Ending a relationship and letting go can be incredibly difficult no matter how toxic it is. Part of this is for simple biological reasons, as recent scientific studies have shown that being in love activates the same reward pathways in the brain as addictive substances like cocaine.

Brain scans of lovers and people experiencing substance addiction both display increased activity in the pleasure centers of the brain (most notably the dopamine centers) and decreased activity in the frontal lobe, which is the area responsible for cognition. This means that while falling in love can make us feel good, it can also profoundly affect our judgment.

While researchers have found overlaps between romantic attachment and addiction-related brain activity, healthy human bonding is not inherently pathological. Neurochemicals such as dopamine and oxytocin help create emotional attachment and connection. In unhealthy or inconsistent relationships, however, these same reward systems can contribute to intense emotional dependence and make it harder to leave, especially when affection and distress occur in cycles.

It is for this reason that love can sometimes be compared to an addiction. In love, much like addiction, there may be negative side effects such as abuse or gaslighting. But despite all of those bad circumstances, it can still be difficult to kick the romantic attraction and feelings of love when letting a relationship go.

Not all unhealthy relationships look the same. Some relationships may involve poor communication or codependent patterns, while others may include emotional abuse, manipulation, coercion, or trauma bonding. The process of leaving and healing can look very different depending on the dynamics involved, and some situations may require additional support or safety planning.

If you find yourself feeling trapped in a relationship you know is not healthy, consider these 15 tips for letting go of it for good:

1. Recognize the Problem

Awareness is the first step. Educate yourself or consider talking to a therapist or counselor about what constitutes an unhealthy relationship. Take a good, hard, and objective look at your relationship and be honest with yourself.

Ask yourself these questions:

• Is this relationship serving my highest good?
• Is this relationship negatively impacting other areas of my life?
• Is this relationship detrimental to my self-esteem?

If you answered yes to any of these questions, consider ending or talking to a professional about the relationship.

2. Allow Yourself to Feel

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Letting go of a relationship is usually not easy. It can be painful to end a relationship even if the relationship was not serving your highest good. Honor any feelings of grief you may have, and allow yourself to feel those emotions rather than attempting to suppress them. What people often experience as “missing them” may also involve emotional withdrawal and a dysregulated nervous system. In relationships marked by inconsistency, conflict, or intermittent reinforcement, the brain and body can become conditioned to cycles of emotional highs and lows. The urge to reconnect often intensifies when the discomfort feels overwhelming, not necessarily because the relationship was healthy. Accept grief as a part of the experience, and allow yourself the time you need to heal.

3. Discover the Lesson

Many people reflect on past relationships to better understand themselves and their patterns. However, not everyone is ready to take meaning from the experience right away, and that’s okay. Sometimes healing first needs to come before insight. If and when you feel ready, consider asking yourself what the relationship revealed about your needs, boundaries, values, or hopes for future relationships.

In life, lessons may often be repeated until they are learned. Look for the lesson from this relationship and you may be less likely to carry the same lesson over into your next relationship.

4. Create Separation

It can be hard to distance yourself from someone you’re used to spending so much time with, but it is usually necessary if you want to move on from the relationship. This doesn’t mean you can’t maintain a friendship with your ex, but it’s usually best to allow some time for both parties to heal before you try to spend time together as friends.

For some people, especially in relationships involving manipulation, repeated boundary violations, or trauma bonding, a period of no contact may be necessary to allow emotional healing and nervous system regulation. In other situations, limited contact may be more realistic, particularly when co-parenting, shared responsibilities, or practical concerns are involved. Creating space can help you gain clarity and reduce the emotional intensity that often keeps unhealthy dynamics going.

5. Let Go of the Mementos

It can be tempting to hang on to all the old relics of a past relationship. Doing so, however, may prevent you from moving on with your life. If you must keep the old love letters, movie ticket stubs, photos, or romantic gifts, you may want to store them somewhere out of sight until you’re ready to move on.

6. Take Off Your Love Goggles

Love often has a way of clouding your perception, which sometimes makes it difficult to see someone for who they really are. If you really want to get out of an unhealthy relationship, you must be willing to take off your love goggles and look at the person objectively. Consider talking with a close family member or friend or even finding a therapist to help you look at the relationship impartially.

It’s common to hold onto isolated moments of connection while minimizing larger behavioral patterns. When you slow things down and look at the relationship over time, the overall dynamic often becomes clearer. Ask yourself whether the relationship consistently felt emotionally safe, respectful, and supportive, not just whether there were occasional good moments.

It isn’t uncommon to only hold on to the good memories of an ex and completely shut out the bad memories. Maintain your perspective by remembering both sides of the experience. Remind yourself of the good times, but don’t forget those bad times or you could end up forgetting why you ended the relationship in the first place.

7. Compose a Letter to Your Ex

Consider writing out all your feelings in a letter, even if you have no intention of sending it. You can choose to give this letter to your former partner or destroy it when you’re finished. The point of the letter is to allow you to release your feelings. Writing or journaling can help you reflect on the relationship as a whole, while giving you a way to further your mental and emotional wellness.

8. Focus On Empowering Yourself

Try your best to shift focus off the relationship and back to yourself. Consider trying new things or putting your energy into a hobby you’ve neglected. Remembering why the relationship was unhealthy and focusing on what it is you do want in a relationship can be empowering.

After an unhealthy relationship, many people realize they lost parts of themselves along the way. You may reconnect with interests, friendships, goals, or aspects of your identity that became smaller during the relationship. Rebuilding your sense of self is often an important part of healing.

Most importantly, work on your relationship with yourself. Focus on cultivating self-love and respect. Remind yourself that you are worthy of love and that you deserve a healthy relationship.

9. Rewrite Your Story

We often tend to place the weight of our identities into our self-professed life stories. We believe we are what we continually tell ourselves. Examine your story and rewrite it in a more empowering way to start making positive changes in your life.

If you continually tell yourself you lost your soul mate and you’re destined to be alone, you might struggle to hang on to a relationship that is no longer serving you. Reframe your story and consider the fact this relationship may have just been one step on the journey toward an even better relationship in the future.

10. Practice Forgiveness

Release any feelings of guilt or regret you have surrounding the relationship. Forgive yourself for anything that happened in the past because you can no longer change it. You can only move forward and learn from it.

Forgiveness is often a gradual process and should not be rushed. For some people, trying to forgive too quickly can bypass important feelings such as anger, grief, or betrayal. Forgiveness does not mean excusing harmful behavior or abandoning accountability. Instead, it may eventually involve loosening your emotional attachment to the pain or dynamic so you can move forward more freely.

11. Live in the Present Moment

Life exists in the present moment and healing is rarely linear. Many people move forward, then revisit old feelings, memories, or urges before continuing to heal again. Experiencing setbacks or moments of doubt does not mean you are failing or that ending the relationship was the wrong decision. Choose to live in the present rather than getting lost in nostalgia. Often, people stay in a relationship that is no longer healthy because they are clinging to the past. Judge your relationship based on how it is at present rather than how it once was.

12. Accept What Is

We must be able to accept things as they are if we want to move forward. Many people remain in relationships that are unhealthy hoping they can somehow change their partner. It is important to remember you cannot change anyone, especially if they have no willingness to change themselves. If the relationship isn’t working for you, then you have the choice to leave and move on. That is something you can change.

13. Contribute to a Cause You Care About

If you’re having trouble letting go of the past, consider getting involved in a cause you feel passionate about. Doing this can not only occupy your time and mind as you process feelings and let go of the relationship, but it can also help shift your focus to something bigger than yourself. Recent research has shown volunteering can significantly improve overall well-being, with benefits including reduced mortality, increased functioning, and better social connections. This can provide perspective and help you feel good as you also help your community.

14. Practice Self-Care

Most importantly, work on your relationship with yourself. Focus on cultivating self-love and respect. Remind yourself that you are worthy of love and that you deserve a healthy relationship. Letting go isn’t easy, and it isn’t uncommon to forget our own physical and emotional health after a painful breakup. The grief can be overwhelming and we may start to neglect our own needs, as emotional pain activates the same brain regions involved in processing physical pain.

During and after unhealthy relationships, the nervous system can remain in a heightened state of stress or emotional activation. Gentle routines, consistent sleep, movement, time outdoors, mindfulness practices, and supportive relationships can help your body gradually regain a sense of stability and safety.

Help yourself by choosing to practice self-care every day. Get plenty of rest. Eat nutritious food. Indulge. Take a hot bath. Get a massage. Whatever it is, just do something to meet your personal needs.

Furthermore, learning how to practice self-compassion. Moving on can be a big and scary step, so be gentle with yourself as you heal and create a new life after this relationship.

15. Embrace the Impermanence of Life

Forever is a misleading term. The only constant that exists in life is change. Despite our efforts to the contrary, we truly cannot hold on to anything in life forever. Everything—friends, family, and relationships—come and eventually go.

When it comes time for something to end, rather than clinging to what no longer is, realize impermanence is the nature of life and try to embrace it. Appreciate the good moments you had, cherish those memories, and let them go in exchange for new experiences. Missing someone after a breakup does not automatically mean the relationship was healthy or that reconnecting is the best choice. Emotional attachment can persist even when a relationship caused harm.

Know When to Ask for Help

The first few moments, days, or weeks following a breakup can seem debilitating. For some, ending a relationship means a loss of identity, support, and normalcy. Ending a relationship—even a toxic one—can be incredibly challenging and emotionally draining. However, you do not have to do it alone. Know when to seek support if you need it.

Some signs it may be time to seek additional support include repeatedly returning to the relationship despite ongoing harm, feeling stuck between knowing what needs to change and being unable to act on it, experiencing a significant drop in self-worth, or struggling to function in daily life after the relationship ends. Therapy can help people process grief, rebuild identity, strengthen boundaries, and better understand attachment patterns that may be contributing to the cycle.

If feelings of grief, shame, guilt, or other negative emotions persist and begin affecting your daily life after a relationship ends, consider finding a qualified therapist or counselor who can help you process and acknowledge your feelings in a healthy way. A qualified mental health professional can help you examine the past relationship in a safe place free of judgement while you work toward achieving a more complete sense of self after the relationship has ended.

Even if you feel like there is no hope after severing an important tie in your life, remember you can heal and you deserve a healthy relationship that meets your needs and complements you and your happiness.

Letting go of an unhealthy relationship is rarely just a single decision, it is often a process of building the emotional capacity, support, and safety needed to move forward. That process can take time, and it often requires significant courage.

References:

1. Pierce, A. F., Protter, D. S. W., Watanabe, Y. L., Chapel, G. D., Cameron, R. T., & Donaldson, Z. R. (2024). Nucleus accumbens dopamine release reflects the selective nature of pair bonds. Current Biology, 34(2), 341-349. https://doi.org/10.1016/j.cub.2023.12.041
2. Rinne, P., Lahnakoski, J. M., Saarimäki, H., Tavast, M., Sams, M., & Henriksson, L. (2024). Six types of loves differentially recruit reward and social cognition brain areas. Cerebral Cortex, 34, bhae331. https://doi.org/10.1093/cercor/bhae331
3. Yang, Y., Wang, C., Shi, J., & Zou, Z. (2024). Joyful growth vs. compulsive hedonism: A meta-analysis of brain activation on romantic love and addictive disorders. Neuropsychologia, 204, 109003. https://doi.org/10.1016/j.neuropsychologia.2024.109003
4. Nichol, B., Wilson, R., Rodrigues, A., & Haighton, C. (2024). Exploring the effects of volunteering on the social, mental, and physical health and well-being of volunteers: An umbrella review. Voluntas: International Journal of Voluntary and Nonprofit Organizations, 35(1), 97-128. https://doi.org/10.1007/s11266-023-00573-z
5. Kang, S. J., Liu, S., Kim, J. H., Kim, D. I., Oh, T. G., Peng, J., Ye, M., Lee, K. F., Evans, R. M., Goulding, M., & Han, S. (2025). Thalamic CGRP neurons define a spinothalamic pathway for affective pain. Proceedings of the National Academy of Sciences, 122(29), e2505889122. https://doi.org/10.1073/pnas.2505889122
6. Tabassum, F., Mohan, J., & Smith, P. (2016). Association of volunteering with mental well-being: A lifecourse analysis of a national population-based longitudinal study in the UK. BMJ Open, 6(8), e011327. https://doi.org/10.1136/bmjopen-2016-011327

Even people without an extensive knowledge of mental health concerns have likely heard of narcissistic personality disorder (NPD), or narcissism, as it’s commonly called. The term “narcissist” is often used casually to refer to people who don’t necessarily have a diagnosis of narcissism if they appear to have some narcissistic traits, such as grandiose delusions, low empathy, arrogance, and a need for admiration.

Portrayals of characters with narcissism in movies and television have also increased the condition’s notoriety. While depicting characters with mental health issues in the media can help increase awareness, it can also create problems. In the case of narcissism, much of what’s seen in popular culture rests heavily on stereotypes associated with grandiose and malignant narcissism. If people with narcissism aren’t portrayed as outright villains, they’re typically portrayed as toxic or harmful individuals.

If you’ve had a close relationship with someone who has NPD, you might agree that many of these stereotyped traits have truth to them. Still, it’s important to recognize that NPD can occur in varying degrees of severity, occurs on a spectrum, and can present in different ways. As a result, you may not always recognize someone has narcissism, especially if they live with a less-known subtype such as covert (vulnerable) narcissism.

Covert narcissism is also known as shy, vulnerable, or closet narcissism.

Covert vs. Overt Narcissism

Covert narcissism is also known as shy, vulnerable, or closet narcissism. People with this subtype tend not to outwardly demonstrate arrogance or entitlement. Instead, they might put themselves down and seem anxious about what others think of them, rather than exuding charm or confidence. Other people may describe them as quiet and sensitive, especially to criticism.

Similarities between subtypes may become more evident with closer exploration of symptoms and feelings. People with overt narcissism generally seek attention outwardly and put themselves forward as superior. They might show patterns of exploitative or manipulative behavior that relate to a personal sense of entitlement and need for recognition.

Covert narcissism often involves a more internalized experience. People with these traits still feel unappreciated, need admiration, have contempt for those they consider inferior, and believe they should get special treatment. But instead of displaying outward grandiosity, they may privately fantasize about having their special qualities recognized or getting revenge on people they believe have slighted or wronged them in some way.

Signs of Covert Narcissism

Not every person with some or all of the listed traits will have any type of NPD, but the following characteristics may help identify covert narcissism in people who meet criteria for NPD.

• A reserved or self-effacing attitude
• Humility or a tendency to put themselves down
• Smugness or quiet superiority
• Passive-aggressive behavior
• Envy of others and/or feeling that they deserve what other people have
• A lack of empathy for the feelings or situations of other people
• A tendency to step in and help others out of a desire for recognition

Narcissistic traits usually show up in all of a person’s relationships and interactions, but they might manifest in slightly different ways depending on the situation.

• In parents: Parents may seem to prioritize their child’s needs and feelings and make sacrifices to ensure their child’s success. But these behaviors generally result from the desire to be the “best” or perfect parent and achieve recognition and admiration from others. Not receiving this recognition may lead to anger or self-pity. Parents with covert narcissism may also use guilt to manipulate children who attempt to claim some independence.
• In the workplace: People with covert narcissism may feel superior to coworkers or supervisors, believe they’re the most intelligent or best at what they do, and harbor fantasies of being elevated above others. They may envy peers who do receive recognition, believing others don’t understand or appreciate them. This may contribute to interpersonal difficulties or subtle bullying.
• Among friends: Friends may offer admiration and respect, and it’s common for people living with narcissism to manipulate others in order to get sympathy, support, or attention. People with narcissism don’t always completely lack empathy for the difficulties of others, but the empathy they can offer tends to be limited to what they’ve experienced themselves. They tend to feel neglected or rejected when they’re not getting the attention they feel they deserve, so they may try to bring every conversation back to them—but this may be done in less obvious ways.

Covert Narcissism and Relationships

Recognizing covert narcissism in a loved one may be more difficult than recognizing grandiose or malignant narcissism. Some people living with narcissism may function well in society and maintain romantic relationships without causing their partner distress. But it’s very common for partners of people with NPD, especially untreated NPD, to experience gaslighting, neglect, and manipulation.

Some common experiences include:

• Lack of empathy from your partner
• Passive-aggressive attempts to get your sympathy
• Dismissiveness or contempt from your partner
• Feeling controlled or belittled

Covert narcissism involves a high level of sensitivity, so your partner might take things you say as criticism, rejection, or personal attack. They might act as if you bore them and show disinterest in your emotions and experiences. It’s important to reach out to a therapist if you feel manipulated, neglected, or otherwise distressed as a result of your partner’s actions. Couples counseling may help in some instances, but it won’t work unless your partner wants to change. Individual therapy, however, can help you get support.

Covert Narcissism and Mental Health

According to 2015 research looking at the diagnostic and clinical challenges associated with narcissism, people often seek treatment for co-occurring mental health conditions rather than narcissism itself.

People with covert narcissism may be more likely to have anxiety or depression than people with other subtypes. Non-suicidal self-harm is also not uncommon, and people with covert narcissism often experience feelings of emptiness or low self-esteem that can contribute to suicidal ideation.

Treating narcissism can be difficult, since many people living with the condition never seek or want help. The stigma associated with narcissism can make it even more difficult to get help. Receiving messages like “narcissists are evil” and “narcissists can’t change” may discourage even those who do want to seek help from trying.

Like other personality disorders, narcissism involves a long-standing pattern of emotions and behavior that may not seem unusual to someone living with the condition. Because of this, people who have covert narcissism, or any NPD subtype, will probably seek treatment for a co-occurring mental health issue. A therapist who recognizes traits of narcissism may then be able to help a willing individual begin working to change problematic patterns of behavior.

Some therapies show particular promise in helping address NPD. Schema therapy and psychodynamic therapy are two approaches considered most helpful. Therapists who offer compassion, validation for negative emotional experiences, and empathy for distress may be able to help clients uncover reasons for their vulnerability and address problematic behaviors, which may lead to change. People with covert narcissism may do better in therapy than those with malignant narcissism, which is often characterized by manipulative and sadistic behavior.

It’s generally accepted in the mental health field that people who want to change can improve if they seek support and are willing to make an effort. If you’d like to seek support for yourself or a loved one, begin looking for a compassionate counselor at GoodTherapy today.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
2. Behary, W. T., & Dieckmann, E. (2011, July 20). Schema therapy for narcissism: The art of empathic confrontation, limit-setting, and leverage. In W. K. Campbell and J. D. Miller (Eds.), The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Hoboken, NJ: John Wiley & Sons.
3. Caligor, E., Levy, K. N., & Yeomans, F. E. (2015, April 30). Narcissistic personality disorder: Diagnostic and clinical challenges. American Journal of Psychiatry, 172(5), 415-422. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14060723?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
4. Dickinson, K. A., & Pincus, A. L. (2003). Interpersonal analysis of grandiose and vulnerable narcissism. Journal of Personality Diosrders, 17(3), 188-207. Retrieved from https://pdfs.semanticscholar.org/8db5/d181e5ec85fd61de162d3c43e70611eaf4a4.pdf
5. Jauk, E., Weigle, E., Lehmann, K., Benedek, M., & Neubauer A. C. (2017, September 13). The relationship between grandiose and vulnerable (hypersensitive) narcissism. Frontiers in Psychology, 8. doi: 10.3389/fpsyg.2017.01600
6. Luchner, A. F., Mirsalimi, H., Moser, C. J., & Jones, R. A. (2008). Maintaining boundaries in psychotherapy: Covert narcissistic personality characteristics and psychotherapists. Psychotherapy, 45(1), 1-14. doi: 10.1037/0033-3204.45.1.1
7. Mayo Clinic Staff. (2017, November 18). Narcissistic personality disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662
8. Poless, P. G., Torstveit, L., Lugo, R. G., Andreassen, M., & Sutterlin, S. (2018, March 12). Guilt and proneness to shame: Unethical behaviour in vulnerable and grandiose narcissism. European Journal of Psychology, 14(1), 28-43. doi: 10.5964/ejop.v14i1.1355

Avoidant personality disorder (AVPD) is a mental health condition characterized by long-term, persistent social restraint, usually due to feelings of:

• Social ineptitude or awkwardness
• Inadequacy or low self-esteem
• Extreme fear of the possibility of humiliation, rejection, negative criticism, or disapproval from other people

People living with this condition often tend to struggle in personal and professional social situations, which can make it difficult to succeed in certain careers or intimate relationships. Even friendships can be affected. Many people with avoidant personalities may become isolated, and this can significantly impact emotional wellness.

Professional support can help people with AVPD cope with these difficult feelings and the social challenges they spark. But as the condition shares some similarities with other mental health concerns, it’s important to arrive at the correct diagnosis before developing a treatment plan. Therapy may not have the same benefit when it doesn’t address the specific challenges of avoidant personality.

Avoidant Personality: What Makes It Different?

Diagnosing AVPD may prove challenging, as this condition can involve traits and symptoms that resemble those of other personality disorders, including dependent and schizoid personality disorders. When these conditions co-occur, one may be missed in diagnosis.

Personality disorders involve deeply entrenched patterns of thought and behavior, characteristics that become part of personality over time.

People with dependent personality disorder (DPD) are also likely to feel inadequate, have greater sensitivity to criticism, and need frequent reassurance from loved ones. This condition can occur along with avoidant personality. Experts suggest this may happen because people living with AVPD tend to develop strong attachments when they become close to someone and may eventually become dependent on those loved ones. DPD is characterized by an extreme need to be taken care of, however, which sets it apart from AVPD.

Schizoid personality disorder may also involve avoidance of social and interpersonal relationships, but people living with this personality disorder tend not to seek out social contact because they don’t desire the company of others. People with AVPD, on the other hand, do want to interact with others and develop relationships. They simply fear rejection, so they avoid doing so until they feel certain they’ll be accepted.

Social anxiety (social phobia) also shares many symptoms with AVPD, so these conditions may be misdiagnosed as each other. They also sometimes co-occur, which can make distinguishing between them even more difficult.

AVPD and social anxiety differ in one important way. Personality disorders involve deeply entrenched patterns of thought and behavior, characteristics that become part of personality over time. The feelings and emotions that occur with personality disorders seem very real to the person experiencing them, even if they don’t represent the truth. For example, a person with AVPD may truly believe in their own inadequacy and doubt any other outcome than their inevitable rejection.

Social anxiety, on the other hand, is a type of anxiety. Feelings of insecurity, worry, and fear may not be any less intense than those experienced by people with a personality disorder, but people with anxiety are far more likely to recognize their feelings as an anxiety response. In other words, people living with social anxiety may realize their fear of social rejection isn’t grounded in reality, and they may have an easier time challenging these anxious thoughts.

A 2015 study looking at 91 adults who had either social anxiety or AVPD found evidence to suggest childhood neglect could increase risk for AVPD. This factor could help explain some key differences between the two conditions.

Avoidant Personality Treatment Options

Personality disorders can improve with treatment. Support from a compassionate therapist can help people with avoidant personality disorder explore any issues causing distress or having a negative impact on their lives and learn how to cope with these challenges.

Possible approaches that may help soothe symptoms of AVPD include:

Therapy

Therapy is the recommended treatment for any personality disorder. Different approaches may have more benefit than others for specific personality disorders. When it comes to AVPD, helpful approaches include:

• Psychodynamic therapy
• Schema therapy
• Emotion-focused therapy

While therapists may use these approaches less frequently than standard therapies such as cognitive behavioral therapy (CBT), research suggests they can often lead to greater improvement of personality disorder symptoms.

Complementary treatments

Many people living with personality disorders such as AVPD find alternative approaches helpful.

These might include:

• Biofeedback
• Acupuncture
• Art therapy
• Yoga therapy
• Meditation

These approaches may have benefit for some but may not work well for everyone. Research generally supports them as possibly helpful and not harmful in most cases.

Avoidant Personality and Self-Care

People living with AVPD may want to take steps on their own, outside of therapy, to try and improve symptoms or find relief from emotional distress. It’s common for people struggling with personality disorders, or any mental health issue, to fall back on coping methods that don’t help and might even cause harm.

These coping strategies, such as drinking, drugs, impulsive or reckless behavior, or self-harm, might feel safe, even easy, and they may help manage or relieve pain in the moment. But choosing positive, helpful coping strategies can do more than relieve pain for a short time. These techniques can promote long-term healing and growth.

• Live healthfully. It may not seem like it, but eating nutritious meals, getting enough physical activity, and sleeping well can all promote mental wellness. Spending time in nature and getting some sun can also help improve emotional wellness.
• Develop social skills. People struggling with social interaction might find classes helpful. Therapists and counselors, university wellness centers, and similar organizations can offer more information about these and related classes. These classes may have the most benefit after a few sessions of therapy.
• Don’t force it. When trying to improve emotional health, it’s important to sit with difficult feelings and confront challenges that arise. In terms of AVPD, this can involve increasing interactions with other people in order to recognize that rejection is not the inevitable outcome. But it can take time to feel ready to do this. Working with a therapist to develop a plan of action that seems both realistic and feasible can help make success more likely.
• Seek out enjoyable hobbies. Combining social interaction with a favorite activity can make the social interaction easier and help increase the chances of meeting like-minded people. It’s usually easier to naturally fall into conversation with people who share interests, and these new connections may seem less challenging or stressful as a result.

If a person diagnosed with avoidant personality does not receive treatment, they may continue to experience difficulty forming close relationships with others, leading to isolation and deep feelings of loneliness.

Whether or not you have received a formal diagnosis, therapy can help if you feel you may have symptoms of AVPD. A licensed mental health professional can screen you for AVPD and other similar conditions in order to create the best treatment strategy for you. Find a therapist near me.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
2. Avoidant personality disorder. (n.d.). Retrieved from https://www.bridgestorecovery.com/avoidant-personality-disorder
3. Eikenaes, I., Egeland, J., Hummelen, B., &; Wilberg, T. (2015, March 27). Avoidant personality disorder versus social phobia: The significance of childhood neglect. PloS One, 10(3). doi: 10.1371/journal.pone.0122846
4. Guina, J. (2018, April 30). The talking cure of avoidant personality disorder: Remission through earned-secure attachment. The American Journal of Psychotherapy, 70(3), 233-342. Retrieved from https://psychotherapy.psychiatryonline.org/doi/full/10.1176/appi.psychotherapy.2016.70.3.233
5. Kvarnstrom, E. (2016, April 6). Avoidant personality disorder goes beyond social anxiety. Retrieved from https://www.bridgestorecovery.com/blog/avoidant-personality-disorder-goes-beyond-social-anxiety
6. Lampe, L., & Malhi, G. S. (2018, March 8). Avoidant personality disorder: Current insights. Psychology Research and Behavior Management, 11, 55-66. Retrieved from doi: 10.2147/PRBM.S121073
7. Lampe, L., & Sunderland, M. (2015). Social phobia and avoidant personality disorder: Similar but different? Journal of Personality Disorders, 29(1), 115-130. doi: 10.1521/pedi_2013_27_079
8. Pos, A. E. (2014). Emotion focused therapy for avoidant personality disorder: Pragmatic considerations for working with experientially avoidant clients. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy, 44(2), 127-139. Retrieved from https://psycnet.apa.org/record/2013-41393-001

We all know perfection is an illusion. If perfection is unattainable and unrealistic, why do so many people strive to achieve it, setting themselves up for a perpetuating cycle of disappointment and shame?

For many perfectionists, there is an underlying fear that they are not “good enough,” “won’t succeed,” or “won’t be loved” if they don’t strive for perfection. At its core, perfectionism may essentially be an act of disowning our true selves. It’s often a coping mechanism for shame and inadequacy. Perfectionism thrives in convincing us that striving for it will make us our “best self,” when in reality, it can cause us to play small and take us away from our true selves.

Perfectionism can be like a coach who initially appears to want you to succeed, but then berates you, makes you practice to the point of exhaustion, and yells at you when you try to take a break. You may think that without this type of pressure, you won’t be able to achieve your goals⁠— but the opposite is actually true. If you allow yourself to rest, acknowledge your progress, and engage in positive self-talk, you’re much less likely to burn out and more likely to achieve your goals without sacrificing your health and quality of life along the way.

Perfectionism can be like a coach who initially appears to want you to succeed, but then berates you, makes you practice to the point of exhaustion, and yells at you when you try to take a break.

If you’re struggling with perfectionism, it’s important to keep in mind that it doesn’t go away overnight and that it takes time to learn how to overcome perfectionism. Below are seven tips to help you learn how to start letting go of perfectionism and be kinder to yourself.

7 Tips to Overcome Perfectionism

1. Identify the beliefs and rules that drive your perfectionism.

It can be helpful to identify the underlying beliefs and rules that drive your behavior. For example, many perfectionists have an underlying belief that they are not “good enough.” As a result of this belief, they may adhere to certain rules and all-or-nothing thinking such as “I must be perfect or I will be rejected,” or “I must be perfect or I will fail.” Often these beliefs and rules were formed in childhood. Bringing awareness to these beliefs and rules as well as how they impact different areas of your life can be the first key in the process of deprogramming these beliefs.

2. Honestly evaluate your expectations.

Take some time to honestly evaluate your expectations. It’s not realistic to expect that you will never fail or make mistakes because you are human, and you will inevitably make mistakes as we all do. Consider how you can create more realistic expectations for yourself. When you create realistic expectations, you are able to meet them. You’ll also build up your self-trust and self-confidence, two tools that can help you combat perfectionism.

3. Acknowledge the costs of perfectionism.

Perfectionism often leads to loss. These losses include: loss of quality time spent with others, loss of enjoying the present moment, and loss of connection with oneself. Many perfectionists struggle with modifying their standards due to fear they will fail as a result. Reflecting about what perfectionism has cost you in different areas of your life can help you realize that the costs outweigh the benefits. This realization can help boost your motivation to tackle perfectionism and be a helpful reminder for those times you feel tempted to give in to your inner critic.

If perfectionism were a physical illness, doctors would most certainly prescribe self-compassion as a way to treat it.

4. Practice self-compassion.

One of the most helpful ways to combat one’s inner critic and address perfectionism head-on is to practice self-compassion regularly. If perfectionism were a physical illness, doctors would most certainly prescribe self-compassion as a way to treat it.

Perfectionists are often their own worst critic. While they can be compassionate towards others, they may have difficulty being supportive of themselves. When you’re feeling critical towards yourself, some questions that can help you increase your self-compassion are:

• What would I say to a friend in this situation, and how can I apply that to myself?
• What would a friend say to me?
• How can I take care of myself right now?
• What do I need right now that I’m not getting?
• What are some ways I show others compassion that I can apply to myself?

Certain meditations can also help increase your self-compassion.

5. Engage in activities that build resilience.

Individuals who struggle with perfectionism often over-prepare and actively avoid making mistakes or putting themselves in situations where they may be bad at something. This fear can hold them back from learning that mistakes do not define their self-worth and most likely won’t cause others to reject them. It can be helpful to engage in activities you fear you will be bad at. Think of these activities as experiments that can help you practice letting go of unrealistic expectations and build resilience. This can be an anxiety-provoking process that takes time, but it can ultimately be very freeing for many perfectionists.

6. Reach out for support from others.

Perfectionism thrives in silence and isolation. Often perfectionists are surprised to find many others struggle with similar issues once they start opening up about it; this can reduce the feelings of shame that typically accompany perfectionism. Start by identifying one person in your life that you trust, and share with them about some of your struggles. The more you practice being vulnerable with people whom you trust, the less isolated you will feel, and the freer you may become.

7. Reduce your social media use.

Social media contributes to frequent social comparison, which can exacerbate perfectionism. Try taking a break from technology for a half or full day and see how you feel. When you start using social media after the break, notice how you feel. Are you engaging in social comparison and feeling “not good enough?” If so, consider implementing a regular break from social media a few times per week.

Keep in mind that it’s helpful to have realistic expectations for yourself as you’re working on your perfectionism—it’s a process that takes time. If you find yourself getting stuck during the process, it can be helpful to find a therapist who specializes in perfectionism and can help you combat your inner critic.

Posttraumatic stress (PTSD) and complex posttraumatic stress (C-PTSD) are related but distinct from each other. C-PTSD is thought to be an enhanced version of PTSD. C-PTSD is, in turn, related to borderline personality (BPD).

Ongoing Interpersonal Trauma and C-PTSD

PTSD is usually caused by a single traumatic event (or a series of traumatic events) that result in a real or imagined threat to one’s life or bodily integrity. Events that could cause PTSD include exposure to war, a terrorist attack, physical or sexual assault, or even the threat of such attacks. C-PTSD is different in that it’s typically caused by ongoing trauma which is often interpersonal in nature. C-PTSD tends to be associated with continued trauma that occurs at a young age. Children who grow up in neglectful or abusive environments may go on to develop C-PTSD (Giourou et al., 2018).

Borderline Personality and Ongoing Interpersonal Trauma

Borderline personality is also connected to ongoing interpersonal trauma during childhood. Researchers have linked exposure to chronic fear and stress as a child, as well as suffering from physical, sexual, and/or emotional abuse as a child, to the development of BPD. Growing up with a parent who had a serious mental health issue is also a risk factor for the development of BPD.

BPD and C-PTSD share an association with maltreatment in childhood, and up to 71% of individuals who experience BPD report severe abuse in childhood.

BPD is a serious issue characterized by a constellation of emotional, social, cognitive, and behavioral dysregulation. The most notable features of BPD are difficulty managing emotions, impulsivity, identity problems, and dysfunctional interpersonal relationships (Hecht, Cicchetti, Rogosch, & Crick, 2014).

Common Characteristics of C-PTSD and BPD

BPD and C-PTSD share an association with maltreatment in childhood, and up to 71% of individuals who experience BPD report severe abuse in childhood. BPD and C-PTSD also share symptoms. Overlapping symptoms relate to the areas of emotion processing and regulation, security in relationships, and self-concept (Ford & Courtois, 2014).

Some common symptoms of BPD and C-PTSD include:

Emotion processing and regulation difficulties

People with BPD and C-PTSD are known to have difficulties managing and regulating emotions. When experiencing uncomfortable emotions such as anger, fear, or sadness, the person may have difficulty controlling the intensity and duration of the emotion. It can be very hard to “let things go” and return to a neutral or uplifted mood once they’ve been thrown off balance.

Relationship issues

Those with BPD and C-PTSD often have relationship issues. Relationships may be unstable, insecure, and can often be traumatic or stressful for one or both partners. We start learning how relationships work in childhood. If our caregivers in childhood were neglectful or abusive, we tend to carry these learned perceptions of ourselves, such as “I’m bad, worthless, or not worthy of support,” into our adult relationships, as well as lessons about relationships, such as “They are unpredictable, unreliable, and sometimes dangerous.”

Individuals with BPD may have an especially difficult time trusting and relating to others. It is thought that because they may not have experienced empathy from their primary caregivers during childhood, they have developed limited abilities to see past their own emotional responses and understand how others may be feeling.

Adults with C-PTSD may also have difficulty with empathy and relationships, although it depends on the nature of the trauma and whether they had access to at least one caring adult during their childhood. We are all unique, and how we develop and respond to early trauma is variable and can depend on many different factors within the environment and the individual.

Self-concept

BPD and C-PTSD are both associated with impulsive behaviors and dissociation. People may behave in ways that are self-destructive and reckless. Unsafe sex, abuse of drugs and alcohol, and disregard for one’s own safety can occur.

Dissociation is highly prevalent in BPD, and it’s known to occur in PTSD as well (Krause-Utz & Elzinga, 2018). Dissociation can result in a feeling of being disconnected from oneself and the world. Especially during times where stress levels are high, dissociation can act as a defense mechanism where the sufferer feels detached from themselves and what’s happening around them. In certain cases, amnesia may result, as well as a feeling of “lost time.” Identity confusion can also occur, and the person may feel as though they don’t have a strong sense of self or that their identity seems to shift depending on the circumstances and the environment they find themselves in.

High levels of worry, sadness, and shame

Borderline personality and C-PTSD are associated with high levels of general distress. Many feel isolated and empty, as a significant portion of their symptoms can affect their relationships and connection with others. They may have high levels of shame and sometimes experience a feeling that they have been permanently damaged. This can lead to the desire to withdraw from others, as relationships are often a source of stress, insecurity, and/or conflict.

What If You Have Symptoms of Both C-PTSD and BPD?

Complex posttraumatic stress and BPD require treatment and support. If you are experiencing symptoms of C-PTSD and BPD, it can help to first receive an accurate assessment and diagnosis. It is important to understand that nobody is permanently damaged, and there are treatment approaches that have demonstrated effectiveness for both C-PTSD and BPD.

Therapy can help you develop strategies and techniques that allow you to better cope with stress and manage difficult emotions. Ongoing support from a therapist who understands what you are experiencing and where your feelings and symptoms are coming from can be enormously helpful for your healing journey. Find a therapist near me.

If you are struggling, it is important to reach out and take advantage of the support and options available. With treatment, you can not only feel better, but also avoid the negative consequences of behavioral and emotional symptoms. Feeling better and coping with stress can improve other areas of your life as well, such as how you function in professional and personal relationships.

References:

1. Ford, J. D., & Courtois, C. A. (2014, July 9). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1, 9. doi: 10.1186/2051-6673-1-9
2. Giourou, E., Skokou, M., Andrew, S. P., Alexopoulou, K., Gourzis, P., & Jelastopulu, E. (2018, March 22). Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World Journal of Psychiatry, 8(1), 12-19. doi: 10.5498/wjp.v8.i1.12
3. Hecht, K. F., Cicchetti, D., Rogosch, F. A., & Crick, N. R. (2014). Borderline personality features in childhood: The role of subtype, developmental timing, and chronicity of child maltreatment. Development and Psychopathology, 26(3), 805-815. doi: 10.1017/S0954579414000406
4. Krause-Utz, A., & Elzinga, B. (2018). Current understanding of the neural mechanisms of dissociation in borderline personality disorder. Current Behavioral Neuroscience Reports, 5(1), 113-123. doi: 10.1007/s40473-018-0146-9
5. Luyten, P., Campbell, C., & Fonagy, P. (2019, May 7). Borderline personality disorder, complex trauma, and problems with self and identity: A social‐communicative approach. Journal of Personality. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/jopy.12483

Fear is something all of us have experienced at some point in our lives. Everyone is scared of something. In fact, there are so many times when fear keeps us from doing what we want. At times, it’s a fear of what others might think. And at other times, it can be a fear of something that we are not willing to face.

There is nothing wrong with being scared; as humans, feeling scared is natural.

Fear is the body’s natural response to a stimulus. A stimulus can be anything that your mind perceives as a threat. Your body prepares itself to deal with fear by activating fight-or-flight response. No matter how much you deny fear, it is part of your survival kit. It is inevitable.

Fear is not just a feeling, but a form of energy. Any energy that is accumulated will require an outlet at some point.

4 Steps to Breaking Free from Fear

1. Face your fears

If you do not address your fears, they can accumulate with time. Fear is not just a feeling, but a form of energy. Any energy that is accumulated will require an outlet at some point. No energy can be contained for too long. When you don’t allow fear to get released, it starts expressing itself as struggle and pain.

In order to liberate yourself from your fears, you may need to put in some effort. It is not easy, but it is not impossible either. It is essential to liberate yourself from the fears that are holding you back.

2. Acknowledge your fears

Most people like to pretend that nothing happened after a frightful experience. They think that by trying to forget or ignore the fact that they felt scared, the fear will disappear. In reality, this is not the case. Whenever you feel sacred, you should acknowledge the emotion and face it. Instead of running away, you should tell yourself that it is okay to experience fear.

3. Communicate with your fears

Whenever you experience fear, learn to communicate with it. Seek to understand what your fear is trying to tell you. In order to communicate with your fear, first observe where exactly the fearful energy has accumulated in your body. Sometimes you may feel tightness in your heart, an uneasy feeling in your stomach, or tension in your limbs. Once you are successful in finding the crux of this energy, you can then communicate with it.

Ask questions like:

• What is my fear trying to tell me?
• What does it want me to do to support its release?

A dialogue with your fear can reveal some useful and important pieces of information. You will be able to understand the origin of fear and how to make yourself feel safe.

4. Find a way to release fear

A duck flutters its wings intensely after a quarrel to release the energy of fear. Similarly, you can find ways that help you release negative energy. It can be crying, screaming, shouting, or any vigorous physical movement.

Focus on the part of the body where you feel fear has accumulated and understand what kind of movement your body wants. Once you understand, all you need to do is surrender to the movement, amplify it, and repeat until it comes to an end.

4 Tips for Emotional Healing

Most people today may deal with damaged emotions. Many have been through one thing or another that has left them emotionally devastated. In some cases, people suffer so much that they’re scared if they open up about it, others might see them differently. Some people are scared their emotions will be misjudged. Others are scared that they won’t be able to live up to what is expected of them.

In order to start healing yourself emotionally and liberate yourself from your fears, follow the tips below:

1. Be yourself

It’s important to be yourself and be able to do what you like without being afraid of what anyone thinks. Be your own first priority, and try not to let others tell you how you should be.

2. Invent yourself

All of us mold ourselves according to the environment we live in. Give yourself a break and think about how you can reduce the emotional distress you’re feeling. Become a person you think can handle the distress better. Invent yourself with characteristics that were missing earlier.

3. Love and be loved

It is essential to love yourself and allow yourself to be loved. Try not to look down on yourself. You should feel worthy of love, your own and others’.

4. Flip the anxiety switch off

Promise yourself you will continue to work on addressing fears that contribute to unwanted worry or anxiety.

It can take much emotional strength to liberate yourself from fear. Facing and fighting fear can require courage, which can often come with the ability to emotionally regulate. For support as you work to build courage or face your fears, reach out to a trained and empathetic mental health professional in your area.

Recently, I had the opportunity to participate in the Overcoming Shame & Guilt Online Conference, hosted by Avaiya and Enlightenment Village. During the 7 day conference, doctors, psychotherapists, thought leaders, and others shared their opinions on navigating experiences of shame and guilt and talked about how these two differing-but-sometimes-related feelings can impact well-being, relationships, and the ability to achieve happiness.

I found it really interesting to contemplate the differences between shame and guilt and to hear various perspectives on how encountering each of these feelings impacts our lives. While there were some slightly differing views on whether there are any benefits to shame and guilt and whether you can ever completely get rid of them, the consensus seemed to be that these emotions can be quite destructive, yet also come with some benefits, especially in terms of guiding a person’s moral code and helping us grow.

Guilt vs. Shame

“Guilt says I did wrong. Shame says I am wrong.”

I see guilt as an emotion you experience when you feel bad about a specific thing or event—something you did or didn’t do. Shame, on the other hand, is an overarching feeling that you are inadequate or that you are somehow bad or wrong as a person on the whole. It’s always there, whether you do right or wrong. It’s about feeling fundamentally flawed or worthless as a person. Lisa Burgess summed it up nicely in her interview, saying, “Guilt says I did wrong. Shame says I am wrong.”

How Shame Can Impact Behavior and Mental Health

I do a lot of work in terms of helping individuals improve self-esteem and have seen how shame really plays a role in the lives of people who feel worthless or inadequate. Shame keeps people trapped, preventing them from being okay with who they are or believing they are good enough. Shame can wreak havoc on a person’s self-esteem and ability to navigate the world and relationships in a successful way.

It can be quite difficult to have healthy, authentic relationships when one or both parties experience a great deal of shame. People with shame tend to hide behind a facade, not wanting the world to know how badly they feel about themselves. Bullies, for example, are individuals who often put others down with the flawed belief that doing so will help them feel better, conquering their shame by putting it on someone else. Similarly, narcissism is a defense mechanism for hiding deep-seated feelings of shame and inadequacy. These ineffective, often subconscious attempts to prove the shame away don’t work. Rather, they create dysfunction and unhealthy patterns that only complicate the situation and interfere with one’s ability to have healthy, truly connected relationships.

How Are Shame and Guilt Connected?

People with shame tend to experience a lot of guilt, often stemming from a cycle of these dysfunctional patterns and a downward spiral of behaviors that ultimately make things feel worse. Guilt, on the other hand, is not always synonymous with shame. People with low levels of shame and a healthy level of self-esteem undoubtedly will experience situations and encounters that lead to feelings of guilt; however, they tend to navigate these experiences well and address guilt in effective ways that propel them forward rather than keeping them trapped in a place of self-hatred.

Guilt, when it’s rightfully experienced, can help guide a person’s morals and help people grow and learn from mistakes. For example, if you cheat on a test and feel guilty, you may learn that’s not a way you want to be and decide to make different choices in the future. If you say something to hurt someone’s feelings, you may go on to apologize, deepening the connection in the relationship. But when guilt is unwarranted, irrational, blown out of proportion, or coupled with feelings of shame, it can lead to feelings of more shame and may be an indication of mental health or identity issues that need to be addressed.

I specialize in working with new moms experiencing perinatal mood and anxiety disorders. This population represents one example of how excessive guilt can be a symptom of a larger issue rather than just a feeling that comes during isolated incidents and can be resolved through growth and understanding. Statistics show 1 in 5 to 7 new moms will experience a mental health issue such as depression, anxiety, obsessive-compulsive disorder (OCD), or posttraumatic stress (PTSD) during or following pregnancy, and excessive guilt can play a huge role in the struggles shared by this population.

In general, most moms face some layer of “mom guilt” at some point during parenting, but those struggling with untreated perinatal mood and anxiety issues tend to be ridden with overwhelming and irrational guilt—guilt regarding beliefs that they aren’t a good enough mom, that they are doing things wrong, that they are not effectively bonding with their new baby, or guilt because they may have obsessive or unsettling thoughts regarding their baby’s well-being. This type of unchecked, mounting guilt becomes unhealthy and needs to be acknowledged and treated.

Often, conquering shame and guilt involves learning to pay attention to your own internal dialogue and the potentially irrational beliefs and destructive messages that create feelings of inadequacy.

How Can We Overcome Guilt and Shame?

I do think it’s possible to overcome shame and guilt; however, it often takes some work and a willingness to seek help. In cases of perinatal mood and anxiety disorders, where guilt is a symptom of a larger issue, medication and/or therapy may be vital and can lead to relatively quick improvements that prevent a potential downward spiral into shame.

Tackling other instances of excessive guilt or destructive shame may take more time and involves exploration and processing of events that created the shame, but working to rid yourself of this crippling feeling is well worth the time and investment involved in therapy and self-discovery. Conquering shame requires an openness to becoming more self-aware and a willingness to make changes. The tools I teach in my building self-esteem workshops and in therapy with the individuals I see in my private practice help people focus inward and gain insight regarding where shame and guilt begin to develop.

Often, conquering shame and guilt involves learning to pay attention to your own internal dialogue and the potentially irrational beliefs and destructive messages that create feelings of inadequacy. People in general, and especially those who have a lot of shame, tend to have a negativity bias, especially when it comes to the thoughts they have about who they are and how they fit into the world. Negative and self-depreciating thoughts, whether conscious or subconscious, can breed feelings of shame.

When we begin to monitor our own thinking and make connections to the experiences or specific messages we hear, assume, or internalize throughout life, we can more clearly recognize where shame stems from, then can ultimately work to challenge, reframe, or shift these messages to allow for a future where we can move beyond shame.

Part of this process involves learning to accept ourselves as we are and recognizing that nobody is perfect. We are going to make mistakes, have flaws, have skeletons in our closets, and have encounters with others who treat us poorly. Despite any of these things, we all are worthy and capable of creating a better future.

The decision to let go of shame versus stay stuck in a place of shame is ultimately a choice. It’s not easy; it takes a lot of strength, courage, and determination to face the ugly shame monster, but doing so will grant us the opportunity to move forward with a happier and more fulfilling future as the veil of shame is lifted.

If you’re struggling with deep-seated guilt or shame, there is hope. Find a therapist in your area who can help you develop healthy thought processes to deal with shame.

Reference:

Gunyon-Meyer, B., Cole, J., Tremayne, L, & Standeven, L. (2018). Perinatal mood disorders: Components of care [Training manual]. Retrieved from Postpartum Support International 2-Day Perinatal Mood and Anxiety Disorders Training.

The transition from actively parenting children to a quieter life without children in the home can be difficult for any dedicated parent. For single parents, the transition may prove especially challenging. Empty nest syndrome, however, is not always a negative experience. An emerging line of research suggests many parents actually experience a sense of generativity, renewed relationships, and excitement when children leave home.

It’s normal to experience both elation and sadness as children transition into adulthood. When a parent does not have a partner from whom to seek support, these emotions can feel overwhelming.

Empty Nest Syndrome: What Is It?

For many parents, parenting becomes a primary source of identity. They may spend almost all of their time on parenting tasks over the course of 18 or more years. So when a child leaves home, a parent may be left with feelings of emptiness, loneliness, and confusion about their identity. It’s normal to struggle with a transition and to grieve the loss of time with a child. For some parents, though, empty nest syndrome triggers feelings of guilt, worthlessness, and loneliness that can morph into depression.

It’s normal to experience both elation and sadness as children transition into adulthood. When a parent does not have a partner from whom to seek support, these emotions can feel overwhelming.

The classic, stereotypical form of empty nest syndrome is considered to strike stay-at-home parents. When a parent, stereotypically a mother, stays home with a child, that parent may have few other sources of identity. When a child no longer needs the parent, they may feel overwhelmed by their own freedom.

According to the research of psychologist Karen Fingerman, however, this phenomenon is shifting. More mothers work outside of the home. Communicating with children who are away at college is easier and more affordable than ever. So fewer parents, especially mothers, may experience empty nest syndrome.

In single parent families, the mother may be even more likely to work. This could reduce the risk of empty nest syndrome, since single parents already have another source of identity and fulfillment. However, the lack of a partner can make an empty house feel even emptier. There is no specific research on the risk of empty nest syndrome among single parents as opposed to partnered parents, and because empty nest syndrome is not a disease but instead an amorphous collection of symptoms, little research has identified specific risk factors for this phenomenon.

Empty Nest Syndrome for Single Moms and Dads

Single parents make many sacrifices for their children. While a partnered parent may be able to sneak in a few hours of leisure time each week or sleep a little later thanks to the help of another parent, single parents are often forced to do it all alone. That means less leisure time, less sleep, less time for other pursuits. Some single parents forego career changes, romance, new hobbies, and new friendships so they can have more time for their kids.

When a child moves away, single parents have more time. That can mean more time to do things they enjoy, but it may also remove a sense of purpose and joy. Some single parents may feel depressed about things they gave up because of their kids. For example, they may grieve the romantic relationships that could have been or fear that it’s too late for a career change or new hobby.

Empty Nest Syndrome: Myth vs. Reality

While many single parents experience empty nest syndrome, many also experience a renewed sense of purpose when their children leave. It’s a myth that a child’s transition to adulthood is always painful for the parents. Parenting is exhausting, time-consuming work.

Some parents relish the chance to sleep in, have more free time, pursue new relationships, and reconnect with an identity separate from parenting.

Many parents report feeling pride and joy as their children transition to adulthood. Sometimes the parent-child relationship also improves when a child moves out, since the parent can begin cultivating a friendship with the child. Some parents report connecting to their child on a deeper level when the child moves out.

Though popular myths suggest mothers are more likely to experience empty nest syndrome, some research finds empty nest-related grief is actually more prevalent among men.

Dealing with Empty Nest As a Single Parent

There’s no “right” way to feel after a child leaves home. Indeed, many parents vacillate between feelings of sadness and joy. Instead of worrying about whether their feelings are appropriate, parents should give themselves permission to explore their emotions as they transition into the next chapter of their parenting lives.

Some strategies that may help parents deal with the transition to an empty nest include:

• Finding help from a support person or support group. A sounding board for your emotions can be helpful. Other parents who have been there can help validate your feelings and offer coping mechanisms. Find a support group near you.
• Avoiding leaning on your child for support. This can harm the parent-child relationship and may actually intensify feelings of empty nest syndrome.
• Planning fun events with your child without intruding on their newfound freedom. For example, plan a family trip for the holiday break or ask your child what would make a visit more fun.
• Taking up a new hobby. You have more time and deserve to fill that time with something that brings joy. Try signing up for a class, going on dates, or curling up with a good book.

Talking through your emotions with a therapist can also help. A therapist can help you understand the role parenthood plays in your identity, then work with you to cultivate a new sense of identity. In therapy, you will work to identify self-defeating thoughts, adopt self-care tactics that reduce the risk of depression, and work toward a deeper understanding of yourself outside your role as a parent.

The right therapist can also help you adopt strategies that preserve your relationship with your child as they transition to greater independence. If your child’s transition to adulthood has shifted the family dynamic or caused conflict with other children or family members, family therapy may help.

To find a therapist who can help with empty nest syndrome, click here.

References:

1. Clay, R. A. (2003). An empty nest can promote freedom, improved relationships. Monitor on Psychology, 34(4), 40. Retrieved from https://www.apa.org/monitor/apr03/pluses
2. Heffernan, L., & Wallace, J. B. (2017, August 2). How to thrive in an empty nest. The New York Times. Retrieved from https://www.nytimes.com/2017/08/02/well/family/how-to-thrive-in-an-empty-nest.html
3. Mitchell, B. A., & Lovegreen, L. D. (2009, July 13). The empty nest syndrome in midlife families: A multimethod exploration of parental gender differences and cultural dynamics. Journal of Family Issues, 30(12), 1651-1670. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/0192513X09339020
4. Raup, J. L., & Myers, J. E. (1989). The empty nest syndrome: Myth or reality? Journal of Counseling & Development, 68(2), 180-183. Retrieved from https://libres.uncg.edu/ir/uncg/f/J_Myers_Empty_1989.pdf
5. The dangers of empty nest syndrome. (2014, October 7). Retrieved from https://healthcare.utah.edu/the-scope/shows.php?shows=0_etom70c6

Antisocial personality (ASPD) is one of the cluster B personality disorders, which typically involve emotional, impulsive, or dramatic thoughts and actions. This group of personality disorders is also significant because it includes borderline personality disorder (BPD) and narcissistic personality disorder, in addition to ASPD. These issues, and personality disorders in general, are among the most stigmatized mental health conditions.

Colloquially, many people use the terms psychopath and sociopath interchangeably with antisocial personality. A common assumption is that all people who have ASPD are incapable of emotion and feeling and will eventually commit violent crimes and harm others. It’s true many people living with ASPD typically don’t feel remorse or guilt. They may also lack empathy, struggle to understand the emotions of other people, or experience frequent legal issues, due to a tendency toward impulsive and often dangerous or illegal actions.

But sociopathy isn’t a mental health diagnosis, and not every person with ASPD will hurt other people or engage in violent acts. It’s possible for people who have ASPD to avoid actions that could harm others, especially when they have support from a compassionate therapist. In therapy, people can develop interpersonal skills along with coping techniques for impulsivity and aggression. These tools can benefit people who want to improve relationships and avoid illegal or dangerous activities and behaviors that harm others.

It’s possible for people who have ASPD to avoid actions that could harm others, especially when they have support from a compassionate therapist.

How Common Is ASPD?

The estimated prevalence of ASPD may vary depending on the study and criteria used. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), between around 0.2 and 3.3% of the population has ASPD in a given 12-month period. This condition is only diagnosed in people over the age of 18.

More than 90% of people diagnosed with ASPD also live with another mental health issue. Substance abuse is the most common co-occurring condition. Research suggests ASPD occurs much more frequently in men diagnosed with alcohol use disorder. Higher prevalence is also seen in prison settings, as well as population samples from impoverished areas. Other common co-occurring issues are anxiety and depression.

Though ASPD is far less common in women than it is in men, some research has suggested when ASPD develops in women, the condition may become more severe. Women living with ASPD are even more likely to abuse substances than men living with ASPD. However, research also indicates antisocial behavior may persist longer in men. Men who have ASPD also have an increased risk of early death.

Aggressive and violent behavior in childhood, such as that seen with conduct disorder, can be an indicator for ASPD. Not all children who have conduct disorder will go on to develop ASPD, but a history of conduct disorder is one of the diagnostic criteria for ASPD. These symptoms must appear before the age of 15. Parental neglect, abuse, or inconsistency and a lack of stability from primary caregivers can all increase the risk that a child with conduct disorder will develop ASPD.

Asocial vs Antisocial

It’s not uncommon to hear antisocial used to refer to people who prefer to be on their own and avoid spending a lot of time with others. But “asocial” is a more accurate way to define this lack of interest in social interaction. Asocial can describe a general disinterest in society and engagement with others, but it doesn’t indicate a person harbors any ill will or negative intent toward others.

Antisocial, on the other hand, goes beyond a general dislike or avoidance of society and community. People who meet criteria for a diagnosis of ASPD typically feel hostile toward other people. Even those who don’t have actively hostile feelings toward others may care very little for the safety, general well-being, and feelings of most other people. It’s also not uncommon for people who have antisocial traits to have significant disregard for their own safety.

It’s important to note that these feelings don’t necessarily translate to violent tendencies. Studies of people in prison do reveal high rates of ASPD, but this condition occurs on a spectrum, and not everyone living with the condition becomes violent or dangerous. Research has also observed that some people who display antisocial traits may have developed these behaviors in order to survive and protect themselves when growing up in difficult circumstances.

Many people use psychopathy as a synonym for ASPD, but this usage isn’t accurate. Psychopathy can best be considered a severe form of ASPD, rather than the most characteristic presentation of the condition. Most people who meet criteria for psychopathy according to the Psychopathy Checklist – Revised (PCL – R) do also meet criteria for ASPD. But only about 10% of people diagnosed with ASPD also meet criteria for psychopathy.

What Is Antisocial Personality Disorder?

At the core of ASPD lies a consistent lack of regard for the rights of others, which generally includes impulsive, irresponsible, and reckless behavior. People may take action without considering potential consequences and experience little or no remorse for harm caused by their behavior. Theft, manipulation, and other deceit are common, and people living with ASPD also tend to rationalize or minimize their actions.

Antisocial behavior can include violent or criminal acts, but people living with ASPD aren’t always aggressive or violent. Similarly, while many people with ASPD lack empathy, this isn’t always the case. People living with ASPD often struggle to develop or maintain meaningful relationships, and they may cause emotional harm to their partners; but it’s still possible for people with ASPD to feel love and empathy, often for a select few people such as children, partners, or close family members.

Abuse, neglect, or absent caregivers can increase risk for ASPD when other factors are present, particularly early onset conduct disorder. In people who develop ASPD, early childhood mistreatment can reinforce the belief that no one else will look out for them, so they should do whatever they can to look after themselves and get their needs met. This belief commonly occurs with ASPD.

In recent years, a few people with ASPD have written about their experience living with the condition. This may have had a small effect on the stigma surrounding the condition, but many people still struggle to accept that ASPD doesn’t always mean a person is violent or “evil.” The stigma associated with personality disorders, ASPD in particular, may make it even more difficult for people who want to improve to get the help they need. Negative attitudes from caregivers and educators may begin early on, often when children first display signs of conduct disorder.

The stigma associated with personality disorders, ASPD in particular, may make it even more difficult for people who want to improve to get the help they need.One study of 202 kindergarten teachers found teachers were most likely to have a harsh response toward aggressive children. But negative attitudes, or writing children off as troublemakers or delinquents, can reinforce ideas such as, “I’m bad,” “I’ll never amount to anything,” or “No one cares what happens to me,” from early childhood. Some experts believe this can increase the chances aggressive behavior and disregard for others will continue and worsen.

Treatment for Antisocial Personality Disorder

Not everyone considers ASPD a mental health issue. Research has shown that many people believe people with this condition are:

• Violent
• Evil
• Dangerous
• Impossible to treat

Having a mental health issue doesn’t absolve a person of responsibility for their actions, but it’s an important factor in understanding why some people behave the way they do. When stigma perpetuates the idea of a group of people as evil, positive change becomes even more difficult to achieve.

Specific characteristics associated with ASPD, such as self-sufficiency, a tendency to externalize problems, disdain for authority, and general hostility, also make it less likely people with ASPD will ever reach out for help, complicating treatment and decreasing the chance of improvement.

When people with ASPD do enter treatment, it’s more often to get help for a co-occurring condition or because a legal authority or family member has steered them toward therapy. Among those who do get help, many drop out of treatment early. Negative attitudes among therapists or ineffective treatment methods can contribute to this.

It’s important for people with ASPD to work with therapists who offer compassionate support and are willing to try a range of approaches to find the most effective treatment. In many cases, people with antisocial traits can learn skills to cope with their condition and avoid acting in ways that negatively affect others. When people with a dual diagnosis seek treatment, it’s essential for therapists to recognize the ways ASPD can contribute to and worsen other mental health symptoms.

A key factor in successful therapy for ASPD is recognizing individual fault. People living with ASPD who can’t admit or accept their actions are harmful or that they have a role in the harm they’ve caused may not be able to improve. One approach to treatment that’s shown some promise is mentalization-based therapy. This approach helps people explore their state of mind, including emotions, desires, and feelings toward others. Once they better understand their thoughts, they can use this understanding to address impulses and control them.

Some research suggests schema therapy, an approach that helps people work to identify and address maladaptive behavior patterns and develop more effective ways of relating, may also be helpful for people with ASPD. It’s effective for other personality disorders, including BPD and narcissistic personality, and some research suggests people are less likely to drop out of this type of therapy than other approaches.

Research has shown treatment can help improve many of the behaviors associated with ASPD when a person is willing to work toward change. It’s important for future research to continue exploring the most helpful types of treatment for ASPD to increase the chances of people with the condition improving with treatment. Successful treatment can not only improve well-being and quality of life for people with ASPD, it can also have a positive impact on the people in their lives.

If you or a loved one is struggling with the effects of ASPD, know that help is available. Begin your search for a trained, compassionate counselor at GoodTherapy.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
2. Antisocial personality disorder. (2017, November 20). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9657-antisocial-personality-disorder
3. Antisocial personality disorder. (2018, May 25). NHS. Retrieved from https://www.nhs.uk/conditions/antisocial-personality-disorder
4. Arbeau, K. A., & Coplan, R. J. (2007). Kindergarten teachers’ beliefs and responses to hypothetical prosocial, asocial, and antisocial children. Merrill-Palmer Quarterly, 53(2), 291-318. doi: 10.1353/mpq.2007.0007
5. Brians, P. (2016, May 17). Asocial. Retrieved from https://brians.wsu.edu/2016/05/17/asocial
6. Brill, A. (2017, June 16). Life with antisocial personality disorder (ASPD). Retrieved from https://www.mind.org.uk/information-support/your-stories/life-with-antisocial-personality-disorder-aspd/#.XMY0wJNKjOT
7. British Psychological Society. (2010). Antisocial personality disorder: Treatment, management, and prevention. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK55333
8. Hesse, M. (2010). What should be done with antisocial personality disorder in the new edition of the diagnostic and statistical manual of mental disorders (DSM-V)? BMC Medicine, 8, 66. doi: 10.1186/1741-7015-8-66
9. Mayo Clinic Staff. (2017, August 4). Antisocial personality disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/diagnosis-treatment/drc-20353934
10. Sheehan, L., Nieweglowski, K., & Corrigan, P. (2016, January 16). The stigma of personality disorders. Current Psychiatry Reports, 18, 11. doi: 10.1007/s11920-015-0654-1

Impulsivity, mood swings, irritability, high and low periods, patterns of troubled relationships—these symptoms often indicate bipolar, but they can just as easily appear in people who have borderline personality (BPD).

Neither condition is uncommon. Approximately 2.6% of adults in the United States live with bipolar. Estimates for BPD vary, but it’s believed somewhere between 1.6% and 5.9% of adults in the U.S. live with this condition. Many people have a dual diagnosis, or both conditions.

The resemblance between the traits characterizing each issue and the possibility of co-occurrence has led some professionals to question whether BPD is a subtype or variation of bipolar. The general consensus among mental health experts, however, is that while these conditions often present with similar features, they are two separate mental health issues that can usually be distinguished in a few key ways.

It’s during periods of mania that bipolar may be most suggestive of BPD, as manic episodes often involve thrill-seeking, impulsive, or aggressive behavior.

Bipolar vs. Borderline Personality

A mood disorder, bipolar is primarily characterized by shifts between high-energy (manic) states and low-energy (depressive) states. Bipolar-related mood changes can range from mild to extreme, and they’re typically accompanied by changes in a person’s energy and activity.

Not every person who has bipolar will experience a classic manic episode. These episodes generally last several days and frequently involve increased activity and productivity in schoolwork, work-related tasks, or creative pursuits. Feeling very energized or charged, with little or no need to sleep, is common.

People living with bipolar II experience milder manic periods known as hypomania. Cyclothymia, a subtype of bipolar, involves hypomanic and depressive periods that don’t meet typical bipolar criteria. But mania is a symptom specifically linked to bipolar, so having even one manic episode indicates bipolar in most cases.

It’s during periods of mania that bipolar may be most suggestive of BPD, as manic episodes often involve thrill-seeking, impulsive, or aggressive behavior. Impulsive actions might include risky sex, excessive spending, or substance abuse, along with other behavior that isn’t typical. Rapid cycling bipolar may particularly resemble BPD, as mood fluctuations happen more frequently than with typical bipolar.

Frequent manic episodes could also contribute to relationship difficulties, since the way a person behaves during a manic episode could have a negative impact on the people close to them. For example, during a manic episode, a person in a monogamous relationship may cheat on their partner or decide to redo all of their home furnishings and max out multiple credit cards in order to purchase new interior decorations. A person who uses drugs during a manic episode could face legal consequences, especially if their actions while under the influence of drugs cause harm to others.

But with BPD, particularly untreated BPD, emotional shifts tend to be sudden and happen frequently. BPD is a personality disorder, so the associated traits don’t simply relate to mood changes, they’re persistent behavior patterns. Extreme, all-or-nothing thinking patterns also help characterize this condition. For example, a person with BPD who experiences mild criticism at work may become very upset and distressed. They may feel they’ve failed and fear they’ll lose their job.

Another characteristic of BPD is difficulty interpreting emotions. People often view neutral or other expressions as negative, and this misinterpretation could lead to conflict or strained personal relationships.

Similarly, a minor disagreement with a partner could lead someone to believe they’re unlovable and the relationship is over. They might end the relationship first, fearing rejection. Relationship conflict can also trigger devaluation of a partner who was previously idealized, depending on the circumstances. With devaluation, feelings of anger, disdain, and contempt may abruptly replace feelings of love and happiness in the relationship.

Lifetime suicide risk is high with either bipolar or BPD, while recurring non-suicidal self-harming behaviors as well as multiple suicide attempts are common with BPD. Cutting and other self-harm doesn’t necessarily indicate suicidal intent. Research indicates many people with BPD self-harm as a way of coping or as a way of feeling something during a period of dissociation.

How Do Treatment Approaches Differ?

These two conditions have separate underlying causes, though people with a family history of either bipolar or BPD have a higher risk for that condition.

The causes of BPD aren’t fully known, but it’s believed to develop from a combination of factors. A tendency to experience extreme emotionality, which can also run in families, is believed to contribute, especially in people who’ve experienced abuse, trauma, and neglect. Brain chemistry is a significant contributing factor to bipolar, though environmental factors can also increase risk.

Correct diagnosis is important, because treatment approaches vary depending on the condition. It’s important to understand that therapy alone typically can’t treat mania in people living with bipolar. It may also not be enough to treat severe depression in some people.

Therapy can help address some symptoms and challenges of living with bipolar, but in most cases people with typical bipolar will need medication to help stabilize mood shifts. Untreated mania and depression can have serious emotional and even physical health consequences, so it’s important to seek, and continue with, treatment.

Mood stabilizers such as lithium won’t help BPD symptoms. In some cases, bipolar treatment might even make certain symptoms worse. There’s no medication that specifically treats BPD. The typical treatment is dialectical behavior therapy, though other therapy approaches such as schema therapy can also have significant benefit.

Can Bipolar and Borderline Personality Co-occur?

A person experiencing symptoms of both bipolar and borderline personality may have both conditions.

A person experiencing symptoms of both bipolar and borderline personality may have both conditions. This isn’t uncommon, in fact. A 2013 review of multiple studies on the two conditions found that around 10% of people diagnosed with borderline personality also had bipolar I, while about 10% had bipolar II as well as BPD.

Living with untreated borderline personality and bipolar can cause significant distress, in part because the two conditions may play off each other.

• Feelings of emptiness or failure may be even worse during a bipolar depressive period, causing emotional turmoil or disconnect, both of which may increase risk for self-harming behavior or suicide.
• A person struggling with trust or abandonment issues in their relationship could have an even harder time maintaining a healthy relationship during a low mood state.
• A period of mania may be more likely to trigger risky or impulsive behavior in a person who feels distressed or disconnected from their sense of self and wants to feel something.
• Substance abuse isn’t uncommon with BPD or bipolar, and alcohol and drugs can often trigger mania.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recommends mental health professionals avoid diagnosing personality disorders during untreated mood episodes. Taking a detailed mental health history that looks back at patterns and symptoms over a longer period of time can help differentiate the two conditions.

Between manic and depressive episodes, people with bipolar generally experience fairly normal moods. Months or even years could pass between high and low periods, especially when treatment is effective at managing symptoms. So once a mood episode has stabilized, diagnosis may be somewhat clearer. When a manic or depressive mood seems to respond to treatment but symptoms of emotional dysregulation persist, a dual diagnosis is likely.

Treatment for Co-occurring Bipolar and Borderline Personality

Living with co-occurring BPD and bipolar may be more challenging than having either condition alone, especially if it takes time to get an accurate diagnosis. Bipolar-related mood swings, when combined with more frequent and rapid changes in emotional state, can make daily life difficult and negatively affect work, school, and personal life. People living with bipolar and BPD may feel even more unstable or unable to control what’s happening around them than those living with only one of these conditions.

While treatment such as therapy can be very helpful for reducing symptoms and improving quality of life, the recommended treatments for each condition differ. This makes an accurate diagnosis essential for successful treatment.

For bipolar, therapy may involve learning to recognize mood triggers, developing ways to cope with bipolar symptoms, and working to reduce the effects symptoms have on daily life. The combination of mood stabilizing medication and dialectical behavior therapy may be recommended for people with both bipolar and BPD, since DBT is generally the ideal approach to therapy for BPD. This therapy involves developing the skills to manage and cope with difficult emotions and practicing positive ways of relating to others.

For people experiencing BPD-related distress during a manic or depressive episode, mood stabilization is an important first step. Research suggests BPD symptoms may improve slightly once mood has stabilized, which can increase the chance of successful treatment. It’s also essential to talk about suicidal thoughts or self-harm, since these may be more likely in people with both conditions than people who only have bipolar.

Psychotic symptoms such as hallucinations can also occur during a manic episode, and these can be dangerous. They’re not as common with BPD, but they do occur, so it’s important to discuss any hallucinations, delusions, or magical thinking when a person presents with symptoms of both conditions.

Finding a Therapist for Bipolar or Borderline Personality

For some mental health concerns, diagnosis may not significantly impact treatment since symptoms can still be addressed in therapy. But when bipolar and BPD, which sometimes present similarly, are misdiagnosed for each other, treatment may be less effective. Symptoms of both conditions can further complicate diagnosis. Some mental health professionals may fail to recognize the presence of both issues, particularly if they’re less experienced with the differences between the two or unaware bipolar and BPD often occur together.

When seeking a diagnosis or working to address symptoms of both bipolar and BPD, it’s recommended to seek support from a therapist who has experiencing helping people with both conditions. While other trained, empathic therapists can certainly provide compassionate care, a therapist who specializes in working with people living with these conditions may offer support that’s designed to address specific symptoms of these conditions. This may be especially important when beginning therapy for the first time.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
2. Bipolar disorder. (2017). National Alliance on Mental Illness. Retrieved from https://www.nami.org/learn-more/mental-health-conditions/bipolar-disorder
3. Bipolar disorder. (2018). National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml
4. Borderline personality disorder. (2017). National Alliance on Mental Illness. Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder
5. Borderline personality disorder. (2017). National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
6. Fenske, S., Lis, S., Liebke, L., Niedtfeld, I., Kirsch, P., & Mier, D. (2015, June 26). Emotion recognition in borderline personality disorder: Effects of emotional information on negative bias. Borderline Personality Disorder and Emotion Dysregulation, 2, 10. doi: 10.1186/s40479-015-0031-z
7. Ghaemi, S. N., Dalley, S., Catania, C., & Barroilhet, S. (2014). Bipolar or borderline: A clinical overview. Acta Psychiatrica Scandinavica, 130(2), 99-108. doi: 10.1111/acps.12257
8. Kvarnstrom, E. (2017, October 5). Borderline personality disorder misdiagnosed as bipolar disorder: Differences and treatment. Retrieved from https://www.bridgestorecovery.com/blog/borderline-personality-disorder-misdiagnosed-as-bipolar-disorder-differences-and-treatment
9. Linehan, M. M., Korslund, K. E., & Harned, M. S. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475-482. doi:10.1001/jamapsychiatry.2014.3039
10. Paris, J. (2004). Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders. Harvard Review of Psychiatry, 12(3), 140-145. doi: 10.1080/10673220490472373
11. Zimmerman, M., & Morgan, T. A. (2013). The relationship between borderline personality disorder and bipolar disorder. Dialogues in Clinical Neuroscience, 15(2), 155-169. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811087

This topic likely comes as a surprise to many. Just the idea of abuse of this nature, between a mother and her son, is shocking to most. The idea of mother-son incest is so far out of the realm of what we as a culture understand about mothers and women that even its victims rarely seek help.

As a society, our views of mothers as nurturers who would never willingly hurt their children may be so ingrained in our psyche that even trained psychologists can be uncomfortable entertaining the idea that sexual abuse can happen between a mother and her son (Osborne, 2015).

Why the Silence?

Incest (sexual relationships between family members) is taboo and can bring a strong sense of guilt and shame to its victims (Kluft, 2011). While the idea that fathers sexually abuse their children is disturbing, it is accepted as something that can (and does) happen. It is well documented and studied.

Although the idea that some fathers can be sexual predators towards their own family is accepted, the parallel idea, that mothers can be sexual predators towards their own children, has not been widely accepted. We live in a culture that tends to idolize motherhood. Mothers sacrifice so much to give us everything we need. In our society, speaking against a mother is almost sacrilegious. Unfortunately, the perception of a male monopoly on perpetrating incest has led to the creation of damaging myths that silence the male victim.

Reporting incest and seeking professional help may be both shameful and difficult in any situation, but it can be even more difficult in the case of a mother. Often, the reaction will be complete rejection or disbelief. Unfortunately, the perception of a male monopoly on perpetrating incest has led to the creation of damaging myths that silence the male victim.

Males and Sexual Abuse: The Myths

Researcher Lucetta Thomas has identified persistent and damaging myths in regard to male sexual victimization. These myths not only exist in the minds of boys and men who themselves are victims—they are also prevalent in the attitudes and perception of social workers, law enforcement, and even psychologists or counselors (Friedersdorf, 2016). Myths around males and sexual abuse include the following:

• Boys and men can’t be sexually victimized; they must have consented.
• Mothers do not do this; she must have been overly affectionate.
• If the boy experiences sexual arousal or pleasure during the abuse, he enjoyed it, and it was not abuse, because he participated.
• Boys are less traumatized by sexual abuse than girls, and this is because boys are more sex-focused in general.
• The mother or son must have mental health issues.

Prevalence and Long-Term Outcomes of Mother-Son Abuse

Due to the refusal of boys and men to seek help or press charges against mothers who abuse them, it is nearly impossible to determine the prevalence of sexual abuse committed by mothers. However, a few studies offer surprising results and indicate the problem is more widespread than most people would assume.

For example, one study that conducted in-depth interviews of seven men and seven women who reported sexual abuse by a female perpetrator, most of whom experienced severe sexual abuse by their mothers, found a range of long-term damaging effects. Victims reported and/or experienced depression, difficulties with substance abuse, self-injury, increased suicide rate, rage, strained relationships with women, identity issues, and discomfort with sex (Denov, 2004).

Another study conducted in 2002 found that 17 of 67 men who endured sexual abuse during childhood reported mother-son incest. The study found in comparison to the other men in the study, the men who were abused by their mothers experienced more symptoms of trauma. Further, about half of the men abused by their mothers had mixed feelings regarding the abuse, and those with mixed feelings had more adjustment problems compared to men who had purely negative feelings toward the abuse (Kelly, Wood, Gonzalez, MacDonald, & Waterman, 2002).

Lucetta Thomas reported that after her story of mother-son sexual abuse aired on ABC 80, males accessed the online survey over the next two days to report maternal abuse and requested to be interviewed. It must be understood that this type of abuse is possible, does happen, and can do extraordinary damage to its victims.

When we examine outcomes of victims of any type of incest, we find this type of abuse is related to issues around relational trauma and betrayal trauma. Abuse by a trusted family member leads to a significant loss of trust and changes in beliefs around the self and safety in relationships (Kluft, 2011). Understandably, when the perpetrator is a mother, the trauma is likely to carry a particularly high level of damage, especially in light of the cultural perceptions of mothers as nurturers. Furthermore, the implications of reporting abuse of this nature can be catastrophic for the victim, the mother, and the entire family. In many cases, this leaves the victim feeling as if he has no choice but to deal with the trauma in silence.

What Professionals Need to Know

Professionals, particularly those working with sexual abuse cases, need to examine their own perceptions around women as potential abusers. It must be understood that this type of abuse is possible, does happen, and can do extraordinary damage to its victims. In general, many people have been under the impression that a woman cannot really harm another person sexually. This is not the case. As new research surfaces, we are finding that sexual abuse from mother to son can bring lasting trauma and long-term mental health effects (Denov, 2004).

Further, men and boys are much less likely to report sexual abuse (Holmes, Offen, & Waller, 1997). Researchers have put forth the possibility that attitudes and beliefs among mental health professionals in myths regarding the male as an unlikely victim do not create conditions that encourage men or boys to talk about sexual abuse. Professionals need to be aware of the reality of mother-son sexual abuse as well as the existence of the myths surrounding the male as unlikely to be vulnerable to sexual abuse and especially unlikely to be the victim of abuse by his own mother.

If you are a victim of any type of sexual abuse or assault, reach out to a therapist. There is no need to suffer in silence when help is available. If you are a victim of mother-son incest, clearly articulate your experiences to your therapist. The shame is not yours.

References:

1. Denov, M. S. (2004, October 1). The long-term effects of child sexual abuse by female perpetrators: A qualitative study of male and female victims. Journal of Interpersonal Violence, 19(10), 1,137-1,156. doi: 10.1177/0886260504269093
2. Friedersdorf, C. (2016, November 28). The understudied female sexual predator. The Atlantic. Retrieved from https://www.theatlantic.com/science/archive/2016/11/the-understudied-female-sexual-predator/503492
3. Holmes, G. R., Offen, L., & Waller, G. (1997). See no evil, hear no evil, speak no evil: Why do relatively few male victims of childhood sexual abuse receive help for abuse-related issues in adulthood?. Clinical Psychology Review, 17(1), 69-88. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9125368
4. Kelly, R. J., Wood, J. J., Gonzalez, L. S., MacDonald, V., & Waterman, J. (2002). Effects of mother-son incest and positive perceptions of sexual abuse experiences on the psychosocial adjustment of clinic-referred men. Child Abuse & Neglect, 26(4), 425-441. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12092807
5. Kluft, R. P. (2011, January 12). Ramifications of incest. Psychiatric Times, 27(12). Retrieved from https://www.psychiatrictimes.com/sexual-offenses/ramifications-incest
6. Osborne, T. (2015, August 7). New research sheds light on sex abuse committed by mothers against their sons. ABC News. Retrieved from https://www.abc.net.au/news/2015-08-08/new-research-mothers-who-sexually-abuse-their-sons/6679102

Narcissistic personality (NPD) and histrionic personality (HPD) are both cluster B personality disorders. These personality disorders are characterized by the following:

• Patterns of thinking and behavior that seem erratic or unpredictable
• Actions or thoughts that others consider dramatic
• Patterns of thinking and behavior that seem too emotional for a specific situation
• Behaviors are persistent and inflexible and lead to impairment and distress

Some mental health experts consider HPD and NPD the most similar of the four cluster B personality disorders. Similarities between these conditions may include attention-seeking behavior, flirtatiousness that’s often inappropriate, behavior that seems shallow or uncaring, and a need for approval and admiration from others.

Some researchers have even suggested HPD is a manifestation of NPD rather than a unique condition, but the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists HPD as a separate diagnosis. However, it’s possible to have both conditions, or any combination of personality disorders, and this may sometimes complicate diagnosis.

Some people believe those with personality disorders will never change their behavior. It’s true these behavior traits often respond less readily to therapy than symptoms of other mental health conditions, but treatment is still possible.

What’s the Difference Between Histrionic Personality Disorder and Narcissistic Personality Disorder?

These two conditions may present similarly, but they differ in several ways.

Prevalence

Estimates suggest HPD only occurs in about 1.8% of people, while NPD is more common. Diagnostic criteria can vary, and the actual prevalence isn’t known for certain, but recent estimates suggest about 5% of the general population could meet diagnostic criteria for NPD. Among people diagnosed with NPD, between 50 and 75% are men. Research suggests HPD is more commonly diagnosed in women.

Ability to Show Empathy

A main characteristic of NPD is a failure to show empathy for the feelings of others. Lack of empathy, however, is not a primary characteristic of histrionic personality. The behavior of people with HPD may seem shallow or self-centered at times.

One study from 2018 suggests people with any cluster B personality disorder may have a hard time identifying emotions—those of others as well as their own. Being unable to clearly recognize emotions can make it challenging to know when to offer compassion or support, which could seem like a lack of empathy.

Different Types of Attention-Seeking Behavior

Grandiosity, or feelings of superiority or exaggerated self-importance, is a primary feature of narcissism. This trait is not a significant feature of other personality disorders. People who have NPD think highly of themselves and their abilities and may, out of this superiority, tend to keep themselves apart from others in a group. People living with HPD, on the other hand, tend to want to belong and fit in.

This desire for belonging and approval marks another distinction between narcissistic and histrionic personality disorders. Both involve a deep-seated need for attention, and people living with either condition may manipulate others in order to get this attention. People with NPD don’t only need attention, however. They need admiration, praise, and recognition.

People with HPD may care less about the type of attention they receive and allow themselves to be seen in a vulnerable or even negative way, so long as attention is centered on them. They’re more likely to have a low sense of self-worth and seek approval from others to build up their self-esteem.

With HPD, efforts to get attention may seem excessively emotional or dramatic. People living with this condition may become upset easily and shift rapidly between moods. This extreme emotionality, a hallmark of histrionic personality, is less common with narcissism. People with narcissism usually show less emotion and tend to be more reserved and self-possessed.

Why Do These Differences Matter?

Narcissism and histrionic personality affect personal relationships and general well-being in different ways. Both issues are characterized by unstable or impaired personal relationships. People with HPD may struggle to be emotionally intimate with others, while people with NPD are more likely to cause significant emotional harm.

The words and actions of people with NPD are often hurtful since they generally have little regard for the feelings of others. In relationships, people with narcissism may require complete focus on their own needs and feelings. A partner who attempts to share feelings or get their own needs met will usually face emotional rejection or complete withdrawal. The person with narcissism may accuse the partner of being selfish or not caring for them enough.

Narcissism can make it difficult to do well in the workplace, as a fear of shame or failure can lead people with NPD to leave jobs when they face criticism. They also tend to react with outrage or disdain when facing embarrassment or criticism. Persistent feelings of shame can lead to withdrawal or depression. Other issues linked to narcissism include substance abuse and anorexia.

People with HPD may struggle in relationships for different reasons. A desire for gratification and excitement can lead to boredom in long-term relationships, and they may seek new partners frequently. Histrionic personality is also marked by a tendency to consider relationships more intimate than they actually are. Having to face the true nature of a relationship may lead to distress.

In relationships, people with HPD often depend very strongly on partners and may act in manipulative ways in order to get attention or comfort. However, people with HPD can and do show empathy and compassion for the needs and feelings of others. They may experience depression and feelings of emptiness when they lack attention or affection and make suicidal gestures or threats to increase the attention or care they receive.

Because people living with HPD often struggle with boredom, they may struggle to keep the same job and change positions or careers frequently. They may be more successful in jobs that are less routine and involve varying duties.

Somatic symptoms and conversion disorder both commonly occur with HPD. People living with the condition may seem to be in poor health or report a variety of health symptoms to get attention, but they may also truly experience the health symptoms.

Existing research on the two conditions suggests people with HPD are more likely to eventually get help, either for symptoms of depression or anxiety or when their behavior causes difficulties like friendship or relationship issues. Behaviors associated with histrionic personality are more likely to improve than those associated with narcissism.

Treatment for HPD and NPD

Personality disorders are diagnosed when behavior patterns are unyielding and persistent over a long period of time. Some people believe those with personality disorders will never change their behavior. It’s true these behavior traits often respond less readily to therapy than symptoms of other mental health conditions, but treatment is still possible.

For treatment to succeed, a person must be able to recognize harmful patterns of behavior and want to make changes. People with HPD and NPD often don’t feel they need treatment and may not seek therapy on their own. It may be particularly challenging for people with narcissism to understand how their actions harm others, so they may see nothing wrong with their behavior.

Research on treatment for narcissism is very limited since people with narcissism rarely seek treatment. When they do, therapy can help them realize how their behavior impacts others. Skills training can teach how to relate to people in positive ways and how to accept and cope with personal flaws, failures, and criticism from others. The root of NPD is often a deep sense of self-loathing and low self-esteem, so when therapy can address these concerns, some behaviors associated with narcissism may improve.

Schema therapy is one specific approach that has shown promise in treating narcissism. This approach helps people identify and address maladaptive schemas, or patterns, that affect their behavior. Through therapy, people may be able to heal these schemas and learn to get needs met in healthier ways that don’t cause harm.

Several approaches can have benefit in treating histrionic personality. Therapy often focuses on helping people develop self-esteem and learn to meet emotional needs in healthier ways.

Cognitive behavioral therapy may help people learn to challenge thoughts that lead them to desire attention and replace attention-seeking behaviors with other actions. Psychodynamic therapy can help people understand the reasons behind the interpersonal challenges they experience, which can help contribute to positive change. Family counseling may also help, since involving loved ones in counseling can help people realize the impact their behavior has on others. Skills training and group therapy helps people learn to relate to others who deal with similar challenges.

In some cases, couples counseling can help people with personality disorders address relationship issues. But keep in mind that narcissism in particular often involves patterns of deceit, manipulation, and emotional abuse, and many therapists don’t recommend relationship counseling for abusive relationships. It’s important to first address and change long-standing patterns of manipulation and other harmful behavior. Good progress in individual therapy could indicate relationship counseling may help in the future.

Therapy typically also addresses co-occuring issues, including depression, anxiety, or substance abuse. Some people might also have more than one personality disorder. If this is the case, a combination of therapy approaches may be most helpful. If it’s not possible to address all presenting concerns at the same time, therapy generally aims to treat the most serious or harmful issue first and then continues to help the person work through other challenges.

Getting Help

Traits of any personality disorder can lead to serious emotional distress and impact your life, relationships, and the people close to you. If you or a loved one have signs of any personality disorder, reach out to a qualified counselor today. Therapy is the best way to address symptoms and learn new methods of coping and behaving.

The stigma surrounding personality disorders can be discouraging. You may have heard that some therapists won’t work with people who are living with a personality disorder, particularly narcissistic personality disorder.

But contrary to what many people believe, personality disorders are treatable, and there are skilled therapists who can offer support. If you want to make changes in your life, begin your search for a trained, compassionate therapist at GoodTherapy.

References:

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