On the Couch with Gail Saltz, M.D. | A Mental Health Blog at iVillage.com
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CSD (Compulsive Shopping Disorder) is one of the obsessive-compulsive disorders much like compulsive gambling and binge eating. In fact, people with other addictive behaviors may also suffer with CSD. People with CSD may also suffer from anxiety and depression. They often shop in hopes it will reduce their tension or low mood, and not only does this fail to work, but they tend to feel worse due to the consequences of over shopping.
Many of these people have credit card debts they cannot possibly handle, legal problems including bankruptcy, destroyed marriages and ruined friendships as a result of lying about their compulsive spending. They often shop for the same object over and over again; objects that they do not even use. They may even have emotional “blackouts” where they cannot remember buying the things they did buy.
In July 2005, of The Journal of Clinical Psychiatry published a study from Stanford by Dr. Lorrin Koran. It looked at the use of Celexa (a serotonin reuptake inhibitor) for compulsive-shopping disorder. In this initial study it appeared that celexa was effective in reducing the symptoms of CSD. The celexa also reduced the patients anxiety and depression.
If you think you have a problem with shopping, there are ways to curb your “addiction” and it's important for both you and your family that you do so.
- Shop only in a store. Shopping by catalogue, internet and TV shopping channels are ways to shop huge volumes in a short time. It is far too tempting for a shopaholic. Make these other methods completely off limits.
- Stick to a list. Before you go shopping, at all make a list of what you need and buy ONLY what is on the list.
- Use only cash or a check. Credit cards lead to less control and lots of debt. Only keep a credit card for true emergencies. For all purchases, only allow yourself to use cash or checks.
- Group therapy. Just like for other addictions there are groups for people who share this problem and often being with others and hearing their harrowing stories is a help.
- Medication and psychotherapy. If you truly have compulsive-shopping disorder you will likely not be able to control it on your own. Get a professional evaluation and consider treatment with therapy (to look at the underlying mood problem which may be fueling the addiction) and with medication which appears in this latest research to be effective.
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It is true that as one ages there are issues that come up, both physical and psychological, that can put a real crimp in your sex life. In fact, a third of people post 50 report having real sexual problems that range from erectile dysfunction to loss of libido. But, that also means that 75% of people are not reporting a problem.
As age goes up, so do medical problems and use of medications, both of which can interfere with sexual functioning. Many couples kind of give up once they don't feel like it or sex is fraught with some failure or disappointment. Once a couple throws in the towel, it is highly unlikely they will get back to sex. The point being that a problem should be addressed as soon as it arises. Sometimes hormone replacement is needed or a medical problem addressed or medication changed, and certainly above all there needs to be discussion about improving the sex and trying new things to see what might work.
Many couples, however, report the best sex they have ever had after 50. Both men and women may become more comfortable with their bodies, know what works best for each other, and feel generally less inhibited. They don't have to worry about pregnancy and birth control--though they should continue protected sex unless this is their longterm, STD free and monogamous partner.
While there are certainly more challenges to sex after menopause and with advancing age, the idea that there is no great sex then is a myth. If you are experiencing difficulty, see your doctor to check medical issues and hormone levels.
Remember that this time requires more communication and openness, but there is much to be gained!
I will discuss on the TODAY Show what happens when your partner has a wandering eye.
First off, it is worth saying that humans all have some measure of voyeurism and exhibitionism: we like to look and we like to show. Some of us like it however, more than others. I tend to hear more distress from women about their male partner looking at other women and how much this bothers them.
Both men and women are visual, but it is true that men tend to look more at women's bodies than women checking out men, but women having a wandering eye is on the rise. Men also tend to think about sex more times per day than women and this becomes a part of their looking.
Still, there is looking and there is LOOKING. Most people are not very bothered by the occasional glance. But blatantly checking out, commenting on, repeated admiring of and certainly flirting or touching usually feel quite undermining to a partner. Such behavior makes one feel unappreciated, and even threatened in the relationship. Unless both parties are confident of the others' affection, appearance, and fidelity it generally will stir envy and hurt.
It's helpful to know that some people don't really realize what they are doing and how it makes you feel. You really do have to point it out, make them aware of it and how it makes you feel. Many partners, once told how hurtful and disrespectful it is to you, will make an effort to curb such behavior, but the hurt party will often have difficulty explaining how they feel.
Make it clear: you don't expect them to wear blinders, or stare at the ground; just don't ogle. If your partner really won't make any effort to change and doesn't appear to care how it makes you feel, it's likely you have other such issues and couples therapy may be in order. Most important is to be rational and reasonable in your request. Being unreasonably jealous with unreasonable requests is likely to make your partner throw out the baby with the bathwater and pay you no heed.
Also make sure you do give your partner positive feedback and admiration because everyone needs that and if you don't at all, they may be "looking" for that feedback elsewhere.
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Less than a month left till Labor Day, the unofficial close to summer. Ever wonder why you start getting that sinking feeling about now? Look around and you will see you are not alone. Many people feel down in anticipation of the close of summer. There are numerous reasons for this.
Many people take vacation time in the summer (more than in any other season). Kids are out of school, making family vacations possible, and because it's universally agreed upon at work that lots of folks will vacation, the work place sort of slows down and it's much more acceptable to take long weekends.
For those who thrive better with less stress and more holidays, this makes the summer a more enjoyable and relaxing season than other seasons. I say for those that do thrive, because some don’t. For the type A’s out there, all the relaxing can be downright stressful.
Additionally, however, sunlight can have a very positive effect on mood. Longer days and more outdoor time can affect the entire cortisol system which, for some people, especially those with Seasonal affective disorder, can improve mood.
Autumn brings many associations. Autumn is the season where the earth “dies” in its cycle of renewal. It is also the season of back-to-work and back-to-school gearing up. Many students and workers begin some new task in the fall and this can be anxiety-inducing. Some parents will be sending their child off to a new school situation or having a new empty nest and this can be a very sad and difficult time. Old feelings of when you were a student and summer vacation was over can also come back to you now and leave you feeling sad and anxious without your really knowing why.
There is really nothing wrong with feeling a little mourning at the passing of summer. But if you are really down in the dumps, perhaps you are letting it get the better of you. Try to consider this.
If you are a little blue then:
1. Try focusing on one new thing you will do this fall that you feel will be very exciting or gratifying.
2. Pick something that represents something of the summer to you and preserve it. For example, a song you heard during vacation and loved. Then get the album! Or make a photo album of some particularly good times, or a craft project using shells you found during a wonderful time at the beach.
3. Be aware of what sad end-of-the-summer memories may be about in your past. Is it when you left for that difficult boarding school or first year of college you hated? Did you see less of your Dad after the summer was over? Understanding that your sadness may not be only about this summer but past summers can help you put it in perspective.
4. Avoid self medicating the blues with alcohol or drugs.
5. If you feel overwhelmingly sad or anxious, then screen yourself for true depression. Depression is very treatable if not left too long untreated.
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Friendships are very important to most women. They often emerge out of a similarity in lifestyle, common interests and values, educational and socioeconomic status and developmental time in life.
The issue of being in a similar developmental place means that most friends are similar in age. But sometimes women make friends with someone much older or younger than they are. Our mothers are actually our first loves and so it is not surprising that our relationship with them would lay the groundwork for love of other women. At times these older female friendships could even be a stand in for our mothers, without all the baggage.
These relationships are often tremendously beneficial to both the younger and older woman. The younger gets wisdom and the voice of experience from a woman who has lived it. She gets someone to bolster her competence and stability. She may even get someone who can be an advocate for her, as well as a nurturer.
The older woman gets someone to whom she can impart her many acquired skills, be the idealized mentor, help a person make life changes, get attention she may feel she has lost with age, and identify with the fresh start on life that the younger person has.
What these friendships lack is the competition and comparisons of same-age friendships as well as the mother-daughter baggage of an actual mother-daughter relationship. It can be a real win-win all around.
With improving methods of fertility treatments and with the ability to have babies at an older age comes families where the gap between the last child and next child is really substantial, eight years and more. This kind of family dynamic brings unique challenges and joys.
Older children initially may be upset by the concept that their parents are having another baby. They may worry that their parents will be so preoccupied by the new child that they will get less time and attention.
How can they see a baby as a sibling if they are a teenager and thinking about school, dating and fun with friends? The pregnancy (evidence their parents do in fact have sex) often "weirds out" the older kid who does not want to think about the mother's body or parents who have sex.
Often once the child is there, the older ones grow comfortable with this cute , smiling, loving baby. While parents may appreciate that their older one is able to really be a caretaker, babysitter and substantially pitch in, asking your older child to give up his or her social life for this purpose can have really negative consequences. Parents need to remember it was their decision to have another child, not their child's. Making them the little mom or dad is bound to create tremendous resentment. It's important to let your older child take the initiative and feel they have some say.
What an older parent may lack in energy, they make up for in wisdom and experience. In fact some parents make this choice because they feel their first child's upbringing blew past while they were busy trying to make a living, and that they want to have the experience again. This is not necessarily the best reason to have another child, but realizing that you do want to spend more time with a child can mean that all your children benefit.
Dealing with very different issues at the same time also presents a challenge. One minute you are helping with midterms or a boyfriend problem, the next is finger-painting. Switching headsets can be hard, but also fun. Each set of issues requires you to be flexible and versatile, good traits to develop.
Suggestions.
Expect initial resistance. Your older children may not be happy about it. Give them space and understanding, give them the chance to express themselves and come around on their own.
Tell them about themselves. Everyone loves to hear what a cute baby and kid they were. Tell them the stories and it will get them in the groove for the approaching baby.
Respect their time. If you ask them to babysit, then compensate them like any sitter. A bit of family chipping-in is important, but asking them to cancel their own social plans to take care of a sibling will breed resentment.
Be ready for comments. People are curious and often overstate their opinions. Be ready for, "Are all those yours?" or "From the same marriage?" It's human nature (albeit not pretty) but being prepared with what you want to say will make it have less effect.
Click here to watch the "Baby Gap" segment on the TODAY Show.
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Today we discussed how to help Sharon with her "divorce makeover". Here were some of the psychological points that I thought would be helpful to Sharon.
Sometimes a person allows herself to be treated badly in a marriage because she feels she deserves it, that she is really not worthwhile or valuable, lovable and maybe even are deserving of punishment. Many overweight women struggle with feeling no one will ever want them, so they think they should hold onto a terrible guy or they will always be alone. Women who don't think much of themselves are often terrified of being alone and would hold onto someone who makes them miserable rather than risk being alone. It is a belief that they cannot take care of themselves.
Sharon has already taken the important step of both knowing that she can take care of herself alone (at least as well as together with him), and that she does have good stuff and deserves some happiness. She needs to continue to grow her self-confidence, which can happen through financial planning, making outside friends who enrich her life and being a good mom. She should review her attributes which are more than her new lower weight. She should make some future goals of where she would like to be personally in life in two years, five years, ten years. This will help her see that life will move on and she has opportunities for gratification in the future too.
Children do suffer with divorce. There is no way to completely avoid it: the two people she loves are separating and so she cannot have you both at the same time. She has to miss one of you. This is painful and it is normal that she will grieve. Let her do so and let her talk to you about her sad feelings. Tell her most children feel that way and that with time she will feel less sad, but that you understand and can let her talk about her feelings. Be on the lookout for feelings of real anxiety or depression (changes in sleep, appetite, social withdrawal or constant seeking of attention from anyone, school problems), and if there is concern let a professional evaluate her. Reassure her that you and daddy will always love her, even if your love for each other is gone. You two will always be there for her.
Her biggest fear is if you stopped loving him, could you stop loving her? You need to tell her that won't happen and how a child is different from a spouse. Try to work with your ex, for her benefit. If a mediator would help, use one. Despite anger, you need to talk about your child and do what is best for her. Argue elsewhere; do not put each other down in front of her. She needs to hold onto two parents who are good and love her. Making either one of you bad takes a parent away from her.
Reassure her you will both be there for her and love her. Also tell her, you will each be okay. She will worry you won't be, she needs to know you can each take care of yourselves as well.
The definition of love is infinite. People mean many different things when they speak of loving and being loved. But many couples both fight over and even break up over "not feeling loved enough" or "not loving you anymore" or even, "I love you, but I am not in love with you." One’s subjective experience of love clearly counts a lot.
Where does it come from — your feelings of how you love another or what makes you feel loved? Much of it is molded by your first love — mom and dad. How you felt loved by them and how you saw them love each other often sets the stage for what you seek out in a love relationship — for better or worse. If your parent was aloof and distant, you may seek the same, but then feel constantly tortured by the endless struggle to get more attention. If your parent was smothering and controlling, you may not feel loved unless your partner is practically up your nose 24/7. The model of your parents’ relationship may also set the stage for how you consider a relationship should function. If they fought a lot, you may provoke fights in order to feel "loved."
This need to repeat the past (called repetition compulsion) can hold you in its grip unless you take a look back at what shaped you and why. Once you have that knowledge then you can do it differently. Feeling loved is a state of mind and it has a lot to do with early feelings of bonding. Staying in a loving relationship has to do with more than feeling swept up in love — it has to do with choosing to make love work.
Do you love but want out because you are not in love? I hear this quite often, and let me tell you that the new feelings of “in love” have a lot to do with newness and lust. Your relationship will naturally become old if you stay together, and lust often fades and turns to a more mature but still satisfying sexual attraction. “In love” often means that you have this new person idealized — they can do no wrong, they seem perfect and you can't get enough. But that is both the newness — you not having time to see their faults (which everyone has) — and the nuerochemical dopamine being released and keeping you dopped up for a while. The only way to keep feeling this way all the time is to keep getting new partners. If you want to stay in a marriage, then loving but not “in love” is no reason to break up. And it is not a reasonable expectation. All love relationships have ups and downs. Loving is a decision to commit, to compromise, to give to the other, to care about their needs, sometimes to sacrifice and to enjoy them for who they are.
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I was on the Today show yesterday and talked about how holiday parties can be torture for the many of us that struggle with any amount of social anxiety or shyness. Here is some more information for those of you struggling with how to handle holiday party anxiety.
You enter the party and look around at the people there. Immediately your heart starts to pound, your palms sweat, you can’t breathe and you are certain whatever you manage to say will sound ridiculous and everyone will think badly of you. Shyness, discomfort in any kind of situation where you are speaking to others, is far more common than you think. At least half of all Americans report being shy during some period of their lives. This is not the same as but is even worse in those with Social Phobia. Social phobia is the persistent and excessive fear of social performance which causes the physical symptoms described above plus blushing and tense muscles and results in either great distress or avoidance of the situation. It is the third most common mental health problem, effecting more than 10 million Americans. As you can imagine, both shyness and social phobia can be debilitating for both your job and for developing friendships or romantic involvements.
What causes shyness? Certainly some professionals believe that there is a genetic predisposition towards shyness. It is true that babies are born with temperaments and the more sensitive child may seem predisposed to shyness but there is no real data to show that these children are more likely to grow up shy. It does on the other hand seem to be true that life experience can affect a person’s degree of shyness. The reason for this is that most shy people have low self esteem. Shy people believe that what they think and have to say is not worth listening to, and they fear rejection by others. Most people think shy people are introverts but there are many extroverts who are shy. In fact many celebrities and politicians are shy. They are fine in a “role” that is scripted and under their control but once they are in a spontaneous social situation they feel shy.
There are some up sides to being shy. Shy people tend to be good listeners and tend to make close friends to whom they are very loyal. However, if shyness is getting in your way, there are some things you can do about it.
Tips:
- Think about and make a list for yourself of the good attributes you have. What you have to offer others. This will help combat those debilitating insecurities.
- Think ahead of time of subjects you feel comfortable discussing. You can even write out a script of a conversation, which you review ahead of time so that you feel in more control of the social situation.
- Be sure to make eye contact with others, smile and give compliments. Engaging with others this way will make them receptive to you. Shy people are often mistakenly perceived as arrogant or rejecting others because their discomfort makes them withdraw. If you make yourself respond to others they will respond back giving you the positive feedback you need to overcome your fear.
- Medications. Paxil is effective for true social phobia. Certain other medications, like beta blockers can relieve the physical anxiety symptoms that appear during specific moments of anxiety, for instance while giving a speech.
- Therapy. If shyness is truly undoing you, consider psychotherapy because pinpointing why you feel unworthy or what experience in life started your shyness in the first place can help you control your anxiety and its symptoms.
The holidays are supposed to be a joyful time surrounded by family and loving feelings. But what happens when someone you loved that was always part of your holiday is gone? Grieving is difficult enough, but the holidays tend to make the absence feel worse. In addition, the disparity between the happy holiday feelings others are having and the mourning you are feeling can make you feel really removed from the whole holiday spirit.
The most important thing to know is that it is OK to feel sad. Many people try to fight off the painful feelings rather than accepting the normality of their sadness. Sometimes people feel that once it is no longer the “first year” they should “get over it.” The truth is that while sadness will lessen over time, it usually doesn’t go away altogether. Each holiday without your loved one, you may feel that loss.
On the other hand some people find themselves feeling guilty if they don’t feel horribly sad and are able to enjoy themselves. This then ruins the experience and they rob themselves of the joy of the holiday to pay penance. Try to remember that your loved one would want you to be happy and that it does not in any way reflect a lack of love or respect for the person who is gone.
Taking good care of yourself helps a lot: eat healthfully, exercise regularly and get plenty of rest. Exercise diminishes feelings of stress and depression. Treat yourself nicely and don’t expect too much from yourself in planning and execution. Over-planning may be your way of distracting yourself from your sadness but then the stress of too much will likely catch up with you and make anxiety rise. Allow yourself to do less and allow others to pick up the slack.
Also remember to enjoy memories of your loved one and the holidays you spent together in the past. The temptation may be to run away and not think of them. But embracing those memories will be both sad and happy and will help the mourning process. Look at photos from past years and share stories with others who loved them, too. Celebrating both of your lives will make the holiday more meaningful.
It is the day after the Thanksgiving weekend and many of you are basking in the glow of having been with close family and friends. Also many of you are breathing for the first day in the last 4 or 5 after a marathon of cooking, hostessing, cleaning and dealing with family politics of the highest order.
Some may even be dealing with dread as they ponder the upcoming December holidays because there was personal tension, criticism and perhaps even a fight at Thanksgiving. When a lot of family comes together with high expectations, you can be sure there will be some tension and arguing.
Don’t wait for December to come to have a repeat of whatever just happened during Thanksgiving. Now is the perfect opportunity to deal with the issues or arguments that came up and clear the air so that the next holiday will be relaxed and fun. Give everyone a few days and then pick up the phone or get together for coffee to talk about what happened and resolve the tension.
I would suggest starting the conversation by saying something like, “Because I value our relationship so much…”. Generally this statement is true but often not spoken because you feel angry at the other person. Starting out this way will make it clear you are there to improve things rather than be attacking. The other person will be far more likely to work with you than to go on the defensive.
Because it always takes “two to tango” to some degree, try to think about what you may have brought to the situation and accept responsibility for that. You can explain how whatever that person did that you found difficult made you feel and how you would rather be spoken to. If you find it too difficult to speak in person, consider writing a letter. Writing allows you to organize your thoughts and sometimes prevents anger from getting the better of you and making you say things you regret.
Holidays are really about relationships and remembering that these are the people in your life that count the most. It is worth putting in the effort to making them work.
Recently there have been a number of young celebrity marriages which have failed. Reese Witherspoon and Ryan Phillippe announced their plans to call it quits. The two were formerly thought of as “the perfect Hollywood couple." Jessica Simpson and Nick Lachey broke up last year and reports say the reason lies in the fact they were too young. Britney Spears and Kevin Federline have finally ended it. Is marriage in your early 20's doomed to fail? Statistics show that people are getting married later in life. But does getting married in your teens and early twenties make divorce more likely?
A recent study by the National Institute of Mental Health and UCLA's Laboratory of Neuro-Imaging stated that the point of intellectual maturity, the so-called "age of reason," comes at about age 25, and that major life-changing decisions shouldn't be made before then. The problem is, the study says, that teenagers and young adults make decisions with the amygdala (the instinctual and emotional portion of the brain) and the frontal lobe of the brain (which controls judgment and the ability to evaluate consequences) and that these regions of the brain are not fully developed by the teenage years.
Another study conducted by the National Healthy Marriage Resource Center claimed that postponing marriage until after the age of 25 can reduce the chance of divorce by up to 25 percent. The National Center for Health Statistics found nearly half of all marriages in which the bride is 18 years or younger end in separation or divorce within 10 years. For brides 25 and older, half as many marriages break up. The 2005 census bureau found that the median age for first marriages in the United States is 26.7 years for men and 25.1 for women. Overall the age of marriage tends to be older in cities than in more rural areas.
These statistics alone are enough to make one think twice about marrying very young. In fact, the growing trend for adults to seek higher education is delaying the age at which most people think about getting married. This is especially true for women who are making more money and may not feel as pressured to get married because they can live on their own and support themselves.
One advantage of waiting to marry is the ability to spend some time on your own which helps build your confidence -- you know you can make it on your own, you know you bring something to the table. That kind of confidence helps you to be a better partner and be more secure in a marriage relationship. People who are insecure can feel desperate to cling onto their partners and yet may have difficulty making compromises because they fear losing themselves if they do. Feeling confident in your identity makes being flexible easier and less threatening.
Life experience may also help you have a more realistic expectation of marriage. That life acquired wisdom also makes it clear that divorce results in greatly diminished income for the home as well as negative effects on both physical and mental health for both people involved as well as any children. This knowledge often helps both parties to work harder at their relationship rather than opting for divorce.
Of course there are couples who marry young and have a long and fruitful marriage. Sometimes they really grow together and therefore work well as a team to make the marriage work. Overall, though, it is worth considering your maturity, age and life experience before entering into the commitment of marriage.
Have a seat and get comfy. I will be writing to you about all manner of things psychological. I hope to deal with topics of mental health, relationships, sexuality and a psychological understanding of what goes on in the news and trends I find in my practice and in my interactions with viewers of the Today Show, where I am a regular guest expert.
After 14 years of psychiatry practice, I truly believe that self knowledge gives you power. Understanding what goes on in your mind and why, enables you to make better decisions about your behavior in the world. It amazes me to find that even in the enlightened 21st century many people still stigmatize mental illness. Too many people are afraid to seek help because they are ashamed. I hope to debunk these myths by providing current information about mental illnesses and their treatments. I also hope to “normalize” mental suffering. If you look at the numbers, many people struggle with suffering at some time or another in life and being able to acknowledge that and examine it is what allows one to get relief.
I will also try to stir your interest and inner curiosity about your own life struggles and choices. The more you ask yourself “Why?”, the better. Why am I bothered by something? Why am I sad, angry, frustrated, anxious? Why do I like someone, hate someone, love someone? Why do I struggle with certain people or situations? Why do I keep repeating behaviors or patterns that really aren’t working out for me? I hope this blog will help you to ask yourself “why,” because that is the way you get to the bottom of what makes you tick and allows you to consider what is working for you and what is not. Inner curiosity is the instrument of change.
While I cannot provide advice to any of you personally and directly, I do hope that informing you will help you on your own road of self discovery. Life is not easy and we all face many struggles, but it is also rich, exciting and textured. You are the master of your inner universe and only you have the power to make the most of it. I hope that you will write in comments and questions as I will be reading them and will try to respond to as many as I can through the blog. In that way we can all benefit from a little “group therapy.” Please let me know what you would like to hear about and what you feel concerned about. So now its time for you to lie back on my couch and tell me what’s on your mind.
