Looking trim and fit is a top priority among many Americans today. We have perhaps never been so health-obsessed, constantly trying new exercise regimes and fad diets. While regular exercise and healthy eating habits are great ways to stay fit, some people may take dieting and exercising to the extreme. This may lead to the development of an eating disorder, which can be very dangerous.

There are several types of eating disorders including compulsive overeating, body dysmorphia, anorexia nervosa and bulimia nervosa. The two most common disorders are anorexia and bulimia and may begin developing early in childhood.

An estimated 5- to 10-million females and 1-million males are battling an eating disorder in the U.S. Young white females seem to be the most common group of individuals affected due to more social pressures to have a thin figure in the white community than in other ethnic communities. Eighty-seven percent of the estimated with eating disorders are younger than 20.

Many factors play into the formation of an eating disorder, including an individual's family history or situation, genetics, and cultural standards. However, people with a history of depression, anxiety, or obsessive-compulsive behaviors are often at higher risk for developing an eating disorder.

The most common factor in developing an eating disorder is a lowered self-esteem, often due to a lack of self-esteem building at home by parents, or through physical, emotional, or sexual abuse.

Anorexia is an eating disorder in which people starve themselves. Some perceive anorexia as a simple case of vanity taken too far, but rather it is a complex psychological problem. Many times, anorexia begins around the onset of puberty.

Individuals with this disorder suffer extreme weight loss, usually fifteen percent below the person's normal body weight. These individuals are very skinny but are convinced that they are overweight. The weight loss may be obtained through excessive exercise, intake of laxatives, and not eating. People with anorexia have an intense fear of becoming fat and often refuse to eat in front of others. The most common group afflicted with anorexia is adolescent girls and those involved in activities like dancing, long distance running, gymnastics, modeling, and wrestling.

Signs of anorexia include body weight that is inconsistent with age, refusal to eat in public, anxiety, brittle skin and hair, obsessiveness about calorie intake, and irregular menstrual cycles. Luckily, anorexia can be overcome. Professional counseling, encouragement and understanding from home, and paying close attention to medical and nutritional needs can all assist in an individual's recovery.

Bulimia is a psychological eating disorder characterized by episodes of binge-eating followed by inappropriate methods of weight control including vomiting, fasting, enemas, laxatives, and compulsive exercising. Bulimia often begins with dissatisfaction of one's body or extreme concern over their size and weight. Binge eating is not a response to intense hunger rather a response to stress, depression, or self-esteem issues.

During the binge episode, the individual experiences a loss of control which is followed by a sense of calmness. This calmness is often followed by a period of self-loathing. The cycle of binging and purging are often repeated twice a day to several times a day and become an obsession.

People with bulimia look perfectly normal. They are usually of normal weight, but can be overweight. It is often difficult to determine whether a person is bulimic because binging and purging are done in secret and most individuals will deny their condition.

Symptoms include eating uncontrollably then strict dieting or excessive exercise, weakness, mood swings or depression, irregular periods, preoccupation with body weight, and using the bathroom frequently after meals. The group most common affected as well as the treatment is similar to those individuals with anorexia.

Prevention of eating disorders begins at home. Parents are the primary teachers in their children's lives so kids learn beliefs and behaviors about food, nutrition, and self-image starting at an early age. The child who is raised with healthy eating behaviors is bound to develop into an adolescent and young adult with positive attitudes towards food and the self. This is the best prevention of eating disorders.

There is a difference between eating disorders and disordered eating. Some people just don't eat right, but if eating controls your life, then you may have an eating disorder. If you think you or someone you know has an eating disorder, please contact a health professional.

next: Eating Disorders Prevention: Help for Parents
~ eating disorders library
~ all articles on eating disorders

Dear Kristen,

A few weeks ago, we were sitting in the living room. You were playing with Jacob and I was working on a report. I looked up at you and realized that we had hardly said two words to one another for hours. I asked you, "Krissie, what do you think you need to have a happy childhood?" You looked puzzled for a moment and then asked, "Do you mean, what do I need to be the happiest kid in town?" I smiled and replied, "Yea, honey, that's it. What do you need?" You hesitated for a minute and then replied, "You, mom. I just need you." How those words touched me, flooded me with feeling. They reminded me of the tremendous responsibility parenting carries. At the same time, I am graced with the knowledge of how very significant I am in this vast world, in the eyes of a small child. Thank you sweetheart.

Love, Mom

next: What Will You Remember?

Getting well is a process that began for me a long time ago. I never expect to finish. Given different responses from responsible adults and health care professionals in my life, my journey might have been very different. In this article, I want to share what did happen and how I actually am getting well. At the conclusion of the article, I will share some perspectives on how I think my life could have been different (and a lot of pain averted) and how symptoms of depression and manic depression might be more appropriately dealt with to keep us from becoming "chronic mental patients". ( I feel that psychiatric disorders, as with all disorders, have a physiological and a psychological component. Response to particular treatment, management and self help scenarios varies with each individual. There is no one answer for everyone. We have to each search out the right path for ourselves.)

When did my mood instability start? I think it began when I first felt that I was different from other kids in school. I didn't know what was different about me, but I knew something was different. Was it because my friend was hit by a car and killed when I was walking home from school when I was five years old? Was it because my mother was in a mental hospital? Was it because I never felt wanted, affirmed or loved? Was it because there were two older male relatives who harassed me and molested me for many years? Was it because a caretaker kept telling me all the things that were wrong with me? As I look back at pictures of me when I was a little girl, it is clear that I looked like any other kid. What was it in my mind that made me different?

Sometimes I gave in to the despair and spent as much time as I could, alone in my room, crying uncontrollably. At other times I responded to the bleak circumstances of my life by being a "too bright and cheery" overachiever. There never seemed to be any middle ground.

Even back then, as a child and as a teen-ager, I was looking for answers-ways to feel better. I became an avid reader of self help magazine articles and books. I tried diet and exercise. I constantly tried to achieve an elusive perfection. Nothing helped much.

But I got by. When I finished school, I did all the things women were supposed to do in those days. Go to college, get married and have a family. Sometimes everything seemed so hard. Other times, everything seemed so easy. Was everyone's life like this? Trying to keep going or going too fast.

Then there came a time when the depression got too deep. I couldn't get out of bed, much less take care of my five children and administer the small private school I started when I was feeling "up". I went to see a psychiatrist. He listened to my story and said there was no question about it. I was manic depressive like my mother. He said lithium three times a day would take care of the whole problem. What an easy answer! I was thrilled.

For ten years, I took my lithium and continued to do everything I could to improve myself. My life continued to be very chaotic. But my ups weren't so up, and my downs weren't so down.

Then I was overtaken with a dangerous episode of lithium toxicity. Why hadn't anyone ever told me that if you keep taking your lithium when you are dehydrated from a stomach bug, you can get lithium (Eskalith) toxicity? Come to think of it, I knew very little about this substance I was so religiously putting in my mouth. Although I was doing everything in my power to keep myself well, I still felt that the ultimate responsibility for my well-being was in the hands of my psychiatrist. I was totally trusting that he was making the right decisions in my behalf.

After the experience with lithium toxicity, my body didn't seem to want it anymore. Every time I tried to take it, the symptoms of toxicity returned. And without it, those deep dark depressions and periods of high achievement returned. Only now they were overwhelming. The depressions were dark and suicidal. The mania was totally out of control. Psychosis became a way of life. I lost my job. Friends and family members backed off. I spent months on the psychiatric ward. My life felt like it was slipping away. They tried one drug after another, usually several at a time. Nothing seemed to bring me back to life.

Through the haze, I was searching for answers. I wondered how other people with these kinds of episodes get by. They couldn't all be like me-unable to work and almost unable to take care of myself. I asked my doctor how people with manic depression get by on a day-by-day basis. He told me he'd get me that information. I looked forward to my next visit with great anticipation, fully expecting to find some answers. What a disappointment! He said that there was information on medication, hospitalization and restraint but nothing on how people live their lives.

I took this dilemma to my vocational rehabilitation counselor who was trying desperately to find a place in the world for this mentally ill woman. I described to her a dream. A dream of finding out how others with depression and manic depression keep themselves stable. To my surprise she supported my ideas. With her as my back-up and the help of a Social Security PASS plan, I began a study of 120 people who agreed to share their strategies for keeping themselves.

As information started coming in, my foggy brain got scared. How was I going to compile this data and put it into any kind of format that could be useful to me and others like me? I kept plugging away. The information was so fascinating that I was drawn to it. Once again, I had something meaningful to do. I think my return to wellness may have started there.

The first and most important thing I learned from compiling this data was that there is lots of HOPE. Contrary to popular belief, people with recurring episodes of depression and manic depression, get well, they stay well for long periods of time and they do what they want to with their lives. This message of hope, which I had never heard, must be spread by all of us who know it is true.

I soon became aware of a clear difference in responses from study participants. Some people were blaming their instability on everyone else. "If only my parents hadn't.....", "if only my doctor would try.....", "if only my fourth grade teacher had.....", etc.. Mood instability was controlling these people's lives. Others were taking responsibility for their own lives, advocating for themselves, educating themselves, getting the support they need, etc., These people were getting well and staying well. You can bet I made an about face at that point and joined the ranks of people taking responsibility for themselves as fast as my brain could adapt. That was the first giant step on my way back to life.

Then I learned from these people who had so much knowledge to share, that I had to advocate for myself, no matter how difficult that might seem for someone with wildly oscillating moods and self esteem in the basement. I began thinking about what I wanted for myself in terms of treatment, housing, relationships, support, work and activities. Then I figured out strategies to make these things happen and went for it. Things began to change in my life and they continue to change. My life gets better and better.

As many others have done, but I hadn't, I began to educate myself. I read everything I could about depression, manic depression, medications, and alternative treatments. I contacted national, state and local organizations for help in this process. I told my health care professionals what I wanted and expected from them rather than depending on them to make decisions for me. I began to take better care of myself. I developed a plan that instructed certain people to make decisions for me in the event that I couldn't make them for myself, and told them how I wanted to be treated in these circumstances.

Through this effort I discovered that, even though I had been hospitalized at several major medical centers, no one had bothered to give me a complete thyroid test. I found that I had severe hypothyroidism (hypothyroidism causes depression) which needed to be treated. Once that treatment began, my mind really began to clear and my progress was remarkable.

I got connected with the national movement of psychiatric survivors. I began attending meetings and conferences with other people whose journeys had been similar to mine. I felt validated and affirmed. I began teaching in earnest the skills I was learning through my study to others who could benefit like I was.

With the help of several excellent counselors, co-counseling and numerous self help resources, I undertook the task of getting to know myself and my symptoms in a successful attempt to discover early warning signs of impending moodswings and, in effect, cut them off at the pass. At first, I developed detailed daily charts to assist me in this process. As I got to know myself better, I found that I didn't need to use the charts anymore.

Now, as I notice early warning signs I alleviate them with a variety of simple, safe, inexpensive or free, effective self help techniques including stress reduction and relaxation techniques, talking to a supporter, peer counseling, doing activities that I enjoy and that I know make me feel better, exercise, improving my diet, and simplifying my life.

I have discovered my diet really affects the way I feel. If I overload on junk food, sugar and caffeine, I soon find myself feeling lousy. If I focus my diet on high complex carbohydrates (six servings of grains and five servings of veggies a day) I feel great. I have gotten in the habit of keeping a variety of easy to fix healthy foods on hand so I won't succumb to the junk food trap when I don't feel like cooking.

I try to get outside for a walk every day. This gives me two things-exercise which always makes me feel better, and light through the eyes which I have found also helps. Light has been a big issue for me. As the days get shorter and darker in the fall, my winter depression begins to set in. I have virtually eliminated these winter depressions by getting outside for at least half and hour a day, and by supplementing my light for two hours in the morning with a light box.

I got rid of my electric blanket and substituted a warm comforter after discovering the hazardous effects of being wrapped up in an electromagnetic field all night. I noticed another positive upswing in my overall wellness after making this change.

I finally realized that I create my thoughts and I can change them. I have worked hard at changing old negative thought patterns that increase depression to new, positive ones. I think I will always be doing this work. For example, when my mother was depressed, she would often repeat, over and over, thousands of times a day, "I want to die". When I got depressed, I started doing the same thing. The more I said "I want to die", the more suicidal I became. I finally realized that if I said instead, "I choose to live" I felt much better and the suicidal ideation decreased.

Another thought that plagued me was "I have never accomplished anything". I decided to take a different approach. I decided I had accomplished a great deal. For a while I became quite fanatical about making long lists of things I had accomplished. Everything from getting up in the morning and completing kindergarten to two masters degrees and raising five kids was on the lists. After a while, I realized I didn't have to make these lists anymore, that this negative thought was no longer a factor in my life.

When negative thoughts become obsessive, I wear a rubber band on my wrist. Every time I start thinking negative thoughts, I snap the rubber band. It reminds me to refocus on more positive aspects of my life. A rubber band on my wrist is a cue to family and friends that I am working on obsessive thoughts.

Using cognitive therapy techniques to reinforce positive self talk, by treating myself better and better, and by spending time with family members and friends who affirm me, I have raised my self esteem out of the depths. When I notice I am starting to feel badly about myself (an early warning sign of depression) I repeat over and over my own personal statement of my worth. It is "I am a wonderful, special, unique person and I deserve all the very best that life has to offer".

Working with several exceptional counselors, alternative health care practitioners, and using a variety of self help resources, I have learned a variety of stress reduction and relaxation exercises. I use these techniques daily to increase my feelings of well-being, reduce anxiety and help me sleep. When I notice that I am having early warning signs of depression or mania, I increase the number of times a day I do these simple deep breathing, progressive relaxation exercises.

I have learned that I need to have a structured support system that I can call on when the going gets tough, as well as to share the good times. I have a list of five people (I keep it by my phone) with whom I have a mutual support agreement. I keep regular contact with these people. We often get together for lunch, a walk, a movie or some other activity we both enjoy. When things are getting difficult, I call on them to listen, give me advice and help me make decisions. And I do the same for them. This has been a tremendous boon to my wellness.

I met some of my supporters through regular attendance at support groups for women and for people with mood disorders. Others are family members or old friends with whom I now have a mutual support agreement.

I find that people are more willing to be my supporters now that I work hard at taking responsibility for my own wellness. They like the mutual support arrangement-it has to go both ways. When I realize a supporter is not asking as much of me as I am asking of them. I treat them to lunch or a movie, buy them a small gift or help them a chore.

My supporters like to know that they are not the only person I am depending on. They know that if they are having a hard time and can't be any help to me, there is always someone else I can call.

My counselors have helped me let go of some poor social skills that have also made it easier for me to have a strong support system.

My supporters include an excellent team of health care professionals that include a top rate woman counselor, an endocrinologist ( a physician who specializes in diseases of the endocrine gland system), several body workers and alternative care consultants. I keep reminding myself, I am in charge. If someone suggests a possible treatment, I study it thoughtfully before making a decision to proceed.

I use peer counseling a lot. I need to use it more. It really helps. I get together with a friend for an agreed upon length of time. We divide the time in half. Half the time I talk, cry, fuss, shine, shake, whatever feels right. The other person listens and is supportive but never critical, judgmental and refrains from giving advice. The other half the time is their time to receive the same service. The sessions are totally confidential.

Focusing exercises were recommended to me by colleagues in England who use them regularly to avoid episodes of depression or mania. They are simple self help exercises that help me get to the root of my feelings. Whenever I start to feel overwhelmed, I lay down and relax. Then I ask myself a series of simple questions that lead me to new insight. I often suggest others read a focusing book or going to a focusing seminar. I included a chapter on focusing in my latest book.

One very important decision I made is that I will never again consider suicide or try to take my own life. I have decided I am in this for the duration and I will face whatever comes up. And since I made that decision I have had to do just that many times. I have reinforced that choice over-and-over again and do not allow myself to dwell on suicide.

I look back on my life and think about how things might have been different.

• What if, when my friend was hit by a car, the adults in my life held me, let me cry, affirmed my fear, pain and loneliness, and sat with me all night when I was having nightmares instead of trying to fill my life with activity so I would "forget".
• What if, when they took my mother off to the mental hospital, someone had held me and comforted me and acknowledged my sadness rather than leaving me to cry myself to sleep?
• What if the adults in my life had protected me from the boys who were harassing and molesting me rather than telling me I must be doing something to "lead them on"?
• What if my caretaker had praised me rather than criticized me? What if she had told me how pretty and bright and creative and precious I was so that I believed in myself instead of thinking I was a "bad" girl?
• What if my schoolmates had surrounded me with loving care instead of ostracizing me because my mother was in a mental hospital?
• Why did they think my mother would get well if they locked her in a dark smelly hospital where she slept in a room with 40 other patients, with no privacy, no affirmation, and no support-a living hell? Suppose treatment had instead consisted of warm, loving support. Maybe I would have had a mother when I was growing up.
• Suppose that first doctor who told me I was manic depressive had told me that my wellness was up to me, that I had to learn about mood ups and downs, that a complete physical examination was necessary to pinpoint the cause of the instability, that diet makes a difference, exercise is a great help, that appropriate support can make the difference between a good and bad day, etc.?

A future best case scenario intrigues me-my vision of how people who are overwhelmed with uncomfortable or bizarre symptoms might be treated in the future. Treatment would begin when we requested it (which, given this scenario we would certainly do more often) for overwhelming depression, out of control mania, frightening delusions or hallucinations, or obsessing about suicide or hurting ourselves. When we reach out for help, warm, loving care people offer us a variety of options, available immediately. Options include a cruise ship, a mountain resort, a ranch in the Midwest, or a swanky hotel. All include opportunities for consultation and treatment with top notch, caring, health care professionals. A swimming pool, Jacuzzi, sauna, steam room and work out room are available at all times. A choice of healthy food is offered. Creative expression through a wide variety of art mediums is available. Massage and other kinds of body work are included when requested. Classes in stress reduction and relaxation are offered. Support groups are available on a voluntary basis. Warm supportive people are available at all times to listen, hold and encourage. Expression of emotion is encouraged. Family members and friends chosen by you are welcome to come along. When preferred, such services might even be available in the home setting. Understanding employers would be glad to give employees time out for this wellness promoting experience. Given these circumstances, how long would it take you to get well?

next: Guide to Developing A WRAP - Wellness Recovery Action Plan
~ back to Mental Health Recovery homepage
~ depression library articles
~ all articles on depression

• PAY CLOSE ATTENTION TO WHO IS DOING THE "WANTING."

• EVERY ANSWER MUST BE A DIFFERENT NUMBER.

• PICK A SPECIFIC TIME PERIOD.

• USE THE EXAMPLES ONLY AS A GUIDE.

LET THE NUMBER YOU CHOOSE REFLECT THESE MEANINGS:
From 00 to 05 = "It doesn't happen" or "Not at all."
From 06 to 15 = "It goes terribly."
From 16 to 25 = "It goes very badly."
From 26 to 35 = "It goes badly."
From 36 to 45 = "It goes a little badly."
From 46 to 55 = "It doesn't go well or badly. It's in the middle."
From 56 to 65 = "It goes a little well."
From 66 to 75 = "It goes well."
From 76 to 85 = "It goes very well."
From 86 to 95 = "It goes extremely well."
From 96 to 100 = "It goes fantastically!"

The Questions

back to: Relationship Quiz Table of Contents

Dear Stanton:

What psycho-social tendencies, if any, are inherited by the children of alcoholics?

Michael

Dear Michael:

Cloninger claims that male alcoholics inherit antisocial, criminal tendencies. That doesn't register for me. It seems more plausible to say that alcoholics inherit (1) an impetuous, (2) emotionally labile nature. One might also imagine that alcoholics inherit some reactivity to alcohol that makes it an effective tranquilizing substance for some.

But this is hardly determinative. Sometimes descriptions of alcoholics sound to me like descriptions of salesmen.

And how about personalities of children of alcoholics? This is a group said to inherit hyperresponsibility since they have to cope with an alcoholic parent. On the one hand, this sets up the possibility that alcoholics can be either (a) irresponsible, (b) very responsible. Secondly, it indicates that this trait is bad. But isn't a trait that assists in accomplishment arguably positive?

In the case of proposed children-of-alcoholic traits, of course, we tend to be looking to environmental causation, as opposed to inherited traits. This additionally raises the question of their modifiability with insight and changing situations. I think the area of alcoholic traits is pretty iffy.

Best, Stanton

next: Why and by Whom the American Alcoholism Treatment Industry is Under Siege
~ all Stanton Peele articles
~ addictions library articles
~ all addictions articles

how to have good sex

It's talk. Telling your partner what you want may be the best way to keep both of you satisfied.

Steve and Cathy Brody of Cambria, Calif., on the Golden State's scenic Central Coast, are psychotherapists who specialize in couples counseling. When it comes to sexual dysfunction and its treatment, however, the Brodys' best success story is their own. And the best weapon in their personal therapeutic arsenal is the same advice they give others.

If you want a better sex life, they say, find the courage to share your sexual secrets -- to talk about what you want and don't want, sexually speaking.

"When sex hasn't worked for us," says Cathy, a marriage and family therapist, "we talk about it afterward. Because it's not the orgasm that's the goal, it's the intimacy. One thing couples can actually do when they're lying there is talk about it and say, 'We can try this instead.' "

Millions of Americans find it hard to talk about sex. Medical and behavioral scientists have said this for years, based on their clinical experience. And a recent survey of 200 people conducted by the Midwest Institute of Sexology in Southfield, Mich., strongly suggests they're right.

Nearly 9 in 10 men in relationships with women reported serious problems articulating their needs and desires. Of the women respondents in heterosexual relationships, half reported some difficulties articulating their needs and desires when talking to their partners about sex. The findings cut across all age categories, from teens to seniors.

In sharp contrast, most men and women in same-sex relationships said it was easy to discuss sex. The institute's survey, conducted on its web site, included questions that probed the frequency with which people told their partners what they wanted sexually and asked them to identify the reasons when they felt they could not. Seven of 10 gay men said sex was easy to talk about, and 2 in 3 lesbian women said the same, making the gay and lesbian respondents dramatically less reluctant to communicate sexual desires than the straight respondents.

Survey Imitates Life

While critics and the survey takers alike say the study, because of online data gathering, is not scientific, the findings do reflect what therapists hear in practice. "I see couples married 20 or 30 years and they're still having problems, says psychologist Linda Carter, director of the Family Studies Program at New York University Medical Center. "People have told me they've never talked about how they wanted sex, where they wanted it, and when they wanted it."

The good news? Shortcomings can be remedied and the lines of communication opened, experts say, if both partners are willing to work on it, change some bad habits, and talk, talk, talk. First, it's vital to understand why it is so difficult to talk about sex in the first place.

What's the Problem?

Co-authors of Renew Your Marriage at Midlife, the Brodys make it clear that learning to talk intelligently about sex is doable, not impossible.

But deep down, most people are conflicted, at least a little. "There's an idea in this society that a lot of people are engaging in sex freely, without inhibition -- it's the Playboy philosophy," says the Midwest Institute's director, psychologist Barnaby Barratt, PhD, professor of family medicine, psychiatry, and human sexuality at Wayne State University's School of Medicine. "In fact, everyone has conflicts. Though many of us try, strenuously, to make it appear that we don't, we do."

On one hand, he says, everything in our culture is greatly sexualized. On the other, we feel profoundly guilty and ashamed about sex and think that talking about it in detail is despicable in personal relationships.

Easier for Some?

Why do gays and lesbians fare better than straights when it comes to straight talk, at least in the survey? Barratt ventures a guess, but stresses that it is pure speculation. If your sexual orientation and preferences are those of the minority, he says, you may learn to speak about your sexual wishes as you develop them. You have to work out your shame and guilt. "You have to own your sexuality," he says. This attitude of course, probably applies most to those who are "out" and comfortable with their orientation. Those who are just beginning to realize they are gay or lesbian may think about what they want but not speak openly about it.

More Difficult for Others?

Heterosexual men, on the other hand, may find it more difficult to communicate their wishes because they may be afraid of what they'll hear in response, says New York City psychologist Elyse Goldstein. "They're afraid that if they speak up about their needs and desires, the woman will speak up about hers and they won't be able to satisfy her."

Chicago psychologist and online relationship counselor Kate Wachs says that heterosexual men are often conditioned from an early age to shut up and perform.

The Brody Success Story

Whatever your orientation and level of discomfort, the Brodys say you can become better at talking about your needs and desires.

Married 29 years, the Brodys have learned to communicate their sexual desires very effectively. He's 53 and she's 49, but there are times, Cathy says, when Steve makes her feel like a 17-year-old in the back seat of a car.

"I'll say to Steve, 'I really like it when you undress me,' " Cathy says.

"And sometimes,'' Steve says, "I'll say, 'I really need oral sex now, that would help.' "

Cathy: "Or saying, 'Let's have sex on the floor instead of the bed.' " Or doing it in the morning instead of at night.

Simple Self-Improvement Tips

There are many ways to improve your sex-talk skills, say the Brodys and other experts. Among them are some tips that sound obvious -- but are often overlooked.

• Is your partner doing something that pleases you? Tell him or her. It's called positive reinforcement. It works on lab animals and it works on humans, too.
• Make concrete requests, such as, "Hold me and kiss me.'' This is more likely to get the desired result than expressing a vague wish, like "Be romantic."
• Talk gently and honestly about sex afterward, about what worked and what didn't. When stating your preferences, begin by saying something like "I like it when . . ." It sounds better (and will evoke better results) than "You always do this wrong . . ."

Honesty, the Best Policy

Sometimes the truth hurts, but you can always look back and laugh. All Steve Brody has to do is remind himself of the Great Nibbled Ear Fiasco.

"For several years," he says, "I'd nibble on Cathy's ear. I thought it was supposed to drive her wild. Finally Cathy said, 'That doesn't really do anything to me.' "

Says Cathy: "I thought if I grunted loud enough when he got to the other places, he'd sort of get the hint!"

Now they both know not to leave their sexual wishes and desires to guesswork and grunts, but to communicate them clearly.

Scott Winokur is a San Francisco Bay Area journalist who often writes about health and human behavior.

next: Conditions for Good Sex

Suggestions for coping more effectively when someone close to you has a mental illness.

Supporting Someone with Bipolar - For Family and Friends

A friend of a person experiencing a mental illness may encounter common difficulties. Although situations differ, there are basic suggestions to help to facilitate a smoother adjustment.

• Understand that behavior may change from day to day.
• Learn as much as you can about the illness from mental health professionals.
• Encourage the person to keep appointments with mental health professionals and to take medications as prescribed. This will help in stabilizing the illness.
• Encourage the person to avoid alcohol and "street" drugs. These substances may interfere with the effectiveness of medications.
• Be open and direct with the person when talking about the illness or treatment. Don't keep secrets.
• Be a good listener. Open communication is good for everyone.
• Do not be frightened by or hide the fact that someone you care for is mentally ill.
• Be clear and firm that lying and violence are not acceptable ways to get needs met.
• Remember that improvement takes time and may not be easy to see on a day-to-day basis.
• Treat the person as an adult.
• Avoid words like "never" and "always" when the person repeats past mistakes. Be positive.
• Realize that criticism usually makes things more difficult
• Remember that everyone makes mistakes.
• Expect adult behavior and encourage self-reliance.
• Point out with pleasure the small tings that the person does well.
• Say clearly what you want from the person. Remember to be understanding.
• Suggest to the person that personal appearance is important. Offer help if necessary.
• Keep your promises so the person knows you can be counted on.
• Take care of yourself. Eat, sleep, exercise and play. Consider joining a support group.
• Relax and do your best. Avoid worrying that what you do will make the person worse.

next: Bipolar Disorder: Is It Ignored?
~ bipolar disorder library
~ all bipolar disorder articles

Bipolar NOT Depression

by Heather
August 1, 2005

Believe it or not, the doctors misdiagnosed me with depression at the age of 13. Ten years later, I found a doctor who got it right.

The symptoms of bipolar kept me distant from everyone for fear that they couldn't truly understand what was really going on in my head. In addition, the thoughts of suicide would scare them too much. I also believed that others felt that I really didn't care about their problems because if they only knew what was in my head, their problems would pale in comparison.

Over the years, there was also the extraordinary amount of sex, typical during manic episodes along with spending, what for me was, exorbitant amounts of money.

When I got the first misdiagnosis of depression, I knew what that was and I knew I didn't have it because I had some days where I didn't feel bad. In fact, during those periods, I felt pretty good.

Getting a Bipolar Diagnosis

Being diagnosed correctly for the first time was crushing, but when I got home I started to research bipolar disorder and it was like a great weight had been lifted because finally someone truly understood what was going on and paid attention to what I was saying.

I was able to share the diagnosis with my family and that explained so much of my behavior. It explained the mood swings; which many of my family members thought was a result of a drug problem (I didn't take drugs). Now I could show them what being bipolar meant with reference materials I found and with going to DBSA meetings (Depression Bipolar Support Alliance).

Therapy made a difference in that I had a place to talk about what was going on in my head without being judged badly. I also found that I could regulate my moods by maintaining a sleep schedule, using calming techniques, adjusting my diet. Learning about my disorder and how it affects me has really helped.

I'm 28 now. By caring for myself, I'm actually able to work full-time, keep and maintain an apartment and not have the out-of-control thoughts of suicide. My life is a lot better.

how to have good sex

Saying yes doesn't mean a whole lot if you can't say no.

According to clinical psychologist and therapist Bernie Zilbergeld, men would be happier knowing when they were comfortable having sex. He says men would experience less anxiety, fewer performance worries and greater comfort in the bedroom if they had sex only when their personal conditions were met.

With a little thought, you can create your own list. And you can help destroy the myth that men can and should have sex absolutely any time the opportunity arises.

This is adapted from one of Zilbergeld's exercises in his book, The New Male Sexuality: The Truth About Men, Sex and Pleasure.

Compare two or three sexual experiences in which you were highly aroused with two or three in which you weren't. Example: "I felt rested, close, not preoccupied with work, wasn't in a hurry."

Your descriptions of the high-arousal list form the basis for your conditions. Be specific.

Consider all areas.

- Your physical health.

- Anxiety or tension.

- Use of alcohol.

- Amount of time you had.

- Preoccupation with performance, pregnancy, etc.

- Your feelings toward your partner.

When you finish your list, put it away for a day or two, then reread it and see if there is anything you want to change. Now go through each item and make it specific enough to put into practice.

Let's say one of your items is "Need to make love earlier." You should talk to your partner and let her know. You may need to consider ways of initiating sex earlier.

The importance of being specific in your conditions cannot be overemphasized. If they are worded too vaguely, you won't be able to put them into practice. Take all the time you need to determine what your conditions are and how you they can be fulfilled.

next: The Requirements for Great Sex

Narcissists attract abuse. Haughty, exploitative, demanding, insensitive, and quarrelsome - they tend to draw opprobrium and provoke anger and even hatred. Sorely lacking in interpersonal skills, devoid of empathy, and steeped in irksome grandiose fantasies - they invariably fail to mitigate the irritation and revolt that they induce in others.

Successful narcissists are frequently targeted by stalkers and erotomaniacs - usually mentally ill people who develop a fixation of a sexual and emotional nature on the narcissist. When inevitably rebuffed, they become vindictive and even violent.

Less prominent narcissists end up sharing life with co-dependents and inverted narcissists.

The narcissist's situation is exacerbated by the fact that, often, the narcissist himself is an abuser. Like the boy who cried "wolf", people do not believe that the perpetrator of egregious deeds can himself fall prey to maltreatment. They tend to ignore and discard the narcissist's cries for help and disbelieve his protestations.{

The narcissist reacts to abuse as would any other victim. Traumatized, he goes through the phases of denial, helplessness, rage, depression, and acceptance. But, the narcissist's reactions are amplified by his shattered sense of omnipotence. Abuse breeds humiliation. To the narcissist, helplessness is a novel experience.

The narcissistic defense mechanisms and their behavioral manifestations - diffuse rage, idealization and devaluation, exploitation - are useless when confronted with a determined, vindictive, or delusional stalker. That the narcissist is flattered by the attention he receives from the abuser, renders him more vulnerable to the former's manipulation.

Nor can the narcissist come to terms with his need for help or acknowledge that wrongful behavior on his part may have contributed somehow to the situation. His self-image as an infallible, mighty, all-knowing person, far superior to others, won't let him admit to shortfalls or mistakes.

As the abuse progresses, the narcissist feels increasingly cornered. His conflicting emotional needs - to preserve the integrity of his grandiose False Self even as he seeks much needed support - place an unbearable strain on the precarious balance of his immature personality. Decompensation (the disintegration of the narcissist's defense mechanisms) leads to acting out and, if the abuse is protracted, to withdrawal and even to psychotic micro-episodes.

Abusive acts in themselves are rarely dangerous. Not so the reactions to abuse - above all, the overwhelming sense of violation and humiliation. When asked how is the narcissist likely to react to continued mistreatment, I wrote this in one of my Pathological Narcissism FAQs:

"The initial reaction of the narcissist to perceived humiliation is a conscious rejection of the humiliating input. The narcissist tries to ignore it, talk it out of existence, or belittle its importance. If this crude mechanism, the cognitive dissonance, fails, the narcissist resorts to denial and repression of the humiliating material. He 'forgets' all about it, gets it out of his mind and, when reminded of it, denies it. But this is usually only a stopgap measure. The disturbing data is bound to float back to the narcissist's tormented consciousness. Once aware of its re-emergence, the narcissist uses fantasy to counteract and counterbalance it. He imagines all the horrible things that he would have done (or will do) to the source of the humiliation. It is through fantasy that he seeks to redeem his pride and self-respect and to re-establish his damaged sense of uniqueness and grandiosity.

Paradoxically, the narcissist does not mind being humiliated if this were to make him more unique. For instance: if the injustice involved in the process of humiliation is unprecedented, or if the humiliating acts or words place the narcissist in a unique position - he often tries to encourage such behaviours and elicit them from his human environment. In this case, he fantasises how he demeans and debases his opponents by forcing them to behave even more barbarously than usual, so that their unjust deeds will be universally recognised as such and condemned and the narcissist be publicly vindicated. In short: martyrdom is as good a method of obtaining Narcissist Supply as any.

Fantasy, though, has its limits and once reached, the narcissist is likely to experience a wave of self-hatred and self-loathing. These are a result of feeling helpless and of realising the depths of his dependence on Narcissistic Supply. These feelings culminate in severe self-directed aggression: depression, destructive, self-defeating or suicidal ideation. These reactions, inevitably and naturally, terrify the narcissist. He tries to project them on to his environment. The way from this defence mechanism to an obsessive-compulsive disorder or even to a psychotic episode is short. The narcissist is suddenly besieged by disturbing, uncontrollable thoughts whose violence cannot be harnessed. He develops ritualistic reactions to them: a sequence of motions, an act, or an obsessive counter-thought. Or he might visualise his aggression, or experience auditory hallucinations. Humiliation affects the narcissist this deeply.

Luckily, the process is entirely reversible once Narcissistic Supply is resumed. Almost immediately, the narcissist swings from one pole to another, from being humiliated to being elated, from being put down to being reinstated, from being at the bottom of his own, imagined, pit to occupying the top of his own, imagined, ladder."

next: The Two Loves of the Narcissist