Understanding Vocal Stimming in ADHD and Autism


Key Takeaways

  • Vocal stimming helps people with ADHD and autism manage their emotions and sensory experiences.
  • Creating a supportive environment with quiet spaces and sensory tools can reduce the need for stimming. 

Stimming” or self-stimulation can be used to define any conscious or unconscious self-soothing behaviors a person does. These behaviors are usually in the form of repetitive sounds or movements. Vocal stimming (or auditory stimming) specifically, refers to any self-stimulation behavior that involves the use of the vocal cords, mouth, lips, and ears.

The reasons for stimming will vary from person to person; however, these behaviors usually serve to help an individual stimulate their senses, reduce anxiety, cope with sensory overload, express frustration, or relieve physical discomfort.

While stimming behaviors can be found and conducted by all people, it is commonly associated with individuals with autism (ASD), attention deficit hyperactivity disorder (ADHD), and other disorders.

There are also many different types of stimming behaviors; such as visual, touch (tactile), verbal, and vestibular (balance-based). However, this article will be exploring verbal stimming alone, as well as, the signs, examples, reasons why it is done, and how it is managed.

What is Vocal Stimming?

Vocal stimming (also known as auditory stimming) can be understood as any self-stimulating behavior that involves the use of the vocal cords, mouth, lips, and ears.

When we generally think of stimming, it is usually associated with autism due to it being a part of the autistic diagnostic criteria. However, these behaviors are common among individuals with varying neurodevelopmental differences, thus, individuals with ADHD will also exhibit stimming behaviors.

However, in these instances, the reasons for stimming will differentiate. For instance, people with ADHD will tend to stim as a means to improve impulse control and focus; whereas, autistic people will tend to do it to relieve anxiety or sensory overload.

The manifestation and type of stimming behavior may be different too. After all, ADHD and autism are neurological disorders that affect different parts of the brain. That said, there is yet to be more research on the experiences of individuals with both (AuDHD).

My son who is autistic and ADHD makes some great noises when he is happy! When he was younger he would do a small woof — which was a sign I knew he was enjoying himself. I asked him why he did it and he said he liked the sound and it made him smile!

Additionally, while stimming behaviors have long been associated with children, more current research has begun to highlight the ways these behaviors present in adults too.

Signs and Examples

This type of stimming usually manifests in the form of giggling, singing, excessive throat clearing, the repetition of specific words, and the making of repetitive sounds (such as humming or murmuring).

“Signs to look out for include frequent repetition of certain sounds or words, a fixation on specific vocal patterns, and engaging in vocal stimming in various environments,” says Mike Iwinski, Lead Therapist at DreamLife Recovery. These behaviors may vary in intensity and form from person to person.

“In addition, this behavior can also include grunting, sighing, singing the same line from a song repeatedly, or even repeating lines from TV programs or movies,” says Hester Grainger, a certified ADHD coach and co-founder of Perfectly Autistic.

Grainger was personally diagnosed with ADHD in her forties and is wife and mum to her autistic/ADHD husband and autistic/ADHD/dyspraxic children — thus has a lot of lived experience when it comes to stimming.

“I often repeat specific words I like the sound of or phrases from TV programs. I find it comforting but also find it involuntary. It genuinely makes me happy repeating certain words that I like the sound of,” adds Grainger.

Why Do People With ADHD or Autism Stim?

“This behavior can serve various functions, including self-regulation, sensory stimulation, communication, and expression of emotions,” says Iwinski. Thus, vocal stimming can be said to occur due to sensory processing differences, emotional regulation challenges, and a need for self-soothing.

“It can provide a sense of predictability and control in an overwhelming world, or serve as a method to express inner feelings that may be difficult to communicate verbally,” he adds.

I often have words or phrases that go round and round in my head. This can be anything from a song lyric or a line from Friends. They make me happy and if I can’t say them out loud, it makes me feel uncomfortable, like I am trying to hold a hiccup in!

For example, a 2021 study on autistic and non-autistic adults found autistic adults (diagnosed and suspected/self-diagnosed) reported having greater sensory sensitivities and stimming than non-autistic adults.

They found that the sensory sensitivity of these individuals had negative emotional, physical, and cognitive effects on individuals. Therefore, stimming worked as a self-regulatory mechanism that allowed for positive and negative emotional expression, and cognitive distraction.

Additionally, this work highlighted that suppression of these behaviors had a negative effect on both emotions and cognition. Yet, due to social pressure individuals tended to suppress them regardless.

How Is Vocal Stimming Managed?

While vocal stimming shouldn’t be seen as a negative behavior, it can sometimes occur during inappropriate times, resulting in individuals feeling the need to suppress their behaviors. In moments such as these, different management strategies can be employed as a means to help. This could include behavioral modifications, therapy and in the case of people with ADHD, medication

Iwinski has listed the following management tools as a means to help the navigation of vocal stimming. He states, that a multi-faceted approach is best employed:

  1. Environmental Modifications: Creating a supportive environment with sensory-friendly tools and resources can help individuals regulate their sensory experiences, reducing the need for stimming behaviors. Providing quiet spaces, fidget tools, and sensory objects can contribute to self-regulation.
  2. Replacement Behaviors: Identifying alternative, socially acceptable behaviors that fulfill the same sensory needs can help redirect stimming tendencies.
  3. Communication Skills: Developing communication skills through speech therapy, social skills training, or augmentative and alternative communication (AAC) systems can provide individuals with alternative ways to express themselves and reduce the need for vocal stimming.
  4. Coping Strategies: Teaching coping strategies such as mindfulness, grounding techniques, and emotion regulation skills can help individuals manage overwhelming feelings without resorting to stimming.
  5. Individualized Approaches: Tailoring interventions to the individual’s specific needs, preferences, and sensory sensitivities is essential. Collaborating with the individual, their caregivers, and a multidisciplinary team can yield effective strategies.
  6. Social Support: Educating family members, peers, and educators about stimming behaviors can foster understanding and acceptance, creating a more inclusive environment.

Possible Replacement Behaviors

As mentioned above, replacement behaviors can be utilized as a means to fulfill the same sensory needs as stimming. Some examples of healthier alternatives to vocal stimming include using stress balls, soft fabrics, or engaging in deep breathing exercises. 

“Sucking can also help some individuals organize, increase their attention, and soothe or calm themselves,” says Grainger. She also points out “5,4,3,2,1 grounding techniques” as another exercise that can be of benefit. While this technique can be done in any different ways, she states the following as an example:

  • List five things you can see
  • Touch/feel four things
  • Listen and share three things you can hear
  • Name two things you can smell
  • Find one thing you can taste or think about tasting

A Note on Neurodivergence

It should be emphasized that nothing about the behaviors or characteristics associated with ADHD or Autism are inherently wrong, nor do they need to be “fixed”. If stimming makes someone with ADHD or Autism feel more comfortable then that’s exactly what they should do. But this information may be helpful to some people, as everyone’s situation and needs are unique.

Clinical Interventions

Regarding the clinical management of stimming, medical practitioners may look to the use of a combination of therapeutic modalities. “These include Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and sensory integration techniques,” says Iwiniski.

It is vital that individuals experiencing vocal stimming work towards finding a balance between self-expression and functional communication. Therefore, these modalities are often utilized alongside the implementation of adaptive behaviors. “With the goal of enhancing their overall well-being and quality of life,” Iwiniski finishes.

Navigating Stigma and Stimming

Once again, while it’s important to note that while the management of stimming behaviors can be beneficial for a person in terms of socialization, and relationships, stimming behaviors should not be seen as a negative trait needing to be “fixed” or “cured”.

After all, neurotypical people stim too and stimming is the body’s way of calming itself down. Therefore stimming shouldn’t be seen as something to be suppressed and in some instances, stimming can even be a lot of fun, too!

In the same regard, it’s important to also note that both ADHD and autism are highly stigmatized. As a result, some individuals may find that they (consciously or unconsciously) mask their stimming behaviors.

In these instances, individuals should research the topic as a means to uncover any “unknown” stims they have. After all, while stimming may be beneficial in the short term, it is an exhausting practice that can lead to burnout.

“I never knew I vocal stimmed until I was diagnosed with ADHD at 43. I have spent years repeating certain words over and over again — as I like how they sound but I didn’t know why I did this. For example, saying ‘Hamburger’ on repeat, like Steve Martin in the Pink Panther movie!” says Grainger.

“Now I understand my ADHD, I understand why I stim. When I work with my ADHD clients coaching them, I let them know it is okay to let the stim out. I always advise not to try and repress it if you are in a situation where you can be yourself.”


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Signs, Types, Causes, Treatment, Coping

Key Takeaways

  • Dysphoria is a feeling of unease or unhappiness that can happen with mental health issues like depression or anxiety.
  • About 5% of people feel dysphoria, and it might not mean they have a mental illness.
  • Exercising, eating a healthy diet, and spending time with others can help cope with dysphoria.

Dysphoria or dysphoric mood is a mental state in which a person has a profound sense of unease or dissatisfaction. While not a mental health diagnosis on its own, dysphoria is a symptom associated with a variety of mental illnesses, some of which include stress, anxiety, depression, and substance use disorders.

Dysphoria is the opposite of euphoria, which describes a state of extreme happiness.

There are different types of dysphoria that a person may experience. This includes gender dysphoria, which is a sense of unease caused by a conflict between a person’s assigned sex at birth and their gender identity.

Learn how to recognize the signs of dysphoria or dysphoric mood, some of the factors that may contribute to this sense of unease, and the different types of dysphoria that a person may experience. We also cover available treatments and ways to cope.

Signs of Dysphoria

Dysphoria may accompany other signs of depression or mental health problems, such as crying, loss of interest in pleasurable activities, and disturbances in appetite or sleep. Some of the common signs of dysphoria include:

  • Apathy
  • Fatigue
  • Low life satisfaction
  • Sadness
  • Unease
  • Worry

An example of dysphoria might include feeling unable to relax, dissatisfied, tense, and unable to find the energy or interest to do anything.

People who experience dysphoria also appear to think differently. A 2019 study published in Psychiatry Research found that dysphoria was linked to more frequent thoughts about the future.

People with dysphoria reported more negative thoughts and more unrealistic or implausible outcomes.

It’s unclear whether more negative thoughts about the future cause dysphoria or whether dysphoria causes a bleaker outlook.

Prevalence of Dysphoria

A person experiencing dysphoria might not necessarily qualify for a mental illness diagnosis such as depression. Instead, their symptoms may be too mild or too short in duration to meet the criteria.

It’s estimated that about 5% of the general population experiences dysphoria, with women between ages 25 and 44 at the highest risk. Dysphoria may be fleeting or short-lived. It often resolves quickly. But long-term dysphoria, which is often related to mental illness, may cause a higher risk of suicide.

Causes of Dysphoria

There are a number of different factors that can contribute to feelings of dysphoria. Some of these include:

  • Stress: Environmental stressors, like the loss of a loved one, a stressful work environment, or family conflict may cause feelings of dysphoria.
  • Health conditions: Some physical health conditions, like nutritional deficiencies, thyroid problems, or toxicities may also cause dysphoria.
  • Medications: Dysphoria may additionally be a side effect of certain medications.

Other Mental Health Conditions

Dysphoria may be associated with a variety of mental health conditions. People with the following mental illnesses may report dysphoria:

Substance Use

Up to 70% of people with alcohol dependence report dysphoria during heavy drinking. People with alcohol dependence and a mood disorder are especially likely to experience more dysphoria as well as poorer clinical outcomes.

In some cases, dysphoria may lead to heavy drinking. In other cases, heavy drinking may cause dysphoria. Mood often improves when a person stops drinking, but the improvement may not be immediate.

Dysphoria often occurs in the weeks following withdrawal. As appetite and sleep improve, dysphoria usually subsides.

Tobacco Use

Dysphoria has also been linked to tobacco use. It is associated with higher levels of tobacco dependence, greater perceived barriers to smoking cessation, and more severe nicotine withdrawal symptoms. Among all depressive symptoms, dysphoria holds the strongest association with smoking outcomes. Researchers suspect it is central to the development and maintenance of maladaptive smoking.

A 2019 study published in Addictive Behaviors found that individuals with pain-related anxiety are especially likely to smoke cigarettes to cope with feelings of dysphoria.

Types of Dysphoria

Because dysphoria is not considered a diagnosable mental health condition, it is not formally divided into different types. However, there are different related conditions that may be unofficially considered as types of dysphoria.

Gender Dysphoria

Currently, the term dysphoria is most commonly used when discussing gender dysphoria. Gender dysphoria refers to the distress a person experiences when their gender identity differs from the sex they were assigned at birth.

The dysphoria sometimes resolves when the individual transitions or begins to live as the gender they identify with. However, some people continue to experience dysphoria during and after transitioning.

Premenstrual Dysphoric Disorder (PMDD)

Dysphoria may also be talked about in terms of premenstrual dysphoric disorder (PMDD). PMDD is a much more severe form of premenstrual syndrome (PMS).

Symptoms may include a variety of physical and psychological symptoms, including moodiness, irritability, depression, and poor self-image. It may be treated with medication and lifestyle changes.

Tardive Dysphoria

Tardive dysphoria is used to describe treatment-resistant chronic depression. This type of dysphoria is linked to the long-term use of antidepressants.

Treatment for Dysphoria

If you are experiencing a dysphoric mood that lasts more than two weeks, it’s important to seek professional help. Start by talking to your physician. Your doctor will want to rule out any medical conditions or medication interactions that may be causing your dysphoria.

Once physical health issues are ruled out, you may be referred to a mental health professional, who can assess your symptoms and determine if your dysphoria is part of a mental health condition. Treatment depends on the cause of the dysphoria.

Talk therapy, medication, or lifestyle changes may be recommended to help improve your mood and assist you in feeling your best.

Get Help Now

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Coping With Dysphoria

In addition to professional treatments, there are also lifestyle modifications that may help people cope with feelings of dysphoria. Some things that you can do if you are having dysphoric feelings include:

  • Adjust your routines: Sometimes getting stuck in a rut can make it difficult to break out of the routines that are contributing to feelings of dysphoria. Finding ways to adjust your daily habits may help lift your mood.
  • Eat a healthy diet: Nutritional factors can play a role in mood and mental health, so making sure that you are eating well may be helpful in reducing feelings of dysphoria.
  • Exercise: Research has shown that exercise can play an important role in mental health and may even be useful as a treatment for depression. Try to follow the CDC’s guidelines for physical activity, which include at least 150 minutes of moderate-intensity activity per week.
  • Spend time with others: Dysphoria can sometimes cause people to isolate themselves, but social support can play an important role in mental well-being. Focus on finding ways to make more time for family and friends.
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. Hallford DJ. The phenomenological characteristics of autobiographical future thinking in dysphoric and non-dysphoric individuals. Psychiatry Res. 2019;273:481-486. doi:10.1016/j.psychres.2018.12.100

  2. Fromson JA, Bell IR. Depression. In: Mushlin SB, Greene HL, eds., Decision Making in Medicine. Maryland Heights, MO: Mosby; 2010. doi:10.1016/B978-0-323-04107-2.50236-2

  3. García-Vega E, Camero A, Fernández M, Villaverde A. Suicidal ideation and suicide attempts in persons with gender dysphoriaPsicothema. 2018;30(3):283–288. doi:10.7334/psicothema2017.438

  4. Bodnar LM, Wisner KL. Nutrition and depression: Implications for improving mental health among childbearing-aged womenBiol Psychiatry. 2005;58(9):679–685. doi:10.1016/j.biopsych.2005.05.009

  5. Doerr-Zegers O. Dysphoria in mania and in depression. Eur Psychiat. 2015;30(suppl 1):28-31. doi:10.1016/S0924-9338(15)30023-7

  6. Winstock AR, Reed KD. Alcohol misuse. In: Wright P, Stern J, Phelan M, eds., Core Psychiatry. Philadelphia, PA: Saunders Ltd.; 2011. doi:10.1016/B978-0-7020-3397-1.00028-8

  7. Buckner JD, Farris SG, Zvolensky MJ, et al. Dysphoria and smoking among treatment seeking smokers: the role of smoking-related inflexibility/avoidanceAm J Drug Alcohol Abuse. 2015;41(1):45–51. doi:10.3109/00952990.2014.927472

  8. Smit T, Peraza N, Garey L, et al. Pain-related anxiety and smoking processes: The explanatory role of dysphoriaAddictive Behaviors. 2019;88:15-22. doi:10.1016/j.addbeh.2018.08.008

  9. Dhejne C, Van Vlerken R, Heylens G, Arcelus J. Mental health and gender dysphoria: A review of the literatureInt Rev Psychiatry. 2016;28(1):44–57. doi:10.3109/09540261.2015.1115753

  10. Hadj-Moussa M, Ohl DA, Kuzon WM. Evaluation and treatment of gender dysphoria to prepare for gender confirmation surgerySexual Medicine Reviews. 2018;6(4):607-617. doi:10.1016/j.sxmr.2018.03.006

  11. Kaiser G, Janda C, Kleinstäuber M, Weise C. Clusters of premenstrual symptoms in women with PMDD: Appearance, stability and association with impairmentJ Psychosom Res. 2018;115:38–43. doi:10.1016/j.jpsychores.2018.10.004

  12. El-Mallakh RS, Gao Y, Jeannie Roberts R. Tardive dysphoria: The role of long term antidepressant use in-inducing chronic depression. Medical Hypotheses. 2011;76(6):769-773. doi:10.1016/j.mehy.2011.01.020

  13. Firth J, Gangwisch JE, Borsini A, Wootton RE, Mayer EA. Food and mood: How do diet and nutrition affect mental wellbeing? BMJ. Published online June 29, 2020;369:m2382. doi:10.1136/bmj.m2382

  14. Belvederi Murri M, Ekkekakis P, Magagnoli M, et al. Physical exercise in major depression: Reducing the mortality gap while improving clinical outcomesFront Psychiatry. 2019;9:762. doi:10.3389/fpsyt.2018.00762

  15. CDC. How much physical activity do adults need?

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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15 Marriage Counseling Questions to Ask Your Partner


Key Takeaways

  • Before talking about problems, focus on the positive parts of your relationship.
  • Working on communication and being open can help improve your marriage.
  • If one partner doesn’t want to go to therapy, focus on learning skills together as a team. 

No marriage is perfect; every couple faces their share of problems. Marriage counseling exists to help couples resolve these issues and repair from conflict, better understand each other, and improve relationship dynamics and communication. 

Although there are always ups and downs in a marriage, if there are too many low points, it may be a sign of trouble. It is estimated that on average, couples wait for 2.68 years after problems arise before starting therapy. While a marriage counselor can’t tell couples if their marriage will last, they can help you work through problems in a tried and true manner.

A study showed Emotionally Focused Couple Therapy (EFT) increased relationship satisfaction and attachment for two years after engaging in EFT. This can be seen as evidence that marriage counseling can prevent couples from getting a divorce.

This article explores relationship questions to ask your partner, common sources of conflict and effective strategies to help resolve relationship problems.

15 Marriage Counseling Questions to Ask Your Partner

Asking your partner questions can help determine the health of your marriage. This is done in marriage counseling, where partners often have to dig deep into the relationship to thoughtfully answer questions about their relationship and how they view it. Before starting the conversation, it’s essential to focus on the positive attributes instead of criticism, blame, guilt and shame

“You want to make sure each person leaves the conversation feeling positive, has constructive ways they can improve the relationship, and has a clear understanding of what the other person needs without feeling personally attacked”, says Dr. Sabrina Romanoff, a clinical psychologist, professor, and writer in New York City.

Here are some questions to ask your partner and how it relates to the quality of your marriage:

1. When you do you feel peaceful and content with me? When do you feel sad with me? Happy? Angry? Frustrated?

This helps bring out the feelings you experience with each other and what causes those feelings. Not everyone is comfortable with or has the experience of talking about their feelings and what evokes them. Practice listening and patience with your partner and approach these questions and their responses with curiosity. The intention is not to judge, shame, or criticize, but to better understand your partner. Try your best to create a safe and encouraging space for them express themselves to you in a way that’s true for them.

2. What are your favorite memories of us? 

Remind yourselves of the good in the relationship. Think about the memories and experiences that brought you together. Reflect on the foundation that you have built and what you want to continue strengthening together.

3. Are there things we used to do together that you’d like us to start doing again?

Life gets busy. Whether it’s a making a career change, having kids, or moving to a new city, it’s easy to put the things we enjoy on the back burner. Think about shared activities, hobbies, and interests from the past. What did you each enjoy and what would you like to make time and space to share together again?

4. What do you feel our strengths are, as individuals and together as a couple?

Identify your individual and shared strengths. How do you complement each other? What do you do well together? How can you use your strengths to support each other as members of the same team?

5. What are our current issues and areas of improvement?

It’s hard to begin conflict resolution without identifying what the problems are.

Dr. Romanoff explains, “It is important for couples to first identify their issues or core conflicts and then both agree and commit to working on these problems when they arise in the future…a couple that is determined to stay in the relationship, be introspective, and work on themselves tend[s] to have better outcomes.”

6. What concerns or worries you about us?

It can be difficult to hear your partner’s concerns, but this question also allows you to better understand where they are coming from so worries can be addressed and tended to.

“Having the ability to listen to understand instead of respond or react is the way around this. Being able to grasp your partner’s perspective without feeling like you have to defend yours is key to creating a harmonious, drama-free relationship,” explains Lesli Doares, Licensed Marriage and Family Therapist and the Founder of Foundations Coaching.

7. How could we approach and improve these things together? 

Brainstorm ideas and strategies to find a solution to your core issues. Doing this together can help you think as a team rather than as individuals fighting for what they need and want in the marriage.

8. Are there things you’d like that we have yet to try together?

Think outside the box and come up with creative solutions. This may be scheduling a date night once a month. Or this could be signing up for a class you’ve both always wanted to try. This may also mean attending marriage counseling sessions. 

9. What could I do or change to help you feel more comfortable sharing even more honestly and openly with me? 

Acting and behaving authentically around your partner is crucial for a healthy marriage. If you or your partner feel like they’re walking on eggshells or need to constantly bite their tongue, it can be difficult to talk about the issues in a meaningful way.

10. What would help help strengthen and deepen your trust even more with me?

A relationship without trust is one without intimacy or honesty. If you or your partner does not trust the other, it is very difficult to show vulnerability. You will tend to doubt each other and trouble can easily arise.

11. How effective do you feel our communication styles are, what patterns do you notice we have, and how could we improve together?

Effective communication is key to any relationship, especially in a marriage. 

“Couples who work on their communication — meaning they are introspective and identify their issues, create safety with each other to openly discuss them without criticizing or hurting the other, and are aligned in their goals to improve the relationship and how they work together as a team (instead of trying to change the other person) tend to have more success,” says Dr. Romanoff.

12. What is something I’ve done for you that you appreciated and what about it made you feel cared for?

It’s important to understand how each partner likes to be cared for and what they view as signs of love and affection. Expressing gratitude by acknowledging and actively appreciating these acts can strengthen your connection, reduce feelings of resentment and isolation, and increase feelings of warmth and closeness.

13. What do you think of marriage counseling?

Not everyone is open to the idea of attending couples therapy. It’s important to be on the same page before considering it. 

14. If you/we are thinking about leaving this relationship, what would we each need to consider staying?

This is a question that could be triggering and is something to bring up when you are both feeling calm, centered, and open. If one or both of you are considering leaving the relationship, addressing this question directly could help you each gather more information needed to consider next steps.

15. Is there anything on your mind you’d like to share with me that you haven’t yet and would like to now?

Again, it’s important to be open and honest about your feelings towards each other. This can help clear the air and identify potential issues that are contributing to feelings of resentment.

It is important to ask this question when you are both in a grounded and emotionally regulated safe and to create a safe space for both of you to share from a place of curiosity, care, compassion, and understanding instead of shame, blame, criticism, or judgment.

What Causes the Most Conflict Between Couples?

Everyone is unique: we all grew up with different family influences, in different environments and social landscapes. Therefore, most conflicts between couples are due to “having different perspectives, experiences, and expectations,” Doares says.

Conflict can be related to extended family issues, intimacy, finances, parenting or running a household; however, “all [are] a result of the couple not knowing how to both accept and navigate their differences,” explains Doares.

Talking about these differences effectively and making a plan that caters to both of your unique experiences can help you gain a deeper perspective of each other.

Additionally, regardless of what is causing conflict in the relationship, marriage counselors should have protocol that applies.

What Happens If My Partner Refuses to Attend Therapy or Slacks Off On the Work?

Viewing therapy as goal setting instead of work can make people more inclined to attend session. “Having a good relationship takes effort, energy, and intent — not work”, says Doares.

Although one person can makes improvements on their own and change the relationship, they also need to understand and believe in the relationship. You can take responsibility for this by inviting them to therapy. It’s crucial to focus on solutions rather than blame.

“Going in as a team to learn skills as opposed to either one of you or the relationship being broken is going to make it easier. Focusing on compassion and understanding, not judgment also works,” Doares explains.

Should Couples Have a Time Limit to Fix Their Issues?

It may be a good idea to set a time limit to fix your issues as it makes it “easier and faster to get guidance early on so they learn and implement what makes relationships work instead of trying to repair a rift later,” says Doares.

Specifically, Doares explains, “Couples should be willing to commit to six months to get things on track. This is assuming both people are willing to take direction and ownership. If they stay stuck in right or wrong, blame and judgment, things will take longer.”

What Strategies Help Couples Save Their Marriage?

Before setting any goals or picking strategies to improve your marriage, it’s important to set realistic expectations. People tend to pick one another as partners because their problems are complementary. 

For instance, one partner is a taker and the other is a giver. Or one partner criticizes or pursues and the other avoids or withdraws. Dr. Romanoff adds, “These are life-long coping styles and cannot be turned into black-or-white issues”.

In addition to couples therapy, whether it’s online couples therapy like Tallkspace or in-person with a therapist, having daily check-ins with your partner about these fundamental issues can be an effective strategy. 

Check-ins provide you both with a regular opportunity “to share how each person is feeling in the relationship, how they are relating to each other, and what they need from the other…[and] positively reinforce the good in the relationship by increasing [your] bond,” explains Dr. Romanoff.


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The Best Ways to Overcome Eye Contact Anxiety

Key Takeaways

  • Use the 50/70 rule by maintaining eye contact 50% of the time when speaking and 70% when listening.
  • Try the triangle technique by imagining a triangle between the person’s eyes and mouth, shifting your gaze every 5 seconds.
  • Look near the eyes, such as at a spot on their nose or chin, if direct eye contact is too stressful.

Eye contact anxiety refers to the discomfort a person feels when looking at someone directly in the eyes. A person with eye contact anxiety may avoid making eye contact when talking to someone. If they do make eye contact, they may feel like they are being judged or scrutinized.

Eye contact anxiety can interfere with everyday social interactions. By the same token, the ability to maintain good eye contact is an important aspect of social interaction. People who look others in the eye are perceived as friendly and welcoming. However, many shy and socially anxious people have difficulty with this part of communication. 

If you’ve not been diagnosed with an anxiety disorder but still find that eye contact makes you anxious, you can build your tolerance by engaging in increasing amounts of eye contact over time, or practice strategies like the 50/70 rule, looking away slowly, and using the triangle technique among others that will be covered in this article.

Why People Avoid Eye Contact

People have eye contact anxiety for many reasons. For those without a diagnosed mental health condition, avoidance of eye contact could be related to shyness or a lack of confidence. Looking someone in the eye while speaking can feel uncomfortable for those without a lot of practice making conversation or who tend to prefer not being in the spotlight.

To find out if your eye contact anxiety may be related to an official anxiety disorder, you’ll want to speak to a mental health professional who can diagnose you. In fact, it’s recommended that all adults under the age of 65 get routine screening for anxiety.

Eye Contact and Social Anxiety Disorder

Often, people with social anxiety disorder (SAD) describe looking someone in the eyes as anxiety-provoking and uncomfortable. This is likely due, in part, to genetic wiring.

Research has shown that people diagnosed with SAD have a pronounced fear of direct eye contact. If you have SAD, the part of your brain that warns you of danger (your amygdala) can be triggered by eye contact. 

A 2017 review published in Current Psychiatry Reports found that social anxiety is related to a mixture of being on guard and avoiding processing emotional social stimuli. This means that at a party, you might both be on the lookout for people who seem to be judging you, but also try to avoid situations in which you feel you are being judged.

In addition, the review showed that socially anxious people tend to avoid maintaining eye contact. Again, this is likely due to the fear of being judged.

Eye Contact and Autism

Research on autism shows that autistic people are hypersensitive to eye contact such that their brains show higher than normal activity in the pathways that process expressions on people’s faces. This means that they may avoid eye contact because it can cause extreme discomfort and even pain.

The Power of Eye Contact

Making eye contact during conversation is an important social skill. It can affect how you are perceived by others both in personal and professional relationships. In fact, researchers have uncovered numerous benefits of maintaining eye contact during a conversation, including:

  • People will be more likely to remember your face.
  • People will be more likely to remember what you said long after the conversation has ended.
  • People are more likely to believe what you’re saying.
  • People will perceive you as more confident and intelligent.
  • People will be better able to read and mirror other non-verbal cues.

Overcoming Eye Contact Anxiety

We all have varying levels of comfort when it comes to maintaining eye contact. While some people may be predisposed to fearing or avoiding eye contact, most can learn to improve their skills and become better at making good eye contact, starting with:

  • Reducing anxiety about eye contact
  • Improving skills for making eye contact

Reducing Anxiety About Eye Contact

People with a diagnosed anxiety disorder may benefit from treatment including cognitive behavioral therapy (CNT) or medication. Most people with social anxiety disorder can learn to overcome their fear response and maintain better eye contact. In this way, eye contact is just one aspect of social interaction that you can become desensitized to through practice and exposure.

Start small with people who make you feel less anxious, such as a good friend, and work your way up to more anxiety-provoking situations such as holding eye contact with your work supervisor.

You could even try starting with making eye contact with characters on television, in online videos, or over Facetime or other video chats if real-life eye contact feels too stressful at first. If you find your anxiety rising before or during situations in which you must make eye contact, try practicing deep breathing to slow your heart rate and calm yourself down.

Improving Eye Contact Skills

If you are talking to someone one-on-one (or looking at people within a group), choose a spot directly between or slightly above the listener’s eyes. If this doesn’t feel comfortable, try letting your eyes go slightly out of focus, which has the added benefit of softening and relaxing your gaze.

You can and should also look away occasionally. Staring too intensely can make people uncomfortable.

Tips for Making Eye Contact

  • Establish eye contact at the start. Make eye contact before you start talking to someone.
  • Use the 50/70 rule. Maintain eye contact 50% of the time when speaking and 70% when listening.
  • Look for 4–5 seconds. Hold eye contact for about four to five seconds at a time, or about as much time as it takes you to register the color of their eyes. When you break eye contact, glance to the side before resuming your gaze.
  • Look away slowly. When you look away, do it slowly. Looking away too quickly (darting your eyes) can make you appear nervous or shy.
  • Use the triangle technique. Rather than looking away or looking down (as this shows a lack of confidence), you can also look at another spot on their face. Imagine an inverted triangle connecting their eyes and mouth. Every five seconds, rotate which point of the triangle you are looking at.
  • Make a gesture. Break your gaze to make a gesture or to nod, as this appears more natural than looking away because you’ve grown uncomfortable with the amount of eye contact.
  • Look near the eyes. If looking someone directly in the eyes is too stressful, instead look at a spot on their nose, mouth, or chin.

Employing these two strategies to improve your eye contact will make your listeners feel more connected to you and increase the likelihood that you will feel more comfortable when speaking—either to a group or to an individual.

When speaking to a group of people, instead of thinking of the group as a whole, imagine having individual conversations with one person in the group at a time.

As you speak, choose one person in the group and pretend that you are talking just with that person. Look at that person as you finish your thought or sentence. As you begin a new sentence or idea, choose another person in the group and look them in the eye as you finish your thought. Make sure that you eventually include everyone in the group.

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.

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. US Preventive Services Task Force. Screening for Depression and Suicide Risk in Adults: US Preventive Services Task Force Recommendation StatementJAMA. 2023;329(23):2057–2067. doi:10.1001/jama.2023.9297

  2. 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

  3. Chen NTM, Clarke PJF. Gaze-based assessments of vigilance and avoidance in social anxiety: A review. Curr Psychiatry Rep. 2017;19(9):59. doi:10.1007/s11920-017-0808-4

  4. Hadjikhani N, Åsberg johnels J, Zürcher NR, et al. Look me in the eyes: Constraining gaze in the eye-region provokes abnormally high subcortical activation in autism. Sci Rep. 2017;7(1):3163. doi:10.1038/s41598-017-03378-5

  5. Mason M, Hood B, Macrae CN. Look into my eyes: Gaze direction and person memoryMemory. 2004;12(5):637-643. doi:10.1080/09658210344000152

  6. Fullwood C, Doherty-Sneddon G. Effect of gazing at the camera during a video link on recallApplied Ergonomics. 2006;37(2):167-175. doi:10.1016/j.apergo.2005.05.003

  7. Kreysa H, Kessler L, Schweinberger SR. Direct speaker gaze promotes trust in truth-ambiguous statements. Paterson K, ed. PLoS ONE. 2016;11(9):e0162291. doi:10.1371/journal.pone.0162291

  8. Murphy NA, Hall JA, Colvin CR. Accurate intelligence assessments in social interactions: mediators and gender effects: accurate intelligence assessmentsJournal of Personality. 2003;71(3):465-493. doi:10.1111/1467-6494.7103008

  9. Prinsen J, Bernaerts S, Wang Y, et al. Direct eye contact enhances mirroring of others’ movements: A transcranial magnetic stimulation studyNeuropsychologia. 2017;95:111-118. 10.1016/j.neuropsychologia.2016.12.011

  10. Jefferson JW. Social anxiety disorder: More than just a little shyness. Prim Care Companion J Clin Psychiatry. 2001;3(1):4-9. doi:10.4088/pcc.v03n0102

  11. Weick M, Mccall C, Blascovich J. Power moves beyond complementarity: A staring look elicits avoidance in low power perceivers and approach in high power perceivers. Pers Soc Psychol Bull. 2017;43(8):1188-1201. doi:10.1177/0146167217708576

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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Intimacy vs. Isolation: Psychosocial Stage 6


Key Takeaways

  • Intimacy is more than sex; it involves closeness, honesty, and love in relationships.
  • Identifying your interests can help you build lasting friendships.
  • If you are struggling with forming healthy, intimate relationships, talking to a therapist can be helpful.

In our 20s and 30s, close relationships become more important. Dating, marriage, and romantic commitments are important, but so are friendships and other social relationships. These connections provide the social support we need to thrive, which is why establishing solid interpersonal relationships is vital during young adulthood.

According to psychologist Erik Erikson’s theory of psychosocial development, this stage represents a period he called “intimacy vs. isolation.” It marks the sixth stage of his developmental theory and spans from approximately 19 to 40 years of age. It follows identity vs. role confusion, the fifth stage.

Erikson believed that people face conflict at each major stage of life. In the intimacy vs. isolation stage, this conflict centers on relationships. When we are able to navigate this period of life successfully, we end up having fulfilling, enduring relationships. Struggling, on the other hand, can result in loneliness and isolation.

Verywell / Nusha Ashjaee 

At a Glance

  • Psychosocial conflict: Intimacy vs. isolation
  • Major question: “Will I be loved, or will I be alone?”
  • Basic virtue: Love
  • Important event(s): Romantic relationships

Intimacy, According to Erikson

Although many associate the word intimacy with sex, Erikson believed that intimacy is characterized by closeness, honesty, and love—and is essential to emotional well-being. This stage is all about forming close, loving connections, whether romantic, platonic, familial, or otherwise.

Whereas one person might form healthy relationships with romantic partners as well as a circle of friends, acquaintances, family, and others, another person might lack the ability or desire to form social connections, healthy relationships, and general social support. This is the intimacy vs. isolation conflict.

Navigating this conflict successfully fosters the intimate relationships and supportive social networks that are so vital for physical and mental health.

The Benefits of Intimacy

Intimacy has very real benefits for mental and physical well-being. As experts often say, we’re social creatures, so having a social network of people to lean on for support, guidance, and validation is pivotal.

People who successfully resolve the intimacy vs. isolation conflict are able to develop:

  • Close romantic relationships
  • Deep, meaningful connections
  • Enduring connections with other people
  • Positive relationships with family and friends
  • Strong relationships

Intimacy has also been linked to a range of health benefits. This includes lower stress levels, more healthy behaviors, fewer symptoms of depression, and lower blood pressure.

Resolving the Intimacy vs. Isolation Conflict

Intimacy requires listening to, supporting, and sharing with others in a reciprocal relationship: The parties share equally.

Successful relationships entail support, intimacy, and companionship, but sometimes, things don’t go smoothly. Rejection or other responses can cause withdrawal and erode confidence, self-esteem, and courage to reach out in the future, resulting in isolation.

Relationships aren’t always easy for everyone for a number of reasons, however. Factors that can increase the likelihood of isolation include:

  • Childhood experiences such as neglect and abuse
  • Divorce or death of a partner
  • Fear of commitment
  • Fear of intimacy
  • Inability to share thoughts and feelings
  • Relationship experiences

No matter the cause, isolation can be detrimental, causing loneliness and even depression.

Intimacy

  • Strong romantic relationships

  • Close relationships with friends and family

  • Strong social support network

Isolation

  • Poor romantic relationships that lack intimacy

  • Few or no relationships with friends and family

  • Weak social support network

The Consequences of Isolation

In reality, struggling in this stage of life can leave people feeling lonely and isolated if they fail to form supportive relationships with others. Adults who struggle with this stage typically experience:

  • Few or no friendships
  • Lack of intimacy
  • Lack of relationships
  • Poor romantic relationships
  • Weak social support

They might never share deep intimacy with their partners—or develop any relationships at all. This can be particularly difficult as their friends and acquaintances fall in love, get married, and start families. It can also lead to greater loneliness since people who have “settled down” often have less time to spend with their single, unattached friends.

Loneliness can affect overall health in other ways. For example, socially isolated people tend to have unhealthier diets, exercise less, experience more daytime fatigue, and have poorer sleep than their more social counterparts.

Loneliness and isolation can lead to a wide range of negative health consequences, including:

  • Cardiovascular disease
  • Depression
  • Substance misuse
  • Stress
  • Suicide

Loneliness and social isolation are increasingly common in the U.S. According to the Centers for Disease Control and Prevention (CDC), 33% of adults report feeling lonely, and 25% say that they do not have enough social and emotional support.

How to Build Intimacy

If you are wondering how to level up your intimacy, there are things you can do to help. The key? It’s all about openness and vulnerability. Sharing time together is important, yes, but it also takes letting down your walls and letting people see the real, unfiltered you.

Some important tasks that can play a role in succeeding or struggling at this point of development include:

  • Being intimate: This is more than just engaging in sex; it means forging emotional intimacy and closeness. Intimacy does not necessarily have to be with a sexual partner. People can also gain intimacy from friends and loved ones. Authentic, close connections are what matters.
  • Caring for others: It is essential to be able to care about the needs of others. Relationships are reciprocal. Getting love is important at this stage, but so is giving it. That means being a good friend and partner. It means being there when people need you and offering the care and validation you expect them to give you.
  • Making commitments: Part of forming strong relationships involves being able to commit to others for the long term. This might involve saying, “I do,” but marriage isn’t the only way to show someone you are committed to the relationship. Communicating, setting goals, and making long-term plans are also effective ways to show someone you are in it for the long haul.
  • Self-disclosure: To get close to others, we must reveal details about ourselves. This involves sharing part of oneself while maintaining a strong sense of self-identity.

Importance of Sense of Self

Things learned during earlier stages of development also play a role in being able to have healthy adult relationships. For example, Erikson believed that having a fully formed sense of self (established during the previous identity vs. role confusion stage) was essential to being able to form intimate relationships.

People with a poor sense of self tend to have less committed relationships and are more likely to experience emotional isolation, loneliness, and depression.

Such findings suggest that having a strong sense of who you are is important for developing lasting future relationships. This self-awareness can play a role in the type of relationships you forge as well as the strength and durability of those social connections.

How to Overcome Isolation

If you are struggling with feelings of isolation, there are things that you can do to form closer relationships with other people:

Avoid Negative Self-Talk

The things we tell ourselves can have an impact on our ability to be confident in relationships, particularly if those thoughts are negative. When you catch yourself having this type of inner dialogue, focus on replacing negative thoughts with more realistic ones.

Build Skills

Sometimes practicing social skills can be helpful when you are working toward creating new relationships. Consider taking a course in social skill development or try practicing your skills in different situations each day.

Determine What You Like

Research suggests that factors such as mutual interests and personality similarity play important roles in friendships. Knowing your interests and then engaging in activities around those interests is one way to build lasting friendships. If you enjoy sports, for example, you might consider joining a local community sports team.

Evaluate Your Situation

What are your needs? What type of relationship are you seeking? Figuring out what you are looking for in a partner or friend can help you determine how you should go about looking for new relationships.

Practice Self-Disclosure

Being able to share aspects of yourself can be difficult, but you can get better at it through practice. Consider things you would be willing to share about yourself with others, then practice. Remember that listening to others is an essential part of this interaction as well.


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What Is a Karmic Cycle?

Key Takeaways

  • A karmic cycle is a repeated pattern in your life that gives you a chance to learn and grow.
  • Recognizing a karmic cycle involves noticing if you keep facing similar challenges or relationships.
  • To break a karmic cycle, become aware of it and work on changing how you respond to challenges.

What Is a Karmic Cycle?

A karmic cycle is a repetitious pattern of events, emotions, or realizations that occur in your life. It appears in your life as an opportunity to break negative cycles and subsequently reap great wisdom.

It is believed that karmic cycles are opportunities to master a life lesson, and until that lesson is mastered, we will continue to repeat the cycle.

A karmic cycle isn’t a medical term and has minimal research backing. For students of yoga, astrology, Buddhism, Indian spirituality, or New Age spirituality practices, the term karmic cycle may feel somewhat familiar. However, this may be an entirely new concept for those of us who don’t dabble in the aforementioned worlds.

Either way, fully understanding karma, karmic cycles, and how both are vehicles for change in your life is the first step to healing. Let’s dig into the history behind this concept.

History of Karmic Cycles

The history behind the concept of karmic cycles begins with the idea of karma. At its simplest definition, karma is a concept stating that the quality of a person’s actions influences the quality of the outcome. In other words, a good deed will lead to a positive outcome, whereas a bad deed will lead to a negative outcome.

The term karma is a Sanskrit word and a central idea in Hinduism and Buddhism. In these Eastern religions, there is a belief in reincarnation—that every human has lived multiple lifetimes, with each lifetime being an opportunity to evolve and grow.

This growth comes through a series of moral, ethical, and spiritual challenges, which is when a karmic cycle comes in.

What a Karmic Cycle May Look Like

For example, let’s say you experienced a moral challenge in a previous lifetime that ultimately resulted in failure—perhaps you didn’t act in accordance with your morals due to fear, societal expectations, or simply because it didn’t occur to you that there was another option. In a karmic cycle, you’ll face a similar challenge in this lifetime. These challenges can come through familial dynamics, relationships, and even experiences in the workplace. 

Signs of a Karmic Cycle

Here are two attributes of karmic cycles: First, they appear to invite you to actualize your highest potential by having the chance to make different choices. Second, they’re relatively easy to spot once you recognize the signs.

Something Feels Very Familiar 

Perhaps your boyfriend reminds you of your angry father. Or, try as you might, you keep ending up in toxic work environments. On the other hand, maybe you’re struggling with something a bit more serious, like drinking half a bottle of wine every night while realizing that you watched your mother do the exact same thing.

In psychology, such scenarios may be linked to attachment styles or intergenerational trauma. In spiritual terms, this scenario can be considered a karmic cycle. The identifying factor is a repeated maladaptive pattern in your life. 

You Keep Attracting the Same Types of People

If every partner you’ve had featured the same not-so-great traits from your parents, you are likely in a karmic cycle of sorts.

Studies show that we gravitate towards what feels comfortable, even if that means we end up repeating a traumatic pattern.

If we are used to those who love us having a hot temper, the discomfort of seeing our partner get easily angered may be eerily familiar and even tolerated with a familiar level of suffering. Alternatively, having an upbringing with absentee caregivers may result in feeling comfortable in the loneliness of a relationship where emotional intimacy is lacking.

You Are Being Faced With Your Fears

Let’s say one of your greatest fears is financial insecurity. Because of this fear, you may have unhappily stayed in your unfulfilling job for many years because it is stable and secure. However, on the inside, you may dream of a more fulfilling and creative career.

If you lose your current job, this could be considered a karmic opportunity. Instead of continuing the cycle of only applying for jobs that will support you financially but not fulfill you emotionally, you might choose instead to face your fear and decide to do something different. You might choose to finally go for a career that you feel would satisfy you, operating from a place of courage and inspiration instead of fear.

Facing your biggest fear is a karmic opportunity to reevaluate your true desires.

How to Use a Karmic Cycle for Healing

Remember, the purpose of a karmic cycle is to ultimately achieve a higher level of ethical and moral wisdom in this lifetime. Karmic cycles by design are for our healing. If we become aware of our karmic cycles and are ready to do the mental, emotional, and spiritual work to change them, then deeper healing and greater self-actualization are possible.

Seeking the support of a trusted mental health professional who honors your spiritual beliefs is important. The themes that can come up on these journeys can be harrowing and it can be challenging making different choices than any others you’ve made in the past, yielding different results. You do not have to do this work or walk this journey alone.

Seeking a form of holistic therapy can be a great fit, as many forms are spiritually-affirming, utilize an eclectic mix of cognitive and somatic therapies, and tend to the root cause of issues. 

Turn your focus towards your relationship with yourself. Are you overly self-critical? Do you find yourself acting out of alignment with your values? Then, with gentle care, begin to extend grace to yourself.

Moving through a karmic experience can be immensely challenging, and the stronger your connection is to your highest and truest self, the greater your chance to break old karmic cycles that no longer serve you. The ride may not be easy, but it is always worth it.

The Impact of Karmic Cycles

A karmic cycle has the potential to change your life. With the proper support, perspective, intention, and action, you will find that your life circumstances begin to shift for the best.

Remember, at the core philosophy of a karmic cycle is a lesson that transcends lifetimes. As you break free of old karmic cycles, you may observe and experience relationships, jobs, and ways of living your life significantly shifting as you continue your growth and evolution.

Potential Pitfalls of a Karmic Cycle

The path to change and maturation is seldom comfortable. However, when a karmic cycle begins to feel unbearable, reflect on how you feel when you try to avoid the issues at hand. More often than not, the pain we experience when we run from emotional work is worse than the discomfort of facing the pattern head-on. 

Something to be aware of when navigating a karmic cycle is the concept of spiritual bypassing. This is when spiritual concepts are used to avoid unresolved issues. Acknowledging you’re in the midst of a karmic cycle isn’t enough to create change. It is merely the first step to meeting your new life.

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. Larson P. Karma. In: Leeming DA, ed., Encyclopedia of Psychology and Religion. Springer International Publishing. doi:10.1007/978-3-030-24348-7_373

  2. Van der Kolk BA. The compulsion to repeat the trauma. Re-enactment, revictimization, and masochismPsychiatr Clin North Am. 1989;12(2):389-411.

Julia Childs Heyl headshot

By Julia Childs Heyl, MSW

Julia Childs Heyl, MSW, is a clinical social worker and writer. As a writer, she focuses on mental health disparities and uses critical race theory as her preferred theoretical framework. In her clinical work, she specializes in treating people of color experiencing anxiety, depression, and trauma through depth therapy and EMDR (eye movement desensitization and reprocessing) trauma therapy.


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Obsessive-Compulsive Personality Disorder (OCPD) vs. OCD


Key Takeaways

  • OCD is defined by intrusive thoughts and compulsive behaviors, whereas OCPD involves rigid perfectionism and control without obsessions or compulsions.
  • OCPD affects a person’s ability to function in life by being inflexible and having extreme dedication to work, often at the expense of relationships.
  • People with OCPD may believe their actions have purpose, which can prevent them from seeking help.

OCD and OCPD share some similarities, but they are distinct conditions that differ in important ways. OCD is characterized by intrusive thoughts that then compel a person to engage in behaviors to relieve feelings of distress and anxiety. This can be contrasted with OCPD, which is marked by excessive attention to detail and perfectionism. 

Keep reading to learn more about the symptoms of OCPD and how to distinguish between OCPD vs. OCD. It also covers how OCPD is diagnosed, what causes it, and how it is treated.

What Is Obsessive-Compulsive Personality Disorder?

Obsessive-compulsive personality disorder (OCPD) is defined by strict orderliness, control, and perfectionism. Someone with OCPD will likely try to stay in charge of the smallest details of their life, even at the expense of their flexibility and openness to new experiences.

OCPD is a personality disorder, which means it involves personality traits that are stable, long-held, atypical, and problematic in some way. In the case of OCPD, people with this condition may find it hard to relate to others, and their devotion to perfectionism and rigid control can make it difficult to function.

Other personality disorders in this category include narcissistic personality disorder, histrionic personality disorder, and borderline personality disorder.

OCPD is not the same as narcissism, however. People with OCPD dwell on doing things perfectly, while people with narcissistic personality disorder have an exaggerated sense of grandeur and believe they should receive constant praise and attention.

Symptoms of OCPD

The primary symptoms of OCPD focus on an obsession with perfectionism and a need for control. Someone with OCPD may experience symptoms like:

  • Acting restrained or restricted with their emotions
  • Adherence to rules in an inflexible, rigid way
  • Creating order and lists for tasks
  • Desire to control their relationships with others
  • Difficulty empathizing with others and/or maintaining intimate relationships
  • Extreme dedication to their work
  • Having trouble giving things to others
  • Need for perfection even in the smallest details
  • Problems with self-identity and/or self-direction
  • Trouble giving up control and delegating tasks

At first glance, OCPD may seem similar to an anal personality type. While someone with an anal personality might share some of these traits, like perfectionism, orderliness, and a need to be in control of their environment, having these quirks isn’t the same thing as having a personality disorder.

How Is OCPD Diagnosed?

There is no specific test that can determine if a person has OCPD. In order to make a diagnosis, a clinician will ask questions about your symptoms and the effect they have on your life. They may also conduct lab tests and a physical exam to help rule out other conditions.

To be diagnosed with OCPD, a person must exhibit a persistent pattern of preoccupation with perfectionism, order, and control of the self, situations, and others.

It must also be accompanied by at least four of the following symptoms described in the DSM-5-TR:

  • Excessive devotion to work at the expense of family or friends
  • Extreme need for perfection and relentless control over your environment and interpersonal relationships
  • Inability to be generous to others
  • Inability to delegate tasks
  • Inability to get rid of worn-out or worthless items (even those without sentimental value)
  • Over-conscientiousness
  • Preoccupation with details, rules, lists, and order, which can result in missing the major objective of an activity
  • Rigidity and inflexibility with regards to morals, ethics, values, and/or the adherence to rules

They may also look for additional signs of OCPD. These include the presence of rigid perfectionism and at least two more personality traits:

  • Intimacy avoidance
  • Getting mentally “stuck” on an idea
  • Reduced emotional expression

Your doctor may also check for any difficulty you have with empathy and intimacy. People who have OCPD often struggle to maintain interpersonal relationships, including romantic relationships. They may find it difficult to empathize with others and are sometimes described as cold or aloof. They also struggle with intimacy and find it difficult to show affection or express emotions.

In order to be diagnosed with OCPD, these symptoms must create significant disruptions in a person’s ability to function in important life areas, including school, work, family, and other relationships. 

Related Conditions

OCPD also bears a close resemblance to some other conditions, such as OCD, eating disorders, autism spectrum disorder, and other personality disorders. OCPD may also co-occur alongside them. A doctor will need to rule out these other conditions before diagnosing OCPD.

It may take some time for a doctor or therapist to determine if you have OCPD. They may need to meet with you a few times to discuss and observe your symptoms. A doctor or therapist may also need to talk to loved ones to get a better picture of your daily behaviors and interactions before they make a diagnosis.

Recap

Diagnosing OCPD requires experiencing at least four symptoms listed in the DSM-5-TR. These symptoms must have begun during early adulthood and must interfere with the person’s ability to function in daily life.

OCPD vs. OCD

While OCD and OCPD are distinct forms of mental illness with their own unique and specific characteristics, there is considerable overlap between them. There are, however, some basic ways to distinguish between them.

OCD

  • Obsessive-compulsive and related disorders

  • Distress over thoughts and behaviors

  • Behaviors fluctuate

  • True obsessions and/or compulsions

Presence of True Obsessions and/or Compulsions

OCD is defined by the presence of true obsessions (an irrational thought or idea that continually repeats) and/or compulsions (an irrational behavior performed repeatedly). These behaviors can occur together or on their own, and they interfere with a person’s quality of life and ability to function.

With OCPD, on the other hand, the personality traits are not directed by uncontrollable thoughts or irrational, repeated behaviors. While people with OCPD often engage in rigid behaviors that may be centered on following certain procedures, they don’t have the same intrusive thoughts and overwhelming compulsions that people with OCD do.

Feelings About Obsessive Behaviors or Thoughts

People with OCD often feel distressed by the nature of their behaviors or thoughts, even if they are unable to control them. People with OCPD, however, typically believe that their actions have an aim and purpose.

Because of this, those with OCPD may also avoid seeking professional help.

In some situations, the traits of OCPD can even translate to success—someone who is overly dedicated to their job and conscientious of every detail, for example, might see benefits at work, even if they are struggling in other areas of their life.

Consistency of Symptoms

The symptoms of OCD tend to fluctuate in association with the underlying level of anxiety. People with OCD engage in behaviors as a way to deal with feelings of fear, anxiety, and uncertainty. This means that their symptoms may be less severe during times when they are experiencing less anxiety.

Because OCPD is a personality disorder that’s defined by inflexibility, the behaviors tend to be persistent and unchanging over the long term. These symptoms do not fluctuate depending on anxiety levels and are present in almost every area of the person’s life.

Can you have OCD and OCPD?

It is also possible for the two conditions to occur together at the same time. Research suggests that around 20% to 30% of people with OCPD may also have OCD. Around 52% of people with OCD have at least one co-morbid personality disorder.

What Causes OCPD?

We don’t yet know what causes OCPD, although there are some theories that explain different possibilities. One theory deals with attachment styles and says that OCPD may develop in children who:

  • Had overprotective parents or caregivers who didn’t offer much care
  • Didn’t develop emotionally and empathetically during their childhood
  • Weren’t able to form secure attachments with their parents or caregivers

There may also be a biological component to OCPD, as having relatives with the condition might make you more likely to have it.

Risk Factors for OCPD

OCPD is one of the most common personality disorders. Men and women seem to experience it at about the same rate, though it’s less common in younger adults. It can occur with several other conditions, like:

One study found that around 7.8% of adults will have OCPD at some point during their lifetime.

How Is OCPD Treated?

Though more research is needed in this area, most treatment plans for personality disorders begin with psychotherapy, while medication might be used as a complement.

Psychotherapy

Therapy options for OCPD can include:

  • Cognitive behavior therapy (CBT), which focuses on helping you notice and, eventually, change the negative thought patterns associated with OCPD
  • Psychodynamic therapy, which is intended to help you understand your conscious and unconscious thoughts and emotions so you can make healthier choices in your daily life

Medication

There is no specific medication that has been FDA-approved to treat OCPD. However, your doctor might recommend medication to help control some of your OCPD symptoms, especially if you’re also experiencing another condition like depression. This might include medication to control your anxiety and/or antidepressants.

Coping With OCPD

The condition can make relating to others much more difficult for a person with OCPD. Excessive perfectionism and an inability to delegate tasks can create a create deal of stress. Being rigid, having high expectations, and struggling to empathize with others can also affect interpersonal relationships. People with the condition may feel isolated and misunderstood as a result.

In addition to seeking treatment, you can learn some coping strategies for OCPD. These could include:

  • Educating yourself: Learning more about your condition can be an empowering experience. It may help you notice when a symptom of OCPD is causing your behavior, so you can take steps to cope.
  • Managing your stress: Keeping your overall stress levels low is always a good idea. Try developing a plan to reduce stress so you’ll be ready to cope with whatever comes your way.
  • Practicing self-care: If you have OCPD, it can be easy to neglect yourself while you focus on your current project. Consider making self-care a regular part of your day.
  • Trying mindfulness and meditation: Mindfulness can help you spot times when perfectionism is causing anxiety, for example, so you can take steps to calm yourself. Meditation pairs well with mindfulness, and it’s an effective stress reliever.

Recap

An accurate diagnosis can help ensure you get the most appropriate treatment, which may include a combination of psychotherapy and medication. Coping strategies such as lowering your stress and learning more about your condition can also be helpful for managing your symptoms.

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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By Owen Kelly, PhD

Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders.


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