People with ADHD tend to have more sex issues than those without ADHD—difficulty focusing during sex, an increased rate of risky sexual behaviors, and a need for sexual novelty. Ari Tuckman Psy.D., MBA, a psychologist, ADHD specialist, and author of three books on ADHD, including More Attention, Less Deficit: Success Strategies for Adults with ADHD, tells us more about how ADHD impacts sex lives—and what to do about it.
What are some of the most common issues people with ADHD face in regards to sex?
People in happy relationships tend to have more sex, but ADHD (especially when undiagnosed and untreated) can negatively impact a couple's happiness. It's hard to feel sexually attracted to and generous with someone that you are angry at. It's also possible that sex just gets squeezed out of the day because one or both partners run out of time or energy.
How often do people with ADHD experience difficulties or stress related to sex?
People with ADHD have the same difficulties with sex as people without ADHD, but perhaps more often or more intensely. I call this the ADHD multiplier: the ADHD multiplies the difficulties, but doesn't really create unique problems that others aren't also experiencing. Many of the sexual problems for these folks isn't about sex per se, but about the relationship struggles that undermine a satisfying sex life.
There is some debate as to whether one can actually be addicted to sex or porn, but what is clear is that people with ADHD tend to have more difficulties with problematic sexual behavior. This can include making impulsive sexual choices, with all the consequences that that can bring. People who are thrill-seekers (such as some people with the hyperactive and impulsive symptoms of ADHD) are more likely to engage in problematic sexual behaviors, including over-using pornography.
What treatments do you recommend for a person with ADHD whose high sex drive has lead to difficulties in their current relationship? Is individual therapy or couples therapy recommended?
Depending on the severity of the situation, it would probably be helpful to engage in both couples and individual therapy, for both partners. I would first want to address the ADHD, probably with medication, and be sure that there are no other conditions here, such as bipolar disorder. I would also want to explore with the client what is driving that high sex drive. For some it's simply that they have a biologically higher sex drive. If this is the case, I would want to work with the couple to help them decide how this is to be handled in the relationship, what kinds of sexual behaviors are acceptable or not, etc. The couple needs to negotiate this out and find a solution that works for both partners. However, if some of that high sex drive comes from the person's attempts to self-medicate and feel better, for example when bored or frustrated, then I would want to work with that client on more effective ways of dealing with uncomfortable feelings and situations.
How often does distraction play into sexual difficulties for people with ADHD, such as difficulty achieving orgasm?
Everybody gets distracted during sex sometimes, but people with ADHD may be more likely. Losing focus during sex can cause men to lose some or all of their erection or for women to lose some of their lubrication and can delay orgasm for both. The important thing, for both partners, is to not make too much out of the distraction or take it too personally. Simply refocus and get back in the game!
Why is novelty, especially sexual novelty, is such a turn-on for the ADHD brain?
People with ADHD will often get bored more easily than others or will more quickly get used to something. Therefore they will seek novelty to re-engage their attention and cause their brain to light up again. Just as it can happen in the classroom, it can also happen in the bedroom. This doesn't necessarily mean that a couple's sex life needs to get forever more intense, but it may be that the couple will need a bigger repertoire of activities, positions, and/or locations that they rotate through in order to keep both partners interested.
A 2010 study by Garcia et al. that found that people with ADHD may be more likely to cheat. What are the factors that you feel may contribute to this increased rate of cheating?
Some of this is probably due to the person with ADHD making an impulsive decision in the moment without a clear intent ahead of time. For example, kissing someone in a bar. However, people in unhappy relationships are more likely to engage in extramarital activities and ADHD (especially when undiagnosed and untreated) can lead to more unhappiness. So sometimes affairs are a way to cope with an unhappy relationship, even though it will often make a bad situation worse.
According to Barkley et al. (2008), people with ADHD are more likely to have sexually transmitted diseases and have more sexual partners. What are some ways that people with ADHD can protect themselves?
I suspect that this is mostly the result of impulsive decision making regarding sexual partners and activities. Also, it often takes some planning and delay of gratification in the moment to practice safe sex. If you struggle with that, you are more likely to have unprotected sex. If you're someone who sometimes engages in unplanned sex, especially with people with unknown STD status, it is important to always have condoms with you--and then to really make a point of using them. It's probably also a good idea to avoid drinking too much or doing too many drugs in certain situations that are more likely to lead to unplanned sex. You may even want to avoid certain situations entirely, because it's too easy to fall into behaviors that you will later regret. Finally, you may find that medication helps you slow down and make better thought out decisions.
Because people with ADHD may have difficulty expressing their sexual concerns or needs to their partner, what are some ways these topics can be addressed?
As in any other relationship, it's important to be able to talk openly and honestly about sexual desires and concerns. However, in order to be able to have good conversations in bed, you have to be having good conversations outside of bed too--and not just about sex, but about all the other parts of the relationship. The better you address the other matters in the relationship, the more generous your partner will be sexually and also the stronger position you are in when discussing sexual matters. If there are too many other unresolved issues in the relationship, your partner isn't likely to be sexually receptive.
How does one go about finding a therapist that specializes in ADHD and sex issues?
That's a hard one! It can be hard enough to find a good therapist who understand ADHD, let alone one who also understands sex. So you may need to first work on your ADHD with one therapist and then work on your sex life with another one.
Ari Tuckman PsyD MBA: www.tuckmanpsych.com
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