OVERFOCUSING: POWERFUL FUEL FOR BDD

Overfocusing, or selective attention, might cause dissatisfaction with appearance. It may even create a type of visual distortion, in that focusing on one particular aspect of appearance gives that area visual prominence and makes it very noticeable. Other aspects of appearance fade into the background and may even be ignored. The view becomes unbalanced. By emphasizing the defect, it becomes unduly negative. One woman told me, “I can’t even see my own face. All I see is my defect.” Another said, “I focus on the negative things, and they become too prominent. I lose my balance; I get tunnel vision. I put too much weight on one particular aspect and get bogged down in it.” One of my patients said that focusing on a small pimple would cause it to “grow to hideous proportions.” He made a mountain out of a molehill. A man I treated said, “It’s like when I put my thumb under a microscope—that’s how I see my skin. I’m like a walking microscope—my perspective is off. I can’t see my whole face the way other people do.”
These comments fit with the neuropsychological study results discussed in chapter 10, which showed that people with BDD overfocus on minor, irrelevant details and don’t see the big picture. They miss the forest for the trees. Extrapolating to appearance, rather than seeing all of themselves and focusing on liked—as well as disliked—body areas, they seem to overfocus on and selectively attend to disliked areas, which unduly influences their ratings of overall attractiveness and makes them negative . Furthermore, as shown in the figure, individuals come to the conclusion that they look bad based on “selective interpretation”—this conclusion is based on “evidence” that other people don’t see as valid (e.g., thinking you’re being stared at).
Self-portraits of people with BDD also illustrate this. They tend to emphasize the perceived defect while giving only cursory attention to other body parts. One woman, for example, drew a massive, messy, and detailed head of hair while portraying the rest of her body as a stick figure. A man’s self-portrait consisted only of 3 views of his nose, covered with huge and gaping holes.
*213\204\8*

OVERFOCUSING: POWERFUL FUEL FOR BDDOverfocusing, or selective attention, might cause dissatisfaction with appearance. It may even create a type of visual distortion, in that focusing on one particular aspect of appearance gives that area visual prominence and makes it very noticeable. Other aspects of appearance fade into the background and may even be ignored. The view becomes unbalanced. By emphasizing the defect, it becomes unduly negative. One woman told me, “I can’t even see my own face. All I see is my defect.” Another said, “I focus on the negative things, and they become too prominent. I lose my balance; I get tunnel vision. I put too much weight on one particular aspect and get bogged down in it.” One of my patients said that focusing on a small pimple would cause it to “grow to hideous proportions.” He made a mountain out of a molehill. A man I treated said, “It’s like when I put my thumb under a microscope—that’s how I see my skin. I’m like a walking microscope—my perspective is off. I can’t see my whole face the way other people do.”These comments fit with the neuropsychological study results discussed in chapter 10, which showed that people with BDD overfocus on minor, irrelevant details and don’t see the big picture. They miss the forest for the trees. Extrapolating to appearance, rather than seeing all of themselves and focusing on liked—as well as disliked—body areas, they seem to overfocus on and selectively attend to disliked areas, which unduly influences their ratings of overall attractiveness and makes them negative . Furthermore, as shown in the figure, individuals come to the conclusion that they look bad based on “selective interpretation”—this conclusion is based on “evidence” that other people don’t see as valid (e.g., thinking you’re being stared at).Self-portraits of people with BDD also illustrate this. They tend to emphasize the perceived defect while giving only cursory attention to other body parts. One woman, for example, drew a massive, messy, and detailed head of hair while portraying the rest of her body as a stick figure. A man’s self-portrait consisted only of 3 views of his nose, covered with huge and gaping holes.*213\204\8*

DIETS AND ASTHMA: VITAMINS AND NUTRIENT SUPPLEMENTS

There is little doubt that vitamins C, E, A, B12 and B1, zinc, calcium, magnesium, essential fatty acids, fish oil, evening primrose oil, ginko, quercitin and garlic, as well as an ample supply of the B vitamins, are of great help in the treatment and prevention of asthma. But because no two people are alike and because asthmatics may suffer an attack and even die if they have an allergic reaction to something they happen to be sensitive to, you should always try each supplement alone and under controlled conditions. A careful history by a health practitioner will help to eliminate some possibilities; for example, if you react to aspirin, the practitioner will know immediately that garlic supplements can cause reactions in salicylates-sensitive people, so this otherwise very important treatment may not be precribed for you. Single vitamins and single minerals seldom cause allergic reactions but compounds or the excipients (fillers used to make them into tablets) might do so. Even the capsules may cause a reaction.
In my long clinical experience I have seen reactions to the most diverse substances — lettuce, carrots, apples, spinach, meat, potatoes and, occasionally, to just about every vitamin you can think of. Deaths caused by monosodium glutamate ingestion have been reported but we know now that such reactions can be dramatically reduced by taking some vitamin B6.
*50\145\2*

DIETS AND ASTHMA: VITAMINS AND NUTRIENT SUPPLEMENTSThere is little doubt that vitamins C, E, A, B12 and B1, zinc, calcium, magnesium, essential fatty acids, fish oil, evening primrose oil, ginko, quercitin and garlic, as well as an ample supply of the B vitamins, are of great help in the treatment and prevention of asthma. But because no two people are alike and because asthmatics may suffer an attack and even die if they have an allergic reaction to something they happen to be sensitive to, you should always try each supplement alone and under controlled conditions. A careful history by a health practitioner will help to eliminate some possibilities; for example, if you react to aspirin, the practitioner will know immediately that garlic supplements can cause reactions in salicylates-sensitive people, so this otherwise very important treatment may not be precribed for you. Single vitamins and single minerals seldom cause allergic reactions but compounds or the excipients (fillers used to make them into tablets) might do so. Even the capsules may cause a reaction.In my long clinical experience I have seen reactions to the most diverse substances — lettuce, carrots, apples, spinach, meat, potatoes and, occasionally, to just about every vitamin you can think of. Deaths caused by monosodium glutamate ingestion have been reported but we know now that such reactions can be dramatically reduced by taking some vitamin B6.*50\145\2*

ISD AND RELATIONSHIPS

While ISD is sometimes caused by physical problems and often relates to individual emotional problems, there is always a connection between ISD and your relationship. ISD always affects and is affected by your relationship. Even if, like Maggie, you are at first reluctant to believe it, as you read this chapter and take a closer look at your own relationship, you will find that a connection of some kind does indeed exist.
ISD is never just your problem or just your partner’s. How can it be, when one partner’s low or absent sexual desire inevitably shapes the sex life both partners share? However, the connections between ISD and relationships extend well beyond the damage done after one partner loses interest in sex. Not only do hurt feelings and conflicts over sexual desire problems spill over into the rest of your relationship, but they almost always reflect unresolved relationship problems that existed prior to the onset of ISD. In fact, if your relationship is already floundering, a sexual problem like ISD may be a symptom of the tension in your relationship, as well as the straw that breaks the camel’s back.
*109\261\8*

ISD AND RELATIONSHIPSWhile ISD is sometimes caused by physical problems and often relates to individual emotional problems, there is always a connection between ISD and your relationship. ISD always affects and is affected by your relationship. Even if, like Maggie, you are at first reluctant to believe it, as you read this chapter and take a closer look at your own relationship, you will find that a connection of some kind does indeed exist.ISD is never just your problem or just your partner’s. How can it be, when one partner’s low or absent sexual desire inevitably shapes the sex life both partners share? However, the connections between ISD and relationships extend well beyond the damage done after one partner loses interest in sex. Not only do hurt feelings and conflicts over sexual desire problems spill over into the rest of your relationship, but they almost always reflect unresolved relationship problems that existed prior to the onset of ISD. In fact, if your relationship is already floundering, a sexual problem like ISD may be a symptom of the tension in your relationship, as well as the straw that breaks the camel’s back.*109\261\8*

FUTURE OF VITAMIN C

The controversy still goes on between orthodox dietitians who regard ascorbic acid merely as a vitamin which in small doses will prevent scurvy, and the orthomolecular scientists and nutritionists who believe that to maintain health and resist disease every tissue in the body needs to be saturated with ascorbic acid — sufficient for the blood to contain 1 mg per cent and to spill over into the urine.

Over the last 50 years, since Dr Albert Szent-Gyorgyi identified and isolated Vitamin C as ascorbic acid, a tre­mendous amount of research has been carried out all over the world and thousands of papers published on the sub­ject. But there has been no co-ordination in the research. Thus no firm conclusions can be drawn from the many controversial results as to how much is needed by the human body to maintain health, to resist disease and con­trol poisons and pollution. How individuals differ in their requirements for ascorbic acid is not decided, nor optimum dosage in the stress of surgery, infections, injuries or in degenerative and malignant disease.

A great deal of co-ordinated research is still needed to resolve these questions.

However, research into vitamins and their practical value in clinical nutrition and therapy is going ahead, but is not popular in orthodox scientific circles, and there is little money forthcoming for such research.

Even Linus Pauling has had to turn to popular sub­scription to fund his research institute on the place of Vitamin C in cancer control — a most vital issue in the epidemic proportions that malignancy has reached in the ‘civilised’ world. National Institutions in U.S.A have re­fused to subsidies his research laboratories and sought to denigrate his work in every way, especially through the media.

The ridicule and disbelief with which Linus Pauling’s book on the common cold was received by the Establish­ment and orthodox nutritionists was, however, belied by the avidity with which the lay public received it; and, what is more, carried out his advice for scotching their winter colds.

The amazing thing is that Vitamin C works, if enough is taken; and it is now generally accepted almost as a normal practice, apart from all medical prescribing, to take Vitamin C daily as a supplement in far larger doses than the Rec­ommended Daily Allowance. Thousands of people are tak­ing 250 mg to 500 mg to 1000 mg a day — with up to 4000 mg to combat a cold, as recommended by Linus Pauling.

This practice is frowned on by some dietitians, who believe we can obtain our 30 mg to 50 mg of C in a good mixed diet and that is all we need. Indeed, the Common­wealth Pharmaceutical Board has reduced the dose avail­able to pensioners from 500 mg to 50 mg doses as a phar­maceutical benefit.

Elderly pensioners who cannot afford to buy much fresh fruit will certainly not get frank scurvy on 50 mg to 150 mg ascorbic acid a day, but they will still suffer from bleeding gums, loose teeth and pyorrhoea, easy bruising and frequent colds, bronchitis and residual coughs, — which could all be prevented by a larger intake of Vitamin C as age advances.

There are a growing number of doctors, bio-chemists, nutritionists, dentists and other scientists who have seen and experienced the tremendous health saving — even life saving — effects of large or ‘mega’ doses of Vitamin C taken by mouth and/or by injection, intravenous or in­tramuscular. They have the courage of their convictions, and are proving not only through biochemical research but by their spectacular clinical results the, value of this simple harmless substance which we humans cannot make for our­selves.

The new orthomolecular dosage of Vitamin C is largely based on the amount of ascorbic acid manufactured by all animals normally and under circumstances of stress — all except man, monkeys and guinea pigs, who must take it in their food.

It is the fond hope of Dr Irwin Stone — expressed in his book The Healing Factor, Vitamin C Against Disease that ‘as further research is conducted on hyposcrobaemia, and the realization of its importance is confirmed, a National Megascorbic Authority will eventually be organized for Vitamin C with general aims and purposes similar to the proposed National Cancer Authority for cancer.

‘The main purpose of this agency would be to deter­mine the optimum levels of ascorbic acid intake based on the genetic concepts, under normal and stress conditions, and the human individual variations and responses’.

Once the value of Vitamin C in clinical and preventive medicine is recognized, who, except the ultra-conservative, is going to wait for results to be ‘proven’ by double-blind trials to be ‘statistically significant’ in the face of its ability to cut short the lingering disability of hepatitis and glandular fever, the pain of shingles, the severity of infectious diseases (measles, mumps, chickenpox and rubella), to prevent the fatality of encephalitis and virus pneumonia, detoxify poison of carbon monoxide, mercury and lead and of the bites of snakes and poisonous insects; to hasten healing and finally to prevent and control the growth of cancer cells — and all in a reasonable, non-toxic form with no side effects.

Looking into the future, I can see that Vitamin C in one of its injectable forms will be part of the medical equipment of all hospitals and casualty wards; every ambulance and every first aid post and every life-savers club will be equipped with ampoules of sodium ascorbate for injection and tablets to take by mouth; and every doctor’s bag will contain Vitamin C ready to inject as he now carries antibi­otics — as a first line of defence in the many emergencies and infections that must be met in the course of a day’s practice.

Ascorbic acid in one of its easily assimilated and accept­able forms will form part of our daily diet — and be ac­cepted as part of the preventive medicine programme which we all realize must be the next step in community health.

I believe that a well balanced diet coupled with ample ascorbic acid or ascorbate daily will overcome the menace of malignancy and, should it occur, that ascorbate will be used as the best non-toxic chemotherapy to help control the growth of tumours and to prevent metastacies (that is spread of the malignancy to other parts of the body).

Much research and many trials are still needed, but I believe that the realisation of the value and life saving properties of Vitamin C (in one of its forms) will be one of the most important medical breakthroughs of this century and will ensure better health to thousands and freedom from many of the diseases that now beset us.
*37/21/7*
Pharmacy information ,side effects, interactions

VITAMIN C: BIBLIOGRAPHY AND CHEMOTHERAPY

This Brisbane doctor has now, treated over 100 cancer cases referred to her in the last 11 months with Vitamin C injections followed by sodium ascorbate by mouth. Not all have carried out the full 10 injections. Some were terminals. Many had recurrent growth and all had run the gamut of orthodox treatment which had failed to control the disease.

However, every case, she says, benefitted greatly by the injections of sodium ascorbate given very slowly until the pain or distress ceased. There were few side effects. Every patient felt better and what is most important, had contin­uous cessation of pain.

In those cases which received the full course of in­travenous ascorbate therapy, patients not only felt better but there was a reduction in size of the tumour.

A case of breast cancer is typical:

The cancer had metastasized in the spine so that the patient had continuous pain, could not walk and was de­teriorating rapidly, even under radiation. After 10 injec­tions of sodium ascorbate the patient lost her pain, was actually walking and was so greatly improved in general health that she was able to complete her radiation therapy without distress. She continued taking 10 to 12 grams of sodium ascorbate daily by mouth.

These cases do not constitute scientific proof of the efficacy of Vitamin C in controlling cancer, but the great pain-relief and sense of well being it gives the patient, without any toxic side-effects, makes it well worth using as an additional treatment in all cases of cancer.

Other doctors in various centres in Australia are trying out Vitamin C therapy in cancer. Their results are eagerly awaited by both doctors and cancer victims.

Those in the forefront of nutritional and vitamin re­search believe that as long as the body is maintained in positive Vitamin C balance, cancer cells cannot grow and spread; and that good daily doses in fresh fruits and veget­ables as well as in synthetic Vitamin C is the best preventive measure against malignancy.

It is too early to assess the final outcome of the cancer cases treated by large doses of intravenous sodium ascor­bate by injection and by mouth.

A careful, detailed follow up service is necessary to assess continued dosage and the possibility of further I.V. ascorbate to control the disease.

Vitamin C therapists are at present feeling their way, being guided by patient response, trial and error.

A great deal of truly scientific, unbiased research by nutritional biochemists, cancer experts and clinicians must be carried out to assess the role of ascorbic acid in the prevention and control of cancer.

Being non-toxic and therapeutically beneficial, there is no reason why the research should not be done directly with human patients, using it with, not instead of, present or­thodox treatments as a first line of defence rather than as a last-stand ditch in cases already declared hopeless.
*36/21/7*
FDA Approved Prescription Drugs.

MEDICAL PHILOSOPHY: CHANGES IN SIZE AND DESIGN

Shakespeare speaks of the seven ages of man, but from the medical point of view man has been considered in three periods: childhood, when we practice pediatrics on him; the grown-up stage, when we have no special term for our procedures; and old age, when we now say that he is a candidate for geriatrics. But as Sir Thomas Browne points out, and as we are told that the Chinese reckon, we are nine months old when we are born. In many respects these nine months are the most important portion of our life, for we are then being formed in a pattern which cannot change.
The best you can do for the child during the first nine months in the moist climate of the mother’s womb is to take good care of this parent. If all goes well with her, the chance of a satisfactory child developing is as good as is anything desirable in this world.
There is no great transformation when the baby is born. It just seems so because of the spectacular aspects of birth. He still needs to receive oxygen and give up carbon dioxide, but he uses his own lungs instead of his mother’s; he prepares his own food in his digestive tract from now on; and for the first time bacteria begin to grow in his intestine, which has previously been sterile. How difficult to distinguish our friends from our enemies! We view bacteria with fear, yet evidently these intestinal ones have rushed to our aid. Later in life we find that these beneficent inhabitants of our alimentary depths may be persecuted by the wonder drugs just as the wicked bacteria are. The balance of nature has to be maintained here as in the great outdoors.
The baby’s skin has been secreting a fatty waxy material and continues to do so after birth. The kidneys have already been secreting urine. Of course the muscles, including the heart, have been working. Whether the baby has been thinking I will not pass upon, but up-to-the-minute psychologists have suggested that he has been. In fact, the birth of the baby merely modifies, in a continuous sequence, his bodily functions. One of the chief wonders of our incredible body is the unostentatious way in which it adapts its activities as needs arise.
In our second age of man, a combination of Shakespeare’s infant, “mewling and puking,” and his schoolboy with “the shining morning face,” I would say that the emphasis is on growth rather than development, though, of course, there are changes other than mere increase in size. In my youth, for example, I had the pleasure of knowing a young woman who, presumably because of some change in her pituitary gland at the age of three, had ceased to grow in stature.   Later she was a beautifully proportioned and unusually keen-minded adult, whose only lack of development was in her size. Otherwise she had progressed as all normal children do. It is our bones that largely determine our size. Not until a little over a half century ago, when Roentgen discovered the X-ray, did we realize how the bones grow from centers of cartilage which we often cannot see at first, and that some of these centers have not finished their work even when the person has reached puberty. Adolescence, the period between puberty or sexual maturity and the time when the individual has achieved the wisdom to vote, does not mark but accompanies the final change in stature. But this period signifies little, for Goethe said that man is a perpetual adolescent. The years from birth to the voting booth are the formative ones, but we are pretty well equipped before we start these, as the primitive functions necessary to keep us alive have been laid down, with the sympathetic nervous system in command.
Yet we learn to assume some partial control over even these primitive functions. Breathing we can stop for a while, or hurry up. Our bowels and bladder we learn to take charge of. On the other hand, the infant is born with the instinct to milk nourishment from a nipple, using for this purpose muscles in the cheek which will later waste away with disuse. Once lost, this valuable function cannot be acquired again.
The use of most of the voluntary muscles becomes automatic, particularly the ones with which we acquire skills. As age advances, the acquiring of new muscular skills becomes more and more difficult. However, a few people with inherent dexterity seem to belie this rule. We cannot generalize accurately about adolescence either of the body or of the mind. We see boys who are giants on their school football teams or precocious intellectuals like Thomas Babington Macaulay, who, when a few years old, could recite Scott’s Marmion and knew several languages. But a few exceptional cases prove little. The progress of the great majority of us can be charted in advance.
*101/276/5*
GENERAL HEALTH

CHILDREN AND THERAPEUTIC NURSERY

Through his research, Dr. Jerome Kagan, a psychologist at Harvard University, found two types of children: One, by the middle of the second year, is timid and shy, fearful and wary. The other is outgoing, sociable, and not easily frightened. Both types can come from similar families.
By school age, half the fearful children Dr. Kagan had studied had lost their timidity; 10 percent of the fearless had become fearful. This, Dr. Kagan says, shows that although biology may produce a child who tends to be vulnerable (fearful), environment can push him or her into the other column. In short, if parents knew what to do, they could overcome biology.
Dr. Paul V. Trad, assistant professor of psychiatry and director of the Child and Adolescent Outpatient Department at Cornell University Medical Center in White Plains, New York, teaches the parents of his difficult infant patients how to deal with them. One, a 32-year-old mother who works outside the home, had given birth to a baby daughter who cried all the time. We’ll call them Diane and Maggie.
“Every time Maggie cried, I’d think she needed feeding,” Diane says. “I’d try to feed her, and she’d cry more. I’d try to play with her, and she would cry more. Then I’d get anxious, and it would get worse.”
Diane and Maggie had what psychiatrists call a poor mother-child fit. Just because you’re the parent doesn’t mean you and your baby are guaranteed to like each other from the start. Some parents have to learn how to play with and love their babies.
Dr. Trad took videotapes of Diane playing with and feeding Maggie and then played them back. “It became clear that I was overanxious,” Diane says. “I wasn’t watching her. I didn’t wait for her signal. I was doing too much. Watching the tape, you can see her turn away – that’s a signal telling you, ‘Don’t press it.’”
Dr. Trad took Maggie on his lap and played with her to demonstrate how to watch for a baby’s signals. “It’s an adventure, learning about your own child,” Diane says. “Now I am able to respond to her, and she has become a relatively easy baby.”
But the adjustment is harder for babies born into what Dr. Stanley Greenspan calls multi-risk families. Dr. Greenspan is clinical professor of psychiatry at George Washington University Medical School in Washington, D and C. In one study, he and Dr. Arnold Sameroff observed families without “difficult conditions” and others with problems that included one or more of the following:
•   The father was absent.
• The mother had suffered from mental illness at least twice in her life.
•   The mother was not spontaneous (i.e., didn’t smile at or touch the child).
•   The mother was highly anxious.
•   The head of the household was unemployed or unskilled.
•   There already were four or more children in the family.
If a family had none of these “risks,” the average IQ for the child was 118. If more and more risks existed, the child’s IQ dropped steadily, reaching 85 with seven or eight family problems. Generally, the high-risk families produced children with emotional problems.
*101/266/5*
GENERAL HEALTH

CHILD’S HEALTH/SKIN DISORDERS: ECZEMA PREVENTION

When to see your doctor

• if you suspect that this is the first episode of eczema in your child;

• if the rash is weeping or bleeding;

• there is no significant improvement after a few days, despite the measures you usually take for your child’s eczema;

• if your child is having trouble sleeping due to excessive itching;

• if your child is generally unwell in addition to the rash;

• if you have any doubts that the rash is due to eczema.

Prevention

Avoid dressing your child in woollens and synthetics. Cotton garments are preferred for a child who has eczema. Avoid the use of soaps and bath preparations. Avoid overheating as this can make the itch worse. Avoid very hot baths or showers. If you suspect that your child’s eczema is due to a food allergy, but have been unable to find out which is the offending food, discuss the possibility and value of allergy testing with your doctor.

*306\90\8*

YOUR CHILD’S HEALTH CARE: WATER SAFETY AND, SPORT AND SPORTING INJURIES

WATER SAFETY

Drowning is almost always preventable. Always supervise your toddler or young child around water. There is no such thing as ‘drownproofing’ a young child. By all means, take your child swimming with you to get him used to water — most children can begin swimming lessons at preschool or early school age — but do not will not!

Make sure you can see your child all the time when near water. Do not rely on supervision by other children, or on the use of safety devices such as floaties — they will not prevent your child from drowning. Check all the gates and fences around your pool. Make sure that they are child resistant.

SPORT AND SPORTING INJURIES

The foundations of our fitness and well-being are established during childhood. Athletic activity provides children with the opportunity to develop self-confidence and interpersonal skills. Involvement in athletic events also exposes children to physical and emotional risks. Parents and sporting coaches have a vital role to play in preventing and minimising any sort of trauma or injury. Children who are involved with a sport often focus all their attention on participation and enjoyment. Fear seems to disappear as the game progresses. A child will often unwittingly go beyond the limits of safety. It is the responsibility of adults to anticipate potential hazards and enforce the rules.

Sporting injuries seen most often in children are bruises, cuts and grazes, as well as fractures of limbs. Head injuries can occur in children, but these are fortunately rare. Simple measures such as the wearing of protective clothing are often the most important in the prevention and treatment of sporting injuries in children.

*10\90\8*

YOUR MARITAL HEALTH/FINDING OUT WHO’S THE MATTER WITH US: HOT SEXUALPROBLEMS – SHORTENING OF REFRACTORY PERIOD

SHORTENING OF REFRACTORY PERIOD: I think I could go again and again. We don’t, but I can have sex and then go into the bathroom and masturbate and then come back and have sex.

I just stop because we stop. I can get ready in a matter of a few minutes, no, seconds. I could do it over and over if I had to, ïî, I mean, if I wanted to.

Can you tell which is the husband and which is the wife? The first is the wife. Both partners are experiencing shortened refractory periods in part because of hyperarousal and in part because of their “hot running, keep on going” style of living. There is less of a refractory period following a hurried, less intense sexual experience than following a mutually involving, prolonged, emotionally intense sexual interaction. One hundred eleven men and 44 women reported this type of problem as occurring often in their sexual relationships. Remember that the problems mentioned here are re-norted at a higher frequency when the question is changed to “Have vou ever experienced this problem?” instead of “Is this problem characteristic of your sexual relationship?” When the first question is asked, all of us have some or many of these problems sometimes, and discussing them even before they are experienced can be good preventive sexual therapy.

*169\97\8*

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