Understanding Antisocial Personality: The Stigma Tied to ASPD

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

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

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

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

How Common Is ASPD?

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

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

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

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

Asocial vs Antisocial

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

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

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

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

What Is Antisocial Personality Disorder?

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

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

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

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

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

Treatment for Antisocial Personality Disorder

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

  • Violent
  • Evil
  • Dangerous
  • Impossible to treat

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

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

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

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

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

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

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

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


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

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How to Tell the Difference Between Bipolar and Borderline Personality

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

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

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

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

Bipolar vs. Borderline Personality

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

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

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

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

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

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

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

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

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

How Do Treatment Approaches Differ?

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

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

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

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

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

Can Bipolar and Borderline Personality Co-occur?

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

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

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

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

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

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

Treatment for Co-occurring Bipolar and Borderline Personality

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

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

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

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

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

Finding a Therapist for Bipolar or Borderline Personality

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

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


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

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The Untold Impact of Mother-Son Incest

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

As a society, our views of mothers as nurturers who would never willingly hurt their children may be so ingrained in our psyche that even trained psychologists can be uncomfortable entertaining the idea that sexual abuse can happen between a mother and her son (1).

Why the Silence?

Incest (sexual relationships between family members) is taboo and can bring a strong sense of guilt and shame to its victims (2). While the idea that fathers sexually abuse their children is disturbing, it is accepted as something that can (and does) happen. It is well documented and studied.

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

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

Males and Sexual Abuse: The Myths

Researcher Lucetta Thomas has identified persistent and damaging myths in regard to male sexual victimization. These myths not only exist in the minds of boys and men who themselves are victims—they are also prevalent in the attitudes and perception of social workers, law enforcement, and even psychologists or counselors (3). Myths around males and sexual abuse include the following:

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

Prevalence and Long-Term Outcomes of Mother-Son Abuse

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

For example, one study that conducted in-depth interviews of seven men and seven women who reported sexual abuse by a female perpetrator, most of whom experienced severe sexual abuse by their mothers, found a range of long-term damaging effects. Victims reported and/or experienced depression, difficulties with substance abuse, self-injury, increased suicide rate, rage, strained relationships with women, identity issues, and discomfort with sex (4).

Another study conducted in 2002 found that 17 of 67 men who endured sexual abuse during childhood reported mother-son incest (5). The study found in comparison to the other men in the study, the men who were abused by their mothers experienced more symptoms of trauma. Further, about half of the men abused by their mothers had mixed feelings regarding the abuse, and those with mixed feelings had more adjustment problems compared to men who had purely negative feelings toward the abuse (5).

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

When we examine outcomes of victims of any type of incest, we find this type of abuse is related to issues around relational trauma and betrayal trauma. Abuse by a trusted family member leads to a significant loss of trust and changes in beliefs around the self and safety in relationships (2). Understandably, when the perpetrator is a mother, the trauma is likely to carry a particularly high level of damage, especially in light of the cultural perceptions of mothers as nurturers. Furthermore, the implications of reporting abuse of this nature can be catastrophic for the victim, the mother, and the entire family. In many cases, this leaves the victim feeling as if he has no choice but to deal with the trauma in silence.

What Professionals Need to Know

Professionals, particularly those working with sexual abuse cases, need to examine their own perceptions around women as potential abusers. It must be understood that this type of abuse is possible, does happen, and can do extraordinary damage to its victims. In general, many people have been under the impression that a woman cannot really harm another person sexually. This is not the case. As new research surfaces, we are finding that sexual abuse from mother to son can bring lasting trauma and long-term mental health effects (4).

Further, men and boys are much less likely to report sexual abuse (6). Researchers have put forth the possibility that attitudes and beliefs among mental health professionals in myths regarding the male as an unlikely victim do not create conditions that encourage men or boys to talk about sexual abuse. Professionals need to be aware of the reality of mother-son sexual abuse as well as the existence of the myths surrounding the male as unlikely to be vulnerable to sexual abuse and especially unlikely to be the victim of abuse by his own mother.

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


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

© Copyright 2019 GoodTherapy.org. All rights reserved. Permission to publish granted by Fabiana Franco, PhD, therapist in New York City, New York

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Overcoming Impostor Syndrome in the Age of Social Media

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Social media enable everyone to build, create, and curate their own brand. Others interact with this personal brand, refining and changing it. This dynamic process can create a social media image that feels divorced from the person behind the profile.

Most social media profiles present a person’s life through rose-colored glasses, depicting only the best and most likable aspects of a person. A single “candid” image might have required hours of preparation and hundreds of photographic outtakes. The unfavorable or imperfect images all go unseen.

For some individuals, social media use can contribute to impostor syndrome. These individuals may have trouble acknowledging their accomplishments. They may feel as if their true selves don’t live up to their reputations and feel severe self-doubt as a result. An estimated 70% of people will feel impostor syndrome during their lifetime.

Recognizing Impostor Syndrome

In the 1970s, researchers first identified the phenomenon among high-achieving women who felt like frauds. Since then, researchers have identified impostor phenomenon among many groups, including white men. Yet marginalized groups—women, genderqueer individuals, racial/ethnic minorities, people with disabilities, etc.—may be more vulnerable to impostor syndrome.

Historically marginalized communities see fewer examples of successful people who look like them. Oppression, discrimination, and microaggressions may help activate feelings of self-doubt. A 2017 study linked impostor syndrome among racial and ethnic minority students to increased depression and anxiety.

People with impostor syndrome may worry that they have fooled everyone into overestimating their talent, intelligence, popularity, etc. They often believe their success is merely illusory, a product of luck instead of merit. Other common characteristics of impostor syndrome include:

  • Being unable to claim credit for one’s own achievements. For example, a woman receiving an award at work might downplay her contributions and highlight the accomplishments of her team.
  • Fearing judgment for perceived failures or shortcomings. They may fear being “found out.”
  • Not feeling a sense of belonging. This is especially prevalent among minorities in competitive workplaces, political organizations, and other groups whose membership provides social status.

Impostor syndrome can sometimes be a self-fulfilling prophecy. When people are unable to claim credit for their achievements, others may be less likely to notice those achievements. This can slow career progress, reducing rewards and encouragement which could convince a person that they deserve their success.

How Social Media Can Amplify Impostor Syndrome

Social media platforms allow a person to display the things they most want others to see. Some social media users are better at this than others, creating a compelling personal brand that creates the illusion of a perfect and highly successful life. The ready availability of social media profiles makes it easy to compare oneself to dozens of other people in just a few minutes. A person can even search for people with similar backgrounds, in similar jobs, or of the same age.

The viewer can’t compare to this flawless image. This can lead to insecurity and impostor syndrome, especially when a person compares themselves to people at work, school, or those in the same profession.

Social media users may be able to push back against impostor syndrome by viewing social media as a curated, deliberate branding effort—not an honest and complete presentation of a person’s life.It’s easy for even mundane aspects of daily life to become a source of comparison online. Self-care, for example, is vital for well-being. It can also be a way to signal how much leisure time, support, and money a person has. A struggling college student who sees photos of their peer at an expensive spa may feel hopeless about their own prospects for self-care.

Parenting, pet ownership, gift-giving, time management, and even cleaning can likewise trigger social media comparisons. So while a person who felt like an impostor at work might previously have comforted themselves with reassurances about their other skills, social media make it possible to feel inadequate across numerous domains.

Over time, this constant comparison can lead to impostor syndrome and other mental health issues. A person viewing an apparently flawless life may wonder, “Why can’t I do that?” The reality is that the person who appears to be living a flawless life probably doesn’t lead the life they present on social media.

A 2017 study found people who spent 121 minutes or more per day on social media were more likely to report feelings of isolation and identify with statements such as “I feel like people barely know me.” Other studies also support a link between heavy social media use and worsening mental health. For instance, a 2015 study of adolescents found that those who used social media for more than two hours per day were more likely to report poor mental health.

Social Media Literacy

Social media can undermine our sense of what is normal. For example, after days of scrolling through perfectly organized homes, people with flawless skin and hair, or employees who never make mistakes at work, a social media consumer may begin to view these experiences as the norm. This can be deeply unsettling, especially for those who are already vulnerable to impostor syndrome. A person may also view their own social media image as fraudulent while taking another person’s image at face value.

Social media users may be able to push back against impostor syndrome by viewing social media as a curated, deliberate branding effort—not an honest and complete presentation of a person’s life. Social media accounts act like personal advertisements, highlighting the good and framing a person’s life in only the most positive terms.

How to Deal with Impostor Syndrome

A handful of strategies may help counteract impostor syndrome. These include:

  • Consuming representative and diverse media. When minorities see people who look like them in successful roles, they may be less likely to feel like frauds.
  • Employ cognitive strategies. Remind yourself that many successful people feel like impostors. People often present a much more confident, “together” image than they internally feel.
  • Limit social media usage if it consistently hurts your self-esteem.
  • Find a mentor who has similar experiences to your own.
  • Build a diverse support system.
  • Remind yourself of recent accomplishments. Keeping a file of compliments or awards may help. Remember that achievements may also be more subtle, such as training a subordinate to succeed in their role or improving morale at the office.

Therapy can help with impostor syndrome and the painful emotions it triggers. A therapist can also help an individual prevent impostor syndrome from hindering their success. In therapy, a person may learn cognitive-behavioral strategies for correcting self-defeating thoughts. They might explore how their history—familial, cultural, and social—influences their self-concept. Or they might practice strategies for becoming more assertive and taking credit for their achievements.

A licensed counselor can help you manage impostor syndrome and prevent social media from destroying self-esteem. You can find a counselor here.


  1. Bothello, J., & Roulet, T. J. (2018, April 28). The imposter syndrome, or the mis-representation of self in academic life. Journal of Management Studies, 56(4), 854-861. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/joms.12344
  2. Brooks, R. (2017, April 24). Study: Impostor syndrome causes mental distress in minority students. USA Today. Retrieved from https://www.usatoday.com/story/college/2017/04/24/study-impostor-syndrome-causes-mental-distress-in-minority-students/37430839
  3. Cokley, K., Smith, L., Bernard, D., Hurst, A., Jackson, S., Stone, S., . . . Roberts, D. (2017). Impostor feelings as a moderator and mediator of the relationship between perceived discrimination and mental health among racial/ethnic minority college students. Journal of Counseling Psychology, 64(2), 141-154. Retrieved from https://psycnet.apa.org/record/2017-09930-002
  4. Imposter syndrome? 8 tactics to combat the anxiety. (2018). Retrieved from https://www.americanbar.org/news/abanews/publications/youraba/2018/october-2018/tell-yourself-_yet–and-other-tips-for-overcoming-impostor-syndr
  5. Sakulku, J. (2011). The impostor phenomenon. International Journal of Behavioral Science, 6(1), 75-97. Retrieved from https://www.tci-thaijo.org/index.php/IJBS/article/view/521
  6. Weir, K. (2013). Feel like a fraud? gradPSYCH Magazine, 11(1), 24. Retrieved from https://www.apa.org/gradpsych/2013/11/fraud

© Copyright 2019 GoodTherapy.org. All rights reserved.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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How White Denial of Racism Can Fuel Inequality

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Denial has been said to be the trademark of addiction, and it has been long identified in the field of psychology. Denial is also relevant to experiences of trauma. These include witnessing trauma, inflicting trauma, and surviving trauma. Furthermore, white denial of racial trauma is the breath of racism.

What Is Denial and Why Do People Do It?

Denial is a refusal to accept reality in order to protect oneself from a painful event, thought, or feeling. It is a common defense mechanism that gives a person time to adjust to distressing situations. For example, a person with drug or alcohol addiction will often deny that they have a problem. People indirectly dealing with the addiction, such as family or friends of the addicted person, may also deny the severity of the issue.

It is possible to deny some aspects of reality while accepting other aspects. For example, a person may acknowledge there is an issue (such as addiction) while denying the need to take action (such as quitting the drug).

Denial isn’t limited to individuals. It has also been recognized on a cultural scale. Current examples include conspiracy theorists’ claims that the Holocaust never occurred or the renunciation of global warming.

Some experts theorize that denial occurs in linear, progressive stages. These types of denial include the following:

  • Denial of fact (“That’s not true”)
  • Denial of awareness (“I had no idea”)
  • Denial of responsibility (“It’s not my fault”)
  • Denial of impact (“That wasn’t my intention”)

Denial is initially an unconscious adaptive response. It can also be one of the most primitive, meaning that while it can be very effective short-term, it is ineffective and potentially harmful in the long-term. Staying in denial interferes with change.

How Denial Can Contribute to Racism

The stigma associated with being racist often fuels white denial—the refusal to accept that racism exists. Racism can be defined as the discrimination and/or oppression inflicted upon individuals belonging to a socially constructed racial category. Racism happens at three levels:

  1. Institutional—Discrimination through laws or social norms.
  2. Individual—When one person discriminates against a minority group.
  3. Internalized­—When a marginalized person believes stereotypes about their group and/or blames themself for any discrimination they face.

Racism requires the combination of prejudice, power, access, and privilege. It has been summarized as a pathology of power marked by ignorance.

The infamous photograph of the horrific lynching of Rubin Stacy in 1935 is a striking example of white denial. The photo shows a white child in the crowd dressed in her Sunday best. She is smiling while looking at the dead body of a black man hanging in the tree.

Transforming and healing the societal trauma of racism must include healing the numbness of people who benefit from racism.The child could be considered a visual representation of how the short-term coping response of denial evolves into a long-term strategy. The photo demonstrates how racism can be embedded in the culture we grow up in (institutionalized). It also shows how our belief system and our physiology can embody racism (individualized and internalized).

Studies on epigenetics reveal how trauma responses can be passed down through generations, not only through learning and conditioning, but also through genetics. One study shocked male mice while exposing them to the scent of a cherry blossom. The mice then showed a trauma response every time there was the scent, even without being shocked. The trauma response was also present in the mice’s children and grandchildren when they were exposed to the scent of a cherry blossom, even though they never experienced a shock. Their genes were altered.

The study suggests that a person may not have to directly experience a traumatic event to enact a trauma response. In other words, a traumatic response to a relevant trigger can occur even when a person doesn’t know what the original stimulus was. Regarding the photo, the loved ones grieving Rubin Stacy’s death could have passed down their trauma response to their descendants. Future descendants of the white child may embody her physiological response as well.

White denial, and the identified physiological response, may be relevant in the concept “the privilege of numbness”. The term refers to emotional numbness as an adverse effect of racism. This numbness may enable white individuals to ignore or perpetuate a system of racism that benefits them without feeling guilt about others’ suffering. Transforming and healing the societal trauma of racism must include healing the numbness of people who benefit from racism.

When Ignorance Is Intentional

Conscious acts of denying can also appear when people face ethical dilemmas. A study examining shopping behaviors found that if consumers were specifically told that a product was made in an unethical way, the consumers wouldn’t purchase the product. However, when consumers were given the choice to hear the backstory on the product, most people chose to not know.

Researchers asked participants to rank jeans by picking two of four categories to do so:

  1. Style
  2. Color
  3. Price
  4. Whether or not child labor was used to make the clothing

More than 85% of participants did not choose child labor as a category for their consideration. These results suggest the vast majority of participants were “willfully ignorant.” Researchers found the conscious act of denial was at least in part due to an unconscious fear of being upset by what would be discovered.

Next, researchers asked the willfully ignorant participants what they thought of consumers who chose to research a brand’s labor practices before making a purchase. The response? The willfully ignorant participants tended to degrade the ethical consumers, not just with criticism, but also with character attacks.

Why the hate? Research indicated the participants were unconsciously acting out due to their own guilty feelings. Perhaps even more concerning, a related study demonstrated that willfully ignorant consumers who degraded their ethical peers were less likely to support the social cause in the future.

Addressing Denial Through Self-Examination

Challenging denial is typically an ongoing process of self-examination and radical honesty. Denial is universal—everyone perceives events through personal bias. Therefore, confronting denial often starts at an individual level.

When challenging your own denial, remember to consider the following:

  • Realize that denial and personal bias are largely implicit and unconscious processes. Uncovering and confronting social conditioning requires ongoing effort and outside feedback. We all have blind spots.
  • Remove the blame and shame. Binary judgments of good/bad can further increase stigma. Stigma in turn can heighten defense mechanisms and trigger trauma reactions (i.e. denial).
  • Replace blame and shame with vulnerability, curiosity, and humility. Embrace feelings that allow for growth. Seek understanding. Stretch your worldview.
  • Befriend the body. Increase your awareness of your body. Understand how it reacts when you are stressed or ashamed. Learn to tell the difference between discomfort and pain.
  • Focus on holding yourself responsible and accountable. Consider if your internal and external resources are being used in accordance with your values. Action often alleviates guilt.

Sometimes confronting personal bias or past mistakes can feel emotionally overwhelming. A licensed therapist can offer confidential support without judgment. You can find a therapist here.


  1. Aizenman, N. (2016). Do these jeans make me look unethical? National Public Radio. Retrieved from https://www.npr.org/sections/goatsandsoda/2016/01/07/462132196/do-these-jeans-make-me-look-unethical
  2. Aldebot, S., & de Mamani, A. G. (2009). Denial and acceptance coping styles and medication adherence in schizophrenia. The Journal of Nervous and Mental Disease, 197(8), 580–584. doi:10.1097/NMD.0b013e3181b05fbe
  3. D’Angelo, R. (2011). White fragility. The International Journal of Pedagogy, (3) Retrieved from http://libjournal.uncg.edu/ijcp/article/view/249/116
  4. Kendi, I. X. (2018). The heartbeat of racism is denial. The New York Times. Retrieved from https://www.nytimes.com/2018/01/13/opinion/sunday/heartbeat-of-racism-denial.html
  5. Lewis, T. (2013). Fearful experiences passed on in mouse families. Live Science. Retrieved from https://www.livescience.com/41717-mice-inherit-fear-scents-genes.html
  6. Lynching of Rubin Stacy in Fort Lauderdale, Florida [Photograph]. (1935) Retrieved March 2019 from https://www.alamy.com/stock-photo-lynching-of-rubin-stacy-in-fort-lauderdale-florida-49908098.html
  7. Raheem, M. A., & Hart, K. A. (2019, March). Counseling individuals of African descent. Counseling Today, 61(9). Retrieved from https://ct.counseling.org/2019/03/counseling-individuals-of-african-descent
  8. Winn, M. E. (1996). The strategic and systemic management of denial in the cognitive/behavioral treatment of sexual offenders. Sexual Abuse, 8(1), 25–36. Retrieved from https://journals.sagepub.com/doi/10.1177/107906329600800104

© Copyright 2019 GoodTherapy.org. All rights reserved. Permission to publish granted by Tahmi Perzichilli, LPCC, LADC, therapist in Minneapolis, Minnesota

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Grow Old with Me: Some Advice on Aging in Relationships

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“Grow old along with me! The best is yet to be, the last of life, for which the first was made.” -Robert Browning


Relationships and marriages come with all sorts of expectations. We often hear the words “forever” and “lifetime” used when marriages are discussed. Up until quite recently, long-term monogamy has been set out as a goal for young people in committed relationships. The expectation is that we’ll love each other all of our lives, growing old together in wedded bliss. As a couples counselor, I frequently hear these expectations from clients in my office practice. Ideal love, romantic love, passion, desire, connection: will these last forever?

For some people, I think they will. However, there are a lot of variables that determine longevity in relationships. Expectations are one of them. Rigidity and unwillingness to change, grow, and adapt will definitely affect the longevity of a love relationship. We don’t remain the same people over the years. Not emotionally, not mentally, and certainly not physically. Age and time march on, and we are vulnerable to their impact on our lives and relationships.


The reality is that change is a constant. Our interactions and our experiences cause us to grow and evolve into the people that we become. If we are willing and open to it, we will continue to evolve and grow as individuals and as a couple for the rest of our lives. There isn’t an age or time when learning and growth stops. It never needs to.

The secret to an enduring relationship is for both parties to accept the reality that their partner is not the same person they were 10, 20, 30 years ago, and neither are they. When a couple can accept this, they are able to embrace the changes in themselves and in their partner and treat them kindly throughout the process. The excitement in an authentic long-term relationship is that you get to be with a new person throughout that timeline. Every person your partner becomes is someone new to discover and to fall more deeply in love with.

The problems come when one or both partners get stuck in their perception of the person that their significant other used to be. They fail to see that person’s change and growth. Or perhaps the individual themself is not open to growth and becomes stuck. They risk losing the relationship because they are not willing to accept the new changes in their partner nor support that growth.

Aging with a loving partner requires acceptance of physical changes, of an inability to do what we once did, and even of the mild to severe cognitive deficiencies that occur as we age. It takes a great deal of patience to deal with declining health issues or to show love when people are at their least lovable. But that’s when they need love the most.

Adapt and Thrive

It is possible to have a strong and loving relationship in your golden years. Understand that all relationships go through peaks and valleys, ups and downs. There will be times when you think all is lost. Other times you’ll feel like you want to stay like this forever. It’s all changeable; fluid and dynamic.

The best advice I can give my clients is to be grateful, to show appreciation, and to never take your loved one for granted. Try to stay in the habit of being kind to each other, no matter what is happening in this cycle of your lives together. Try to see that having someone in your life that you can love and that loves you back is a great gift.

Be willing to adapt to what’s needed. As you age, you’ll need to change your approach to just about everything in life as your physical abilities change. Sexuality is one area in which adaptability is crucial. You may need to use different positions, shorter sessions, or pharmaceutical intervention. But you don’t ever need to give up your sexual relationship unless you choose to. It can be a fulfilling and special part of your relationship until the end of life.

Topics of Conversation

Talk to one another about everything. Tell your partner what you need and encourage them to express their needs to you. Then set about meeting those needs. Give your partner what they need to continue to feel loved by you and to feel like you value them deeply. Show them every day how grateful you are to have them in your world.

The excitement in an authentic long-term relationship is that you get to be with a new person throughout that timeline. Every person your partner becomes is someone new to discover and to fall more deeply in love with.Talk about the hard stuff too. When things are tough for them, be supportive. Don’t always try to fix things. Sometimes a listening ear is what they truly need. Talk about how you both can adapt and try to make things better going forward.

Encourage each other to feel important and loved. It’s hard to feel old and unattractive. Tell your partner that you still find them desirable. Show them.

Let your partner know that you still “see” them for who they are and love them even more now than you did then. Build each other up and spend quality time together. Have fun and laugh a lot. Talk about the future; make plans for your golden years that include loving interactions and new adventures.

Talk about your fears and plan for contingencies. You never know what life will throw at you next. The most important thing to remember is that you’re in this together. You’re stronger together.

Long-Term Monogamy

Through the ups and downs of your relationship, you’ve probably had attractions to other people. You may have had crushes and flirtations. It’s normal to experience this. We’re all human with basic sexual desires that can be triggered by someone other than our partner. The question is, what happens when you see a young attractive person? Do you act on that desire? Or do you realize that the best thing that ever happened to you is right there at home, and chuckle to yourself and move along home?

Long-term monogamy is a wonderful way to have a relationship. Monogamy can be sexy, exciting, and ultimately fulfilling. There’s something so wonderful about being in a relationship late in life where you can look back on decades of memories, shared experiences, and joy with a feeling of accomplishment that you saw it through the hard times and the good and made it all the way to your golden years together. You and your love can enjoy the end of your lives knowing you went through it all together and that you are stronger and more in love than ever.

© Copyright 2019 GoodTherapy.org. All rights reserved. Permission to publish granted by Stuart Fensterheim, LCSW, therapist in Scottsdale, Arizona

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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Histrionic vs. Narcissistic Personality: What’s the Difference?

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

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

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

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

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

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

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


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

Ability to Show Empathy

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

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

Different Types of Attention-Seeking Behavior

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

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

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

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

Why Do These Differences Matter?

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

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

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

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

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

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

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

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

Treatment for HPD and NPD

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

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

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

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

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

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

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

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

Getting Help

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

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

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


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  2. Behary, W. T., & Dieckmann, E. (2013). Schema therapy for pathological narcissism: The art of adaptive reparenting. In J. S. Ogrodniczuk (Ed.), Understanding and treating pathological narcissism (pp. 285-300). Washington, DC, US: American Psychological Association.
  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). 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. Dieckmann, E., & Behary, W. (2015). Schema therapy: An approach for treating narcissistic personality disorder. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26327479
  5. Ekselius, L. (2018). Personality disorder: A disease in disguise. Upsala Journal of Medical Sciences, 123(4). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327594
  6. Histrionic personality disorder. (2018, January 23). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9743-histrionic-personality-disorder
  7. Mayo Clinic Staff. (2016, September 23). Personality disorders. Retrieved from https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463
  8. Mayo Clinic Staff. (2017, November 18). Narcissistic personality disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662
  9. Ritzl, A., Csukly, G., Balázs, K., & Égerházi, A. (2018, September 13). Facial emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders. Psychiatry Research, 270. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30248486
  10. Teen drama vs. histrionic personality disorder. (2018, July 18). Newport Academy. Retrieved from https://www.newportacademy.com/resources/mental-health/histrionic-personality-disorder-in-teenagers

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Do Ideology and Stigma Impact How We See Sex Addiction?

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

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

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

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

Is Sex Addiction Real?

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

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

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

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

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

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

Ideology and ‘Sex Addiction’

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

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

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

Signs Sexual Behavior Has Become a Problem

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

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

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

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

  • Continuing to have or pursue sex even when you do not want to. Note that this is sometimes also a sign of religiously induced sexual shame.
  • Making sexual choices that consistently undermine a relationship.
  • Being unable to succeed at work or school because of a preoccupation with sex.
  • Needing to have progressively more sex to get the same “rush” that less sex once offered.
  • Abusive or aggressive sexual behavior, such as coercing people into sex or having sex with underage children.

Seeking Help for Problematic Sexual Behavior

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

  • Discussing sexual values, the role of childhood experience in sexual values, and how religious and cultural norms can affect sexual behavior.
  • Helping a person engage in sexual behavior consistent with their values.
  • Supporting people in relationships to negotiate sexual boundaries and recover from sexual transgressions.
  • Reassuring clients that “normal” sexual behavior comes in many forms.
  • Offering a safe space to explore sexuality and move beyond sexual shame.

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

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


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

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From the Shallow to the Deep End of Love: How EFT Guides to the Deep

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Our culture has taught us to label showing emotion as “being emotional”. To label a desire for love as “desperation”. To label a need to be loved as “being needy”. It’s no wonder that knowing what to look for in love, understanding what we need in it, and falling in love can be so confusing.

How We Learn to Think About Love

What we long for in a romantic relationship is actually there long before the courtship gets started. We learn our behavior in relationships even before we turn 2 years old.

As infants, we are helpless. The only way we have to communicate is through our cries. The way adults respond to these cries teaches us early whether we can count on our caregivers to show up and take action on our behalf. Caregivers can build secure attachment and trust with a child or develop insecurity.

If our caregivers are responsive, we learn to internally trust that they will show up and tend to our emotional needs and cries for help. If our caregivers don’t respond, our cries get louder and more intense. These louder cries may move our caregivers to respond, or they may still go ignored. Eventually we learn to internalize that experience and expect it in future relationships. How we adapt to this emotional injury ends up being the strategy we adopt long-term.

When Attachment Injuries Affect A Relationship

Just because we get older doesn’t mean that our needs and longings go away. They show up in adult love and ask to be met. Often this “ask” isn’t verbal. Even when it is, partners may find it difficult to show up and meet those needs because they have their own needs that also ask to be met.

Relationships are hard. It’s difficult to know how to love if you haven’t had the experience of it yourself.

Relationships are hard. It’s difficult to know how to love if you haven’t had the experience of it yourself. Love and relationships require us to show up in ways that we often only somewhat learn to do by trial and error.

Old attachment injuries can draw us into relationships that have a hard time delivering what we need. They can make it difficult for us to deliver what our partner needs too. Some couples go on for months not knowing how quickly even a tiny smirk can ignite a cycle of detachment that is all too familiar and all too difficult to get out of.

In many relationships, what’s missing is an understanding of each partner’s individual attachment styles and how that affects our way of attaching to one another. This can devastate a relationship or marriage, toppling it like a house of cards.

Married couples often get stuck in this negative pattern of disconnection for years before seeking help. The end result of months and years of this cycle can bring growing frustration. We may feel defeated, alone, misunderstood, or unloved. We often withdraw into ourselves, resting parallel to our significant other but unable to cross over to them and express our feelings and needs.

Emotionally Focused Couples Therapy

Emotionally Focused Couples Therapy (EFT) can be the solution for a couple seeking to understand the negative cycle they get caught in. Through my EFT training, I help couples look deeper into their relationship challenges to increase their bond, understanding, and secure attachment. I hold hope for couples as they learn to hold it for themselves.

EFT can create the security that is often missing between partners who are insecurely attached. This process involves taking risks with one another. I help people share thoughts they feel are too scary or vulnerable to express to their partner alone. In this process I’ve learned so much from my clients, including how to slow down in my own life to create opportunities for good understanding. It’s important to genuinely share one’s heart and words before making assumptions about another’s truth.

As the developer of EFT (Sue Johnson) says, at the end of the day people just want to know, “Are you there for me?” and “Do I really matter to you?” As an EFT therapist, I can surely respect and appreciate those questions. Most of us in a relationship want to know just that.

As a therapist and couple work through the three stages of EFT, partners may feel a bit of relief. However, they will see the best benefits if they complete all three steps, whether they are a premarital couple or have been married for years. A complete course of EFT can help couples create lasting safety in their relationship. Couples can become more responsive and connected instead of detached and alone in their distress.

If you would like to meet an EFT therapist in your area, you can search for a therapist here.

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Resilient Children Grow Up to Be Resilient Adults–True or Not?

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Problems in life are inevitable. Challenges cannot be avoided. Life is not always a bed of roses. The ability to recover from a difficult or unpleasant situation is resilience. Resilience means being able to get back on track, as strong as before, after an unanticipated setback such as physical or emotional trauma.

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

Developing Resilience

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

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

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

  1. Individual
  2. Family
  3. Environment

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

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

Healthy Risk Taking

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

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

Let the Child Solve Their Problems

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

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

Don’t Ask Why, Ask How

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

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

Help Your Child Understand Emotions

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

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

Support Your Child Emotionally

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

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

Characteristics of a Resilient Child

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

  • Tackle problems on their own
  • Manage their emotions
  • Take risks
  • Face challenges confidently
  • Solve problems efficiently

Long Term Effects of Resilience

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

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

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