In the years following the wars in Iraq and Afghanistan, media reports of veteran violence began accumulating. Formerly social and kind people returned from war angry, and often violent. Rates of domestic violence among former combatants surged. Some veterans killed their partners or families. Many people were shocked, but the truth is that research has long linked PTSD to feelings of anger, and even violent aggression. People with PTSD may be angry about the trauma they survived or feel helpless or out of control.

In the popular imagination, posttraumatic stress (PTSD) is an anxiety disorder. Many envision people who cannot leave their homes, who are easily triggered into fear or panic attacks. Anger, though, is a common symptom of PTSD—so common, in fact, that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) specifically lists anger as a common emotional reaction among people with PTSD. Feelings of anger can make it difficult to get support from loved ones. A person who feels angry or out of control may feel guilty or ashamed, intensifying the isolation of experiencing trauma.

Even when loved ones want to be supportive, they may not fully understand the severity of the trauma, leaving trauma survivors feeling as if their suffering has been ignored or forgotten.

The Link Between Anger and PTSD

Trauma can be deeply isolating. Loved ones may not understand the trauma or may react inappropriately. For example, rape survivors frequently report being interrogated about their own behavior, while returning soldiers say that civilians are often eager to ask about violent combat experiences. Even when loved ones want to be supportive, they may not fully understand the severity of the trauma, leaving trauma survivors feeling as if their suffering has been ignored or forgotten. This can trigger anger, distrust of others, and related emotions.

Trauma itself may also cause feelings of anger. For example, a birthing person abused by a doctor may be angry both about the abuse and about losing a more positive birth experience. A child abuse survivor may have overwhelming feelings of anger directed at their abuser.

Sometimes a person’s feelings of anger are complicated. A returning solider might be angry about politicians who do not understand war, while also feeling proud about their service. An adult child abuse survivor may love their parents but be very angry about the abuse they suffered. These mixed emotions can make it difficult to manage feelings of anger and rage. In some cases, a person might feel like their anger is unacceptable or be unable to articulate why they feel angry or at whom.

How Anger Complicates PTSD Symptoms

Spending time with an angry person can be difficult. The friends and family of people struggling with PTSD-related anger may eventually grow tired of dealing with mood swings or angry outbursts. They may experience compassion fatigue or even end their relationship with their loved one. This can intensify feelings of alienation and anger.

People with anger from PTSD may feel both ashamed of their emotions and entitled to them. This challenging cocktail makes it difficult to talk about how they feel or to try new coping strategies. For example, when a person feels righteously indignant about being abused, they may not want to try meditation or other coping skills. After all, the thinking goes, they shouldn’t have to have experienced trauma, and shouldn’t be the one stuck coping with the after-effects. While these feelings make perfect sense, they can also be quite self-defeating.

Research has also uncovered a correlation between PTSD, anger, and other mental health conditions. A 2014 analysis, for example, found that 30.3% of people with intermittent explosive disorder (IED) also have PTSD, compared to 14.3% in the general population. When a person presents with a secondary condition, such as depression or IED, their PTSD may go unnoticed and untreated. This prolongs their suffering and may cause them to drop out of treatment, especially when they do not see results.

Other Symptoms That May Co-Occur with Anger

The hallmarks of PTSD include persistently reliving memories or experiences associated with the trauma, such as in dreams, flashbacks, or emotions during the day. People with PTSD also may avoid stimuli associated with the trauma, and experience depression, sadness, anxiety, and anger.

People who experience PTSD-related anger are more likely to experience certain other symptoms, such as:

• Relationship problems, including disruptions in marriages and relationships with children.
• Feelings of isolation, especially when a person with PTSD wants support but has difficulty controlling their anger around other people.
• Physical health problems related to anger, including headaches, chronic pain, and even cardiovascular health issues.
• Legal problems, particularly if they act out aggressively or self-medicate with illegal substances.

Getting Help for PTSD-Related Anger

PTSD can disrupt a person’s life and relationships. It can make them feel hopeless and even suicidal. But no one has to live with the aftereffects of trauma forever. PTSD is highly treatable. Some strategies that can help include:

• Therapy. Therapy gives an outlet and offers a compassionate ear. Certain types of therapy, including exposure therapy, can help with many symptoms of PTSD. Therapeutic methods that help a person better control their emotions, such as cognitive behavioral therapy (CBT) may ease anger.
• Support groups. PTSD can be deeply isolating. Support groups, especially those that cater to people with similar experiences, offer reassurance, companionship, and practical support.
• Medication. No specific medication is approved for the treatment of PTSD, but certain drugs may help ease symptoms like anxiety and depression.
• Education. People who understand that their anger is a normal reaction to trauma, but also that this reaction is treatable, may feel more hopeful.
• Lifestyle changes. Some people find relief from exercise, a healthier diet, or pursuing a new hobby, especially when these choices restore a sense of agency.
• Social support. People with PTSD need support from loved ones. It’s especially important that loved ones not diminish their feelings, tell them how to feel, mock them for their emotions, or shame them for not healing fast enough.
• Complementary treatments. Massage, acupuncture, and other complementary therapies may help some people with PTSD. These modalities can be particularly effective at easing the physical symptoms of PTSD, such as chronic pain and sleep disturbances.

A person may have to experiment with treatment options or therapists before they find what works for them. This persistence can be challenging for someone who is already in pain. Friends and family should offer support, research treatment best practices, and remind their loved one that there is hope.

As with all mental health diagnoses, it is important to note that PTSD, even PTSD that causes intense anger, does not make violence inevitable. People with mental health conditions are far more likely to be victims of violence than perpetrators. Stigmatizing mental health issues can deter treatment, especially when people are dismissed as violent or needlessly angry.

Find a compassionate therapist who understands the many complex emotions a person with PTSD faces here.

References:

1. Center for Substance Abuse Treatment (U.S.). (2014). Trauma-informed care in behavioral health services. Rockville, MD: Substance Abuse and Mental Health Services Administration (U.S.)
2. Mental health myths and facts. (2017, August 29). Retrieved from https://www.mentalhealth.gov/basics/mental-health-myths-facts
3. Morris, D. J. (2014, April 17). PTSD contributes to violence. Pretending it doesn’t is no way to support the troops. Slate. Retrieved from https://slate.com/technology/2014/04/ptsd-and-violence-by-veterans-increased-murder-rates-related-to-war-experience.html
4. Reardon, A. F., Hein, C. L., Wolf, E. J., Prince, L. B., Ryabchenko, K., & Miller, M. W. (2014). Intermittent explosive disorder: Associations with PTSD and other Axis I disorders in a US military veteran sample. Journal of Anxiety Disorders, 28(5), 488–494. doi: 10.1016/j.janxdis.2014.05.001

Separation anxiety is one of the most common challenges parents face. It can make leaving a child with a caregiver or at daycare difficult and can undermine quality of life for both the parent and child. Separation anxiety is also completely normal, especially in very young children.

Children naturally long to be close to their caregivers, and separations compromise that closeness. Managing separation anxiety requires parents to balance the child’s need to be close to them with the expectation that children will become progressively more independent as they get older.

In some children, separation anxiety persists well beyond the toddler and preschool years, affecting their ability to comfortably attend school or spend time with friends. This type of severe separation anxiety affects 4% of children and 1.6% of teenagers.

Separation anxiety usually begins when a child is 6 or 7 months old, then peaks in the toddler and preschool years.

Separation Anxiety in Children: Symptoms and What’s Normal

Separation anxiety usually begins when a child is 6 or 7 months old, then peaks in the toddler and preschool years. Older children may have occasional bouts of separation anxiety, especially in new situations such as before going to sleepaway camp.

Babies and young children may have symptoms such as:

• Not wanting to sleep alone
• Crying when a caregiver leaves
• Throwing tantrums to prevent a caregiver from leaving
• Being anxious about serparations
• Clinging to a parent before serparations

Older children may have additional symptoms, including:

• Lying and other behaviors to avoid going to school
• Changes in behavior as a separation approaches
• Excessive worry about a parent or other loved one

When Separation Anxiety Is Extreme: What Is Separation Anxiety Disorder?

When separation anxiety is severe and chronic, or when it interferes with daily life, it may be considered a mental health diagnosis.

Researchers do not know what causes separation anxiety disorder. Like other mental health conditions, it is likely a combination of social, biological, and psychological factors. Children with a history of trauma or abuse may be more vulnerable. Symptoms usually appear in elementary school, between third and fifth grades. They include:

• Being terrified to sleep alone
• Excessive, chronic worry about the safety of a parent
• Refusing to go to school or crying each day before school
• Nightmares about separation
• Physical complaints such as muscle pain and stomach aches
• Not wanting to be alone
• Chronic worry about getting lost
• Unusual safety concerns
• Being clingy in a way that is not age typical, such as when a 10-year-old wants to be with their parents and not their friends
• Not wanting to do fun things or spend time with friends if it means being away from home

How to Deal with Separation Anxiety

Separation anxiety is no one’s fault. It is not a sign that a child is spoiled or manipulative. The distress children feel is very real, though as children get older, they learn that vocal expressions of distress may stop their parents from leaving. When dealing with separation anxiety, parents should not:

• Punish children.
• Lie about separations. Sneaking out of the house after promising not to leave can erode trust.
• Say things that might trigger anxiety. If a child is showing no signs of separation anxiety, don’t reassure them or tell them how brave they are to go off on their own.
• Make goodbyes last too long. It’s natural to want to comfort a crying child, but long goodbyes and long buildups to inevitable departures may actually prolong a child’s suffering.
• Panic or look distressed. Parents love their children and do not want to see them sad. But when parents express sadness or fear about separations, this can make the child think there is real danger.
• Reward children for separations. Rewards and punishments are controversial for many reasons. Even experts who support them agree that they work best for behaviors children choose—such as cleaning up a bedroom or doing homework. Separation anxiety is an emotional reaction, not a behavioral choice.

Choosing the right care provider is also critical for reducing separation anxiety. Daycare providers, nannies, and babysitters who are sensitive to the child’s needs can help. Talk to care providers about the importance of comforting and distracting the child—not ignoring them while they cry or punishing them for becoming anxious.

Some research suggests that forming a close attachment to a loving, accessible secondary care provider can ease separation anxiety. This means that daycares that provide the same carer each day, nannies, and consistent babysitters may be better options than an ever-shifting roster of childcare providers.

Some other strategies parents can adopt to ease separations include:

• Develop a comfortable (but short) ritual for separations. Some children like to have a special blanket, sing a song, or get a set number of kisses.
• Talk to children about why they are anxious. Young children may have trouble articulating their fears, but older children can often explain them. You may find that the problem is not separation, but something else, like a mean teacher or bully at school.
• Explain departures in language children can understand. For example, you might tell a toddler that you will see them after their nap, at dinner, or in “three sleeps.”
• Be honest and keep promises. Don’t say you won’t leave, that you will only leave when the child gives permission, or that you will be back in just a minute if these things aren’t true.
• Practice separations in low-stress contexts. Try dropping a child off at grandpa’s house for an hour or inviting a beloved uncle or aunt to take them on an outing. This gets the child used to separations and can help with preparing for the transition to school.
• Don’t spend lots of time talking about the separation before it happens. This can build anxiety.
• When your departure draws near, talk about the fun things your child can do while you are gone.
• Be loving and affectionate, not distracted or frustrated, during departures.
• Develop a plan with caregivers for supporting a child with separation anxiety. Each care provider should have several strategies they can try to help calm a child who is anxious or upset. Care providers should never ignore or punish a crying child.

Separation anxiety can be difficult for both parents and children. Parents may feel stress at each separation or adjust their entire lives to reduce separations when a child has intense anxiety. This can affect an entire family, and even undermine careers. A therapist can help families manage separation anxiety in a way that minimizes trauma and honors the needs of every family member. GoodTherapy can help you find a therapist.

References:

1. Bowlby, R. (2007). Babies and toddlers in non-parental daycare can avoid stress and anxiety if they develop a lasting secondary attachment bond with one carer who is consistently accessible to them. Attachment & Human Development, 9(4), 307-319. doi: 10.1080/14616730701711516
2. Ehmke, R. (n.d.). What is separation anxiety?. Retrieved from https://childmind.org/article/what-is-separation-anxiety
3. Krecklow, L. L. (2018, August 28). Separation anxiety: Dos and don’ts to help your child (and you) be brave. Retrieved from https://gozen.com/separation-anxiety-dos-and-donts-to-help-your-child-and-you-be-brave
4. Separation anxiety disorder in children. (n.d.). Stanford Children’s Health. Retrieved from https://www.stanfordchildrens.org/en/topic/default?id=separation-anxiety-disorder-90-P02582
5. Swanson, W. S. (2015, November 21). How to ease your child’s separation anxiety. Retrieved from https://www.healthychildren.org/English/ages-stages/toddler/Pages/Soothing-Your-Childs-Separation-Anxiety.aspx

Businesses have long used the term churn to denote the loss of customers and clients. More recently, psychologists have introduced the concept of relationship churn. In this context, relationship churn refers to unstable on-again, off-again relationships. When couples break up and then reconcile—sometimes many times in a row—this is churn.

Although more prevalent among adolescents and young adults, people of all ages can experience relationship churn. Churning relationships often inspire intense emotions. A person may cycle through intense love, anger, jealousy, grief, and anxiety over the state of the relationship in just a few days.

How Common Are On-Again, Off-Again Relationships?

Relationship churn is a new concept that remains poorly studied, so it is unclear how common these tumultuous relationships are. Most research into the topic has examined relationships among people in their teens, twenties, and thirties, so most data on the topic apply to adolescents and emerging adults. A 2012 study of adolescents and young adults found 44% of participants who had a romantic relationship during the two years prior to the study had at least one breakup followed by a reconciliation. A 2013 study found that more than a third of couples who break up will reunite. The same study found that a fifth of married people experience relationship churn.

Defining relationship churn can prove challenging. One partner might think the couple has reconciled after they have sex, even when the other thinks they are still fighting. Likewise, breakups are not always certain. One partner might think the couple is merely taking time apart even as the other believes the relationship to be permanently over.

The media is filled with depictions of on-again, off-again relationships. Penny and Leonard on The Big Bang Theory broke up only to later reunite and marry. Ross and Rachel on Friends spent much of the series pining away for one another. They remained broken up even after having a child and finally reconciled in the season finale.

Why People Get Back with Their Ex

Permanently breaking up with a partner can be very difficult. Even when a relationship is irretrievably broken (or even abusive), partners may love one another or experience intense infatuation and attraction.

A 2017 study identified numerous reasons for the cycle of breaking up and getting back together, including:

• Believing that problems in the relationship will improve or that the breakup may change a partner’s behavior.
• A strong sense of investment in the relationship.
• Relationship ambivalence. For example, a person might dislike relationship conflict but feel intense love or trust for their partner.
• Uncertainty about the future, which may motivate couples both to break up and to later get back together.
• A sense of familial duty. Even if a relationship is unhappy, partners may reunite because of family obligations.
• Fear of being alone. Singlehood can be difficult, especially for someone who is accustomed to being in a relationship. For some people, such as those with separation anxiety or anxious attachment styles, being single can be scary. Even if a relationship is unhappy, loneliness can trigger a reconciliation.

Bringing Up Baggage

Everyone brings their life experiences to their relationships. These experiences color their expectations, their perceptions of what is normal, and their hopes and fears about the relationship. A reunion following a breakup is no different. However, it can be difficult for couples to separate the baggage from their prior relationship from the new relationship.

Research published in 2013 found that ongoing relationship churn makes it progressively more difficult to end the relationship. Couples trapped in a cycle of breaking up and making up report lower relationship satisfaction and greater uncertainty about the future of the relationship. Another 2013 study found that high-churn relationships had higher conflict than stable relationships, including relationships in which couples remained stably broken up.

This doesn’t mean that it is impossible for a relationship to succeed following a breakup. Some people even successfully remarry after an acrimonious divorce and are able to enjoy many years of happy marriage.

To increase the odds of success a second—or third—time around, it’s important to identify what went wrong in the earlier relationship. A therapist may be able to help couples sort through old issues. Treating the new relationship as a fresh start may also help. Bringing up long-resolved emotional wounds, especially as a weapon in fights, can make it difficult to move forward.

When Should You Break Up for Good?

Relationships in which there is abuse—including verbal, sexual, physical, or financial abuse—are not safe for either partner. Reuniting without addressing the abuse is a recipe for further abuse, and it may give the abusive partner greater control. Likewise, when a partner is abusive to children, reuniting can be traumatic to the kids and harmful to the entire family. Before considering a reunion, each partner must weigh the effects of the relationship on their physical and emotional wellbeing.

Abuse isn’t the only reason to break up for good. Some signs that a relationship is doomed include:

• Continually repeating old patterns. Every couple has a few fights that repeat themselves. But if a couple continues to fight about the same things that caused the earlier break-up, this may indicate the relationship is beyond repair.
• Getting back together without discussing relationship problems. Couples who reunite without committing to sustained change tend to repeat the same patterns as before.
• Reuniting solely because of loneliness or jealousy. Getting back together without a commitment to ongoing communication and relationship improvements can make the next breakup even more painful.

A couples counselor may be able to help couples assess whether their relationship can be saved and what must happen to save it. Therapy can even ease the breakup process by offering support to each partner and helping couples transition to a different type of relationship. For parents of young children who must continue to co-parent, therapy can be particularly helpful.

Both partners do not have to go to therapy to see improvements. It takes two people to create relationship conflict. Individual therapy can help a person identify their role in the conflict. It may also help a person understand why they keep returning to the relationship. If the relationship ends, the right therapist can help ease feelings of grief, jealousy, or low self-esteem.

Find a therapist who can help you cope with relationship churn here.

References:

1. Halpern-Meekin, S., Manning, W., Giordano, P., & Longmore, M. (2012). Relationship churning in emerging adulthood: on/off relationships and sex with an ex. Journal of Adolescent Research, 28(2), 166-188. Retrieved from https://journals.sagepub.com/doi/10.1177/0743558412464524
2. Halpern-Meekin, S., Manning, W., Giordano, P., & Longmore, M. (2013). Relationship churning, physical violence, and verbal abuse in young adult relationships. Journal of Marriage And Family, 75(1), 2-12. Retrieved from https://www.researchgate.net/publication/256378542_Relationship_Churning_Physical_Violence_and_Verbal_Abuse_in_Young_Adult_Relationships
3. Joel, S., MacDonald, G., & Page-Gould, E. (2017). Wanting to stay and wanting to go: unpacking the content and structure of relationship stay/leave decision processes. Social Psychological and Personality Science, 9(6), 631-644. Retrieved from https://journals.sagepub.com/stoken/default+domain/rSnPjUjJKhefxXSuwIJt/full
4. Vennum, A., Lindstrom, R., Monk, J., & Adams, R. (2013). “It’s complicated”: The continuity and correlates of cycling in cohabiting and marital relationships. Journal of Social and Personal Relationships, 31(3), 410-430. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/0265407513501987

Although most autism literature focuses on children, autism is a lifelong spectrum condition that affects about 1% of adults. People who are diagnosed with autism in adulthood may have a range of reactions. Some may feel confused about their identity, while others might feel peace of mind now that they have an explanation for their unique cognition. No single reaction is “right,” and many people bounce from one emotion to another following a diagnosis.

Autistic adults who did not receive supportive services in childhood may have struggled in school or with relationships. While finding support can be difficult, a wide range of organizations offer help to autistic adults. Many organizations focus on helping autistic adults see their diagnosis as a unique way of thinking—not a disease or syndrome.

Barriers to Official Diagnosis

A generation or two ago, many people had their autism go unnoticed, especially if their symptoms were relatively mild. Even as recently as 2000, just 1 in 150 children were diagnosed with autism, compared to 1 in 59 in 2014. This apparent increase in the autism rate is likely due to better early diagnosis and detection. The shift toward greater awareness of autism means that people who did not get diagnosed in childhood may pursue diagnosis as adults.

Even as early diagnosis becomes more prevalent, some groups are less likely to be diagnosed as children:

• Adults may miss autism symptoms in girls, particularly since most media coverage of autism focuses on boys. A 2017 study found that autistic girls may have better social skills than their male peers, masking symptoms of the condition. This can delay diagnosis, sometimes into adulthood.
• Racism may lead to underdiagnosis of autism in children of color, especially black children. Children of color are diagnosed later than their white peers, and black children are more likely to be misdiagnosed, leading to inadequate or inappropriate treatment regimens.
• Poverty and classism can reduce access to appropriate health care. Children who attend underserved public schools may not have the resources that wealthier children possess. Additionally, without quality doctors or adequate insurance coverage, parents may delay seeking treatment for unusual symptoms in their children. Even in adulthood, financial woes may deter a person from seeking mental health care or make it difficult to find a competent clinician.

Self-Diagnosis

As autism awareness spreads, some people self-diagnose with autism spectrum conditions. This practice is controversial. Supporters of self-diagnosis point to the many barriers to official diagnosis, emphasizing that even when a person can afford treatment, they may not receive an accurate or timely diagnosis. Some other arguments in favor of self-diagnosis include:

• Neurodivergence as identity. Many adult autistics view autism as a type of neurodivergence, not a disease. They see autism as something that brings both benefits and challenges, and they embrace autism as an identity. Many disability activists herald the right of a neurodivergent person to self-identify as such.
• Potential for improved accuracy. An autistic person knows their own symptoms better than anyone else. Armed with sufficient research and a sound understanding of autism, a person may be able to accurately diagnose themselves. In fact, they may do so faster than a professional.
• Stress of diagnosis. Getting a diagnosis often requires many long and involved tests. It also requires numerous interactions with medical professionals, receptionists, insurance representatives, and other people involved in managed care. These interactions can be highly stressful, especially to some people with autism.

Conversely, the arguments against self-diagnosis include:

• Potential reliance on autism stereotypes. Stereotypes about people with autism are pervasive and often paint an inaccurate portrait of the diagnosis. While some autistic people struggle with social interactions and cues, others do not. Autism is a continuum of symptoms, and people who rely on media portrayals or popular articles as their primary source of information may get the diagnosis wrong.
• Fear of appropriation. Some autistic self-advocates feel that people who self-diagnose are co-opting another person’s identity and lived experiences. There is a concern that some self-diagnosed individuals might present themselves as representatives of the autistic community without understanding its history.
• Lack of access to support. Some forms of support may require an official diagnosis. A person seeking accommodations at work, for example, may need a letter from a doctor.

Members of the same community who share similar values often have significant disagreements about the value of self-diagnosis.

Reacting to the Diagnosis

People diagnosed with autism should know that the diagnosis does not change anything about who they are. It merely gives them a label to apply to their symptoms and experiences.

There is no “normal” or “right” reaction to an autism diagnosis. Indeed, many people cycle through a wide range of reactions. Some quickly join self-advocacy communities and become disability rights activists. Others feel embarrassed or ashamed. Some are angry that they did not get a diagnosis earlier. Still others feel comforted because they finally have a label that describes the challenges they have experienced.

Newly diagnosed autistics may find that processing the diagnosis with friends, family, or a therapist helps them manage their emotions.

Finding Autism Services for Adults

Autistic adults often struggle to find services, since many advocacy organizations and public health agencies focus on children. The right doctor or therapist may be able to offer a referral to local organizations. The Autistic Self Advocacy Network offers a rich variety of resources, including tips on advocating for oneself and talking about autism with others. The Asperger/Autism Network has compiled a list of resources specifically for adults.

Autistic adults should know that discrimination against people with autism is a form of disability discrimination. The Americans With Disabilities Act prohibits employers from making hiring or firing decisions based on disability status. It also requires that, in most cases, employers offer “reasonable” accommodations to people with disabilities, including those with autism. In some cases, a lawyer may be a valuable resource who can help with identifying specific rights and accommodations to which a person may be entitled.

Therapy can help autistic adults in many ways. Therapists who specialize in autism can connect autistic people to additional services, offer coping strategies, and educate adults about life on the spectrum. A therapist can also help autistic adults talk to others about their diagnosis and manage relationship challenges. In addition, therapy can help a person cope with the social or economic barriers that may have delayed their diagnosis.

You can find a compassionate autism therapist here.

References:

1. Dababnah, S., Shaia, W., Campion, K., & Nichols, H. (2018). “We had to keep pushing”: caregivers’ perspectives on autism screening and referral practices of black children in primary care. Intellectual and Developmental Disabilities, 56(5), 321-336. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30273522
2. Data and statistics on autism spectrum disorder. (2019). Retrieved from https://www.cdc.gov/ncbddd/autism/data.html
3. Murphy, C., Wilson, C., Robertson, D., Ecker, C., Daly, E., & Hammond, N. et al. (2016). Autism spectrum disorder in adults: diagnosis, management, and health services development. Neuropsychiatric Disease and Treatment, Volume 12, 1669-1686. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940003/
4. Sarrett, J. (2016). Biocertification and neurodiversity: The role and implications of self-diagnosis in autistic communities. Neuroethics, 9(1), 23-36. Retrieved from https://link.springer.com/article/10.1007/s12152-016-9247-x
5. The Americans with Disabilities Act of 1990 (ADA). Retrieved 8 January 2020, from https://www.carautismroadmap.org/the-americans-with-disabilities-act-of-1990-ada/

Most people crave social connection. While social media, endless apps, and new technology promises to connect more people, many people feel lonelier than ever. While isolation can be a trigger for loneliness, loneliness and isolation are not identical. A person can feel lonely even when surrounded by others, especially if they don’t have deep connections that feel meaningful to them.

Loneliness doesn’t just feel bad. It can have profound implications for health. Some research even suggests that chronic loneliness can be as harmful to a person’s health as smoking 15 cigarettes per day.

Research on gender differences in loneliness is mixed. Some studies show that women are lonelier than men; others show the reverse. Most researchers, however, agree that single men tend to be especially lonely, and that certain social norms governing masculinity may increase the risk of loneliness in men. Some early research on loneliness also suggests men may be less likely than women to admit to feelings of loneliness.

Social Isolation in Men

Studies consistently find that women are more likely to have dense social networks than men. From childhood, women are socialized to value friendship, confide in their friends, and to foster deep intimacy with close friends. Even when men have many friends, they may feel uncomfortable sharing emotions or airing feelings of vulnerability.

A 2018 analysis of people living in rural regions found that 63 percent of men felt comfortable opening up to friends, compared to 74 percent of women. Women were also more likely to participate in activities, such as church gatherings, that foster friendship and a sense of community.

Although social isolation is a serious concern among single men, research suggests that emotional feelings of loneliness are even more important. A 2011 study tied social isolation to reduced life satisfaction, but the link was even stronger for emotional loneliness. Researchers also found that male university students were significantly more likely to report emotional feelings of loneliness than female students.

How Stigma Can Be a Cage

Masculine social norms teach men that vulnerability is weakness. Homophobia is also prevalent. Straight cisgender men may fear being labeled “gay.” These two forces can make it very difficult for men to reach out to others in friendship. Even when men have friends, they may fear judgment if they display weakness or ask for help.

Heterosexual male friendships often feature a boastful sort of masculinity, in which men brag about their sexual prowess, their financial success, or their independence. This culture can make it hard for men struggling in their relationships to share their challenges. It also shows men that the ideal man is one who uses others—not one who invests deeply in interdependent relationships.

This isolation can be a self-replicating intergenerational cycle. Men may discourage sons from showing weakness or emotion. Boys also witness their fathers modeling stoic behavior and may mimic it. In this way, the stigma of emotionally connecting to other men passes from one generation to the next.

The Marriage Effect

Men in most studies are more likely than women to have long-term partners. These partners can ease some loneliness. Indeed, many men rely on their partners as a primary or sole source of emotional support. This increases men’s vulnerability to loneliness when relationships end or partners die. A 2017 survey found women are more comfortable being single than men. Sixty-one percent of single women in the UK reported being happy, compared to just 49% of single men.

In addition to supporting their male partners, women in long-term heterosexual relationships may help them socialize by building and fostering social networks. Emotional labor like remembering birthdays, sending holiday cards, planning family get-togethers, and scheduling outings with friends has traditionally fallen to women. When a man loses his partner, he may lose an important social lubricant. That may mean losing friends and social opportunities.

How to Build Bromance

Building friendships with other men can be challenging, especially when a man is no longer in school. A few strategies may help:

• Join communities and organizations that foster intimacy. Churches, volunteer organizations, and support groups may offer groups specifically for men looking for closer relationships.
• Seek friendships with men who value alternative forms of masculinity and who are willing to talk about the need for human connection.
• Consider working to turn acquaintances into friends. Invite a social media friend who speaks out against toxic masculinity or male loneliness to an outing.
• Take a more active role in family efforts to grow relationships. Don’t rely on women to plan all social outings or reach out to others.
• Try starting a new group or organization. Ask other dads to meet up once a month or invite acquaintances from church to start a group for men who want to grow meaningful relationships.
• Identify any harmful beliefs you have about friendship or masculinity. Do you believe that crying indicates weakness or that real men don’t need others? Work to understand where these beliefs come from and actively correct them.
• Practice conversations with other men ahead of time. Think about questions to ask them about their lives or opinions. Consider what you hope to share about yourself.
• Don’t rely on social media as a sole or primary source of socialization. While social media can bring people together, it also relies heavily on brief interactions rather than the sustained, meaningful connection that grows lasting friendship.
• Model vulnerability to other men and boys. Men who see that strong men can be vulnerable may feel more comfortable being vulnerable themselves. Sons who see their fathers invest in friendships may be less reticent to do so themselves.

Therapy can help many men practice and master new social skills. Men may also benefit from therapy when social anxiety impedes relationships or when loneliness is so severe that it leads to depression.

GoodTherapy connects people to caring, ethical therapists who can help with a range of challenges, including loneliness and making new friends. Find a therapist who can help you here.

References:

1. Henning-Smith, C., Ecklund, A., Moscovice, I., & Kozhimannil, K. (2018). Gender differences in social isolation and social support among rural residents [Ebook]. University of Minnesota Rural Health Research Center. Retrieved from http://rhrc.umn.edu/wp-content/files_mf/1532458325UMNpolicybriefsocialisolationgenderdifferences.pdf
2. Neville, S., Adams, J., Montayre, J., Larmer, P., Garrett, N., Stephens, C., & Alpass, F. (2018). Loneliness in men 60 years and over: the association with purpose in life. American Journal of Men’s Health, 12(4), 730-739. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131432
3. Salimi, A. (2011). Social-emotional loneliness and life satisfaction. Procedia – Social and Behavioral Sciences, 29, 292-295. Retrieved from https://www.sciencedirect.com/science/article/pii/S1877042811027029
4. Sex differences in loneliness: the role of masculinity and femininity. (1998). Sex Roles, 38(7-8). Retrieved from https://link.springer.com/article/10.1023%2FA%3A1018850711372#page-2
5. Yarrow, A. (2017). All the single ladies: 61% of women in the UK are happy to be single, compared to 49% of men. Retrieved from https://www.mintel.com/press-centre/social-and-lifestyle/all-the-single-ladies-61-of-women-in-the-uk-are-happy-to-be-single-compared-to-49-of-men

The world is full of suffering. People committed to helping others—including those in helping professions such as mental health and medicine, activists, volunteers, and highly empathetic people—face nonstop exposure to a wide range of suffering. Compassion fatigue is a type of vicarious trauma that happens when a person is overwhelmed by the trauma and struggles of other people.

In its early stages, compassion fatigue may cause a person to be preoccupied by injustice and the desire to fix it. As compassion fatigue intensifies, however, it can lead to apathy and burnout. This can undermine a person’s relationships and connection to others. And for people in helping professions, compassion fatigue may prove professionally disastrous.

What Is Compassion Fatigue?

Compassion fatigue resembles burnout in that it may sap a person’s physical, emotional, and spiritual energy. Unlike burnout, however, it appears only in contexts where a person is providing extensive emotional support or emotional labor. In some cases, the symptoms of compassion fatigue resemble those of posttraumatic stress (PTSD).

Compassion fatigue resembles burnout in that it may sap a person’s physical, emotional, and spiritual energy.

Some other ways in which compassion fatigue differs from burnout include:

• Burnout happens when a person’s environment is stressful, whereas compassion fatigue happens when a person’s interactions with other people saps their emotional reserves.
• People with compassion fatigue may begin avoiding situations in which they must confront another person’s suffering but may not avoid other work.
• Compassion fatigue may cause a person to lose empathy for others.
• People with compassion fatigue may feel cynical, apathetic, or disconnected from others.
• Burnout typically gets better when a person takes time away from the source of the burnout. Compassion fatigue may persist.

Who Gets Compassion Fatigue?

Anyone who spends significant time helping others or thinking about others’ suffering may develop compassion fatigue. Some especially vulnerable populations include:

• Very empathetic people who tend to serve as the “therapist” in their family or among their friends.
• People in dysfunctional families who continually try to support other family members without seeking support for themselves.
• People in medical and mental health professions, especially providers who work with traumatized, abused, or dying people.
• People in fields that confront systematic injustice. Lawyers who work on challenging cases or issues of social justice, activists, people who work in child abuse prevention, and others who work to end systemic issues are at risk. The work does not have to be paid work. A volunteer rape crisis counselor, for example, could easily develop compassion fatigue.
• Professionals who routinely intervene in traumatic or life-threatening situations. First responders such as firefighters, police officers, and EMS professionals may report vicarious trauma or compassion fatigue.
• Caregivers to chronically ill people. An adult child caring for a parent with dementia or another terminal illness may feel fatigued and burned out.

Some research suggests that compassion fatigue is more prevalent when a person receives inadequate support for their work. A caregiver for a person with dementia may be more vulnerable to fatigue when other members of the family refuse to help or constantly criticize their caregiving.

Symptoms of Compassion Fatigue

The symptoms of compassion fatigue vary from person to person and may change with time. They include:

• Symptoms that resemble PTSD, such as flashbacks, avoidance, disturbing dreams, and nightmares.
• An inability to show compassion or empathy. A once-caring doctor may begin blaming their patients for their maladies, while a social worker may lose interest in helping struggling families.
• Anger and resentment.
• Becoming socially disconnected.
• Feeling poorly understood by others.
• Having increasingly few boundaries between work and home.
• A decrease in productivity and effectiveness.
• Feeling trapped.
• Depression.

Strategies for Preventing Compassion Fatigue

Compassion fatigue is a common struggle, and it is not always preventable. It often comes on suddenly, even after a person has managed stress well for years. Certain prevention strategies, however, may reduce the risk and help a person better manage symptoms of compassion fatigue:

• Schedule time for self-care, including eating healthy meals, exercise, and spending time on enjoyable hobbies.
• Set clear boundaries. No one needs to answer calls 24 hours a day or provide constant care to another person.
• Take time away from work or from caregiving labor whenever possible.
• Spend time with people who support and understand the work you are doing. A public interest lawyer, for instance, may find support and help from weekly meetups with attorneys in similar fields.
• Practice mindfulness. Compassion fatigue can cause a person to feel distracted and overwhelmed. Meditation and mindful living strategies may counteract these sensations.
• Avoid taking work home. Don’t read upsetting emails or listen to voicemails during down time. People involved in unpaid caregiving or activism should schedule time away from their pursuits.
• Seek help. No single person can solve the world’s problems. Family caregivers should look in to paid care options or ask other family members for help. Professional helpers should explore additional resources to help their clients while reducing their own exhaustion.
• Reward yourself for difficult tasks. For example, plan an outing with friends following a meeting with a difficult client.

Treatment of Compassion Fatigue

Compassion fatigue is a response to chronic stress, not a mental health diagnosis. This means that treating compassion fatigue requires a person to get some relief from their stress. That might mean:

• Reducing their workload or seeing fewer clients.
• Taking time away from work.
• Establishing clear work-life boundaries.
• Changing one’s approach to work.

In some professions, it may not be possible to reduce the stress. For example, an emergency room doctor who treats abuse survivors may have little control over their workload, while a skilled death penalty attorney might be the only person in their region who can handle such complex cases. People in these situations may require extensive ongoing support, medication to manage anxiety and depression, and regular breaks from work.

No matter the cause of compassion fatigue, a therapist can help a person:

• Assess their boundaries. In some cases, a person develops compassion fatigue because they feel an obligation to “save” everyone.
• Create a better work-life balance. Time away from work, meaningful hobbies, exercise, and self-care may all help with compassion fatigue and burnout.
• Relax. Develop relaxation strategies such as meditation and cultivating mindfulness in the moment.
• Identify other resources that may help. For example, a doctor may gain significant stress relief by hiring an office assistant or relying more on their nursing staff.
• Gain new skills. New strategies to deal with personal or workplace challenges may help a person avoid compassion fatigue. For example, by learning to listen without offering advice, a parent might offer greater support to a struggling child without feeling so exhausted after each conversation.

GoodTherapy can help you find a therapist who specializes in compassion fatigue. Begin your search here.

References:

1. Compassion fatigue. (n.d.). The American Institute of Stress. Retrieved from https://www.stress.org/military/for-practitionersleaders/compassion-fatigue
2. Compassion fatigue. (2017, August 23). American Bar Association. Retrieved from https://www.americanbar.org/groups/lawyer_assistance/resources/compassion_fatigue
3. Gallagher, R. (2013). Compassion fatigue. Canadian Family Physician, 59(3), 265-268. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596203
4. Pfifferling, J., & Gilley, K. (2000). Overcoming compassion fatigue. Retrieved from https://www.aafp.org/fpm/2000/0400/p39.html

Psychotherapist Salvador Minuchin developed the concept of enmeshment to characterize family systems with weak, poorly defined boundaries. The entire family may work to prop up a single viewpoint or protect one family member from the consequences of their actions. In these family systems, individual autonomy is weak, and family members may over-identify with one another. For example, a child may be unable to see their own interests as distinct from their parent’s and may defend that parent’s interests even when doing so is harmful.

Enmeshment inevitably compromises family members’ individuality and autonomy. It can also enable abuse. Abuse within an enmeshed family system is a unique sort of trauma. Some survivors of such trauma may not recognize their experiences as traumatic and may even defend their abusers. Because boundaries are weak in these family systems, family members who correctly identify their experiences as traumatic may be ostracized or even labeled as abusive.

Characteristics of Enmeshed Families

Most healthy families are loyal to one another and may share certain values. In an enmeshed family, this loyalty and shared belief system comes at the expense of individual autonomy and well-being. For example, the entire family might support the idea of the father as a wonderful parent or great leader, even though he is physically abusive.

Enmeshment does not always lead to abuse, but it is a potent tool for shielding abusers from the consequences of their actions.

Some characteristics of enmeshed family systems include:

• Each family member fills a specific role. In most cases, these roles enable dysfunctional behavior from other family members. For example, the family peacemaker may smooth over conflicts the family abuser creates or might guilt other family members for attempting to build healthy boundaries.
• Enmeshment often begins when one family member has a mental health condition or substance abuse issue. Enmeshment normalizes harmful behavior and can be a way to avoid treatment.
• Enmeshed families often view dissent as betrayal.
• Enmeshed families may demand an unusual level of closeness even from adult children. For instance, an adult child with children of their own may be expected to spend every holiday with the family. If they spend a holiday with in-laws or with their own family, the enmeshed family may shun or otherwise punish them.
• Family members’ emotions are tied up together. It can be difficult to discern where one person’s emotions begin and anther’s end.
• There may be unspoken family norms that family members take for granted. Outsiders may rightly view these norms as unusual or dysfunctional. For example, an enmeshed family may have a norm of never calling the police on a family member who abuses their partner.

Some people also use enmeshment to refer to covert, or emotional incest. This is when a parent or other caregiver treats a child as a partner or equal. The parent may rely on the child for support and unconditional love rather than filling these basic needs for the child.

How Enmeshment Enables Abuse

Enmeshment does not always lead to abuse, but it is a potent tool for shielding abusers from the consequences of their actions. Enmeshed family members may be reflexively defensive of one another and view even deeply harmful behavior as normal and good.

Enmeshment can make it difficult for a person to form close relationships with other people. Without these relationships, it is very difficult for enmeshed family members to recognize that their family’s relational style is not healthy.

Even when enmeshed family members do form outside relationships, their enmeshed family may intrude on these relationships. Alternatively, the enmeshed person may view their family as normal and their partner as the problem. For example, an adult who gets married may still prioritize their childhood family over their spouse or may expect their spouse to defer to family members or accept abusive behavior.

The Trauma of Enmeshed Families

Enmeshment itself can be traumatic, especially when enmeshment normalizes abuse. In other cases, though, enmeshment is the byproduct of trauma. A serious illness, natural disaster, or sudden loss may cause a family to become unusually close in an attempt to protect themselves. When this pattern persists well beyond the initial trauma, enmeshment loses its protective value and can undermine each family member’s personal autonomy.

Enmeshed family systems are often dismissive of trauma. A parent might dismiss their drunken night of abuse as a normal reaction to a child’s bad grades. In adulthood, siblings may defend a parent’s abuse by insisting that the parent was under immense stress or that the abuse was actually the children’s fault. By dismissing trauma as normal or deserved, enmeshed family systems make it difficult for family members to understand their emotions and experiences. In this form of gaslighting, a family might consistently substitute the family’s collective judgment for an individual’s feelings. Over time, the individual family member may struggle to distinguish their own emotions from the emotions the family insists they should have.

Trauma Bonding and Enmeshment

People who experience trauma or intense emotions together may bond in unusual and unhealthy ways. Patrick Carnes developed the concept of trauma bonding to characterize these relationships.

With trauma bonding, the cycle of abuse tightly binds family members, creating intense emotional attachments. In abusive relationships, the abuser may become abusive and frightening, then apologetic and extremely loving. Some abusive parents attempt to compensate for their abuse with gifts, special outings, or intense love. Many survivors of abuse report that, when their parents were not abusive, they were extremely creative, dynamic, and loving.

This intermittent reinforcement of love and affection can be very difficult to escape. The longer it persists, the more difficult it may become for a person to leave. Abuse survivors may truly love their abusers and believe that their abusers love them, too.

Even when survivors correctly identify the abuse and establish boundaries or leave the relationship, trauma bonding and enmeshment can affect future relationships. The cycle of abuse can feel normal in these situations, as an intermittent schedule of love and affection becomes the person’s point of reference for a relationship. This may cause trauma and enmeshment survivors to seek out and remain in abusive or enmeshed relationships. It can also make it easier for their family to pull them back into the abuse and chaos.

People who grow up in dysfunctional family systems may ignore their own emotions. They may question their memories, wonder if their trauma really happened, or believe that they deserve to be abused. Even when a person is able to see their family through a more objective lens, establishing boundaries can prove difficult. Holidays, family vacations, and other times of intense family closeness can trigger old habits and lead to new trauma.

Therapy can help a person draw clear boundaries, take their emotions seriously, and move beyond enmeshment. A therapist is also an outside voice who can help a person understand that the behaviors their family normalized are not healthy and that they do not have to remain trapped in their usual family role forever.

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

References:

1. Carnes, P. J. (1997). The betrayal bond: Breaking free of exploitative relationships. Deerfield Beach, FL: Health Communications, Inc.
2. Green, R., & Werner, P. D. (1996). Intrusiveness and closeness-caregiving: Rethinking the concept of family enmeshment. Family Process, 35(2), 115-136. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1545-5300.1996.00115.x
3. Trauma bonding. (n.d.). Retrieved from http://www.abuseandrelationships.org/Content/Survivors/trauma_bonding.html

What Is Dopamine Deficiency? Low Dopamine Symptoms to Watch For

September 26, 2019 • By Zawn Villines

Dopamine is a neurotransmitter and hormone. As a neurotransmitter, it transmits nerve signals across a synapse. And like other hormones, dopamine helps send messages throughout the body. This means that it plays a key role in the brain’s ability to send certain nerve signals.

Dopamine plays an important role in numerous functions, including motivation, reward, learning, movement, memory, and more. Dopamine deficiency is linked to numerous ailments, including Parkinson’s, schizophrenia, and addiction. However, dopamine deficiency itself is not a medical diagnosis. Furthermore, there is no evidence that supplements which promise to increase dopamine levels offer any measurable benefit.

Dopamine deficiency is linked to numerous ailments, including Parkinson’s, schizophrenia, and addiction.

DOPAMINE: HOW IT WORKS, WHAT IT DOES

Dopamine, like other neurotransmitters, helps carry nerve signals across a synapse. It sends signals that can support feelings of pleasure and motivation. It also supports learning and working memory, enables coordinated movements, and may play a role in attention and concentration.

Dopamine is manufactured in the midbrain, in two separate regions called the tegmental area and substantia nigra. Damage to these brain regions may affect dopamine production. A person may also experience symptoms of low dopamine when their body does not properly respond to dopamine. Drugs that inhibit the reuptake of dopamine allow the brain to access more dopamine, potentially reversing some forms of dopamine deficiency.

Bupropion, a noradrenaline and dopamine reuptake inhibitor, increases dopamine levels in the brain. It is a popular smoking cessation treatment that doctors also prescribe to treat depression and seasonal affective disorder (SAD).

Dopamine is listed on the World Health Organization’s List of Essential Medicines. It can treat several life-threatening conditions, including dangerously low blood pressure and cardiac arrest, especially in newborns.

SIGNS OF LOW DOPAMINE

Dopamine affects many brain functions and physical symptoms, so signs of low dopamine may vary greatly. Some of them include:

• Depression
• Problems with motivation or concentration
• Working memory issues, such as difficulty remembering the first part of a sentence a person just spoke
• Restless leg syndrome
• Shaking hands or other tremors
• Changes in coordination
• Low sex drive
• Inability to feel pleasure from previously enjoyed activities
• Symptoms of attention-deficit hyperactivity (ADHD)
• Symptoms of schizophrenia, such as hearing voices or believing things that cannot be true
• Symptoms of dementia, such as problems with executive functioning, short-term memory, managing daily tasks, or solving simple cognitive problems

Depending on the brain systems affected, a person’s lifestyle, genetics, and myriad other factors, low dopamine may manifest much differently from person to person. For example, addiction, depression, and dementia are all linked to low dopamine.

Age, health status, brain injuries, and chronic medical conditions can change dopamine levels. So a person who has normal dopamine at one point in their life may still later be affected by dopamine-related health issues.

Low dopamine is not a medical diagnosis, and doctors rarely check dopamine levels. To treat low dopamine, doctors first look at symptoms, then assess a person to determine the right diagnosis. Treatment is based on the specific condition a person has. Even when a person has low dopamine, increasing dopamine levels is not always the right treatment. People with Parkinson’s disease may take a form of dopamine to help with movement disorders, while those with depression may use antidepressants that target serotonin.

DOPAMINE AND MENTAL HEALTH ISSUES

Numerous mental and neurological health conditions are linked to dopamine issues. Drugs and alcohol temporarily flood the brain with dopamine. The pleasurable sensations this causes can encourage a person to continue seeking out addictive substances. Over time, however, the person needs more and more of the addictive substance to get the same dopamine rush. When they stop using, their brain may temporarily produce less dopamine, increasing the risk of a relapse.

Other mental health and neurological issues that may appear in people with low dopamine include:

• Depression: Depression can be caused by one’s body or one’s circumstances. Sometimes it can be caused by a mixture of both. Most mental health experts agree brain chemistry plays a major role in depression. The brain has chemicals called dopamine and serotonin. These chemicals affect our ability to feel pleasure and well-being. If the brain does not make enough of these chemicals, or if it doesn’t process them right, depression can result.
• ADHD (attention deficit hyperactivity disorder) and executive dysfunction: ADHD is a neurodevelopmental disorder. People with ADHD may have difficulty focusing, or controlling impulsive behavior. Experts do not know exactly what causes ADHD, but some experts think that changes in dopamine activity may contribute.
• Dementia: A generalized and chronic loss of brain functioning, is not a disease in itself. Rather, the condition can be described as a variety of symptoms that are linked to a decline in memory and other cognitive functions.
• Parkinson’s disease: Parkinson’s disease is a degenerative disorder of the central nervous system. It can cause tremors, muscle stiffness, and problems with balance and coordination. The main cause of Parkinson’s disease is the loss of dopamine-producing cells.

Too much dopamine may also damage the brain. Mental health researchers have long theorized that too much dopamine in the brain may lead to schizophrenia. The research on this point is mixed, and no single cause has been conclusively shown to trigger the condition. Because both too much and too little dopamine can be harmful, however, it is important not to self-medicate or self-diagnose a dopamine-related issue.

HOW TO INCREASE DOPAMINE

Diagnosing dopamine deficiency is difficult. Although a blood test can measure dopamine levels in the blood, it cannot assess how the brain responds to dopamine. Some diseases can cause a person’s body not to manufacture dopamine transporters. So most doctors do not test dopamine levels, and instead diagnose a person based on symptoms.

A person who thinks they may be deficient in dopamine should see a doctor, since the diseases dopamine deficiency causes are treatable. If a person does not have a diagnosable illness, they may wish to try natural dopamine-increasing remedies. There is no conclusive evidence that a supplement, food, or other home remedy can increase dopamine. Some small studies have found a link between vitamin D, omega-3 supplements, or magnesium and dopamine, but more research is necessary to prove this theory.

A number of healthy lifestyle strategies may help safely increase dopamine. They include:

• Exercise
• Massage
• Meditation
• Activities that a person enjoys, such as gardening, reading, or playing with a pet

Supplements that increase dopamine levels include:

• Tyrosine. Tyrosine is a natural amino acid and a precursor to dopamine. (Dopamine is made from tyrosine.)
• L-theanine. L-theanine is another precursor to dopamine.
• Vitamin D, B5 and B6. These vitamins are needed to make dopamine.
• Omega-3 essential fatty acids.
• Magnesium.

Therapy may help a person manage the symptoms of low dopamine. In therapy, a person can learn to better manage symptoms of an illness such as Parkinson’s, advocate for their needs, and manage challenges such as low motivation and depression. Find a therapist to begin the process of healing.

References:

1. Brisch, R., Saniotis, A., Wolf, R., Bielau, H., Bernstein, H., Steiner, J., Bogerts, B., Braun, K., et al. (2014, May 19). The role of dopamine in schizophrenia from a neurobiological and evolutionary perspective: Old fashioned, but still in vogue. Frontiers in Psychiatry, 5, 47. doi: 10.3389/fpsyt.2014.00047
2. Cadman, B. (2018, January 17). Dopamine deficiency: What you need to know. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/320637.php
3. Dopamine. (n.d.). U.S. National Library of Medicine. Retrieved from https://pubchem.ncbi.nlm.nih.gov/compound/Dopamine
4. Dopamine reuptake inhibitors. (n.d.). Science Direct. Retrieved from https://www.sciencedirect.com/topics/neuroscience/dopamine-reuptake-inhibitors
5. Dopamine transporter deficiency syndrome. (2019, September 10). U.S. National Library of Medicine. Retrieved from https://ghr.nlm.nih.gov/condition/dopamine-transporter-deficiency-syndrome
6. How addiction hijacks the brain. (2011). Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/newsletter_article/how-addiction-hijacks-the-brain
7. Martorana, A., & Koch, G. (2014, September 25). Is dopamine involved in Alzheimer’s disease? Frontiers in Aging Neuroscience, 6, 252. doi: 10.3389/fnagi.2014.00252
8. Symptoms of dopamine deficiency. (n.d.). Retrieved from http://www.anftherapy.com/brain/symptoms-of-dopamine-deficiency
9. WHO model list of essential medicines. (2017). World Health Organization. Retrieved from https://www.who.int/medicines/publications/essentialmedicines/20th_EML2017.pdf?ua=1

© Copyright 2019 GoodTherapy.org. All rights reserved.

According to a recent Gallup poll, 44% of full-time employees experience occasional burnout, with an additional 23% reporting frequent or constant burnout. A person’s desire to work hard, be productive, and succeed at work may come into conflict with their need for time with family and desire for a fuller life that isn’t just defined by work.

Most workers say work is more demanding today than it was a generation ago. Research consistently shows Americans face higher burnout rates than people living in other nations. This suggests burnout is widespread cultural problem, not just an individual struggle.

Burnout Basics

The World Health Organization now recognizes burnout syndrome as a clinical syndrome. Because burnout is closely related to working conditions, however, burnout may not get better until a person changes jobs or their workload becomes more manageable. While therapy can help a person identify burnout and work toward solutions, their distress may continue until their working environment improves.

A Gallup study looking at employee burnout identified five factors that best predicted burnout:

• Unfair treatment at work
• A workload that feels unmanageable
• Poor communication and low support from a manager
• Inadequate clarity about one’s job role or tasks
• Time pressure and unreasonable deadlines

People experiencing job burnout may worry the problem is their inability to handle the workload or to fit in at work. The evidence suggests otherwise. Employer and management practices are a major predictor of job burnout. But sometimes, what feels like burnout is actually something else.

Depression vs. Burnout

Distinguishing depression from burnout can be difficult, because both cause emotional exhaustion, low motivation, and anhedonia (difficulty finding pleasure). Moreover, burnout is a risk factor for depression. So it’s possible to be both depressed and burnt out.

Some factors that may distinguish one from the other include:

• Burnout is closely linked to work. So a person may feel better after a vacation or during less stressful times at work.
• While burnout can affect motivation to do most tasks, a person is more likely to feel unmotivated at work. Depression affects motivation even to do tasks a person enjoys.
• The negative emotions of burnout center around a person’s job. A person may feel cynical or frustrated at work, less effective in their role, or frequently feel angry about work.
• Burnout symptoms tend to get worse during times of high work stress.

Anxiety vs. Burnout

Burnout can cause immense anxiety, especially when a pile of work accumulates and a person does not feel equipped to tackle it. When anxiety extends beyond work or does not get better when a person’s working conditions change, the culprit might be an anxiety diagnosis such as generalized anxiety or posttraumatic stress (PTSD).

Some signs that the problem might be anxiety and not burnout include:

• The anxiety does not improve when a person’s workload gets more manageable or when they take time away from work.
• The anxiety is not limited to work-related matters.
• A person has a history of anxiety or trauma unrelated to work.
• Anxiety causes problems at work, such as when a person is too anxious to say no to a request from a boss—especially if there’s no reason to believe the boss will react unreasonably.

When Job Burnout Comes with Company

Burnout is more than just frustration with work. It’s a serious affliction that can affect a person’s physical and mental health. Possible physical health effects of burnout include:

• A weaker immune system
• Insomnia and chronic exhaustion
• Heart disease
• Type 2 diabetes
• High blood pressure

These symptoms can compound the stress of job burnout and may even make other mental health symptoms worse. Physical health issues may also make a person less effective at work. Symptoms can force people to take time off, potentially making the stress of a hefty workload even worse.

People experiencing burnout should know there is also significant overlap between mental health diagnoses and job burnout. A person with a mental health condition is more vulnerable to job burnout, and a person with job burnout is more likely to develop a mental health condition.

Mental health interacts with workplace challenges in complex ways. For example, a person with generalized anxiety may struggle to discuss unfair job expectations with their boss. A person with depression may be unable to take pride in workplace accomplishments.

Mental health is complex, with biological, social, psychological, and environmental roots. It rarely has a single cause. The more risk factors a person has for mental health issues, the more likely it is that burnout will lead to a mental health condition.

When to Get Help

It’s not always possible to leave a bad job. That doesn’t mean a person has to struggle with burnout forever though. Self-care strategies such as using the vacation time one has earned, separating one’s identity from work, doing enjoyable hobbies, and getting plenty of rest can protect a person’s mental and physical health.

A therapist can provide a healthy outlet, brainstorm solutions, and offer strategies that may help mitigate burnout. When a person is ready to leave their job, the right therapist can support them during their job search. A therapist can help with common job search challenges, such as impostor syndrome, anxiety, and low self-confidence.

People struggling with depression and anxiety may believe medication is the only option. Yet therapy can also prove invaluable. When a person uses medication, therapy increases its efficacy. And when a person prefers to avoid medication, therapy is a viable alternative that can help a person master new coping skills. Research shows therapy can even change the brain.

When burnout and other mental health issues collide, it’s even more important to get quality mental health care. A therapist can help a person sort through their emotions, develop viable solutions to workplace challenges, and steadily work their way out of the hole of burnout, depression, or anxiety.

GoodTherapy can help you find a therapist who specializes in burnout.

References:

1. Job burnout: How to spot it and take action. (2018, November 21). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642
2. QD85 burn-out. (n. d.). Retrieved from https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/129180281
3. Schonfield, I. S., Bianchi, R., & Palazzi, S. (2018). What is the difference between depression and burnout? An ongoing debate. Rivista di Psichiatria, 53(4). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30087493
4. Smith, S. B. (n. d.). Americans tend to burn out faster than other countries’ workers—Here’s why. Retrieved from https://www.rd.com/advice/work-career/american-workplace-burn-out
5. Wigert, B., & Agrawal, S. (2018, July 12). Employee burnout, part 1: The 5 main causes. Retrieved from https://www.gallup.com/workplace/237059/employee-burnout-part-main-causes.aspx
6. Wigert, B., & Agrawal, S. (2018, July 16). Employee burnout, part 2: What managers can do. Retrieved from https://www.gallup.com/workplace/237119/employee-burnout-part-2-managers.aspx?g_source=link_wwwv9&g_campaign=item_237059&g_medium=copy
7. Wigert, B., & Agrawal, S. (2018, July 18) Employee burnout, part 3: How organizations can stop burnout. Retrieved from https://www.gallup.com/workplace/237185/employee-burnout-part-organizations-stop-burnout.aspx?g_source=link_wwwv9&g_campaign=item_237059&g_medium=copy
8. Workplace stress. (n. d.). Retrieved from https://www.stress.org/workplace-stress

Emotional manipulation can undermine close personal relationships and leave the manipulation victim feeling powerless, confused, and frustrated. Yet all people manipulate others from time to time—often without intending to. Some definitions of emotional manipulation are so broad that they can apply to any behavior, even something as innocuous as a baby crying for food.

So when is an attempt to get one’s needs met or to achieve one’s goals actually a form of manipulation? And when does manipulation cross the line into emotional abuse? Here are some red flags that may signal a serious relationship problem.

WHAT IS MANIPULATION?

Manipulation is any attempt to sway a person’s emotions to get them to act in a specific way or feel a certain thing. While it’s common in interpersonal relationships, it also frequently happens on a broader scale. Advertisers routinely attempt to manipulate people’s emotions to get them to buy a product. Political candidates manipulate voters to win votes, convince voters of untrue claims, or change a voter’s opinions about a given issue.

“We’re all manipulators,” says Melissa Stringer, LPC, NCC, B-TMH, a Texas therapist who works with many clients to handle a wide range of individual and interpersonal concerns. “Socially acceptable manipulation, such as smiling and making eye contact, are considered healthy ways to increase the chances of human connection. But when manipulative behavior is used to avoid vulnerability and establish power over others, it becomes unhealthy.”

People who deliberately use manipulation tactics often do so in an attempt to avoid healthier strategies, such as direct communication of their needs or mutual intimacy and vulnerability.

TWELVE COMMON MANIPULATION TACTICS

People can manipulate others using hundreds of tactics. Some of the most common signs of emotional manipulation include:

1. Using intense emotional connection to control another person’s behavior. For example, an abusive person may try to manipulate a person by moving very quickly in a romantic relationship. They may overwhelm their victim with loving gestures or love bombing to lower their guard or make them feel indebted.
2. Playing on a person’s insecurities. This is a popular tactic among advertisers, such as when a cosmetic company makes a person feel unattractive or “old.” It also works well in interpersonal relationships. For instance, someone may make their romantic partner think no one else could ever possibly love them.
3. Lying and denial. Manipulators may bombard their victims with lies. When they’re caught, they may deny the lie or cover it up with another falsehood.
4. Hyperbole and generalization. It’s difficult to respond to an allegation of “never” being loving or “never” working hard. Specific details can be debated, while vague accusations are often harder to dispute.
5. Changing the subject. In an argument about one person’s behavior, the individual may deflect attention from themselves by attacking their critic. The deflection often takes the form of, “Well what about [X]?” For example, when one spouse expresses concern about their partner’s drug use, the partner may attack their spouse’s parenting skills.
6. Moving the goalposts. This happens when a manipulative person constantly shifts the criteria one must meet in order to satisfy them. For example, a bully may use their coworker’s clothes as an excuse to harass them. If the individual changes outfits, the bully may claim the person won’t “deserve” professional respect until they change their hairstyle, their accent, or another miscellaneous trait.
7. Using fear to control another person. For instance, a person may use threats of violence or physically intimidating body language.
8. Using social inequities to control another person. For example, a neurotypical person might attempt to use a cognitive disability to demean or ridicule another person or dismiss their experiences.
9. Passive-aggressive behavior. This is a broad category of behavior that includes many strategies such as guilt-tripping, giving backhanded compliments, and more. Passive-aggression is a way of voicing displeasure or anger without directly expressing the emotion.
10. Giving a person the silent treatment. It’s fine to ask for time to reflect on an argument or to tell someone who deeply hurt you that you no longer wish to speak to them. But ignoring a person to punish them or make them fearful is a manipulative tactic.
11. Gaslighting. Gaslighting involves causing the manipulation victim to doubt their own understanding of reality. For example, an abusive person might deny that the abuse happened, telling the victim there’s something wrong with their memory.
12. Recruiting others to help with manipulation. For example, an abusive parent might ask family members or loved ones to remind a child how much the parent has sacrificed for the child. The social pressure may convince the child to stop complaining about abusive behavior.

A manipulative person may combine these forms of emotional manipulation or alternate between them depending on the context.

If you feel like you are being manipulated contact one of our therapist in Phoenix or find a city closer to you.

WHY DO PEOPLE MANIPULATE OTHERS?

Not all manipulation has malicious intent, even when it causes immense harm. Some common reasons people engage in manipulation tactics include:

• Poor communication skills. Some people may be uncomfortable with direct communication. Others may have grown up in houses where manipulative communication was the norm.
• A desire to avoid connection. Some people treat others as means to an end and use manipulation to control them. This is sometimes a symptom of a personality disorder such as narcissistic personality.
• Fear. People may engage in manipulation out of fear, especially fear of abandonment. This often happens during breakups or relationship fights.
• Defensiveness. Manipulation can be a way of avoiding blame. While some people avoid blame as a way to control or abuse another person, others do so because they fear judgment, have low self-esteem, or struggle to face their own shortcomings.
• Social norms. Some forms of manipulation are normal, and perhaps even beneficial. For example, most people learn that it is important to be friendly and cheerful around work colleagues in order to professionally advance.
• Marketing, advertising, and other financial or political incentives. Entire industries are dedicated to manipulating people’s emotions to change their minds, convince them to buy products, or urge them to vote a certain way.

“In many cases, manipulative individuals were not taught effective communication skills. Or worse, they were punished by an influential figure for expressing needs or wants. As a result, the original means for connecting gets overridden and replaced by strategies centered around avoiding any sense of fault. This is adequately achieved in two primary ways: indirect communication and a refusal to be accountable for actions,” Stringer emphasizes.

PROTECTING YOURSELF FROM EMOTIONAL MANIPULATION

If you have fallen for manipulative tactics in the past, know that you are not at fault. Nearly everyone is manipulated at some point. There’s no way to prevent all manipulation.

However, a number of strategies can reduce the impact of emotional manipulation and help you set boundaries. These include:

• Communicating in direct, clear, and specific ways. Direct communication models the behavior you hope for in your relationships and can make it easier to identify manipulation.
• Understanding when manipulation is normal and when it’s not. Most people occasionally make passive-aggressive or manipulative comments. Manipulation is more problematic, and may even be abusive, when it is part of a systematic attempt to control or harm another person and their well-being..
• Setting clear boundaries around manipulation. When a person attempts to manipulate you, tell them how you want them to treat you and then follow your own guideline. For example, “Mom, I understand that you sacrificed a lot for me, but that doesn’t mean you get to belittle me. I can’t talk to you about this until you’re willing to stop changing the subject.”
• Asking for insight from trusted third parties. This can be risky, since manipulative people sometimes recruit outsiders. But if you have a spouse, friend, or family member whom you can trust to be objective, they may offer helpful insights.

Victims of chronic manipulation and emotional abuse may find relief in therapy. A therapist can work with you to identify manipulation, break free from an abusive or emotionally manipulative relationship, and reduce the risk of being trapped in a toxic relationship again. In therapy, you’ll develop healthy boundaries and work through any reluctance or self-doubt you have to enforce those boundaries.

Families and couples who struggle with manipulation can also find help in therapy. A mental health professional may work with all parties to understand why direct communication is a challenge for them, cultivate healthier communication patterns, and find better ways to get their needs met.

Begin your search for a therapist here.

References:

1. Burton, N. (2015, April 14). Don’t fool yourself: seven signs you’re being passive-aggressive. Washington Post. Retrieved from https://www.washingtonpost.com/news/inspired-life/wp/2015/04/14/dont-fool-yourself-seven-signs-that-youre-being-passive-aggressive/
2. Collins, R. F. (n. d.). 10 ways to manipulate at work or at home [PDF]. Retrieved from https://www.ndsu.edu/pubweb/~rcollins/manipulationposter9-16.pdf
3. What is gaslighting? (n. d.). Retrieved from https://www.thehotline.org/what-is-gaslighting

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