ADHD Sex Drive Explained: How Executive Dysfunction, Sensory Overload, and Hormones Affect Desire | Dr. Leann Borneman

25:55Even having to do the awkward waddle sometimes to the bathroom to just pee, right? And you're just like, this is so much work. And like, they just roll over and go to sleep and you're like, as if. Yeah. And I think you spoke volume when you were just talking about your shower routine and how some days there's just so many different things you know you have to do. That's also talking about sex. All the things you have to do. You have to kiss. You have to do foreplay. You have to touch. You don't have to get the lube. You have to do this. You have to do that. That right there is the task initiation and the shutdown that can happen with so many of us because it becomes very overwhelming.

26:32And like, for instance, I took a shower the other day and I got out of the shower and I had to sit on the couch for like 10 minutes before I could blow dry my hair because just taking a shower can be so exhausting depending where you're at. Some days you might have it in you to do the whole routine, start to finish, but then some days you might not. And it goes back to this concept and idea of sex can never be about consistency. It has to be about persistency because that also is a support to the ADHD brain. Say more, what do you mean by persistency for people listening? Yeah. So persistency is this idea of showing up when you can.

27:05Consistency is this idea of you have to do it all the time. So for instance, if you have this idea that sex has to look the same in the sense of foreplay, start to finish, you're setting yourself up for failure. Because you might not be able to start and finish. You might just be able to start. You might only be able to do foreplay. That is then about showing up and doing what you can when you can. But when we don't know that we have access to have persistency in the bedroom, we avoid because we're thinking we're failing or that we're not going to do it right. Right. And that again, creates the disconnect.

27:40Yeah. No, I think this is going to help a lot of people because it's normalizing the experience that we all have with ADHD. And I like to also frame it as like, you only have so many decisions you can make in a day. You only have so many. And so, I mean, I will tell my family when I'm tapped out. I'm like, I've made all my decisions for the day. I have nothing left. Or I'll tell my assistant, like everything else has to go to tomorrow because I will make the laziest decision possible and it's not the right decision. That's awesome that you're able to tap in and you know that about yourself. Oh yeah, well, that took like getting to my 40s.

28:13Let me tell you. So I'm like, let me be fair. I do this podcast so you all like don't fall into the potholes that I did on this road of life. And I'm hoping that we can illuminate those so that you're like, oh, I'm just going to sidestep that. So I want to ask you though, because you are a practicing clinician, you work with neurodivergent people, but you also are within this field that quite honestly, not everybody really understands neurodivergent people. What are the most common mistakes clinicians make when addressing sexual dysfunction in neurodivergent people. Before you answer everyone, sexual dysfunction, air quotes, is what the studies, the research says, and medicine diagnoses you.

28:51I don't like the term, but yeah, I don't want you to feel like you're dysfunctional, but it is the often sexual dysfunction just for people listening to is not a, that something is wrong with you and you're broken. It is that something is off and it's distressing you and it's affecting you in a negative way. So also wanting to frame it in that way. I don't want anyone to feel bad about themselves. Yeah, no. And I think that's a great layer to that because the word itself is not sexy at all and it can make you feel like crap 100%. But I think when we look at the field, the field is coming and growing, but we are still so far behind.

29:29We see it in the research, pathologizing ADHD experiences about where we're failing. We have higher levels of divorce. We have higher levels of dissatisfaction. We suck at conflict resolution. We're not able to have orgasms and satisfaction, and we're more likely to have low desire. And it just keeps repeating all these things. And no one is asking why, right? And so when we look at sex therapy and we look at mental health, when we're navigating sexual discrepancies, We're going to use that word. One of the biggest issues is that therapists that don't have an ADHD lens, they are using interventions that were not by default created for a neurodivergent brain.

30:14They are expecting keen executive functioning. I don't know about you, but I don't have that as an ADHD-er. I have barriers to that. So when you are instilling interventions or approaches that are relying on functions that your brain is struggling to tap into, what ends up happening is now the person showing up, they're doing their part, right? They reached out. They identified a quote problem. They're being given interventions. They're now trying it. It's not working. What ends up happening? You feel shame. You're broken. You're the problem. Or worse, the relationship just isn't meant to be. And that right there is a huge issue we still have in the field because not enough people are understanding the ADHD lens to the experience, specifically when we're tapping into executive function.

31:02You brought up scheduling sex. What are the other tools that you wish that people with ADHD would be aware of that might not work for them so that they don't feel like a failure? So there's a few. One of them is mindfulness. Now, mindfulness is a beautiful, beautiful, beautiful technique. I just, I'm sorry, I'm laughing because I've had my own experience with a therapist who was like, you just need to meditate for an hour. And I'm like, you said you were ADHD literate, friend. I don't think you are. And she's like, well, I can meditate for an hour. I'm like, are we talking about you? Or are we talking about me?

31:33Let me know. Yeah. So sorry, go for mindfulness. Let's vote. I appreciate the laughter because we've all been there and we've all been without really understanding in those moments, we've learned to internalize it and think that we're the problem. Mindfulness acquires self-awareness, right? Interception. So one of the core executive functioning barriers or how they define it in medical terms, deficits, is self-awareness. Self-awareness is, let's say, you're going about your day, something happens, and you're automatically able to say, hey, how's that making me feel, right? And interoception is our ability to tap into those internal cues, those alarms.

32:12So think just about like appetite, like you're hungry, you have to go to the bathroom. For us ADHDers, we have barriers, deficits to those things. So let's say you're in the moment with your partner and your therapist is saying, practice mindfulness. In order for you to gravitate and navigate to mindfulness, guess what? You have to be self-aware. And if you have deficits there, you're not going to be able to grab that tool. And so now, how are you supposed to implement it? Eczema is unpredictable, but you can flare less with EpGliss, a once-monthly treatment for moderate to severe eczema. After an initial four-month or longer dosing phase, about four in ten people taking EBCLIS achieved itch relief and clear or almost clear skin at 16 weeks.

32:53And most of those people maintain skin that's still more clear at one year with monthly dosing. EBCLIS, LibriKizumab, LBKZ, a 250 milligram per two milliliter injection, is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema. Also called atopic dermatitis that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. EBCLIS can be used with or without topical corticosteroids. Don't use if you're allergic to EBCLIS. Allergic reactions can occur that can be severe.

33:21Eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with EBCLIS. Before starting EBCLIS, tell your doctor if you have a parasitic infection. Ask your doctor about EBCLIS and visit EBCLIS.lily.com or call 1-800-LILY-RX or 1-800-545-5979. Mindfulness is wonderful post-reflection, right? Giving yours. And that, I think, is a huge strength for us ADHDers. We're really good. at reflecting after the fact, taking in data, asking ourselves what we were thinking and feeling in that moment, trying to pull as much from that experience.

33:52But in the moment, mindfulness sucks. It is not helpful. And why mindfulness works better in the therapeutic room is because your therapist is your executive functioning. They're literally telling you what to do, how to do it. They're giving you the pause that your brain is struggling to do in the moment. So that's number one. The other one is cognitive behavioral therapy. Oh, go off. I'm here for this. CBT. CBT, again, beautiful, beautiful thing to use. It helps you challenge your negative thinking. It gives you another area of reflection and pause, stopping yourself from automatically going to one area.

34:31But again, you need self-awareness to do that. And if you're a therapist listening to this right now, stop giving your ADHD clients homework activities that are paper. The last thing an ADHD-er is thinking in the moment of heightened stress is, oh, let me go get that PDF. Let me go get that piece of paper that my therapist told me to print out and take pause and write down. How am I thinking? Why am I thinking this? Is there any other thought I could have? Oh, that is not ADHD-friendly. So again, CBT, wonderful tool, but not something that an ADHD or can just rely on because we have executive functioning barriers.

35:13I think that is so important for people to hear. And I have, I want to say for people who follow this podcast, I've talked about cognitive behavioral therapy for hot flashes. It can work beautifully because I invited all the perimenopause women here. It can work beautifully for how it affects you. But I agree with the concept that, I mean, I just don't think CBT was ever made with the neurodivergent brain in mind. Not that mental health interventions are. That's a whole, like, okay, you're coming back on the podcast. We're going to talk about all that. But I mean, the other thing that we see though, okay, so we tell people that are struggling sexually going to CBT.

35:49We tell women with PMDD going to CBT. Well, who has PMDD? Mostly neurodivergent women. The interventions that we're constantly giving people when it comes to CBT to treat things, I want people to understand, do the studies look great? Hell yes, they do. Because when you isolate a person and you do exactly what you said, you become their executive function. You do all of that in a controlled setting, which is what a research study does. The outcomes are going to be phenomenal. But when you put it out into the wild, we see people struggle. And then they feel like they must be broken because it worked for their best friend.

36:23So why is it not working for them? And I'll even piggyback that off. There was a study done about two years, a year and a half ago. Very small study, but still significant in my professional opinion. It was out of Australia or Austria. I can't remember which place, but they had 10 participants doing CBT, all of which were ADHDers, and they were looking to see if they believe that CBT was helpful or harmful. And then they asked all these individuals to give actual feedback, which was wonderful. It wasn't just like an assessment. They wanted the feedback. Out of the 10 participants, only one said CBT was helpful.

36:56Every other participant said it was stupid, a waste of time. It was harmful. It was not helpful. The reason that one participant said it was helpful was because the person implementing it used an ADHD lens. They tweaked it to actually work with the ADHD brain and the expectations attached to what it's like to live in an ADHD brain in real time. So I want to ask you, for partners that are living with an ADHD individual, how can they differentiate between disinterest and executive function shutdown? So I think this is a good question, but I would like to focus on the person in the relationship who has ADHD.

37:37Ask yourself, do you find your partner attractive? Are you interested in them? Do they bring you joy? Are you turned on by them in safer settings when you're out and about or they're at work and you're on the phone and they say something and you're like, ooh, I like. That's a really good way for you to navigate and understand that, you know, you are interested. If you don't hold that, you're not attracted to your partner, there's more likely than executive functioning barrier is not necessarily the big thing here. It might just be disinterest. So I like to just gauge with my clients, like if there is an interest outside of the bedroom, you love your partner, you're attracted, you're turned on, that's a really good way for you to navigate and know that no, you are interested, but there is something blocking your access.

38:26And generally it does have to do with executive functioning barriers. So let me ask as a follow-up. So in a relationship, when one partner has ADHD, what helps keep the connection alive? Communication, understanding each other's needs and sensory related concerns. One of the things that I see quite often, especially with my women ADHD clients, especially going into the area of perimenopausal ages, whether perimenopause is a thing or not for them in that moment. Sensory gets a big front for a lot of our concerns. So touches are going to be different. Smells might cause barriers. Sex ends up not looking like what you thought it was supposed to look like anymore.

39:13It's going to have to look more about what are your needs? How do you implement them? Can you be okay with it? So checking in and better understanding what are your brakes and accelerators and understanding too within that one day a brake might be a real brake, but the next day you might be able to navigate it differently. So this goes back to the persistence versus consistency as well. When you say brakes versus accelerators, can you break that down for people listening? Yeah. So Emily Nagowski used this term, brakes versus accelerators in terms of our interest. So if you are interested and it feels safe, you're going to have this accelerator in your brain.

39:53You're going to want to go and gravitate towards it. You're going to be present. But if there's anything in your interaction that is a turnoff or something is affecting your ability to be in line and feel safe, your brakes are going to go off. Brakes are basically saying that it's a no-go. You're not going to want to show up. You're not going to be attentive. You're not going to be present. And for people listening, this is born out of the research from Bancroft and Janssen, which was originally done on men. So this is when, of course, it was originally done on men, but they were like, we should explore this.

40:25Does it apply to women? Lo and behold, it does. So what do we know? Any body on the planet has these brakes and these accelerators, and this can affect you. And I think this is really important because we often get into a conversation of gender dynamics and women just never want sex and men always want sex. And I think those myths harm people as well. Oh, a hundred percent. And I love that you are a wealth of information because that was very important too. When we think of also accelerators versus breaks, it goes back to the main concept of the work I do. My job is to help formulate where are the blocks.

41:04How do we gain access? Because at the end of the day, I like to always reinforce this to all of my clients. It's not you being incapable. There's a block to your access. And access in this domain is the accelerator, your ability to feel safe and able to show up in that moment. And when we have an ADHD lens, it's important because in the literature, and when we're looking at therapeutic styles and interventions, we're not thinking about that layer. Even in the research right now on low desire, an ADHD lens has not been integrated in that. Well, let's talk about that because you've actually developed a model to integrate the ADHD lens and break free of like this traditional mold that we're all being expected to fit in.

41:48And this is, I'm talking clinically, we're being expected to fit into this mold and it doesn't necessarily work for us. So talk to us, like tell us the name of your new model and talk to us about it. Yeah, so the last three and a half years through observation, combing through all the research, working with so many amazing clients, my own personal life, I started creating and identifying patterns that I was reading all the books on low desire. I was taking all the educational classes for my certification and my PhD on better understanding, low desire. And yet I was still struggling. I was implementing all these things and my clients were struggling.

42:25I had like a moment I was like, wow, am I a really shitty therapist? Like what is going on here? And then I had my aha moment and I was like, holy crap, we are not integrating an ADHD layer here. And this is where executive desire model came about. And what I'm doing is I'm creating a layer to the desire understanding. So think of like Shrek and his onion. I don't know if anyone here and listening has watched Shrek. I love my Shrek. Desire is like an onion. There's multiple layers to it. And the neurodivergent layer has not been integrated. And what I'm doing is I'm saying, if you're somebody that, let's even say, has struggled with responsive desire.

43:04So think about like whenever you make a plan with a friend. I always like using this example. And you're really excited to make those plans. And then the day comes and you're like, why did I make my plans? But you're getting dressed. You're still struggling immensely. You get in the car. You're driving. You get there. You're with your friend. you start, you know, conversating, interacting, you become responsive. You're like, oh, I'm having a good time. You're enjoying it. You're engaging. That's responsiveness in the bedroom as well. Sometimes you need to integrate, get into it with your partner before you're really like, okay, I'm ready.

43:40I'm there. Dr. Lori Mintz, a wonderful woman, wonderful researcher, she says that sometimes it's about having sex to get horny, not being horny to have sex. And kind of a good example of responsiveness. But when we think of ADHD, sometimes that's not enough. Because what if you're showing up and your environment isn't set up for your success? What if your environment is not supporting your neurodivergent needs? Now you've done the deed, right? You've shown up. You're touching your partner. Your partner's touching you. But what if the other things haven't been implemented? Now you've failed, right?

44:18Because lo and behold, you've been advised. There is spontaneous, there is responsive, do this, you'll be fine. But you're still not integrating the needs to support your brain. And that's what the executive desire model does. It's bringing in that layer of understanding that if you have ADHD and you are still struggling and you're horny, you're turned on by your partner, but something is stopping you, it's most likely the executive functioning barriers that become the gate to accessing your desire. Okay. So talk to us about what are the signs of executive functioning gatekeeping during intimacy and how can couples start to work around it?

44:56So the biggest, most common one is sensory related issues. Okay. So if you are experiencing any level of sensory issue, your brain is going to shut down. You're not going to feel safe. Think of your nervous system. So for instance, if I'm going to go personal, my husband has a beard. I love his beard, But beards also can have smells to them and texture. And certain things have to be in place for me to be able to gain access to my safeness to show up and access the desire. So for instance, my husband knows it has to be freshly trimmed. He has to use his beard oil. It has to be freshly shampooed.

45:31He has to brush his teeth. All of those things are otherwise barriers. And that I'm not going to show up to. That's a sensory barrier. And that's a gatekeep to my desire. If I am able to have a conversation with him and he's able to do all those things, I now gain access to it. I'm now showing up. I'm there. Another one is when we think of task initiation. You know, if you believe that sex has to have a start and a finish, you might struggle. And now you're going to avoid. That's a gatekeep. But if you have a conversation and you're like, listen, I just want to cuddle. I want to have kisses tonight.

46:09And that's all you do. Guess what? Now you're accessing your desire, right? These are those examples of how executive function plays and how we're showing up or what's causing us to not want to show up. Because again, I work with a lot of people that sometimes, yes, they're struggling to even feel horny, but more times than not, my clients are horny. They're interested. They're turned on by their partner, but something is stopping them. And when we are able to take apart and map out how their ADHD is showing up for them specifically. Where are their concerns? That's where we can navigate and create access to it.

46:44Another example I like to give, and I think this goes back to the sensory related issues, I apologize. It's very common, but lube. I have women that literally cringe with the idea of lubrication. It is a noise and also a tactile sensory experience that can completely shut them off. So finding ways to navigate that is going to help them gain access to feeling safe to even show up. Because if, again, you don't feel safe to show up, you're shutting down. Yeah. I think about the Cardi B song that came out, WAP, and she said macaroni in the pot. I didn't know what that meant. And like, I had to get it explained to me by my husband.

47:22He's like, you know, that sound sometimes is like, I'm like, oh, no. And that is something that like, I was instantly like, oh, that's so gross. And like, you know, my husband is like, what's wrong? Like, why is that gross? Like, it's just normal. It's what normal bodies do. I just appreciate that from him. But I'm like, it's a sensory thing. I hear certain noises and like my stomach flips upside down or I just, I just, you know, feel like sometimes like my teeth will fall out. I don't know. I can't explain it. It's just the sensory input. And so I think, you know, for women listening, hearing you say that is really validating for them too.

47:59And I think also, you know what I'd love you to speak to is like the use of like toys in the bedroom, because a lot of therapists are like, just bring in toys and like toys can be great. I like to call it like Batman's accessory tool belt, like, right? Like you use whatever tool you need to get the job done. However, it doesn't always work. It's not always the solution. And it's also sometimes very overstimulating for some people. So that's another form of a barrier for a lot of people, we have to talk back to the concept of stimulation. And there's twofold. You can either be overstimulated or understimulated.

48:32And that's going to also depend on your availability to access your desire and showing up. Plan B is a backup birth control option that's there for you when things don't go according to plan. It specifically works after unprotected sex and before pregnancy occurs by temporarily delaying ovulation. Plan B is available nationwide at all major retailers and through delivery apps like DoorDash. No ID, prescription, or age requirement. It's the number one OBGYN recommended brand of emergency contraception, and it won't impact your future fertility. That's freedom to be. Use as directed. So when we think about toys, toys can be a great tool if indeed you're struggling to be under-stimulated, where you need more stimulation to keep you present and to feel fulfilled and to stay in the moment.

49:20But for a lot of women, it can be overstimulating. And on top of that, again, I think you speak volume to the concept and the scripts and the pressure that could place, oh, spice up your life, bring in a toy. And then let's say you're this person that's like, toys don't work for me. And then you feel shame. And then maybe you don't feel comfortable saying that. And that's a whole other barrier that you need to address and how you're integrating it in the bedroom, and now you're not even having a good time. You're overstimulated galore. Toys don't always work. Sometimes it complicates the situation.

49:56So again, this goes back to you having to map out what are your needs, and your needs are not wrong. They're yours, but important to know what they are so you can navigate that, especially when we're talking about toys. Through the lens of the executive desire model, what do you think clinicians are getting wrong when it comes to low desire in ADHD individuals? What I see when people come to me, they don't have low desire. They don't. Because low desire means that you have no interest. You're avoiding. That is generally what low desire is describing. But for a lot of my clients, they do have interest.

50:35They're just struggling to feel comfortable and safe to show up to it. and it is because of it not being set up for success. Think about sex. Sex has a neurotypical expectation placed on it. Sex in general is not set up for neurodivergent brains. Can you explain that when you say it's, so sex expectation, sexpectation. There you go. Why is that set up for the neurotypical brain? Like, what does that mean when you say that? Because when you think of executive functioning, it's basically the management system that's letting you literally go across your day-to-day, do things, plan, prioritize, show up, be aware, make changes, stop yourself, right?

51:16Okay. Us ADHDers, we have deficits attached to all of those systems, okay? So when we think of sex, sex has this expectation, you're going to show up, you're able to just jump right in, you're going to kiss, you're going to do whatever your idea looks like, you're going to be able to transition with no issues, this, that, and whatever, and then you're done, okay? Girl, that is not ADHD friendly because for first and foremost, we generally can't jump. Think of task switching. That's another big one that I forgot to mention. For us ADHDers, task switching is this concept of being able to go to one thing to another with little ease, right?

51:56Like pretty easy. For us, we can't jump. This is like very common for like, let's say you're in the living room or the kitchen, you're on your phone, your child or your partner walks in and they start talking to you and you start to get like irritable. It's because you were literally zoned into one thing and now you're being demanded by your environment to switch. Our brains don't do that very well. So what we end up experiencing is distress because our brains are like, what's going on? That applies to the bedroom. The bedroom reinforces and expects you just to be able to switch tasks. Tasks switch so easily.

52:33We can't do that. So when we think of sex, sex has to be integrated in a way that, again, works with our brains, not by a default of what has been expected neurotypically. And neurotypically, I'm talking about no issue with executive function. Like you have easy transition, you're able to pause. Think about even if, let's say, you are having sex with your partner and something doesn't feel right. For somebody who has no deficits or barriers to their executive function, they're going to be able to execute their inhibition. They're gonna be able to pause. Now they're gonna be able to self-reflect, right?

53:12Self-awareness, like, ooh, what's bothering me? What am I not liking? They're gonna be able to relay that information. For a lot of us ADHDers, we are not able to take that pause. We struggle with that self-awareness. And so now we may be integrating and we're not enjoying something. And now we're creating conditions where we're disconnected. Does that make sense? Yeah, it does. And as you bring this up, I think about the research that we do have that shows that women with ADHD and autism are more likely to be diagnosed with endometriosis and adenomyosis, which are two conditions that can lead to pain with sex.

53:48And so as I hear this, and I think about nervous system dysregulation that's taking place, trigger points in the pelvis, Like there are so many times in an, and so everybody, to be very clear, maybe you're picking it up, but I'm talking about heteronormative, like penetrative sex in this instance where a woman would be experiencing pain, but she doesn't have the executive functions and the bandwidth to be like, wait, this isn't right. I need to communicate. We need to switch things. And how that, that executive, this is like a light bulb moment for me of like this executive dysfunction lending itself to more sexual issues because of the pain and not being able to communicate it.

54:30And then the reinforcement of pain and starting, I mean, be very careful here. This is not trauma in the sense that your partner did something wrong to you, but it's trauma in the sense that you experienced pain during this situation and the nervous system says guard, protect, keep us safe at all costs. And that right there, I think is where a lot of therapists also get things wrong is because what you're talking about is executive functioning barriers. And this is what the executive desire model is trying to outline is that executive functioning barriers are always there. When we think of low desire, low desire, Dr.

55:05Brado does a wonderful job of explaining that there is like an initiation, like a thing that provokes it, whether it be medication, chore division issues, what have you. And then there are just engagements that reinforce that. So there's a provoked thing that occurs and then the reinforcement. You're talking about executive functioning, provoking it at every corner and turn. And then let's say continuously, repetitively doing something that doesn't feel good, you're reinforcing the disconnect that, yes, can 100 % lead to then low desire. But if you don't understand executive functioning barriers, you're never going to be able to help clear out the reinforcement piece of it because you have to set it up originally to work with your brain, not against it.

55:56Does that make sense? Yes. So what I want to ask now is that how can women be able to step back? Well, men as well, if you're listening, I want to help you too, but to actually be able to, because right, you said earlier on communicate, like communication is so important, but that requires interception, executive functions. So how can people start to cultivate that to get the sex life that they want? Never try to do it in the moment. Okay. That's fair. Okay. So one of the things is pre and post. So pre-check-in. So think of kink and BDSM, okay? Kink and BDSM is wonderful in the sense that they have a wonderful platform for so much communication.

56:38Communication is vital before, during, and after. This is one of the biggest mistakes we all tend to make when we're trying to have sex, especially heterosexual couples, where we forget the most important part is communication. and for ADHDers in the moment, communication can be hard because we might need to take pause or our partner might have to be the pause for us. So doing something before and then after can be very helpful in these moments. So before can look like, where are you at? You know, are you overwhelmed? Do we need more of a bridge before we can get into it? What are you interested in tonight?

57:15Are you interested in soft touch, firm touch? Do we want to do sensory exploration? You can think about all these different things. And then after the fact, you can also check in and say, what did you like about that experience? What didn't you like? You can use that as data. Understanding though, that data doesn't get to be applied as a consistent thing. Because what ends up happening a lot of the times, what I see in my couples is that partners, it can go both ways, wives, husband, doesn't matter. The second they see something work, they latch onto it, especially if they have ADHD, they become hyper-focused on it and they try to start implementing it every single time now.

57:54And the other person's like, no, it's not working for me. So conversation is huge. And so a lot of my clients, they are not able to start integrating sex until they have a conversation first and then also during, but more importantly, after. How do you approach this conversation if somebody has RSD? Because data and feedback isn't always received as just data and feedback. Yeah, so this is very important. I actually have on my website an intimacy partner menu and also a ADHD-informed bedroom check-in that kind of goes through all these different areas. And the language I have specifically attached to it is as a team, it's collaborative.

58:35So it's not about one person or the other. When we think of rejection sensitivity, it's a lot of emotional dysregulation to the sense of being criticized, or being rejected. And when we think about conversations around sex, we have to practice curiosity and collaboration. So jumping into these conversations, if you haven't been able to have them yesterday, you can kind of automatically going to be able to do them right now, today. So we have to slowly integrate it and do it more on a collaboration. So not about I, more about we. How can we create this experience? Part of that is unlearning your role, right?

59:15What are you supposed to be doing? How is it supposed to look? There's so many layers to this. So it's really hard for couples just to automatically be able to jump in and do everything without also feeling your feels and getting comfortable just about conversating and being a team when we get like into those emotional dysregulation modes. I experience RSD a lot in my relationship, outside of my relationship. Anytime there's any sense of criticism and criticism can look like I said something and my husband laughs it off and I'm like, oh wait, you don't agree with me? And like, I'll shut down. Like, I'll be like, he doesn't love me, right?

59:54I have had conversations outside of those moments with my husband. So he is aware and we have a system. We have a conversation and a plan that he's able to check in with me. So having conversations outside of the moments of RSD, asking each other, how can we show up if this happens is also really important. For people who don't know what RSD is, can you explain it? Because I think sometimes people get it in their head that RSD is you just being dramatic, overly sensitive, but it's so much more than that. Yeah. So rejection sensitivity dysphoria, it isn't an actual criteria for ADHD. It's something that we just see more commonly across the board around emotional dysregulation, trauma response related as well.

1:00:40But what we see, especially with ADHDers, is that because we experience emotional dysregulation, so we experience our emotions more intensely, think of your upbringing. Many ADHDers, unfortunately, we have grown up in a society that has told us we're not doing it right, we're screwing up, and we've kind of learned that we're always being criticized. We're always being rejected. Your body becomes conditioned to that within the realm of intense emotions. And so any form of trigger to rejection, criticism, whether it's real or perceived, it does not matter. Your body goes into dysregulation, but think of dysregulation on like steroids.

1:01:28Some people that can look like shutdown. Other people, it can look like literal crying. Other people, it can look like projection and anger. It is not being overdramatic. It is your nervous system literally being flooded and feeling very unsafe and your body not knowing what to do with it. And it is a very exhausting experience for a lot of people to the point that for some people, the turnaround time of it can take days depending on the navigation and the thing that kind of triggered you in the moment. You brought up kink before, and I think we should just talk about it for a minute. Last night we were at dinner, and I was actually thinking about this this morning because I said to you, you know, statistically speaking, one in five people have tried kink.

1:02:11So if you ever go to dinner, you say party of five, know that one person on that table has tried kink. We were we were a party of 10 last night. So there was at least two of us at the table, but I think there was probably more. Our friends are going to be like, what? No, but let's explain that because I think people think kink and they think, you know, the only one has been seen in the media, right? What was that one big 50 shades of gray? People are like, that's kink. That's BDSM. It's scary. It's dangerous. And they shut down. So let's talk about that for a minute because this is something that a lot of neurodivergent people gravitate towards we see.

1:02:50And when I say that, I mean the umbrella of neurodivergent individuals. We're not just talking ADHD here. Yeah. And I think first and foremost, we have to go to the research first. So when we look at the research, there is significant gaps in the intersection of looking at neurodivergence and BDSM and kink, okay? Now, we do have very little research specifically looking at individuals engaging in kink who have autism. There was a study done. It was, I don't know how many years ago it was, but they looked at it and what they were able to see is that there was a lot more association of individuals with autism engaging in kink more than the general population that did not have autism.

1:03:32Your call has been forwarded to voicemail. Hi, this is Zoe Deutsch. And Nick Robinson. Our brand new movie, Voicemails for Isabel, is all about those little moments that feel like the universe is looking out. Feeling homesick, then your sister calls. Hearing that perfect song exactly when you need it.

1:03:53Sometimes life rigs things in our favor, like learning about your new favorite rom-com, Voicemails for Isabel, now playing only on Netflix. And when we unpack what BDSM is, it makes total sense. It is a supportive integration for a neurodivergent brain. Think of structure, boundaries, conversations. Before you engage in scenes, scenes are the conversations of like, what are we doing today? Are we doing impact play? So taking a whip or a paddle. What is the level of pressure? How long are we doing this? What are your sensory needs? Having check-ins while you're doing it. not having to read anybody's cues, not having to be a mind reader.

1:04:39That is a like chef's kiss support system. And unfortunately though, we haven't looked at the ADHD's experience, but the community has been talking about this for years. Yes. And that's the thing I'm going to say is that we learn what to research by listening to lived experiences, but then not researchers so much, but clinicians will act like, well, if the research isn't there, whatever you're experiencing invalid, not real, not true. And there can be that real disconnect that creates further shame in someone's life. Yes. And as a clinician, I specifically wanted my dissertation research to amplify the community's voice because prior to my dissertation, there was absolutely no research looking at the intersection between BDSM engagement and ADHD.

1:05:25But my clients were talking about it. You go on FetLife or any other community and read it like they're all talking about it, But no one is acknowledging the experience. And unfortunately, like you said, there's a lot of people that are not going to take these things seriously or know how to navigate and integrate interventions if the science isn't supporting that. So what my research did is I wanted to look specifically at heterosexual women, ADHDers. I gave them an attention test, which was testing a mechanism of ADHD. I had them do the typical ASRS ADHD assessment screener. And then I had them do some BDSM-related questionnaires to see if BDSM engagement was helping them be present and also help with their satisfaction.

1:06:13And what I found was all of the women that were failing the attention test and also scoring out on the ASRS to be likely to be ADHDers, they were also showing that BDSM engagement was actually supportive. And this speaks volume to the importance of environmental support and how kink and BDSM doesn't just have to be a sexual preference. It can be a very well-informed, adaptive environment and accommodation for ADHDers. And when we look at society, there is so much stigma. There's still stigma even in therapeutic practices. Like I've heard of sex therapists that do not want to touch pink kink and BDSM with a 10-foot pole because they don't agree with it.

1:06:54but they're sex therapists. How is that even possible? So we still have a lot to do in terms of that respect. But with that shame, understanding that sometimes how we navigate in the bedroom can just be also more importantly, an accommodation. And this checks two boxes that we brought up at the beginning, which is novelty and safety, which the ADHD brain needs. And I think that's the really important thing to understand. I was on a podcast recently and as I brought this up and I brought up talking about this concept, I mean, the women who were also on the podcast immediately jumped to like, no, but this is not always safe.

1:07:32No, it's dangerous for women. Women get tied up, things get done to them. And I'm like, no, like that's unethical. And that is not tolerated in these communities. And it was interesting because when I was going through my sex counseling training, that's the first time I was presented with the research of like, and it was primarily, you're correct, with autistic individuals, how they gravitate towards this. And the reasoning is nothing about sexual preference. It's all about predictability, communication, that the rules of engagement are laid out ahead of time. So what do autistic, and I would say ADHD individuals also struggle with this sometimes, is knowing what's the right thing to do, what's the right thing to say, how does this person want me to be, right?

1:08:14We can fall into a trap of being mind readers in so many aspects of our lives. And what these practices do is they say, communication forward. This is front and center. Nothing happens until it's been discussed. Yeah. And I think also what's really important here too, is you bring up ethical versus non-ethical. I have tons of people that I work with where they are navigating kink. And I hear that they're navigating kink in the little pieces that they've taken from their day-to-day knowings, they're not engaging in ethical kink. And that is a very huge discrepancy that you can practice, but it has to be ethical.

1:08:53So one of the best things that I like to tell people is that if you're ever thinking of engaging in any level of kink, always learn the ethics behind it first. Before you start engaging, before you start determining what you like, what you don't like, start learning about consent, the rules, the ethics, because you need a really good foundation before you integrate so you also are aware and you're safe in your interaction so you can advocate if someone else isn't informed ethically on those approaches. How can people get informed? Read. There are so many great resources out there. You just told ADHDers to read.

1:09:26I know. There's also videos. There's YouTube. That's wonderful as well. I think YouTube is a great place. There are great practitioners, researchers who have made YouTube channels and I'm very, YouTube will not ever show them to you. You have to go search for them because YouTube's like, this is bad. This is wrong. I'm like, this is researched backed, like evidence-based. Like, this is as good as it gets. Yeah. So what's really struggling or frustrating for me is that I've done this research. I work with this and then I always get asked, like, what are some resources? And I feel like I never have answers to them.

1:10:01I know Tashra.org is a wonderful organization that anyone can look up. They are specifically research-oriented with all kink related. But then again, it's all reading. But if you go on YouTube and you just search what are consent in BDSM, what's ethical versus non-ethical, what's abuse versus non-abuse, you can indeed find resources that are going to help you better understand what these things are. I also like to remind people, and maybe I'm jumping here, this is my ADHD brain going off, but like even BDSM and like scene creation is somewhat still neurotypical. And what I mean by that is like, for instance, let's say you're into rope play and you're the ADHDer, your partner isn't ADHD, and you're the one that has to hold the time, okay?

1:10:55let's say you have to set up the scene we kind of struggle with time blindness and understanding how long something may or may not take so you can go into it and now maybe you've taken 30 minutes too long and your partner's sitting there like what the hell is going on right or maybe when you're involved a clock can cause too much of a dysregulation or a clock in the room might not work. So they actually have really cool resources like candles that are time candles that when you light them, they can actually go across a time and they'll like burn out to the time. Do you know where those candles originate from?

1:11:33No, I don't. So, and maybe they're not exactly the same, but the time candles, this is the story as it goes. I grew up in a gold mining town and so have to learn the history of all these things. So when someone would come to court your daughter, there would be a candle of time they got and more money and more. So the more wealthy he was, the more cattle he owned, whatever it is, the more time would get put on that clock. And so that's your time to court my daughter. And they would, they would measure that. That is so cool. I am forever using that now. I love that. So yeah, those candles can be great and they can be very friendly to like your nervous system and how you react.

1:12:12So that was just like a side note. I just want to let people know also, even when you're integrating or you're engaging and you are maybe somebody that already understands ethical BDSM and kink, but maybe you're struggling and you're feeling like, oh, there's some things that aren't necessarily full-on neurodivergent friendly. There's realities to that. Yeah. I think that's all really important for people to hear and to just, you know, explore all that. You know, I had one patient one time had said to me that why she likes BDSM is because she liked Dungeons and Dragons. And so she was like it's Dungeons and Dragons in the bedroom.

1:12:46And it's something that I just find really fun. And I was like, that is so interesting. And also like the most vanilla way to like put something right. Because I think people who are outside of that community or aren't educated on it, they're just like devious thing was so dangerous and bad. And then to hear that, like, yeah, it's just like bedrooms, Dungeons and Dragons for some people. They're like, that's the nerdiest thing I ever heard. But do you want to know why? No, say it. That's the stimulation. I can't tell you how many clients I've met that enjoy role play. They're in chat rooms and they enjoy just talking with people.

1:13:19They're not even integrating it in real time because of how stimulating those conversations are. They are tapping into the brain in regards to what is needed in that moment. That is talking about the novelty specifically to reinforce stimulation. When you think of Dungeons and Dragons, everything is stimulation. It's creativity. It's thinking. It's amazing. And so yes, When you think of kink and BDSM, it's the exact same thing. You are constantly integrating and engaging in such stimulating ways. That right there is the accommodation. That is what your brain generally needs. And again, not everybody.

1:13:58And if you're not into kink and BDSM, that's totally fine. Being into kink and BDSM is not a criteria for ADHD by any means. But we do know, at least with the work I've done and how the community has stated, it is definitely an accommodation to how our brains are wired. So I want to go back to the conversation of like desire, helping ADHD people navigate intimacy. And if you could challenge the audience to do one thing over the next seven days to really help them start to cultivate intimacy, what would that be? I would say map out sensory first. And I say sensory because that can be a variety of different things.

1:14:35It can be smells, taste, sight, tactile. First start there. See what things you generally know you like and don't like. You know, are you the type of person that you don't like clutter? Because let me tell you something, if you're in a room, generally the bedroom, and there's any form of clutter, you might be paying attention to it without you even realizing it. And that in itself can be the barrier. So really start thinking in spaces outside of the moment. What are your likes and dislikes? What are your sensory needs? Start mapping your experience out. Really become educated on what it means for you to have ADHD.

1:15:13How does it show up for you? What are those things looking like? That is the really important place to start because if you're not doing that, you're never going to be able to then start setting the environment up to support the needs. What might people experience if they commit to this over the next seven days? Awareness that wasn't there, which means that you have the ability to tap into access to actually advocate for yourself and then to tap into integrating experiences that are empowering instead of making you feel like crap. That's a beautiful thing. And then when you can start feeling empowered instead of feeling like you're broken or shamed, you then can also tap into, which I think is a huge strength for a lot of us ADHDers, is that curiosity.

1:15:57Lean into it, get creative, collaborate with your partner, enjoy. And when you can feel safe to, It's really nice. Well, thank you so much for sharing your expertise and taking the time to chat with us today. I really appreciated this. Thank you so much for having me. This was awesome. Yeah. Pandora Jewelry brings the sparkle to your summer. Now with even better prices. Enjoy up to 50 % off select styles. From personalized pieces to must-have favorites made for the summer. Timeless designs that shine with you through every moment, wherever the summer takes you. Shop in-store or online. Now through July 6th.

1:16:35Terms and conditions apply. Visit Pandora.net for details.

1:16:43That's the sound of zero sugar, 200 milligrams of caffeine, and the power to burn body fat. Storm, energy for life. Storm Energy Blend helps boost metabolism, which in combination with exercise and a healthy diet helps burn fat. This product alone does not produce weight loss. Individual results may vary.