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.

References:

  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.

References:

  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.

References:

  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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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.

Prevalence

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.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
  2. Behary, W. T., & Dieckmann, E. (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

© 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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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.

References:

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

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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.

© 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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Could Schema Therapy Help Treat Narcissistic Personality?

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Narcissistic personality disorder (NPD), or narcissism, as it’s often called, is one of the cluster B personality disorders, or emotional/impulsive personality disorders.

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

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

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

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

The Roots of Narcissism

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

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

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

  • Having a parent who is extremely adoring or overly critical, or a parent who switches between these modes
  • Having a parent with narcissism
  • Inheriting certain traits that increase risk for personality disorders
  • Experiencing trauma, abuse, neglect, or indifferent parenting

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

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

  • Overt narcissism most often involves entitled, attention-seeking behavior. A primary feature is an exaggerated sense of self-importance. People with this subtype tend to be charming and arrogant and often exploit others. They may do fairly well in the workplace but struggle to get along with others or do tasks they consider demeaning or otherwise beneath them.
  • Covert narcissism may include anxiety, significant emotional distress, and extreme sensitivity to criticism or perceived insults. This subtype is often characterized by shyness, even social isolation. People with covert narcissism tend to have an internal sense of superiority and fantasize about their talents being recognized while speaking modestly about themselves, even putting themselves down.
  • High-functioning narcissism involves similar traits to overt narcissism, but people with this subtype can generally function well in society and may not appear to have a personality disorder. They are often able to adapt narcissistic traits such as charm and competitiveness in order to achieve success and may have relationships that are shallow but lasting. Criticism, perceived failure, or age-related challenges such as poor health or perceived loss of attractiveness may cause distress or crisis.
  • Malignant narcissism, considered the most severe subtype, involves overt narcissism traits along with traits of antisocial personality and paranoia. People with this subtype may lie and manipulate others easily, behave in aggressive ways, enjoy intimidating others, and avoid any work or task unless it benefits them in some way. They often have no desire to change, so treatment may be very difficult.

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

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

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

Schema Therapy: An Effective Treatment for Narcissistic Personality?

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

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

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

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

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

The schema modes commonly associated with narcissism are:

  • Detached Protector/Self-Soother: This avoidant mode involves behaviors that are soothing, stimulating, or distracting—anything that helps turn off emotions. These behaviors might include substance abuse, risky sex, gambling, fantasizing, or overwork. It’s also common to shut out or reject people as well as emotions. Typical function isn’t always affected, but it may seem almost mechanical and lack any personal investment.
  • Self-Aggrandizer: A mode in the overcompensation category, this involves many behaviors typically associated with narcissism—superiority, entitlement, and manipulative tactics. People in this mode tend to show little interest in anyone but themselves, boast of real or inflated achievements, and openly seek admiration to avoid revealing hidden vulnerabilities and insecurities.

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

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

Why Do Narcissists Seek Therapy?

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

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

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

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

People with narcissism may seek help for:

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

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

Finding a Schema Therapist

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

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

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

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

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
  2. Behary, W. T., & Dieckmann, E. (2011, July 20). Schema therapy for narcissism: The art of empathic confrontation, limit-setting, and leverage. In W. K. Campbell and J. D. Miller (Eds.), The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Hoboken, NJ: John Wiley & Sons.
  3. Behary, W. T., & Dieckmann, E. (2013). Schema therapy for pathological narcissism: The art of adaptive reparenting. In J. S. Ogrodniczuk (Ed.), Understanding and treating pathological narcissism (pp. 285-300). Washington, DC, US: American Psychological Association.
  4. Caligor, E., Levy, K. N., & Yeomans, F. E. (2015, April 30). Narcissistic personality disorder: Diagnostic and clinical challenges. American Journal of Psychiatry, 172(5). Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14060723?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
  5. Dieckmann, E., & Behary, W. (2015). Schema therapy: An approach for treating narcissistic personality disorder. Fortschritte der Neurologie-Psychiatrie, 83(8), 463-477. doi: 10.1055/s-0035-1553484
  6. Ekselius, L. (2018). Personality disorder: A disease in disguise. Upsala Journal of Medical Sciences, 123(4), 194-204. doi: 10.1080/03009734.2018.1526235
  7. Mayo Clinic Staff. (2017, November 18). Narcissistic personality disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662
  8. Ritzl, A., Csukly, G., Balázs, K., & Égerházi, A. (2018, September 13). Facial emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders. Psychiatry Research, 270, 154-159. doi: 10.1016/j.psychres.2018.09.017
  9. Young, J., & First, M. (2003). Schema mode listing. Retrieved from http://www.schematherapy.com/id72.htm
  10. Young, J., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York City, NY: Guildford Press. Retrieved from https://www.guilford.com/excerpts/young.pdf?t

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5 Myths and Facts About Drug Rehab

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

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

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

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

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

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

Drug Rehab Myths and Facts

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References:

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

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Nutrition for Anxiety: Foods to Eat and Avoid

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Nutrition is fuel for your body. Choose the right fuel and your body, including your mind, may function better.

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

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

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

The Science Behind Foods That Reduce Anxiety

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

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

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

  • Promoting general health. Some evidence suggests that simply eating a more balanced, nutrient-dense diet can help with anxiety. For example, some people report reductions in anxiety when they eat a whole foods diet or when they correct nutritional deficits.
  • Neurotransmitter regulation. Certain chemicals, particularly eicosapentaenoic acid (EPA) and docosehexaenoic acid (DHA) may help regulate neurotransmitters, which are brain chemicals that help carry messages across a synapse. Many anti-anxiety and antidepressant medications also work on neurotransmitters.
  • Vitamin D. Vitamin D deficiency is common, especially among seniors and those who do not spend much time in natural sunlight. Vitamin D supports healthy brain function and may regulate neurotransmitters. Doctors think it may be especially critical for regulating dopamine, a brain chemical that plays important roles in motivation and pleasure.
  • Fighting inflammation. Inflammation is the body’s natural response to an injury. Chronic inflammation, however, can cause a wide range of maladies. Some research links it to anxiety. Foods that fight inflammation may help with anxiety as well as other chronic health problems.

8 Best Foods for Anxiety

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

Pieces of salmon sashimiSalmon

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

Nuts and seeds

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

Cup of chamomile tea with chamomile flowersChamomile

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

Eggs

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

Pieces of dark chocolate with cocoa powderDark chocolate

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

Berries and citrus fruits

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

Bowl of turmeric powder with roots in backgroundTurmeric

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

Dairy products

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

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

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

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

References:

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

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Shock and Testing: Two More Twists on the Road to Grief Recovery?

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In her seminal book, On Death and Dying, psychiatrist Elisabeth Kübler-Ross identified five distinct stages of grief. Kübler-Ross worked with dying people and designed her model to describe the distinct grief of dying.

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

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The Seven Stages of Grief

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

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

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

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

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

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

Shock: The First Stage of Grief

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

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

Some hallmarks of shock include:

  • Difficulty expressing emotions
  • Trouble processing the meaning or effect of the news. A family member might be unable to plan a funeral, while a newly diagnosed patient may feel ill-equipped to make treatment decisions.
  • Feeling numb, paralyzed, or overwhelmed
  • Feeling overstimulated and in need of a break from the weight of the grief

Testing: An Often Overlooked Stage of Grief

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

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

A person in the testing stage may:

  • Be interested in learning about grief or their specific loss
  • Try new strategies for coping
  • Reach out to loved ones for support
  • “Try on” different philosophies or spiritual traditions

How Helpful Are the Stages of Grief?

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

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

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

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

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

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

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

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

References:

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

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