A look at the psychology behind why married men visit prostitutes and seemingly risk everything in the process.

There are few things more devastating to a spouse than the betrayal of infidelity, and we can only imagine how intensified that devastation becomes when made public. However, there is a psychological difference between paid sex and other types of infidelity. Visiting a prostitute is usually only about the sex. It isn't about friendship. It isn't about ego, or admiration, or conquest. It is a cold and emotionless business transaction.

It is difficult to speculate as to why married men visit prostitutes, because the reasons are so varied. A man may, of course, simply be "bored" and consider an emotionless business deal not really cheating. (We're not discussing ethics here, just possibilities.) He may, in fact, have a partner who refuses to be sexual, while he refuses to abstain. Or, he may desire certain things that he is embarrassed to ask his wife to participate in.

The great sex researcher Helen Kaplan once wrote of a powerful man whose marriage ended when his wife, whom he loved very much, found out that he was seeing a dominatrix. Sadly, Dr. Kaplan said, the man's "requirements" were minimal, but he was afraid his wife would abandon him if he even suggested she do what the dominatrix did. There also are issues of total control, and the fact that there is little chance of ever being hurt or embarrassed, even if unable to perform.

Before telephones and the advent of paid phone sex (or the online equivalent), visiting a prostitute was the only way for a person to be sexual with anonymity (assuming this wasn't a public figure) and without the risk of emotional complication. Recent studies show that certain brain chemicals are released after partnered but not solitary sex, and one might speculate this plays a part as to why a man who visits a prostitute prefers it to online masturbatory fantasy, even if it does put him at risk of losing things very important to him.

Statistics tell us that about 20 percent of married men are unfaithful to their spouses. That was even the case in the survey we did for our book, "He's Just Not Up for It Anymore. When Men Stop Having Sex and What You Can Do About It." The fact that these men weren't sexual with their wives didn't cause them to cheat more, or less, than the average. However, only a small portion of men use "escort" services or prostitutes, and even that can vary from a one time lapse to an ongoing habit.

Needless to say, we can only speculate on what the story is in the (N.Y. Governor Elliott) Spitzer marriage. (Indeed, one thing we've learned over the years is that the only people who maybe know what's going on within a marriage is the married couple themselves. And clearly, there are even surprises there.) But you have to wonder why someone with so much to lose would participate in such high-risk behavior that could be (and in this case was) found out. Is it possible that someone in that position wants to be unconsciously discovered? Has so much guilt seeped into his psyche that he purposely leaves a trail of easily-followed clues? (The governor was fighting for much stricter laws on the books to prosecute the men who visit prostitutes. In actuality, did he want to punish himself?) Or is there a sense of self-delusion? Did he think of himself as omnipotent, that is, too smart to be caught? Did the rules apply to everyone except him?

One other possibility, although improbable, is that some couples may have a private deal. She's not interested in having sex, or if she is, it's not the kind that he wants, and therefore he has permission to visit a prostitute. No emotion that might threaten the marriage is allowed, but he can remain sexual. This might be on the condition that he practices safe sex and uses complete discretion.

Many therapists define sexual addiction as obsessive behavior that puts marriage, family, career, health and personal safety in peril. The recent situation with the governor of New York State certainly fits that description.

Dr. Bob Berkowitz earned his doctorate in Clinical Sexology at The Institute for the Advanced Study of Human Sexuality in San Francisco.

Bob and Susan Berkowitz's book, "He's Just Not Up for It Anymore: Why Men Stop Having Sex and What Women Are Doing About It," was published by William Morrow on December 26, 2007.

If you are a consistently jealous person, or have persistent feelings of jealousy, here are some ways to effectively overcome jealousy.

How can I deal with my jealousy?

While everyone gets jealous or suspicious from time-to-time, experiencing jealousy on a daily basis can be problematic.

When jealousy strikes, people often compare themselves to their rival, they feel threatened, and they imagine the worst-case scenario - that their partner or spouse might leave them for someone else. Not only is jealousy unpleasant to experience, but individuals, who are chronically jealous or suspicious, often misinterpret what is going on - taking what might be an innocent event and thinking about it in the worst way possible.

For example, if a boyfriend or girlfriend does not immediately return a phone call, a highly jealous individual will jump to a negative conclusion (my partner doesn't love me or my partner is cheating). Jumping to such conclusions can drive people crazy and it often fuels their suspicions (Pfeiffer and Wong, Salovey and Rodin).

Negative thoughts, doubts, and insecurities often lead to more negative thoughts, doubts, and insecurities.

Not only do highly jealous individuals drive themselves crazy, they often drive their partners crazy as well. Being around a suspicious person is difficult to deal with. No one likes to have everything that happens turned into a negative event. Moreover, being with a jealous person is difficult because highly suspicious partners can be overly controlling, needy, and invasive. As such, it is not uncommon for people who date highly suspicious individuals to pull away from their partners because of all the problems that it causes.

Learning how to deal with jealousy effectively is critical to maintaining a healthy relationship.

Talk About Your Feelings

Typically, the best way to deal with jealousy or suspicion is to talk to your husband or wife, boyfriend or girlfriend, about the issue. When people are suspicious or jealous, they often try to hide their true feelings from their partners, but ignoring our emotions hardly ever works. Our feelings get the best of us and influence our behavior whether we like it or not. So when people experience jealousy, if they do not talk about it, it comes out through sudden mood changes, acting overly controlling, being overly sensitive and needy, causing unnecessary arguments and fights, pointing out a romantic rival's every flaw, attacking a partner ("why did you do that?"), and so on.

In fact, jealousy sometimes leads people to flirt with others as a way of getting their partner's attention or showing them just how awful it can feel. On the other hand, a lot of research shows that talking to a partner about being jealous is the best way of dealing with it. As a general rule, when talking about jealousy, it helps to focus on your feelings and not necessarily your partner's behavior. In other words, do not blame or attack your spouse or partner because you feel jealous - rather explain how you feel ("Sometimes my jealousy gets the best of me, and I don't like feeling this way...").

If you can talk directly to your spouse or partner about how you feel, you are less likely to act in ways that create more distance and distrust in your relationship or marriage. In fact, people often feel closer when they can talk to their partners about their problems in a constructive manner. Also, you are most likely to get the reassurance that you need from a partner when you discuss your jealousy in a calm, cool manner. And if your partner gives you reassurances when you are feeling jealous, your feelings will fade over time. However, you need to determine if talking about your problem is likely to be productive given your own relationship. Some people have a difficult time listening to their partners or spouses discuss their problems. Some people are just more uncomfortable with intimacy and closeness - so talking may not always work.

Interpret Things Differently

Another way of overcoming jealousy involves trying to think differently about events that make you suspicious.

Again, jealous partners or spouses put the worst spin on everything that happens. And a lot of things that happen in a relationship or marriage are somewhat ambiguous - events and actions are almost always open to more than one interpretation. For instance, if a husband or wife, boyfriend or girlfriend does not answer the phone right away - there are many different possible explanations (people are busy, batteries die, calls don't go through, etc). Overly jealous individuals, however, jump to the worst case scenario and dwell on it, which just leads to more problems in the long run.

So, when events that trigger jealousy occur, it helps to interpret them in a different light. Rather than jump to the worst case scenario, why not try to think about the best case scenario?

Learning to interpret events positively, if done consistently, can help individuals overcome their jealousy. In fact, a romantic partner's ability to put a positive spin on things that happen is one of the key differences between relationships and marriages that succeed and those that fail. Putting a positive spin on things, however, is difficult to do because old habits and ways of thinking die hard. Typically, this strategy is often best accomplished through some counseling.

As a Last Resort - Try to Gain More Information

Suspicion is often fueled by a lack of information. Being jealous involves imagining the worst, but not being sure if your feelings are correct. For some people, the most difficult part of being suspicious is not knowing what the truth might be. So as a last resort, one way to deal with jealousy and suspicion involves trying to get to the bottom of things. In fact, some people have a very difficult time letting go of their suspicions until they have enough information to make up their mind or until they have the answers that they are looking for.

The problem with this approach is that the quest for information usually takes on a life of its own. People seek out information, but they do not know when to stop, and their search only fuels their suspicion even more. With this in mind, what are some guidelines for trying to get to the bottom of things?

To begin with, asking a lot of invasive questions is usually not a good way to go about discovering the truth. If husbands or wives, boyfriends or girlfriends, are trying to hide things from you, they are not likely to tell you about it simply because you ask. There are much better ways of getting romantic partners to be more forthcoming.

Secondly, many people resort to snooping. But, snooping raises some ethical issues. But, if you do snoop on your partner, try to set a reasonable time limit - a week, a month, or whatever, given the issue at hand. It is important to set a strict time limit and keep to it. Otherwise, your search will just lead to a never-ending quest for more information, which only fuels suspicion even more. If you do not discover anything within the time limit then try to let it go. If you are still suspicious, remind yourself that you tried to get the truth and discovered nothing - you gave it your best shot and came up empty-handed.

On the other hand, if you do discover something, at least now you can deal with a real problem rather than spend your time worrying about what might be.

Parents of children with ADHD and behavior problems experience highly elevated levels of daily child-rearing stresses. Some parents turn to drinking alcohol to deal with the stress caused from parenting an ADHD child.

Several publications in the psychological literature support the theory that children are a major source of stress for their parents. Not surprisingly, parents of children with behavior problems - particularly children with attention deficit hyperactivity disorder (ADHD) - experience highly elevated levels of daily child-rearing stresses. Children with ADHD disregard parental requests, commands, and rules; fight with siblings; disturb neighbors; and have frequent negative encounters with schoolteachers and principals. Although many investigations have dealt with parenting stress caused by disruptive children, only a handful of studies have addressed the question of how parents cope with this stress.

Those findings are presented, including a series of studies assessing parental distress and alcohol consumption among parents of normal children and ADHD children after the parents interacted with either normal- or deviant-behaving children. Those studies strongly support the assumption that the deviant child behaviors that represent major chronic interpersonal stressors for parents of ADHD children are associated with increased parental alcohol consumption. Studies also have demonstrated that parenting hassles may result in increased alcohol consumption in parents of "normal" children. Given these findings, the stress associated with parenting and its influence on parental alcohol consumption should occupy a salient position among the variables that are examined in the study of stress and alcohol problems.

Stress and Parenting in Adults Interacting With Children With ADHD

The idea that children can cause stress in parents is an often-exploited scenario in cartoon pages. "Dennis the Menace" has tormented his parents and other adults for decades, and Calvin, the little boy in the cartoon series "Calvin and Hobbes," kept a record on his calendar of how often he drove his mother crazy. Similarly, in the noncartoon world, the question of whether children cause stress yields numerous raised hands in any group of parents. Indeed, a considerable number of publications in the psychological literature support the argument that children are a major source of stress for their parents (Crnic and Acevedo 1995).

Not surprisingly, parents of children with behavior problems-particularly children with attention deficit hyperactivity disorder (ADHD)-experience highly elevated levels of daily child-rearing stresses (Abidin 1990; Mash and Johnston 1990). Children with ADHD disregard parental requests, commands, and rules; fight with siblings; disturb neighbors; and have frequent negative encounters with schoolteachers and principals.

Although many investigations have dealt with parenting stress caused by disruptive children, only a handful of studies have addressed the question of how parents cope with this stress. For example, if stress in general can precipitate alcohol consumption, it would not be surprising to discover that some parents might attempt to cope with their parenting stress and distress by drinking. This article first reviews the relationship between childhood behavior problems and subsequent adult drinking behavior and then explores the effects of child behavior on parental drinking. The discussion includes a review of a series of studies assessing parental distress and alcohol consumption among parents of normal children and ADHD children after the parents interacted with either normal- or deviant-behaving children.

Childhood Behavior Disorders and Adult Alcohol Consumption

Children with ADHD have problems paying attention, controlling impulses, and modulating their activity level. Two other disruptive behavior disorders-oppositional defiant disorder (ODD) and conduct disorder (CD)-overlap considerably with ADHD. Children with ODD are irritable and actively defiant toward parents and teachers, whereas children with CD exhibit norm-violating behavior, including aggression, stealing, and property destruction. Substantial comorbidity occurs among these disorders, ranging from 50 to 75 percent. A large body of research has demonstrated many connections between alcohol problems in adults and these three disruptive behavior disorders (Pelham and Lang 1993):

• Children with externalizing disorders are at increased risk for developing alcohol or another drug (AOD) abuse and related problems as adolescents and as adults (Molina and Pelham 1999).
• Adult alcoholics more commonly have a history of ADHD symptomatology compared with non-alcoholics (e.g., Alterman et al. 1982).
• The prevalence of alcohol problems is higher among fathers of boys with ADHD and/or CD/ODD than among fathers of boys without these disorders (e.g., Biederman et al. 1990).
• Similarities exist between the behavioral, temperamental, and cognitive characteristics of many children of alcoholics and such characteristics of children with ADHD and related disruptive disorders (Pihl et al. 1990).

In summary, these findings indicate that childhood externalizing behavior disorders are associated with an increased risk of familial alcohol problems, as well as subsequent adult alcohol problems. Furthermore, parental alcohol problems may contribute to a child's current and future psychopathology. Conversely, a child's behavior problems may intensify parental drinking, which in turn may exacerbate the child's pathology. This vicious cycle may result in ever more serious problems for the entire family.

Effects of Childhood Behavior Problems on Parental Drinking

As described in the previous section, in families with children with behavior disorders and/or parental alcoholism, both the parents and children appear to have an elevated risk for alcohol-related problems. Researchers have only recently begun, however, to explore the causal mechanisms operating in these relationships. In addition, the research has focused primarily on the effects that parental drinking has on the children and their behavior. Some recent studies, however, have begun to examine the possible effects of deviant child behavior on parental alcohol problems.

Researchers and clinicians widely believe that children with behavior problems, particularly those with such externalizing disorders as ADHD, can adversely affect their parents' mental health (Mash and Johnston 1990). Childhood externalizing problems frequently result in stressful family environments and life events affecting all family members, including parents. For example, numerous investigators have reported higher rates of current depression in mothers of children who were referred to a clinic because of behavioral problems than in mothers of healthy children (e.g., Fergusson et al. 1993). In addition, a significant correlation exists between daily parenting hassles (e.g., experiencing difficulty finding a baby sitter, having to talk to a child's teacher, or coping with fighting among siblings) and child behavior problems. Thus, studies investigating the distressing effects of deviant child behavior on the immediate reactions and long-term functioning of parents have shown that exposure to difficult children is associated with dysfunctional parental responses, such as maladaptive discipline practices (Crnic and Acevedo 1995; Chamberlain and Patterson 1995).

Despite the evidence that children with behavior problems cause substantial stress and other dysfunctional responses in their parents, almost no research has investigated whether these parental responses include elevated alcohol consumption and/or alcohol problems. This lack of research is particularly surprising given the well-documented association between adult alcohol problems and childhood externalizing disorders. Several relationships may exist among deviant child behavior, parental stress, and two broad types of dysfunctional responses in parents-emotional problems, such as anxiety and depression (i.e., negative affect), and problem drinking. These hypothesized relation-ships are shown in the model in Figure 1. The relationships among parental affect, drinking, and child behavior problems are believed to be transactional, with each variable influencing the other over time. In addition, various parental and child characteristics may influence these relationships. We have hypothesized that child behavior problems increase parental distress, which in turn influences drinking and parental affect. Drinking and negative affect result in maladaptive parenting behaviors, which exacerbate child behavior problems.

Studies of the Influences of Child Behavior on Parental Drinking

Between 1985 and 1995, researchers at the University of Pittsburgh and Florida State University conducted a series of studies examining the relationships described above. Although some of those analyses have examined the influences of parental alcohol consumption on child behavior (Lang et al. 1999), most of the investigations have focused on the influences exerted by child behavior on parental behavior. Thus, these studies have manipulated child behavior and measured the resulting levels and changes in parental alcohol consumption. In order to determine the direction of effect in the documented associations between child behavior problems and parental drinking problems, the studies were conducted as experimental laboratory analogues, rather than as correlational studies in the natural environment.

Thus, all the studies described in this section have employed a similar design and similar measures. The participants, of whom most were parents and all were social drinkers (i.e., none were alcohol abstainers and none were self-reported problem drinkers), were recruited for what they believed were studies designed to investigate the effects of alcohol consumption on the way they interacted with children. The participants were told that they would have a baseline interaction with a child, followed by a period in which they could consume as much of their favored alcoholic beverage as they wanted (i.e., an ad lib drinking period), followed by another interaction with the same child. Each interaction period consisted of three phases:

1. a cooperative task in which the child and adult had to cooperate to solve a maze on an Etch-a-Sketch,
2. a parallel task during which the child worked on homework while the adult balanced a checkbook, and
3. a free-play and clean-up period.

In all three settings, the adult was responsible for ensuring that the child stuck to the required task but also was directed to refrain from providing the child with too much assistance.

The adult participants were led to believe that the aim of the study was to compare their interactions with the children before and after drinking in order to learn about alcohol's effects on adult-child interactions. The adults also were told that the child with whom they would interact might be a normal child from a local school or an ADHD child who was receiving treatment in a clinic. In fact, however, all of the children were normal children who had been hired and trained to enact carefully scripted roles that reflected either ADHD, non-compliant, or oppositional behavior (referred to as "deviant children") or normal child behavior (referred to as "normal children"). The true goal of the study was to evaluate each adult's emotional, physiological, and drinking behavior in response to his or her first interaction with a particular child and while anticipating a second interaction with the same child.

Studies Involving Undergraduate Students

Using undergraduate students as subjects, the first study of the series was designed to evaluate the validity of the concept that interactions with deviant children could induce both stress and stress-related alcohol consumption in adults (i.e., a proof-of-concept study) (Lang et al. 1989). In that study, both male and female subjects who interacted with deviant children reported consider-ably elevated levels of subjective distress and consumed significantly more alcohol compared with subjects who interacted with normal children. No significant differences in subjective distress or alcohol consumption existed between male and female subjects interacting with the deviant children. Thus, the study demonstrated that interactions with a deviant child could produce stress-induced drinking in young adults.

Intriguing as these results were, however, they could not be generalized to parents of children with behavior disorders, because the subjects were single undergraduate students who were not parents. The results did illustrate, however, that child behavior could be used to manipulate adult drinking behavior and that interactions with deviant children were potentially stressful, at least in young adults without parenting experience.

Studies Involving Parents of Normal Children

Using the same study design, Pelham and colleagues (1997) replicated these results with a sample of parents of normal children (i.e., children with no prior or current behavior problems or psychopathology). The subjects included married mothers and fathers as well as single mothers. The study found that both mothers and fathers were substantially distressed by interacting with deviant children and showed increases in negative affect and self-ratings of how unpleasant the interaction was overall, how unsuccessful they were in the interaction, and how ineffective they were in dealing with the child. More-over, parents from all three groups who interacted with a deviant child consumed more alcohol than did parents who interacted with a normal child. Interestingly, for both reported subjective distress and drinking behavior, the differences between subjects interacting with deviant and normal children were considerably larger among parents of normal children than among college students in the investigation by Lang and colleagues (1989). These findings indicate that when parents are presented with a stress-inducing factor (i.e., an ecologically valid stressor) relevant to their normal life, such as child misbehavior that induces considerable subjective distress, they may engage in increased alcohol consumption (i.e., stress-induced drinking).

It is notable that these effects were obtained in a sample of parents of non-deviant children. Thus, the results are consistent with other studies showing that parenting hassles can cause distress even in normal families (Crnic and Acevedo 1995; Bugental and Cortez 1988). Furthermore, because the effects were obtained in both mothers and fathers, the study demonstrated that problematic child behavior can influence drinking behavior regardless of parent gender. Among the mothers studied, interactions with deviant children had the largest impact on single mothers, who have also been shown to be particularly vulnerable to numerous stressors, including parenting difficulties (Weinraub and Wolf 1983) and drinking problems (Wilsnack and Wilsnack 1993).

Studies Involving Parents of ADHD Children

To explore the link between alcohol problems and deviant child behavior in parents of children with ADHD, Pelham and colleagues (1998) employed the same study design with a sample of parents who had children with an externalizing disorder. Again, the study included single mothers as well as married mothers and fathers to allow analysis of potential differences in drinking behavior as a function of gender and marital status. In addition, after the initial data analysis, the investigators conducted an unplanned analysis using the Michigan Alcoholism Screening Test to determine problematic drinking behavior of the subjects' parents and associated familial risk for drinking problems. This analysis was prompted by considerable research indicating that familial history of alcohol problems may be associated with the effects of stress and alcohol on a person's behavior (Cloninger 1987).

As in the studies by Lang and colleagues (1989) and Pelham and colleagues (1997), parents of ADHD children responded with self-ratings of increased distress and negative affect after interactions with the deviant children. The magnitude of the elevations in parent distress was as great as that seen in parents of normal children. Because parents of children with disruptive behavior disorders are exposed to such deviant child behavior on a daily basis, these observations suggest that those parents experience chronic interpersonal stressors. Other studies have indicated that such chronic interpersonal stressors have a greater impact in causing negative mood states (e.g., depression) in adults than do one-time (i.e., acute) and/or non-interpersonal stressors (Crnic and Acevedo 1995). Consequently, these findings illustrate the importance of child behavior on parental stress and mood levels.

Despite the increased distress levels, however, parents of ADHD children as a group did not display the stress-induced drinking shown by college students or parents of normal children. Deviant child behavior resulted in elevated drinking levels only when the investigators conducted the subgroup analyses based on family history of alcohol problems. Thus, parents with a positive family history of alcohol problems exhibited higher drinking levels after interacting with deviant children than after interacting with normal children. Conversely, parents without a family history of alcohol problems showed lower drinking levels after interacting with deviant children than after interacting with normal children.

This finding was somewhat surprising, because the investigators had strongly expected parents of ADHD children as a group to exhibit elevated drinking in response to deviant child behavior. The study results suggest, however, that some parents of ADHD children (i.e., parents without a family history of alcohol problems) may have developed coping techniques other than drinking (e.g., reducing their alcohol consumption or establishing problem-solving strategies) to cope with the stressors associated with raising a child with deviant behavior. Consequently, it is important to measure additional differences among individuals in order to fully explain responses to various types of child behavior.

Notably, the effect of a family history of alcohol problems on drinking levels was comparable for mothers and fathers. Most previous studies had demonstrated an association between a positive family history and alcohol problems in men, whereas the evidence for such an association in women was less convincing (Gomberg 1993). Furthermore, two distinct subgroups of parents, differentiated by their family history of alcoholism, appeared to exist, and they exhibited different coping techniques. Thus, parents with a family history of alcohol problems more commonly used maladaptive, emotion-focused coping techniques (i.e., drinking), whereas parents without such a history more commonly used adaptive, problem focused coping techniques (i.e., not drinking). Accordingly, the researchers continued to explore whether these sub-groups also existed among mothers of ADHD children.

To facilitate data interpretation, the investigators modified the study design in several ways, as follows:

• They determined the subjects' family histories of alcohol problems, defined as having a father with alcohol problems, prior to the study and used this information as a criterion for subject selection.
• They quantified stress-induced drinking for each subject using a within-subject design rather than the between-subject design employed in previous investigations. Thus, rather than comparing subjects who had interacted with a deviant child with subjects who had interacted with a normal child, the investigators had each subject participate in two laboratory sessions 1 week apart. In one session, the subject interacted with a deviant child and in the other session she interacted with a normal child.
• They measured the subjects' heart rate and blood pressure during their interactions with the children in order to obtain physiological information about subjects' stress levels.
• They administered numerous tests in order to identify dispositional characteristics, such as psychopathology, personality, coping, attributional style, alcohol expectancies, life events, family functioning, and drinking history, which might influence the subjects' response in addition to the family history of alcohol problems.

The results of the study confirmed the previous findings on the effects of child behavior on parental stress levels that were obtained from college students and parents of normal children. After interacting with the deviant children, the mothers of ADHD children showed greater physiological distress (i.e., significantly increased heart rate and blood pressure) than after interacting with the normal children. These mothers also showed greater subjective distress (i.e., increased negative affect; decreased positive affect; and increased self-ratings of unpleasantness, unsuccessfulness, and ineffectiveness). Furthermore, the mothers consumed approximately 20 percent more alcohol after interacting with the deviant children than after interacting with the normal children (Pelham et al. 1996a).

These findings clearly demonstrate that interactions with ADHD children engender large stress responses from their mothers in multiple domains. Furthermore, the mothers in this study as a group coped with this distress by drinking more alcohol. Contrary to the family history analysis in the previous study (Pelham et al. 1998), however, the subject's paternal history of alcohol problems (selected in advance) did not affect alcohol consumption in this larger sample.

To further clarify the results of the study among mothers of ADHD children, the researchers also evaluated the mothers' dispositional characteristics before their interactions with the children to identify potential associations with their stress-induced drinking (Pelham et al. 1996b). The investigators correlated these measures with the amount of alcohol the mothers consumed after interacting with a deviant child (i.e., stress-induced drinking), controlling for the amount of alcohol consumed after the interaction with the normal child. These analyses identified numerous factors associated with higher levels of stress-induced drinking, including the following:

• Higher levels of routine drinking (i.e., a greater number of drinks per drinking occasion)
• More negative consequences of drinking
• Higher levels of drinking problems
• A denser family history of alcohol problems (i.e., alcoholic relatives in addition to the father)
• Maternal history of drinking problems
• Higher self-ratings of using maladaptive coping strategies, feeling depressed, and experiencing more daily life stressors

Although many mothers of ADHD children showed elevated drinking levels in response to interacting with a deviant child, a substantial number of mothers decreased their alcohol consumption after such interactions. This pattern of divergent responses is comparable to the one observed among mothers of ADHD children in the earlier study by Pelham and colleagues (1998) and points to the need for more fine-grained analysis.

The individual differences in coping with deviant child behavior noted in both studies suggest that alcohol consumption in mothers of ADHD children is a complex phenomenon. Clearly, some mothers resort to maladaptive coping mechanisms (i.e., drinking) in response to the stress of dealing with their child. Such a dysfunctional coping response often can be predicted by the mothers' general coping styles. Other mothers, however, cope in a problem-solving fashion by decreasing their alcohol consumption when anticipating another interaction with the deviant child, apparently believing that drinking would decrease their effectiveness in interacting with that child.

Whereas a paternal history of alcohol problems did not predict stress-induced drinking in the mothers of ADHD children, a maternal history of alcohol problems and the frequency of alcohol problems in other first-degree relatives did predict stress-induced drinking. These findings suggest that in addition to, or instead of, paternal alcohol problems, researchers should consider maternal drinking history and family density of drinking when assessing the influence of family history on female drinking behavior.

The study on the mothers of ADHD children, as well as all the other studies in this series, was conducted in an "artificial" laboratory setting. The fact that subjects' self-reported drinking levels (i.e., number of drinks per occasion) and self-reported alcohol problems correlated highly with stress-induced drinking measured in this setting confirms that this type of investigation can generate information that reflects real-life behavior. Thus, the laboratory findings provide strong support for the hypothesis that among mothers of ADHD children, routine drinking and drinking problems are at least in part a response to the daily stress of coping with their children.

Conclusions

A recent review of the relationship between AOD abuse and parenting concluded that huge gaps exist in understanding the association between parental alcohol abuse and parent-child relationships (Mayes 1995). For example, more information is needed regarding the effects of alcohol on parenting behaviors (e.g., overly punitive discipline) that are known to affect child development. Lang and colleagues (1999) recently demonstrated in a laboratory setting that alcohol negatively influences parenting behaviors (e.g., lax monitoring) that mediate the development of conduct problems in children (Chamberlain and Patterson 1995). This finding confirms the parent-to-child influence on the relationship between parental alcohol problems and externalizing behavior problems in children. Conversely, the studies described in this article strongly support the assumption that the deviant child behaviors that represent major chronic interpersonal stressors for parents of ADHD children (Crnic and Acevedo 1995) are associated with increased parental alcohol consumption, thereby confirming a child-to-parent influence on the same relationship.

Childhood externalizing disorders affect approximately 7.5 to 10 percent of all children, with a considerably higher incidence among boys. The association between childhood behavior disorders and parental alcohol problems means that many adults with drinking problems are parents of children with behavior problems. Moreover, the study by Pelham and colleagues (1997) involving parents of normal children has demonstrated that parenting hassles may result in increased alcohol consumption even in normal families. Together, the results described in this article indicate that the stress associated with parenting and its influence on parental alcohol consumption should occupy a salient position among the variables that are examined in the study of stress and alcohol problems.

Source:
Alcohol Research & Health - Winter 1999 Issue

About the authors:
Dr. William Pelham is a Distinguished Professor of Psychology, Professor of Pediatrics and Psychiatry at the State University of New York at Stony Brook and has studied many facets of ADHD.
Dr. Alan Lang is a Professor of Psychology at the University of Wisconsin-Madison and specializes in alcohol use and related problems, including addictive behavior more generally.

Today there are a number of effective therapies available to people living with HIV. There are a also number of things to think about during the initial search for the right treatment and the right doctor.

Social worker Cynthia Teeters has extensive experience counseling a diverse population of HIV positive patients in both private and hospital settings. Below, she offers some advice to those first diagnosed with HIV.

Finding an experienced doctor you can trust
The first thing to keep in mind as you consider an HIV treatment program is that you are the most important member of the treatment team. Be sure you find someone with whom you can work, ask questions, and address your concerns. When you begin to receive medical care for HIV, it is important to do your homework. Depending on your insurance plan, availability of physicians will vary. Learn about providers in your community that currently work with HIV patients. Most major hospitals will have physicians who specialize in treating HIV disease. You should look for a doctor who has experience with HIV, as treatments and medications change rapidly. Feedback from other patients can also help you choose a provider. If you are involved with a community organization or support group, ask other patients about their experiences with their physicians.

Depending on where you were tested for HIV, you may or may not be connected with a doctor. If you were tested at a health department or private testing site, their staff may be able to refer you to reputable HIV providers in your area. If you were tested at your family doctor's office, you may want to continue in his or her care. However, it is in your best interest to ask your doctor about the extent of his or her experience with treating HIV. It is important to receive medical treatment from an experienced HIV provider. When and if you and your doctor decide to begin treatment, it is very important to stick with the agreed-upon plan. If you are having any problems adhering to the plan (for example, taking medications as directed), contact your doctor as soon as possible.

Support for fighting drug and alcohol addiction
If you feel you may have a problem with drugs or alcohol, be proactive and ask for help. Fighting addiction to drugs and/or alcohol can be difficult. However, there are a variety of resources and support services available nationwide. Taking steps to address your drug and alcohol use will help you be more prepared to deal with your HIV diagnosis. The longer you put off dealing with substance abuse problems the more you may damage your body.

Investigating your health benefits for HIV
Medical treatments for HIV are very expensive. It is extremely important to be knowledgeable about your health insurance options. If you are currently covered by an insurance plan, investigate the limits of your policy. Explore whether or not you have access to an HIV specialist. Don't be afraid to speak with a customer service representative should you have questions about your policy. Some people worry about their insurance companies learning about their HIV status. By law, if you are currently insured and test positive, you cannot be discharged from your insurance plan. If you have specific questions about your policy and do not feel comfortable talking with your employer or company representative you should consider contacting the National AIDS hotline at 1-800-342-2437 (AIDS). Hotline staff will try to locate a local case manager in your area who can help you investigate your plan.

AIDS drug assistance program
You may find that your health plan has a cap on annual medication costs. For some people who do not have adequate prescription drug coverage, there is a federal program called the AIDS Drug Assistance Program (ADAP). ADAP was designed to provide access to expensive HIV medications for people who are considered to be underinsured or have no insurance. Eligibility for ADAP is determined based on your financial situation. Eligibility will also vary from state to state, as will the number of medications covered. States with larger numbers of people living with HIV tend to have a larger list of covered medications.

If you are currently unemployed or have a low income, you may be eligible for Medicaid. Medicaid is a federal program that provides health care for people who cannot afford to purchase insurance on their own. If you qualify for supplemental security income (SSI), you will automatically receive Medicaid.

Protecting yourself and others
HIV is not easily transmitted. In order to transmit HIV, there must be an exchange of body fluids, blood, semen, vaginal secretions, or breast milk. HIV is often transmitted through unprotected sexual contact. This includes oral, anal, and vaginal sex. Using condoms will significantly reduce the risk of transmitting HIV to a sexual partner. If you are using intravenous drugs, do not share needles with others. HIV can be transmitted through breast milk, therefore new mothers are advised against breastfeeding. Women who are pregnant can take medications to reduce the risk of transmission to their child.

Educating yourself
We are learning more each day about HIV and its treatment. Try to educate yourself. Evaluate which methods of information gathering work best for you. Be careful not to overload yourself and don't forget to stop and take a breath. Most of all, ask for help when and if you need it. Many people living with HIV continue to lead active lives after they are diagnosed. By working closely with your doctor and leading a healthy lifestyle, you can continue to lead a happy and productive life.

Cynthia Teeters is a social worker with The Center for Special Studies AIDS program at New York Presbyterian Hospital, Weill Cornell Center. Ms. Teeters has provided individual and family counseling to a diverse population of HIV positive patients, both in the hospital and in a clinic setting.

Self-injury disclosure can come as a complete shock if you are on the receiving end. Your reactions to self-injury disclosure, though, are important. Here’s why.

If you know someone who self injures, the first thing you need to do is be aware of self-injury and what self-harm actually is. From personal experience, I know that many people find the idea of self-injury incredulous, and many people tend to back away from self-injurers out of fear. This fear often stems from a limited knowledge of self-injury as a whole.

About Self-Injury Disclosure

If someone confesses their self-injurious behavior to you...

... you must realize that on the whole, people do not injure themselves in order to get attention. I say 'on the whole' because I am not intending to categorize self-injurers here. However, self-injury cutting, and other forms of self-harm, can be a cry for help due to intense and unbearable emotions (see Causes of Self-Injury). If someone confesses their self-injury to you, horror is the last thing you need to express. I realize that this can be difficult, as shock is bound to be an element of your natural reaction. Most self-injurers are incredibly clever at concealing their actions from people, and so a confession of this sort can be a very big surprise! However, a reaction such as 'That's disgusting!' is not going to do wonders for the confidence of the person!

What you must realize is that to confess to something such as self-injury is a very big step for someone. Many people are extremely worried about the reactions they will get from people if they 'come out' about their problem, and therefore if they do confess, it is likely that they confide in someone they trust.

Self-Harm Disclosure Reactions

On a personal note, self-harm is a very difficult topic to cover as I have witnessed many different reactions to my own self-injury disclosures; some of which have been extremely beneficial and have worked wonders for me, and some of which have effectively made the problems a little harder to handle. Therefore, in writing this article, I appealed to other self-injurers as well as people who had friends/relatives who harmed themselves. (You can find additional information on responding to people who self-injure on the self-injury statistics and facts page.)

These were the comments they gave me when I asked the question: "How did people react to your self-harm disclosure?"

"They freaked, flipped, were angry, confused, and tried to control me in every way possible, and that just made me more hostile and angry myself. But not everyone reacts that way - that was mainly my doctors, and family. my real life friends were concerned. At the time the people I told on the net didn't understand either, that's why they called my family *sigh* but I have people that understand now and that helps A LOT."

"My friend told me that she wouldn't talk to me again unless I stopped it. She did that because she cared, but it made everything a lot worse for me."

"When I told my closest friend about the cutting she cried. That upset me in a way but it shocked me because it showed that she really did care. She was very supportive and told me that she would help me in any way that she could. That was everything that I could have wished for. I am very grateful to her and I owe her a lot."

"My family made me feel very uncomfortable. They just didn't understand when I told them. They thought I was crazy and my Mom thought it was her fault that I was doing all this to myself. She shouted and told me it would get infected. I couldn't believe that she believed that would matter to me."

"Cutting is me. If people can't take that, they can leave it. All of my friends know and some ignored me. They weren't my real friends and I have learnt to deal with that."

"My father seemed only to care about the fact the self-harm scars were there for life."

"All of my friends knew and a few of them just made fun of it. They thought it was cool. The others didn't do anything about it. They knew I had problems."

"Telling my friend I self-injure was the hardest thing I have ever done. I didn't know why I wanted to confess, but I kinda needed to. He just shook his head at me and ran out of the room. I should have expected that, but for years it stayed in my mind - from that day on I vowed I would never tell a soul about it."

"My friend encouraged me to talk to her about my self-injury, but one day it must have become too much for her. She couldn't cope. She told me that if I didn't stop hurting myself then she would tell my parents. I never talked to her after that."

"Someone found out about the self-injury cutting before I really told anyone. I confessed to a friend that day, because I needed some help in dealing with people knowing, and cause I didn't want her finding out another way. That was a long time ago now, and at first she was wonderful - concerned, worried, and supportive. She told me she was there for me. Along the road, she had problems dealing with it. There were times I thought I would die because she just didn't want to be anywhere near me - she was trying to handle my problems as well as her own. It was unfair to her. When I started to see a therapist and get cutting treatment, it helped. Now we are friends again.   The cutting is a sore subject and I don't tell people about it now. It's not a big part of my personality. It is just a part of the inner me rebelling against the outer me."

"All I wanted was a shoulder to cry on and someone to tell me they would help me. What I got was panic about my health. Everyone seemed to take it that the cutting itself was the issue, and what it was doing to my health... the scars would always be there. No one asked me why I self-harm or what I was feeling. No one seemed to care. After that the cutting got worse. All I wanted was someone to listen to me and tell me that they understood, instead of telling me that they were worried about what I was doing to myself. No one understood."

Preferred Reactions to Disclosing Self-Injury

How Do You Want People to React?

"I wish my parents would have left me alone. They followed me everywhere when they found out - and it made me want to cut even more."

"I guess I want understanding.. but then no one seems to understand."

"My friend told me we would get through it together. I was lucky.   He helped me through it every step of the way - just by being there and letting me know that he cared."

How Do You Not Want People to React?

"My friend left. I hated myself."

"I was scared of telling people because I thought they'd be afraid of me. I was right."

"All they care about is infections and scars. So I give them more to care about."

About the author: Clover, is a self-injurer and started the self-injury website, "A Healing Touch."

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For too long, African-American women and their sexual needs have been ignored. Over the decades, media-glorified studies have claimed to break new ground in regard to sexuality, but they seldom addressed the needs and concerns of African-American women. In fact, studies that addressed Black women usually focused on transmission of disease.

Ebony magazine readers wanted to know more. What turns us on, what turns us off? What are our major problems and concerns? Where do we go when we have problems or questions?

In response to the thousands of reader queries the magazine continued to get, Ebony undertook a major study to answer some of these questions. Ebony has commissioned Hope Ashby, Ph.D., a psychotherapist based in New York City, to help design a groundbreaking new sex survey that delved into the hearts and sex lives of Black women. The survey results were published in October 2004. The magazine wanted to hear about the issues that affect the quality of black women's lives and relationships. In the end, they hoped to shed some light on personal concerns and let black women know that they are not alone; other women have the same problems that you do. And there are solutions that can lead to a healthier, more fulfilling sex life.

Here, Dr. Ashby, offers some insight into Black women and sexuality.

Question: What are the sexuality problems affecting Black women?

Dr. Ashby: A major sexuality problem facing Black women today is HIV/AIDS. Another is the lack of information available in our communities. There is a lot of misinformation or just nonexistent information about anorgasmia, low libido, painful sex and even simple things such as the effect of hormones on sexual functioning.

Question: Are there sexuality issues that affect Black women more so than other women?

Dr. Ashby: A continual complaint about their partners not wanting to wear condoms. Black women also bring up the inability to have an orgasm and low or lost libido as White women do.

Question: Are there aspects of sexuality that Black women seem to enjoy an advantage?

Dr. Ashby: I think that the one advantage that Black women have is high body esteem. We tend to be more comfortable in our bodies, especially Black women who are plus-size. Having a high body esteem helps to enhance one's sexual feelings about herself.

Question: When a Black woman has a problem with sex, where does she go for help and advice?

Dr. Ashby: Black women tend to go to their friends; it is rare that they go to their doctors with sex issues because they are unaware that there is help out there for these types of problems. There are professionals, like myself, who specialize in sexually related issues and can help. Some medical doctors are beginning to listen to their patients' sexuality complaints and learn about the area of sexual medicine.

Question: For those who are not comfortable talking to their partners, what advice do you have?

Dr. Ashby: First and foremost, don't choose to start having these conversations when you're about to have sex. That is the wrong time. It is important to begin these conversations in a neutral, non-threatening place, especially if you haven't been having orgasms and you have been faking. Begin by asking your partner what he thinks about your sex life. Are there fantasies he would like to explore?

Question: How do history and culture affect our sexuality?

Dr. Ashby: Throughout White history, Black women have been portrayed in two paradigms--that of Jezebel and that of "mammy." Jezebel being the slut, promiscuous woman and "mammy" being completely asexual but always passive and caretaking. Because Black women have generally been looked at through these two lenses, it has been difficult for us to find middle ground. How can you be a comfortable sexual being when you could be perceived as a slut? This message is also pervasive in American culture. Little girls are taught that sex is to be saved for marriage without ever hearing any mention of enjoyment. It gets conveyed in a subtle way that pleasure is reserved for your partner and that you are the conveyer of that pleasure. Thus Black women are often caught between being a "good girl" (nonsexual), or a "bad girl" (sexual). Another aspect of Black history that is tied to these paradigms is that as slaves Black women were regularly raped and sodomized by their masters, and also sold off from their families. This traumatic history is still an unconscious remnant in the lives of Black women.

Question: Why do some Black women feel bad or "dirty" about initiating sex with their mate?

Dr. Ashby: It is an issue of feeling they are not entitled to pleasure and not recognizing themselves as sexual beings with needs of their own. This also goes back to how gifts are socialized in American society. Some girls are socialized to think that sex is dirty and that only bad things can come of it if you engage in sex. Boys, on the other hand, are socialized to think that they can have sex with anyone at any time and that it is their right to do so.

Question: Based on your research, how do Black women feel about oral sex and anal sex?

Dr. Ashby: Black women are more comfortable today than they were a few years ago in giving and receiving oral sex. I usually hear about male partners having problems giving oral sex. Anal sex is still relatively taboo for Black women.

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Question: What can mothers do to make sure their daughters are informed about sex?

Dr. Ashby: It is imperative that mothers sit down with their daughters and talk about sex and sexuality. Adolescence is a time for experimentation; adolescents question their sex appeal, whether they are gay, straight, or bisexual, whether oral sex is "sex," and how to go about it. Being open and honest with your teen is key to impacting their behavior. Even though the information is available, children still need and seek guidance from the ones they trust most--their parents.

Question: Are Black women today more comfortable in accepting their lesbianism?

Dr. Ashby: From many conversations with my patients, it seems that Black women are much more comfortable than they were a few years ago about accepting their lesbianism, but it is still a struggle. My patients state that the African-American community still has difficulty accepting and dealing with the gay and lesbian subpopulation. Black lesbians are confronted with a triple handicap--being Black, female and a lesbian. This comes with a host of challenges that White lesbians don't have to face.

Question: Many women are concerned about whether sexual desire decreases during menopause. Does it?

Dr. Ashby: The wonderful thing about being human is that we are all different and some are lucky not to have a decrease in sexual activities. I have seen some women who are barely affected by the changes brought on by menopause and others whose lives are completely devastated by the hormonal imbalance.

Question: Why is HIV affecting Black women disproportionately?

Dr. Ashby: Because many are engaging in sexual activity without condoms. Many women I see as patients say that their man won't wear a condom because it "feels" better; or if she insists that he wears one, he accuses her of cheating. If your man won't wear a condom, there are ways you can protect yourself. First, there is a female condom available; secondly, there are nonoxynol-9 spermicides that can be inserted into the vagina prior to intercourse. Thirdly, abstinence is always an option until you find that someone who will respect you and your body. The ultimate form of caring and respect is when someone places your feelings and needs above their own.

Question: How do Black women approach masturbation and sex toys? Are there feelings of guilt?

Dr. Ashby: Masturbation is still somewhat taboo for Black women as it is seen as "dirty." My patients have said they are embarrassed to seek out sex toys and feel that buying them would make them appear "loose." Sex therapists have had their patients use sex toys either with a partner or alone as a way to figure out what turns them on and what turns them off.

Question: If there is one message about sexuality that you would like to deliver to African-American women around the country, what would that be?

Dr. Ashby: I think the message I would like to deliver to both African-American and African Sisters is that you are much more than disease carriers and baby-makers. You are sexual beings with needs and desires, and you are entitled to healthy, fulfilling sexual lives, and that there is help for your sexual problems. Everyone is entitled to a fulfilling sex life.

We do it but we don't like to talk about it. Sex, that is.

African-American women may be stereotyped as Lil' Kims in music videos, but for the most part, black women can be extremely prudish when it comes to discussing sex.

That's why the results of a landmark sex survey of black women appearing in the October 2004 issue of Ebony magazine sure raised a few eyebrows.

For starters, according to the survey of 8,000 women nationwide and abroad, brothers apparently aren't taking care of their business. When asked "How satisfied are you with your sex life?" 26.8 percent of respondents said they were "somewhat satisfied," 13.6 percent said they were "somewhat dissatisfied," and only 15.7 percent of the women said they were completely satisfied.

Even more telling, while "cheating" is usually seen as a primarily male behavior, the Ebony sex survey found that 44.2 percent of the women said they had cheated on their partners, while 41.4 percent said they had not strayed.

The 56-question survey asked about the kind of sex that most black women won't even discuss with their best friends, like what is your preferred position for sex and method of penetration. That black women tend to shy away from openly discussing their sexuality is understandable.

Black women were objectified and sexually abused during slavery and the Jim Crow era. Today, young black women are demeaned as sexual objects in rap lyrics and videos. In real life, black teenage girls are being sexually assaulted by older men, including male relatives, at an alarming rate.

Ebony's survey found that 41.9 percent of black women agreed with the statement: "The stereotypical media portrayal of black women (as loose, unrestrained, bossy) has had a negative impact on our sexual development." And about 37 percent of respondents said they had a history of sexual abuse.

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Yet the "ready-at-the-drop-of-a-hat" black woman is largely a myth.

According to the Ebony survey, although 59.7 percent of black women said "masturbation is healthy and normal," 25.3 percent of those women said they never masturbate. When asked: "How often do you experience orgasm?" 22 percent said "very often," 25.2 percent said "often," 26.4 percent said "sometimes," and 18.4 percent said "once in a while."

"This was an issue that we needed to address," said Lynn Norment, Ebony's managing editor. "I have done dozens of relationship stories over the years and I saw the need. There's been sex surveys about women in general, but black women were almost a footnote in those surveys. I thought it was time for us to focus on black women and the issues that we face in our lives."

The survey was conducted online. But some respondents mailed their responses to Ebony. Obviously, an online survey gave respondents a lot of privacy. Still, there are indications that respondents were uncomfortable answering some questions.

For instance, consider the subject of oral sex.

Only 2.7 percent of women surveyed admitted giving oral sex, while 11.6 percent said they were recipients of oral sex, and a whopping 82.1 percent claimed both parties engaged in oral sex. But when asked: "How often do you experience oral sex?", 16.9 percent said very often; 29 percent said "often;" 21.9 percent said seldom; and 24.4 percent of the respondents said "sometimes."

I can't prove this, but 2.7 percent seems an awful small number for givers. What that tiny number says to me is oral sex is still so taboo in the black community, most black women still won't admit to giving oral sex without getting it too.

Most of the respondents live in the South (37.9 percent), are college graduates (52.7 percent) and have never been married (50.2 percent).

"I'm a minister's daughter," said Hope Ashby, the New York City- based sex therapist who helped Ebony formulate the sex survey. "My mother is a Southern belle, and we didn't discuss this stuff. That is why this is quite wonderful. Black women deal with the same issues as white women. We are not having as much sex as we might want, and when we are having sex, we are not being sexually satisfied," she said.

Given the "down low" phenomenon -- that is, black men who have sex with women but do not identify themselves as gay or disclose to their female partners that they also have sex with men -- I was surprised Ebony didn't ask outright about condom use.

Forty-eight percent of respondents said they were very concerned about "brothers on the down low," 16.5 percent said they were "somewhat concerned," and 27.3 percent said they were not concerned.

"What we didn't want to do was alienate people from answering the questions," Ashby said. "Being in your face about it makes people go the other way and not want to talk about it."

Hopefully, Ebony's sex survey will jump-start the real conversation.

SISTERS SPEAK OUT

1. How satisfied are you with your sex life?

Completely satisfied 15.77%

Mostly satisfied 25.42

Somewhat satisfied 26.85

Somewhat dissatisfied 13.62

Mostly dissatisfied 9.09

Completely dissatisfied 9.25

2. How often do you engage in sexual intercourse?

Daily 6.36

Once a week or more 41.64

Once a month 11.69

Two or three times a month 23.31

Once or twice a year 9.05

Not at all 7.95

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3. How often would you like to have sex?

Daily 32.01

Once a week or more 58.04

Once a month 1.79

Two or three times a month 6.22

Once or twice a year 0.44

Less than once a year 0.18

Not at all 1.32

4. How often do you experience orgasm?

Very often 22.07

Often 25.23

Sometimes 26.43

Once in a while 18.41

Never 7.86

5. Have you ever cheated on your partner?

Yes 44.23

No 41.47

Considered it, but did not 14.29

The survey included 8,000 black women, most of whom answered questions online. Some mailed responses to Ebony. The survey was conducted between March 8 and April 30, 2004.

If you suffer from flashbacks, you’ll want to know what the treatments for posttraumatic stress disorder (PTSD) flashbacks are. This is understandable as PTSD flashbacks can be frightening and interrupt day-to-day activities. Feeling like you are re-experiencing a trauma is not something anyone wants.

There are many ways to treat PTSD flashbacks.

Professional PTSD Flashbacks Treatment

It’s important to reach out for help if you have PTSD. Serious PTSD is not generally something you can handle on your own. Both psychiatrists and psychologists are equipped to help with this mental illness. Ideally, you should seek professional PTSD flashback treatment from someone who specializes in trauma-related illnesses.

In addition to one-on-one treatment, there is often group therapy available for PTSD treatment.

According to Understanding and Treating Unwanted Trauma Memories in Posttraumatic Stress Disorder, some of the aspects of the psychological treatments for PTSD flashbacks include the following:

• Updating trauma memories: addresses the disjointedness of memories of the worst moments of the trauma from information that gives them a less threatening meaning by:
  • Identifying the moments during the trauma that create the greatest distress and sense of “nowness” (“hotspots”)
  • Identifying the personal meanings of these moments
  • Identifying “updating” information that puts the impressions the patient had at the time or the problematic meanings into perspective
  • Actively linking the updating information to the hotspots in memory, for example, by bringing the hotspot vividly to mind and simultaneously using verbal reminders, images, incompatible actions or incompatible sensations to remind the patient of the new meanings
• Stimulus discrimination training: addresses the easy triggering of intrusive memories by matching sensory cues. People learn to identify the subtle sensory triggers and learn to realize that they are responding to a memory. They learn to pay close attention to the differences between the harmless trigger and its present context (“now”) and the stimulus configuration that occurred in the context of trauma (“then”).
• Reclaiming your life homework assignments: addresses appraisals of permanent change and problems in retrieving specific memories of a person’s life before the trauma. These assignments involve doing things that the patient has given up since the trauma, for example, resuming social contacts, sports or other leisure activities. These activities provide cues for specific memories of themselves before the trauma.

It’s also important to note that anything that treats PTSD in general, will typically also diminish the effects of PTSD flashbacks. These types of therapies include:

• Cognitive behavioral therapy (CBT)
• Eye movement desensitization and reprocessing (EMDR)

For more information on more techniques you can on your own (alongside professional help), see: How to Stop PTSD Flashbacks?

Coping with Flashbacks Worksheet

When you’re undergoing PTSD flashbacks treatment, you may find using this coping with flashbacks worksheet helpful. This worksheet helps when you are coping with flashbacks by getting you to answer simple questions.

Fill in the following:

1. Right now I am feeling (Describe your current emotion, such as “terrified.”): ____________________________________________________________
2. Right now I am sensing in my body (Describe your current sensations such as pounding heart, shaky legs, etc.): ____________________________________________________________
3. Because I am remembering (Name the trauma but do not describe it.): ____________________________________________________________
4. At the same time, I am looking around now in ___current year___, here ___current location____.
5. And I can see (Describe what you see in the present moment and place.): ____________________________________________________________
6. And so know I know, ___trauma name (not details)___ is not happening now or anymore.

This flashback coping worksheet is designed to help you ground yourself in the moment of a flashback.

(This flashback halting protocol worksheet was adapted from: Rothschild, B. (2000) The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment, New York: Norton)

See also PTSD Self-Help Worksheets

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The answer to the question, "do sociopaths cry or have feelings?" is perhaps best expressed in song. Lesley Gore's 1963 song It's My Party and I'll Cry If I Want To answers the question quite nicely, if not thoroughly.

Sociopaths Don't Have Feelings

A sociopath, by definition, views the entire world as his party. It's his shin-dig, and he'll cry if he wants to. Indeed, crying or any other emotion is nothing more than a choice. If an emotion serves to gain him something, he'll use it. Otherwise, he's unemotional.

There's a difference between having feelings and expressing feelings. Do sociopaths have feelings? With few exceptions, no they do not. They do, however, express feelings.

High-functioning sociopaths are extremely skilled at faking emotion. Depending on the party and attendees, he manipulates by expressing a range of human emotion: happiness, joy, excitement, incredulity, shock, disappointment, sadness, and grief. If he wants to, a sociopath can cry. These false feelings are purely superficial. Non-sociopaths feel things on an emotional level as well as on a physical level. No butterflies flutter in a sociopath's stomach. He never feels his heart race in anticipation or pound in fear.

The shallow and insincere expressions of feeling are mere tools used by a sociopath to entrap people. This makes it effortless for her to take advantage of people, to use them for her own personal gain, and to hurt them physically, emotionally, or both. A sociopath is incapable of feelings such as empathy, regret, and remorse. She doesn't experience emotional pain herself; thus, she can't understand the expression of those feelings in others.

Sociopaths don't have feelings or emotions, nor do sociopaths cry genuinely. However, they do experience proto-emotions, primitive emotions that rear their ugly heads in moments of perceived need. The sociopath is quite capable of intense anger, frustration, and rage.

• Sociopath M.E. Thomas (2013) describes suddenly experiencing a flash of anger that then leaves as quickly as it arrives. She doesn't forget what angered her; instead, her rage morphs into "a sense of calm purpose" (How Abusers Gain Control By Appearing To Lose It). A sense of purpose for a sociopath means that some unsuspecting person has a target on his back.
• James Fallon is a neurobiologist who studies the sociopathic brain. He also happens to be a sociopath (he uses the term psychopath). In discussing his own anger, he says, "...and when I pop it's fierce, and frightening [to others]" (2013).

Why Don't Sociopaths Cry or Even Have Feelings?

One of the causes of antisocial personality disorder (the clinical diagnostic term for sociopathy) is biological in nature. There are issues in the brain that affect processing and responses to stimuli. This could answer the question, "Can a sociopath change?" with an unfortunate "no." However, these organic sociopathic causes provide at least a partial explanation for why sociopaths don't have feelings.

Brain scans and imaging such as functional magnetic resonance imaging (fMRI) scans and electroencephalogram (EEG) tests show that the sociopathic brain doesn't register emotional words and pictures the way a "normal" brain does.

• The brain of a sociopath is unable to grasp abstract concepts such as love.
• All words and concepts like emotions are merely words. This makes thinking concrete. A word is nothing but a word whether that word is "dog" or "grief."
• Sociopaths aren't stupid, and high-functioning sociopaths are highly intelligent. They know the meaning of the words for feelings like love, glee, anxiety, etc. However, they know these abstract concepts only on a concrete level, and this makes it impossible to fully experience them.

Do sociopaths cry? They cry if they want to. Do sociopaths have feelings? Beyond primitive emotions like anger and rage, sociopaths don't have feelings. Remarkably, their social skills are so honed, so highly developed, that no one can tell. Everyone else at a sociopath's party feels emotion. What the sociopath cannot feel in himself, he elicits in others.

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Dating a sociopath, having any type of relationship with a sociopath, is usually a shallow, confusing, one-sided experience.

"Having a psychopath [or sociopath] in your life can be an emotionally draining, psychologically debilitating, and sometimes physically harmful experience" (Babiak & Hare, 2006).

Dating a Sociopath

Unbeknownst to the innocent person about to begin dating a sociopath, she was targeted by him for his personal gain. He'll woo her and sweep her off her feet, and when she decides to date him, she'll think it's her choice. She has no idea that it wasn't her choice at all. From the beginning of the relationship, the sociopath was in control. The real reason she will date him is hidden to her. She'll date him because he's identified her as someone who will meet a need (Sociopathic Traits: Characteristics of a Sociopath.

Dating a sociopath can be marvelous. Mary Jo Buttafuoco was married to a sociopath. Despite all of the difficulties, her sociopathic husband was someone "...with whom I shared a million happy, fun times" (2009). The sociopath carefully crafts his relationships so that he can get his partners to do his bidding, whatever that may be. He treats the person he's dating like a queen so he can get away with sneakily treating her like a pawn. He needs to achieve checkmate, and this is his strategy.

On the surface, dating a sociopath doesn't seem like dating a sociopath at all. The sociopath can't love, but she can fake it incredibly well. Therein lies one of the first problems that comes with dating a sociopath. The relationship is fake. The sociopath has fabricated a character and is playing a role in order to manipulate and control her unsuspecting partner.

A relationship with a sociopath is often one-sided (the sociopath has a selfish motive whereas her partner is emotionally invested in an actually relationship). Because of this, dating a sociopath is usually not a long-term endeavor. Once she feels she has benefited as much as possible from her partner, she'll abruptly leave him in search of her next victim.

Sociopaths and Relationships

Sociopaths are cold and calculating. To a sociopath, relationships are nothing other than a means to an end, some sort of personal gain be it for money, power, sex, amusement, or any combination thereof. Sociopaths in relationships are entirely self-serving (What is a Sociopathic Person Like?).

A sociopath is in total control of the relationship before he even enters it. A sociopath's relationships typically involve three phases:

• assessment; he sizes up the prey to decide if it's worth pursuing and, if so, how best to do it
• manipulation; this is the actual relationship and is not the "love" or "romantic" or "togetherness" phase but instead is the period of time during which he does what he needs to do to meet his goals
• abandonment; sociopaths easily grow bored, and they only go through the trouble of faking a relationship when they have something to gain—when they've gained it, the sociopath's relationship is over.

Sociopaths in relationships see nothing wrong with what they do to the people with whom they're involved. Why would they? Sociopaths feel nothing other than a desire to hurt others and gain something for themselves. They've played the game before, and they'll play it again.

The person who is or was in a relationship with a sociopath, on the other hand, eventually sees many things wrong with the relationship. Here are some signs you're dating a sociopath:

• What at first appears to be love and devotion is actually shallow charm and manipulation.
• Sociopaths in relationships are confusing. They're insincere and incapable of emotion and empathy; therefore their doting words don't always match their actions.
• Power struggles abound, and the sociopath uses whatever it takes—charm, intimidation, and/or violence—to win. She always wins.
• The sociopath is adept at reading his partner, and once he identifies her weak spots, he uses them to manipulate her.
• The one-sided relationship with a sociopath leaves the exploited partner full of self-blame and self-hatred. A sociopath is incapable of self-hate, so she walks away unscathed.

Don't bother sticking around to see if the sociopath can change. An opportunistic sociopath doesn't even want to change. Their methods work very well.

"[Sociopaths] can charm the birds out of the trees and tell you black is white, and have you believing it" (Buttafuoco, 2009).

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Due to the severity of the disorder, you’d be hard-pressed to find any famous people with antisocial personality disorder. Certain infamous people, such as serial killers John Wayne Gacy, Jefferey Dahmer, and Ted Bundy, did have antisocial personality disorder.

Famous People with Antisocial Personality Disorder

While you won't read about famous people with antisocial personality disorder here, you can look over this list of top Hollywood movies featuring main characters with the disorder:

The Godfather, 1972, starring Marlon Brando

The Godfather Part II, 1974, starring Robert De Niro

Wall Street, 1987, starring Michael Douglas

Silence of the Lambs, 1991, starring Anthony Hopkins

The Last King of Scotland, 2006, starring Forest Whitaker

There Will Be Blood, 2007, starring Daniel Day-Lewis

Unforgiven, 1992, starring Clint Eastwood

No Country for Old Men, 2007, starring Javier Bardem

A Clockwork Orange, 1971, Malcolm McDowell

According to Psychology Today, antisocial personality disorder is the most frequently displayed condition (23 %) among award-winning movies, featuring main characters with mental disorders. That's a lot of people with antisocial personality disorder in the movies!

Regarding celebrities with antisocial personality disorder, some people claim Tour de France athlete, Lance Armstrong, has the condition. They base this assumption on his observable behavior (antisocial personality disorder symptoms) and his reaction to the scandal that stripped him of his winning titles from the famed cycling race. Can we know with any certainty if a celebrity or public figure has this or any other disorder for that matter? Just through our own observations? Hardly. Still, fans and detractors alike love to play armchair psychiatrist and diagnose their favorite celebrities.

Some documentaries about the serial killers mentioned above could give you better insight into what this disorder looks like and the behavior patterns that go along with it. Check out these links to documentaries about these cold-hearted killers:

• Ted Bundy
• Jeffery Dahmer

 

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