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If you’re looking for a simple answer as to what causes mental health conditions, the answer is that there isn’t one. The fact is that mental conditions have *many* causes. However, experts believe that it’s often a combination of genetics and stress that contributes to their onset.

The diathesis-stress model is a theory suggesting that mental disorders and medical conditions are caused by a combination of an inherent predisposition and the person’s experience of stress. Also known as the vulnerability-stress model, it is a framework for understanding how existing vulnerabilities and environmental stresses interact to influence mental health conditions.

It also explains why prolonged stress often contributes to anxiety, depression, and other disorders. And while we can’t really change our genetic vulnerabilities, there are steps we can take to limit and manage our stress. According to the diathesis-stress model, doing so can play a big role in protecting your mental well-being.

Understanding Diathesis and Stress

While the term sounds unwieldy and complex, the phenomenon it explains is relatively easy to understand. 

• Diathesis refers to a predisposition or vulnerability to developing a mental disorder. This can be due to genetic factors, early life experiences, or other biological susceptibilities. 
• Stress refers to the environmental factors that trigger the onset of mental illness or exacerbate existing conditions. These can include significant life events, trauma, and daily stressors.

History of the Diathesis Stress Model

The model can trace its origins to the 1950s, although roots of this theory date to much earlier. Paul Meehl, in the 1960s, applied this approach to explain the origins of schizophrenia. Since then, it has also been utilized to understand the development of depression.

According to researchers who use this viewpoint, people with a predisposition for depression are more likely to develop the condition when exposed to stress. This theory was later expanded to include other mental health conditions, including anxiety and eating disorders. 

How the Diathesis Stress Model Works

Everyone has vulnerabilities due to genes, genetic abnormalities, or the complex interaction of various genes. But just because these predispositions exist does not mean that an individual will develop a particular condition. 

In many cases, a disorder will only emerge when stress-related pressures trigger the underlying diathesis. This exposure to stress can trigger the mental disorder’s onset or worsen existing symptoms.

The diathesis-stress model is one way to explain why some people are more vulnerable to mental illness than others. It also explains why some people may develop a mental disorder after exposure to stressful life events while others do not.

However, it is essential to remember that in most cases, no single gene is responsible for causing a mental disorder. Instead, it is often the result of many genes or other biological factors interacting with environmental variables that determine overall risk.

Types of Conditions Linked to Diathesis and Stress

The diathesis-stress model has been implicated in the onset of lots of different mental health conditions. This includes some of the most common mental disorders in the U.S., such as anxiety and depression. Some of many different types of mental health conditions include:

Anxiety Disorders

While the exact causes of anxiety disorders are unknown, genetic vulnerabilities and exposure to stressful life events can play a big part. Researchers note that anxiety disorders tend to run in families. Having an inherited predisposition means that traumatic experiences are more likely to trigger anxiety. Genetics can also impact how people manage stress.

Depression

A combination of factors is believed to contribute to the onset of depression, including genetics, a family history of depression, and exposure to stressful life events. The theory suggests that people with genetic vulnerabilities are more likely to become depressed when they are dealing with prolonged stress.

Financial problems, relationship issues, or trauma can trigger emotional and physical responses that overwhelm a person’s coping abilities. When these stresses surpass a person’s ability to cope, it can contribute to the development of depression.

Schizophrenia

Experts suggest that schizophrenia is caused by a combination of genetics and stressful events. For example, around 25% of individuals with 22q11.2 deletion syndrome (aka DiGeorge Syndrome) develop schizophrenia, indicating a significant genetic component.

However, not everyone with this genetic variation experiences schizophrenia, suggesting that environmental factors also play a part.

Eating Disorders

Genetic, environmental, and psychosocial factors are believed to contribute to the development of eating disorders. For many people, stressful life events that leave them feeling a loss of control can lead people with inherent vulnerability to extreme behaviors to control weight and food intake.

Uses for the Diathesis Stress Model

The diathesis-stress model has been used to help improve research, diagnosis, and treatment of mental disorders. Some uses for this model include:

• Understanding the causes of mental illness: Where other models of mental illness focus primarily on nature or nurture, the diathesis-stress model suggests that mental disorders are best understood as resulting from biological and environmental influences. 
• Reducing the stress that contributes to mental disorders: Because of the emphasis on the role stress plays in causing mental illness, this model encourages the use of stress reduction strategies to help limit disease risk. While genetic and other biological factors cannot be controlled, stress is a modifiable risk factor that people can address through lifestyle changes. This may include stress-relief techniques, such as relaxation and mindfulness.
• Exploring the interactions of biological and environmental influences: The diathesis-stress model is also helpful in understanding the complex interaction of biological and environmental factors in developing mental disorders. It can help guide research to identify the causes of mental illness, ultimately leading to the development of more effective treatments.
• Understanding the impact of genetics and environment: This model helps explain why some people are more likely to develop mental health conditions following stressful events and why others are not.

Impact of the Diathesis-Stress Model

The diathesis-stress model has influenced how researchers investigate mental health conditions. It has helped shift the focus of research from nature vs. nurture debates to a more nuanced understanding of how biological and environmental factors contribute to mental illness.

The diathesis-stress model has also helped change how mental disorders are treated. The model suggests that treatment should reduce stress and address the underlying diathesis to the degree possible. This has led to the use of new therapies, such as mindfulness-based stress reduction, that might mitigate these risks.

How to Manage Your Stress

Avoiding all sources of stress isn’t realistic (let’s face it, life *is* stressful sometimes). However, limiting your stress and developing strong stress management skills may help lower your health risks. Some things you can do include:

• Identify your sources of stress: Where is it coming from? What is it about the situation that is stressing you out?
• Explore ways to avoid or minimize your stress: Can you get rid of the stress? Are there things you can do to limit your exposure to the stress?
• Develop healthy coping mechanisms: Healthy coping skills can include self-care, relaxation, and problem-solving techniques.
• Use relaxation strategies: Try stress relief techniques such as deep breathing, progressive muscle relaxation, and guided meditation
• Exercise regularly: Research has shown that regular physical activity can help lower stress.
• Write in a gratitude journal: Gratitude interventions help you focus on the good things in your life, which can improve your ability to cope with stress.

Protective Factors

Stress and genetic factors work together to increase your vulnerability, but there are also protective factors that can help counteract some of the effects of stress. A few of these helpful protective factors that buffer the interaction of diathesis and stress include secure attachments, positive relationships, stress management skills, and emotional competence.

Depression is a mental health condition that affects one in six people at some point during their lifetime. It can take many different shapes and forms, and affect people in different ways.

High-functioning depression or functional depression is a lay term that is sometimes used to describe experiencing symptoms of a depressive disorder, but to outside appearances, you look fine, says Aimee Daramus, PsyD, a licensed clinical psychologist.

‘High-functioning’ depression is not a term used in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR), the tool that clinicians use to diagnose mental health conditions. Instead, it is a colloquial term that has gained popularity in recent years to describe hidden symptoms of depression that often go unnoticed by others and don’t appear to impair day-to-day functioning.

While it isn’t a specifically-recognized condition, in some cases it may represent an actual clinical diagnosis of depression. You may seem fine because you can go about your day and be productive. Other people may not even realize that you are experiencing depression unless you tell them, says Dr. Daramus. However, you may not be alright.

About the Term ‘High-Functioning Depression’

Despite the growing use of the term “high-functioning depression,” some experts suggest that its use can be problematic or even harmful.

While the use of the term demonstrates how depression can often be an invisible illness, causing distressing symptoms without being outwardly visible, its use may also play a part in perpetuating stigma about mental illness. It may cause some people to feel that they should be able to function at a high level even while struggling with serious symptoms of depression.

It’s also important to emphasize that describing it as ‘high-functioning’ often makes it seems like the symptoms are less serious or less severe. This might increase the likelihood that people will dismiss their symptoms, feel like others won’t take them seriously, or fail to seek treatment.

Symptoms of ‘High-Functioning’ Depression

Depression can cause emotional and physical symptoms, which can include:

• Having a persistent feeling of sadness or emptiness
• Feeling hopeless or pessimistic
• Feeling guilty or worthless
• Feeling irritable or anxious
• Losing interest in everything
• Withdrawing from others around you
• Feeling tired and fatigued
• Talking or moving slowly
• Having trouble focusing, remembering, or making decisions
• Experiencing sleep changes and difficulties
• Experiencing changes in appetite and weight
• Thinking about death, self-harm, or suicide
• Experiencing physical symptoms such as headaches, cramps, aches and pains, and digestive issues that don’t have a clear cause and don’t get better with treatment

Someone who lives with you may notice the fatigue, irritability, isolation, sadness, and other signs of depression, says Dr. Daramus. “A lot of the time, though, people can’t really tell unless you choose to be open about it.”

Causes of ‘High-Functioning’ Depression

Depression is usually caused by a combination of several factors, such as:

• Brain chemistry: Imbalances of certain neurotransmitters (brain chemicals) that regulate mood, among other things, can lead to depression.
• Genetics: Depression often has a genetic contribution and can run in families, so having a relative with depression can make you more likely to develop depression.
• Life events: Upsetting or stressful life events, such as the end of a relationship, the loss of a job, or the death of a loved one can trigger depression.
• Trauma: Experiencing trauma or stressful conditions can contribute to the development of mental health conditions such as depression, anxiety, and post-traumatic stress disorder.
• Medical conditions: If you have a health condition such as heart disease, diabetes, cancer, Parkinson’s disease, or chronic pain, you may be more likely to develop depression simultaneously. It’s important to report the symptoms of depression to your healthcare provider and seek treatment for it, as depression can worsen other health conditions.
• Medication: Certain medications may also cause depression as a side effect.
• Substances: Alcohol and recreational drugs can also cause or exacerbate depression.
• Personality: Certain personality traits may make you more prone to experiencing depression.

Diagnosing ‘High-Functioning’ Depression

It’s important to note that ‘high-functioning’ depression isn’t an official diagnosis in itself, says Dr. Daramus. It is sometimes used to describe dysthymia, but it can happen with any type of depressive disorder.

According to Dr. Daramus, there are several types of depressive disorders and specifiers, including:

• Major depressive disorder (MDD): Also known as clinical depression, major depressive disorder is a form of significant depression that persists for over two weeks. 
• Persistent depressive disorder (PDD): Also known as dysthymia, persistent depressive disorder persists for over two years, with periods of more and less severe symptoms.
• Seasonal affective disorder (SAD): Formerly known as major depressive disorder with seasonal pattern. This is a form of depression people often experience in winter, when there is less sunlight. Seasonal affective disorder tends to recede in summer and reappear in winter.
• Perinatal depression: Known as major depressive disorder with peripartum onset in the DSM-5. This is a form of depression that some pregnant people may experience. It encompasses antepartum depression (depression during pregnancy) and postpartum depression (depression after pregnancy).
• Premenstrual dysphoric disorder (PMDD): PMDD is a more severe form of premenstrual disorder (PMS) with prominent mood symptoms, that people typically experience in the days leading up to their menstrual period.
• Bipolar depression: People who have bipolar disorder may alternate between periods of elevated moods and high-energy, known as mania, and periods of significant depression. 
• Psychotic depression: People who have psychotic depression (known as major depressive disorder with psychotic features) also experience symptoms of psychosis, such as hallucinations (seeing or hearing things that are not real) and delusions (believing things that are not true).

A mental healthcare provider can determine whether your symptoms meet the diagnostic criteria for these depressive and other psychiatric disorders listed in the “Diagnostic and Statistical Manual of Mental Disorders,” a guide published by the American Psychiatric Association.

If you have symptoms of these depressive disorders, you may still be functioning on some level as though everything’s fine, but it may not be. If you are able to hide it or still do very well in life, that might be considered ‘high-functioning’ depression, says Dr. Daramus.

Hiding the Fact That You Have Depression

According to Dr. Daramus, these are some reasons why you may feel like you have to hide your depressive symptoms from others:

• You might have come from a family or culture that teaches people not to talk about mental illness.
• You think you’ll feel better by powering through on your own.
• You’re trying to avoid any impact on your job and relationships hoping the depression lifts.
• You are someone who isn’t comfortable showing vulnerability or perceived weakness. 
• You think having depression is something to be ashamed of.
• You feel that your life will fall apart and people will abandon you if they find out about the depression.

Treating ‘High-Functioning’ Depression

While a person who has depression may be described as ‘high functioning,’ this does not mean that they do not need treatment. Treatments for depression can include:

• Therapy: Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and mindfulness techniques can help you work on the shame or fear of having depression, in addition to the depression itself. Therapy can help you take a step back from the urge to hide the depression from everyone. A therapist would work with you within the boundaries of your work life, family, cultural background, or other factors that are influencing you to hide your depression.
• Medication: Antidepressant medication will likely be prescribed for moderate to severe depression. These medications work by improving the balance of neurotransmitters in the brain. There are many different types of antidepressants, so it may take some time for you to find the one that works best for you.
• Support groups: Support groups can be helpful in providing a safe space for you to discuss your depression with people who have similar experiences if you’re not comfortable talking to others in your life about it.

Final Thoughts

People can sometimes find it hard to believe that someone who is highly functional may have depression. However, it’s important to remember that depression can affect anyone, even those who are rich, famous, or successful, or those who seem to be living in comparatively ideal circumstances.

Depression is neither a character flaw nor a weakness, and it is not something to be ashamed of. In fact, some people with high-functioning depression choose to be very open about it and advocate for others with depression, says Dr. Daramus.

If you are experiencing depression, it’s important to get help for it so you can start feeling better. Depression is among the most treatable of mental health conditions and treatment has a highly significant likelihood of success.

Treatment can also be helpful with difficulty accepting that you have depression or felt the need to hide the fact that you have depression from others.

Ibuprofen is a medication classified as a nonsteroidal anti-inflammatory drug (NSAID). People take ibuprofen for fevers, aches and pains, headaches, stiffness, and swelling. People who are athletic or work in physically demanding jobs will often reach for a bottle of ibuprofen for pain relief.

Ibuprofen works by inhibiting the production of substances (such as an enzyme known as cyclooxygenase or COX) that cause pain, inflammation, and fever. It is meant for short-term relief of symptoms, and the dose can range from 400mg to 800mg, four times per day. However, it is not recommended to be taken on a daily basis for more than 30 days due to the side effects of COX inhibition on other organ systems.

Branded versions of ibuprofen include Motrin, Midol, and Advil; however, there are several generic versions as well. While some ibuprofen medications require a prescription, non-prescription strength ibuprofen is available over the counter at most supermarkets and drugstores. Ibuprofen is available in tablets, capsules, chewable tablets, and liquid medication.

“Most people think of addiction as either abusing prescription medications, excessive alcohol use, or substances one may obtain in a dark alley, not an over-the-counter medication that is thought to be safe and effective for people as young as 3 months old. However, ibuprofen addiction is real and there can be serious side effects,” says Francis.

This article explores the symptoms, causes, diagnosis, and treatment of ibuprofen addiction.

Symptoms of an Ibuprofen Addiction

Ibuprofen addiction is not what we think of in the traditional sense, and is more like a misuse of the drug while seeking pain relief. Over time, you may need higher doses to stop the pain and you can have withdrawal symptoms (for example: rebound headaches) when you stop taking them.

A case study recorded the symptoms of a person with HIV met the criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders (5th edition) for moderate substance use disorder, as she took more than the amount of ibuprofen prescribed to her. The four criteria of eleven possible symptoms that she experienced included:

• Developing a tolerance to ibuprofen
• Using more ibuprofen than was prescribed or intended
• Tried but failed to stop using ibuprofen
• Strong desire to take ibuprofen

Signs of an Overdose

Taking too much ibuprofen could result in an overdose. The symptoms of an ibuprofen overdose include:

• Agitation
• Blurred vision
• Chills 
• Confusion
• Convulsions 
• Diarrhea
• Dizziness 
• Drowsiness
• Heartburn
• Low blood pressure
• Nausea and vomiting
• Rash 
• Ringing ears
• Severe headache
• Slow or labored breathing
• Stomach pain
• Sweating 
• Unsteadiness 
• Weakness 
• Wheezing 

Diagnosing an Ibuprofen Addiction

If you suspect that you or a loved one have an ibuprofen addiction, Francis recommends seeing a licensed mental healthcare professional right away. 

Your healthcare provider will conduct a formal assessment of your symptoms and medical history in order to diagnose your condition, determine its severity, and develop a treatment plan.

Causes of Ibuprofen Addiction

Ibuprofen addiction can be motivated by physical causes as well as emotional reasons. Francis outlines some of the causes below.

Physical Dependence

One in five U.S. adults (over 50 million Americans) suffer from chronic pain and taking over-the-counter pain medication is typically the first line of defense. However, reliance on these types of medications may actually increase pain. 

If taken more frequently or at a higher dosage than directed, you may experience more intense and additional symptoms once the medication is discontinued. When the effect of the ibuprofen wears off, you may experience withdrawal symptoms, prompting you to take more medication. This creates an addictive cycle. 

For example: If you have been depending on ibuprofen to get rid of your daily headaches for more than 30 days, you may have entered unknowingly into that addictive cycle. You can talk with your doctor about getting alternative forms of treatment for your underlying condition. Some physicians may provide a brief prednisone taper to help you get safely off of ibuprofen.

Physical Impact of Ibuprofen Addiction

Ibuprofen misuse can put you at risk for health conditions such as:

• Heart attack
• Holes in the stomach or intestine
• Kidney damage
• Liver damage
• Stroke
• Ulcers

Emotional Dependence

Many forms of trauma and depression manifest through physical ailments and, without intervention from a licensed therapist, may be misdiagnosed. 

It’s important to understand that addictive behaviors and substance use are often motivated by unresolved stress or mental health issues and address the underlying cause through a dual-diagnosis mental health and substance use-focused treatment program.

Treating an Ibuprofen Addiction

Mental health treatments include cognitive behavioral therapy and trauma-based therapies to resolve underlying needs currently not being met in a person’s life, which may include acceptance of self, safety, contentment, or feeling in control, says Francis. 

Treatment for substance use generally incorporates the following principles:

• Addiction is a disease that alters brain function and affects behavior. It is complex, but treatable.
• There is no one-size-fits-all form of treatment. Treatment must be customized to the individual’s needs and modified as their needs evolve.
• In order to be effective, treatment shouldn’t address only substance use; it needs to cater to multiple needs of the individual.
• It’s important for the individual to continue treatment for an adequate amount of time.
• Relapses may occur, so the healthcare provider must monitor the individual carefully

Research has consistently shown that good social relationships are critical for optimal health, both mentally and physically. Studies have found that people with healthy relationships are more likely to engage in healthy behaviors and tend to have better health outcomes. They also often enjoy a longer life.

Learn some of the characteristics of healthy relationships, along with signs that suggest poor relationship health. We also share several steps you can take to create healthier relationships in your life.

Questions to Assess Relationship Health

No relationship is perfect, each having a mix of healthy and unhealthy characteristics. While people often spend a lot of time talking about how to spot an unhealthy relationship, they don’t necessarily discuss what constitutes a healthy one.

When assessing the health of your relationship, it’s helpful to ask yourself questions such as these:

• Do you have trust in one another?
• Do you respect each other?
• Do you support each other’s interests and efforts?
• Are you honest and open with each other?
• Are you able to maintain your individual identity?
• Do you talk about your feelings, hopes, fears, and dreams?
• Do you feel and express fondness and affection?
• Is there equality and fairness in your relationship?

Characteristics of Healthy Relationships

While all relationships are unique in their own way, there are some characteristics that differentiate a healthy interpersonal connection from an unhealthy one. Here are several to consider.

Trust

Trust is a key component of healthy relationships. Research suggests that your ability to trust others is influenced by your overall attachment style. In other words, relationships experienced early in life help shape a person’s expectations for future relationships.

If your past relationships have been secure, stable, and trusting, you are more likely to trust people in future relationships. If, however, your past relationships were unstable and undependable, you may have to work through trust issues going forward.

Trust is also established by how two people treat one another. When you see that the other person treats you well, is dependable, and will be there when you need them, you are more likely to develop trust in them. As this trust grows, the relationship becomes a greater source of comfort and security.

Openness and Self-Disclosure

Another characteristic of healthy relationships is feeling able to be yourself. While different couples have varying levels of openness and self-disclosure—the latter of which refers to what you are willing to share about yourself with another person—you should never feel like you have to hide aspects of yourself or change who you are.

At the beginning of a relationship, you may hold back and exercise more caution about what you’re willing to reveal. Over time, as the intimacy of a relationship increases, partners begin to reveal more of their thoughts, opinions, beliefs, interests, and memories to one another. 

Being open with each other helps you feel more connected as a couple while fostering greater trust. Self-disclosure can further enhance trust in your relationship.

This doesn’t mean that you must share every single thing with your partner. Each individual has their own privacy and space boundaries. What matters most is whether each partner feels comfortable sharing their hopes, fears, and feelings if they so choose. 

Healthy Boundaries

Although your partner may have different needs than you, it’s important to find ways to compromise while maintaining your boundaries. Boundaries are not about secrecy. Instead, they establish that each person has their own needs and expectations.

Healthy boundaries are unique to each individual and each couple. They establish what you will and will not accept in your relationship. Examples of healthy boundaries include agreeing not to go through each other’s phones, giving each other the time and space to have friendships outside of the marriage, and respecting each other’s personal space.

A partner with unhealthy expectations of openness and honesty might expect to know where you are and what you’re doing at all times. They may also restrict who you can spend time with or demand access to your personal social media accounts.

Mutual Respect

In close, healthy relationships, people have a shared level of respect. They don’t demean or belittle one another and offer support and security.

There are a number of different ways that couples can show respect for one another. These include:

• Listening to one another
• Not procrastinating or stonewalling when your partner asks you to do something
• Being understanding and forgiving when one person makes a mistake
• Building each other up, not tearing each other down
• Making room in your life for your partner
• Taking an interest in the things your partner enjoys
• Allowing your partner to have their own individuality
• Supporting and encouraging your partner’s pursuits and passions
• Showing appreciation and gratitude for one another
• Having empathy for one another

Love and Affection

Healthy relationships are characterized by love and affection. A relationship often begins with passionate love or an intense longing, strong emotions, and a need to maintain physical closeness. This eventually transforms into compassionate love, which is marked by feelings of affection, trust, intimacy, and commitment.

The initial passion that marks the start of a new relationship tends to decline over time. Even though intense feelings early on eventually return to normal levels, couples in healthy relationships are able to build progressively deeper intimacy as the relationship progresses.

It is important to remember that physical needs are different for each individual. There is no right amount of affection or intimacy that applies to everyone. The key to a healthy relationship is that both partners are content with the level of affection they share.

Good Communication

Healthy, long-lasting relationships—whether friendships or romantic partnerships—require the ability to communicate well. Being able to communicate doesn’t mean having no conflicts. It means being able to resolve differences of opinion effectively.

When conflicts do arise, those in healthy relationships are able to avoid personal attacks. They remain respectful and empathetic of their partner as they discuss their thoughts and feelings and work toward a resolution.

Sometimes conflict can even be an opportunity to strengthen a connection with your partner. Research has shown that conflict can be beneficial in intimate relationships when serious problems need to be addressed, allowing partners to make changes that benefit the future of the relationship.

Give-and-Take

Strong relationships are marked by natural reciprocity. It isn’t about keeping score or feeling that you owe the other person. You do things for one another because you genuinely want to.

This also doesn’t mean that the give-and-take in a relationship is always 100% equal. At times, one partner may need more help and support. In other cases, one partner may simply prefer to take more of a caregiver role. Such imbalance is fine as long as each person is okay with the dynamic and both partners are getting the support they need.

Signs of Unhealthy Relationships

Relationships can change and not every relationship is healthy all the time. A relationship is unhealthy when the bad outweighs the good or when certain behaviors are harmful to one or both individuals. Times of stress, in particular, can lead to behaviors and coping mechanisms that create issues.

Signs of poor relationship health include:

• Attempts to control your behavior 
• Avoiding one another
• Being afraid to share your opinions or thoughts
• Being pressured to quit the things you enjoy
• Criticism of what you do, who you spend time with, how you dress, etc.
• Feeling pressured to change who you are
• Feeling that spending time together is an obligation
• Lack of fairness when settling conflicts
• Lack of privacy or pressure to share every detail of your life
• Neglecting your own needs to put your partner first
• Poor communication
• Unequal control over shared resources such as money and transportation
• Yelling

Some of these may be temporary and something you can address together, either through self-help methods or by consulting a mental health professional. When it comes to more serious issues, such as abusive behaviors, your primary concern should be maintaining your safety and security.

Are You in a Healthy Relationship? Take the Quiz

If you’ve got questions about your relationship, our fast and free quiz can help you better understand if your partnership is rock solid or if it could use some work.

This healthy relationship quiz was reviewed by Sabrina Romanoff, PsyD.

How to Build Healthier Relationships

Toxic behaviors are often a sign that an unhealthy relationship should end. For other issues, there are many ways to fix weaknesses and build a healthier relationship. 

Commit to the Work

Relationships take work—on both your parts. If you’re the only one who is trying to make things better, it leads to a one-sided relationship. This type of scenario can leave you feeling stressed, resentful, and emotionally exhausted.

Each person must be willing to do their part to maintain the connection and remedy issues that may exist. Commit to each other that you’ll do the work to build a stronger partnership.

Show Appreciation

Couples who feel gratitude for one another often experience greater closeness and personal well-being. Finding ways to express this gratitude is also important.

One study found that showing gratitude to a partner can improve the relationship, especially when the gratitude is genuinely given. A different piece of research notes that feeling gratitude from a partner helps protect the relationship, even during times of conflict and financial strain.

Ways to show a partner that you appreciate them include:

• Taking care of a household chore that they typically do
• Giving them a card to let them know how you feel
• Making their favorite meal
• Purchasing tickets to an event that they would enjoy

Keep Things Interesting

Keeping up with the daily grind of work and kids can cause couples to fall into the same old routine. Over time, this can make you feel bored in your relationship, also making you less likely to engage in activities with one another.

What are some things that you can do to keep the romance alive over the long term?

• Schedule regular dates or set aside time each week to focus on one another
• Try new things together, such as taking a class or starting a hobby that you both enjoy
• Look for ways to surprise each other, like sending a random “I’m thinking of you” text in the middle of the day
• Find time for intimacy and do things to get in the mood beforehand

When to Seek Relationship Help

All relationships have their bumps in the road. Conflicts over finances, challenges of parenting, and other differences can all create ups and downs in a long-term relationship. Even if you and your partner have a healthy relationship most of the time, problems might sometimes arise that could benefit from professional help.

If you feel like your relationship may benefit from outside help, consider talking to a counselor or therapist. Finding a mental health professional skilled in addressing interpersonal and relationship issues can help you both learn to communicate and cope with some of the issues that you might find challenging.

It’s important to remember that you can’t force someone to change their behavior unless they want to. If your partner is not interested in or willing to go counseling, you can always go on your own and focus on your own needs and wellness. Work on building your social support system outside of the relationship and consider ending the relationship if it is ultimately unhealthy.

Detachment is a way of setting boundaries with a person who has an addiction. It can be difficult, but it can be a helpful way to protect yourself and preserve your relationship with a person who has a substance use problem.

For friends and family of a person dealing with alcohol or drug addiction, detachment can be a difficult concept to grasp. In the context of the Al-Anon program, “detach with love” is the idea that the family has to let go of their loved one’s problem.

It gives you permission to let them experience any consequences associated with their drinking or drug use and focus on your own health and well-being.

What Is Detachment?

Detachment means creating a boundary and stopping reacting to the other person’s behaviors. Detachment allows family members and friends to create psychological and emotional boundaries that allow them to offer support to their loved one while still protecting their own well-being.

This process involves stepping back and avoiding enabling behaviors. By detaching, family members separate themselves from the chaos that addiction brings.

Rather than becoming emotionally, psychologically, or financially drained, loved ones refuse to involve themselves in their loved one’s addictive behaviors. For example, they won’t make excuses when a loved one is too hungover to go to work or provide money to cover that person’s financial obligations.

Detachment is similar in some ways to other family interventions, such as the CRAFT method. CRAFT encourages family members to use positive reinforcement to encourage good behaviors and employ natural consequences.

The Importance of Detachment

If you’ve dealt with someone’s progressive alcoholism (severe alcohol use disorder) or drug use, it might be hard to imagine finding happiness while the substance misuse continues. This is especially true when you have tried everything possible to keep the situation from growing worse.

The stress and exhaustion associated with caring for someone with an addiction can be overwhelming. It may lead to anxiety, depression, and unhealthy behaviors or unsafe living conditions for your family.

The reality of living with alcoholism or any other addiction usually often means dealing with one crisis after another. While you may feel like you’re constantly in rescue mode, learning to detach relieves you of the responsibility to protect them.

Detachment Is Not Kind Nor Unkind

As the Al-Anon literature says, “Detachment is neither kind nor unkind. It does not imply judgment or condemnation of the person or situation from which we are detaching. It is simply a means that allows us to separate ourselves from the adverse effects that another person’s alcoholism can have upon our lives.”

Instead, it demonstrates that you don’t like or approve of their behavior. It is stepping back from all the problems associated with addiction and stopping any attempts to solve them. You still care, but it is best for everyone involved if you take care of yourself first.

Many times, family members find that they have become too involved with the addictive behavior. The Al-Anon program teaches people to “put the focus on ourselves” and not on the person with alcoholism or on anyone else.

For example, if your family member shows up for work late or missing it entirely becomes a habit, detachment teaches you that it’s not your responsibility to cover for them. It also applies to making excuses and trying to fix situations, as well as avoiding arguments.

Ideally, detaching from this person will help them see how their negative behavior affects everyone around them. As Al-Anon and Alcoholics Anonymous teach, it’s important to have the wisdom to know the difference between the things you can and can’t change. 

Does Detachment Really Help?

When you’re considering detachment, you might be concerned about what happens to your loved one after you detach yourself from them. Maybe you think all of the things you did over these years to “help” that will be wasted. Or, you might have fears about what crisis—jail, hospitalization, death, etc.—may be next.

As Al-Anon teaches, “Detachment helps families look at their situations realistically and objectively, thereby making intelligent decisions possible.” Al-Anon members also learn that no individual is responsible for another person’s disease or recovery from it.

This is very difficult and, on the clearheaded side of addiction, you probably know what should or should not happen, but this logic may be lost to the person with the disease. They need to want to change themselves and find the help needed to do that.

This will not happen overnight. It requires time, a lot of patience and love, and support to help you along the way. As they say in the program, “It’s simple, but it ain’t easy.” You don’t have to do it alone. 

How to Practice Detachment

Detaching from a person with an addiction can vary depending on your relationship, the severity of the addiction, and how the behaviors are affecting your life. In order to detach, it is important to:

Stop enabling: Even if the person is facing serious consequences as a result of their addiction, you need to avoid making excuses or protecting them from facing the reality of their behaviors.

• Set boundaries: Don’t engage with them while they are drinking or using. Establish and communicate clear rules, such as not allowing them to consume substances in your home and refusing to communicate with them when they are under the influence.
• Join a support group: You may also find it helpful to join a support group such as Al-Anon. Such groups can give you further guidance on how to detach from a loved one’s addiction.
• Care for yourself: Prioritize your own needs. Make sure that you are getting what you need in terms of your emotional and physical health. 

While you have detached from the problem, you can continue to encourage your loved one to seek treatment for their addiction. Provide information and encouragement. Remind them how much they have to gain if they talk to a professional and start the treatment process.

Keep in Mind

There is probably an Al-Anon Family Group meeting nearby where you will find people who understand what you’re going through. It’s by no means an easy process to detach from a loved one with an addiction, so don’t try to go it alone. By sharing your experience with others who have been there, you can find strength and hope to help you better deal with the situation.

Gabapentin, sold under the brand name Neurontin, is an anticonvulsant used to treat seizures and nerve pain. It is also sometimes prescribed “off-label” to treat migraines, fibromyalgia, and pain. If you’ve been on this drug for some time, you may experience withdrawal when discontinuing its use.

As of 2023, the U.S. Drug Enforcement Administration (DEA) has not classified gabapentin as a controlled substance because experts have always believed it showed little potential for abuse or dependence. However, several states have independently declared it as a controlled substance. Despite its legal status, gabapentin prescriptions have increased significantly over the past decade, and recent research points to an uptick in illicit abuse and accidental overdose-related deaths.

Gabapentin Withdrawal Prevalence

It is rare to experience withdrawal symptoms from gabapentin, but it does happen. A review of medical journals published between 1993, when gabapentin was approved, and 2015 found 18 case reports of gabapentin addiction, dependence, or withdrawal.

Healthcare providers publish case reports when they encounter a patient with a rare disorder or with a condition that they want to make their colleagues aware of. Case reports are significant because they help further knowledge and identify subjects worthy of future research.

It’s also possible that we may see more cases of gabapentin withdrawal in the future because, according to the DEA, gabapentin use is on the rise. Healthcare providers wrote more than double the number of gabapentin prescriptions in 2021 (70.9 million prescriptions) as they did in 2011 (33.4 million prescriptions).

Gabapentin Withdrawal and Other Drug Use

The illicit use of gabapentin also appears to be increasing. In a small survey of prescription drug abusers in Appalachian Kentucky, 15% reported using gabapentin to get high. That number is a 165% increase from the year prior (from 2013 to 2014) and a 2,950% increase from 2008 to 2014.

It appears as though gabapentin dependence and withdrawal are most common among people who use at least one other substance, such as opioids or alcohol. In the case reports, all patients had past drug or alcohol addiction issues.

Opioid users have reported using gabapentin to intensify their high. Cocaine users have reported the same, as well as attempts to use gabapentin to help alleviate cocaine withdrawal.

Gabapentin Withdrawal Timeline

Among the documented cases, gabapentin withdrawal began between 12 hours and 7 days after the last dose. The majority saw withdrawal symptoms within 24 to 48 hours.

Among the cases reported, gabapentin withdrawal symptoms typically peaked three days after someone’s last dose. In almost all cases, healthcare providers eventually treated the symptoms by resuming the previous gabapentin dose. Once people resumed their dose, their symptoms disappeared within hours.

Signs and Symptoms of Gabapentin Withdrawal

The most common symptom of gabapentin withdrawal was agitation, occurring in about half of the recorded cases. Confusion and disorientation were the next most common symptoms, followed by:

• Sweating
• Gastrointestinal symptoms
• Tremors
• Fast heart rate
• High blood pressure
• Insomnia

In many of the cases reported in the medical journals, individuals entered gabapentin withdrawal without the intention to do so. This was typically a result of running out of gabapentin or leaving it at home during a trip out of town.

This sample of cases is unlikely to be reflective of most people’s experiences with gabapentin withdrawal. The reason for this is that only people with severe or alarming symptoms seek emergency medical treatment. 

Gabapentin Withdrawal Treatment

Your long-term treatment plan for gabapentin dependence will depend on the presence of pre-existing conditions, including substance abuse, and your reasons for taking the drug in the first place.

There are no clinical protocols designed to manage gabapentin withdrawal. You and your healthcare provider can work together to figure out the best way forward.

If you have been taking high doses of gabapentin that was prescribed by your doctor, then that doctor should be consulted before you taper on your own or stop taking the medication. Your healthcare provider will talk about the risks and benefits of stopping gabapentin.

Long-Term Treatment

If you have been abusing your gabapentin prescription by mixing it with other drugs or alcohol, tapering your dose may not be sufficient. Addiction is a complex disorder of the brain, and it requires a long-term treatment plan.

Comprehensive addiction treatment programs typically combine a variety of tactics to help you understand why you began abusing drugs in the first place.

Individual and group therapy sessions can teach you to recognize the negative behavioral patterns that lead you toward drugs. A counselor, therapist, or psychologist can also help you develop strategies for dealing with triggers and cravings.

Coping With Gabapentin Withdrawal

The best way to cope with gabapentin withdrawal will depend on the severity of your withdrawal symptoms and the state of your mental and physical health. Your current dose of gabapentin and your reasons for taking it are also important factors.

While it may sound odd, the best treatment for severe gabapentin withdrawal symptoms is gabapentin. Resuming your normal dose of gabapentin will get rid of potentially dangerous symptoms, like delirium.

After resuming your normal dose, you should make an appointment with your healthcare provider to discuss your motivations for quitting gabapentin. They can help you safely taper your dose. Tapering means taking progressively smaller doses of medication over a period of several weeks or months.

How slowly should you come off gabapentin? The answer depends on your prescribed dosage, how long you’ve been taking it, and if you have any other conditions or issues. In some cases, it has taken more than a year of tapering to avoid or better manage gabapentin withdrawal symptoms.

Gabapentin Withdrawal Warnings

While gabapentin withdrawal may not be well understood, the recorded cases are alarming. Many of the gabapentin withdrawal case studies involve people with a history of psychiatric disorders or substance abuse problems. If you share either of these risk factors, there is cause for concern.

Pre-Existing Conditions

During detox and gabapentin withdrawal, the symptoms of pre-existing conditions often return. People with a history of bipolar disorder, psychosis, depression, and epilepsy are all at risk.

If you have been taking gabapentin for pain, your pain may return to pretreatment levels. People with these conditions may be safer detoxing in a hospital setting, where healthcare providers are prepared to treat any possible complications. 

If you have a pre-existing condition or a history of complicated substance withdrawal, you might want to consider spending the first few days of your gabapentin withdrawal in a hospital or specialized inpatient detox facility.

Pregnancy

If you are pregnant, gabapentin can have unpredictable effects. There is one case study in which an infant was admitted to the neonatal intensive care unit because she was born in gabapentin withdrawal.

Gabapentin Withdrawal Resources

If you or someone you love is experiencing serious signs of gabapentin withdrawal, such as confusion or delirium, do not hesitate to seek emergency medical attention. If you are planning to stop taking gabapentin, you will want to make an appointment with your prescribing doctor or a primary care doctor who can help see you through the tapering process.

If you are struggling with addiction issues, especially if you’ve been mixing gabapentin with other drugs or alcohol, you will want to find long-term support. You have several options, including:

• A psychologist, psychiatrist, or counselor in private practice or at a hospital
• An inpatient detox facility
• An addiction treatment center that offers inpatient or outpatient programs
• A peer support group, like Narcotics Anonymous (NA)
• A provider licensed to distribute buprenorphine, a treatment for opioid dependence