Hello, friends! In this Q&A episode, I take three awesome questions that listeners sent in and try my best to give some helpful advice. These cover a range of topics including health anxiety, PTSD in literature, and coping with a sexless marriage.
My husband and I have not had sex in 1.5 years. We have been together for 7 years, but only married for almost one year: Aug 25th will be our first married anniversary.
I just found out 4 days ago that my 50 lb weight gain is why my husband is no longer physically attracted to me. He said “I didn’t choose to be less physically attracted to you, it just happened.” What does that mean? He has gained as well. He has also said to me that he partially blames me for getting him fat. (Background story: he has battled obesity so have I. We both lost a ton of weight, me from 165 to 90 lbs; I am now at my heaviest 170. He said he is 340 lbs, minimally now from 220.)
I was devastated when he finally disclosed to me why we were not having sex. I had asked him throughout our year and a half of celibacy why we weren’t having sex and he said it was because he was having body issues. What was most devastating was that I had asked him if he were still attracted to me and he lied to me saying yes and now it turns out that it was actually me.
How can you help me/us get through this? My husband has always been emotionally unavailable, never wanting to share his feelings, never taking ownership, never apologizing. It breaks my heart that I feel like he doesn’t care when he doesn’t want to talk to me. I have asked several times that we go to therapy. He has refused, saying he doesn’t need someone to tell him why he’s unhappy.
Thank you for asking this question. Sexless marriages or big disparities in sexual desire among partners is a very very common issue that isn’t always talked about. I’m sorry you are going through this, but hopefully I can provide some helpful thoughts.
First off, this definitely does not sound like a purely sexual issue. It sounds like there are some underlying issues in the relationship between the two of you that are being expressed in a variety of ways. One of those is reduced sex and another could possibly be the decreased focus on fitness (and possibly taking care of yourselves in other ways). I suspect that you guys need to first work on your relationship before worrying about whether you are having sex. To be clear, I think that it’s totally valid for you to be concerned about sex and if you are not satisfied being celibate for the rest of your life, then something definitely needs to change. But there are definitely other issues at play.
I’m glad that you were able to get this honesty from your husband even though it probably hurt like hell to hear. It’s important for you to realize that even if what he is saying is true, this doesn’t make it all on you. There are two of you in the relationship and it’s not either one of your faults that you are in this situation right now. There are elements of this that are on him and elements that you need to take responsibility for. It’s not worth trying to point fingers.
Work on your communication
It’s clear that the communication between you two could use some work. I think that increasing communication overall could be helpful. Making sure that you are making time to have meals together without distractions, go for walks together, and do other light activities that allow time for conversation to happen naturally. This is a topic that you both have probably avoided diving deep into, which is why it took so long for him to build up to blurting out that he is not attracted to you. Having conversation more regularly and making a point to come back to this topic repeatedly may help to reduce the sting and the feeling of dread that you have when broaching the topic. This will hopefully allow you to move more into problem-solving and looking at things as they currently stand rather than holding onto resentments and hoping for some magical spontaneous resolution that may never come.
In these conversations, it would be important to try to get a feel for what he wants. Does he want to fix things? Does he want to want you again? Not whether he can force himself to be attracted to you and invested in the relationship right now, but does he want to capture that again if there were some way to do so? Sometimes these issues like disrupted sex life or physical health come up as expressions of dissatisfaction with the relationship. So it will be important to determine if you are both even on board with the relationship still.
When it comes to therapy, it could definitely be helpful. Couples therapy or sex therapy is a possibility. You said that your husband might be a little resistant to that, so it could help to frame it as trying to work on the relationship, not just about sex. Personal therapy could be helpful for either of you as well. The feelings that you are talking about along with the rebound in weight gain just paints a picture of two people who are not that happy right now. For your sake, independent of the relationship, therapy might be a good idea to help you find some hope in the situation and cope with these negative feelings that are burdening you. If this is someone that you still love, and that you can still see a future with, then you guys have time to figure this out. A year and a half in the context of a very, very long relationship, is still quite small, so it’s important to keep that timeline in mind. It sucks, but it doesn’t have to be forever.
Invest in the relationship
Aside from communication, another thing that you can do is try to take responsibility for adding more positivity into the relationship in general. Schedule some collaborative experiences, date nights, compliment him more often, watch funny movies together, and generally just invest into the relationship. You might be stuck in a rut, much like a depression, where you guys just aren’t generating pleasure and happy feelings for one another anymore. This is sort of like priming the pump and getting that process started. If he doesn’t respond at all to this or seems to shoot you down, that should tell you something about where his head is at.
You can also focus on increasing intimacy in other ways. If you are feeling so disconnected physically that even holding hands feels weird, start there. Hold hands, cuddle, rub his shoulders, and spend quality time together in ways that are close and intimate, but don’t involve sex. If you do decide to try to have sex again, don’t just jump into it. I would suggest building up to it using something like the sensate focus protocol I talk about in episode 160.
The goal with all of these things I’m talking about is to start at the top with your own personal happiness and the quality of your relationship with the hope that some of this trickles down. Eventually, you might find that you are motivated to work out or engage in active hobbies together because you want to work toward progress as a couple. Right now that fire is not there.
It’s also important to realize that sensuality, sexiness, etc. isn’t just linked to physical size/shape. It might be time to broaden your horizons a bit. This could mean following more sexy body-positive accounts on social media, taking a dance class, or even watching high-quality porn together.
Sex is secondary
But again, all of this is a little secondary. Figure out whether you are both still in this for the long run. Figure out if you both want to be sexual with one another again. Work on more frequent communication and investing in the relationship itself. If this all remains viable, then focus on intimacy and sex. There are lots of resources out there, but it requires this underlying buy-in first. If that isn’t there, it may be time to face the facts, whatever they might be. Whether that means that you don’t need to be in this relationship anymore, you need to take a break, or have that need met elsewhere…it could be a variety of things. But, we need to get a lay of the land first, establish the underlying issues and then try to deal with them, try to compensate for them, or remove the issues.
Hopefully, some of these thoughts are helpful to you. I know that it sucks to be in your situation – there are a lot of people who will be able to relate what you’re going through. Altogether, I think this is a good prompt to focus on you and on your relationship and the communication between you, and then see where it goes and take it from there.
Hello Dr. Duff, The question: Do you have any suggestions on how to accurately portray mental illness in literature? Some backstory: I’m currently working on a book series, and one of the main characters has PTSD and I want to make sure I portray his symptoms correctly. I’ve done my own research on PTSD so I know roughly how he should feel/act. He’s been in war, but his PTSD stems from Physical/mental abuse. As a result he puts up a front, where on the outside everything looks fine, but on the inside he’s always on high alert. His major symptoms consist of insomnia, disassociation, and claustrophobia panic attacks. Are these appropriate symptoms for him to have?
Really good question – I’m glad that you are thinking about this! It can be annoying to people with mental illness and sometimes even harmful in the way it perpetuates stereotypes when authors do not try to be accurate in their portrayals, so thank you!
The suggestions that I have for creating an accurate depiction is to try to gain some personal experience with people that have lived with PTSD. Even among people with PTSD, you will see a ton of variability in the way that their symptoms are expressed. Facebook groups, subreddits, twitter hashtags, and online forums are all great ways to find communities of people that have PTSD and would probably love to help you stay accurate with your depiction.
Another resource that I would highly suggest are books. Even before I was in graduate school for psychology, I would consume a lot of mental health memoirs. Books written from the first person describing someone’s actual experiences with a given mental health condition. You will see a lot of these in the psychology section of brick and mortar book stores such as Barnes and Noble. The great thing here is that you get to go deep into an actual person’s experiences. It doesn’t require interpretation and they aren’t looking at things through a clinical lens. They are telling you what it felt like for them. For instance, there was a book called Skin Game by Caroline Kettlewell that I read early in college that helped me learn so much more about non-suicidal self-injury. Once I finally was able to work with people in a professional capacity that struggled with self-harm, this book really helped me have a head start in being able to empathize with them and to not fall into common misconceptions. If you go on Amazon and search for PTSD memoir, there are a ton that pop up.
In terms of your character, I like that you make the distinction that he was in war, but his PTSD stems from abuse. In my recent interview with Dr. Laura Copley, we talk about how important it is to avoid making assumptions about what would be traumatizing for someone. It is totally plausible that someone could be in infantry or special forces and see combat, but not be traumatized by it, but have serious trauma due to sexual abuse or parental violence.
I think that all of the symptoms that you listed could easily be present. I would be sure to think about how this person’s experience affects their interpersonal relationships. Some people might withdraw and be very closed off emotionally for fear of tapping into feeling that they do not want to come flowing out. Others become much more irritable and tend to snap more often. Hypervigilance, or always looking for signs of danger, is a common symptom and it’s important to recognize that this causes exhaustion. It takes a lot of effort to try to be a normal functioning person with these background processes running. Therefore for this person, their insomnia is probably brutal. They are exhausted, but can’t get themselves to get restful sleep. Then there is a carry-over effect where they are going to be even more exhausted and more out of it the next day. That alone is enough to make you feel like you are going mad.
So you are definitely on the right track. Keep doing your research. Reach out to some individuals, sit back and take in some memoirs and personal accounts via the internet and keep your good intentions in mind throughout.
I have suffered from crippling anxiety for 50 years. I am familiar with techniques in your book. Now I am having physical problems. Do you have any tips for handling the anxiety that comes with physical problems which anxiety makes worse. It takes a while to get to see doctors and have tests. It’s hard not to worry. I am 66 years old and female.
Thank you for getting in touch and listening to the show, I really appreciate that. First off, I just want to say you are strong for living your life in the context of this difficult anxiety for so long. I’m proud of you for that. Sorry to hear that new physical issues are starting to pop up that complicate things a bit.
As we get older, medical problems are more common, so your situation is definitely not unusual. One important thing to remind yourself of is that your physical health status is largely uninfluenced by your thoughts. By this I mean that if you got blood drawn and you are waiting to hear back about the results, those results are going to be the same whether you pay it no mind or you dwell on your worries constantly until you get the call. So, it sucks to have anxiety and to feel that icky sense of anticipation, but just remember that even if you do fall down the rabbit hole of convincing yourself that something is terribly wrong, it doesn’t change the fact of the matter. We can sometimes have these illusory correlations where we think that we caused something to happen because of our thoughts. But it’s important to remember that those results were going to be the same no matter what, so you don’t need to beat yourself up by thinking it was your thoughts that caused this. Remember, no matter how much you worry about something in the future, it’s not going to change the fact of that matter.
It is also common to have physical symptoms that either cause or worsen anxiety. For instance, a lot of people with asthma or COPD can have anxiety triggered because they get the worrying sense that they can’t breathe or are not getting adequate oxygen. You’re already doing one thing right in this scenario, which is to do your due diligence with the medical workup. To figure out if you are actually in any risk that you need to keep in mind. This can help to separate out symptoms that you should be legitimately concerned about and ones that you can let exist on the back burner while you go about your life.
It sounds like you have already learned some strategies for managing anxiety when it pops up, which is great. Those still apply here. However, it might be that your focus needs to switch a little bit more to managing your thoughts. Keeping some notes or even a thought log can be helpful to identify your common catastrophic thoughts, meaning when you take a small worry or symptom and blow it up into a catastrophe in your mind. Keeping these notes will help you stay grounded and aware of your own patterns.
For instance, I had a period of time for a few weeks where I was getting anxious every time I drove on the freeway because I would feel an odd tingling feeling that I normally feel when having an asthma attack. I was sure that I wasn’t getting enough oxygen, but after getting checked out, that wasn’t the case. I kept a small log on my phone of how often the symptom occurred and in what circumstances. What I learned was that I never noticed the symptom when I was intently focused on something else. For instance, I never once felt it while gaming or focusing heavily in class. It was mainly while driving, which was an activity that allowed my mind to wander. I was also able to use those notes to recognize that for the 20+ instances that I logged, 0% lead to me passing out or running off the road. Literally, nothing happened. I just felt weird. So perhaps there is a way that you could use some form of journaling or logging to gain a more objective perspective on your symptoms in a similar fashion.
When it comes to waiting for appointments and the anticipatory anxiety that can come from worrying about what you will find out. Again, writing down those worries can be helpful so that you aren’t simply carrying them around in your head all day. I will say that it is always helpful to have support. Whether they are professional or friends/family, having someone that you can call and complain to when you are scared about your health can be very helpful in simply unburdening yourself. They may also be able to point out if your catastrophizing, giving you a red flag to step back and think about things a little more logically.
Finally, I think that it would be wise to make sure that you have other activities to occupy yourself. Rather than focusing hard on trying to get rid of the worrying thoughts, which is hardly ever successful, you could instead pour your attention and energy into something else, especially if it is enjoyable. If you have any activities that put you in a flow state where you are not focusing on anything else and time seems to fly by, those are perfect. Whether it be knitting or playing cards with friends, or dance, whatever it might be, any activity that puts you into a flow state, then you can rely on that to distract you in those periods of waiting.
Overall, I think this is a really legitatment concern that you have, but you have so many skills already that carry over. I think right now you need to focus a little more on the thoughts and a bit more on placing your focus elsewhere rather than trying to fight the anxiety head on so hard. Thank you for writing in!
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