What is anxiety? And how is it different from stress?
Anxiety and stress can feel the same, mentally and physically. Mentally, it can feel like being out of control or feeling trapped. Your thoughts may be racing and maybe you are talking faster than usual. It is harder to concentrate. Physically, you may feel an internal restlessness or fidget more. Some people manifest their anxiety or stress by biting their nails or chewing on a pen. You might find your heart is pounding in your chest and you are sweating without exertion. It is hard to fall asleep or relax, because you feel you need to be doing something. It can hard to differentiate the two, but one way to figure out if it is stress or anxiety is to ask, “Do I have reason to be anxious?” Stress is the result of external forces. These external might be final exams, approaching deadlines, an illness, or looming bills. Anxiety exists whether or not there is a stressor.
Doesn’t everyone feel anxious though? How do I know it’s a disorder?
Anxiety is a normal human state. A normal amount of anxiety can be beneficial. For example, a student who is nervous about an upcoming exam studies more intensely in the two days leading up to it. The difference between normal anxiety and dysfunctional anxiety is the severity or the length of time. If you are so anxious about an exam that you end up not studying at all, that needs addressing. We psychiatrists diagnose an anxiety disorder after six months of feeling anxious without a stressor most days of the week.
A panic attack usually lasts about 5 to 20 minutes. You may feel a cold sweat with heart palpitations and light-headedness. You may feel like the world is closing in on you or that you might faint or die. People coming into the emergency department with a panic attack are often worried they are having a heart attack, because it often presents as chest pain and trouble breathing. Most people will have a panic attack or two in their lifetime. They are often in response to danger or terrible news, but they can also occur without any trigger. One or two panic attacks is not unusual. However, if you are having a panic attacks several times per month or every day, it can be debilitating.
What are some medical causes of anxiety?
There are a lot of medical causes of anxiety. For example, an overactive thyroid can cause the symptoms mentioned above, in addition to feeling overly hot, losing weight, hair thinning. With COPD (chronic obstructive pulmonary disease) and asthma, a patient often feels like she can’t take a full breath, which can cause a great deal of anxiety. Heart disease can also mimic symptoms of anxiety. If you have new onset anxiety, especially as an older adult, I would recommend getting a medical check up with labs in addition to seeking help from a psychiatrist (although a good psychiatrist should also be ruling out medical causes.)
What are some natural remedies for anxiety?
My favorite recommendation for anxiety is exercise. As Americans, our school and work life involve a lot of sitting and staring at screens. Making sure you get 30-minutes of exercise daily will make a world of difference if you are feeling anxious. At least three times per week, the exercise should be strenuous enough that it should be difficult to carry a conversation while doing. When the body’s fatigue matches mental fatigue, there is a concordance that helps us relax and sleep. Staying away from processed foods, caffeine, alcohol, and drugs will also help with anxiety. Therapy, especially cognitive behavioral therapy, can help you identify why are anxious and help stop unhelpful thoughts as they are happening.
I think my anxiety might be out of control. I would be open to medication, but I don’t want to be dependent on anything to feel “normal.”
It can be hard to ask for help for anxiety, especially since it exists in everyone to varying degrees. There are medications that you can use both short-term and long-term for anxiety. Benzodiazepines, like Xanax, Klonopin, or Ativan are good short-term choices for severe anxiety and panic attacks, but use beyond a few months should be discouraged, because patients can become dependent on them to function. A selective serotonin reuptake inhibitor or SSRI is a great long-term medication for anxiety. Examples of SSRIs include Zoloft, Prozac, Celexa, and Lexapro. They tend to be tolerated well and there is no risk of dependence. The most common side effects are headaches and nausea when starting the medication, when increasing the dose, or when there is a missed dose. Some people can notice a decrease in libido or “feel like a zombie” if the dose is too high or the medication isn’t right. A side effect with one medication does not mean you will have it with all SSRIs. Most doctors can manage medications for anxiety, but a psychiatrist can be helpful when “first-line” medications fail to help. People who suffering from anxiety may also be struggling from other psychiatric disorders like depression or ADHD, which a psychiatrist will be able to catch.
I find it sad when a patient comes to me and says, “I’ve never been happy.” Imagine looking back on your life, and not being able to recall any moment of joy. Unless you have a rare brain disorder, it is impossible for you to have not enjoyed anything even for a brief moment. My follow up questions are often: “What is happiness?” “How would your life be different if you were happy?” “Would you act differently if you were happy?” The answers are often confused and dejected. The problem begins with thinking of happiness as perpetual state of bliss. True happiness occurs in spurts or for short periods. People who consider themselves “happy” are probably more accurately described as “grateful, “content,” “mindful,” or “present.” So how do you get more of that in your life?
1. Find your purpose.
The Declaration of Independence lists among our unalienable rights: “Life, Liberty, and the pursuit of Happiness.” The problem with pursuing Happiness and giving it that capital ‘H’ is that humans are not capable of sustaining happiness. It is not evolutionarily beneficial to be happy all the time. Our brain has a limited supply of dopamine to dole out, because our survival depends on us growing, hunting, or seeking. And if the goal is happiness, that means that every time you are unhappy you are failing. Write yourself a mission statement. Take an hour and meditate on this question: “What do I want to do with my finite time on Earth?” Those who have defined their purpose in life feel their struggles are significant. When they look back on their achievements and adversities, they feel a sense of pride and self-worth. It feels counterintuitive, but giving up on being happy will actually give you more happy moments.
2. Take care of your body.
Our brain is a beautiful and delicate computer. Instead of electricity, it runs on water, nutritious food, sleep, sunlight, socialization, and exercise. If you deprive it of sleep, starve it, isolate it, ignore pain, drown it in alcohol, caffeine, or other substances, you brain will not work for you, at least not long-term. You can only whip a horse to go faster for so long, before it gives up or bucks you off. Taking medications for chronic medical or psychiatric disorders is also part of caring for your body.
3. No one is responsible for your happiness (and you are not responsible for anyone else’s.)
Let that sink in. You alone are responsible for your happiness. It is not your nagging mother-in-law, or your chronic pain condition, or unrelenting work schedule making you unhappy. It is your behavior, your choices, and your thoughts that make you unhappy. This is one of the hardest truths to accept, but once you do you realize that the inverse must be true as well. If you worked through the exercise in #1 and wrote down, “My life’s purpose is for [insert person’s name] to be happy,” go back to the drawing board. This is the hardest one for parents. You raise a child who is completely dependent on you for everything for the first years of their life. The child grows up, makes mistakes, chooses incorrectly, and struggles with unhappiness. Sometimes that child is severely unhappy. It feels like a selfless act to tie your happiness to that of your children. Except we already learned that happiness is a transient state. So, what does this mean? You have signed yourself up for a lifetime of feeling unhappy. Not only that, but you have unfairly put the responsibility for your happiness onto your children. If you identify with the child in this scenario, the good news is…
4. You are in control of your life.
The movie “Groundhog’s Day” is a perfect example of how events themselves are not “good” or “bad,” but only have the meaning we ascribe to them. Bill Murray’s character starts out as negative, sarcastic, and self-pitying, and he has a terrible day. The day and all its events repeat themselves endlessly. He begins to realize that his behavior has a huge impact on the people around him. He only breaks the cycle once he adopts a position of gratitude. Many people live with the false belief that they have no control.
Let’s say your dog had diarrhea overnight, you hit traffic on the way to work, you spill coffee on your favorite sweater, and your boss chews you out for being late. If you approach the world from a negative or victim mentality, you are more likely to wallow in negative emotions, more likely to spend the day complaining, and less likely to produce quality work. At the end of the day, you decide it was a “bad” day, something to be endured. You didn’t deserve such a bad day. You deserved better. You follow up the bad day by acting out or engaging in destructive behavior. You’re short with your wife, you hide from your children, you have a drink. You wake up the next day and your opinion of yourself and others is worse.
Now imagine you wake up feeling you are in control. The same events happen, but you look more objectively at your behavior. It is possible you contributed to the events of the day. Maybe you chose to ignore your first alarm. Maybe you had a thought to put a lid on the coffee and didn’t. It was not the traffic, or the coffee, or the boss, it came down to decisions you made. Or let’s say there was nothing you could have done differently. At the very least, you have a choice in how to react to those events.
5. No one knows what you’re thinking.
Up until the time of this writing, there has been no proven cases of telepathy. You cannot expect an apology from a friend, if you never told her you were hurt. Even if you are married 50 years, you cannot know with 100% certainty what your spouse is thinking. Just like a child who does not make a list for Santa, you are not going to get what you want if you don’t speak up. Therapy is greatly helpful in learning to identify needs and communicate them effectively.
If these concepts are intriguing to you, I highly recommend The Subtle Art of Not Giving a F*ck by Mark Manson and The Four Agreements: A Practical Guide to Personal Freedom by Don Miguel Ruiz. As you might expect from the title, the former is lighter with some irreverent humor not suitable for young children. It comes in an audiobook form that is easy to listen to in the car or while doing housework. The latter is more serious and spiritual. It is written simply, but it gives you a lot to ponder.
At the start of the COVID-19 pandemic, a curious thing happened in my clinic. The majority of the child and adolescent patients with anxiety appeared to be doing better. They continued to do well through the summer. I believe this is because the biggest stress in a child’s life is school, whether for social or academic reasons. This is not to say that stress is bad, just that some children handle it better than others. As parents, you may be wondering how to help your child cope with the school stress. Here are some DO’s and DON’Ts for building your child’s confidence and resilience.
DON’T call your child ‘smart.’ Children who perceive themselves as smart are often more likely to give up on tasks that do not come easily. Being labelled as smart often comes with the expectation that they should never struggle with a subject, so it can also lead to a lot of shame.
DO compliment her on her effort. For example, “That took you three tries, but you did it!” If the A on a test came easily without studying, it does not deserve a reward. A B on an assignment that she worked hard on for a whole weekend deserves a celebration with ice-cream.
DON’T get lax with discipline, because he is the younger child. Try to apply the same rules as you did for your older children. Doing less may cause resentment and jealousy in the older children, and lead to less academic success in the younger ones.
DO ask your son what he thinks the appropriate response should be and involve him in the process. If he forgot to turn in an assignment, ask him what distractions kept him from preparing appropriately. Then, ask him what he thinks is a fair punishment and compromise with him. He is much more likely to accept the rules if he feels he had some say in them, and he learns how to discipline himself.
DON’T take your daughter’s word about her grades. There are a lot of reasons kids and teens lie about grades. Either they fear punishment, are ashamed, or are overly optimistic about their ability to raise the grade with future assignments. It often happens that a busy parent learns that their child is failing only at the end of the semester, causing stress for the entire family.
DO check on her grades periodically, whether it be once per week or once every three weeks. If you can catch a problem early, there is a much better chance of solving it. As your daughter becomes more independent and trustworthy about reporting grades, the frequency for checking grades may decrease, but it should never stop completely.
DON’T automatically take your son’s side when a bad grade comes in. If your instinct is to immediately question the teacher’s competency, the child receives the message that a poor outcome is “unfair” and that he deserves better treatment. entitlement.
DO help him understand why he got a bad grade. Maybe he missed a deadline or chose to play Fortnight until 11pm the night before the test. Make the connection between his behavior and the outcome. Help him to accept the grade and move on from disappointment. In the case that the grading did happen to be unfair or unreasonable, show him how to evaluate his own actions first before looking for fault in others.
DON’T reinforce gender stereotypes about learning. Most parents are aware of this already, but gender stereotypes are harmful to kids. It could be a gym teacher that tells a young girl that she will stop liking PE class once she hits middle school or a science teacher that says girls are better at reading than math. Just like calling your child ‘smart,’ this gives her an idea that she has immutable qualities that are not worth working on.
DO reflect on your own biases about gender. If you have internalized a stereotype, you could be passing it on without realizing it.
Other DOs
Encourage reading of any kind. Comic books count!
Get an evaluation if teachers suspect she has a learning disability or ADHD and intervene early.
Make time for breakfast.
These recommendations are made from reading about child development and my observations as a psychiatrist working with parents and children. Categorizing things as DOs and DON’Ts was for ease of communicating the ideas, not as judgement. There is no absolute right or wrong way to parent children. Just as we don’t want to label children as good or bad at school, there are no good and bad parents. If you are putting in the effort, remember to reward yourself, too.
Insomnia is a concern for the majority of patients I have seen in the hospital and in outpatient clinic. Many patients have decided that they have always been and always will be light-sleepers or night owls. Sometimes, they will insist that they are just like a parent who also had disordered sleep. They do not see sleep as a skill, but as a personality quirk. For this reason, they insist that changes to their environment or habits will be useless and ask for sleep-aiding medications. While there are a number of medications that are helpful for sleep, the first steps for optimizing sleep are not found in a bottle. Here are some tips for becoming better at sleeping:
1. Develop a consistent sleep schedule. Keeping the same bed time and wake time during the week and on weekends will have you feeling better rested. Some phones now have the option of setting a bedtime and wake time to remind you when it is time to hit the hay.
2. Get your six to 8 hours. The amount of sleep needed for a person to be well-rested and function normally throughout the day will vary from person to person, but six to eight hours is the average amount needed by adults. If you have trouble sleeping for longer than four or five hours, one trick is to decrease your hours to 3 for two nights and then let yourself sleep normally. Your fatigue may help you sleep for longer and get into a good routine.
3. Invest in “black out” curtains. The reason for poor sleep could be your environment. This could be the case if the bedroom is messy and causes anxiety, or if your curtains let in too much light during the early morning. Animals in the bedroom may be waking you at night. Using cues like a white noise machine or a scent like lavender can help signal to your brain that you would like to sleep. Having pillows and sheets that you like also help promote sleep. Make the changes you need to make the bedroom a restful place to which you look forward.
3. Avoid caffeine, nicotine, alcohol, heavy meals, and exercise late in the day. If you sleep poorly, start monitoring how late in the day you are engaging in these habits. Alcohol may seem to promote sleep, but it actually interferes with REM sleep and causes earlier awakenings.
4. Train your brain to sleep. A puppy learns that she should not urinate inside the house when the owner consistently takes her outdoors whenever she begins to squat. Instead of falling asleep on the couch, move yourself to the bedroom when you begin nodding off. It’s important that your brain instinctually associates bed with sleep by not using your bed during the day, for eating meals, or for studying. If you move to the bed and suddenly cannot sleep, give yourself 15 minutes to nod off. If sleep is escaping you, get up and leave the bed. When you are tired again, return to bed. Training your brain, like training a puppy, takes time, but it is worth it.
5. Turn off all electronic devices. Much like during the take off portion of a flight, the use of cell phones should be prohibited before sleep for at least 30 minutes. The blue light from electronics mimics daylight and tells the pineal gland in the brain that it’s daytime. This results in decreased melatonin and resulting alertness. If you have to look at your phone before bed, many smartphones come with the option of “night shift” where the display’s tone becomes warmer or more yellow.
6. Address concerns about snoring with your doctor. If you or your partner snores loudly or excessively, there is a problem with the airway. The answer may like in weight loss, using strips to open the nasal passages, or even in using a machine that assists breathing. If you awaken multiple times per night gasping for air, your brain could be waking you up, because you cannot breathe. A sleep study can look at patterns of sleep to better diagnose the problem.
7. Remain calm. If you find yourself worrying that sleep will never come, put on a YouTube video of guided meditation, take a warm shower, or read a book to take your mind off your worries. If you’re interested in seeing a therapist for anxiety, there is cognitive behavioral therapy specifically for insomnia, called CBT-i.
8. And if all else fails…If you have done everything on this list and are still struggling, ask your doctor about sleep medications that are not habit-forming. Trazodone and mirtazapine (Remeron) are often my first choice for patients, although they are not right for everyone.
A lot of these bad habits can start in adolescence, when sleep schedules become less strict and the body’s nature circadian rhythm shifts such that teens have less fatigue at night. This is also a time where TVs or other electronic devices are allowed in bedrooms. If you notice that your teenager is overly tired, try using the tips above to optimize sleep so that he can become a skillful sleeper.
So many people feel hopeless about sleep., and if you are one of them I hope that this article inspires you to institute some changes.
A common complaint among my patients is their home and how the level of clutter makes them unhappy. Here are some examples:
A woman who suffers from dysthymia (persistent low-level depression) recently returned to her home after a trip to Japan. When she came back, she noticed she felt sad to be in her home. Although jet lag could have also been contributing to her mood, she felt the clutter was responsible. A few years ago, the inherited a lot of items when her mother died suddenly. There are family records and antiques dating back to the 1800s as well as useless documents and papers. She does not have the heart to go through them. Her own mess is also mixed in with her mother’s things. She asks for advice on how to feel better in her home.
Part of what is keeping this woman from tackling her mess is grief. She is reminded of the loss of her mother every time she considers cleaning it out. By avoiding and leaving the mess undisturbed, she lives among objects that make her sad. Her return from her trip made her realize just how much her space oppresses her. When facing clutter with sentimental value, it’s good to call on a friend, spouse, sibling, or child to help lend emotional support as you go through items.
There is another woman who unhappy with her space. The tub in her bathroom is full of furniture. There are plastic bags with checks that need to be shredded by the toilet. The area around her sink is so crowded with toiletries that she knocks something each time she washes her hands. She has piles of clothes in her closet that have not fit her in years. There is an entire room dedicated to “crafts and cr#p,” that is full of things that she has bought in discount bins and sales racks. She estimates that she spends $50 per month on shopping sprees, but when she talks about her purchases it is apparent that she spends more than she is willing to admit. She tries to give away items to her children and grandchildren, but no one wants them. She feels shame about her house. She would like to be proud of her home and invite people over more often, but, at the same time, she feels “lazy” and does not want to do it.
This woman holds a negative belief about herself that she is a “lazy” person. Labeling herself this way frees her from the responsibility for the mess. It prevents her from living the life that she wants. She needs to change her thinking before she can change her environment, (which is true for everyone.) It turns out she is motivated by before and after pictures. She cleared her bathroom and was proud to show the photos of what she had accomplished. Her efforts are praised, so that she may start to look at herself as capable or industrious instead of “lazy.” It will be helpful to understand where the compulsion to shop is coming from. Does it relieve stress? Does it help her to feel in control or to feel less lonely? Understanding what drives the behavior may help her to find other ways to fill that psychological need.
If you have spring cleaning on your mind, I highly recommend The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing by Marie Kondo. The KonMari method of tidying is interesting. She starts the process with assessing how her client feels in the space, asks him to envision how their home would feel ideally. She suggests cleaning the house all at once rather than in small increments, so that he can feel the change in the space and a change can occur in his thinking. She goes through her house by category, not by room. Instead of tackling the bathroom one day and the bedroom the next, she will go through all the items in the house in this order:
· Clothes
· Books
· Papers
· Miscellaneous, or kimono
· Mementos, or things of sentimental value
These categories have subcategories as well. As the client goes through items, she asks if these objects “spark joy.” If they do not, they get discarded. She also has suggestions for the best way to store items. If you don’t have time to sit down and read a book (which I can admit that I do not,) you can listen on audiobook. She also has a show on Netflix called “Tidying Up with Marie Kondo.”
Other ways of motivating yourself are to take before-and-after pictures of your home or to record a time-lapse video of the cleaning process. It makes it all the more satisfying at the end of the day. Good luck with the cleaning of your house (and your mind!)
Stroll through the self-help section of any bookstore (yes, they still exist!), and you will find a huge selection of books of on positive thinking and positivity. Bright book jackets promise everything from solid friendships to job promotions to a hypercharged immune system all through the power of positive thinking! While it is true that optimism and gratitude are traits of happier people, there is a darker side to the positivity trend that has begun to be called toxic positivity.
What does toxic positivity look like? Let's imagine a woman is fired from her job. If she has adopted the “positive vibes only” way of life, there may be inadequate room for emotions like sadness or anger. She surrounds herself with upbeat quotes. She invites her friends to go out to dinner to celebrate this opportunity and tell the group that it’s all good! Her friends’ express admiration for your positive attitude.
Consider another scenario. A woman's beloved dog has died, and she invites a male friend to come over. If he Is committed to positive thinking, he may feel his job is to cheer her up by distraction. He brings over a pint of Ben and Jerry ice cream. When she shows pictures of her dog or brings up memories of her pet, his responses are: “He’s in a better place!” or “He lived a good life.” He tries to cheer her up by talking about other topics and put on her favorite reality TV show. She smiles and seems in a better mood when he leaves.
You may have read these situations and thought that the responses were not so bad. Sadness and anger are uncomfortable, both for the person experiencing them and for those around them. But by pushing away our feelings or dismissing those feelings in others, we are missing key lessons. In the first situation, the person is avoiding thinking about the job loss. Instead of asking herself, “What was missing from my job performance?” or “Why did I clash with my boss?,” she has chosen to simply move on and forget about it. This leaves her vulnerable to making the same mistakes at the next job. If she were able to tolerate negative emotions, she would be in problem-solving mode. Instead of allowing her friends to comfort her or give her valuable insight as to what went wrong, she brushes off their help.
In the second situation, the man did not validate or join in her friend’s sadness. Instead of listening to his friend talk about her love for her dog, he shut down conversation with quips and distractions. When she leaves, the friend’s feelings remain, but maybe now she feels ashamed of “wallowing” and feels pressured to “move on” from the death of her dog.
Ignoring pain and discomfort limits our human experience. There are different versions of emotion wheels or feelings wheels online. Look at all the colors. If we were painters, why would we limit ourselves to only one half of the palette. Life is rich and complicated, and it is disingenuous to pretend that it is not.
A personality consists of characteristics patterns of thinking, feeling, and behaving that is consistent across time and situations. One person might be described as outgoing, open to experiences, anxious, and impulsive. Another might be introverted, conventional, trustworthy, and calm. Some personality traits are apparent at birth, and others arise from experience.
A disordered personality is a cluster of traits that significantly impairs a person’s relationship with others or themselves. A psychiatrist begins to suspect a personality disorder when she hears that a patient has been married multiple times, cannot keep or move up in a job, has few close friends, or has a history of impulsive or dangerous behavior. Here is a short overview of personality disorders that are present in the DSM, or Diagnostic and Statistical Manual of Mental Disorders. For fun, I have included some characters from TV and film that I feel exemplify the disorder. Some words of caution before you go diagnosing friends and family. Even though there may be concerning personality traits in childhood or adolescence, personality disorders should not be diagnosed until a person is an adult. The problematic thinking and behavior cannot be better explained by another mental disorder, drug abuse, head injury, etc.
Paranoid Personality Disorder
Mad-Eye Moody, Harry Potter
As children, people with this disorder may have experienced trauma or neglect, or they may have seemed “odd” or “eccentric,” which attracted teasing on the playground. As adults, they are constantly vigilant for threats. They are suspicious and secretive. They do not like to reveal a lot about themselves. They are easily insulted and tent to react quickly and angrily to perceived attacks. They hold onto grudges.
Schizoid Personality Disorder
Severus Snape, Harry Potter
The schizoid person is a loner by choice. He does not want close relationships, has little interest in romance. He does not care for the opinions of others. He is indifferent to praise or criticism. He has few hobbies and prefers solitary activities.
Schizotypal Personality Disorder
Kramer, Seinfeld
This person is a bit of an oddball. He may be superstitious have “magical thinking,” a belief that his thinking or behavior can influence events. He may believe he has the power to read others’ minds, predict the future, or see ghosts. He has an odd way of speaking and an eccentric appearance. He only has a few friends. He continues to have anxiety around others no matter how long he has known them.
Antisocial Personality Disorder
Patrick Bateman, American Psycho
A person with antisocial personality disorder believes he is above the law. He enjoys manipulating others and often feels superior to them. His impulsive and thrill-seeking behavior gets him in trouble, but he never feels remorse for his actions because he lacks empathy.
Borderline Personality Disorder
Alex Forrest, Fatal Attraction
A person with borderline personality disorder has a changing sense of self and often feel empty. Her affect (the way she displays emotion) may not match the way she feels. She has extreme emotions and a temper, often in response to perceived abandonment or rejection. I have found that many patients who describe themselves as “bipolar” often are referring to this way of reacting to situations and people. A patient with this disorder is more likely to have a history of self-injury or suicide attempts.
Histrionic Personality Disorder
Scarlett O’Hara, Gone with the Wind
“Histrionic” derives from the Greek word for actress, which perfectly describes this disorder. Similar to those with borderline personality disorder, the histrionic person is excessively emotional. Unlike the deep and strong feelings of borderline personality, the histrionic person’s feelings are shallow and often expressed in a bid for attention. In fact, the histrionic person will do just about anything to be the center or attention. She will dress seductively or flamboyantly. She expresses strong opinions but is either unable to provide reasoning for them or is not firmly held to them.
Narcissistic Personality Disorder
Lucille Bluth, Arrested Development
Narcissus is the character from Greek mythology who is cursed for being vain and dies admiring his own reflection. In childhood, the narcissistic person likely felt they did not get adequate attention or love from their parents. The need for praise and admiration continues into adulthood. The narcissist sees the world in terms of winners and losers. She is jealous of others and believes others are jealous of her. Like the antisocial person, the narcissist lacks empathy for others and will often exploit them to get what she wants. She knows she is better than other people and wants to be recognized as such. She fantasizes about unlimited success, power, brilliance, or beauty.
Avoidant Personality Disorder
Amelie, Amelie
The avoidant person is shy. Unlike with schizoid personality, her lack of friendships comes not from the desire to be alone, but intense fear of criticism and judgement. She often feels inferior to others. She avoids taking risks and is hypersensitive to negative feedback.
Dependent Personality Disorder
Buster Bluth, Arrested Development
The dependent person has difficulty existing on his own. He has difficulty making decisions without the input of others. He is submissive and does not like to disagree. When a relationship or friendship ends, he urgently seeks a new one.
Obsessive-Compulsive Personality Disorder
Leslie Knope, Parks and Rec
This is the personality disorder that people often refer to as “Type A.” The obsessive-compulsive person is rigid in both thought and behavior. She is highly disciplined and likes routine, order, and rules. She keeps the original packaging to everything, has trouble throwing away worthless items. She is often described as a perfectionist or a workaholic. She has trouble delegating tasks and needs to do everything herself. Disruption in routine is greatly upsetting to the obsessive-compulsive. A small change of plans causes great anxiety.
Why do we say “Type A personality?”
In the 1950s, two cardiologists noticed the chairs in their waiting room were worn out on the front edge of the seats. This made them wonder if their patients were less likely sit back in their seats and relax than the average person. They hypothesized that there was a type of personality that was more likely to heart disease. Though their theory was never proved, the terms “Type A” and “Type B” remain part of our vernacular. A Type A person is an impatient, ambitious, meticulous, and aggressive workaholic. A Type B person is a patient, easy-going, flexible, and creative procrastinator.
What are the origins of “anal-retentive” or “anal” personality?
People generally use this term to mean that they like things to be a certain way. This can be generally or about one area in particular (e.g. “I’m really anal about the way my books are arranged.”) This term dates back to Freudian psychoanalysis. Freud believed that differences in personality could be explained by difficulty during developmental stages. Those children who were overly chastised for accidents during potty-training would grow up to be uptight, orderly, and stubborn. While parenting style certainly can influence a child’s personality, there has been no link between toilet-training trauma and anal-retentive personality in adulthood.
What about “sociopath” and “psychopath?”
“Pathos” comes from the Greek word for suffering. Pathology is used in medicine to mean abnormal or diseased. As its name hints, a sociopath does not adhere to societal rules. A psychopath is someone whose psyche (mind) is suffering. In popular culture, a psychopath is violent. In psychiatry, psychopathology simply means a disorder of the mind. Examples of psychopathy include personality disorders, schizophrenia, depression, anxiety, OCD, and cognitive disorders.
Can someone change their personality?
Psychiatrists prefer to think of personality traits as maladaptive or adaptive, rather than bad or good. Maladaptive means that the trait is not meeting the needs of the moment. For example, a person who grew up with an abusive father may mistrust and avoid others. Being alert to threats helped him to survive childhood. These traits become maladaptive once they start hurting more often than they help. The first step to changing maladaptive personality traits is to acknowledge them and to then learn more about them. From there, therapy is important. A therapist provides an objective assessment of your patterns in thinking and behavior and works with you to break these patterns and find new ways to relate to yourself and the world.
Dating can be incredibly stressful. Whether you’re on your first date after a breakup or hitting the dating scene for the first time, sitting across from a stranger to see if you are compatible can be nerve-wracking. This is especially true for individuals who already struggle with social anxiety. For my patients that struggle with dating, I often compare the experience to job interviews. Here are some tips to make dating less stressful.
Explain gaps in your dating resume.
Just like an employer would be curious about why you have a two-year gap without work, a date is going to wonder why you are not off the market. Have an honest answer prepared. Maybe you were not over your ex. Were you focused on your career and not ready for a family? Maybe you knew you had a lot of moves in your future.
Be clear about your goals.
A common question on a job interview is “Where do you see yourself in five years?” The question is just as important in dating. Don’t be afraid to be honest about your goals. You won’t scare anyone away by saying you’re open to a relationship…at least not anyone who has the same goal. If you’re not sure what you want, consider taking time to reflect on that question or being upfront about not knowing. Sometimes it takes some dating to figure out what you want. You may not think religion is that important to you, but then you realize you are not comfortable raising your kids a different religion. You may think you want to be with an extroverted outdoorsman, but then you decide you prefer lazy beach days to hiking and rock-climbing trips. Having these conversations helps you understand who you are and what you want.
Provide references and clean up your online presence.
If you are thinking of asking a girl out, it’s best if you have mutual friends that can talk about you in a positive way. She is more likely to say yes if she already likes your family or your friends. If the date goes well, she will be gathering information about how you have treated people in the past. She will be looking up your social media accounts, so if you’re with a new girl in every picture maybe consider pruning those back a bit if you want a relationship. Try looking at your instagram objectively. If the majority of your pictures are seductive selfies, your date might assume you require more attention than he is willing to provide.
First impressions matter.
Take a shower. Brush and floss your teeth. Wear a deodorant or perfume that won’t give someone a headache. If you have a beard, shape it. If you have patchy facial hair, shave before the date. Ask advice from friends before heading out. They might point out that your dress has a rip or your socks clash. Show up on time or early. Smiling and making good eye contact helps put the other person at ease. A little alcohol can help with first date jitters, but getting drunk looks sloppy. Put your phone away and give the conversation your full attention. Avoid talking about politics, religion, or sex on the first few dates. It’s an old rule, but a good one. Speaking of taboo first date topics…
Don’t trash your ex.
If an employer asks why you left the last place you worked for, it’s best to give a neutral answer, even if there was mistreatment. The same is true for dating. If she provides a laundry list of everything her last boyfriend did wrong, she has not recovered yet and she may not be taking responsibility for her part in the failing relationship.
Go on a lot of interviews…erm…dates!
Practice makes perfect. The more dates you go on, the more natural making conversation becomes. What is different from typical interviews is that you have the option to pick where they happen. Have a few places in mind that you know have good food and ambiance. An interactive activity like bowling, axe-throwing, arcade game-playing give you a lot of information about the other person without all the awkward small talk. Play to your strengths. If you’re a biology major, you could make a trip to the zoo really interesting. If you’re creative, a paint and pinot class is a low-pressure way to show off a little.
Send a follow up thank you note.
Ok, so it would be awkward to send a thank you email after a date, but it’s a nice courtesy to follow up the day after a date with a text or a call to say you had a nice time. You can also add whether or not you would be interested in seeing them again. Be gentle with the latter: “I didn’t feel we were compatible, but I had a nice time and enjoyed talking with you.” If you’re on the receiving end of one of these texts, please accept it gracefully. He could have ghosted or disappeared on you, but he chose to be honest instead. That takes courage. And if you are on the receiving end of one of those texts…
Don’t take rejection personally.
This advice is often hard to follow, especially if there has been a lot of rejection in a row. There can be a lot of shame and self-doubt when the other person does not want another date. Fight the impulse to self-criticize. You are worthy! That other person does not know you after one or two dates. The truth is you probably won’t ever learn why he didn’t call. Try to analyze the the date objectively. Maybe you talked a little bit too much about a conspiracy theory and ignored some hints that he wasn’t interested in lizard people. Maybe the bar you chose was too loud for meaningful conversation. Identify some problems and work to improve them, but if you can’t think of anything that went wrong try not to worry too much.
Ultimately, when you have become skilled enough at dating, you begin to get an intuition for which dates feel natural, easy, and fun and which feel stale or forced. Trust your gut. And good luck out there!
I have tried resolutions in the past, but I never seem to make it past January. Why bother?
You are not alone. A study by the University of Scranton shows that only 8% of people are successful at keeping a resolution through the year. Here are the most important elements of a successful resolution:
1. It matters to you. Everyone says they want to work out more, right? But if it’s not important to you, chances are you will buy a year gym membership for nothing. Be honest with yourself about changes you actually want to make.
2. It’s simple and realistic. A lot of people make the mistake of trying to make too many changes at once, or being too optimistic as to how quickly they can change a pattern of behavior. Don’t try to fix your diet, quit smoking, drink less, and volunteer more all at once. Pick one!
3. It’s quantifiable. Avoid vague resolutions like, “Be nicer to people” or “Cook more at home.” Instead set a goal of “Three random acts of kindness per day” or “Four meals at home per week.” Then, use those numbers to track your progress. In this marvelous age of technology, there is an app for everything.
4. It is shared with others. People who attempt resolutions with a partner are much more likely to succeed at them. If no one around you wants to join, there are plenty of online communities that can act as support groups. Also, sharing your resolution on social media adds some accountability and pride in your progress.
What are the most popular New Year’s resolutions?
According to a YouGov poll, the most popular New Year’s resolutions in 2024 were:
#1 Exercise more
#2 Save money
#3 Eat healthier
#4 Improve physical health
#5 Be happier
#6 Improve mental health
#7 Learn something new
#8 Lose weight
#9 Spend more time with family
#10 Read more
My resolution every year is to lose weight. I am really committed to doing it this year. How do I finally do it?
Weight loss is tricky. While the numbers on the scale can be helpful for tracking your progress, they can also hinder it. Remember that muscle weighs more than fat, and it is common to gain weight when starting an exercise program. Instead of being discouraged, ignore the numbers in the beginning and focus on how your body feels. Documenting progress through photos might be more motivating for you than a number. Nutritionists’ tips for losing weight include drinking more water, following the Mediterranean diet, cooking more at home, choosing an exercise program that includes cardio and strength-training, and avoiding alcohol and sugar. Making those changes month-by-month will help you to achieve your weight-loss goals and help you feel good.
Why do we even make resolutions?
The ancient Babylonians were rumored to start making promises over 4,000 years ago during their new year’s celebrations called Akitu. They agreed to things like paying off their debts and returning things they had borrowed to the neighbors. During their exile in Babylon, the Jewish people began to borrow elements from their captors’ holiday in shaping their own New Year celebration, Rosh HaShanah.