Silhouette of man sitting in front of a computer in the darkAccording to a 2008 study, between 3-6% of Americans engage in compulsive sexual behavior (CSB), better known as sex addiction. Other studies cite similar statistics, and some addiction facilities cite even higher figures. Many people feel plagued by unwanted sexual feelings or by a desire to engage in sex or view pornography that feels compulsive.

Yet the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) asserts there is insufficient empirical support for the existence of sex addiction. In 2017, the Center for Positive Sexuality (CPS), The Alternative Sexualities Health Research Alliance (TASHRA), and the National Coalition for Sexual Freedom (NCSF) echoed this sentiment in a statement published in The Journal of Positive Sexuality. The Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition (DSM-5) does not list sex addiction as a diagnosis.

So what explains the discrepancy? Mental health advocates disagree on this, too. Sex addiction remains a controversial concept. One thing is certain, however: sexual behavior can cause difficulties in a person’s life even when their behavior does not rise to the level of an addiction.

Even if sex is not addictive in the traditional sense, people may still struggle with sexual behavior.

Is Sex Addiction Real?

Research on sex addiction is mixed. Some studies claim to have uncovered a fairly high rate of addictive sexual behavior. These researchers say sex addiction functions like other addictions, triggering a release of dopamine that causes a person to continually chase a sexual “high.” Like other behavioral addictions—shopping, gambling, video gaming—these studies say sex addiction can act like a drug and cause a person to make damaging and unsafe decisions.

Most bodies that research human sexuality, including AASECT, argue that the concept of sexual addiction is rooted in ideology, not science. They cite research finding no specific level of sexual activity that is inherently addictive or harmful.

A 2013 study looked at the brains of 52 people who said they struggled with sex addiction. Researchers used brain imaging to look at participants’ brains while they viewed sexually suggestive images. Contrary to what theories of sex addiction would predict, their brains did not behave in a way consistent with addiction. People addicted to drugs and alcohol show distinct brain patterns when viewing addictive substances. “Sex addicts” did not display these patterns.

It’s possible that sex addiction functions through different neural pathways or that the study was poorly constructed. It’s also possible that sex truly is not addictive.

Even if sex is not addictive in the traditional sense, people may still struggle with sexual behavior. There are many reasons to seek treatment for sexual issues. For example, a person might find that their sexual behavior is inconsistent with their values or that childhood guilt and shame undermine their ability to seek sexual fulfillment. Others may want to pursue non-normative relationships, such as open or polyamorous relationships, and wonder if doing so signals a problem.

It is important for people to be able to label their own behavior in a way that feels comfortable. If the sex addiction model fits, there’s no harm in identifying with it. For others, the notion of sex addiction—or the ideology that sometimes accompanies it—may feel stigmatizing.

Ideology and ‘Sex Addiction’

Sex is an inherently social activity that is heavily colored by social norms. In some cultures, polygamous relationships are common, while in others, having sex with multiple partners during the same time frame is stigmatized. Religious, cultural, and other ideologies are inextricably linked to people’s feelings about sex, sexuality, and sex addiction.

Many religious traditions have strongly advocated for the existence of sex addiction. In many cases, these religions also argue that pornography use, especially frequent pornography use, can cause addiction. Conversely, advocates who argue for greater sexual freedom and acceptance are less likely to accept the notion that sex can be addictive or that certain sexual practices are more likely to lead to addiction.

When evaluating addiction treatment programs or looking at your own behavior, it’s important to weigh the role ideology plays. A religious sex addiction program may draw more on its spiritual tradition than on empirical research. Likewise, a person’s internalized cultural values may cause them to feel guilty or ashamed of their sexual behavior even when there is nothing inherently wrong with it.

Signs Sexual Behavior Has Become a Problem

Because sex addiction is not a widely recognized disorder, different sources list different symptoms of the addiction. Sometimes ideology plays a role in the list of symptoms. For example, a religious sect that believes sex outside of marriage is sinful may list repeated sexual encounters outside of marriage as a sign of sexual addiction.

There is no empirically supported amount of sex or interest in sex that is inherently harmful or addictive. Having a high sex drive, multiple sex partners, or significant interest in sex does not mean a person has an addiction. Non-normative sexual interests, such as an interest in bondage or group sex, are common and do not mean a person has a sex addiction.

Instead, consider looking at how sex affects your life. People who find that sex damages relationships or self-esteem may benefit from therapy.

Some warning signs that sex may be a problem warranting treatment include:

Seeking Help for Problematic Sexual Behavior

A therapist can help with problematic sexual behavior in many ways. Those include:

Some mental health diagnoses can affect sexual behavior. For example, people with bipolar may become hypersexual during a manic episode. Therapy can also help with these symptoms.

Finding a therapist who shares your values about sexuality is important. To begin your search, click here.

References:

  1. AASECT position on sex addiction. (n.d.). Retrieved from https://www.aasect.org/position-sex-addiction
  2. Karila, L., Wery, A., Weinstein, A., Cottencin, O., Petit, A., Reynaud, M., & Billieux, J. (2014). Sexual addiction or hypersexual disorder: Different terms for the same problem? A review of the literature. Current Pharmaceutical Design, 20(25), 4012-4020. doi: 10.2174/13816128113199990619
  3. Keenan, J. (2013, July 24). Is sex addiction real or just an excuse? Retrieved from https://slate.com/human-interest/2013/07/sex-addiction-study-ucla-researchers-find-that-sex-and-porn-might-not-actually-be-addictive.html
  4. Kuzma, J. M., & Black, D. W. (2008). Epidemiology, prevalence, and natural history of compulsive sexual behavior. Psychiatric Clinics of North America, 31(4), 603-611. Retrieved from https://www.sciencedirect.com/science/article/pii/S0193953X08000725

Toddler son sitting on his dad's shoulders, mimicking his arm motionsProblems in life are inevitable. Challenges cannot be avoided. Life is not always a bed of roses. The ability to recover from a difficult or unpleasant situation is resilience. Resilience means being able to get back on track, as strong as before, after an unanticipated setback such as physical or emotional trauma.

Resilience is not something a person is or isn’t born with; it is an acquired skill a child develops gradually. Kids are vulnerable. For some, the slightest stress can cause major anxiety issues that last a lifetime. Others can counter stress better.

Developing Resilience

It is during childhood that a kid is most likely to develop this skill. Resilient children grow up to be resilient adults as they learn how to deal with stress and difficulties from a young age.

Development of resilience in children occurs at three levels, which are:

Resilience is not something a person is or isn’t born with; it is an acquired skill a child develops gradually.

  1. Individual
  2. Family
  3. Environment

Development of resilience requires input from within, from family, and from the environment, which may also mean society at large.

Not all children can be the same physically, mentally, or emotionally. Everyone has a different threshold of bearing stress, but resilience can be developed at a young age through various methods.

Healthy Risk Taking

Children should not be sheltered by their families from taking risks. In fact, healthy risk taking should be encouraged. Healthy risk taking means letting your child take risks which could hold some risk but also reward.

An example is letting a child try a new sport. Even if they fail, no significant damage is done. This can teach children to face failure positively and come out more confident than before.

Let the Child Solve Their Problems

It’s natural for a parent to want to solve every problem their child has. If and when a parent does that, the child would never learn to solve problems independently. They would never learn what independence is. You should always let your child know you are there to support them. However, try not to walk your child to a solution. Let your child solve their problems independently.

Ask your child questions and let the problem bounce back to your child. Leave it to them to find the solution. It will develop problem solving skills in your child from a very young age.

Don’t Ask Why, Ask How

Avoid ‘why’ questions with your kids. Asking your child why they did something may often get you a response such as “I don’t know,” “I forgot,” or something similarly straightforward. Instead, ask your child how they plan on fixing something they messed up.

Try asking your child questions like, “You let the tap keep running; there is water all over the place. How do you think you can fix it?” Asking ‘how’ questions can promote problem-solving skills in your child. They will think about ways they can fix things. Letting a child analyze situations and solve problems is one of the most important keys to developing resilience.

Help Your Child Understand Emotions

A child may have difficulty labeling the emotions they are feeling. For development of resilience in children, it is important that they understand what they are feeling and deal with their emotions accordingly.

If you assist your child in labeling and understanding their emotions, they will be better able to cope with emotional stress and turmoil. An emotionally stable child will often grow up to become a resilient adult.

Support Your Child Emotionally

Children can be emotionally vulnerable. They may need constant emotional support from people they love. Children often need emotional support to feel strong. Knowing they aren’t alone in a situation will not only make them more confident, but they may be willing to try new and challenging ways to solve problems.

Tell your child how much you love them, and don’t forget to remind them how proud you are of them. Just by telling your child that you believe they can do it can really make them want to do it!

Characteristics of a Resilient Child

If you want to see how resilient your children are, keep an eye out to see if they can:

Long Term Effects of Resilience

When these qualities are inbuilt in someone from an early age, they are able to reach their long term goals and work their way through their problems independently. A resilient child is strong, self sufficient, self sustaining, and self reliant when all grown up. In this way, development of resilience in children holds special significance in their upbringing.

A therapist can help you learn skills to develop resilience in your child. To find a therapist in your area, start here.

Closeup of hand writing in a journal in a pretty outdoor setting at sunriseNarcissistic personality disorder (NPD), or narcissism, as it’s often called, is one of the cluster B personality disorders, or emotional/impulsive personality disorders.

Narcissism is one of the least studied personality disorders. Different subtypes of narcissism present with varying features, making diagnosis challenging. People with narcissism may also see no need for counseling and consider it pointless or beneath them. If they do begin therapy, they may react angrily when faced with challenges, try to manipulate their therapist, or find it hard to consider things from other perspectives. They often leave therapy early, especially if they don’t see any benefit in it.

Recent research aims to identify new therapy approaches that can help people living with personality disorders achieve lasting change. Schema therapy, one such treatment, is considered helpful for people who don’t respond well to other types of therapy. It’s proven effective in treating borderline personality, another condition long considered difficult to treat.

Research looking at schema therapy for narcissism is still in the early stages, but existing clinical data suggests it has promise.

People living with narcissism have a deep need for admiration and recognition and draw self-esteem from the praise and positive regard of others.

The Roots of Narcissism

Personality disorders are characterized by rigid, long-lasting patterns of behavior that affect life and relationships, causing distress and making it difficult to function. People living with personality disorders may not always recognize that some of their behaviors cause problems or affect others negatively.

Like other personality disorders, narcissism is a serious mental health issue. Many consider it more serious and harmful than most other personality disorders, since people with narcissism generally lack empathy and may not care about the effects of their actions.

The causes of narcissism aren’t fully understood. Some potential factors in development may include:

People living with narcissism have a deep need for admiration and recognition and draw self-esteem from the praise and positive regard of others. Since connecting with people on an intimate level requires a level of vulnerability, people with narcissism may avoid meaningful relationships in order to protect their illusion of grandiosity and keep an unstable self-identity from being revealed.

Researchers have identified four main subtypes of NPD. It’s possible to have features of multiple subtypes or shift between subtypes at different points in life.

Narcissism often involves symptoms that are less known than grandiosity and lack of empathy, including:

Most people with narcissism struggle to maintain employment and personal relationships, changing partners readily when they don’t receive the admiration they need. It’s also common for people to fantasize about being recognized for their superiority and humiliating people who have “wronged” them.

When therapy can help address these concerns, particularly vulnerability and self-esteem, narcissistic behaviors may improve.

Schema Therapy: An Effective Treatment for Narcissistic Personality?

Even when people with narcissism do seek therapy, whether for distress related to narcissism or other mental health symptoms, treatment can be complicated. Believing a therapist has insulted them, failed to recognize their specialness, or isn’t skilled or reputable enough to treat them leads many people with narcissism to quit therapy early in treatment. Research suggests therapy progresses more slowly for people with narcissism, leading to slower improvement of symptoms.

Schema therapy, however, may have increased potential to treat NPD. Schema therapists offer support and validation while helping people work to understand and address the emotional mindsets causing problems in their life. For narcissism, this is often the persistent, private sense of inferiority and fear of failure.

Schema therapy combines elements of cognitive behavioral therapy, emotion-focused therapy, Gestalt therapy, and psychodynamic therapy, among others. The idea behind this approach is that schemas, or patterns of thought and behavior, develop as a result of unmet emotional needs and other early childhood experiences. These schemas are reinforced throughout life by challenges, abuse, trauma, and other negative or harmful experiences. Unless they’re addressed in positive ways, they contribute to the development of harmful or unhealthy methods of coping. These coping styles can affect behavior throughout life, often in ways that cause distress.

Schema therapists offer support and validation while helping people work to understand and address the emotional mindsets causing problems in their life.

The goal of the approach is to help people identify needs that weren’t met in childhood and learn how to get them met in healthy ways that don’t cause harm, either to themselves or to others. To help clients achieve this goal, schema therapists group schemas and coping responses into modes and use a range of strategies to address them, including roleplay, interpersonal techniques, and cognitive behavioral approaches. Therapists may set limits, as a parent would, within the bounds of the therapeutic relationship to help clients confront schemas.

The schema modes commonly associated with narcissism are:

By confronting these modes and working through them with the help of the schema therapist, people in therapy can begin to access the Healthy Adult mode, which helps heal the vulnerabilities of early childhood and fosters healthier modes of coping. After reaching this mode, people may be able to begin functioning at a more typical level and be more able to take responsibility for their actions and see how they affect others.

Schema therapy has been successful in the treatment of other personality disorders, including borderline personality. Clinical trials on its use with narcissism are still forthcoming, but research and clinical observations suggest schema therapy could help people with narcissism have more success in treatment.

Why Do Narcissists Seek Therapy?

People living with NPD often believe themselves superior and struggle to consider the feelings and needs of others. This can make their actions particularly hurtful. Narcissism also often involves intentional manipulation or emotional abuse—behaviors that cause significant pain to partners of people with narcissism. In fact, many therapists specialize in helping the partners of people with narcissism heal.

The typical traits linked to narcissism, along with the tendency of many with NPD to see nothing wrong with their behavior, have contributed to the belief that therapy can’t treat narcissism. But therapy can help people with narcissism improve—if they want to change.

Andrea Schneider, LCSW, a therapist in San Dimas, California, explains what might prompt a person with NPD to seek counseling. “Typically,” she says, “Someone … with narcissistic personality may have some flexibility with some behavioral change when they are confronted with significant stressors (like a relationship ending or other crisis).”

People with NPD may not ever seek therapy for symptoms associated with narcissism. Instead, they might decide to get help for other symptoms or issues. These could be co-occurring conditions or long-term mental health effects associated with narcissism. In many cases, it’s these challenges that contribute to the desire for change.

People with narcissism may seek help for:

Narcissistic personality and associated conditions can significantly impact quality of life and emotional well-being. Addiction and stress can cause health concerns, for example, while the inability to sustain a relationship could lead to complete isolation.

To date, few studies have looked at treatment for narcissism because people with NPD don’t seek therapy often. If they do, they may only do so because someone else has urged them into it. Therapy can still have benefit, but the person with narcissism must recognize the problems with their behavior and make efforts toward change.

Finding a Schema Therapist

People who don’t see a need to address their behavior are unlikely to be able to make lasting change. But research on schema therapy suggests the approach could benefit people living with narcissism when other types of therapy don’t help. Experts do agree that narcissism often poses treatment challenges for therapists and can make progress in therapy difficult.

Schema therapy involves validation and empathy for a person’s difficulties and distress. When people with narcissism approach therapy with a willingness to change, or at least to make an effort to address harmful behaviors, the mode work involved in schema therapy may help them learn to confront the vulnerabilities they fear in a healthier way.

It can be difficult to find a schema therapist, especially if you live in a smaller city. But many therapists may be trained to incorporate elements of schema therapy into treatment. If you or a loved one has symptoms of narcissistic personality disorder, consider reaching out to a therapist who offers schema therapy or practices mode work. Don’t be discouraged by the myths about narcissism—change is possible for anyone. Begin your search for a trained, compassionate counselor today.

Author’s Note: If you’re involved in a relationship where there is intimate partner abuse of any kind—physical, emotional, or sexual—relationship therapy is usually not recommended. We encourage you to review our crisis page and reach out for support.

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. Behary, W. T., & Dieckmann, E. (2013). Schema therapy for pathological narcissism: The art of adaptive reparenting. In J. S. Ogrodniczuk (Ed.), Understanding and treating pathological narcissism (pp. 285-300). Washington, DC, US: American Psychological Association.
  4. Caligor, E., Levy, K. N., & Yeomans, F. E. (2015, April 30). Narcissistic personality disorder: Diagnostic and clinical challenges. American Journal of Psychiatry, 172(5). 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&
  5. Dieckmann, E., & Behary, W. (2015). Schema therapy: An approach for treating narcissistic personality disorder. Fortschritte der Neurologie-Psychiatrie, 83(8), 463-477. doi: 10.1055/s-0035-1553484
  6. Ekselius, L. (2018). Personality disorder: A disease in disguise. Upsala Journal of Medical Sciences, 123(4), 194-204. doi: 10.1080/03009734.2018.1526235
  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. Ritzl, A., Csukly, G., Balázs, K., & Égerházi, A. (2018, September 13). Facial emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders. Psychiatry Research, 270, 154-159. doi: 10.1016/j.psychres.2018.09.017
  9. Young, J., & First, M. (2003). Schema mode listing. Retrieved from http://www.schematherapy.com/id72.htm
  10. Young, J., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York City, NY: Guildford Press. Retrieved from https://www.guilford.com/excerpts/young.pdf?t

Man sitting on windowsill with cup of tea, looking out windowDrug abuse is a serious health concern. Overdose-related deaths in the United States have reached epidemic level. In fact, the Centers for Disease Control and Prevention (CDC) estimate an average of 130 people die from opioid overdose each day. This number doesn’t take into account deaths related to other drugs, which may increase this number.

Any drug use can become dangerous. Marijuana, now legal for medicinal and recreational use in many states, may help relieve pain, chemotherapy side effects, and symptoms of mental health concerns such as anxiety and posttraumatic stress. Research has also suggested marijuana may help treat addiction in some people. But despite these potential benefits, it can become addictive and could have health effects such as short-term memory impairment, impaired brain function, and respiratory health issues, among others.

Recreational use of illegal substances, even short-term use, can have serious health effects, including anxiety, paranoia, depression, suicidal thoughts, hallucinations, nausea, increased heart rate and blood pressure, and more. There’s also a risk of death due to overdose or complications. Long-term use of certain drugs could increase risk of violent behavior and may lead to legal trouble. Abusing drugs can also lead to drug dependency, or addiction.

Rehab can help people who’ve reached their absolute low work to overcome addiction, but it can also help people begin to break free of addiction before it significantly impacts their lives.

If you’re experiencing addiction, you’re not alone. According to statistics from the Substance Abuse and Mental Health Services Administration, more than 20 million Americans experienced a substance abuse disorder in 2014. Addiction can be difficult to overcome, no matter how hard a person tries. Professional support, in the form of inpatient or outpatient drug rehab, can benefit many people living with drug addiction.

Myths about drug rehab are plentiful. If you’re considering rehab for yourself or a loved one, making sure you have all the facts will help you make a more informed decision. Here, we present five common myths about drug rehab and the facts to counter them.

Drug Rehab Myths and Facts

Myth: Only wealthy people go to rehab.
Fact: Anyone can go to rehab.

It’s true that drug rehab can become expensive. Some people may not even consider inpatient rehab an option, believing it to be out of their budget. But the cost of drug rehab can depend on a number of factors, and there are rehab options for a range of budgets. See our article here for a more detailed explanation of rehab costs.

Some drug rehab centers offer low-cost or sliding-scale fees, based on your income. According to the 2012 National Survey of Substance Abuse, 62% of rehab facilities charge based on a sliding scale. Facilities may also offer payment programs or other types of financial assistance to people in need. Many drug rehab centers accept insurance, though not all insurance providers cover rehab.

When considering rehab, talk to your insurance provider and the rehab facility you’re interested in to get a better idea of the cost involved. Some centers may be able to work with you or refer you to another quality center that is more affordable. If the cost of inpatient rehab is a barrier, you might also consider outpatient drug rehab programs.

Myth: Rehab is for when you hit “rock bottom.”
Fact: You can begin recovering from addiction at any time.

Many people go to rehab when no other treatment option has worked. Often, they’ve lived with addiction for many years. Rehab can help people who’ve reached their absolute low work to overcome addiction, but it can also help people begin to break free of addiction before it significantly impacts their lives. Research suggests early intervention helps improve treatment outcomes.

Addiction not only contributes to emotional and physical health concerns, it can also lead to homelessness, unemployment, debt, and breakup or divorce. Choosing to enter rehab when you first find yourself becoming dependent on substances can help you begin the recovery process before addiction can have more of an effect on your life.

Myth: Rehab is only for people who can’t quit on their own.
Fact: Anyone experiencing addiction can get help in rehab.

The idea that addiction only happens to weak or flawed people is widespread. It might seem logical: Many people experiment with drugs, but not everyone becomes addicted. But drug abuse alters brain chemistry and affects cognitive function, leading to cravings for the substance and eventually addiction. Certain factors, including genetics, can increase a person’s risk for addiction.

Although a person might choose to try drugs, they don’t choose to become addicted. Once addicted, many people can’t stop using drugs without professional help. Needing rehab isn’t a sign of weakness. Changes in the brain resulting from addiction can make it extremely challenging, if not impossible, to stop using drugs without the support of health care providers trained in addiction support.

Whether you’ve tried to stop using drugs and relapsed or are just beginning to realize you may have a problem with substance abuse, rehab can help you begin recovery.

Myth: Rehab will prevent a person from relapsing.
Fact: Relapse is common, but treatment can help reduce its impact.

Between 40 and 60% of people dealing with addiction will relapse, according to the National Institute on Drug Abuse. While rehab may help reduce your risk of relapse, completing a drug rehab program doesn’t guarantee you’ll never relapse.

But rehab still has benefit. Research shows rehab can help by helping you develop skills to resist cravings, making relapse less likely. If you do relapse, the length of the relapse may be shorter. People who participate in treatment programs such as rehab also tend to relapse fewer times than people who don’t. Rehab can also lead to improvements in your relationships with friends, family, and loved ones. Developing stronger bonds with people you care for can also decrease the likelihood of relapse.

Myth: Rehab doesn’t work if you force someone to go.
Fact: Rehab can work even if you don’t want treatment.

Some people choose to enter rehab on their own, but some people experiencing addiction may not see its effects on their life, or they may not believe they have a problem with substance abuse. They may only decide to enter rehab grudgingly, after a court order or intervention from loved ones.

Being issued an ultimatum or feeling otherwise “forced” into rehab could make some people resistant to treatment, at first. According to the National Institute on Drug Abuse, however, people who feel pressured to overcome addiction in order to maintain an important relationship or avoid criminal charges, for example, often do better in treatment, even though they didn’t choose to enter rehab on their own.

Substance abuse and addiction can have serious, lifelong consequences. But there is help. Drug rehab may seem like an extreme measure, but this is partially due to the many myths surrounding rehab treatment.

Numerous studies support the benefits of rehab for addiction recovery. Inpatient centers provide a safe place to begin the detox and recovery process at any stage of addiction. Some facilities are expensive, but it’s possible to find affordable centers that will work with you to find a treatment program that’s right for your needs and your budget.

Don’t let myths about drug rehab keep you from getting addiction recovery support. Compassionate care is available! Begin your search today at GoodTherapy. Recovery may be a lifelong journey, but you are not alone.

References:

  1. American Addiction Centers. (2019, February 14). How much does rehab cost? Retrieved from https://americanaddictioncenters.org/alcohol-rehab/cost
  2. American Addiction Centers. (2018, October 15). Rehab success rates and statistics. Retrieved from https://americanaddictioncenters.org/rehab-guide/success-rates-and-statistics
  3. Blending perspectives and building common ground. Myths and facts about addiction treatment. (1999, April 1). U.S. Department of Health and Human Services. Retrieved from https://aspe.hhs.gov/report/blending-perspectives-and-building-common-ground/myths-and-facts-about-addiction-and-treatment
  4. Centers for Disease Control and Prevention. (2018, December 19). Understanding the epidemic. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html
  5. Leshner, A. I. (n.d.). Exploring myths about drug abuse. National Institute on Drug Abuse. Retrieved from https://archives.drugabuse.gov/exploring-myths-about-drug-abuse
  6. Mayo Clinic. (2017, July 20). Intervention: Help a loved one overcome addiction. Retrieved from https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/intervention/art-20047451
  7. Mayo Clinic. (2017, October 26). Drug addiction (substance use disorder). Retrieved from https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
  8. National Academies of Science, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Retrieved from http://nationalacademies.org/hmd/reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx
  9. National Institute on Drug Abuse. (2018). Drugs, brains, and behavior: The science of addiction. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
  10. National Institute on Drug Abuse. (2018). Is marijuana addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-addictive
  11. Substance Abuse and Mental Health Services Administration. (2015). Behavioral health trends in the United States: Results from the 2014 national survey on drug use and health. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf
  12. Substance Abuse and Mental Health Services Administration. (2016). Early intervention, treatment, and management of substance use disorders. In Facing addiction in America: The surgeon general’s report on alcohol, drugs, and health [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK424859
  13. Substance Abuse and Mental Health Services Administration. (2019, January 30). Mental health and substance use disorders. Retrieved from https://www.samhsa.gov/find-help/disorders
  14. Walsh, Z., Gonzalez, R., Crosby, K., Thiessena, M. S., Carrolla, C., & Bonn-Miller, M. O. (2017). Medical cannabis and mental health: A guided systematic review. Clinical Psychology Review, 51, 15-29. Retrieved from https://www.sciencedirect.com/science/article/pii/S0272735816300939?via%3Dihub
  15. Weber, L. (2015, July 11). How much does inpatient rehab cost? Retrieved from https://addictionblog.org/rehab/inpatient-rehab/how-much-does-inpatient-rehab-cost

Grid of plates, each with a different health foodNutrition is fuel for your body. Choose the right fuel and your body, including your mind, may function better.

Research on the role of nutrition in fighting anxiety is mixed, but studies consistently find people with anxiety may have lower quality diets that are low in fruits and vegetables and high in fats and sugars. Emerging research also suggests some foods may help regulate neurotransmitters, thereby improving brain health and potentially reducing anxiety.

Dietary changes are not magic, and a few nutritional tweaks are unlikely to correct serious anxiety or the lingering effects of trauma. They may, however, supplement the effects of therapy, medication, lifestyle changes, and other strategies. Diet changes may also help alleviate some of the physical effects of anxiety, such as muscle tension and a racing heart.

Experimenting with a different diet can help people with anxiety feel an increased sense of control and self-efficacy. Many people with anxiety struggle with feeling out of control. Proactive measures to fight anxiety may help with this feeling. Be open to experimentation, and know that it can take time to realize the anxiety-fighting benefits of anti-anxiety foods.

The Science Behind Foods That Reduce Anxiety

Nutrition affects anxiety in both direct and indirect ways. Low blood glucose can be an anxiety trigger, so crash diets and prolonged periods without food may make anxiety worse. Sugary foods, caffeine, and alcohol can also trigger or exacerbate anxiety. People struggling with anxiety may wish to cut back on these ingredients or eliminate them altogether.

Experimenting with a different diet can help people with anxiety feel an increased sense of control and self-efficacy.

Certain foods may also reduce anxiety. There’s no single mechanism through which food reduces anxiety. Each anxiety-friendly food boasts its own unique benefits. Some common features include:

8 Best Foods for Anxiety

The best foods for anxiety are rich in nutrients, tasty, and adaptable to a wide range of diets. This ensures that even if they don’t immediately help with anxiety, they offer other health benefits. Try incorporating some of the following anxiety-reducing foods into your diet:

Pieces of salmon sashimiSalmon

Salmon is rich in vitamin D, DHA, and EPA. It’s also a healthy source of protein and an excellent substitute for other meats. A 2014 study weighed the effects of salmon on men seeking inpatient mental health treatment. Men who ate salmon three times a week for 5 months had fewer symptoms of anxiety. Salmon was especially effective at alleviating physical measures of anxiety, such as a rapid pulse.

Nuts and seeds

Nuts and seeds are nutritionally dense foods that are rich in DHA. DHA is linked to improved brain health, including reductions in anxiety and better regulated neurotransmitters. Additionally, most nuts and seeds are high in selenium.

Cup of chamomile tea with chamomile flowersChamomile

Chamomile tea is one of the world’s oldest and most popular folk remedies for insomnia. This may be due in part to its effects on anxiety. A 2009 double-blind, placebo-controlled study found that chamomile could modestly improve symptoms of generalized anxiety.

Eggs

Choline is an essential nutrient that plays a role in numerous functions, including supporting brain health, memory, and concentration. It’s also a precursor to acetylcholine. Preliminary research suggests choline deficiency may increase the risk of anxiety. Many vegetarians are deficient in choline, since the primary sources of this important nutrient are all meats. Eggs offer a viable alternative. Consider incorporating one or two hard-boiled eggs into your diet for a protein-packed source of this important nutrient.

Pieces of dark chocolate with cocoa powderDark chocolate

Dark chocolate is rich in antioxidants that can fight inflammation. It’s also a healthy substitute for milk chocolate and other sugary snacks. A 2012 study found that regular consumption of dark chocolate was associated with a decrease in biochemical measures of stress, such as cortisol production. For some people, dark chocolate can also be a powerful comfort food that eases stress after a difficult day.

Berries and citrus fruits

Inflammation may be a culprit in anxiety. Inflammation can also trigger other health issues, such as chronic pain and autoimmune disorders. These conditions can intensify anxiety. Fruits that contain antioxidants may help reduce chronic inflammation. Berries, especially blueberries, are high in anti-inflammatory ingredients. Citrus fruits are a rich source of the antioxidant vitamin C.

Bowl of turmeric powder with roots in backgroundTurmeric

Turmeric has long been used in herbal medicine. Emerging research suggests it may play a role in general brain health, perhaps by fighting inflammation. A 2015 study found significant reductions in anxiety scores among people who consumed turmeric.

Dairy products

Most dairy products are fortified with vitamin D. For people who do not get enough vitamin D in the diet or who spend little time outdoors, vitamin D supplementation can ease anxiety. Dairy is also a rich source of protein. Particularly for people who do not eat meat, dairy consumption may ensure adequate protein intake. Protein helps the body produce key neurotransmitters, potentially improving mood and reducing anxiety.

Every person is different. The ideal diet for one person can prove catastrophic for another. Foods that ease anxiety in some people may make it worse than others. For example, a 2015 case study details how fish oil supplements made anxiety and insomnia worse following treatment of depression.

It’s important to consult with a doctor or mental health provider who is knowledgeable about nutrition and up-to-date on recent nutritional research.

Even with expert advice, some people find their anxiety makes it difficult to adopt a healthy lifestyle or change their diet. The right therapist can help people overcome anxiety and make healthy diet and lifestyle changes. Therapy also supports people in understanding their anxiety, managing the lingering effects of trauma, and improving their quality of life. To find your therapist, click here.

References:

  1. Amsterdam, J. D., Li, Y., Soeller, I., Rockwell, K., Mao, J. J., & Shults, J. (2009). A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. Journal of Clinical Psychopharmacology, 29(4), 378-382. doi: 10.1097/JCP.0b013e3181ac935c
  2. Bjelland, I., Tell, G. S., Vollset, S. E., Konstantinova, S., & Ueland, P. M. (2009). Choline in anxiety and depression: The Hordaland Health Study. The American Journal of Clinical Nutrition, 90(4), 1056-1060. Retrieved from https://academic.oup.com/ajcn/article/90/4/1056/4596992
  3. Blanchard, L. B., & Mccarter, G. C. (2015). Insomnia and exacerbation of anxiety associated with high-EPA fish oil supplements after successful treatment of depression. Oxford Medical Case Reports, 2015(3), 244-245. doi: 10.1093/omcr/omv024
  4. Cui, X., Gooch, H., Groves, N. J., Sah, P., Burne, T. H., Eyles, D. W., & Mcgrath, J. J. (2015). Vitamin D and the brain: Key questions for future research. The Journal of Steroid Biochemistry and Molecular Biology, 148, 305-309. doi: 10.1016/j.jsbmb.2014.11.004
  5. Dyall, S. C. (2015). Long-chain omega-3 fatty acids and the brain: A review of the independent and shared effects of EPA, DPA and DHA. Frontiers in Aging Neuroscience, 7, 52. doi: 10.3389/fnagi.2015.00052
  6. Esmaily, H., Sahebkar, A., Iranshahi, M., Ganjali, S., Mohammadi, A., Ferns, G., & Ghayour-Mobarhan, M. (2015). An investigation of the effects of curcumin on anxiety and depression in obese individuals: A randomized controlled trial. Chinese Journal of Integrative Medicine, 21(5), 332-338. Retrieved from https://link.springer.com/article/10.1007/s11655-015-2160-z
  7. Hansen, A., Olson, G., Dahl, L., Thornton, D., Grung, B., Graff, I., . . . Thayer, J. (2014). Reduced anxiety in forensic inpatients after a long-term intervention with Atlantic salmon. Nutrients, 6(12), 5405-5418. doi: 10.3390/nu6125405
  8. Martin, F. J., Antille, N., Rezzi, S., & Kochhar, S. (2012). Everyday eating experiences of chocolate and non-chocolate snacks impact postprandial anxiety, energy and emotional states. Nutrients, 4(6), 554-567. doi: 10.3390/nu4060554
  9. Murphy, M., & Mercer, J. G. (2013). Diet-regulated anxiety. International Journal of Endocrinology, 2013, 1-9. doi: 10.1155/2013/701967
  10. Naidoo, U. (2018, March 14). Eating well to help manage anxiety: Your questions answered. Retrieved from https://www.health.harvard.edu/blog/eating-well-to-help-manage-anxiety-your-questions-answered-2018031413460
  11. Salim, S., Chugh, G., & Asghar, M. (2012). Inflammation in anxiety. Advances in Protein Chemistry and Structural Biology, 88, 1-25. doi: 10.1016/b978-0-12-398314-5.00001-5

Gnarled, twisted tree trunks line each side of a small road.In her seminal book, On Death and Dying, psychiatrist Elisabeth Kübler-Ross identified five distinct stages of grief. Kübler-Ross worked with dying people and designed her model to describe the distinct grief of dying.

In On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss, a book co-authored with David Kessler, Kübler-Ross expanded her model to include many other types of grief. A modified version of Kübler-Ross’s model adds two new stages, shock and testing. This seven-stage model of grief is familiar to many people who have grieved a loss, yet little research supports the model. [amazon_affiliate]

The Seven Stages of Grief

According to Kübler-Ross, and later to her co-author David Kessler, there are five stages of grief: denial, anger, depression, bargaining, and acceptance.

Some grief experts suggest this model might leave out two additional stages. This is sometimes called the Extended Kübler-Ross Model. According to that seven-stage model, the stages of grief are as follows:

  1. Shock: This is a person’s initial sense of paralysis and shock following bad news.
  2. Denial: Denial is an attempt to avoid the pain of the loss. Sometimes people distract themselves with other pursuits.
  3. Anger: Anger is a reaction to the loss of control that often accompanies a loss. A person may experience overwhelming feelings of frustration or target their anger to a specific source, such as God, a doctor, or the person who shared the bad news.
  4. Bargaining: Bargaining is an attempt to regain control. During this stage, a person tries to find a way to escape the pain. For example, a person dying of cancer might adopt a very healthy lifestyle, or a parent whose child is dying might spend lots of time praying.
  5. Depression: When bargaining fails and a person realizes they cannot control the loss, they may enter a state of intense depression.
  6. Testing: During this stage, a person experiments with ways to better manage and cope with the loss.
  7. Acceptance: During acceptance, a person integrates and understands the loss. This does not mean they are “over” it, but they are able to move forward. The degree to which a person is able to accept the loss and move forward depends on the specific loss, personal psychological factors, a supportive environment, and more.

In his book Finding Meaning: The Sixth Stage of Grief, David Kessler argues that the quest for meaning might be the final stage of grief before acceptance.

While the original model was presented as sequential, most grief experts now argue that a person can go through the stages in any order. They may also repeat or revisit stages, especially during times of intense emotional distress. For example, a person grieving the loss of their father might become angry over his loss when he is not present at their wedding, even if they already experienced the anger stage years before.

While the original model was presented as sequential, most grief experts now argue that a person can go through the stages in any order.

Shock: The First Stage of Grief

Grief often begins with bad news—a stunning diagnosis, a phone call announcing a loved one’s death, or an ultrasound that reveals a baby is not developing normally. This can feel like a massive blow, sending a person into a state of emotional shock. During this earliest stage of grief, a person may feel unable to process the meaning of the news.

Shock can last just a few moments or for many days. For some people, shock reappears as the grieving process unfolds. A person grieving the death of a relative may feel another wave of shock settle in at the funeral or burial, for instance.

Some hallmarks of shock include:

Testing: An Often Overlooked Stage of Grief

As a person meanders through the stages of grief, they may arrive at a period of testing. This stage of grief is similar to bargaining, but typically occurs later. During testing, a person experiments with different ways to manage their grief. For example, a person going through a divorce might contemplate joining a support group, weigh the benefits of a new hobby, or consider dating.

Testing differs from bargaining in that testing is about finding sustainable strategies for living with bad news. Bargaining is about escaping the bad news and regaining control.

A person in the testing stage may:

How Helpful Are the Stages of Grief?

While many grieving people report experiencing at least a few of the stages of grief, most research does not support a stage-based model of grief. A 2007 study found people grieving a death experience denial, anger, depression, and acceptance in a similar sequence to that identified by Kubler-Ross. That study, however, found no support for bargaining and found the most prevalent grief-related emotion was yearning for a lost loved one.

Factors such as a person’s social environment, how supported they feel, and the nature of the loss may also change how a person grieves.

Factors such as a person’s social environment, how supported they feel, and the nature of the loss may also change how a person grieves.

Some studies have found a person’s grief may depend on the loss. A 2016 study, for example, argues that people caring for a loved one with dementia face a unique grieving process. This is because they “lose” the person before they die but then experience another loss at death. The study proposes a dementia-specific model of grieving and argues that ambiguity is a core component of each stage of dementia grief.

The extent to which a stage-based model of grief helps people is unclear. People who experience one of the traditional stages may feel less alone when they learn their feelings are common. People who do not go through the stages of grief, however, may feel alone or stigmatized. They may even feel pressured to manifest outward signs of internal grief stages they do not actually feel.

There is no right or wrong way to grieve. Grief is the natural reaction to a loss. Cultural norms, personal factors, social support, health, religious and social values, and myriad other factors may affect how a person experiences grief. Therapy can help people manage their grief and find a way forward. The right therapist may even help a person find meaning in a loss, or a sense of purpose in persisting despite the loss.

“These models can…help people understand and explain their experience. However, grief is not predictable, linear, stable, or neat. It is an experience marked by its ferocious aliveness and proclivity for shape shifting. Models run the risk of being too prescriptive…and can render people feeling like they have a map of mere country borders and seashores, not the detail or scope to actually navigate one’s way around with any seriousness. Use the seven stages as a basic introduction to the language of grief, but when one becomes fluent in their own personal grief experience, they will realize it’s a language entirely unto its own. Therapy and other therapeutic work help hold and develop the latter,” says Jade Wood, MA, LMFT, MHSA, a Washington, D.C. therapist who specializes in managing grief.

To begin your search for a compassionate grief therapist, click here.

References:

  1. Additional stages of grief. (n.d.). Retrieved from http://www.econdolence.com/learn/articles/additional-stages-of-grief
  2. Blandin, K., & Pepin, R. (2016, October 15). Dementia grief: A theoretical model of a unique grief experience. Dementia (London), 16(1), 67-78. doi: 10.1177/1471301215581081
  3. Kübler-Ross, E. (2009). On death and dying. Abingdon: Routledge.
  4. Maciejewski, P. K., Zhang, B., Block, S. D., & Prigerson, H. G. (2007, February 21). An empirical examination of the stage theory of grief. JAMA, 297(7), 716. doi: 10.1001/jama.297.7.716
  5. Testing stage. (n.d.). Retrieved from http://changingminds.org/disciplines/change_management/kubler_ross/testing_stage.htm
  6. The Kübler-Ross Grief Cycle. (n.d.). Retrieved from http://changingminds.org/disciplines/change_management/kubler_ross/kubler_ross.htm

Girl sitting on windowsill, looking outside at some trees.Some people use the words “isolation” and “loneliness” interchangeably, but this does not reflect the true meaning of each term. Isolation may lead to loneliness, and in some cases, loneliness may exacerbate isolation. Both have been found to occur with other mental health issues such as anxiety or depression.

Knowing how loneliness and isolation are distinct and related can help people who struggle with them best address and work through these issues. Here are a few things to know about handling loneliness and social isolation in your life.

The Difference Between Isolation and Loneliness

Social isolation occurs when a person has little or no contact with other people. It can occur over long or short periods of time and is a distinctly physical state. Isolation specifically may be characterized by:

Isolation can have many negative emotional effects, including increased sadness, restlessness, and loneliness. While isolation can cause loneliness, the two don’t always occur together. People may find themselves socially isolated regularly as a side effect of an isolating mental health issue such as social anxiety or agoraphobia. For example, someone with agoraphobia may feel too anxious to leave their house on some days.

Loneliness, on the other hand, is an emotional state. It’s defined as feeling alone or separate from others, or as feeling empty. Loneliness may accompany social isolation but can be caused by other things, including breakups or divorce, moving to a new location, or the death of a close friend or loved one. Someone who has difficulty making friends may also experience frequent loneliness. In the case of mental health, loneliness can accompany depression, anxiety, and many addictions and phobias.

Does Isolation Cause Loneliness?

There are some cases in which isolation can lead to loneliness. Sometimes not being around others for long periods of time can make people feel intensely alone. For example, if someone works from home, they may spend all day alone in their house without much social contact, in which case they may experience feelings of loneliness. Bullying or the experience of being alienated from a social group is also likely to bring about feelings of loneliness.

Loneliness can sometimes lead to isolation. People who feel lonely for long periods of time may have a hard time engaging with others in social situations. If it seems too difficult to reach out to others or if a fear of rejection has taken hold, people may isolate themselves to deal with their loneliness. The isolation-loneliness cycle often feeds into itself but does not offer respite or relief to the people stuck in it.

In some cases, isolation and feelings of loneliness may occur simultaneously without one being caused by the others. This typically means that other social, psychological, or mental health-related factors may be involved.

How Isolation and Loneliness Affect Mental Health

Isolation has been shown in studies to affect people with mental health issues. In some cases, such as when people have anxiety or depression, isolation can aggravate what may already feel like an intense symptom. This could be particularly true when the depression and anxiety are usually alleviated by social contact.

Prolonged loneliness can even lead to health problems. Too much time alone has been shown to impact cognitive development in young people and lead to poor physical health habits. Sometimes feeling lonely for a long time can make people feel that taking care of themselves isn’t worth the effort, and they may give up eating well or exercising.

Some other effects of isolation and loneliness to look out for may include:

Loneliness may accompany social isolation but can be caused by other things, including breakups or divorce, moving to a new location, or the death of a close friend or loved one.

When Isolation and Loneliness Are Symptoms

Sometimes loneliness and/or isolation present as primary symptoms of a mental health issue. For example, if someone suddenly begins to pull away from friends and family, this could indicate that a number of potential issues. They could have depression or an eating disorder, or they may be affected by an abusive relationship. Isolation may be a first sign of many mental health issues, so identifying the unique context of each situation is key in order to understand it.

Loneliness and isolation can be symptoms of the following mental health issues, among others:

Risk Factors for Isolation and Loneliness

Just as with any other issue, some people may be more susceptible to isolation and loneliness than others, although anyone can become isolated or feel lonely. People who have recently had traumatic life changes, who live in tumultuous home environments, or who have witnessed or experienced domestic violence or abuse may be more prone to both loneliness and isolation.

For example, a person who’s recently been divorced and has moved to a new neighborhood may feel the absence of their former partner and community, causing them to be lonely. Additionally, an elderly person whose spouse has died may be isolated in their day-to-day life, which may lead to loneliness and poor health.

People who live in abusive homes may isolate themselves because the shame of their environment makes them think they can’t talk with others about their life. They may also feel intensely lonely if they become worried no one will be able to relate to their life experiences.

Getting Help

If you’re feeling lonely or experience isolation for long periods of time, it may help to reach out to a licensed mental health professional who can offer support as you work through those struggles. Not addressing prolonged loneliness and isolation can negatively impact your physical and mental well-being.

If there is a deeper mental health issue causing your feelings of loneliness or isolation, a therapist can help treat that issue and put you on the path to your best self. Remember that you are not alone and there is never shame in asking for help.

References:

  1. Cherry, K. (2018, November 20). What you should know about loneliness. Retrieved from https://www.verywellmind.com/loneliness-causes-effects-and-treatments-2795749
  2. Ge, L., Heng, B. H., Ong, R., & Yap, C. (2017, August 23). Social isolation, loneliness and their relationships with depressive symptoms: A population-based study. PLOS One. Retrieved from https://doi.org/10.1371/journal.pone.0182145
  3. Hawthorne, G. (2008). Perceived social isolation in a community sample: Its prevalence and correlates with aspects of peoples’ lives. Social Psychiatry and Psychiatric Epidemiology, 43(2), 140-150. Retrieved from https://doi.org/10.1007/s00127-007-0279-8
  4. How to cope with loneliness. (2016). Retrieved from https://www.mind.org.uk/information-support/tips-for-everyday-living/loneliness/#.WzV1gxJKiRs
  5. Stickley, A., Koyanagi, A., Koposov, R., Schwab-Stone, M., & Ruchkin, V. (2014). Loneliness and health risk behaviours among Russian and U.S. adolescents: A cross-sectional study. BMC Public Health, 14, 366. Retrieved from http://www.biomedcentral.com/1471-2458/14/366
  6. What is loneliness doing to your brain? (2018, June 27). Retrieved from https://www.seeker.com/videos/health/what-is-loneliness-doing-to-your-brain
  7. Williams, Y. (n.d.). Social isolation: Definition, causes, and effects. Retrieved from https://study.com/academy/lesson/social-isolation-definition-causes-effects.html

Young couple sitting in coffee shop in disagreementAuthor’s note: It is always a challenge to choose genders when writing about neurodiverse couples. Here I use the example of an autistic man and a neurotypical woman. I don’t mean to imply there are no cases in which this is reversed. It’s just that at this time, men are diagnosed at a 4:1 ratio to women, and in my practice, it is the majority of men who are the autistic partners. This could reflect the higher frequency of autism among men, or it could mean more couples like this present for counseling than couples in which the autistic partner is female. It is also important to note that individuals on the spectrum can be susceptible to gaslighting from others, and I will address this in a separate article.

In my work with neurodiverse couples in which one partner is autistic, one of the words I hear most often is “gaslighting.” Here’s an example:

“It would be one thing if we just fought like other couples who eventually make up. But that’s not how it is with us. Instead, we argue about something, and he tells me I’m being irrational. Or childish. Or critical. Then he shuts down. Often, he storms out of the room. If I try to bring it up later, he tells me I’m imagining things, that he didn’t say that, or if he did say it, he didn’t mean it the way I took it. He says I’m being too sensitive. And he shuts down again. I’m left feeling as if I’ll explode with frustration. I’m furious. And I have nowhere to go with it. I start to wonder if he’s right about me. I don’t know what to believe anymore. Is this gaslighting?”

Gaslighting Defined

In brief, gaslighting is a term that derives from the 1944 movie called Gaslight in which a husband successfully manipulates his wife into doubting her own reality. The husband in the story has a dark secret which is at the root of everything he says and does to his wife. To him, she is not a person with her own interior life. She is a pawn in his selfish game, which until the end he plays shrewdly enough to cause her to doubt her own version of reality.

“Instead, we argue about something, and he tells me I’m being irrational. Or childish. Or critical. Then he shuts down. Often, he storms out of the room. If I try to bring it up later, he tells me I’m imagining things, that he didn’t say that, or if he did say it, he didn’t mean it the way I took it.”

In reference to the flickering gaslights in the story, this effect has become known as gaslighting: intentionally treating a person in such a way as to cause confusion and cognitive dissonance, which eventually lead to collapse into self-doubt.

Of note is that at the heart of the husband’s motivation is a desire for riches, symbolized by jewels. This part of the story is often overlooked, but it is worth consideration when we are talking about autistic behavior.

Questioning Reality in Neurodiverse Relationships

First, let’s return to the comments of the neurotypical partner I quoted above. One way to view her statement is in terms of gaslighting, just as it is laid out in the movie.

In this model, time after time, incident after incident, she is cajoled into questioning what her own eyes, ears, and heart are telling her. Finally, she gives up. She begins to believe the mirror her partner holds up to her reflects an accurate representation of who she is. In order to believe that, she has been forced to discount any impulse of her own that contradicts such an image. She collapses into self-doubt. His manipulation has succeeded. Does this make him right? His smugness suggests that he believes so. He feels clever. He has won.

What would motivate someone to treat another person this way? Such manipulation may be observable in certain personality disorders, such as narcissistic personality disorder (NPD), antisocial personality disorder, and borderline personality disorder (BPD). In short, it is not healthy to intentionally set out to dominate someone else by negating that person’s reality. Such individuals leave a trail of emotional wreckage in the lives of others. Shelves full of books and countless hours of therapy are devoted to helping those victimized by such manipulators.

Looking Beyond the Behavior: Self-Protection

Behind the behavior of the personality disordered, there is an unconscious drive to protect that which feels threatened, which is usually the person’s self-worth. In twisted logic, anything that might compromise such fragile emotional integrity must be extinguished at all costs before it can extinguish the very life of the manipulator. This may be felt as desperation.

As a result, manipulation can be rationalized. It may not be viewed as a choice but rather as a necessity for survival. Incidentally, there is no respect for someone who can be manipulated, which makes further mistreatment easier and may even be viewed as what the person deserves.

But this is not the motivation of someone with autism.

The Tragic Dance of the Neurodiverse Couple

The jewels an autistic person guards could best be described as personal integration and a sense of security in who he is. Threats may come from feeling overwhelmed emotionally in the face of what seems like unmanageable ambiguity and uncertainty, which often lead to untenably high anxiety. Reducing that anxiety, consciously or not, is the most likely driver for behavior that appears to be gaslighting in someone with Asperger’s.

Reducing that anxiety, consciously or not, is the most likely driver for behavior that appears to be gaslighting in someone with Asperger’s.

Often, this person is oblivious to the harmful effects of his behavior and doubts the validity of someone’s observation that it might be gaslighting. The fact is that I have never met an autistic person whose conscious intent is to manipulate his partner.

But the key phrase is “conscious intent.” Because even though a person with Asperger’s may not mean to manipulate (gaslight) his partner, her actual experience is the same as it would be if intent were there.

In short, we have a couple in which one partner feels as if he is fighting for survival and another partner who feels as if she is fighting for survival, and in a two-way charge, one person’s means of doing so obliterates the reality of the other. It is what I call the tragic dance of the neurodiverse couple.

Addressing the Tragic Dance in Couples Counseling

The autistic person can learn in counseling that his behavior has the effect of invalidating his partner’s emotional life. He can come to understand that even though he does not intend to inflict such pain, the effect is real. Her dismayed and perhaps argumentative behavior is how a neurotypical person might justifiably respond to what feels like manipulative behavior from someone else. She is not trying to criticize him. She is trying to express her pain.

More often than not, this realization is met with deep remorse and often guilt. In time, he can learn to understand his own way of being in the world without judging himself harshly as being wrong or defective, because that is not the correct metric. Emotional support for him is key to his growth in this area.

The neurotypical partner can learn, first and foremost, that her response to feeling manipulated is normal. Her pain and confusion are normal. They are valid. She must be allowed to acknowledge and heal her wounds, because it doesn’t matter whether she was stabbed intentionally or inadvertently: she is still bleeding.

The second step, though, is to begin to understand that her autistic partner is not trying to hurt her; instead, what she experiences as manipulation is his way of trying to reduce omnipresent anxiety, which usually derives from a lifelong experience of not quite getting things right when it comes to understanding someone else’s emotions. She needs emotional support in order to move forward. At the same time, she also has to come to terms with the fact that her partner’s way of offering this support may not align with her idea of what that support must look like.

The way to view communication in a neurodiverse couple, or any couple, is in terms of its effectiveness. This is the only metric that matters. It’s not a matter of who is right or who is wrong. The goal of communication is mutual understanding. In order to improve communication skills and strategies, recognizing differences with an effort to respect them without judgment becomes the foundation for growth in the relationship.

When I work with couples, we concentrate on slowing down conversational speed, considering linguistics and the formal logic of argument, and identifying the emotional subtext and context inherent in communication. It takes time. It takes practice. It is not always successful. When it is, it can be described as a process of two steps forward and one step back as two parallel lives learn to build bridges between two lines that will never completely merge.

Learning to trust deeply after years of being hurt, having the faith that being vulnerable one more time might be worth the risk, accepting that one’s interpretation of another’s behavior may not be the same as that person’s intent: these are the challenges.

It can’t be gaslighting without the intent to manipulate. Regardless, it can feel like gaslighting. Education about neurodiversity, skilled counseling, and communication in renewed mutual respect create the tools for interrupting this revolving door.

Reference:

Gaslight (1944). (n.d.). Retrieved from https://www.imdb.com/title/tt0036855

The silhouette of a person standing in a field of yellow mustard flowers.Social anxiety and avoidant personality disorder share some common features, but they are separate mental health conditions. Because the two conditions appear similar in many ways, it’s not uncommon for people to mistake one for the other.

Sometimes simply getting help is more important than having a specific diagnosis. But some people also find it beneficial to know what’s affecting them. In some cases, the best approach to treatment differs for separate mental health issues, so misdiagnosis can affect treatment and make it harder for a person to improve.

Social anxiety, or social phobia, is a specific type of anxiety characterized by a fear of social situations. People with social anxiety worry about embarrassing themselves in public or doing something that will cause others to judge them negatively. It’s fairly common for people to feel nervous about doing something embarrassing in public, but the feelings of fear and anxiety that occur with social phobia can become so distressing they cause difficulty at work, school, or other parts of daily life. About 75% of people with social anxiety are between the ages of 8 and 15 when diagnosed.

Avoidant personality disorder is a cluster C personality disorder. Personality disorders are a specific kind of mental health issue where patterns of thought and behavior affect daily life, and those with personality disorders often experience difficulty in professional and personal life because they have a hard time understanding other people and common situations.

Levana Slabodnick, LISW-S, a therapist in Columbus, Ohio, notices one difference between social anxiety and avoidant personality may lie in how a person views their own experience. She explains, “A fundamental difference between social anxiety disorder and avoidant personality disorder relates to how the sufferer perceives their own pain. Those with anxiety understand on a basic level that their anxiety is irrational and that the world doesn’t judge them as harshly as they judge themselves. Those with APD, on the other hand, lack this insight. They hold deep rooted feelings of insecurity and worthlessness that they believe to be factual.”

People with avoidant personality often feel socially awkward and inferior to others. They tend to be very sensitive to criticism and rejection and often avoid making friends or participating in social events unless they are sure of their welcome. Feelings of shame or self-loathing are more strongly associated with avoidant personality than social anxiety. This condition is not often diagnosed in children, though it often develops in childhood.

Avoidant Personality Disorder vs. Social Anxiety

Social anxiety and avoidant personality share an intense fear of being embarrassed or judged in social situations. People might describe a person with either condition as shy, timid, awkward, or fearful.

Fear associated with these conditions can present in many ways, such as:

Debate over whether avoidant personality is a more severe type of social anxiety exists among mental health experts. According to the fifth edition of the DSM, these issues are often diagnosed together and can overlap to the point where they might seem like different presentations of the same concern. But while an avoidant personality typically involves patterns of avoidance in most or all areas of life, social anxiety may only involve avoidance in a few specific situations. The DSM continues to categorize them separately.

Debate over whether avoidant personality is a more severe type of social anxiety exists among mental health experts.

The two issues continue to share similarities when it comes to risk factors. Genetic and environmental factors can contribute to the development of either condition. Avoidance can be a learned response. People might begin to avoid social situations after a negative experience, for example. Being shy as a child can also increase the likelihood that a person will go on to develop social anxiety or an avoidant personality, though being shy does not necessarily mean a person will develop either issue for certain.

Experiencing abuse, trauma, bullying, or other negative events in childhood can increase the risk for both social anxiety and avoidant personality. But neglect, particularly physical neglect, is a significant risk factor for avoidant personality. A 2015 study comparing the two conditions found that having disinterested caregivers, feeling rejected by caregivers, or not having enough affection in childhood was more common in people with avoidant personalities.

Certain risk factors do differ between the two conditions:

Should I Get Treatment for Social Anxiety or APD?

Therapy is generally recommended for both avoidant personality and social anxiety. Only a mental health professional can diagnose mental health issues. If you think you might have symptoms of either avoidant personality or social anxiety, making an appointment with a qualified therapist or counselor can be a good place to start.

Letting any potential counselors know your particular symptoms and describing your specific experience can help them decide whether they’re qualified to help you. Not every therapist has experience treating every mental health condition, but an ethical therapist will always let you know if they think another therapist might be more helpful.

Social anxiety is often treated with cognitive behavioral therapy (CBT). This therapy helps you identify thoughts that cause distress and affect you negatively. Once you identify them, you learn how to change them. You can do CBT alone, but some people find group therapy helpful.

Exposure-based CBT is a specific approach to CBT where you slowly expose yourself to feared situations. This approach often involves skills practice or role-playing techniques, both of which can help people get more comfortable interacting with others in the safe space of therapy.

According to a 2015 study, performing random acts of kindness for others led to a decrease in symptoms of social anxiety in study participants after 4 weeks.

While therapy can have great benefit, sometimes social anxiety doesn’t improve right away. If you are working with a counselor and still experience significant difficulty in your daily life, a psychiatrist may recommend medication, such as:

Anxiety medication can help relieve some symptoms of social anxiety, but it’s a good idea to continue with therapy at the same time, as therapy helps you learn how to cope with what you’re experiencing. This can have a more lasting effect on your symptoms.

Many people believe personality disorders are not treatable, but this isn’t the case. They can be difficult to treat, especially if you’ve had symptoms for a long time. But therapy can still be very helpful. People with avoidant personality often seek treatment when they experience loneliness and distress as a result of being unable to participate in social events.

Research has shown people with avoidant personality may do better in therapy if they have the support of family members.

Any kind of talking therapy can be helpful for avoidant personality. CBT is commonly used to treat this condition, but other helpful approaches include family and group therapy. Research has shown people with avoidant personality may do better in therapy if they have the support of family members. Group therapy can help people learn how to develop relationship and communication skills in a safe space, and it’s often recommended for treating personality disorders.

There’s no specific medication used to treat avoidant personality. However, antidepressants and anti-anxiety medications may help relieve some severe symptoms.

Conclusion

Social anxiety and avoidant personality have some similarities, and some approaches to treatment may be similar. Regardless of which condition you have, therapy can help. It’s important to reach out for help if you’re struggling with social situations. When social anxiety or avoidant personality go untreated, complications like depression, isolation, and substance abuse can develop. Some people may experience significant loneliness and distress.

Talking to a therapist can help you get a diagnosis. But you’ll also begin to learn ways to cope with the feelings you experience and explore methods of overcoming these feelings. Therapy can help you become more used to the company of others. In time, you may find it easier to participate in social situations.

If you need help finding a counselor in your area, our therapist directory is a good place to start. Remember, you aren’t alone!

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association. 103-110.
  2. Anxiety disorders. (2017, December 15). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders
  3. Avoidant personality disorder. (2017, November 20). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9761-avoidant-personality-disorder
  4. 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(5). doi: 10.1371/journal.pone.0122846
  5. Kvarnstorm, E. (2016, April 6). Avoidant personality disorder goes beyond social anxiety. Bridges to Recovery. Retrieved from https://www.bridgestorecovery.com/blog/avoidant-personality-disorder-goes-beyond-social-anxiety
  6. Lampe, L. (2016). Avoidant personality disorder as a social anxiety phenotype: Risk factors, associations and treatment. Current Opinion in Psychiatry, 29(1), 64-69. doi: 10.1097/YCO.0000000000000211
  7. Personality disorders. (2016, September 23). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463
  8. Smith, K. (2018, November 19). Avoidant personality disorder. Retrieved from https://www.psycom.net/avoidant-personality-disorder
  9. Social anxiety disorder (social phobia). (2017, August 29). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
  10. Trew, J. L., & Alden, L. E. (2015, June 5). Kindness reduces avoidance goals in socially anxious people. Motivation and Emotion, 39(6), 892–907. Retrieved from https://link.springer.com/article/10.1007/s11031-015-9499-5

Angry boy sits at table, looking at a puzzle.Oppositional defiant disorder (ODD) is a behavioral issue most often diagnosed in childhood. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists it in the category of disruptive, impulse-control, and conduct disorders.

ODD presents as a pattern of defiance, argumentativeness, anger, irritable mood, and/or vindictive behavior. For a diagnosis of ODD, the behavior must last 6 months or longer and occur with at least one person besides a sibling.

Children with mild ODD might only show symptoms at home or with family. Some children show behavioral symptoms without anger or irritation. But children who have mood symptoms usually also show argumentative and defiant behavior. Children who have ODD tend to justify their behavior, often blaming outbursts on unfair rules or the actions of others.

ODD and Mental Health

Children with ODD often have other mental health concerns, which may sometimes be mistaken for ODD. Issues commonly occurring alongside ODD include:

Recognizing co-occurring mental health issues is important, in part because ODD symptoms often improve when other concerns are treated. Symptoms that go untreated can make ODD more challenging to treat, and symptoms may get worse. An accurate diagnosis usually leads to the most improvement.

ODD Stigma and Associated Myths

Children with symptoms of ODD are often judged or viewed negatively because of their behavior. ODD may become a label to describe them. This stigma can have a negative effect on development and growth, especially when it stems from the (false) assumption that ODD can’t be treated.

If parents or teachers decide a child is problematic or will always misbehave, they may not pay attention to them or try to help them improve. Children may continue to act out as a result, and their behavior may get worse. They may continue to struggle at home or school. Having trouble developing friendships and other relationships is common. Children may also frequently come into conflict with authority figures throughout life.

If parents or teachers decide a child is problematic or will always misbehave, they may not pay attention to them or try to help them improve. Children may continue to act out as a result, and their behavior may get worse.

ODD may be partially stigmatized due to a fear of outbursts, violence, or aggressive behavior. While it is not typically characterized by violence, children may throw tantrums, attempt to annoy others and provoke reactions, and be difficult to work with in other ways. Stigma, and the isolation that results, can contribute to serious concerns, including depression, suicidal ideation, and substance abuse.

Stigma and myths about mental health issues often go hand-in-hand. Here are some common myths about ODD—and the facts to dispel them.

1. ODD only occurs in children.

While ODD is most often diagnosed in children, teenagers and adults can also have ODD. Symptoms of ODD usually first appear in childhood. When they aren’t diagnosed or treated, they can persist into adulthood.

Adults who have ODD typically show similar symptoms of anger and irritability. They might have difficulty concentrating, a tendency to hold grudges or seek revenge when they feel wronged, and a pattern of trying to control or disobey others. It’s common for adults with ODD to struggle in relationships and experience conflict with people in authority. Conflicts may lead to unemployment or legal concerns.

2. ODD and conduct disorder are the same thing.

Along with ADHD, conduct disorder is the condition that most commonly occurs with ODD. Having ODD, especially severe ODD, also increases the risk of developing conduct disorder, which affects about 30% of children with ODD, according to the American Academy of Child & Adolescent Psychiatry.

ODD involves irritable, argumentative, and defiant behavior. Those with ODD may defy or ignore rules or requests from authority figures, but behavior that’s violent or outright illegal isn’t common with ODD. Conduct disorder involves repeated violence, illegal activity, and/or disregard for others’ rights or property.

3. ODD is always a result of trauma.

It’s not fully known what causes ODD, but experts believe the condition most likely results from a combination of factors. While ODD may occur after an individual experiences trauma, this is not always the case.

Possible biological risk factors include family history of ODD, family history of mood issues, being exposed to toxins (including cigarette smoke), malnourishment, and brain impairment.

Possible social risk factors include poverty, neglect, unstable home life, and lack of supervision and involvement from parents.

Possible psychological risk factors include difficulty understanding social cues or developing relationships with peers. Having a parent who is frequently away or doesn’t seem to care is also a risk factor.

4. ODD is a result of bad parenting.

It’s true that ODD is associated with absent or neglectful parenting, but children with loving and present parents can also develop the condition. Research hasn’t determined a clear cause of ODD, but it’s likely to result from more than just parenting style. Some children may be genetically more likely to develop ODD. Other mental health and developmental issues can also contribute. When children first show symptoms of ODD, the way peers and parents respond can affect whether these behaviors get better or worse.

5. Punishment is the best way to correct behavior.

Research has shown that punishing behaviors associated with ODD does not help. In fact, harsh discipline is a risk factor for developing the condition. Inconsistent, severe punishment often leads to worse behavior. Experts also agree sending children to camps or retreats for “problem children” is unhelpful.

Finding the best way to discipline a child with ODD can be challenging. Strategies for parents of children with ODD include parent-management training, which teaches ways to positively respond to and discipline inappropriate and disruptive behavior.

6. ODD is impossible to treat. Expecting the behavior of individuals with ODD to improve is pointless.

ODD is very treatable. More than 65% of children with ODD see their symptoms go away in 3 years or less. It’s recommended that parents and teachers who note disruptive behavior consider underlying conditions instead of simply punishing or ignoring the child.

Treating children as if they’ll never improve can become a self-fulfilling prophecy. Children who are written off may doubt themselves or believe no one cares. As a result, they may be unmotivated to work on behavior, which may become worse.

When working with a child or young adult who has ODD, patience and compassion are key factors. It’s important to show children they’re loved and accepted, no matter how they act.

Helpful approaches to treatment may include:

Start here to find a licensed and compassionate therapist in your area who can help you, your family, or a loved one work through ODD and any co-occurring issues.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association. 103-110.
  2. Biederman, J., Faraone, S. V., Milberger, S., Jetton, J. G., Chen, L., Mick, E., Greene, R. W., & Russell, R. L. (1996). Is childhood oppositional defiant disorder a precursor to adolescent conduct disorder? Findings from a four-year follow-up study of children with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 35(9). Retrieved from https://www.jaacap.org/article/S0890-8567(09)63494-8/abstract
  3. Hamilton, S. S., & Armando, J. (2008). Oppositional defiant disorder. American Family Physician, 78(7). Retrieved from https://www.aafp.org/afp/2008/1001/p861.html
  4. Mental health: Overcoming the stigma of mental illness. (2017, May 24). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477
  5. ODD: A guide for families by the American Academy of Child and Adolescent Psychiatry. (2009). American Academy of Child and Adolescent Psychiatry. Retrieved from https://www.aacap.org/app_themes/aacap/docs/resource_centers/odd/odd_resource_center_odd_guide.pdf
  6. Oppositional defiant disorder. (2013). American Academy of Child & Adolescent Psychiatry. Retrieved from https://www.aacap.org/aacap/families_and_youth/facts_for_families/fff-guide/Children-With-Oppositional-Defiant-Disorder-072.aspx
  7. Oppositional defiant disorder (ODD). (2018, January 25). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831
  8. Oppositional defiant disorder (ODD) in children. (n.d.). Johns Hopkins Medicine Health Library. Retrieved from https://www.hopkinsmedicine.org/healthlibrary/conditions/mental_health_disorders/oppositional_defiant_disorder_90,p02573
  9. Signs & symptoms of oppositional defiant disorder. (n.d.). Valley Behavioral Health System. Retrieved from https://www.valleybehavioral.com/disorders/odd/signs-symptoms-causes

Blurred view of elderly woman with a migraineMigraine headaches are one of the most common chronic conditions worldwide. Depending on the study, chronic migraines affect around 1 in 10 people, with twice as many sufferers being female.

Migraine headaches are disabling and cause significant loss of productivity and quality of life. Once they strike, a migraine can last anywhere between 4 and 72 hours. In addition to substantially reducing quality of life, frequent migraines can place one’s job at risk and prevent daily functioning.

Currently, the causes of migraine headaches are not well understood. Genetics are thought to play a role as well as environmental effects and changes in the way the brain interacts with the trigeminal nerve, a pain pathway.

Maladaptive Response to Stress?

It may be that migraine headaches are a result of the brain’s maladaptive response to stress. Researchers have found that when a migraine is triggered, the body’s responses (pain, increases in stress hormones, nausea, and vomiting) are in excess of what is normal. Even during migraine-free periods, a migraine sufferer’s brain is more excitable in response to stimuli.

If we understand how the brain operates on a neural level, we know that much of what is going on inside the brain is inhibitory. It is not optimal to have cascades of neurochemicals circulating through the brain. Overexcitability in the brain reduces the effectiveness of the calming mechanisms in the brain and increase pain sensitivity. What this means is the brain’s response to stimuli between attacks is heightened in an abnormal way.

We know the experience of stress is a significant factor in migraines. Work stress and home stress contribute to the likelihood of a migraine episode.

Childhood Trauma and Headaches

We know that too much stress can change the brain and its reactivity to one’s inner environment, or thoughts, and one’s outer environment, or lights, sounds, and other stimuli. Adults who were exposed to ongoing stress or trauma while growing up often have an impaired ability to calm themselves both mentally and physiologically in response to stress.

A difficult childhood is not a life sentence of heightened stress and suffering. We can take steps to alter our response to stress.

When we look at migraine sufferers as a group, we see a connection between adverse childhood experiences (ACE) and migraine headaches. Examples of ACE are domestic violence, emotional neglect, emotional abuse, and sexual abuse.

Researchers have also begun to investigate the connection between adverse childhood experiences and headaches. Individuals who suffer from migraine headaches are more than twice as likely to have experienced ACEs such as domestic violence while growing up.

How Trauma Results in Migraine: A Possible Mechanism

The connection between childhood stress and migraines is likely linked, at least in part, through the hypothalamic-pituitary-adrenal axis (HPA axis).

The HPA axis is a complex set of interactions among the pituitary gland and the adrenal glands. This hypothalamic-pituitary-adrenal axis controls and regulates bodily processes related to stress reactions. It is easily understood as the fight or flight response. When an individual senses a threat, the body reacts appropriately. Energy is taken away from the digestive and immune systems and is moved to the muscles in order to get ready to run or fight. The adrenal glands are stimulated, and heart-rate, blood pressure, and breathing rates increase. This is an energy-expending state and not optimal for growth or restorative activities.

It is well understood that repeated exposure to stress and trauma during childhood often results in an impaired ability to regulate the stress response over one’s lifetime. Childhood trauma affects the HPA axis. What this means is that over time, the HPA axis loses its ability to effectively control the stress response. During times of upset, the person has an intense reaction that lasts too long. The result is overexposure of the body and brain to high levels of the stress hormone, cortisol.

Migraines may be tied to the same neurochemical conditions associated with trauma, depression, and anxiety, with an overactive stress response (de-regulation of the HPA axis) playing a role. An investigation into certain neurochemicals in migraine sufferers found abnormal patterns of hypothalamic hormonal secretion, a condition also associated with trauma and child abuse.

What Can We Do to Help?

A difficult childhood is not a life sentence of heightened stress and suffering. We can take steps to alter our response to stress. Exercise and meditation have been shown to help calm the mind and body. These activities can begin to reverse the damage caused by an overactive HPA axis. Cognitive behavioral therapy (CBT) is also an effective tool for learning coping strategies and allows individuals to take greater control of reactions to daily life events that cause stress.

Research on migraines and childhood trauma is relatively new and is not well understood. However, if we understand that stress plays a role in migraines, taking steps to reduce stress may help reduce the frequency and duration of migraine episodes. At the very least, a reduction in stress can help us in every area of life, giving us more resilience to deal with a migraine once triggered.

If you think stress or trauma are a source of migraines for you, learning how to manage your stress response in therapy could help. Begin your search for a licensed and compassionate counselor here.

References:

  1. Anda, R., Tietjen, G., Schulman, E., Felitti, V., & Croft, J. (2010). Adverse childhood experiences and frequent headaches in adults. Headache: The Journal of Head and Face Pain, 50(9), 1473-1481. doi: 10.1111/j.1526-4610.2010.01756.x
  2. Brennenstuhl, S., & Fuller‐Thomson, E. (2015). The painful legacy of childhood violence: Migraine headaches among adult survivors of adverse childhood experiences. Headache: The Journal of Head and Face Pain, 55(7), 973-983. doi: 10.1111/head.12614
  3. Dumas, P. (2014). Calling in sick? Good conversations about migraine at work. Retrieved from https://migraineagain.com/calling-sick-good-conversations-about-migraine-work
  4. Exercise and stress: Get moving to manage stress. (2018). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/exercise-and-stress/art-20044469
  5. Maleki, N., Becerra, L., & Borsook, D. (2012). Migraine: Maladaptive brain responses to stress. Headache: The Journal of Head and Face Pain, 52(2), 102-106. doi: 10.1111/j.1526-4610.2012.02241.x
  6. Migraine. (2018). Retrieved from https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201
  7. Goadsby, P. J. (2009). Pathophysiology of migraine. Neurologic Clinics, 27(2), 335-360. doi: https://doi.org/10.1016/j.ncl.2008.11.012
  8. Lubin, E. (2018). Migraine headache FAQs. Retrieved from https://www.emedicinehealth.com/migraine_headache_faqs/article_em.htm
  9. Nelson, S. M., Cunningham, N. R., & Kashikar-Zuck, S. (2017). A conceptual framework for understanding the role of adverse childhood experiences in pediatric chronic pain. The Clinical Journal of Pain, 33(3), 264-270. doi: 10.1097/AJP.0000000000000397
  10. Peres, M. F. P., Sanchez del Rio, M., Seabra, M. L. V., Tufik, S., Abucham, J., Cipolla-Neto, J., Silberstein, S. D., & Zukerman, E. (2001). Hypothalamic involvement in chronic migraine. Journal of Neurology, Neurosurgery, and Psychiatry, 71, 747-751. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737637/pdf/v071p00747.pdf
  11. Understanding the stress response. (2018). Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
  12. Woldeamanuel, Y., & Cowan, R. (2015). Worldwide migraine epidemiology: Systematic review and meta-analysis of 302 community-based studies involving 6,216,995. Neurology, 86(16). Retrieved from http://n.neurology.org/content/86/16_Supplement/P6.100

Young boy standing on step stool to steal cookies form kitchen cupboardLying is developmentally normal for children of all ages, even when a child lies frequently. Lying allows children to test the boundaries between fantasy and reality, to protect themselves from the consequences of their actions, and to better understand how other people think.

Some parents worry their children may become pathological or compulsive liars. However, lying is rarely cause for concern in children. Parents who worry about their child’s lying should know that lying is developmentally normal and may even be a sign that a child is hitting appropriate developmental milestones.

Nevertheless, some lying may signal a deeper problem, such as a mental health issue or a tendency to manipulate others. Parents concerned about their child’s lying should seek help from a therapist or a pediatrician. An expert who has experience working with children can help parents understand whether lying is age-appropriate or indicative of a potential problem.

Pathological vs. Compulsive Lying

Neither pathological nor compulsive lying are mental health diagnoses. Their existence remains controversial among many mental health clinicians. Some clinicians argue there is no such thing as pathological or compulsive lying. Others assert that these behaviors only arise as part of another diagnosis or as the product of fear, trauma, and other motivations.

Those who do distinguish pathological and compulsive lying from one another argue that the difference is one of intent. Pathological liars may lie for no clear reason, seemingly without planning or motive. For example, a child might claim something happened when it clearly did not, even when there is no reason—such as fear or wishful thinking—for them to do so.

Compulsive liars may use lying to get things they want or need or to escape punishment. This type of lying is much more common among children and is developmentally typical at many ages. For instance, a child might say they didn’t eat a slice of cake, even as their mouth is covered with crumbs. Or they might tell a story about a present they never received because they wish someone had given them that present.

Parents should know that children almost always lie for a reason. Identifying the reason is more important than stigmatizing or punishing the lie. Punishing lies may even encourage children to lie more, in the hopes that they will not be caught next time.

Signs of Compulsive Lying in Children

Parents should know that children almost always lie for a reason. Identifying the reason is more important than stigmatizing or punishing the lie. Punishing lies may even encourage children to lie more, in the hopes that they will not be caught next time.

Some warning signs a child’s lying might be a problem and not just developmentally typical behavior include:

Even when a child shows these symptoms, lying may be developmentally normal. It often goes away on its own without treatment or intervention. Numerous studies have even shown that lying can be a sign of empathy and appropriate social development.

Lying tends to peak between the ages of 3 to 8. Thereafter, children’s lies become more sophisticated and center around bolstering self-esteem and avoiding punishment.

Why Is My Child Lying?

Children lie for a wide variety of developmentally typical reasons. Those include:

Children may also lie for reasons that point to an underlying mental health issue. Those include:

Treating Child Compulsive Lying

Lying can be frustrating to parents, even when it is developmentally normal. A therapist can help parents determine whether lying is age-typical or the sign of a more serious problem.

Family therapy can help parents and children communicate better. Parents may learn strategies that reduce their child’s desire and incentive to lie. For example, rather than asking a child if they have broken the rules when the evidence suggests they have, a parent might simply talk about the broken rule. If a child lies because they fear punishment, therapy can help a parent and child move beyond fear and create fair, consistent family rules.

When a child’s lying causes problems for the child or family, individual counseling can support the child and help them lie less. A therapist may work with the child to ease anxiety and depression, boost self-esteem, and develop a strong sense of self. Children with a history of trauma may need help to process and talk about the trauma. Children with personality disorders may benefit from specific therapeutic techniques such as dialectical behavior therapy for borderline personality.

References:

  1. Dike, C. C. (2008, June 1). Pathological lying: Symptom or disease? Psychiatric Times, 7(25). Retrieved from http://www.psychiatrictimes.com/articles/pathological-lying-symptom-or-disease
  2. Ding, X. P., Wellman, H. M., Wang, Y., Fu, G., & Lee, K. (2015). Theory-of-mind training causes honest young children to lie. Psychological Science, 26(11), 1812-1821. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/0956797615604628
  3. Hausman, K. (2003). Does pathological lying warrant inclusion in the DSM? Psychiatric News, 38(1), 24-24. Retrieved from https://psychnews.psychiatryonline.org/doi/10.1176/pn.38.1.0024
  4. Miller, C. (2018, March 19). Why kids lie and what parents can do about it. Retrieved from https://childmind.org/article/why-kids-lie
  5. Talwar, V., & Lee, K. (2008). Social and cognitive correlates of children’s lying behavior. Child Development, 79(4), 866-881. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483871
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GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.

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