Risks of Casual Sex?

A recent study found that casual sex among college students was associated with greater frequency of anxiety and depression. I think the relationship between casual sex and mental health is important one, but I think it is also important to note the scope of such a study. It is tempting to read that there is a greater occurrence of poor mental health among people who have recently had casual sex as thinking that casual sex leads to poor mental health, in fact it seems that one researchers kind of suggests this. However, the study is quite superficial.

From the press release at least, there was no aspect of the study that addresses whether people with anxiety and depression are more likely to engage in casual sex and therefore the cause effect relationship may be in reverse of how it is presented. Additionally, we do not know if there is a factor (such as low serotonin) increases the occurrence of anxiety and depression (which we know to be true) and casual sex (?) independently of each other, and that the two phenomena co-occur without having a causal relationship with each other.

It is plausible to me that the presence of anxiety and depression (in mild forms at least) are likely to facilitate casual sex. For one thing, sex can be a fantastic way to experience immediate gratification on a physical level, which can be a temporary relief from the negative feelings . Few mental health professionals don’t recognize that a leading motivation of casual sex is an attempt to feed one’s self-esteem–it shows that I am desirable, and in turn “worthy.” Sex is likewise a way in which many people seek “connection” (without the possibility or any real success) in lieu of actually risking emotional intimacy. Many people (wrongly) perceive sex as a “love delivery system.” To not acknowledge the role poor mental health as motivational factor in casual sex is just irresponsible–and suggests a moral agenda to me.

As a mental health professional who embraces the potential mental health benefits of casual sex, I am genuinely interested in the negative affects of casual sex too. In my experience, the negative effects of casual sex are usually in the cognitive interpretation of the action. Something I see in my clients frequently is sadness (depression ?) following casual sex which specifically results from the casual sex not meeting the desire for emotional intimacy or adequately satisfying the need for validation–things for which casual sex will almost never be successful. And again I note, these clients did not begin the pursuit of casual sex from a place of good mental health to begin with. Another common negative outcome from engaging in casual sex is the guilt of doing something that is a violation of societal values (though less so societal norms), especially when it failed to meet the desired outcome of appeasing bad feelings.

If in fact casual sex can promote (or exacerbate) poorer mental health–which seems almost certain to occasionally happen–then I think it is potentially dangerous to condemn casual sex without looking at the mechanisms at play in why it does. Is there something inherent in the brain chemistry that causes poor mental health after casual sex, or is this a purely cognitive interpretation relationship? The reality is that it is probably a combination of the two. But until we understand the relationship better–both in terms of chicken-and-egg and in terms of the mechanisms,  we need to be cautious in condemning casual sex.

Having Been “Raised” by One’s Parents

Many of my clients express a sense of obligation to their parents or family, despite not being able to report anything rewarding about the relationship. When I inquire about why they feel obligated to do things for their family I frequently hear “because they raised me.” I love the word “raised,” it is so poorly defined that it covers all matter of sin.

I usually inquire if there is a difference between providing the minimal requirement of food, shelter, and clothes and “raising” a child. My clients usually react that they have never had the idea that “raising” might be more than simply providing the minimum asked of them before. Unfortunately, I also often discover that “the minimum” wasn’t even met–clients who report having gone hungry as children or one client who moved 15 times by the time he was 18 years old because his family kept getting evicted–in their concept of owing their parents continued exploitation of them because their “raised” the.

I recently discussed with a client the notion of an obligation being a contract–which is often they way people think about. In exploring this idea, we looked at the two aspects of legal contracts–namely entering in the contract willfully and for an exchange (reward). My clients frequently speak of potential (possible, but unlikely) reward, but not current reward, nor any certainty of future reward. Having a child obligates one–it is entering into a contract willfully and with an implication of the reward of being a parent. It can be a risky option, but it meets the basic criteria of a valid contract. Being born (to one’s particular parents especially) is not a willful act. And if it is not rewarding, then can it really be seen as a valid contract or obligation?

Working Best Under Pressure

I have had a number of clients tell me they “work best under pressure.” I don’t argue with them, though the research shows that we actually don’t perform our best (with regard to efficiency and decision-making) while under pressure. I do acknowledge that pressure and deadlines are often necessary for meaningful motivation–I think they interpret “work best under pressure” as “work with the most urgency/intensity under pressure.” It isn’t really the same thing.

When I do hear someone say this I think to myself “So, you ‘work best’ when you are potentially doing metabolic and cardiovascular damage to yourself–great!”

Simple But Good Advice

A Huffington Post blog this week posted 10 Things to Stop Tolerating in one’s life. The piece doesn’t really go into how to rid oneself of the 10 things very much, but they are things worth reminding people to be aware that they can be damaging to physical and mental health. Some of the references they the author makes though can be good sources to solutions.

I would add an important 11th one–unsatisfying relationships. Unsatisfying relationships plague many of my clients. Frequently they are aware the relationship is unsatisfying and yet continue the relationship for some reason. It isn’t necessary to ditch an unsatisfying relationship in all cases though–sometimes it is a matter of figuring out how to make the relationship satisfying. This can be done by (1) changing the way one behaves within a relationship, (2) better communicating one’s needs within a relationship, or (3) learning how to adjust expectations so that the relationship is no longer unsatisfying. Often these  approaches are at the core of relationship counseling. Sometimes none of these approaches works, but they are at least options.



Transgender SEAL

A new book has come out about a former Navy SEAL who is transgendered. This type of hypermasculinity is not uncommon among MTF transgendered people. That someone who internally identified as female would pursue an occupation which is so publicly identified with masculinity challenges the ideas of masculinity and femininity.

I think it also challenges the idea that transgender people are in some way mentally unstable. Clearly, to perform at the elite level of a Navy SEAL requires great mental strength and character. I hope that her coming out opens people’s eyes about the “normalcy” and health of people who experience Gender Dysphoria. Gender Dysphoria is still considered a mental disorder in the 5th Edition of Diagnostic and Statistical Manual (DSM-5), but with greater societal and personal acceptance we are seeing fewer symptoms of poor mental health associated with being transgendered (much like homosexuality 40+ years ago).

BDSM is Healthy

A recent study showing the overall relative well-being of people who engage in BDSM compared to those who don’t was brought to my attention recently by a client and by a friend. Like with gays and lesbians up until the 50s, there has been a general feeling within the mental health profession that those who practice alternative sexualities have higher rates of psychopathology. This opinion is changing.

This current study does not use the American “gold standards” of assessing mental health [one of the instruments they used (NEO) I use in my practice specifically because it is designed to NOT measure psychopathology], but still can provide good evidence of overall mental well-being. There has, so far, been insufficient research on the mental health of alternative sexualities (and relationships), but this appears to be a good start.

Another recent sign of the changing opinion on alternative sexuality is the recent publication of the fifth edition of Diagnostic and Statistical Manual (DSM-5). This is the first time in the history of the book–intended to guide the diagnosis of mental disorders– has specifically distinguished between paraphilias and paraphilic disorders, noting that “a paraphilia is necessary but not sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not necessarily justify or require clinical intervention” (p. 686).

Keep Your Relationship Sexual

Here is a quickie on things that may be interfering with your sex life within a relationship. Some pretty standard stuff, but probably worth considering. I think people forget that keeping a relationship sexual actually usually takes a deliberate effort. By being mindful of what can interfere with the sex within a relationship can you prevent losing the sex from your relationship.

I have sex many times, sex begats sex. Don’t let the sex slip away and you will never have to work toward bringing it back in–bringing it back is much harder than keeping it in. Foster sex in your relationship BEFORE you need to.

Good Relationship Advice Summary

In social science research we have a technique called “meta-analysis,” in which numerous studies on the same topic are all compared at once. I ran across a piece on Huffington Post Divorce today which is an informal “meta-analysis of the advice that has been dispensed on there for the last few years. I am truly impressed with this summary. I felt particularly good that so much what I try to teach clients is included in this summary.

The outgoing editor of this section of the Huffington Post touches upon some major key points–overall a thorough and balanced perspective. She even recognizes the need to re-consider affairs and monogamy and endorses non-traditional arrangements.  I am glad to see her reject the myth that you ought not go to bed angry. She also tackles the myth that one’s spouse should be “everything” to anyone–this is relatively new notion (of the last 60 years or so) which has proven to be very dangerous in relationships. She also touches on the importance of cultivating passion/romance and sex within the relationship and to be mindful (weary?) of the appealing aspects relationships which lead to a loss of passion.

One thing which I teach my clients which was not included, but is consistent  with the advice given, is that love will involve heartbreak. Usually people think of this in terms of the break-up. I don’t. You partner will unintentionally and thoughtlessly eventually hurt you–and you will likewise unintentionally and thoughtlessly hurt your partner. We are a flawed species whose survival instinct occasionally leads to selfishness. One needs to be able to endure being heartbroken occasionally–and be capable of forgiveness–in order to maintain a relationship. The trick is knowing when the rewards of the relationship are worth the heartbreak and when they are not.

Love is as Necessary…

I received this fortune in a cookie the other day and it reminded me of Maslow’s hierarchy of needs. In common discussion the basic needs are discussed as “food, water, and shelter.” And I suppose this is true to a large degree. But really all the body needs to subsist is food and water. Shelter prolongs life, but we can endure exposure to a lot of “the elements” before it kills most of us. We tend to have a shorter life span (and certainly a lower quality of life and poorer health) without proper shelter, but most bodies can survive most elements well enough


Social support (also known as “love”) also prolongs life (and improves the quality of life and health). However, we rarely refer to love or social support as a basic need on par with food and shelter. There is abundant research that shows that people with social support have better health and longer life spans than those without social support. It is largely considered that the presence of social support is one of the factors contributing to married people and people who are involved in churches having longer life spans and better health. One of the most remarkable (and earliest) studies is known as “Harlow’s Monkeys.”

In this study Harry Harlow studied the effects of separating infant primates from their caregivers. The most famous of this series of experiments had infant monkeys choose between spending time with a wire surrogate mother which provided milk and another surrogate mother which was made of a soft cloth but did not provide milk. The infant monkeys clung to the cloth mother and climb on her, going to the wire mother only for sustenance and then immediately returning to the cloth monkey. He also discovered that lack of meaningful interaction with an adequate mother figure left the infant monkeys with social dysfunction throughout childhood and into adulthood.

When I teach General Psychology at the university I teach Maslow’s hierarchy of needs. Within his theory he divides his sets of needs into “D needs” and “B needs.” B Needs are the needs that make us human and fully actualized, but are not considered basic for survival. The D Needs are the needs which he claimed without fulfillment we will fail to thrive. I have never seen a text book which put Belongingness-Acceptance-Love-Support as a B Need, but rather in the category of the more essential D Needs.

It would seem intuitive that social support is essential for “survival” of primates, yet this is something that almost runs counter to the “rugged individualism” of American culture. We have fostered a general value of self-sufficiency, including emotional support in many people’s minds. I continue to be amazed by the number of people who come into my office and when I ask them “who do you turn to when you are upset” respond “no one” or “myself.” However, not one of these people has expressed that they do not want to experience social support—many of them do report of fear of (depending on) it though.

I have learned through my practice that one of the best gifts one can give another is to quietly sit with that person when that person is in pain. Our tendency is to deflect or try to problem solve. But there is great power in just sitting. There is great comfort in knowing that we can be vulnerable, weak, or sad in the presence of another and they will not reject us for it. It simply fosters a sense of acceptance—also known as love.

There seems to be a perverse tendency of people to not reach out of support from others out of fear of rejection. I say perverse because one chooses to not have support (by not reaching out) than to risk not receiving social support. This basically boils down to assuring the worst outcome option through not trying. Failing to reach out actually rarely prevents us from experiencing a sense of rejection anyway. I acknowledge that reaching out for support is full of pitfalls, but not reaching out is simply a pitfall of sorts in itself.

Genetic Root of Many Mental Disorders

A recent study showed genetic linking among autism, attention deficit disorder, bipolar disease, schizophrenia and major depression. The researchers noted the overlap of symptoms among these disorders and suggest that the disorders may be more like a continuum than five distinct disorders.

When I was in graduate school we discussed the artificiality of distinguishing one diagnosis from another, though it does provide for a heuristic to understanding symptom clusters—and provide for insurance reimbursement. I only provide a diagnosis to clients when they need it, either for insurance reimbursement or for their own piece of mind, instead focusing on symptom clusters (rather than syndromes) and severity.

Hopefully, as we learn more about the role of genetics in mental disorders this will improve the ways in which we treat them both pharmacologically (the biology of the disorder) as well as with psychotherapy (the circumstances that triggered the genetic predisposition)—and even learn when and how to engage in preventive psychotherapy to pre-empt the onset given a genetic predisposition.