How does ADD impact sexual behavior and functioning?
Over the years, behind the closed door of my office, I have heard hundreds of unusual stories regarding my patients’ sexual activities. I have come to appreciate that, while the topic is often emotionally loaded, the behaviors are generally completely understandable when put into the context of ADD.
A certain amount of body exploration and sexual experimentation is normal for all children; in young children with ADD this exploration and experimentation can seem extreme because we see it. Young ADD children often lack that inner voice that says, “Keep your hands out of your pants when others are around” or “Do not touch other kids’ private body parts” or “Don’t draw that in school.” While other children may have the same impulses, they usually have enough self-control and social monitoring to think first and, in this way, stay out of trouble with their sexual thoughts and feelings.
As children get older it is normal for them to be sexually curious. Oftentimes, older children and adolescents with ADD impulsively act on their curiosity. Then, as a consequence of their poor monitoring and decision-making, they get caught doing something that seems bizarre or perverted to others. The number of older children and adolescents in our practice who have been caught looking at, taking, or even wearing mom’s lingerie, exploring pornographic websites on the computer, using (and running up huge bills) on phone sex hotlines, or sending pornographic photos of themselves to someone they met on the Internet is astonishing. In my experience, upon taking the time to debrief the events with my patients, clearly these behaviors are not signs of perversion or serious mental health problems but rather normal sexual interest in the absence of good self-control.
We all know that in adolescence, sexual exploration continues, and that its consequences can be very serious. Premature experimentation or early sexual involvement can lead to unplanned pregnancy, sexually transmitted diseases, and serious legal trouble. Adolescents with ADD who are struggling with a low self-esteem and lack of acceptance by peers can too easily become involved in sexual relationships to feel good and be accepted never thinking about the potential consequences. In my experience, impulsive kids who struggle in reading the social signals often finds themselves caught up in the heat of the moment and have no idea how to get out. Many of my ADD adults share with me their scary versions of this story still feeling the regret and guilt.
I have found that adults with ADD often struggle with relationships and sexual activities as much as the adolescents do. Impulsivity frequently leads the adult with ADD to jump into relationships and sexual intimacy too quickly. At first, this intimacy feel good; it blots out the pain of loneliness that often accompanies adult ADD. But this quick, feel-good approach to sexuality commonly contributes to promiscuity, addictive involvement in pornography, and risky sexual behavior in the ADD population. In fact, individuals with ADD have been found to have a four times greater risk of acquiring a sexually transmitted disease than the general population.
ADD can also have a significant impact on sexual functioning in “normal” adult relationships as well. It is easy to imagine how the ADD adult with low arousal who finds himself particularly exhausted at the end of the day often has no interest or energy for sex. Many of my patients who have experienced chronic stress as a result managing their weak attention day in and day out struggle with the spectrum of sexual dysfunctions that occur in people who are depressed and anxious — decreased libido, difficulty with arousal, and an inability to reach an orgasm.
Apart from these sexual difficulties, it is not uncommon for the ADD individual’s poor communication and listening skills to interfere with intimacy and, in turn interfere with the quality of his sexual relationships. In my discussions with spouses of ADD individuals, complaints about self-centeredness in the bedroom are the norm.
We’re talking tricky topics this week on the Being Well Center blog. Check in for discussions about ADD and drug abuse and ADD and chronic health problems.
Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.