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If you have concerns about your baby’s behavior, you might be wondering if your baby is showing signs of attention deficit disorder (ADHD). This might be a particular concern for you if you have ADHD yourself, your other children do, or if the condition runs in your family.

Your concerns are valid, but it’s important to remember that ADHD cannot be formally diagnosed until your child is 4 years old.

There is a small amount of research that suggests babies may also show signs of ADHD, but the disorder cannot be treated until the child is older.

Here’s what to know about ADHD in babies, including signs and symptoms, causes, and how and when ADHD is diagnosed and treated.

What to Know About ADHD in Babies

ADHD is a behavioral condition that is characterized by hyperactivity, impulsiveness, and an inability to concentrate or pay attention. It’s common in childhood and can impact school performance, relationships, and day-to-day functioning. Between 4% and 12% of children have ADHD and its two times as likely to be seen in boys than girls.

However, a 2019 research paper published in European Child & Adolescent Psychiatry found that signs of ADHD can be seen as early as infancy. Signs of ADHD can also be seen during the toddler years, according to the Journal of Clinical Child & Adolescent Psychology.

Signs and Symptoms

Again, ADHD is not usually recognized as a disorder until a child is older, usually age four and up. There are no criteria as of now in terms of signs and symptoms that are present in the baby years to indicate ADHD.

However, there is limited research showing that certain characteristics in babies may indicate an ADHD diagnosis in the future. For example:

• You may notice that your baby has a more challenging temperament
• Your baby may show signs of a language delay, especially between 9 and 18 months of age
• Your baby may show signs of motor delays between the ages of 9 and 18 months
• You may find yourself describing your baby as “difficult,” fussy, or a “handful”

As your baby gets closer to their toddler years, there may be additional signs of possible ADHD:

• You may notice that your toddler has trouble concentrating and focusing
• You may notice that your toddler can’t stop moving and is hyperactive
• Your may notice that your toddler is more impulsive than other toddlers their age

Causes and Risk Factors

ADHD doesn’t just have one cause. Usually it’s a multitude of factors at once that cause a child to have ADHD. According to the Academy of American Pediatrics (AAP), some of these causes may include:

Genetics

ADHD often runs in families, so genetics may be at play. For example, if your child has ADHD, there’s a 25% chance that one of their parents does as well. If one sibling has it, it’s likely that another sibling has it too.

Brain Function

Different areas of the brain control our ability to pay attention and focus. People with ADHD may exhibit lower levels of function in these areas of the brain.

Head Injuries

If your child had a significant head injury, this may contribute to their ADHD diagnosis.

Prenatal Environment and Prematurity

What happens during pregnancy and childbirth can increase your child’s risk for ADHD. Birthing parents who drink alcohol or smoke are more likely to have a child with ADHD. Babies born prematurely have an increased risk of developing the condition.

Lead and Other Toxins

In rare cases, your child’s exposure to toxins in their environment—most notably lead exposure—can increase their risk of having ADHD. According to the AAP, food allergies, food dyes, and sugar do not increase the risk of ADHD.

Diagnosis

Your baby will not be diagnosed with ADHD, even if you see possible signs. First of all, babies change and develop quite a bit in those first few years, so signs like fussiness, crying excessively, or any other troubling behaviors, may diminish as time goes on.

Although your baby can’t be diagnosed with ADHD yet, you should still bring up any concerns that you have about your baby’s symptoms with your pediatrician so that you can both stay on top of what is going on, and continue to monitor for ADHD signs as your baby gets older.

In order to be diagnosed with ADHD, your child will be evaluated by their pediatrician or a child psychologist. There are certain criteria your child must meet to be diagnosed:

• If your child is between the ages of 4 and 17, they must exhibit at least 6 signs of ADHD as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Signs include specific symptoms of impulsivity, inattention, and hyperactivity
• These symptoms must be present in at least two settings, which may include school, home, and during social activities
• Symptoms must have lasted more than 6 months
• Symptoms must cause significant disruptions to your child’s life

Treatment

Infants may be monitored for ADHD, but they can’t be diagnosed or treated. If your child eventually is diagnosed with ADHD, a treatment plan will be devised by your child’s care team.

Once a child has been diagnosed, common treatments for ADHD in children include:

• Support for parents so that they can create an environment and structure that supports their child’s needs
• Correct placement in academic settings so that a child’s needs are met
• Psychostimulant medications (e.g., Ritalin, Adderall, and Dexedrine), are highly effective at treating ADHD

Antidepressants can help relieve symptoms of depression and other mental health conditions, but they can also have side effects. Nightmares or other changes in dreaming are one possible effect you might notice after you start taking an antidepressant.

While more research is needed to understand precisely why this happens, being aware of this potential effect can help you feel more prepared if you are baffled by your dreams or nightmares.

How Antidepressants Affect Dreams

If you have clinical depression, you’re probably familiar with the wee hours of the morning. Depression is known to cause sleep disturbances such as insomnia, early morning awakenings, and bad dreams or nightmares. In fact, it has been shown to alter the part of sleep associated with rapid eye movements called REM sleep, where dreaming occurs.

Specifically, depression decreases the time it takes to enter REM sleep (called REM sleep latency) and increases the frequency of rapid eye movements during sleep (called REM sleep density). In conjunction with these changes in REM sleep, people with depression report having more negative or bad dreams.

Research has shown that antidepressants may induce different dream emotions, which can lead to both pleasant dreams and nightmares. Antidepressants can also influence how often you dream and decrease your recall of dreams. This lines up with what patients tend to report about their sleep while on antidepressants. 

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Studying the Impact of Antidepressants

In a 2013 report published in Sleep Medicine Reviews, Gotthard Tribl and his research team completed a systematic review that examined the impact of antidepressants on dream content in both depressed and non-depressed individuals.

The studies compared dream content across a spectrum of different antidepressants as well as making comparisons between the dream content of those taking or not taking an antidepressant. A variety of methods were used to record dream content, including:

• Morning dream diaries
• Immediate verbal reports upon forced awakening during REM sleep
• Questionnaires designed to collect information about dream content as well as the frequency of nightmares

The Class of Antidepressant Matters 

The evidence indicates that different types of antidepressants can play a role in the impact on dreams.

Tricyclic Antidepressants

Tricyclic antidepressants (TCAs) are older antidepressants that inhibit the reuptake of serotonin and norepinephrine. They include such medications as:

• Anafranil (clomipramine)
• Ascendin (amoxapine)
• Elavil (amitriptyline)
• Norpramin (desipramine)
• Pamelor (nortriptyline)
• Sinequan (doxepin)
• Surmontil (trimipramine)
• Tofranil (imipramine)
• Vivactil (protriptyline)

Researchers have found that taking antidepressants tends to make both depressed and non-depressed individuals remember their dreams less often. This effect was most prominent for people taking tricyclic antidepressants. On the other hand, tricyclics tended to produce more positive or pleasant dreams.

SSRI and SNRI Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) increase the amount of serotonin in the brain, and serotonin-norepinephrine reuptake inhibitors increase the amount of serotonin and norepinephrine in the brain.

Examples of SSRIs include:

Research suggests that SSRIs are less likely to interfere with the ability to recall dreams. One case report found that the SSRI Viibryd (vilazodone) led to intense and frightening nightmares in one patient after three doses.

Antidepressants belonging to the SNRI class, or serotonin-norepinephrine reuptake inhibitors, have also been shown to intensify dreams and increase how often people reported having nightmares. SNRIs include such medications as:

Other Medications

In addition to antidepressants, other types of medication that are sometimes prescribed to treat mental health conditions are also linked to nightmares and other changes in dreams. 

Monoamine oxidase inhibitors (MAOIs) block the breakdown of neurotransmitters, including serotonin, norepinephrine, and dopamine. One MAOI called Nardil (phenelzine) has also been shown to increase dream recall.

Beta-blockers are used to treat high blood pressure and heart failure, but they are also sometimes prescribed to treat anxiety. However, research suggests that they can also impair sleep and may increase the risk of having nightmares.

More Research Is Needed

Researchers have noted, however, that little attention has been paid to dream recall and content. More studies are needed to characterize how antidepressants affect dreaming.

The effect on dreams, including the increased likelihood of nightmares, may affect patient preferences regarding medication. It may also affect recommendations for which antidepressant best suits each individual.

Final Thoughts

Nightmares and changes in dreaming are not frequently discussed side effects of antidepressants. However, being aware that they may occur can help you be more aware of what you can expect when you begin taking an antidepressant medication.

Talk to your doctor or therapist if you are concerned about any changes in sleep or other side effects that you might be experiencing due to your antidepressant.

Prenatal development is the process that takes place between conception and birth and lays the foundation for later growth and psychological development. This period is divided into three key stages: the germinal stages (weeks 0-2), the embryonic stage (weeks 3-8), and the fetal stage (from 9 weeks until birth). During this time, the brain and body undergo rapid, crucial changes that set the stage for life after birth.

Overview of Prenatal Development

The three stages of prenatal development are marked by rapid changes in physical and neurological development. These early stages lay the foundations for the baby’s brain development, growth, and health after birth.

Important fetal milestones at each of the prenatal development stages include:

1. Germinal stage: The division of cells and implantation of the blastocyst
2. Embryonic stage: The development of the neural tube and organs
3. Fetal stage: Continued growth of organs and physical development in preparation for birth

The first 13 weeks of pregnancy are considered the most critical in prenatal development. It is during this period that the embryo forms organs. It is also the period when most miscarriages occur.

1. Germinal Stage (Weeks 0-2)

The germinal stage begins at conception when the sperm and egg cell unite in one of the two fallopian tubes. The fertilized egg is called a zygote. Just a few hours after conception, the single-celled zygote begins making a journey down the fallopian tube to the uterus.

Cell Division

Cell division begins approximately 24 to 36 hours after conception. Through the process of mitosis, the zygote first divides into two cells, then into four, eight, sixteen, and so on.

Cell Differentiation

Once the zygote reaches eight cells, the cells begin to differentiate and take on certain characteristics that will determine the type of cells they will eventually become. As the cells multiply, they will also separate into two distinctive masses: The outer cells will eventually become the placenta, while the inner cells form the embryo.

Blastocyst Development

Cell division continues at a rapid rate during the approximately week-long journey from the fallopian tube to the uterus wall. The cells develop into what is known as a blastocyst. The blastocyst is made up of three layers, each of which develops into different structures in the body.

1. Ectoderm: Skin and nervous system
2. Endoderm: Digestive and respiratory systems
3. Mesoderm: Muscle and skeletal systems

Implantation

Finally, the blastocyst arrives at the uterus and attaches to the uterine wall, a process known as implantation. Implantation occurs when the cells nestle into the uterine lining and rupture tiny blood vessels. The connective web of blood vessels and membranes that form between them will provide nourishment for the developing being for the next nine months.

However, it is important to recognize that implantation is not always an automatic and sure-fire process.

When implantation is successful, hormonal changes halt the normal menstrual cycle and cause a whole host of physical changes.

2. Embryonic Stage (Weeks 3-8)

At this point, the mass of cells is now known as an embryo. The beginning of the third week after conception marks the start of the embryonic period, a time when the mass of cells becomes distinct as a human embryo.

Formation of the Neural Tube

The embryonic stage plays an important role in the development of the brain.  Approximately four weeks after conception, the neural tube forms. This tube will later develop into the central nervous system, including the spinal cord and brain.

The neural tube begins to form along with an area known as the neural plate. The earliest signs of neural tube development are the emergence of two ridges that form along each side of the neural plate.

Over the next few days, more ridges form and fold inward until a hollow tube is formed. Once this tube is fully formed, cells begin to form near the center. The tube begins to close, and brain vesicles form. These vesicles will eventually develop into parts of the brain, including the structures of the forebrain, midbrain, and hindbrain.​

Other Basic Structures Start to Form

Around the fourth week, the head begins to form, quickly followed by the eyes, nose, ears, and mouth. The blood vessel that will become the heart starts to pulse. During the fifth week, buds that will form the arms and legs appear.

By the eighth week of development, the embryo has all of the basic organs and parts except those of the sex organs. At this point, the embryo weighs just 1 gram and is about 1 inch long.

By the end of the embryonic period, the basic structures of the brain and central nervous system have been established. At this point, the basic structure of the peripheral nervous system is also defined.

As neurons form, they migrate to different areas of the brain. Once they have reached the correct location, they begin to form connections with other neural cells, establishing rudimentary neural networks.

3. Fetal Stage (Weeks 9-40)

Once cell differentiation is mostly complete, the embryo enters the next stage and becomes known as a fetus. The fetal period of prenatal development marks more important changes in the brain. This period of development begins during the ninth week and lasts until birth. This stage is marked by amazing change and growth.

Nervous System Develoment

The early body systems and structures established in the embryonic stage continue to develop. The neural tube develops into the brain and spinal cord, and neurons continue to form. Once these neurons have formed, they begin to migrate to their correct locations. Synapses, or the connections between neurons, also begin to develop.

Between the ninth and twelfth week of gestation (at the earliest), reflexes begin to emerge. The fetus begins to make reflexive motions with its arms and legs.

Differentiation of Sex Organs

During the third month of gestation, the sex organs begin to differentiate. By the end of the month, all parts of the body will be formed. At this point, the fetus weighs around 3 ounces. The fetus continues to grow in both weight and length, although the majority of the physical growth occurs in the later stages of pregnancy.

The end of the third month also marks the end of the first trimester of pregnancy.

Second and Third Trimester Growth

During the second trimester, or months four through six, the heartbeat grows stronger, and other body systems develop further. Fingernails, hair, eyelashes, and toenails form. Perhaps most noticeably, the fetus increases about six times in size.

So, what’s going on inside the brain during this important period of prenatal development? The brain and central nervous system also become more responsive during the second trimester. Around 28 weeks, the brain starts to mature faster, with an activity that greatly resembles that of a sleeping newborn.

During the period from seven months until birth, the fetus continues to develop, put on weight, and prepare for life outside the womb. The lungs begin to expand and contract, preparing the muscles for breathing.

What Happens After Prenatal Development

Brain development does not end at birth. A considerable amount takes place postnatally, including growing in size and volume while changing in structure. The brain quadruples in size between birth and preschool.

As children learn and have new experiences, some networks in the brain are strengthened while other connections are pruned. Early experiences in childhood can have a powerful effect on brain development, which can impact cognitive, emotional, and social functioning.

Self-determination theory is a psychological framework suggesting that people feel more motivated when they can make their own choices. The theory suggests that motivation, well-being, and personality are shaped by three innate, universal psychological needs: autonomy, competence, and relatedness.

When these needs are met, people experience a stronger sense of intrinsic motivation and engagement. However, motivation and well-being can suffer if these needs are neglected. First introduced by psychologists Edward Deci and Richard Ryan, self-determination theory also highlights the differences between intrinsic motivation (which is internal and driven by values and interests) and extrinsic motivation (which is controlled by external pressures).

3 Psychological Needs in Self-Determination Theory

According to self-determination theory, people need to feel the following to achieve psychological growth:

• Autonomy: People need to feel in control of their own behaviors and goals. This sense of being able to take direct action that will result in real change plays a significant part in helping people feel self-determined.
• Competence: People need to master tasks and learn different skills. When people feel they have the skills required for success, they are more likely to take actions to help them achieve their goals.
• Connection or relatedness: Another essential part of self-determination is the ability to experience a sense of belonging and attachment to other people.

Basic Assumptions of Self-Determination

Self-determination theory makes two key assumptions:

• The need for growth drives behavior. The first assumption of self-determination theory is that people actively strive for growth. To develop a cohesive sense of self, people need to gain mastery over challenges and take in new experiences.
• Autonomous motivation is important. While people are often motivated to act by external rewards such as money, prizes, and acclaim (known as extrinsic motivation), self-determination theory focuses primarily on internal sources of motivation, such as a need to gain knowledge or independence (intrinsic motivation).

Types of Motivation in Self-Determination Theory

Self-determination theory suggests that motivation exists on a spectrum, ranging from behaviors controlled by outside forces to those directed by personal choice.

• Extrinsic motivation is a type of motivation that comes from outside forces. This can include external rewards, recognition, or a desire to avoid negative consequences. Sometimes, extrinsic motivation can be more controlled and involve things like pressure and obligation. In other cases, people can internalize it. Adopting external goals and values as their own can deepen their commitment and sense of personal choice.
• Intrinsic motivation is the most self-determined form of motivation. It involves engaging in an activity because it is enjoyable, interesting, or meaningful. This type of motivation is associated with greater well-being, persistence, and creativity.

The more people experience autonomy, competence, and relatedness, the more likely they are to experience intrinsic motivation.

Self-Determined vs. Non-Self-Determined Behaviors

Rather than thinking of motivation as being driven by extrinsic or intrinsic rewards, viewing it as a continuum between self-determined and non-self-determined behaviors is often helpful.

• Self-determined behaviors: On one end of the continuum are purely self-determined behaviors that tend to be intrinsically driven and done for the enjoyment of, interest in, and inherent satisfaction for the action itself.
• Non-self-determined behaviors: On the other end are non-self-determined behaviors, which are performed only because they must be done. There is a complete lack of control on this extreme end of the scale.

However, it’s important to remember that behaviors are often driven by both extrinsic and intrinsic factors to varying degrees. If you are training to compete in a marathon, for example, you might be extrinsically motivated by a desire to gain approval from others. At the same time, you may also be intrinsically motivated by the satisfaction you gain from the activity itself. Typically, behaviors tend to lie in the middle of the continuum.

There is also often a varying amount of external motivation, which can fuel the degree of internal motivation. People may engage in actions because they feel they have some level of personal control, and the behaviors ultimately align with something important for their self-concept.

Applications for Self-Determination Theory

The concept of self-determination has been applied to a wide variety of areas, including education, work, parenting, exercise, and health. Research suggests that having high self-determination can foster success in many different domains of life.

Workplace

When people are more satisfied with their jobs, they are more likely to work harder and enjoy their work more. Research has shown that people with self-determination feel more satisfied at work while playing a key role in that organization’s success.

How can employers build self-determination in their workers?

• By allowing team members to take an active role
• Not overusing extrinsic rewards since this can undercut intrinsic motivation, a phenomenon known as the overjustification effect
• Offering employees greater responsibilities
• Offering support and encouragement
• Providing employees with meaningful feedback

Competition

Fostering a sense of self-determination can motivate people to excel in competitive settings, such as sports and athletics. Some suggest that it works, at least in part, by increasing a person’s level of mental toughness.

Athletes who feel capable of achieving their goals and overcoming challenges are often driven to perform better. Excelling allows them to gain a sense of competence and build mastery in skills that are enjoyable and important to them.

Social Settings

Self-determination can also play an important role in social relationships. For instance, when members of a group feel supported in their needs for autonomy, relatedness, and competence, they are more likely to develop a positive social identity within the group.

In other words, belongingness fosters greater self-determination and increases people’s likelihood of contributing meaningfully to the group.

To forge close, affectionate relationships with others that support a strong sense of self-determination:

Education

Self-determined students are more likely to feel motivated to achieve. They also tend to feel greater levels of competence and satisfaction. Educators can help students foster a sense of self-determination and intrinsic motivation by:

• Providing unexpected positive feedback when students perform well, which helps improve their feelings of competence
• Avoiding excessive external rewards for actions students already enjoy, which helps improve their internal motivation
• Fostering autonomy by giving students choices about how to complete tasks
• Offering resources to help students succeed in order to build greater competence

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What Shapes a Person’s Sense of Self-Determination?

It’s important to realize that the psychological growth described by self-determination theory does not happen automatically. While people might be oriented toward such growth, it requires continual sustenance.

Sometimes people may be more active about pursuing growth. In other cases, they take a more passive role. Understanding what causes people to take action is a big part of understanding the motivation puzzle.

Ryan and Deci have suggested that the tendency to be either proactive or passive is largely influenced by the social conditions in which we are raised. Social support is key. Our relationships and interactions with others can foster or thwart well-being and personal growth.

Other factors that also help or hinder the three elements needed for growth include:

• Extrinsic motivators can sometimes lower self-determination. According to Deci, giving people extrinsic rewards for intrinsically motivated behavior can undermine autonomy, a phenomenon known as the overjustification effect. As the behavior becomes increasingly controlled by external rewards, people begin to feel less in control of their behavior or their intrinsic motivation diminishes.
• Positive feedback can also boost self-determination. Deci suggests offering unexpected positive encouragement and feedback on a person’s task performance to increase intrinsic motivation. This feedback occurs spontaneously, feels authentic, and helps people feel more confident about their performance. Such feedback helps people feel more competent, a key need for personal growth.

Traits of Self-Determined People

If you are interested in strengthening your self-determination, it is helpful to think about what a highly self-determined individual might look like. People high in self-determination tend to:

• Believe that they have control over their own lives. Self-determined people have an internal locus of control and feel that their behaviors will have an influence on outcomes. When confronted with challenges, they feel that they can overcome them through diligence, good choices, and hard work.
• Have high self-motivation. Someone with high self-determination doesn’t rely on external rewards or punishments to motivate them to take action. Instead, they engage in behaviors because they are motivated intrinsically. They have an internal desire to set goals and work toward them.
• Base their actions on their own goals and behaviors. In other words, people with self-motivation intentionally engage in actions that they know will bring them closer to their goals.
• Take responsibility for their behaviors. Highly self-determined people take credit for their success, but they also accept the blame for their failures. They know they are responsible for their actions and don’t shift blame elsewhere.

How Self-Determination Affects Well-Being

Self-determination theory grew out of the work of psychologists Edward Deci and Richard Ryan, who first introduced their ideas in their 1985 book “Self-Determination and Intrinsic Motivation in Human Behavior.”

Self-determination theory has significant implications for health, behavior change, and overall well-being. When people feel like they have control over their own choices, they are more likely to feel motivated, persist in pursuing their goals, and feel satisfied with their efforts.

• Higher motivation to change: People are more likely to take action when they feel like their choices and efforts impact the outcome.
• Healthier behaviors: Supporting autonomy and competence can help improve healthy behaviors, such as sticking with an exercise plan or dietary change.
• Greater well-being: Meeting the needs for autonomy, relatedness, and competence can improve emotional health and resilience.
• Increased inclusivity: Promoting self-determination is a best practice when supporting people with intellectual or developmental disabilities. It empowers people to make choices about their own lives.
• Lasting behavior change: External rewards can lead to short-term changes, but intrinsic motivation is more likely to result in sustained, consistent, self-directed effort.

Examples of Self-Determination

To understand self-determination behavior, it can be helpful to look at some examples of what might happen in a situation where a person is highly self-determined vs. poorly self-determined:

• High self-determination: Imagine a person who fails to complete an important project at work. If this person is high in self-determination, they will admit their fault, believe that they can do something to fix the problem, and take action to correct the mistake.
• Poor self-determination: If that same person were low in self-determination, they might instead look for other things that they can blame. They might make excuses, assign blame elsewhere, or refuse to admit their own role in not completing the project on time.

How to Improve Your Self-Determination

Self-determination can change based on our experiences and environments. If you want to be more self-determined, you can take a few steps to improve your self-determination skills.

• Improve your self-awareness: Self-awareness is associated with self-determination and can even help prepare you to make more purposeful decisions. Meditation, seeking regular feedback, and writing down your thoughts and feelings are all ways to improve self-awareness.
• Engage in self-regulation: Developing a higher level of self-determination also involves working on self-regulation skills. Strategies that can help you better regulate yourself include being more mindful of how you feel mentally and physically and practicing cognitive reframing to regulate your emotional responses better.
• Find social support: Strong social relationships can foster motivation and well-being. Seek people who make you feel welcome and cared for. This may be a family member or friend, or it could be a member of your church, a counselor, or anyone else who provides a sense of support and belonging.
• Gain mastery: Becoming skilled in areas that are important to you can help build your sense of self-determination. Whether you have a strong interest in a hobby, sport, academic subject, or another area, learning as much as you can about it and improving your skills can help you feel more competent.

We’ve all had those moments when we feel overwhelmed with intense emotions, but instead of letting them out, we bottle them up and shove them to the back of our minds. Keeping our emotions close to our chests can often feel safer, but it isn’t always the healthiest way to move through life. It might seem like you’re being strong or avoiding conflict, but bottling up your emotions can lead to even bigger problems down the line.

Consider those times when you’ve smiled through your sadness, only to burst into tears when someone makes a thoughtless comment. Or when you’ve swallowed down your irritation only to explode with anger over a *minor* inconvenience.

Here’s the thing: Bottling up our emotions prevents us from discussing our needs (which can turn into a cyclical issue) and prevents us from truly connecting with others. Over the long term, it eventually backfires, often in unexpected ways, which can seriously damage mental *and* physical health.

Why We Tend to Bottle Up Our Emotions

There are so many scenarios in which we feel compelled to suppress our feelings. For example, we may just want to get through the day, we tell ourselves we’ll deal with the emotion later, we think the feeling isn’t worth exploring, or we try to conceal our feelings in order to make a relationship “work.”

“The reasons we sometimes—or most times—bottle up our emotions can vary, but they all seem to stem from a fear of vulnerability. Out of this fear, we react through self-protective emotional measures,” says Dr. Colleen Mullen, PsyD, LMFT.

She says that some people learn, as they grow up, that expressing their emotions isn’t safe. There are different ways this can play itself out in childhood.

For some, the parent is dismissive or minimizing of their emotions, while for others, the parent is scary in their own expression of emotions or threatening to them. For others, it can be an early awareness that the parent is overwhelmed and doesn’t respond well if the child expresses their needs or feelings.

“Those children can grow up to be the adult who becomes stifled emotionally,” Dr. Mullen says. “The stifling, or avoidance, of emotional expression ends up feeling like a fear of being told ‘no,’ abandonment, or being judged negatively.”

Why Hiding Our Feelings Can Often Backfire

Though bottling up our emotions can feel like a good plan in the short term, doing so can adversely affect us in the following ways: 

Puts Strain on Our Mental Health

Chronic dismissal of our own feelings can ultimately impact our self-confidence. Over time, we may feel like nobody cares about our needs or desires and that our opinion or voice doesn’t matter.

It can also cause us to feel stressed, depressed, or anxious. Those feelings continue to fester and grow even when they aren’t expressed. In some cases, we may even feel deeply angry or rageful and develop feelings of resentment toward others.

Compromises Our Physical Health

“There is some evidence that bottling up your emotions can lead to physical stress on the body,” says Dr. Mullen. “The stress caused to the body can lead to increased diabetes and heart disease risks. Other effects can be memory difficulties.”

Bottling up emotions can create a type of chronic stress. When your mind and body are subjected to this type of stress for long periods, you may experience significant health effects such as muscle pain, reduced immunity, gastrointestinal problems, and cardiovascular disease.

Impedes Our Social Relationships

Nourishing social relationships are vital to our overall well-being. After all, we are social creatures at our core. When we don’t adequately express ourselves, our relationships cannot grow in meaningful ways.

“Human to human contact can help balance our nervous system and allows for a broader perspective, protecting us from digressing into loops of fear and false beliefs,” says Shari Foos, MA, MFT, MS.

Research has shown that people who suppress emotions are more likely to avoid close relationships. They are also less satisfied with life and more likely to experience symptoms of depression.

Signs You’re Bottling Emotions

While in some cases we consciously push down our feelings, it’s common to do so without even realizing it. Some signs you’re not wholly expressing your emotions include:

• It seems like other people don’t “get you.”
• You’re not getting what you want out of time spent with others.
• You often experience somatic symptoms, such as an upset stomach or digestive issues, headaches, racing heart, and tension.
• You experience growing anger and frustration with the world and others.
• You develop feelings of resentment toward others.

If you think someone else might be bottling up their emotions, there are some things to look out for, as well.

“Signs that someone is bottling up emotions can be detected in choice words, tone, and body language. Some individuals may also unconsciously fold their bodies inward, wring their hands, tap their fingers or feet, dart their eyes, or shake their heads,” says Foos.

She adds, “Their response to being asked something as basic as, ‘tell me about yourself,’ might range from a simple ‘I don’t know,’ to an attempt to change the subject, shut down the conversation, or even leaving the room.” 

How to Get Better at Expressing Yourself

Expressing our emotions doesn’t always come naturally. Rather, it’s something that takes practice and a dedicated to honoring ourselves. Over time, we can develop the skillset to process and express our feelings.

It sounds simple enough, but this will take practice. Start small and focus on positive feelings, and over time you’ll build that muscle.

It might mean saying things like:

• “I felt really loved when you cooked dinner the other night.”
• “I’m hoping you can help me out on Saturday with the project.”
• “I want to make sure you understand where I am coming from.”
• “I feel happy when we do things like this together.”

From there, you can graduate to expressing neutral or disappointed feelings. Some examples might include:

• “Sometimes I feel like you don’t hear me.”
• “I’m really disappointed that you are not going to help me on Saturday.”
• “I felt sad when you forgot about XYZ.”
• “I’m frustrated that I need to bring this topic up again.”

The tendency to conceal our emotions is often a deeply ingrained habit we’ve developed over time. It requires real diligence to break the cycle and to begin expressing ourselves to others. Though doing so might feel uncomfortable, dangerous, or difficult, the reward is worth the effort.

If you are struggling to process and deal with your emotions, don’t be afraid to reach out to a mental health professional. They can help you better understand your feelings, practice healthy ways of talking about your emotions, and teach effective emotional coping skills.

Bargaining is a natural reaction to grief. Bargaining in grief involves making deals with yourself or God to help yourself feel better. It is one of the primary stages of grief and often occurs alongside other difficult emotions, including denial and anger.

If you’ve lost someone, you would probably be willing to give anything to bring them back. Alternatively, you may wonder whether being a better person or doing something differently could have prevented the loss.

You may even experience these thoughts if you’ve lost something important to you, such as a business, a job, a friendship, a relationship, a physical ability, or a sense of control or independence.

You’re not alone if you feel this way. Many people experience bargaining during their grief process, which is a normal response to loss.

This article explores bargaining as one of the five stages of grief, discusses what bargaining may look like, and suggests some coping strategies that may be helpful.

What Are the Five Stages of Grief?

The five stages of grief is a theory proposed by Dr. Elisabeth Kübler-Ross, a Swiss-born American psychiatrist. The theory, which was published in 1969 in her book, “On Death and Dying,” says that people grieve in five stages, which are:

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

The theory offers us a way to conceptualize the grief process, says Dr. Romanoff. It helps us make sense of something difficult.

According to the U.S. National Library of Medicine, Dr. Kübler-Ross’s theory has helped change the face of medicine because death was a subject many physicians tended to avoid up until then. Dr. Kübler-Ross’s theory became well-known in academic circles and popular culture.

Contemporary Views

However, more recent research shows that the process of grieving may not necessarily follow a set pattern of specific reactions over time. People react to loss in different ways and grief can be messy.

Therefore, Dr. Romanoff explains that a more current interpretation of the theory is that:

• Denial, anger, bargaining, depression, and acceptance are some of the common reactions to loss.
• People may experience these emotions at any time during the grieving process and not necessarily in any particular order.
• Everyone may not necessarily experience all five of these emotions when grieving, as each person tends to have a unique bereavement process.
• Factors such as the severity of and circumstances surrounding the loss, individual differences in personality and temperament, and cultural, spiritual, and religious beliefs can play a role in the person’s grieving process.

What Is Bargaining in Grief?

Bargaining is one of the stages of grief, or one of the experiences you may have if you’re grieving a loss. In this stage, you may find yourself negotiating with yourself, with people around you, with fate, or with a higher power to try and mitigate or undo your loss.

Dr. Romanoff explains that bargaining-type thinking may apply to the past or the present: 

• Bargaining in the present: People may try to make a deal with themselves, or with a higher power for those who are spiritual or religious, under the condition that if they act in a particular way, they might feel better or the situation may improve.
• Bargaining over the past: People may ruminate over ‘what if’ situations and wish to go back and change the past in the hopes of preventing the loss.

Characteristics of the Bargaining Stage of Grief

These are some of the characteristics of the bargaining stage of grief:

• Feeling guilty or ashamed of your thoughts or actions
• Feeling scared, insecure, or anxious
• Ruminating over what could have been
• Holding yourself responsible for the circumstances
• Punishing yourself
• Worrying and overthinking things
• Judging yourself and others
• Making comparisons to others’ circumstances
• Trying to predict the future and assuming the worst
• Wishing or praying for a different outcome
• Thinking or saying “What if…” or “If only I had…” or “If I do this then…”

Examples of Bargaining in Grief

These are some examples of the types of thoughts you may have during the bargaining stage of grief, according to Dr. Romanoff:

• Offering to be a better person, to help others, or to make donations to deal with and manage the pain of the loss.
• Negotiating with fate, a higher power, God, or the universe. 
• Wishing for miracles to negate the loss.
• Bargaining about the past and wondering if the loss wouldn’t have happened if you did certain things differently. For instance, you may think: “If I stopped by his house that night, he would still be here,” or “I gave up on the relationship too quickly; if only I had tried harder, we would still be married.”

When Bargaining in Grief Becomes a Problem

Bargaining is a normal and expected part of grief. However, it can become problematic when it leads to obsessive thinking, excessive rumination, and other feelings that create significant distress.

Complicated grief is a prolonged mourning that keeps you from moving forward and healing after a loss. It is characterized rumination and sorrow that is so intense that it makes it difficult to focus on anything else. Prolonged grief disorder affects about seven percent of bereaved people. 

Coping With the Bargaining Stage of Grief

Dr. Romanoff shares some strategies that can help you cope with the bargaining stage of grief:

Normalize Bargaining in Grief

Bargaining is a way for people to hang on to hope, which is what many people need while they are grieving. Bargaining tends to decrease over time as acceptance of reality starts to sink in.

Give Yourself Time

With time, your pain will likely become more manageable, and the idea of accepting circumstances outside of your control may be more tolerable. For some people, however, grief remains extremely challenging even years after a loss.

Avoid Ruminating Over These Thoughts

A good way to cope during this stage is to try to get perspective and emotional distance from these thoughts, instead of perseverating over them. It can be helpful to share these thoughts with a loved one who can help you rationalize them.

Write Down Your Thoughts and Feelings

It can be a good idea to write down your feelings, wishes, and bargains, and reflect on them so you can become more aware of your true feelings and motives for these thoughts, instead of getting caught up in them.

Shift Your Focus

People are best able to move on from this stage when they decide to shift their focus from what they cannot control to everything they can, as they begin to make changes in their lives that are more productive for them to move forward.

It can even be helpful to start with small things you can control. For example, deep breathing can be beneficial in that it shifts your focus to a very basic thing you can control: your breath.

Get Help If You Need It

If you find yourself caught in a spiral of guilt and blame, or if your grief is overpowering you to the extent that you cannot function even if weeks or months have passed since your loss, it can be helpful to seek treatment from a mental health professional. There are also support groups for grief that you may find helpful.