Dissociation can be described as feeling disconnected from the self, the world, or reality. Someone experiencing dissociation may not remember what happens during the episode. They might also feel as if they are observing themselves from an outside perspective.

Many people begin dissociating while experiencing abuse or another traumatic event. Dissociation can help people cope with what’s happening, but if it continues after the trauma stops, it can negatively affect a person’s life.

There are several types of dissociation, though they share some common features. According to Mental Health America, about a third of people experience dissociation on occasion. About 4% of people have more frequent or severe dissociation.

People who dissociate might:

• Seem distracted, not fully present
• “Space out” while talking or working
• Do things on autopilot
• Seem dreamy or move slowly
• Say or do out-of-character things
• Have gaps in their memories or sense of time

Dissociative identity (DID) is perhaps the most well-known dissociative condition. It occurs in about 1.5% of the population, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

People with DID have more than one identity state. These different identities, often called alters, can take control of the person’s thoughts and behavior, often during times of trauma or stress. The person may not remember what happens when an alter is in control.

As with other types of dissociation, DID can develop in response to trauma. It’s often linked to ongoing trauma in childhood.

What Does Dissociation Feel Like?

Mild dissociation is common. Most people daydream or lose track of time on occasion. Even briefly seeing familiar surroundings as strange or unrecognizable isn’t unusual. If these feelings happen often, last for a long time, or cause distress, it may be a good idea to talk to a counselor.

How dissociation feels may vary based on the type of dissociation and the person who has it. There are three main types of dissociation: dissociative identity, dissociative amnesia, and depersonalization-derealization. The DSM also lists other specified dissociative disorder and unspecified dissociative disorder.

People with dissociative identity might:

• Feel like they’re more than one person
• Feel more than one other “self” within their thoughts
• Take on other identifies that have different memories, mannerisms, or speech patterns
• Lose memories or periods of time. Lost time may relate to switching between identities (alters)
• Have flashbacks, nightmares, or sleep issues
• Have panic attacks
• Have depression, anxiety, or other mental health conditions

DID can cause distress and emotional strain. People with DID also have an increased risk for self-harm and suicidal thoughts. They may feel powerless to maintain their identity, afraid of what their alter states might do while in control, and frustrated with their inability to remember events.

Dissociative amnesia is memory loss associated with trauma. People may:

• Lose memories of the traumatic event or time period
• Lose only memories of a certain part of an event or time period
• Lose memories of a specific person
• Be unable to remember new events
• Be unable to remember anything about themselves or use learned skills
• Have memory gaps or flashbacks
• Have difficulty forming relationships
• Experience confusion or distress
• Have trouble sleeping

Dissociative fugue, a rare form of dissociative amnesia, can indicate DID. It occurs when a person has a period of memory loss and takes on a new identity away from home. The person may not regain memories and identity for some time.

Depersonalization-derealization disorder (DDD) is characterized by a sense of detachment from reality. People with this condition may:

• See things and people as foggy or dreamlike
• Feel that time is moving too fast or too slow
• Feel like their actions aren’t their own. Events may seem like they’re from a movie.
• Feel like their surroundings aren’t real, while being aware that they are real

People often seem unconcerned, detached, or disoriented during episodes. But because people with DDD remain aware of reality while feeling disconnected from it, the condition often causes significant distress.

5 Triggers for Dissociation

Dissociation typically develops in response to trauma. Research has linked dissociation and several mental health conditions, including borderline personality, ADHD, and depression.

Dissociative depression

Dissociative depression, a type of chronic depression, tends to develop earlier than other types of depression, sometimes as early as childhood. It’s been linked to trauma and post-traumatic anger. People may have more somatic symptoms, like pain, and are at increased risk for suicidal thoughts. They may experience mood swings, difficulty concentrating, and weight fluctuation more frequently than people with other types of depression.

Research suggests this type of depression is most common in women who experienced childhood sexual abuse. It’s often treatment-resistant—until dissociative symptoms are treated. Then the depression typically improves.

Borderline personality (BPD)

Some characteristics of dissociation are similar to those of borderline personality. For example, an alter identity may be seen as an unstable sense of self. Self-harm, suicidal ideation, and difficulty managing emotions when stressed are associated with both dissociative issues and BPD. People with BPD also often struggle in relationships and avoid difficult experiences, and many hear voices. BPD is also commonly linked to childhood trauma and neglect.

Seventy-five to eighty percent of people with BPD may experience dissociation during stress. In fact, dissociation is one of nine diagnostic criteria for BPD (five are needed for diagnosis). According to a 2016 analysis of 10 studies, dissociation occurs more often with BPD than with other mental health issues.

Recent research suggests dissociation may affect memory and emotional learning, which may be one reason why BPD is often difficult to treat.

Addiction

Research has linked addictive behaviors and dissociation. A 2005 study found that more than 17% of people getting help for substance abuse had a form of dissociation. Addiction, which can be seen as a type of dissociative behavior, has further been linked to trauma and alexithymia, a condition where people can’t identify their emotions. A study published in 2014 suggested trauma, alexithymia, and dissociation could often predict alcohol dependence. Like dissociation, addiction to alcohol may develop in response to trauma.

A 2015 study looking at 68 people who were substance-free for at least six months found that almost 25% had severe depersonalization symptoms, while over 40% experienced mild depersonalization. The study did not determine a cause of the symptoms, but the findings suggest a further link between addiction and dissociative symptoms.

Obsessive-compulsive disorder (OCD)

Multiple studies have found links between dissociation and OCD. Dissociative symptoms occur often with OCD. People with OCD might have dissociative episodes without having a specific dissociative condition. OCD symptoms can resemble dissociative symptoms, especially when the person experiences distress related to their thoughts or compulsions. People trying to resist intrusive thoughts, for example, may push them away by making themselves experience memory loss (forcible amnesia).

When people have both conditions, dissociative symptoms tend to be more severe. The risk for depression also increases, as does the risk for a co-occuring personality disorder.

Attention-deficit hyperactivity (ADHD)

ADHD is often misdiagnosed. Research suggests some children thought to have ADHD may in fact be showing signs of trauma. Telling the two conditions apart can be difficult. Blanking out while remembering something frightening, having difficulty focusing, and acting out are all signs of both posttraumatic stress and ADHD. A small 2006 study found that children who experienced abuse were more likely to show apparent symptoms of ADHD but actually have a dissociative condition.

Many children exposed to repeated trauma or abuse go on to develop a dissociative condition.
Though they may still have ADHD, it’s often not be the primary cause of symptoms. Mental health professionals may find it helpful to evaluate for posttraumatic stress as well as ADHD and ask the children they work with about home and school.

A study published in 2017 further linked ADHD and dissociation. According to the study, people with BPD are more likely to have a history of childhood trauma, dissociation, and ADHD symptoms.

Does the Cause of Dissociation Influence How It’s Treated?

Therapy is the primary treatment for dissociation. Medication might be recommended when severe symptoms of depression or anxiety accompany dissociation, but there is no medication that treats dissociation itself. If another mental health issue occurs with dissociation, effective treatment should consider both concerns.

People with borderline personality, ADHD, depression, substance abuse issues, or OCD can also benefit from therapy, but the most helpful types of therapy vary.

Dialectical behavior therapy is considered the most effective therapy for BPD, but some research suggests dissociation may negatively impact the success of DBT. People who have both conditions may respond better to treatment that focuses on dissociative symptoms. Treatment that focuses on managing BPD symptoms may not help dissociative symptoms. Research shows it’s important to address the underlying trauma as well.

Dissociative depression is often resistant to treatment when dissociation symptoms aren’t addressed, so it’s important for mental health professionals to be able to recognize dissociative issues in therapy. If chronic depression is treated with antidepressants, people with dissociative depression may see little improvement. But treating the dissociation often helps improve depression.

One study suggested screening people with substance abuse issues for dissociative symptoms, in order to treat both issues. Dissociation symptoms in people with addiction could persist if only addiction is treated.

Dissociative symptoms often go unrecognized in therapy, especially when the person seeking support has another mental health condition. Dissociation is treatable, but it’s important for therapists to recognize and address symptoms when they occur with other mental health conditions. Treatment may have less benefit when the person seeking help is dissociating, as they may not be as “present” in therapy.

When seeking help, tell a therapist about all symptoms, even if they don’t seem connected. Therapy is most effective if you can discuss all symptoms and begin to work through underlying trauma.

Remember you are not alone! Help is available. Begin your search for a counselor today.

References:

1. American Psychiatric Association. (2018). What are dissociative disorders? Retrieved from https://www.psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders
2. Craparo, G., Ardino, V., Gori, A., & Caretti, V. (2014). The relationships between early trauma, dissociation, and alexithymia in alcohol addiction. Psychiatry Investigation, 11(3), 330-335. doi: 10.4306/pi.2014.11.3.330
3. Dissociative disorders. (2017, November 17). Retrieved from https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/diagnosis-treatment/drc-20355221
4. Endo, T. (2006). Attention-deficit/hyperactivity disorder and dissociative disorder among abused children. Psychiatry and Clinical Neurosciences, 60(4), 434-438. doi: 10.1111/j.1440-1819.2006.01528.x
5. Foster, C. (2016). Understanding dissociative disorders. Retrieved from https://www.mind.org.uk/media/4778451/understanding-dissociative-disorders-2016.pdf
6. Goff, D. C., Olin, J. A., Jenike, M. A., Baer, L., & Buttolph, M. L. (1992). Dissociative symptoms in patients with obsessive-compulsive disorder. The Journal of Nervous and Mental Disease, 180(5), 332-337. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/1583477
7. Kleindienst, N., Limberger, M. F., Ebner-Priemer, U. W., Keibel-Mauchnik. J., Dyer, A., Berger, M., Schmahl, C., & Bohus, M. (2011). Dissociation predicts poor response to dialectical behavior therapy in female patients with borderline personality disorder. Journal of Personality Disorders, 25(3), 432-447. doi: 10.1521/pedi.2011.25.4.432
8. Krause-Utz, A., & Elzinga, B. (2018). Current understanding of the neural mechanisms of dissociation in borderline personality disorder. Current Behavioral Neuroscience Reports, 5(1), 113-123. Retrieved from https://link.springer.com/article/10.1007%2Fs40473-018-0146-9
9. Kulacaogu, F., Solmaz, M., Ardic, F. C., Akin, E., & Kose, S. (2017, September 30). The relationship between childhood traumas, dissociation, and impulsivity in patients with borderline personality disorder comorbid with ADHD. Psychiatry and Clinical Psychopharmacology, 27(4), 393-402. Retrieved from https://www.tandfonline.com/doi/full/10.1080/24750573.2017.1380347
10. Mosquera, D., & Steele, K. (2017). Complex trauma, dissociation and borderline personality disorder: Working with integration failures. European Journal of Trauma and Dissociation, 1(1), 63-71. Retrieved from https://www.sciencedirect.com/science/article/pii/S2468749917300145
11. Ruiz, R. (2014, July 7). How childhood trauma could be mistaken for ADHD. The Atlantic. Retrieved from https://www.theatlantic.com/health/archive/2014/07/how-childhood-trauma-could-be-mistaken-for-adhd/373328
12. Saddichha, S., Pradhan, N., Gupta, H. (2011). A case of obsessive-compulsive disorder presenting as dissociative disorder: The role of sodium thiopental interview. The Primary Care Companion for CNS Disorders, 13(3). doi: 10.4088/PCC.10l01134
13. Sar, V. (2015). Dissociative depression is resistant to treatment-as-usual. Journal of Psychology and Clinical Psychiatry, 3(2). Retrieved from https://pdfs.semanticscholar.org/2e1f/54678c76ed2071655c9378ce60c56d4abfc1.pdf
14. Sar, V. (2014). The many faces of dissociation: Opportunities for innovative research in psychiatry. Clinical Psychopharmacology and Neuroscience, 12(3), 171-179. doi: 10.9758/cpn.2014.12.3.171
15. Scalabrini, A., Cavicchiolo, M., Fossati, A., & Maffei, C. (2016, November 21). The extent of dissociation in borderline personality disorder: A meta-analytic review. Journal of Trauma and Dissociation, 18(4), 522-543. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/15299732.2016.1240738
16. Schafer, I., Langeland, W., Hissbach, J., Luedecke, C., Ohlmeier, M. D., Chodzinski, C. … Driessen, M. (2010, June 1). Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both-A multi-center study. Drug and Alcohol Dependence, 109(1-3), 84-89. doi: 10.1016/j.drugalcdep.2009.12.012
17. Sirvent, C., & Fernandez, L. (2015, May 11). Depersonalization disorder in former addicts (Prevalence of depersonalization-derealization disorder in former addicts). Journal of Addiction Research & Therapy, 6. Retrieved from https://www.omicsonline.org/open-access/depersonalization-disorder-in-former-addicts-prevalence-of-depersonalizationderealization-disorder-in-former-addicts-2155-6105-1000225.php?aid=52845
18. Spiegel, D. (2017). Dissociative amnesia. Retrieved from https://www.merckmanuals.com/home/mental-health-disorders/dissociative-disorders/dissociative-amnesia

Misophonia, sometimes called selective sound sensitivity syndrome, is sensitivity to specific sounds. Some common triggers include eating sounds such as chewing, throat sounds, nasal sounds such as a person blowing their nose, and repetitive noises such as tapping or clicking a pen.

While it is a potentially challenging symptom, misophonia is not a mental health diagnosis. Recent research indicates that 4.6% of U.S. adults experience clinical levels of misophonia, though 78.5% report sensitivity to misophonic sounds to some degree.

Misophonia can be extremely distressing both to the person with misophonia and their loved ones. It can cause conflict in relationships and make it difficult for couples to go to certain public places. In addition, sensitivity to the sounds a romantic partner makes may feel hurtful or critical to the partner who is making them.

How Misophonia Impacts Relationships

People with misophonia may struggle to gain understanding and acceptance from their partner. A partner might dismiss the misophonia, arguing the person is being too sensitive or controlling. The person with misophonia may also be critical of their partner when they make noises perceived to be annoying.

In relationships, misophonia can be a source of conflict, hurt feelings, and criticism on both sides. Some common issues include:

• Parenting children together. Many children make loud, annoying, or repetitive noises. This can make it difficult to equitably distribute the parenting load and may also cause the person with misophonia to be angry or impatient with the child.
• Going out in public. Common misophonia triggers include the sounds of people eating, clicking sounds such as pens and clocks, sounds associated with driving and traffic, and other people’s body sounds.
• Eating together. Many people with misophonia are sensitive to sounds such as chewing and silverware scraping against a plate.
• Understanding and identifying misophonia. The partner of a person with misophonia may think their partner is exaggerating or being excessively critical. The person with misophonia may not understand that their sensitive reaction to sounds is not typical.

A person with misophonia isn’t just annoyed by certain sounds; they find these sounds intolerable.

According to Melissa Klass, LMFT, the emotional impact of misophonia often gets misunderstood in relationships. “Partners sometimes assume the reaction is about them or their behavior, when in reality the nervous system is reacting very quickly to a specific sound,” Klass explains. “Part of the work in couples therapy is helping both people understand that the reaction is real while also finding ways for the couple to respond to triggers without shame or blame.”

Some even describe the sensation as physically painful, while others experience revulsion and disgust. In the context of a relationship, both partners may feel they have to plan their lives around misophonia. When a partner of a person with misophonia makes a triggering sound, they may feel judged, shamed, and criticized.

Misophonia Relationship Tips

People with misophonia may be able to improve their relationships by:

• Talking openly with their partner about their misophonia. Clear communication about triggers and needs can help partners understand and support each other.
• Seeking individual treatment for misophonia. Research demonstrates that CBT can effectively reduce distress related to tinnitus, hyperacusis, and misophonia.
• Ruling out medical causes. Studies suggest that 12% of patients with misophonia also have tinnitus, Autism, sensory processing disorder, and other diagnoses may also play a role in misophonia.
• Talking about how certain sounds make you feel rather than blaming or shaming your partner. Expressing disgust at the sound of chewing can be hurtful. Telling your partner that loud chewing makes you feel anxious or overwhelmed, even when you love the other person, is often more productive.
• Practicing strategies for managing your emotional reactions. Deep breathing, visualization, and positive affirmations, for example, may help with angry reactions to everyday sounds.
• Identifying your misophonia triggers. The more specific you can get, the better. One strategy for coping with misophonia is to slowly expose yourself to your triggers at low doses and in low-stress situations. This strategy works best with the help of a therapist or doctor.
• Try carrying earplugs when you go out in public. This may enable you and your partner to enjoy yourselves in public settings that might otherwise prove difficult or overwhelming.
• “When couples talk about misophonia, the goal isn’t to eliminate every trigger immediately,” says Melissa Klass, LMFT. “The goal is helping partners shift from reacting to each other toward working together against the trigger itself.”

People in relationships with partners who have misophonia can support their relationship and partner by:

• Taking misophonia seriously. If your partner says they cannot stand a sound, believe them and empathize with their emotions. Your partner may feel panic, rage, or pain in response to sounds that are neutral or only mildly annoying to you.
• Practicing self-care. If your partner is unable to go to certain places or do activities that you enjoy, do them on your own or recruit a friend.
• Separating your partner’s reaction to sounds from their feelings about you. It can be hurtful if your partner dislikes a sound you make, such as chewing or clicking a pen. This reaction is about the sound, not their feelings for you.
• Making reasonable accommodations for your partner’s needs. If you make a sound your partner cannot tolerate—such as chewing with your mouth open—it’s easy to feel defensive. But when this sound is something you can easily change, try to do so. People make many changes, small and large, in relationships. Reminding yourself of this fact can make it easier to change the sounds you make.
• Helping your partner identify misophonia triggers. Try to narrow to a list of specific triggers. For example, “traffic sounds” is vague and make numerous public outings difficult. Disliking squealing tires is more specific. Specific information makes it easier to work around your partner’s sound sensitivities.

Recent research shows both short-term and long-term efficacy of CBT for misophonia, with 37% showing clinical improvement. However, treatment approaches continue to evolve as researchers better understand this condition.

Couples Counseling and Misophonia

Individual counseling may help a person with misophonia better understand their diagnosis and triggers, develop coping skills, and perhaps even overcome their triggers through progressive exposure.

Couples counseling can help partners understand one another’s needs and may empower both partners to stop misophonia from undermining their relationship and quality of life. A compassionate therapist may:

• Help couples strategize ways to work around the misophonia. This might include creating quiet spaces at home or developing signals for when triggers occur.
• Support partners in better-balancing family and household labor when misophonia makes certain tasks—such as caring for a crying baby—difficult.
• Empathize with one another’s emotions. People with misophonia may feel dismissed and poorly understood by their partners, who may feel criticized or judged for their own sounds or resentful that misophonia limits the activities they can do together.
• Foster productive communication that avoids blame and shame. Learning to discuss triggers and needs without defensiveness benefits both partners.
• Teach couples skills to foster intimacy and closeness even when some outings and tasks are impossible.

The right therapist helps both partners feel respected and safe. Therapists offer solutions without judgment in the privacy of a completely confidential session and can help you set goals that align with your values. Find a therapist near you who can help.

• Aazh, H. (2025). Cognitive Behavioural Therapy (CBT) for Managing Tinnitus, Hyperacusis, and Misophonia: The 2025 Tonndorf Lecture. Brain Sciences, 15(5), 526. https://doi.org/10.3390/brainsci15050526
• Dixon, L. J., Schadegg, M. J., Clark, H. L., Sevier, C. J., & Witcraft, S. M. (2024). Prevalence, phenomenology, and impact of misophonia in a nationally representative sample of U.S. adults. Journal of Abnormal Psychology, 133(5), 403-412. https://doi.org/10.1037/abn0000904
• Guzick, A. G., Rast, C. E., Maddox, B. B., Rodriguez Barajas, S., et al. (2023). Clinical characteristics, impairment, and psychiatric morbidity in 102 youth with misophonia. Journal of Affective Disorders, 323, 728-738.
• Jager, I. J., Vulink, N. C., Bergfeld, I. O., van Loon, A. J., & Denys, D. (2021). Cognitive behavioral therapy for misophonia: A randomized clinical trial. Depression and Anxiety, 38(7), 708-718. https://doi.org/10.1002/da.23127
• Palumbo, D. B., Alsalman, O., Ridder, D. D., Song, J., & Vanneste, S. (2018). Misophonia and potential underlying mechanisms: A Perspective. Frontiers in Psychology, 9. doi: 10.3389/fpsyg.2018.00953
• Pfeiffer, E., Allroggen, M., & Sachser, C. (2024). The prevalence of misophonia in a representative population-based survey in Germany. Social Psychiatry and Psychiatric Epidemiology, 60, 257-264. https://doi.org/10.1007/s00127-024-02707-0
• Rosenthal, M. Z., Anand, D., Cassiello-Robbins, C., et al. (2022). Misophonia, psychiatric symptoms, and lifetime prevalence of psychiatric disorders in a large sample. Comprehensive Psychiatry, 115, 152302.

References:

1. Aazh, H. (2025). Cognitive Behavioural Therapy (CBT) for Managing Tinnitus, Hyperacusis, and Misophonia: The 2025 Tonndorf Lecture. Brain Sciences, 15(5), 526. https://doi.org/10.3390/brainsci15050526
2. Dixon, L. J., Schadegg, M. J., Clark, H. L., Sevier, C. J., & Witcraft, S. M. (2024). Prevalence, phenomenology, and impact of misophonia in a nationally representative sample of U.S. adults. Journal of Abnormal Psychology, 133(5), 403-412. https://doi.org/10.1037/abn0000904
3. Guzick, A. G., Rast, C. E., Maddox, B. B., Rodriguez Barajas, S., et al. (2023). Clinical characteristics, impairment, and psychiatric morbidity in 102 youth with misophonia. Journal of Affective Disorders, 323, 728-738.
4. Jager, I. J., Vulink, N. C., Bergfeld, I. O., van Loon, A. J., & Denys, D. (2021). Cognitive behavioral therapy for misophonia: A randomized clinical trial. Depression and Anxiety, 38(7), 708-718. https://doi.org/10.1002/da.23127
5. Palumbo, D. B., Alsalman, O., Ridder, D. D., Song, J., & Vanneste, S. (2018). Misophonia and potential underlying mechanisms: A Perspective. Frontiers in Psychology, 9. doi: 10.3389/fpsyg.2018.00953
6. Pfeiffer, E., Allroggen, M., & Sachser, C. (2024). The prevalence of misophonia in a representative population-based survey in Germany. Social Psychiatry and Psychiatric Epidemiology, 60, 257-264. https://doi.org/10.1007/s00127-024-02707-0
7. Rosenthal, M. Z., Anand, D., Cassiello-Robbins, C., et al. (2022). Misophonia, psychiatric symptoms, and lifetime prevalence of psychiatric disorders in a large sample. Comprehensive Psychiatry, 115, 152302.

Rejection is dangerous. A broken heart is similar to a broken arm. The pain of social rejection often leads to an avalanche of emotional and cognitive consequences, but mindfulness can be an efficient healer.

I originally wrote these meditations for a work-related event with the day’s theme as “Be Present.” In the 72 hours before the event, I experienced an intense and unexpected sequence of social rejection from individuals who overlap in my personal and professional circles.

As I sent a clear and honest email about my feelings and boundaries the morning before my presentation for work, I said to myself, “The last thing I want to do is be present for pain.” I was quickly reassured by the prospect that perhaps this was the exact dose of medicine I needed.

We are social animals, hardwired for connection, belonging, and acceptance—needs that originate from our ancestral tribal roots. Personally and professionally, I’ve struggled with rejection, especially these past 3 years. And particularly as a woman with a sexual trauma history and an abusive childhood, this political climate is toxic to me.

This social rejection and attack on my person on a federal level is compounded by more usual, daily forms of rejection that never used to bother me, ones I didn’t even notice as forms of rejection: delayed answers to texts, the lack of recognition at work, the lack of likes on an Instagram photo, my husband leading with asking me if I can pick up some toilet paper before, if at all, asking me how my day went.

All this to say: When isolated moments of more intense rejection strike, such as the one before my work-related meditation workshop, I learned the degree to which I overlook assessing for rejection in my work as a therapist and the degree to which I’ve become normalized to it.

Coping with the Rejections of Daily Life

Ironically, I’m writing this article about rejection without the guarantee it will be accepted. I accept rejection is a part of the human condition, but over time and without care, rejection can erode motivation, self-esteem, and courage. I do know that when I feel rejection, mindfulness meditation is one evidenced-based coping strategy that works for me.

Science supports the relationship between rejection and brain chemistry, just as science supports the relationship between mindfulness and brain chemistry.

Science supports the relationship between rejection and brain chemistry, just as science supports the relationship between mindfulness and brain chemistry.

According to licensed psychologist Guy Winch, PhD, “Rejection piggybacks on physical pain pathways in the brain. fMRI studies show that the same areas of the brain become activated when we experience rejection as when we experience physical pain.”

He reports that rejection affects our intelligence, reason, and self-esteem. But mindfulness makes us less sensitive to feel rejection for its effective use in emotional regulation, because mindfulness allows individuals to focus on the present moment while calmly acknowledging and accepting one’s feelings and thoughts.

Two Meditations to Help Heal the Pain of Rejection

Dr. Alexandra Martelli, the lead author of a study recently published in Social Cognitive and Affective Neuroscience, found a correlation between mindfulness and reduced social distress in fMRI imaging, as researchers found there was less activation in the region of the brain associated with the inhibitory regulation of both physical and social forms of pain. I offer below two meditations that I wrote that can apply to healing the pain of rejection.

To Gain Perspective: Limited One Minute Metta Meditation

Take one deep inhale, filling your abdomen with air. Slowly exhale. Repeat two times. Repeat to yourself three times: “Like clouds, this will pass.” Take one deep inhale, filling your abdomen with air. Slowly exhale. Repeat two times.

To Be Present and Focused on the Self: Guided Metta Meditation with Visualizations 

Metta: “I am present. I am ready. I am able. I am worthy.”

Allow your eyes to close if you are comfortable doing so. You can take a moment here to make any adjustments to your posture that you need to make to be comfortable. Begin this exercise by making yourself feel comfortable. There is no wrong way to sit, to breathe, to be. There’s no wrong way to do this. You are here now, as yourself, in this room.

Take this time to experience a few, deliberate inhales and exhales at a pace that feels comfortable for you. As you inhale, fill your abdomen with air like you are filling a balloon. Slowly exhale. Continue breathing like this. Leave a few moments of silence.

You might imagine yourself like a snow globe that has been shaken up. Imagine that you set the snow globe down and you watch as all the little snowflakes and sparkles come to rest on the bottom. Letting everything in your body settle down and rest. Continue to experience a few, deliberate inhales and exhales at a pace that feels comfortable for you. Leave a few moments of silence.

Now, start to bring to mind your desire for clarity, calm, and healing. You might even reflect on a time when you felt particularly focused, productive, attractive, connected, confident, or accomplished. Leave a few moments of silence.

Using this intention or memory, you can start to repeat some phrases to yourself. In your mind, you can say to yourself: “I am present. I am ready. I am able. I am worthy.” Whenever the mind wanders, just come back to these phrases. Leave a few moments of silence.

If your mind is wandering, come back to these phrases of goodwill for yourself: “I am present. I am ready. I am able. I am worthy.” Leave a few moments of silence.

Throughout your day, you can come back to your breathing or to these phrases whenever you need them. Try to maintain some of this goodwill you have cultivated for yourself. When you are ready, you can open your eyes.

References:

1. Ireland, T. (2014, June 12). What does mindfulness meditation do to your brain?. Scientific American. Retrieved from https://blogs.scientificamerican.com/guest-blog/what-does-mindfulness-meditation-do-to-your-brain
2. McNelll, B. (2018, June 14). Social rejection is painful and can lead to violence: A new study suggests that mindfulness may be a solution. Virginia Commonwealth University News. Retrieved from https://news.vcu.edu/article/Social_rejection_is_painful_and_can_lead_to_violence_A_new_study

Stuttering is a complex speech issue that affects about 1% of adults. People who stutter may become socially anxious, fear public speaking, or worry their stuttering will undermine their performance at work or school.

Research shows that stuttering is not a mental health diagnosis, and anxiety is not the root cause of stuttering. Anxiety can, however, make stuttering worse. This can create a vicious feedback loop in which a person fears stuttering, causing them to stutter more. In some cases, anxiety about stuttering may disrupt a person’s relationships and ability to communicate.

What Causes Stuttering?

The hallmark of stuttering is repeating certain sounds, syllables, or words. It exists on a continuum from mild to severe. In some people, stuttering is so mild that others might not notice it at all. For a minority of people who stutter, the condition can be so severe that it makes it extremely difficult to communicate at all.

Most people who stutter fall somewhere in the middle. They stumble over words and repeat certain syllables. They may feel anxious about speaking, and others may notice their speech is not typical. But they’re able to speak to others, and others are able to understand what they say.

Types of Stuttering

Researchers used to think that stuttering was a mental health problem caused by trauma or fear. While it’s possible for trauma to cause stuttering, it’s rare. Instead, providers divide stuttering into two distinct types:

Developmental stuttering

Developmental stuttering is the most common type of stuttering. Common among children ages 2-6 who are learning to speak, it usually goes away on its own. Five to 10 percent of children stutter at some point, and at least 75% outgrow it. For the remaining 25%, stuttering may continue to be a problem in adulthood.

Developmental stuttering is often much worse when a child is anxious. The speech of children who stutter may improve when they speak for longer periods. This means the first few sentences of a conversation may be slow and halting, but as a child become more relaxed, they may stutter less.

Developmental stuttering runs in families. This suggests a genetic link, and researchers have identified a few genes linked to stuttering. However, the specific causes of and triggers for developmental stuttering are still not fully understood.

Neurogenic stuttering

Neurogenic stuttering is much less common than developmental stuttering. It’s due to a problem with the brain caused by an injury, developmental issue, or disease. For example, some people develop a stutter following a stroke or a traumatic brain injury (TBI).

Although anxiety may make neurogenic stuttering worse, anxiety is more closely tied to developmental stuttering.

Negative experiences with others can fuel a person’s anxiety about stuttering, and this anxiety may make stuttering worse.

The Link Between Anxiety and Stuttering

For many people, verbal communication is an important way to connect with others. Stuttering makes this communication more difficult. This may trigger anxiety, especially abut social relationships. A 2009 study found stuttering increased the odds of being diagnosed with anxiety by six- to seven-fold and increased the likelihood of a diagnosis of social anxiety 16- to 34-fold. Another 2009 study found that 50% of adults who stutter have social anxiety.

Stuttering may change the way people relate to the person who stutters. Children who stutter sometimes experience bullying and isolation. Adults may struggle to feel heard at work or in high-pressure situations, such as speaking publicly at an academic conference. Negative experiences with others can fuel a person’s anxiety about stuttering, and this anxiety may make stuttering worse.

A person who stutters may also have false beliefs about stuttering, such as that stuttering necessarily means others won’t take them seriously or listen to them. This fear may affect major life decisions such as where to go to school and which jobs to seek. For example, a talented researcher might opt not to speak at a conference or accept a professorship because of their fears about public speaking.

Coping with Stuttering-Related Anxiety

People who experience anxiety related to stuttering may find relief in a number of strategies. Those include:

• Relaxation exercises. Meditation, deep breathing, and positive self-talk may help.
• Support groups. Spending time with other people who stutter through a support group can make stuttering feel less isolating, alleviating anxiety.
• Practicing social skills. Some people who stutter deliberately avoid social situations because of their anxiety. This can undermine their social skills, making them feel more anxious in social situations. Finding opportunities to practice communication may help.
• Education about stuttering. Understanding what stuttering is may help some people feel better about their stuttering.

How Parents Can Help With Stuttering-Related Anxiety

Most people who stutter are children. Parents and other family members can do a lot to help. Try the following:

• Create a relaxed environment around speech and communication. Don’t talk over your child, correct their speech, or ask them to speak more quickly.
• Attentively listen to your child while they speak. Children who stutter may worry the person to whom they are speaking is annoyed or bored. Give your child time.
• Don’t correct your child’s stutter or give them the word they appear to be looking for.
• Encourage your child to talk about their feelings about stuttering. Reassure them that stuttering is common and offer support for the anxiety they feel.
• Consider family therapy. Counseling in a family setting can help destigmatize stuttering. The right therapist can offer each member of the family specific strategies for supporting a child who stutters.

How Therapy Can Help with Anxiety Caused by Stuttering

Stuttering can be treatable. Many people see immense improvements in their speech after seeking help from a speech-language pathologist. A therapist can help with anxiety and other stuttering-related issues, allowing a person who stutters to focus on overcoming their speech difficulties.

A strong therapeutic relationship is the most important factor in therapy’s success. Research also shows specific techniques can help with stuttering-related anxiety. Exposure therapy may help people who have anxiety about stuttering in specific situations, such as on a date or while at a conference for work. Cognitive-behavioral therapy (CBT) can curb social anxiety by helping people identify, correct, and eventually prevent automatic self-defeating thoughts.

Even for people who continue stuttering, therapy can restore a sense of self-worth. Addressing the anxiety stuttering causes may prevent it from getting worse. Stuttering does not have to undermine a person’s quality of life or ability to succeed. It’s just one of many human differences. For many people who stutter, therapy offers a path out of shame and isolation and into confidence and better relationships. With the right support, people who stutter may no longer see their stuttering as a deficit or something to fear.

References:

1. Büchel, C. & Sommer, M. (2004). What causes stuttering? PLoS Biology, 2(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC340949
2. Craig, A. & Tran, Y. (2005, January 5). What is the relationship between stuttering and anxiety? Retrieved from https://www.stammering.org/speaking-out/articles/what-relationship-between-stuttering-and-anxiety
3. Iverach, L., O’Brian, S., Jones, M., Block, S., Lincoln, M., Harrison, E., . . . Onslow, M. (2009). Prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Journal of Anxiety Disorders, 7(23), 928-934. doi: 10.1016/j.janxdis.2009.06.003
4. Menzies, R. G., Onslow, M., Packman, A., & O’Brian, S. (2009). Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists. Journal of Fluency Disorders, 3(34), 187-200. doi: 10.1016/j.jfludis.2009.09.002

Sleepwalking and sleeptalking both belong to a group of behaviors called parasomnias—unusual or harmful behaviors that occur during sleep. Sleep talking is one of the most common parasomnias. A 2010 study found that 68.8% of people talk during their sleep at some point during their lives. According to the same study, 22.4% of people have sleepwalked at least once.

Both sleepwalking and sleeptalking can happen for many reasons. Sometimes they are symptoms of a mental health condition, and both may cause psychological distress and interfere with relationships, work, and even overall life satisfaction.

What Causes Sleepwalking?

Sleepwalking, known sometimes as somnabulism, happens in deep sleep when a person is very difficult to wake up. Normally, when a person sleeps, the body paralyzes skeletal muscles—the muscles responsible for walking and other complex behaviors. GABA, a neurotransmitter, is one of the primary chemicals involved in preventing sleepwalking. When GABA doesn’t work to paralyze the skeletal muscles, a person may walk, make food, or even try to drive during their sleep.

Sleepwalking is more common in children. Some research suggests this might be because the neurons that release GABA are still developing in children. Sleepwalking in children tends to peak between 8 and 12 years old. Children who sleepwalk may also have a condition called confusional arousal, which occurs when a person appears to be awake but is confused or unaware.

Though it’s difficult to wake a sleepwalking person, it’s a myth that doing so is dangerous. However, a person who is woken up from a sleepwalking episode may be confused or alarmed.

What Causes Sleep Talking?

Sleep talking, which used to be called somniloquy, is more common in children than adults. It typically happens during rapid eye movement (REM) sleep. Adults are more likely to talk in their sleep if they have depression, are experiencing a nightmare, or are under the influence of drugs or alcohol.

Is Walking or Talking in Your Sleep a Sleep Disorder?

Sleepwalking and sleeptalking are both considered sleep disorders. They are more common in people who have other sleep disorders, such as sleep apnea, insomnia, or sleep behavioral issues. Both sleepwalking and sleeptalking tend to run in families.

Sleepwalking and sleeptalking are more common in boys than in girls, though researchers don’t know why. Both tend to decrease or disappear by the age of 12, but when they don’t, a person may be diagnosed with a sleep disorder.

Sleep behavioral disorders, which cause people to do unusual things when they are asleep, are closely related to sleepwalking. For instance, a person might drive their car or attempt to have sex with their partner while sleeping. Rarely, do people even become violent in their sleep. A handful of rape defendants have successfully used a “sexsomnia” defense, arguing they did not intend to rape someone and instead were sleepwalking. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes sexsomnia as a mental health diagnosis.

Therapy can help with sleepwalking or sleep talking when these issues are due to a mental health condition or stress.

Mental Health Issues Associated with Sleepwalking and Sleep Talking

A number of mental health issues can cause sleepwalking and sleeptalking. When sleep issues are related to a mental health issue, seeking treatment for the underlying mental health condition is usually the fastest way to resolve the sleep problem.

Any mental health condition can interfere with sleep and lead to unusual behavior at night. Sleep issues are especially prevalent in people who have:

• Nightmares, night terrors, and other nighttime sleep issues
• Depression
• Anxiety
• Posttraumatic stress (PTSD)
• Neurological injuries such as a traumatic brain injury (TBI)
• Schizophrenia

Drugs and alcohol can cause some people to talk or walk in their sleep. Due to this, people with substance abuse issues, as well as those going through drug or alcohol withdrawal, may experience sleepwalking or sleeptalking.

Medical Issues Linked to Sleepwalking and Sleep Talking

Certain medical issues have been linked to sleepwalking and sleeptalking. Those include:

• Sleep apnea, a disorder that causes frequent nighttime wakings due to breathing issues.
• Breathing disorders such as asthma and chronic obstructive pulmonary disorder (COPD).
• Cardiovascular health issues such as heart arrhythmias.
• Infections and illnesses, especially when they cause a high fever.
• Brain health issues such as tumors or a brain injury. This is a rare cause of sleep issues but is more likely if sleep issues appear suddenly or are severe.

Certain medications have also been linked to sleepwalking and sleeptalking. Some sleeping medications, such as Ambien and Lunesta, can cause unusual nighttime behavior. Sleep eating is one of the most common medication-related behaviors, but driving and other unusual behaviors have also been reported.

Therapy can help with sleepwalking or sleep talking when these issues are due to a mental health condition or stress. Many people also find therapy helps them deal with the challenges of parasomnias, such as sleep deprivation or conflicts with a partner oversleep. The right therapist can help you craft a healthy sleep environment, set healthy sleep goals, and get better sleep.

According to the National Sleep Foundation, therapy can help with many sleep issues. Cognitive behavioral therapy (CBT) has proven especially effective.

Sleep issues can affect an entire family. When a child sleepwalks, parents may struggle to get a good night’s sleep, and siblings may feel anxious. A spouse who sleepwalks or sleep talks can trigger sleep issues in their partner. Nighttime sleep issues, such as sexsomnia or nighttime eating, can even be a source of marriage or relationship problems. Family or couples therapy can help families manage and understand these issues.

References:

1. Bjorvatn, B., Grønli, J., & Pallesen, S. (2010). Prevalence of different parasomnias in the general population. Sleep Medicine, 10(11), 1031-1034. doi: 10.1016/j.sleep.2010.07.011
2. Cognitive behavioral therapy for insomnia. (n.d.). Retrieved from https://www.sleepfoundation.org/sleep-news/cognitive-behavioral-therapy-insomnia
3. Mohebbi, A., Holoyda, B. J., & Newman, W. J. (2018). Sexsomnia as a defense in repeated sex crimes. The Journal of the American Academy of Psychiatry and the Law, 46(1), 78-85. Retrieved from http://jaapl.org/content/46/1/78.long
4. Oliviero, A. (2008, February 1). Why do some people sleepwalk? Retrieved from https://www.scientificamerican.com/article/why-do-some-people-sleepwalk
5. Pediatric parasomnias. (n.d.). Retrieved from https://www.childrens.com/specialties-services/specialty-centers-and-programs/sleep/programs-and-services/sleep-medicine/nightmares-sleepwalking-sleep-talking-sleep-terror
6. Post-traumatic stress disorder (PTSD) and sleep. (n.d.). National Sleep Foundation. Retrieved from https://www.sleephealthfoundation.org.au/pdfs/Post-Traumatic-Stress-Disorder.pdf
7. Sexsomnia: A new DSM-5 diagnosis. (2014, October 28). Retrieved from https://www.psychiatryadvisor.com/sleep-wake-disorders/sexsomnia-a-new-dsm-5-diagnosis/article/379644
8. Sleep talking: Causes. (n.d.). Retrieved from https://www.sleepfoundation.org/sleep-disorders-problems/sleep-talking/causes
9. Sleep talking: What is it? (n.d.). Retrieved from https://www.sleep.org/articles/sleep-talking
10. Sleepwalking. (n.d.). Retrieved from https://www.sleepfoundation.org/sleep-disorders-problems/abnormal-sleep-behaviors/sleepwalking

According to data from the U.S. Department of Justice, most intimate partner violence (82%) is committed against women. Increased awareness of domestic violence against women has spurred an international movement, led to the creation of domestic violence shelters, and helped a generation of women leave their abusers.

Men can be victims, too. According to Centers for Disease Control and Prevention (CDC), 1 in 4 men have experienced some form of domestic violence, and 1 in 7 have been victims of severe physical violence. Anti-domestic violence rhetoric has not caught up to this reality, leaving many male victims with few resources. Some worry that the abuse is their fault or a sign of weakness. Others are met with derision and stigma when they seek help.

Therapy can help male victims of abuse identify signs of abuse, understand that it’s not their fault, leave abusive partners, and recover from the long-lasting trauma of abuse. For men to fully gain the support they need, the conversation about domestic violence must include them.

Domestic Violence Against Men: What Are the Facts?

Between 5-7% of male murder victims are killed by intimate partners. This figure is smaller than the number of women homicide victims killed by intimate partners (55%) but shows that domestic violence is more than an inconvenience or annoyance. It can and does kill men.

Even when men are the victims, most perpetrators of domestic violence are male. Nevertheless, women can and do abuse their partners. A 2005 study of domestic violence arrests in Tennessee found that 16% of perpetrators were female. A 2002 study of Air Force personnel put the figure even higher, finding that 23% of abusers were women.

The 1990 National Family Violence Survey found similar rates of self-reported domestic abuse among women and men. Wives reported committing violence at a rate of 12.4%, compared to 11.6% of husbands.

Men who have romantic relationships with men face an even higher rate of domestic abuse. A 2018 study of 160 male-male couples in three different cities found that 46% of respondents reported experiencing some form of domestic violence in the past year.

Research on domestic violence among nonbinary and transgender populations is still in its infancy. Rates of many forms of violence are higher in gender nonconforming populations, so it’s likely that domestic violence is more prevalent in gender nonconforming groups as well. Violence against transgender and nonbinary people often uses their identity and vulnerabilities as a means of control and exploitation. For instance, an abusive partner might threaten to out a transgender man to his employer.

Intersecting oppressions can further compound the effects of domestic violence. A 5 year University of Texas study found that black and Latinx couples are 2 to 3 times more likely to report domestic violence. Differences in access to power and privilege may intensify the effects of domestic abuse. For instance, high profile stories about police shootings of unarmed black people may make black male abuse survivors more reluctant to contact law enforcement for help.

Pervasive myths about domestic violence against men can deter men from seeking help. Even when they do seek help, men face an uphill battle to find resources.

‘I’m Serious’: Overcoming the Obstacle of Disbelief

Domestic abuse survivors of all genders and backgrounds may struggle with getting people to believe their claims. Abusers may seem superficially nice and use that to their advantage. Male survivors are even more likely to struggle to gain acceptance of their claims. Some of the barriers male survivors face include:

• Disbelief that the perpetrator could be abusive. If the perpetrator is nice, friendly, or well-respected, people are often reluctant to believe they are abusive. In some cases, they may wonder what the survivor did to “provoke” the abuser. When the abuser is a woman, it can be even more difficult to convince people that an apparently “nice” person behaves violently.
• Gender myths. The notion that women are weak or naturally nonviolent works against male survivors when the perpetrator is a woman. Bystanders might think it’s impossible for a woman to overpower a man or believe that if the man really wanted to fight back, he could.
• Homophobia. The homophobic belief that being an abuse victim makes a man weak, and therefore gay, pervades in some communities. Straight men who fear being labeled gay may hesitate to report their abuse. Gay or bisexual abuse survivors may worry that people will blame their abuse on their sexuality.
• Intersecting oppressions. Men who experience other forms of oppression, such as racism or ableism, may be more reluctant to report their abuse. A disabled man, for example, may fear that reporting his abuse will make others perceive him as weak. A person of color might fear the police even more than they fear their abuser.

Is There a Lack of Access to Resources for Men?

Pervasive myths about domestic violence against men can deter men from seeking help. Even when they do seek help, men face an uphill battle to find resources.

One study of 302 heterosexual men who sought help from domestic violence hotlines found that most did not get the help they need. Sixty-four percent of hotline workers told the men that the hotline only served women. In 32% of cases, abused men were referred to programs for abusers, suggesting that the person who took the call did not believe the caller needed help. Sixty-nine percent of participants reported their call to a hotline was “not helpful.”

Leaving an abusive relationship can be dangerous. Research consistently shows that abusers are more likely to kill their partners in the weeks immediately following the relationship’s end. Domestic violence shelters can provide a safe space for people escaping abuse, especially when the abuser also controls access to financial resources. Most shelters, however, cater exclusively to women. Even shelters that are open to men have a limited number of beds available. Men may have to wait months to gain access to a shelter, assuming a shelter is available at all.

Prompt intervention by law enforcement immediately following an act of domestic violence can save lives. For decades, women’s rights groups have lobbied police departments to take intimate partner violence seriously. While the culture of some police departments regarding female victims has changed, men continue not to be believed in many cases. Police may not take abuse against men seriously or even mock men who claim to be victims.

Bringing Inclusivity to the IPV Conversation

Widespread discussions of concepts such as toxic masculinity, misogyny, and male abuse of women have brought male abuse to the fore of our collective consciousness. This has the power to spur important social change. But the widespread nature of male violence conceals a less well-known problem: violence against men. Discussions of violence that assume a male perpetrator and a female victim are stigmatizing. They uphold inaccurate gender myths, support a false gender binary, and deter people who need help from seeking it.

In therapy, providers must take seriously the possibility that men, women, and people of all genders can be abused. Therapists concerned about violence between couples should talk to both members of the couple about experiences with violence rather than assuming the perpetrator is male.

It’s equally important for friends and family to be mindful of the effects of domestic violence on men. Domestic violence is not a joke. A man who shares an experience with intimate partner violence has taken a significant risk. Listen to him. Offer support. Reassure him that he is not alone.

Only by destigmatizing revelations of violence can we begin upending a culture of abuse. Male victims matter, too.

References:

1. Domestic violence varies by ethnicity. (2018, June 10). Retrieved from https://www.verywellmind.com/domestic-violence-varies-by-ethnicity-62648
2. Black, M. C., Basile, K. C., Breiding, M. J., Smith, S. G., Waters, M. L., Merrick, M. T., . . . Stevens, M. R. (2011). National intimate partner and sexual violence survey 2010 summary report. Retrieved from https://www.cdc.gov/violenceprevention/pdf/NISVS-StateReportBook.pdf
3. Khazan, O. (2017, July 24). Nearly half of all murdered women are killed by romantic partners. Retrieved from https://www.theatlantic.com/health/archive/2017/07/homicides-women/534306
4. Male survivors of domestic violence. (2017). Pennsylvania Coalition Against Domestic Violence. Retrieved from http://www.pcadv.org/Learn-More/PCADV-Publications/STOP-TA-Bulletins/#SpotID_16429
5. Researcher: What happens when abused men call domestic violence hotlines and shelters? (n.d.). Retrieved from https://nationalparentsorganization.org/blog/3977-researcher-what-hap-3977
6. Suarez, N. A., Mimiaga, M. J., Garofalo, R., Brown, E., Bratcher, A. M., Wimbly, T., . . . Stephenson, R. (2018). Dyadic reporting of intimate partner violence among male couples in three U.S. cities. American Journal of Men’s Health, 12(4), 1039-1047. doi: 10.1177/1557988318774243
7. Swan, S. C., Gambone, L. J., Caldwell, J. E., Sullivan, T. P., & Snow, D. L. (2008). A review of research on women’s use of violence with male intimate partners. Violence and Victims, 23(3), 301-314. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2968709
8. Truman, J. L. & Morgan, R. E. (2014). Nonfatal domestic violence, 2003-2012. U.S. Department of Justice Bureau of Justice Statistics. Retrieved from https://www.bjs.gov/content/pub/pdf/ndv0312.pdf

It’s that time of year when the kids have gone back to school and we are approaching daylights savings. I know in my family, it’s been an adjustment to get everyone on a better sleep schedule after the late nights of summer fun.

Simultaneously, I’ve noticed in my practice that several of the people I work with have mentioned difficulties getting to bed at decent times, struggles maintaining an ideal sleep schedule, and a lack of feeling rested upon awakening in the mornings. Given this common trend around issues related to sleep, I thought before we head into the dark nights of winter, now would be a good time for us all to think about our own sleep hygiene.

What Is Sleep Hygiene?

I find the phrase “sleep hygiene” a little odd. For me, it conjures up images of bubble baths, toothpaste, and soap in the bedroom. While brushing your teeth before bed is a good habit and one that may help signal an end to your day, sleep hygiene isn’t just about cleanliness. Rather, it’s about all of the habits and agendas you maintain around your bedtime routine and night of sleep.

The definition of hygiene according to Dictionary.com is “conditions or practices conducive to maintaining health and preventing disease, especially through cleanliness.” As cleanliness is only one aspect, it makes sense to think about all of the other conditions and practices surrounding sleep. Sleep may seem like a trivial thing. We all do it; it’s a natural process that should be easy. But easy isn’t always the case.

The Challenge of Maintaining Good Sleep Hygiene

Getting good sleep can be a challenge for many, yet sleep is truly a vital component to life. It’s fairly common knowledge that research confirms getting enough restful sleep is an important part of staying healthy and operating at your best. Unfortunately, some adults find it difficult to sleep well, and many have fallen into patterns that are counterproductive to obtaining the best rest possible. If this rings true for you, stop to think about your own bedtime routine and the conditions you maintain for sleep.

Many parents of young kids are familiar with the importance of a bedtime routine—they’ve likely established one to help their babies and toddlers learn to easily go to bed each night. Whether it’s bath, story, milk, and a song, or some other type of tuck-in ritual, we know that a good routine helps kids get to bed, and we know how important it is for them to sleep. Sleep helps children to grow, develop, function well, be attentive in school, and avoid crankiness.

While adults may not need as many hours of sleep as kids, rest is still important. Yet as we get older, have more free will, and are inundated with modern technologies and daily stressors, we often neglect good sleep habits and can consequently wind up facing things like chronic insomnia, poor health, irritability, lack of concentration, and even impaired judgment from neglecting to give our bodies the sleep they require.

Tips for Better Sleep Hygiene

Below is a list of some of the most common recommendations involved in developing and maintaining good sleep hygiene:

• Establish regular and consistent times for going to bed and waking up. This helps regulate your internal clock.
• Determine how many hours of sleep your body needs. Each person requires a certain amount of sleep to feel rested and to achieve optimal functioning while awake. Figure out through trial and error what your optimal amount of sleep seems to be, then strive to get this amount of sleep every night by adjusting your going-to-bed and wake-up times accordingly.
• Develop rituals before bedtime. Routine things like locking up the house, drinking a cup of tea, putting on pajamas, washing your face, and brushing your teeth can become rituals when performed regularly and consistently before bed. Your brain eventually associates these things with winding down and going to sleep. Having a regular routine can make it easier for you to feel tired and ready for sleep at bedtime.
• Pair bedtime with something that engages one of your senses. Smelling the same scent or listening to the same sound every night at bedtime can help your brain learn when it’s time to feel tired and fall asleep. Try spraying fragrant pillow spray on your sheets, lighting a scented candle, or using a scented eye pillow. Lavender is an especially relaxing scent. A sound machine with calm sounds such as the ocean, rain, or white noise may also be helpful.
• Use the bedroom only for sleep and sex. Using your bedroom to work or perform other activities will cause your mind to associate the space with activities that may conflict with the ability to sleep.
• Make your bedroom a sanctuary for sleep. Make sure your bedroom is a calm space with a comfortable bed. Determine what type of pillows, sheets, and blankets are the most comfortable for you. Some people like to sleep with little weight on them; others like heavier blankets. Keep the thermostat at a comfortable level. Block out any bright or distracting lights.
• Get sunlight in the morning or during the day. Circadian rhythms are regulated by light and darkness and are closely related to our sleep-wake cycles. Sensing natural light through your retina signals the brain to be awake and alert. In contrast, the absence of light signals our bodies to produce melatonin, a hormone that aids in sleep. The contrast between light during the day and darkness in your bedroom at night helps regulate the sleep-wake cycle.
• Put away your iPad and/or smart phone before getting ready for and into bed. Don’t check email before bed. Electronics can pose a threat to sleep, not only because they keep your brain activated, but also because their light can disrupt melatonin production and impede your ability to feel tired. It’s best to avoid electronics at least half an hour to an hour before bedtime. That said, many people unwind before bed by reading. If you read on your electronic device, be sure to dim the backlight or turn on “Night Shift.”
• Use relaxation techniques to release stress and tension. It is very difficult to fall and stay asleep if you are very anxious, ruminate on stressful things that happened in the day, or fixate on things happening in the future. Practicing mindfulness techniques, meditation, progressive muscle relaxation, and other techniques can help slow down your mind and create a sense of calm that will be more conducive to sleeping peacefully.

Routine things like locking up the house, drinking a cup of tea, putting on pajamas, washing your face, and brushing your teeth can become rituals when performed regularly and consistently before bed.

How to Wind Down Before Bed

Remember that it’s hard to benefit from these tools unless you practice and become familiar with them during times when you are not already feeling stressed, overly anxious, or experiencing insomnia. Try them often and as you become more comfortable with various techniques, they can be tools to help you get to sleep faster.

• Try warm baths or showers before bedtime. Bathing or showering can raise your core body temperature, which naturally induces drowsiness and can help you fall asleep faster.
• Eat a good meal a few hours before bedtime. Going to bed hungry or feeling too full can impact your ability to fall asleep, so be mindful of what and when you are eating in the evenings.
• Exercise regularly. Research shows that exercise decreases stress and contributes to better and more restful sleep. However, avoid rigorous exercise too close to bedtime if you find that it impacts your ability to fall asleep.
• Avoid physical and mental stimulation before bedtime. Stimulation, including suspenseful books, action shows/movies, and video games, can increase brain activity and heart rate, making it difficult to fall asleep. If you get into bed too soon after engaging in these activities, you may face frustration regarding your inability to quickly fall asleep, which perpetuates sleep disturbances. Your body needs time to unwind and slow down after engaging in these activities and before getting into bed.
• Avoid naps if possible. For some people, short naps can be energizing and rejuvenating. But naps, especially long ones, can interfere with sleep-wake cycles and sabotage the ability to maintain a regular bedtime.
• Avoid caffeine in the afternoon/evenings. The effects of caffeine can last for several hours, often creating a feeling of being wired or on edge, which can impact some people’s ability to fall asleep.
• Keep a glass of water by your bed. Having a glass of water nearby can help you stay hydrated and allow you to quickly reach for a sip of water when you wake up thirsty in the night. Keep anything else you may need to stay comfortable (chapstick, a sweatshirt if you tend to get cold, etc.) nearby and avoid getting out of bed for anything but using the bathroom.
• Hide the clock or get a projection clock. If you are someone who constantly looks at the clock, becoming frustrated with how long it is taking you to fall asleep and fixating on how little sleep you will be able to get, hide the clock or resist looking at the time. A projection clock that shows the time on the ceiling could be helpful if you feel you have to know the time. Constantly rolling over and moving to look at the clock interferes with your ability to relax and can create feelings of anxiety and stress that make it even harder to fall asleep.
• Try not to stress about or fixate on sleep difficulties. Fixating on sleep difficulties only increases the problem. Know that it takes some time, practice, and trial and error to develop optimal sleep habits and ultimately create better sleep. Be patient with yourself and know that good sleep hygiene doesn’t happen overnight.

If you struggle with sleeping well or maintaining a healthy sleep schedule, consider implementing these tips to see what might help. Be patient with yourself. It may take time to break bad habits and establish healthier ones, but with time and persistence, you can discover better sleep hygiene and ultimately train your body to get better rest.

Working with a therapist may help you find sleep strategies that work for you if you have a difficult time maintaining good sleep hygiene.

Reference:

Hygiene. (2018.) Retrieved from https://www.dictionary.com/browse/hygiene?s=t

Nearly 7% of Americans will be diagnosed with posttraumatic stress (PTSD) at some point during their lives. In any given year, 3.5% of Americans have PTSD. Many struggle with sleep problems such as insomnia, sleeping too much, and nightmares. For people struggling with trauma during the day, nighttime can feel like a battleground that offers little respite from traumatic memories and intrusive thoughts.

Are Sleep Problems a Symptom of PTSD?

Trauma changes the brain, and these changes can also affect sleep. The Diagnostic and Statistical Manual (DSM) lists sleep disturbances—such as insomnia, frequent waking, or nightmares—as one of many potential symptoms of PTSD. Specifically, to be diagnosed with PTSD, a person must show at least two of six “alterations in arousal and activity.” Those changes include:

• A heightened startle response
• Trouble concentrating
• Sleep disturbances
• Hypervigilance
• Self-destructive or reckless behavior
• Irritability or aggression

For some people, other symptoms of arousal play a role in sleep problems. For instance, a person who is anxious and hypervigilant may be too afraid to fall asleep, while a person with a heightened startle response may startle awake at every sound as they drift off to sleep. This change in sleep can also exacerbate other PTSD symptoms. A chronically exhausted person may be more irritable or have greater difficulty concentrating.

Some research suggests that sleep problems are more than just a symptom of PTSD. Instead, they may be a core component of the diagnosis. Research published in 1989 suggests that disturbances in rapid eye movement (REM) sleep are a PTSD hallmark that play a key role in other PTSD symptoms. Subsequent research has yielded mixed results. While some studies, including of animals, find a pattern of REM disturbances associated with PTSD, others do not.

A 2013 review of the literature argues that disturbances in sleep, especially REM sleep, may increase the risk of PTSD. Sleep issues may also worsen outcomes in people with PTSD. The study further argues that sleep issues can decrease the effectiveness of many PTSD treatments and that targeted treatments for sleep issues may speed recovery.

How Does PTSD Affect Sleep?

People with PTSD often find that their traumatic memories intrude on their ability to sleep. Some common PTSD-related sleep symptoms include:

• Being unable to fall asleep because of anxiety or agitation.
• Difficulty staying asleep because of frequent nightmares.
• Poor quality sleep because of nightmares. Some people report waking up many times each night and struggling to fall back asleep each time. This is called maintenance insomnia.
• Sleep problems related to drugs or alcohol. Some people with PTSD use alcohol or drugs to cope, which can cause sleep problems. Some medications for PTSD and anxiety may also cause sleep problems. For example, benzodiazepines may make it difficult to wake up in the morning.

A study that compared people with insomnia who did not have PTSD to those with combat-related PTSD and insomnia found important differences in the two groups. Those included:

• More repetitive nightmares in people with PTSD. People with PTSD were more likely to say their nightmares made it difficult to go back to sleep.
• More anxiety during the day in people with PTSD.
• More fatigue during the day among people with PTSD.

This suggests a feedback loop between sleep issues and other PTSD symptoms. Sleep problems can intensify daytime PTSD symptoms, which may make it even more difficult to sleep at night. People who feel anxious or fatigued during the day may ruminate more on their traumatic memories, increasing the risk of nightmares and other issues when they try to sleep.

Sleep problems can intensify daytime PTSD symptoms, which may make it even more difficult to sleep at night. People who feel anxious or fatigued during the day may ruminate more on their traumatic memories, increasing the risk of nightmares and other issues when they try to sleep.

Other Sleep Problems and PTSD

Sleep issues are common, even in people without PTSD. A 2009 study found that about 30% of people experience insomnia in a given year. Some people also struggle with sleeping too much or with not feeling rested after sleeping. This may be due to:

• Shift work sleep disorder, a condition that alters the “internal clock” of people who work nights or unusual hours.
• Sleep apnea, a disorder that affects breathing during sleep, causing people to briefly wake many times during the night.
• Sleep behavior disorder, which causes people to do unusual things while sleeping, such as sleepwalking, driving, or eating.

People with PTSD who have a pre-existing sleep disorder may find their symptoms get worse following a traumatic experience. Conditions that affect sleep can also compound the effects of PTSD, leading to depression, anger, difficulty concentrating, and more trouble coping with PTSD symptoms.

Even when the symptoms of a sleep disorder are not directly related to PTSD, it’s important to get help. Getting quality sleep is an important component of PTSD self-care.

Strategies for Coping with PTSD-Related Sleep Problems

Lifestyle changes can help some people with PTSD sleep more soundly. The National Sleep Foundation emphasizes that sleep is a habit, so the right changes can help the body adopt healthy sleep habits that offer better sleep. Try the following:

• Design a comfortable sleeping area, with a firm and supportive mattress and comfortable pillow.
• Develop a relaxing bedtime ritual.
• Stick to the same sleep schedule every day, even on weekends or vacations.
• Avoid napping during the day if you have trouble sleeping at night.
• Exercise every day, but not right before bed.
• Keep your bedroom cool, between 60-67 degrees Fahrenheit.
• Keep your bedroom quiet. Some people find that a white noise machine helps.
• If you can’t fall asleep, get up and do something else.
• Use your bed only for sleeping—not to play, read, or do work.
• Eat a light snack 45 minutes before bed if you tend to wake up hungry.
• Avoid heavy meals, alcohol, caffeine, and cigarettes before bed. Some people find drinking caffeine in the afternoon makes it harder to sleep.

Stress and anxiety management strategies can be especially helpful for managing PTSD-related sleep problems. Some people find relief from meditation or yoga. Others find that guided imagery or positive mantras as they try to sleep can help.

Medications, including anti-anxiety and sleeping medications, may help some people. However, when the underlying PTSD symptoms remain, sleep problems will likely return when you stop using medication.

Therapy can help with both sleep issues and PTSD. A compassionate therapist will help you work through your trauma in a safe space, free of judgment. Your therapist can help you set goals, cultivate new tools for managing stress, help you understand how trauma changes the brain, and work with your doctor to decide which, if any, medications are appropriate.

PTSD can feel overwhelming. Some people become depressed because they think things will never change. Others are too exhausted to work or enjoy time with their family. It doesn’t have to be this way. Reach out to a therapist who is highly skilled at treating PTSD.

References:

1. Germain, A. (2013). Sleep disturbances as the hallmark of PTSD: Where are we now? American Journal of Psychiatry, 4(170), 372-382. doi: 10.1176/appi.ajp.2012.12040432
2. Gradus, J. L. (2007, January 31). Epidemiology of PTSD. Retrieved from https://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp
3. Healthy sleep tips. (n.d.). Retrieved from https://sleepfoundation.org/sleep-tools-tips/healthy-sleep-tips
4. Inman, D. J., Silver, S. M., & Doghramji, K. (1990). Sleep disturbance in post-traumatic stress disorder: A comparison with non-PTSD insomnia. Journal of Traumatic Stress, 3(3), 429-437. doi: 10.1007/BF00974782
5. Phillips, K. (2015, February 4). What are the types of sleep disorders? A full list of sleep disorders. Retrieved from http://www.alaskasleep.com/blog/types-of-sleep-disorders-list-of-sleep-disorders
6. Sleep and PTSD. (2015, August 13). Retrieved from https://www.ptsd.va.gov/public/problems/sleep-and-ptsd.asp
7. Yehuda, R., Hoge, C. W., Mcfarlane, A. C., Vermetten, E., Lanius, R. A., Nievergelt, C. M., . . . Hyman, S. E. (2015). Post-traumatic stress disorder. Nature Reviews Disease Primers, 15057. Retrieved from https://www.nature.com/articles/nrdp201557#t1

In 2013, former CIA employee and government contractor Edward Snowden released classified documents revealing the broad scope of U.S. government surveillance. Suddenly, fears that once seemed paranoid were decidedly rooted in reality. Paranoia and anxiety are common. They can be part of the typical range of human experience or signs of a serious mental health diagnosis.

Drawing the line between normal fears, anxiety, and paranoia can be difficult. That’s especially true when a person’s apparently paranoid fears turn out to be true—as was the case for activists targeted by programs such as COINTELPRO, and for Ernest Hemingway, who really did have an FBI file. Knowing where to draw that line, and how to decide whether a fear is reasonable or not, can help people seek appropriate mental health care.

What Is Paranoia?

Paranoia is persistent anxiety about a specific fear. Paranoid anxieties often center around persecution, being watched, or being treated unjustly. The hallmark of paranoia is that it is rooted in a false belief. People with paranoid thoughts may also have false beliefs about their own power or importance. For example, a person who does not occupy a political position or engage in activism might believe in an international conspiracy to monitor and torture them. In some cases, exposure to trauma or severe stress can make people more likely to experience paranoia.

People experiencing paranoid thoughts are often preoccupied by these thoughts. They may be fixated on getting other people to accept their beliefs as true. They may make unusual choices designed to protect themselves from the sources of their anxiety.

Fleeting moments of paranoia are common and don’t necessarily mean a person has a mental health condition. Paranoia is also distinct from anxiety in that:

• Paranoia is focused on a specific source of anxiety.
• People who experience paranoia often have false beliefs about themselves, the world, or people they know.
• A person with paranoid thoughts may experience perceptual issues. A 2008 study that compared social anxiety to paranoia found that people with unusual perceptions, including hallucinations, were more likely to experience paranoia.

Delusional vs. Reasonable Paranoia

Delusional paranoia is paranoia due to a false belief. While often a hallmark of schizophrenia, it can also be due to other mental health diagnoses. When a person’s fears are rooted in reality or reasonable, they’re not paranoid. The challenge is determining which beliefs are reasonable and which are not.

A lawyer working with detained immigrants might worry that they are being monitored by the government. A doctor working with infectious diseases may be concerned about becoming infected or spreading the disease. Even if the fear does not come to fruition, it is rooted in reality.

It’s important for mental health providers to critically examine why a person has a specific fear and how their social bubble, occupation, culture, and other factors may affect that fear. For instance, young black Americans may be fearful of the police. To someone who has never had a negative interaction with police, this fear might seem unreasonable, even paranoid. To a person exposed to police violence against young black people, the fear seems reasonable and is unlikely to be due to a mental health diagnosis. Dismissing a person’s reasonable fears can be very harmful, especially when it happens in therapy.

It’s important for mental health providers to critically examine why a person has a specific fear and how their social bubble, occupation, culture, and other factors may affect that fear.

One way to assess whether a person’s anxiety is reasonable or not is to assess how they respond to conflicting evidence. People with schizophrenia, for example, may continue to endorse false beliefs even when given evidence to the contrary. The conflicting evidence may even be viewed as a sign of a larger conspiracy, or as a reason to distrust a mental health provider. A person without schizophrenia who learns their false belief is untrue may be relieved rather than defensive.

People who think someone they love may have schizophrenia should not spend time arguing about false or paranoid beliefs. This can harm the relationship, making it difficult for the person to feel understood or loved. Arguing about false beliefs may inadvertently stigmatize the person or make them feel judged.

Schizophrenia Symptoms: The Link to Paranoia and Anxiety

A person who has paranoid thoughts may have schizophrenia or a related condition. Only a mental health professional can treat and diagnose this condition, so it’s important to seek expert insight.

Schizophrenia usually begins in adolescence or early adulthood. Someone who develops paranoid thoughts later in life might have another mental health condition, such as dementia.

Some schizophrenia symptoms to watch for include:

• Loss of touch with reality. Schizophrenia can cause people to see or hear things that others can’t.
• Thoughts and beliefs that others perceive as strange or unusual.
• Changes in affect. A person with schizophrenia may have an affect that seems flat, presenting few emotions and seeming very detached.
• Trouble with memory, especially working memory.
• Executive function difficulties that make it difficult to concentrate or stay on task.
• Trouble starting or sticking with new hobbies or activities.
• Not talking much.
• Behavior related to false beliefs. A person with schizophrenia might try to contact a celebrity to warn them of a threat or reach out to a lawyer to report government surveillance that doesn’t seem to be happening.

When to Seek Treatment for Anxiety About Being Watched

Mental health treatment can help anyone experiencing anxiety, whether their anxiety is rooted in a real source or the product of a mental health diagnosis. Activists such as lawyers or protest leaders who have reasonable fears about being monitored may find therapy helps them manage their anxiety, deal with the effects of those fears on their relationships, and separate reasonable fears from unreasonable ones.

People who have a condition linked to unreasonable paranoia may also find immense relief in therapy. Therapy can help a person understand their anxiety, confront false beliefs, and assess the effects that false beliefs have on their life. People with diagnoses linked to delusions often struggle at work, school, and in their relationships. Therapy can help with developing better communication skills and dealing with the challenges of schizophrenia and other diagnoses linked to delusions.

References:

1. Freeman, D., Gittins, M., Pugh, K., Antley, A., Slater, M., & Dunn, G. (2008). What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation. Psychological Medicine, 8(38), 1121-1132. doi: 10.1017/S0033291708003589
2. Schizophrenia. (2016, February). Retrieved from https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
3. Shakeel, M. K., & Docherty, N. M. (2015). Confabulations in schizophrenia. Cognitive Neuropsychiatry, 1(20), 1-13. doi: 10.1080/13546805.2014.940886

Stockholm syndrome is a psychological condition that occurs when a victim of abuse identifies and attaches, or bonds, positively with their abuser. This syndrome was originally observed when hostages who were kidnapped not only bonded with their kidnappers, but also fell in love with them.

Professionals have expanded the definition of Stockholm syndrome to include any relationship in which victims of abuse develop a strong, loyal attachment to the perpetrators of abuse. Some of the populations affected with this condition include concentration camp prisoners, prisoners of war, abused children, incest survivors, victims of domestic violence, cult members, and people in toxic work or church environments.

The Characteristics of Stockholm Syndrome

It may be easier to understand Stockholm syndrome as an actual survival strategy for victims. This is because it seems to increase victims’ chances of survival and is believed to be a necessary tactic for defending psychologically and physically against experiencing an abusive, toxic, and controlling relationship. Stockholm syndrome is often found in toxic relationships where a power differential exists, such as between a parent and child or spiritual leader and congregant. Some signs of Stockholm syndrome include:

• Positive regard towards perpetrators of abuse or captors.
• Failure to cooperate with police and other government authorities when it comes to holding perpetrators of abuse or kidnapping accountable.
• Little or not effort to escape.
• Belief in the goodness of the perpetrators or kidnappers.
• Appeasement of captors. This is a manipulative strategy for maintaining one’s safety. As victims get rewarded—perhaps with less abuse or even with life itself—their appeasing behaviors are reinforced.
• Learned helplessness. This can be akin to “if you can’t beat ‘em, join ‘em.” As the victims fail to escape the abuse or captivity, they may start giving up and soon realize it’s just easier for everyone if they acquiesce all their power to their captors.
• Feelings of pity toward the abusers, believing they are actually victims themselves. Because of this, victims may go on a crusade or mission to “save” their abuser.
• Unwillingness to learn to detach from their perpetrators and heal. In essence, victims may tend to be less loyal to themselves than to their abuser.

Anyone can be susceptible to Stockholm syndrome. Yes, there are certain people with abusive backgrounds that may be more likely to be affected, such as people with abusive childhoods; but any person can become a victim if the right conditions exist.

Battered partners or spouses are a prime example of Stockholm syndrome. Oftentimes, they are reluctant to press charges or initiate a restraining order, and some have attempted to stop police from arresting their abusers even after a violent assault. After the relationship has ended, victims of domestic violence may often make statements such as, “I still love him,” even after being brutally beaten.

Battered partners or spouses are a prime example of Stockholm syndrome. Oftentimes, they are reluctant to press charges or initiate a restraining order, and some have attempted to stop police from arresting their abusers even after a violent assault.

How Stockholm Syndrome Works

Stockholm syndrome occurs when certain dynamics are at play, and it happens within particular circumstances. Following is a list of ingredients that can contribute to the development of the syndrome in individuals:

• The condition can develop when victims of abuse believe there is a threat to their physical or psychological survival, and they also believe their abusers would carry out that threat.
• When victims of kidnapping are treated humanely or simply allowed to live, they often feel grateful and attribute positive qualities to their captors believing that they are, indeed, good people.
• Intermittent good/bad behavior can create trauma bonds. Stockholm syndrome is a form of trauma bond, where the victims “wait out” the bad behaviors for the “crumbs” of good behaviors bestowed on them.
• Victims are isolated from others. When people are in abusive systems, such as a kidnapping situation, access to outside input and communication is limited, or even nonexistent. This way, only the perpetrators’ input is allowed. It’s like “uber-propaganda.”

How to Help People Who May Have Stockholm Syndrome

Understanding the underlying psychology surrounding Stockholm syndrome can help you know how to help someone who has it. Stockholm syndrome is the victim’s response to trauma and involves many social dynamics. Some of these social dynamics include conformity, groupthink, deindividuation, romantic love, and fundamental attribution error, among others.

• Try psychoeducation. Psychoeducation involves teaching victims of Stockholm syndrome what is going on. Remember the saying, “Knowledge is power”? Knowing what you’re up against is the best offense to win the battle for your loved one’s freedom.
• Avoid polarization. Don’t try to convince the victim of the villainous traits of the abuser; this may cause the victim to polarize and defend the perpetrator.
• Use the Socratic method. Ask the victim questions about how they see the situation, how they feel and think, and what they believe needs to happen next.
• Listen without judgment. As the victim ponders everything that’s happened and processes their experience with the perpetrator, listen and use reflection to show concern and validation.
• Don’t give advice. Victims of abuse need to be empowered to make their own decisions. If you come along and tell them what to do because you “obviously know better,” then you are not helping the victim build their muscle of personal power. Remember, the road to healing from abuse is often to empower the victim to make their own decisions, to know this, and to own it.
• Address the cognitive dissonance. Being in a manipulative relationship can cause cognitive dissonance. This means the victim’s intuition has been damaged, and they may be confused about reality. Help them by validating their truth and encouraging them to trust themselves.
• Identify the “hook.” Victims of Stockholm syndrome can become dedicated to a cause or an unspoken desire. They may over-identify with the perpetrator in a dysfunctional way in order to fulfill a personal need. This is the “hook.” Help the victim identify what the underlying need is that is being fulfilled by the abusive relationship connection. Once the victim understands why they are so committed to the relationship, they can start making positive changes.

Examples of hooks include a variety of feelings, such as those of loyalty. They can be found in statements such as “I’ll be there no matter what,” or “It’s you and me against the world.” These types of needs tend to be unconscious and may have developed at an earlier stage of an individual’s life.

Being aware of the psychological underpinnings of Stockholm syndrome can help you understand how to best help someone with the condition. Its treatment is under-researched. While there is ample discussion of the legal ramifications of the disorder, very little has been written on how to help someone who has been affected. The bottom line, no matter what intervention you use to help someone who has this condition, is to remember to offer empathy always and coercion never.

If you think you or a loved one is experiencing Stockholm syndrome, a therapist may help you or them work through some of the steps to healing above. Start your search for the therapist best suited to helping you today.

References:

1. Alexander, D. A. & Klein, S. (2009, January 1). Kidnapping and hostage-taking: A review of effects, coping and resilience. Journal of the Royal Society of Medicine, 1(102), 16–21. doi: 10.1258/jrsm.2008.080347
2. Carver, J. M. (2014, December 20). Love and Stockholm syndrome: The mystery of loving an abuser, page 1. Retrieved from https://counsellingresource.com/therapy/self-help/stockholm
3. Dittman, M. (2002). Cults of hatred. American Psychological Association, 10(33), 30. Retrieved from http://www.apa.org/monitor/nov02/cults.aspx
4. Gray, M. D. (2017, January 16). How to treat Stockholm syndrome. Retrieved from https://health.onehowto.com/article/how-to-treat-stockholm-syndrome-7546.html
5. Kerkar, P. (2017, August 28). What is a Stockholm syndrome & how is it treated? Retrieved from https://www.epainassist.com/mental-health/stockholm-syndrome
6.  Social psychology. (2010). Retrieved from https://www1.psych.purdue.edu/~willia55/120/LectureSocialF10.pdf

It’s difficult to spend time in any women’s community, online or otherwise, without hearing a reference to retail therapy. In the popular press, shopping is gendered as a pursuit for women. So resources for people with compulsive buying disorder, sometimes called oniomania, often focus on women. The truth is that men, women, and people not on the gender binary can struggle with shopping addiction.

What Is Shopping Addiction?

Buying things is an inescapable part of life. Most people who can afford to do so make some unnecessary purchases. It can even be difficult to discern what constitutes an unnecessary purchase—are seeds or a rose bush really unnecessary to a dedicated gardener? These factors all make it difficult to separate typical shopping behavior from a shopping addiction.

Additionally, the Diagnostic and Statistical Manual (DSM-5) does not list shopping addiction or compulsive buying as a separate addiction. This makes diagnosis more challenging, especially for those who want to know whether they meet diagnostic criteria.

People who are addicted to shopping are often preoccupied with it. While most spend money, some simply think about or plan to shop. Some characteristics of shopping addiction as opposed to normal shopping include:

• Shopping that continually causes negative personal consequences, such as debt or relationship problems.
• Being preoccupied by shopping and spending time thinking about shopping instead of other pursuits.
• Feeling guilty or ashamed about shopping.
• Concealing purchases or shopping.
• Being unable to quit shopping or thinking about shopping.
• Continually using shopping to cope with negative emotions.
• Spending more money than one can afford.
• Consistently buying things that go unused.

Shopping addiction can have devastating effects on a person’s life. It may undermine their ability to make important purchases such as buying a home or funding college. It can cause them to drain their savings. It may lead to debt and bankruptcy or destroy relationships.

Because people who compulsively shop often do so to cope with stress, the stress of compulsive shopping can actually fuel more shopping.

People of all genders can experience an addiction to shopping or buying. Most research estimates that 6-7% of people worldwide compulsively shop.

What Research Says About Shopping Addiction and Women

People of all genders can experience an addiction to shopping or buying. Most research estimates that 6-7% of people worldwide compulsively shop.

Research on gender differences is mixed and inconclusive. A German study found equal rates of compulsive buying among men and women. A Spanish study arrived at a different conclusion, finding slightly higher rates of compulsive shopping among women.

Despite the fact that people of all genders may shop too much, 80-94% of people seeking treatment for compulsive buying are women. A 2016 analysis argues that this may not be because of gender differences in shopping style. Instead, this may be due to an increased likelihood that women will recognize and seek help for a problem with shopping.

A 1997 article analyzed compulsive shopping among women through a feminist lens. That article argues compulsive shopping is often compensatory in nature. Compensatory consumption is an attempt to overcome perceived or actual deficits in status, relationships, or self-perception. In a sexist society, the article argues, compensatory consumption may be one way women cope with gender inequity.

Culture, Family, and Genetics: What Leads to Shopping Addiction?

Like other mental health issues, no single factor has been proven to cause all cases of shopping addiction. Shopping addiction is a complex mental health challenge that may be caused or exacerbated by numerous factors.

While some analysts speculate that compulsive shopping may be genetic, no research has found a clear genetic link to compulsive buying. However, many people who shop compulsively have another mental health condition such as depression or anxiety. These diagnoses do have genetic underpinnings, so genetics could play an indirect role.

Despite a dearth of genetic research, compulsive shopping sometimes runs in families. This may be because parents and other caregivers model to children that shopping is a good way to relieve psychological distress.

Some other factors that may play a role in the development of compulsive shopping include:

• Living in a market economy in which numerous purchase options are available.
• A materialistic outlook.
• Low self-esteem or a weak sense of identity.
• Access to credit cards or to enough disposable income to compulsively shop.

Brain imaging scans of people with behavioral addictions, including compulsive shopping, have found differences in several regions of the brain. Those include the limbic system, which plays a role in memory and emotion, and various areas of the brain associated with reward and motivation.

Why Do People Become Compulsive Shoppers?

Most research suggests that people who shop compulsively do so to alleviate feelings of boredom, anxiety, sadness, depression, and other painful emotions. In some cases, people shop to alleviate discomfort caused by shopping itself. For instance, a person who receives a large credit card bill may try “retail therapy” to cope.

People who use shopping to deal with psychological pain are more likely to have certain personality traits. Those include:

• Impulsiveness
• Compulsiveness
• A high sensitivity to rewards
• A desire for novelty and excitement

For When You Can’t Stop Shopping: Overcoming Shopping Addiction

Shopping addiction often happens in secret, but admitting you have a problem is the first step to recovery. Shopping addiction is not a character defect. It’s a real diagnosis that warrants real treatment.

Some people find relief from 12-step programs such as Debtors Anonymous. Others find that antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) help, possibly by alleviating underlying psychological symptoms. Most people with an addiction to shopping need therapy to help them quit.

Cognitive behavioral therapy, which helps people understand the connection between their thoughts, emotions, and behaviors, has proven particularly helpful for fighting compulsive shopping. Other forms of therapy may also help by:

• Supporting people as they manage painful emotions without shopping.
• Helping repair broken relationships.
• Offering emotional support for managing debt and other financial issues.

Shopping addiction is treatable, as are the many problems it can cause in a person’s life. For help managing an addiction to shopping, begin your search for a therapist here.

References:

1. Granero, R., Fernández-Aranda, F., Mestre-Bach, G., Steward, T., Baño, M., Pino-Gutiérrez, A. D., . . . Jiménez-Murcia, S. (2016). Compulsive buying behavior: Clinical comparison with other behavioral addictions. Frontiers in Psychology, 7. doi: 10.3389/fpsyg.2016.00914
2. Mattos, C. N., Kim, H. S., Requião, M. G., Marasaldi, R. F., Filomensky, T. Z., Hodgins, D. C., & Tavares, H. (2016). Gender differences in compulsive buying disorder: Assessment of demographic and psychiatric co-morbidities. PLoS One, 11(12). doi: 10.1371/journal.pone.0167365
3. Pinna, F., Dell’Osso, B., Di Nicola, M., Janiri, L., Altamura, A. C., Carpiniello, B., & Hollander, E. (2015). Behavioural addictions and the transition from DSM-IV TR to DSM-5. Journal of Psychopathology, 380-389. Retrieved from http://www.jpsychopathol.it/wp-content/uploads/2015/12/12_Art_ORIGINALE_Pinna1.pdf
4. Piquet-Pessôa, M., Ferreira, G. M., Melca, I. A., & Fontenelle, L. F. (2014). DSM-5 and the decision not to include sex, shopping, or stealing as addictions. Current Addiction Reports, 1(3), 172-176. doi: 10.1007/s40429-014-0027-6
5. Woodruffe, H. R. (1997). Compensatory consumption: Why women go shopping when they’re fed up and other stories. Marketing Intelligence & Planning, 15(7), 325-334. Retrieved from https://www.emeraldinsight.com/doi/abs/10.1108/02634509710193172

Gambling addiction is one of the most prevalent behavioral addictions. Between 1-5% of Americans engage in compulsive gambling. Among young people and ethnic minorities, the rate is even higher. A 2010 study found that 6-9% of adolescents and young adults have a gambling addiction.

Gambling addiction can lead to other problems, including debt and relationship woes. It also commonly co-occurs with other addictions, especially to alcohol. It’s easy to feel hopeless and overwhelmed while in the grips of an addiction to gambling. The right treatment can help those with a gambling problem regain control over their lives.

When Does Gambling Become an Addiction?

A 2016 Gallup poll found that gambling is a common diversion, with 64% of a representative sample of Americans saying they gambled at least once during the last year. Gambling is everywhere, from state lotteries to school raffles. This can make it difficult to distinguish problem gambling from typical gambling. For people in recovery, the omnipresent nature of gambling opportunities can make gambling sobriety challenging.

Typical gambling is a fun activity that a person can easily leave behind. They don’t feel the need to lie about their gambling or gamble in secret, and they are unlikely to feel guilty about gambling. Gambling addiction is often secretive, leading to feelings of shame and guilt. People with gambling addiction may experience a range of other problems related to their compulsive gambling.

The DSM-5 lists the following symptoms of compulsive gambling. To be diagnosed with a gambling addiction, a person must exhibit at least four of these symptoms in a year:

• Needing to gamble larger sums of money to get the same level of excitement.
• Feeling restless or anxious when attempting to quit gambling.
• Repeated efforts to stop or reduce gambling.
• Persistent thoughts of gambling.
• Gambling as a way to cope with emotional distress.
• Returning to gambling even after losing money and often as a way to recoup gambling losses.
• Lying to others about gambling.
• Jeopardizing or losing something important, such as a job or relationship, because of gambling.
• Experiencing financial distress due to gambling. Many gambling addicts rely on others to help with financial problems related to gambling.

A 2004 study that compared typical gambling to gambling addiction points to the following hallmarks of gambling addiction:

• Using gambling to manage unpleasant feelings such as depression and anxiety.
• Physiological arousal and excitement associated with gambling.
• Feeling a sense of achievement related to gambling winnings.

To those unfamiliar with behavioral addictions, it might seem strange to compare gambling addiction to chemical addictions. Yet gambling addiction can, over time, change the brain in ways similar to alcohol and drugs.

What Makes Treatment for Gambling Addiction Difficult?

Unlike drugs such as alcohol and tobacco, gambling doesn’t directly change the brain. To those unfamiliar with behavioral addictions, it might seem strange to compare gambling addiction to chemical addictions. Yet gambling addiction can, over time, change the brain in ways similar to alcohol and drugs.

Gambling offers a powerful sense of reward and achievement. This can strongly motivate people to keep gambling. Research on gambling addicts suggests that gambling can release dopamine, a neurotransmitter that is also linked to chemical addictions. This release of dopamine can make a gambler feel elated, and even “high.”

As a gambling addiction progresses, problem gamblers can face a range of hardships. Those include:

• Debt
• Difficulty paying bills
• Losing family resources
• Marriage and relationship problems
• Threats from bookies, especially related to illegal gambling ventures

This stress may actually trigger more gambling, since people with gambling addiction may use the behavior to manage stress. This initiates a vicious cycle, in which gambling undermines a person’s quality of life, and they then use it to cope. Life gets steadily worse, leading to progressively more gambling.

Gambling often occurs alongside other addictions, especially alcoholism. One study found that about 23% of people seeking treatment for gambling addiction were also addicted to alcohol. The interplay between two more addictions can complicate treatment, making recovery more challenging.

Most people with a gambling problem find that they have to totally abstain from gambling to avoid relapsing. This can prove difficult. Many forms of gambling are legal, so opportunities abound, making it difficult to avoid. Because gambling is a popular social activity that’s readily available everywhere from church fundraisers to sports events, avoiding temptation can feel like a full-time job.

How People Overcome Their Gambling Problem

Gambling addiction is a treatable issue. The key to effective treatment is addressing the underlying emotions that lead to the addiction, since most problem gamblers use gambling to deal with psychological pain. To be effective, treatment must also respect a treatment-seekers values, cultural needs, and spiritual beliefs. Some options that may help include:

• Treating underlying mental health issues, such as depression or anxiety.
• Psychotherapy to address the emotions linked to gambling and offer constructive feedback that helps gamblers quit.
• Inpatient gambling addiction rehab.
• Outpatient programs such as intensive addiction outpatient or addiction day treatment programs.
• Support groups. One of the most popular options is Gamblers Anonymous, a loosely spiritual 12-step program. Some people instead choose secular programs, such as SMART Recovery.

Some people find they have to try several treatments before one works. Others pursue two or more treatment options at the same time. About 90% of people with a gambling addiction relapse the first time, leading many addiction experts to view relapse as a part of the recovery journey. Each relapse affords the chance to learn more about what works and what doesn’t in recovery and to get closer to permanent gambling sobriety.

If You or Your Loved One Has a Gambling Problem

Addiction thrives on shame and so often operates in secrecy. For many people, simply admitting that they have a problem, or contemplating that a loved one might have a problem, is a powerful first step toward recovery. This admission helps remove justifications and excuses and shifts the focus toward finding appropriate treatment.

How to Help Someone with a Gambling Addiction

If someone you love appears to have a gambling addiction, it’s important to treat their compulsive behavior not as a moral or personal failing, but as a health problem no different from diabetes or heart failure. No one willingly chooses to become an addict. Your loved one would stop on their own if they could.

Try talking to them without judgment. Express concern and support, and offer to help them find treatment—or even to go with them to treatment. If someone to whom you are close has an addiction that is affecting your life, it’s important to draw and verbalize clear boundaries. For instance, parents might clarify they will no longer give children money that will be used on gambling, while a partner might open a solo bank account to protect the family’s finances.

How to Stop Gambling Addiction

Some people struggling with gambling hope they can stop on their own without getting help or telling anyone. This goal is often motivated by shame and denial. Most addicts will need treatment and support to get and stay sober.

A compassionate therapist who specializes in addictive behaviors can help you decide if you have an addiction and explore next steps. The right therapist can also help you talk to loved ones, repair broken relationships, and devise a plan for getting your life back.

References:

1. Auter, Z. (2016, July 22). About half of Americans play state lotteries. Retrieved from https://news.gallup.com/poll/193874/half-americans-play-state-lotteries.aspx?g_source=Social%2BIssues&g_medium=newsfeed&g_campaign=tiles
2. Calado, F. & Griffiths, M. D. (2016). Problem gambling worldwide: An update and systematic review of empirical research (2000–2015). Journal of Behavioral Addictions, 5(4), 592-613. doi: 10.1556/2006.5.2016.073
3. DSM-5 diagnostic criteria: Gambling disorder [PDF]. (n.d.). Retrieved from http://www.ncpgambling.org/wp-content/uploads/2014/08/DSM-5-Diagnostic-Criteria-Gambling-Disorder.pdf
4. Gambling disorders [PDF]. (n.d.). National Center for Responsible Gambling. Retrieved from http://www.ncrg.org/sites/default/files/oec/pdfs/ncrg_fact_sheet_gambling_disorders.pdf
5. Grant, J. E., Kushner, M. G., & Kim, S. W. (2002). Pathological gambling and alcohol use disorder. Retrieved from https://pubs.niaaa.nih.gov/publications/arh26-2/143-150.htm
6. Ricketts, T. & Macaskill, A. (2004). Differentiating normal and problem gambling: A grounded theory approach. Addiction Research & Theory, 12(1), 77-87. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/1606635031000112546?journalCode=iart20