Frequently asked questions

Many causes can lead to sexual dysfunction. These include:

• Physical causes such as cardiovascular diseases, hormonal changes, diabetes, surgical interventions in the genital organs (for example, cervical removal/prostate removal), cancer, rheumatism or Parkinson's disease. Physical pain during sex, caused by inflammation, for example, can also lead to dysfunctions.
• Taking medications can cause side effects that lead to sexual dysfunction. Antidepressants can reduce libido and hormone-based contraceptives reduce sexual desire.
• Excessive consumption of alcohol and the use of drugs such as marijuana can reduce sexual desire or excitability.
• Mental causes such as anxiety about pregnancy or stress, grief and conflict can impair sexual function.
• Problems in a partnership can also be the cause of sexual dysfunction. Constantly arguing or paralysing routine, tabooing of sexual desires or lack of tenderness have a negative effect on lust, excitability and ability to have an orgasm. 

From a medical standpoint, this is strongly contraindicated. Withdrawal means liberation of the body from the addictive drug. Depending on the addictive substance, withdrawal can have serious physical consequences. Withdrawal should therefore always take place under inpatient psychiatric supervision. It is easier to confront the disease outside the familiar environment which may be tightly connected to the addiction. Without supervision, the risk of failure is very high.

Binge eating is a mental disorder. This makes it difficult or downright impossible for affected individuals to control it without professional help. This is because the causes are multifactorial. Examples of causative factors include familial eating behaviour, familial conflicts, low self-esteem, a high body-mass index (BMI), or depression.

Cognitive behavioural therapy (CBT) has proved effective. The goals are to normalise the eating behaviour, to strengthen self-acceptance, and to recognise the triggers for binge episodes and find ways to deal with them.

Co-dependence is defined as addiction-promoting behaviour of people surrounding an affected person. Animated by the intention to help and support the affected person, they end up in a type of dependence directed at the life of the addicted person.

Co-dependence can be recognised in three phases. Initially, the co-dependent person protects and finds excuses for the addicted person, typically in interaction with an employer. The addictive drug is procured, and the gravity of the situation is generally downplayed. In the second phase, the co-dependent person tries to control the addicted person, for instance by hiding the addictive drug and by more intense scrutiny. The third phase start with the insight that these behaviours do not solve the problem. The co-dependent person develops feelings of accusation, exclusion, and avoidance towards the addicted person.

Other features are:

• Co-dependent persons have difficulty in setting boundaries; they often lack self-esteem.
• Their life is completely put on the back burner.
• They feel responsible for the affected person and for keeping up the façade to the surrounding world.
• They are often severely exhausted and feel under a lot of pressure.
• They suffer from psychosomatic symptoms like headache, tension, and depression.

Playing computer games can be addictive, with similar mechanisms to those when taking addictive substances. Winning activates the reward centre in the brain. The desire to relive a feel-good sensation develops. In time, tolerance develops. The dose, in this case the amount of game-playing, must be increased. As with other addictive situations, control is lost. Gaming dominates. School, education, and family are neglected.
Successful games are designed in a way that binds the user. These games last forever. Graphic features change frequently so that there is always something new to discover. Games distribute rewards, but players do not know when. Games that involve team activity generate social bonding. The degree of difficulty is tailored to the player; this leads to winning, which motivates the player to keep playing. Not every phase of intensive play can be qualified as addiction. Since 2019 however, gaming disorder is recognised as a disease by WHO. This designation facilitates diagnosis and treatment.

For people suffering from sexual dysfunction, it is particularly important to talk openly about the problem. Sexuality is still a taboo subject that is not discussed for many people. Openness can help if the dysfunction leads to problems in the partnership or if problems in the partnership are responsible for the dysfunction.

Successful treatment starts with the insight that you have an addiction disease. Even if this confession is painful and possibly shameful, it puts you in a position to act and face your disease.

Withdrawal, which broadly means the elimination of the toxic substance from the body, is followed by recovery. During mental recovery, the issue is to rebuild your life without the addictive drug. Several protective factors can support you: a positive way to deal with stress and problems, a supportive social milieu, the opportunity to shape your own life, a positive self-image, and high resilience.

Participation in self-help groups can also be beneficial. You can meet people with similar experience and feel that they understand you. You can find more on the topic self-help here.

It is important for those affected to become aware of the disease, to accept it and to face it. The tendency to avoid fear-causing things or situations can add to anxiety or phobias. Facing these fears can be understood as training that helps to reduce the anxiety itself. For many of those affected, however, this is a particularly daunting challenge.

Anyone seeking medical attention for fears or phobias is not revealing personal weakness, but rather a desirable way of dealing with the disease. This also includes involving one's own environment, such as family or friends. Valuable support can come from those close to them.. In addition, the visit of self-help groups for exchanges with other sufferers shows good results for some sufferers.

Relaxation techniques such as yoga, autogenous training or progressive muscle relaxation can also be helpful for therapy. Exercise is generally recommended, especially endurance sports such as running or cycling.

Treatment success depends on your participation. It is of critical importance to admit that you are ill. This insight is difficult, especially since an eating disorder produces shame, guilt feelings, secrecy, or self-control. Use the professional help that you receive as part of your treatment to deal in a candid way with your problems, including those that are not obviously connected with the disease.

As part of the treatment, you will learn a new approach to eating. You should support this process. The path to normal eating behaviour includes eating regularly and in an alert state of mind, recognising satiety, and relishing your food. Interaction with other affected individuals is also helpful.

The treatment of a sleep disorder depends on its cause. If it is a symptom of another disease, this disease must be treated first. If sleep itself is the problem, behavioural therapy or sleep therapy are usually used. In addition, sleep hygiene must be improved. This means behaviour that promotes good sleep. You can contribute significantly to this:

• Eliminating the midday nap
• Using a cool, dark, well-ventilated sleeping room only for sleep
• Getting up at the same time every day
• Set up a sleep ritual (e.g., a yoga session, a cup of tea, reading several pages)
• Avoid heavy meals in the evening, avoiding alcohol, avoiding nicotine
• Go to bed only when very tired
• Eliminate caffeine after lunch
• Eliminate electronic devices or TV from the bedroom
• Practice regular physical activity
• Use relaxation techniques (e.g., self-training, meditation)

Internal restlessness often prevents affected individuals from sleeping. Ongoing conflicts, persistent stress, worry, and physical or mental overload can also impair sleep. It is important to look for the concrete causes of these types of stress and to find better coping mechanisms. Psychotherapy can help.

Fears and phobias are serious mental illnesses that require professional help and treatment. The many different factors that can lead to a disease make it difficult for patients to identify the causes alone and to take effective countermeasures.

Among the different treatment methods, behavioural therapy has proved to be particularly promising. This can be supplemented by the administration of drugs, depending on the severity of the disease. A deep-psychological therapy, which is carried out by psychotherapists or psychiatrists, may also be appropriate in some patients.

In addition to professional treatment, regular exercise, exercise and a fundamentally healthy lifestyle have proved to be helpful. Relaxation techniques such as breathing exercises, yoga, autogenic training or progressive muscle relaxation are equally beneficial.

Depending on the cause diagnosed, sexual dysfunction can be treated with drugs. But there are other good options. If there is a mental disorder, for example due to traumatic experiences, psychotherapeutics with individual therapy is possible. If the cause of sexual dysfunction is not due to physical or mental illness, sexual therapy, behavioural therapy, or couples therapy may be indicated.

Psychosocial treatment approaches have proven to be more effective than the use of drugs. They can be used to treat physical and psychological causes of the dysfunction. For beyond the restoration of sexual functions, it can be helpful to broaden the understanding of sexuality and also to enable other forms of physical communication. Since medications are also a possible cause of sexual dysfunction, changing medications or adjusting doses can help after consultation with your doctor.

Intellectual disabilities accompany those affected throughout their lives. Depending on their severity and characteristics, there are therapeutic measures that can improve their quality of life:

• Occupational therapy with regard to individual performance levels
• Sports and exercise therapy
• Physiotherapy exercises
• Social-therapeutic care, including the social environment
• Cognitive training depending on the extent of the loss of intelligence
• Supporting psychological conversations, provided that cognitive performance and communication skills are sufficient for this
• Stress tests in the current or new environment, including work tests in a workshop for disabled people
• Psychopharmacotherapy for pronounced behavioural abnormalities or accompanying mental disorders such as depressive syndromes

There are several approaches to prevent a relapse. One aspect of addiction treatment is to explore life circumstances that favoured dependence. Strategies to deal with these very individual factors are then worked out.

In addition, there are some general principles to avoid relapses:

• Regular participation in a self-help group enables the exchange of information with other affected individuals, developing motivation, and mutual support.
• The brain has become accustomed to the feeling of reward through the addictive drug. When the drug is no longer used, an empty space is created. New habits, hobbies or interests can fill this empty space.
• Stress and overload in the family or at work increase the risk of relapse. Professionals can teach you strategies to deal with mental overload.
• In certain cases, the social milieu favoured the dependence. It is important to critically evaluate who and what places are not conducive to an addiction-free life.
• The need for the addictive drug will be overwhelming at times. An emergency plan to guide the behaviour in moments of high risk of relapse is helpful and should be drawn up in advance.

The terms "intellectual disability" and "loss of intelligence" are often used interchangeably and refer to the same phenomenon. However, those affected no longer use the term "mental disability", because it is perceived as degrading and is not clearly defined.

Asexuality is the total absence of sexual desire. Asexual people do not feel sexually attracted to other people; they have no need for sexuality. This is not due to physical or psychological causes. It is thought that the sexual orientation is innate. Asexuality is not considered to be a sexual dysfunction.

In the case of a loss of intelligence, the disorders of the brain are irreparable, so that it cannot be cured. Targeted training and training tailored to the individual needs of those affected can help to improve cognitive performance. These lead to an increase in the general mental abilities as well as stability of the acquired knowledge. Normal intelligence cannot be achieved despite these efforts.

The aim of therapy is to improve the existing skills as much as possible so that daily tasks can be partially or almost completely taken over by the person concerned.

Unlike previously suspected, genetic defects that trigger intelligence reduction are rarely inherited by children from their parents. Rather, the mutations occur spontaneously in a large proportion of patients. New mutations arise after fertilization of the egg and are not anchored in the genome of the mother or father. In many cases, parents of a child with reduced intelligence do not have a significantly increased risk that their next child will be born with a corresponding impairment.

An intellectual disability is often caused by genetic defects and mutations. In addition, problems before, during and after birth can lead to this, including from premature births or birth traumas. The use of drugs, medicines or alcohol during pregnancy is also a possible trigger. Other causes include brain defects in development and infections. In many cases, however, the exact cause is not known.

Fears and phobias can have very different causes, which in combination can trigger the disease. These include family predisposition, early childhood experiences, traumatic experiences, stressful situations or various personality disorders. Anxiety and phobias can also be caused by organic diseases, for example diseases of the cardiovascular system, the respiratory tract, thyroid disorders or pathological changes in the brain’s nerves.

Bulimia nervosa rarely has a single cause. In most cases it develops from the interplay of biological, psychological, familial, and/or sociocultural factors.

A biological example is genetic predisposition for an eating disorder. Familial influence refers to the attitude towards eating in the family. Examples include families in which frequent dieting occurs, or settings where excessive attention is paid to weight, physique, or appearance.

One of the psychological factors is almost always low self-esteem, which ill individuals try to offset by good looks. They frequently have a hard time dealing with feelings; depression is also frequent.

Societal influence also plays a role. Despite some opposite trends such as body positivity, mass media and social media are dominated by the beauty ideal of slimness. Affected individuals think that their urge to pursue this ideal makes them feel better.

Sleep disorders have multiple causes. These include physical and mental issues, certain medicines, the sleep environment, lifestyle issues, or certain periods in life. A frequent physical problem is sleep apnoea, consisting of periods of nocturnal breathing arrest. Other common physical causes are restlessness in the legs (restless-legs syndrome), pain syndromes, or cardiovascular disorders. Sleep disturbances can also accompany several mental diseases, such as depression, anxiety, or bipolar disorder.

Other common triggers are noise, shift work, bruxism (teeth grinding), use of drugs or alcohol, sleepwalking, or the special circumstances of pregnancy and menopause. Also, the influence of worry, stress and burdensome events on sleep should not be underestimated.

Not every change in eating behaviour reflects an eating disorder. For instance, decreased food intake can be a reaction to stress or sadness. Pathologically reduced food intake as part of anorexia is characterised by the following:

• Excessive preoccupation with the issue of eating.
• Eating behaviour displays a high level of self-control.
• Count calories incessantly and weigh themselves daily (even more than once).
• They eat slowly.
• They drink plenty of water to fill the stomach.
• They find excuses to avoid eating in the company of others or, when that is inevitable, to avoid eating (“I have eaten already”).
• Severe weight loss.
• Excessive sports activity.
• Consider themselves fat despite obvious underweight.
• Have difficulty concentrating, lose hair and have dry skin, and feel cold.
• Develop lanugo hair (new-born facial hair).

Anorexia causes the whole body to be undernourished. The intake of nutrients, electrolytes and water is insufficient. This can lead to long-term mental and physical consequences: excessively slow heartbeat, heart and kidney disorders, osteoporosis, hormonal disturbances progressing to infertility, impotence, loss of nerve cells, anaemia, loss of heart muscle and skeletal muscle, depression, isolation and anxiety disorders. Anorexia that starts at an early age can impact development: menarche does not occur and bone growth can be impaired.

As the disease progresses, the body does not function properly. A mild bacterial infection can become lethal. Anorexia nervosa has the highest case-fatality rate of all mental diseases.

Body-mass index (BMI) shows the relationship between height and weight. The normal range is between 18.5 and 24.9. Values below 18.5 indicate underweight, and values below 14.5 are life-threatening.

Even though the BMI is not the ultimate parameter of health, it is a good indicator of extremes. Severe overweight can also have life-threatening effects, albeit less acute. A BMI of more than 30 indicates severe overweight; this should be reduced.

Relatives and friends must first acknowledge and accept that a loved one is suffering from anxiety disorder – and that this is a mental illness. It is important to learn about the disease. This can be done through professional medical advice as well as through discussion with other affected persons.

Friends and family members can help people affected by listening to them and showing that they understand the situation. In no case should suffering be a cause for criticism, reproach or ridicule. It is important that sufferers see that they are not alone and are supported. It is equally important to encourage those affected to seek professional help or, in the extreme case, to initiate their own medical examination.

Rapid heart rate, dizziness, shortness of breath – the symptoms of acute anxiety or panic attacks - are varied and usually last a few minutes to half an hour. Patients can either go to an emergency room with a psychiatric ambulance or try to help themselves with simple measures. These include breathing exercises, such as the 4-6-8 technique, in which they inhale for four seconds, hold the air for six seconds, and then exhale for eight seconds. Another self-help measure is not to suppress or control the feeling, but to accept the panic attack. It can also be helpful to look for a distraction, for example, to talk to people or to concentrate on a specific activity.

Most of the people affected depend on the support of their family in their daily lives as part of a reduction in their intelligence. This is a big, lifelong task for family members and often a full-time job. In order to have the necessary patience, perseverance and care, it is essential that family members pay attention to their limitations and do not take over. It is essential to make use of early offers of help that relieve family life and support relatives in the challenges they face. Visiting self-help groups helps many.

Depending on the cause of the sexual dysfunction, relatives and especially partners play an important role in treatment. In the case of physical illness of the affected persons, it is helpful if relatives learn about the illness and actively support those suffering. If they are directly affected by their partner’s dysfunction, understanding the difficult situation is helpful. Even if it is difficult, partners should not exert any pressure or downplay the problems. Open and honest exchange of expectations and wishes can help in some cases. In many cases, it is beneficial for the couple to seek therapeutic help together.

The best way to help affected individuals is by being informed. What consequences does an addiction disease have and what do you have to prepare for? Use professional advice and exchange information with people in the same situation. You can also find more about self-help on curamenta.

Being informed also means setting boundaries. Even though you want to help the suffering person unconditionally, don`t take responsibility for their addiction. Be careful to avoid entering a situation of co-dependence, which is adopting an addiction-promoting type of behaviour, frequently without being aware of it. Such behaviour includes procuring the addictive drug, or justification of the addiction to yourself or others, for example.

Relatives frequently feel helpless, even though they would like very much to help. It is important not to put the affected person under pressure. Therapeutic assistance is most effective when they are highly motivated to seek help. The best thing relatives can do is to encourage self-motivation. It is also important not to criticise or ridicule body and eating behaviour issues, and not to reduce affected individuals to only their disease.

Given that the situation is difficult for everyone involved and relatives go through their own emotional problems, it is reasonable for them too to seek professional help.

Sleep disorders can very directly affect relatives. A typical example is the sleepless partner tossing and turning in bed, or constantly turning the light on. Relatives should avoid reacting in an irritable or angry way, even if that is sometimes difficult. Affected individuals in most cases suffer markedly and are tense due to their inability to sleep. Anger and blame do not help. If the situation lasts longer, separate beds can help prevent sleep deprivation.

Understanding for the situation and consideration for decreased daytime fitness and concentration bring temporary relief. In the long run, the affected individual must deal with the sleep disorder and seek help. Relatives can motivate them and show their support.

Intelligence is the brain's ability to learn and remember things, to adapt easily to new situations and to think abstractly. The intelligence of a person can be measured with special tests. The so-called intelligence quotient (IQ) is determined as a meaningful value.

An IQ of 85 to 115 is considered "normal intelligence". IQ in the range of 70 to 85 is below average; in this case, it is referred to as a learning disability. If the measured value is less than 70, it is an intellectual disability. This is divided into the four severity levels slightly (IQ from 69 to 50), moderately (IQ from 35 to 49), severely (IQ from 20 to 34) and most severe loss of intelligence (IQ under 20).

Depression can be both a trigger and a consequence of sleep disorders. Ongoing sleep problems for long time mean persistent stress for the body. This can overload the body and mind. This can lead to depression. At the same time, disturbed sleep is one of the most common symptoms of depression.

Many sufferers have difficulty going to sleep or wake up too early in the morning. As a result, their energy and wellbeing are reduced. A sleep disturbance should also be addressed during therapy.

The main thing is to find the cause of the ongoing problem to fall asleep. The sleep disorder can be conquered over the long term with targeted measures, therapy, or lifestyle changes. Difficulty in sleeping is often exacerbated by worry about not being able to sleep and not being in best shape the next day. Affected individuals should also try to relax as best they can, even though inability to relax may be the main problem.

The following recommendations could help:

• Getting out of bed and seeking distraction with a relaxing activity
• Doing breathing exercises
• Writing down thoughts, worries and feelings to get them out of mind
• Listening to a relaxing podcast, a piece of meditation, or some relaxing noise such as the sound of the sea
• Reading something that does not provoke excitement or tension

Although psychotherapy is considered to be the first choice in the treatment of anxiety disorders, in some cases medications can also be used. This is especially true if the affected persons are so severely impaired that psychotherapy in the first step is not possible or psychotherapy has not shown the desired success. In general, antidepressants are used to reduce anxiety and phobias, and to improve the mood of those affected relatively quickly. Benzodiazepines, also known as sedatives, offer another possibility. They can quickly resolve anxiety, but they are not a permanent solution and do not cure anxiety disorder. Medications are only given as part of a treatment and should never be taken without medical supervision.

Sleeping pills, even plant-based, should never be taken without medical supervision or for a long time. The danger of becoming dependent is very high. Doctors prescribe sleeping pills in most cases only as a short-term temporary solution. In healthy people, the natural sleep-wakefulness cycle regulates itself without outside help. That is why the most important goal in the management of sleep disturbances is to find the cause and correct it.

Alcohol withdrawal can have both physical and mental symptoms. The most common physical symptoms include shaking, sweating, restlessness, nausea, headache, sleep disturbance, high blood pressure, and seizures.

A particularly severe form is delirium tremens. This condition manifests itself through short-term memory impairment, respiratory problems, and heart and circulatory symptoms. Altered consciousness is a life-threatening complication which can progress to coma. This can develop when alcohol is discontinued abruptly after prolonged regular use.

Mental withdrawal symptoms can include depressive mood, anxiety state, concentration problems, mood swings, and aggressiveness.

Alcohol withdrawal should always take place under medical supervision.

The boundary between temporary changes or limitations on sexuality and sexual dysfunction cannot always be clearly defined. Since sexuality is complex and the body and psyche are equally involved, many influences can have a short-term negative effect on sexual life. Occasional periods of unhappiness or orgasm difficulties are normal and occur in many people.

A central feature of a sexual dysfunction is that the symptoms persist for at least half a year. They also can cause distress: Sexuality, as you know it and like it, can no longer be interpreted satisfactorily. This leads to problems in partnership, to psychological effects and to a generally stressful life.

At the time of menopause, women go through a change in their hormonal balance and their fertility. Oestrogen and progesterone (sex hormones) production decreases. This leads on the one hand to shortened deep-sleep phases, and on the other hand to frequent night hot flashes. Both can severely impair sleep.

Internal restlessness and mood swings also develop frequently during menopause. The extensive internal and external changes of this life phase put many women under stress. All these circumstances can lead to sleep disorders. Age also plays a role. The body produces less melatonin sleep hormone and the depth of sleep decreases.