May 14, 2025 • 57 mins
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The invisible connection between trauma and sexual intimacy affects countless relationships, yet remains largely hidden in silence and shame. In this episode, we dive deep into why PTSD creates significant barriers to healthy sexual function—even when the original trauma had nothing to do with sex.
Sexual arousal shares remarkable physiological similarities with threat response, creating a devastating paradox for trauma survivors. The racing heart, flushed skin, and heightened sensitivity that should signal pleasure become warning signs of danger to a traumatized nervous system. Beyond the physiological responses, trauma rewires our capacity for connection. Partners often interpret this withdrawal as personal rejection, creating a destructive cycle that leaves both feeling isolated and misunderstood.
If you or someone you love struggles with trauma's impact on intimacy, know that recovery is possible. Effective trauma treatment can help break the association between arousal and threat. Partners play a crucial role by educating themselves about PTSD, creating safety without enabling avoidance, and maintaining patience through the healing process. Digital self-help resources and specialized trauma therapy can provide accessible starting points for reconnecting with your capacity for intimacy after trauma.
**Have you noticed how trauma affects your relationships? Healing happens when we break the silence around these struggles. If you walk to talk through it and get help, book a call with Dr. Kibby.
Resources:
- If you're navigating someone's mental health or emotional issues, join KulaMind, our community and support platform. In KulaMind, we'll help you set healthy boundaries, advocate for yourself, and support your loved one.
- Follow @kulamind on Instagram for podcast updates and science-backed insights on staying sane while loving someone emotionally explosive.
- For more info about this podcast, check out: www.alittlehelpforourfriends.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hey guys, welcome to A Little Help for Our Friends, a
podcast for people with lovedones struggling with mental
health.
Hello, little Helpers.
So some of you may know that Ihave worked at the Bronx VA for
the last eight months, and so Ihave been steeped in trauma
training, and today I wanted tobring a topic that I think is
(00:24):
really interesting and nottalked about enough, which is
the effect of PTSD on sex.
So, um, kibbe and I lovetalking about interpersonal
topics, romantic topics, andthis is one that is so
hyper-relevant to PTSD, but it'snot even a symptom of PTSD,
(00:50):
like it's not a diagnosticcriterion, um, and so I think a
lot of people who maybe are inrelationships with people who
have experienced significanttrauma or who have PTSD
themselves, can be extremelyconfused about why they are
experiencing so much sexualdysfunction.
So that's what I want to talkabout today, but I'm going to
kick it over to Kibbe to talk tous about Glow Mind.
Speaker 2 (01:14):
Thanks.
I'm really excited about thistopic because trauma we've seen
can really affect everything.
It could affect your health,could affect self-esteem, the
way you see the world.
Your health could affectself-esteem the way you see the
world right.
It really has such profoundeffects on someone and we've
been really seeing it inrelationships, whether it's like
anger issues or just problemswith trust or intimacy and I
(01:38):
know that the sexual intimacy issomething that's really
impacted by trauma.
So I'm really excited to hearfrom you all about this.
But if you have a loved one whohas experienced trauma and you
don't know how to help themmaybe it's been tough on your
relationship or vice versa youhave a trauma and it's affecting
your relationship let us know.
(01:58):
We'd love to figure out ways tohelp you.
I have a few spots forindividual coaching in skills
about emotion, regulation andcommunication and setting
boundaries and working throughthe trauma in order to connect
to your loved one or justsupport yourself.
And also we have this amazingcommunity and, because we've
(02:24):
been listening to what you guyswant, we're going to start a
group, so like a weekly class onall these topics so we can
learn from each other and in areally safe and supportive
environment.
So if you're interested in anyof that, check out Kulamind
K-U-L-A-M-I-N-Dcom, or there's alink in the show notes for how
(02:45):
to book a free 30 minute calljust to chat with me about what
you're going through and whatyou might be interested in.
So we also want to do a shoutout to some of you who've
written us messages through theshow notes, like where it says
send us a text.
We got a lovely message.
We've got a bunch, but we got alovely message from someone who
(03:05):
said she's a teacher and shehas listened to our episodes,
has really helped her go througha really hard time, and that
those kind of messages mean theworld to us.
So whoever wrote that, I meanwe you know, annoyingly we can't
write back on that feature, sojust know that we really
appreciate it and this is why wedo what we're doing to help
people like you.
(03:25):
So please send us notes andthank you so much for listening
and being part of our community.
So thank you, teacher.
Speaker 1 (03:33):
Thank you, teacher.
So there's so much to talkabout here because practically
every symptom of PTSD can berelated to sexual dysfunction in
some way, and I think when mostpeople think about sex and PTSD
, they're thinking about sexualassault in particular.
(03:53):
But what has actually beenfound is that the presence or
absence of PTSD is actually themore proximal cause for sexual
dysfunction than trauma type.
Yeah, so that means thatsomebody who has been sexually
assaulted but does not have PTSDis has a lower likelihood of
(04:17):
having sexual dysfunction than,like, a combat vet with PTSD.
Obviously, if somebody has bothsexual trauma and PTSD, then
that's another story, but thepresence or absence of PTSD is
really crucial here For peoplewho might not know what PTSD is.
Speaker 2 (04:36):
can you go through some of the hallmark signs of
post-traumatic stress disorder?
Speaker 1 (04:44):
yeah, so they're.
They're basically symptomclusters.
So one symptom cluster is um,basically like intrusive, like
intrusive um memories or kind ofre-experiencing.
So people who basically it'skind of like you're just going
through your day and thesememories of the trauma keep kind
of intruding on your awarenessthat you're in.
(05:05):
You're trying really, reallyhard to, you know, just to get
through your day, but you're,but you're constantly kind of
ambushed by these thoughts orfeelings.
You may all of a sudden feelsimilarly to how you did when
the trauma took place.
Um, you may have triggers thatremind you of what happened, and
they they're not necessarilydirect triggers, like if, if
(05:29):
there was a fire, you know, youmight actually be triggered by
being on the subway, even thoughthere was no subway in the fire
catastrophe that you were in.
It's just the feeling of beingpotentially trapped or having a
lot of people around orsomething like that.
So then there is this avoidancesymptom cluster, so where
(05:53):
you're really trying to doanything you can to kind of keep
away from the trauma.
So this might mean you avoidthose triggers, but it also
might mean that you avoid anykind of like physical state that
reminds you of the trauma.
So you might avoid being like,um, really like, uh, emotionally
, like aroused, physically, youknow, aroused, which we'll talk
(06:15):
about as relevant to this.
Um, you might be doing a lot ofmental work to try to
constantly distract yourselffrom these memories or these
feelings.
So, um, this is when you'll getpeople who can be very kind of
numbed out or have difficultyconcentrating because, um,
basically, like, if I do anexercise with you right now,
(06:37):
like, hey, kibbe, how many timesin the last month have you
thought about a big yellow Jeep?
How many would you say Zero,okay, cool.
Last month, have you thoughtabout a big yellow jeep?
How many would you say zero,okay, cool.
So for the next 10 seconds Iwant you to do, to think about
whatever you want, but not abouta big yellow jeep one two,
three, four, six, seven, eight,nine, ten.
(07:02):
Did you think about a big yellowJeep?
I did, okay, how many times?
Twice, twice, okay, the rest ofthe time, what were you doing?
Speaker 2 (07:11):
I was trying to focus on your face and and I know the
trap of like I'm like I'mlooking at her face, so I don't
think about a big yellow Jeep.
And then I was like, ah right,I thought about it.
Speaker 1 (07:26):
So when we have, when we have people who are
constantly trying to avoidthinking about something, two
things happen.
One, they think about it more,and the other is they put so
much effort into not thinkingabout it that they're kind of
constantly distracted.
Like if you were to, if youwere to do a math problem while
trying not to think about thebig yellow Jeep, while
(07:46):
concentrating on my face, thatwould be very difficult.
Right, you've got this onestrategy of concentrating on my
face to keep you away from thebig yellow Jeep.
It's going to be hard for youto then concentrate on anything
else.
So you also see that theirworlds become smaller because
they're avoiding trauma triggers.
They're avoiding any place thatmight make them feel the way
(08:07):
they did when they weretraumatized.
Another symptom cluster is likehypervigilance, arousal.
So you might see that somebodywith PTSD gets.
They go from like zero to 60.
So they'll be kind of walkingaround to do and suddenly
they're fucking mad or they'refreaking out or they're really
(08:29):
stressed out, and the reason isbecause they're not going from
zero to 60, they're going from40 to 60.
So that means that they arekind of constantly in a state of
arousal, hypervigilance.
They're kind of always got thislike irritable edge to them, um,
because it's taking so muchwork to detect threat everywhere
(08:50):
and to keep themselves safe andto, you know, not think about
certain things.
It's just it's it's kind ofthrowing the body out of whack a
little bit and so they can havethey can be very easily
startled, um, looking aroundlike um like looking over their
shoulder, kind of constantly,this constant kind of low level
irritability, that kind of thing.
(09:10):
And then beside that you've gotkind of this like negative
beliefs cluster so people canstart to really blame themselves
or blame the world for whathappened, kind of seeing
themselves as inherently dirty,shameful, guilty, worthless, or
(09:35):
the world as like a totallydangerous place.
And then so these beliefs canreally kind of take you as well,
because you're just thinkingsuch negative things all the
time and you're viewing yourselfand the world and others in
such negative ways.
So it's a really tough disorderand all of those symptom
(09:56):
clusters can influence yourrelationships and then also
influence sex.
Speaker 2 (10:05):
Got it, got it.
This is kind of going off topic,but I'm wondering, now that
you're learning so much aboutPTSD and trauma, but yet now
these days, our idea of traumahas really expanded right so
like you know, some people havelike capital T, capital T trauma
(10:29):
of like they were in a war andsome people were, you know, have
had years of criticism fromtheir family and they also have
trauma symptoms or feeling likethey've been traumatized.
Can you have you learned anyany more more about you know,
like what, how we understandtrauma these days?
Because it's now kind of nowit's, it's kind of everywhere.
(10:51):
It's like everything that'sstressful and painful is called
a trauma, and now I hesitate tosay what's a trauma and what's
not a trauma.
But like what are your thoughtson that right now?
I have a bunch of thoughts.
Speaker 1 (11:02):
So one thing you need for a PTSD diagnosis is what we
call a criterion, a trauma, andthat is I'm not going to go
into like everything that thatcould possibly be, but generally
what you're looking for is thatyou have gone through an
experience that was terrifyingor horrifying and that made you
feel powerless, out of controland like your life was
(11:25):
threatened.
And what often happens whenpeople come in for trauma
treatment is that they can feelinvalidated or the therapist can
feel like they are invalidatingby saying no, your experience
of emotional abuse, for instance, or neglect, or your even your
(11:47):
child dying from cancer, is nota criterion, a trauma you
wouldn't meet for PTSD.
And what's important to notehere is that criterion a should
not be understood to mean worse,like watching your child die of
cancer is likely to be theworst thing that can ever happen
(12:10):
to you, worse than beingsexually assaulted, for instance
.
Obviously not saying everybody,but we're really not trying to
categorize traumas as likebetter or worse, or more severe
or less severe.
It's really about what kinds oftraumas are going to lead to
PTSD symptoms Other kinds oftraumatic experiences can lead
(12:33):
to other symptoms, um, but PTSDlike it's, you're probably not
going to have those hyperarousal symptoms and
hypervigilance symptoms fromwatching your child die of
cancer, because that was like aslow process right, where you're
terrified of losing her butyou're not terrified in the same
(12:55):
way.
It's not this like ambush ofterror and, like you know, I
don't know whether I'm going tolive or die, I don't know what's
happening to me, I'm completelythrown out of control.
It's just a different kind oflike emotional process, um, and
so it's going to lead todifferent symptoms.
So like having PTSD does notmean that your trauma was worse
(13:15):
or better.
Um, another kind of thing isI'll talk like when we think
about like early childhood andvalidation, right, right, so
like what's going to lead tosomething like bpd.
Bpd and ptsd are certainly likecomorbid a lot of the time, but
that kind of like persistent,pervasive, like invalidation
(13:38):
through childhood might leadmore into something like a
personality disorder than againthat kind of like hypervigilant,
um, you know, or like numbnessor just basically what you'd see
in PTSD.
And the third thing is that youcan have a criterion, a trauma,
without developing PTSD, and themajor kind of understanding of
(14:03):
that is like, let's say, youknow you were like shot at in
war, like some.
Basically, when you, when mostpeople, go through a trauma,
like a criterion, a trauma,they're going to experience
(14:24):
symptoms of PTSD during thatfirst month or so, but it's not
PTSD.
That's why it actually we don'tgive a PTSD diagnosis until
like 30 days have passed, andthe reason is because it is not
pathological for after you'vebeen traumatized, to be attuned
to threat and to not want tothink about it and you know to
(14:47):
have negative beliefs.
So the difference is that whatmakes it pathological quote
unquote is that it doesn'trecover.
So most people they undergo acriterion, a trauma, they're
able to recover because they'reable to process the experience
of it.
They have loved ones whosupport them, they can cry,
(15:09):
they're held, they get to feelsafe, they get to talk about it.
So they basically go throughthis recovery process.
The people who develop PTSDtypically were prevented from
going through that and it's oneof the reasons you see it a lot
in veterans, because when you'reat war there's no time to
process your trauma.
(15:29):
You have to keep going and youknow like the military is very,
very good at meeting the aims ofthe military, but it's not very
good at turning out healthycivilians because the military
has really really differentgoals and needs than civilian
life does.
So one thing you'll hear fromveterans constantly is they went
(15:51):
through this trauma and theywere told get over it, it's not
that big of a deal, you've gotto move on, push it down, shove
it down, do whatever it takes,keep going.
And they and that's becausethey have to, because who's
going to give you a hug?
Who's going to let you fallapart?
Right, you can't do that inactive combat, and so they are
(16:11):
prevented from going throughthat recovery process and then
they come home and they havePTSD.
Speaker 2 (16:18):
So sad, and also why invalidation after something
like rape is such a problembecause what you really need
(16:40):
after sexual assault is to bebelieved and heard.
Symptoms can affectrelationships.
Intimacy and sex is what we'retalking about Like.
How does it affectrelationships like broadly?
Speaker 1 (16:52):
Yeah, I mean.
well, the way it affectsrelationships is, I mean, I'm
sure, not all in one way, but Imean, I think it'd be hard for
PTSD not to affect relationships, because if you're
fundamentally spending all ofyour time trying to squash down
any triggering memories, thenhow connected can you be?
Right, so I'll just start withthe symptom cluster.
(17:20):
Which one should I start with?
Let's do hyperarousal.
Which one should I start with?
Let's do hyper arousal.
So they're all kind ofinterconnected.
But basically, if you look atsexual arousal and, um, like,
like threat, like threat arousal, ptsd kind of arousal, they
look very, they're very similarprocesses.
(17:41):
So you might get someone whofinds a beating heart and a
flushed face very threatening,because that is how, that, that
those were the physical symptomsthey had when they were
traumatized and any kind ofsense of arousal.
(18:02):
Right, and we know, like I mean, there are experiments where if
you, if you have like aparticipant, watch a video of
like a rollercoaster or do likea VR on a a roller coaster,
they'll like be hornier afterlike there'll be, you know.
So like the there's across-contamination between just
like regular emotional arousaland sexual arousal.
(18:24):
But for these people this iskind of complicated because in a
sense they're alwaysemotionally aroused but they're
also always trying to avoidbeing really emotionally aroused
and so getting into like sexualarousal itself can be, can feel
really threatening.
They start having all of thesephysical symptoms that were
(18:46):
associated with threat anddanger.
And the other thing is thatsexual arousal requires it's
kind of like a bell curve.
So it requires like a certainamount of arousal, a certain
amount of norepinephrine, acertain amount of like limbic
system activation, but once youget past that, then it's an
(19:11):
inhibitory.
So you know, this is like we seethis when, um, we think about
the, the model of the dualcontrol model.
So if you've got like you'vegot breaks and the gas pedal
with sexual desire, and ifyou've got too much on the
brakes, meaning like if you'retoo stressed out, if you're too
(19:31):
tired, um, if you're too angryto whatever, like you're not
going to want to have sex, thoseare like the breaks.
But at the same time you wantlike some excitement, some
novelty, some fun, some arousalto get it going.
And this gets all screwy inpeople with PTSD because they go
(19:54):
from 40 to 60 so easily.
So, a, there's kind of like thisfear associated with getting
aroused in the first place, and,b, they risk getting too
aroused, not too sexuallyaroused, but to just like
hyperactivated, basically to apoint where then they're
disinhibited again.
So if you, you know like, forinstance, sexual arousal
(20:16):
requires, you want activation ofthe limbic system, so that's
like the emotional center of thebrain, but you don't want the
amygdala, which is part of thesystem.
You don't want that to befiring off too much.
When you have PTSD you've gotan amygdala that's extremely
sensitive.
So, when that limbic system getsactivated, so will the amygdala
gets activated, so will theamygdala, and so again.
(20:39):
So you're like with when youhave PTSD you're working with
such a fragile and sensitivebell curve here of okay, I have
to get aroused, but that'sthreatening.
And then as soon as I feelthat's threatening, then I'm
likely to go over overboard andthen I'm disinhibited again.
Speaker 2 (20:52):
Interesting.
So what, what is has?
What does this look like,either in your experience or the
people you worked with, wherepeople have PTSD or trauma and
then they, you know, are at riskfor you know, feeling really
complicated about feelingaroused.
Speaker 1 (21:13):
Yeah, well, I mean I'm trying to think it hasn't
been as much of a topic ofconversation, but that could be
for a variety of reasons.
I mean, one thing I've seen issex becoming uh I almost want to
answer this question later Um,sex can become kind of
(21:33):
associated with like conqueringand aggression.
And the reason for this is sojust what I just talked about
right, that these systems ofarousal are so linked, is that
you know how, like in the in old, like in medieval times,
(21:53):
whenever there was a war, therewould be like a lot of raping
and pillaging.
This is likely partly becauseit's actually extremely common
to have an erection or besexually aroused when going into
a threatening combat situation,because your general arousal is
so high.
Speaker 2 (22:15):
So no way, I mean, that makes total sense.
Speaker 1 (22:18):
But yeah, oh my God, my supervisor was talking about,
um, a patient had said like wewould all point to each other's
like boners on our way, like tocombat, like kind of making fun
of each other.
Um, because, yeah, becauseyou're in this like state of
arousal that's so similar tosexual arousal and this can do a
(22:43):
couple of different things Like.
Speaker 2 (22:44):
One is it can associate sex with aggression,
pillaging, conquering right, andthat is a very different
emotional experience than younecessarily want to have with
your girlfriend or your wife andit's probably definitely
different than what she'slooking for, except in certain
exciting exceptions okay, that'sso like sad and disturbing, but
(23:10):
also really helpful, because Iwas wondering if that there's
some mixing like if there's somemixing of aggression and
violence with sex, becausethere's some times where I
really think to myself like whywould anyone rape someone else?
Speaker 1 (23:28):
Like.
Speaker 2 (23:28):
I, just I.
That is so far from anythingthat I've felt before and I'm a
very like aggressive.
You know me like.
I'm really an intenseaggressive, like woman.
But the idea of sex likefundamentally doesn't, like it
doesn't make any sense to me,right.
And I want, like you weresaying, that someone going into
war and like a battle situationwould be sexually aroused.
(23:51):
But I wonder if the sexualarousal then would be tied to
this feeling of violence, sopeople might get aroused by the
idea of hurting someone else,exactly.
Speaker 1 (24:04):
Well, right, and this is extremely complicated.
So one thing is that we find inPTSD they have higher
testosterone and lower oxytocin.
So already you see, like ifyou're with your wife and you've
got high testosterone but lowoxytocin, so already you see,
like if you're with your wifeand you've got high testosterone
but low oxytocin, that islikely to be a situation where
you may be more like sexuallyaggressive, but feel lower
(24:27):
intimacy, trust and connection,um.
But the other problem is thatit's not like these men are, are
monsters, right?
They get maybe sexually arousedby this, and I'm not saying
they're getting sexually arousedby dead bodies or anything, but
it's just like going intocombat raises the arousal level
and like being kind of, likebeing in a situation of threat,
(24:50):
like sharpens, sharpenseverything right and like
increases blood flow, yada, yada, yada.
Um, they don't want toassociate sex with violence.
So this thing can happen wherethey get very, very confused and
ashamed by the fact that therewas any kind of sexual arousal
during these situations and thenthey start, um, not wanting to
(25:13):
do it right, because they'relike who am I Like?
Why am I feeling this way?
This is so fucked up and Ireally don't want to associate
the girl I love or the guy Ilove, you know, with this.
So, um, you know, and that'sprobably very hard to explain to
your civilian partner of like,yeah, I experienced sexual
(25:34):
arousal in con, like while doingor experiencing like horrific
things.
It's hard for your partner toeven understand that.
And so we see the sense ofdisconnection that people with
PTSD have from their loved onesand from other people, where and
this you know, this happens formultiple reasons.
Like one, lowered oxytocinmeans that it's just hormonally,
(25:55):
like, you're less connected andintimate, um, but b, it's like,
how can other people evenunderstand what I'm, what I'm
going through?
And then c, right, like all ofthe mental energy it's taking to
avoid trauma reminders, um, sothere's just this kind of a
lowered sense of like, intimacyin general and a lot of beliefs
(26:18):
about like, what does it meanabout me that I've experienced
sexual arousal?
In these contexts, you know,when you get this, a lot with,
like, with like rape survivorstoo, right, like, a lot of rape
survivors experienced sexualarousal while it was happening
and this is really, reallytriggering for them and shameful
for them.
But it makes sense, right,because the brain and the body
(26:38):
are very connected, but in someways they're not always
connected to you, your observerself, like your higher order
self, and what's happening tothe body during rape is its
threat, its threat response isheightened.
There's heightened arousal ingeneral and also their sexual
content.
That's happening, arousal ingeneral and also their sexual
(26:59):
content.
That's happening, um, and thebody is kind of primed to
respond to that.
Um, and there are evenpotential evolutionary
explanations, like it is justsafer to become aroused when you
are being assaulted from alubrication perspective, from a
cooperation perspective.
Right then, like then not doingthat, and so it's just another
(27:20):
thing, that's just like anotherlayer of complication.
Speaker 2 (27:23):
I'm trying to think of what this looks like, because
now I'm picturing this, likethis aggression and sex, right,
but I'm also thinking about,like, the shutdown right of
people who might not feel sexy,might not feel like they might
be tired or their bodies aren't,you know, the more quieter,
like I just don't want sex right.
(27:45):
And it's just scary, it'sconfusing because when I think
about when trauma and sex, kindof you know, conflict with each
other, are times when you knowsome of our the cool of mind
clients are, they've they've hadsome problems with their
partners and their partners, forexample, they've had like
(28:06):
really bad fights, um, and maybeit's more often husbands but it
can be wives, but like, or um,same sex or same sex
relationships, but the husband,for example, was violent or
aggressive during a fight,through through a piece of
furniture or maybe shoved thepartner, and then then there's a
(28:29):
shutdown of sex.
Then the other then like, let'ssay, the wife is like, like you
know what?
I don't, I don't want to havesex anymore, I, I don't really
feel safe, I don't feelcomfortable.
Every time he touches me, Ikind of get jumpy.
And then the sad part is thatthat shutdown will lead the
husband to feel even morerejected and ashamed and angry.
(28:50):
And then it's kind of like this, this terrible cycle of wanting
.
Both sides want to connect, butmaybe they they're just too
scared.
So that's what I've seen, butthat's a little bit more about
like sexual trauma andaggression with that person.
Um, interfering with the, thefeeling of like, yes, I want to.
I feel safe enough to have sexwith this.
(29:12):
You know my partner againpartner again.
Speaker 1 (29:15):
Well, yeah, I mean, but this exists in a system,
right?
Like if I, if Jason, had PTSDand was aggressive in some way,
or disconnected, or treating melike a conquerable object, yeah,
or you know, whatever the casemay be, like I would not and I
(29:38):
would not want sex either, andthen he is going to then get
messages that he's rejected andunlovable and unwanted, which
might map on directly with themessages he's already giving
himself because of the negativesort of self beliefs that come
with PTSD.
So I think that it's reallyimportant for partners to
understand what's going on,because this sucks for them and
(30:03):
because probably their responsesare going to exacerbate the
problem.
But it's kind of like, whatelse are you going to do?
Just be infinitely patient and,like you know, fawning over
that person.
So it's, it's really tough.
Speaker 2 (30:18):
It's making me think of, like this connection between
violence and sexual arousalmakes me think of this scene.
And have you ever watchedEuphoria?
Yeah, yeah.
So there's a scene that reallysticks in my head, because it
was so disturbing, where I don'twant to give too much away, too
many spoilers, but, um, therewas a couple and they're um,
(30:41):
they're you know, they'rehanging out.
I think they're almost havingsex.
Um, in the dorm room and the afraternity bursts in and does a
hazing ritual on the boy rightand he, they like pin him down
and they're really rough,they're really like scary and
aggressive and they like laughand run away and he is so shaken
up and he goes to the bathroomand you could see that he is
(31:03):
really like traumatized.
He's like shaking and scared, um, and the girl goes like are you
, uh, sydney, sweeney?
She's like amazing.
And she's like, are you okay?
And then he's like yeah, I'mfine, and goes in and they have
really aggressive sex and shelooks really upset and confused
after and I remember thinkinglike I wonder if that's just a
(31:25):
um, like almost kind of likethis ego protection, like I was
so humiliated that I want tofeel powerful over someone or
something, but I didn't thinkabout the, the, the.
I mean this kid was about tohave sex.
He was just traumatized andthen all these feelings of
arousal just was like pent up inhim.
(31:46):
So that's really interestingand sad to think that something
so loving and intimate and safecan also be tied to something so
terrifying and unsafe.
Speaker 1 (31:58):
Well, yeah, I mean it's probably both and right,
like he was just humiliated, andso I'm sure there was a desire
to reclaim his masculinity.
And I think that is a problemhere is that sex and masculinity
are so culturally tied thatwhen, when this dysfunction
(32:18):
shows up and I mean I've gotsome numbers here 73% of OIF
veterans with PTSD haddiminished libido.
That's Operation Iraqi FreedomUm 49% have ED, um 15%
ejaculatory dysfunction.
Speaker 2 (32:39):
Yeah, yeah and this is all.
This is all men and women, Imean.
I'm sure it's like most, mostlymen, but I think so yeah, um
yeah, just says oia, veterans,so it's a big deal, I mean does
this happen similarly to men andwomen, like with the fear of
arousal or negative associationswith feeling aroused affects
(33:02):
both men and women, because Iimagine I would think so, but I
don't.
Speaker 1 (33:09):
I'm sure that these studies had primarily men yeah,
you know so, cause it's in, it'sin it's in combat veterans.
So, um, it would be interesting.
I mean, when we think aboutlike people with PTSD have
higher testosterone, like womenhave much lower testosterone
than men to begin with, so Iassume there's like some
(33:31):
differences there.
Um, yeah, and then, you know,for women the trauma is so
likely to be sexual trauma, evenwithin the military, like rates
of military sexual trauma areextremely high.
So I don't know, it seems a bitconfounded there.
But I mean, if we think, evenlike, even without the hormonal
(33:53):
aspect of this or the arousalaspect of this, like if we just
imagine having sex, it involvesthings that are very vulnerable,
like being naked, um, likebeing in a, you know, in bed in
a horizontal position,concentrating on a partner
instead of what threats could beexisting out in your
(34:13):
environment.
Right Like it.
It's not an optimal setup forsomebody who's constantly
hypervigilant.
It's like very hard to bevulnerable and soft when you're
like I can't see what's going on.
I can't attend to threat rightnow.
I have to like attend to thisother person, but this itself is
making me feel vulnerable.
Speaker 2 (34:35):
I'm thinking about also talking to people recently
about how confusing toxicrelationships can be.
Where you might have a part,you might be drawn to these,
like these narcissistic,emotionally unavailable men, and
you have lots of fights, lotsof breakups, a lot of you know
(34:56):
hot makeup sex, and I'veexperienced this myself.
I'm talking to some people whosay that they almost feel kind
of sad and ashamed that theydon't feel as attracted to safe,
nice partners.
There's something I mean, thisis super complicated has so much
(35:18):
to do with like infatuation andchase and something, something
that's beyond sex, yeah, and sosome people who might associate
conflict, fight, argument,argument, with like emotional,
emotional strife, with sexy,with being turned on in
situations that are toxic, andthen you know, seeing the other
(35:42):
side, where people feel really,you know, almost like ashamed
that safe, loving, comfortablerelationships don't feel as sexy
.
I mean, yes, there's also justthe plain like are you attracted
to this person or not?
Right, do you actually justhave chemistry or not?
But I felt this in myself andI've seen people struggle when
they go from these abusiverelationships to a safe one.
(36:04):
They're surprised that theydon't feel that same sexual
attraction.
Is this?
Do you think that the arousalpiece is part of that or do you
think that that's also?
Speaker 1 (36:13):
I mean, it would be speculative.
I don't like, if you're thinkingabout PTSD, it's.
I mean, I think that oftentimesI think, when we're talking
about people who are likerepeating relational patterns,
where they are going into likeonly high arousal situations,
(36:34):
that might be something morerelated to like how they were
brought up than having like asingle criterion a trauma.
But I think maybe a relatedfactor might be like if, like,
there's so much shame and guiltassociated with trauma, so much
of the time that it may thatthere can be feelings of like
(36:55):
not deserving to be intimate orhave like a loving, trusting,
safe relationship, not deservingto have sex, and so I could see
an argument for it's like, youknow, maybe finding somebody
who's more toxic or chaoticwouldn't generate those feelings
as much Like I think.
I think there can be this issuewhere, when people have been
(37:19):
horribly traumatized and theyhave a partner who is healthy,
it's kind of like I'm thisbroken mess of a human being
with this intact, loving, youknow, person who's too, who's
too good for me, who couldn'tpossibly understand me, who I'm
just going to sully with mybadness, right, yeah, and maybe
(37:43):
that could go down in a moretoxic relationship that sounds
super complicated.
Speaker 2 (37:50):
What have you seen?
What have you seen be helpful?
When someone has this mix of,like, sexual dysfunction and
trauma, well, can they come backfrom it, is it is like sex
ruined forever.
I mean, I'm sure a lot ofpatients worry about that, where
they're like oh, you know, I'mbroken sexually.
I'm broken in all these ways.
Speaker 1 (38:11):
No.
Speaker 2 (38:11):
I think a lot of things can help.
Speaker 1 (38:12):
I mean, the thing is like there's probably I think it
would be interesting to seesome specific like sex and PTSD
protocols.
Then they might exist.
I'm just not trained in them.
But I think one thing thathelps is just psychoeducation,
because these men and women areprobably so confused and so
(38:35):
ashamed of having thisdysfunction and especially
something like like some peoplelike combat vets, who went from
feeling like complete badasses,you know, who have like higher
testosterone, right, and they'relike really masculine and the
whole like mantra of themilitary affirms masculinity and
all that.
Then they come home and theycan't have sex.
It's like that is going to bereally shameful whiplash and so
(38:59):
understanding like there'snothing wrong with you this is
what PTSD does can be reallyhelpful and especially having
helping the partners understandthat that's what's going on,
that they're not just beingrejected, right Like their
partner isn't just hasn't justsuddenly decided they don't love
them anymore, it's just thatthere's so there's so much
(39:19):
numbing associated, right Likethere's so much numbing and
arousal.
It's a really kind of confusingcondition because people can
either feel numbed out or theycan feel full of rage or full of
terror, and that feels thatconceptually seems very
different.
But numbing out can mean thatall your emotions are so high
they're all bleeding togetherand turning to mud and you kind
(39:39):
of aren't willing to feel any ofthem, so you're pushing them
down at the same time and it'sjust this whole complicated
process.
So I really I think justknowing that can be really
helpful.
I mean, one piece of advice isjust, if you are a therapist,
like ask about sexual functionin the people, in your patients
with trauma, because it's notpart of the DSM criteria, it's
(40:01):
not an obvious thing to askabout and the veteran is
unlikely to bring it up becauseit's so associated with shame.
Um, but you know, like doingsomething like prolonged
exposure that treats the PTSDcould also go a long way to
treating the sexual dysfunction.
And then, of course, couplestherapy can be helpful.
Speaker 2 (40:23):
That's interesting.
I imagine that people withtrauma and PTSD might then also
for these like secret and whatfeels like shameful reasons,
might not be open to SSRIs orother antidepressants.
Because we also know thatpeople on antidepressants often
get sexual dysfunction and theydon't like to talk about it,
(40:45):
don't like to admit it to theirpartners or their doctors.
But that's like one of thenumber one reasons why people
don't take meds and then havethat be on top of trauma.
I imagine that you know it'sjust.
It's one of those things whereif there is sexual trauma or,
sorry, sexual, if there issexual dysfunction, it really we
(41:07):
tie it so quickly to our senseof self, our sense of worthiness
as a sexual attractive person.
Right, like anytime I haven'tfelt, especially, like you know,
going through cancer treatmentsor all the things that I've
been going through.
Um, anytime, like my body or Idon't work sexually there, even
(41:29):
though, even though I knew, likeof course, I'm not feeling
horny, I can't, I don't feelleft out, I'm literally going
through chemo, there's stillsomething about.
Oh, this is.
But this is so tied to me as awoman, this is so tied to me as
like a, a wife and a worthypartner.
This is what you know I do toconnect to my partner.
You know, there's just so muchof my sense of self that's tied
(41:50):
into, like how sexy I am in waysthat I wasn't even aware of,
and I imagine that if you havetrauma, you have a really hard
time feeling comfortable in sex.
That could like add to any ofthese negative feelings you have
about yourself.
Right, if you have any kind oflike blame or shame about
yourself, this would be evenworse.
Speaker 1 (42:13):
I mean, I still have so many thoughts.
I mean we haven't talked muchabout sexual trauma because we
did a separate episode on it,but I think you know for for for
sexual trauma especially.
It's kind of like, okay, I wasraped and now not only did they
terrify me and violate me, butnow they've taken away my
(42:35):
intimacy, my what you're talkingabout, right, like my sense of
sexiness and connectedness andintimacy, and that's really hard
to have to enjoy sex after rapefor so many reasons.
One is like you know, you'vebeen treated as though you are
nothing, as though you're anobject, and then sex becomes
(42:56):
associated with, like, how areyou going to feel?
Like sex is an, it is an act oflove and care.
When you've had this experience,that rips all of that away and
is an act of violence.
And you know, valuelessness,worthlessness.
It's also like when you're witha safe partner, it might be
your body's first chance to sayno.
(43:16):
That's really interesting.
I mean, it's probably going totake it so, um, so that can be
really confusing.
It's like, why am I turningagainst my safe, loving partner?
I think there are all sorts ofreasons, um, and then for SSRIs,
I could see it going going bothways.
(43:36):
Like SSRIs are not a very goodtreatment for PTSD.
Basically all they can do istake the edge off but they are
also the only medication that issort of prescribed for for PTSD
I mean, maybe like a Xanax orsomething, but I don't think
that's a very good idea.
And SSRIs do dampen sexualdesire and arousal.
Speaker 2 (44:00):
So that's an issue Can you make a note about?
Can you say why Xanax is not agood idea?
I feel like it's so common forus psychologists to know that
benzos are not great for PTSD,trauma and really high anxiety,
but most people don't.
Most people are prescribed andtake Klonopin or Xanax all the
(44:20):
time.
So for trauma like, let's say,I'm hearing this and I'm like,
oh, I have PTSD.
Why don't I just take a benzobefore I have sex?
Maybe that will help take theedge off, why not?
Speaker 1 (44:32):
Because, for several reasons, ptsd is chronic and you
don't want to be using benzoschronically.
It's a high addiction potential.
But I mean, the main kind ofconceptual reason is, if you are
taking benzos every time youfeel triggered, you are never
like the way.
The way PTSD works is basicallythere's a big, scary monster
(44:58):
that you feel is chasing youaround everywhere and your whole
brain becomes an alarm system.
That's like do not let themonster in, don't let the memory
of the monster in, don't letthe image of the monster in,
don't let the physicalsensations experienced with the
monster come in, don't letreminders of the monster come in
, right.
And so the more the brainbecomes a threat system, the
(45:20):
more it kind of reinforcesitself as a threat system and as
the monster is terrifying.
So the more you basically saythis is terrifying, you can't go
near it, the more your brain isgoing to be like oh okay, yeah,
yeah, it's terrifying, I can'tgo near it.
I have to do everything in mypower to stay as far away from
it as I can.
And so the treatment for traumais to say no, no, no, you are
(45:44):
going to go towards it Once you,once you go towards the memory,
right, like prolonged exposure,involves closing your eyes,
going to the present tense andgiving every detail you can
about the trauma memory over andover and over and over again.
Because what that does is itsays brain it's okay, you can go
(46:04):
, you can hold hands with themonster, it's not that scary,
it's okay.
And the brain calms down likeoh, okay, okay, okay, I don't
have to be scared of this.
Well, instead, when you givesomebody a Xanax, they learn.
The only reason I'm safe isbecause I took a Xanax.
But fundamentally, this thingis still incredibly threatening
and I will not be okay if I haveany contact with it.
(46:26):
So that's why there's like ahigh abuse potential with Xanax.
It doesn't interfere on theproduct.
It's not going to cure yourPTSD in any way.
Going to cure your PTSD in anyway.
It just might give you a fewhours of like relief, which a
lot of people would opt for,right, but it's just going to
make your your PTSD more chronic.
Speaker 2 (46:46):
That's interesting, but SSRIs.
Speaker 1 (46:49):
I can also see an argument where they bring down
your emotional arousal justenough to where you're actually
more capable of having sex.
So I don't know.
But the problem is like SSRIsaren't very good at PTSD because
they don't fix that underlyingpsychic process.
So the only thing that's reallygoing to help is to do the
trauma treatment.
But the trauma treatment is soaversive that people avoid it
(47:10):
and then we're in a cycle again.
Speaker 2 (47:12):
Well, I'm also wondering too, if someone has
trauma and they feel, withouteven realizing it, that arousal,
being vulnerable, is so scary,right, which makes them not want
to have sex, that it would alsohelp to do like almost exposure
to sex, um with sex therapy.
I remember we talked about thiswith dr rosenthal, with um in
(47:36):
the sex therapy episode of um.
If you have, you go to a sextherapist and sometimes the
homework is let's takepenetrative sex off the table
and you're just going to exploreeach other in other ways,
whether it's just like touching,like touching or any other
sexual activity.
That's not sex, just kissing.
And I wonder if, along withtreatment for trauma, but you
(48:00):
could also just start to gethabituated and comfortable with
like slower levels of sexualarousal until it starts to feel
more safe.
Do you think that would help?
Or do you think no, you need tojust get trauma treatment to
get through that?
Speaker 1 (48:13):
No, I think that could help.
I don't know enough about it soI don't want to say anything
definitively.
But I mean, if we think aboutwhat trauma treatment is, it
means getting exposure to yourtriggers, and sex can be very
triggering for people, and soit's like okay, well, what do
you do about that?
You don't want to avoid themforever, so you've got to go
towards them and then you know.
(48:34):
But I would work really heavilywith the partner I mean, I
guess you would have to with sextherapy anyway but really
getting the partner tounderstand exactly what's going
on, how to create a sense ofsafety, how to not create a
sense of like rejection you havea partner who's been through
(48:59):
trauma, let's say the wives ofveterans or people who have
experienced like really badtrauma.
Speaker 2 (49:01):
They have a hard time with sex, what can?
Because I'm sure as a partneryou just want to step back or
you might get frustrated, youmight get sad of the
disconnection, but I imagine itmight be like, okay, I'm too
scared to upset my partner andnot have my needs, but we won't
have our needs met.
So what can they do to help thesituation?
Speaker 1 (49:24):
Get educated as much as possible about PTSD would be
the first thing, so that yourpartner doesn't feel so alone
and confused and like they haveto explain everything to you
when there's a lot of shameinvolved anyway, lot of shame
involved anyway.
So, um, you know, like if youcan get involved in your
partner's treatment to anyextent, that can be helpful.
(49:44):
That doesn't mean, you know,like interrupting his trauma
treatment or busting in or, likeyou know, getting confidential
information or anything likethat, but just rather saying
like I would be superappreciative if I can join you
for a session just to understandmore about PTSD in general and
like PTSD and sex.
(50:05):
I just, I just want to know sothat I can better support you,
and I and I know you probablydon't want to spend all your
time telling me about it, so Iwould really like to hear it
from your therapist.
So kind of being thatsupportive ear, trying to
de-shame it as much as possible,trying to resist the urge to be
rejected and act from a placeof rejection and defensiveness,
(50:27):
because that's going to shutthem down further, having a lot
of patience for what they aregoing through.
You know, I think just beinglike slow, kind, patient, um,
understanding can go a long wayand then just trying to be, you
know, basically trying to createa safe space where it's
(50:50):
something that can be talkedabout, um, but I I also think
this, this thing can happen withpartners called accommodation,
where they kind of collude withavoidance with their partner,
and to some extent that's okay.
But you don't want to bebasically facilitating your
(51:10):
partner, avoiding life andavoiding sex and avoiding
absolutely everything all thetime, because then that's not
good for you and it's not goodfor them.
And so that's another where,like place where I would
probably talk to therapistsabout like how can I support and
be patient?
And I certainly, especiallywith sex, don't want to push
myself on that but at the sametime not just say it's okay,
(51:33):
we'll never have sex again.
Speaker 2 (51:37):
I would love for us to do an episode on
accommodation, because I findthat really, really complicated
to know what's right or wrongright If you love someone or
you're close to someone who hasa lot of anxiety, a lot of PTSD,
and you know that bringing upstories, bringing up situations
or activities that would triggerthem, like I imagine, like the
(52:03):
the most natural thing is tohelp is to protect them from
that right like to to, you know,like to say okay, I don't, I
really don't want to upset them,let's just not.
I won't even just initiate sex.
I won't talk about this, youknow.
But then how do you know whenthat is like too much right,
when you're just likereinforcing that avoidance too
much?
That's such a complicated.
(52:25):
I just imagine that with sexuallike, if my partner, husband,
for example, had some sexualdysfunction from trauma, I would
feel really hesitant to bringup sex at all and really like I
would be a horrible person andpartner, so selfish or whatever,
if I, like I say I want sex orinitiate, knowing that it would
(52:48):
put them in this state of beingyou know, and like triggered,
like and that's hard for mebecause I'm like, oh, I don't.
I'm like, oh, I don't want to,like I don't want to feel like
my, my sexual needs or mewanting to have sex with my
partner is like triggering theirtrauma.
Speaker 1 (53:04):
That would just feel so like sad, like the thing that
I want to connect them with somuch would be something that's
like threatening rightespecially with sex, that you
know consent is such a big dealwith sex right it's different
from like playing a song thatmight be triggering, right, like
this is like a reallyconsensual process.
I'd probably do it with atherapist and just basically be
(53:26):
like hey, I've learned a lotabout what this might be like
for you.
I'd love to hear it from you.
But ultimately, like, I don'tthink either of us want to have
a sexless life.
So how could I support gettingthat?
You know, how can I support youand like coming back alive in
that way?
Um, you know, but like can our,can our goal be to have a sex
(53:49):
life again?
Yeah, be connected again.
And how can we do that?
And I hope that more peoplewith PTSD will be open to
treatment.
The treatment can be rough, butit is effective, and really
suffering in silence and tryingto suppress and push it down is
(54:10):
incredibly ineffective.
Yeah, yeah.
Speaker 2 (54:13):
I'll put a plug just because I'm in that now in like
mental health world, mentalhealth like digital, digital
companies and apps and stufflike that.
I'm in that world and there areactually a lot of really great
resources out there.
There's my friend made arebound.
She was Aaron Barron.
She was on our podcast beforeWonderful trauma psychologist
(54:37):
who made an app that basicallywalks people through some
exposure, some prolongedexposure, but for people who
might not be ready to or notable to find like a full trauma
therapist.
There's, I think Nima is acompany that does like online
PTSD treatment.
I mean, if you're, you know ifany of your family is in, you
(54:59):
know the military.
There's a veterans affairswhere Jacqueline works.
I mean there's a lot ofresources out there and um yeah,
just like explore differentoptions.
Speaker 1 (55:09):
Yeah, ptsd coach can also be helpful.
Um, pe coach is also CPT coach.
These are like, um, you know,meant to kind of facilitate like
homework with PE and CPT.
But but PTSD coach I mean it'sgot like breathing exercise,
coping strategies, a lot ofstuff that you can try on your
own to, you know at least likekind of bring that arousal down,
(55:31):
get into more relaxed state.
Speaker 2 (55:33):
So I'll link those in the show notes, because there's
so much crap out there.
There's so much like on socialmedia.
There's like so many peopletalking about trauma that really
don't know what they're talkingabout.
But I'm going to link PTSD,coach and rebound and like
resources that we know is legitin the show notes.
Speaker 1 (55:51):
So, all right, little helpers.
Well, it feels a little dark tocome up with a quippy one
letter for rating us on Applepodcasts and Spotify, but if
you'd like to give us five stars, we would love it and we'd love
to read your comments.
So we'll see you next week.
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(56:12):
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The information, opinions andrecommendations presented in
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(56:33):
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(56:55):
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such approval or endorsement.
Hey guys, welcome to A Little Help for Our Friends, a
podcast for people with lovedones struggling with mental
health.
Hello, little Helpers.
So some of you may know that Ihave worked at the Bronx VA for
the last eight months, and so Ihave been steeped in trauma
training, and today I wanted tobring a topic that I think is
(00:24):
really interesting and nottalked about enough, which is
the effect of PTSD on sex.
So, um, kibbe and I lovetalking about interpersonal
topics, romantic topics, andthis is one that is so
hyper-relevant to PTSD, but it'snot even a symptom of PTSD,
(00:50):
like it's not a diagnosticcriterion, um, and so I think a
lot of people who maybe are inrelationships with people who
have experienced significanttrauma or who have PTSD
themselves, can be extremelyconfused about why they are
experiencing so much sexualdysfunction.
So that's what I want to talkabout today, but I'm going to
kick it over to Kibbe to talk tous about Glow Mind.
Speaker 2 (01:14):
Thanks.
I'm really excited about thistopic because trauma we've seen
can really affect everything.
It could affect your health,could affect self-esteem, the
way you see the world.
Your health could affectself-esteem the way you see the
world right.
It really has such profoundeffects on someone and we've
been really seeing it inrelationships, whether it's like
anger issues or just problemswith trust or intimacy and I
(01:38):
know that the sexual intimacy issomething that's really
impacted by trauma.
So I'm really excited to hearfrom you all about this.
But if you have a loved one whohas experienced trauma and you
don't know how to help themmaybe it's been tough on your
relationship or vice versa youhave a trauma and it's affecting
your relationship let us know.
(01:58):
We'd love to figure out ways tohelp you.
I have a few spots forindividual coaching in skills
about emotion, regulation andcommunication and setting
boundaries and working throughthe trauma in order to connect
to your loved one or justsupport yourself.
And also we have this amazingcommunity and, because we've
(02:24):
been listening to what you guyswant, we're going to start a
group, so like a weekly class onall these topics so we can
learn from each other and in areally safe and supportive
environment.
So if you're interested in anyof that, check out Kulamind
K-U-L-A-M-I-N-Dcom, or there's alink in the show notes for how
(02:45):
to book a free 30 minute calljust to chat with me about what
you're going through and whatyou might be interested in.
So we also want to do a shoutout to some of you who've
written us messages through theshow notes, like where it says
send us a text.
We got a lovely message.
We've got a bunch, but we got alovely message from someone who
(03:05):
said she's a teacher and shehas listened to our episodes,
has really helped her go througha really hard time, and that
those kind of messages mean theworld to us.
So whoever wrote that, I meanwe you know, annoyingly we can't
write back on that feature, sojust know that we really
appreciate it and this is why wedo what we're doing to help
people like you.
(03:25):
So please send us notes andthank you so much for listening
and being part of our community.
So thank you, teacher.
Speaker 1 (03:33):
Thank you, teacher.
So there's so much to talkabout here because practically
every symptom of PTSD can berelated to sexual dysfunction in
some way, and I think when mostpeople think about sex and PTSD
, they're thinking about sexualassault in particular.
(03:53):
But what has actually beenfound is that the presence or
absence of PTSD is actually themore proximal cause for sexual
dysfunction than trauma type.
Yeah, so that means thatsomebody who has been sexually
assaulted but does not have PTSDis has a lower likelihood of
(04:17):
having sexual dysfunction than,like, a combat vet with PTSD.
Obviously, if somebody has bothsexual trauma and PTSD, then
that's another story, but thepresence or absence of PTSD is
really crucial here For peoplewho might not know what PTSD is.
Speaker 2 (04:36):
can you go through some of the hallmark signs of
post-traumatic stress disorder?
Speaker 1 (04:44):
yeah, so they're.
They're basically symptomclusters.
So one symptom cluster is um,basically like intrusive, like
intrusive um memories or kind ofre-experiencing.
So people who basically it'skind of like you're just going
through your day and thesememories of the trauma keep kind
of intruding on your awarenessthat you're in.
(05:05):
You're trying really, reallyhard to, you know, just to get
through your day, but you're,but you're constantly kind of
ambushed by these thoughts orfeelings.
You may all of a sudden feelsimilarly to how you did when
the trauma took place.
Um, you may have triggers thatremind you of what happened, and
they they're not necessarilydirect triggers, like if, if
(05:29):
there was a fire, you know, youmight actually be triggered by
being on the subway, even thoughthere was no subway in the fire
catastrophe that you were in.
It's just the feeling of beingpotentially trapped or having a
lot of people around orsomething like that.
So then there is this avoidancesymptom cluster, so where
(05:53):
you're really trying to doanything you can to kind of keep
away from the trauma.
So this might mean you avoidthose triggers, but it also
might mean that you avoid anykind of like physical state that
reminds you of the trauma.
So you might avoid being like,um, really like, uh, emotionally
, like aroused, physically, youknow, aroused, which we'll talk
(06:15):
about as relevant to this.
Um, you might be doing a lot ofmental work to try to
constantly distract yourselffrom these memories or these
feelings.
So, um, this is when you'll getpeople who can be very kind of
numbed out or have difficultyconcentrating because, um,
basically, like, if I do anexercise with you right now,
(06:37):
like, hey, kibbe, how many timesin the last month have you
thought about a big yellow Jeep?
How many would you say Zero,okay, cool.
Last month, have you thoughtabout a big yellow jeep?
How many would you say zero,okay, cool.
So for the next 10 seconds Iwant you to do, to think about
whatever you want, but not abouta big yellow jeep one two,
three, four, six, seven, eight,nine, ten.
(07:02):
Did you think about a big yellowJeep?
I did, okay, how many times?
Twice, twice, okay, the rest ofthe time, what were you doing?
Speaker 2 (07:11):
I was trying to focus on your face and and I know the
trap of like I'm like I'mlooking at her face, so I don't
think about a big yellow Jeep.
And then I was like, ah right,I thought about it.
Speaker 1 (07:26):
So when we have, when we have people who are
constantly trying to avoidthinking about something, two
things happen.
One, they think about it more,and the other is they put so
much effort into not thinkingabout it that they're kind of
constantly distracted.
Like if you were to, if youwere to do a math problem while
trying not to think about thebig yellow Jeep, while
(07:46):
concentrating on my face, thatwould be very difficult.
Right, you've got this onestrategy of concentrating on my
face to keep you away from thebig yellow Jeep.
It's going to be hard for youto then concentrate on anything
else.
So you also see that theirworlds become smaller because
they're avoiding trauma triggers.
They're avoiding any place thatmight make them feel the way
(08:07):
they did when they weretraumatized.
Another symptom cluster is likehypervigilance, arousal.
So you might see that somebodywith PTSD gets.
They go from like zero to 60.
So they'll be kind of walkingaround to do and suddenly
they're fucking mad or they'refreaking out or they're really
(08:29):
stressed out, and the reason isbecause they're not going from
zero to 60, they're going from40 to 60.
So that means that they arekind of constantly in a state of
arousal, hypervigilance.
They're kind of always got thislike irritable edge to them, um,
because it's taking so muchwork to detect threat everywhere
(08:50):
and to keep themselves safe andto, you know, not think about
certain things.
It's just it's it's kind ofthrowing the body out of whack a
little bit and so they can havethey can be very easily
startled, um, looking aroundlike um like looking over their
shoulder, kind of constantly,this constant kind of low level
irritability, that kind of thing.
(09:10):
And then beside that you've gotkind of this like negative
beliefs cluster so people canstart to really blame themselves
or blame the world for whathappened, kind of seeing
themselves as inherently dirty,shameful, guilty, worthless, or
(09:35):
the world as like a totallydangerous place.
And then so these beliefs canreally kind of take you as well,
because you're just thinkingsuch negative things all the
time and you're viewing yourselfand the world and others in
such negative ways.
So it's a really tough disorderand all of those symptom
(09:56):
clusters can influence yourrelationships and then also
influence sex.
Speaker 2 (10:05):
Got it, got it.
This is kind of going off topic,but I'm wondering, now that
you're learning so much aboutPTSD and trauma, but yet now
these days, our idea of traumahas really expanded right so
like you know, some people havelike capital T, capital T trauma
(10:29):
of like they were in a war andsome people were, you know, have
had years of criticism fromtheir family and they also have
trauma symptoms or feeling likethey've been traumatized.
Can you have you learned anyany more more about you know,
like what, how we understandtrauma these days?
Because it's now kind of nowit's, it's kind of everywhere.
(10:51):
It's like everything that'sstressful and painful is called
a trauma, and now I hesitate tosay what's a trauma and what's
not a trauma.
But like what are your thoughtson that right now?
I have a bunch of thoughts.
Speaker 1 (11:02):
So one thing you need for a PTSD diagnosis is what we
call a criterion, a trauma, andthat is I'm not going to go
into like everything that thatcould possibly be, but generally
what you're looking for is thatyou have gone through an
experience that was terrifyingor horrifying and that made you
feel powerless, out of controland like your life was
(11:25):
threatened.
And what often happens whenpeople come in for trauma
treatment is that they can feelinvalidated or the therapist can
feel like they are invalidatingby saying no, your experience
of emotional abuse, for instance, or neglect, or your even your
(11:47):
child dying from cancer, is nota criterion, a trauma you
wouldn't meet for PTSD.
And what's important to notehere is that criterion a should
not be understood to mean worse,like watching your child die of
cancer is likely to be theworst thing that can ever happen
(12:10):
to you, worse than beingsexually assaulted, for instance
.
Obviously not saying everybody,but we're really not trying to
categorize traumas as likebetter or worse, or more severe
or less severe.
It's really about what kinds oftraumas are going to lead to
PTSD symptoms Other kinds oftraumatic experiences can lead
(12:33):
to other symptoms, um, but PTSDlike it's, you're probably not
going to have those hyperarousal symptoms and
hypervigilance symptoms fromwatching your child die of
cancer, because that was like aslow process right, where you're
terrified of losing her butyou're not terrified in the same
(12:55):
way.
It's not this like ambush ofterror and, like you know, I
don't know whether I'm going tolive or die, I don't know what's
happening to me, I'm completelythrown out of control.
It's just a different kind oflike emotional process, um, and
so it's going to lead todifferent symptoms.
So like having PTSD does notmean that your trauma was worse
(13:15):
or better.
Um, another kind of thing isI'll talk like when we think
about like early childhood andvalidation, right, right, so
like what's going to lead tosomething like bpd.
Bpd and ptsd are certainly likecomorbid a lot of the time, but
that kind of like persistent,pervasive, like invalidation
(13:38):
through childhood might leadmore into something like a
personality disorder than againthat kind of like hypervigilant,
um, you know, or like numbnessor just basically what you'd see
in PTSD.
And the third thing is that youcan have a criterion, a trauma,
without developing PTSD, and themajor kind of understanding of
(14:03):
that is like, let's say, youknow you were like shot at in
war, like some.
Basically, when you, when mostpeople, go through a trauma,
like a criterion, a trauma,they're going to experience
(14:24):
symptoms of PTSD during thatfirst month or so, but it's not
PTSD.
That's why it actually we don'tgive a PTSD diagnosis until
like 30 days have passed, andthe reason is because it is not
pathological for after you'vebeen traumatized, to be attuned
to threat and to not want tothink about it and you know to
(14:47):
have negative beliefs.
So the difference is that whatmakes it pathological quote
unquote is that it doesn'trecover.
So most people they undergo acriterion, a trauma, they're
able to recover because they'reable to process the experience
of it.
They have loved ones whosupport them, they can cry,
(15:09):
they're held, they get to feelsafe, they get to talk about it.
So they basically go throughthis recovery process.
The people who develop PTSDtypically were prevented from
going through that and it's oneof the reasons you see it a lot
in veterans, because when you'reat war there's no time to
process your trauma.
(15:29):
You have to keep going and youknow like the military is very,
very good at meeting the aims ofthe military, but it's not very
good at turning out healthycivilians because the military
has really really differentgoals and needs than civilian
life does.
So one thing you'll hear fromveterans constantly is they went
(15:51):
through this trauma and theywere told get over it, it's not
that big of a deal, you've gotto move on, push it down, shove
it down, do whatever it takes,keep going.
And they and that's becausethey have to, because who's
going to give you a hug?
Who's going to let you fallapart?
Right, you can't do that inactive combat, and so they are
(16:11):
prevented from going throughthat recovery process and then
they come home and they havePTSD.
Speaker 2 (16:18):
So sad, and also why invalidation after something
like rape is such a problembecause what you really need
(16:40):
after sexual assault is to bebelieved and heard.
Symptoms can affectrelationships.
Intimacy and sex is what we'retalking about Like.
How does it affectrelationships like broadly?
Speaker 1 (16:52):
Yeah, I mean.
well, the way it affectsrelationships is, I mean, I'm
sure, not all in one way, but Imean, I think it'd be hard for
PTSD not to affect relationships, because if you're
fundamentally spending all ofyour time trying to squash down
any triggering memories, thenhow connected can you be?
Right, so I'll just start withthe symptom cluster.
(17:20):
Which one should I start with?
Let's do hyperarousal.
Which one should I start with?
Let's do hyper arousal.
So they're all kind ofinterconnected.
But basically, if you look atsexual arousal and, um, like,
like threat, like threat arousal, ptsd kind of arousal, they
look very, they're very similarprocesses.
(17:41):
So you might get someone whofinds a beating heart and a
flushed face very threatening,because that is how, that, that
those were the physical symptomsthey had when they were
traumatized and any kind ofsense of arousal.
(18:02):
Right, and we know, like I mean, there are experiments where if
you, if you have like aparticipant, watch a video of
like a rollercoaster or do likea VR on a a roller coaster,
they'll like be hornier afterlike there'll be, you know.
So like the there's across-contamination between just
like regular emotional arousaland sexual arousal.
(18:24):
But for these people this iskind of complicated because in a
sense they're alwaysemotionally aroused but they're
also always trying to avoidbeing really emotionally aroused
and so getting into like sexualarousal itself can be, can feel
really threatening.
They start having all of thesephysical symptoms that were
(18:46):
associated with threat anddanger.
And the other thing is thatsexual arousal requires it's
kind of like a bell curve.
So it requires like a certainamount of arousal, a certain
amount of norepinephrine, acertain amount of like limbic
system activation, but once youget past that, then it's an
(19:11):
inhibitory.
So you know, this is like we seethis when, um, we think about
the, the model of the dualcontrol model.
So if you've got like you'vegot breaks and the gas pedal
with sexual desire, and ifyou've got too much on the
brakes, meaning like if you'retoo stressed out, if you're too
(19:31):
tired, um, if you're too angryto whatever, like you're not
going to want to have sex, thoseare like the breaks.
But at the same time you wantlike some excitement, some
novelty, some fun, some arousalto get it going.
And this gets all screwy inpeople with PTSD because they go
(19:54):
from 40 to 60 so easily.
So, a, there's kind of like thisfear associated with getting
aroused in the first place, and,b, they risk getting too
aroused, not too sexuallyaroused, but to just like
hyperactivated, basically to apoint where then they're
disinhibited again.
So if you, you know like, forinstance, sexual arousal
(20:16):
requires, you want activation ofthe limbic system, so that's
like the emotional center of thebrain, but you don't want the
amygdala, which is part of thesystem.
You don't want that to befiring off too much.
When you have PTSD you've gotan amygdala that's extremely
sensitive.
So, when that limbic system getsactivated, so will the amygdala
gets activated, so will theamygdala, and so again.
(20:39):
So you're like with when youhave PTSD you're working with
such a fragile and sensitivebell curve here of okay, I have
to get aroused, but that'sthreatening.
And then as soon as I feelthat's threatening, then I'm
likely to go over overboard andthen I'm disinhibited again.
Speaker 2 (20:52):
Interesting.
So what, what is has?
What does this look like,either in your experience or the
people you worked with, wherepeople have PTSD or trauma and
then they, you know, are at riskfor you know, feeling really
complicated about feelingaroused.
Speaker 1 (21:13):
Yeah, well, I mean I'm trying to think it hasn't
been as much of a topic ofconversation, but that could be
for a variety of reasons.
I mean, one thing I've seen issex becoming uh I almost want to
answer this question later Um,sex can become kind of
(21:33):
associated with like conqueringand aggression.
And the reason for this is sojust what I just talked about
right, that these systems ofarousal are so linked, is that
you know how, like in the in old, like in medieval times,
(21:53):
whenever there was a war, therewould be like a lot of raping
and pillaging.
This is likely partly becauseit's actually extremely common
to have an erection or besexually aroused when going into
a threatening combat situation,because your general arousal is
so high.
Speaker 2 (22:15):
So no way, I mean, that makes total sense.
Speaker 1 (22:18):
But yeah, oh my God, my supervisor was talking about,
um, a patient had said like wewould all point to each other's
like boners on our way, like tocombat, like kind of making fun
of each other.
Um, because, yeah, becauseyou're in this like state of
arousal that's so similar tosexual arousal and this can do a
(22:43):
couple of different things Like.
Speaker 2 (22:44):
One is it can associate sex with aggression,
pillaging, conquering right, andthat is a very different
emotional experience than younecessarily want to have with
your girlfriend or your wife andit's probably definitely
different than what she'slooking for, except in certain
exciting exceptions okay, that'sso like sad and disturbing, but
(23:10):
also really helpful, because Iwas wondering if that there's
some mixing like if there's somemixing of aggression and
violence with sex, becausethere's some times where I
really think to myself like whywould anyone rape someone else?
Speaker 1 (23:28):
Like.
Speaker 2 (23:28):
I, just I.
That is so far from anythingthat I've felt before and I'm a
very like aggressive.
You know me like.
I'm really an intenseaggressive, like woman.
But the idea of sex likefundamentally doesn't, like it
doesn't make any sense to me,right.
And I want, like you weresaying, that someone going into
war and like a battle situationwould be sexually aroused.
(23:51):
But I wonder if the sexualarousal then would be tied to
this feeling of violence, sopeople might get aroused by the
idea of hurting someone else,exactly.
Speaker 1 (24:04):
Well, right, and this is extremely complicated.
So one thing is that we find inPTSD they have higher
testosterone and lower oxytocin.
So already you see, like ifyou're with your wife and you've
got high testosterone but lowoxytocin, so already you see,
like if you're with your wifeand you've got high testosterone
but low oxytocin, that islikely to be a situation where
you may be more like sexuallyaggressive, but feel lower
(24:27):
intimacy, trust and connection,um.
But the other problem is thatit's not like these men are, are
monsters, right?
They get maybe sexually arousedby this, and I'm not saying
they're getting sexually arousedby dead bodies or anything, but
it's just like going intocombat raises the arousal level
and like being kind of, likebeing in a situation of threat,
(24:50):
like sharpens, sharpenseverything right and like
increases blood flow, yada, yada, yada.
Um, they don't want toassociate sex with violence.
So this thing can happen wherethey get very, very confused and
ashamed by the fact that therewas any kind of sexual arousal
during these situations and thenthey start, um, not wanting to
(25:13):
do it right, because they'relike who am I Like?
Why am I feeling this way?
This is so fucked up and Ireally don't want to associate
the girl I love or the guy Ilove, you know, with this.
So, um, you know, and that'sprobably very hard to explain to
your civilian partner of like,yeah, I experienced sexual
(25:34):
arousal in con, like while doingor experiencing like horrific
things.
It's hard for your partner toeven understand that.
And so we see the sense ofdisconnection that people with
PTSD have from their loved onesand from other people, where and
this you know, this happens formultiple reasons.
Like one, lowered oxytocinmeans that it's just hormonally,
(25:55):
like, you're less connected andintimate, um, but b, it's like,
how can other people evenunderstand what I'm, what I'm
going through?
And then c, right, like all ofthe mental energy it's taking to
avoid trauma reminders, um, sothere's just this kind of a
lowered sense of like, intimacyin general and a lot of beliefs
(26:18):
about like, what does it meanabout me that I've experienced
sexual arousal?
In these contexts, you know,when you get this, a lot with,
like, with like rape survivorstoo, right, like, a lot of rape
survivors experienced sexualarousal while it was happening
and this is really, reallytriggering for them and shameful
for them.
But it makes sense, right,because the brain and the body
(26:38):
are very connected, but in someways they're not always
connected to you, your observerself, like your higher order
self, and what's happening tothe body during rape is its
threat, its threat response isheightened.
There's heightened arousal ingeneral and also their sexual
content.
That's happening, arousal ingeneral and also their sexual
(26:59):
content.
That's happening, um, and thebody is kind of primed to
respond to that.
Um, and there are evenpotential evolutionary
explanations, like it is justsafer to become aroused when you
are being assaulted from alubrication perspective, from a
cooperation perspective.
Right then, like then not doingthat, and so it's just another
(27:20):
thing, that's just like anotherlayer of complication.
Speaker 2 (27:23):
I'm trying to think of what this looks like, because
now I'm picturing this, likethis aggression and sex, right,
but I'm also thinking about,like, the shutdown right of
people who might not feel sexy,might not feel like they might
be tired or their bodies aren't,you know, the more quieter,
like I just don't want sex right.
(27:45):
And it's just scary, it'sconfusing because when I think
about when trauma and sex, kindof you know, conflict with each
other, are times when you knowsome of our the cool of mind
clients are, they've they've hadsome problems with their
partners and their partners, forexample, they've had like
(28:06):
really bad fights, um, and maybeit's more often husbands but it
can be wives, but like, or um,same sex or same sex
relationships, but the husband,for example, was violent or
aggressive during a fight,through through a piece of
furniture or maybe shoved thepartner, and then then there's a
(28:29):
shutdown of sex.
Then the other then like, let'ssay, the wife is like, like you
know what?
I don't, I don't want to havesex anymore, I, I don't really
feel safe, I don't feelcomfortable.
Every time he touches me, Ikind of get jumpy.
And then the sad part is thatthat shutdown will lead the
husband to feel even morerejected and ashamed and angry.
(28:50):
And then it's kind of like this, this terrible cycle of wanting
.
Both sides want to connect, butmaybe they they're just too
scared.
So that's what I've seen, butthat's a little bit more about
like sexual trauma andaggression with that person.
Um, interfering with the, thefeeling of like, yes, I want to.
I feel safe enough to have sexwith this.
(29:12):
You know my partner againpartner again.
Speaker 1 (29:15):
Well, yeah, I mean, but this exists in a system,
right?
Like if I, if Jason, had PTSDand was aggressive in some way,
or disconnected, or treating melike a conquerable object, yeah,
or you know, whatever the casemay be, like I would not and I
(29:38):
would not want sex either, andthen he is going to then get
messages that he's rejected andunlovable and unwanted, which
might map on directly with themessages he's already giving
himself because of the negativesort of self beliefs that come
with PTSD.
So I think that it's reallyimportant for partners to
understand what's going on,because this sucks for them and
(30:03):
because probably their responsesare going to exacerbate the
problem.
But it's kind of like, whatelse are you going to do?
Just be infinitely patient and,like you know, fawning over
that person.
So it's, it's really tough.
Speaker 2 (30:18):
It's making me think of, like this connection between
violence and sexual arousalmakes me think of this scene.
And have you ever watchedEuphoria?
Yeah, yeah.
So there's a scene that reallysticks in my head, because it
was so disturbing, where I don'twant to give too much away, too
many spoilers, but, um, therewas a couple and they're um,
(30:41):
they're you know, they'rehanging out.
I think they're almost havingsex.
Um, in the dorm room and the afraternity bursts in and does a
hazing ritual on the boy rightand he, they like pin him down
and they're really rough,they're really like scary and
aggressive and they like laughand run away and he is so shaken
up and he goes to the bathroomand you could see that he is
(31:03):
really like traumatized.
He's like shaking and scared, um, and the girl goes like are you
, uh, sydney, sweeney?
She's like amazing.
And she's like, are you okay?
And then he's like yeah, I'mfine, and goes in and they have
really aggressive sex and shelooks really upset and confused
after and I remember thinkinglike I wonder if that's just a
(31:25):
um, like almost kind of likethis ego protection, like I was
so humiliated that I want tofeel powerful over someone or
something, but I didn't thinkabout the, the, the.
I mean this kid was about tohave sex.
He was just traumatized andthen all these feelings of
arousal just was like pent up inhim.
(31:46):
So that's really interestingand sad to think that something
so loving and intimate and safecan also be tied to something so
terrifying and unsafe.
Speaker 1 (31:58):
Well, yeah, I mean it's probably both and right,
like he was just humiliated, andso I'm sure there was a desire
to reclaim his masculinity.
And I think that is a problemhere is that sex and masculinity
are so culturally tied thatwhen, when this dysfunction
(32:18):
shows up and I mean I've gotsome numbers here 73% of OIF
veterans with PTSD haddiminished libido.
That's Operation Iraqi FreedomUm 49% have ED, um 15%
ejaculatory dysfunction.
Speaker 2 (32:39):
Yeah, yeah and this is all.
This is all men and women, Imean.
I'm sure it's like most, mostlymen, but I think so yeah, um
yeah, just says oia, veterans,so it's a big deal, I mean does
this happen similarly to men andwomen, like with the fear of
arousal or negative associationswith feeling aroused affects
(33:02):
both men and women, because Iimagine I would think so, but I
don't.
Speaker 1 (33:09):
I'm sure that these studies had primarily men yeah,
you know so, cause it's in, it'sin it's in combat veterans.
So, um, it would be interesting.
I mean, when we think aboutlike people with PTSD have
higher testosterone, like womenhave much lower testosterone
than men to begin with, so Iassume there's like some
(33:31):
differences there.
Um, yeah, and then, you know,for women the trauma is so
likely to be sexual trauma, evenwithin the military, like rates
of military sexual trauma areextremely high.
So I don't know, it seems a bitconfounded there.
But I mean, if we think, evenlike, even without the hormonal
(33:53):
aspect of this or the arousalaspect of this, like if we just
imagine having sex, it involvesthings that are very vulnerable,
like being naked, um, likebeing in a, you know, in bed in
a horizontal position,concentrating on a partner
instead of what threats could beexisting out in your
(34:13):
environment.
Right Like it.
It's not an optimal setup forsomebody who's constantly
hypervigilant.
It's like very hard to bevulnerable and soft when you're
like I can't see what's going on.
I can't attend to threat rightnow.
I have to like attend to thisother person, but this itself is
making me feel vulnerable.
Speaker 2 (34:35):
I'm thinking about also talking to people recently
about how confusing toxicrelationships can be.
Where you might have a part,you might be drawn to these,
like these narcissistic,emotionally unavailable men, and
you have lots of fights, lotsof breakups, a lot of you know
(34:56):
hot makeup sex, and I'veexperienced this myself.
I'm talking to some people whosay that they almost feel kind
of sad and ashamed that theydon't feel as attracted to safe,
nice partners.
There's something I mean, thisis super complicated has so much
(35:18):
to do with like infatuation andchase and something, something
that's beyond sex, yeah, and sosome people who might associate
conflict, fight, argument,argument, with like emotional,
emotional strife, with sexy,with being turned on in
situations that are toxic, andthen you know, seeing the other
(35:42):
side, where people feel really,you know, almost like ashamed
that safe, loving, comfortablerelationships don't feel as sexy
.
I mean, yes, there's also justthe plain like are you attracted
to this person or not?
Right, do you actually justhave chemistry or not?
But I felt this in myself andI've seen people struggle when
they go from these abusiverelationships to a safe one.
(36:04):
They're surprised that theydon't feel that same sexual
attraction.
Is this?
Do you think that the arousalpiece is part of that or do you
think that that's also?
Speaker 1 (36:13):
I mean, it would be speculative.
I don't like, if you're thinkingabout PTSD, it's.
I mean, I think that oftentimesI think, when we're talking
about people who are likerepeating relational patterns,
where they are going into likeonly high arousal situations,
(36:34):
that might be something morerelated to like how they were
brought up than having like asingle criterion a trauma.
But I think maybe a relatedfactor might be like if, like,
there's so much shame and guiltassociated with trauma, so much
of the time that it may thatthere can be feelings of like
(36:55):
not deserving to be intimate orhave like a loving, trusting,
safe relationship, not deservingto have sex, and so I could see
an argument for it's like, youknow, maybe finding somebody
who's more toxic or chaoticwouldn't generate those feelings
as much Like I think.
I think there can be this issuewhere, when people have been
(37:19):
horribly traumatized and theyhave a partner who is healthy,
it's kind of like I'm thisbroken mess of a human being
with this intact, loving, youknow, person who's too, who's
too good for me, who couldn'tpossibly understand me, who I'm
just going to sully with mybadness, right, yeah, and maybe
(37:43):
that could go down in a moretoxic relationship that sounds
super complicated.
Speaker 2 (37:50):
What have you seen?
What have you seen be helpful?
When someone has this mix of,like, sexual dysfunction and
trauma, well, can they come backfrom it, is it is like sex
ruined forever.
I mean, I'm sure a lot ofpatients worry about that, where
they're like oh, you know, I'mbroken sexually.
I'm broken in all these ways.
Speaker 1 (38:11):
No.
Speaker 2 (38:11):
I think a lot of things can help.
Speaker 1 (38:12):
I mean, the thing is like there's probably I think it
would be interesting to seesome specific like sex and PTSD
protocols.
Then they might exist.
I'm just not trained in them.
But I think one thing thathelps is just psychoeducation,
because these men and women areprobably so confused and so
(38:35):
ashamed of having thisdysfunction and especially
something like like some peoplelike combat vets, who went from
feeling like complete badasses,you know, who have like higher
testosterone, right, and they'relike really masculine and the
whole like mantra of themilitary affirms masculinity and
all that.
Then they come home and theycan't have sex.
It's like that is going to bereally shameful whiplash and so
(38:59):
understanding like there'snothing wrong with you this is
what PTSD does can be reallyhelpful and especially having
helping the partners understandthat that's what's going on,
that they're not just beingrejected, right Like their
partner isn't just hasn't justsuddenly decided they don't love
them anymore, it's just thatthere's so there's so much
(39:19):
numbing associated, right Likethere's so much numbing and
arousal.
It's a really kind of confusingcondition because people can
either feel numbed out or theycan feel full of rage or full of
terror, and that feels thatconceptually seems very
different.
But numbing out can mean thatall your emotions are so high
they're all bleeding togetherand turning to mud and you kind
(39:39):
of aren't willing to feel any ofthem, so you're pushing them
down at the same time and it'sjust this whole complicated
process.
So I really I think justknowing that can be really
helpful.
I mean, one piece of advice isjust, if you are a therapist,
like ask about sexual functionin the people, in your patients
with trauma, because it's notpart of the DSM criteria, it's
(40:01):
not an obvious thing to askabout and the veteran is
unlikely to bring it up becauseit's so associated with shame.
Um, but you know, like doingsomething like prolonged
exposure that treats the PTSDcould also go a long way to
treating the sexual dysfunction.
And then, of course, couplestherapy can be helpful.
Speaker 2 (40:23):
That's interesting.
I imagine that people withtrauma and PTSD might then also
for these like secret and whatfeels like shameful reasons,
might not be open to SSRIs orother antidepressants.
Because we also know thatpeople on antidepressants often
get sexual dysfunction and theydon't like to talk about it,
(40:45):
don't like to admit it to theirpartners or their doctors.
But that's like one of thenumber one reasons why people
don't take meds and then havethat be on top of trauma.
I imagine that you know it'sjust.
It's one of those things whereif there is sexual trauma or,
sorry, sexual, if there issexual dysfunction, it really we
(41:07):
tie it so quickly to our senseof self, our sense of worthiness
as a sexual attractive person.
Right, like anytime I haven'tfelt, especially, like you know,
going through cancer treatmentsor all the things that I've
been going through.
Um, anytime, like my body or Idon't work sexually there, even
(41:29):
though, even though I knew, likeof course, I'm not feeling
horny, I can't, I don't feelleft out, I'm literally going
through chemo, there's stillsomething about.
Oh, this is.
But this is so tied to me as awoman, this is so tied to me as
like a, a wife and a worthypartner.
This is what you know I do toconnect to my partner.
You know, there's just so muchof my sense of self that's tied
(41:50):
into, like how sexy I am in waysthat I wasn't even aware of,
and I imagine that if you havetrauma, you have a really hard
time feeling comfortable in sex.
That could like add to any ofthese negative feelings you have
about yourself.
Right, if you have any kind oflike blame or shame about
yourself, this would be evenworse.
Speaker 1 (42:13):
I mean, I still have so many thoughts.
I mean we haven't talked muchabout sexual trauma because we
did a separate episode on it,but I think you know for for for
sexual trauma especially.
It's kind of like, okay, I wasraped and now not only did they
terrify me and violate me, butnow they've taken away my
(42:35):
intimacy, my what you're talkingabout, right, like my sense of
sexiness and connectedness andintimacy, and that's really hard
to have to enjoy sex after rapefor so many reasons.
One is like you know, you'vebeen treated as though you are
nothing, as though you're anobject, and then sex becomes
(42:56):
associated with, like, how areyou going to feel?
Like sex is an, it is an act oflove and care.
When you've had this experience,that rips all of that away and
is an act of violence.
And you know, valuelessness,worthlessness.
It's also like when you're witha safe partner, it might be
your body's first chance to sayno.
(43:16):
That's really interesting.
I mean, it's probably going totake it so, um, so that can be
really confusing.
It's like, why am I turningagainst my safe, loving partner?
I think there are all sorts ofreasons, um, and then for SSRIs,
I could see it going going bothways.
(43:36):
Like SSRIs are not a very goodtreatment for PTSD.
Basically all they can do istake the edge off but they are
also the only medication that issort of prescribed for for PTSD
I mean, maybe like a Xanax orsomething, but I don't think
that's a very good idea.
And SSRIs do dampen sexualdesire and arousal.
Speaker 2 (44:00):
So that's an issue Can you make a note about?
Can you say why Xanax is not agood idea?
I feel like it's so common forus psychologists to know that
benzos are not great for PTSD,trauma and really high anxiety,
but most people don't.
Most people are prescribed andtake Klonopin or Xanax all the
(44:20):
time.
So for trauma like, let's say,I'm hearing this and I'm like,
oh, I have PTSD.
Why don't I just take a benzobefore I have sex?
Maybe that will help take theedge off, why not?
Speaker 1 (44:32):
Because, for several reasons, ptsd is chronic and you
don't want to be using benzoschronically.
It's a high addiction potential.
But I mean, the main kind ofconceptual reason is, if you are
taking benzos every time youfeel triggered, you are never
like the way.
The way PTSD works is basicallythere's a big, scary monster
(44:58):
that you feel is chasing youaround everywhere and your whole
brain becomes an alarm system.
That's like do not let themonster in, don't let the memory
of the monster in, don't letthe image of the monster in,
don't let the physicalsensations experienced with the
monster come in, don't letreminders of the monster come in
, right.
And so the more the brainbecomes a threat system, the
(45:20):
more it kind of reinforcesitself as a threat system and as
the monster is terrifying.
So the more you basically saythis is terrifying, you can't go
near it, the more your brain isgoing to be like oh okay, yeah,
yeah, it's terrifying, I can'tgo near it.
I have to do everything in mypower to stay as far away from
it as I can.
And so the treatment for traumais to say no, no, no, you are
(45:44):
going to go towards it Once you,once you go towards the memory,
right, like prolonged exposure,involves closing your eyes,
going to the present tense andgiving every detail you can
about the trauma memory over andover and over and over again.
Because what that does is itsays brain it's okay, you can go
(46:04):
, you can hold hands with themonster, it's not that scary,
it's okay.
And the brain calms down likeoh, okay, okay, okay, I don't
have to be scared of this.
Well, instead, when you givesomebody a Xanax, they learn.
The only reason I'm safe isbecause I took a Xanax.
But fundamentally, this thingis still incredibly threatening
and I will not be okay if I haveany contact with it.
(46:26):
So that's why there's like ahigh abuse potential with Xanax.
It doesn't interfere on theproduct.
It's not going to cure yourPTSD in any way.
Going to cure your PTSD in anyway.
It just might give you a fewhours of like relief, which a
lot of people would opt for,right, but it's just going to
make your your PTSD more chronic.
Speaker 2 (46:46):
That's interesting, but SSRIs.
Speaker 1 (46:49):
I can also see an argument where they bring down
your emotional arousal justenough to where you're actually
more capable of having sex.
So I don't know.
But the problem is like SSRIsaren't very good at PTSD because
they don't fix that underlyingpsychic process.
So the only thing that's reallygoing to help is to do the
trauma treatment.
But the trauma treatment is soaversive that people avoid it
(47:10):
and then we're in a cycle again.
Speaker 2 (47:12):
Well, I'm also wondering too, if someone has
trauma and they feel, withouteven realizing it, that arousal,
being vulnerable, is so scary,right, which makes them not want
to have sex, that it would alsohelp to do like almost exposure
to sex, um with sex therapy.
I remember we talked about thiswith dr rosenthal, with um in
(47:36):
the sex therapy episode of um.
If you have, you go to a sextherapist and sometimes the
homework is let's takepenetrative sex off the table
and you're just going to exploreeach other in other ways,
whether it's just like touching,like touching or any other
sexual activity.
That's not sex, just kissing.
And I wonder if, along withtreatment for trauma, but you
(48:00):
could also just start to gethabituated and comfortable with
like slower levels of sexualarousal until it starts to feel
more safe.
Do you think that would help?
Or do you think no, you need tojust get trauma treatment to
get through that?
Speaker 1 (48:13):
No, I think that could help.
I don't know enough about it soI don't want to say anything
definitively.
But I mean, if we think aboutwhat trauma treatment is, it
means getting exposure to yourtriggers, and sex can be very
triggering for people, and soit's like okay, well, what do
you do about that?
You don't want to avoid themforever, so you've got to go
towards them and then you know.
(48:34):
But I would work really heavilywith the partner I mean, I
guess you would have to with sextherapy anyway but really
getting the partner tounderstand exactly what's going
on, how to create a sense ofsafety, how to not create a
sense of like rejection you havea partner who's been through
(48:59):
trauma, let's say the wives ofveterans or people who have
experienced like really badtrauma.
Speaker 2 (49:01):
They have a hard time with sex, what can?
Because I'm sure as a partneryou just want to step back or
you might get frustrated, youmight get sad of the
disconnection, but I imagine itmight be like, okay, I'm too
scared to upset my partner andnot have my needs, but we won't
have our needs met.
So what can they do to help thesituation?
Speaker 1 (49:24):
Get educated as much as possible about PTSD would be
the first thing, so that yourpartner doesn't feel so alone
and confused and like they haveto explain everything to you
when there's a lot of shameinvolved anyway, lot of shame
involved anyway.
So, um, you know, like if youcan get involved in your
partner's treatment to anyextent, that can be helpful.
(49:44):
That doesn't mean, you know,like interrupting his trauma
treatment or busting in or, likeyou know, getting confidential
information or anything likethat, but just rather saying
like I would be superappreciative if I can join you
for a session just to understandmore about PTSD in general and
like PTSD and sex.
(50:05):
I just, I just want to know sothat I can better support you,
and I and I know you probablydon't want to spend all your
time telling me about it, so Iwould really like to hear it
from your therapist.
So kind of being thatsupportive ear, trying to
de-shame it as much as possible,trying to resist the urge to be
rejected and act from a placeof rejection and defensiveness,
(50:27):
because that's going to shutthem down further, having a lot
of patience for what they aregoing through.
You know, I think just beinglike slow, kind, patient, um,
understanding can go a long wayand then just trying to be, you
know, basically trying to createa safe space where it's
(50:50):
something that can be talkedabout, um, but I I also think
this, this thing can happen withpartners called accommodation,
where they kind of collude withavoidance with their partner,
and to some extent that's okay.
But you don't want to bebasically facilitating your
(51:10):
partner, avoiding life andavoiding sex and avoiding
absolutely everything all thetime, because then that's not
good for you and it's not goodfor them.
And so that's another where,like place where I would
probably talk to therapistsabout like how can I support and
be patient?
And I certainly, especiallywith sex, don't want to push
myself on that but at the sametime not just say it's okay,
(51:33):
we'll never have sex again.
Speaker 2 (51:37):
I would love for us to do an episode on
accommodation, because I findthat really, really complicated
to know what's right or wrongright If you love someone or
you're close to someone who hasa lot of anxiety, a lot of PTSD,
and you know that bringing upstories, bringing up situations
or activities that would triggerthem, like I imagine, like the
(52:03):
the most natural thing is tohelp is to protect them from
that right like to to, you know,like to say okay, I don't, I
really don't want to upset them,let's just not.
I won't even just initiate sex.
I won't talk about this, youknow.
But then how do you know whenthat is like too much right,
when you're just likereinforcing that avoidance too
much?
That's such a complicated.
(52:25):
I just imagine that with sexuallike, if my partner, husband,
for example, had some sexualdysfunction from trauma, I would
feel really hesitant to bringup sex at all and really like I
would be a horrible person andpartner, so selfish or whatever,
if I, like I say I want sex orinitiate, knowing that it would
(52:48):
put them in this state of beingyou know, and like triggered,
like and that's hard for mebecause I'm like, oh, I don't.
I'm like, oh, I don't want to,like I don't want to feel like
my, my sexual needs or mewanting to have sex with my
partner is like triggering theirtrauma.
Speaker 1 (53:04):
That would just feel so like sad, like the thing that
I want to connect them with somuch would be something that's
like threatening rightespecially with sex, that you
know consent is such a big dealwith sex right it's different
from like playing a song thatmight be triggering, right, like
this is like a reallyconsensual process.
I'd probably do it with atherapist and just basically be
(53:26):
like hey, I've learned a lotabout what this might be like
for you.
I'd love to hear it from you.
But ultimately, like, I don'tthink either of us want to have
a sexless life.
So how could I support gettingthat?
You know, how can I support youand like coming back alive in
that way?
Um, you know, but like can our,can our goal be to have a sex
(53:49):
life again?
Yeah, be connected again.
And how can we do that?
And I hope that more peoplewith PTSD will be open to
treatment.
The treatment can be rough, butit is effective, and really
suffering in silence and tryingto suppress and push it down is
(54:10):
incredibly ineffective.
Yeah, yeah.
Speaker 2 (54:13):
I'll put a plug just because I'm in that now in like
mental health world, mentalhealth like digital, digital
companies and apps and stufflike that.
I'm in that world and there areactually a lot of really great
resources out there.
There's my friend made arebound.
She was Aaron Barron.
She was on our podcast beforeWonderful trauma psychologist
(54:37):
who made an app that basicallywalks people through some
exposure, some prolongedexposure, but for people who
might not be ready to or notable to find like a full trauma
therapist.
There's, I think Nima is acompany that does like online
PTSD treatment.
I mean, if you're, you know ifany of your family is in, you
(54:59):
know the military.
There's a veterans affairswhere Jacqueline works.
I mean there's a lot ofresources out there and um yeah,
just like explore differentoptions.
Speaker 1 (55:09):
Yeah, ptsd coach can also be helpful.
Um, pe coach is also CPT coach.
These are like, um, you know,meant to kind of facilitate like
homework with PE and CPT.
But but PTSD coach I mean it'sgot like breathing exercise,
coping strategies, a lot ofstuff that you can try on your
own to, you know at least likekind of bring that arousal down,
(55:31):
get into more relaxed state.
Speaker 2 (55:33):
So I'll link those in the show notes, because there's
so much crap out there.
There's so much like on socialmedia.
There's like so many peopletalking about trauma that really
don't know what they're talkingabout.
But I'm going to link PTSD,coach and rebound and like
resources that we know is legitin the show notes.
Speaker 1 (55:51):
So, all right, little helpers.
Well, it feels a little dark tocome up with a quippy one
letter for rating us on Applepodcasts and Spotify, but if
you'd like to give us five stars, we would love it and we'd love
to read your comments.
So we'll see you next week.
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