Sex Addiction: What you need to know

Sex Addiction: What you need to know

Dr. Kate Balestrieri: Good evening Los Angeles! Welcome to “ Behind Closed Doors” with every Saturday six pm, right here, on Talk Radio 790KABC. I’m Dr. Kate Balestrieri ….

Dr. Lauren Dummit: Hi, I’m Lauren Dummit.

Dr. Kate: This is a show about all things related to mental health, addiction, sex, love, relationships and crank reverence that are all related to those topics. Tonight specifically, we’re gonna be focused on sex addiction. Everything you need to know and never knew you needed to know about sex addiction. So, if you have any questions about this topic, call us now at 1800 222 5222. That’s 800 222 KABC.

So Lauren, before we get started talking about sex addiction, I thought it may be interesting since it’s our first episode together, for us to talk a little bit about how we met. Specially, because it’s related to sex addiction. So I wonder if you remember where we were when we first met.

Dr. Lauren: I do. We were in Kansas City, I think, by neither of our choice.

[ laughter ]

Dr. Kate: …. not our first choice for sure.

Dr. Lauren: Not. For sure.

Yeah, we were there at the second module for sex addiction training. And we were the two girls from LA …

Dr. Kate: That’s right. So, Lauren and I were getting trained to become certified sex addiction therapists through the organization called EATA, and they have trainings all across the country. And we were fortunately lucked to be the only two women there from LA. The only two people from LA. So, everyone kept running up to us and saying : Oh, Kate, have you met Lauren? Oh. Lauren, have you met Kate? And finally we met.

Dr. Lauren: Yeah. We were like instant friends and we can have talked about our future, vision for practices and our goals and dreams, and they seemed strangely alike.

Dr. Kate: So alike in fact, that we started talking about opening our group practice, which we did two years later.

Dr. Lauren: Yeah, [ unintelligible ] seems longer than that thing. It, actually, happened pretty quickly

Dr. Kate: Mhm. Lauren and I are so lucky to work together… well, from my perspective.

Dr. Lauren: From mine as well. For sure.

Dr. Kate: We are like yin and yang in the way we share roles in our Group. But what’s certainly exciting about the organization that Lauren and I opened is that we focus on helping people recover from all different kinds mental health issues, addiction issues, relationship issues, with the focus on meeting everyone where they are. When they’re ready to start. That’s really important because a lot of practitioners or treatment centers have a pretty curated treatment program, and often time someone’s not necessarily ready for that level and focus on their issues. So Lauren and I have the… good fortune of getting really creative with people to help them take a step forward from wherever their starting point is.

Dr. Lauren: Yeah, and fortunately enough, we are also able to provide various levels of care, to meet them where they are. We do not have a residential component, but [ unintelligible ] create of, with that if they don’t require more structure.

Dr. Kate: Which is really helpful when we are looking at healing from all different kinds of things, especially trauma and addiction. As much support as you can get is really helpful. So, today we’ll be talking about sex addiction. I thought it may be curious to rack our brains about how on earth we both ended up in this corky nitch within this field of psychology. So, Laurna what –

Dr. Lauren: Definitely it’s corky


Dr. Kate: – so, what brought you into the field of sex addiction?

Dr. Lauren: Hmm. I was just thinking about that question and trying to remember exactly ..erm.. I do remember ..erm.. one of my friends had brought me into it. She was someone I’d been working previously, at another agency and we’d known each other for many years , ….and she knew that my entire career I had been working with trauma and addictions of various kinds … And sex addiction treatment was relatively unheard of … and, not many people even were aware and educated about sex addiction in general. And she called me … and said she’s just got that new job and it was really interesting and exciting field… and knowing that I had been in trauma work, she really was suggesting it for me, because there is so much trauma work in both when working with betrayed partners of the sex addict. So it was my initial drive. She suggested a few books which I read, and then she suggested that we do the first training together, just to kind of get the taste within, to see what it’s like. And I had no idea what to expect and I was completely blown away. It was such a comprehensive training and… erm … in addiction in general, that’s specifically with sex addiction.. and I just was really amazed how prevalent it is … And all the different facets, you know, just seemed really exciting to me

Dr. Kate: I couldn’t agree with you more. I think one of the things that stood up to me throughout all our trainings was how, I think, underreported and misunderstood sex addiction is, as a construct within a mental health and addiction communities. But like you, I sort of stumble into it not really expecting to be specializing in this field, with my background as a licensed clinical and forensic psychologist, and my training and all of my early career work within the prison systems, and within the court systems. So I used to spend a lot of time with sex offenders, another high risk offenders, because for me what’s always been curious in this work is what motivates the most egregious and the most benevolent of human behaviors . So, I find that working in those setting you get the taste for both –

Dr. Lauren: mhm

Dr. Kate: – But what I noticed in working with sex offenders was that there were sort of two different kinds of offenders. Some had more compulsive behaviors that were driving their offending behaviors, they couldn’t stop even though they wanted to. They didn’t want to be doing the same things they were doing, but they felt out of control and they had so much shame around their behavior. Another was another track of offender. They had no shame and they were far less compulsive and more intentional in their behaviors. So, it just became very clear to me that there were these distinct groups as people that I was working with, and I didn’t have vocabulary to understand what sex addiction was. And I wouldn’t know it until years later, that what I was looking at was an overlap of sexual offending and sexual addiction. —-

Dr. Lauren: mhm

Dr. Kate: – behavior with some of those man. So I think, you know, as I partriculated out of prison systems cause it’s not fun to share an office with cockroaches or rats, [ laughter ] which is often the case of prison system. But, as I moved away from working in prisons and started the private practice, I started working more and more with people who were in recovery from lots of different kinds of addictions. For primarily, substance abuse related issues, gambling disorders, eating disorders, everything you may think about on addiction continuum and … What I noticed is that people were getting better in their identified addiction, and then all of the sudden obvious relational issues would start to pile up. They were much more compulsively dating or they were acting out sexually outside their relationship, and they didn’t have an understanding of what was going on, and they also couldn’t stop. And that’s when I really started getting keyed into this concept of sex addiction and started learning more about it .

Dr. Lauren: Yeah, I found this more experience in working with addiction, how … quite frequently, especially when someone is new, and recovery is like a game when one addiction ends up surprisingly and then another then tops up.

Dr. Kate: mhm

Dr. Lauren: – and frequently, again this is a huge generalization, but frequently come in a bad numb where there is a lot of sexual acting out. With women there is a lot of numbing with food –

Dr. Kate: mhm

Dr. Lauren:– and obviously that can go for both genders and all genders. That was a very typical pattern that was coming up.

Dr. Kate: Yeah. I’ve seen that pattern as well. So I wonder, in another, you’ve been doing this work for a while. What do you love about it? What do you get out of it?

Dr. Lauren: Well, one of the things I love about it is, there is no lex formula or a typical sex addict. There is such a variety and it’s something that affects people on so many different levels. You know, it’s not just one, it’s all genders. There’s so many different … erm… subtypes of addiction and, you know , different things that turn each person on –

Dr. Kate : mhm

Dr. Lauren: – and it is such an interesting overlap with other addictions, with love addiction, porn addiction. It’s so interesting how it keeps coming up in the media, how technology has been [ crosstalk] [ inaudible] and sex addiction and porn addiction . And I just find it a really fascinating and exciting field to be a part of, as we’re learning more about it and , you know, different types of studies or, you know, are coming up with a new research every day.

Dr. Kate: mhm.. I couldn’t agree with you more. And we were seeing more and more discussion about sex addiction. Even though, I don’t think people understand that what they’re talking about is often sex addiction. In the media there is a lot of confusion around what exactly sex addiction is, what it isn’t. What is predatory behavior, what isn’t. So I think, it’s really exciting that we’re in this field end we get to help to spell some of those myths and get them clear around this. Because for me, what’s really exciting about doing this work is recognizing that with the sex addiction or porn addiction, love addiction or any kinds of compulsive relationship behavior, really, the underlying issue is an intimacy disorder –

Dr. Lauren: mhm

Dr. Kate: – right with disconnection from oneself and from other people. So, what I get out of this work is helping people along the process and the journey, and in doing so, seeing them build this remarkably profound and deep relationship with themselves, and being able to generalize that to the relationships with the other people. And in one year, two years, three years looking back and seeing the transformation and seeing how much more connected they feel –

Dr. Lauren: Oh, absolutely.

Dr. Kate: – how beautiful.

Dr. Lauren: You know, working with couples for example, you know, you hear of the most egregious betrayals and times. Listening to people’s ,you know , disclosures and.. erm… you could imagine that their partner would never forget them. But like you mentioned, where there is a disconnection with themselves, they often are able to heal and create a relationship that is more profound that they ever had.

Dr. Kate: Yeah. We need to take a quick break now. But coming back after the break, we’re going to be speaking with Dr. Rick Isenberg, who is the executive director for the American Foundation for Addiction Research. And we’ll be diving in more in depth about the sex addiction. What it is, isn’t and what you need to know.

[ commercial break]

Dr. Kate: Welcome back! You’re listening to ” Behind Closed Doors”. I’m Dr. Kate –

Dr. Lauren: And I’m Lauren Dummit

Dr. Kate: – and we’re talking about sex addiction. We’re about to bring on the line Dr. Rick Isenberg, who is the executive director for the American Foundation for Addiction Research and the medical director of Psychological Counseling Services, and intensive outpatient program in Scottsdale, Arizona, that focuses on treating sex addiction and the betrayal that the partners endour among a variety of other issues.

Dr. Rick are you with us?

Dr. Rick Isenberg ( on the phone) : I am. Thank you very much.

Dr. Lauren: Hi, Dr. Rick. Welcome!

Dr. Kate : Thank you so much for being on our show!

Dr. Rick, can you tell us a little bit more about what you focus on in your area of expertise.

Dr. Rick : Sure-sure. I actually feel very fortunate, because I did to be involved in the field of tri-insexual addictions from a couple of different perspectives. I am involved clinically, I work with … erm…[ unintelligible] therapies here in Scottsdale. We take ..erm.. groups of individuals through an eight-day intensive program on weekly basis. We see a lot of people with some …erm… significant issues, with sexual addiction as well, as other kind of issues , and we also work with their partners. Sometimes we see them as couple. Sometimes it’s one or the other. But I get to be involved with treating those individuals. And my perspective, my approach is through integrated medicine and I do a lot with the mind – body connection, so –

Dr. Kate : hmm

Dr. Rick :: – Part of what I do, is provide support for people coming to the programs, so like, they can be as finally turned medically. And in terms of their brain half, I do a lot of functional wellness coaching, be trying optimize people’s brain performance, cause we do things all the time [unintelligible] under carter ,mental acuity, our decision making, our judgments –

Dr. Kate : mhm

Dr. Lauren: Certainly.

Dr. Rick : So, I get to be involved in that regard clinically, but the second hat that I wear to the American Foundation for Addiction and Research, has me involved on the more purely scientific side. I’m doing research in helping to found research projects that are looking at what actually underlies this disorder. How can we approach it? How can we understand it better? And what seems to be causing it? And what do rise it? These are fascinating questions from a scientific perspective. And I feel very fortunate to be able to be involved in that aspect of investigation as well.

Dr. Lauren: That’s great! Kate and I are so very fortunate, too, to have the opportunity to get to know you better working along, find you on this research study as well. And we’re really excited for the impact that we’re expecting that we’ll have.

Dr. Rick : I feel so grateful to have you as a part of team.

Dr. Kate : Well, thank you. We’ll talk a little bit more about the research studies, specifically … erm … in a few minutes. But before we jump into that, Rick, we hear a lot of back and forth about what is sex addiction, what isn’t sex addiction. And I wonder if you can way in and tell our listeners a little bit from your perspective, what is sex addiction exactly?

Dr. Rick : This is something that has emerged in the awareness, I think, of the public. There’s some rather notable recent examples of people with sexual excess and sexual exploitation . So I do think there is some real confusion about what is and what isn’t sexual addiction. And-and it’s great whether they get the discussion started. I take a fairly medical and scientific approach when I’m looking at the question, because …we’re talking about an addiction, which is a specific kind of disorder –

Dr. Kate : Right.

Dr. Rick : – It really is a brain illness –

Dr. Lauren: mhm

Dr. Rick : – and whenever we’re talking about various types of drug addiction or into gambling.. erm.. we consider certain things to be addiction based on the kind of behaviors, and the consequences of those behaviors that people have.

Dr. Kate : mhm

Dr. Rick : Not everybody who has a highly active sex life, certainly is going to be an addict –

Dr. Kate : mhm

Dr. Rick : – Not everybody who has an unusual sex life, would be considered as an addict.

To be an addict really means that on the one hand your behavior is really out of your control. You’re doing whatever it is you’re doing. And when it comes to searchful things to be many different types of searchful behaviors –

Dr. Kate : Yes, a lot of many options.

Dr. Rick : – You’re doing them a way more than you really want to be doing them. You’re spending way more time thinking about it, preparing about it, fantasizing about it, remembering about it, and it’s actually really disrupting your life. The consequences that come in something that [unintelligible] with an addiction can be quite severe. And one of the home marks of addiction is that you keep doing it. Despite the fact that you’re having serous consequences. –

Dr. Kate : mhm

Dr. Rick : – And when we’re talking about sexual types of behavior, the consequences could be in your partner relationship. It could be…. health, it actually turns many infections. It could be legal, could be related to your employment. Consequences come in many different forms. But the true sex addict keeps going, despite having the consequences over and over again. That is a home mark of the disorder.

Dr. Kate : mhm

Dr. Rick : …erm.. Again, somebody who is highly sexual, who enjoys having sex on a very frequent basis, whether it is with one individual, many individuals et cetera, would not necessarily be a sex addict. If he or she is not having consequences from it, and not persisting in it , despite common sense, despite good judgment, despite having consequences all over. Over and over again.

So there’re certain features that we look for in terms of addiction. I’ll just mention a couple of them. And then I’ll be interested in what is your perspective.

We know that people who have [unintelligible] addiction … enough is never really enough –

Dr. Kate : Right.

Dr. Rick : – so the behaviors escalate …erm… Whereas if I’m a porn addict, watching pornography for half an hour may not be enough any more. It ratchets up. I need it to be more [unintelligible] race fear, I need it to be more extreme. We see it increased. Just like a drug addict who needs more, more heroine to get that high.

Dr. Kate : Sounds like you’re describing tolerance, Dr Rick.

Dr. Rick : That’s exactly what I’m talking about.

Dr. Lauren: mhm

Dr. Kate : Aha, yes

Dr. Rick : Tolerance… erm… it turns into the escalation behavior [ crosstalk- inaudible] behavioral process addiction. So, those are the important features that we look at when we have somebody come in, who is having problematic sexual behavior. And we’re trying to decide whether they going in addiction. We look for things like that. It’s actually thing you look for when you are assessing a drug addict.

Dr. Kate : Right. One of the things that we often talk to our patients about is whether or not they experience any withdrawal symptoms, when they are not able to be in a sexual ritual or their prefatory ritual.

I wonder if you see any of that.

Dr. Rick : Yeah, I think that is an important part, and again, it parallels all the other addictions. If you don’t get your drug, you crave it. And you have withdrawal symptoms from it. Here there would be physical withdrawal symptoms, but most of them are more on the emotional level. I mean some people will get irritable ..erm.. headaches, a stomach upset, from not having access to that which they are addicted to. –

Dr. Kate : mhm

Dr. Rick : – What kind of things do you see?

Dr. Lauren: Oh, I think it’s an important thing to point out, because I know a common mess is that, you know, withdrawal is something that only exists when you’re withdrawing from a substance ..erm… physiologically. So I think, a lot of people underestimate the power of, you know, emotional withdrawal. And like you mentioned in your work, the connection between mind and body and how our emotional state can affect our physical state. And yes, we see definite signs of withdrawal with the irritability, anger, restlessness, inability to [unintelligible] frustration [ crosstalk-unintelligible

Dr. Kate : Yeah, I think that would be the primary indicator for me. But, ..erm.. I’m looking at some kind of withdrawal statuses when I see someone going to a state of regression –

Dr. Lauren: mhhm

Dr. Kate : – when they’re not able to access their addicted behavior. We see a lot of … erm.. people showing up much younger that they are chronologically and really struggling to adapt to their emotional state.

Dr. Lauren: Yeah, just to clarify, much younger is not a positive thing [ laugh] and usually much younger develop [unintelligible]. That’s not appropriate for [unintelligible].

Dr. Kate : So Dr. Rick, what are some of the biggest myths that you’ve encountered when you’re discussing with people the topic of sex addiction ?

Dr. Rick : I think …erm… one would be just a general disbelief that such a condition can possibly exist.

Dr. Kate : mhm

Dr. Rick : That, you know.. Okay. So there is a range of how sexual person can be. He’s just got really active sex life. How can you call him an addict?

Dr. Kate : mhm

Dr. Rick : And what’s more, if you call him an addict, now you’ve given him an excuse –

Dr. Kate : mhm

Dr. Lauren: hmm All right.

Dr. Rick : – and he can get away with …erm…. whatever kind of behavior he wants, because he is simply an addict to be sick. I think, that is an important one to address…erm…

How do you folks approach that kind of point when it comes up?

Dr. Lauren: Well, in my experience what’s definitely the most common myth is whether it’s an excuse for bad behavior, you know, [unintelligible] and they blame it on sex addiction. But, I think it’s important to realize that whether it’s a sex addiction or not, it doesn’t absolve anyone from the responsibility for the pain and problems they’ve created.. erm.. Part of recovery is admitting their problem and taking a countability for the wreckage that they’ve created. It certainly doesn’t give them an excuse.

Dr. Rick : I certainly agree with that.

Dr. Lauren: Although, I’m sure there are people that use this as an excuse, it doesn’t necessarily mean that it doesn’t exist.

Dr. Kate : Great. So, Lorna and I are going to take a quick break. And when we come back, we’ll talk more with doctor Rick about sex addiction and take up from there .

[ commercial break]

Dr. Kate : Welcome back! You’re listening to Talk Radio 79OKABC. This is ” Behind Closed Doors”. I’m Dr. Kate Balestriari –

Dr. Lauren: And I’m Lauren Dummit.

Dr. Kate : Our guest today, is Dr. Rick Isenberg, who specializes in a treatment of sex addiction at Psychological Counseling Services in Scottsdale, Arizona.

Dr Rick, thanks so much for staying on the line with us.

Dr. Rick : My pleasure.

Dr. Kate : So when we took a break, before we were just starting to talk a little bit about what is a sex addiction and what are some of the myths around sex addiction. And I’m curious, you know, have you guys ever heard someone come back to you and say something like : ” Come on. It’s never really something like too much sex. I mean, if there is any kind of addiction to have, sex addiction is the thing. I’d love to be a sex addict!

Dr. Lauren: And what turns it then to addiction. Like how does the demand start?

Dr. Kate : Yeah. Dr Rick, can you talk to us a little bit about, like what’s the difference between somebody who has a really healthy, active affection for sex and somebody who, you know, it’s gotten to an extreme and kind of what it feels like to be a bad person.

Dr. Rick : Great – great place to start. I think it boils down to ” I’m having problems” –

Dr. Kate : mhm

Dr. Rick :– Is your behavior creating problems for you or for somebody else?-

Dr. Kate : mhm

Dr. Rick : – Somebody has a very active sex life, no matter what form it takes, and is thriving, and the people he is in love with, or she is in love with, are also happy and thriving… In my book, [ unintelligible} doesn’t have a problem –

Dr. Kate : mhm

Dr. Rick : People who end up coming just see us chronically, turn up to be the people who are happy, and doing well.

Dr. Kate : Right

Dr. Rick : Meanwhile, people who have gotten themselves in big trouble are creating enormous amounts of pain for other people and for themselves. And since they haven’t been able to stop doing it, they are coming for help. That to me is the main thing that makes the difference. And it’s important to pay attention to that, because somebody who is [ unintelligible]

Dr. Kate and Dr. Lauren: Absolutely

Dr. Rick : And the addict is going to be like that

Dr. Kate : mhm

Dr. Rick : He wouldn’t be sitting in my office. He would be out there doing whatever he likes doing, creating more havoc. But if he is insane or just partner or her partner.. erm… that we pay attention to, because all those people need help.

Dr. Kate : I’m so glad that you mentioned that. Because that’s really how I answer this question, too. There is no such thing as too much sex unless there’s such a thing as too much sex for one person. And it’s not a problem until it is. And those are the people that we see. Those are the people who come into our offices say: ” Something is going wrong here with my sexual behavior and my sex life . And I don’t know how to get the wheels back on the bus, in appropriate way.

Dr. Lauren : It’s important to differentiate these, because these days I think, a time a sex addict therapy is getting a bad rapture for [ laugh – inaudible] in a sexually compulsive behaviors or range of sexual behaviors. And I think it’s important to point out that we’re going on a community and [ unintelligible] people to come in for treatment.

People are coming in because their lives are falling apart and they’re in a real state of crisis. And we’re trying to help them leave their behaviors that are causing their lives to fall apart. And furthermore identifying what those behaviors are, and the consequences that are creating a pain.

Dr. Kate : So I wonder, you know, Dr. Rick and Loren , how do you think sex addiction impacts men and women differently?

Dr. Lauren : It’s a good question.

Dr. Kate : Rick, do you wanna answer that?

Dr. Rick : Well, I can speak to it .. erm.. from what I see in a clinic and what we see in a leader group. There is no question that both men and women can become sex addicts.

Dr. Kate : mhm

Dr. Rick : The changes that happen in the brain, the imbalances, the illness in the brain does not pay attention to gender. It shows up a little differently .. –

Dr. Lauren and Dr. Kate : mhhm

Dr. Rick : – and not surprisingly, because men and women are different, …erm.. for men it most commonly presents as compulsive sexual behaviors, whether it has to do with pornography ,or prostitutes ,or one-night stands, or anonymous sex … erm… They are many different presentations. But it’s mostly about sexual behaviors. My experience is, for women, well, it can be the same, there is a greater emphasis on relationships.

Dr. Lauren : hmm

Dr. Rick : And we do know that relationships can be a target of addiction. Not just sexuality. Do you find it as well?

Dr. Lauren : We do. And I think there is also, you know, a difference between love addiction and sex addiction, which we can talk about more if we have time today. Erm.. but I see a lot more women with behaviors that look more like love addiction with quite heavy sexual acting out.

Dr. Kate : mhhm

Dr. Lauren : Although, there are certainly women that present just equally as men.

Dr. Kate : In terms of their sexual behaviors?

Dr. Lauren : Yeah. But I see a lot of …erm.. power and control issues with women and men, …erm… in terms of women using their sexuality for power and control. And also a need for praise and attention at times, especially when there is a history of trauma nad low self-esteem.

Dr. Kate : mhm. How was it different than male sex addict?

Dr. Lauren: Well, with men it seems to be that there is a lot more objectification going on. And power and control comes into play with men as well. I think it just present a lot differently.

Dr. Kate : Could we give objectification as a form of power and control?

Dr. Lauren: Yeah. Absolutely.

I read a statistics the other day, that I thought was interesting, that one third of sex addicts are actually women. And, so I think that’s different in a way from what people believe.

Dr. Rick : Yeah, I think that is-is not what people think.

Dr. Lauren: No, not at all.

Dr. Kate : Yeah. I think that, you know, people are really misinformed about, just female sexuality, in general. And that really leads them to underestimate the level of compulsivity that females might exhibit compared to men.An there are a lot of reasons why that might be the case, right? Why women’s sexuality is really underestimated. But I see a lot of women in my practice, who are sex addicts. Who present as hardcore sex addicts. Their behavior is very externalized and it’s anonymous often, or it croaches on all kinds of boundries that you might not expect women to encroach on. And… erm.. it’s pretty fascinating to ask the question, you know, what would happen if there were no shame around this subject? And how many more women might come forward to talk about their own issues?

Dr. Lauren: Right. Along with that , [ unintelligible] one and three women being sex addicts if it’s also compared to one or five women taking treatment. So I think there is a lot of stigma for women and shame around taking treatment for it, and so, a lot of this goes underreported.

Dr. Kate : So Dr. Rick, how does someone develop a sex addiction? From your perspective.

Dr. Rick : That’s an important question. Because for some people, you think it comes out of [inaudible], like ..erm.. Look at this person upstanding in the community, church for all intension purposes, you know , prominent in business or whatever. Where does it come from? What does this behavior really represent? –

Dr. Kate : mhm

Dr. Rick : – And I think..erm.. if you take a sex addict or a love addict and you scratch a little bit out of the surface, what you’re going to find underneath is trauma.

Dr. Kate : Absolutely

Dr. Rick : – and in-in particular sexual trauma, although, certainly not always. But I think there is something about childhood experiences, how sexual molestation, and of emotional and physical abuse, that sat people up to become addicts. Not just sex addicts. It takes any kind of addict. And you look under the surface, you’re likely to find some serious, serious trauma. And even one may ask: ” Oh, you know, my childhood was a little rough in some areas. To that, is it enough for me to justify becoming an addict?” Well it kind of depends on what we’re talking about. Nobody’s childhood is perfect but when you look at people who are struggling with addiction, they have much heavier burden than most healthy people do. In terms of what they [ unintelligeble] using their addiction to help cope with.

Dr. Kate : mhhm

Dr. Rick : And it’s interesting to me, one of the common denominers. Regardless what the behavior is or what the substance is and if it’s a drug addiction, is this the compulsivity ?

Dr. Kate : Right.

Dr. Lauren: mhm

Dr. Rick : And I think that, actually, an important concept for people to understand is what is compulsivity. When I have an idea popping to my head and I cannot – I cannot keep myself from acting on it . Maybe not in that moment. It may be hours. It may be days later. But that far is just running obsessively in my head and I cannot get it out until I act on it, that’s compulsivity.

That’ one of the home marks in all the addictions, especially this one. And we know that compulsivity is linked to trauma. We see a very clear ..erm.. association, because when you’re a kid you learn different survival mechanisms. When you’re facing lots of trauma. And those survival mechanisms outline the usefulness when you grow up.-

Dr. Kate : Right.

Dr. Rick : – But they don’t go away. And you keep responding in the same way, compulsively, to things that trigger you, in ways that may have helped keep you alive in the past, but don’t any more.

And they transfer automatically into behaviors or substances as a way of trying to cope.

Dr. Kate : Right. So how does sex get paired up with the compulsivity? For talking about childhood trauma, you know, children are not having sex. So how do those things get fused together?

Dr. Lauren : Well, I do think there is a statistic that came across, like, every three percent of sex addicts had some type of sexual abuse in their childhood. So I think some of them also has to do with your arousal template, getting set in childhood, around sexuality.

Dr. Kate : Arousal template?

Dr. Lauren: Yes. So will we talk a little bit about the arousal template then? [laughter] Oh, it’s a fascinating topic. So, an arousal template…. We are all attracted to different things. But how do we develop, what we’re attracted to … So, each person has a type that they are attracted to. Different people have different fetishes. The arousal template is something like get paired early on with our body sexual development, and it’s one of our first imprints of sexuality. So it’s a lot more common for someone who maybe had a baby-sitter with a particular look in their childhood , and it emerging out [ unintelligible] to suddenly ..erm.. proper lives really, have an attraction to that type of women.

Dr. Kate : Dr Rick, what are your thoughts on how our arousal template develops?

Dr. Rick : I think there is a natural process in child and young adult development, where sexuality emerges. And there is imprinting [unintelligible] much like you’re saying, you know, early experiences can color what basically turns us on later on in life. The unfortunate thing is bad experiences have much more pouted effect …erm.. forming what we’re attracted to later on in life. So if that baby-sitter abused you sexually, there is much higher likelihood that there is something about that baby-sitter that will attract you. And this is, I think, a really interesting and important point, because we find it crossing gender lines –

Dr. Kate : mhhm

Dr. Rick : – for instance, you could have a boy who is molested by an older man –

Dr. Lauren: mhm

Dr. Rick : – and grows up confused. He may be wired entirely to beheld asexual

Dr. Kate : mhhm

Dr. Rick : – and yet he continues about his sexual orientation on a subconscious level, because of imprinting from those experiences so early on, which were very traumatic. And we know that traumatic memories, boy, they take a punch at an average memory.

Dr. Kate : Yes, they do.

Dr. Lauren: Right.

Dr. Rick : And so, it’s not uncommon for me and my practice to be talking to men who -who disclose…erm .. same sex abuse when they were growing up. And even some sense of seeing sex attraction as an adult but they find very confusing.

Dr. Kate : I agree with that

Dr. Lauren: Yes, I agree with that as well

Dr. Kate : Yeah. What I see also is that for example, in a case of same sex …erm.. sexual abuse or same gendered sexual abuse, often times people will apply the characteristics of their abuser to their offsets at sex …erm.. attraction. And they will start picking out. For example, as if a man has been offended against, then will start picking out women who have body similar kinds of characteristics with their abuser. And vice versa. So it’s an interesting way that the brain generalizes those traumatic experiences, but fuses in the difficult and traumatic scripts to seek out unconsciously another people.

Dr. Lauren: So you’re talking about really, is the common repetition and then the projection of those qualities onto their partner.

Dr. Kate : Yes –

Dr. Rick : It’s really interesting. You know, the mind is so fascinating –

Dr. Kate : – we need to take a break just now. But when we come back, we’ll continue this conversation and keep talking about sex addiction.

[ commercial break]

Dr. Kate : Welcome back. You’re listening to Talk Radio 79OKABC. If you’ve just tuned in, you’re listening to ” Behind Closed Doors“. I’m Dr. Kate Balestriari.

Dr. Lauren: And I’m Lauren Dummit.

Dr. Kate : And we’re here with Dr Rick Isenberg from Psychological Counseling Services in Scottsdale, Arizona.

Dr Rick, we were just talking a little bit about how trauma can influence the development of someone’s arousal template and ultimately lead to a sex addiction. I wonder if there are any other ways that you’ve observed in working with your team around this topic ..erm.. that sex addiction really can come into play.

Dr. Rick : Yes, the link with trauma, I did wanna say, one of the piece about because-

Dr. Kate : mhm

Dr. Rick : – when we realize we extend the trauma that underlies so much of the behavior that is coming forward with sex addicts. It’s important to pause for a moment and have some empathy-

Dr. Kate : mhm

Dr. Rick : – That what we’re seeing here may be an individual, who truly has a very strong value system. May be a very good person. Probably is a good person, and has done some horrific things that are really hurtful to other people, hurtful to him or herself. And it might be really easy to point the finger and blame such a person, but it’s important to at least pause and reflect on. The likelihood that what we’re seeing is this compulsive, repetitive behavior, that is so damaging, is coming from a place of real woundedness, –

Dr. Kate : hmm

Dr. Lauren: Yes

Dr. Rick : – that this individual has experienced and not been able to heal.

Dr. Lauren : mhm

Dr. Kate : Right

Dr. Rick : There is something really fascinating about the brains, the minds need to re-experience that traumatic event over and over and over again. People recreate aspects of it. And yes, it might be that my baby-sitter who molested me was a brunette, so I’m going after brunette women. Or it might crossed gender lines, but the mind is just driven to master that experience. Finally, maybe this time I’ll achieve mastery and I’ll be a little bit closure and I’ll feel better. –

Dr. Kate : Right

Dr. Rick : – One thing is, with every repetition comes the shame that we have. Probably an outstanding person who is outline violating the values system, feels awful about what he or she has done and wounds oneself all over again with every repetition. –

Dr. Kate : Right

Dr. Rick : – And he can’t help, but have some compassion for those people.

Dr. Kate : Absolutely. It’s a disease of profound loneliness, ultimately.

Dr. Lauren : Right.

Dr. Kate : And when, you know, someone might say whether they’ve been social and having sex with all those people, how can I be lonely? But it’s usually, from my experience, pretty empty sex. And empty behavior. And the greater the theme of forward in the trajectory in sex addiction, the more isolated and lonely and shameful they feel. And that just creates a scenario where unconsciously they’re becoming a perpetrator of their own abuse. And neglect in-in continuing this psycho.

Dr. Lauren: Right. And there is such a link between fun and shame. And shame is such an intolerable feeling. It’s the feeling that most addicts have been trying their whole life to run away from and numb with their behaviors. And the more deeper into their addiction they go, the more shame comes up and the stronger they need to numb that shame. And it really becomes as a really toxic psycho.

Dr. Rick : Yes, that sucks people down.

Dr. Lauren: It does.

Dr. Kate : It does. If here comes a huge albatross on their neck and their life, and it really prevents people from achieving potential [ unintelligible] sometimes professionally and financially, certainly across all their aims of life.

Dr. Lauren: And I think, the empathy piece is very important because, I think, addiction across the board. When someone doesn’t understand that when they haven’t experience to the addiction, it’s very easy to judge. “Why don’t they just stop? You know, that behavior is just disgusting. Why don’t they just stop?” And they’re still to recognize the power of these compulsions.

Dr. Kate : mhm

Dr. Rick : And it’s so different with any other kind of addiction as [ unintelligible]

Dr. Lauren : Right .

Dr. Kate : That’s right. What are your thoughts about the influence of technology on sex addiction? As it , you know, continues to be a topic of conversation and pop culture and the media…

Dr. Lauren: That’s a great question.

Dr. Rick : Oh yeah. Oh boy,-

[ crosstalk]

Dr. Rick : – Technology is just exploding at such a rapid rate that it’s hard to keep up with the advances. But it’s really clear that in the 90’s when the Internet gave birth to the universe of internet pornography, then the use of pornography just go through the roof. And it is only continued. It is a multi-billion- dollar business for those people who produce it. ..erm.. And the number of potential consumers is infinite. It’s so easy to access. You don’t have to be accountable, you don’t have to pay for it. It can be completely anonymous. It’s actually, for the addict, ideal. Which is not a good thing but it makes it so easy to act out. But in the internet pornography, that’s so 90’s. [ laughter] We are now in a new millennium. We’ve got virtual reality –

Dr. Kate : Right

Dr. Lauren: Right

Dr. Rick : – which is the next way that theory hear. That’s gonna take us to another level where it becomes even easier to act out, experience something sexually, even without involving another human being. ..erm.. in an extraordinarily realistic and, you know, ..err .. provocative way. That actually is going to take us to a whole new level of …erm.. addictive behaviors.

Dr. Lauren: Some people might say; “ Wow, that sounds great!” Right? Now there are no consequences, no one gets hurt if I’m acting out with someone in virtual reality or with a computer generated other person in virtual reality. What’s the problem with that?”

Dr. Rick : Well, again there are [inaudible ] ways under the sun to be sexual –

Dr. Kate : mhm

Dr. Rick : and there is nothing intrinsically wrong with any of them. So that’s my judgment. And it’s when it becomes a problem, that is a problem. –

Dr. Kate : Right

Dr. Rick : – So as I’m interacting with my computer generated image, or my virtual image, for hours and hours… and hours and hours… to the point that I’m hurting myself, or I’m neglecting my responsibilities, then I’ve got a problem.

Dr. Kate : So it also calls back to looking at those consequences.

Dr. Lauren: Right. I’m imagining it as a quite expensive bound .. And another thing, I think, that is important to bring up is we talk about technology, ..erm… especially for any parents who are listening, is that pornography is so easily accessible these days. And it’s happening with younger and younger children. I mean, we .. I just got asked about treatment for a six-year-old that is addicted to porn. And that is really scary to think about. And so I think for parents it’s really important to be aware of these issues and to really inforce like supervision when it comes to what they children are doing on the Internet.

Dr. Rick : And to remember that your children are going to be much more adaptive, whatever the new technology today is, than you are –

Dr. Kate and Dr. Lauren: mhm

Dr. Rick : – and especially to be mindful. But we were just a moment ago talking about how traumatic experiences in childhood imprint your sexuality growing up, and can cause lots of confusion… and cause some really aberrant behaviors. And you should stop and think about it. If I’m six years old, or I’m eight years old, or I’m ten years old and I’m a boy and I am discovering pornography, it really only takes a couple clicks to get to something really really extreme. How is that going influence me growing up?

Dr. Kate : Right

Dr. Rick : – And am I ever gonna be able to have a concept that help your sexuality with another person if I’m being raised on this intimate diet of highly stimulating and-and not normal sexuality.

Dr. Lauren: And also violence. I mean there is a lot of violence and racism embedded in pornography.

Dr. Kate : Absolutely. Well, switching topics a bit Lauren mentioned at the beginning of our episode right here today like we know you through our work on this study, regarding the genetic underpinnings of sexual addiction. And I wonder if you can tell our audience a little bit about what this study is. About what we’re looking for, what we’ve found this far

Dr. Rick : Sure. This is the first of its kind and a really exciting …. really big scale. We’re looking and trying to understand what is this sex addiction from a scientific prospective. So we’re looking at it. From.. if we take a whole bunch of sex addicts and we compare them to healthy normal people, what can we learn? What the difference is? We’re looking at things from a psychological perspective. Like are there some certain psychological profiles that predispose someone to become a sex addict? And interestingly, maybe a pornography addict? I suppose the one who compulsively uses escorts, or one who has serial affairs or becomes a voyeur…. What – what predispose these people to move the one direction or another? Are there psychological things that we can identify? Psychological features. And what makes this study, I think especially exciting and cutting edge, is we’re looking at the genetics. We’re actually taking all of thirty-four thousand genes in the human DNA sequence and looking through it, coming through that to look – to see what genetic thing predispose someone to become a sex addict. Because we believe, as we do understand, that in alcohol addiction, a nicotine addiction there are genetic things that predispose you.

Dr. Kate : So Rick , how could [ crosstalk.] –

Dr. Rick : – [ inaudible] in some degree. And we’re looking to see if it’s the same for sex addiction.

Dr. Kate : Great.

Dr. Lauren: So Rick, for people there listening right now, and want to become involved in the study, how can they do that?

Dr. Rick :…Erm. We would love to have people involved in the study… erm…. There are eight centers that we have investigators enrolling people across the United States.

erm.. In Los Angeles it’s the center that the two of you run –

Dr. Kate : That’s right

Dr. Rick : – Triune Therapy.

Dr. Kate : mhm

Dr. Rick : erm .. We have a center in Houston, a center in Phoenix .erm.. in Harrisburg, Mississippi ..erm.. They are scattered across the country.. in Seattle. We don’t have them in every city, which makes it challenging because you have to actually be physically present to be involved in this study.

Dr. Kate : So Rick, what we can tell our listeners is that if anyone wants to participate in this study, they can email Laurna and I at That’s info@ And we can help you get matched to the closest investigation site to you. And we wanna thank you so much Dr. Rick for joining us here today.

Dr. Lauren: Thank you very much!

Dr. Kate : And for our listeners out there: thank you very much for tuning in. You can tune in with us every Saturday at six p.m. for more salacious, smart and timely information in ” Behind Closed Doors“. Have a great weekend everyone!

Dr. Lauren: Thank you!

Dr. Rick : Thank you all!


Ask the experts

Often, when anger is the first response, it’s considered impolite, crazy, bitchy or dismissed as overly emotional. Yet, there are many instances in which one’s anger is stirred, and the key is putting it to good use. For instance, when a loved one is unfaithful, or when insensitive remarks are made concerning one’s ambitions or dreams, when feelings are questioned or when a woman is told to be more vulnerable and subservient. Though family and social expectations place unnecessary burdens on women (and men too), they can channel their anger-filled responses into action by going against the grain, pursuing their own interests or business, going to graduate school and much more. In turn, they’re encouraged to surround themselves with like-minded individuals, committed to supporting and cheering on one another, and ultimately helping the other discover their true potential. This system of support will continue to help individuals convert their anger into action, and perhaps enjoy a few laughs, too.

Yes. One hundred percent. Women are socialized to put relationships before themselves, and this often leads to stifling anger or any feeling that might compromise the bond between two people. This is especially the case in their relationships with men, or in competition for men, and over time, women’s anger and aggression has become more user wraps, or covert. Passive aggression seems to be both the only “acceptable” means of communicating anger, but women are also labeled “manipulative” when they attempt to express themselves indirectly. It becomes a vicious circle of anger, denial or minimization of anger, and then make ourselves smaller just to avoid being a “problem.”

While it is becoming more acceptable for women to show anger, progress is slow. Most of the time, female anger is couched in comedy or parody, and only accepted in small soundbites. Those invested in a patriarchal perspective, men and women, hold firm in their beliefs that women ought to act a certain way, or not make waves. The vary act of saying “we’re angry!” is a bold and pioneering move. Further, some women hold more internalized oppressive views, and refuse to participate in a movement that is labeled feminist or angry. For some women, to do so would compromise their social standing, romantic relationships, financial security, etc. It is scary, because the backlash is real. To take a stand is mark of bravery, and not everyone is ready to avail themselves to the fiery response of those in opposition. My opinion is that over time, the backlash will subside and change will take place. Cultural growth is a slow moving process, and with every voice heard, the collective voice of a paradigm shift grows louder and more effective. I don’t think women (or men) should care about acceptability. The more those who are angry attempt to hustle for the approval of their oppressors, the more power is given away. From my perspective, those who are angry a well suited to unite and establish new norms, refusing to tolerate mistreatment any further.

There are so many way to channel one’s anger constructively. I do not condone any violence (unless in self-defense) and instead think about using anger as a collaborating force within and with others. Being of service to others is one way to channel anger. This is especially relevant because so many women today do not have strong female role models, who they can turn to for advice. Get engaged. Mentor younger women, get a mentor, get creative. How can you pass along the resources (i.e., emotional, financial, logistic, etc) that were not available to you and resulted in your marginalization? What do you wish existed that could have helped you through a particularly challenging experience? Create it. I did, and it changed my relationship with anger and helped me take it for what it is a healthy emotion that lets us know when we feel disrespected or mistreated. This is key information that keeps us psychologically and rationally healthy. Anger is invaluable and an essential part of the human experience. When we embrace that, we can make it work for us in myriad ways.

As a psychologist, patients, friends and family are always asking me advice on their relationships and, let’s be real, everyone else’s relationships. One of the biggest questions they have, is why are there no good men or no good women out there? There are good people out there, I reassure them, but they inevitably come back with some retort about having to settle or face being single forever; for some, a fate worse than death. So herein lies the conundrum stay single forever or settle. Well, let’s back out of the black and white thinking that keeps us stuck for a moment and think about what it means to settle. Most of us have arbitrary ideas or checklists we drag around to assess our swiping situation. Does he make a certain amount of money? Is she pretty enough to take around my friends? Is she/he tall enough/too tall? Is she/he fit enough? What kind of car does he/she drive? Do they like dogs? All-important questions, but what do they really mean about a person’s character or how well you’ll get along? When considering the question of settling, it is important to ask what we:

  1. need in relationships
  2. want in relationships and
  3. won’t tolerate in relationships?

No two relational blue prints will look the same, and there are no right or wrong answers. Let’s look at needs first. We all have intimacy needs, like support, trust, security, communication, touch, respect, etc. They may change over time. That’s okay. Its hardwired in us. We also have relationship wants, the qualities that might ignite our fire a little more intensely. Physical appearance, fitness level, similar hobbies, values, job, financial standing, etc. are examples of wants. There is nothing wrong with wanting whatever you want in a partner. But many times, we mistake our wants for needs and then we feel like we’re settling if the want boxes are not checked, because we’re ignoring the meaning we assign to these traits. For example, consider meeting someone who is two inches shorter than your preferred height in a partner. He or she is funny, witty, charming, consistent, honest, and generous with their time, all of the other wants and needs you’ve identified. They just happen to be a little short-changed in the height department. What does height mean to you? Does it represent strength? Safety? Protection? Status? What does it mean about you if you date this person anyway? Whose judgment do you hear in your head? Why is their judgment so important? Asking these tough questions can help you decide if this is a want or a need, and if the underlying meaning is a need, can that need be met in other ways by this partner or other people in your circle? We often expect our partner to meet all of our needs, and overlook the inevitable disappointment in that expectation. Many people do not know what they need or want in relationships, because they are so eager to be in a relationship that they haven’t stopped to consider what they are looking for in their other half. They accept what is available, to avoid being alone. One day, they wake up and think, “Hey, I think I want more than this. I wish my partner would….” and realize that they might be settling but are afraid to leave. This brings me back to the last point, knowing what you won’t tolerate in relationships. It is just as important to know what doesn’t work for you when considering whether to start, stay in or leave a relationship. For some, deal breakers might include violence or infidelity. For others, perhaps smoking or liking heavy metal is the end of the line. Knowing yourself is key in defining your needs, wants, and deal breakers for relationships. If you don’t know some answers to these three factors, perhaps you’ve been neglectful (and settling!) in the most relationship of all, the relationship you have with yourself. Only when you set intentions and cultivate a relationship with yourself can you invite in the kind of love you are seeking and deserve to have. Until then, you’ll be running in circles, chasing ideas and looking to define yourself in the reflection of another.

Obsession, a thought that continually preoccupies or intrudes on a person’s mind, is often what drives addiction. Obsession is about hypervigilance. When we feel the object of our affection (whether real or in fantasy) may not feel the same way, we perseverate about them, ourselves and the relationship. This rumination and over-focus is an emotional survival strategy that keeps our brain playing out all of the what-ifs and looking for answers to the sometimes unconscious ques- tion, “How can I make sure my partner doesn’t leave me?” A milder version of obsession can look like ruminating thoughts. “What if he likes her more than me?” “Did she talk to her ex-boy- friend last night?” “If only I lost those last 10 pounds…” Perhaps you find yourself checking their social media accounts for proof they are with you, or have moved on. Maybe you enlist your friends or family to investigate or check on your desired. At the extremes, obsession can morph into stalking and domestic violence. If we feel threatened at the loss of someone, and re- taliate with this level of possession, it can be dangerous for everyone involved. Contrary to what may be glamorized in movies, extreme jealously and stalking are not healthy courtship behaviors, and can lead to emotional and physical trouble.

Obsession with another person may be a symptom of love addiction, which is essentially an ad- diction to the experience or “high” of being in love, and generally appears on the form of putting another person on a pedestal, creating the fantasy that they are perfect or the one, ignoring their faults or certain red flags that point to the contrary. Love addicts often expect their partners to care for all of their needs. Love addicts often neglect to care for or value themselves while they in the relationship. There often exists a toxic bond or an obsessive attachment in love addicted relationships. Love addicts often continue to engage in the relationship, trying desperately to connect as they search for their self-worth in the relationship, even if the object of their desire is pejorative, hurtful, or abusive. Inappropriate boundaries, abuse, neglect, intimacy issues, chaos, drama are some of the deleterious characteristics of these relationships. Love addicts suffer from profound feelings of shame, anguish, and fear of abandonment.

Since love addicts typically suffer from an anxious or preoccupied attachment (hypervigilance about their partner or the relationship), some signs to watch out for would be someone who is wanting speedy closeness, says “I love you before the first argument, has poor boundaries, is constantly expressing insecurities and worrying about rejection, is often very unhappy when not in a relationship, plays games to keep your attention, has difficulty with direct communication, struggles to effectively express their wants, needs, thoughts, and feelings, expecting you to guess or read his or her mind, acts out, tries to make you jealous, always makes things about him/her- self in the relationship, lets you set the tone of the relationship, seems preoccupied with the relationship, calls or texts excessively, stops by your home or work unexpectedly, fears that the small acts will ruin the relationship, seems to be trying too hard to keep your interest, and is extremely jealous.

If you suspect that the person you are getting to know has obsessive or love addicted tendencies, this does not mean you have to cut them out of your life completely. However, it is important to take things slowly, establish very clear boundaries, assess what works for you and get consulta- tion from friends and loved ones about your experience, pay attention to any attempts to get you to change or disregard your boundaries or needs, use direct, clear communication, and effectively verbalize your wants, needs, thoughts, and feelings. – Dr. Kate Balestrieri, Psy.D., CSAT-S, Licensed Clinical and Forensic Psychologist, and Lauren Dummit-Schock, LMFT, CSAT, CoFounder

The first step to getting help from this type of toxic relationship is to recognize narcissism in your partner or spouse. This involves identifying the traits and warning signs of this disorder, which you may have been living with for quite some time. At Triune Therapy Group, we have skilled clinicians who are highly trained to treat those that are in a relationship with a narcissist.

To help you understand the condition and how you may or may not have been affected, please explore the following Frequently Asked Questions and Answers provided by Licensed Psychologist Dr. Kate Balestrieri: Read More FAQs About Narcissistic Personality Disorder

Perhaps the greatest hope surrounding the #MeToo movement and other similar movements is that it will generate an awareness of the magnitude of sexual assault and harassment, particularly in the workplace. In doing so, maybe it will initiate and rebirth conversations regarding equality that have since gone underground. This is important, because many people fail to see the ways in which others misuse power and privilege, and how this leads them to engage in predatory behaviors. In another sense, the #MeToo movement could educate people on how to avoid being exploitative, while enlightening them on affirmative consent, power imbalances and how to classify and pursue intimacy and happiness in a authentic, healthy manner.

I work with new mothers and I have on multiple occasions worked with mothers who have experienced a the loss of a pregnancy close to becoming a mother. It is indeed a double whammy. There is so much that gets stirred up, and it intensifies the transition into motherhood and the processing of these loss, exacerbating common life-cycle events, and resulting in undue pressure on new moms, emotionally, physically, spiritually. When we’re trying to understand how motherhood and losses affect us, it is imperative to remember that the transition into motherhood and assimilation of loss are multi-dimensional and encompass physical, social, emotional, spiritual aspects of humanity. Although we mostly associate motherhood with new beginnings and joy, the questions of loss and death and endings actually also come up. Becoming mothers is a definite end to our earlier self, our pre-motherhood bodies and relationships, and mothers must mourn how the idealized fantasy of motherhood is never matched with the reality of the day to day. This is all considered “normal” to go through unless it gets complicated with trauma or major stressors. But if the transition to motherhood coincides with a loss, mothers get all of this thrown at them at the speed of light. It’s like existential pressure overload. – Helena Vissing, M.S., Psy.D. Clinical Associate, Psychological Assistant

The mental health of mothers is a major public health concern. Research demonstrates that depression and anxiety in mothers impact their children. The exact ways children are impacted by their mothers’ mental health involves a complex interplay of factors. We always have to look at the unique combination of risk factors and protective factors for each mother-child couple. If you grew up with a mother who suffered from postpartum depression, you are not necessarily determined to suffer. But we know that on a large public health scale, there is a clear connection between mothers’ mental health and lifelong mental health of their children. The immediate effects of mothers’ depression is that babies become withdrawn and irritable. This is happening at a sensitive time when babies are beginning their lifelong development of emotion regulation. Development is layered and scaffolding throughout life, so a baby who is experiencing these challenges already during their first years will be What we often experience in the consulting room is adults who struggle with feelings of shame and inadequacy or “never being enough”, even when they are normally functioning. They might describe a vague sense of unworthiness that has always “haunted” them. Although it’s widely acknowledged now that our sense of ourselves is rooted in our earliest relationships, it is still overlooked how issues in this area can stem from the emotional pain the child of a depressed mother experienced. This pain does not just disappear as the child grows or if the mother’s mental health improves, as it has influences the very core of the child’s sense of self. Infants and children are developmentally unable to make sense of the intensity of their mother’s depression, but they still feel it. This is because our earliest sense of self is built from our early nonverbal and physical experiences of being cared for. The only way and infant can interpret the signals from a depressed mother is to internalize it, which manifest as a sense of never being enough. Even when the child grows up to be an adult who can rationally separate their mother’s emotions from their own self-worth, the early experiences can still linger and manifest as issues with unworthiness. For each person, it’s a unique story of with all the risk factors and the negative impact on one hand, and then all the mitigating factors and strengths on the other hand. The adult who describes feeling shame and unworthiness might struggle to pinpoint the root of their issues, especially if their mother’s emotional issues were hidden, denied in the family, or minimized. The mother’s emotional state during the crucial early years is often that missing piece to help an adult fully understand their development and life story. Often they are not in a position to communicate about sensitive material with their mothers. This is why it’s crucial that maternal mental health is addressed clearly at all levels of society. The taboo still surrounding motherhood and postpartum emotional issue has devasting consequences for the entire family. I know this is a lot. Feel free to use what makes sense, and let me know if I should clarify things? I tried to use language for laypeople. – Helena Vissing, M.S., Psy.D.