Underdiagnosis of sexual dysfunction in men and women is a big problem. Read why and find out about the treatments for sexual dysfunction.

Even though more than two out of five adult women and one out of five adult men experience sexual dysfunction in their lifetime, underdiagnosis occurs frequently. To increase recognition and care, multidisciplinary teams of experts recently published diagnostic algorithms and treatment guidelines.The recommendations emanated from the 2nd International Consultation on Sexual Medicine held in Paris from June 28 to July 1, 2003, in collaboration with major urology and sexual medicine associations. Psychiatrists were among the 200 experts from 60 countries who prepared reports on such topics as revised definitions of women's sexual dysfunction, disorders of orgasm and ejaculation in men, and epidemiology and risk factors of sexual dysfunction. Several committees' summary findings and recommendations were published recently in the International Society for Sexual and Impotence Research's inaugural issue of the Journal of Sexual Medicine. Full text of the committees' reports is in Second International Consultation on Sexual Medicine: Sexual Medicine, Sexual Dysfunctions in Men and Women (Lue et al., 2004a).

"The First [International] Consultation in 1999 was restricted to the topic of erectile dysfunction. The second consultation broadened the focus widely to include all of the male and female sexual dysfunctions. The conference was truly multidisciplinary in orientation and patient-centered in its approach to treatment," Raymond Rosen, Ph.D., a vice chair of the international meeting, told Psychiatric Times. Rosen is also associate professor of psychiatry and medicine and director of the Human Sexuality Program at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School.

"Sexual problems are highly prevalent in men and women, yet frequently under-recognized and under-diagnosed in clinical practice," even among clinicians who acknowledge the relevance of addressing sexual issues, reported the Clinical Evaluation and Management Strategies Committee (Hatzichristou et al., 2004).

Dysfunctions and Prevalence

Statistics gathered by the Epidemiology/Risk Factors Committee revealed that 40% to 45% of adult women and 20% to 30% of adult men have at least one manifest sexual dysfunction (Lewis et al., 2004). These estimates are similar to those found in a U.S. study (Laumann et al., 1999). In a national probability sample of 1,749 women and 1,410 men ages 18 to 59, among individuals who were sexually active, the prevalence of sexual dysfunction was 43% for women and 31% for men.

Sexual dysfunction in women can include persistent or recurrent disorders of sexual interest/desire, disorders of subjective and genital arousal, orgasmic disorder, and pain and difficulty with attempted or completed intercourse. At the meeting, the International Definitions Committee recommended several modifications to the existing definitions of female sexual disorders (Basson et al., 2004b). The changes include a new definition of sexual desire/interest disorder, division of arousal disorders into subtypes, proposal of a new arousal disorder (persistent genital arousal disorder), and the addition of descriptors indicating contextual factors and degree of distress.

Rosemary Basson, M.D., vice chair of the international meeting and clinical professor in the departments of psychiatry and obstetrics and gynecology at the University of British Columbia, told PT that the revised definitions have been published in the Journal of Psychosomatic Obstetrics and Gynecology (Basson et al., 2003) and are in press in the Journal of Menopause..

Some of the revised definitions are "based on theoretical constructs that we have yet to prove," said Anita Clayton, M.D. Clayton is David C. Wilson professor of psychiatric medicine at the University of Virginia and was a participant in the Clinical Evaluation and Management Strategies Committee. "We need to study these in order to see if they are really going to help us better define sexual dysfunction in women, and therefore be better able to help women seeking treatment."

At the B.C. Centre for Sexual Medicine in Vancouver, which is directed by Basson, some clinicians are diagnosing sexual dysfunction in women using both the revised definitions and the DSM-IV diagnostic criteria for female sexual arousal disorder, hypoactive sexual desire disorder and female orgasmic disorder to help determine which definitions are of benefit in guiding further research and therapy.

For women, the prevalence of manifest low levels of sexual interest varies with age (Lewis et al., 2004). Approximately 10% of women up to age 49 have a low level of desire, but the percentage climbs to 47% among 66- to 74-year-olds. Manifest lubrication disability is prevalent in 8% to 15% of women, although three studies reported prevalence of 21% to 28% in sexually active women. Manifest orgasmic dysfunction is prevalent in one-fourth of women ages 18 to 74, based on studies in the United States, Australia, England and Sweden. Vaginismus is prevalent in 6% of women, as reported in studies of two widely divergent cultures: Morocco and Sweden. The prevalence of manifest dyspareunia, according to different studies, ranges from 2% in elderly women to 20% in adult women generally (Lewis et al., 2004).

Disorders of sexual function in men include erectile dysfunction (ED), orgasm/ejaculation disorders, priapism and Peyronie's disease (Lue et al., 2004b). The prevalence of ED increases with age. In men age 40 and younger, the prevalence of ED is 1% to 9% (Lewis et al., 2004). The prevalence climbs to 20% to 40% in most men ages 60 to 69 and is 50% to 75% in men in their 70s and 80s. Prevalence rates for ejaculatory disturbances range from 9% to 31%.

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Comprehensive Assessments

Evaluation and treatment of sexual dysfunction problems in men and women need to include patient-physician dialogue, history taking (sexual, medical and psychosocial), focused physical examination, specific laboratory tests (as needed), specialist consultation and referral (as needed), shared decision making and treatment planning, and follow-up (Hatzichristou et al., 2004).

They warned, "Careful attention should always be paid to the presence of significant comorbidities or underlying etiologies." Potential etiologies for sexual dysfunction include a wide range of organic/medical factors, such as cardiovascular disease, hyperlipidemia, diabetes, and hypogonadism and/or psychiatric disorders, such as anxiety and depression. Additionally, organic and psychogenic factors may coexist. In some disorders, such as ED, diagnostic tests and procedures can be used to separate organically based cases from psychogenic cases. Medications that can cause problems in sexual functioning include antidepressants, conventional antipsychotics, benzodiazepines, antihypertensive drugs and even some medications for treating stomach acid and ulcers, Clayton noted.

When treating patients with psychiatric disorders, Clayton said clinicians should also consider the presence of sexual dysfunction.

"If you look at depression, the most common complaint is a diminished libido associated with other symptoms of depression," she said. "Sometimes people have arousal problems as well. Orgasmic dysfunction with depression is usually related to the medications, not to the condition itself."

Among patients with psychotic disorders, men in particular may experience significant sexual dysfunction, according to Clayton. They are less likely than women with psychotic conditions to be involved in sexual activity with another person, and they have problems throughout the phases of the sexual response cycle.

Individuals with anxiety disorders can have problems with arousal and orgasm, Clayton said. "If you don't get arousal, it is hard to have an orgasm. And then as a result, you start to see decreased desire--mostly avoidance, performance anxiety or concerns that it is not going to work right," she added.

Patients with substance use disorders, such as alcoholism, may also experience sexual dysfunction.

Psychosocial assessments should be an integral part of patient evaluations, several committees emphasized. For example, Hatzichristou et al. (2004) wrote:

The physician should carefully assess past and present partner relationships. Sexual dysfunction may affect the patient's self-esteem and coping ability, as well as his or her social relationships and occupational performance.

They added "the physician should not assume that every patient is involved in a monogamous, heterosexual relationship."

More in-depth guidance on the psychosocial assessment was provided by the Committee on Sexual Dysfunctions in Men (Lue et al., 2004b). They presented a new screening tool for male sexual function (Male Scale) that includes psychosocial and sexual function assessments as well as a medical assessment. The psychosocial assessment asks the male patient, for example, whether he has sexual fears or inhibitions; problems finding partners; uncertainty about his sexual identity; a history of emotional or sexual abuse; significant relationship problems with family members; occupational and social stresses; and a history of depression, anxiety or emotional problems. Another critical aspect of assessment "is the identification of patient needs, expectations, priorities and treatment preferences, which may be significantly influenced by cultural, social, ethnic and religious perspectives" (Lue et al., 2004b).

The Committee on Sexual Dysfunctions in Women emphasized that assessment of psychosocial and psychosexual history is strongly recommended for all sexual dysfunctions (Basson et al., 2004a). The psychosocial history needs to establish the woman's current mood and mental health; identify the nature and duration of her current relationships, as well as societal values and beliefs impacting sexual problems; clarify the woman's developmental history as it relates to caregivers, siblings, traumas and losses; clarify circumstances, including relationship at the time of the onset of sexual problems; clarify the woman's personality factors; and clarify her partner's mood and mental health.

For women who disclose a history of past sexual abuse, further assessment was recommended (Basson et al., 2004a):

This includes assessment of the woman's recovery from the abuse (with or without past therapy), whether she has a history of recurrent depression, substance abuse, self-harm or promiscuity, if she is unable to trust people, especially those of the same gender as the perpetrator, or if she has an exaggerated need for control or need to please (and an inability to say no). The details of the abuse may be needed, especially if they were previously unaddressed. Assessment of the sexual dysfunctions per se may be deferred temporarily.

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Sexual dysfunctions are often comorbid (e.g., sexual interest/desire disorder and subjective or combined sexual arousal disorder) (Bason et al., 2004a):

Occasionally women with emotionally traumatic pasts reveal that their sexual interest occurs only when emotional closeness with a partner is absent. In such cases, there is an inability to sustain that interest when and if emotional intimacy with the partner develops. This is a fear of intimacy and is not strictly a sexual dysfunction.

With regard to sexual functioning, Clayton told PT the Clinical Evaluation and Management Strategies Committee looked at various instruments to assess the current level of sexual functioning. Several were found to be comprehensive and useful, including the Changes in Sexual Functioning Questionnaire (CSFQ) developed at the University of Virginia, the Derogatis Interview for sexual functioning (DISF-SR), the Female Sexual Function Index (FSFI), the Golombok-Rust Inventory of Sexual Satisfaction (GRISS), the International Index of Erectile Function (IIEF) and the Sexual Function Questionnaire (SFQ). The sexual function instruments can be used not only at the beginning stages of assessment but to follow patients through the course of treatment.

Treatment Considerations

After patients receive a comprehensive evaluation, patients (and their partners where possible) should be given a detailed description of available medical and nonmedical treatment options (Hatzichristou et al., 2004).

Rosen noted that treatment is the most advanced in the area of ED. "We have three approved drugs: ... tadalafil [Cialis] as first-line treatment agents, along with couple's or individual therapy for the treatment of ED," he said. "Effective and safe treatments are lacking for most sexual dysfunctions in women."

For psychological management of low sexual interest and comorbid arousal disorders in women, cognitive-behavioral techniques (CBT), traditional sex therapy and psychodynamic treatments are used (Basson et al., 2004a). There is limited evidence of the benefits of CBT in terms of controlled trials and some empirical support for traditional sex therapy with sensate focus. Psychodynamic treatment is currently recommended, but there are no randomized studies to support its use. For vaginismus, conventional psychotherapy has included psychoeducation and CBT. Cognitive-behavioral therapy is also used for treating anorgasmia, according to the Disorders of Orgasm in Women Committee (Meston et al., 2004):

Cognitive-behavioral therapy for anorgasmia focuses on promoting changes in attitudes and sexually-relevant thoughts, decreasing anxiety, and increasing orgasmic ability and satisfaction. Behavioral exercises traditionally prescribed to induce these changes include directed masturbation, sensate focus, and systematic desensitization. Sex education, communication skills training, and Kegel exercises are also often included.

For patients with ED, oral therapies, such as selective phosphodiesterase type 5 (PDE5) inhibitors (e.g., sildenafil, vardenafil and tadalafil); apomorphine SL (sublingual), a centrally acting nonselective dopamine agonist registered in several countries since 2002; and yohimbine, a peripherally and centrally acting α-blocker, "may be considered first-line therapies for the majority of patients with ED because of potential benefits and lack of invasiveness" (Lue et al., 2004b). It should be noted, however, that PDE5 inhibitors are contraindicated in patients receiving organic nitrates and nitrate donors.

For treatment of premature ejaculation, there are three drug treatment strategies: daily treatment with serotonergic antidepressants; as-needed treatment with antidepressants; and the use of topical local anesthetics, such as lignocaine or prilocaine (McMahon et al., 2004). A meta-analysis of daily treatment with paroxetine (Paxil), clomipramine (Anafranil), sertraline (Zoloft) and fluoxetine (Prozac) found that paroxetine exerts the strongest ejaculation delay (Kara et al., 1996, as cited in McMahon et al., 2004). (See related article on premature ejaculation on p16 of the printed version of this issue--Ed.)

Administration of an antidepressant as needed four to six hours prior to intercourse is efficacious and well tolerated and associated with less ejaculatory delay. It is "unlikely that phosphodiesterase inhibitors have a significant role in the treatment of PE with the exception of men with acquired PE secondary to comorbid ED" (McMahon et al., 2004).

Clayton noted that the biggest sexual problem that women in the general population tend to have is low desire, adding that studies are underway to look for potential pharmacologic treatments.

There are no approved non-hormonal pharmacologic therapies for women with low sexual interest and arousal disorders (Basson et al., 2004a). These authors noted that the use of tibolone for postmenopausal women is promising, but the women in those two randomized clinical trials did not have sexual dysfunction. Tibolone is a steroid compound marketed in the United Kingdom; it combines oestrogenic, progestogenic and androgenic properties that mimic the action of the sex hormones. The use of bupropion (Wellbutrin) is of interest but needs further study (Basson et al., 2004a). The use of phosphodiesterase inhibitors is not recommended for low interest and comorbid arousal disorders in women. (Recently, Pfizer, Inc. reported that several large-scale, placebo-controlled studies including some 3,000 women with female sexual arousal disorder showed inconclusive results in the efficacy of sildenafil--Ed.)

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While estrogen therapy may improve low interest and/or arousal disorders, low doses and the use of progesterogen to oppose estrogen's adverse effects are recommended in all women with an intact uterus (Basson et al., 2004a). More research is needed on the use of testosterone therapy.

In women with genital arousal disorder, the use of local estrogen therapy for sexual symptoms resulting from vulvovaginal atrophy is recommended. These include not only genital arousal disorder with its lack of pleasure from direct genital stimulation, vaginal dryness, and dyspareunia but also frequent urinary tract infections lowering sexual interest and arousability. However, long-term systemic estrogen therapy is not recommended because of the lack of safety versus benefit data. For genital arousal disorder unresponsive to estrogen therapy, the investigational use of phosphodiesterase inhibitors is "cautiously recommended" (Basson et al., 2004a).

For women suffering from vulvar vestibulitis syndrome, the use of tricyclic antidepressants or anticonvulsants was also "cautiously recommended" (Basson et al., 2004a).

In women suffering from female orgasmic disorder, data on pharmacological approaches were noted to be scarce (Meston et al., 2004):

Placebo-controlled research is needed to examine the effectiveness of agents with demonstrated success in case series or open-label trials (i.e., bupropion, granisetron [Kytril], and sildenafil) on orgasmic function in women.

Regardless of the treatment options chosen for specific sexual dysfunctions, "follow-up is essential to ensure the best treatment outcome" (Hatzichristou et al., 2004). Important aspects of follow-up include "monitoring of adverse events, assessing satisfaction or outcome associated with a given treatment, determining whether the partner may also suffer from a sexual dysfunction, and assessing overall health and psychosocial function."

SOURCES:

Basson R, Althof S, Davis S et al. (2004a), Summary of the recommendations on sexual dysfunctions in women. Journal of Sexual Medicine 1(1):24-34.

Basson R, Leiblum S, Brotto L et al. (2003), Definitions of women's sexual dysfunction reconsidered: advocating expansion and revision. J Psychosom Obstet Gynecol 24(4):221-229.

Basson R, Leiblum S, Brotto L et al. (2004b), Revised definitions of women's sexual dysfunction. Journal of Sexual Medicine 1(1):40-48.

Hatzichristou D, Rosen RC, Broderick G et al. (2004), Clinical evaluation and management strategy for sexual dysfunction in men and women. Journal of Sexual Medicine 1(1):49-57.

Laumann EO, Paik A, Rosen RC (1999), Sexual dysfunction in the United States: prevalence and predictors. [Published erratum JAMA 281(13):1174.] JAMA 281(6):537-544 [see comment].

Lewis RW, Fugl-Meyer KS, Bosch R et al. (2004), Epidemiology/risk factors of sexual dysfunction. Journal of Sexual Medicine 1(1):35-39.

Lue TF, Basson R, Rosen R et al., eds. (2004a), Second International Consultation on Sexual Medicine: Sexual Dysfunctions in Men and Women. Paris: Health Publications.

Lue TF, Giuliano F, Montorsi F et al. (2004b), Summary of the recommendations on sexual dysfunctions in men. Journal of Sexual Medicine 1(1):6-23.

McMahon CG, Abdo C, Incrocci L et al. (2004), Disorders of orgasm and ejaculation in men. Journal of Sexual Medicine 1(1):58-65.

Meston CM, Hull E, Levin RJ, Sipski M (2004), Disorders of orgasm in women. Journal of Sexual Medicine 1(1):66-68.

Learn about the different types of marriage counseling, relationship therapy and which might prove helpful for your situation.

Marriage or relationship counseling helps couples to rediscover themselves and their feelings for each other. Many marriage counselors suggest that it can take at least 12 sessions (1 a week for 3 months) before a relationship can get back on track. Keep in mind though, it could take longer depending on how difficult the problems experienced by the couple are and their ability to deal with them effectively.

If you are experiencing problems in your relationship that you haven't been able to solve on your own, then it may be time to turn to outside help.   There are several different types of relationship therapy which may be beneficial.

Family counseling or therapy may help to promote better relationships and understanding within a family. It may be incident specific, as for example family counseling during a divorce. Family counseling often occurs with all members of the family unit present. The therapist observes interactions between family members and also observes the perception of non-interacting family members. Thus, if two family members get into an argument in a session, the therapist might want to know how the other family members are dealing with the disagreement or the way in which the two fighting members comport themselves.   Family counseling often teaches family members new and more positive ways to communicate to replace old, negative communication patterns.

Couples counseling involves the couple directly. Couple's counseling is based on the premise that individuals and their problems are best handled within the context of the couple's relationship. Couples therapy or couple's counseling is a useful method to help couples who are experiencing difficulties such as repetitive arguments, feelings of distance or emptiness in the relationship, pervasive feelings of anger, resentment and or dissatisfaction or lack of interest in affection or in a physical relationship with one another.

At times, the therapist may resort to individual counseling if one partner has difficulty communicating honestly when the other partner is in the room.

Group counseling can be used in combination with individual and couple's therapy. In group counseling, the couple individually, as well as together, are grouped with others facing similar problems. There are various group discussions as well as lectures or workshops dealing with communication, how to fight fairly, dealing with feelings of anger or rejection, etc. This helps the couple not only express their own problems in front of others, but it also lets them know they are not the only ones dealing with relationship or marriage problems. The work of a marriage or relationship counselor is usually to help the couple communicate and develop, understand and reignite feelings for each other. The therapist helps the couple to explore ways to stay together in a positive and fulfilling manner. Finally, if all of this does not work and the couple cannot manage to solve their problems, the counselor can help them to have a reasonable and civil separation.

With the aid of a qualified clinician, couples can bring peace, stability and communication back into their relationship thus affecting their lives and the lives of those most impacted by them and their relationship.

Sources:

• Center for Addiction and Mental Health. Couple therapy: Factors influencing a couple's relationship.
• Misty Will, MSW, The Effectiveness of Couples Counseling

Psychopaths are known for their lack of emotion but can psychopaths love? Can psychopaths cry or experience happiness? Emotional incapacity is well documented in psychopaths but some psychopaths may show some normal and even some hypersensitivity to some emotions. When answering "can psychopaths love?" it's also important to take into account how severe the psychopathy is in the individual. (How To Recognize and Identify Psychopathic Behavior)

Psychopaths and Shallow Emotions

Having shallow emotion and a lack of empathy, fear and guilt altogether are diagnostic symptoms of psychopathy. However, this still means that psychopaths can experience emotions like happiness to a smaller extent and in a fleeting way. These are not emotions to the intensity that the normal person would experience, but they are there. Rage may be an exception to this rule as rages appear to be something that psychopaths can feel.

Can Psychopaths Love?

The answer to this question may lie in how severe the psychopathy is. Psychopathy is typically measured on Hare's Psychopathy Checklist-Revised (PCL-R) and individuals are given a score out of 40. Those that score over 30 are considered classic psychopaths like these famous psychopaths. (The typical criminal who is not a psychopath scores around a 22 while non-criminal, non-psychopaths score around a two.)

The lower on the scale a psychopath is, the more likely they are to develop some sort of love for people such as family members. Psychopaths are much less likely to develop deep bonds with others, however. Interestingly, psychopaths may still want to be loved even if they are almost incapable of truly loving another. However, psychopaths typically experience many shorter-term relationships or even many marriages (Are you dating or married to a psychopath? Check this out and see).

Can Psychopaths Cry or Experience Sadness?

There are some areas where psychopaths may experience normal emotions and grief is one such area. In response to death of a person with whom there is a bond, some psychopaths can experience sadness and this may even bring about feelings of guilt which are otherwise impossible to feel. Crying may be a part of this. Exposure to trauma may also bring about emotions that would normally be suppressed in a psychopath.

It is also known that psychopaths are aware of the emotional separation between them and the rest of the world and this can cause them great dissatisfaction and suffering. Suffering may also be as a result of a desire for attention.

There are other areas where psychopaths may actually be hypersensitive to emotions due to a history of abuse or neglect - which is common in psychopaths (Psychopathic Personality and How It Develops). Examples of this can be experiences of disrespect, rejection by others, changes in circumstances that are not under their control and loneliness.

Can Psychopaths Experience Happiness?

There is little research on whether psychopaths can experience happiness, per se, but one could assume that psychopaths experience some positive emotion when they commit antisocial acts (one psychopathic serial killer calling killing a "high") thus being part of the reason they continue to commit them. Additionally, psychopaths constantly strive for stimulation and this may be a way of seeking positive emotions as well.

article references

Are you totally comfortable becoming physically intimate with a new partner or do you have nagging doubts about sexually transmitted diseases (STDs)? How can you bring up the subject of STDs without ruining the mood?

You're lying on the couch with a new lover getting hot and heavy, about to make the big move into the bedroom to have sex for the first time. Obviously not the best time to bring up the subject of IDS or STDs. If you and your partner had already discussed this, you'd probably just relax and enjoy the experience. But if you've not talked it through and you do go ahead with sex, be prepared for an experience that is less than perfect.

In this age of AIDS, when the stakes can be life and death, open communication with a lover before you have sex is imperative. Of course, talking about sexual issues is never easy. But it's less difficult when you take the time to get to know your partner and not rush into sex.

Talking About STDs

So how do you broach the subject of STDs? It may be easier than you imagine. Many people find it a relief when their partner brings up the subject since it's a concern for any responsible person. It shows that you care about your own health and your partner's.

Start by telling your partner how you feel about STDs and your experiences. You might say something like "It's gotten very complicated to be close to people these days. I feel really concerned about it so I've gotten tested for AIDS and other STDs. What do you think about it? What have you done?" Or you could comment that you find it scary that people on TV and movies still seem to be jumping into bed without using protection and ask your date what he or she thinks.

How your date responds is a telling indicator of what sort of person he or she is. If he has a tough time with self-revelation and being honest and straightforward, you can be sure that's the way the relationship will continue.

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If your date indicates that he or she isn't being responsible in regard to STDs, you may want to re-think your relationship. Even if a partner assures you that he or she is careful, you can't depend on that; you don't know his or her partners' sexual histories. The most prudent solution is for both partners to get tested for AIDS and STDs before becoming intimate. Testing is readily available through your doctor or at clinics; you can choose to get an anonymous AIDS test if confidentiality is a concern. You should also be tested for herpes (HSV), chlamydia, gonorrhea, human papillomavirus (HPV), and hepatitis B.

Practicing "Safer Sex"

Even when we know better, we may still succumb to temptation and jump into bed with someone we don't know well. In that case, you should absolutely practice "safer sex," since any exchange of bodily fluids is not entirely safe. Using a condom properly can prevent against HIV, HSV, and other STDs. Men should remove the condom in a way that it prevents fluids from touching their partner.

Since genital herpes may include sores on the genitals (or may be transmitted by a partner who has no visible skin lesions but is still shedding virus), and HPV produces genital warts, both of these infections can be spread when the infected skin in the genital area of one partner rubs against the skin of the other partner; therefore condoms may not prevent the spread of infection. Doctors suggest that people with HPV and genital herpes abstain from sex while warts and sores are present and use a condom when symptoms are not present.

It goes without saying that anyone who has HIV or HSV must tell all potential partners. We've all heard of the tragic situations in which people with the HIV or HSV virus infect unsuspecting partners.

next: 10 Questions To Ask Your New Partner Before Having Sex

Learn about work addiction treatment through therapy and support groups like Workaholics Anonymous and what recovery from workaholism really means.

First Steps in Treatment of Work Addiction

Confronting the workaholic will generally meet with denial. Co-workers, family members, and friends may need to engage in some type of intervention to communicate the effects of the workaholic's behavior on them. They may enlist the help of a therapist who works with workaholics to assess the person and recommend treatment options for work addiction.

Therapy may begin by exploring childhood experiences since the workaholic's rigid beliefs and behaviors are formed in childhood. The work addict has often taken on parental responsibilities as a child to manage a chaotic family life or to take refuge from emotional storms, or physical or sexual abuse.

An important step in workaholism treatment is to establish the workaholic's right to give attention to his/her own health and well-being, rather than constantly responding to others' needs. Cognitive-behavioral therapy will assist him/her to examine the rigid beliefs and attitudes that fuel overwork.

A core belief such as "I am only lovable if I succeed" may be replaced by the more functional belief, "I am lovable for who I am, not for what I accomplish."

Work Addiction Treatment: What Constitutes Sobriety from Workaholism?

Clearly, abstinence from work is not a realistic goal. Sobriety involves changing one's attitudes and behaviors. In treatment for work addiction, the workaholic develops a moderation plan that introduces balance into life, including a schedule that allows time for physical health, emotional well-being, spiritual practices, and social support. Setting boundaries between home and work are critical, as is scheduling daily and weekly time for self-care, friendships, and play. Each day, the recovering workaholic makes time for a quiet period, for prayer or meditation, listening to music, or engaging in another "non-productive" activity.

Workaholics Anonymous for Support

Meetings of Workaholics Anonymous, a 12-step program, can provide support and tools for recovery. Medication may also be helpful. In some cases, attention deficit disorder (ADD) underlies workaholism. Assessment by a psychologist can clarify whether ADD or ADHD is a factor. If anxiety or depression is a contributing factor, medication may help to provide a more stable emotional climate as the workaholic makes the needed behavioral changes.

The work addiction treatment can also provide an occasion for the co-workers, family members and friends to examine themselves. These people, possibly with the help of a therapist, may participate in group sessions where they reflect on ways that they may be encouraging the person's overworking. Do tensions exist at work or home that the workaholic and others avoid by overworking or other addictive behaviors? Do family members hold an ideal of "the good father/mother" that does not allow for the normal successes and failures of human life? As the others who surround the workaholic examine their own lives, these people will be better able to support the workaholic as he/she continues his/her recovery.

About the author: Martha Keys Barker, LCSW-C is a therapist in the Talitha Life Women's Program at Saint Luke Institute.

The main task in treating a work addict is helping him/her reconnect with their feelings, which can be a slow and difficult process, but recovery for a person addicted to work is possible.

If you're an unhappy work addict, there are steps you can take to change your lifestyle for the better, says Dr. Steven Ino, a clinical psychologist at the University of California-Santa Barbara who specializes in work addictions.

"There are stressors in the workplace that are very real," he says. "Organizations expect more and more from us, and employees without great energy, drive and determination may not make it. It's often true that you have to be somewhat work-addicted to survive. But most work addicts I see in treatment resent the time they spend on the job. They think it ruins whatever personal life they might have, but haven't a clue about what they need to do to change things around. They take on everyone else's responsibilities because they don't think anyone else can do the work as well as they can," he says.

Why Are You Addicted to Work?

To start dealing with an unhealthy work addiction, you should carefully appraise why you continue to work so single-mindedly despite the physical and emotional harm. You also must change how you relate to your subordinates, says Dr. Ino. Instead of being driven by distrust and micro-managing, focus on using your subordinates' time more productively and offering them greater direction and encouragement.

Of course, before you can change your behavior, you must examine the basis of your work addiction, such as who taught you to be a workaholic and what you can do to change the messages you were given about work as a child, says Dr. Cynthia Brownstein, an associate professor at Bryn Mawr College's School of Social Work in suburban Philadelphia.

"Overly controlling people are deeply distrustful, and need to change the reasons for their distrust," she says. "If work is the only personal life you have, you must be challenged to examine your fear of relationships and be shown how work is a poor substitute for love and affection."

From Work Addict to Peak Performancer

Alan Machican, chief computer analyst for the Bureau of Land Management in Bozeman, Mont., is a former work addict who decided to become a peak performer.

"It isn't easy to change a lifetime of believing that work has to be central in your life," he says. "While work is still very important, I've discovered that time-outs to relax, a personal life and other interests make me much happier. What used to take me 80 hours to accomplish now takes only 50. That's 30 hours each week for myself."

The key to Mr. Machican's success was his new-found ability to delegate. "I did most of it by just letting my subordinates do their work without constantly trying to do it for them," he says. "Change is tough, but I saw a counselor and it became clear that unless I stopped being so obsessive about work, it would end up killing me."

Getting Help When You're Addicted to Work

To help you diagnose a possible work addiction, review the following questions. If you answer yes to any of them, it's likely that you have an unhealthy addiction to work, says Susan Mendlowitz, a clinical social worker at Pacific Clinics, a treatment facility in Pasadena, Calif.

• Is work more exciting than family or anything else in your life?
• Do you often take work with you to bed?
• Have your family and friends given up expecting you to be on time because of your work demands?
• Do you become impatient with people who have priorities besides work?
• Is the future a constant worry for you even when things are going well?
• Have your long hours at work hurt your personal relationships?
• Do you think about work while driving, falling asleep or when others are talking?
• Is your life full of work-related stressors that affect your ability to sleep, diet and health?

Take our Workaholic Test.

Unhealthy work addictions are best dealt with by counselors and therapists who specialize in workplace problems. "Like all addictions, it's tough to stop the addicting behavior without professional help," says Ms. Mendlowitz. "Many agencies advertise help on the Internet, and a number of free self-help groups have sprung up. But like all addictions, workaholism gets worse with time. If you are a work addict, seeking help in the early stages may save you many years of unhappiness." (read about Workaholism Treatment)

Mental and Physical Health Effects of Being A Work Addict

A study of several large public and private social agencies in Southern California clarified the harmful effects of unhealthy work addictions. Mid- and senior-level managers were asked to estimate the amount of time they spent on the job each week. The productivity and effectiveness of their work was then evaluated. The study found that highly effective managers worked an average of 52 hours a week, while less productive managers averaged 70 hours of work per week.

Common standardized tests were administered to evaluate anxiety and depression levels in both groups of managers. Not surprisingly, managers who put in more hours and were considered less productive suffered from significantly greater depression and anxiety. They also reported twice the level of stress-related health problems, such as stomach ailments, headaches, lower back pain, and common colds. In fact, unproductive managers were absent from work almost three times as often as productive managers.

In this performance-driven economy, working hard is necessary to succeed on the job. But when work consumes you and makes you unhappy, you must face your addiction, perhaps with professional help. On the other hand, if you love your work and don't need to control every aspect of your job, you're one of the lucky people whose addiction to work is positive. You can expect the emotional, monetary and personal benefits of a happy career. Truly, some addictions can be good for your health.

About the author: Dr. Glicken is a professor of social work at California State University in San Bernardino, and a frequent contributor to the National Business Employment Weekly.

Adjustment disorder with anxiety is one of six types of adjustment disorders described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the accepted authority on mental illness published by the American Psychiatric Association. All adjustment disorders share these common features:

• They’re caused by an identifiable stressor(s) of any size
• They have pronounced emotional and/or behavioral symptoms in response to the stressor that exceeds an expected stress response

When the symptoms of adjustment disorder are anxious in nature, then the specific diagnosis is adjustment disorder with anxiety.

Symptoms of Adjustment Disorder with Anxiety

Adjustment disorder with anxiety occurs when someone is having difficulty adjusting to and coping with a life stressor or change. Whether the stressor is big or small, if it leads to life-disrupting anxiety, the person is said to have adjustment disorder with anxiety.

The symptoms of adjustment disorder with anxiety can include:

• Excessive, constant or near-constant worry
• Fear
• Nervousness
• Separation anxiety
• Jitteriness
• Feeling keyed-up and on-edge
• Irritability
• Suicidal ideation or behavior

Adjustment disorder with anxiety can make people feel overwhelmed. A stressor causes adjustment disorder, and the resulting symptoms of anxiety can make the stressor even more difficult to deal with. It can become a vicious cycle of stress, difficulty coping with and adjusting to the stressor, and anxiety that can be difficult to break out of. Of course, this perpetuates anxiety.

Difference between Adjustment Disorder with Anxiety and Anxiety Disorders

Because the primary symptoms of adjustment disorder with anxiety are anxiety-based, it can be difficult to know whether someone has adjustment disorder or an anxiety disorder. A key to differentiating adjustment disorder with anxiety from anxiety disorders is examining the cause of the symptoms of anxiety.

Adjustment disorder with anxiety is caused by one or more specific stressors that can be identified. Prior to the onset of the stressor, symptoms of anxiety are either absent or minimal. If the stressor leads to anxiety, then adjustment disorder with anxiety is likely. If anxiety is present before a stressor is experienced, then the diagnosis is an anxiety disorder rather than an adjustment disorder.

When someone experiences a stressor or a series of identifiable stressors and develops symptoms of anxiety as result, he/she likely is experiencing adjustment disorder with anxiety. A visit to a doctor can help determine this and get him/her on the path to wellness with a treatment plan.

Adjustment Disorder with Anxiety Temporary and Treatable

Experiencing one or more stressors and dealing with symptoms of anxiety that disrupt mental health and wellbeing is frustrating at best. Happily, it’s also temporary. Adjustment disorder with anxiety can be overcome.

People can transcend adjustment disorder with anxiety. Effective adjustment disorder treatment exists, and it involves addressing the stressor as well as treating the symptoms, in this case, the symptoms of anxiety. Therapy can help people address the stressors and develop skills and techniques to deal with anxiety.

Sometimes, medication taken temporarily can help reduce the symptoms of anxiety.

Once the stressor is removed or the person has learned to adjust to and cope with it, adjustment disorder with anxiety wanes within six months. People have the ability to live free from adjustment disorder with anxiety.

article references

Recovery and rehabilitation from stimulant addiction may require a treatment program ranging from addiction counseling to residential rehab.

Ritalin and dexedrine are highly addictive prescription drugs.

Treatment of addiction to prescription stimulants, such as Ritalin, is often based on behavioral therapies that have proven effective in treating cocaine addiction and methamphetamine addiction. At this time, there are no proven medications for the treatment of stimulant addiction. However, The National Institute on Drug Abuse is supporting a number of studies on potential medications for treating stimulant addiction.

Depending on the patient's situation, the first steps in treating prescription stimulant addiction may be tapering the drug dosage and attempting to ease withdrawal symptoms. The detoxification process could then be followed by one of many behavioral therapies. Contingency management, for example, uses a system that enables patients to earn vouchers for drug-free urine tests. (These vouchers can be exchanged for items that promote healthy living.) Cognitive-behavioral therapy also may be an effective treatment for addressing stimulant addiction. Finally, recovery support groups may be helpful in conjunction with behavioral therapy.

Read detailed information about drug addiction therapy.

Sources:

• The National Institute on Drug Abuse, Prescription Drugs: Abuse and Addiction.

Misuse of CNS depressants can lead to addiction. Unfortunately, there isn't a lot of research on treatment of addiction to sedatives and tranquilizers.

Patients addicted to barbiturates and benzodiazepines should not attempt to stop taking them on their own. Withdrawal symptoms from these drugs can be problematic, and in the case of certain CNS depressants- potentially life-threatening.

Although no research regarding the treatment of barbiturate and benzodiazepine addiction exists, addicted patients should undergo medically supervised detoxification because the treatment dose must be gradually tapered. Inpatient or outpatient counseling can help the individual during this process.

Cognitive behavioral therapy, which focuses on modifying the patient's thinking, expectations, and behaviors, while at the same time increasing skills for coping with various life stressors, also has been used successfully to help individuals adapt to the discontinuation of benzodiazepines.

Often barbiturate and benzodiazepine abuse occur in conjunction with the abuse of another substance or drug, such as alcohol or cocaine. In these cases of polydrug abuse, the treatment approach must address the multiple addictions.

Source:

The National Institute on Drug Abuse, Prescription Drugs: Abuse and Addiction.

Opioid addiction can profoundly impact a person's daily functioning. Find out about treatments for addiction to painkillers.

Several options are available for effectively treating prescription opioid addiction (addiction to painkillers). These options are drawn from research regarding the treatment of heroin addiction and include medications such as naltrexone, methadone, and buprenorphine, as well as behavioral counseling approaches.

Naltrexone is a medication that blocks the effects of opioids and is used to treat opioid overdose and addiction. Methadone is a synthetic opioid that blocks the effects of heroin and other opioids, eliminates withdrawal symptoms, and relieves drug craving. It has been used successfully for more than 30 years to treat heroin addiction. The Food and Drug Administration (FDA) approved buprenorphine in October 2002, after more than a decade of research supported by NIDA. Buprenorphine, which can be prescribed by certified physicians in an office setting, is long-lasting, less likely to cause respiratory depression than other drugs, and is well tolerated. However, more research is needed to determine the effectiveness of these medications for the treatment of prescription drug abuse.

A useful precursor to long-term treatment of opioid addiction is detoxification. Detoxification, in itself, is not a treatment. Rather, its primary objective is to relieve withdrawal symptoms while the patient adjusts to being drug-free. To be effective, detoxification must precede long-term treatment that either requires complete abstinence or incorporates a medication, such as methadone or buprenorphine, into the treatment program.

It is also important to understand that medications for addictive disorders generally are most effective when provided with counseling, which helps decrease the risk of relapse and addresses the effects of addiction. Counseling and lifestyle changes often are needed to address these addictions.

Source:

• The National Institute on Drug Abuse, Prescription Drugs: Abuse and Addiction. June 2007.