It May be Time to Seek a Therapist

We all reach moments in life when things feel like too much — when struggles pile up, and even small tasks feel overwhelming. Maybe you’ve noticed it’s harder to get through the day, or that your once-familiar joy just isn’t there anymore. It’s not always easy to tell when a rough patch has become something deeper, but being aware of certain signs can help you decide when to reach out for extra support. When any type of mental health or emotional concern affects daily life and function, therapy may be recommended. Therapy can help you learn about what you’re feeling, why you might be feeling it, and how to cope. Psychotherapy, talk or talking therapy, counseling, or simply therapy — no matter the name it’s known by, mental health counseling can benefit people struggling with emotional difficulties, life challenges, and mental health concerns.

Why You Should Consider Therapy?

Seeking therapy isn’t about needing to be “fixed” or having something “wrong.” Instead, it’s a safe space where you can work through thoughts, emotions, and life’s complexities with someone who understands and has the tools to guide you toward feeling better. Therapy can help improve symptoms of many mental health conditions. In therapy, people can learn to cope with symptoms that may not respond to treatment right away. Research shows the benefits of therapy last longer than medication alone. Medication can reduce some symptoms of mental health conditions, but therapy teaches people skills to address many symptoms on their own. 

Therapy also lets you talk through life’s challenges, such as breakups, grief, parenting difficulties, health impacts, or family struggles. For example, couples counseling can help you and your partner work through relationship troubles and learn new ways of relating to each other. Note that crisis resources, not couples counseling, are typically recommended for abusive relationships.

If you’ve been wondering whether it’s time to ask for help, keep reading to learn about a few common signs that therapy could bring you relief, greater understanding, and the strength to take on life’s challenges with a renewed sense of purpose.

How Common are Mental Health Issues?

Mental health issues are common. Recent statistics from the National Alliance on Mental Health show 1 out of every 5 American adults lives with a mental health condition, while 1 in 20 adults experience a serious mental health condition each year. 1 in 6 U.S. youth age 6-17 experience a mental health disorder.

But only about 40% of people with mental health issues get help. Untreated mental health issues often get worse and may have other negative effects. They could also lead to:

• Inability to work or go to school
• Difficulty in relationships or taking care of children
• Increased risk of health issues
• Hospitalization
• Suicide

Suicide is the second leading cause of death for people in the United States between the ages of 10 and 34. About 90% of people who die by suicide in the U.S. lived with a mental health condition.

The best option for anyone contemplating suicide is to get immediate help is reaching out to a suicide helpline through phone, text message, or online chat. You may be encouraged to call or visit the nearest emergency room. A therapist can help support you going forward, once you are no longer in crisis.

The GoodTherapy registry might be helpful to you. We have thousands of therapists listed with us who would love to walk with you on your journey. Find the support you need today!

Recognizing the Signs You Could Benefit From Therapy

It may take some consideration before you decide you’re ready for therapy. You might want to wait and see if time, lifestyle changes, or the support of friends and family improves whatever you’re struggling with.

The American Psychological Association suggests you consider a time to see a therapist when something causes distress and interferes with some part of life, particularly when:

• Thinking about or coping with the issue takes up at least an hour each day
• The issue causes embarrassment or makes you want to avoid others
• The issue has caused your quality of life to decrease
• The issue has negatively affected school, work, or relationships
• You’ve made changes in your life or developed habits to cope with the issue

If you experience any of the following emotions or feelings to the extent that they interfere with life, therapy may help you reduce their effects. It’s especially important to consider it’s time to see a therapist if you feel controlled by symptoms or if they could cause harm to yourself or others.

1. Feeling Constantly Overwhelmed, Anxious, or Have Intrusive Thoughts. 

• While life is frequently stressful, constant feelings of overwhelm, unease, or anxiety can sometimes linger without relief and become so present that they negatively impact your daily life. When these feelings cause physical symptoms, constant intrusive thoughts, interfere with your ability to work, connect with others, or manage day-to-day responsibilities, it might be time to seek support. Therapy offers tools to manage anxiety and ways to identify its root causes, helping you regain a sense of calm and control.

2. Experiencing Persistent Sadness or Hopelessness.

• Sadness in certain quantities is a normal part of life, but if it persists or intensifies into depression, therapy can offer a safe space to work through your feelings. Losing hope or motivation, or feeling as if you have no future, can indicate depression or another mental health condition. Whether due to loss, major life changes, or something harder to pinpoint, a therapist can help you process dark days, find coping strategies, and regain hope.

3. Struggling with Self-Esteem or Negative Self-Talk.

• Feeling like you’re not enough or constantly doubting your self-worth can be exhausting and isolating. If self-criticism is holding you back from being social, pursuing goals, or feeling proud of yourself, therapy can help you see your inherent value. If you often compare yourself to others or constantly feel unworthy, these patterns could be signs that professional support may be needed.

4. Facing Major Life Transitions.

• Major changes, such as a new job, a move, political events, or a relationship shift, often come with their fair share of tough questions and difficult emotions. If these transitions leave you feeling stuck, unprepared, overly stressed, or totally lost, therapy can help you manage the change. Experiencing an intense fear of failure, regret, or constant second-guessing might be signs that professional support might be needed to make the transition smoother.

5. Difficulty in Relationships.

• Healthy relationships take effort, but if you find yourself facing recurring conflict, isolation, or trust issues, therapy can offer tools to navigate these challenges and strengthen your connection. Signs of recurring resentment, loneliness, or emotional distance are often early indicators that couples therapy or individual therapy might be necessary. Working with a relationship counselor can help you understand unhealthy patterns, improve communication, and build stronger, more fulfilling emotional bonds.

6. Turning to Unhealthy Coping Mechanisms.

• Turning to habit-forming behaviors for comfort can provide a quick fix, but will often lead to lasting issues. If you’re increasingly relying on substances, excessive screen time, unhealthy eating, or other habits to cope, therapy can provide a better alternative. Exploring these patterns in a nonjudgmental space can offer clarity and provide new ways to handle stress in healthier, more sustainable ways. Signs like secrecy, guilt, or relying on substances or habit-forming activities to escape your emotions can indicate a need for support in making changes.

7. Difficulty After Trauma

• Unprocessed trauma can lead to flashbacks, hypervigilance, or a constant sense of unease. If you find yourself avoiding certain places or people, struggling with trust, fighting intrusive emotions, or feeling on edge without explanation, it might be time to consider therapy. Working through the trauma with a professional can help you feel safer, and more grounded, ultimately opening, and ultimately open the door for healing.

8. Feeling “Stuck” or Lacking Motivation.

• When you feel stuck, unmotivated, or disconnected from the things you once enjoyed, therapy can help you reestablish a sense of purpose. Processing these feelings with a therapist can provide fresh perspectives, renewed energy, and the inspiration you need to face life head-on.

9. You’re Interested in Bettering Yourself.

• If you’re asking whether or not you need therapy, you might want to go ahead and try it out. Therapy isn’t just for people with trauma or “something wrong” — professional mental guidance can benefit just about anyone by improving self-understanding, everyday coping strategies, empathy, communication, and so much more. Even the “healthiest” individuals can gain so much from having a protected space to share and reflect. You don’t need to wait for things to get bad before starting therapy, just like you shouldn’t wait for health problems to appear before starting regular checkups with a physician.

Additional Signs: 

Fatigue. 

• This physical symptom often results from or accompanies mental health issues. It can indicate depression. Fatigue can cause you to sleep more than usual or have trouble getting out of bed in the morning.

Disproportionate rage, anger, or resentment. 

• Everyone feels anger at times. Even passing rage isn’t necessarily harmful. Seeking support to deal with these feelings may be a good idea when they don’t pass, are extreme compared to the situation, or if they lead you to take violent or potentially harmful actions.

Agoraphobia. 

• People with agoraphobia fear being in places where they might experience panic attacks or become trapped. Some people may become unable to leave their houses.

Apathy. 

• Losing interest in usual activities, the world around you, or life in general can indicate mental health issues like depression or anxiety.

Social Withdrawal

• Many people feel better when they’re able to spend at least some time alone. Introverted people may need even more time alone than others. But if you feel distressed around others or fear being with other people, therapy can help you understand and deal with these feelings.

What If I’ve Already Tried Therapy and It Didn’t Work?

Sometimes therapy doesn’t “work” right away. Even in an ideal therapy situation, it can take time for symptoms to improve. – months or years. Going to therapy and seeing no change may cause frustration. Perhaps you haven’t found the right therapist, so it’s worth it to continue your search for help. If you’re still experiencing any of the symptoms above, therapy should still be an option. Don’t stop your quest to improve your mental health.

It can help to look for a therapist who treats what you’re experiencing. If you don’t have a diagnosis, you can talk to potential therapists about your symptoms. Most therapists will let you know if they’re able to treat your concern. If they can’t, they may be able to recommend someone who can.

Keep in mind different approaches may be better for different issues. If you didn’t feel heard in your previous therapy, or if your symptoms have changed since your last therapy session, a different therapist might be exactly what you to move forward.

The Benefits to Seeking Therapy

If you’re considering therapy, you may be thinking about the possible drawbacks. Cost might be a concern for you. You might also be aware that therapy is often difficult. Trauma or other painful events from the past can be frightening to remember and discuss with someone. Working through challenges isn’t easy, and therapy isn’t always a quick fix. Make sure that when you’re ready to see a therapist that you can be honest with yourself and with your them.

But if you’re willing to do the work, therapy can be rewarding. It’s a safe, judgment-free space where you can share anything, with a trained professional who is there to help.

Here are a few benefits of therapy:

• You’ll learn more about yourself. Therapists listen to your story and help you make connections. They might offer guidance or recommendations if you feel lost. Therapy can empower you to take action on your own.
• Therapy can help you achieve your goals. If you aren’t sure of what your goals are, therapy can help you clarify them and set realistic steps to meet them.
• Therapy can help you have more fulfilling relationships. Whether you’re single or in a relationship, therapy can help you address difficulties relating to others, such as insecurity in relationships or difficulty trusting your partners.
• You’re more likely to have better health. Research supports a link between mind and body wellness. Untreated mental health issues can impact physical wellness. On the other hand, people in good emotional health may be more able to deal with physical health issues that arise.
• Therapy can lead to improvement in all areas of life. If you feel like something is holding you back from living life as you envision it, therapy can help you address this. When you aren’t sure what’s keeping you from making change, therapy can help you discover the answer.

How Therapy Can Help You Move Forward

If you recognize the signs that a change is needed, starting therapy could provide a gateway to greater well-being. It’s more than just talking about what’s not right — it’s a chance to explore new perspectives, recognize patterns, and build skills that help you manage stress, strengthen relationships, and improve your overall mental state. With the right therapist, you’ll work together to set goals that feel meaningful to you, taking small steps that create lasting change.

At GoodTherapy, we make it easy to find the perfect therapist for your individual personality and needs, cutting the guesswork and difficulty out of finding empowering support. Whatever challenges you face, remember you’re not alone — help is here when you’re ready.

Even if you aren’t sure you want to commit to therapy, many therapists offer a free first session or phone consultation to talk through what you’re dealing with. Based on your symptoms, they might encourage you to get help. Begin your search for a therapist today!

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Anxiety is a mental health condition, so it may seem logical to assume it primarily involves mental or emotional symptoms, not physical ones. But anxiety often also involves somatic symptoms, or symptoms felt in the body. In fact, some people may experience more physical symptoms than emotional ones.

Anyone who’s ever felt nervous can likely name many common physical symptoms, including:

• Shaking or trembling
• Flushed skin
• Increased sweating
• Nausea
• Pounding heart

But people living with chronic anxiety issues, including panic, phobias, general anxiety, or social anxiety, may experience more persistent symptoms, even when they don’t have any reason to feel nervous.

These symptoms can resemble those of serious health conditions, and some people may not recognize the nature of their distress. They may worry instead they have heart trouble, chronic migraines, or other health issues. Accordingly, these physical symptoms may not only cause immediate distress, they also often contribute to long-term confusion and stress around the true cause of symptoms.

Learning more about anxiety’s physical effects on the body can help make anxiety more recognizable to people dealing with physical symptoms.

Learning more about anxiety’s physical effects on the body can help make anxiety more recognizable to people dealing with physical symptoms.

Seven Physical Symptoms of Anxiety

Anxiety can cause plenty of physical complaints, so people living with anxiety could notice the following physical signs, in addition to mental health symptoms.

1. Anxiety and dizziness

Dizziness often arises as a symptom of anxiety. You might feel:

• Lightheaded
• Off-balance, particularly in crowded areas or open spaces
• As if you’re spinning or swaying from side to side

The relationship between anxiety and dizziness can go both ways, creating a feedback loop. People who worry about losing their balance, falling, or losing control in a public place may become anxious whenever they feel dizzy, and one symptom may worsen the other.

Research from the Academy of Neurologic Physical Therapy suggests this happens when the vestibular system, which helps regulate sensations of movement in your environment and the position of your body, interacts with the limbic system, which helps regulate emotional experiences.

These fears can lead many to cope by avoiding activities likely to cause one or both symptoms, including physical activity or experiences likely to provoke anxiety or stress. This can have a negative impact on quality of life over time.

2. Anxiety and chest pain

Chest pain is one anxiety symptom that often causes alarm, especially when pain accompanies a rapid increase in heart rate and shortness of breath. These symptoms, of course, can also suggest a heart attack, so many people who experience chest pain worry their symptoms are life-threatening. When seeking emergency medical care, they may feel frustrated and distressed when there’s no medical explanation for their pain and heart palpitations.

But according to one study of 151 patients reporting chest pain, 59 percent had symptoms of anxiety. Research from 2006 supports the finding that people who seek emergency care for chest pain often have anxiety rather than a cardiac condition. Panic attacks, in particular, may share many similarities with an oncoming heart attack.

Someone having a heart attack, however, will most likely experience a squeezing pain that may radiate toward the jaw or left arm. Women often notice pain in their upper back or shoulders.

3. Anxiety and headaches

Experts have linked anxiety to both tension headaches and migraines. Headaches can develop as a symptom of anxiety for many reasons, including the following:

• Sleep disturbances. Insomnia and other sleep issues also commonly occur with anxiety, so many people living with anxiety don’t get enough sleep. Insufficient or disrupted sleep can trigger a migraine.
• Low serotonin. Some research suggests the neurotransmitter serotonin can help regulate emotional health. Low levels of serotonin may contribute to mental health symptoms, including anxiety. A rapid drop in serotonin levels could also narrow your blood vessels, which can lead to headaches.
• General stress. Stress can contribute to anxiety, especially when you feel overwhelmed and aren’t sure how to cope. Both stress and anxiety can cause muscles to tense up repeatedly, and lingering muscle tension often leads to head pain. But stress is also known to trigger migraines.

4. Anxiety and digestive issues

Persistent gastrointestinal distress often occurs as a physical symptom of anxiety. Medical research suggests this happens because of the connection between the brain and the gut. Nerves shared by the gut and the brain can interact with each other and have a negative impact on normal bodily processes.

Most people have experienced stomach “butterflies” or nausea when nervous or worried about something. But people living with chronic anxiety might notice more serious issues, such as:

• Chronic stomach pain or cramping
• Diarrhea or vomiting
• Constipation
• Appetite changes
• Ulcers
• Worsened irritable bowel syndrome (IBS)

Worries about experiencing things like vomiting or diarrhea in public can contribute to increased anxiety and emotional distress. Long-term GI distress can even make it difficult for some people to function as they usually would, which can lead to significant negative consequences for their quality of life.

5. Anxiety and breathing difficulties

Many people experience breathing problems when feeling anxious. Breathing troubles can range from hyperventilation, or very rapid breathing, to sensations of choking or feeling unable to draw a breath.

These symptoms don’t typically persist over time. They generally happen whenever a situation becomes tense or involves some fear or nervousness. Panic attacks often involve choking sensations, and it’s not uncommon to feel as if you can’t breathe. These feelings can be very frightening, and they often worsen anxiety’s emotional symptoms.

6. Anxiety and numbness

Numbness or tingling can also occur as a physical sign of anxiety. People with anxiety tend to experience this sensation, often described as pins and needles, in the hands, arms, legs, or feet.

Experts believe it happens in response to bodily arousal. Anxiety symptoms develop when the body feels threatened. In response to this perceived threat, the body redirects its resources, like blood, away from the extremities and to the more essential organs, such as the heart.

Hyperventilation can also contribute to numbness and tingling. When you hyperventilate, you end up with an excess of oxygen in your blood. This excess of oxygen means the body doesn’t have enough carbon dioxide to maintain typical processes. As a result, blood vessels constrict, and blood doesn’t flow to areas the body considers less essential, like hands and feet. Other symptoms, including head pain, increased heart rate, and dizziness can also happen in response to this lack of carbon dioxide.

7. Anxiety and chronic pain

There’s plenty of scientific evidence supporting the connection between chronic pain and anxiety.

Results of one study from 2013 found that, among 250 people living with chronic pain, 45 percent of them also had symptoms of at least one type of anxiety. The chronic pain patients who also had anxiety tended to experience greater pain and lower quality of life than those who did not have anxiety symptoms.

People with both chronic pain and anxiety often have a lower tolerance for pain and become trapped in a distressing cycle of symptoms.

People constantly in pain may:

• Feel distressed and worried about experiencing more pain
• Avoid activities that could relieve anxiety symptoms because pain makes it difficult to move around.
• Become anxious about their ability to take care of responsibilities due to pain

Long-term chronic pain has also been linked to depression. It’s not uncommon for people living with anxiety and chronic pain to also have symptoms of depression.

Long Term Effects of Anxiety

Anxiety symptoms develop because the body mistakenly believes it’s about to face a serious threat. Physical and emotional symptoms result from bodily changes known as the “fight-or-flight” response. Once the body engages in this mode, hormones enter the bloodstream at higher levels than usual, triggering those well-known symptoms of anxiety.

So, although anxiety serves an important purpose—to prepare the body to face threats in the environment—problems can develop when anxiety sends the body into fight-or-flight mode too often or the body remains in fight-or-flight mode for a long period of time, which can happen when you have trouble coping with anxiety symptoms.

Medical research has found evidence to suggest links between long-term anxiety and the following conditions:

• Heart attack and other cardiovascular issues
• High blood pressure
• Irritable bowel syndrome (IBS)
• Chronic obstructive pulmonary disease and other respiratory issues

To sum up, people with anxiety, especially untreated anxiety, don’t only experience immediate physical and emotional symptoms of anxiety. They may also see a decline in overall health over time.

Can Therapy Help with the Physical Effects of Anxiety?

Just as therapy can help address the emotional impact of anxiety, it can also help people manage physical symptoms. Addressing anxiety causes and triggers will generally lead to improvement of all symptoms, physical or mental.

People who experience physical symptoms of anxiety will typically work with a therapist who helps them identify and address possible causes or triggers of anxiety. Specific types of therapy, including cognitive behavioral therapy (CBT) or exposure therapy, can help people learn to address anxiety in the moment and learn potential methods of reducing anxiety in daily life.

But therapists can also offer guidance on specific ways to address physical symptoms. These might include:

• Breathing exercises to cope with hyperventilation
• Coping skills and lifestyle remedies to manage pain or headaches
• Relaxation techniques to decrease muscle tension and pain
• Tips to better manage stress and help prevent various physical symptoms from developing

Because many physical signs of anxiety do resemble symptoms of serious health conditions, it’s always wise (and highly recommended) to talk to a doctor about any concerning physical symptoms, especially if you have any doubt about what’s causing the symptom.

This is particularly important with chest pain. Since chest pain occurs during heart attacks as well as panic attacks, it’s often best to talk to a medical professional even when you feel certain anxiety has caused the pain. Once they’ve ruled out a heart attack or similar issues, talking to a therapist can be a helpful next step.

Find a compassionate, skilled therapist at GoodTherapy today.

References:

1. Anxiety and physical illness. (2018, May 9). Harvard Women’s Health Watch. Retrieved from https://www.health.harvard.edu/staying-healthy/anxiety_and_physical_illness
2. Calm your anxious heart. (2019, October 1). Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/heart-health/calm-your-anxious-heart
3. Chronic pain. (2016). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/chronic-pain
4. Chronic pain sufferers likely to have anxiety. (2013, May 8). Health Behavior News Service. Retrieved from https://www.sciencedaily.com/releases/2013/05/130508213112.htm
5. Demiryoguran, N. S., Karcioglu, O., Topacoglu, H., Kiyan, S., Ozbay, D., Onur, E., Korkmaz, T., & Demir, O. F. (2006). Anxiety disorder in patients with non-specific chest pain in the emergency setting. Emergency Medicine Journal, 23(2), 99–102. doi: 10.1136/emj.2005.025163
6. Goodman, K. (n.d.). How to calm an anxious stomach: The gut-brain connection. Anxiety and Depression Association of America. Retrieved from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/how-calm-anxious-stomach-brain-gut-connection
7. Komaroff, A. L. (n.d.). The gut-brain connection. Healthbeat. Retrieved from https://www.health.harvard.edu/diseases-and-conditions/the-gut-brain-connection
8. Marksberry, K. (2012, August 10). Take a deep breath. The American Institute of Stress. Retrieved from https://www.stress.org/take-a-deep-breath
9. Morris, L. O. (2015). Dizziness related to anxiety and stress. Retrieved from http://neuropt.org/docs/default-source/vsig-english-pt-fact-sheets/anxiety-and-stress-dizziness4ca035a5390366a68a96ff00001fc240.pdf?sfvrsn=80a35343_0
10. Peres, M., Mercante, J., Tobo, P. R., Kamei, H., & Bigal, M. E. (2017). Anxiety and depression symptoms and migraine: A symptom-based approach research. The Journal of Headache and Pain, 18(1), 37. doi: 10.1186/s10194-017-0742-1
11. Rajagopalan, A., Jinu, K. V., Sailesh, K. S., Mishra, S., Reddy, U. K., & Mukkadan, J. K. (2017). Understanding the links between vestibular and limbic systems regulating emotions. Journal of Natural Science, Biology, and Medicine, 8(1), 11–15. doi: 10.4103/0976-9668.198350
12. Raymond, V. (2018, February 23). Is your chest pain a heart attack or anxiety? Right as Rain by UW Medicine. Retrieved from https://rightasrain.uwmedicine.org/well/health/your-chest-pain-heart-attack-or-anxiety
13. Schwarz, J., Prashad, A., & Winchester, D. E. (2015). Prevalence and implications of severe anxiety in a prospective cohort of acute chest pain patients. Critical Pathways in Cardiology, 14(1), 44–47. doi: 10.1097/HPC.0000000000000038
14. Woo, A. K. (2010). Depression and anxiety in pain. British Journal of Pain, 4(1), 8–12. doi: 10.1177/204946371000400103
15. Yoder, W. M. (2018, October 27). Anxiety and numbness—A typical reaction. Calm Clinic. Retrieved from https://www.calmclinic.com/anxiety/symptoms/numbness
16. Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018, September 7). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353. doi: 10.3389/fnhum.2018.00353

Some level of picky eating is generally par for the parenting course. Children of any age might show some selectiveness about the food they eat, but parents often have the most struggles with toddlers and preschool-age children.

Most developmental picky eating will resolve itself by the time your child begins school—we have some tips below to help you manage until then.

In some cases, though, picky eating can be a symptom of something beyond an age-appropriate desire for independence. So, if your child won’t eat anything besides Cheerios or white bread and you don’t know what to do, keep reading. We’ll go over what typical picky eating looks like and offer some guidance on getting help for more serious concerns.

In some cases, picky eating can be a symptom of something beyond an age-appropriate desire for independence.

Why Are Some Kids Picky Eaters?

There are numerous reasons for picky eating, according to a large research review published in 2015. Some possible factors include:

• Being an only child
• Personality
• Maternal diet
• Increased pressure at mealtimes
• Social influences

It’s also worth noting that many children simply have a limited range of preferred tastes in early life. Developing a taste for new food is often a lengthy process, so your child may need to try a food multiple times, not just once or twice, before they’re willing to eat it on a more regular basis.

Children begin developing preferences for specific foods as they approach the preschool years. Of course, this is also when they begin to find their sense of independence. Preschoolers don’t have many opportunities to demonstrate this newfound independence, so they often choose the table as their stage. This can lead to any number of battles over food—whether the issue actually involves the food or not.

They also often lack the words to express how they really feel about certain foods. They may not want to eat something for a more specific reason than simply not liking it, but they don’t know how to tell you exactly what they think. Maybe the texture feels uncomfortable in their mouth, or they have an aversion to the smell of the food or the spice you used.

Allergies can also lead to picky eating behavior. Children with a mild allergy to a specific food may not have a serious or life-threatening reaction, but they may associate the food with any minor symptoms they experience and avoid it entirely.

Anxiety and other distress can also contribute to pickiness. Think about what you want to eat after a bad day. Everyone has preferred comfort foods: soup, macaroni and cheese, ice cream, popcorn, etc. Children experience stress and unhappiness, too, even if they don’t know how to talk about it. Confronting a new spiky green vegetable may be the last thing they want to do after a long day that left them tired, cranky, or otherwise out of sorts.

Mealtime Tips for Parents

The battle to get your child to eat may frustrate you, but you can avoid distress (for yourself and your child) by not looking at mealtime as something you need to “win.”

Keeping calm helps. If you’re frustrated or irritated with your child for wasting food or being stubborn, they’ll likely pick up on that. Sometimes, this can provide more incentive for them to push to win the argument. In the end, it boils down to control.

You might feel stressed about your child’s health or believe you’ve “failed” as a parent if you can’t get your child to eat nutritious foods. But try not to let that get to you. If they meet developmental milestones, enjoy general good health, and have energy to play, they’re probably just fine. If you do have specific concerns, your pediatrician can offer more guidance.

Try these tips to help make mealtimes easier:

Don’t force or bribe your child to eat.

This generally only creates more problems later. Offer nutritious foods in small amounts and let your child decide how much to eat.

Promising dessert after so many bites of vegetables may seem like a great way to get your child to eat those vegetables. However, this teaches children that dessert is better than everything else, an idea that can potentially contribute unhealthy eating habits later in life.

When you offer dessert, don’t make it conditional on finishing their dinner, either—this may lead children to eat more than they really need.

Don’t serve separate meals.

If your child refuses lunch, don’t offer to make them something you know they like. This just reinforces their behavior. Similarly, eat the foods you want your child to eat—at least in front of them. If you offer them a lunch of broccoli, apple slices, brown rice, and scrambled eggs while you have pizza, you may not be sending the best message.

Involve your child in food preparation.

Let your child choose vegetables and fruits at the store, then get them involved in the cooking process. You might not always succeed with this approach, but children may have more interest in trying new things when they helped create them.

Try not to get frustrated when they don’t want to take a single bite, even after helping you in the kitchen. They may be testing you, but they also might just need time. Keep calm and continue offering the new food.

Avoidant-Restrictive Food Intake Disorder

Children who don’t seem to grow out of picky eating, or who eat fewer foods as they grow older, may actually have an eating disorder: avoidant restrictive food intake disorder, or ARFID.

Experts aren’t fully certain what causes ARFID, but it often appears related to trauma. These children may have choked previously, had trouble eating as a baby, or experienced birth trauma or trauma in utero. They might refuse to eat new foods because they believe the food may lead to choking or other harm.

ARFID can also relate to sensory distress around the textures of specific foods. People with autism (ASD), attention-deficit hyperactivity (ADHD), or any sensory issues may have a higher risk for ARFID.

Most children will eventually eat the food you offer them when they get hungry. But children with ARFID generally won’t eat foods besides their select “safe” food items. Mealtimes generally become very difficult for them, as they tend to experience anxiety and distress as a result of their inability to eat.

It’s generally best to seek a professional opinion if your child:

• Seems truly distressed by specific foods
• Loses weight or cannot put on weight
• Experiences pain or other stomach issues
• Has trouble sleeping or concentrating
• Feels cold or tired regularly

ARFID can have serious health consequences, since a child with a severely restricted diet likely isn’t getting the correct nutrients.

Treatment for ARFID

There’s help for picky eaters—even severely picky eaters.

A good first step is to talk to a therapist who specializes in working with children. Depending on your location, you may even be able to find a therapist who treats eating disorders in children.

Just be aware that other mental health concerns beyond ARFID, including obsessive-compulsive tendencies and other anxiety issues, can also contribute to picky eating. Your child’s therapist will start by determining what’s actually going on, since the most effective treatment generally depends on what’s causing their picky eating.

Your child’s treatment plan might include:

• Exposure therapy that gradually introduces them to new foods
• Somatic therapy (Somatic Experiencing), which can help them become accustomed to new textures without distress
• Individual counseling
• Nutrition counseling
• Group therapy or peer support

If something doesn’t seem typical about your child’s refusal to eat, don’t hesitate to reach out to a counselor. There may be nothing serious going on, but you aren’t overreacting–even if their eating behaviors fall within the range of usual picky eating, it’s generally better to know for sure.

Begin your search for a compassionate, trained counselor at GoodTherapy today.

References:

1. Avoidant restrictive food intake disorder (ARFID). (n.d.). National Eating Disorders Association. Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid
2. Children’s nutrition: 10 tips for picky eaters. (2017, July 28). Mayo Clinic. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/childrens-health/art-20044948
3. Ehmke, R. (n.d.). More than picky eating. The Child Mind Institute. Retrieved from https://childmind.org/article/more-than-picky-eating
4. Elliot, S. (n.d.). What exactly is ARFID? National Eating Disorders Association. Retrieved from https://www.nationaleatingdisorders.org/blog/what-exactly-arfid
5. Knopf, A. (n.d.). When picky eating is a sign of psychological distress. Bradley Hospital. Retrieved from https://www.bradleyhospital.org/when-picky-eating-sign-psychological-distress
6. Taylor, C. M., Wernimont, S. M., Northstone, K., & Emmett, P. M. (2015, December 1). Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite, 95, 349-359. Retrieved from https://www.sciencedirect.com/science/article/pii/S0195666315003438?via%3Dihub
7. Tips for picky eaters. (n.d.). United States Department of Agriculture. Retrieved from https://www.choosemyplate.gov/browse-by-audience/view-all-audiences/children/health-and-nutrition-information/preschoolers-picky-eating

If you’ve never gone to therapy, you might not have much idea what happens in a therapy session. This is fairly common, since much of what people know about therapy comes from (often inaccurate) media portrayals.

In the past decade, awareness around mental health issues has increased significantly. Greater awareness has helped reduce mental health stigma by supporting therapy as a beneficial, normal method of getting help. Accordingly, the shroud of secrecy around therapy has started to fall away. Your friends, family members, even your coworkers may be perfectly willing to open up about their experience in therapy and how talking to a mental health professional has helped them.

But if you’re still unsure about therapy, or don’t know anyone who’s gone to therapy, you might hesitate before booking your first session. Maybe you feel nervous about what a therapist will do, or you don’t think your distress actually merits therapy.

You don’t need to experience any significant mental health issues or emotional distress for therapy to work.

Before exploring how therapy works to help people who are struggling, let’s bust that myth right now. You don’t need to experience any significant mental health issues or emotional distress for therapy to work. If you’re struggling, confused, feel like you want to sort out a problem or your life and don’t know where to start—therapy can help.

Therapy Is Personalized

The process of therapy can differ somewhat based on what you’re experiencing.

For one, the length of therapy can vary based on the issue you want help with. If you’re struggling with depression after a breakup or job loss, for example, therapy often helps you work through the problem within a few months. You might not be completely “cured,” but you’ll generally be able to resolve lingering distress on your own. That’s a key goal of therapy.

Serious or longer-lasting concerns, like trauma from abuse or chronic depression, may require more therapy sessions and a more intensive approach.

In most cases, you’ll spend just an hour each week in therapy. But your therapist might also recommend specialized types of therapy to meet your needs. Dialectical behavior therapy, for example, generally involves an hour of therapy, an hour of skills training, and an additional hour of group therapy each week.

Therapy doesn’t operate as a blanket remedy or one-size-fits-all approach. Therapy for intrusive thoughts (a component of OCD) will likely look much different than therapy for a phobia of dogs.

But even two people with generalized anxiety might see treatment proceed in different ways, based on the type of treatment the therapist specializes in and their individual needs.

If you’ve tried various coping strategies and still struggle with severe anxiety, for example, you might want to try medication, a perfectly valid (and helpful) treatment option. Your therapist should support your decision and work with you to find the right drug.

If you know you don’t want to take medication at all, unless absolutely necessary, you might look for a therapist who specializes in alternative treatments, like yoga or nature therapy.

Therapy Helps People Reach Goals

You might consider going to therapy (or want to avoid therapy entirely) with the idea that your therapist will give you advice, tell you what to do, or ask how every little thing makes you feel.

But therapy doesn’t work like that. Rather, therapy offers a safe, nonjudgmental space for you to talk about problems and anything that’s overwhelming you or even just making life a little tough. Your therapist listens to what you have to say and then works with you to develop a plan to confront challenges and achieve an improved quality of life.

You can also go to therapy if you aren’t experiencing significant distress. Therapy can be beneficial in the pursuit of any goal, no matter what that goal is.

Maybe you want to date but feel you lack the skills to approach someone or make a relationship work. Perhaps you want to work on being closer with your teenage children. Or maybe you just want to break a lifelong nail-biting habit.

Whatever your goal, your therapist will help you explore potential changes you can make to arrive at the outcome you desire. But you come to therapy with your goals (or spend time identifying them in session). You also have an opportunity to share solutions that don’t work, which can help you and your therapist work together to find something that will have benefit.

Say you’ve been feeling low because you no longer have time to create art. Your therapist asks what a typical day looks like for you. After you explain your schedule, they point out you’re spending all your time doing things for others, something you never stopped to consider.

In short, therapy can help you work to identify and break concerning patterns or habits on your own. Therapists don’t give you all the answers. They help you find the right tools to help yourself.

In therapy, you drive the car. Your therapist can help you navigate when you get lost or help dig you out if you get stuck in the mud.

Therapy Puts You in Control

In therapy, you drive the car. Your therapist can help you navigate when you get lost or help dig you out if you get stuck in the mud. But your therapist doesn’t decide where you go or how you get there. You do that work yourself.

That’s why finding a therapist you can work well with is so important. You can often help personalize your own therapy experience by choosing your own therapist, so look for someone you feel comfortable with.

Therapists aren’t machines. Their unique personalities, mannerisms, and styles of interaction will likely show through in the therapy process. Their personality can help attract you to the work you’re doing together, or put you off it.

Finding a therapist who will encourage you to keep pushing through difficulties, even when it’s unpleasant, is also essential. Therapy often feels uncomfortable, even unpleasant. That’s a normal part of the process. But when you and your therapist have a strong working relationship, you trust them to support you through the discomfort and arrive at a place where you feel ready to make change.

If you don’t believe your therapist will continue offering compassion and support, regardless of the thoughts you share or challenges you face, you’ll have a harder time opening up and sharing your vulnerabilities. As a result, therapy may have less effect.

You pay for therapy. It’s your space to create change. Your therapist offers guidance during the process, but you work toward what you need.

Conclusion

If you go into therapy looking for a quick, easy solution, or with the hope your therapist will solve all your problems, you won’t get much out of the process.

Therapy can be hard work, and going into therapy with this in mind can help prepare you for the occasional tough session. But when you work with the right therapist, therapy can be productive and healing, and most of your sessions will probably feel rewarding, even when they’re a little difficult.

Ready to find a compassionate therapist? GoodTherapy is the best place to start. Start your search here.

References:

1. Frey, E. (2017, April 27). How therapy actually works and 5 myths about therapy debunked. Retrieved from https://medium.com/kip-blog/5-myths-about-therapy-debunked-17e7fdd8b8a5
2. Going to a therapist. (2018). TeensHealth. Retrieved from https://kidshealth.org/en/teens/therapist.html
3. Understanding psychotherapy and how it works. (n.d.). American Psychological Association. https://www.apa.org/helpcenter/understanding-psychotherapy
4. What is psychotherapy? (2019). American Psychiatric Association. Retrieved from https://www.psychiatry.org/patients-families/psychotherapy

Dependency on others is the hallmark characteristic of dependent personality disorder (DPD). This can create problems within relationships, since nearly all adult relationships need a degree of interdependence to be considered healthy. Interdependence, simply put, means the people in the relationship maintain their sense of self while working together to meet each other’s needs as well as their own.

If you live with DPD, you may have an intense and overwhelming need for others to take care of you, so much so that you fear being abandoned or left alone. To avoid the possibility of abandonment, you might find yourself going out of your way to make certain you have the continued support of your romantic partner, family members, or friends. This might cause you to go to great lengths to please them, often by doing things you’d prefer not to do.

This behavior may seem to help you get your needs met, but it often leads to unhealthy or imbalanced relationships. You might end up staying with a partner who isn’t right for you, or even one who’s toxic or takes advantage of you, simply because you don’t want to be alone.

But it is possible to build healthy relationships when you have DPD. Awareness of the condition, and how it affects your interactions with others, is a good first step.

If you live with DPD, you may have an intense and overwhelming need for others to take care of you, so much so that you fear being abandoned or left alone.

What Is Dependent Personality?

In basic terms, dependent personality means you rely on other people to take care of you. You might experience serious distress at the thought of having to do things on your own, because you don’t think you can care for yourself. You might feel helpless or unable to make decisions for yourself—both significant decisions, like the career you choose, and minor decisions, like what you’ll make for dinner.

You might lack well-developed self-esteem and have little confidence in your own abilities. This can contribute to beliefs like, “I can’t do anything myself,” “Someone else can do a better job,” or “If I upset them, they’ll leave me.” Because you need continued support from loved ones, you may withhold normal, healthy responses, like anger, frustration, or disagreement, even if they do something problematic or upsetting.

This condition is diagnosed in adulthood, and only in people who do have the ability to make decisions on their own without excessively depending on others. People sometimes experience dependency as a result of a health condition or other mental health condition, and this isn’t quite the same as DPD. It’s also important to note that people in abusive relationships may display traits that seem similar to those associated with DPD, such as extreme submissiveness or fear of disagreeing with the abuser. If these behaviors only happen in the abusive situation, DPD wouldn’t be diagnosed.

It’s important to understand these characteristics aren’t your fault. Personality disorders are complicated issues that develop from a multitude of factors, and it’s not always easy to recognize there’s something problematic about your behavior. These traits are ingrained—a part of your personality—and they can be difficult to change. But change is possible.

Romantic Relationships and DPD

There’s nothing wrong with consulting your romantic partner about decisions you make, especially those affecting you both. In fact, this is pretty normal (and beneficial) in a healthy relationship. What sets this type of dependency apart from DPD? In a healthy relationship, you don’t wholly depend on your partner. You ask their advice, consider it, then make a decision that works for both of you.

If you have DPD, it may seem natural to turn to your partner for help with decisions, since you may feel incapable of doing anything alone. You might ask them to choose what stores you shop at, what kind of clothing you buy, what you do with your free time, and whether you should go for a promotion. You might harbor your own opinions about these choices, your partner’s behavior, or other issues that pop up in daily life. But because you worry expressing your true feelings will lead to disapproval and withdrawn support from the people who take care of you, you don’t say what you truly feel. This can eventually diminish your sense of self.

If these behaviors resonate with you, it can help to practice making your own decisions in your relationship. A caring partner can support you by:

• Stepping back to let you make your own decisions
• Encouraging you to take responsibility for household matters
• Encouraging you to express your true opinions

Many people with DPD end up in relationships with people who take advantage of them. A few signs of abuse include:

• Threatening to withdraw emotional or financial support
• Belittling or attempting to control you
• Insisting on sexual acts you aren’t comfortable with as a condition of support

A therapist can offer guidance and support if your relationship is abusive.

Parenting and DPD

Having dependent personality means you may not trust yourself to make your own decisions. You believe you can’t function without the help of others. This can contribute to the distorted view that your child is more capable of making decisions for you.

Accordingly, parents living with DPD may overly rely on children to handle tasks or decisions children aren’t emotionally capable of making. This may be more common in situations where you’re a single parent living with DPD and don’t have another person to rely on.

It’s normal for children to have opinions on things like meal planning, where to purchase their clothing, or how to spend free evenings. And children, especially older children, should also contribute around the house and help manage their own schedules and responsibilities. But it’s not healthy for parents to ask children to take care of all household tasks and responsibilities or make decisions about adult responsibilities or social situations.

As a parent, you may have interest in what your child thinks of your romantic partner. But there’s a difference between asking, “What do you think about (Partner’s name)?” and “Should I keep dating (Name) or should we break up?”

Workplace Relationships and DPD

DPD can make workplace interactions challenging, if you struggle to get necessary tasks done on your own. Your coworkers may notice your difficulty with self-starting, and some might consider your continued need for prompting and encouragement troublesome.

Presenting yourself as incapable or needing regular support and assistance to do your work can create challenges, even conflict, in the workplace. If you’re left to work alone, you might believe you can’t complete the task or project successfully and end up not doing it at all. However, you might do fairly well when you have supervision or support from someone else.

Friendships and DPD

If you have DPD, you may notice your friendships follow a pattern similar to your romantic relationships. Your fear of being left alone can play out in ways that make you seem clingy and needy. You may worry disagreeing with friends will result in them no longer caring for you and avoid expressing personal opinions and desires to ensure their continued support.

You might also readily volunteer to help friends out, even when you’d rather not do something (like help them move or clean their house). Because you want them to continue to be there for you, you sacrifice your time, but less-than-ethical friends may take advantage of this trait.

Good friends should be there for each other and support each other in times of need, but true friends should also encourage you and support you in doing things for yourself.

Treatment for Dependent Personality: Does It Get Better?

It’s very difficult to address personality disorders without help from a therapist trained to recognize symptoms and help you work through them effectively. But therapy can always have benefit. Personality disorders can’t be cured, but therapy can help you address behaviors causing problems in your life and learn new ways of relating to others.

Dependent personality treatment can be incredibly beneficial, since it can lead to more fulfilling, healthy relationships. A trained therapist can support you as you work to realize your own capabilities, both when it comes to making decisions and taking care of yourself. Since people with DPD can sometimes transfer feelings of dependency to their therapist, it’s important to work with a therapist experienced in helping people with DPD.

In therapy, you might:

• Practice self-sufficiency and assertiveness skills
• Learn to cope with fears of being alone
• Practice decision-making
• Become comfortable spending time on your own
• Learn to express disagreement in productive ways

DPD can often occur with other conditions. Childhood illness, attachment issues, or separation anxiety sometimes play a part in its development. But DPD can also factor into the development of concerns like social anxiety or depression. Therapy can help you address symptoms of these conditions, as well.

Healthy relationships should be fairly balanced. Some of the time, you might need more support from your partner than usual, and at other times, they may need more from you. But typically, it’s unhealthy for one person to rely solely on another.

If DPD makes it difficult to develop and maintain healthy relationships with others, the best option is to seek help from a compassionate, supportive therapist. Begin your search today.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
2. Blair, O. (2018, October 23). Dating someone with dependent personality disorder: Balancing support and self-care. Retrieved from https://www.bridgestorecovery.com/blog/dating-someone-with-dependent-personality-disorder-balancing-support-and-self-care
3. Dependent personality disorder. (2007). Harvard Mental Health Letter. Retrieved from https://www.health.harvard.edu/newsletter_article/Dependent_personality_disorder
4. Dependent personality disorder. (2017, March 30). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9783-dependent-personality-disorder
5. Maccafferi, G. E., Dunker-Scheuiner, D., De Roten, Y., Despland, J. N., Sachse, R., & Kramer, U. (2019, October 15). Psychotherapy of dependent personality disorder: The relationship of patient-therapist interactions to outcome. Psychiatry. doi: 10.1080/00332747.2019.1675376

It’s not uncommon to hear “narcissism” and “narcissist” used to casually describe people who:

• Seem vain and self-centered
• Seem to care only about themselves
• Demand attention, admiration, and respect
• Exaggerate achievements
• Manipulate others for their own purposes

While these traits are all associated with narcissistic personality disorder (NPD), people with just a few of these traits may not necessarily meet criteria for diagnosis. What’s more, other significant characteristics of narcissism are less recognizable, so they aren’t always associated with the condition.

It’s generally a good idea to avoid labeling people with mental health diagnoses when you don’t have a full picture of their mental health. In other words, someone’s diagnosis is typically between them and their therapist or psychologist, unless they choose to share that diagnosis. But it is true that people with traits of narcissism generally show a mask of superiority and arrogance to the world. They may seem full of themselves, demand appreciation from others, and appear to have high self-esteem. But an inner core of insecurity often lies behind this mask.

Narcissism and Insecurity

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people with NPD almost always have a fragile sense of self-esteem. Because of this, they spend a lot of time thinking about how others perceive them and how well they’re doing in life. This insecurity contributes to the continuous demand for admiration associated with NPD.

Many people with narcissism struggle with pervasive feelings of insecurity underneath the outward superiority and entitlement they present to the world.

Many people with narcissism struggle with pervasive feelings of insecurity underneath the outward superiority and entitlement they present to the world. But this experience may be most commonly associated with covert, or vulnerable narcissism. Many people with this subtype of narcissism do show outward signs of sensitivity to criticism and insecurity. This insecurity, often tied to the concept of being less than perfect, can contribute to mental health concerns such as stress, anxiety, or depression.

This insecurity can manifest as difficulty accepting criticism, or anything seen as criticism, since critiques can trigger feelings of vulnerability. Someone with narcissism may, for example, take constructive advice from a supervisor as a personal attack and react angrily. They might offer a reply laced with contempt or derision or they make a passive-aggressive or mocking comment. This reaction, lashing out in response to a slight, can humiliate or reject the person offering the critique. People with NPD generally do this to help relieve the potential threat to their self-esteem.

NPD is a complex personality disorder that involves feelings of insecurity, but insecurity is not only linked to narcissism. It’s not uncommon to feel insecure or struggle with moments (or longer periods) of low self-esteem, even if you have no mental health diagnosis at all. One way to differentiate narcissistic insecurity involves looking at the person’s response to perceived criticism or other threats. Responding with aggression, rage, or passive-aggression could suggest narcissism, though this isn’t a definitive diagnostic tool.

Narcissism, Insecurity, and Relationships

Maintaining a relationship with someone who has NPD can be difficult, especially without support from a mental health professional. Many people living with narcissistic traits may have had a parent with NPD, experienced insecure attachment as a child, or have other attachment issues. It’s also not uncommon for people living with NPD to experience depression, anxiety, and suicidal thoughts, or abuse substances. These can all cause relationship difficulties, though dealing with the main traits of narcissism may pose the greatest challenge.

People with narcissism generally need a lot of admiration and approval, since receiving this admiration may help combat the underlying insecurity. But because NPD typically involves a lack of empathy, they usually don’t offer much in the way of reciprocation. This is one key reason why people living with NPD are usually labeled “toxic.” They need their romantic partners to praise them, listen to them talk about their feelings and topics of personal interest, and demand devotion and regard. They might talk about their envy for others or project those feelings by talking about how others envy them.

This can be draining for romantic partners and family members of people with narcissism, particularly as people with NPD may also express insecurity by accusing partners of being unfaithful, not caring about them enough, or not doing enough for them. They might use emotional abuse tactics, including gaslighting, to try and control partners so they’ll remain in the relationship and continue offering admiration and regard.

These attitudes and attacks can cause a lot of emotional pain. They can also lead to feelings of insecurity in anyone involved with a person with NPD:

• Frequent negativity and derision can have a significant impact on self-esteem.
• Gaslighting can cause doubts about what’s really true and make the person affected feel as if they’re in the wrong.

Are ‘Narcissists’ Insecure?

Existing research on narcissism suggests people with NPD do tend to feel insecure, whether they display this insecurity outwardly or not. Insecurity may provoke many of the problematic behaviors associated with narcissism. Both a 2015 article looking at the diagnostic challenges of narcissism and a 2017 review examining the connection between narcissism and behavior on social network sites like Facebook suggest insecurity is more often seen in people with vulnerable narcissism, who might present as humble or reserved and tend to put themselves down.

Katherine Fabrizio MA, a licensed professional counselor in Raleigh, North Carolina, helps people who were raised by narcissistic parents heal. She explains, “At their core, the person with narcissistic personality disorder is deeply insecure. They feel unworthy, ashamed, and empty. They hide this emptiness from themselves and others with a set of defenses that act as a storefront. The cover-up story they tell themselves and others constitutes those defenses, which are designed to artificially fill them up—all while hiding the fact that they feel truly empty.”

It’s important to recognize that although people with narcissism may struggle with unwanted emotions and experiences that cause distress, these feelings don’t excuse their behavior. Insecurity can be hard to face, but it’s possible to work through this, along with any other emotional or mental health challenges like anxiety, without emotional abuse or other problematic behaviors.

If you often feel insecure, working with a therapist can help you overcome this mindset and develop a greater sense of personal empowerment. If you struggle to recognize or understand the feelings of others, or if you tend to lie or manipulate others to get your needs met, you may want to reach out to a therapist who can help you learn new ways of relating to others so you learn how to meet your own needs and support the people in your life.

Anxiety and insecurity can result from setting too-high standards for yourself or wanting to achieve things that aren’t realistic. But in either case, a therapist can help you recognize your capabilities and potential for success so you can set more achievable goals for yourself.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
2. Caligor, E., Levy, K. N., & Yeomans, F. E. (2015, April 30). Narcissistic personality disorder: Diagnostic and clinical challenges. The American Journal of Psychiatry, 172(5). Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14060723?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
3. Dickinson, K. A., & Pincus, A. L. (2003). Interpersonal analysis of grandiose and vulnerable narcissism. Journal of Personality Disorders, 17(3), 188-207. Retrieved from https://pdfs.semanticscholar.org/8db5/d181e5ec85fd61de162d3c43e70611eaf4a4.pdf
4. Gnambs, T., & Appel, M. (2017, February 7). Narcissism and social networking behavior: A meta-analysis. Journal of Personality, 86(2), 200-212. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/jopy.12305
5. Jauk, E., Weigle, E., Lehmann, K., Benedek, M., & Neubauer, A. C. (2017). The relationship between grandiose and vulnerable (hypersensitive) narcissism. Frontiers in Psychology, 8, 1600. doi: 10.3389/fpsyg.2017.01600
6. Narcissistic personality disorder treatment. (n.d.). Retrieved from https://www.bridgestorecovery.com/narcissistic-personality-disorder/narcissistic-personality-disorder-treatment

Vaping refers to the process of using electronic cigarettes (also known as e-cigarettes, vapes, vape pens, or ENDS). Since 2007, when e-cigarettes began appearing in the United States, vaping has become fairly common.

Many believed e-cigarettes to be harmless, but as vaping has increased in popularity, news reports of vaping-related illnesses and deaths have also increased. In October 2019, the Centers for Disease Control and Prevention reported a total of 1,080 cases of lung injuries linked to vaping in the United States. They also reported 18 vaping-related deaths.

E-cigarettes have become popular among teens and young adults in particular. According to the same CDC statistics:

• 80% of patients were under 35 years old.
• 21% were between the ages of 18 and 20.
• 16% were under age 18.

Some people simply enjoy the taste of flavored e-cigarettes. Others may use them as a less harmful alternative to cigarette smoking. According to Johns Hopkins Medicine, while it is true that e-cigarettes generally don’t contain as many toxic chemicals as traditional cigarettes, they’re still not great for your health.

What Is Vaping?

The term “vaping” refers to the “vapor” produced by e-cigarettes. This vapor, which e-cigarette users inhale, comes from liquid heated inside the e-cigarette. Some assume it’s just water vapor, but in fact, it is an aerosol. In other words, the vapor is made up of very fine particles of the substances contained in the liquid. If the liquid contains toxic chemicals, so does the aerosol.

Although e-cigarettes don’t contain tobacco, the substances they do contain can vary widely. Most contain nicotine. In fact, according to the American Cancer Society, even e-cigarettes labeled as nicotine-free may still contain some nicotine. What’s more, JUULs, a specific brand of e-cigarette, always contain nicotine.

E-cigarette liquid and vapor could contain the following chemicals:

• Formaldehyde, which can form when the liquid gets too hot or when too little liquid reaches the heating element
• VOCs, or volatile organic compounds, which can damage the liver or kidney
• Flavoring agents that have varying levels of the chemical diacetyl, which in turn has been linked to lung disease
• THC (tetrahydrocannabinol, the agent in marijuana that creates the marijuana “high”)
• CBD (cannabinoid) oils
• Flakka or other synthetic drugs

In a September 2019 press release, the CDC suggested vaping THC products could be particularly dangerous, though experts continue to investigate the exact cause of the illnesses. Research supports the link between vaping THC and health issues. After interviewing 578 people who had become ill after vaping, the CDC found most had vaped THC products.

Dangers of Vaping

E-cigarette use involves the direct inhalation of vapor rather than the direct smoking of a substance. No smoke is produced, and since they don’t contain tobacco, they don’t produce any tobacco smell. Because of this, many users find vaping more appealing and believe it causes fewer, if any, harmful effects.

But this isn’t necessarily the case. Science hasn’t conclusively identified all potential health risks associated with vaping, but existing evidence does suggest e-cigarettes—while likely not as harmful as traditional cigarettes—can still negatively affect health.

What’s more, medical experts have linked the chemicals in e-cigarettes to a range of health conditions, including:

• Lung irritation and lung disease
• Nose and throat irritation
• Chest pain
• Liver, kidney, and nervous system damage
• Nausea, vomiting, or diarrhea
• Increased heart rate, high blood pressure, and other circulatory issues
• Cancer

As evidence linking THC in e-cigarettes to illness and death emerges, medical experts continue to advise against using e-cigarettes, especially e-cigarettes containing THC. Since e-cigarettes might, in theory, contain any chemical, people are encouraged to use extreme caution when unsure of exactly which substances they’re vaping.

Is Vaping Addictive?

E-cigarettes don’t contain as many harmful chemicals as traditional cigarettes (which contain thousands of chemicals). But they do typically contain nicotine—a toxic, addictive chemical, and some e-cigarettes may provide even more nicotine than a traditional cigarette. This means e-cigarettes are still addictive.

Even teens who do know e-cigarettes contain nicotine may not realize they’re addictive or that they can have serious health effects.Research also suggests e-cigarettes can function as a “gateway drug” to cigarette smoking and other tobacco use. The risk is especially high for teens and young adults who might not have started smoking otherwise.

Some people may look to e-cigarettes as a way to ease themselves out of smoking. However, the research on this strategy is mixed. One study suggests e-cigarettes work as well as other nicotine replacements such as patches or gums. Another study found most people who used vaping to quit nicotine ended up smoking both traditional and electronic cigarettes. The FDA has not approved of using e-cigarettes as a smoking cessation tool.

Why Is Vaping So Popular Among Teens?

An annual survey from the National Institutes of Health found that vaping increased among high school seniors by 9% between 2017 and 2018. The research found increases in vaping across several substances: nicotine, marijuana, and hash oil, as well as flavored e-cigarette liquid.

Experts point to a few key reasons that help explain why many teens find vaping appealing.

First, e-cigarette marketing often involves advertising methods like animation, bright colors, and youthful actors, all of which seem designed to attract teens and young adults. Ad messages also often appear to suggest vaping is linked to increased popularity and happiness. E-cigarettes also come in a range of flavors, which can make them seem more fun and enjoyable to younger people.

Lack of education on e-cigarettes can also further the mistaken belief that vaping doesn’t have any serious effects. Many teenagers don’t know much about e-cigarettes. Some aren’t aware they contain nicotine or other substances, and many believe the vapor contains nothing more than flavor. Even teens who do know e-cigarettes contain nicotine may not realize they’re addictive or that they can have serious health effects.

Treatment for E-Cig Addiction

Teenage vaping addiction is a growing health concern. Research has yet to determine the full effects of vaping on the brain and body, but experts believe it can have a particularly harmful impact on teens.

The brain continues to develop throughout the teen years, and while it’s still developing, teens face a higher risk for addiction than adults. Vaping during the teen years also has the potential to permanently affect brain development.

If you believe your teen is using e-cigarettes, these tips can help you start a conversation and get them help, if necessary.

• Have a conversation, not a lecture. If you don’t know anything about vaping, do some reading so you’re prepared to talk with your teen. Spend time reviewing articles and information from credible sources about vaping and the health effects it can cause with your teen.
• Start with general questions instead of asking directly, “Have you tried vaping?” For example, you might ask, “Do other kids at school/your friends use e-cigarettes?” “What do you know about vaping?” This can help you understand what your child knows about e-cigarette use and its effects.
• Talk with your teen about getting help with quitting. Offer your encouragement and support if they want to quit on their own. (Consider setting a good example and quitting yourself, if you also use e-cigarettes). If they’ve tried to quit and can’t, ask them to consider talking to their primary health care provider or a counselor who can offer professional assistance with quitting.

Medical science still has much to uncover about e-cigarettes, but recent news reports highlight a number of recognized concerns. E-cigarettes may involve fewer health risks than tobacco cigarettes, but that doesn’t mean they’re healthy. They may pose even more dangers to teens—an age group in which e-cigarette use has recently increased.

A compassionate therapist can support you in the process of quitting e-cigarettes or any other addiction. Begin your search today!

References:

1. 5 vaping facts you need to know. (n.d.). Johns Hopkins Medicine. Retrieved from https://www.hopkinsmedicine.org/health/wellness-and-prevention/5-truths-you-need-to-know-about-vaping
2. Bates, J. (2019, October 1). CDC says for first time that some THC products could be behind vaping deaths and illnesses. Time. Retrieved from https://time.com/5688229/cdc-thc-vaping-deaths
3. Hellman, J. (2019, October 3). CDC: Cases of vaping-related illness top 1,000. The Hill. Retrieved from https://thehill.com/policy/healthcare/464279-cdc-cases-of-vaping-related-illnesses-top-1000?fbclid=IwAR1N76JddJm8vCrx6D9T0oJTnLkc7u9cSdsBc39nJ-SnXgBGwQwqaXcC9Lc
4. Martinelli, K. (n.d.). Teen vaping: What you need to know. Child Mind Institute. Retrieved from https://childmind.org/article/teen-vaping-what-you-need-to-know/
5. Outbreak of lung injury associated with e-cigarette use, or vaping. (2019, September 27). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
6. Richter, L. (2018). What is vaping? Retrieved from https://www.centeronaddiction.org/e-cigarettes/recreational-vaping/what-vaping
7. Vaping rises among teens. (2019). National Institutes of Health. Retrieved from https://newsinhealth.nih.gov/2019/02/vaping-rises-among-teens
8. Vaping: What you need to know. (2019). KidsHealth. Retrieved from https://kidshealth.org/en/parents/e-cigarettes.html
9. What do we know about e-cigarettes? (2019). American Cancer Society. Retrieved from https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/e-cigarettes.html

If you’ve ever sustained an injury and didn’t have access to immediate medical attention, you probably received some form of first aid. This temporary medical assistance likely helped treat the injury and kept it from getting worse until you could get to a hospital or see your doctor.

Like physical injuries, mental health concerns and substance misuse can have serious health effects. They can cause lasting harm and may even lead to death. But these emotional injuries tend to be less visible, and it’s not always easy to identify someone who’s struggling.

A mental health first aid training class is a public education program that aims to teach people how to identify risk factors and warning signs of these concerns. During this 8-hour training, you’ll learn to recognize a mental health crisis, provide immediate support, and help people access resources for longer-term care.

As with first aid for an injury, mental health first aid is not meant to be a long-term solution. The support of a trained mental health professional is essential for people living with mental health concerns or working to overcome substance misuse.

A mental health first aid training class is a public education program that aims to teach people how to identify risk factors and warning signs of these concerns.

In your mental health first aid training, you’ll learn the five-step action plan, ALGEE:

1. Assess for suicide/harm risk
2. Listen non-judgmentally
3. Give information and reassurance
4. Encourage seeking professional support
5. Encourage self-help and coping methods

Read on to discover how this looks in practice.

1. How to de-escalate a tense situation

Remaining calm is an important part of effectively handling a crisis. It can be challenging to help someone experiencing panic, hallucinations or other psychotic symptoms, or acute trauma reach a calmer state of mind if your mood is also elevated.

Someone dealing with acute emotional distress may talk about hurting themselves, which can be frightening to hear. Fear can cause some people to react with judgment, anger, or confusion. But these reactions can worsen a situation.

Mental health first aid training provides an opportunity to develop communication skills—both nonverbal skills like body language and verbal skills like knowing what to say. Knowing how to communicate compassionately can make all the difference when trying to reach someone in a crisis. You’ll learn to offer reassurance and respect, with an attitude that normalizes what someone is going through without blaming them. Role play activities during training give you the chance to practice applying these skills in a variety of scenarios.

2. How to gauge risk of harming self or others

You might worry someone living with depression or another mental health condition has a high risk of hurting themselves. Symptoms of certain mental health conditions, like schizophrenia, bipolar, or borderline personality disorder, are also often associated with increased risk of hurting the self or others.

It’s important to recognize the following:

• Most people with mental health conditions never harm anyone.
• Many people who have thoughts of suicide don’t plan to attempt suicide.
• Many people who self-harm don’t plan to attempt suicide.

However, it’s still important to talk to a trained professional about self-harming behaviors or suicidal thoughts. Recognizing certain warning signs can help you become more informed about when someone might be dealing with these challenges so you can better assess the possibility of harm. This can help you direct someone to the right resources.

Some possible warning signs of suicide include:

• Talking about dying, hopelessness, or feeling like a burden
• Talking about wanting a way out
• Withdrawal or isolation
• Rapid, dramatic, or significant mood changes
• Sleeping a lot or not enough
• Behaving in risky or extreme ways

Supporting a person experiencing hopelessness and thoughts of suicide might involve finding and reaching out to a therapist who can help them work through the underlying causes. But a person with a clear plan for suicide needs immediate, urgent help. The 988 Suicide & Crisis Lifeline can offer guidance at 1-800-273-TALK (8255), but you can also call your nearest emergency room.

3. Coping techniques

Coping and self-care techniques can help anyone manage distress, not just people living with mental health issues. But these techniques usually benefit those who experience emotional challenges regularly, since they can increase resilience and promote calm. People who use coping tools can often address symptoms before they become overwhelming.

During mental health first aid training, you’ll learn more about some of the many coping methods you might suggest, such as:

• Relaxation techniques
• Meditation
• Exercise or movement therapy
• Pet therapy
• Journaling, art, or music
• Peer and social support
• Cognitive behavioral self-help techniques

4. Supporting next steps and follow up care

Training in mental health first aid enables you to support someone through a mental health crisis or period of substance misuse. It doesn’t train you to provide long-term care or support. A key part of mental health first aid is learning how to refer people to the professionals who can offer the best type of treatment for their needs.

Depending on a person’s symptoms or concerns, you might help them locate any of the following types of health care professionals:

• Medical doctor
• Therapist or counselor
• Psychiatrist
• Social worker
• Peer support specialist

You can’t force anyone to seek treatment, but in mental health first aid training, you’ll learn how to encourage people to get help. This might include explaining how therapy or counseling can help or talking about available treatments. You might also help someone locate a nearby therapist or find a number for a clinic or helpline.

5. What to do when you, yourself, are in a crisis

Although you might find a profession that involves helping others find potentially life-saving support rewarding, you may also find it stressful. You might even feel drained or overwhelmed on occasion, as working with people in crisis can affect your own emotional wellness over time.

Mental health first aid providers help people learn to take care of their emotional health and access helpful resources when needed, but before they can offer this help, they must also know how to take care of their own well-being. By participating in a mental health first aid training course, you’ll be better positioned to recognize when your emotional reserves are running low. This awareness can help you know when to take time to recharge, prioritize self-care, and get help for yourself.

Awareness of mental health concerns and their varied signs and symptoms has increased in recent years. This awareness is a key factor in treatment. Compassionate understanding is another factor that’s just as important in preventing suicide.

Mental health first aid training teaches you how to offer this compassion and care as you help someone find resources for dealing with an immediate emotional crisis. Once they’ve weathered the immediate challenge, they can reach out for help. Compassionate therapists are only a few clicks away in our therapist directory, located here.

References:

1. ALGEE: The action plan. (n.d.). Retrieved from https://www.mentalhealthfirstaid.org/wp-content/uploads/2017/04/THE-ACTION-PLAN.png
2. Frequently asked questions. (n.d.). National Council for Behavioral Health. Retrieved from https://www.mentalhealthfirstaid.org/faq
3. Mental health first aid. (n.d.). National Council for Behavioral Health. Retrieved from https://www.thenationalcouncil.org/about/mental-health-first-aid
4. Risk and protective factors. (n.d.). Suicide Prevention Resource Center. Retrieved from https://www.sprc.org/about-suicide/risk-protective-factors
5. Stress management. (n.d.). Substance Abuse and Mental Health Services Administration. Retrieved from https://www.integration.samhsa.gov/health-wellness/wellness-strategies/stress-management
6. Wellness strategies. (n.d.). Substance Abuse and Mental Health Services Administration. Retrieved from https://www.integration.samhsa.gov/health-wellness/wellness-strategies
7. What you learn. (n.d.). National Council for Behavioral Health. Retrieved from https://www.mentalhealthfirstaid.org/take-a-course/what-you-learn

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

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

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

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

Covert vs. Overt Narcissism

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

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

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

Signs of Covert Narcissism

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

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

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

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

Covert Narcissism and Relationships

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

Some common experiences include:

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

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

Covert Narcissism and Mental Health

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

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

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

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

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

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

References:

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

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

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

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

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

Avoidant Personality: What Makes It Different?

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

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

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

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

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

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

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

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

Avoidant Personality Treatment Options

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

Possible approaches that may help soothe symptoms of AVPD include:

Therapy

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

• Psychodynamic therapy
• Schema therapy
• Emotion-focused therapy

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

Complementary treatments

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

These might include:

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

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

Avoidant Personality and Self-Care

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

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

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

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

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

References:

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