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Medicating women’s sexual desire still highly controversial

November 2, 201700Featured news, Health, Integrative Medicine, Low Sexual Desire, Meditation, Psychopharmacology, Sex November, 17

Source: Minjung Gang at flickr, Creative Commons

On August 18, 2015, the U.S. Food and Drug Administration (FDA) approved Flibanserin, a drug that treats low sexual desire in women.

With the medication’s presence on the market, you’d think that low sexual desire in women would be well understood. In fact, there is still widespread debate on the issue. Marta Meana, a psychologist at the University of Nevada, writes:

“Desire is the most subjective and acutely amorphous component of sexuality.”

And Lori A. Brotto, a Professor of Gynecology at the University of British Columbia, offers a similar view, explaining:

“There is no clear consensus on the causes of sexual dysfunction in women.”

While women experience obstacles to fulfillment, the causes are complex. According to Brotto:

“An abundance of data indicates that low sexual desire is strongly influenced by a woman’s relationship satisfaction, mood, self-esteem, and body image.”

Medication is, at best, a partial treatment for problems with desire.

There are also differing perspectives on proper terminology around the issue. In an interview with the Trauma and Mental Health Report, Kristen Mark, Director of the Sexual Health Promotion Lab at the University of Kentucky, said:

“Sexual dysfunction may not be the most accurate way to describe low sexual desire. Women may experience sexual problems, but sexual desire ebbs and flows, so people should expect that it will fluctuate.”

Deciding between the word “dysfunction” or “problem” may seem trivial. But language creates meaning, and shapes how health professionals treat clients and conduct research.

Other clinicians agree. Leonore Tiefer, Associate Professor at the New York University School of Medicine, offers two metaphors for sex. The first is digestion. In this metaphor, sex is “just there”. Like digestion, it does not require learning, but is a natural or innate action that the body is equipped for at birth.

The other metaphor is dance. There are many ways to dance. Some people are better at dancing, and some people like dancing more than others. Tiefer argues that sex, like dance, is a learned skill.

Tiefer has advocated extensively against pharmaceutical interventions for female sexual problems. In 2000, she convened The New View Campaign, a collective of clinicians and social scientists dedicated to reframing the conversation around sexuality.

In a 2006 article on disease mongering, Tiefer explains why a purely biological approach to sexual health is inadequate:

“A long history of social and political control of sexual expression created reservoirs of shame and ignorance that make it difficult for many people to understand sexual satisfaction or cope with sexual problems.”

To emphasize that sex has a social context, the New View wrote an alternative system of classification for sexual problems. The first category is “sexual problems due to socio-cultural, political, or economic factors”, and the second is, “problems relating to partner and relationship”.

These categories includes specific causative factors, such as “ignorance and anxiety due to inadequate sex education, lack of access to health services, or other social constraints.”

According to Tiefer:

“Popular culture has greatly inflated public expectations about sexual function. People are fed a myth that sex is “natural”—that is, a matter of automatic and unlearned biological function—at the same time as they expect high levels of performance and enduring pleasure, they are likely to look for simple solutions.”

The drug Flibanserin is one of these ‘simple solutions’. Its approval has been met with controversy.

According to Loes Jaspers and colleagues at Erasmus University Medical Center, the effectiveness of Flibanserin is very low. In a meta-analysis examining the effect of the medication in about 6000 women, Jaspers found that those receiving the drug experienced, on average, only 0.5 more “sexually satisfying” events per month compared to those receiving a placebo.

At the same time, it carries a black label, which the FDA assigns to drugs that include serious side effects. For Flibanserin, these include sedation and fatigue. When combined with alcohol and other common drugs, it can cause dangerously low blood pressure and fainting.

And non-medical treatments, such as mindfulness-based sex therapy, can be effective for treating low sexual desire. According to Brotto, mindfulness shifts attention away from negative, self-defeating thoughts, and towards sensation and pleasure.

Mark, however, thinks that hope should not be abandoned for a medical solution. She says:

“At this point, I would not recommend Flibanserin for most women coping with desire problems. There may be a medication in the future that meets women’s needs when used in conjunction with other approaches, but this just isn’t it.”

Whether women’s sexual problems should be medically treated is still debatable. But what is clear is that social and cultural factors shaping women’s sexual experiences should not be bypassed for a quick solution.

–Rebecca Abavi, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

This article was originally published on Psychology Today

Medicating Women's Sexual Desire Still Highly Controversial

November 2, 201700Featured news, Health, Integrative Medicine, Low Sexual Desire, Meditation, Psychopharmacology, Sex November, 17

Source: Minjung Gang at Flickr/Creative Commons

On August 18, 2015, the U.S. Food and Drug Administration (FDA) approved Flibanserin, a drug used to treat low sexual desire in women.

And Lori A. Brotto, a Professor of Gynecology at the University of British Columbia, has offered a similar view: “There is no clear consensus on the causes of sexual dysfunction in women.”

While women experience obstacles to fulfillment, the causes are complex. According to Brotto, “An abundance of data indicates that low sexual desire is strongly influenced by a woman’s relationship satisfaction, mood, self-esteem, and body image.”

Medication is, at best, a partial treatment for problems with desire.

There are also differing perspectives on proper terminology. “Sexual dysfunction may not be the most accurate way to describe low sexual desire,” says Kristen Mark, Director of the Sexual Health Promotion Lab at the University of Kentucky. “Women may experience sexual problems, but sexual desire ebbs and flows, so people should expect that it will fluctuate.”

Deciding between the terms “dysfunction” or “low desire” may seem trivial. But language creates meaning and shapes how health professionals treat clients and conduct research.

Other clinicians agree. Leonore Tiefer at the New York University School of Medicine offers two metaphors for sex. The first is digestion. In this metaphor, sex is “just there.” Like digestion, it does not require learning but is a natural or innate action that the body is equipped for at birth.

The other metaphor is dance. There are many ways to dance. Some people are better at dancing, and some people like dancing more than others. Tiefer argues that sex, like dance, is a learned skill.

To emphasize that sex has a social context, the New View wrote an alternative system of classification for sexual problems. The first category is “sexual problems due to socio-cultural, political, or economic factors,” and the second is “problems relating to partner and relationship.”

These categories include specific causative factors, such as “ignorance and anxiety due to inadequate sex education, lack of access to health services, or other social constraints.”

According to Tiefer:

“Popular culture has greatly inflated public expectations about sexual function. People fed a myth that sex is “natural”—that is, a matter of automatic and unlearned biological function—at the same time as they expect high levels of performance and enduring pleasure, they are likely to look for simple solutions.”

The drug Flibanserin is one of these “simple solutions.” Its approval has been met with controversy.

According to Loes Jaspers and colleagues at Erasmus University Medical Center, the effectiveness of Flibanserin is very low. In a meta-analysis examining the effect of the medication in about 6,000 women, Jaspers found that those receiving the drug experienced, on average, only 0.5 more “sexually satisfying” events per month compared to those receiving a placebo.

Mark, however, thinks that hope should not be abandoned for a medical solution.

“At this point, I would not recommend Flibanserin for most women coping with desire problems,” she says. “There may be a medication in the future that meets women’s needs when used in conjunction with other approaches, but this just isn’t it.”

–Rebecca Abavi, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

This article was originally published on Psychology Today

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Denmark Declassifies Transgender as Mental Illness

June 1, 201700Bias, Featured news, Health, Identity, Sex, Sexual Orientation, Stress, Transgender June, 17

Source: Chey Rawhoof at flickr, Creative Commons

In March 2016, North Carolina passed a law that bars transgender individuals from using public restrooms that match their gender identity, and prohibits cities from passing anti-discrimination laws that protect the rights of gay and transgender people. The bill has thrust North Carolina into the centre of a national debate over equality, privacy, and religious freedom in the wake of a 2015 U.S. Supreme Court ruling to legalize same-sex marriage.

For individuals who identify as transgender, this law has caused “emotional harm, mental anguish, distress, humiliation, and indignity,” according to U.S. Attorney General Loretta Lynch. These consequences are in addition to the emotional anguish and shame that transgender people frequently experience when their identity is classified as mental illness.

The World Health Organization (WHO) categorizes transgender individuals as having a “gender identity disorder” in their “Classification of Mental and Behavioural Disorders”.

But in Denmark, the issue is being addressed very differently.

Effective January 2017, transgender will no longer be considered mental illness in the country, and the term ‘transgender’ will no longer be listed as mental illness, making Denmark the first country in the world to remove the link between mental illness and individuals who identify with a gender other than the one they were born with.

Sexual orientation has always been a contentious topic, and homosexuality and other forms of expression of same-sex orientation are often stigmatized. According to Susan Cochran, a professor of epidemiology at UCLA, this stigma is worsened when sexual orientation is pathologized.

Research by psychologist Walter Bockting of the University of Minnesota Medical School found that transgender individuals often experience sanctioned prejudice, such as job discrimination, health discrimination, verbal aggression, and barriers to substance dependency services.

In 2014, the WHO acknowledged that linking transgender people to mental illness is harmful and pledged to remove the link from their next International Statistical Classification of Diseases and Related Health Problems (ICD)—but this version isn’t slated for release until 2017.

In response, social democrat health spokesman Flemming Møller Mortensen told The Local:

“The WHO is currently working on a new system for registering diagnoses. It has been working on it for a very, very long time. Now we’ve run out of patience, and want to send out a signal saying that if the system is not changed by October, then we in Denmark will go it alone.”

Mortensen also told Danish news agency Ritzau:

“At the moment, transgender is listed as a mental illness or behavioural problem. But that is incredibly stigmatizing and in no way reflects how we see transgender people in Denmark. It should be a neutral diagnosis.”

This is not the first transgender rights legislation that Denmark has passed. It was also the front-runner in enacting a law passed in 2014 designed to allow transgender adults to change their gender status without any legal or medical interventions. In many European countries, this is still not the case, and restrictive laws requiring sterilization and divorce are still in effect.

Amnesty International, a major player in LGBTQ human rights, has praised the Danish Parliament for their decision, which comes at a time when states in the U.S., such as North Carolina, are passing more restrictive and discriminatory legislation against transgender populations.

It is likely that the North Carolina ‘bathroom law’ will spark court cases for years to come, and a number of groups, including local LGBTQ organizations and celebrities, are boycotting the state. Even within the state, the University of North Carolina is refusing to enforce the bathroom portion of the law and, in fact, holds sensitivity orientation programs regarding LGBTQ students so that non-transgender populations will see their trans peers as equal and worthy of respect.

The entire question of transgender rights promises to be a hot-button issue with underlying mental-health implications in the coming years. But for now, Denmark is taking the first step to ensure the inclusion of transgender individuals by acknowledging them as normal human beings.

–Veerpal Bambrah, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

This article was originally published on Psychology Today

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Lack of Regulation in Porn Industry Leaves Women Unprotected

January 25, 201700Career, Featured news, Health, Law and Crime, Pornography, Sex, Trauma January, 17

The documentary film ‘Hot Girls Wanted’, produced by Rashida Jones and released in the spring of 2015, follows several young women living in a North Miami Beach home as they attempt to enter the amateur pornography industry. Since its release, the film has sparked major discussion about the experiences of female performers and the porn industry itself.

There is very little research available on the impact on performers within this poorly regulated industry. In the U.S., the government turns a blind eye to many of the issues surrounding the production of pornography, unless it involves performers under the age of 18. And despite laws prohibiting the employment of performers under the legal age, there are still issues involving consent among newly legal women in the 18-21 age range.

During an AOL BUILD discussion led by Jones, Gail Dines, a professor of sociology and women’s studies at Wheelock College in Boston, emphasized the lack of understanding that some young women seem to have:

“I meet woman after woman who went into this industry, thinking they were going through consent. They’re young. They don’t know what they’re up against.”

Jones also interviews one of the film’s main performers Rachel Bernard, who has since left the industry, and who openly speaks about her experience working in amateur pornography. She addressed the concept of consent, and how it can become even more problematic on porn sets:

“When you walk in, your agent might’ve told you what you’ll be doing or they were general about it because they don’t want you to have an opinion whether you like it or not.”

In the AOL BUILD discussion, Bernard explained how it was common for her to enter onto a set without previously being told the details of her performance and, eventually, she would be pressured to perform acts she was not comfortable with. In one instance, she was told to say a highly demeaning line. When she refused, the director responded by saying, “Well, it’s part of the script, so you have to.”

A lack of agency in young people entering into any field of work is problematic. But working in pornography can open performers to elevated health risks and uncomfortable situations. During the AOL BUILD discussion, Bernard described how sex work was not comparable to most other lines of work because it required a higher degree of vulnerability:

“Every job does have points where it’s maybe uncomfortable but, when you go to a regular job, you’re not showing every single part of your body. The fact that I am out there and I am completely open. Every part of my body, soul, and mind is having to be in that position. It’s a little bit more than uncomfortable.”

Not only can pornography be uncomfortable, but due to the lack of regulation in the industry, the work can also have a negative impact on performers’ health. Condom use is reported to be very low in heterosexual adult films, with only 17% of performers using condoms. And performers in the study reported feeling pressured to work without condoms to remain employed.

The average age of performers entering the industry could explain a hesitance to speak up about rights on set.

For over 40 years, the average age of entry for female porn performers has been approximately 22. In an interview with VICE, Jones expressed the significance of the age of performers in influencing how they experience this line of work:

“When you’re 18 and you’re making choices for yourself, you’re not thinking about the eternal effects of footage online. You’re not thinking about the external and internal costs; the psychological, emotional, physiological, physical costs of having sex for a living. You’re thinking about the fame part. And so you may not be the best candidate to make a decision for yourself but you’re allowed to because you’re 18 and that’s all you need to be.”

So what do performers say about the development of regulations for this industry?

In February 2016, California officials in charge of workplace safety rejected a proposal requiring the use of condoms, dental dams, and goggles for porn actors on set. The decision was made after six hours of testimony from almost 100 performers and producers who strongly opposed the proposal.

Performers who spoke up in protest of the proposal worried that those particular regulations would either hurt the porn industry and their job security, or drive it underground, resulting in even more dangerous conditions.

In an interview with The Guardian, Ela Darling, a porn performer who spoke at the hearing, explained how those regulations would further limit performers’ rights:

“This law denies bodily autonomy to an already marginalized population, and it denies us our voice.”

In a statement made after the February decision, Erich Paul Leue, the executive director of the Free Speech Coalition, a trade association for the adult entertainment industry, discussed industry members’ interest in being involved in deciding industry regulations.

“We’re not opposed to regulation,” he said. “We’re opposed to this regulation.”

In terms of regulation, the aim should be to provide performers with the freedom to make their own decisions without fear of risking job security or safety. Individuals working in the industry should not be required to compromise health, safety, or wellbeing. And despite the current lack of understanding about the implications of working in porn, one thing is clear: Performers who wish to enter and remain in the industry should be able to do so without having to check their rights at the door.

–Abbi Sharvendiran, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

This article was originally published on Psychology Today

Is Casual Sex Really So Bad?

December 3, 201520Anxiety, Depression, Featured news, Health, Relationships, Self-Esteem, Sex December, 15

Source: John Perivolaris on Flickr

Smartphone apps like Tinder, Grindr, Down, Tingle and Snapchat have opened up a new chapter in the complicated world of dating and casual sex. Dubbed “hookup culture,” smartphone users 18-30 years of age are said to be navigating a very different sexual landscape than their parents did.

Early research on the topic found that undergraduates who engaged in casual sex reported lower self-esteem than those who did not. Yet, other studies reported no evidence of higher risk for depressive symptoms, suicidal ideation, or body dissatisfaction.

According to adjunct professor Zhana Vrangalova of New York University, the phenomenon of casual sex is layered with individual, interpersonal, emotional, and social factors. Reasons for engaging in hookups are different.

Her recently published study demonstrates that casual sex is not harmful in and of itself, rather one’s motivations for engaging in casual sex is what affects psychological well-being.

Vrangalova draws upon self-determination theory: Behaviours arise from autonomous or non-autonomous motivations. When we do something for autonomous reasons, we are engaging in behaviours that reflect our values – the ‘right’ reasons. When we do something for non-autonomous reasons, we are seeking reward and avoiding punishment – the ‘wrong’ reasons.

In the context of casual sex, Vrangalova and her team of researchers were able to show that those who hooked up for non-autonomous reasons (i.e. wanting to feel better about themselves, wanting to please someone else, hoping it would lead to a romantic relationship, and wanting favours or revenge) had lower self-esteem and higher levels of depression and anxiety.

But those who engaged in casual sex for autonomous reasons – fun and enjoyment, sexual exploration, learning about oneself – reported higher than normal levels of self-esteem and satisfaction, with lower levels of anxiety.

If hooking up for the right reasons, casual sex does not appear to have a negative impact. Still it’s not so simple. A number of issues need to be addressed.

Many studies examine “hookup culture” on college campuses, particularly the sex life of middle to upper class young adults. Since college years are often a tumultuous time of self-discovery and changing opinions, longitudinal research on the long-term benefits (or drawbacks) of casual sex need to be carried out. Few studies have explored how casual sex affects the mental health of individuals above age 30.

Outside the college domain, information on how different casual sex arrangements (one night stands vs. friends with benefits vs. non-monogamy) affect mental health is scarce, as is research exploring how casual sex behaviours vary between people of different ethnicities. Preliminary research shows that non-white women report lower desire for casual sex. How or why this is the case has not been examined.

There is little doubt that the sexual landscape has changed in the past few decades. Technologies, and more specifically social media, have altered the way we approach and engage in interpersonal relationships. But the idea that younger generations are ditching the traditional dating scene in favour of hooking up has not been supported by recent research.

Hang-outs, group dates, friends with benefits, no-strings-attached… For those emerging adults who are engaging in these behaviours with a psychologically healthy frame of mind, is it really so bad?

– Magdelena Belanger, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

This article was originally published on Psychology Today

The Sex Offender Next Door: Why Reintegration Helps

September 24, 201500Emotion Regulation, Featured news, Free Will, Law and Crime, Loneliness, Psychopathy, Sex September, 15

Source: Sara/Flickr

The release of a sex offender back into a community can be a deeply unnerving experience. Many of us are fearful for our comfort and safety, but attitudes like these may play a role in leading many sex offenders to re-offend.

Sex offenders are faced with multiple challenges upon release. Apart from self-regulation and learning how to control their thoughts and actions, they need to find housing, employment, and most important, a community that will accept and support their continuous rehabilitation.

Sex offenders are not typically strangers lurking in dark alleyways. The perpetrator is often someone the victim knows and trusts. Robin Wilson, professor and program coordinator at the Humber Institute of Technology and Applied Learning, states that relatively few sex crimes, around 23%, involve a stranger previously unknown to the victim. The public has a misguided notion of who the typical sex offender is, and while sexual offender registries are valuable law enforcement tools, there is a growing need for community support.

Wilson considers a best practice approach as involving collaboration between respective operational, professional, and jurisdictional domains. For real rehabilitation to take place, the community must be involved in the process.

In 1994, the Circles of Support and Accountability (COSA) model of reintegration began after a Canadian Mennonite pastor started a voluntary support group for a repeat sex offender. After almost 20 years in Canada and now functioning internationally, the COSA outlines a restorative approach to the risk management of high-risk ex-offenders, using professionally facilitated volunteerism.

Each ‘Circle’ is made up of a core member (the ex-offender) and four to six community members, individuals who volunteer their time to assist the core member in the community. The program aims to create supportive relationships based on friendship and accountability for behavior –the development of openness among members being a crucial part of the process.

Simply put, ex-offenders are least likely to reoffend when they have ‘friends’ who believe in them.

Wilson found that offenders in COSA had an 83% reduction in sexual recidivism (repeating undesirable and/or criminal behaviours), a 73% reduction in violent recidivism and an overall reduction of 71% in all types of recidivism when compared to the matched non-COSA offenders. His 2012 study shows that community volunteers have an immense impact on improving offenders’ chances for leading normal and productive lives.

Sex offenders are a heterogeneous group, motivated by different factors says Michael Seto, the director of Forensic Rehabilitation Research at the Royal Ottawa Health Care Group. Seto considers that successful reintegration is not simply the absence of further offending. “Successful integration would also mean that the person could live a pro-social, productive life within their circumstances. This might include intimate relationships, stable employment, and positive community ties.”

The success of programs like COSA that work in conjunction with professional treatment programs can be attributed to the continuous re-humanization and the re-moralization of the offender.

Offenders are treated as members of the community and their network of support approaches them without apprehension about the past. Most important, they are given the confidence that they are in control of themselves and that they can choose to behave differently than before.

Seto says that a major obstacle for sex offender treatment is the stigma associated with being labeled a sex offender and being seen forever as high-risk, and that positive social support has a tremendous impact on treatment outcome.

Perhaps most encouraging is the story of a small community in Florida called ‘Miracle Village’, home to over 100 registered sex offenders – none of whom have reoffended. Its residents actively support each other in their attempts to build new lives and work to establish themselves as functioning members of their community.

Of note, the village does not accept those who have been diagnosed with pedophilia or convicted of violent sex crimes against strangers. Some say it is made up of lower risk ex-offenders who are easier to rehabilitate.

Wilson says that offenders targeted for COSA are usually those who have long histories of re-offending, have typically failed in treatment and have displayed intractable antisocial values and attitudes. Stable housing, as well as social support, has shown a relationship to reduced sexual recidivism and criminality among both child molesters and rapists.

The results are compelling: A supportive social network makes a difference. Addressing an offender’s humanity, loneliness, and need for positive relationships has a strong impact.

Still, some sex offenders really are too high-risk to allow back into their communities. Seto says that while “successful reintegration is the aspiration for most sex offenders, some individuals pose such a high risk of re-offending that incapacitation is the only viable option. This can come in the form of long sentences, long term hospitalization, or indefinite sentencing according to (in Canada) Canada’s Dangerous Offender designation.”

Does it all seem too easy? One can’t help but wonder. Then again, shouldn’t it be evident that an approach that shuns and ostracizes is doomed from the start? Cananyone “re-integrate” when viewed as a pariah?

Perhaps the take-home message is about compassion and humanity. And our ability to overcome our insecurities when in the company of those who frighten us.

When Seto was asked whether he truly believes sex offenders can change, he responded “Yes…some of them.”

– Jana Vigor, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

This article was originally published on Psychology Today

Taboo of Male Rape Keeps Victims Silent

June 25, 201500Depression, Featured news, Friends, Gender, Post-Traumatic Stress Disorder, Sex, Stress June, 15

Source: Mitchell Joyce/Flickr

“My name is Will, and I think rape is hilarious…when it happens to a dude,” begins the monologue in a recently posted video written and performed by actor, Andrew Bailey. In this powerful mostly-satirical piece, Bailey opens discussion about how male sexual assaults are brushed off. “A male can’t be raped because he must have wanted it.”

Rape can and does happen to men. Approximately 1 in 6 men have experienced some form of sexual abuse as children, and 1 in 33 American men are reportedly survivors of attempted or completed rape.

And these statistics are likely an under-representation. According toRAINN, an anti-sexual violence organization, about 60% of all sexual assaults are not reported to police.

Although women are more likely to be sexually assaulted, Western notion of masculinity and gender have made it difficult to view men as victims of abuse. Men are often expected to welcome sexual advances, not view them as unwanted, rendering them less able to identify a sexual assault when it occurs to them.

“Male survivors may be less likely to identify what happened to them as abuse or assault because of the general idea that men always want sex,” Jennifer Marsh, the vice president for Victim Services at RAINN told CNN.

A further challenge is the widely-held view that physical strength makes men incapable of being overpowered or assaulted. James Landrith, a sexual assault survivor, spoke to CNN: “We [men] are conditioned to believe that we cannot be victimized.”

But, a research study led by Janice Du Mont from the University of Toronto, reported that male victims are often drugged prior to assault. While the assailant is usually male, female aggressors who violently sexually abuse male victims are not uncommon.

After an assault, the victim often feels troubled by his inability to protect himself, questioning his masculinity, feeling that a sense of control has been taken from him. They may also feel ashamed about the incident, making them reluctant to speak out. In fact, 71% of adult sexual assault survivors hold the view that “nobody would believe me” as a reason for not reporting the incident.

Many report receiving little to no support from family and friends, as they often fear disclosing the abuse. In an interview with theDepartment of Justice Canada, a male sexual assault victim recounts, “no one knew about it, so I just felt very alone, and I didn’t communicate any of that.”

“All the guys would laugh at me about it,” Bailey says in his monologue. Uncomfortable disclosing the reality of the experience, Bailey’s character gives in to rape humour, to fit in with friends. “I was like ‘psych’, I totally did enjoy it; then they high-fived me and told me I was cool.” Indeed, it is not unusual for male victims to fear rejection and harassment from others. Many keep silent.

Victims also report a complex range of emotional difficulties: isolation, anger, sadness, shame, guilt, and fear. Post-traumatic stress disorder (PTSD), major depression and anxiety disorders are also common among victims.

Raising awareness and encouraging male survivors to reach out for support may be challenging, but education regarding sexual abuse and demystifying misconceptions surrounding rape is essential to help male survivors heal.

In research by the Department of Justice Canada, survivors suggested raising awareness through campaigns to better inform male survivors about available resources.

A recent UK initiative created a £500,000 fund for male victims of sexual abuse, bringing considerable public attention to the issue. The UK Ministry of Justice began an international social media campaign using the hash-tag #breakthesilence to end stigma and raise awareness.

Duncan Craig of Survivors Manchester, a survivor-led/survivor-run organization states, “In the future I would like to see both the government and society begin talking more openly about boys and men as victims and see us trying to make a positive change to pulling down those barriers that stop boys and men from speaking up.”

– Khadija Bint Misbah, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

This article was originally published on Psychology Today

Human Trafficking Remains Widespread Form of Slavery

April 2, 201500Bias, Featured news, Gender, Health, Law and Crime, Politics, Sex, Stress, Therapy, Trauma April, 15

Source: Bruno Casonato//Flickr

Despite being mostly illegal, slavery remains a global reality. It is estimated that over 20.9 million people are currently enslaved and involuntarily trafficked within their own countries and across borders.

In an interview with Mark Lagon, Chair of International Relations and Security at Georgetown University’s foreign service program, former Ambassador, and Adjunct Senior Fellow for Human Rights at the Council on Foreign Relations, The Trauma & Mental Health Report learned about human trafficking and the traumatic experiences survivors encounter.

Q: What is human trafficking?

A: Human trafficking is a contemporary form of slavery – whether for sexual exploitation or forced labour. It’s not a general form of exploitation that we sometimes see with globalization, but rather, an extreme version.

It involves appealing to someone who is desperate for a better life and looking for economic opportunities. The work however, often onerous and violent, is very different from what was promised. It’s important in terms of mental health and trauma to understand that while human trafficking often involves violence, especially for sexual exploitation, much of the control is psychological by the recruiter or trafficker.

Q: Who is most vulnerable to becoming a victim of human trafficking?

A: Those who are desperate for a new life and wooed into a situation that is exploitative are most vulnerable. These groups are denied access to justice; they are not treated as human beings in full under the law, women or minorities – or in South Asia, those of a lower caste. Migrants are also particularly vulnerable. It’s not just undocumented workers around the world, but even some legal guest workers who are, through fraud, indebtedness, and having their papers seized, vulnerable to human trafficking.

Q: How do gender stereotypes play a role in human trafficking?

A: Females are particularly vulnerable to human trafficking. Public attitude that “men have always bought women for sex and they always will” is based on gender stereotypes. Society regularly tolerates women being turned into near commodities.

But women and girls are also victims of human trafficking for labour – in agriculture and domestic services. In Kuwait, I met a woman who had been victimized as a domestic servant. She showed me photographs of herself taken weeks earlier. Her employers treated her any way they wanted. In cases like these, women and migrant workers are seen as property.

Q: What are some signs of people stuck in trafficking situations?

A: There are some clear danger signs. The one key sign is people who are intimidated and afraid. Often, victims seem isolated. Their boss, whether a pimp or supervisor, keeps them from having access to society.

Q: What are some barriers to receiving help?

A: Human trafficking victims often don’t identify themselves. They are afraid that they will be treated as criminals.

Also, aspects of the trauma are not often discovered. Someone might be rescued but the psychological hold that their trafficker has may not be fully appreciated. They may flee the shelters and end up going back to their tormentor because of a kind of Stockholm syndrome or post-traumatic stress. Survivors need mental health treatment, not just shelter and physical health treatment.

Q: Much of humanitarian work is based on the notion of restoring survivors’ “human dignity,” Can you elaborate?

A: All human beings are of equal basic worth and there are places where people are not treated as human beings at all. So, dignity is key. Two things human dignity depends on are agency – someone’s ability to thrive and prosper in making choices, and social recognition – being treated like a human being. Human trafficking is a classic example of agency and social recognition being crushed.

Q: How can we empower survivors?

A: Human trafficking victims are treated like slaves, but are very seldom in shackles or in chains. Their tormentors convince them that they are unworthy or they have no ability to flee. It is essential to restore survivors’ dignity, giving them the therapy and mental health treatment they need.

Q: What can the general public do?

A: They can understand that even a small amount of public funding from the government for human trafficking victims and mental health care goes a very long way to help people have their freedom.

Q: Tell us about your upcoming co-edited book, “Human Dignity and the Future of Global Institutions”?

A: It looks at how the proper goal for institutions like the UN and the International Criminal Court, is to fight for human dignity, and how well they serve that goal.

I’ve written a chapter on human trafficking, and the partnerships between governments, international organizations, non-profits, and businesses that attempted to combat this issue. And I distinguish between those partnerships that are transformative in helping people reclaim their dignity and those that are doing little for this issue.

For more resources and information on fighting human trafficking, visit the Polaris Project.

– Contributing Writer: Khadija Bint-Misbah, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Photo Credit: Bruno Casonato//Flickr

This article was originally published on Psychology Today

Love Is War: Post Infidelity Stress Disorder

March 12, 201560Anger, Attention, Cognition, Dreaming, Empathy, Featured news, Health, Hormones, Infidelity, Memory, Post-Traumatic Stress Disorder, Relationships, Self-Esteem, Sex, Sleep, Stress, Trauma March, 15

Source: Daquella manera/Flickr

Blind-sided by the one you love, the one you married.

Learning about your spouse’s infidelity can be emotionally and physically devastating. The emotional damage is reflected in what some mental health professionals call Post-Infidelity Stress Disorder (PISD), for the stress and emotional turmoil experienced afterward.

Psychologist Dennis Ortman, author of Transcending Post-Infidelity Stress Disorder, describes the term as “not to suggest a new diagnostic category but to suggest a parallel with post-traumatic stress disorder, which has been well documented and researched.”

In Post-Traumatic Stress Disorder (PTSD), re-experiencing the trauma repeatedly is the first of three categories of symptoms described. The disorder is marked by flashbacks of war for veterans, nightmares of the accident for car wreck survivors, and painful memories of abuse for survivors of intra-familial trauma.

So too, in PISD husbands and wives will replay the painful realization of betrayal. Even after the initial fall-out, people will have recurring thoughts of their partner with another.

Psychologist and certified sex therapist, Barry Bass, adds, “Like trauma victims, it is not unusual for betrayed spouses to replay in their minds previously assumed benign events,” those times when their spouse became defensive when asked a simple question, or the late nights at work, or the text messages from unnamed friends, all of these become viewed as possible deceitful acts.

The second category of symptoms for PTSD, avoidance and emotional numbing, is seen in PISD as well. Rage or despair that comes after the initial shock of discovering the infidelity can be followed by a state of emotional hollowness. Formerly pleasurable activities lose their appeal. Those who were cheated on sometimes withdraw from friends and family and describe feelings of emptiness.

The last category of PTSD symptoms, hyper-vigilance and insomnia, can also arise for those dealing with infidelity. Sleep patterns become erratic; and concentration becomes a challenge, affecting work performance and family life.

PISD can have physical consequences as well as emotional ones. The stress of discovering infidelity can lead to what has been dubbed broken heart syndrome, also termed stress cardiomyopathy. The American Heart Association describes symptoms such as sudden chest pain, leading to the sense that one is having a heart attack. Physical or emotional stressors, such as a loved one passing or major surgery trigger a surge of stress hormones that temporarily affect the heart. The condition typically reverses within a week.

Despite the stress, there is life after an affair. Due to the symptomatic similarities, therapists are now beginning to use PTSD counseling techniques to help couples either stay together or move on.

Exposure and cognitive restructuring are techniques used when dealing with traumatic memories. In exposure, spouses are asked to gradually imagine those heart-wrenching moments and to cope with them gradually, whereas cognitive restructuring substitutes irrational thoughts, feelings, and behaviours induced by the trauma, with adaptive ones.

Counselors use these “trauma focused” explorations with clients, sifting through the distressing memories and aversive feelings, to help build the client’s self-esteem and confidence in dealing with the betrayal or loss of the relationship.

Therapists are also working with their clients to help them understand the unique reasons that led to the infidelity. Understanding why the affair occurred can help both people.

Along with help from family and friends, wounds can be bandaged and trust restored. Infidelity trauma and the time and strength involved in recovery remind us that love, like war, can have its casualties.

– Contributing Writer: Justin Garzon, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Photo Credit: Daquella Manera/Flickr

This article was originally published on Psychology Today

Why Does Anyone Love Men Who Won’t Love Back?

February 19, 201510Anxiety, Attachment, Bias, Featured news, Health, Media, Relationships, Sex February, 15

Source: conrado/Shutterstock

You’ve seen the character a thousand times—the mysteriously sexy male protagonist. The lone wolf.

He saunters into women’s lives, gives them a wink, and they trip over themselves to gain his affections. Little do they know, he is incapable of such basic inclinations as love, having in fact buried his emotions years ago in the corners of his cold heart. Naturally, he becomes even more desirable, and the women who were tripping over themselves before, are now desperately crawling after him. This cannot last forever, and the lone wolf must leave. And so he does, leaving a trail of broken hearts in his wake.

The plot has appeared in many Hollywood movies, from classic westerns to gangster films to the James Bond series. Even romantic comedies have jumped on the bandwagon, with jaded, rejecting players who finally meet “the one” and struggle to learn how to love.

50 Shades of Grey, the film based on the novel about a fictional BDSM relationship, just hit theaters. Anastasia, the female protagonist, is portrayed as a normal, healthy young woman, while Christian Grey is the king of lone wolves—though presumably all lone wolves are the de facto kings of their prides.

Christian Grey has all the typical trappings of the tall, dark, and mysterious stranger. He refuses any type of romantic relationship, claiming to not be a “flowers and romance kind of guy.” He forbids Anastasia from touching him or even making eye contact during sex. Though we may shake our heads and claim we would never endorse such a relationship, the book series has sold over 100 million copies worldwide.

A quick perusal of most fan-generated lists of the sexiest fictional male characters reveals our obsession with solitary, rejecting men—James Bond, Indiana Jones, George Clooney in pretty much anything, Batman, Edward Cullen (whose heart is literally dead)—and the list goes on.

We love characters who can’t love us back. Though there are slight differences, the Christian Greys and James Bonds of the world are strikingly reminiscent of the dismissive-avoidant attachment style.

Briefly: The dismissive-avoidant style is characterized by discomfort with intimacy or feelings of vulnerability. Being emotional or dependent, for such people, is equated with weakness. Hollywood has ensured that we find this type of character irresistible. It’s hard to find a movie that doesn’t frame the solitary male as desirable. By the same token, it’s rare to find a “clingy” (or anxiously-attached) character portrayed in a positive light.

Of course fiction is fiction, but pop culture permeates our norms. It’s hard to ignore the influence on our vocabulary and perceptions of self and other. Who doesn’t secretly want to be as cool as James Bond? As nonchalant as Don Draper? Or, for that matter, as flippant as the avoidant Mary Crawley of “Downton Abbey”? Nobody wants to be the clingy ex-girlfriend or the nagging mother-in-law.

So why do dismissive-avoidant types get all the screen time, portrayed as the coolest-of-the-cool while the anxiously attached are stereotyped as clingy and annoying? Is being stoic and rejecting really better than seeking too much affection?

It’s important to draw a distinction between what actual dismissive-avoidant individuals are like and Hollywood’s portrayal of them. It’s not that being dismissing-avoidance gives you physical agility, a six-figure salary, or an arsenal of quippy pick-up lines. More likely, you would have frustrating intimate relationships, a higher likelihood of mental health difficulties, and an underlying anxiety kept at bay by defensiveness. Films often portray such individuals without the negative aspects we would more clearly see in real life.

So why continue to portray dismissive-avoidance in such glowing terms?

It sells.

Imagine if, in the first James Bond film, Agent 007 had settled down with Honey Ryder in a gated community with two kids and a dog. There would hardly be a chance for a 25-film franchise. To keep milking the character, he must never be tied down. The character rarely changes. And the producers hit “reset” when they start creating the next film.

Although 50 Shades of Grey is far from the main culprit, it is symptomatic of our masochistic submission to dismissive-avoidant characters.

Category: Sex