The ADHD Woman's Guide To Intimacy: No more shame, no more guilt!

1. 0:00 – 1:56

   Trailer

   1. SPSpeaker0:00

      Female ADHD can have huge difficulties. Anorgasmia is a distraction, that not feeling right, that sensory zone that has to be right for somebody to be able to carry through to orgasm. And men as well. There are erectile difficulties with performance anxiety. One thing is focus. What about the distraction, just losing their moment? Karen Doherty is a leading ADHD couples therapist who's helped thousands of people with ADHD. She's here to discuss ADHD and how it affects intimacy in your relationship. It's quite difficult for some people with ADHD to transition from actually what they're doing in order to be able to respond maybe to an initiation, to move into an intimate or sexual mode.

   2. APAlex Partridge0:39

      What would you recommend if somebody is listening or watching and they think, "That sounds like my relationship. We don't perhaps like each other, but we have sex a lot." Is it healthy to maintain a relationship that way?

   3. SPSpeaker0:50

      Well, I would say

   4. APAlex Partridge0:52

      Can I have just a second of your time? If this podcast has helped you understand your brain or made you feel less alone, can you do me one favor? Can you hit the subscribe button? And I'll repay the favor by continuing to book the best and most exclusive conversations on this topic. Please enjoy the episode, and always remember, you're not broken, just different, and you have always been enough. [upbeat music] Karen, welcome back.

   5. SPSpeaker1:17

      Hello, Alex. Lovely to be back.

   6. APAlex Partridge1:19

      Last time you were on, Karen, you suggested that we cover the topic that we're gonna cover today, which is ADHD and how that crosses over with intimacy-

   7. SPSpeaker1:28

      Yes

   8. APAlex Partridge1:28

      ... and sex. And I don't know why I'm quite nervous about this conversation because my parents listen to this podcast. [laughs]

   9. SPSpeaker1:34

      [laughs] I will be reserved, Alex. [laughs]

   10. APAlex Partridge1:37

       [laughs]

   11. SPSpeaker1:37

       I will be very careful. I'll choose my words carefully. [laughs]

   12. APAlex Partridge1:39

       I won't be. Sorry, Mom. I'm joking. [laughs]

   13. SPSpeaker1:41

       Sorry. Yeah, my kids too, but they're used to me, so it's all right. [laughs]

   14. APAlex Partridge1:45

       [laughs] I mean, such a big topic, obviously. Huge, sensitive conversation. Um, I suppose the first question, just to set the foundation,

2. 1:56 – 4:38

   How ADHD impacts sexual relationships

   1. APAlex Partridge1:56

      how does ADHD impact sexual relationships?

   2. SPSpeaker2:01

      So the biggest question first, as usual, Alex.

   3. APAlex Partridge2:04

      [laughs]

   4. SPSpeaker2:05

      Um, uh, there are many ways in which ADHD impacts a relationship and impacts a sexual relationship, impacts the intimacy between two people. Now, I can name... Uh, let's name a few of the traits of ADHD.

   5. APAlex Partridge2:17

      Okay.

   6. SPSpeaker2:18

      Okay? So we've got emotional dysregulation, sensory processing, difficulties with sensory processing, difficulty with transitioning from one place to another, rejection sensitivity dysphoria, um, uh, time blindness, over-focus, distraction, body dysphoria. Um, there, that's just to name a few. Now, of course, not, that one person is not gonna have all of them, um, but they, there, there's a lot in the mix when we're talking about how these, how, how neurodivergence itself is impacted within the, within an intimate, an intimate life.

   7. APAlex Partridge2:57

      Gosh, there's a lot there. Where do we start? W- which trait should we start on?

   8. SPSpeaker3:02

      Well, let's think about, um, let's think about what shows up in the room. All right? So what shows up in the room often, and y- I'm an, I'm a psychosexual therapist, so honestly, if I've got a couple in the room, I've got sex. Whether they're having it or not, there's intimacy. Actually, should we think about intimacy? Would that be helpful to start off with actually how I define intimacy, and how that impacts the couple, and how that actually weaves into the traits of ADHD, and w- you know, how, how they can, how c- how they mix and match? Would that be helpful?

   9. APAlex Partridge3:40

      Sure. What is your definition of an intimacy? And I suppose the, the bigger question is, how is that different to sex?

   10. SPSpeaker3:46

       Oh, it's completely different. Um, so intimacy, it's, there are many, many different types of intimacy. Okay? We've got psychological intimacy. We have sensual and sexual intimacy. We have emotional intimacy, energetic intimacy, intellectual intimacy. Um, uh, humor, humor i- is a form of intimacy. So you have a panoply of, of, of, of different, of different types of intimacy that couples or people in... Well, actually, anybody in a relationship moves between those. They're all facets of a connection. Um, and of course, we know that quite a lot of those will be impacted by ADHD traits. So it's not that, um, it, everybody has difficulties, but perhaps there are just, uh, a few more potholes around where ADHD is concerned.

3. 4:38 – 10:26

   Difference between love & limerence

   1. APAlex Partridge4:38

      With ADHD, you seem to get incredibly excited in the early stages of a relationship, and I suppose at that stage, is it possible for somebody to love bomb somebody? Uh, what I mean is, h- is it, is it possible to be confused with loving someone and just being overwhelmed by all of the stimulation that having that hyperfocus on one particular person is giving you?

   2. SPSpeaker5:07

      Definitely. So the limerence of that, of those early, early months, early years sometimes, that intensity is really experienced by ADHD. Uh, it's, it's almost, it's almost as if you've met your twin flame or your soulmate or your missing piece. I mean, it's that intense, the oxytocin, the dopamine. Everything's bubbling up there. And, uh, it's, it's intense. And that happens in a lot of relationships, most relationships, but with ADHD that experience it in the, in the way that they do, then it's, um, it's easy to think that maybe this is the love of your life.Um, my experience around this is, yes, it goes on for quite a while. If the, it... And this is your, I think this is your question, is how do you know when that sort of first flush or limerence is, is over, and how do you know whether that is going to transition into something more serious? Um, and that's, that's really the, the, the tipping point, isn't it? Whether it's love or not. You talk about love bombing, I mean, that's a classical sort of early, early doors response to being, to, to having met your soulmate, to having met [laughs] the one that's g- that your missing piece. It's an early response. Um, but I think, I think that transition is sometimes difficult. But in, in relationships, I see a lot of people who talk about this, they're couples, that talk about this period as being, I mean, it was magical, absolutely magical, and something came in and broke the spell. Not just that they got fed up with each other, because relationships take about two years to either gel or break. Okay? You probably know after a certain age that something is going to stay or not stay after two years. So with the ADHD, it's quite difficult making that transition when a third person or a third thing comes into the relationship, and that's what breaks the limerence, and then you know whether actually, is this love? The other aspect to this, and it was so interesting that you're talking about this, was yesterday, only yesterday, I, I was, I was talking to a couple and, um, a young woman in her 30s was saying, "I don't really know if I'm in love. I don't really know if this is love. How do I know if this is love?" And it really got me thinking about how, you know, sometimes female ADHD just has real difficulty identifying, naming what it feels, understanding that what they feel, can they relate that to love? So it's quite complex for some people. I mean, she's got three children and they're married, but [laughs] but she's not quite sure that she's in love. [laughs] So it, it's, it's a, it's a, you know, it's a, it's a mixed bag there, isn't it?

   3. APAlex Partridge7:57

      What kind of thing could come in and be that third-party source that breaks that limerence? Like, I think last time you said perhaps a child, like a pregnancy. But are there, are there other, other blind spots-

   4. SPSpeaker8:09

      Oh, yeah

   5. APAlex Partridge8:09

      ... other things that can really derail that in-

   6. SPSpeaker8:11

      Yeah

   7. APAlex Partridge8:11

      ... that limerence that they might not see coming?

   8. SPSpeaker8:14

      The biggest, the biggest one is work, isn't it? The biggest one is career traject- trajectories, especially where ADHD is concerned, because work is such a driver. And so work, career, redundancies, anything that happens around work can, uh, really distract, can really detract from the relationship. And once that happens, then you know whether there is... Well, then you, then I think when you transition from the, from the fantasy into the reality, that's when you sort of know whether you, you, you are in love or not.

   9. APAlex Partridge8:45

      We talk a lot on this podcast about the boom and bust cycle that many people with ADHD go on, and the classic example is you can get super excited, almost obsessed, hyper-focused with some thing, or in this case, someone, and that can last for some months, and then it can drop off very quickly. And the pattern of that happening time and time again, how that can affect someone's self-esteem. They can truly start, I guess, believe that they are incapable of following through or sticking at something. And in the, in the context of relationships, can somebody who experiences this, I suppose, limerence and then drop off time and time again, can they begin to believe that they are unlovable?

   10. SPSpeaker9:29

       Yes. Sadly, they can. That drop off, um, is, is quite a negative place. Um, it's a distraction. It's something else that they've, they've experienced. They've moved off to somewhere else. It's also the biggest problem within, within relationships. Even if somebody has decided to stay in a relationship, it's the biggest problem, isn't it? Because the other, the other half of the relationship feels as if they don't exist sometimes. Um, so yes, I think that can add in, but you mentioned something there that's very interesting. And talking about self-esteem, and I do believe that self-esteem is something that, um, is, is, is very, is, is developed very late in life for a lot of neurodivergent people.

   11. APAlex Partridge10:12

       Karen, you mentioned earlier that there were a list of ADHD traits that could impact people in the bedroom.

   12. SPSpeaker10:20

       Yeah.

   13. APAlex Partridge10:20

       And I, I think you said a, a transitional phase and having an issue with that.

   14. SPSpeaker10:25

       Yeah.

   15. APAlex Partridge10:25

       What did you mean by that?

4. 10:26 – 14:21

   How to manage transition difficulty

   1. SPSpeaker10:26

      I mean that it's quite difficult for some people with ADHD to transition from actually what they're doing, um, in order to be able to respond maybe to an initiation, to move into an intimate or sexual mode. That transition can be really tricky. [laughs] And if they're not expecting it, you know, that, it can be a bit of a curveball and, "No, I'm not ready for that. I don't like that." Or maybe they have high sensory, sensory, uh, high sensory difficulties in that they're not quite ready for that. They haven't prepared themselves. They're not clean, or they haven't had hair wash, or their teeth aren't cleaned, and no, no, no, no. Or somebody sort of tried to initiate that transition with, um, a touch that has actually hurt or turned them off. Partner has no idea, but that's what happens. So that's what I'm talking about, you know, being able to transition from one phase to another.

   2. APAlex Partridge11:17

      Does the transition need to be over a longer period of time, rather than, say, you know, you're sat on the sofa watching a film and one half of the partner makes a move-

   3. SPSpeaker11:27

      Mm

   4. APAlex Partridge11:28

      ... and the oth- and it's met with a, "Nope, not in the mood." Okay, fair enough. Does the transition need to be over a longer time period, so you need to start being quite flirtatious early in the day?

   5. SPSpeaker11:37

      Yes.

   6. APAlex Partridge11:37

      Little touches throughout the day perhaps. You know, putting on a nice aftershave, whatever it is. If the transition is over a longer period of time, so it feels less jarring, is that a counter to that issue that some people have with the transitional period?

   7. SPSpeaker11:51

      It is definitely one of themYou know, slow but sure, connecting up during the day, just that exactly as you describe, a slower approach. Um, but the other, I mean, I advocate actually sort of notice period [laughs] as, you know, sort of scheduling sex. Loads of my couples don't, they don't schedule time to have a chat, let alone sex. So it's not a bad thing for a couple who might need time and time and thought, um, to get ready for sex, to actually may have, maybe have an intention. And I'm not saying they have to have the intention to have sex, but maybe there's something about scheduling just time together, intimate time together. Doesn't have to end in sex, 'cause that, of course, will agitate the performance anxiety, make everybody more, more agitated, especially if somebody doesn't feel in the mood, so doesn't want it. So just creating an intimate space, um, is helpful. It's helpful, and there is, there's an intention to create that which may lead into something more.

   8. APAlex Partridge12:51

      That's interesting because the, the advice that I've been told by numerous people over the years is that, be spontaneous, and, and the idea of kind of scheduling intimacy or scheduling sex is quite icky. But I suppose if, perhaps if you are somebody who likes routine and you don't like surprises, or if spontaneity is going to trigger your issue with transitional periods-

   9. SPSpeaker13:16

      Yeah

   10. APAlex Partridge13:16

       ... then stop being spontaneous. Start putting something in the daily planner. [laughs]

   11. SPSpeaker13:22

       I hate to say it-

   12. APAlex Partridge13:23

       [laughs]

   13. SPSpeaker13:24

       [laughs] But yes. I, I have a lot of fun with this, the spontaneity. You can see clients' faces change, especially men. Not spontaneous. You're gonna lose all the spontaneity. And then the next question is, "Okay, when did you last have sex? Spontaneous sex?" Well, maybe it was a while ago. [laughs]

   14. APAlex Partridge13:41

       [laughs]

   15. SPSpeaker13:41

       I rest my case.

   16. APAlex Partridge13:43

       Yeah.

   17. SPSpeaker13:43

       Wouldn't it be better if there was some sort of, you know, scheduled intimate space, intimate time, and maybe, maybe you'd get lucky a bit more often? [laughs]

   18. APAlex Partridge13:51

       [laughs] W- w- just trying to think of my, uh, my diary now. I can see the, the slots-

   19. SPSpeaker13:57

       Whiteboard

   20. APAlex Partridge13:57

       ... filling up. [laughs]

   21. SPSpeaker13:58

       You know I'm called the Whiteboard Witch.

   22. APAlex Partridge13:59

       [laughs]

   23. SPSpeaker13:59

       Okay, have you got it on the whiteboard, Dan? [laughs]

   24. APAlex Partridge14:02

       Yeah.

   25. SPSpeaker14:02

       Where is it scheduled? 'Cause couples often have to plan, and so where is it on the... W- which part, which, which day is it on? Yes. It, it, it... I know it sounds horrible, but it works, particularly so as everybody's working so hard, k- kids in the mix, um, just the pressure, just the pressure of life.

5. 14:21 – 17:00

   Sensory issues during intimacy

   1. APAlex Partridge14:21

      What about sensory processing? You mentioned earlier. It, it... Can, can touch be unwanted sometimes? Can it sometimes feel like a cactus? Like, can-

   2. SPSpeaker14:30

      [laughs]

   3. APAlex Partridge14:30

      ... can, can that groove be going, you could be getting in the mood, and then you kiss them on the neck or you, or s- or something happens and it's like an instant jar-

   4. SPSpeaker14:37

      Oh

   5. APAlex Partridge14:37

      ... because there's some sensory process issue happening simultaneously?

   6. SPSpeaker14:41

      Totally. It is a problem. And so I... I- if I'm working psychosexually with couples, or even if I'm, we're just having a chat about their intimate life, you know, the sensory processing in ND is, is, is, is very, it's very heightened. Um, the more that the couples understand this, the easier it gets. You know, a tickle, just a stroke, it's ticklish. No, I don't like that. The kiss on the neck, nope, nope, I don't like being kissed. P- people can't kiss. It's too intense. But it's all about communicating that. It's all about sitting down with a glass of wine and saying, "Right, this is what I don't like." 'Cause if that doesn't happen, people, it gets very confusing for people. They feel rejected. Oh my goodness, I'm doing it wrong. And that's not just the ADHD part of the couple, that's the other person as well who starts to feel, "I don't know what to do. I don't know how to do this. I, all, all my, all my tricks are not working. [laughs] What, what next?" And so they become shy, and disconnected, and withdrawn, and we know that the ADHD person needs a particular frame of mind to actually want sex i- in the norm, when we're talking about couples. I'm not talking about, you know, outside of the couple, but within the couple. So it, it, it, it really needs to be managed.

   7. APAlex Partridge15:58

      Mm. Uh, is it about having an awareness of what your sensory sensitivities are? Like, are there any blind spots, like a particular lighting, or a scent, or-

   8. SPSpeaker16:10

      Yeah

   9. APAlex Partridge16:10

      ... a type of fabric on the bed that-

   10. SPSpeaker16:13

       All of that. All of that is a big part of it. So if I go back to my scheduling intimate time, do we think about what sheets are on the bed? Do we think about how we're dressed? Do we think about is there, is there, I can't stand that candle, let's not put that on. Do I like that lighting? No, I don't like that lighting. It's an opportunity. It's an opportunity for people to play and for people to get to know each other. But I want to add something in here, because I think it's really important and it's, it's, it, it... We all have to take responsibility for knowing ourselves, so we have to know our own bodies. We have to understand what we like, what we don't like. We'd have to, without shame, we need to know our own bodies so that we can share them with somebody else, and I think this is particularly relevant with neurodivergence

6. 17:00 – 22:12

   The trouble with orgasms

   1. SPSpeaker17:00

      and all the quirks and, and, and difficulties and sensory perceptions that can be very confusing, not only for that person, but for their partner.

   2. APAlex Partridge17:10

      We're a community that feel different and have felt misunderstood for, for, for many, many years, and I've spoken to a lot of women and men in the community who have actually, in the bedroom, struggled to reach an orgasm, and I wonder if what we're talking about plays a part in that. Can you be such an over thinker, such a person who perhaps has sensory stimulation or sensory s- sensitivities but doesn't realize, and that's actually interfering in your ability to focus and be in the zone enough to, to reach that O?

   3. SPSpeaker17:45

      Definitely.Definitely. I mean, a female ADHD can have huge difficulties. Anorgasmia is, is really quite a common presentation. You know, the distraction, the not feeling right, all of the things we've just talked about in that, uh, that, that sort of sensory zone. That has to be right for somebody to be able to, to carry through, to see through to orgasm. And men as well, I mean, don't like to think about this too much, but there, uh, there are erectile difficulties with performance anxiety, erectile difficulties with distraction that just lose... You know, one thing is focus. What about the distraction, just losing their moment off somewhere and it's not working? So all of those things play a big part, which is why one of the first exercises I will do as a sex therapist [laughs] is to get people thinking about where they come from. That's obviously part of it, their me- their early messaging around sex and if there was shame or whether it was able to be talked about in their, in their family. But the next thing is actually, what about you? Do you... How m- how well do you know your body? And if you know your body well, then let's sit down bet- with the all three of us, and let's see how you both can exchange that information. Uh, and it's fascinating 'cause somehow, because I've demystified it and normalized it, people can be really honest, and it's safe. Uh, and it's a, it's a great exercise to do.

   4. APAlex Partridge19:09

      Surely it can lead to impotence, and perhaps in, in women it's like a, a complete lack of arousal.

   5. SPSpeaker19:16

      Yes.

   6. APAlex Partridge19:17

      Is, is, is it just about being totally honest and communicating with your partner over a period of time and slowly becoming comfortable enough to, to deal with the sensory sensitivities that maybe are causing you emotional blockages for you to reach that state of arousal?

   7. SPSpeaker19:32

      Yeah, definitely, the blockages. It is all about communication, but it's also about psychoeducation, isn't it? Knowing, "Okay, I'm emotionally dysregulated. I'm out of sync now. This might not work for me. My executive function's all over the place, and now I'm, now I'm thinking about the shopping list. What's happening?" Uh, the body dysphoria, huge in, um... It's huge in neurodivergent folk, actually. There's a real, there's a real difficulty in accepting bodies, and because perhaps they are basically distasteful to them, you know, squidgy fat, um, funny toes, just not liking bodies very much, and then i- i- interjecting that into their own, "Oh, no, I can't show my body." How difficult is that to, you know, make love or have fun with somebody who actually do- is not comfortable in their own body at all?

   8. APAlex Partridge20:20

      It seems to be a bit of a, a contradiction because you have to spend enough time and perhaps years or months with somebody to feel comfortable enough to have these conversations for you to address the blockages that are stopping you from reaching that state of arousal. But many, some people with ADHD, heightened impulsivity, perhaps are somebody who might go out and meet somebody and perhaps get intimate quite quickly before they have had a chance to feel comfortable enough to deal with those conversations, and therefore they might not perform in the bedroom. They might not get an erection, or, or they might not get aroused. And can that lead to, like, a feeling of, "I must be broken"? Like, "What is wrong with me?"

   9. SPSpeaker21:06

      Uh, yes, I think that's... I think it's very confusing for people who, um, can work very well outside of their relationships but can't work in their relationships, but that's the nature of it, isn't it? You know, spontaneous sex, uh, visu- particularly for men, visual attraction, risk, impulsivity. Yes, and women too, actually. I don't know why I'm calling it a male thing. It's men and women, they can both do exactly the same. They can go out on the razz, and that's great. Um, it's when they bring it into the bedroom, and it's a, it's, it's, it's a far more emotionally complex relationship, and that's where the difficulties come in. That's where the, that's where the, the, the perceived shame or the difficulty in being present come in because, you know, casual sex is casual sex. It doesn't really require an awful lot of being totally present or necessarily consideration for the other. Performance can take over, and that's, that's... You know, it's done and dusted. But it's that, it's when you, it's when you move into the couple relationship, when you move into something that's a bit more, that's, that's not as transitory, actually, and needs n- it needs

7. 22:12 – 23:14

   Tiimo advert

   1. SPSpeaker22:12

      more thought.

   2. APAlex Partridge22:12

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8. 23:14 – 28:45

   RSD in the bedroom

   1. APAlex Partridge23:14

      Where does RSD come into the conversation? Because obviously intimacy is an extremely vulnerable thing. You're opening yourself up to somebody that you, you, you might know very well or you might not know well at all. And I suppose how that is met, what happens in the immediate aftermath, if you're not flooded with praise or affection, anyone would suffer with that. Like, "Did I perform badly? What's wrong with me?" But if you have RSD and you're not met with an overtly positive response-After sex. Like, how devastating can that be?

   2. SPSpeaker23:53

      Well, I, I think there's ... I think you've got, I think you've got two categories of that. You know, the spontaneous, impulsive, performance-orientated sex, I don't think that's as, as ... It, it, the RSD is not necessarily as pronounced in that type of sex because there ... it's not complicated. The RSD within a, within a more serious connection is, it's rife. You know, one, one, one small criticism, one rejection perhaps, God forbid, that, you know, you're not in the mood, all of that stuff can really g- can really hit in and, uh, leave people feeling as if they're not good enough to have the sex, and if they were, then how do they do it? It's a big part of, um, the reciprocation, the, the sort of back and flo- the flow of sex. And that RSD, if it gets triggered, it's gone, and everyone's left thinking, "Now what?"

   3. APAlex Partridge24:45

      You mean if the RSD is triggered mid-sex?

   4. SPSpeaker24:48

      Yeah.

   5. APAlex Partridge24:49

      What could happen to trigger it mid-sex?

   6. SPSpeaker24:52

      Oh, lots of things. Somebody could just ... Somebody might say, "No, I don't particularly want that." And it's gone, isn't it? And they, they may not have any idea that, and then no intention to criticize, no intention to be negative, just perhaps wanna change it, wanna change position or something, and that would just, wow, that ... the RSD's triggered, and then it's over. Pract- it's practically over. And then the shame of that and the d- discomfort of that for both people is really, you know, it's, it's, it's profound. That can have a big impact on relationships. I often see couples that come in, and they, they've literally stopped having sex. Um, ADHD's been in the mix. Um, not necessarily that they don't know about it now, all right, but they haven't known about it for a long time. And those, those sort of, those, those micro, tho- those micro hits, if you like, to their intimacy have accumulated and accumulated and accumulated, and they've, they've sort of given up on sex. They've given up on trying to create, to, to connect with each other. Had a, a, a couple that, uh, was, uh, did exactly that, and they were living abroad. They had no sex for years. And, um, they came into the, to the room and talked about this, and they both yearned for sex, but they didn't know really how, what had gone wrong. Had no idea. He's come back to the UK, and he was being diagnosed. He got diagnosed. And they were really wanting to kickstart their relationship. Now, two neurodivergent pieces to this, okay? One ADHD, and the other one's slightly AS. Um, so y- you've gotta be very aware of how those two conditions, uh, uh, coalesce. Um, and it was really difficult at first because it'd been so long since they'd done it, that actually there was, the, the, the fear, the anxiety of actually trying to do, to have sex was too much. And there we come into the process of the, the Sensate Focus program that I use, a slow, gradual approach to reintroducing sex. And the, the, the sort of spark came back over the months. It was, took a long time, six, nine months, but actually the spark came back, and all of the misunderstandings that occurred while there were no diagnosis were worked through, and it made a difference. Oh, that's what it is. I am good enough. It's not that. It's, oh, it's the ADHD. It's that knowing and being able to contextualize what's happened and what you can do going forward to avoid that same sort of hurt, rejection, criticism, and withdrawal.

   7. APAlex Partridge27:23

      Can the RSD or the fear of being triggered be so intense that you actually end up pushing love away?

   8. SPSpeaker27:31

      Yes.

   9. APAlex Partridge27:31

      By, you detect, you, you sense, you perceive a threat is on the horizon, and rather than wait for it to attack and for you to feel that visceral, instant, horrible pain that RSD causes, i- is, is it safer to sometimes break the relationship up yourself? Almost you take control, put yourself in the driver's seat, and get out of it before RSD can get you?

   10. SPSpeaker27:55

       I think that happens in relationships. I think that the RSD is so acute that if it is triggered over and over again, then there is a definite withdrawal. I'm g- I'm gonna withdraw from this. I'm gonna put ... I'm gonna get out of this before this hurts anymore. And I think a lot of relationships have felt, fallen foul of that when they don't understand the process. They might have ended early, or, um, they've ended acrimoniously.

   11. APAlex Partridge28:21

       Karen, how many ADHD female clients do you think you've seen in your therapy room over the years?

   12. SPSpeaker28:27

       Well, probably thousands. I mean, it's been a very long time, and I'm not saying that I would've recognized it as clearly as I do now, even though it was a woman that got me first thinking about ADHD, full stop. Um, so yes, many, many, many, many.

9. 28:45 – 29:35

   How ADHD impacts sex drive

   1. APAlex Partridge28:45

      And out of those many, have you noticed a, a pattern in the sex drive that they purport to talk about? Any, any patterns amongst your clients?

   2. SPSpeaker28:55

      So I think they fall into two camps. There's either people who really like sex, and, uh, actually the creativity, spontaneity, that's all part of their, part of their gift, and they just can carry on and do it. And then there's the others that actually find it very difficult. All of the, all that we've talked about, all that we've spoken about with the, you know, very, very difficult sensory experiences that go on, the, the distraction, the anorgasmia, um, difficulty p- maybe even vaginismus sometimes. There's lots of, lots of pitfalls actually for female ADHD and sex, um, especially when, especially if undiagnosed. [laughs]

10. 29:35 – 32:07

    Vaginismus

    1. APAlex Partridge29:35

       Vaginismus, I think I know what that is, but describe that to me.

    2. SPSpeaker29:39

       Vaginismus is where the, um, vaginal walls have frozen. They've, they've ... It's, it's a mind, it's a, it's a, it's a brain thing. The, the rejection of any sort of, um, intercourse is being, is, is ... The, the, the walls of the vagina have just closed up. They won't, they won't let in, [laughs] if you like. And that is, that's done in response to trauma or fear or anxiety or pain or fear of pain, and it's a, it's a psychological phenomenon that actually, yes, vaginismus, that's very difficult to, um, to undo in many c- in many pla- in many women.Um, I'm not saying that it's particularly an ADHD thing, but I have seen ADHD women with vaginismus

    3. APAlex Partridge30:22

       Is it ... I mean, w- in terms of ... 'Cause I, I've, I've ... I know it. I've heard it mentioned lots, and I wonder ... We know being neurodivergent in itself is very traumatic-

    4. SPSpeaker30:33

       Mm

    5. APAlex Partridge30:34

       ... um, the, the 20,000 horrible comments that we experience. And I know that's un- unrelated, but what past events in somebody's life could lead to vaginismus?

    6. SPSpeaker30:44

       Trauma. D- I, well, and I say trauma. What past events? There could be ... It's a, it's a very odd, it's a very odd question, because actually we never know what triggers somebody into a space where they've psychologically closed down. We don't really know. Um, obvious- there's the obvious ones of some sort of abuse or perceived abuse, coercive, coercive behavior. Um, but it could actually be something like high sensory perceptions, being outraged, and actually I can't do that anymore, and the whole brain, body mix just freezing, just closing down. I can't go there. I can't do it. Um-

    7. APAlex Partridge31:20

       And can that compound in somebody who perhaps already thinks that they are broken or that-

    8. SPSpeaker31:24

       Yes

    9. APAlex Partridge31:24

       ... there's something wrong with them-

    10. SPSpeaker31:26

        T- yes

    11. APAlex Partridge31:26

        ... and then they have this as on top of that?

    12. SPSpeaker31:27

        Yes. Yes, very much so. So it's a, a combination of it all together, definitely.

    13. APAlex Partridge31:32

        What about their partner? Because it, their partner may think it's their job to, to, male or female, to g- to s- find arousal in their partner, and there's this block. That could they blame themselves for-

    14. SPSpeaker31:44

        Yes

    15. APAlex Partridge31:44

        ... the lack of arousal?

    16. SPSpeaker31:45

        Yes, they can blame ... Well, no, not even the lack of arousal. They could even blame themselves for, "Was I the reason that actually caused this terrible reaction in somebody?" Um, but there, there's, the, it, there is a process for vaginismus. Um, there is, there is treatment for vaginismus. There is help for it out there. So, yeah, yeah. But I think, I think people should seek the help. I really do think they should.

11. 32:07 – 37:09

    When sex becomes a mask to save the relationship

    1. APAlex Partridge32:07

       Have you seen couples come to you that perhaps they're, there's something toxic going on in the relationship? They're not good for each other, however, there is this glue that's holding them together, and that glue is sex?

    2. SPSpeaker32:19

       Yes, I see it. I've seen it. I've seen it quite a lot actually. It's an interesting question, this one, because, uh, I think the relationships, there are, there are many relationships that, uh, that sex is a glue, and it is a way of, of getting through the relentless years. If they can touch base and have sex, then maybe they can, you know, rally together to get through th- those years of kids, and jobs, and redundancies, and house moves, and all of that. But it's a very interesting piece, isn't it? When people are using it as a glue, and actually the relationship is really bad. And I, I, I ... Yes, I've recently had a case where actually they carried on having sex even though the relationship was extremely toxic. Now, interestingly, in, in response to the relationship being extremely toxic, the more ADHD part of the couple became quite desperate to make sure that the relationship was okay and became very, very, very hypersexual, if you like, and wanted to have sex a lot, and that was more to, that was more to soothe rather than to actually have sex. And the partner withdrew, slowly, slowly, slowly. Even though it had been okay to keep the sex together when they were re- ticking the relationship over, as the relationship got worse, as the need to touch base became more intense, so she just actually withdrew, withdrew, withdrew, and she got to the point where that, that she could not have sex at all, at all with that person. It was quite sad.

    3. APAlex Partridge33:53

       Can the relationship be incredibly contradictory if sex is the only thing that's holding you together? Because obviously sex is a very intimate act, however, if the t- if the relationship is weak, and toxic, and not good outside of the bedroom, can the optics of that be so far away from the togetherness that sex creates? Can you be completely together in the bedroom and yet so, so distant outside of it?

    4. SPSpeaker34:18

       I think you can. And, and interestingly, I think with neurodivergence, that's, um, that's not such a difficult call, 'cause being present and actually physically having sex can be split off from the outside, outside of the bedroom. It can. It's, it's ... It, it ... You know, we have a, we have a tendency, there's a tendency to be able to focus in on something, on the present, and the past, well, that was yesterday, and maybe that's tomorrow, but actually we're here and now. Okay, well, we can do that. So I think, [laughs] I think it can happen-

    5. APAlex Partridge34:51

       [laughs]

    6. SPSpeaker34:51

       ... quite easily with our, with our neurodivergent, uh, folk, yeah.

    7. APAlex Partridge34:55

       So what would you recommend if somebody is listening or watching and they think, "That sounds like my relationship. Actually, we don't get on or we don't perhaps like each other, but we have sex a lot, and we, we love the chemicals, and we love the feeling afterwards"? But is it healthy to maintain a relationship that way? Is it masking some terminal problems?

    8. SPSpeaker35:13

       Well, I would say i- i- the case that I've just described to you, I would say that that would happen. If it was so bad, if the relationship was really bad, I would say that one or the other would have to withdraw. They wouldn't be able to tolerate the sex. It would then ... The, the, the outside would permeate the bubble of sex. So, um, that, that's, I think, how that would play out in the end. But, you know, it's not a bad thing if, if it's sex that keeps people together through the really hard da- hard years. It's okay. You know, the relationship can be okay. The sex can be good enough. That's not a bad recipe for those, those middle years, the relentless years that, you know, life can take its toll, and if people can still connect, and it makes their life, it makes the couple work a little bit better, the, you know, the wheels work a little bit better, then I don't think it's a bad thing. I think it's, I think it's possibly a good thing. And don't forget, there's always that possibility of a complete reset later on down the way when the kids are older, and, uh, that can be a complete opportunity for something completely new, and ADHD's great at that

    9. APAlex Partridge36:17

       How do you keep sex interesting and exciting, Karen, as, as perhaps you age together and-

    10. SPSpeaker36:22

        Yeah

    11. APAlex Partridge36:22

        ... kids come into the mix?

    12. SPSpeaker36:24

        That's what I'm saying. You have to, it, th- those, those relentless years, they have to be good enough. So you have to, you have to make sure it, there has to be intention. Somehow communication and intention are the two things that, that maintain intimacy. Communication and intention. Communication and intention. And those two things get lost. I mean, I can't tell you how many times I say this to a couple. You're doing everything. You're working really hard. You're l- you know, you're making beautiful homes. You're looking after your kids. All the kids want is to see you two happy, and you don't, you two don't even see each other. Because of the, the, the drive to work, the drive to get on, the drive to keep everything perfect sometimes, especially with ADHD, and the priority of the couple just drops off the, the, the top shelf.

12. 37:09 – 39:39

    Sexual OCD

    1. APAlex Partridge37:10

       Can you describe sexual OCD to me?

    2. SPSpeaker37:13

       Well, sexual OCD is, is a, is a, it's a subdivision of, uh, of OCD, and it's where there are, um, there are really d- really, um, pernicious thoughts that come into mind, sexual activities, um, sexual positions, pe- inappropriate sex, and it sort of, it, it sort of grows. And, uh, the, the, the point is that it's at odds with one's values. So it sets up this awful dissonance, and then, then you have, then you have the anxiety created by all of that and compulsive behaviors to try and quell the anxiety. Um, and it can be quite prevalent in neuro d- diversity, you know. It feeds straight into that rumination, that constant overthinking, that constant revisiting, catastrophizing. It feeds right in there. So I think, yes, it is, it is, it is something that we have to be aware of, especially if we're working with, um, uh, especially working in a couple, and making sure that there's enough communication around that between the two partners.

    3. APAlex Partridge38:16

       Some of the thoughts, some of the obsessive thoughts, you've mentioned sexual positions or things that you, m- that might be distant from what you know to be right.

    4. SPSpeaker38:27

       Yes.

    5. APAlex Partridge38:28

       Can those perhaps be fantasies that you don't know about?

    6. SPSpeaker38:32

       Uh, yeah, they can be fantasies, but they still trigger the same shame. They still trigger the same anxiety. They still trigger, you know, that, that sort of fear of one's self, and that has, uh, dramatic effects on, um, ADHD or AS with that, with that potential to overthink all the time. And the catastrophizing, the negativity, so it's all rolled up into a ball that just... Actually, it's a shackle, isn't it? You're, you're, you're tied up in it, and it's very difficult for people who are, who are in that mindset to get out of it, to get any, any peace.

    7. APAlex Partridge39:07

       And the obsessive thoughts, positions, d- does that ever cross over into reality?

    8. SPSpeaker39:14

       So I'm gonna separate, I'm gonna separate OCD and what we're talking about with all sorts of sexual practices. And I think that the neurodivergent community are really good at alternative sexual practices. It can cross over really easily. And with consent and creativity, I think it brings a whole new, whole new flavor to peop- to, to, to sex.

    9. APAlex Partridge39:36

       We mentioned before, Karen, that s- some people struggle

13. 39:39 – 42:07

    AuDHD intimacy

    1. APAlex Partridge39:39

       with transitional periods, and I suppose the ultimate transition is perhaps a relationship ending and then you meeting somebody new and deciding to get intimate with somebody new. But that transition, can that present unique challenges for somebody who perhaps is AuDHD?

    2. SPSpeaker39:53

       Oh, very much so. Very much so. Um, on the one hand, the ADHD could be really excited about that and stimulated by the change and the difference and the, the risk and the impulsivity, but the AS might be slightly more cautious, slightly more used to routine and, uh, set timings and set positions, set smells, set... You know, they may be much more used to it, so it might be more of a challenge there to get out and, and sort of find new people and actually take that leap of being intimate with them. But again, you know, I do, I do maintain that if you can talk about this stuff, if you can own the neurodivergence, if you can say, "Well, I might be a bit rusty at this," or [laughs] "I might not be quite on the page here," I think it really helps. And people, people really understand it now. I mean, you know, working with youngsters, they're wearing their neurodivergence as a badge, you know that. They're really happy with it. "Yeah, I'm neurodivergent. I'm gonna work for Google." Good on you. Um, so it's, it's, it's, it's, it's getting a bit of that actually into, into the frame so that people can feel more confident going out there and talking about their sort of proclivities, likes, dislikes. We're all entitled to them. And, but it's having the confidence-

    3. APAlex Partridge41:04

       Mm-hmm

    4. SPSpeaker41:04

       ... to be able to chat about them before they scupper you really and then you end up feeling, "Oh, I've, it, I c- I can't do it. There's something wrong with me." So I do urge that early communication is really helpful.

    5. APAlex Partridge41:17

       Speaking of communication, Karen, and confidence, I asked my community what questions they wanted me to ask you on the topic of intimacy and sex.

    6. SPSpeaker41:26

       Ooh.

    7. APAlex Partridge41:26

       And I think they were very confident when they were submitting their questions 'cause I've got three of the most in demand ones to ask you now.

    8. SPSpeaker41:32

       [laughs] Okay.

    9. APAlex Partridge41:33

       So I'm gonna reach over and grab the washing machine of rose-

    10. SPSpeaker41:36

        The washing machine

    11. APAlex Partridge41:36

        ... which is where the audience questions live.

    12. SPSpeaker41:38

        I remember that. [laughs]

    13. APAlex Partridge41:39

        [laughs] We go, uh... Do you remember why it's a washing machine?

    14. SPSpeaker41:42

        It's you, because you leave your washing in the washing machine-

    15. APAlex Partridge41:44

        Yes. Yeah, yeah, yeah

    16. SPSpeaker41:44

        ... and it gets wet. [laughs]

    17. APAlex Partridge41:46

        Yeah. [laughs]

    18. SPSpeaker41:47

        I do remember that.

    19. APAlex Partridge41:48

        It's the weekly reminder for the listeners to check their machines. [laughs]

    20. SPSpeaker41:52

        Get down there and get the-

    21. APAlex Partridge41:53

        Yeah, yeah

    22. SPSpeaker41:53

        ... washing out of them.

    23. APAlex Partridge41:54

        Although the sponsor of the show, the Tiimo app, does remind me, and I am getting better, um, but still a work in progress-

    24. SPSpeaker41:59

        [laughs]

    25. APAlex Partridge41:59

        ... like, like many of us. Um, but this week, Karen, the audience, on the very specific topic of intimacy and sex, have

14. 42:07 – 54:49

    Sex addict or just love having sex

    1. APAlex Partridge42:07

       asked, "I have ADHD. How do I know if I'm a sex addict or if I just love having sex?"

    2. SPSpeaker42:14

       [laughs]

    3. APAlex Partridge42:16

       [laughs]

    4. SPSpeaker42:16

       Okay.

    5. APAlex Partridge42:17

       What a question.

    6. SPSpeaker42:17

       Sex addict. What a question. So what is addiction? Yes. There is a, y- there is a tendency, we haven't talked about porn or the, uh, the, the, the, the place of porn in terms of it being easy, much more easy to use than getting involved in all the mess and pain of sex [laughs] We know that it can bring with all the, the thinking and the, what's needed. So we haven't talked about it, but, uh, uh, ad- addiction, what is addiction, you know? Perhaps you like sex because it is feeding your dopamine levels, because it is, it is providing stimulation, because it is giving you that heady mix. And if that's the case, why don't you recognize it as that, that you're seeking it as stimulation, not part of a relationship? So there's the difference, you know. Sex in a relationship, okay, but maybe if all you're doing is going out and wanting to have sex, then perhaps there's more to it. Perhaps you need to start thinking about how your ADHD is impacting your impulsivity and in, and your se- your seeking out of maybe a lot of sex. I'm not... There's no judgment, but perhaps it's worth working out why you like sex, how you like sex, and do you need that much sex, or can it be translated into a relationship where maybe you might feel calmer and not need so much stimulation?

    7. APAlex Partridge43:37

       Surely that can cause problems perhaps in relationships if you are in a rocky area. And I suppose, I mean, the, the, the, the, the availability of porn, surely if you are somebody who might be susceptible to sex addiction, that seems like the low-hanging fruit to grab your-

    8. SPSpeaker43:51

       Well, which came first? Did the porn come first, or did the sex addiction come first? Which came first?

    9. APAlex Partridge43:57

       But I suppose porn has made the viewing of sex so accessible now.

    10. SPSpeaker44:03

        It has.

    11. APAlex Partridge44:03

        There's no barriers to entry. So if somebody is susceptible to seeking that stimulation, and they're at a rocky patch in their relationship, can that cause problems? Do, do you, do you perceive that viewing of porn is being unfaithful to your partner?

    12. SPSpeaker44:20

        The b- it's... Yeah. It's, it's... I have it a lot. I have this in the room a lot. Um, people come in and say, "He's absolutely addicted. He's a porn addict. He's a sex addict. Um, and it's, it's affecting our, our relationship." So when that happens, all right, you sort of... I, I, I have to do a s- a sort of litmus test. I, is it sex he's after or, or, or she? Is it sex, or is it just the dopamine hit? Is it just the searching for stimulation? And in fact, um, I've had a couple of cases where they have presented as sex addicts on, on porn. Um, b- not sex addicts. They're not out having sex. They're using porn instead of having sex with their partners. And actually, if we've traced it back, it's usually gone back to early doors when, um, their neurodivergence was obviously never recognized, understood, and they started to soothe themselves with masturbation. Then the masturbation turned into porn, then the porn turned into easy, easy access to dopamine. They weren't medicated. They didn't know. There was no diagnosis. That turns into easy stimulation. That then grows and embeds and becomes a habit, and then they come, the couple comes in and says, "Well, we're not having sex," and that is a fact. Not only are they not having sex, they've probably got other issues now in the mix because the porn, the porn habit has embedded so far that it may even be affecting erectile dysfunction. They may not be able to actually see each other properly anymore, actually connect physically anymore. So yes, it is, it is quite a, it's, it's, it's quite a difficult thing to... There's a lot of it around.

    13. APAlex Partridge46:01

        Mm.

    14. SPSpeaker46:02

        A lot.

    15. APAlex Partridge46:02

        I think I'm amazed at how many men I've spoken to who don't see the viewing of porn as being a betrayal to their relationship.

    16. SPSpeaker46:12

        And often their mates won't think it's a betrayal to the relationship. The problem comes when there is no sex, then there's a problem. It- they don't feel betrayed to the porn. They feel betrayed because they're not, that because the porn has taken over from them. Um, and so it's, it's, it's quite couple, couple specific that some people might see it as a sort of betrayal, a semi betrayal. Other, other people are really cool about it. "Yeah, porn is porn, and everybody's accessible, and it's on the phone. I just don't want him not having sex with me," or vice versa, "I don't want her always on her phone n- needing porn and not me." It's not just a, a male thing. It's a, you know, it's pretty equally split actually.

    17. APAlex Partridge46:57

        Mm.

    18. SPSpeaker46:58

        Um, so yeah.

    19. APAlex Partridge46:59

        Like s- surely s- knowing that your partner, male or female, is watching porn, and therefore all of the comparison that comes with that, like, you know, if you're a bloke or a, or a woman-

    20. SPSpeaker47:09

        Yeah

    21. APAlex Partridge47:09

        ... like, "Oh, my boyfriend is seeing these porn stars having sex, and, and he's gonna be comparing their breasts to mine and their-

    22. SPSpeaker47:17

        Yeah

    23. APAlex Partridge47:17

        ... body to mine and their orgasm noises to mine," and, and the, the self-esteem issues that that can cause in a relationship must chip away at, at the, the trust.

    24. SPSpeaker47:26

        Oh, yeah, definitely the trust can break, but it's also the, the, the one who's really, really, um, getting the damage done to them is the, is the continual watcher of the porn.

    25. APAlex Partridge47:36

        Mm.

    26. SPSpeaker47:36

        That is, that is impacting their neural pathways. It's changing the way that they will respond in person. So it is, it is an issue for people to start thinking about and start taking seriously. Um, but the, yeah, the rejection, the sensitiv- yes, of course, all of that comes out, uh, comes off the back of that, and I find it, I, it, it's quite difficult. People, people who come in with this, it's quite easily to, it's quite easy to work with because once it's all been uncovered and un- unpicked, um, then there is a reduction in the use of porn, or they might use a bit of porn together. Um, and there is a more, there's an acceptance of some porn use, but at least they've reconnected.

    27. APAlex Partridge48:17

        Mm. I feel like a lot of women or, uh, and men perhaps just might not have the confidence to bring their partner up on it.

    28. SPSpeaker48:23

        Yes.

    29. APAlex Partridge48:23

        So they might just be silently incredibly uncomfortable that their partner-

    30. SPSpeaker48:26

        Yes

Episode duration: 54:49