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Sertraline withdrawal can occur when someone abruptly stops taking their antidepressant medication. It can lead to flu-like symptoms, irritability, nausea, imbalance, strange skin sensations, headache, and insomnia. Such symptoms are common and affect more than half of people who take antidepressants, so talk to your doctor before changing or stopping your medication.

What to Know About Sertraline Withdrawal

Sertraline withdrawal symptoms may persist for anywhere from a few days to a few weeks after your last dose. For most people, sertraline withdrawal begins within three to four days of their last dose. The duration of SSRI withdrawal can vary, but you can expect it to last anywhere from a few days to a few weeks; however, sometimes it can last much longer.

Sertraline (Zoloft) is a commonly prescribed antidepressant. It is part of a class of drugs known as selective serotonin-reuptake inhibitors (SSRIs). It is used to treat:

It is also used to treat severe premenstrual symptoms caused by premenstrual dysphoric disorder (PMDD) and obsessive-compulsive disorder (OCD).

More than half (56%) of people quitting antidepressants experience withdrawal symptoms. The experience is different for everyone. Some people experience mild symptoms, while others have symptoms severe enough to interfere with daily life.

Why Sertraline Withdrawal Happens

Sertraline works by preventing the reabsorption (reuptake) of serotonin, thereby increasing the serotonin available in the brain. Serotonin is a neurotransmitter that plays an essential role in mood and emotions.

When you stop or reduce your dose of sertraline, these serotonin levels will drop, eventually reaching pretreatment levels. Withdrawal symptoms happen as your mind and body adapt to this change.

Sertraline has a relatively short half-life compared to other SSRIs—about one day. This means that within a few days, you will have very little sertraline in your bloodstream.

It’s important to know that discontinuing your antidepressants may lead to a relapse of your original symptoms and even to the emergence of suicidal thoughts.

What It Feels Like

The most common symptoms that develop during sertraline withdrawal include:

• Flu-like symptoms
• Insomnia
• Nausea
• Imbalance
• Sensory disturbances
• Anxiety or agitation

While these may be the most common symptoms, SSRI withdrawal affects many of the body’s systems. The full range of potential withdrawal symptoms includes:

• Digestive: Nausea, vomiting, cramps, diarrhea, or appetite loss
• Balance: Dizziness or lightheadedness, sometimes making it difficult to walk
• Sleep problems: Nightmares, unusual dreams, excessive/vivid dreams, or insomnia
• Overall: Flu-like symptoms, including headache, muscle pain, weakness, and tiredness.
• Mood: Anxiety, agitation, panic, suicidal ideation, depression, irritability, anger, mania, or mood swings
• Bizarre sensations: Brain zaps (like an electrical shock or shiver in your brain), pins and needles, ringing in the ears, strange tastes, or hypersensitivity to sound
• Heat intolerance: Excessive sweating, flushing, or an intolerance to high temperatures
• Motor control: Tremors, muscle tension, restless legs, unsteady gait, or difficulty controlling speech and chewing movements 

Withdrawal symptoms vary from person to person. Some people have no symptoms at all, whereas others have symptoms severe enough to interfere with their responsibilities at home, work, or school.

If you do have severe withdrawal symptoms, it does not mean that you are addicted to sertraline. Addiction is characterized by the pattern of the use of substances in the face of adverse consequences. Withdrawal can happen to anyone taking sertraline for a few months or longer.

To get a better idea of the range of symptoms and symptom severity, you may want to check out the Discontinuation-Emergent Signs and Symptoms Scale (DESS), which is sometimes used by clinicians to measure the severity of SSRI withdrawal symptoms.

Tapering Off Sertraline

One method that people use to quit SSRIs is a medication taper. This means gradually reducing your dose over the course of several weeks or months.

Your doctor may:

• Switch you to a different antidepressant: Some doctors prefer to switch their patients to a longer-acting SSRI before beginning a taper. Because sertraline has such a short half-life, the amount of drug in your system can drop off quickly. Switching to a longer-acting SSRI, like Prozac, may help you avoid these peaks and valleys.
• Taper your dose over a long period: In the past, doctors weren’t sure whether tapering SSRIs was an effective treatment for withdrawal. However, new research suggests that a slow taper over several months may be more effective than traditional tapering schedules.
• Taper until your dose is below therapeutic levels: The researchers recommend continuing the taper until your dose is nearly zero, well past therapeutic levels. This means that by the end of the taper, you may be breaking pills into tiny pieces or switching to a liquid dose.

How to Feel Better If You Experience Withdrawal

If you are still experiencing withdrawal symptoms, these remedies may help.

• Psychotherapy: Psychotherapy can improve mood, reduce anxiety, and help you better cope with your symptoms.
• OTC medications: You can treat aches and flu-like symptoms with over-the-counter pain relievers and anti-nausea medications.
• Natural remedies: Vitamins, minerals, and herbal supplements may be helpful. However, you should always review all of these with your doctor before taking any natural supplements or home remedies.

Lifestyle Changes

There are also steps you can take that might decrease your withdrawal symptoms, or at least make them easier to manage. These include:

• Exercise. Getting at least 45 minutes of moderate activity three times a week can improve mood and reduce stress.
• Sleep. Make sure that you are getting adequate rest each night. Focus on going to bed and waking up at the same time each day.
• Eat well. Eat nutritious meals on a regular schedule, and stay hydrated. Try to avoid foods that may increase your anxiety, such as caffeinated beverages.

Social Support

One of the most important factors in SSRI withdrawal management is the presence of a social support system. Having people around who can help and support you through a difficult time can reduce stress and anxiety, both of which can make withdrawal symptoms even worse.

When your friends and family understand that you are in withdrawal, they will be more forgiving of irritability and mood swings. By preventing interpersonal conflict at home, you will avoid some of the negative social effects of withdrawal.

Important Warnings and Safety Notes

Sertraline, like other SSRIs, comes with a warning from the FDA about the potential for an increase in suicidal ideation and behaviors in children and young adults, particularly when medication is initiated or dosages are changed.

Recognizing the signs of suicidal ideation in yourself or someone else can help save your life or the life of a loved one. Call for help right away if you or a loved one shows any of the following symptoms:

• Planning how you would commit suicide if you were going to do it
• Talking or thinking about suicide more than normal, for example, “I wish I were dead”
• Gathering the means to commit suicide, such as bullets or pills
• Feeling hopeless or trapped
• Having intense mood swings
• Engaging in risky or self-destructive activities, such as driving drunk
• Becoming preoccupied with death, dying, or violence
• Getting affairs in order or giving away belongings
• Saying goodbye to people as if it were the last time

If you are pregnant or planning to become pregnant, talk to your obstetrician/gynecologist or psychiatrist about the risks and benefits of continuing and discontinuing sertraline. There is a small risk of giving birth too early if you take antidepressants during your second and third trimesters. On the other hand, if you do discontinue sertraline while you’re pregnant, you are more likely to relapse.

Managing Mental Health in the Long Term

You may require additional treatment after the withdrawal period has ended. If you are still experiencing mental illness such as depression or anxiety, you may require continued care.

Some people stay on antidepressants indefinitely to prevent such an outcome, whereas others choose different modalities of treatment, such as psychotherapy. Researchers have found that psychotherapy reduces the risk of relapse in people discontinuing antidepressants.

Where to Get More Support

• Call a hotline: The National Suicide Prevention Lifeline will connect you with staff or volunteers at a crisis center near you. The people on the other end of the line can help you calm down and figure out what to do next. It is available 24/7, 365 days per year.
• Try a chatline: If you are hesitant to call, you may prefer to chat with a counselor. The chat services are also open 24/7.
• Contact a local provider: If you have health insurance, you can also search the company’s list of local providers who accept your insurance. Most insurance companies have at least some mental health coverage, including state and federal plans.

Sertraline withdrawal symptoms are real, and discontinuing this medicine is a real challenge for lots of people. Don’t hesitate to talk to your doctor or other members of your support system about the way it’s affecting your life. And remember: Withdrawal symptoms are only temporary.

Phrases to express gratitude can range from a simple “thank you” to something more profound that explains just how much you appreciate someone. Kindness is important for relationships and mental health. Telling someone you are grateful for them is a way to show your love and feel closer to others.

Why Expressing Gratitude Is So Important

Acts of kindness are needed now more than ever. And they’re good for you, too: Studies show that expressing kindness releases powerful hormones, such as endorphins and oxytocin.

Whether they are random moments of courtesy that pay respect to the ways we are all interconnected or well-thought-out acts of love to those dearest to us, sometimes a simple “thank you” just isn’t enough.

As a therapist, I am in the business of connection. In the therapy room, we work tirelessly to get past the layers of symptoms and accumulated wounds. What we eventually arrive at is the core part of us that needs to give and receive love, that longs to belong and be part of something greater than ourselves.

Ways to Say ‘Thank You’

The 40 following phrases aren’t just sweet sign-offs to use in the body of emails or at the end of birthday cards. They’re words you can say aloud as needed or spontaneously send in a text to convey the depths of your gratitude for those who mean the most to you.

1. This means a lot.

Though simple, it is precise. Letting someone know their actions hold weight for you can be moving in of itself. 

2. I can’t express my gratitude enough.

I can think of dozens of times when there haven’t been words to explain how deeply someone’s actions have moved me. When words fail to do us justice, simply stating that can speak volumes.

3. This makes me feel…

You fill in the rest! ‘Thank you’ is a courtesy, telling someone how you feel is a gift.

4. This reminds me of …

Similar to the previous phrase, you’ll fill in the rest with what the act of kindness reminds you of. It could be a childhood memory, a movie you once saw, or a dream. Whatever it is, letting someone know that their actions have pleasantly jogged your memory can be moving.

5. Your support means more than you know.

Support is often the buoy that keeps us afloat. Unfortunately, the people offering support may not even know how important their actions are to you. So don’t be afraid to let them know.

6. I feel honored.

Receiving care is an honor. Express that to them.

7. I can’t wait to return the favor.

I like to consider gratitude as part of the dance of relationships. You receive, you give, you continue the tango of connection. 

8. I’m not sure how to say thank you enough.

It can be hard to find the words to say thank you. Saying that alone can speak volumes.

9. I’m grateful for you.

Let them know how grateful you are for them – it conveys the meaning they hold in your life.

10. I will always remember this.

Some things people can live in our minds as core memories. Nothing is a higher compliment than to be told that your act of kindness will resonate with someone forever.

11. I am not sure I’ll ever be able to repay you.

There are some things we can never repay someone for. The greatest gift we can offer in return is letting them know that. 

12. I’ll never forget this.

Similar to “I’ll always remember this,” this phrase can stick with others the same way their actions did for you.

13. Sending warmth your way.

Admittedly, this is how I sign off my emails. But it is also the truth. In expressing my gratitude for someone reaching out, I do send warm, good, connective feelings their way.

14. I receive this with warmth and care.

How we receive an act of kindness can show our gratitude. Let them know you receive it with warm feelings and care for them.

15. I appreciate your help.

Appreciation is an important thing to convey. Let them know that you appreciate their actions.

16. You always have my back.

For those you feel truly have your best interests in mind, make sure they know it doesn’t go unnoticed.

17. I haven’t experienced something like this before. 

There can be things people do that are so gracious, it is unlike anything we’ve ever experienced. Don’t be afraid to say that.

18. You are the best.

If someone has done something that you feel is otherworldly, letting them know they are the best conveys the place they hold in your life.

19. This moment will stick out to me forever.

Letting someone know they have given you the gift of a moment that will stick with you forever holds far more value than a thank you gift. 

20. All my gratitude.

Easy, brief, and honest. What more could you need to say?

21. How can I ever repay you?

If someone has gone above and beyond, it is thoughtful to ask them if there’s anything you can do in return. After all, acts of service may be a love language for them.

22. Please let me know what I can do for you.

Similar to the previous phrase, this one is direct. It isn’t a question, it is a statement, a declaration that you will offer the same care they gifted you.

23. You are very generous.

While many give selflessly, it is safe to say most of us hope to hear an acknowledgment in return.

24. Your generosity doesn’t go unnoticed.

Hearing your generosity is noticed and appreciated can feel good, even if you didn’t think what you were doing was generous.

25. I’m so moved by this gesture.

Sometimes, people do things without realizing it is a kind gesture. Acknowledge that—it lets them see how their actions are being viewed.

26. I’m wishing you all good things.

Dedicating a hope and a dream to someone is a sweet and understated way to express your gratitude.

27. I appreciate you.

You might want to tell someone you appreciate their help, like I suggested above, or you appreciate a certain thing they did for you. However, simply saying you appreciate them is a generous offering of care.

28. You mean a lot to me.

How often do we hear someone tell us we mean a lot to them? Probably not enough.

29. You’ve changed my life.

There is no higher expression of gratitude and no greater honor than hearing you’ve changed someone’s life. Use this one sparingly, when you truly mean it.

30. You truly understand me.

A core human desire is to understand and be understood. When you feel that someone gets you, tell them that.

31. Let’s spend quality time together.

Consider this one a thank-you gift. Quality time together trumps physical gifts any day.

32. I admire how you care for me. 

Sometimes, we are lucky enough to have someone care for us in a way that we find admirable. Don’t hesitate to let them know that.

33. I feel seen by you.

Feeling truly seen by someone isn’t something everyone can offer. Let them know how connected you feel to them.

34. How can I support you?

Offering someone support in exchange for something kind they did for you is an incredible gift to give.

35. I’ve been thinking about what you did for me.

Sometimes we are quick to thank someone and don’t voice how their actions have stayed with us. This phrase lets someone know they’re still on your mind.

36. Your actions have changed me for the best.

What a compliment it is to hear someone feels you’ve helped shape them as a human being. 

37. You have given me such a gift.

This phrase is excellent for experiences of love, kindness, and care that don’t necessarily feel pointed. It allows someone to see how much they do for you.

38. This is such an example of how caring you are. 

Let someone know that you see how caring they are and their actions are yet another example of it.

39. You are so attentive.

Undivided attention can feel rare these days, so acknowledging when someone is attentive can be moving.

40. I see you. 

At the end of it all, we want to know someone notices, understands, and sees us. The simplest way to say it may be the best.

Signs of narcissism are often hard to spot in the beginning stages of a relationship, but over time, these signs can be seen more clearly. A narcissistic marriage is where one partner constantly prioritizes their own needs, lacks empathy, and uses manipulation and control to get what they want. Understanding these patterns can help you recognize when the relationship has become harmful.

How Narcissism Affects Marriage

The “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” (DSM-5) defines narcissism as a pervasive pattern of grandiosity, a constant need for admiration, and a lack of empathy. At least five of these criteria must be present:

• A grandiose sense of self-importance
• A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
• A belief that he or she is special and unique and can only be understood by, or should associate with, other special or high-status people or institutions
• A need for excessive admiration; craving narcissistic supply
• A sense of entitlement
• Interpersonally exploitive behavior
• A lack of empathy
• Envy of others or a belief that others are envious of him or her
• A demonstration of arrogant and haughty behaviors or attitudes

These traits can have a profound impact on marriages and relationships. They often lead to one-sided, unbalanced relationships where one person is always giving and the other is always taking. The narcissistic partner may have problems with empathy, compromise, and accountability. That makes it hard to trust them and leaves the other person feeling neglected, confused, and emotionally exhausted.

How to Tell If You’re in a Narcissistic Marriage

Let’s take a look at some behaviors that someone with narcissistic personality disorder (NPD) may present. While many of the following behaviors can be indicative of narcissistic personality disorder, only a mental health professional can provide an accurate diagnosis.

1. You Don’t Feel Connected

• Your partner talks with you when it is convenient for them. However, they have never actually asked what your plans are for the future or how you can work together to build the life you want.
• They constantly brag about themselves and their accomplishments and rarely show interest or ask questions about anything going on in your life.
• Their happiness comes from external sources such as prestige at work and money. You wonder if they are even capable of feeling romantic love or emotional connection.

2. You Feel Manipulated

• Your partner will make subtle threats throughout the relationship. They may not be direct with their words, but you’ll get a sense that if you don’t do something for them or give in to what they want, bad things will happen.
• Sometimes, it’s easier just to go along with what they want, even if you don’t really agree with it. This is a way of controlling and manipulating their partners to get what they want.
• Often, people in this kind of relationship forget what life was like before the manipulation started.

3. You Don’t Feel Good Enough

• You feel inadequate despite what you’ve accomplished in your life.
• Your partner tends to put you down or make negative comments about what you do.
• You’ve lost touch with the things that you used to enjoy doing because you don’t have time for them anymore.
• Maybe you’re always tired, and it isn’t easy to get out of bed in the morning.
• You’ve begun hiding things from family or friends or feel ashamed about what goes on in your life.
• You lie to cover up the things that your partner does or does not do.

4. You’re Constantly Being Gaslighted

When someone constantly denies things that you know to be true, they are gaslighting you. This is often seen in abusive or controlling relationships and is a common tactic among narcissists.

For example:

• They deny what happened: Your spouse may comment, “You just don’t remember right,” about something that you know happened. They will gaslight you into believing that certain things never happened or that they did things because of something you did or said first.
• They lie to make themselves look better: Your partner may tell lies about your behavior and twist reality to fit their version of events rather than what really happened. You might begin second-guessing yourself and feel like you’re going crazy.

If they do this in front of family members and friends, those people may start to think the problem lies with you rather than with your partner. It can be difficult for others to realize what happens behind closed doors because your partner appears so charming on the surface.

5. You Avoid Conversations

• It may seem as though every conversation with your partner ends in an argument, no matter how hard you try to stay calm and not get upset by what they say or do.
• The narcissist constantly tries to push your buttons to get you to react; controlling others’ emotions gives them a sense of satisfaction.
• Often, it’s easier to avoid having a conversation entirely than to deal with the constant mind games.

6. You Feel Responsible for Everything

Narcissists think that everything is always someone else’s fault, including the things that they do wrong.

• You won’t get an apology from a narcissistic person. Narcissists don’t see other people as being on equal footing with them, so it makes sense why apologizing would be out of the question.
• Your narcissistic partner likely never takes responsibility for their actions and always blames you.
• If something goes wrong, it is your fault, even if they’re to blame.

7. You’re Walking on Eggshells

Do you feel as though you’re walking on eggshells because you never know when your partner is going to explode or be in one of their moods?

Typically, it goes like this:

• Everything seems fine, but then something minor happens and they go into a rage.
• Even a small thing like someone at work being recognized for an accomplishment while your partner feels overlooked can cause a narcissist to throw a fit. This is known as narcissistic rage.

You probably feel like you’ve lost yourself because now all of your decisions are based on what will keep your narcissistic partner happy.

8. You See Through the Charm

On the surface, your partner is charming, confident, and accomplished. However, they seem this way only because they are so skillful at hiding their true colors when in public.

They say all the right things, and people love them, but the second that you’re alone with your partner, everything changes. The switch flips, and suddenly you’re dealing with a completely different person than the one everyone else sees on the outside.

9. You Feel Criticized Constantly

• Your partner is excessively critical of your appearance. They might make comments about your weight, clothes, or choice of hairstyle.
• They make fun of you or put you down; this might happen behind your back and/or to your face.
• They make fun of others, especially people they perceive as lesser than them (i.e., someone they deem as less attractive or wealthy).
• In general, they are highly critical of everyone.

10. Your Needs Are Ignored

Your partner thinks only about their own needs and how things affect them, not you or anyone else—including the kids if you have a family. They will do only things that benefit themselves, not you or your relationship together.

For example, your partner might:

• Want to have sex when they want it, but not so much when you want it
• Expect you to pick up after them
• Take credit for your hard work
• Get upset when others treat their family better than yours
• Favor certain children over others in the family if they feel one child makes them look better

11. Your Family Is Warning You (or Is Oblivious)

Your family has told you that they don’t like how your partner treats you. Or, your family is oblivious that anything is wrong because your partner has been feeding them lies about you. Either way, your partner is a point of contention when it comes to family relations.

12. You’ve Been Cheated On

A narcissist is often a master flirt and might be cheating on you.

• They are very charming and know how to sweep people off their feet.
• You may find yourself constantly questioning if your partner is being faithful because of their flirting.
• They might have cheated multiple times, so nothing will stop them from doing it again.

13. You Feel Unloved

When you first got together, you felt like the most amazing person in the world. However, as time went on and problems arose, your partner began to devalue and ignore you. This is a red flag that they’re not who they made themselves out to be in the first place.

You likely were receiving love bombs in the beginning to get you hooked, but once you were married, those love bombs went away.

14. You Get the Silent Treatment

• Your partner uses the silent treatment as a power play to control you.
• They’ll withhold affection and ignore your existence until they feel like being nice again.
• They are only affectionate or attentive when it will benefit them in some way (like getting what they want).

You might think that this behavior is normal or even “expected” of people who are married. However, the truth is that the silent treatment isn’t part of a healthy, loving, and respectful relationship.

15. You’re Stuck Financially

If there’s one thing that narcissists know how to do well, it’s to take advantage of their spouses financially. You might be paying for everything while your partner can’t hold down a job, or their job might be bringing in a lot of income but they’re not letting you see any of it.

If this is the case, chances are that your partner has been spending every last cent on themselves and isn’t planning to share with you now or in the future.

16. You Can’t Rely on Your Partner

When they make promises, you never know if they’re going to keep them. Narcissists are notorious for making promises and then breaking them when it’s convenient. You don’t feel as though you have a partner you can rely on, and you find yourself having to do everything yourself.

17. You’ve Asked, They Won’t Change

Narcissists aren’t willing to change because this would mean admitting something is wrong within themselves—and narcissists never admit such things. On the other hand, some will proudly admit that they are narcissists, but claim that everyone else is the problem.

What to Do If You’re in a Relationship With a Narcissist

Being in a relationship with a narcissist can have significant, long-lasting effects on your mental health. If your partner is emotionally abusive and unwilling to change their behavior, it’s time for you to reconsider the relationship. And if you decide to leave it, have a support system in place beforehand—people you trust enough to confide in. This might be your friends, family, or therapist, for example.

If you continue your relationship with the narcissist:

• Seek therapy or outside support.
• Create and maintain boundaries.
• Keep records of conversations, events, etc., to ward off gaslighting.
• Try to remain calm and assertive.
• At work, resist gossip, even though you might need to vent.
• Learn all you can about narcissism so you can recognize their tactics and manipulation.

The biggest difference between a sociopath vs. a psychopath is that sociopaths tend to be impulsive and reactive, while psychopaths are cold and calculating. For example, a psychopath might be a careful planner and charming manipulator, while a sociopath tends to act more aggressively and erratically in the heat of the moment. Psychopathy is linked to genetic causes and results in a lack of empathy, while sociopathy is more influenced by environmental causes, including traumatic experiences.

Key Differences Between a Sociopath and a Psychopath

Sociopaths have a limited, albeit weak, ability to feel empathy and remorse. They’re also more likely to fly off the handle and react violently when confronted by the consequences of their actions. Psychopaths are classified as people with little or no conscience, but can follow social conventions when it suits their needs.

While psychopaths have problems processing emotional experiences, research has shown that they are affected by social exclusion and loneliness. Being rejected socially is perceived as stressful, sometimes resulting in selfish and aggressive behavior. Most have led hurt-filled lives and have an inability to trust people, but like every human being on the planet, they, too, want to be loved and accepted.

However, their own behavior makes this extremely difficult, if not impossible, and most are aware of this. Some feel saddened by the actions they are unable to control because they know it isolates them from others even more.

What the Terms Mean

Although sociopath and psychopath are often used interchangeably and may overlap, each has its own clear lines of distinction. For example, sociopathy is the unofficial term for antisocial personality disorder (ASPD), while psychopathy is not an official diagnosis and is not considered an ASPD.

“Sociopaths are generally more clearly aligned with symptoms of ASPD, but psychopathy can cross over to these characteristics as well,” says Hannah Owens, LMSW. “Labeling someone as a sociopath or a psychopath is a big deal – but not distinguishing between the two, and using them interchangeably, doesn’t do either of you much good.”

Sociopath is a term people use, often arbitrarily, to describe someone who is apparently without conscience and is hateful or hate-worthy. The term psychopath is used to convey a sociopath who is simply more dangerous, like a mass murderer.

Approach to Violence

While it’s common to think of sociopaths and psychopaths as being inherently dangerous, this is more a construct of a TV drama than a true reflection of the disorder. Violence, while certainly possible, is not an inherent characteristic of either sociopathy or psychopathy.

With that being said, people with ASPD will often go to extraordinary lengths to manipulate others, whether it be to charm, disarm, or frighten them, in order to get what they want. When psychopaths do become violent, as in the case of someone like Jeffrey Dahmer, they’re just as likely to hurt themselves as others.

Where These Traits Come From

Some say that “sociopaths are made, and psychopaths are born,” but this characterization may be too broad. Although psychopathy is indeed believed to have genetic components (perhaps caused by the underdevelopment of the parts of the brain that regulate emotion and impulsiveness), there are clearly other factors that contribute to the behavioral disorder.

Research suggests that psychopaths often experience:

• Childhood maltreatment, including neglect and physical abuse
• Exposure to violence in their home and community during childhood
• A history of trauma

While genetics plays a clear role in psychopathy, research also shows that social and environmental factors can disrupt a child’s emotional development and increase the likelihood of psychopathic traits.

Sociopathy also tends to be associated with harmful childhood experiences, including:

This differentiation may suggest that nature plays more of a role in the creation of a psychopath than a sociopath. This is supported by research showing that traits associated with sociopathy tend to decline as a person ages. These traits tend to peak in young adulthood (3.91%) and drop significantly by age 65 (0.78%).

Signs of Sociopathy and Psychopathy

As a reminder, sociopath and psychopath are not clinical diagnoses in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR). The DSM does, however, classify ASPD by a range of personality and behavioral traits that describe how a person functions, how they relate to others, and how those beliefs express themselves through actions.

Self-Functioning Characteristics

Self-functioning characteristics are those that reflect a person’s nature and how they view their actions or goals. To be diagnosed with ASPD, you must exhibit all of the following characteristics:

• Attaining self-esteem from power, personal gain, or pleasure
• Egocentricity or self-centeredness
• Setting goals based on personal gratification with little regard to law or ethics

Interpersonal Characteristics

Interpersonal characteristics are those that describe how a person interacts with others in general. You must also exhibit these traits to be diagnosed with ASPD:

• A lack of empathy for other people’s suffering or hurt or when confronted with the hurt or anger of people they have manipulated
• The inability to have a truly mutually emotionally intimate relationship because of the instinct to control (by dominance or intimidation), coerce, or deceive

Behavioral Characteristics

Behavioral characteristics complete the clinical diagnosis by describing the route a person will take to either control, coerce, or deceive, such as:

• A strong tendency to disregard commitments, promises, and agreements, including financial ones
• Difficulty in making plans, preferring to believe you’re able to nimbly navigate problems as they appear
• It is not uncommon for someone with ASPD to be in repeated fights or assaults.
• Lying as a means to gain social entry or advantage, such as proclaiming yourself a decorated war hero when you have never served
• Making decisions on the spur of the moment with little regard to consequence if an immediate goal is to be achieved
• Persistent anger or irritability, even over small things, as well as mean, spiteful behavior
• Reacting with callousness, aggression, remorselessness, or even sadism when confronted by the fallout of your actions
• Risk-taking, becoming easily bored, and an ability to ignore personal boundaries and justify even the most outrageous of actions
• The emotional manipulation of others—for example, pretending to be interested in someone simply to achieve a goal

Can Sociopaths and Psychopaths Be Treated?

ASPD has no cure or first-line recommended treatment. Instead, therapeutic strategies often focus on problematic behavior, coping skills, and comorbidities such as substance use disorders. Typical approaches include:

• Talk therapy (individual and group): Helps people recognize harmful behavior patterns, explore emotions, and learn healthier relationship and coping skills
• Cognitive behavioral therapy (CBT): Helps people identify distorted thoughts and replace them with healthier responses
• Mentalization-based therapy (MBT): Helps people improve their emotional understanding to reduce the risk of impulsive or aggressive reactions
• Democratic therapeutic community (DTC): A type of group treatment that can foster greater accountability, social learning, and behavior change
• Impulsive lifestyle counseling: Helps people learn to recognize triggers and teach safe, prosocial choices to help reduce risky, impulsive behaviors
• Medications: Antidepressants, antipsychotics, and mood stabilizers can help reduce symptoms such as aggression, mood instability, irritability, and other symptoms of co-occurring mental disorders

How They Differ From Narcissists

Despite common usage and some overlap of features, not all people with narcissism are sociopaths/psychopaths, and not all sociopaths/psychopaths are narcissists.

Sociopathy falls under the classification of antisocial personality disorders, which are marked by “a pervasive pattern of disregard for, and violation of, the rights of others.” In contrast, narcissism is a distinct personality disorder.

However, DSM-5 classifies both antisocial and narcissistic personality disorders as cluster B personality disorders, a category that also comprises borderline and histrionic personality disorders.

In practical application to daily life, the main differences lie in the person’s intent. People with narcissistic personality disorder (NPD) are:

• Self-serving
• They exaggerate their self-importance
• Crave constant praise
• Go to great lengths to feed their ego
• Are exceedingly concerned with image

For these reasons, narcissists often appear to be successful and high-functioning. Unlike sociopaths, some narcissists are capable of empathy and remorse. People whom the narcissist hurts are merely unintended casualties on the way to a desired result.

On the other hand, sociopaths intend to harm others and often derive pleasure in the act. They aren’t concerned with what others think of them; they lack the narcissist’s preoccupation with image, which frequently translates to an inability to hold a job and maintain relationships.

If Someone You Know Has ASPD

If a friend or loved one shows signs of antisocial personality disorder, it can be challenging for them to get the help they may need. In many cases, they may not accept or acknowledge that there is even an issue with their behavior. At a certain point, you may have to decide if the relationship is worth preserving. Some tips that can help:

• Set clear boundaries and communicate them clearly.
• Stick to your limits when the person tries to test them.
• Protect your personal time, energy, and resources.
• Encourage them to get personal help, but understand they may refuse or drop out of treatment.
• Get support from friends, family, or a mental health professional.
• Watch for signs of physical, emotional, or financial abuse and seek help immediately if your safety becomes an issue.
• Prioritize your own well-being.

Letting someone go may be one of the hardest things you’ll ever have to do, but ultimately it may be for the best. As always, it’s most important to take care of yourself and your needs, and surround yourself with people who enrich your life, support you, and appreciate your support of them.

A case study is an in-depth investigation of a person, group, or event used to understand behavior or identify patterns. In psychology, this involves closely examining a subject’s history, experiences, and responses to gain detailed insights that other methods may not capture. While case studies can reveal valuable insights, their findings are often subjective and may not generalize to broader populations.

How Case Studies Help and Where They Fall Short

A case study can have its strengths, but that doesn’t mean that it’s right for every situation. Researchers must consider these pros and cons before deciding if this type of study is appropriate for their needs.

Pros

One of the greatest advantages of a case study is that it allows researchers to investigate things that are often difficult or impossible to replicate in a lab. Some other benefits of a case study:

• Allows researchers to capture information on the ‘how,’ ‘what,’ and ‘why’ of something that’s implemented
• Gives researchers the chance to collect information on why one strategy might be chosen over another
• Permits researchers to develop hypotheses that can be explored in experimental research

Cons

On the other hand, a case study can have some drawbacks:

• It cannot necessarily be generalized to the larger population.
• It cannot demonstrate cause and effect.
• It may not be scientifically rigorous.
• It can lead to bias.

Researchers may choose to perform a case study if they want to explore a unique or recently discovered phenomenon. Through their insights, researchers develop additional ideas and study questions that might be explored in future studies.

Examples of Famous Psychology Case Studies

There have been numerous notable case studies in the history of psychology. Much of Freud’s work and theories were developed through individual case studies. Some great examples of case studies in psychology include:

• Anna O: Anna O. was a pseudonym of a woman named Bertha Pappenheim, a patient of a physician named Josef Breuer. While she was never a patient of Freud’s, Freud and Breuer discussed her case extensively. The woman was experiencing symptoms of a condition that was then known as hysteria, and found that talking about her problems helped relieve her symptoms. Her case played an essential part in the development of talk therapy as an approach to mental health treatment.
• Phineas Gage: Phineas Gage was a railroad employee who experienced a terrible accident in which an explosion sent a metal rod through his skull, damaging important portions of his brain. Gage recovered from his accident but was left with serious changes in both personality and behavior.
• Genie: Genie was a young girl subjected to horrific abuse and isolation. The case study of Genie allowed researchers to study whether language learning was possible after missing critical periods for language development. Her case also served as an example of how scientific research may interfere with treatment and lead to further abuse of vulnerable individuals.

In Genie’s case, her horrific abuse denied her the opportunity to learn a language at critical points in her development. This is clearly not something researchers could ethically replicate, but conducting a case study on Genie allowed researchers to study phenomena that are otherwise impossible to reproduce.

Different Types of Case Studies

There are a few different types of case studies that psychologists and other researchers might use:

• Collective case studies: These involve studying a group of individuals. Researchers might study a group of people in a certain setting or look at an entire community. For example, psychologists might explore how access to resources in a community has affected the collective mental well-being of those who live there.
• Descriptive case studies: These involve starting with a descriptive theory. The subjects are then observed, and the information gathered is compared to the pre-existing theory.
• Explanatory case studies: These are often used for causal investigations. In other words, researchers are interested in examining factors that may have caused certain events.
• Exploratory case studies: These are sometimes used as a prelude to further, more in-depth research. This allows researchers to gather more information before developing their research questions and hypotheses.
• Instrumental case studies: These occur when the individual or group allows researchers to understand more than what is initially obvious to observers.
• Intrinsic case studies: These are cases in which the researcher has a personal interest in the case. Jean Piaget’s observations of his own children are good examples of how an intrinsic case study can contribute to the development of a psychological theory.

The three main case study types often used are intrinsic, instrumental, and collective. Intrinsic case studies help researchers explore unique cases. Instrumental case studies help look at an individual to learn more about a broader issue. A collective case study can be helpful for looking at several cases simultaneously.

Where Do You Find Data for a Case Study?

There are a number of different sources and methods that researchers can use to gather information about an individual or group. Six major sources that have been identified by researchers are:

• Archival records: Census records, survey records, and name lists are examples of archival records.
• Direct observation: This strategy involves observing the subject, often in a natural setting. While an individual observer is sometimes used, it is more common to utilize a group of observers.
• Documents: Letters, newspaper articles, administrative records, etc., are the types of documents often used as sources.
• Interviews: Interviews are one of the most important methods for gathering information in case studies. An interview can involve structured survey questions or more open-ended questions.
• Participant observation: When the researcher serves as a participant in events and observes the actions and outcomes, it is called participant observation.
• Physical artifacts: Tools, objects, instruments, and other artifacts are often observed during a direct observation of the subject.

How to Write a Psychology Case Study

If you have been directed to write a case study for a psychology course, be sure to check with your instructor for any specific guidelines you need to follow. If you are writing your case study for a professional publication, check with the publisher for their specific guidelines for submitting a case study.

Here is a general outline of what should be included in a case study.

Section 1: A Case History

This section will have the following structure and content:

Background information: The first section of your paper will present your client’s background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses.

Description of the presenting problem: In the next section of your case study, you will describe the problem or symptoms that the client presented with.

Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported.

Your diagnosis: Provide your diagnosis and give the appropriate Diagnostic and Statistical Manual code. Explain how you reached your diagnosis, how the client’s symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.

Section 2: Treatment Plan

This portion of the paper will address the chosen treatment for the condition. This might also include the theoretical basis for the chosen treatment or any other evidence that might exist to support why this approach was chosen.

• Cognitive behavioral approach: Explain how a cognitive behavioral therapist would approach treatment. Offer background information on cognitive behavioral therapy and describe the treatment sessions, client response, and outcome of this type of treatment. Make note of any difficulties or successes encountered by your client during treatment.
• Humanistic approach: Describe a humanistic approach that could be used to treat your client, such as client-centered therapy. Provide information on the type of treatment you chose, the client’s reaction to the treatment, and the end result of this approach. Explain why the treatment was successful or unsuccessful.
• Psychoanalytic approach: Describe how a psychoanalytic therapist would view the client’s problem. Provide some background on the psychoanalytic approach and cite relevant references. Explain how psychoanalytic therapy would be used to treat the client, how the client would respond to therapy, and the effectiveness of this treatment approach.
• Pharmacological approach: If treatment primarily involves the use of medications, explain which medications were used and why. Provide background on the effectiveness of these medications and how monotherapy may compare with an approach that combines medications with therapy or other treatments.

This section of a case study should also include information about the treatment goals, process, and outcomes.

Discussion

When you are writing a case study, you should also include a section where you discuss the case study itself, including the strengths and limitations of the study. You should note how the findings of your case study might support previous research. 

In your discussion section, you should also describe some of the implications of your case study. What ideas or findings might require further exploration? How might researchers go about exploring some of these questions in additional studies?

Low self-esteem means struggling to see your own worth, which can lead to self-doubt, lack of confidence, and feeling you don’t belong. It involves more than just generally disliking yourself and affects how you value your needs, trust your abilities, and even how you let others treat you.

How to Recognize Low Self-Esteem

While not a mental illness, poor self-esteem can still affect a person’s thoughts, emotions, and patterns of behavior. Sometimes, its signs can be fairly apparent. Other times, low self-esteem symptoms are much more subtle.

For example, some people with low self-esteem talk negatively about themselves, while others go out of their way to make sure other people are pleased with them. In either case, a lack of personal worth and value can have a negative impact on life and wellness.

Some common signs or symptoms of low self-esteem include:

1. Lack of confidence
2. External locus of control
3. Negative social comparisons
4. Trouble asking for help
5. Worry and doubt
6. Difficulty accepting compliments
7. Negative self-talk
8. Fear of failure
9. Poor outlook for the future
10. Lack of boundaries
11. Being a people-pleaser

Poor Confidence

People with low self-confidence tend to have low self-esteem, and vice versa. Low self-esteem can play a role in causing a lack of confidence, but poor confidence can also contribute to or worsen poor self-esteem.

Being confident in yourself and your abilities allows you to know that you can rely on yourself to manage different situations. This self-trust means that you feel comfortable and confident navigating many different things you might encounter in life, which can play an important role in your overall well-being.

Finding ways to gain confidence in yourself and your abilities can be helpful. Acquiring and practicing new skills is one tactic you might try. This may even help reduce feelings of anxiousness as research connects a lack of confidence with higher anxiety levels, especially when under stress.

Lack of Control

People who have low self-esteem often feel that they have little control over their lives or what happens to them. This can be due to the feeling that they have little ability to create changes in themselves or in the world. Because they have an external locus of control, they feel powerless to do anything to fix their problems.

Research has found that in situations where people have little control over what happens, having higher self-esteem can help relieve some of the negative effects of this loss of control, which ultimately benefits mental health.

Negative Social Comparison

Social comparison can sometimes serve a positive function, enhancing a person’s sense of self. But comparing yourself to others can also damage self-esteem. People with low self-esteem may be more likely to engage in upward social comparison, or comparing themselves to people they think are better than them.

Upward social comparison isn’t always bad. For instance, these comparisons can be a source of information and inspiration for improvement. When people are left with feelings of inadequacy or hopelessness, however, it can inhibit self-esteem.

Social media can also contribute to such comparisons, exacerbating low self-esteem. If you often compare yourself unfavorably to others on social media sites like Facebook and Instagram, your self-esteem may take a hit.

Problems Asking for What You Need

When a person has low self-esteem, they may struggle to ask for what they need. Trouble asking for what you need can be caused by feeling embarrassed. Or you may feel that a need for assistance and support is a sign that you are incompetent.

Because their self-regard is low, someone with low self-esteem might also feel that they don’t deserve help. They don’t prioritize their own desires, so they struggle to assert themselves when they are in need.

Worry and Self-Doubt

Even after making a decision, people who have low self-worth often worry that they’ve made the wrong choice. They doubt their own opinions and may defer to what others think instead of sticking to their choices.

This can lead to a great deal of second-guessing and self-doubt. This makes it harder for people with low self-esteem to make decisions about their lives.

Trouble Accepting Positive Feedback

A 2017 study published in the Journal of Experimental Social Psychology found that low self-esteem is directly correlated to not being able to accept or capitalize on compliments from others.

Positive feedback is often met with suspicion and distrust. Complimentary words do not align with their self-beliefs, so people with self-esteem issues may feel that the other person is being flippant or even cruel. 

Negative Self-Talk

Low self-esteem causes people to focus on their flaws rather than their strengths. Rather than build themselves up with positive self-talk, they always seem to have something negative to say about themselves, engaging in negative self-talk instead.

When things go wrong, people with low self-esteem often blame themselves. They find fault with some aspect of themselves, whether it is their appearance, their personality, or their abilities.

Fear of Failure

Because they lack confidence in their abilities, people with low self-esteem doubt their ability to achieve success. Because they fear failure, they tend to either avoid challenges or give up quickly without really trying. 

This fear of failure can be seen in behaviors such as acting out when things go wrong or looking for ways to hide feelings of inadequacy. People with low self-esteem might also make excuses, blame external factors, or try to downplay the importance of the task. 

Poor Outlook

Low self-worth can cause people to feel that there is little chance that the future will be any better than the present. These feelings of hopelessness can make it hard for people with low self-esteem to engage in behaviors that will bring about positive changes in their lives. 

Self-sabotage is a common way of coping with such feelings. By finding obstacles to prevent success, people with low self-esteem are able to find something else to blame for not achieving their goals or finding greater levels of happiness in their lives.

Lack of Boundaries

The ability to set boundaries is often established early in life. Children with caregivers who show them that they are respected and valued are better able to create good boundaries in adult relationships. They are also more likely to have a more positive view of themselves in general.

A lack of healthy boundaries can create problems when others don’t respect a person’s space and time. The lack of respect not only adds to the person’s stress levels but may also make them feel less valued. 

Trying to Please Others

People-pleasing is another common symptom of low self-esteem. In order to gain external validation, people who don’t feel good about themselves may go above and beyond to make sure that others are comfortable and happy.

Pleasing others often involves neglecting their own needs. The person with low self-esteem winds up saying yes to things they may not want to do and feeling guilty about saying no. 

How Having Poor Self-Esteem Might Affect Your Life

Self-esteem plays an essential role in your ability to pursue goals, develop healthy relationships, and feel good about who you are. While everyone struggles with their confidence once in a while, low self-esteem can affect your ability to feel happy. It can even make you more susceptible to mental health conditions such as anxiety and depression.

Research suggests that low self-esteem has numerous effects. For instance, having lower levels of self-esteem is linked to a number of mental health issues, including:

Low self-esteem may even play a role in the development of certain mental health conditions, such as depression. Research has also shown that people with low self-esteem are more likely to be at risk for suicidal thinking.

Another effect of low self-esteem is that you may find it more difficult to achieve your goals and form healthy, supportive relationships. It might also make you more sensitive to criticism or rejection.

Where someone with high self-esteem is likely to be able to shake off negative feedback, someone with poor self-value might take it more personally. This can also make people with self-esteem issues more likely to give up when faced with challenges or obstacles.

Research has found that people with low self-esteem often engage in behaviors that are designed to help preserve their limited self-worth. Actions such as acting sad or sulking are used to garner support from others.

Why Your Self-Esteem Might Be Low

What causes lower self-esteem in some individuals? Several factors could be at play, some of which include:

Specifically, social media can have negative effects if it is used as a way to measure your popularity or likability. But if you use social media to share your interests with like-minded individuals, its impact can be more positive.

Physical health and appearance are additional factors contributing to low self-esteem. For instance, one study found that having missing teeth or untreated dental decay negatively contributes to self-esteem.

Ways to Cope When Your Self-Esteem Is Low

Building or fixing low self-esteem often takes time. But there are things you can do to help protect your mental well-being while taking steps to improve your self-regard.

Focus on Hopeful Thoughts

Spend a little time each day focusing on positive, hopeful thoughts. Notice the little things that you are good at and allow yourself to feel proud of them.

Also, think about times in the past when you made it through something really difficult. Remind yourself that even though you might not feel your best right now, you have the ability and strength to get through it.

Care for Yourself

Poor self-esteem can sometimes leave you feeling like you don’t deserve care and consideration. Work on reminding yourself that you need care and look for things that you can do to show kindness to yourself, no matter how small they may be.

One way to practice self-care is to spend some time doing something that you enjoy. Go for a walk, chat with a friend, or engage in a hobby. Caring for yourself also involves regularly making time to rest and relax, giving your body and mind time to recoup and regroup.

Get Outside Support

If you have low self-esteem, it can be helpful to share your struggles with someone who offers unconditional support. This might be a friend or family member, but it can also be a healthcare provider, therapist, teacher, or clergy member.

Having a network of caring people who value you and want you to value yourself can be beneficial as you work toward improving your self-esteem.

Steps to Build Stronger Self-Esteem

If you are dealing with low self-esteem, there are several things you can do to help improve how you feel about yourself.

• Notice your thoughts: Start paying attention to the automatic negative thoughts you have each day. When these negative thoughts take hold, work to actively identify cognitive distortions, such as all-or-nothing thinking and jumping to conclusions. Then, replace these distortions with more positive thoughts.
• Forgive yourself: If you tend to ruminate over your mistakes or failures, learn how to forgive yourself and move on. Doing so can keep you focused on what you can do better in the future rather than on the negative things that have happened in the past.
• Practice self-acceptance: Let go of the idea that you need to be perfect to have value. If this is how you feel, it can be helpful to work on accepting who you are today. Self-acceptance can still mean there are things you want to work on, but it allows you to it’s recognize that you are worthy of love and esteem—from yourself and from others—exactly as you are right now.
• Value yourself: Spend time reflecting on the things you have accomplished and are proud of. Allow yourself to appreciate your worth and talents without comparing yourself or focusing on areas you’d like to improve. You don’t need to be better to value yourself—but learning to value yourself can help you work toward your goals.

It can be helpful to think of yourself as you would a friend. How would you treat someone you care about who was in the same situation? In many cases, you may find yourself giving them understanding, patience, empathy, and kindness. Show yourself the same unconditional support instead of beating yourself up. 

Additional Ways to Increase Low Self-Esteem

Here are a few additional things you can do to help boost your self-esteem:

• Do something that makes you feel good.
• Stay physically active—exercise can help improve mood.
• Think about something you are good at.
• Keep a gratitude journal.
• Challenge negative thoughts.
• Spend time with people who make you feel good about yourself.
• Volunteer to help others.
• Remember that everyone makes mistakes.
• Celebrate your accomplishments, both the big and the small achievements.

If you are experiencing symptoms of poor self-esteem, help is available. Consider talking to a healthcare provider or mental health professional to learn your treatment options. A therapist can help you change the thought patterns that contribute to low self-esteem, boosting your confidence and opinion of yourself and your abilities.

Raising your self-esteem may take some time and effort. But over time, you can learn to better see and appreciate yourself for who you are.