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Do you ever feel like, no matter what you do, you’re always the one who gets the blame for all the family drama? One minute, things are fine, and the next, it’s somehow *your* fault that your sister didn’t attend the family dinner or your mom flaked out and forgot your brother’s birthday.

Scapegoating refers to blaming a person or group for something bad that has happened or that someone else has done. It can happen to protect the image of the family or those favored in the family, not just the self. It is common for one person to be scapegoated, but it can happen with more than one person.

It’s common in families with unhealthy dynamics and tends to start in childhood when children are blamed for all of the problems in dysfunctional households. It’s unfair and frustrating, and it can do a real number on your sense of self.

When children are assigned the role of the family scapegoat, the impact can be detrimental to their mental health and emotional well-being for a lifetime. In addition, it results in an upbringing in which the scapegoated child’s inherent worth, goodness, and lovableness are ignored. Instead, insults, bullying, neglect, and abuse are deemed appropriate for the child forced into this position.

Family Scapegoating at a Glance

Who becomes the family scapegoat is complex. It can be based on birth order, gender, physical characteristics, or identity. It’s often a form of projection in which adults mistreat a child who reminds them of someone else. Whatever the causes, it can have serious negative side effects, including trauma, toxic relationships, boundary problems, and self-harm.

If you’ve endured scapegoating, it’s important to prioritize your well-being and heal from the childhood trauma. Self-care is important, but social support and therapy can also help you break free and recover from this role that you never signed up for.

Origins of the Term “Scapegoat”

The term “scapegoat” originates from the Bible.

In the book of Leviticus, the Israelites conduct a ceremony in which they direct their sins onto an “escape goat.” Afterward, they set the goat free into the wilderness to metaphorically cleanse the wickedness from their community. The scapegoat, then, bears the burden of taking on the misdeeds of a tribe, community, or family. 

How Scapegoats Are Chosen

There are myriad reasons why a parent might choose to scapegoat a child, but it is never the child’s fault. While some might be nonsensical, some arbitrary factors that can influence this can include:

• Birth order
• Gender
• Looks/appearance
• Intellect
• Skin color
• Sexual orientation and/or gender identity

For example, the only boy in the family might be the favorite or golden child, while the second-born daughter is assigned the scapegoat role. On the other hand, a narcissistic parent might prefer the child who brings the most glory to the family while scapegoating the child who does not boost the family’s public image.

Scapegoating as a Form of Projection

In some cases, parents might mistreat children who resemble or remind them of their ex-partners. For example, biological children might be treated differently from stepchildren or adopted children in the home.

Only children of dysfunctional and abusive parents report that they are sometimes the golden child, and other times, the scapegoat. The same child can have these roles projected onto them, indicating just how troubled parents who engage in this behavior are.

Parents who scapegoat their kids tend to lack the ability to introspect and understand their projections. They might have been raised in dysfunctional families in which some children were scapegoats and others were golden children. They might also have a personality disorder, such as narcissistic personality disorder or borderline personality disorder, which leads them to idealize and devalue others or engage in black-and-white thinking.

Unfortunately, children tend to internalize that they are the problem and don’t have the life experience to recognize that parents who scapegoat them are the ones with the problem. They don’t know that loving and mature parents don’Fgolt divide children into “all good” or “all bad” roles but recognize that everyone has strengths and weaknesses. 

Effects of Being a Scapegoat

Clearly, being a scapegoat puts children at a disadvantage. Some ways this can show up in their life include:

• Trauma: Being deprived of a family’s love, singled out as the “bad one” in the household, and having one’s positive attributes overlooked can set up a child for a lifetime of emotional and psychological distress, where they struggle believing they are good, worthy, competent, or likable.
• Toxic relationships and environments: It can also result in these individuals entering friendships, romantic relationships, and working environments that are abusive and harmful. 
• Normalizing dysfunctional behavior: Dysfunction and abuse often feel “normal” for family scapegoats, making it difficult for them to spot dangerous people and places before harm is done.
• Difficulties with boundaries: The fact that gaslighting is common in dysfunctional families makes it challenging for abused individuals to set boundaries and recognize when other people’s behavior crosses the line. They are more likely to believe that they are exaggerating, are being too sensitive, or can’t trust their judgment.
• Self-sabotage or self-harm: Scapegoats tend to internalize the harmful messages they’ve received about themselves from birth or early childhood onward. This could result in the child engaging in self-sabotage or self-harm, such as doing poorly in school, neglecting self-care, engaging in risky activities or behaviors, and acting out in ways that indicate they deserve the title of the scapegoat (even though no child does).

Learning From Your Painful Childhood

Being a scapegoat is a lonely, heartbreaking experience for a child, but it may also yield a more desirable outcome in some cases. For example, the maltreatment scapegoats endure in families is often the impetus that drives them to leave the dysfunctional, high-conflict home. Meanwhile, the golden child typically remains enmeshed in this harmful family system.

In other words, being a scapegoat may give someone the ability to see a toxic family for what it is. This can result in scapegoats distancing themselves from their families of origin and getting help to recover from the abuse they experienced.

Coping With Family Scapegoating As an Adult

Scapegoats bear the burden of recovering from a childhood full of bullying, put-downs, unequal treatment, and abuse generally. They were deprived of the experience of growing up in a safe, stable home where they had the unconditional love of their parents or caregivers. Rather, the dysfunctional adults in their lives singled them out for maltreatment and pitted them against their siblings or other family members. 

Healing From Childhood Trauma

Attempting to heal from this reprehensible behavior can take a lifetime, which is why it’s important to consult a mental health provider who specializes in dysfunctional families and childhood trauma about starting the recovery process.

Healing will look different for each individual, but people who have been scapegoated as children will have to decide how to interact with their families as adults.

Be prepared for other relatives, friends, or even strangers to convince you to rethink your boundaries. Many people know little about the psychological toll that dysfunctional families or parents with personality disorders, substance use disorders, or other problems have on a child. It’s easy for outsiders to assume that because they had loving parents, everyone else did as well .

Some people may also get confused by a parent’s public persona. For example, if a parent appears to be loving in front of an audience, the idea that this person could be abusive in private may result in cognitive dissonance. 

Next Steps

If your parents continue to be abusive in your adulthood, ceasing contact may be in your best interest. Some scapegoats might also decide to cut contact if they believe the childhood abuse they endured was unforgivable.  

Other people scapegoated in childhood may choose to go low contact, meaning they have firm boundaries about what types of contact they’re willing to have with their relatives. Low contact might mean communicating with family members only via text, email, or phone call. It might mean never or rarely visiting family members in person or limiting visits to special occasions such as holidays, weddings, graduations, births, or funerals. 

How you move forward is up to you. With a support system, including a mental health provider, you can decide what will serve you best.

Life is full of choices and paths not taken, so it isn’t surprising that people sometimes feel regret over both the decisions they made and the ones they didn’t.

Regret can be an incredibly painful emotion. While rooted in feelings of contrition, disappointment, guilt, or remorse for things that have happened in the past, such feelings can have a powerful influence over your life in the here and now. The problem is that when you are feeling regret over past choices or past mistakes, you might sometimes miss out on the joys of the present moment.

Learn more about the power of regret, what causes it, and what you can do to cope.

What Is Regret?

Regret is defined as an aversive emotion focused on the belief that some event from the past could have been changed in order to produce a more desirable outcome.

It is a type of counterfactual thinking, which involves imagining the ways your life might have gone differently. Sometimes counterfactual thinking might mean appreciating your good luck at avoiding disaster, but at other times it focuses on being disappointed or regretful.

The reason why regret feels so awful is because, by its nature, it implies that there is something you could have done, some choice you could have made, or some action you might have taken that would have made something good happen or avoided something terrible.

Regret is a difficult thing to feel, but some experts suggest it can also have a positive impact if you cope with it well and allow it to help you make better choices going forward.

“No regrets” has become a popular mantra for many, signifying the idea that regret is a waste of time and energy. It’s a worldview repeated in popular culture and touted by everyone from social media influencers to celebrities to self-help gurus.

And, according to psychologist Daniel Pink, author of “The Power of Regret,” it is 100% wrong. He suggests that regret is not only perfectly normal, it can even be healthy. According to Pink, regret can act as a source of valuable information. When utilized well, it can guide, motivate, and inspire you to make better choices in the future.

Tips for Coping With Regret

While you can’t avoid regret, there are things that you can do to minimize these feelings. Or take the negativity out of these feelings and turn your regrets into opportunities for growth and change. 

Regret is most often characterized as a negative emotion, but it can serve an important function and even act as a positive force in your life at times. For example, regret can be motivating. It can drive you to overcome past mistakes or take action to correct them

Research has also found that both experienced regret and anticipated regret can influence the decisions that you make in the future. Efforts to avoid future regrets can help you make better decisions.

Practice Self-Acceptance

Acknowledging and accepting what you are feeling is essential. When you accept yourself and what you are feeling, you are able to recognize that your value isn’t defined by your mistakes or failures.

Accepting yourself and your feelings does not mean you don’t want to change things or do better. It just means that you are able to recognize that you are always learning, changing, and growing. 

Forgive Yourself

Because regret involves a component of guilt and self-recrimination, finding ways to forgive yourself can help relieve some of the negative feelings associated with regret. Forgiving yourself involves making a deliberate choice to let go of the anger, resentment, or disappointment you feel about yourself.

Accepting your mistakes is one part of this process, but forgiveness also requires you to practice self-compassion. Rather than punishing yourself for mistakes, treat yourself with the same kindness and forgiveness that you would show a loved one.

You can do this by taking responsibility for what happened, expressing remorse for your errors, and taking action to make amends. You might not be able to change the past, but taking steps to do better in the future can help you forgive yourself and move forward instead of looking back.

Apologize for Mistakes

In addition to forgiving yourself, you may find it helpful to apologize to other people who may have also been affected. This can be particularly important if your regrets are centered on conflicts in relationships or other problems that have caused emotional distress and pain.

A sincere apology can let the other person know that you feel remorse about what happened and that you empathize with their feelings.

Take Action

One way to help cope with feelings of regret is to use those experiences to fuel future action. Consider what you might have changed and done differently, but instead of ruminating over what cannot be changed, reframe it as a learning opportunity that will allow you to make better choices in the future. 

In reality, you may not have been capable of making a “better” choice in the past simply because you didn’t have the knowledge, experience, or foresight to predict the outcome. You made the choice you did based on what you knew then and the tools and information you had at your disposal.

Remind yourself that now that because of what you learned in the past, you now have the knowledge you need to make a better choice the next time you encounter a similar dilemma.

Reframe It

Cognitive reframing is a strategy that can help you change your mindset and shift how you think about a situation. This approach can help you change your perspective, show compassion for yourself, and validate the emotions that you are feeling. It can also help you to see situations in a more positive way and overcome some of the cognitive distortions that often play a role in negative thinking.

As Pink notes in his book, the popular “no regrets’ philosophy isn’t so much about denying regret as it is about reframing it, or as he calls it, optimizing it. It is an acknowledgment that mistakes of the past have shaped who you are today. 

It is about reframing that regret and seeing it as a learning opportunity that helps build resilience and wisdom. It’s not that you wouldn’t change past decisions if you could–it’s about recognizing that those choices helped you learn and can help you make better decisions in the future.

What Causes Regret?

Anytime you are required to make a choice, there is an opportunity for regret. Did you make the right decision? Could things have turned out better? Would you be happier if you’d chosen differently? 

Such regrets sometimes center on the mundane (like whether you should have had the soup or the sandwich for lunch) to the life-altering (like whether you should have picked a different career or married a different partner). 

But what exactly causes people to regret some decisions and not others? According to researchers, opportunity itself plays a major role.

If the decision was out of your hands or largely influenced by outside forces, you’re less likely to feel regretful about what happened. The reason for this is that processes such as cognitive dissonance and rationalization kick in to unconsciously minimize your personal responsibility for the outcome. 

For example, if you buy an item knowing you cannot return it, you’re less likely to regret your purchase. According to researchers, people often unconsciously suppress or distort many of life’s daily regrets without even realizing that it is happening. 

It is when you have more opportunities to change your mind, such as when you know you can return an item and pick something different, that you are more likely to wish you had chosen differently. Researchers refer to this as the opportunity principle, which suggests that more opportunity leads to more regrets.

What Do People Regret Most?

In an older study published in 2008, researchers analyzed archival data to learn more about which areas were most likely to trigger feelings of regret. The results indicated that the six most common regrets were centered in the areas of education, career, romance, parenting, the self, and leisure. Beyond those top six, regrets then centered on the topics of finance, family, health, friends, spirituality, and community.

Interestingly, people are often more likely to regret inaction than action. For example, you’re more likely to regret not choosing a certain career or not asking out someone you were interested in than to feel regret over the job and partner you did choose. This is because actions not taken are more subject to imagined outcomes. 

The consequences of the actions you did take are set in stone and readily apparent, but the ones you didn’t take seem like boundless opportunities wasted. In other words, the perceived gains of the choices you didn’t make seem to outweigh the actual consequences of your actions, so the sting of regret for missed opportunities looms much larger in your mind.

Impact of Regret

Regret can take both a physical and emotional toll on your body and mind. Feelings of regret can often lead to physical symptoms such as muscle tension, sleep disturbances, changes in appetite, headaches, muscle pain, joint pain, and chronic stress. 

Studies have shown that persistent regret can increase your risk of problems with breathing issues, chest pain, joint pain, and poorer overall health.

Constantly ruminating on past regret can lead to symptoms such as anxiety, depression, poor self-esteem, helplessness, and feelings of hopelessness. 

Fear of future regret can also affect your behavior. Anticipated regret, or the belief that you will regret something in the future, can also play a role in risk-taking and health-related behaviors you engage in today.

When people think taking an action will lead to greater regret, they are less likely to engage in risky behavior. And when people think that not taking action will lead to feelings of regret (such as not taking care of their health or not engaging in regular exercise), they become more likely to take steps to avoid those anticipated regrets.

Studies have also found that concern about anticipated regret can influence the decisions that people make on the behalf of others. When people are worried that people are going to be disappointed or regretful, they are more likely to make more conservative choices.

St. John’s wort (Hypericum perforatum) is a flowering plant named for its bright yellow flowers that were said to bloom for the first time around St. John the Baptist’s birthday. The word “wort” means “plant” in Old English.

People have been using St. John’s wort for centuries. Its purported benefits include alleviating symptoms of depression, relieving anxiety, and treating premenstrual syndrome (PMS) and menopause.

Benefits of St. John’s Wort

St. John’s wort is purported to boost mood and provide some relief from depression, but it’s not exactly clear how it works. It may work because of the effect St. John’s wort has on the brain.

Researchers suspect that ingredients in the herb (hypericin and hyperforin) may affect levels of certain brain chemicals, like serotonin. People with depression may have low levels of serotonin and other neurotransmitters.

One reason people decide to try St. John’s wort (as opposed to antidepressants that can increase serotonin) is its lower incidence of side effects than medications.

The herb is also being explored for the following health concerns:

St. John’s wort may also benefit the skin. An oil made from St. John’s wort has been used topically for wound healing and other skin conditions such as eczema and hemorrhoids.

Mild to Moderate Depression

Although the benefits of St. John’s wort are still being explored, research suggests the herb can be more effective than a placebo in alleviating mild to moderate depression. A 2015 review published in the Annals of Family Medicine examined whether antidepressants were more effective than a placebo for patients being treated for depression by their primary care doctor.

The researchers examined 66 previously published studies (with a total of 15,161 participants) and found that both antidepressant medications and St. John’s wort extracts were more effective than a placebo for treating mild to moderate depression.

People taking St. John’s wort were also more likely to continue treatment, as the herb was associated with fewer adverse effects compared to tricyclic and tetracyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), a noradrenaline reuptake inhibitor (NRI), a serotonin-noradrenaline reuptake inhibitor (SNRI), and noradrenergic and specific serotonergic antidepressant agents (NaSSAs).

A 2022 review of the research also found that St. John’s wort was more effective than placebo in treating mild to moderate depression. In some studies included in the review, St. John’s wort had efficacy comparable to SSRIs.

Severe Depression

The most comprehensive research on St. John’s wort and major depression includes a report published in the Cochrane Database of Systematic Reviews.

Researchers looked at 29 previously published clinical trials (with a total of 5,489 participants) that compared the effects of St. John’s wort to a placebo or standard antidepressant medication for a period of four to 12 weeks.

The authors noted that the studies conducted in German-speaking countries (where St. John’s wort has a long history of use and is often recommended by physicians) reported more positive results than studies conducted in the United States and other countries.

Possible Side Effects

People taking an oral St. John’s wort supplement for a short period of time may experience side effects. These may include:

• Mild stomach upset
• Diarrhea
• Dry mouth
• Headache
• Tiredness
• Dizziness
• Anxiety
• Restlessness
• Tingling
• Allergic skin reactions
• Sexual or erectile dysfunction
• Vivid dreams
• Liver injury
• Psychosis (rare)

When used topically, St. John’s wort may cause a skin rash. St. John’s wort (both oral or topical) can also increase the sensitivity of your skin and eyes to sunlight.

If you have a condition such as lupus or are taking medication that can cause photosensitivity (such as some acne medications), review the risks and benefits of taking St. John’s wort with your doctor or pharmacist.

Possible Drug Interactions

St. John’s wort can cause serious interactions with commonly used medications because of how it gets broken down by the liver. The herb can interact with medication in different ways. It can make some drugs less effective while making the effect of others stronger. The types of medications that may interact with St. John’s Wort include:

• Antibiotics
• Antidepressants
• Oral contraceptives
• Immunosuppressants
• Blood thinners such as warfarin
• Sedatives and medications used to treat anxiety
• Drugs used to treat cancer, heart conditions, and HIV/AIDS
• Over-the-counter medications for sleep, coughs, and colds

St. John’s wort can also interact with other herbs and supplements. You should avoid taking any nutritional supplement or remedy that can raise serotonin, such as 5-hydroxytryptophan (5-HTP), L-tryptophan, or SAMe, if you are taking St. John’s wort.

Taking St. John’s wort with antidepressants or any substance that raises serotonin can cause serotonin syndrome, a potentially dangerous condition resulting from an excess of serotonin. Symptoms of serotonin syndrome include confusion, fever, hallucinations, nausea, loss of muscle coordination, sweating, and shakiness.

Contraindications

There may be certain situations where it would be unsafe for you to take a supplement such as St. John’s wort or you will need an adjusted dose.

For example, if you are pregnant, breastfeeding, trying to conceive, or taking oral contraceptives (birth control pills), it’s important to talk with your doctor before you start taking St. John’s wort.

St. John’s wort may worsen symptoms in people with certain conditions, including:

Some research has indicated taking certain herbal supplements, including St. John’s wort, may increase your risk of complications if you are put under anesthesia. You should not take St. John’s wort for at least five days before having surgery. If you have received an organ transplant, you will need to avoid St. John’s wort as it can interact with the medications given to help prevent transplant rejection.

Dosage and Preparation

There is not enough scientific data to provide a standard recommended dose of St. John’s wort, though there are doses commonly used by researchers who are investigating the herb’s effect on depression.

The appropriate dose of St. John’s wort for you will depend on several factors including your age, biological sex, and medical history. It’s best to work with a doctor, pharmacist, and/or an alternative health practitioner to personalize your dose to ensure effectiveness and safety.

St. John’s wort can be found in several different preparations depending on how it will be used. There are dry, oil, and liquid preparations, including tinctures, capsules, elixirs, and teas. Each preparation of St. John’s wort will have different potencies. The strength may also vary from one supplement brand to another.

If you are taking St. John’s wort for depression, you may find taking a daily capsule more effective than using a topical treatment (which may be better suited to treating muscle pain, for instance). While you can take St. John’s wort every day, it’s generally recommended that you don’t exceed 1800mg per day and that you take it for a specific period of time, such as six to eight weeks.

To help maintain its effectiveness, all preparations of the herb should be kept in a cool, dry, place. Active ingredients in St. John’s wort may be affected by light, which is why the supplements are often packaged in a dark-colored container. Make sure to store the bottle or package out of direct sunlight.

What to Look For

St. John’s wort is widely available in pharmacies, supermarkets, and health food stores and comes in different doses. Check the Supplement Facts label for the product you choose to ensure you are getting the appropriate dose. This label also provides information about other ingredients the supplement may contain.

Look for products with a seal of approval from a third-party organization that provides quality testing, such as U.S. Pharmacopeia, Consumer Lab, or NSF International.

Avoidant personality disorder (AVPD) is an enduring pattern of behavior related to social inhibition, feelings of inadequacy, and sensitivity to rejection that causes problems in work situations and relationships.

The disorder is characterized by extreme shyness and sensitivity to criticism from others and is known as a Cluster C personality disorder or one that involves anxious and fearful personality disorders.

AVPD is often associated with other mental health conditions like anxiety disorders, in particular, social anxiety disorder. People with the disorder show a pattern of avoidance due to fear of rejection or disapproval, which they experience as extremely painful. The disorder affects about 2.5% of the population, with roughly equal numbers of men and women being afflicted.

Symptoms of Avoidant Personality Disorder

The following is a list of common symptoms associated with avoidant personality disorder:

• A need to be well-liked
• Anhedonia (lack of pleasure in activities)
• Anxiety about saying or doing the wrong thing
• Anxiety in social situations
• Avoiding conflict (being a “people-pleaser”)
• Avoiding interaction in work settings or turning down promotions
• Avoiding intimate relationships or sharing intimate feelings
• Avoiding making decisions
• Avoiding situations due to fear of rejection
• Avoiding social situations or events
• Easily hurt by criticism or disapproval
• Extreme self-consciousness
• Failure to initiate social contact
• Fearful and tense demeanor
• Feelings of inadequacy
• Hypersensitivity to negative evaluation
• Lack of assertiveness
• Lack of trust in others
• Low self-esteem
• Misinterpreting neutral situations as negative
• No close friends/lacking a social network
• Self-isolation
• Social inhibition
• Unwilling to take risks or try new things
• Viewing oneself as socially inept or inferior
• Vigilant for signs of disapproval or rejection

Diagnosis of Avoidant Personality Disorder

Avoidant personality disorder can only be diagnosed by a trained mental health professional based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While a family physician can be the first point of contact for a diagnosis, your doctor should make a referral to a psychologist, psychiatrist, or other mental health professional for diagnosis.

According to the DSM-5, a person must have a consistent pattern of avoiding social contact, being overly sensitive to rejection and criticism, and feeling inadequate, as displayed by at least four of the following criteria:

• Avoidance of occupational activities involving significant social contact out of fear of criticism, disapproval, or rejection
• Unwillingness to become involved with others unless you are certain that they will like you
• Holding back in intimate relationships out of fear of being ridiculed or humiliated
• Preoccupation with criticism or rejection in social situations
• Inhibition in new social situations due to feeling inadequate
• Feelings of being socially inept, unappealing, or inferior to others
• Hesitation to take risks or do new things out of fear of embarrassment

Avoidant Personality Disorder vs. Social Anxiety Disorder

Avoidant personality disorder can seem very similar to social anxiety disorder, with some overlap in symptoms. However, they are distinct conditions that have different causes. 

Like AVPD, social anxiety is a type of anxiety disorder that causes people to feel that they will be judged or rejected by others. However, social anxiety is driven by high levels of anxiety, while significant feelings of worthlessness cause AVPD. While they are distinct, a person can be diagnosed with both conditions.

What Triggers Avoidant Personality Disorder?

The causes of avoidant personality disorder are thought to involve genetic, environmental, social, and psychological factors. Some factors that can play a part in the development of the condition include:

• Emotional abuse
• Criticism
• Ridicule
• Lack of affection or nurturing by a parent or caregiver in childhood
• Rejection by peers

Often, individuals with the disorder are very shy as children and do not outgrow this shyness as they age. Children who are high in behavioral inhibition may be more likely to have negative social experiences, which play a part in the development of thought patterns that increase their risk for developing AVPD.

Related Conditions

Avoidant personality disorder may co-occur and overlap with a variety of other conditions, including:

How Serious Is Avoidant Personality Disorder?

Unfortunately, the outlook for people with avoidant personality disorder who do not seek treatment is rather bleak. Typically, they become self-isolated and use avoidance as their only coping strategy.

People with the condition may have few relationships and often become very isolated. This often leads to other long-term difficulties, including problems with work and school.

It is not uncommon for people with this condition to avoid school or occupations that involve a lot of social contact. People with the condition may be more likely to experience alcohol and substance use disorders.

Treatment of Avoidant Personality Disorder

Most people with avoidant personality disorder do not seek treatment. When they do, it is often for a specific life problem they are experiencing or other types of symptoms such as depression and anxiety, and they will usually discontinue treatment if that problem is resolved.

Like other personality disorders, avoidant personality disorder can be difficult to treat because it is an enduring pattern of behavior. It can be difficult for the person living with the disorder to recognize that psychotherapeutic help is needed and can be beneficial.

Talk Therapy

Talk therapy for avoidant personality disorder may include cognitive behavioral therapy (CBT), psychodynamic therapy, and schema therapy. Group therapy and social skills training may also be helpful.

CBT helps people learn how to change unhelpful thinking patterns. while psychodynamic therapy is aimed at being aware of how past experiences, pain, and conflict may be contributing to current symptoms.

Schema therapy for avoidant personality disorder is an integrative approach that builds on CBT as well as many other therapeutic techniques. It has a focus on the therapeutic relationship between therapist and client, and a goal of improving daily functioning and gaining insight for change based on understanding and re-engineering of early life experiences.

A key feature of schema therapy is “limited reparenting,” in which the client expresses childhood needs and learns to develop and internalize a healthy parent voice.

Medication

While there are currently no medications specifically approved for treating avoidant personality disorder, if a person has other related disorders such as depression or anxiety, medication may be prescribed to help with those symptoms.

For example, antidepressant medication can be helpful for improving mood and anhedonia, decreasing anxiety symptoms, and may also reduce sensitivity to rejection.

Coping With Avoidant Personality Disorder

One of the first steps in improving quality of life with avoidant personality disorder is to recognize the signs. By understanding your specific symptoms, you’ll be able to better work with your therapist to find ways to work around them.

Consider involving friends and family in your therapy, too, so they have a better understanding of what you’re going through and how to help.

Self-care is also essential, including finding healthy coping skills that prevent you turn to drugs or alcohol, smoking, overeating, or self-harm when you’re having a hard time.

If you think someone you know or love may be living with avoidant personality disorder symptoms, it is important to encourage that person to seek help. Without professional treatment such as talk therapy, it is unlikely that the symptoms and their related impacts on relationships will improve.

How important is sex in a healthy relationship? While every couple is different, research suggests that sexual connection can play a crucial role in intimacy, satisfaction, and overall well-being. There’s no one-size-fits-all answer for how much sex you should be having, but evidence supports the idea that regular sex can reduce stress, improve closeness, and support the long-term stability of your relationship.

Benefits of Sex in Relationships

Psychological Benefits

• Better self-image and happiness: Sex can boost self-esteem and reduce feelings of insecurity, leading to more positive perceptions of oneself. Research also suggests that more consensual, better-quality sex increases happiness.
• More bonding: Brain chemicals are released during sex, including endorphins, which decrease irritability and feelings of depression. Another hormone, oxytocin (the “hug drug”), increases with nipple stimulation and other sexual activity. The oxytocin released during sex enhances a sense of bonding and improves emotional intimacy.
• Stress relief: Chronic stress may contribute to lower sex frequency. However, sex can be an effective stress management technique. Sex reduces stress response hormones, like cortisol and adrenaline (epinephrine), with effects lasting well into the next day.
• Improved sleep quality: Orgasms trigger the release of the hormone prolactin, which aids sleep.
• Better relationship satisfaction: Sex in a monogamous relationship increases your commitment and emotional connection with the other person. Expressing love through sex increases the likelihood of couples staying together. As a result, sex is positively associated with a lower divorce rate.

Physical Benefits

• Better physical fitness: Sex is a form of exercise. Sexual activity is equivalent to moderate physical activity, like brisk walking or climbing two flights of stairs. The motion of sex can tighten and tone abdominal and pelvic muscles. For women, improved muscle tone improves bladder control.
• Enhanced brain function: Preliminary studies on rats found that more frequent intercourse was correlated with better cognitive function and the growth of new brain cells. Similar benefits have since been observed in human studies. A 2018 study of over 6,000 adults linked frequent sex with better memory performance in adults ages 50 and older.
• Improved immune function: Being more sexually active has positive effects on immune function. Regular sex may even lower your likelihood of getting a cold or the flu.
• Lower pain levels: The endorphins from sex promote more than just a sense of well-being and calm. Sex endorphins also appear to reduce migraine and back pain.
• Positive cardiac effects: Research also suggests sex can help lower blood pressure. Elevated blood pressure increases the risk of heart disease and stroke. Sexual activity helps dilate blood vessels, increasing the delivery of oxygen and nutrients throughout the body while reducing blood pressure.
• Additional physical benefits: Being more sexually active boosts libido and increases vaginal lubrication. Frequent intercourse is associated with lighter menstrual periods and less painful period cramps. In addition, an improved sense of smell, healthier teeth, better digestion, and glowing skin may be related to the body’s release of the hormone DHEA after orgasm.

Why the Importance of Sex Varies

Can a relationship survive without sex? Yes. Sex isn’t always necessary. But it can be an important part of a healthy, fulfilling relationship.

How important sex is can vary from one individual to the next. Some reasons the importance may vary include

• Individual preferences: Some people may feel that being a sexual couple is absolutely vital. Others may feel that other types of intimacy and connection are more important. 
• Relationship dynamics: The importance of sex may vary depending on how you feel about your partner and your relationship. The type of relationship, such as whether you are in a monogamous, open, or casual relationship, can also play a part.
• Perceptions of sex: How you feel about sex can play a role. For example, you might desire more sex if you find it important for feeling closer to your partner, showing affection to your partner, or as a way to feel confident and sexy.
• Life stage: Age often plays a role in sex frequency, largely due to declines in sex hormone levels as people get older.
• Challenges: Hormones, children, stress, medical conditions, and relationship difficulties can all play a role in how frequently couples engage in sex. Sometimes, maintaining an active sex life is difficult or impossible due to physical or psychological conditions.

Ways to Build Intimacy Outside of Sex

Couples can maintain a strong, healthy relationship despite these barriers by looking at non-sexual ways to improve intimacy. Ideas to consider include:

• Cuddling while watching a movie or sitting in the park
• Doing activities together that you both enjoy, such as dancing
• Giving frequent hugs and kisses
• Holding hands when you’re walking together
• Spending time talking to each other

How Often Should You Have Sex in a Relationship?

When considering how often a couple should have sex, one study found that general well-being is associated with sexual frequency, but only to an extent.

Relationship satisfaction improved progressively from having no sex up to having sex once a week, but did not improve further (and actually decreased somewhat) beyond this point.

One sexual encounter per week is fairly consistent with the current average. However, our increasingly busy lives may be getting in the way of having more sex. Compared to the frequency of sex in the 1990s, adults in 2010 were having sex nine fewer times per year.

Although frequency often decreases with age, sexual activity in older adults remains important. In general, older married couples tend to have sex more often than unmarried peers within the same age group.

Can Too Much Sex Be a Bad Thing?

It was once believed that sex increases the risk of prostate cancer. However, a 2016 study discovered that men who had more ejaculations (21 or more per month) were less likely to develop the disease than men who had fewer ejaculations (seven or fewer per month). Since prostate cancer is the second leading cause of cancer-related deaths in men, this effect is worth noting.

For some, sex may increase the chances of a heart attack. Despite this risk, higher sex frequency may help. Researchers suggest that having sex 52 times per year is associated with a 10% drop in heart disease mortality. Discuss your sexual activity with your doctor to evaluate your risks.

How to Have More Sex

The frequency of sex can, and often does, change over time. But that doesn’t mean sex frequency has to be an unstoppable downhill slide.

If you’re wondering whether it’s possible for sex to be as good as when you first fell in love, the answer is yes. Sex and intimacy can improve as your relationship matures. It may just require a little extra work.

• Talk openly about sex: It’s often said that the biggest sex organ is the one between the ears. Having sex more often without connecting emotionally or increasing communication isn’t likely to produce lasting improvements in your relationship.
• Prioritize intimacy: Feeling connected to your partner isn’t just about how often you have sex. Boosting emotional intimacy and non-sexual touch can be a way to help you feel more in the mood for sex.
• Get a handle on your stress: Managing stress is another key factor for a healthy sex life. Prioritize self-care and relaxation to make sure that you are taking care of your mental and physical well-being.
• Schedule time for sex: Let’s face it, life gets hectic. Instead of waiting for the mood to strike, put sex on your schedule.
• Experiment: Talk to your partner about your fantasies and consider adding novelty to help spice things up in the bedroom.
• Address physical or emotional barriers: Talk to your doctor if you are dealing with health issues, medication side effects, or mood challenges that make intimacy difficult.
• Talk to a professional: If you are not having sex regularly, ask yourself why. Sometimes seeing a sex therapist may be the best way to work through your relationship and personal issues. Sex therapy benefits individuals and couples alike.