Read about ECT's use in depression, ECT's effect on memory and how patients in one study perceived ECT.

"ECT has a higher success rate for severe depression than any other form of depression treatment"

Electroconvulsive Therapy has received some bad press as a result of what the treatment used to be like. Yet "ECT has a higher success rate for severe depression than any other form of depression treatment." It has also been shown to be an effective form of treatment for schizophrenia accompanied by catatonia, extreme depression, mania, or other affective components. The following excerpt on ECT's use in depression from Overcoming Depression, by Dr. Demitris Popolos, should help shed some light on the issue.

There's been a resurgence of interest in ECT because it has evolved into a safe option, one that works. But for a public influenced by Ken Kesey's One Flew Over the Cuckoo's Nest, whose associations with ECT start with the electric chair & move on to lightning bolts, electric eels & third rails, it makes for queasy conversation. For all of us. Let's replace a few of the myths with facts.

ECT has a higher success rate for severe depression than any other form of treatment. It can be life-saving & produce dramatic results. It is particularly useful for people who suffer from psychotic depressions or intractable mania, people who cannot take antidepressants due to problems of health or lack of response & pregnant women who suffer from depression or mania. A patient who is very intent on suicide, and who would not wait 3 weeks for an antidepressant to work, would be a good candidate for ECT because it works more rapidly. In fact, suicide attempts are relatively rare after ECT.

ECT is usually given 3 times a week. A patient may require as few as 3 or 4 treatments or as many as 12 to 15. Once the family & patient consider that the patient is more or less back to his normal level of functioning, it is usual for the patient to have 1 or 2 additional treatments in order to prevent relapse. Today the method is painless, and with modifications in technique, it bears little relationship to the unmodified treatments of the 1940s.

The patient is put to sleep with a very short-acting barbiturate, and then the drug succinylcholine is administered to temporarily paralyze the muscles so they do not contract during the treatment and cause fractures. An electrode is placed above the temple of the non-dominant side of the brain, and a second in the middle of the forehead (this is called unilateral ECT); or one electrode is placed above each temple (this is called bilateral ECT). A very small current is passed through the brain, activating it & producing a seizure.

Because the patient is anesthetized & his body is totally relaxed by the succinylcholine, he sleeps peacefully while an electroencephalogram (EEG) monitors the seizure activity & an electrocardiogram (EKG) monitors the heart rhythm. The current is applied for one second or less, & the patient breathes pure oxygen through a mask. The duration of a clinically effective seizure ranges from 30 seconds to sometimes longer than a minute, & the patient wakes up 10 to 15 minutes later.

Upon awakening, a patient may experience a brief period of confusion, headache or muscle stiffness, but these symptoms typically ease in a matter of 20 to 60 minutes. During the few seconds following the ECT stimulus, there may be a temporary drop in blood pressure. This may be followed by a marked increase in heart rate, which may then lead to a rise in blood pressure. Heart rhythm disturbances, not unusual during the period of time, generally subside without complications. A patient with a history of high blood pressure or other cardiovascular problems should have a cardiology consultation first.

Because as many as 20 to 50 percent of the people who respond well to a course of ECT relapse within 6 months, a maintenance treatment of antidepressants, lithium or ECT at monthly or 6 week intervals might be advisable.

Short-term memory loss has always been a concern to patients who receive ECT, but several studies conclude that patients who received unilateral ECT performed better on attention/memory tests than those who received bilateral ECT. However, there is a question as to whether unilateral treatment is as effective. Experts agree that changes in memory function do occur & persist for a few days following treatment, but that patients return to normal within a month. A 1985 NIMH Consensus Conference concluded that while some memory loss is frequent after ECT, it is estimated that one-half of 1 percent of ECT patients suffer severe loss. Memory problems usually clear within 7 months of treatment, although there may be a persistent memory deficit for the period immediately surrounding the treatment.

How distressing is ECT to patients?

While there are certainly patients who perceive the treatment as terrifying and shameful, and some who report distress about persistent memory loss, many speak positively of the benefits. An article entitled "Are Patients Shocked by ECT?" reported on interviews with 72 consecutive patients treated with ECT. The patients were asked whether they were frightened or angered by the experience, how they looked back at the treatment, and whether they would do it again. Of the patients interviewed, 54% considered a trip to the dentist more distressing, many praised the treatment, and 81% said they would agree to have ECT again. Those are comforting statistics about a treatment that has an ugly name and ugly connotations but beautiful and even life-saving results.

Why is there a resurgent interest in ECT?

The scientific evidence regarding the efficacy of the treatment has been firmly established in the professional literature. In addition, decades old studies showing brain cell death have been refuted in recent studies (but some anti-ECT activists still quote them).

However, ECT is like all other treatments. Doctors often underplay the potential side-effects. In addition, it is sometimes prescribed for conditions it is not medically appropriate for. And like other treatments, the effect is not always permanent. Like with medicines, ECT is not used once and you are better forever. Maintenance ECT may be required.

Unfortunately, some well-intentioned activists received ECT inappropriately; were erroneously told the effects were always permanent; and/or suffered side effects (ex. memory loss) that their doctors did not explain. Some of these activists have attacked the treatment itself when it is really the doctor who delivered the treatment who was at fault. NAMI's (The National Alliance for the Mentally Ill) official policy is that while it does not endorse particular forms of treatment, it believes informed individuals with neurobiological disorders have the right to receive NIMH approved treatments like ECT from properly trained practitioners. NAMI opposes actions intended to limit this right.

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20 questions to help the adult with ADHD select a good career choice.

What are the best careers for an adult with ADHD?

We are living in an era of speed. We expect faster computers, instant answers to our questions, and simple, across-the- board, guaranteed results. Amazingly, we are rewarded for our high expectations by a generally positive outcome. Most of the time we get what we're after! The danger comes when we expect the same all of the time.

We need to make certain generalizations in order to communicate large ideas. When we speak of adults with Attention Deficit Disorder (ADD), we list common symptoms associated with this challenge, per the DSM IV definition. We outline a stereotypic "profile" that describes what we often see in that person. However, when we are asked to work with an individual with ADD in identifying good career options, we cannot use the same profile outline. Not all adults with ADD are creative, as may be the norm. Not all adults with ADD work best in an entrepreneurial endeavor. For some, a highly creative, autonomous career is a terrible match. It is as hard to generalize a good career match for a person with ADD as it is to ask what careers work best for an adult with blue eyes! We need to start with the plusses of person, and add the challenges later! How then, can we go about assisting those with ADHD in finding suitable work environments? How can we help them maximize the probability of success and minimize the possibility of failure? It isn't by an instant, quick, simple fix of stereotypic generalizations.

We need to start with all of the strengths, and in so doing, ask the following 20 questions:

1. What are the passions-those interests that really "light up" the person?

2. What have been the accomplishments of this individual thus far?

3. What personality factors contribute to ease of handling life?

4. What are the specifics that feel as natural and automatic as "writing with one's dominant hand?

5. What are the priority values that must be considered to feel good about oneself?

6. What are the aptitude levels that maximize success?

7. What is the person's energy pattern throughout the day, week, and month?

8. What are the dreams of the individual and how do they relate to the real world of work?

9. What are the pieces of jobs that always attracted the individual and how can those pieces be threaded together?

10. How realistic are the related options in terms of today's job market needs?

11. How much does the individual know about the related options?

12. How can the options be tested out, rather than tried with the possibility of failure?

13. What special challenges does the individual have?

14. How do the challenges impact on the individual?

15. How might the challenges impact on the work option?

16. How might the challenges be overcome by appropriate strategies and interventions?

17. How great is the degree of match between the option and the individual?

18. Can we "test out" the degree of match before pursuing the field?

19. How does one enter and sustain the work environment chosen?

20. What supports can be in place to ensure long-term success?

If we help individuals collect this relevant data (which admittedly takes more time than a one-liner answer would require), then we have an excellent chance of directing the individual with ADD. We cannot accomplish the same results with the "cook book" method, which is trial and error at best. As with many difficult decisions, a trained professional who understands about individuality within the diagnosis of ADHD can provide the framework in which to collect data, test out the options and provide appropriate support for the "journey."

What are the best careers for an adult with Attention Deficit Disorder? What are the best careers for an adult with blue eyes? Perhaps the better question is what are the best career options for a wonderfully unique individual with special challenges? Let's help them take the time to really get the job done and find what works best for them!

About the author: Wilma Fellman has over 16 years of clinical experience working as a Career Counselor. In her practice she specializes in working with adolescents and adults with ADHD, with respect to making good career choices. She is the author of The Other Me: Poetic Thoughts on ADD for Adults, Kids and Parents and Finding a Career That Works for You: A Step-by-Step Guide to Choosing a Career and Finding a Job.

Terms of Use: This educational material is made available courtesy of the author and Attention Deficit Disorder Resources. You may reprint this article for personal use only.

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Dr. Peele,

We adopted a biracial baby girl named Francis, at birth, and have been noticing that she is not progressing like our other daughter. I know, Don't Compare, but she is different and can't really put our finger on it. We have her in a county program called First Steps in which she was evaluated by several therapists and we now have speech therapist come to our home once a week and a developmental therapist.

She is now 18 months old and can only say "baby" and that, only sometimes. I have been trying to teach her to "hug" and just recently she has allowed me to hold her hand when we move from one room to another. If we cough loud, sneeze or holler for a family member in another room. . . . she screams and cries and runs to me to be held! Now don't get me wrong. . . . she is happy and laughs a lot, but she bites, hits, pulls and pushes her older sister and is generally frustrated because she cannot communicate.

Last night, I called the birth mother and confronted her about drug and alcohol abuse during pregnancy . . . at first she balked, but when I asked her for honesty from one mother to another . . . she confessed. Now we love Francis no matter what may come, she is our baby, but I want to begin now to create a solid foundation of life for her and her needs. But I am not real sure what her needs are. Do I just let First Steps decide or is there something I can do or read or call, etc.

I have my doubts about trying to find a chat room for this situation, because I don't want to assume that Francis is an exact replica of someone else. Please . . . where should I begin to help her future life?

Blessings,
Jeanette

Dear Jeanette:

As I understand it, Francis has already been evaluated by a number of therapists and is seeing a developmental specialist. Thus, we may wonder if there is anything more that will be discovered. I am not a developmental specialist, but obviously you should begin with the professionals with whom you are already working to discover all further steps-assessments that can be taken. It would seem that you should get a thorough-going assessment - perhaps contact your hospital - for neurological/developmental issues.

You are thinking about this and dealing with Francis in a highly sensible way - whether the drug and alcohol use during pregnancy is the cause of the problem, or other things the birth mother did, or something else - all are a bit secondary at this point. Pending what other impairments you discover and what medical or professional assistance can be beneficial, you are working on the old question of a long, very long, relationship between mother and baby, acceptance and nurturance, love and bonding, encouragement and support, attention to Francis's special needs. You seem to be a person who is capable of providing this special attention and care.

Stanton Peele

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Dr. Peele:

My father has what I consider to be an addiction, but it is not addressed in any literature that I have read (including any that I could find on your website), so I am unsure of how to proceed.

For his entire adult life, my father has been drawn to high-risk, relatively low-investment get-rich-quick schemes. It does not satisfy many definitions of addiction, because it has not become steadily or increasingly worse, and he has always managed to keep his losses less than devastating, so he does have a certain amount of control over it. But he has consistently lost money, adding up to a considerable lifetime total. And although he is in many ways a very intelligent and competent person, when it comes to these investments, he loses all perspective and reason: he once invested in a perpetual motion machine; in a gold mine in Peru operated by a couple of American teenagers; etc. He also consistently hooks up with other investors who have admittedly lost money on the venture in question, but convince him they are going to turn things around any day now and start raking in the bucks.

I spent my younger adult life trying to distance myself from this and to learn to say no for his requests for money for investments, but things are at a point now where I would like to do some kind of intervention. About three years ago, he made one of these investments that cost him (and my mother) virtually all of their retirement savings and put them in a very difficult situation. My husband and I helped them out somewhat, and things were bad enough that he promised to cool it (even though he immediately proceeded with ridiculous plans to finance another project, but none of his own money was actually spent on it). But a couple of weeks ago he wrote a letter addressed to only my husband, asking my husband not to let me or my mother know, urging my husband to help him with an investment plan for trading on-line. That was the last straw for me and I want to stop just trying to keep out of his way, and I want to try to do something to stop him. Not to mention, to help my mother from living any more of her life just above the edge of poverty.

I am especially concerned because of the stories I have heard of big losses happening very quickly with those on-line trading accounts. I am concerned because my mother is 75, my father 80, and they cannot weather any more of his losses at their age and in their current financial situation. This is tricky because there is no book I can buy on stupid investment addictions or verse from the Bible that I can quote to try to convince both of them that he has a serious problem — he has a thousand excuses and evasions, including "You don't want to take away an old man's dreams, do you?" or "I would have no reason to go on living." And my mother's main concern is always to avoid confrontation and to be a good, supportive wife.

I read on your site that you are against interventions, but what can I do that might reasonably make a positive difference, or at least to protect my mother from further harm?

Any help would be greatly appreciated,

JoAnne

Dear JoAnne:

You have described remarkably well a fairly frequent occurrence, and one that in such extreme cases as your father's merits the label "addiction," marked in this case by the desire to get immediately back into the saddle with a new investment, to recoup the losses of the last scheme.

This is a favorite topic in literature — the individual addicted to the get-rich-quick scheme, the one break that will make over their life. Arthur Miller's Death of a Salesman, Wallace Stegner's Big Rock Candy Mountain, and F. Scott Fitzgerald's The Great Gatsby — all describe characters looking for a way to make it in an American society that prizes success and wealth above everything.

Let's work backwards. Your father is 80, and he hardly has any money left? He may not have a long time to live, but the idea is to keep him comfortable, and to provide for your mother. But it seems (from his contacting your husband) that, in order to get capital for his next scheme, he needs an injection of money from your household.

Unless I'm missing something, you can nip this all in the bud by letting all his schemes die through lack of funds — who will let your father invest on credit, in stocks or anything else?

You don't need to do an intervention that makes your father own up to his misguided life — which, it sounds as though you agree, is going to be a tough sell. If you wished to take a radical step, you could have him declared incompetent with you as guardian, so that you make his major financial decisions and he can't sign agreements on his own. You could hire a lawyer or find a form book to make this application, then file on your own at your county court house. Remember, competence determinations are not global; they apply to specific areas, so that your father could be declared incompetent in financial matters but retain his autonomy in the other areas of his life.

If you have to explain your actions to your father, you might say, "Dad, you're asking us for money, and you're hurting mom's well-being. I can't let you risk either of those two things. I'm afraid your investment-entrepreneurial career is over."

We could also ask the significance of all of these things for you. Your father disregards you (along with your mom), makes outlandish choices without consulting or listening to either of you, forces you to reject him as a significant figure in your life (while your mother simply "rolls over" to his demands and reckless actions). How has all this influenced your view of yourself, your attitudes towards risk, your choice of and relationships with men? Is some of your bitterness towards him due to the toll all this has extracted from your life?

All best,
Stanton

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Mother responds to her daughter's question - "Mommy, do you love me?"

Dear Kristen,

Some time ago, you crawled into bed with us in the wee hours of the morning. You wrapped your little arms around me, laid your golden head upon my chest, and said, "Mom, did you ever notice that when someone is mad at you, it feels like they don't love you anymore?" I smoothed back the hair from your eyes. With a lump in my throat, I remembered that when my mom was mad at me when I was your age, she became cold (as I do) and distant (that's me). How scared and all alone that used to make me feel. I was terrified of losing her love. How would I live without it? Who would take care of me if she decided some day that she no longer wanted me? Sometimes, my darling girl, you get glimpses of the pain of my own childhood. They are mirrored through me. I'm so sorry that I unknowingly (and unwisely) inflict them upon you.

I hold you tightly and do my best to reassure you that I'll always and forever love you -even when I'm mad at you. I tell you that I understand that it makes you afraid sometimes when my voice is stern, and I turn away from you. I share with you that I used to worry that my mom didn't love me anymore, too. I ask you to tell me when you need reassurance from me. You lean over me, look deeply into my eyes, and say, "will you right now mom?" And so I do....

Love, Mom

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There is a hard, dark, very murky lump, that aches a bit in the middle of my chest. It is gray, but not the warm, gray of tree trunks or chick-a-dees. It is a foreboding and sinister gray, one that has the capacity to sap my life energy and spiral me down into the pits of despair. This is a warning-a warning that if I don't notice it, and slowly excise it, it will grow until it encompasses all of my being, sending me for weeks, maybe months into the depths of discouragement and despair-a condition that has no redeeming features and leaves me feeling empty and alone.

Through years of recurring severe depressions, I have come to know what that lump means. I know I have to hurry to get rid of it, before it claims any more of my being-before the energy it takes to erase it is gone.

I begin working, a little bit at a time. It grows smaller as I connect with my daughter and other close friends for some ranting and raving time. Time when they listen as I vent my feelings and frustrations at being a passenger on this planet. And when I finish and collapse into slumber or go for a walk, it gets even smaller.

I greet the day, still dark outside, with my close friend of four years, my light box. Reading the paper-skipping the bad parts-in this warm glow continues to lift my spirits. Through the day, I take time-outs to relax, breathe deeply and listen to some good music. A time when I let the past and the future drift away and exist in the present. Being really good to myself, I relax in a tub of warm water filled with the scent of sweet birch or lavender or rose.

I save a few minutes to work on that quilt that I have neglected for so long, feasting my eyes on the bright colors and the design, changing as I stitch. None of the cares of the world exist as I work away at the quilt while the lump in my chest grows smaller still.

That book I have been meaning to read. A couple of hours with it and a cup of herb tea curled up in my soft recliner and the lump continues to decrease in size and intensity.

For a change of pace a bracing walk with the dog. Together we walk and run a bit, exploring the woods and meadows as if we have never been there before. The lump is just barely noticeable now.

I check out my diet of the last few days and usually discover that I have not been paying close attention to nourishing myself. So I head for the farm or the co-op and buy myself a supply of good, healthy easy to prepare food in the guise of preparing for the worst, a pending episode of depression which no longer comes. So I enjoy eating all the good food-especially the black olives roasted in garlic.

In addition, there is a very important technique which has become a mainstay of my protocol for reducing that lump. It's called "focusing". I had never heard of it until after my first book, The Depression Workbook, was published. Friends from England called and said, "Mary Ellen, we really like your book, but you didn't mention "focusing". In England, we use it all the time to reduce symptoms." I admitted, rather sheepishly that I had never heard of "focusing". They directed me to several resources and I was on my way to becoming a "focuser".

This simple little technique doesn't cost anything. It's easy to learn. It can' t be done wrong. It's best done in a quiet space, but I have done it on airliners, in crowded offices and even during boring lectures. It's like meditation, but instead of totally quieting myself, I give an ear to what the feelings in my body are trying to tell me (I often don't bother to take the time to listen). I can do it with a focusing partner as a guide, or by myself. I usually do it alone because when I feel the need there is often no one else around.

Then I ask myself the question, "What's between me and feeling fine right now?" I don't answer with my brain. I let the answers come from my heart, my soul. As the answers come, I don't give them any attention. I just make a mental list of them. One of my recent lists included feeling overwhelmed by having too much to do and not enough time to do it, concerns about an elderly, ailing parent, that funny place in my breast that I'm supposed to wait and see about, a hurtful comment from a good friend, a delicate relationship with an adult child.

I ask myself again, "Is there anything else that should be on that list?" And if my soul speaks, I add the comments to the list. Ah, yes, that awful television news piece about atrocities in a distant part of the globe.

Once I have my list in order and it seems complete, I ask myself "Which of these items stands out-which is the most important?" Again, I shut my brain off and let my soul answer. I am usually surprised. What I thought would be number one was not number one! It's that relationship with my adult child that really stands out. Ah hah! I am learning.

Then I ask myself, "Is it OK to spend a little time with this issue?" If my soul responds with a yes, I proceed. If I get a no, I can return to the list and get something else that stands out as needing attention.

I focus my attention not on various aspects of this issue as if to solve a problem, but rather on the feeling this issue creates in my body. I let my soul come up with a word, phrase or image that matches this feeling in my body. I get the image of a big ceramic vase, red and blue, but very brittle, showing signs of cracking. I go back and forth between the word, phrase or image and the feeling, testing to see if they are really a match. If they are not, I let that image go and choose another until I am really comfortable with the match. This time the brittle vase seems to fit. I spend a few moments, whatever feels right, going back and forth between the word, phrase or image and the feeling in my body. In that process I notice a change in the way my body feels-a shift. I linger with this new feeling for a few moments. It feels better, like a release.

Then I ask myself if I need to go further, or if this is a good place to stop. This time I continue, asking myself some simple question like:

• "What is it about the problem that makes me feel so ____ (word or image)?"
• "What is the worst of this feeling?"
• "What's really so bad about this?"
• "What does it need?"
• "What should happen?"
• "What would it feel like if it was all OK?"
• "What is in the way of feeling that?"

I relax and let the answers come to me, just being with the answers that come from my soul, always remembering to leave my analytical and critical brain out of it. Then I spend some time with the answers that came, particularly noticing the changes in my feelings. Bit by bit I unravel the pieces of my life that may be causing of worsening this feeling of depression.

If it feels right, I may do another round of focusing, or resume my hectic life with a new sense of well-being, that lump in my chest perhaps gone, or almost gone. If it's still there I repeat all of the above until it is gone for good-keeping my bag of tricks ready for the next time.

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ADHD medication, Ritalin, is one of the drugs on the Banned Substances in Sport list in the UK. If you participate in Olympic sports or other sport with a governing body, here's what you need to know.

Methylphenidate (Ritalin) is on the list for Banned Substances in Sport and will show up on any random drug test either during a competition or other random test during non-competition time. This is according to the list available from the International Sports and Olympics Sports Governing Bodies. These lists are used for all competitive sports and are taken as guidelines for all other sports governing bodies. However any person who is prescribed methylphenidate can apply for a medical dispensation, which can be granted by the individual governing body. This means that you have to contact the governing body for the sport in question and ask their advice as to how to apply for a medical dispensation. This has to be applied for before every competition and has to have medical evidence of need for use signed by a consultant each time. The certificate of dispensation has to be taken to every meeting and shown to the organisers before the start of any competition.

In the UK, the governing bodies for sport are all individual at the present time, but there are moves to make this a more combined service in the near future and therefore this should make things easier when applying for medical dispensations. I have recently spoken to someone from UK Sport Drug Information Service, (the full list can be found at http://www.uksport.gov.uk/ which is the main government body, who confirmed the above to me and has said that they are aware of the concerns regarding Ritalin and young people in sport who may have ADD/ADHD who may be prevented from taking part in sport competitions due to the lack of awareness about the banned drug lists. I was also informed that UK Sport is working with the governing bodies to bring them all together under one roof so to speak and therefore make applying for dispensations easier for all.

I will hopefully update this when I manage to find out more in the future, but in the meantime please be aware that in the UK medical dispensation has to be sought before every competition. Also be aware that dispensation is not always granted and can take awhile to sort out so make sure it is applied for in enough time and always make sure that you have signed evidence from a consultant which is also kept with the dispensation certificate/letter and taken to each competition. When speaking to the person at UK Sport, we did discuss the possibility of some sort of scheme where this could be made simpler and we will keep an eye on this and try to work with them to sort something out.

With regard to school competitions, it is best to speak to the local school sports officer at the Local Education Authority to confirm if they need any form of medical evidence within Sport in their Authority, as it would be very upsetting for any child to take part in an event only to be disqualified when someone found out they were taking ADHD medication. Although most times there is no actual drug testing for school events, it only takes someone to inform the competition organisers that this child takes Ritalin or another ADHD medication, which is on the Banned Drug List for things to turn very difficult for the child. As a lot of children with ADD/ADHD excel at sport, it is essential to find out all we can to ensure that the child is able to continue to enjoy sport and to be able to continue in something they are good at.

Although fewer men than women suffer from eating disorders, a new study indicates that the number of men with anorexia nervosa or bulimia nervosa is much higher than previously believed. Despite this, men, whose treatment needs are the same as those of women, do not seek help and, therefore, do not get adequate treatment.

"Eating disorders have been seen largely as an issue affecting women, and because of that, I think men have been far less likely to identify themselves as affected by it or to seek out treatment -- much in the same way as men with breast cancer tend to show up in breast cancer clinics much, much later," says the study's author, D. Blake Woodside, MD.

Because there are few large studies of men with anorexia and bulimia, Woodside, who is with the department of psychiatry at the University of Toronto, evaluated and compared 62 men and 212 women with eating disorders with a group of almost 3,800 men with no eating disorders.

Although more than twice as many women as men had eating disorders, there were more men affected than would be expected, suggesting that the occurrence of eating disorders may be higher among men than the current National Association of Anorexia Nervosa and Associated Disorders estimates. According to the group, men are thought to make up about 1 million of the 8 million Americans with eating disorders.

In terms of symptoms and unhappiness with their lives, there was little difference between men and women with eating disorders. Both sexes suffered similar rates of anxiety, depression, phobias, panic disorder, and dependence on alcohol. Both groups also were much more unhappy with how things were going in their lives than men with no eating disorders.

Woodside says his study supports the assumption that anorexia and bulimia are virtually identical diseases in men and women.

A number of reports in the medical literature suggest that gay men account for a significant percentage of male anorexia. Woodside's study did not look at this issue, but he says it should be studied further to rule out whether gay men may simply be more likely to seek treatment for anorexia, though not necessarily more likely to suffer from the disorder than heterosexual men.

"Perhaps it may have a bit of a 'snowball effect,' because men may feel if they come forward they will be thought of as homosexual, even if they are not," Woodside says.

Another expert who treats eating disorders says society has a tendency to glamorize eating disorders while at the same time making fun of the people who have them.

"The media and society believe it's all about these beautiful models trying to lose weight, when that's really not what eating disorders are about," says Mae Sokol, MD. "They're less about food and eating and much more about people's sense of self-esteem and identity and who they are."

Sokol says anorexia may be less noticeable in men than women because men can still have muscle mass even though they are thin.

"In fact, it's more dangerous for men to develop anorexia nervosa than for females ... because when males get down to the lowest weight ranges, they've lost more muscle and tissue, whereas [fat] is something you can lose for a period of time without repercussions," says Sokol, a child and adolescent psychologist at Menninger, a psychiatric hospital in Topeka, Kan.

Despite the media's focus on anorexia, bulimia, and other eating disorders, Sokol says that men are still brought up to believe it's not something that's supposed to happen to them.

"The public Woodside's study, Arnold Anderson, MD, writes that men seeking treatment "are often excludedthinks of it as a 'girl disease,' and these guys don't want to have to come out and say, 'I have a girl disease.' Plus, to have to come to a [treatment facility] where most of the patients are women -- they don't feel good about that at all," she says.

Woodside agrees that feeling uncomfortable may be a big part of why men are less likely to go for help for an eating disorder.

"I think, for a lot of them, it's definitely a case of 'Do I fit in here?' when men come into a treatment center," he says.

In an editorial accompanying

from programs by gender alone or are treated indistinguishably from teenage girls."

Anderson, of the department of psychiatry at University of Iowa Hospitals and Clinic in Iowa City, says more research comparing men and women with eating disorders is welcomed because it will help identify factors that may lead to different treatment approaches.

next: Men with Eating Disorders
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how to have good sex

"Are you interested in oral sex?" That's the question marriage therapist Patricia Love asked a couple complaining of a lack of interest in sex one day. He shook his head no. She nodded yes.

Said he, with astonished delight, "You told me you wouldn't do oral sex!"

"That was seven years ago," she responded. "I've changed my mind since then."

Breakthrough. All because the wife was willing to heed two words of advice that Love often offers to couples seeking to improve their sex lives: "Eat crow."

Breakthrough. All because the wife was willing to heed two words of advice that Love often offers to couples seeking to improve their sex lives: "Eat crow."

In fact, Love offers thousands of words of advice in her influential book Hot Monogamy, an extensive guide for monogamous couples wishing to enjoy a passionate sex life. "The brain is the biggest sex organ," observes Love, whose advice centers on knowledge and communication.

All of us can feel when the thrill is gone, for example, but few of us know that this is a simple matter of biology. As Love explains, "It is nature's design for folks to have a spurt of sexual energy at first. Then, when sexual interest fades, we often believe we're not in love anymore."

A couple is even more likely to reach this possibly erroneous conclusion if there is a significant gap in their natural levels of sexual desire. Half of the population has a naturally low libido, the result of lower levels of sex hormones, Love says. This nugget of information can be liberating. "You've just lifted 40 years of guilt from my shoulders!" one woman told Love.

Hot Monogamy prescribes various means of overcoming "the desire discrepancy," including the use of quickies. ("Just five minutes that make everyone feel better.") Love advises both partners to view sex as a gift and to learn to become experts in each other's arousal - an overarching objective that her book furthers with exercises designed to foster uninhibited communication about sex.

The reward for such frank talk can be what Love calls "vintage sex," a blissful communion combining sexual arousal with emotional intimacy. "These are not the so-called beautiful people, but the sort of folks you see at the mall, people who have been together a long time and are really comfortable with each other."

In other words, folks who prove that where sex is concerned, knowledge is indeed power.

How to attain hot monogamy:

• E-mailing your sexual desires to your partner can help overcome your inhibitions.
• Expressing your fantasies can help ensure that your partner will not feel judged.
• A good way to start a sexual discussion is with an apology, such as, "I know I pout when we don't have sex."
• Recognize that a good sex life doesn't just happen but requires lots of communication.
• When your lover does something right during sex, let her know.
• Dress to make yourself feel attractive, especially if you have a negative body image.
• Masturbation can help address an imbalance in sex drive.
• Set aside time for sex, and make the bedroom a sanctuary.

next: Sex Tips For Men: On Being Good In Bed

how to have good sex

Make the time

Sex is like anything else in life: You've got to spend the time to make it good. So while you've read this piece of incredible wisdom over and over, for the sex-goddess-in-training, it bears repeating: Make occasional dates with your husband. "I can't emphasize enough the importance of dating in long-term relationships," says Sydney Biddle Barrows, author of Just Between Us Girls: Secrets About Men From the Madam Who Knows. "Ideally, the two of you should have one night a week all to yourselves, where you can have four to six hours just to think about each other. The ground rules: You can talk about anything or do anything, as long as it doesn't involve your day-to-day life." Do this even if blocking out the time alone feels forced. You'll have more fun than you think.

next: Good Sex is Not Just for New Lovers