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The CIWA protocol for alcohol withdrawal is a questionnaire that measures the severity of an individual’s alcohol withdrawal symptoms.

The goal of the CIWA protocol is to minimize the risk of complications and optimize the patient’s recovery. It is also known as the Clinical Institute Withdrawal Assessment for Alcohol scale.

History of the CIWA Protocol for Alcohol Withdrawal

The CIWA protocol was designed to standardize the care of patients with alcohol withdrawal and to improve outcomes. The original CIWA protocol included 30 items, but has since been reduced to include 10 in the revised version (CIWA-Ar).

More recently, the CIWA protocol has been shown to be an effective tool for managing alcohol withdrawal. A study published in Hospital Pharmacy in 2016 found that patients who were managed with the CIWA protocol had a reduced daily dose of diazepam without any apparent safety issues.

What Is the CIWA Protocol for Alcohol Withdrawal Used For?

The CIWA protocol is used to assess and manage the symptoms of alcohol withdrawal. It can be used in both inpatient and outpatient settings. Scores can be used to guide the intensity of treatment.

For example, a patient with a score of 16 or higher may require more intensive treatment—such as IV fluids or medications—than a patient with a score of 7 or lower. In addition to assessing the severity of symptoms, the CIWA protocol can also be used to monitor the patient’s response to treatment.

Below is a list of different uses for the CIWA protocol:

• Inpatient detoxification: The CIWA protocol is often used in patients who are undergoing inpatient detoxification from alcohol. It is used to assess the severity of withdrawal symptoms and to guide the intensity of treatment.
• Outpatient management: The CIWA protocol can also be used in outpatient settings, such as primary care or addiction counseling offices. It can be used to assess the severity of symptoms and to monitor the patient’s response to treatment.
• Emergency department: The CIWA protocol is sometimes used in the emergency department to assess and manage alcohol withdrawal.
• Research: The CIWA protocol is also used in research studies on alcohol withdrawal and its treatment.

How Do You Score the CIWA?

The CIWA protocol items are scored on a scale of 0-7, with higher scores indicating more severe symptoms. The final item regarding orientation to time and place is rated from 0-4. The CIWA score is based on the patient’s self-reported symptoms and observable signs. It takes two minutes to administer the assessment. Below are the total score ranges and their meaning:

• 7 or below: minimal to mild withdrawal
• 8-15: moderate withdrawal
• 16 or more: severe withdrawal (impending delirium tremens)

Below are the categories covered by the 10 items:

• Agitation
• Anxiety
• Auditory disturbances
• Clouding of sensorium
• Headache
• Nausea/vomiting
• Paroxysmal sweats
• Tactile disturbances
• Tremor
• Visual disturbances

The patient is first asked a question regarding the severity of their symptoms for each item where required. Next, the healthcare professional observes the patient for signs of withdrawal and rates the severity of each sign on a scale of 0-7. The total score is then calculated by adding up the scores for all 10 items.

What Are the Treatment Guidelines for the CIWA Protocol?

The treatment guidelines for the CIWA protocol are based on the severity of the patient’s symptoms.

• Mild symptoms: Patients with mild symptoms may be treated with supportive care, such as IV fluids and close monitoring.
• Moderate symptoms: Patients with moderate symptoms may be treated with more intensive interventions, such as IV medications or sedation.
• Severe symptoms: Patients with severe symptoms may require intensive treatment in an inpatient setting, such as ICU care.

Impact of the CIWA Protocol for Alchohol Withdrawal

The CIWA protocol is a widely used tool for the assessment and treatment of alcohol withdrawal. It is simple to use and has been shown to be an effective way to manage the symptoms of withdrawal.

The impact of the protocol has shown to be positive, both in terms of the patient’s symptoms and the overall course of their treatment. Below are some specific examples of the positive impact of the CIWA protocol:

• It can be used to guide the treatment of alcohol withdrawal, ensuring that patients receive the level of care they need.
• It has been shown to be an effective way to manage the symptoms of alcohol withdrawal.
• Implementation can lead to better outcomes for patients with alcohol withdrawal, including reduced need for medication.

Tips for Using the CIWA Protocol

Here are some tips to keep in mind when using the CIWA protocol for alcohol withdrawal:

• Start the CIWA protocol as soon as the patient arrives at the facility.
• Repeat the assessment at regular intervals until the patient’s symptoms are under control.
• Have a trained healthcare professional implement the CIWA protocol.
• Follow the treatment guidelines based on the severity of the patient’s symptoms.

Potential Pitfalls of the Protocol

There are some potential pitfalls to be aware of when using the CIWA protocol for alcohol withdrawal. These include the following:

• Failure to start the CIWA protocol in a timely manner
• Inadequate training resulting in incorrectly scoring the CIWA
• Not repeating the assessment frequently enough
• Not following the treatment guidelines based on the severity of the patient’s symptoms

Communication is vital for healthy relationships. Being able to talk openly and honestly with the people in your life allows you to share, learn, respond, and forge lasting bonds. This is a vital part of any relationship, including those with friends and family, but it can be particularly important in romantic relationships. 

What Kind of Communicator Are You?

Our fast and free communication styles quiz can help give you some insight into how you interact with others and what it could mean for your interpersonal relationships, both at work and at home.

This communication styles quiz was reviewed by Ivy Kwong, LMFT.

Benefits of Communication in Relationships

According to Dr. John Gottman, a clinical psychologist and founder of the Gottman Institute, a couple’s communication pattern can often predict how successful a relationship will be. Good communication can help enhance your relationship in a variety of ways:

Less Rumination

Communication in relationships can minimize rumination. Instead of stewing over negative feelings, good communication allows people to discuss their concerns and resolve them in a more positive, effective way.

Greater Intimacy

Good communication in relationships also fosters intimacy. Forming a close emotional connection with another person requires a mutual give-and-take when it comes to sharing things about yourself and listening to the other person.

This reciprocal self-disclosure means talking about your experiences, beliefs, values, opinions, and expectations. In order to do this, you both need to possess communication skills that foster this connection and allow it to grow and deepen with time. 

Less Conflict

Communication in relationships reduces and resolves conflict. Every relationship is bound to experience conflict from time to time.

Rather than getting caught up in a cycle of misunderstandings, hurt feelings, and emotional strife, you can address your problems and take steps to improve your relationship.

Communication Doesn’t Solve Everything

While the common assumption has long been that if you want to improve your relationship, you should start by improving your communication, some research has suggested that the answer might not be so simple. 

A study published in the Journal of Marriage and Family found that while there is certainly a connection between communication and relationship satisfaction, good communication alone doesn’t definitively predict how happy you’ll be in your relationships.

Another study found that positive communication did not have a strong connection with relationship satisfaction over time. However, couples that reported less negative communication than usual and reported feeling more satisfied with their relationship than they usually did.

So while research suggests that communicating well isn’t a guarantee for a happy relationship, there is plenty of research indicating that good communication skills enhance relationships and well-being in a number of ways.

Effective communication is one way to foster a positive, supportive relationship with your partner.

For example, one study found that when people feel that their partner values them, they are more likely to sleep better. And ultimately, feeling more valued, positive, and happy in your relationships can have a beneficial impact on your overall well-being. 

Signs of Great Communication in Relationships

So what do experts mean when they talk about “good communication?” Are you and your partner both on the same page or are there signs that might indicate a problem in how you relate to one another? 

First, it is important to think about what we mean by communication. On the surface, it involves the words that people use to convey information to one another.

Some of the hallmarks of effective communication in relationships include:

• Active listening: Active listening involves being engaged in the conversation, listening attentively, and reflecting back on what people have said. It also involves asking for clarification when needed and avoiding making judgments. 
• Not personalizing issues: When communicating in relationships, people who are good at it avoid personalizing their partner’s actions. Instead, they focus on the situation and how things can be resolved.
• Using “I feel” statements: I-statements can be helpful in interpersonal conflicts. Instead of saying, “You never clean up after yourself,” try using an I-statement like, “I feel uncomfortable when there is clutter accumulating around the house.”
• Kindness: Kindness is important because it makes people feel cared for and understood.
• Being present: When talking with your partner, it is important to be fully present in the moment. Getting distracted by outside sources–including electronic distractions such as your phone–can lead to a lack of communication and a poor connection.
• Showing acceptance: Healthy communication is about accepting and validating the other person, even if you might not agree with them. When you communicate well with your partner, you’re able to recognize that people have a right to feel their feelings even if those emotions and reactions are different from your own.

Signs of Poor Communication in Relationships

Some signs that your relationship is being negatively affected by communication problems include:

• Assuming that you know what your partner thinks or feels
• Constantly criticizing one another
• Engaging in passive-aggressive behaviors
• Feeling like you can’t really talk to your partner
• Getting defensive when your partner tries to talk to you
• Giving each other the silent treatment
• Having the same arguments over and over without reaching a resolution
• Refusing to compromise or listen to the other person’s perspective
• Stonewalling in order to avoid problems or conversations

It is also important to learn to recognize some of the more subtle signs of poor communication. This can include avoiding arguments for the sake of keeping the peace.

Withholding issues can be another common communication problem in relationships. Instead of having tough conversations with your partner, you might avoid the issue and then end up dumping all of your anger, irritation, worries, or problems on the other people in your life. 

For example, when you don’t tell your partner you are upset, you might end up ranting to your friend about your frustrations. While this might provide you with an emotional outlet, it doesn’t do anything to resolve the problem. And it might result in passive-aggressive actions designed to “punish” your partner for not being able to read your mind.

5 Ways to Improve Communication in Relationships

If you think that poor communication is having a negative impact on your relationship, there are strategies that can help you improve your connection.

Consider Your Attachment Style

Think about how your attachment style might affect your communication patterns. Attachment styles are your characteristic patterns of behavior in relationships. Your early attachment style, which emerges in childhood based on relationships with caregivers, can continue to affect how you behave and respond in adult romantic relationships.

If you have an insecure attachment style, you may be more likely to engage in communication patterns that can be seen as anxious or avoidant. Recognizing how your attachment style affects how you interact with your partner (and how your partner’s style affects how they interact with you) can give you clues into what you might need to work on.

Be Fully Present

In order to make sure that both of you are listening and understanding, minimize distractions and focus on being fully present when you are communicating. This might involve setting aside time each day to really focus on one another and talk about the events of the day and any concerns you may have. 

Limiting your device use at certain times of day, such as during meals or at bedtime, can be a great way to focus on your partner without having your attention pulled in different directions.

Use “I” Statements

Sometimes the way that you talk to each other can play a major role in communication problems. If you are both focusing on arguing facts without talking about feelings, arguments can quickly turn into debates over who is “right” or who gets the last word.

Using this type of statement can help conversations seem less accusatory or blaming and instead help you and your partner focus on the emotions behind some of the issues you are concerned about.

Avoid Negative Communication Patterns

When you are tempted to engage in behavior like ignoring your partner, using passive-aggressive actions, or yelling, consider how your actions will negatively affect your relationship.

It isn’t always easy to change these patterns, since many of them formed in childhood, but becoming more aware of them can help you start to replace these destructive behaviors with healthier, more positive habits.

Focus on Your Relationship

While good communication is important, research suggests that it is just one of many factors that impact the success, duration, and satisfaction in relationships. 

The more satisfied people are in their relationship, the more likely they are to openly talk about their thoughts, feelings, concerns, and problems with one another.

When to Get Help

There are many steps you can take to improve the communication in your relationship on your own, but there may be times that you feel like professional help might be needed. Couples therapy can be a great way to address communication problems that might be holding your relationship back. 

A therapist can help identify unhelpful communication patterns, develop new coping techniques, and practice talking to one another in more effective ways. They can also address any underlying resentments or other mental health issues that might be having a detrimental impact on your relationship.

Always remember that the goal of communicating is to understand one another. It isn’t about sweeping problems under the rug in order to prevent all conflict. Instead, focus on listening to understand and responding with empathy and care. If you and your partner are struggling with communication issues, consider talking to a therapist for advice and tips on how to cope.

When underlying trauma is repeated and ongoing, some mental health professionals make a distinction between post-traumatic stress disorder (PTSD) and its more intense sibling, complex post-traumatic stress disorder—also known as complex PTSD.

Complex PTSD (or C-PTSD) is an anxiety condition that involves many of the same symptoms of PTSD along with other symptoms. First recognized as a condition that affects war veterans, PTSD can be caused by any number of traumatic events, such as a car accident, natural disaster, near-death experience, or other isolated acts of violence or abuse. 

People with C-PTSD and PTSD have an absence of the sense of safety, the past feels like the present.

C-PTSD has gained attention in the years since it was first described in the late 1980s. However, it is important to note that it is not recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR), the tool that mental health professionals use to diagnose mental health conditions.

What’s the Difference Between C-PTSD and PTSD?

Both PTSD and C-PTSD result from the experience of something deeply traumatic and can cause flashbacks, nightmares, and insomnia. Both conditions can also make you feel intensely afraid and unsafe even though the danger has passed. However, despite these similarities, some characteristics differentiate C-PTSD from PTSD according to some experts.

The main difference between the two disorders is the frequency of the trauma. While PTSD is caused by a single traumatic event, C-PTSD is caused by long-lasting trauma that continues or repeats for months, even years (commonly referred to as “complex trauma”).

When it comes to C-PTSD, the harmful effects of oppression and racism can add layers to complex trauma experienced by individuals. This is further compounded if the justice system is involved.

The psychological and developmental impacts of complex trauma early in life are often more severe than a single traumatic experience—so different that many experts believe that the PTSD diagnostic criteria don’t adequately describe the wide-ranging, long-lasting consequences of C-PTSD.

What Does C-PTSD Look Like in Adults?

In addition to all of the core symptoms of PTSD—re-experiencing, avoidance, and hyperarousal—C-PTSD symptoms generally also include:

• Difficulty controlling emotions. It’s common for someone suffering from C-PTSD to lose control over their emotions, which can manifest as explosive anger, persistent sadness, depression, and suicidal thoughts.
• Negative self-view. C-PTSD can cause a person to view themselves in a negative light. They may feel helpless, guilty, or ashamed. They often have a sense of being completely different from other people.
• Difficulty with relationships. Relationships may suffer due to difficulty trusting others and a negative self-view. A person with C-PTSD may avoid relationships or develop unhealthy relationships because that is what they knew in the past.
• Detachment from the trauma. A person may disconnect from themselves (depersonalization) and the world around them (derealization). Some people might even forget their trauma.
• Loss of a system of meanings. This can include losing one’s core beliefs, values, religious faith, or hope in the world and other people.

All of these symptoms can be life-altering and cause significant impairment in personal, family, social, educational, occupational, or other important areas of life.

Diagnosis of C-PTSD

Although the concept of C-PTSD is longstanding, it is not in the fifth edition text revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), and therefore isn’t officially recognized by the American Psychiatric Association (APA).

Although C-PTSD comes with its own set of symptoms, some believe the condition is too similar to PTSD (and other trauma-related conditions) to warrant a separate diagnosis. As a result, the DSM-5-TR lumps symptoms of C-PTSD together with PTSD.

Many mental health professionals do recognize C-PTSD as a separate condition, because the traditional symptoms of PTSD do not fully capture some of the unique characteristics shown in people who experienced repeat trauma.

Because the condition is relatively new and not recognized in the DSM-5-TR, doctors may make a diagnosis of PTSD instead of complex PTSD. Since there is no specific test to determine the difference between PTSD and C-PTSD, you should keep track of the symptoms you have experienced so that you can describe them to your doctor. 

Treatment for the two conditions is similar, but you may want to discuss some of your additional symptoms of complex trauma that your doctor or therapist may also need to address.

C-PTSD also can share signs and symptoms of borderline personality disorder (BPD). Although BPD doesn’t always have its roots in trauma, this is often the case. In fact, some researchers and psychologists advocate for putting BPD under the umbrella of C-PTSD in future editions of the DSM to acknowledge the link to trauma, foster a better understanding of BPD, and help people with BPD face less stigma.

What Causes or Triggers C-PTSD?

C-PTSD is believed to be caused by severe, repetitive abuse over a long period of time. The abuse often occurs at vulnerable times in a person’s life—such as early childhood or adolescence—and can create lifelong challenges.

Traumatic stress can have a number of effects on the brain. Research suggests that trauma is associated with lasting changes in key areas of the brain including the amygdala, hippocampus, and prefrontal cortex.

The types of long-term traumatic events that can cause C-PTSD include:

In these types of events, a victim is under the control of another person and does not have the ability to easily escape.

C-PTSD Treatment

Because the DSM-5-TR does not currently provide specific diagnostic criteria for C-PTSD, it’s possible to be diagnosed with PTSD when C-PTSD may be a more accurate assessment of your symptoms. Despite the complexity and severity of the disorder, C-PTSD can be treated with many of the same strategies as PTSD, including:

Medications

Medications may help reduce symptoms of C-PTSD, such as anxiety or depression. They are especially helpful when used in combination with psychotherapy. Antidepressants are often used to treat complex PTSD, including Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline).

Psychotherapy

Psychotherapy for C-PTSD focuses on identifying traumatic memories and negative thought patterns, replacing them with more realistic and positive ones, and learning to cope more adaptively to the impact of your trauma. “Psychotherapy for C-PTSD and PTSD focuses on somatic modalities to help people process traumatic experiences and teach people tools to manage symptoms,” explains Renteria.

One type of psychotherapy that may be used to treat both PTSD and complex PTSD is known as eye movement desensitization and reprocessing (EMDR). This approach uses eye movements guided by the therapist to process and reframe traumatic memories. Over time, this process is supposed to reduce the negative feelings associated with the traumatic memory.

How Do I Cope With C-PTSD?

Treatments for complex PTSD can take time, so it is important to find ways to manage and cope with the symptoms of the condition. Some strategies that may help you manage your recovery:

• Find support: Like PTSD, complex PTSD often leads people to withdraw from friends and family. However, having a strong social support network is important for mental well-being. When you are feeling overwhelmed, angry, anxious, or fearful, reach out to a trusted friend or family member. 
• Practice mindfulness: Complex PTSD can lead to feelings of stress, anxiety, and depression. Mindfulness is a strategy that can help you become more aware of what you are feeling in the moment and combat feelings of distress. This practice involves learning ways to focus on the present moment. “Grounding exercises can be really helpful for people during flashbacks, episodes of intense emotions, or when they wake up from a nightmare,” notes Renteria.
• Write down your thoughts: Research has found that writing in a journal can be helpful in managing PTSD symptoms and decreases symptoms of flashbacks, intrusive thoughts, and nightmares. In terms of treatment, a journal can also be a great way to track symptoms that you can later discuss with your therapist.

Support groups and self-help books can also be helpful when dealing with complex PTSD. Helpful book titles include “The Body Keeps Score” by Bessel van der Kolk, MD, and “Complex PTSD: From Surviving to Thriving” by Pete Walker.

If you or someone you care about has been exposed to repeated trauma and are struggling to cope, it’s important to seek help from a therapist who is familiar with PTSD. In addition to asking your primary care physician for a referral, there are many online resources that can help you find mental health providers in your area who treat PTSD.

Attention-deficit hyperactivity disorder (ADHD) is most often diagnosed in childhood. It is characterized by hyperactive, impulsive, and inattentive characteristics, but that doesn’t always mean that every child or adult who exhibits these symptoms necessarily has ADHD. In fact, there are many conditions that are sometimes mistaken for ADHD.

If your child seems hyperactive—fidgety, impulsive, and inattentive—don’t automatically assume that they have attention deficit hyperactivity disorder (ADHD). Anxiety, depression, learning disorders, physical health, and many other conditions can cause symptoms that look like ADHD, but aren’t.

Environmental Conditions

Stress or a sudden life change, such as a move, parents’ divorce, a death, financial difficulties, or even a new sibling, can sometimes lead to ADHD-like behaviors.

Likewise, neglect, parental/marital conflict, inconsistent discipline, bullying, abuse, and other stressors can negatively affect a child’s emotional and mental health. This can lead to distraction, inattention, restlessness, hyperactivity, and “acting out” behaviors that can resemble, but have nothing to do with, ADHD.

Sleep Problems

Sleep disturbances can have a profound effect on the ability to focus. Other issues can include:

• Hyperactivity
• Irritability
• Slowed visual, auditory, sensory, and motor reaction times
• Mental slowness
• Impaired learning of information
• Decreased school performance

Insufficient sleep is also linked to increased risk-taking behaviors in teens. This can include things such as smoking, drinking alcohol, and taking drugs.

Mental Health Issues

Anxiety can manifest as restlessness, an inability to concentrate, impulsive reactions, and hyperactive behaviors. This anxiety can make it extremely difficult to sit still and control fidgeting.

Similarly, depression can cause lack of focus, forgetfulness, low motivation, indecisiveness, trouble getting started on and completing tasks, lethargy and sluggishness, disorganization, and sleep difficulties.

The disruptive behaviors and poor impulse control associated with oppositional defiant disorder and conduct disorder also can look like ADHD.

Bipolar Disorder

Bipolar disorder is a serious mental health condition characterized by extreme changes in mood, energy, thoughts, and behaviors. Symptoms of bipolar disorder can include:

• High energy levels
• Excessive talking
• Racing thoughts that make it difficult to concentrate
• Impulsivity
• Risk-taking
• Intrusive behaviors

Such symptoms typically occur during a manic or hypomanic episode. Because of this, it can also be confused with symptoms of ADHD.

Obsessive-Compulsive Disorder

Attention and concentration problems associated with obsessive-compulsive disorder (OCD) may appear to be ADHD-related, but when delving deeper, a clearer picture emerges. Attention problems may be related to overfocusing, and problems in shifting attention may be due to obsessive thinking.

A person with OCD may be slower to start and finish tasks because of the compulsive behaviors and rituals that they must complete first.

Substance Misuse

ADHD has been associated with a risk for substance misuse. A person who is misusing drugs and/or alcohol can also have behavioral symptoms that mimic ADHD. Such symptoms can include:

• Difficulty concentrating
• Problems with memory
• Restlessness
• Irritability
• Talkativeness
• Sleep problems
• Moodiness
• Academic or work difficulties

Autism

Children and adults on the autism spectrum can have symptoms that resemble ADHD. They may become overexcited, hyperactive, and impulsive in stimulating environments, tend to focus on only those things that interest them, have trouble shifting focus, struggle to understand social cues and boundaries, and experience social impairments.

High motor activity and problems with inhibition are common characteristics of both tic disorders and ADHD. Fidgeting, motor movements, and random noises may hint at ADHD, but tics are defined by rapid, repeated, identical movements of the face or shoulders or vocal sounds or phrases.

Learning Issues and Processing Problems

Similar to a person with ADHD, someone with a learning disability may struggle with issues of attention, processing, organizing, remembering and learning. Learning disabilities in reading, written language, and mathematics interfere with academic functioning, as can speech and language impairments and auditory and visual processing disorders.

A child who is gifted academically but not challenged in the classroom might display ADHD-like behaviors out of boredom, becoming inattentive, impatient, and disruptive. The same issues can also result from a poor educational fit, a classroom with a pervasive negative climate, a non-stimulating curriculum, or ineffective management.

Medical Conditions

Certain medical conditions can cause problems with attention, irritability, impulsivity, or hyperactivity. Examples include:

• Seizures
• Thyroid disease
• Allergies
• Iron-deficiency anemia
• Chronic ear infections
• Hearing/vision impairments

Even certain medications can trigger ADHD-like behavior.

The Importance of Testing and Accurate Diagnosis

ADHD and many conditions like it improve in many people with early intervention. This makes accurate, thorough testing and evaluation using an empirically validated approach so important.

During the evaluation process, the healthcare provider must rule out alternative explanations that might better account for ADHD-like behavior before arriving at an ADHD diagnosis.

To complicate things further, an estimated 77% of children with ADHD have comorbid conditions such as anxiety, depression, behavior issues, learning disabilities, sleep problems, and substance abuse. All of this must be accounted for in your child’s treatment plan, which must be tailored to their needs and diagnosis.

Compulsive shopping disorder is characterized by symptoms such as excessive shopping behaviors and thoughts about shopping. Such thoughts and behavior generate considerable distress and impairment. It can also seriously affect a person’s financial well-being and social relationships.

The American Psychiatric Association (APA) does not recognize compulsive shopping as its own mental disorder. Because of this, there are no consistent criteria for diagnosis. Additionally, researchers debate whether compulsive shopping should be classified as an addictive disorder, obsessive-compulsive disorder, mood-regulation difficulty, or impulse-control disorder.

Characteristics of Compulsive Shopping Disorder

People who have compulsive shopping disorder (sometimes called compulsive buying disorder) are often struck with an irresistible and overpowering urge to purchase goods in spite of negative consequences.

Characteristics of compulsive shopping disorder include:

• Difficulty resisting the purchase of unneeded items
• Financial difficulties because of uncontrolled shopping
• Preoccupation with shopping for unneeded items
• Problems at work, school, or home because of uncontrolled shopping
• Spending a great deal of time researching coveted items and/or shopping for unneeded items

Lastly, to be considered compulsive buying disorder, the compulsive shopping behaviors must not be associated with another mental health condition, such as periods of hypomania or mania with bipolar disorder.

Proposed diagnostic criteria for this condition include:

• Intrusive thoughts and urgest for shopping and buying
• Loss of control over shopping/buying
• Excessive purchasing without intending to use items
• Buying things to regulate internal states
• Negative consequences caused by excessive shopping/buying
• Emotional symptoms when buying/spending is stopped
• Being unable to stop buying/spending behaviors despite negative consequences

Many people who compulsively shop do so as a coping mechanism to mask difficult emotions like stress, anxiety, and low self-esteem. But shopping only provides temporary relief from their struggles. Their inability to control their shopping eventually commonly leaves them with an overwhelming sense of guilt and shame.

Prevalence of Compulsive Shopping Disorder

Compulsive shopping disorder is believed to affect about 5% of the U.S. population. Some research also suggests that women are more likely to be diagnosed with compulsive shopping disorder. However, some researchers suggest this difference may be more of a reflection of women being more open to admitting pathological behavior.

The condition is believed to have an onset in the late teens or early 20s and rarely begins after age 30. This age range is right around when many young adults move away from home and establish their first credit accounts.

Related Conditions

Many compulsive shoppers also experience one of the following co-occurring mental health conditions:

Treatment for Compulsive Shopping Disorder

There is some evidence that cognitive behavioral therapy (CBT) may effectively reduce symptoms in many compulsive shoppers by helping people identify the ways in which they use shopping as a coping mechanism and develop healthier coping skills. However, more research is necessary to determine what types of therapy are effective for whom.

In addition, there is also evidence that compulsive shopping disorder responds to treatment with selective serotonin reuptake inhibitors (SSRIs).

Coping With Compulsive Shopping Disorder

If you are struggling with compulsive shopping, you can use many self-help strategies to help you cope with your symptoms.

Develop New Hobbies

Most people who compulsively shop turn to shopping when they’re bored or stressed. If you use shopping as a stress reliever or a form of entertainment, try to find a healthier replacement.

Stick to a List

When you must go into a store, make a list of what you need before you go and challenge yourself to stick to your list.

Enlist a Friend

If sticking to your shopping list and only buying what you need feels impossible, try enlisting a supportive friend to accompany you to the store. Ask your friend to help hold you accountable.

Pay in Cash

Give yourself a cash allowance and put the credit cards away for emergencies only. You’ll be much less likely to go on a compulsive spending binge when you have a limited amount of cash in your wallet and no credit cards immediately at your disposal.

Unsubscribe and Block

Online shopping has made it even easier to shop from anywhere at any time of the day. To curb compulsive online spending, unsubscribe from marketing emails and use an app and browser extension to block or put limits on your access to websites where you most commonly shop.

If Your Loved One Has Compulsive Shopping Disorder

If your loved one is struggling with compulsive shopping, you may not know how to approach them. Their unhealthy shopping habits may be causing a great deal of emotional turmoil and financial stress, leading you to feel frustrated, angry, maybe even sad.

It’s important to discuss your concerns with your loved one. However, before broaching this sensitive issue with them, it may be helpful to work through your own emotions. Consider consulting a therapist on your own first. A therapist can help you make sense of your emotions and give you a better perspective on the issue.

Further Research Needed

There is a lot of debate around how this condition should be classified. Some researchers link compulsive shopping to addictive disorders, grouping it alongside alcohol and drug use disorders and behavioral addictions like gambling addiction. Others have linked it to obsessive-compulsive disorder (OCD). Still, others link it to mood disorders.

With the prevalence of this disorder, as well as the evidence that the number of people affected by it is increasing, more research needs to be done to learn how to more effectively screen and treat people who live with compulsive shopping disorder.

If you and your partner have separated or gotten divorced, it can be difficult to interact with them regularly and maintain a civil relationship. However, you may have to practice and learn how to do so, for the sake of your child or children, to help them grow up with safety, security, and the love and support of both parents.

This is important to help your child adjust because research shows that conflict between co-parents after a divorce or separation can make it much harder for children to cope.

Children often struggle with changes to their family unit and the addition, subtraction, or transition of parental figures can be extremely hard for them, says Sabrina Romanoff, PsyD, a clinical psychologist and professor at Yeshiva University. Modeling a cooperative mutually respectful relationship for them can help improve their long-term development.

If you and your family are in this situation, you’re not alone. The structures of families have changed over the years and families today come in many different shapes and sizes. It is estimated that 40% of children in the United States don’t live with a family of two married, biological parents.

This article explores the types of co-parenting arrangements, what healthy co-parenting looks like, tips for successful co-parenting, and what not to do as a co-parent.

Types of Co-Parenting

Researchers have identified three major types of post-divorce co-parenting relationships:

Conflicted Co-Parenting

In this co-parenting arrangement, the parents have frequent conflicts and poor communication between each other. They may have different schedules, parenting styles, rules, and priorities, and may be unable to reach agreements about their child’s needs or daily routine. 

Cooperative Co-Parenting

In cooperative co-parenting arrangements, both parents work together to make decisions regarding their child’s upbringing. This arrangement involves communicating regularly, sharing information about their child’s needs and progress, and coordinating schedules to ensure that the child spends quality time with both parents.

Parallel Co-Parenting

Parallel co-parenting means both sets of parents operate independently, with little communication, engagement, cooperation, or conflict with each other. 

Their household routines and parenting rules are often different from each other, which can lead to a lack of consistency in the child’s life. Any similarities in rules or routines are often not planned or intentional.

What Does Healthy Co-Parenting Look Like?

Healthy co-parenting involves working out a plan and aligning with your child’s co-parent on factors such as:

• Visitation schedule: Co-parents need to work out a visitation schedule that ensures that both parents get to spend quality time with the child. The schedule should take into account weekdays, weekends, holidays, birthdays, and other special events. Parents should also discuss when and how they can contact the child when the child is with the other parent.
• Daily routine: In order to maintain consistency across households, it can be helpful for co-parents to discuss the child’s nutrition, extracurricular activities, bedtime, wake-time, and screen time among other things.
• Education: Both parents should be aligned on where and how the child will be educated. It’s also important for parents to agree on how to divide responsibilities such as paying the child’s school fees, signing permission slips, supervising homework, attending parent-teacher conferences, and participating in other school-related activities.
• Medical needs: It’s important for co-parents to work out which parent will accompany the child to doctor’s visits and coordinating consent for medical treatments. Both parents should be aware of any medical issues the child has and be equipped to manage any medical emergencies.
• Finances: Co-parents should discuss and arrive at a financial arrangement that keeps the child’s best interests in mind. If the parents have been through a divorce proceeding, the court may mandate that one parent make child support payments.

Tips for Successful Co-Parenting

These are some tips that can help you and your former partner successfully co-parent your child:

• Maintain regular communication: It’s important to maintain regular communication with your child, co-parent, and any other stepparents, grandparents, or other caregivers in the child’s life. It can be helpful to share important news and relevant updates about your child’s development, school, activities, medical issues, and routine with everyone involved.
• Work out a co-parenting plan: Jointly work out a plan that covers the factors listed above, such as visitation schedule, daily routine, education, finances, medical needs, etc.
• Create an arrangement that works for both of you: Work out a co-parenting arrangement that works for you and your former partner. If you live nearby, you can have your child spend alternate days or weeks with each of you. Or, if your jobs are on different schedules, the child can spend mornings with one parent and evenings with another. If you live in different cities, the child may have to spend school days with one parent and holidays with another.
• Discuss changes to the plan: The co-parenting plan may have to evolve based on the child’s needs and parents’ circumstances. Discuss any changes or updates to the plan with all the stakeholders involved. This can help ensure everyone is on the same page.
• Be flexible: There may be times when things don’t go according to plan, despite the best intentions. Keep some room for flexibility in case the other parent is late or cannot pick up the child, the babysitter doesn’t show up on time, school lets out early, or there’s an unexpected emergency. Cooperating with your former partner when you are able to can help gain their cooperation for times when you need their help.
• Respect different parenting styles: Understand that everyone has a different parenting style. Unless your former partner’s parenting style is harming your child, respect them and let them bond with the child on their own terms. Exposure to different parenting approaches can help your child learn how to adapt to different situations and relationships.
• Make room for stepparents: You or your former partner may move on and start seeing other people. When you bring new partners into your child’s life, they may take on the role of stepparents. As long as they care for your child and are respectful of your relationship with your child, try to make room for them in your child’s life, instead of resenting, being hostile towards, or diminishing their presence.
• Keep interactions cordial: There may be times when you have to meet or interact with your former partner or other people in their life, such as their family members or current partners. For instance, while dropping off or picking up the child, at the child’s birthday parties, or at school events. Try to keep interactions respectful and cordial.
• Make the most of the time with your child: Make it a point to spend quality time with your child when they’re with you, especially if you have limited time together. Keep other commitments and distractions to a minimum and plan fun activities to do together. Try to create meaningful rituals that are unique to your relationship with your child.
• Prepare for when your child isn’t with you: It’s natural to experience a sense of loss or loneliness when your child isn’t with you. This feeling may be more pronounced on the weekends or holidays. Try to reframe the sense of loss as a chance to rest and relax instead. Try to schedule activities that you enjoy but may not get to do when your child is around, such as seeing friends, watching movies, planning trips, or doing other things for yourself.

What’s Your Parenting Style

This fast and free parenting styles quiz can help you analyze the methods you’re using to parent your kids and whether or not it may be a good idea to learn some new parenting behaviors:

This parenting style quiz was reviewed by Ivy Kwong, LMFT.

What Not to Do in Co-Parenting

These are some actions to avoid if you’re a co-parent:

• Disrupt your child’s routine: Try to ensure that your child’s routine stays consistent, across different households, caregivers, and occasions. A consistent daily routine can be a source of stability and comfort in the child’s life.
• Undermine your former partner: Avoid undermining your former partner around or directly to your children. Don’t flout their rules or speak disrespectfully about them in front of your child. This can be burdensome and have a long-lasting adverse impact on your child. It is most beneficial to show children a united front and show respect for each other’s decisions. Discuss any issues you have with your former partner privately, when your child is not around.
• Make your child feel guilty about loving their other parent: Even if you and your former partner are not romantically involved anymore, they are still your child’s parent and should have the chance to have a loving relationship with them. Don’t make your child feel guilty about loving them, spending time with them, enjoying their time together, talking to you about them, or wanting to contact them while they’re with you.