11/12/2008
Chronic Pain Might Contribute To Suicidal Thoughts
New research suggests that patients with chronic pain are more prone than others are to consider suicide. The increased risk remained even when study authors took the possible influence of mental illness into account. "This is further evidence that we need to be aware of the heightened risk for suicide in those with chronic pain," said Mark Ilgen, lead study author. "More work is needed to figure out who's going to be at the greatest risk and how can we intervene and decrease this risk." Ilgen and colleagues conducted the study to gain perspective on the link between pain and suicide in the public. Most prior research on this topic had looked only at patients already receiving treatment for their pain, said Ilgen, a psychologist at the Ann Arbor VA Hospital and assistant professor at the University of Michigan. The researchers examined information collected during a 2001 to 2003 epidemiological survey of 5,692 English-speaking adults in the United States who answered questions about chronic pain and suicidal thoughts in the last 12 months. The study findings appear in the November/December issue of the journal General Hospital Psychiatry.After adjusting the figures to account for the effect of mental illness and chronic physical conditions, the researchers found that those who suffered from head pain were almost twice as likely as others to report having suicidal thoughts. They were also more than two times as likely to report suicide attempts. Those with other types of pain not related to arthritis were four times as liable to have tried to commit suicide. The researchers also found that almost 14 percent of those with three or more pain conditions reported suicidal thoughts and almost 6 percent of these individuals reported a suicide attempt. "Pain is one of those factors that may make someone feel more hopeless and less optimistic about the future and increases the chances that they will think about suicide," Ilgen said. Still, "the vast majority of people with any of these forms of pain are not suicidal," he said. Thomas Joiner, a psychology professor at Florida State University who has written a book on suicide motivations, said people accustomed to pain might think they could tolerate suicide. "The natural and deep fear of pain, injury and death stops people from hurting themselves, and this includes people who have high desire for suicide," Joiner said. "It might not be as hard for someone who has already had to contend with a lot of physical pain." "This particular view has not gotten enough attention, probably because, in the public mind, a kind of fearlessness does not seem to fit with suicide. But here, the public mind is mistaken," Joiner said. General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. Ilgen MA, et al. "Pain and suicidal thoughts, plans and attempts in the United States." General Hosp Psychiatry, 30(6)), 2008. Health Behavior News Servicehttp://www.hbns.org
Autism remains lightening rod
McClatchy-Tribune Information Services -- Unrestricted - November 09
Autism is a word that causes instant angst among parents, not just because the reality of it can be so harsh and there is no medical treatment, but also because myths about it continue to grow.
The brain development disorder is characterized by impaired social interaction and communication and restricted and repetitive behavior.
"It's just a lightening rod topic in the field, with information and misinformation flying around the Internet," Dr. Mark Bertin said during a presentation at Danbury Hospital's annual pediatric conference Thursday.
"The developmental path of a typical child requires them to intuitively read other people and learn to interact and communicate, but children with autism don't."
The number of children with the disease, along with the symptoms, treatment and prognosis for the future, all contribute to families' fears.
But, Bertin said, the statistic that one of every 150 children will be diagnosed on the autism spectrum compared to 1 in 300 just 20 years ago must be put in perspective.
For one thing, a better understanding of autism spectrum disorders means they are more often recognized and diagnosed now.
In addition, the diagnosis has expanded to include more disorders -- autism, Asperger's syndrome, pervasive developmental disorder, and regressive disorders -- all connected by a child's deficient social skills.
"We have a better understanding of autism spectrum disorders, and now that we know what to look for we define it with milder symptoms that were not diagnosed before," Bertin said.
In 1980, 20,000 children were diagnosed with autism spectrum disorder. In 2003, 125,000 were diagnosed. Bertin said during that time the number of children diagnosed with mental retardation dropped as the number of children with autism increased.
The total number of children with one or the other didn't change, which shows the increase in autism had to do with relabeling children's disorders.
"There is a huge amount of relabeling, and that is how you can explain the vast increase in the autism spectrum disorder," Bertin said, adding that some of the increase is not explained.
The cause of autism is still not fully understood. Bertin discounted the theory that childhood vaccines play a role, since research shows there is no difference in the statistics of children who receive vaccines or those who don't and the onset of autism does not correlate to the time the child receives the vaccination.
But some facts are becoming known.
There is a threefold increase in autism among children of older fathers. Some people may have genetic triggers. Two-thirds of children with autism had rapid head growth from 6 to 14 months, and greater brain growth may correlate with more severe symptoms.
Screening and early intervention is key, Bertin said, adding that there are red flags in a child's social, behavioral and language development that parents can watch, in addition to the screenings pediatricians should perform.
Once there are concerns, parents need a medical diagnosis of the disorder as well as an educational diagnosis to determine what services the child needs.
"After diagnosing, what you want is an intensive intervention," Bertin said.
That means more than lining up services. It means connecting parents to support groups and informing parents about the misinformation that could send them on the wrong track.
"The core intervention for a child with autism is behavior therapy," Bertin said.
Adults must ensure the focus is on building the social skills of a child diagnosed with autism spectrum disorder, no matter how well a child is doing in academics.
Some recommendations call for 25 hours of services a week, though many kids do well on less, he said.
"It's like with any other skill that the child wants to learn, it has to be practiced every day. There is a benefit to intense early intervention," Bertin said, though even kids who are diagnosed later will benefit.
Danbury's three school-based health clinics can help identify children who may not have been diagnosed before.
"When you see a child with poor social skills, with poor eye contact, who is not succeeding in school, it has to be looked at to make sure you are not missing something," said Nancy Munn, nurse practitioner at Danbury's Rogers Park Middle School. "There is still time to support them."
She encourages parents to take their young children to play groups, so they can see if they are developing like the other children, and, if not, get them help.
Danbury also has a new Special Education Parent Teacher Association, which will provide workshops and other resources so parents and teachers and other residents can understand the problems students face with learning disabilities, social issues or autism.
"We are a link in the chain to getting parents information -- especially once parents find out about their child's diagnosis -- to help them know where to go for support," said Michelle Keenan, president of Danbury SEPTA.
Jack Fong, clinical associate professor of pediatrics at New York Medical College and retired chief of pediatrics at Danbury Hospital, said autism is a difficult issue for parents.
"Most behavioral and psychiatric conditions are vague. It's not a hard science," he said. "It becomes challenging and confusing."
An knowledge about the future of children with autism spectrum disorders is limited, so doctors have little to offer families except that a child's progress will relate to the severity of the disorder, Bertin said. "Research is relatively new, so we don't know about long-term prognosis."
Contact Eileen FitzGerald
at eileenf@newstimes.com
or at (203) 731-3333.
Red flags for autism spectrum disorders Social development No big smiles by or after 6 months. No back and forth sharing of sounds or facial expression by 9 months. No back and forth gestures like pointing or reaching or waving by 12 months. Poor response to name. Language development Not responding to name by 12 months. No babbling by 12 months. No single words by 16 months. No two-word spontaneous phrases by 24 months. Behavior development No creative or imaginative play. Stuck on toys or topics. Unusual repetitive behaviors. Workshop Handling the maze of special education Nov. 18 7 to 9 p.m. C.H. Booth Library, Main Street, Newtown Presented by psychologist Charles Manos, coordinator of special services for Danbury public schools Free and open to the public. To see more of the News-Times or to subscribe to the newspaper, go to http://www.newstimes.com. Copyright (c) 2008, The News-Times, Danbury, Conn. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
Autism is a word that causes instant angst among parents, not just because the reality of it can be so harsh and there is no medical treatment, but also because myths about it continue to grow.
The brain development disorder is characterized by impaired social interaction and communication and restricted and repetitive behavior.
"It's just a lightening rod topic in the field, with information and misinformation flying around the Internet," Dr. Mark Bertin said during a presentation at Danbury Hospital's annual pediatric conference Thursday.
"The developmental path of a typical child requires them to intuitively read other people and learn to interact and communicate, but children with autism don't."
The number of children with the disease, along with the symptoms, treatment and prognosis for the future, all contribute to families' fears.
But, Bertin said, the statistic that one of every 150 children will be diagnosed on the autism spectrum compared to 1 in 300 just 20 years ago must be put in perspective.
For one thing, a better understanding of autism spectrum disorders means they are more often recognized and diagnosed now.
In addition, the diagnosis has expanded to include more disorders -- autism, Asperger's syndrome, pervasive developmental disorder, and regressive disorders -- all connected by a child's deficient social skills.
"We have a better understanding of autism spectrum disorders, and now that we know what to look for we define it with milder symptoms that were not diagnosed before," Bertin said.
In 1980, 20,000 children were diagnosed with autism spectrum disorder. In 2003, 125,000 were diagnosed. Bertin said during that time the number of children diagnosed with mental retardation dropped as the number of children with autism increased.
The total number of children with one or the other didn't change, which shows the increase in autism had to do with relabeling children's disorders.
"There is a huge amount of relabeling, and that is how you can explain the vast increase in the autism spectrum disorder," Bertin said, adding that some of the increase is not explained.
The cause of autism is still not fully understood. Bertin discounted the theory that childhood vaccines play a role, since research shows there is no difference in the statistics of children who receive vaccines or those who don't and the onset of autism does not correlate to the time the child receives the vaccination.
But some facts are becoming known.
There is a threefold increase in autism among children of older fathers. Some people may have genetic triggers. Two-thirds of children with autism had rapid head growth from 6 to 14 months, and greater brain growth may correlate with more severe symptoms.
Screening and early intervention is key, Bertin said, adding that there are red flags in a child's social, behavioral and language development that parents can watch, in addition to the screenings pediatricians should perform.
Once there are concerns, parents need a medical diagnosis of the disorder as well as an educational diagnosis to determine what services the child needs.
"After diagnosing, what you want is an intensive intervention," Bertin said.
That means more than lining up services. It means connecting parents to support groups and informing parents about the misinformation that could send them on the wrong track.
"The core intervention for a child with autism is behavior therapy," Bertin said.
Adults must ensure the focus is on building the social skills of a child diagnosed with autism spectrum disorder, no matter how well a child is doing in academics.
Some recommendations call for 25 hours of services a week, though many kids do well on less, he said.
"It's like with any other skill that the child wants to learn, it has to be practiced every day. There is a benefit to intense early intervention," Bertin said, though even kids who are diagnosed later will benefit.
Danbury's three school-based health clinics can help identify children who may not have been diagnosed before.
"When you see a child with poor social skills, with poor eye contact, who is not succeeding in school, it has to be looked at to make sure you are not missing something," said Nancy Munn, nurse practitioner at Danbury's Rogers Park Middle School. "There is still time to support them."
She encourages parents to take their young children to play groups, so they can see if they are developing like the other children, and, if not, get them help.
Danbury also has a new Special Education Parent Teacher Association, which will provide workshops and other resources so parents and teachers and other residents can understand the problems students face with learning disabilities, social issues or autism.
"We are a link in the chain to getting parents information -- especially once parents find out about their child's diagnosis -- to help them know where to go for support," said Michelle Keenan, president of Danbury SEPTA.
Jack Fong, clinical associate professor of pediatrics at New York Medical College and retired chief of pediatrics at Danbury Hospital, said autism is a difficult issue for parents.
"Most behavioral and psychiatric conditions are vague. It's not a hard science," he said. "It becomes challenging and confusing."
An knowledge about the future of children with autism spectrum disorders is limited, so doctors have little to offer families except that a child's progress will relate to the severity of the disorder, Bertin said. "Research is relatively new, so we don't know about long-term prognosis."
Contact Eileen FitzGerald
at eileenf@newstimes.com
or at (203) 731-3333.
Red flags for autism spectrum disorders Social development No big smiles by or after 6 months. No back and forth sharing of sounds or facial expression by 9 months. No back and forth gestures like pointing or reaching or waving by 12 months. Poor response to name. Language development Not responding to name by 12 months. No babbling by 12 months. No single words by 16 months. No two-word spontaneous phrases by 24 months. Behavior development No creative or imaginative play. Stuck on toys or topics. Unusual repetitive behaviors. Workshop Handling the maze of special education Nov. 18 7 to 9 p.m. C.H. Booth Library, Main Street, Newtown Presented by psychologist Charles Manos, coordinator of special services for Danbury public schools Free and open to the public. To see more of the News-Times or to subscribe to the newspaper, go to http://www.newstimes.com. Copyright (c) 2008, The News-Times, Danbury, Conn. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
You must remember: Forgetting has its benefits
There's an old saying that inside every 70-year-old is a 35-year-old wondering, "What happened?"
What happened is that countless days, nights, meetings, commutes and other unremarkable events went by, well, unremarked. They didn't make a lasting impression on the brain or they were overwritten by so many similar experiences that they are hard to retrieve. In short, they've been forgotten.
That's not necessarily a bad thing. Neuroscientists say forgetting is crucial to the efficient functioning of the mind, to learning, adapting and recalling more significant things.
"We focus so much on memory that forgetting has been maligned," says Gayatri Devi, a neuro-psychiatrist and memory expert in New York City. "But if you didn't forget, you'd recall all kinds of extraneous information from your life that would drown you in a sea of inefficiency."
That was what prompted Jill Price to contact the memory experts at the University of California at Irvine in 2000. As she wrote in a book published this summer, "The Woman Who Can't Forget," Ms. Price could recall in detail virtually every day since she was 14, but she was mentally exhausted and tormented by her memories. UC Irvine scientists are interviewing more than 200 people who say they have similar "autobiographical" memories, but so far have found only three more.
Memories of singular, significant events - say, last week's historic election - are generally easy to recall; people typically store them in long-term memory with many associations attached.
Memories of mundane, recurring events compete to be recalled, and scientists say the brain appears to be programmed to forget those that aren't important. Neuroimaging studies show that it's the brain's prefrontal cortex, the area of complex thought and executive planning, that sorts and retrieves such "like-kind" memories. Researchers at Stanford University's Memory Laboratory demonstrated last year that the more subjects forgot competing memories, the less work their cortexes had to do to recall a specific one. In short, forgetting frees up brain power for other tasks, says psychologist Anthony Wagner, the lab's director.
A real-world example, he says, is having to learn a new computer password every few months: As your brain suppresses the memory of the old password, it gets easier to summon the new one.
In fact, forgetting is a very active process, albeit subconscious, neuroscientists say. The mind is constantly evaluating, editing and sorting information, all at lightning speed. "Your brain is only taking a small amount in, and it's already erasing vast amounts that won't be needed again," Dr. Devi says.
Much that happens during the day doesn't make an impression at all because our attention is focused elsewhere. Take your daily commute, says Dr. Wagner: "A heck of a lot of stuff is landing on our retinas as we're driving down the road. But if you were focusing on the presentation you have to give, you didn't perceive it and it didn't get stored."
He notes that people face such a constant cognitive barrage that they frequently fail to attend to information that isn't essential at the time. "I have two 4 1/2-year-olds and I'm already thinking, where did those first four years go?" Dr. Wagner says.
Are memories for events you didn't focus on stored in your brain nevertheless - like unwatched bank-surveillance tapes? That's an area of much debate. Some experts believe hypnosis can trigger long-buried associations. But so-called recovered memories are also susceptible to distortion.
"Memory consists of billions of puzzle pieces, and many of them look the same," Dr. Devi says. "Each time you retrieve a memory, you're reconstructing a puzzle very quickly and breaking it down again. Some of the pieces get put back in different places."
What if you want to remember more about each passing day? One simple method is to keep a journal. Writing down a few thoughts and events every day not only makes a tangible record, it also requires you to reflect. "You're elaborating on why they were meaningful, and you're laying down an additional memory trace," says neuroscientist James McGaugh at UC Irvine. Taking photographs and labeling them reinforce memories too.
But remember that forgetting can be very useful, says Dr. McGaugh: "If you used to go out with Bob and now you're married to Bill, you want to be able to say, 'I love you, Bill.' That's why forgetting is important."
---
Email: healthjournal@wsj.com.
What happened is that countless days, nights, meetings, commutes and other unremarkable events went by, well, unremarked. They didn't make a lasting impression on the brain or they were overwritten by so many similar experiences that they are hard to retrieve. In short, they've been forgotten.
That's not necessarily a bad thing. Neuroscientists say forgetting is crucial to the efficient functioning of the mind, to learning, adapting and recalling more significant things.
"We focus so much on memory that forgetting has been maligned," says Gayatri Devi, a neuro-psychiatrist and memory expert in New York City. "But if you didn't forget, you'd recall all kinds of extraneous information from your life that would drown you in a sea of inefficiency."
That was what prompted Jill Price to contact the memory experts at the University of California at Irvine in 2000. As she wrote in a book published this summer, "The Woman Who Can't Forget," Ms. Price could recall in detail virtually every day since she was 14, but she was mentally exhausted and tormented by her memories. UC Irvine scientists are interviewing more than 200 people who say they have similar "autobiographical" memories, but so far have found only three more.
Memories of singular, significant events - say, last week's historic election - are generally easy to recall; people typically store them in long-term memory with many associations attached.
Memories of mundane, recurring events compete to be recalled, and scientists say the brain appears to be programmed to forget those that aren't important. Neuroimaging studies show that it's the brain's prefrontal cortex, the area of complex thought and executive planning, that sorts and retrieves such "like-kind" memories. Researchers at Stanford University's Memory Laboratory demonstrated last year that the more subjects forgot competing memories, the less work their cortexes had to do to recall a specific one. In short, forgetting frees up brain power for other tasks, says psychologist Anthony Wagner, the lab's director.
A real-world example, he says, is having to learn a new computer password every few months: As your brain suppresses the memory of the old password, it gets easier to summon the new one.
In fact, forgetting is a very active process, albeit subconscious, neuroscientists say. The mind is constantly evaluating, editing and sorting information, all at lightning speed. "Your brain is only taking a small amount in, and it's already erasing vast amounts that won't be needed again," Dr. Devi says.
Much that happens during the day doesn't make an impression at all because our attention is focused elsewhere. Take your daily commute, says Dr. Wagner: "A heck of a lot of stuff is landing on our retinas as we're driving down the road. But if you were focusing on the presentation you have to give, you didn't perceive it and it didn't get stored."
He notes that people face such a constant cognitive barrage that they frequently fail to attend to information that isn't essential at the time. "I have two 4 1/2-year-olds and I'm already thinking, where did those first four years go?" Dr. Wagner says.
Are memories for events you didn't focus on stored in your brain nevertheless - like unwatched bank-surveillance tapes? That's an area of much debate. Some experts believe hypnosis can trigger long-buried associations. But so-called recovered memories are also susceptible to distortion.
"Memory consists of billions of puzzle pieces, and many of them look the same," Dr. Devi says. "Each time you retrieve a memory, you're reconstructing a puzzle very quickly and breaking it down again. Some of the pieces get put back in different places."
What if you want to remember more about each passing day? One simple method is to keep a journal. Writing down a few thoughts and events every day not only makes a tangible record, it also requires you to reflect. "You're elaborating on why they were meaningful, and you're laying down an additional memory trace," says neuroscientist James McGaugh at UC Irvine. Taking photographs and labeling them reinforce memories too.
But remember that forgetting can be very useful, says Dr. McGaugh: "If you used to go out with Bob and now you're married to Bill, you want to be able to say, 'I love you, Bill.' That's why forgetting is important."
---
Email: healthjournal@wsj.com.
Does Mozart make you smarter?
By Henkjan Honing
Mozart's Sonata for Two Pianos in D Major (KV 448) is one of the most used compositions in music psychology research. Since the publication of the study Music and Spatial Task Performance in Nature in 1993, numerous researchers have tried to replicate the so-called "Mozart effect" using this composition. And often with little success. The idea is of course compelling: to become smarter by simply listening to Mozart's music. It could be a helpful fact in the much needed support for a more prominent place of music in the curricula. However, the effect has been shown to appear not only with the music of Mozart, but also that of Beethoven, Sibelius, and even a 'Blur effect' was shown (based on a study by Glenn Schellenberg from the University of Toronto using 8,000 teenagers).
Currently, the most likely interpretation of the effect is that music listening can have a positive effect on our cognitive abilities when the music is enjoyed by the listener. Apparently (and in a way unfortunately), it is not so much the structure of the music that causes the effect, but a change in the mood of the listener. While this indirectness might be disappointing for admirers of Mozart's music, it is important to note that, at the same time, it leaves uncovered an important aspect of music appreciation. What makes certain music so effective in changing or intensifying our mood? It seems that while we are all experienced and active users of music as a kind of mood regulator (widely ranging from energizer to consoler of grief), music research has only just begun to explore the how and why of the relation between music and emotion.
Currently, the most likely interpretation of the effect is that music listening can have a positive effect on our cognitive abilities when the music is enjoyed by the listener. Apparently (and in a way unfortunately), it is not so much the structure of the music that causes the effect, but a change in the mood of the listener. While this indirectness might be disappointing for admirers of Mozart's music, it is important to note that, at the same time, it leaves uncovered an important aspect of music appreciation. What makes certain music so effective in changing or intensifying our mood? It seems that while we are all experienced and active users of music as a kind of mood regulator (widely ranging from energizer to consoler of grief), music research has only just begun to explore the how and why of the relation between music and emotion.
How Will Obama Lead?
By John D. Gartner, Ph.D.
This historic election is over, and now the question becomes how will Barack Obama lead? To understand how an Obama White House might be similar to or different from that of his immediate predecessors, Bush and Clinton, it pays to compare and contrast the three men on two components of their basic temperaments: curiosity and hypomania. Clinton was both hypomanic and curious. Bush was neither. And Obama appears to be curious but not hypomanic. For a hundred years, academic personality psychologists have been trying to identify the basic axes on which to map the human personality. Intellectual curiosity, it turns out, is one of these fundamental dimensions, according to the widely accepted Five Factor theory, developed by Paul Costa and Robert McCrea at The National Institutes of Health. According to their data, you are either born curious, or not. Hypomania, too, as I argued in The Hypomanic Edge, and more recently in my book, In Search of Bill Clinton, is also best understood as an innate temperament, imbuing one with dynamic traits such as energy, creativity, confidence, and charisma, but also with problems in self-regulation and impulse control. When Bill Clinton was making the case for Barack Obama with the voters, the first qualification that he noted was that Obama was both intelligent and curious. While at first blush, curiosity might seem like a strange qualification to emphasize, Clinton was not offering feint praise, as some suspected. Clinton knew just how important curiosity really is to the day-to-day work of a president. If one had to point to one factor that distinguished Clinton from Bush, and explained why Bush was a failure and Clinton a relative success, this would be it. Simply put, Bush just wasn't that interested in the details of governing. He didn't like to consider alternate views or findings. He accepted neo-conservative dogma on faith, and that was that. Even when his policies appeared to be failing or unpopular, Bush was had no desire to hear dissenting ideas or inconvenient facts. Bush who is neither curious nor hypomanic kept his meetings short-no point in jaw-boning these things to death-and went to bed early, losing little sleep of America's problems. Clinton, who is both intensely curious and hypomanic couldn't be a stronger contrast. Well-known for being a policy junkie, Clinton was insatiably omnivorous in his consumption of everything ever said or written about every aspect of policy. Clinton reads everything related to public policy, and even more remarkable, remembers it all. Journalist Joe Klein wrote in The Natural that Clinton "seemed to know everything there was to know about domestic social policy....Oh, could he talk policy! He seemed to know more about the school choice experiment in East Harlem than the governor of New York did; he knew all about the competitive bidding for sanitation contracts in Phoenix, the public housing manager in Omaha who'd come up with a great after-school program for kids in the projects, the terrific for-profit welfare to work program in New York." In my interviews with people who know Clinton, I was told again and again by experts in a half a dozen fields "He knows more about my specialty than I do." And, because Clinton was hypomanic as well as curious, there was a driven quality to his quest for endless information and ideas. He often stayed up all night reading, usually half a dozen different books at a time, devouring them with an almost physically greedy intensity. What does a White House run by a curious hypomanic look like? Where Bush' meetings were short and structured, Clinton's were endless and open ended. Clinton wanted to hear every point of view, review every fact, and play with creative variations of every exiting idea. Cabinet officers confessed to me that they were physically passing out from fatigue and hunger during these marathon meeting, asking themselves, as Leon Panetta put it, "Where the hell all this going?" While Clinton was widely criticized for this chaotic creative style, it worked. Panetta argued that Clinton usually made very good decisions, "even if he had to go by way of Mars to get there." Obama, who is curious but not hypomanic, is likely to fall in between these two extreme contrasts in style. Because he is curious like Clinton, Obama is likely to also hear from a range of advisors, review findings and arguments from diverse sources, and consider creative policy approaches. However, because he is not hypomanic, the Obama White House should be less chaotic than that run by Clinton. No drama-Obama has proved to be but unusually steady, cool, and deliberative. Indeed, during the financial crisis, it was Obama's "preternatural calm" that seemed to reassure the country that he was presidential enough to lead. We have reason to be optimistic that Obama's temperament may be just right, not too hot and not too cold. And that should help us all sleep better at night.
Sexual Arousal Disorder
Definition
Sexual arousal disorder is an aberration during any stage of the sexual response cycle (desire, arousal, orgasm, and resolution) that prevents the experience of satisfaction through sexual activity. A person with this disorder may be interested in sexual intercourse but has difficulty becoming stimulated enough to go through with it.
Sexual arousal disorders were previously known as frigidity in women and impotence in men, though these have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity is now described as any of several specific problems with desire, arousal, or anxiety.
For both men and women, these conditions may appear as an aversion to, and avoidance of, sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity. In women, there may be an inability to lubricate enough to complete the sex act.
Considerations
Occasional impotence occurs in approximately 50 percent of American adult men, and chronic impotence affects about 1 in 8 American men, with the chances increasing as a person ages. Between 2 and 30 million men in the United States are affected by impotence problems, according to recent estimates. About 52 percent of men between 40 and 70-years-old have some degree of erectile dysfunction (ED).
Impotence can be classified as primary or secondary. A man with primary impotence has never had an erection sufficient for intercourse. Secondary impotence involves loss of erectile function after a period of normal function. This tends to occur gradually, except in cases caused by injury or sudden illness.
Treatment of secondary impotence is usually more successful than that of primary impotence because the patient has some history of normal penile function in the past.
There are several components required for an erection:
A responsive emotional state of mind
A normally functioning pituitary
Adequate testosterone
Adequate penile blood supply
Premature ejaculation (when orgasm comes on too quickly) is different from impotence, and a couple should seek counseling for this problem.
Male infertility is quite different from impotence. A man who is unable to maintain an erection may be perfectly capable of siring a child. An infertile male may be able to have intercourse normally, but he may be unable to father a child.
Symptoms
In Men or Women:
Lack of interest or desire in sex
Inability to feel aroused
Pain with intercourse (much less common in men than women)
Infertility
In Men:
Inability to achieve an erection
Inability to maintain an adequate erection for intercourse
Delay or absence of ejaculation despite adequate stimulation
Inability to control timing of ejaculation
In Women:
Inability to relax vaginal muscles enough to allow intercourse
Inadequate vaginal lubrication before and during intercourse
Inability to attain female orgasm
Causes
Sexual dysfunction can exist throughout a person's life or may develop after an individual has previously experienced normal sexual responses. The difficulty may develop gradually over time, or may occur suddenly and present itself either as total or partial dysfunction in one or more stages of the sexual response cycle. The cause may be physical, psychological, or both.
Emotional factors include both interpersonal problems (marital/relationship troubles, lack of trust between partners) and an individual's psychological problems (depression, sexual fears or guilt, past sexual trauma, and so on).
Physical factors include drugs (alcohol, nicotine, narcotics, stimulants, antihypertensives, antihistamines, or most psychotherapeutic drugs); complications related to back, prostate, or vascular surgeries; failure of various organ systems (such as the circulatory and respiratory systems); endocrine disorders (thyroid, pituitary, or adrenal gland problems); neurological problems caused by trauma (such as spinal cord injuries) or disease (such as diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis); hormonal deficiencies (low testosterone or androgens); and some fetal development abnormalities.
Sexual dysfunction disorders are generally classified into four categories: sexual desire disorders, sexual arousal disorders, orgasm disorders, and sexual pain disorders.
Sexual desire disorders (decreased libido) may result from a decrease in normal androgen or testosterone hormone production. Other causes may be aging, fatigue, medications, pregnancy, or psychiatric conditions such as depression and anxiety.
Common causes of impotence
Medication use (especially antihypertensives)
Smoking
High blood pressure
Hormonal deficiency caused by disease (diabetes) or injury
Liver disease, usually caused by alcoholism
Circulation problems (arteriosclerosis, anemia, or vascular surgery)
Neurological problems (injury, trauma, disease)
Urological procedures (prostatectomy, orchiectomy, radiation therapy)
Penile implants (or prostheses) that are not functioning properly
Depression, anxiety, fatigue, boredom, stress, fear of failure
Mood altering drugs, alcohol, medications
Deep-seated psychological problems
Orgasm disorders, which can affect both sexes, are a persistent delay or absence of orgasm following sexual excitement. Sexual pain disorders affect many more women than men and are known as dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the musculature of the vagina that interferes with intercourse). Dyspareunia may be caused by insufficient lubrication in the female, which may result from breastfeeding, irritation from contraceptive creams and foams, aging, or by fear and anxiety. Vaginismus may be caused by a sexual trauma such as rape or incest.
Sexual dysfunctions are more common in the early adult years, with the majority of patients seeking care for such conditions during their late twenties into their thirties. The issues increase again in the geriatric population, typically with a gradual onset of symptoms associated most commonly with organic causes of sexual dysfunction.
Increased risk is often linked to a history of diabetes, degenerative neurological disorders, chronic psychological problems, alcohol use, drug abuse, difficulty maintaining relationships, or chronic disharmony with the current sexual partner.
Prevention
Honest and accurate communication regarding sexual issues and body image between parents and their children may prevent children from developing anxiety or guilt about sex and carrying those emotional responses into their adulthood.
Review all medications (prescription and over-the-counter) for possible side effects regarding sexual dysfunction. Avoiding drug and alcohol abuse may help prevent sexual dysfunction.
Couples engaging in adequate communication may be able to avoid some problems within their relationship that could potentially create some forms of sexual dysfunction.
People who are victims of sexual trauma should receive comprehensive treatment, including individual counseling and group therapy. This may prove beneficial in allowing them to fully enjoy voluntary sexual experiences with a partner of their choice.
Treatment
Specific physical findings and testing procedures depend on the form of sexual dysfunction examined. A complete history and physical exam should be done to identify predisposing illness or conditions; highlight possible fears, or guilt specific to sexual performance; and bring out any history of prior sexual trauma. A physical examination of both the partners should not be limited to the reproductive system.
Treatment measures should be specific to the cause of the sexual dysfunction. Organic causes that are reversible or treatable are usually managed medically or surgically. Physical therapy and mechanical aides may help some people with physical illnesses, conditions, or disabilities. Viagra (sildenafil) often improves both organic and psychological sexual dysfunction in males by increasing blood flow to the penis. Men on nitrates for coronary heart disease should refrain from taking sildenafil, as it may cause dangerous drug interactions. Mechanical aids and penile implants are sometimes used. Men with androgen deficiency sometimes benefit from testosterone shots. Women with androgen deficiency can tolerate smaller doses of testosterone orally or topically with a cream.
Self-stimulation and the Masters and Johnson treatment strategies are just two of many behavioral therapies used to treat problems associated with orgasm and sexual arousal disorders.
Some couples may require joint counseling to address interpersonal issues and communication styles. Psychotherapy may be required to address anxieties, fears, inhibitions, or poor body image. In general, the prognosis is good for physical (organically caused) dysfunctions resulting from treatable or reversible conditions. However, many organic causes do not respond to medical or surgical treatments. In functional sexual problems resulting from either relationship issues or psychological factors, the prognosis may be good for temporary or mild dysfunction associated with situational stressors or lack of accurate information. However, those cases associated with chronically poor-functioning relationships or deep-seated psychiatric problems usually do not have positive outcomes. Some forms of sexual dysfunction may cause infertility.
For impotence caused by fear of infection, use safe sex practices and consider abstinence. Talk to your health care provider if impotence is related to fear of recurring heart problems—sexual intercourse is usually safe.
If the problem is persistent or if there are other associated and unexplained symptoms, call your health care provider.
Persistent sexual dysfunction may cause depression. Sexual dysfunction that is not addressed adequately may lead to conflicts or potential breakups for couples.
Sources:
Journal of Men's Health and Gender
Journal of the American College of Cardiology
National Institutes of Health - National Library of Medicine
Sexual arousal disorder is an aberration during any stage of the sexual response cycle (desire, arousal, orgasm, and resolution) that prevents the experience of satisfaction through sexual activity. A person with this disorder may be interested in sexual intercourse but has difficulty becoming stimulated enough to go through with it.
Sexual arousal disorders were previously known as frigidity in women and impotence in men, though these have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity is now described as any of several specific problems with desire, arousal, or anxiety.
For both men and women, these conditions may appear as an aversion to, and avoidance of, sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity. In women, there may be an inability to lubricate enough to complete the sex act.
Considerations
Occasional impotence occurs in approximately 50 percent of American adult men, and chronic impotence affects about 1 in 8 American men, with the chances increasing as a person ages. Between 2 and 30 million men in the United States are affected by impotence problems, according to recent estimates. About 52 percent of men between 40 and 70-years-old have some degree of erectile dysfunction (ED).
Impotence can be classified as primary or secondary. A man with primary impotence has never had an erection sufficient for intercourse. Secondary impotence involves loss of erectile function after a period of normal function. This tends to occur gradually, except in cases caused by injury or sudden illness.
Treatment of secondary impotence is usually more successful than that of primary impotence because the patient has some history of normal penile function in the past.
There are several components required for an erection:
A responsive emotional state of mind
A normally functioning pituitary
Adequate testosterone
Adequate penile blood supply
Premature ejaculation (when orgasm comes on too quickly) is different from impotence, and a couple should seek counseling for this problem.
Male infertility is quite different from impotence. A man who is unable to maintain an erection may be perfectly capable of siring a child. An infertile male may be able to have intercourse normally, but he may be unable to father a child.
Symptoms
In Men or Women:
Lack of interest or desire in sex
Inability to feel aroused
Pain with intercourse (much less common in men than women)
Infertility
In Men:
Inability to achieve an erection
Inability to maintain an adequate erection for intercourse
Delay or absence of ejaculation despite adequate stimulation
Inability to control timing of ejaculation
In Women:
Inability to relax vaginal muscles enough to allow intercourse
Inadequate vaginal lubrication before and during intercourse
Inability to attain female orgasm
Causes
Sexual dysfunction can exist throughout a person's life or may develop after an individual has previously experienced normal sexual responses. The difficulty may develop gradually over time, or may occur suddenly and present itself either as total or partial dysfunction in one or more stages of the sexual response cycle. The cause may be physical, psychological, or both.
Emotional factors include both interpersonal problems (marital/relationship troubles, lack of trust between partners) and an individual's psychological problems (depression, sexual fears or guilt, past sexual trauma, and so on).
Physical factors include drugs (alcohol, nicotine, narcotics, stimulants, antihypertensives, antihistamines, or most psychotherapeutic drugs); complications related to back, prostate, or vascular surgeries; failure of various organ systems (such as the circulatory and respiratory systems); endocrine disorders (thyroid, pituitary, or adrenal gland problems); neurological problems caused by trauma (such as spinal cord injuries) or disease (such as diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis); hormonal deficiencies (low testosterone or androgens); and some fetal development abnormalities.
Sexual dysfunction disorders are generally classified into four categories: sexual desire disorders, sexual arousal disorders, orgasm disorders, and sexual pain disorders.
Sexual desire disorders (decreased libido) may result from a decrease in normal androgen or testosterone hormone production. Other causes may be aging, fatigue, medications, pregnancy, or psychiatric conditions such as depression and anxiety.
Common causes of impotence
Medication use (especially antihypertensives)
Smoking
High blood pressure
Hormonal deficiency caused by disease (diabetes) or injury
Liver disease, usually caused by alcoholism
Circulation problems (arteriosclerosis, anemia, or vascular surgery)
Neurological problems (injury, trauma, disease)
Urological procedures (prostatectomy, orchiectomy, radiation therapy)
Penile implants (or prostheses) that are not functioning properly
Depression, anxiety, fatigue, boredom, stress, fear of failure
Mood altering drugs, alcohol, medications
Deep-seated psychological problems
Orgasm disorders, which can affect both sexes, are a persistent delay or absence of orgasm following sexual excitement. Sexual pain disorders affect many more women than men and are known as dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the musculature of the vagina that interferes with intercourse). Dyspareunia may be caused by insufficient lubrication in the female, which may result from breastfeeding, irritation from contraceptive creams and foams, aging, or by fear and anxiety. Vaginismus may be caused by a sexual trauma such as rape or incest.
Sexual dysfunctions are more common in the early adult years, with the majority of patients seeking care for such conditions during their late twenties into their thirties. The issues increase again in the geriatric population, typically with a gradual onset of symptoms associated most commonly with organic causes of sexual dysfunction.
Increased risk is often linked to a history of diabetes, degenerative neurological disorders, chronic psychological problems, alcohol use, drug abuse, difficulty maintaining relationships, or chronic disharmony with the current sexual partner.
Prevention
Honest and accurate communication regarding sexual issues and body image between parents and their children may prevent children from developing anxiety or guilt about sex and carrying those emotional responses into their adulthood.
Review all medications (prescription and over-the-counter) for possible side effects regarding sexual dysfunction. Avoiding drug and alcohol abuse may help prevent sexual dysfunction.
Couples engaging in adequate communication may be able to avoid some problems within their relationship that could potentially create some forms of sexual dysfunction.
People who are victims of sexual trauma should receive comprehensive treatment, including individual counseling and group therapy. This may prove beneficial in allowing them to fully enjoy voluntary sexual experiences with a partner of their choice.
Treatment
Specific physical findings and testing procedures depend on the form of sexual dysfunction examined. A complete history and physical exam should be done to identify predisposing illness or conditions; highlight possible fears, or guilt specific to sexual performance; and bring out any history of prior sexual trauma. A physical examination of both the partners should not be limited to the reproductive system.
Treatment measures should be specific to the cause of the sexual dysfunction. Organic causes that are reversible or treatable are usually managed medically or surgically. Physical therapy and mechanical aides may help some people with physical illnesses, conditions, or disabilities. Viagra (sildenafil) often improves both organic and psychological sexual dysfunction in males by increasing blood flow to the penis. Men on nitrates for coronary heart disease should refrain from taking sildenafil, as it may cause dangerous drug interactions. Mechanical aids and penile implants are sometimes used. Men with androgen deficiency sometimes benefit from testosterone shots. Women with androgen deficiency can tolerate smaller doses of testosterone orally or topically with a cream.
Self-stimulation and the Masters and Johnson treatment strategies are just two of many behavioral therapies used to treat problems associated with orgasm and sexual arousal disorders.
Some couples may require joint counseling to address interpersonal issues and communication styles. Psychotherapy may be required to address anxieties, fears, inhibitions, or poor body image. In general, the prognosis is good for physical (organically caused) dysfunctions resulting from treatable or reversible conditions. However, many organic causes do not respond to medical or surgical treatments. In functional sexual problems resulting from either relationship issues or psychological factors, the prognosis may be good for temporary or mild dysfunction associated with situational stressors or lack of accurate information. However, those cases associated with chronically poor-functioning relationships or deep-seated psychiatric problems usually do not have positive outcomes. Some forms of sexual dysfunction may cause infertility.
For impotence caused by fear of infection, use safe sex practices and consider abstinence. Talk to your health care provider if impotence is related to fear of recurring heart problems—sexual intercourse is usually safe.
If the problem is persistent or if there are other associated and unexplained symptoms, call your health care provider.
Persistent sexual dysfunction may cause depression. Sexual dysfunction that is not addressed adequately may lead to conflicts or potential breakups for couples.
Sources:
Journal of Men's Health and Gender
Journal of the American College of Cardiology
National Institutes of Health - National Library of Medicine
Relationship Rules
Relationship Rules
Tips on how to build a healthy love life with your spouse.
By: Hara Estroff Marano
Human beings crave intimacy, need to love and be loved. Yet people have much trouble doing so.
It's clear from the many letters I get that lots of folks have no idea what a healthy relationship even looks like. Because I care about these things, and care about the environments children grow in, I'm using this space as an attempt to remedy the problem—again.
From many sources and many experts, I have culled some basic rules of relationships. This is by no means an exhaustive list. But it's a start. Print them out and pin them up on your refrigerator door. I won't test you on them—but life will.
Choose a partner wisely and well. We are attracted to people for all kinds of reasons. They remind us of someone from our past. They shower us with gifts and make us feel important. Evaluate a potential partner as you would a friend; look at their character, personality, values, their generosity of spirit, the relationship between their words and actions, their relationships with others.
Know your partner's beliefs about relationships. Different people have different and often conflicting beliefs about relationships. You don't want to fall in love with someone who expects lots of dishonesty in relationships; they'll create it where it doesn't exist.
Don't confuse sex with love. Especially in the beginning of a relationship, attraction and pleasure in sex are often mistaken for love.
Know your needs and speak up for them clearly. A relationship is not a guessing game. Many people, men as well as women, fear stating their needs and, as a result, camouflage them. The result is disappointment at not getting what they want and anger at a partner for not having met their (unstated) needs. Closeness cannot occur without honesty. Your partner is not a mind reader.
Respect, respect, respect. Inside and outside the relationship, act in ways so that your partner always maintains respect for you. Mutual respect is essential to a good relationship.
View yourselves as a team, which means you are two unique individuals bringing different perspectives and strengths. That is the value of a team—your differences.
Know how to manage differences; it's the key to success in a relationship. Disagreements don't sink relationships. Name-calling does. Learn how to handle the negative feelings that are the unavoidable byproduct of the differences between two people. Stonewalling or avoiding conflicts is NOT managing them.
If you don't understand or like something your partner is doing, ask about it and why he or she is doing it. Talk and explore, don't assume.
Solve problems as they arise. Don't let resentments simmer. Most of what goes wrong in relationships can be traced to hurt feelings, leading partners to erect defenses against one another and to become strangers. Or enemies.
Learn to negotiate. Modern relationships no longer rely on roles cast by the culture. Couples create their own roles, so that virtually every act requires negotiation. It works best when good will prevails. Because people's needs are fluid and change over time, and life's demands change too, good relationships are negotiated and renegotiated all the time.
Listen, truly listen, to your partner's concerns and complaints without judgment. Much of the time, just having someone listen is all we need for solving problems. Plus it opens the door to confiding. And empathy is crucial. Look at things from your partner's perspective as well as your own.
Work hard at maintaining closeness. Closeness doesn't happen by itself. In its absence, people drift apart and are susceptible to affairs. A good relationship isn't an end goal; it's a lifelong process maintained through regular attention.
Take a long-range view. A marriage is an agreement to spend a future together. Check out your dreams with each other regularly to make sure you're both on the same path. Update your dreams regularly.
Never underestimate the power of good grooming.
Sex is good. Pillow talk is better. Sex is easy, intimacy is difficult. It requires honesty, openness, self-disclosure, confiding concerns, fears, sadnesses as well as hopes and dreams.
Never go to sleep angry. Try a little tenderness.
Apologize, apologize, apologize. Anyone can make a mistake. Repair attempts are crucial—highly predictive of marital happiness. They can be clumsy or funny, even sarcastic—but willingness to make up after an argument is central to every happy marriage.
Some dependency is good, but complete dependency on a partner for all one's needs is an invitation to unhappiness for both partners. We're all dependent to a degree—on friends, mentors, spouses. This is true of men as well as women.
Maintain self-respect and self-esteem. It's easier for someone to like you and to be around you when you like yourself. Research has shown that the more roles people fill, the more sources of self-esteem they have. Meaningful work—paid or volunteer—has long been one of the most important ways to exercise and fortify a sense of self.
Enrich your relationship by bringing into it new interests from outside the relationship. The more passions in life that you have and share, the richer your relationship will be. It is unrealistic to expect one person to meet all of your needs in life.
Cooperate, cooperate, cooperate. Share responsibilities. Relationships work ONLY when they are two-way streets, with much give and take.
Stay open to spontaneity.
Maintain your energy. Stay healthy.
Recognize that all relationships have their ups and downs and do not ride at a continuous high all the time. Working together through the hard times will make the relationship stronger.
Make good sense of a bad relationship by examining it as a reflection of your beliefs about yourself. Don't just run away from a bad relationship; you'll only repeat it with the next partner. Use it as a mirror to look at yourself, to understand what in you is creating this relationship. Change yourself before you change your relationship.
Understand that love is not an absolute, not a limited commodity that you're in of or out of. It's a feeling that ebbs and flows depending on how you treat each other. If you learn new ways to interact, the feelings can come flowing back, often stronger than before.
Tips on how to build a healthy love life with your spouse.
By: Hara Estroff Marano
Human beings crave intimacy, need to love and be loved. Yet people have much trouble doing so.
It's clear from the many letters I get that lots of folks have no idea what a healthy relationship even looks like. Because I care about these things, and care about the environments children grow in, I'm using this space as an attempt to remedy the problem—again.
From many sources and many experts, I have culled some basic rules of relationships. This is by no means an exhaustive list. But it's a start. Print them out and pin them up on your refrigerator door. I won't test you on them—but life will.
Choose a partner wisely and well. We are attracted to people for all kinds of reasons. They remind us of someone from our past. They shower us with gifts and make us feel important. Evaluate a potential partner as you would a friend; look at their character, personality, values, their generosity of spirit, the relationship between their words and actions, their relationships with others.
Know your partner's beliefs about relationships. Different people have different and often conflicting beliefs about relationships. You don't want to fall in love with someone who expects lots of dishonesty in relationships; they'll create it where it doesn't exist.
Don't confuse sex with love. Especially in the beginning of a relationship, attraction and pleasure in sex are often mistaken for love.
Know your needs and speak up for them clearly. A relationship is not a guessing game. Many people, men as well as women, fear stating their needs and, as a result, camouflage them. The result is disappointment at not getting what they want and anger at a partner for not having met their (unstated) needs. Closeness cannot occur without honesty. Your partner is not a mind reader.
Respect, respect, respect. Inside and outside the relationship, act in ways so that your partner always maintains respect for you. Mutual respect is essential to a good relationship.
View yourselves as a team, which means you are two unique individuals bringing different perspectives and strengths. That is the value of a team—your differences.
Know how to manage differences; it's the key to success in a relationship. Disagreements don't sink relationships. Name-calling does. Learn how to handle the negative feelings that are the unavoidable byproduct of the differences between two people. Stonewalling or avoiding conflicts is NOT managing them.
If you don't understand or like something your partner is doing, ask about it and why he or she is doing it. Talk and explore, don't assume.
Solve problems as they arise. Don't let resentments simmer. Most of what goes wrong in relationships can be traced to hurt feelings, leading partners to erect defenses against one another and to become strangers. Or enemies.
Learn to negotiate. Modern relationships no longer rely on roles cast by the culture. Couples create their own roles, so that virtually every act requires negotiation. It works best when good will prevails. Because people's needs are fluid and change over time, and life's demands change too, good relationships are negotiated and renegotiated all the time.
Listen, truly listen, to your partner's concerns and complaints without judgment. Much of the time, just having someone listen is all we need for solving problems. Plus it opens the door to confiding. And empathy is crucial. Look at things from your partner's perspective as well as your own.
Work hard at maintaining closeness. Closeness doesn't happen by itself. In its absence, people drift apart and are susceptible to affairs. A good relationship isn't an end goal; it's a lifelong process maintained through regular attention.
Take a long-range view. A marriage is an agreement to spend a future together. Check out your dreams with each other regularly to make sure you're both on the same path. Update your dreams regularly.
Never underestimate the power of good grooming.
Sex is good. Pillow talk is better. Sex is easy, intimacy is difficult. It requires honesty, openness, self-disclosure, confiding concerns, fears, sadnesses as well as hopes and dreams.
Never go to sleep angry. Try a little tenderness.
Apologize, apologize, apologize. Anyone can make a mistake. Repair attempts are crucial—highly predictive of marital happiness. They can be clumsy or funny, even sarcastic—but willingness to make up after an argument is central to every happy marriage.
Some dependency is good, but complete dependency on a partner for all one's needs is an invitation to unhappiness for both partners. We're all dependent to a degree—on friends, mentors, spouses. This is true of men as well as women.
Maintain self-respect and self-esteem. It's easier for someone to like you and to be around you when you like yourself. Research has shown that the more roles people fill, the more sources of self-esteem they have. Meaningful work—paid or volunteer—has long been one of the most important ways to exercise and fortify a sense of self.
Enrich your relationship by bringing into it new interests from outside the relationship. The more passions in life that you have and share, the richer your relationship will be. It is unrealistic to expect one person to meet all of your needs in life.
Cooperate, cooperate, cooperate. Share responsibilities. Relationships work ONLY when they are two-way streets, with much give and take.
Stay open to spontaneity.
Maintain your energy. Stay healthy.
Recognize that all relationships have their ups and downs and do not ride at a continuous high all the time. Working together through the hard times will make the relationship stronger.
Make good sense of a bad relationship by examining it as a reflection of your beliefs about yourself. Don't just run away from a bad relationship; you'll only repeat it with the next partner. Use it as a mirror to look at yourself, to understand what in you is creating this relationship. Change yourself before you change your relationship.
Understand that love is not an absolute, not a limited commodity that you're in of or out of. It's a feeling that ebbs and flows depending on how you treat each other. If you learn new ways to interact, the feelings can come flowing back, often stronger than before.
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