It is not uncommon for a couple to seek out sex therapy and for the sex therapist to discover that one of the partners has been struggling for years with undiagnosed Attention Deficit Hyperactivity Disorder (ADHD/ADD). A recent research literature review by Soldati et al in the Journal of Sexual Medicine found “that subjects with ADHD report more sexual desire, more masturbation frequency, less sexual satisfaction, and more sexual dysfunctions than the general population.”
For partners in which relational intimacy is their primary erotic impulse, a partner with ADHD may struggle to foster and sustain sexually intimate relationships —be it brief or enduring due to the symptoms of the disorder including: impulsivity, novelty seeking, forgetfulness, rapid mood changes and challenges in consistency. Part of this break in intimacy may also be due to the dynamic of the partner who doesn’t have ADHD taking on more responsibilities in the relationship, household and/or with their children. Over time the non-ADHD partner feels more and more resentment and may begin to feel more like a parent while the partner with ADHD may feel a combination of emotions including feeling: nagged, disrespected, embarrassed and angry. These feelings all contribute to a less than desired relational pattern that can spark sexual passion. Part of the work a couples therapist can focus on is to have each partner write blocks of time or deadlines when tasks can realistically get completed in a joint family calendar and have the partner with ADHD utilize reminders or sounds to help them transition into chore time.
Another point in this study was the pattern of partners going to bed at different times when the ADHD partner has extra work to catch up on or who may have poor sleep hygiene. One of the interventions a therapist can help couples with is intentional times that partners can go to bed together and help them create intimacy dates. In terms of the actual sexual experiences, partners who have ADHD/ADD report having trouble attending to some types of physical stimulation when the sexual script becomes repetitive, predictable and less novel over time leading to a lowering of sexual desire, a lost erection, or an inability to orgasm. When involved in a sexual script that is un-varied, the mind of an ADHD person wanders to places that do not include the bedroom like work related tasks that they’re behind on which is a turn-off or alternatively the mind searches for more novel types of erotic fantasies that they’ve watched on sexual explicit media, have had in the past or wish they’d like to have in the future. In fact some of the studies reviewed in this literature review found that the person with ADHD/ADD themselves may has less sexual satisfaction in partnered sexual experiences which may be due to their mind continually wandering. The potential problem when their focus goes to erotic imagination is that it might look like an emotional detachment to their partner, in fact some clients in sex therapy have described this occurence as their partner “ just going away”. These clinical observations are supported by a 2008 survey by Gina Pera of partners of people with ADHD who reported that “30% felt no connection when having sex with their ADHD partner, as if their partner was not there.” In order for emotional intimacy and sexual intimacy to form and grow, it is imperative there be an environment that is built on—and promotes—relaxation and playfulness and a sense of embodiment (a body/mind connection). One can cultivate this through present-focused techniques like yoga or meditation or introducing sex games that both partners would find fun and novel.
There are extensive other sexual difficulties that those with ADHD deal with aside from a lack of focus during partnered sexual activity: Medical News Today found that another desire issue was found in folks with ADHD; hyposexuality—that is, a level of interest or involvement in sexual activity lower than the norm, which is sometimes symptomatic of ADHD and sometimes an effect of medications used to treat ADHD symptoms; a healthy sex drive yet a struggle to reach orgasm despite prolonged stimulation, which is often due to boredom, trouble with focus, or an influx of other feelings; hypersensitivity—that is, a sense of discomfort in response to tactile stimulus, such as painful sensations in response to genital stimulation. It’s important to find out what kinds of touch a partner with ADHD finds pleasurable when working with a couple who have avoided sexual connection due to this issue.
ADHD can cause a person to thrive on excitement and to be fulfilled by an ever-changing landscape. This restlessness, only satiated by new phenomena, grows exponentially and often involves sexual fantasies as well for men. According to a 2019 study by Bothe et al, ADHD symptoms might be a critical driver in the severity of hypersexuality or out of control sexual behavior for folks of both sexes, whereas ADHD symptoms might only be significant with problematic porn use solely among men. The literature review by Soldati et al noted that people with ADHD have demonstrated an extensive use of online pornography, which, in such excess, leads to a difficulty in the formation of secure attachments. However, the studies reviewed bySoldati et al were not fully conclusive that people with ADHD were more likely to struggle with out of control sexual behavior or CSBD (Compulsive Sexual Behavior Disorder). In a study by Bejlenga et al, the most common sexual disorders among men who had ADHD vs. men who didn’t have ADHD were orgasmic problems (10-14% vs 3%), premature ejaculation (PE) (13-18% vs 10%), sexual aversion (12-13% vs 1%), and negative emotions during/after sex (10%, no data in the control group), whereas women reported sexual excitement problems (8-26% vs 3%), orgasmic problems (22-23% vs 10%), and sexual aversion (15% vs 4%). There were no significant differences in the results between patients treated with ADHD medication and patients without psychostimulant treatment.
It is critical for those folks seeking help for these sexual problems to be sure their therapist has the experience to conduct a thorough biopsychosocial assessment to explore the possibility of an ADHD/ADD diagnosis. A therapist needs to address the ADHD/ADD diagnosis, the consequences of this disorder on the couple’s relationship over time and the sexual disorders to which it has contributed. I will add some Sex Esteem tips for couples in a future blog.