9 Tips for Women Living With ADHD


Key Takeaways

  • It is important for women who think they might have ADHD to get diagnosed and create a plan with their doctor.
  • Managing time with a schedule and using timers can help women with ADHD stay focused and on track.
  • Physical activity can help with inattention, hyperactivity, and impulsivity for those with ADHD.

Attention deficit hyperactivity disorder (ADHD) is often underdiagnosed in girls, which is why many women learn that they have ADHD until they reach adulthood. Many women feel a huge sense of relief when they find out they have attention deficit hyperactivity disorder (ADHD).

For years, they may have blamed themselves for their shortcomings, and their self-esteem has taken a hit. Constantly worrying about every detail of their lives may have led to emotional, mental, and physical exhaustion.

After being diagnosed with ADHD, they finally have an answer and know that their symptoms are not their fault. When they realize they have ADHD, feelings of inadequacy can begin to fade away, putting them in a better position to manage their symptoms.

Understand Why Your ADHD Went Unrecognized

Most people have a misperception that ADHD is a predominantly affects school-aged boys. Because ADHD characteristics manifest differently in women, they often don’t get diagnosed until adulthood.

A 2014 review of ADHD in women and girls found several obstacles to identifying ADHD in women, including:

Characteristics Presentation

Women tend to have internalizing traits much more than men. Specifically, girls’ veer more toward inattentiveness and disorganization.

Families and peers often overlook these characteristics, meaning such traits are often attributed to personality rather than ADHD.

Comorbid Psychiatric Disorders

Because ADHD traits are generally less disruptive in girls and women, mood disorders (like anxiety or depression) are commonly diagnosed long before they get evaluated for ADHD.

Coping Strategies

Women who develop better coping strategies than their male counterparts may be able to mask some of their ADHD characteristics. For example, many overcompensate with list-making to help them stay organized. Although doing this works, it also makes it very easy for doctors to miss the diagnosis.

In general, it is often much easier for a teacher to notice a hyperactive young boy than an inattentive, daydreaming girl. Although hyperactivity tends to wane, traits such as inattention can continue into adulthood.

For women, issues related to ADHD may worsen into adulthood. For example, after graduating from high school when the structure of school is no longer in place and the academic or workplace standard is higher, ADHD characteristics can start to cause more problems.

Women Can Also Experience Hyperactivity

Women can be diagnosed with hyperactivity-impulsivity ADHD, although less frequently than women with inattentive ADHD. Having hyperactivity poses its own challenges.

You might find you have more physical energy than your peers and be accused of talking constantly. Because you seemed different, you might have memories of feeling rejected, judged, and excluded by your peers. This experience can continue into adulthood.

Get an ADHD Diagnosis

If you think you may have ADHD but haven’t officially diagnosed yet, make this your priority. Getting diagnosed can have a positive effect on how you feel about yourself.

Research suggests that women could forgive themselves for past mistakes and felt more in control of their current lives once they were diagnosed with ADHD. Knowing they weren’t crazy and there was a name for what they were going through provided an enormous sense of relief.

Once a psychiatrist has diagnosed you, discussing a plan for managing your ADHD traits is important. Stimulant medications, for example, are often highly effective for ADHD.

Identify Coexisting Conditions

ADHD rarely travels alone, which means you might have one or more other conditions in addition to your ADHD. Try not to feel alarmed. Knowing what other conditions you have, if any, allows you to treat each one directly, which in turn means you can be your healthiest.

Sometimes symptoms of one condition can be masked by characteristics of ADHD or vice versa.

Common Co-Occurring Conditions

The majority of adults with ADHD have at least one diagnosed or undiagnosed coexisting psychiatric disorder, including:

  • Anxiety disorders
  • Bipolar disorder
  • Depression
  • Personality disorders
  • Substance use disorders

This is why it’s important to share all your symptoms and concerns with your doctor. Being honest about what you are experiencing doesn’t mean that you are complaining.

Your doctor needs to know how you feel and what you’re struggling with so they can provide you with the most appropriate support.

Drive Safely

Inattention and distractibility are the most common reasons for transport accidents. They are also the most common symptoms experienced by women with ADHD.

Drivers affected by ADHD can increase their safety on the road by doing the following:

  • Drive with a manual transmission. Consider driving a car with a manual gearbox rather than automatic because it forces you to be more engaged in the moment and less likely to zone out.
  • Reduce distractions. Before you start to drive, switch your phone off so that you aren’t distracted by incoming calls or texts. Don’t talk on the phone—even with a headset.
  • Don’t drink and drive. Never drink and drive or take recreational drugs as these can further reduce your attention.

Let Go of Perfectionism

Let go of the need to be perfect. Spending too much time on small things that don’t have a big impact on your life to the detriment of more important tasks creates undue stress and anxiety.

For example, you might spend hours finding the perfect font for a report for work, while neglecting to start a presentation that is due tomorrow. Instead of putting pressure on yourself to meet impossibly high standards, work on putting things into perspective.

Since you have such high standards for yourself, the internal pressure to be perfect can also stop you from starting a task because it feels overwhelming.

Manage Your Time

Difficulty with time management is common for adult women with ADHD. You may lose track of time, have difficulty following through on plans, or underestimate how much time is needed for a task. You may also spend so much time on a task—known as hyperfocus—that nothing else gets done.

These difficulties can leave you feeling overwhelmed, frustrated, and exhausted. Below are some tips to help you manage your time better:

Get Organized

Whether you have to go to work, run errands, or tackle household chores, it can be helpful to write down your top priorities. Try creating a schedule the night before so that you can start your day strong. Having a “game plan” will help you feel calmer.

Identify Your Strengths and Needs

Many women with ADHD say that it takes them longer to do things that other people. Begin by recognizing what you seem to be able to do faster than other people and what takes you more time.

When you can take a balanced look at your ADHD strengths and weaknesses, it will help your confidence and self-esteem.

Allow Yourself Extra Time

Make sure you have plenty of time to finish a project by giving yourself some cushion. Get in the habit of giving yourself an extra 10 minutes for every 30 minutes you think it will take you to complete a task.

Use Timers

Allot yourself a limited amount of time for each task and use a timer to alert you when your time is up. The timer gives you an audible signal to stop what you are working on so you don’t lose track of time. (Tip: You might find that visual timers are the most helpful!)

Exercise

If you have hyperactivity, try incorporating physical activity into your daily routine. Not only will it help you feel focused and calm, but exercise is great for your physical and mental health.

Research suggests that physical activity may help people manage inattention, hyperactivity, and impulsivity.

You can channel your energy in many positive ways. Take this opportunity to become active in your community, help a loved one, or find a project that fulfills you. You may even discover a new hobby.

Find Supportive ADHD Resources

It’s important to recognize that ADHD is a form of neurodivergence. It doesn’t mean that there is something wrong with you or that you need to be “fixed.” It just means that your brain works differently than a neurotypical person’s brain.

Exploring neurodiversity-affirming information, finding supportive people to lean on, and working with professionals who have experience with ADHD and other types of neurodivergence is important.

There are online directories where you can find ND-affirming doctors and therapists. There are also support groups and other resources that provide valuable information and resources. For example, consider exploring How to ADHD, a YouTube channel that offers great insights on living well with ADHD.


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How, When and Why You Should Shake Hands

Key Takeaways

  • A good handshake has a firm, gentle grip and lasts two to three seconds.
  • If unsure about shaking hands, watch the other person’s body language to decide. 

A handshake is a type of greeting that involves grasping hands followed by a brief up and down movement. Handshakes are used as both a greeting and parting gesture throughout the world.

Handshakes can be an important part of making a first impression. Although it is possible to overcome a poor first impression, it is easy to learn how to avoid some of the typical mistakes that people make when shaking hands.

Why Handshakes Are Important

Handshakes can be a valuable communication tool for making a first impression. These gestures are often exchanged within the context of business or social relationships. They signify a greeting, but they also help inspire feelings of trust and intimacy.

During periods of increased illness, such as flu season, some people feel hesitant about shaking hands. Staying up-to-date on vaccines can help lower the risk, but good hand hygiene is essential no matter what. Wash hands frequently and use hand sanitizer if soap and water are not available.

When to Shake Hands

Knowing when to shake hands is also an important part of using this gesture effectively. Handshakes have traditionally been a preferred greeting in a variety of contexts, particularly upon meeting someone for the first time.

The COVID-19 pandemic threw this tradition into a state of limbo. Not only was shaking hands frowned on, but it was also often openly discouraged in many public settings.

For the most part, people have returned to the age-old practice of handshaking, but many individuals may still be less comfortable with a handshake than they once were. This can add a layer of complexity when determining when to shake hands. You need to determine if the situation calls for a handshake, and also if others will even welcome the greeting.

If you’re not sure if extending your hand is the right move to make, pay attention to the body language of the people you are greeting. When others appear to hesitate, consider easing the awkwardness by simply making another greeting gesture and moving forward with the conversation. If someone appears not to want to shake your hand, don’t be offended. And if you’re unsure about whether or not someone will accept your handshake offer, you can let them make the first move.

How to Avoid a Handshake

While shaking hands might be a time-honored greeting, not everyone appreciates or wants to participate in this social tradition. Some people might prefer to avoid this type of contact for a variety of reasons, including a desire to limit contact with germs. Even long before the COVID-19 pandemic, some experts proposed the idea of handshake-free zones.

On the other end of the spectrum, you may find yourself in a situation where you go in for a handshake and the other person wants to bring it all the way in for an embrace. If you’re comfortable with that, just go with the flow! Ultimately, you are the best judge of your relationship to others, so you’ll know what to prepare for.

If you want to avoid the need to shake hands, some strategies you might try include:

  • Make an excuse: The prevalence of social distancing helped make turning down a handshake somewhat easier. You might try simply indicating that you prefer not to shake hands for health reasons. It is a quick way to communicate that you don’t want to engage in this gesture.
  • Use another gesture: You might be able to circumvent a handshake by quickly implementing another gesture before the other person reaches out. Fist or elbow bumps are options you might consider. Or you might try just giving a small wave and a smile. Research suggests that bumping fists can be more hygienic than shaking hands.

Recap

You can preempt a handshake if you are really uncomfortable with it. Strategies you might try include carrying something in both hands or offering a fist bump, elbow tap, or quick wave before the other person reaches out their hand.

How to Shake Hands

Observing some basic guidelines can help you get handshakes right. Handshake grip should be no harder than the strength that you would use to hold a door handle. You should also match your grip to the person you are shaking hands with.

Avoid standing too close when shaking hands. If someone is too close to you, simply take a step back. Unless the other person has you in a vice grip, you should be able to reclaim your personal space.

The ideal handshake lasts two to three seconds and does not go on longer than the verbal introduction. Any longer, and it can seem like you are just holding hands.

If you’re worried about sweaty or clamming hands, try discreetly wiping your palms before you shake hands. For cold hands, you might try warming them up by rubbing them together or keeping an instant heat packet in your pocket.

Bad Handshakes to Avoid

In addition to following some basic advice on how and when to shake hands, there are a few different types of handshakes that you should avoid. Some common “bad” handshakes include:

  • Dominant handshake: This involves placing your palm downward when offering your hand to someone and is a form of aggressive communication. By placing your palm downward, you force the other person to place their palm up, a submissive position.
  • Bone crusher: Like the dominant handshake, the bone crusher is aggressive and involves an excessively strong grip. If you’ve ever been the recipient of a bone crusher, you know how uncomfortable it can be. Older adults require a looser grip.
  • Double-handed: Although there are instances in which a double-handed handshake is appropriate, if used with someone whom you have just met, it can seem overly personal or intimate. Reserve the double-handed handshake for close friends.
  • Too close: The “too close” handshake involves the other person coming in very close to you to shake hands or pulling you in close as you are shaking hands. In either case, the closeness of the handshake is likely to make you feel uncomfortable.
  • Limp fish: Opposite the bone crusher is the limp fish—a limp handshake that signals that you are nervous, uncertain, or uninvolved to the other person. A limp handshake can be particularly detrimental in professional settings.
  • Fingers only: This handshake only offers your fingers to the other person. To avoid this scenario, be sure that the webbed part of your hand between your pointer finger and thumb is touching the other person’s hand before you tighten your grip.
  • Clammy-handed: If you are nervous about introductions, you may have cold, clammy, or sweaty hands in social situations.
  • No eye contact: Not making eye contact during a handshake may signal to the other person that you are not forthcoming.
  • Missed: “The miss” is a handshake that somehow doesn’t come together. While awkward, the other person feels just as responsible, so remember that it was accidental.
  • Long handshake: This handshake lasts past the point of introductions and begins to feel awkward and uncomfortable due to its duration.

Recap

A good handshake involves observing body language, maintaining appropriate distance, and using a firm but gentle grip. Avoiding certain types of “bad” handshakes, such as those that are too strong or too weak, it also important.

In the end, knowing how to shake hands correctly is a skill that requires practice. Shake hands when you have the opportunity, and in time it will become as second nature as saying “thank you.”

When all else fails and you find yourself offering a bad handshake, what should you do? Move on. Try to distract the other person with a question or compliment. Although you can only make one first impression, there is usually plenty of time to make up for a bad one.

Frequently Asked Questions


  • What should I do after a bad handshake?

    The best thing to do after a bad handshake is to simply move the conversation forward. Rather than highlighting the awkwardness, moving past it can help focus on what’s important and help minimize the effects of a poor first impression. This holds true when you are the recipient or the deliverer of the bad handshake.


  • What does it mean when someone gives you a bad handshake?

    The meaning of a bad handshake may depend on the type it was. A dominant or bone-crusher handshake can indicate that the other person is trying to take charge of the conversation. A handshake that is limp, clammy, or that is not accompanied by eye contact might indicate that the other person is anxious.


  • What do different types of handshakes mean?

    Handshakes can have different meanings based on their characteristics. A firm, brief handshake that is accompanied by friendly body language may convey that the other person is genuinely interested.

    A handshake that is too strong might suggest that the other person is trying to dominate the interaction. A weak grip might suggest disinterest or nervousness, while handshakes that last too long or involve standing too close may result in feelings of awkwardness or discomfort.


Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Sklansky M, Nadkarni N, Ramirez-Avila L. Banning the handshake from the health care setting. JAMA. 2014;311(24):2477. doi:10.1001/jama.2014.4675

  2. Mela S, Whitworth DE. The fist bump: a more hygienic alternative to the handshake. Am J Infect Control. 2014;42(8):916-7. doi:10.1016/j.ajic.2014.04.011

  3. Iconaru EI, Ciucurel MM, Georgescu L, Ciucurel C. Hand grip strength as a physical biomarker of aging from the perspective of a Fibonacci mathematical modeling. BMC Geriatr. 2018;18(1):296. doi:10.1186/s12877-018-0991-0

  4. Graziano M. The spaces between us: A story of neuroscience, evolution, and human nature. Oxford University Press.

  5. Schroeder J, Risen JL, Norton MI. Handshaking promotes deal-making by signaling cooperative intent. J Pers Soc Psychol. 2019;(116)5:743–768. doi:10.1037/pspi0000157

  6. Romero FR, Haddad GR, Miot HA, Cataneo DC. Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects. An Bras Dermatol. 2016;91(6):716-725.  doi:10.1590/abd1806-4841.20165358

  7. Schulze L, Renneberg B, Lobmaier JS. Gaze perception in social anxiety and social anxiety disorder. Front Hum Neurosci. 2013;7:872.  doi:10.3389/fnhum.2013.00872

Additional Reading

Arlin Cuncic

By Arlin Cuncic, MA

Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master’s degree in clinical psychology.


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Sleeping Pill Overdose: Causes and Emergency Treatment


Key Takeaways

  • Sleeping pills can cause overdose, especially when combined with alcohol or opioids.
  • Signs of a sleeping pill overdose include difficulty breathing, unconsciousness, and a slowed heartbeat.
  • If you think someone has overdosed on sleeping pills, call 911 right away.

At a Glance

  • Sleeping pills such as barbiturates and benzodiazepines can be addictive and may lead to overdose, particularly when taken in excess quantities or combined with other substances.
  • Do not take sleeping pills with opioid medications or other depressant substances, including alcohol.

Drug overdose deaths in the US have consistently increased since 1999, reaching nearly 92,000 in 2020. Sleeping pills, including benzodiazepines, and barbiturates, are among the chief causes.

Benzodiazepines alone have accounted for nearly one in seven of these deaths, often when combined with opioid drugs such as OxyContin (oxymorphone) and Vicodin (hydrocodone). According to the Centers for Disease Control and Prevention, benzodiazepine overdose deaths increased by 22% between 2019 and 2020.

In 2020, the US Food and Drug Administration (FDA) added a boxed warning on all benzodiazepines to caution people about the serious risks of addiction, abuse, drug interactions, and potential adverse effects.

What Are Sleeping Pills?

Sleeping pills are depressant medications. They act upon the central nervous system to slow down the body’s function. They are classified as “sedative hypnotics,” and are prescribed to ease anxiety or enable sleep. The two main types of sedatives are barbiturates and benzodiazepines.

Some of the more commonly prescribed barbiturates include:

  • Luminal (phenobarbital)
  • Nembutal (pentobarbital)

Benzodiazepines and Z-drugs have supplanted barbiturates as the sedative drug of choice. Z-drugs are a class of non-benzodiazepines used to treat insomnia. Among the most commonly prescribed are:

  • Ativan (lorazepam)
  • Zolpidem (Ambien, Edluar, Zolpimist)
  • Zaleplon (Sonata)
  • Halcion (triazolam)
  • Klonopin (clonazepam)
  • Librium (chlordiazepoxide)
  • Tranxene (clorazepate)
  • Valium (diazepam)
  • Xanax (alprazolam)

Signs of a Sleeping Pill Overdose

Symptoms of an overdose of sleeping pills are similar to those of an overdose of alcohol, which is also a depressant. Slowing of brain function initially affects voluntary functions.

When a person overdoses, the drug can begin to affect involuntary functions, such as breathing and heart rate. Symptoms include:

  • Bluish tinge to the lips, fingers, and skin (cyanosis)
  • Difficulty breathing
  • Dizziness or fainting spells
  • Inability to think or respond normally
  • Increasing coldness of the skin
  • Slowed respiration
  • Slowed heartbeat
  • Slurred speech
  • Unconsciousness
  • Unsteadiness
  • Vomiting
  • Shock
  • Coma

If you suspect someone has overdosed on sleeping pills, call 911 immediately. Keep the person awake and talking if possible until help arrives. If the person is unconscious, place them in the recovery position—on their side, with one leg forward of the other—and wait for help.

Causes of Overdose

As sleeping pills work by depressing the central nervous system, the overuse of the drugs can slow body functions to such a degree as to cause unconsciousness, respiratory failure, and death.

An overdose may be a deliberate suicide attempt. However, not all suicide attempts succeed as vomiting is common when the drug is taken in excess. If this happens, the person may survive but experience brain injury due to the lack of oxygen.

By contrast, an accidental overdose can occur if someone takes too much of a sedative by mistake or combines it with other drugs that enhance the sleeping pills’ depressive effects. From 2002 to 2015, the rate of overdose deaths involving the combined use of sedatives and opioids has doubled. Today, the majority of sedative-related overdose deaths occur for this reason.

Accidental overdoses can also happen if a person becomes dependent on sleeping pills but, over time, become less responsive to the drug. In a desperate attempt to get sleep, they may end up taking too many.

Older adults are at a greater risk of overdose from sleeping pills due to decreased drug metabolism rates.

In some cases, a person who has been taking sleeping pills recreationally may begin to inject the drug. They may miscalculate the dosage, which can lead to overdose.

Emergency Treatment for Sleeping Pill Overdose

People who have overdosed on sleeping pills will be admitted to the hospital and monitored closely, usually in intensive care.

Treatment may involve some or all of the following:

  • A stomach pump
  • Administration of activated charcoal to absorb the excess drug
  • Medications to flush the drug through the bowels or urinary tract
  • Administration of intravenous fluids to prevent dehydration and stabilize body functions
  • A respirator if breathing has been impaired
  • Dialysis to better clean the blood
  • Medications to stabilize heart function
  • Psychiatric care, including short-term monitoring to minimize the risk of suicide

In some instances, the medication Romazicon (flumazenil) will be administered. It acts as a benzodiazepine antagonist to help reverse benzodiazepine binding and inhibit the activity of substances that act on benzodiazepine receptor sites. 

Flumazenil carries some risks, however, and routine use is not recommended. It should not be used in cases where there is a mixed/unknown substance overdose or the individual has a prolonged QRS interval or seizure disorder. It is typically used in limited settings, such as to treat accidental benzodiazepine overdoses in children or to reverse the effects of sedation following a medical procedure.

In cases where co-occurring opioid use is also involved, a medication called naloxone can be administered to reverse the opioid overdose.

Generally speaking, people can recover from a sleeping pill overdose if treatment is started early. Unless a person has experienced prolonged oxygen deprivation, the effects of the overdose tend to last only as long as the drug remains in the system.

Dependence, Addiction, and Withdrawal

Sleeping pills such as barbiturates and benzodiazepines can also be addictive. This risk is greater when a person takes more than their prescribed dose or if they combine sleeping pills with other substances.

Dependence and withdrawal can also happen even when people take their medication exactly as prescribed.

People may also experience symptoms of withdrawal if they reduce their dose or stop taking the medication. Around 60% of people who take benzodiazepines longer than six months experience mild withdrawal symptoms, while 40% experience moderate to severe symptoms.

Symptoms of withdrawal may include:

  • Anxiety
  • Sleep difficulties
  • Irritability
  • Tremors
  • Headaches
  • Muscle spasms
  • Hyperventilation
  • Nausea or vomiting
  • Rapid heart rate
  • Depression
  • Delirium
  • Seizures

Benzodiazepine withdrawal can be life-threatening, so you should only stop taking benzodiazepines under the direction and supervision of your doctor. Your doctor may recommend gradually tapering your medication over a period of time. 

Long-Term Treatment

If you believe you have an addiction to sleeping pills, treatments are available that can help. The right treatment for you may depend on a variety of factors, including the underlying causes of your sleeping difficulties.

Treatment for substance addiction often focuses on psychotherapy, but medications may also be prescribed to help manage symptoms. Types of therapy that your doctor or therapist might recommend include cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), and group therapy. Support groups and 12-step programs can also be important sources of encouragement and information about recovery.

Your doctor may also recommend treatments to help you deal with underlying mental health conditions that can contribute to sleep disturbances, such as anxiety and depression. This might involve psychotherapy, medications, and lifestyle modifications.

Frequently Asked Questions

  • Are sleeping pills and sedatives the same thing?

    “Sleeping pill” is an informal term for “sedative.” Both have the same effects on the body: depressing the nervous system.

  • Is it dangerous to combine sleeping pills with alcohol?

    Yes, it’s dangerous. Since both are depressants, combining these substances can produce unconsciousness, breathing difficulties, seizures, coma, and even death.

  • What are the side effects of sleeping pills?

    Using sleeping pills for a long period can cause forgetfulness, mental health conditions such as depression, anxiety, and liver dysfunction or failure.


Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. National Institute on Drug Abuse. Overdose death rates.

  3. Centers for Disease Control and Prevention. Remembrance increasingly includes lives lost to overdoses involving benzodiazepines.

  4. Food and Drug Administration. FDA requiring boxed warning updated to improve safe use of benzodiazepine drug class.

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  7. Merk Manual: Professional Version. Sedatives.

  8. Kleinman RA, Weiss RD. Benzodiazepine-involved overdose deaths in the USA: 2000-2019J Gen Intern Med. 2022;37(8):2103-2109. doi:10.1007/s11606-021-07035-6

  9. Vukcević NP, Ercegović GV, Segrt Z, Djordjević S, Stosić JJ. Benzodiazepine poisoning in elderlyVojnosanit Pregl. 2016;73(3):234-238.

  10. An H, Godwin J. Flumazenil in benzodiazepine overdoseCMAJ. 2016;188(17-18):E537. doi:10.1503/cmaj.160357

  11. National Institute on Drug Abuse. What is naloxone?

  12. Hood SD, Norman A, Hince DA, Melichar JK, Hulse GK. Benzodiazepine dependence and its treatment with low dose flumazenil. Br J Clin Pharmacol. 2014;77(2):285-94. doi:10.1111/bcp.12023

  13. Brett J, Murnion B. Management of benzodiazepine misuse and dependence. Aust Prescr. 2015;38(5):152-5. doi:10.18773/austprescr.2015.055

By Buddy T

Buddy T is a writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism. Because he is a member of a support group that stresses the importance of anonymity at the public level, he does not use his photograph or his real name on this website.


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What to Know About Hookah Smoking and Its Risks


Key Takeaways

  • Hookah smoking is just as harmful as cigarette smoking, leading to cancer and other serious health issues.
  • Smoking hookah delivers much more nicotine than smoking a cigarette, making it highly addictive.
  • Secondhand hookah smoke is dangerous, similar to secondhand cigarette smoke, and can cause illnesses like heart disease. 

Hookah is often mistaken as a healthier alternative to cigarette smoking, primarily due to its sweet smell and taste and the fact that people typically smoke hookah only occasionally.

But there’s no such thing as a healthy smoking option. Hookah is not healthier than cigarettes, and it carries risks similar to those of cigarette smoking including cancer, heart disease, and lung disease.

The Most Important Information to Know About Hookah

  • Hookah smoke contains harmful chemicals, and hookah tobacco is addictive and as hazardous to your health as traditional cigarettes.
  • In addition to the risk for addiction, hookah also increases a person’s risk for cancer, decreased fertility, low bone density, lung disease, heart disease, stroke, pregnancy problems, and birth complications.

Verywell / Brianna Gilmartin


What Is Hookah?

A hookah is a water pipe that is used to smoke sweetened and flavored tobacco. Other names people use for hookah are narghile, argileh, shisha, hubble-bubble, and goza. The pipe is usually quite large and consists of a water chamber, a tobacco chamber, and one or more flexible tubes stemming from it that allow multiple people to inhale at the same time.

Hookah tobacco is often sweetened with molasses, fruit pulp, or honey, with additional flavors such as coconut, mint, or coffee. Flavorings sweeten the taste and aroma of tobacco, making it especially appealing to young people.

Aside from tobacco, It’s important to note that hookah can be used to smoke herbal shisha, marijuana, and hashish.

Hookah is thought to have originated in India or Persia in the 1500s. Since then, hookah smoking has gained popularity around the world.

Click Play to Learn More About Hookah

Toxins in Hookah

It’s a common misconception that hookah smoking removes nicotine and other toxins from tobacco. While water-cooled smoke is less harsh on delicate lung tissue, the toxicity of the smoke is unchanged and the cancer-causing chemicals present in the hookah tobacco are not filtered out by this process. 

Hookah smoke contains many of the same harmful chemicals in traditional cigarette smoke, including:

Some hookah tobacco products claim they don’t contain tar, but that is misleading. Tobacco doesn’t ever contain tar until it is burned, or in the case of hookah tobacco, heated. This difference leads some to believe that the toxicity of hookah tar may be less than that of cigarette tar—but this is not the case.

Additionally, the charcoal that is used to heat the tobacco contains carbon monoxide, metals, and other cancer-causing agents like polyaromatic hydrocarbons, adding another level of danger for those who smoke hookah.

Hookah vs. Cigarettes

The average, manufactured cigarette contains between 7 and 22 milligrams (mg) of nicotine, with about 1mg absorbed by the person who is smoking. An average hookah bowl contains as much nicotine as a pack of 20 cigarettes. Nicotine is an addictive drug, so smoking hookah can be every bit as addictive as smoking cigarettes.

A person smoking hookah inhales about 90,000 milliliters (ml) of smoke in a single 45-minute session; comparatively, someone smoking a single cigarette inhales 500 to 600 ml of smoke.

Someone smoking hookah inhales 9 times the amount of carbon monoxide and 1.7 times the amount of nicotine that someone inhales from smoking one cigarette.

Those who smoke hookah may take in more of the additional toxins also found in cigarettes—such as tar and heavy metals—because inhalation through the water pipe requires a stronger and longer drag or inhale.

Health Concerns Associated With Hookah

Many health concerns related to hookah smoking are similar to those associated with cigarette smoking, including the risk of cancer, decreased fertility, heart disease, and more.

Addiction

Smoking a water pipe hookah delivers nicotine just as cigarettes and other tobacco products do. Nicotine is highly addictive and can have a variety of health effects. 

Nicotine reaches the brain within seconds, where it acts to trigger the production of adrenaline. Adrenaline is a hormone that plays a role in the body’s fight-or-flight response. It causes physiological changes, including increased heart rate, respiration, and blood pressure. 

Because smoking a hookah delivers much more nicotine than smoking a cigarette, it is possible to become addicted after smoking a hookah only a few times. Because smoking hookah often occurs in social settings such as hookah lounges, people often attribute their addiction to the social nature of the activity rather than to the addictive properties of nicotine.

Cancer

People who smoke hookah are at risk for many different types of cancer, including bladder cancer, esophageal cancer, lung cancer, oral cancer, and stomach cancer.

Damage to Women’s Health

One study found that women who smoke hookah are at an increased risk of premature menopause and reduced bone density.

Decreased Fertility

Hookah smoking may lead to decreased fertility among both men and women.

One study found that sperm motility (the ability of sperm to swim in the proper direction) and sperm morphology (the size and shape of sperm) were negatively impacted in men who regularly smoked hookah compared to men who did not smoke hookah.

Heart Disease and Stroke

Hookah smoking raises your blood pressure and your heart rate, which may increase your risk of heart attack and stroke. Hookah smoking can also contribute to clogged arteries and heart disease.

Lung Disease

Even short-term use of hookah is linked with impaired lung function. You might notice you become out of breath more easily when performing physical tasks. Over time, hookah smoking also increases the risk of impaired pulmonary function and lung diseases like chronic obstructive pulmonary disease (COPD).

Pregnancy Risks

Hookah smoking while pregnant is linked with many risks including chromosomal disorders, ectopic pregnancy, infant disease and mortality, intrauterine growth restriction, and low birth weight. Hookah smoking while pregnant also increases the baby’s risk for respiratory illnesses.

Secondhand Smoke

Secondhand smoke from hookah is also hazardous. If you’re in the room with a lit hookah water pipe, you’re breathing in cancer-causing toxins just as you would with secondhand cigarette smoke.

Secondhand smoke can cause heart disease, lung cancer, and stroke in people who are exposed to it, even if they do not smoke themselves.

Spreading Illness

Hookah smoking can also spread illness. Since people are usually in a social setting when they smoke, with several people often sharing the same pipe and sometimes the same mouthpiece. Colds and other infections, including oral herpes, can be easily passed from one person to another.  


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When Things Aren’t Quite What They Seem

Key Takeaways

  • Smiling depression occurs when people hide their sadness and appear happy.
  • People with smiling depression are often high-functioning but may be at greater risk for suicide.

Although “smiling depression” isn’t a clinical diagnosis, for many people, it’s a real problem. Typically, smiling depression occurs when individuals who are experiencing depression mask their symptoms. They hide behind a smile to convince other people that they are happy.

Consequently, this type of depression often goes undetected because when most people imagine a depressed individual, they think of someone who looks really sad or cries a lot. And while it’s true that sadness and unexplained bouts of crying are common characteristics of depression, not everyone looks sad when they’re depressed.

Signs and Symptoms

Whether you’re the one who works hard to pretend you’re happy when you’re not, or you have a loved one that you suspect might be hiding their pain, understanding smiling depression can help you take positive action. Here’s an overview of the signs and symptoms of smiling depression.

The World Health Organization (WHO) estimates that almost 265 million people around the world have depression. Individuals with smiling depression may experience many classic symptoms of depression, including profound sadness, low self-esteem, and changes in their everyday lives. Some of these symptoms may be observable to others, while other symptoms may be kept private.

It’s not uncommon for people with smiling depression to work really hard to disguise their symptoms. For this reason, it’s important to look for other less-obvious signs that something is wrong, like changes in their habits, fatigue, and a loss of interest in things they once enjoyed.

Here’s a list of possible signs to look for:

  • Changes in appetite: While some people overeat when they’re depressed, others lose their appetite. Weight changes are common with any type of depression.
  • Changes in sleep: Some people struggle to get out of bed when they’re depressed because they want to sleep all the time. Others can’t sleep and they may report insomnia or exhibit major changes in their sleep habits, such as staying awake at night and sleeping during the day.
  • Feelings of hopelessness: Guilt, worthlessness, and feelings of hopelessness are common.
  • Loss of interest in activities: Individuals with smiling depression may not be interested in the activities they usually enjoy.

Despite these signs and symptoms, individuals with smiling depression are still likely to appear high-functioning. They may hold down a steady job and continue to maintain an active social life. They may even appear cheerful and optimistic. For this reason, it’s important to talk about mental health issues in an open way. Doing so may give them the courage to open up about their feelings.

Get Help Now

We’ve tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, BetterHelp, and ReGain. Find out which option is the best for you.

Why People Smile When They’re Depressed

It’s not uncommon for people to keep their depression private. From wanting to protect their privacy to fearing judgment by others, there are many personal and professional reasons why people hide their symptoms of depression and may mask it with a smile. Here’s a closer look at why people keep depression a secret.

Fear of Burdening Others

Depression and guilt tend to go hand-in-hand. Consequently, many individuals don’t want to burden anyone else with their struggles. This fact may be especially true for people who are used to taking care of others rather than having others take care of them. They simply do not know how to ask for help, so they keep their struggles to themselves.

Embarrassment

Some people believe depression is a character flaw or a sign of weakness. They may even believe the lie that they should be able to “snap out of it.” When they cannot, they think there’s something wrong with them. Consequently, they may feel embarrassed about having depression because they think they should be able to handle it themselves.

Denial

Smiling depression may stem from a person’s denial that they feel depressed. They may think that as long as they’re smiling, they must not have depression. Many people cannot admit that there might be something wrong with them. It’s easier for them to pretend like they’re fine than it is to open up about how they truly feel.

Fear of Backlash

Sometimes people worry about the personal and professional ramifications of having depression. For example, a comedian or lawyer may be concerned that their employer will doubt their ability to do their job. Or, someone may worry that a partner will leave them if they reveal that they have depression. So, rather than risk being judged or punished for being depressed, they hide behind a smile.

Concern About Appearing Weak

People with smiling depression often fear that others will take advantage of them if they reveal they have depression. Not only do they worry that others will see them as weak and vulnerable, but they are concerned that others will use their depression as leverage against them. They would rather put on a tough exterior than admit that they need help.

Guilt

Because guilt tends to accompany depression, sometimes people don’t feel as though they should be depressed. They might think they have a good life and shouldn’t feel bad.

They also feel like they must be doing something wrong or that they’re somehow to blame for being depressed. Consequently, they feel guilty and sometimes even ashamed of their depression. So they keep it hidden behind a smile.

Unrealistic Views of Happiness

Social media portrays happiness in an unrealistic way. Many people scroll through social media and see pictures of happy people. Consequently, they grow to believe that they’re the only ones struggling with mental health issues. They may feel more isolated than ever and it could cause them to hide their struggles.

Perfectionism

Perfectionists have often mastered the art of looking perfect. And, for many, that means disguising any pain or problems they are experiencing. As a result, admitting to depression would mean that their lives are less than perfect and they just cannot bring themselves to do that.

Risk of Suicide

Depression often causes thoughts of death and suicide. But sometimes, people with clinical depression lack the energy to create a plan and follow through on completing suicide. While anyone with depression is at risk of suicide, individuals with smiling depression may be at especially high risk because they are high-functioning.

Individuals with smiling depression often have enough energy to follow through on their suicidal thoughts. What’s more, individuals with smiling depression often go untreated as well. And untreated depression may get worse over time and increase the likelihood of suicide.

Treatment for Smiling Depression

Someone with smiling depression might officially be diagnosed with depression with atypical features. For instance, looking happy isn’t typical of someone who feels depressed.

But just like other types of depression, smiling depression is treatable. Treatment may include medication, talk therapy, and lifestyle changes such as diet and exercise.

If you think you may be depressed, talk to your doctor. Explain that you haven’t been feeling yourself lately and describe some of the symptoms that you’re experiencing.

Your physician can rule out physical health issues that may be contributing to your symptoms and can assist with referrals to other treatment providers, such as a psychotherapist or psychiatrist.

How to Help Someone With Smiling Depression

If you think someone you know has smiling depression, share your concerns. Normalize mental health issues and talk to them about how they can get help. Offer emotional support as well as practical support.

For example, you might offer a ride to a medical appointment, or depending on the nature of your relationship, you might even offer to attend an appointment with them. Direct them to community resources as well. Tell them about mental health services that may be available to them.

If a loved one refuses to get help, you might consider talking to a therapist yourself. Talking to someone can help you manage your own stress while also reinforcing strategies you can use to help someone you care about.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. World Health Organization. Depression.

  2. Shetty P, Mane A, Fulmali S, Uchit G. Understanding masked depression: A clinical scenario. Indian J Psychiatry. 2018;(60)1:97-102. doi:10.4103/psychiatry.IndianJPsychiatry_272_17

  3. Pulcu E, Zahn R, Elliott R. The role of self-blaming moral emotions in major depression and their impact on social-economical decision making. Front Psychol. 2013;(4):310.  doi:10.3389/fpsyg.2013.00310

  4. Rössler W. The stigma of mental disorders: A millennia-long history of social exclusion and prejudices. EMBO Rep. 2016;17(9):1250-3. doi:10.15252/embr.201643041

  5. Shensa A, Sidani JE, Dew MA, Escobar-Viera CG, Primack BA. Social media use and depression and anxiety symptoms: A cluster analysis. Am J Health Behav. 2018;(42)2:116-128. doi:10.5993/AJHB.42.2.11

  6. Centers for Disease Control and Prevention. Mental health conditions: Depression and anxiety.

Additional Reading

Amy Morin

By Amy Morin, LCSW

Amy Morin, LCSW, is a psychotherapist and international bestselling author. Her books, including “13 Things Mentally Strong People Don’t Do,” have been translated into more than 40 languages. Her TEDx talk,  “The Secret of Becoming Mentally Strong,” is one of the most viewed talks of all time.


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What the ‘Receiving Gifts’ Love Language Means for a Relationship

Key Takeaways

  • The gifts love language is about showing and feeling love through meaningful presents.
  • It’s important to learn your partner’s love language to improve your relationship.

In 1992, author Gary Chapman revolutionized the way many people view love with his bestselling book, “The Five Love Languages: How to Express Heartfelt Commitment to Your Mate.” In the book, Chapman shares five primary ways romantic partners give and receive love, adding that we all speak certain languages better than others in our romantic lives.

Understanding your love language and the love language of your partner can help you both get what you need from the relationship. Here, we take a closer look at the love language of gift-giving and gift-receiving and what this means for your partnership.

You may know or suspect that one of your partner’s strongest love languages is the act of giving and receiving gifts. Or perhaps gifts are your love language and you’re looking for a better way to communicate your needs.

Chapman’s 5 Love Languages

Giving and receiving gifts is just one love language. It’s helpful to know all five of Chapman’s proposed love languages. They are:

  • Physical touch: Showing and receiving love through affirmative touching, such as by holding hands, cuddling, kissing, and sex
  • Quality time: Needing to spend meaningful time with your partner to feel loved, perhaps chatting over dinner or going for a long walk together
  • Acts of service: Showing and feeling love through helpful actions, such as cooking a meal for your partner or cleaning out their car
  • Words of affirmation: Feeling or showing love through praise, compliments, and other verbal expressions of love
  • Gift giving: Sharing love through presents

“Approaching relationships from the love language perspective is really productive,” says Mark Williams, a licensed mental health counselor and relationship coach. “By learning how to ‘speak’ each other’s love language, you’re ensuring both people in a relationship feel supported and seen.”

It’s possible that you and your partner don’t speak the same love language. According to Chapman, learning your partner’s preferred language is important. since it can improve your understanding of each other, prevent arguments, and foster deeper love.

Take the Quiz to Identify Your Love Language

Take our fast, free quiz to find out your love language:

This love languages quiz was medically reviewed by Sabrina Romanoff, PsyD.

The ‘Gifts’ Love Language

Of all the love languages, gift-giving and receiving is arguably the most often misconstrued. To some, it might seem greedy, or as if the recipient were fixated on material things rather than love. But that’s not the case.

“If you or your partner’s love language is gifts, that means you feel loved [or that you’re demonstrating love] with a tangible item,” says Williams. “Whether that item is a tiny trinket from a thrift store or a 50-foot sailboat is inconsequential. Either convey the same message: I was thinking about you when I saw this. You’re always on my mind.”

Williams explains that, in this sense, the true meaning of gift-giving isn’t extravagance—it’s sentiment. A person with this love language might cherish the gift, however small, more than someone who speaks a different love language. Every time they see it, it serves as a reminder that they are loved.

Examples of how someone with this love language might express love include:

  • Sending their partner flowers, even if it isn’t a special occasion
  • Buying their partner’s favorite snack food while at the grocery store
  • Getting their partner tickets to see their favorite musician or artist
  • Giving their partner a gift certificate to a restaurant they’ve been wanting to try
  • Having a coffee or lunch delivered to their partner while at work
  • Leaving a small gift for their partner to find when they wake up

Know Your Partner’s Love Language

“We often speak the love language to our partners that we ourselves want to receive,” says Williams. “Meaning, if your partner buys you an album two days after you talk about how much you love a new band, or gets you a subscription to a magazine they think you’d like, it’s likely that their love language is gift-giving.”

Another good way to know if your partner’s love language is gifts is by gauging their reaction to presents. Williams says that if they feel embarrassed when presented with a gift, it’s likely not their love language. Conversely, if they’re highly enthusiastic, if they put the item on display, wear it every day, or gush to their friends about it, they likely feel very loved by the gesture.

Understanding Your Partner’s Gift-Giving Language

Even if the gifts love language doesn’t come naturally, it’s important to try learning it if it’s what your partner speaks. Research has connected using a partner’s love language with increased feelings of love and greater relationship satisfaction.

“Just like you put a filter on an Instagram post, look at things in your daily life through the lens of gift-giving,” suggests Williams. “If you pass a bakery every day on the way home from work, look at it through the lens of ‘My partner really feels loved when I bring them gifts’ and stop in for a pastry before heading home.”

“They don’t have to be big purchases,” Williams adds, “and they don’t have to be all the time. They’re just little reminders that they’re always on your mind, and the tangible evidence to prove it.”

Precautions for the Gifts Love Language

If someone’s love language is words of affirmation, hurling an insult will wound that person more than it might another. Similarly, if their love language is physical touch and you were to withhold affection for days, your partner would feel dejected.

“The dark side of knowing each other’s love languages is that you also become equipped with the knowledge of how you might hurt your partner,” says Williams. In the case of someone who speaks gifts as their love language, “not getting them a gift on an anniversary or special occasion would be acutely hurtful to them,” Williams says, “as would approaching the gift-giving as more a chore than an opportunity.”

It’s just as important to be aware that certain behaviors might negatively impact your partner more deeply than others.

Keep in Mind

Though most people use one or two dominant love languages, everyone technically speaks all the languages to some degree. Ideally, we speak all five languages to our romantic partners—physical affection, quality time, acts of service, kind words, and gifts—making sure to prioritize their preferred love language.

Wendy Rose Gould

By Wendy Rose Gould

Wendy Rose Gould is a lifestyle reporter with over a decade of experience covering health and wellness topics.


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40 Questions to Build Intimacy in a Relationship


Key Takeaways

  • Asking questions can help couples feel closer and more intimate.
  • Vulnerability and curiosity are important for building intimacy in relationships. 

Intimacy in a marriage or partner relationship can suffer if you’re busy with other responsibilities, or so caught up in the day-to-day activities of life that you simply lose track of each other and who you’re each becoming.

Studies show that communication and self-disclosure help build intimacy in marital relationships. In short, investing time in deeper conversations with your spouse or loved one can make your bond stronger. One way to use this time effectively is by asking questions to get to know them even better in this state of your lives and to build intimacy.

“Vulnerability and curiosity are crucial components in building intimacy. Partners need to trust that it is safe to be vulnerable and they have to also be interested in learning more about each other,” says Sabrina Romanoff, PsyD.

Romanoff continues, “You can foster these elements by both being more open with your partner, while also displaying a desire to know more about them. Ultimately, intimacy is important because it creates a sense of safety in a relationship where partners can authentically connect with each other.” 

Questions and Tips For Building Intimacy In Your Relationship

Questions to Build Intimacy

If you’re feeling distant from your partner or spouse, try asking questions that can help intimacy improve. Even if you’re not feeling distant, these are still good relationship-building questions that can make your partnership stronger.

When going through these questions, take the time to express your feelings and talk about your answers. You may find that the frank discussions that result will help you and your partner grow closer and get to know each other even better.

With that goal in mind, here are 40 questions for couples that can help build intimacy in your relationship:

  1. If you could choose anyone in the world, living or dead, to have in our home as a dinner guest, who would you choose and why?
  2. If you could choose the activities to do that would make a perfect day, what would you choose?
  3. If you had a crystal ball that could tell you anything at all about your life that you don’t already know, what would you ask it to tell you?
  4. What’s your favorite childhood memory?
  5. What are the 10 most important things on your personal bucket list?
  6. When did you last cry about something and what did you cry about?
  7. If you could wake up tomorrow morning with one new skill or ability, what would you choose?
  8. What do you like best about our relationship?
  9. What’s something that you’d like to try, but that you’re too scared to try?
  10. If all of your friends were asked to describe you, which friend’s description would be the most accurate and why?
  11. What was your favorite book (or movie) as a child and why did you like it so much?
  12. What’s the one thing about yourself that you would most like to change?
  13. What would be your dream vacation?
  14. What are three qualities you admire about yourself?
  15. What are three qualities you admire about me?
  16. What’s one of your best memories from when we were dating?
  17. What was your favorite place to go as a child and why did you love it there?
  18. If you could be any character in a book (or movie), who would you choose to be?
  19. If all of a sudden you knew that you had six weeks left to live, what would you want to do in the time you had left?
  20. What three things in your life could you not imagine doing without?
  21. Let’s say that our house is on fire, but you know that our family members and pets are safe. What things would you want to rescue from the fire and why?
  22. If someone gave you enough money to start a business—no strings attached—what kind of business would you want to start?
  23. What are the five things that you are most thankful for right now?
  24. If you could possess one artistic talent (painting, sculpture, composing music, writing, etc.), which talent would you choose and why?
  25. If you could be an Olympic or professional athlete, what sport would you choose and why?
  26. Do you see yourself in our kid(s)? If so, how?
  27. When you were a kid, did you think about having kids yourself one day? If so, how many and what did you imagine doing with them?
  28. What’s one of the most adventurous things you have ever done?
  29. If you could have been an eyewitness to any event in history, which one would you choose?
  30. What do you dream about the most often?
  31. Which of your parents do you think you’re most like and why?
  32. What was the first thing about me that attracted you?
  33. What do you like most about your appearance?
  34. Over the last five years, how do you think you have changed?
  35. If you could take a year-long paid sabbatical, what would you do?
  36. If you had to guess right now, what do you think our kid(s) would choose as a career someday and why?
  37. When you think about the future, what do you imagine?
  38. When you listen to music, do you focus on the words or the music?
  39. Do you learn new skills or information best by hearing, seeing, or doing?
  40. If you could plan the perfect date with me, what would that include?

Final Thoughts

Make it a point to go through one or two of these questions for couples regularly to keep the lines of communication open and help build or rebuild the intimacy you desire. You could even try writing some of your favorites down on note cards and pull them out if your conversation needs a little boost. The answers to the questions aren’t really the point. What matters are the discussions that ensue and the time spent listening to and focusing on each other.

By Wayne Parker

Wayne’s background in life coaching along with his work helping organizations to build family-friendly policies, gives him a unique perspective on fathering.  


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