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Neurodiversity and Mental Health

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Neurodiversity and Mental Health

Having neurodiverse characteristics or mental health difficulties can impact impact your relationships and sex life. 

People in a Bar

Neurodiversity refers to the various ways in which our minds work. There are people who's cognitionts differ from the average population. and these differences can sometimes make it difficult to form stable connections or sexual relationships with others who may not understand you. 

Autism Spectrum Disorder (ASD)

ASD refers to a cluster of cognitive, emotional and behavioral symptoms that can make it difficult for you to understand other people social cues, you may take information very literally, and you may have some aversions to certain stimulation (loud noises, bright lights, or textures of clothing or food). ASD is considered a spectrum because there are varying ways and severities in which the symptoms can effect you. When children are diagnosed very young with ASD they often have a co-morbid developmental condition. This can make it difficult for adults who receive an ASD diagnosis to accept it, as they feel they are being told they are developmentally delayed. This is not the case. You can have ASD and have full intellectual capacity, sometimes above average. 

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Effects of ASD on Sex & Relationships

ASD frequently results in miscommunication and conflict for couples. You may find it difficult to understand your partners needs, or alternatively think you understand them very well but become perplexed when your partner seems to get upset with you for things they expect you to know already. In addition to this, navigating sex can become quite difficult but from the interpersonal level, and in regards to your particular sensory needs. 

Effects of ADD/ADHD on Sex & Relationships

I see many couples who are effected by ADD/HD. It is not uncommon to see a hyperactive type paired with an inattentive type. Both types struggle with similar cognitive difficulties, but the hyperactive type is more likely to be moving and look erratic, where as the inattentive type is more likely to 'zone out' and become distracted by television or their phones. ADD/HD can cause significant difficulties in navigating conflict, and can also cause conflict. 


Attention Deficit Disorder  (ADD inattentive type) and Attention Deficit Hyperactivity Disorder (ADHD, hyperactive type) both refer to difficulties in paying attention, time management, inattention, distractibility, poor working memory which cause significant difficulties in a persons work, social life and relationships. In reference to sex, sometimes you can easily become distracted and/or disinterested.

ADD/HD is commonly diagnosed in childhood when difficulties in learning, concentrating or controlling behaviors start to show. However some children are not identified at this age due to either their severity of symptoms, gender norms (he is just an active boy, or for girls the presentation can be a little different) or if the child has high levels of masking skills (behaving outwardly like everyone else, but still having the symptoms) and being high functioning (coming up with procedures and routines to deal with the cognitive difficulties) 

It is important to note that ADD/HD is frequently comorbid with anxiety, depression and trauma. Sometimes the scattered thinking poor memory and lack of executive function is diagnosed as ADD/HD but may in fact be a symptom of trauma. 

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Mental Health

There are many mental health conditions that can effect your quality of life. However I do notice a few which consistently effect sex lives and relationships. These include depression, anxiety and bi-polar disorder. 


Depression is one of the most common forms of mental health difficulties, and most people are likely to expereince this as some point in your life. The symptoms include:

Sadness- feeling sad or empty or hopeless most of the day and most days.

Loss of pleasure- loss of enjoyment and pleasure in things that used to feel good to you.

Sleep- changes in sleep patterns (sleeping much more or much less than usual)

Appetite- changes in appetite (eating much more or much less than is usual for you)

Self image- Enhanced sense of shame or guilt and lack of feeling worthy.

Suicidal thoughts- thinking about suicide or thinking a lot about death.

Difficulty concentrating, fatigue and somatic changes (moving slowly or more restlessly).

Additionally to these symptoms, a diagnosis of depression requires that the symptoms cause significant impairment in your life (social, financial, work, intimacy), the symptoms have been present persistently for at least 2 weeks, and the symptoms are not the attributed to another dissorder, drug or alcohol use, and there is no mania/hypomania or psychosis present. 

Effects of Depression on Sex & Relationships

Depression has quite significant effects on relationships, you may pull away from your partner, or feel unworthy to be with them. Your partner may feel rejected by you, and start to feel overwhelmed by the sadness.

Depression also effects sex, if you are not on medication you can loose all interest in sex, or want to rely on sex to feel connected and loved- but your partner may have trouble feeling connected to you enough to want sex. Some people also turn to porn to fill in the gaps here. 

The primary medication for depression are SSRI's which are known to reduce libido and sometimes make it difficult to orgasm. There are some medications that are known to have less effect on libido, and you can ask your GP or Psychiatrist to look into this with you. 

Effects of Anxiety on Sex & Relationships

Anxiety that is not managed can have a huge impact o your relationships, as you may not feel that you able to attend social functions, or family events. You may feel resentful that your partner so easily socialised without you, or that they never seem to be worried about important things. Anxiety frequently causes people to try to control their symptoms with alcohol/drugs or avoidance- or to control their environment which can feel very restrictive and controlling to your partner and family. 


Anxiety is a very common form of mental health problem. Types of anxiety include Generalised anxiety (anxiety about many things most of the time), social anxiety (anxiety about interacting with people), phobias, panic attacks, OCD and PTSD. Generalised and social anxiety as well as panic attacks can create difficulties in relationships, frequently creating a carer relationship amongst the couple which both parties can come to resent. It is vital to get help and guidance for dealing with anxiety in relationships. Medications for anxiety can also contribute to lack or libido or lack of sexual pleasure. 

Anxiety can cause you to avoid situations which make your symptoms worse, and these situations may be things you actually want to do (such as go on a date, get married, or have sex, attend a party or work meeting), yet the anxiety can be so overwhelming that you end up avoiding the situation, or using alcohol or drugs to manage the anxiety.

Bi-Polar Dissorder

Bi-polar disorder can present in tow main ways. Bi-polar I, and bipolar II. Bi-polar I is characterised by periods of depression (seen above) followed by periods of mania or hypomania. Mania is a state of mind that includes grandiose thoughts, impulsivity, delusions, racing thoughts and a decreased need for sleep, and sometimes can lead to psychosis. Hypomania is a lower level of mania which may include the agitation, racing thoughts, increased confidence but lacks the delusional nature of mania. 

Bi-polar II is when the sufferer experiences the depressive episodes followed by periods of "normal mood".

Effects of Bi-polar on Sex & Relationships

If you suspect you have Bi-polar disorder, it is vital that you are under the care of a psychiatrist, and have your medications carefully monitored to your personal needs. Some of the medications can effect your libido, which may require help from a relationship therapist to navigate the sexual needs of the couple.

Cornea Transplant

Bi-polar disorder can contribute significantly to distress in relationships. Both parties try to navigate the changes in personality and it feel very disorienting to adjust to the changes. When someone experiences mania they can become hypersexual, and even engage in sexual behaviors that they would otherwise avoid, such as risky sexual practices (unprotected sex, random hookups in unsafe places, sex with inappropriate people). When the person comes out of their manic episode it can be difficult for the relationship to navigate behavioral and sexual indiscretions. 

Cleaning Computer Keyboard
Effects of OCD on Sex and Relationships

Many people I have worked with experience OCD. Common themes include fears or obsessive thoughts about being a sexual predator or pedophile, and fears and obsessive thoughts about pregnancy. OCD focused on germs and cleanliness can also make sex very difficult, as well as putting pressure and in some cases shame on your sexual partner for usual bodily functions and smells. 

Obsessive Compulsive Disorder

Obsessive Compulsive Disorder is characterised by obsessive thoughts and/or fears, which lead to compulsive ritualised behaviors. 

Obsessive thoughts can include thoughts of germs, fear of harming someone, or fear of forgetting to do something. These thoughts come as intrusive thoughts- that is they keep popping into your head against your will, and you will frequently know the thoughts are excessive but you cannot ignore them or stop them. 

The compulsive behaviors are a way of calming your obsessive thoughts or reducing the fears. This may include frequent handwashing, rituals around cleanliness that are extreme,  or checking locks and faucets repeatedly.

If you suspect you have OCD it is really important to be under the care and guidance of a psychiatrist to make sure that you have achieve the best quality of life. Working with a sex and relationship therapist can help you and your partner to navigate relationships and sex in ways that help you to relax and enjoy your interactions.

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Personality Disorders

There are three main groups of personality disorders:

Group A - Paranoid, Schizoid, and Schizotypal

Group B - Borderline, Narcissistic, Histrionic and Antisocial Disorders

Group C - Avoidant, Dependent, Obsessive Compulsive

Below I cover the three personality disorders which most commonly present in my practice. While i have not covered avoidant and dependent personalities, these tow types are also common and frequently find themselves 'paired up' with each other and have high levels of conflict.  

Borderline Personality Disorder

Borderline Personality Disorder (BPD) is characterised by the following symptoms:

  • A deep fear of abandonment

  • A sense of emptiness

  • Deep but unstable relationships

  • Unstable moods and reactions

  • Suicidal thoughts, threats or attempts

  • impulsive and risky behaviors

Additionally BPD may present is external or internal. The external form will be more likely to explode with anger and threats, and risky behaviors with strangers. Where as the internal (or silent type) directs all of these extreme emotions and threats at themselves and may attempt to mask their mood-swings and emotions outwardly.

BPD is thought to be a result of significant childhood trauma and abandonment. CPTSD overlaps significantly with the symptoms of BPD, and is commonly misdiagnosed as BPD. 

Sad on Couch
Effects of BPD on Sex and Relationships

If you have BPD or are in a relationship with someone who has BPD you may struggle with the ups and downs of emotional lability. Dealing with a break up is difficulty for anyone, but if you have BPD you may experience a break-up or betrayal as unbearable psychic pain. Depsite the bad wrap that people with BPD are given in the media, it is possible to heal from some of the more extreme symptoms if you get the appropriate help. As a partner of someone with BPD you will most likely need your own therapist to help to support you in establishing and maintaining emotional boundaries.

Overt Narcisists

Overt narcists are frequently outspoken, opinionated, overbearing, entitled, lacking in empathy, competitive, exploitative and have a deep need to be praised and admired. An overt narcissist may be antagonistic or communal. The Antagonistic type is more likely to create conflict, be confronting and combative, compete with and take advantage of others. The communal type is more likely to present as altruistic, seek to form close social bonds and be involved in pro-social movements, however their emotions and interpersonal behaviors will not match their talk.

Narcisistic Personality Disorder

While we all have an element of narcissism to us, when someone has NPD the narcissistic element of them is the dominant part of their personality. Narcissism is characterised by an extreme focus on the self, an inflated sense of importance, and a deep need to be recognised and praised. People with NPD are not inherently bad, in fact there are adaptive narcissists, and maladaptive narcissists.  An adaptive narcissist will strive to work within ethical and legal frameworks to meet their needs of success and recognition. Maladaptive narcissists may not regard ethical behavior as important in how they get their needs met. The following explores the more common maladaptive forms of NPD. 

Covert Narcisists

Covert Narcissists, sometimes called vulnerable narcissists are better at keeping their characteristics hidden for longer. They commonly have low self esteem, depression anxiety or shame, are insecure, avoidant, defensive and will see themselves as the victim in most circumstances. They will be very self focussed but plagued by feelings of worthlessness and fear of failure and abandonment. 

Effects of NPD on Sex and Relationhships

Narcissists will often shower you with love and praise )love bombing) early in the relationship. They can be incredibly charming when you meet them. They will turn every conversation to be about them, they may find your feelings (if you express anger or frustration to them) to be deeply offensive and as an attack on them. You being sick or needing care may be perceived as an inconvenience to them. They may need preferential treatment and have double standards about how they treat you versus how you must treat them. If you have NPD or are in a relationship with someone with NPD you will need professional help in order to have happy and healthy relationships.

Beauty Model
Sociopathy and Psychopathy

Antisocial personality disorder is commonly known by both Sociopathy and Psychopathy. People with ASPD have the following characteristics:

  • little to no concern for the feelings of others

  • cheats, lies, steals, even when unnecessary.

  • can be aggressive and violent,

  • Has low regard for their own and others personal safety

  • Has little to no regret of actions that harm others.

  • often know they are different to others and is proud of it. They feel their lack of emotional connection and ethics makes them better and more powerful than others. 

Man with Checkered Shirt
Effects of ASPD  on Sex and Relationships

If you have ASPD or are in a relationship with someone with ASPD, and you want to have a healthy relationship it is vital that you seek assistance from mental health professionals and relationship therapist. There is a very high likelihood that someone with ASPD will use gaslighting, coercive control, emotional abuse, and financial abuse to get what they need out of a relationship. People with ASPD and a high IQ are more likely to mask their lack of emotion and feign empathy. 

For Partners of the Neurodiverse

If your partner is neurodiverse, its really important for you to have your own support and insist on good boundaries. While your partner may find certain things difficult or non-sensical it is still their responsibility to learn about you and what your needs are. You both have a right to be loved and accepted for who/how you are AND you both have a responsibility to learn about each others needs and how they experience love and safety in relationships. 

For partners of people with mental illness

If your partner has a mental illness, this is a factor of their life that you need to take into account as you make plans for your lives and activities together. However, while a partner may offer compassionate support, it is the individuals responsibility to seek help and to do pro-active things to assist their mental health. For example taking their medication, excessive, nutrition and avoiding substances that interfere with good mental health outcomes. Supporting your partner includes caring for yourself, and having good boundaries.

Happy Couple
For partners of people with Personality Disorders

If your partner has a personality disorder, there is very little wiggle room for them to change. Change will take a lot of effort on their part, and will be slow and over time with intensive therapy. People with Borderline personality disorder may be the exception here. BPD is theorised to be a result of extended trauma in childhood on the persons development of personality. With intensive focus and motivation from the individual with BPD, appropriate mental health care and professional psychiatric  intervention people with BPD can have healthy loving relationships. On the other end of the spectrum if your partner has NPD or ASPD and doesn't care or will not recognise this, there is almost no likelihood that they will ever change and there is a high likelihood that you will increasingly suffer in the relationship. 

Resources and Recommended Reading

Here are some links to books that I usually recommend...

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