adjunctive to lithium.

Managing Bipolar II or Bipolar I Without Medication

In short, in almost all of the above cases, the evidence is only preliminary and only available for adjunctive to traditional medication treatment (see also Natural Herbs, Supplements for Bipolar Disorder). While it is understandable that some people may want to manage bipolar disorder without medication, it’s just typically not possible.

Diagnosis

Sexual addiction involves aspects of compulsion or obsession: the addict 'cannot' stop (or cannot stay stopped), and suffers ill effects (social, economic, or other) traceable to the addiction. Such individuals do exist; on the other hand, not all users of pornography are addicts, any more than all users of alcohol are alcoholics.

The Diagnostic and Statistical Manual of Mental Disorders does not presently provide a formal definition for pornography addiction. Many informal "self-tests" have been written (for example, here), but do not appear to have been normed or statistically validated.

Formal criteria have been suggested along lines strictly analogous to the [DSM] criteria for alcohol and other substance addictions. See this article (online copy of Richard Irons, M. D. and Jennifer P. Schneider, M.D., Ph.D "Differential Diagnosis of Addictive Sexual Disorders Using the DSM-IV." In Sexual Addiction & Compulsivity 1996, Volume 3, pp 7-21, 1996). They cite Goodman (1990), who compared the DSM criteria lists for various addictive disorders and derived these general characteristics:

1. Recurrent failure to resist impulses to engage in a specified behavior.
2. Increasing sense of tension immediately prior to initiating the behavior.
3. Pleasure or relief at the time of engaging in the behavior.
4. At least five of the following:
   • Frequent engaging in the behavior to a greater extent or over a longer period than intended.
   • Repeated efforts to reduce, control, or stop the behavior.
   • A great deal of time spent in activities necessary for the behavior, engaging in the behavior, or recovering from its effects.
   • Frequent engaging in the behavior when expected to fulfill occupational, academic, domestic or social obligations.
   • Important social, occupational, or recreational activities given up or reduced because of the behavior.
   • Continuation of the behavior despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behavior.
   • Tolerance: need to increase the intensity or frequency of the behavior in order to achieve the desired effect or diminished effect with continued behavior of the same intensity.
   • Restlessness or irritability if unable to engage in the behavior.
5. Some symptoms of the disturbance have persisted for at least one month, or have occurred repeatedly over a longer period of time.

These criteria can be applied to almost any behavior and would seem to characterize excessive and uncontrollable involvement regardless of the particular behavior. They thus provide one reasonable definition of what a pornography addiction would be.

Dr. Victor Cline provides a model of pornography addiction with 4 progressive steps:

• Addiction - A person compulsively views pornography.
• Escalation - As time progresses, the addict requires more extreme, more deviant material to get the same effect and satisfy the compulsions.
• Desensitization - The addict loses their perception of what is socially acceptable. Illegal material or those considered taboo, immoral, or repulsive seems "normal."
• Acting out sexually - "...an increasing tendency to act out sexually the behaviors viewed in the pornography, including compulsive promiscuity, exhibitionism, group sex, voyeurism, frequenting massage parlors, having sex with minor children, rape, and inflicting pain on themselves or a partner during sex."

Patrick Carnes has published extensive analyses of sexual addiction, including specific behavioral and psychological criteria. Virtually all sexual addicts use pornography; however, not all pornography users are sexual addicts.

A diagnosis of sexual addiction should not be made using a simple checklist, but by a psychologist or psychiatrist expert in the treatment of addictive disorders. Carnes and Cline note that such an addiction (like others), is very difficult to overcome without strong support and help.

Overcoming Pornography Addiction

According to the University of Texas at Dallas Student Counseling Center self-help library page on pornography addiction, "One of the great rewards of overcoming a pornography addiction is the ability to be fully committed to another person in a loving way, having nothing to hide and enjoying great sex." Many pornography addicts have recounted stories of trying to quit, and then, believing they had overcome the addiction, deciding to sample it one more time. For a true addict, one image can be enough to trigger an escalating pornography binge lasting several hours.

Recovery programs for porn addiction include counseling, in-patient and support group meetings.

Online Pornography Addiction

Online pornography addiction is a type of pornography addiction in which the user obtains the pornography through the Internet.

Those who believe in the concept of online pornography addiction argue that it is stronger, and more addictive, than ordinary pornography addiction because of the wide availability, increasingly hardcore nature of the content available, and the privacy that viewing online offers.

Allegations of Connections Between Pornography and Violence

It has been claimed that a small number of people who view pornography develop addictions which lead to violent and anti-social behavior. Pornography addictions have been linked to the enactments of serious crimes, notably in the cases of Ted Bundy and David Berkowitz. However, these links are disputed by some, since they come primarily from the criminals themselves, who have a vested interest in shifting the blame for their actions. No reputable study has uncovered a link between pornography and violence, including some which hypothesized and expected to prove such a connection, such as those of the Meese Commission.

Date rape or acquaintance rape defined plus things to try if confronted with date rape or acquaintance rape.

Date rape and acquaintance rape are forms of sexual assault involving coercive sexual activities perpetrated by an acquaintance of the rape survivor. A perpetrator is almost always a man, and though both men and women can be raped, women are most often the targets of this violence. It is difficult, because of a lack of research on the subject and the tendency for rape survivors not to report attacks, to come up with precise statistics on male survivors. However, men are raped by other men and are also victims of sexual violence. Date and acquaintance rape can happen to or be perpetrated by anyone. Incidences are very high: they comprise from fifty to seventy-five percent of all reported rapes. However, even these figures are not reliable. According to conservative FBI statistics, only three and a half to ten percent of all forms of rape are even reported.

Date and acquaintance rape are quite prevalent on campuses. One in four college women has been raped; that is, has been forced, physically or verbally, actively or implicitly, to engage in sexual activity. A 1985 study revealed that ninety percent of college rape survivors knew their attacker before the incident. Another survey found that one in fifteen college men admitted to having forced a woman into sex.

Some experts believe that one explanation for such high statistics is that young people, constrained for most of their lives by their parents and laws, are unprepared to act responsibly in a "free" environment. This "freedom" can lead to unrestrained drug and alcohol use, which then leads to sexually irresponsible acts, and then to rape.

Another theory portrays America, especially young America, as a rape culture. The values adopted by the dominant society dictate inherent differences between men and women. Women are expected to be passive, unassertive, and dependent. Similarly, men are constrained in their behavior. They are taught to be aggressive, even intimidating, strong, and relentless. They are taught not to take no for an answer. Men who accept or unwittingly exhibit this kind of behavior are likely to misinterpret a woman's communications. Typically, the man will decide that the woman is acting coy or hard to get in a sexual situation. He may believe that she really means yes, although she has been saying no.

Communication is the most important avenue to understanding another person's desires and needs -- often the rapist will ignore the woman's attempts at communication, will misinterpret them and continue his actions, or will realize what the woman is trying to say but will decide that she "really needs to get laid" and doesn't care. The bottom line is that yes means yes and no means no; if you want to play sadomasochistic games, make up a safe word like "cow" to use as a preordained signal to stop.

If a person says no and is still coerced or forced into having sex, then a rape has occurred.

Many times women or men who have been date or acquaintance-raped do not view the assault as rape. They may experience some or all of the symptoms of rape trauma stemming from the violation of the body and the betrayal of a friend but still may not consider the incident rape. Some symptoms of rape trauma include sleep disturbances, eating pattern disturbances, mood swings, feelings of humiliation and self-blame, nightmares, anger, fear of sex, and difficulty in trusting others.

Often, especially in a college situation, the rape survivor and the attacker live near each other or may see each other every day. This can be particularly stressful to the survivor because the man may see the rape as a conquest or "just a mistake." Bystanders and friends of both people may not view the incident as the rape it is and consequently will not lend the survivor the support needed. Friends of the survivor may misinterpret the incident and feel that somehow the rape was deserved or that the survivor "asked for it" by wearing a miniskirt or getting drunk. Some people may belittle the survivor's traumatic experience, saying things such as, "She liked the guy anyway, so what's the big deal?"

These attitudes that blame the survivor, some say, are embedded in our culture and help to perpetuate violence against women and sexual violence such as date and acquaintance rape. Survivors, living and learning in this culture, may also accept "explanations" of "why it isn't rape," although they have been inwardly traumatized. The important thing to remember is that if there are feelings of violation, if a person's lifestyle and self-esteem are negatively affected by the incident, or survivors believe they have been raped, then it is rape.

Date and acquaintance rape is not only a woman's issue. Men must be actively aware of this issue, as they can help minimize rape by educating themselves and others. Lovers, neighbors, friends, co-workers, dates, and classmates -- these can all be perpetrators of date and acquaintance rape. Escort services, blue light phones, and van services are useless if the rapist lives in your home or dorm, is your date, drives you home from work, or is someone you have had reason to trust. In order for date and acquaintance rape to be minimized, men must stop "blaming the victim" and start taking responsibility for their own actions. We all must not allow rapists to use the "rape culture" as a means of silencing rape survivors, nor can we permit their friends to lie for them. And although it is always difficult, and admittedly, sometimes impossible to do, rape survivors and others must speak out and continue to speak out against rape.

There are many organizations which are designed especially to support rape survivors, give referrals, and talk about concerns they may have. All services are confidential.

Things to Try if Confronted with Acquaintance Rape

• STAY CALM.
• Turn the inner voice into a strong voice. TRUST YOUR FEELINGS.
• Appraise your situation, then ACT QUICKLY. Evaluate how much danger you're in, and act accordingly as soon as possible.
• Try to GET AWAY.
• YELL FOR HELP.
• When necessary, ACT FORCEFULLY. Realize, however, that your fighting back might also cause the other person to become violent.
• BUY TIME WITH TALK. Stall the person with a conversation. Flatter him or her. When s/he thinks s/he no longer needs to use force, s/he may ease up on his guard. That's a good time to make a break for the door.
• DESTROY THE IDEA OF A "SEDUCTION." Tell the person that you have a sexually transmitted disease, or if you are a woman that you have your period or are pregnant. Do physical things to turn the person off: urinate on the floor, pick your nose, belch, pass gas, vomit.

REMEMBER THAT GIVING IN IS NOT CONSENT!!!!

Giving in is not something to be ashamed of. The person may threaten you, and be physically violent. He or she may terrify you so that you cannot respond effectively. Going along with the attacker may be the only smart thing to do. Giving in may be a survival strategy.

Do not berate yourself that you "let" the rape happen. A rape-threatening situation is also a life-threatening situation. Your only responsibility as a victim is to yourself. You do not need to sustain injury or death to "prove" you were raped. Stay alive.

Suggestions from Dr. Laura Berman, founder and co-director of the Center for Women's Urology and Sexual Medicine at the UCLA Medical Center.

Q. How should a woman talk to her partner about a sexual problem?

A. Realize that communication is the most important part of identifying and dealing with a sexual problem. The first rule is honesty - let your partner know what you like and want, but never fake an orgasm. The best time to talk is not during sex. Set aside time to talk about what's bothering you.

If your partner is dismissive at first, keep trying. For instance, some partners who act impatient with a partner's problems are really feeling insecure and taking it personally that their partner is not responding sexually. They don't want to consider that they may have a causative role in the problem. You can try educational videos, books and experimenting with what is learned. Therapy is always a good choice, but it may not be available, the partner may refuse to go or the couple may feel uncomfortable.

Q. Many women feel uncomfortable talking to their doctors about sexual problems. How can women talk to their doctor about sexual problems without feeling embarrassed?

A.. Talking with your doctor about your sexual problems can cause you anxiety, but in order to get the best care you must be able to communicate your needs. Some doctors may minimize your problem or dismiss it, but that's usually because they don't know how to help, they think it may be psychological, or they are not aware of potential treatment. Information you take to your doctor will be extremely helpful to him or her as well as to you. Most doctors will be open and receptive to your comments and will be happy to learn of any new information, particularly if it is based on science and research.

Q. What else do you believe women should understand about female sexuality??

A. That sex, like life, is fluid. It changes and grows just as women do. Sex at 20 is not like sex at 30 nor sex when you're a mother, nor sex when you are menopausal, nor sex when you are crazy about your partner or when you are furious with him or her. The context in which women experience their sexuality is probably the most important part of understanding it. The brain is the main sexual organ and sex is about intimacy, sharing, trust, and making yourself vulnerable to another person. It is a basic part of our general health and wellness and something every woman is entitled to.