For Parents, Health Professionals, and Educators

The following are facts that will help you to prevent, address, or treat eating disorders or dysfunctions in your child, student, patient, or loved one.

Myths about healthy eating

• Food is fattening.
• Fat is unhealthy for the body.
• Dieting and restricting food is the best way to lose weight.
• It's okay to skip meals.
• Nobody eats breakfast.
• Food substitutes such as Power Bars and Slim Fast are okay to take the place of meals.
• Meals are to be served, not eaten, by parents.
• Exercise can keep a person slim and fit. You can never overdo a good thing.
• Being fat is about being unhealthy, unhappy and unattractive. It must be avoided at all costs.
• Fat-free eating is healthy for eating disorders.
• A meal is anything you put in your mouth around mealtime.

Myths about eating disorders

• Once anorexic, always anorexic. Like alcoholism, eating disorders are not curable.
• People with anorexia are easy to identify. They are noticeably skinny and don't eat.
• Once an anorexic has achieved a normal weight, she is recovered.
• An eating disorder is about eating too little or too much.
• Parents are the cause of their child's eating disorder.
• Eating disorders affect only adolescent girls.
• People lose weight using laxatives and diuretics.
• Physicians can be counted on to discover and diagnose an eating disorder.

Things you need to know about children at risk for eating disorders

• Of the currently more than 10 million Americans afflicted with eating disorders, 87 percent are children and adolescents under the age of twenty.
• The average age of eating disorders onset has dropped from ages 13-17 to ages 9-12.
• In a recent study, young girls were quoted as saying that they would prefer to have cancer, lose both their parents, or live through a nuclear holocaust than to be fat. 81% of 10 year olds are afraid of being fat.
• The US Dept of Health and Human Services task force reports that 80% of girls in grades 3 to 6 displayed body image concerns and dissatisfaction with their appearance. By the time girls reached the 8th grade, 50% of them had been on diets, putting them at risk for eating disorders and obesity. By age 13, 1o% had reported the use of self-induced vomiting.
• 25% of first graders admit to having been a diet.
• Statistics show that children who diet have a greater tendency to become overweight adults.
• Childhood obesity is at an all time high, afflicting five million children in America today, and with another six million on the cusp.
• Early puberty and the bodily changes that go along with it have become a primary risk factor for the onset of eating disorders. It is normal, and in fact, necessary, for girls to gain 20 percent of their weight in fat during puberty.
• The number of males with eating disorders has doubled during the past decade.
• By the age of five, children of parents who suffer with eating dysfunctions demonstrate a greater incidence of eating disturbances, whining and depression.
• Adolescents with eating disorders are at a substantially elevated risk for anxiety disorders, cardiovascular symptoms, chronic fatigue, chronic pain, depressive disorders, infectious diseases, insomnia, neurological symptoms, and suicide attempts during early adulthood.
• A study of 692 adolescent girls showed that radical weight-loss efforts lead to greater future weight gain and a higher risk of obesity.
• Eating disturbances in your very young child may be the result of anxiety, compulsivity, or the child's imitation of significant adult role models. Issues of control, identity, self-esteem, coping and problem solving are what drive adolescent and adult eating disorders
• 50% of American families do not sit down together to eat dinner.

Things you need to know about eating disorders and their effects

• The number of people with eating disorders and subclinical eating disorders is triple the number of people with AIDS.
• Eating disorders are the most lethal of all the mental health disorders, killing and maiming between six and 13 percent of their victims.
• Increasing numbers of married and professional women in their twenties, thirties, forties and fifties are seeking help for eating disorders that they have harbored secretly for twenty or thirty years. Eating disorders are not restricted to the young.
• Disordered eating is rampant in our society. On American college campuses today, 40 to 50 percent of young women are disordered eaters.
• Osteopenia is common in adolescent girls with anorexia nervosa. It was found that despite recovery for over one year, poor bone mineral accrual persists in adolescent girls with AN in contrast to rapid bone accrual in healthy girls.
• In a recent study, it was determined that estrogen-progestin did not significantly increase BMD compared with standard treatment. These results question the common practice of prescribing hormone replacement therapy to increase bone mass in anorexia nervosa.

Parenting Issues

• Many parents fear that through honest intervention with their child about food and eating, they could make matters worse or lose their child's love. They worry that they may interfere with their child's privacy and developing autonomy by stepping in to rectify an eating problem in the making. Parents need to recognize that a problem cannot be resolved unless and until it is identified and confronted.
• Some health professionals believe that parents do not belong in their child's treatment for eating disorders. Professionals' concerns about the issues of separation/individuation and protecting the child's privacy too frequently blind them to the need to educate and guide parents, through the family therapy process, to become mentors to their child, supportive of recovery efforts. The most successful separation takes place through healthy bonding.
• "Anorexia Strategy: Family as Doctor" - "When a teenage girl develops anorexia, a team of experts usually takes charge of bringing her back to a normal weight, while her parents stand on the sidelines... The goal of the therapy is to mobilize the family as a whole in a fight against the eating disorder." Dr. James Lock, assistant professor of psychiatry at Stanford School of Medicine. The New York Times; June 11,2002.
• Too many or too few parental limits imposed during the growing up years deprive children of the opportunity to internalize the controls they need to ultimately learn to regulate themselves. These children may eventually turn to an eating disorder to compensate; nature abhors a vacuum.

next: Over-Exercising: What Happens When Exercise Goes Too Far?
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Culture has been identified as one of the etiological factors leading to the development of eating disorders. Rates of these disorders appear to vary among different cultures and to change across time as cultures evolve. Additionally, eating disorders appear to be more widespread among contemporary cultural groups than was previously believed. Anorexia nervosa has been recognized as a medical disorder since the late 19th century, and there is evidence that rates of this disorder have increased significantly over the last few decades. Bulimia nervosa was only first identified in 1979, and there has been some speculation that it may represent a new disorder rather than one that was previously overlooked (Russell, 1997).

However, historical accounts suggest that eating disorders may have existed for centuries, with wide variations in rates. Long before the 19th century, for example, various forms of self-starvation have been described (Bemporad, 1996). The exact forms of these disorders and apparent motivations behind the abnormal eating behaviors have varied.

The fact that disordered eating behaviors have been documented throughout most of history calls into question the assertion that eating disorders are a product of current social pressures. Scrutiny of historical patterns has led to the suggestion that these behaviors have flourished during affluent periods in more egalitarian societies (Bemporad, 1997).It seems likely that the sociocultural factors that have occurred across time and across different contemporary societies play a role in the development of these disorders.

Sociocultural Comparisons Within America

Several studies have identified sociocultural factors within American society that are associated with the development of eating disorders. Traditionally, eating disorders have been associated with Caucasian upper-socioeconomic groups, with a "conspicuous absence of Negro patients" (Bruch, 1966). However, a study by Rowland (1970) found more lower- and middle-class patients with eating disorders within a sample that consisted primarily of Italians (with a high percentage of Catholics) and Jews. Rowland suggested that Jewish, Catholic and Italian cultural origins may lead to a higher risk of developing an eating disorder due to cultural attitudes about the importance of food.

More recent evidence suggests that the pre-valence of anorexia nervosa among African-Americans is higher than previously thought and is rising. A survey of readers of a popular African-American fashion magazine (Table) found levels of abnormal eating attitudes and body dissatisfaction that were at least as high as a similar survey of Caucasian women, with a significant negative correlation between body dissatisfaction and a strong black identity (Pumariega et al., 1994). It has been hypothesized that thinness is gaining more value within the African-American culture, just as it has in the Caucasian culture (Hsu, 1987).

Other American ethnic groups also may have higher levels of eating disorders than previously recognized (Pate et al., 1992). A recent study of early adolescent girls found that Hispanic and Asian-American girls showed greater body dissatisfaction than white girls (Robinson et al., 1996). Furthermore, another recent study has reported levels of disordered eating attitudes among rural Appalachian adolescents that are comparable to urban rates (Miller et al., in press). Cultural beliefs that may have protected ethnic groups against eating disorders may be eroding as adolescents acculturate to mainstream American culture (Pumariega, 1986).

The notion that eating disorders are associated with upper socioeconomic status (SES) also has been challenged. Association between anorexia nervosa and upper SES has been poorly demonstrated, and bulimia nervosa may actually have an opposite relationship with SES. In fact, several recent studies have shown that bulimia nervosa was more common in lower SES groups. Thus, any association between wealth and eating disorders requires further study (Gard and Freeman, 1996).

Eating Disorders in Other Countries

Outside the United States, eating disorders have been considered to be much rarer. Across cultures, variations occur in the ideals of beauty. In many non-Western societies, plumpness is considered attractive and desirable, and may be associated with prosperity, fertility, success and economic security (Nassar, 1988). In such cultures, eating disorders are found much less commonly than in Western nations. However, in recent years, cases have been identified in nonindustrialized or premodern populations (Ritenbaugh et al., 1992).

Cultures in which female social roles are restricted appear to have lower rates of eating disorders, reminiscent of the lower rates observed during historical eras in which women lacked choices. For example, some modern affluent Muslim societies limit the social behavior of women according to male dictates; in such societies, eating disorders are virtually unknown. This supports the notion that freedom for women, as well as affluence, are sociocultural factors that may predispose to the development of eating disorders (Bemporad, 1997).

Cross-cultural comparisons of eating disorder cases that have been identified have yielded some important findings. In Hong Kong and India, one of the fundamental characteristics of anorexia nervosa is lacking. In these countries, anorexia is not accompanied by a "fear of fatness" or a desire to be thin; instead, anorexic individuals in these countries have been reported to be motivated by the desire to fast for religious purposes or by eccentric nutritional ideas (Castillo, 1997).

Such religious ideation behind anorexic behavior also was found in the descriptions of saints from the Middle Ages in Western culture, when spiritual purity, rather than thinness, was the ideal (Bemporad, 1996). Thus, the fear of fatness that is required for the diagnosis of anorexia nervosa in the Diagnostic and Statistical Manual, Fourth Edition (American Psychiatric Association) may be a culturally dependent feature (Hsu and Lee, 1993).

Conclusions

Anorexia nervosa has been described as a possible "culture-bound syndrome," with roots in Western cultural values and conflicts (Prince, 1983). Eating disorders may, in fact, be more prevalent within various cultural groups than previously recognized, as such Western values are becoming more widely accepted. Historical and cross-cultural experiences suggest that cultural change, itself, may be associated with increased vulnerability to eating disorders, especially when values about physical aesthetics are involved. Such change may occur across time within a given society, or on an individual level, as when an immigrant moves into a new culture. In addition, cultural factors such as affluence and freedom of choice for women may play a role in the development of these disorders (Bemporad, 1997). Further research of the cultural factors influencing the development of eating disorders is needed.

Dr. Miller is an associate professor at James H. Quillen College of Medicine, East Tennessee State University, and is director of the university psychiatry clinic.

Dr. Pumariega is professor and chair of the department of psychiatry at the James H. Quillen College of Medicine, East Tennessee State University.

next: Eating Disorders: Do Body and Food Issues Differ by Culture?
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This information sheet has been formulated to assist in the implementation of the NHS and Community Care Act 1990. The contents are, however, applicable to all services, present and future, provided for people with ADHD.

Factors to be considered during assessment of people with ADD/ADHD

ADD/ADHD is a perplexing life-long disability, believed to be caused by organic brain damage rather than emotional trauma. The spectrum of autistic conditions covers a wide range. It varies from profound severity in some through to subtle problems of understanding in others of apparently average or above average intelligence. ADD/ADHD often occurs with other learning difficulties.

People with ADD/ADHD have a disability characterised by a triad of impairments as follows:

• absence or impairment of two-way social interaction
• absence or impairment of comprehension and the use of language and non-verbal communication
• absence or impairment of true flexible imaginative activity, with the substitute of a narrow range of repetitive, stereotyped pursuits

This disability leads to related problems which may include:

• resistance to change
• obsession or ritualistic behaviour
• high levels of anxiety
• lack of motivation
• inability to transfer skills from one setting to another
• vulnerability, and susceptibility to exploitation
• depression
• challenging behaviour
• self injury

Additional Specifications for the Provision of Care Services for People with ADD/ADHD

People with ADD/ADHD need and the service should provide:

1. individual and detailed IPPs (Individual Pro- gramme Plans)
2. detailed and specific strategies to achieve social interaction, communication and independence skills
   highly planned structured activity
3. appropriate staff levels to implement the strategies and provide staff support in all areas
4. an appropriate physical environment

The service and the staff should provide:

1. consistency and stability in the environment and in all interaction
2. continuous external motivation and positive intervention

The service also needs to provide:

1. a support system to handle and relieve staff stress
2. specialised staff training providing both an induction programme and an ongoing pro- gramme to reinforce and update the needed staff skills

The staff role is crucial in enabling people with ADD/ADHD to participate more fully in everyday life. Staff need a thorough understanding of the underlying impairment and to be attuned to the way the person with ADD/ADHD sees the world.

The staff training programmes should aim to provide:

1. an ability to understand and interpret the verbal or non-verbal communications of the person with ADD/ADHD
2. an ability to translate situations, events and concepts, into language that can be understood and grasped by the person with ADD/ADHD
3. a sensitivity in the recognition of anxiety levels
4. skills in the managemen

NHS and Community Care Act 1990

1. t and reduction of challenging behaviour
2. recognition of the value of repetitive reinforcement and the ability to make careful use of structure in order to counteract the lack of motivation inherent in this disability

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medical.problems.associated.with.anorexia.and.bulimia

The most common reason for death amongst those with anorexia is heart failure, while the most common reason amongst those with bulimia is rupturing in the intestinal area as well as heart failure. Unfortunately, because eating disorders are constantly glamorized by society, many aren't even aware of the internal and external damage that inevitably occurs from these self-destructive demons. Hopefully this list of medical complications will help you or someone you know see just why it's a grEAT idea to get help ASAP.

anorexia

Thermoregulatory problems: Loss of body fat creates it so that the body has no way of insulating and keeping heat anymore. For the person with anorexia it seems like everyday, even if it is 85 degrees, is freezing. This can also be due to electrolyte disturbances from not eating properly.

Decreased eye movement

Insomnia: Mostly due from electrolytic disturbances and hormonal problems

Anemia: Poor blood from not enough iron; causes lack of vitality and problems with bruising frequently

Dental erosion: Yes, your teeth will rot with anorexia even if you do not purge. Most of those with anorexia do not get enough calcium in their diets and because of this the body begins to find calcium elsewhere and takes it out of body parts such as the bones but also the teeth. The teeth are stripped of the calcium and become weak.

Delayed gastric emptying: The tone of the stomach area becomes poor and weak so that it cannot produce the power to push out whatever food the person with anorexia does eat. This can lead to a lot of toxins building up inside which also weakens the immune system and leaves the person with anorexia susceptible to many more viruses.

Diarrhea: Also from the delayed gastric emptying, but can also be because of laxative abuse.

Dehydration

Acidosis:Blood becomes too acidic, which can lead to other sicknesses

Osteoporosis: Bones become significantly weakened, leaving the person with anorexia susceptible to broken bones from just falling out of bed.

Bradycardia: Slow/irregular heart beat.

Dysrhythmia: Heart out of rythm; sudden death

Edema: Occurs from not eating properly and also purging; there is a water retention imbalance which causes the feet and hands to swell

Ulcers

Amenorrhea: Indicates a failure of hypothalamic-pituitary-gonadal interaction to produce cyclic changes in the endometrium resulting in menses. In other words the periods stop or do not start. Primary amenorrhea is the absence of menarche by age 16 and Secondary amenorrhea is the absence of menarche for more than 3 months.

Metabolic problems - Hypocalcemia: Low blood glucose levels from too low of weight and malnutrition. Signs of this include listlessness, jitteriness, and seizures.

Lanugo: A soft downy hair/fur begins to grow to try to insulate heat because the body does not have enough calories to burn to produce heat.

Decreased cardica muscle, mass chamber size, and output: This often leads to cardiac arrest

Hypkalemia: Deficiency of potassium

Dry skin

Brittle nails

Weak hair that often falls out: Along with dry skin and brittle nails this consequence is a result of not enough fat in the diet.

Urinary tract infections: Decreased fluid intake is the cause of this.

Loss of potassium: Can result in diminished reflexes, fatigue, and cardiac arrythmias.

bulimia

Thermoregulatory problems: Those with bulimia also have this problem. Electrolytic imbalances from purging usually cause the person with bulimia to have erratic temperature changes, so that one minute they are feeling warm and the next getting shivers and cold chills.

Insomnia: Mostly due from electrolytic disturbances and hormonal problems

Anemia: Purging wipes out precious iron from the person with bulimia's system.

Dental erosion: If the person with bulimia does not come forward about their problem, then most likely their dentist will spot it. The acid in our intestines that digests our food comes up when the person with bulimia purges, slowly deteriorating the enamel that protects the teeth. A dentist is able to spot this easily for the fact that many of them have had to go through specific courses when in dentistry school, which has given them a list of problems with the teeth caused specifically from repeated vomiting. The way the food and acid splash up against the teeth leaves a certain pattern that is the trademark of repeated vomiting. The constant erosion of the teeth usually leads to the enamel slewing off, and as a result, lots of cavities. It's not uncommon to hear of someone with bulimia to end up dealing with more than one root canal in their lifetime.

Ruptured blood vessels in the eyes

Paratoid swelling: Glands in the throat and mouth become irritated and swell.

Esophageal tears: The constant heaving of stomach acid eventually causes the stomach lining to wear off. The added pressure from purging also adds into this, and the person with bulimia stands a great risk of tearing their esophagus which leads to hemorraging and even rupturing of the esophagus.

Delayed gastric emptying: The tone of the stomach area becomes poor and weak so that it cannot produce the power to push out whatever food someone with bulimia eats. This can lead to a lot of toxins building up inside the body which also weakens the immune system and leaves the person susceptible to many viruses.

Chronic diarrhea and/or constipation : Those with bulimia often abuse laxatives, which can cause them to forever have diarrhea. In severe cases the person eventually loses all control over their bowels as well, forcing them to have to wear some form of a diaper.

Dehydration

Acidosis: Blood gets too acidic which can lead to other sicknesses

Osteoporosis : Bones become significantly weakened, leaving the person susceptible to broken bones from just falling out of bed.

Bradycardia: From purging, things called electrolytes become imbalanced. Electrolytes help control your heart's beat among other things, and once they are off balance your heart rate will suffer - most likely dropping too low.

Dysrhythmia: Sudden death from potassium levels being too low.

Edema: Bloating and water retention

Ulcers: The stomach lining slews off the more you throw up. Pretty soon the stomach has no protection against its acids, and the stomach acid starts to burn holes through the stomach. Eventually an ulcer forms and often becomes infected (think puss and germs - not pretty).

Amenorrhea: Some people think that you can only lose your period if you are underweight, but this is not true. Purging can seriously mess up a person's hormones which can lead to missing periods.

Metabolic problems - Hypocalcemia

Hypokalemia

Dry skin

Brittle nails

Urinary tract infections: Dehydration is common in those with bulimia, and bladder infections can become an often problem.

Loss of potassium : Purging, laxative, and diuretic abuse is a big factor into this. All three of these things causes vital fluids to be lost and creates the potassium levels of those with bulimia to drop dangerously low, setting them up for heart failure.

Chronic sore throat: Not fun to wake up every morning feeling like you have strep throat.

next: Prevention of an Eating Disorder Relapse
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I'm finally realizing that recovery is about being rather than doing.

When I am being love, my heart is full and giving.

When I am being serenity, my heart is peaceful and relaxed.

When I am being kindness, my heart extends itself to others.

When I am being compassionate, my heart hurts with another's pain.

When I am being affirmation, my heart speaks the language of encouragement and unconditional acceptance.

When I am being peace, my heart has a calming affect on my environment.

When I am being meditation, my heart is attuned to God's creative force.

When I am being joy, my heart sings and dances with lightness.

When I am being emotionally present, my heart is unified with another's.

When I am being thoughtfulness, my heart makes choices based on awareness and wisdom.

When I am being courage, my heart thrills to life's unexpected pleasures.

When I am being forgiveness, my heart is able to make amends.

When I am simply being, my heart is whole; my life is wonderful.

next: Meditation

Self-Therapy For People Who ENJOY Learning About Themselves

Do you think you know Michael Jackson well?
How about Bill Clinton?
Oprah Winfrey? Julia Roberts? Adolph Hitler?

We think we know these famous people quite well even though we've never even shared a cup of coffee with them. They are too well known to be understood.

The same thing happens with popular ideas.

In the United States, for instance, we think we know all about what a democracy is. We even think we live in one (while we actually live in a republic). Democracy is too well known to be understood.

In psychology, "self-care" is like big celebrities and grand ideas. It's too well known to be understood.

SELF-CARE

Self-care means always taking full responsibility for our own safety and warmth.
Each part of this definition needs to be looked at carefully.

ALWAYS?

Since we are the only person who is always with us, we need to ALWAYS be our own caregiver.

FULL RESPONSIBILITY?

It is wise and healthy to allow good people to take care of us sometimes.

It feels great to imagine that someone else is fully in charge of our care.

But if their mood changes dramatically or if they get called away suddenly we need to know immediately that we can continue to feel safe and warm on our own.

We only imagined that they were fully in charge of our care. They were just a temporary substitute for our own good internal parent.

We were always fully responsible ourselves.

SAFETY AND WARMTH?

How do we know when we are safe enough and warm enough?

It would be accurate to simply say "we know it when we feel it," but for a more complete understanding we need to think about when we were infants.

Adults need to feel just as safe and warm as infants do. To feel safe, we need enough-but-not-too-much food, air, heat, water, exercise, rest, and elimination.

Of course, we also need to be away from physical danger.

And to feel warm we need plenty of kind attention.

SAFETY?

Feeling safe seems a lot more complicated when we get older.

Driving a car, violence in the culture, physical addictions, and many other aspects of adult life must be handled.

But all of these can be covered under one umbrella: Do we want to live and do we want to live well?

If we are certain, down deep, that we want both of these things we will almost always be able to find a way to stay safe from real threats.

Our survival instinct is enormously strong.

WARMTH?

Getting emotional warmth in adult life also seems more complicated.

Most of us think that getting enough warmth isn't our job, it's the job of our closest friend or our primary partner.

This thinking comes naturally from our experience of being a small child, and it needs to be changed when we grow up.

Our closest friend and primary partner in adulthood is our self! It is our own job now to find enough good people to get close to.

If we don't do it, it won't get done.

SAFETY OR WARMTH?

Once in a while we will have to choose between safety and warmth.

The most common example is when we live with someone who threatens violence.

Another very different example is when we are angry at our children for dangerous play. Regardless of the reason for the conflict between safety and warmth, we must always choose safety.

If your partner is violent, get away from them - regardless of how warm they are at other times.
If your kids are playing in traffic, scream at them to get the hell back in the yard - regardless!

SELF-CARE PROBLEMS WE ALL HAVE

Even if we had excellent parents who kept us safe and warm ninety-five percent of the time, we still need to learn how to do it for ourselves, and how to keep improving as our circumstances change.

And when we are tired or sick or lonely or feeling weak in any other way, we will notice at least a little resentment about having to do it ourselves.

But most of us quickly accept that we do have to do it, and we do what we need to do.

SELF-CARE PROBLEMS MANY PEOPLE HAVE

Many people had parents who neglected, abused, or continually shamed and terrified them.

They may never have felt well taken care of as a child, even for an instant.

Although they somehow found a way to survive, they did not get what they needed to thrive.

As adults, they deeply resent having to be their own internal parent, and they aren't good at it.

They still need someone who feels like a good parent to them.

And when parent-starved people receive enough safety and warmth from parent substitutes (usually an extremely loving partner, a patient and caring therapist, or both), they actually become better at taking care of themselves than those who had good parents to start with!

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: The Basics

women and sex

A man often feels in love when he is really only in lust. He then declares this lust-love too early in the relationship for the woman involved. What does this quick declaration of love (lust) accomplish? It scares the woman rather than enhancing the budding relationship. The woman fears any man who could fall in love that quickly will be just as quick to fall out of love.

One man told me he always starts a date by deciding if he just wants a roll in the hay or if he is interested in a little longer relationship. This decision determines his actions.

Men can easily engage in sex without love or commitment. "Getting lucky" is considered a desirable state by men. It often doesn't even matter who they "get lucky" with.

Since men use sex as the road to make an emotional connection as well as totally divorcing sex from emotional connections, and women use emotional connections as the road to sex, some serious translating is needed when it comes to sex in our society.

Remember

Both men and women should remember this: when you feel you are right and he/she is wrong, and you degrade the other person for his/her feelings about sex, you block almost any chance of forming an intimate relationship with the opposite sex.

Women can take comfort in the fact that men act in stereotype, masculine ways to feel more secure about their masculinity. They do not act in masculine ways merely to frustrate women.

One thing men don't handle too well is rejection. I'm talking sexual rejection.

next: Men and Sexual Rejection

women and sex

Although the spread is narrowing, there are some basic sexual differences with men and women that make it very hard for women to understand men and sex and vice versa. Bearing in mind there is always that scope for individual variety, here are some almost universal truths about men that women most often fail to understand:

• They daydream about sex with various partners and in various situations.
• They masturbate while indulging these fantasies.
• They add spice to lovemaking by fantasizing about someone other than the current sexual partner.
• The same men who use sex to express love can and will use sex manipulatively and for no other reason than for sex itself.

Most men have times when they just want sex for the physical sake of sex itself without the entanglement of a relationship. Sometimes a man just wants a woman's body. She can be asleep or drunk or even watching television; he doesn't even care.

There was an expression during World War II that explains this thought process: "Throw a flag over her face and do it for Old Glory!"

Women often wonder, "Why would a man pay for sex when it is easily obtained for free in our society?" The fact is that the man will pay because he is only interested in "getting in and getting out," quickly, and without any other involvement. This way of thinking is practically incomprehensible to a woman.

But even more incomprehensible to a woman is that a man can have sex with a woman he does not love at noon and then expect sex from a woman he does love in the same afternoon. Women can not understand this total separation and then total merger of sex and love.

There is another reason men can divorce sex and love. Males reach the peak of their sexual energy in their teens.

This means males seek sex long before they are mature enough for any enduring intimacy or relationship to form. Thereafter, for many years, or at least until a man's sexual vigor wanes with age, this high sexual energy threatens to disrupt any relationship that does form.

How many times has a man told you he's in love with you ... on the first date?

next: More Sex Truths About Men: Lust and Lucky

women and sex

Women are probably even more of a puzzle to men than men are to women.

Even though women are important to men, they live in this mysterious other world of menses and babies and rampant emotions and even tears that men can't or don't want to understand.

This man who is notoriously poor at figuring out his own feelings is even worse at figuring out the feelings of a woman. Just deciding what a woman wants from him in general is fraught with danger.

Many men see sex, though, as a way to get close to women, and possibly, even a way to please them. The fact that they are usually wrong, of course, doesn't stop a man from thinking sex can make everything right with his woman. A cure-all of great proportions... "All she needs is a good f___ ," is a common solution to male/female problems for many men.

Very seldom is that what she needs but that is another story...

next: Sex Truth about Men That Women Rarely Understand: Fantasy, Masturbation

About LEVITRA

LEVITRA is an FDA-approved oral prescription medication for the treatment of erectile dysfunction (ED) in men. It is available in 2.5 mg, 5 mg, 10 mg, and 20 mg tablets and is taken only when needed. Take LEVITRA no more than once a day.

What LEVITRA does:

LEVITRA helps increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. Once a man has completed sexual activity, blood flow to his penis should decrease and his erection should go away.

LEVITRA has been clinically shown to improve erectile function even in men who had other health factors, like diabetes or prostate surgery.

LEVITRA provided first time success and reliable improvement of erection quality for many men. Men reported having harder erections and improved overall sexual experiences.

LEVITRA works:

In major clinical trials in the general ED population, LEVITRA improved the quality of erections for a majority of men.

A lot of guys who took LEVITRA were satisfied the first time they tried it.

It's for the guy who needs a little help once in a while and the guy who needs more frequent help.

LEVITRA safety and side effects

Do not take LEVITRA if you:

• Take any form of medication known as "nitrates" (a type of medicine used to relieve chest pain that can occur as a result of heart disease). Taking LEVITRA in combination with nitrates (such as nitroglycerin, isosorbide mononitrate, and isosorbide dinitrate) may result in serious side effects.
• Take medicines called "alpha-blockers" (sometimes prescribed for prostate problems or high blood pressure). Taking LEVITRA with alpha-blockers may drop your blood pressure to an unsafe level.
• Your doctor determines that sexual activity poses a health risk for you.
• You have a known sensitivity or allergy to any component of LEVITRA.

The most common side effects with LEVITRA are:

• Headaches
• Flushing S
• tuffy or runny nose

LEVITRA may uncommonly cause:

• An erection that won't go away (priapism). If you get an erection that lasts more than 4 hours, get medical help right away. Priapism must be treated as soon as possible or lasting damage can happen to your penis including the inability to have erections.
• Vision changes, such as seeing a blue tinge to objects or having difficulty telling the difference between the colors blue and green.

These are not all the side effects of LEVITRA. For more information, ask your doctor or pharmacist.

LEVITRA should not be taken more than once a day. Your doctor can advise you whether LEVITRA is appropriate for you and can select a dose that is right for you.

Remember, LEVITRA does not protect you or your partner from sexually transmitted diseases including HIV. Before using LEVITRA, you should tell your doctor about any medical problems you have and all medications you are currently taking.

How LEVITRA works

The active ingredient in LEVITRA works specifically on the chain of events that occur in the penis during arousal.

LEVITRA belongs to a class of drugs called "PDE-5 inhibitors." It works by increasing blood flow to the penis to improve erectile function.

In clinical trials, LEVITRA was shown to help men get and keep an erection for successful intercourse.

LEVITRA won't cause an embarrassing, instant erection. For most men, LEVITRA did not cause an erection for longer than they were sexually stimulated.

Clinical proof that LEVITRA works

In an extensive clinical trial program that included more than 50 trials and involved more than 4,400 men with erectile dysfunction (ED), the results of one or more of these clinical trials showed:

• LEVITRA provided first time success and reliable improvement of erectile function for many men.
• In a broad patient population, LEVITRA helped up to 85% of men with erectile dysfunction achieve improved erections.
• Men reported having harder erections and improved overall sexual experiences.
• What's more, LEVITRA has been clinically shown to improve erectile function even in men who had other health factors, like diabetes or prostate surgery.

Men taking nitrate drugs, often used to control chest pain (also known as angina), should not take LEVITRA. Men who use alpha-blockers, sometimes prescribed for high blood pressure or prostate problems, also should not take LEVITRA. Such combinations could cause blood pressure to drop to an unsafe level.

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