Archives for May, 2011
Last week, Part 1 of this entry had some quick facts about adult ADHD, and discussed two of the four top issues that affect the relationships of adults with ADHD: relating to others and success at work. Today covers the remaining top issues adults with ADHD have in relationships: contributing equally at home and sexual functioning. 3. Contributing equally at home: As mentioned in the previous post, having a partner with ADHD can often feel as if you have a child to be responsible for, as opposed to an adult partner who can take care of business themselves. Collaborating to create a system that divides the responsibilities and reminds your partner of what needs to be done when, and communicating effectively about your concerns may help. Many people recommend hiring an ADHD coach who can help your partner identify helpful strategies to organize their life, including home responsibilities. Working with a couples counselor who specializes in ADHD is another idea. This article about being married to a partner with ADHD might also offer some insight.
Your partner forgot to pick up the kids at daycare, again. The dinner with friends was going great until your partner suddenly made a blunt comment that hurt your best friend's feelings. You try to have a conversation with your partner, but always feel as if their attention is elsewhere, or they get up abruptly and walk away when you are mid-sentence, or they fiddle with whatever is within reach and wiggle in their chair like they are a child again until you give up and stop talking. Such is life with a partner with untreated ADHD. Some quick facts about ADHD in adults: Although ADHD is often diagnosed in childhood, it's estimated that 30-70% of adults still have symptoms. Many adults were never diagnosed as children, or they were misdiagnosed with other disorders, such as learning disabilities, depression, anxiety or bipolar disorder. As a result, adults with ADHD sometimes do develop depression or have low self-esteem because they were not treated appropriately or were called "stupid," "lazy," or "unmotivated" because of their ADHD-related behavioral patterns. Forty to sixty percent of adults with ADHD also have a child with ADHD (Waite, 2010). To be given a diagnosis of ADHD (for the first time) as an adult, the symptoms must have been present during childhood. If the symptoms first appear in adulthood, it is likely that the symptoms are related to a different disorder. The pharmacological treatments for adult ADHD are similar to that for children--namely, stimulants and sometimes also antidepressants--but these medications may work differently in an adult than they would in a child. ADHD is recognized as a disability under federal legislation (the Rehabilitation Act of 1973; the Americans With Disabilities Act; and the Individuals With Disabilities Education Act). Appropriate and reasonable accommodations are sometimes made in the workplace for adults with ADHD, which help the individual to work more efficiently and productively. If you look at most ADHD-related websites (see below), they have a special section dedicated just to how this disorder manifests in adults.
If you have a partner with borderline personality disorder (BPD), your relationship may look something like this: Yesterday, in the eyes of your partner, you could do no wrong. Today, everything you do is wrong. Ten minutes ago, your partner was smiling and happy. Now, they are screaming at the top of their lungs about a perceived snarky comment from you, which was not meant in the way it was interpreted, and household objects are being thrown. You hastily leave to go to work. By the end of today, you will get 15 text messages, eight phone calls, and 10 emails from your partner that ask if you still love them, and threatening suicide if you end the relationship. According to the National Institute for Mental Health, two percent of Americans are diagnosed with BPD, which equates to about six million people, although some estimates are as high as six percent, or eighteen million people. Women are more frequently given the diagnosis, but that may be because they present for psychiatric services more often than men, or because of provider bias, with men being diagnosed with antisocial personality disorder instead of BPD. Obviously, having a relationship with someone who experiences BPD is a challenge. At the beginning of your relationship, there may have been a honeymoon period where you were idealized by your partner. But now you may be experiencing the darker side of BPD: fears of abandonment, impulsive behaviors (gambling, unsafe sex, spending sprees, binge eating, drug use), emotional instability, and suicidal gestures or attempts. What does the partner of someone with BPD do?
How do you know when your partner's use of pornography is "too much"? Where is the line between someone just "really liking sex" and needing sex in order to function? Have you had fights with your partner about their sexual behaviors, with promises from them that they will change, only to have the patterns continue (or escalate)? If you have found yourself wondering about some of these questions, or others related to your partner's seemingly "excessive" needs around sex, you may have a partner with sexual addiction.
A few posts ago, I wrote about whether you should keep your partner's illness a secret. Chances are that you have some pretty strong feelings one way or the other about how much disclosure is necessary, and who needs to know about your private life. But no matter what level of sharing about your partner's illness you feel is appropriate, you still need support and other social outlets. Connecting with others is part of your self-care strategy to prevent relationship burnout. Common excuses for why healthy partners avoid connecting with others when their partner is ill: My friends/family/coworkers will judge me or my partner if they know what's really going on. My partner will get jealous or feel resentful if I go out and have fun without them. I have too much to do since my partner isn't taking care of their share of the responsibilities. My partner wants me to keep their illness a secret. I can handle what's going on--I don't need anyone else in our business, and we're doing fine, thanks! You absolutely have the right to privacy, to not be judged, and to make your own decisions about how to handle having a partner with mental illness. But in case you are feeling somewhat isolated and alone in this, and want to know more about how to handle the above situations, here are some points to consider.
Today, May 18, 2011, the American Psychological Association has dedicated the day to blogging about mental health. Obviously, we blog about mental health every day around here on PsychCentral, but in honor of today's celebration, here's a list of 10 ways you can enhance your relationship through good mental health strategies: Laugh together. Did you know that the older we get, the less we tickle each other? We play less, too. Laughter is contagious, and typically done with others, which helps to reduce loneliness and isolation. In addition, laughter has many health benefits. In other parts of the world, they practice laughter yoga and have laughter clubs. There are even laughter clubs online. (Watching a funny movie is a good alternative.) Do good for others together. The Corporation for National & Community Service recently released a report about the health benefits of volunteering, including "lower mortality rates, greater functional ability, and lower rates of depression later in life." Some of the intangibles of volunteering are that you and your partner spend time together, give back to your community, and have something to talk about afterwards.
If you've been thinking this whole time that eating disorders are a "teenager problem," it's okay--you're not alone. Little media attention is given to the exploding number of women (and men!) aged 20+ who struggle with eating disorders, but practitioners and researchers alike are realizing that people outside the "typical" age range of eating disorders are seeking treatment in greater numbers than ever before. Why are we seeing more adults with eating disorders in treatment? A few hypotheses: These adults may have had eating disordered behaviors as teens that were either never treated at all, not fully treated, or are simply resurfacing because of stress, trauma, low self-esteem, depression, anxiety, etc. These adults may have had the eating disorder behaviors all along, but were unable or unwilling to seek treatment previously, for various reasons. For men, eating disorders were once considered something that only women were "supposed" to have. While it's true that women still comprise the vast majority of patients in treatment for EDs, men are presenting for services in increasing numbers as well. While the role of the media is controversial among those who treat EDs, the fact of the matter is that female models are thinner than ever, and male models have impossible-to-obtain muscularity. Yes, airbrushing has a lot to do with it, but many people take what they see on tv, online, and in magazines as the truth of what "beauty" is, and it's an impossible standard. There's lots to know about eating disorders, especially if your partner is struggling with one. This post will just skim the surface with a few basics that you as the healthy partner should know, and I will come back to this topic from time to time.
Effective communication skills can be challenging even in the best of times: tone of voice, choice of words, use of technology vs. face-to-face to deliver the message, emotional circumstances, etc., all affect the message sent and received. When you add to the mix a partner who is experiencing mental illness and a partner who has been dealing with the fallout of the illness, it can be all but impossible to have a conversation that gets anywhere. Regardless of whether your partner is healthy or ill, there are going to be times when you need them to understand your point of view and to contribute to resolving an issue, whether it's something as mundane as whose turn it is to take out the trash to something as serious as your partner remaining medication-compliant for managing their illness. But as previously mentioned, how the message is communicated can go a long way. If your partner hears, "Do it or else!" (i.e., an ultimatum), your chances of success plummet. If your partner hears, "This is what I need from you, and this is what's acceptable and what's not," (i.e., a boundary) everyone is more likely to be on the same page.
Hopefully, your partner has found a therapist they are working well with, and some signs of change are happening. As the healthy, supportive partner, attending a session of counseling with your partner, or meeting with your partner's therapist alone, called a collateral visit, may provide all parties involved further insight into your partner's journey towards wellness. Why might meeting with your partner's therapist be a good idea? If you are thinking that you are not the one with the problem, understand that attending one session with your partner's therapist is not the same as couples counseling. The purpose of the meeting is to share information.
I will begin this post by saying an entire blog itself could be (and should be--anyone out there an expert??) dedicated to the topic of PTSD, and the havoc it wreaks on the lives it touches. This blog entry is mostly to acknowledge the partners and relationships that are struggling under the weight of PTSD from past trauma, and it will be a topic I return to from time to time. When I think of PTSD and therapy clients, I think of experiences such as military service, rape, sexual abuse, and traumatic car accidents, and the subsequent paralyzing symptoms of nightmares, flashbacks, the inability to relax (hyperarousal), intense fear of something bad happening again, and panic attacks. What I don't often hear about is the role the non-traumatized partner has in the life of the partner with PTSD. Again, this blog entry will just touch the tip of the iceberg, but it will be a start and guide you towards other helpful resources. Also, in this entry, I will be speaking generally about PTSD, not to specific causes, such as military experience vs. sexual abuse history, which can look very different.