Compulsion Vs. Addiction

The debate between professionals today relates to how we identify process addictions.  Many professionals view sexual acting out as part of a broader symptomatology of mental illness or compulsive behaviors.   As we learn more about the processes involved with sexual acting it better fits within the addictions model.

Anxiety, depression, and compulsive thoughts apply to sexual acting out.  The sequence with which the individual experiences these emotions seems relevant to making the distinction between an addiction and a compulsion.  Process addictions such as gambling addictions, sex addictions, and binge eating disorders share a lot of common features.

One clear distinction relates to the onset of the anxiety.   Some individuals feel compelled to engage in an action to diminish their anxiety and nothing else will suffice until they have completed the act.  For these individual’s relief follows the action. Even though they realize the disruptive quality of the action on their lives. For example, if you feel the need to drive back home to make sure you locked the door, even though you did, you will not feel relief until you check.  Perhaps you feel like your preoccupation dictates your life.

Sexual addiction has similar qualities.  The preoccupation controls one’s thoughts and sometimes actions.  Just thinking and planning to engage in the action often lifts the person out of their anxiety or depression.  The mere thought of the act results in elation. However, once the addict engages in the act shame, guilt, anxiety, and depression soon set in.  The addict does not experience relief. Rather, and intense downward spiral occurs.

Once the individual completes the action, they feel worse.  The shame, guilt, and anxiety lead the addict to feel out of control and vulnerable.  Therapy is most likely sought during this part of the addiction process. The addict experiences great highs followed by very low lows.  Compulsive behaviors don’t always fit as nicely into this scenario.

The therapist misses the bigger picture by treating all process addictions as compulsive behaviors.  The addict’s treatment approach must involve family members, especially wives or significant others. Therapists describe addiction as a family disease because it has such a profound effect on individuals within the family.  When working with individuals who have children it isn’t wise to include young children in the treatment. Rather, the kids can learn new ways of interacting with their depressed or anxious parent. The children should understand they did not cause the problems.

I’m not criticizing clinicians who treat sexual addiction as a compulsion.  I simply think the two exhibit adequate differences that warrant a different look at treatment goals. In conjunction with individual treatment, marital therapy and meetings are recommended.

If you or someone you love is struggling with a sexual addiction, please don’t hesitate to call or email Dr. Goschi at (312)595-1787 or barbara@drgoschi.com.  I look forward to hearing from you in order to begin the healing process.

ADD and the Evolving Workplace

As technology evolves, workplaces continue to change. Many workplaces offer work from home opportunities, allowing employees to do their jobs without stepping foot in a workplace. Working in a bathrobe and slippers without leaving the house may sounds luxurious to some.

For people suffering from Attention Deficit Disorder (or ADD), a condition known to impact a person's ability to focus or complete tasks, remote work may make it difficult to complete tasks. Fortunately, there are ways to address these challenges utilizing one or more of the following strategies:

1. Get a noise machine

ADD can cause car horns, thunder, and other everyday sounds to shift concentration away from work. Getting a noise machine can help to drown out background noise, making focusing on tasks more manageable.  Noise machines come with different sounds, such as white noise or rain sounds. There is no one size fits all way to program the machine; try experimenting with different sound and volume settings to see what works best for you.

2. See a psychiatrist

Stimulants are commonly utilized by psychiatrists to help patients with ADD stay focused. Additionally, some anti depressants can be used off label to help manage ADD side effects. Speak with a psychiatrist to explore what option may work best for you.

3. Go to therapy

For people with and without mental health diagnoses, task completion can be difficult when there is a lot on the mind. This is particularly true or people with conditions that impede their ability to maintain concentration. Talking to a therapist can help process emotions you may be struggling with. In addition, some therapists can help identify and work on coping skills specifically related to ADD symptoms.

4. Workout

Staying focused while sedentary at home the whole day is nearly impossible. Incorporating exercise into a workday has been shown to improve productivity and concentration. This does not necessarily mean you need to join a gym. Something as simple as taking a long walk or doing a yoga video can be helpful.

ADD symptom management is possible, even when working remotely! Anyone with the condition can try these different coping skills to help mitigate symptoms associated with ADD.

Written by: Sara Fraum

Confronting Male Childhood Abuse: The Untold Stories

The documentary "Leaving Neverland" sheds light on the harrowing experiences of two men who, now in their thirties, bravely recount their childhood abuse at the hands of Michael Jackson. What stands out as particularly tragic is their delayed acknowledgment of the abuse they endured, only feeling safe to speak out after Jackson's death.

This delay in recognition and disclosure is unfortunately common among male victims of sexual abuse. Many young men carry a misguided sense of blame, often internalizing thoughts like, "I should have fought back." Even as adults, they struggle with the belief that they should have been able to stop the abuse, reinforcing the harmful stereotype that boys and men must always be strong and in control. It often takes years for these victims to realize they were powerless children targeted by a manipulative predator.

In some cases, the situation is further complicated by feelings of shame stemming from the mixed emotions associated with the abuse. Some boys may have experienced physical pleasure, which creates a barrier to disclosure, fearing they would be blamed or punished. Allegedly, Michael Jackson exacerbated this fear by manipulating his victims into believing they would face severe consequences, including incarceration, if they revealed the abuse.

Despite the significant strides made by the #MeToo movement, male voices remain conspicuously absent. While statistics suggest that one in four girls and one in ten boys are abused, it is likely that the numbers for boys are underreported. Sexual predators rely on the societal expectation that "boys don’t tell."

In my practice, I have encountered numerous men who were abused as children. Often, it is their spouses who encourage them to seek help, particularly when the abuse has impacted their sexual health and relationships. Childhood sexual abuse can profoundly affect an individual's sexuality and libido, leading to issues such as diminished sexual desire or, conversely, hypersexual behavior.

If you or your partner is grappling with the aftermath of abuse, know that help is available. Dr. Barbara Goschi specializes in addressing these complex issues with compassion and expertise. Reach out via email at barbara@drgoschi.com or call (312) 595-1787 to begin your journey towards healing today.