What Is a Cult? 10 Warning Signs

Key Takeaways

  • Cults demand intense loyalty to a strict belief system or charismatic leader.
  • People may join cults because they desire a sense of belonging, guidance, or purpose, even though there are high personal costs.
  • Recognizing the signs of a cult and knowing where to get help can protect you or the people you care about.

A cult is a group that centers around a shared devotion to a person, belief, or ideology. These groups often require intense devotion and loyalty and use manipulation and control to enforce and maintain power. Recognizing the signs that make something a cult can help people better recognize when a group crosses the line.

Understanding What Makes Something a Cult

While cults are widely recognized, there isn’t a clear consensus on an exact definition of what constitutes a cult. Many definitions suggest that a cult is an organized group whose purpose is to dominate cult members through psychological manipulation and pressure strategies. Cults are usually headed by a powerful leader who isolates members from the rest of society.

Experts suggest that this coercive control distinguishes these groups, not their connection to specific faiths, religions, or belief systems. 

Such groups demand excessive devotion from members. They utilize unethical and manipulative techniques to persuade and control members. Their primary goal is to advance the group leader’s agenda, even though such goals may harm individuals, families, and communities.

Some individuals who join cults remain lifelong members. Others break free and share how it felt to be brainwashed by a charismatic leader. However, some individuals leave a cult and report that their experience was positive.

Cult Warning Signs to Watch For

Sometimes individuals disagree about whether a group, such as a certain religious group, is actually a cult. Even researchers sometimes can’t agree on what constitutes a cult.

Most people can agree that cults have a leader. And the leader (or group of people who serve as leaders) is responsible for the rules that guide the members.

According to the Cult Education Institute, there are specific warning signs to look out for when considering whether a group might be a cult. Cults are characterized by:

  1. Absolute authoritarianism without accountability
  2. Zero tolerance for criticism or questions
  3. Lack of meaningful financial disclosure regarding the budget
  4. Unreasonable fears about the outside world that often involve evil conspiracies and persecutions
  5. A belief that former followers are always wrong for leaving and there is never a legitimate reason for anyone else to leave
  6. Abuse of members
  7. Records, books, articles, or programs documenting the abuses of the leader or group
  8. Followers feeling that they are never able to be “good enough”
  9. A belief that the leader is right at all times
  10. A belief that the leader is the exclusive means of knowing “truth” or giving validation

Cults are dangerous because they typically rely on deceptive and authoritarian practices to make members dependent on and obedient to the group. Cults often cut members off from other forms of social and financial support and pose both physical and psychological risks to members of the group.

Why People End Up Joining Cults

To those on the outside, it can be difficult to understand why anyone would join a cult. However, researchers have found several reasons why individuals may join.

  • They don’t know they’re joining a cult: Most individuals don’t recognize that the group they’re joining is considered a cult. Individuals who are attracted to groups that are considered cults may have certain vulnerabilities that make them more likely to join, such as anxiety or substance abuse problems.
  • They have unresolved insecurities: Another study found that many cult members experience attachment insecurity prior to joining a cult. Their insecurities may drive them toward a group that promises acceptance.
  • They become isolated: Once people join a group, they’re usually distanced from outside influences. After being separated from the outside world, leaving the group becomes difficult. They often grow dependent on being in the group and develop suspicions of anyone outside the group.
  • They believe they are persecuted: This is why some people suspect that cult members are “brainwashed.” And there is some science behind this idea, as members are often told they’re being persecuted by people outside the group.
  • They are manipulated into joining: The other major theory about why individuals remain in cults is mostly sociological. Cult leaders often promise to reward members in some way. They may tell them they’ll move up the ranks within the cult or convince them that something really good is going to happen to their special group.
  • They are subjected to psychological abuse: Some people believe those involved are more like “victims” rather than “members,” since they are often subjected to psychological manipulation tactics that lure them into making unhealthy decisions—including suicide in some cases.
  • Leaving isn’t easy: Getting out of a cult can be quite difficult. Some members don’t have contact with the outside world, so it can be nearly impossible to get help. Others don’t have the financial resources to find a new place to go.

Why It’s Hard to Study Cults

Studying cults is difficult for a few different reasons. It’s nearly impossible to study active cult members due to their unwillingness to let others into their closed societies. Quite often, they are suspicious of outsiders.

Consequently, cults are usually examined from the perspective of former members. But sometimes, individuals are reluctant to talk about their experiences as cult members. For these reasons and others, it can even be tricky to agree on a solid definition of a cult, especially given many of the stereotypes presented in film, TV, and other media. Not all cults have to be high-profile groups that make headlines.

Examples of Well-Known Cults

Why people become cult leaders is also not well understood. Some experts suggest that most cult leaders tend to be psychopaths. They are often charismatic and use psychological tactics to gain power, social control, and allegiance from their followers. 

There have been many cults that have made the news, quite often for their tragic endings.

Charles Manson

In the 1960s, Charles Manson assembled a group of young people and referred to them as his family. Manson expressed his ideas about an imminent race war, and he told his followers he wanted them to go on a killing spree.

One night in 1969, several followers murdered five people, including actress Sharon Tate. Manson was later convicted of first-degree murder.

Jim Jones

Jim Jones founded The People’s Temple in Indianapolis in 1955. He moved his followers to Eureka, California out of fear that a nuclear attack might strike Indiana. He later moved his followers to Guyana, to an area which became known as Jonestown.

An official went to investigate the group in 1978 after the government grew concerned that some members were being abused.

The group shot and killed the official. Jones then instructed his followers to drink Flavor Aid laced with cyanide. Over 900 people died, including Jones, who was found with a bullet wound to the head.

Heaven’s Gate

Heaven’s Gate was a group that started in the 1970s. It was known as a “UFO religious” cult. The tightly knit group required members to give up almost all of their possessions.

In March of 1997, 39 members put on matching dark clothes, ingested barbiturates, and placed plastic bags over their heads and killed themselves. This was one of the largest mass suicides in United States’ history.

David Koresh

David Koresh thought he could have conversations with God and he convinced his followers the world was ending. He and more than 100 people moved to a compound outside of Waco, Texas.

The FBI tried to arrest Koresh in 1993 because of violations of the law, such as advocating for underage girls to marry adult men. This led to a 51-day standoff. Ultimately, 75 people from the group died. Like Jim Jones, Koresh was found dead with a gunshot wound to the head.

How to Get Help Leaving a Cult

If you grew up in a cult or you recently got out of one, you may want to talk to a mental health professional about the complex feelings you may have. Whether you were exposed to traumatic events or you are confused about your identity, there are many reasons why talking to someone might help you.

Research suggests that leaving a cult can be difficult, leading to complex feelings. In one study, former cult members described experiencing a sense of chaos and confusion upon leaving. While in the cult, they reported feeling disconnected from themselves. Afterward, they had to try to reconnect with their feelings and values. Forming new bonds with friends and family outside the cult was an important part of this process, although this, too, could be challenging. 

The good news is that former cult members report eventually seeing the world in a brighter and more hopeful way.

It can be scary if you think a friend or family member may be involved with a cult. Reach out for professional help to get some guidance on what you can do or how you can cope with your emotions. It’s going to take time, understanding, and a lot of patience to help extricate your loved one if they are in a dangerous situation.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Rousselet M, Duretete O, Hardouin J, Grall-Bronnec M. Cult membership: What factors contribute to joining or leaving?. Psychiatry Res. 2017;257:27-33. doi:10.1016/j.psychres.2017.07.018 

  2. Hadding C, Semb O, Lehti A, Fahlström M, Sandlund M, DeMarinis V. Being in-between; exploring former cult members’ experiences of an acculturation process using the cultural formulation interview (DSM-5). Front Psychiatry. 2023;14:1142189. doi:10.3389/fpsyt.2023.1142189

  3. Cult Education Institute. Warning signs.

  4. Coates DD. Counselling former members of charismatic groups: considering pre-involvement variables, reasons for joining the group and corresponding values. Ment Health Relig Cult. 2011;14(3):191-207. doi:10.1080/13674670903443404

  5. Holoyda B, Newman W. Between belief and delusion: Cult members and the insanity plea. J Am Acad Psychiatry Law. 2016 Mar;44(1):53-62. PMID: 26944744.

  6. American Psychological Association. Cults of hatred.

  7. Atchison AJ, Heide KM. Charles Manson and the Family: The application of sociological theories to multiple murder. Int J Offender Ther Comp Criminol. 2011;55(5):771-798. doi:10.1177/0306624X10371794

Amy Morin

By Amy Morin, LCSW

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


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How to Cope With Not Wanting to Live or Die

Key Takeaways

  • Feeling like you don’t want to live or die is often a sign of emotional distress rather than a wish to end your life.
  • Such thoughts are often tied to feelings of hopelessness, powerlessness, mental health issues, or exhaustion.
  • Reaching out for professional help, seeking social support, and taking small, caring steps can help you learn to cope with these thoughts.

Feeling like you don’t want to live, but also don’t want to die, can be a painful and confusing experience. Such thoughts are known as passive suicidal ideation and are a sign of emotional distress and need for support. Learning how to cope with not wanting to live or die is important and may involve therapy, safety planning, and support.

Information presented in this article may be triggering to some people. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

What to Do If You Feel Like You Don’t Want to Live or Die

  • Reach out for support right now: Talk to someone you trust or call a crisis hotline like 988 (the Suicide and Crisis Lifeline) in the U.S.
  • Tell someone how you’re feeling: Sharing your thoughts with someone you trust can reduce feelings of isolation and help you to feel more understood.
  • Focus on the immediate future: Break things down into small steps and focus on dealing with them.
  • Stay safe: Remove or avoid anything that might pose a risk to your life or well-being.
  • Avoid being alone if possible: Stay connected to friends or family, or consider reaching out to someone through text or online in a support group.
  • Do something comforting: Spend time doing something soothing, whether it’s wrapping up in a warm blanket, listening to music, or going for a walk.
  • Talk to a professional: Reach out to a counselor, therapist, or doctor who can help you work through these thoughts and find relief.

What It Means When You Don’t Want to Live or Die

If you’ve ever thought, “I don’t want to live like this, but I don’t want to die,” you’re not alone. Major life stressors, childhood trauma, or untreated depression are all reasons that someone might feel this way.

This can be considered suicidal ideation, which means thinking about taking your own life.

How Common Is It?

  • An estimated 7.8% of people experience suicidal ideation in their lifetimes.
  • Around 14% of those make attempts.
  • For every 31 attempts, there is only one completed attempt.

Passive vs. Active Suicidal Ideation

Passive suicidal ideation means that you’ve thought about not living anymore, but you don’t have any active plan to die by suicide. 

However, passive suicidal ideation can quickly turn active (i.e., having a plan, means, and intent).

It’s important to remember that feeling suicidal is a state that can change rapidly.

This means the feelings can also be reduced quickly, including through promising new interventions such as ketamine infusion therapy and transcranial magnetic stimulation (TMS).

Why You Might Feel This Way

Feeling like you don’t want to live but you don’t want to die means that something hurts. “It can convey emotional pain and a desire for change,” says Cubbage.

It might be caused by:

  • Feeling emotionally numb or empty
  • Feeling like a burden to others
  • Chronic stress or exhaustion
  • Grief or a major loss
  • Depression or other mental health issues
  • Isolation or lack of social support
  • Unresolved trauma or painful memories
  • Hopelessness about the future

It may signify that you feel like much is outside of your locus of control, and those feelings of powerlessness can also lead to the hopelessness that makes it feel pointless to live. Or perhaps you are feeling a bit of an existential crisis—wondering what the point of all this is. You might be wondering why the minutiae of your life matter and why you matter. 

Grappling with these big life questions can be really hard and may feel incredibly isolating, making it easy for you to spiral and believe that nothing matters. However, existential questioning can also open up space for more meaning in your life as you think about what does matter to you.

How to Get Help

You may be feeling desperate right now, but there are a number of things you can do, such as therapy, reaching out to your social support network, and safety planning.

Therapy

If you are not already in some kind of mental health treatment, consider seeing a therapist who can help you work through these feelings and find out why it is that you feel like you can’t live like this.

They can also help you identify coping tools you can use to keep yourself safe and reduce these feelings.

Get Help Now

We’ve tried, tested, and written unbiased reviews of the best online therapy programs, including Brightside, which specifically offers help for people experiencing suicidal ideation. Find out which option is the best for you.

Safety Planning

“Safety planning is an evidence-based way to help prevent hospitalization and attempts,” says Cubbage. 

In research with suicidal patients in the emergency room, safety planning was associated with the patients being less likely to exhibit future suicidal behavior and more likely to attend mental health treatment.

Some key things to include on a safety plan include a list of coping strategies that have worked for you and sources of support. Sources of support can be friends and family, as well as mental health professionals—either your therapist or a local mental health agency that you can contact.

Mental health professionals sometimes use a tool called the “Reasons for Living Inventory” to assess for suicidality, but you might also want to look at it on your own to begin to jog your memory of reasons you want to live. Or you can make a list on your own, and nothing is too small to include. If you want to live because you love your morning coffee, that counts! 

Just as hopelessness can lead to feeling like you don’t want to live—but you don’t necessarily want to die—feelings of hope mean that there is a glimmer of light out there. In a study, those who identified more reasons for living were better able to access those reasons, even in periods of depression.

Seek Social Support

Depression or suicidal thoughts may lie to you and tell you you’re a burden—but they’re lying. Your loved ones care about you and want to help you—and social support is one of the leading protective factors against suicide.

Some benefits that social support provides:

  • Tangible resources, such as providing the number for a hotline or counseling center
  • Physically interrupting a suicide attempt
  • Increased feelings of belongingness 
  • Increase in protective factors such as self-esteem
  • Feedback from others
  • Resources for problem-solving
  • Exposure to positive events 

Feeling like you belong because of social support increases self-esteem and reduces feelings of burdensomeness. A feeling of belonging may contribute to reduced suicidality.

Find Connection

Research shows that having some kind of religious practice reduces the risk of depression and suicide, due to feelings of meaning, purpose, and gratitude often felt in connection with religious involvement.

If you’re not religious but spiritual, the same concept still applies. Practicing your spirituality can help you find meaning in life.

How to Support Someone Who Feels This Way

If you’re a loved one worried about someone who has said they don’t want to live anymore but they don’t want to die either, we know this can be scary for you, too. 

Janel Cubbage

Your natural instinct may be to remind them of the reasons they have for living or to tell them to think about their friends and family and how their death would affect them. Push those instincts to the side and listen to them. Hear them. Let them tell you what’s contributing to their emotional pain.

— Janel Cubbage

Of course, if someone is in imminent danger, contact emergency services or bring them to the nearest emergency department. 

What This Means For You

We acknowledge how brave it is for you to realize that you don’t want to live like this anymore—and that you don’t want to die. A safety plan and a support network can help you through this crisis.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Motillon-Toudic C, Walter M, Séguin M, Carrier JD, Berrouiguet S, Lemey C. Social isolation and suicide risk: Literature review and perspectives. Eur Psychiatry. 2022;65(1):e65. doi:10.1192/j.eurpsy.2022.2320

  2. Koh YS, Shahwan S, Jeyagurunathan A, et al. Prevalence and correlates of suicide planning and attempt among individuals with suicidal ideation: Results from a nationwide cross-sectional survey. Journal of Affective Disorders. 2023;328:87-94. doi:10.1016/j.jad.2023.02.033

  3. Han B, Kott PS, Hughes A, McKeon R, Blanco C, Compton WM. Estimating the rates of deaths by suicide among adults who attempt suicide in the United States. Journal of Psychiatric Research. 2016;77:125-133. doi:10.1016/j.jpsychires.2016.03.002

  4. Jyunn Lai Y, Chi Tan H, Ting Wang C, Chi Wu W, Yi Wang L, Chih Shen Y. Difference in cognitive flexibility between passive and active suicidal ideation in patients with depression. Neuropsychiatry. 2018;08(04). doi:10.4172/Neuropsychiatry.1000446

  5. Ballard ED, Gilbert JR, Wusinich C, Zarate CAJ. New methods for assessing rapid changes in suicide risk. Front Psychiatry. 2021;0. doi:10.3389/fpsyt.2021.598434

  6. Liu RT, Bettis AH, Burke TA. Characterizing the phenomenology of passive suicidal ideation: a systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation. Psychol Med. 2020;50(3):367-383. doi:10.1017/S003329171900391X

  7. Laghaei M, Mehrabizadeh Honarmand M, Jobson L, Abdollahpour Ranjbar H, Habibi Asgarabad M. Pathways from childhood trauma to suicidal ideation: mediating through difficulties in emotion regulation and depressive symptoms. BMC Psychiatry. 2023;23(1):295. doi:10.1186/s12888-023-04699-8

  8. Ribeiro JD, Huang X, Fox KR, Franklin JC. Depression and hopelessness as risk factors for suicide ideation, attempts and death: meta-analysis of longitudinal studies. Br J Psychiatry. 2018;212(5):279-286. doi:10.1192/bjp.2018.27

  9. Stanley B, Brown GK, Brenner LA, et al. Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA Psychiatry. 2018;75(9):894-900. doi:10.1001/jamapsychiatry.2018.1776

  10. Pirani S, Kulhanek C, Wainwright K, Osman A. The Reasons for Living Inventory for Young Adults (RFL-YA-II). Assessment. 2021;28(3):942-954. doi:10.1177/1073191119900242

  11. Luo X, Wang Q, Wang X, Cai T. Reasons for living and hope as the protective factors against suicidality in Chinese patients with depression: a cross sectional study. BMC Psychiatry. 2016;16(1):252. doi:10.1186/s12888-016-0960-0

  12. Darvishi N, Farhadi M, Poorolajal J. The role of social support in preventing suicidal ideations and behaviors: A systematic review and meta-analysis. J Res Health Sci. 2024;24(2):e00609. doi:10.34172/jrhs.2024.144

  13. Wastler H, Lucksted A, Phalen P, Drapalski A. Internalized stigma, sense of belonging, and suicidal ideation among veterans with serious mental illness. Psychiatr Rehabil J. 2020;43(2):91-96. doi:10.1037/prj0000386

  14. Koenig HG. Association of religious involvement and suicide. JAMA Psychiatry. 2016;73(8):775. doi:10.1001/jamapsychiatry.2016.1214

  15. McClintock CH, Worhunsky PD, Xu J, et al. Spiritual experiences are related to engagement of a ventral frontotemporal functional brain network: Implications for prevention and treatment of behavioral and substance addictions. J Behav Addict. 2019;8(4):678-691. doi:10.1556/2006.8.2019.71

Theodora Blanchfield AMFT

By Theodora Blanchfield, AMFT

Theodora Blanchfield is an Associate Marriage and Family Therapist and mental health writer using her experiences to help others. She holds a master’s degree in clinical psychology from Antioch University and is a board member of Still I Run, a non-profit for runners raising mental health awareness. Theodora has been published on sites including Women’s Health, Bustle, Healthline, and more and quoted in sites including the New York Times, Shape, and Marie Claire.


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What to Expect From Effexor Withdrawal


Key Takeaways

  • Symptoms of Effexor withdrawal begin within a day or two and usually get better within three weeks.
  • Withdrawal symptoms can include confusion, changes in appetite, headaches, nausea, and sweating.
  • You can prevent withdrawal by taking your medication as prescribed and talking to your doctor before changing your dose.

Effexor (venlafaxine) withdrawal symptoms typically appear within 24 to 48 hours and go away within three weeks, but can last several months. You might feel nauseated, dizzy, short-tempered, confused, restless, and/or distracted during this time.

Effexor withdrawal is a type of antidepressant discontinuation syndrome that can occur when people stop their medication too quickly. For this reason, healthcare providers usually taper the dose gradually, although withdrawal symptoms may still occur.

What Is the Timeline of Effexor Withdrawal?

Everyone’s experience is different, and the severity of symptoms can vary depending on a person’s dose and how long they’ve been taking their medication:

  • Early symptoms (24 to 48 hours): The first symptoms of Effexor withdrawal may appear in the first 24 to 48 hours, including flu-like symptoms, anxiety, and agitation.
  • Peak symptoms (days 3 to 7): Symptoms of withdrawal usually peak around the end of the first week, often including dizziness and nausea.
  • Improvement phase (week 2): During the second week, symptoms often gradually lessen, but some may continue to linger
  • Recovery period (week 3 and beyond): The physical symptoms will be mostly gone by the third week. However, psychological symptoms, such as mood swings and irritability, may persist for longer.

Not everyone experiences withdrawal when stopping Effexor. Research suggests that around 33% to 56% of people who take antidepressants experience withdrawal symptoms when they stop taking their medication.

What Does Withdrawal Feel Like?

When decreasing or stopping an antidepressant, a neurochemical change takes place in the brain. As the brain readjusts to the new environment, symptoms of withdrawal from Effexor may include:

  • Agitation or irritability
  • Anxiety
  • Changes in appetite
  • Confusion
  • Dizziness
  • Headaches
  • Mood changes
  • Nausea or vomiting
  • Nightmares or other sleep issues
  • Paresthesias (a prickling or tingling sensation)
  • Sweating

‘Brain Zaps’

Some people report experiencing ‘brain shivers’ or ‘brain zaps‘ when they are late taking their prescribed dose of Effexor.

  • People often describe these sensations as a very brief, repetitive, electric shock-like feeling that remains confined to the brain or head.
  • Others report the sensation spreads out to other parts of the body.
  • The sensation can be triggered by moving your eyes and is often accompanied by disorientation, tinnitus (ringing in the ears), vertigo, and/or lightheadedness.

These electric shock-like sensations can cause you to become alarmed or worried, and they may happen frequently enough to disrupt daily life or quality of life. However, no current evidence suggests brain shivers or brain zaps represent any danger.

How to Cope With Effexor Withdrawal Symptoms

Effexor withdrawal symptoms develop quickly, so if you miss a dose, take it as soon as you remember. If it is close to your next scheduled dose, simply skip your missed dose and stick to your schedule.

You can reduce your withdrawal symptoms by getting back on your prescribed dosing schedule as soon as possible.

If you are discontinuing Effexor, there are ways to make Effexor withdrawal more tolerable until the withdrawal symptoms go away. Here are a few steps to consider:

  • Team up with your healthcare provider. They are your best ally when it comes to preventing and coping with symptoms of antidepressant withdrawal. Discuss the benefits and risks of stopping Effexor and work together to figure out how (and when) to slowly stop taking the drug.
  • Ask about OTC medications. Consult your doctor about any over-the-counter medications that can help ease Effexor withdrawal, such as sleep aids, anti-nausea medications, and pain relievers.
  • Consider psychotherapy. According to investigators at Harvard Medical School, engaging in psychotherapy while discontinuing an antidepressant can decrease your risk of having a depression relapse.
  • Seek support. Consider asking a close friend or family member for support and let them know what to expect as you work with your physician to wean off the drug.
  • Keep up with follow-ups. It’s important to keep in touch with your healthcare provider as you are weaning from the drug, as well as after you’ve stopped altogether. Depending on how you feel, you may need to book ongoing monthly check-ins until discontinuation symptoms have eased and there are no signs of relapse.
  • Practice self-care. As you are going through withdrawal, it’s more important than ever to exercise, eat healthfully, get regular sleep, and practice stress management. These acts of self-care can help keep your mood stable as you taper off Effexor. 

Important Warnings About Effexor Withdrawal

Some people may experience disorientation, which can be dangerous when driving or operating heavy machinery. And, although rare, stopping Effexor on your own can result in severe and frightening reactions.

If you or someone you love experiences any of the following symptoms, call 911 or seek medical help right away:

If you experience worsening anxiety or depression during withdrawal, and these symptoms last more than a month, it may mean you’re having a relapse and need ongoing mental health treatment. Talk to your care provider if you have any concerns.

How to Manage Effexor Withdrawal in the Long Run

When you’ve decided to stop taking your antidepressant, it might be tempting to toss out your medication. Instead, take your time and work with your physician to gradually decrease your dose.

How you’ll do this will depend on several factors, including:

  • How long you’ve been taking the drug
  • Your current dose (if you’re on a low dose, you’ll be able to taper off more quickly)
  • Past experience with withdrawal symptoms
  • Overall health

Sometimes, even if you are slow and deliberate when weaning off an antidepressant, you still may experience symptoms. In these cases, your physician may prescribe Prozac (fluoxetine), which has been found to help ease discontinuation symptoms.

Prozac has a long half-life, which means that its concentration in the body decreases more slowly. As a result, people are better able to slowly taper off of it without experiencing bothersome withdrawal effects.

Additional Resources

In addition to teaming up with your healthcare provider and asking a trusted family member or friend to help you through this period, you may find it helpful to reach out to others who are also going through Effexor withdrawal.

The National Association for Mental Illness (NAMI) and the Anxiety and Depression Association of America (ADAA) both offer online discussion groups where you can connect with others who may share similar experiences. You may also be able to find groups on Facebook, in which members can offer each other tips and support.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Fava GA, Benasi G, Lucente M, Offidani E, Cosci F, Guidi J. Withdrawal symptoms after serotonin-noradrenaline reuptake inhibitor discontinuation: Systematic review. Psychother Psychosom. 2018;87(4):195-203. doi:10.1159/000491524

  2. Gabriel M, Sharma V. Antidepressant discontinuation syndrome. CMAJ. 2017;189(21):E747. doi:10.1503/cmaj.160991

  3. Henssler J, Schmidt Y, Schmidt U, Schwarzer G, Bschor T, Baethge C. Incidence of antidepressant discontinuation symptoms: A systematic review and meta-analysis. Lancet Psychiatry. 2024;11(7):526-535. doi:10.1016/S2215-0366(24)00133-0

  4. National Library of Medicine. Venlafaxine.

  5. Papp A, Onton JA. Brain zaps: An underappreciated symptom of antidepressant discontinuation. Prim Care Companion CNS Disord. 2018;20(6):18m02311. doi:10.4088/PCC.18m02311

  6. U.S. Food and Drug Administration. Medication guide: Effexor XR.

  7. Harvard Health Publishing. Going off antidepressants.

  8. Shapiro B, Cohrs D. Fluoxetine substitution for deprescribing antidepressants: A technical approach. J Psychiatry Neurosci. 2025;50(4):E202-E209. doi:10.1503/jpn.250054

By Nancy Schimelpfening

Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.  


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What Is the Fight-or-Flight Response?

Key Takeaways

  • The fight-or-flight response is your body’s natural reaction to danger.
  • It triggers physical and psychological changes that prepare your body to deal with the threat.
  • Learn how to calm your body after this response can help you manage anxiety and improve overall well-being.

The fight-or-flight response is your body’s natural, automatic reaction to stress or danger. It triggers physiological changes, such as a faster heart rate and tenser muscles, that prepare your body to deal with the source of the stress. This can be helpful in the short term, but if it goes on too long without giving your body a chance to relax, it can have negative effects on your physical and mental health.

Illustration by Joshua Seong. © Verywell, 2018.


How the Fight-or-Flight Response Works

The fight-or-flight response, also known as the acute stress response, refers to the physiological reaction that occurs when in the presence of something mentally or physically frightening or stressful. This response is triggered by the release of hormones that prepare your body to either stay and deal with a threat or run away to safety.

The three stages of fight-or-flight are:

  • The alarm stage: During this stage, the central nervous system is ramped up, preparing your body to fight or flee.
  • The resistance stage: This is the stage in which the body attempts to normalize and recover from the initial elevated fight-or-flight response.
  • The exhaustion stage: If the first two stages occur repeatedly over time, such as when under chronic stress, the body can feel exhausted and begin to break down.

Physiologic Changes

The sudden release of hormones activates the body’s sympathetic nervous system in response to acute stress. Fight-or-flight response hormones include adrenocorticotropic and corticotropin-releasing hormones.

These hormones cause the sympathetic nervous system to stimulate the pituitary and adrenal glands, triggering the release of catecholamines, including adrenaline, noradrenaline, and cortisol.

This chain of reactions results in various reactions, including increased:

  • Heart rate
  • Blood pressure
  • Breathing rate

Your body can stay in fight-or-flight for minutes to hours after the threat is gone, which is how long it takes for the parasympathetic nervous system to return to pre-arousal levels.

Why Do We Have It?

The term “fight-or-flight” represents the choices our ancient ancestors had when faced with danger in their environment: to either fight or flee. In either case, the physiological and psychological response to stress prepares the body to react to the danger.

In the 1920s, American physiologist Walter Cannon was the first to describe the fight-or-flight response. Cannon realized that a chain of rapidly occurring reactions inside the body helped to mobilize the body’s resources to deal with threatening circumstances.

Today, the fight-or-flight response is recognized as part of the first stage of Hans Selye’s general adaptation syndrome, a theory describing the stress response.

How to Tell If You’re Having a Fight-or-Flight Response

Physical signs that can indicate that your fight-or-flight response has kicked in include:

  • Dilated pupils: In times of danger, the body prepares itself to become more aware of its surroundings. Dilation of the pupils allows more light into the eyes, resulting in better vision of your surrounding area.
  • Pale or flushed skin: During fight-or-flight, blood flow to the surface areas of the body is reduced, while flow to the muscles, brain, legs, and arms is increased. Paleness or alternating between a pale and flushed face as blood rushes to the head and brain is common. The body’s blood clotting ability also increases to prevent excess blood loss in the event of injury.
  • Rapid heart rate and breathing: Heartbeat and respiration rate increase to provide the body with the energy and oxygen needed to fuel a rapid response to danger.
  • Trembling: The muscles tense and become primed for action, which can cause trembling or shaking.

You can probably think of a time when you experienced the fight-or-flight response. When faced with something frightening, you can feel your heartbeat quicken, you may start breathing faster, and your entire body becomes tense and ready to take action.

Why It Can Be Helpful

The fight-or-flight response plays a critical role in dealing with stress and danger in our environment. When we are under threat, the response prepares the body to either fight or flee. By priming your body for action, you are better prepared to perform under pressure.

The stress created by the situation can actually be helpful, making it more likely that you will cope effectively with the threat.

  • Better performance: This type of stress can help you perform better in situations where you are under pressure to do well, such as at work or school.
  • Inspires prosocial actions: Some experts suggest that the fight-or-flight response may even benefit when the urge to fight others in an attempt to harm them is transformed into the urge to fight to protect them. This may be beneficial when the fight-or-flight response is triggered by negative emotions such as anger and fear.
  • Improves chances of survival: In life-threatening situations, the fight-or-flight response plays a critical role in survival. By gearing you up to fight or flee, it makes you more likely to survive the danger.

When It Becomes Harmful

While the fight-or-flight response happens automatically, that doesn’t mean that it is always accurate. Sometimes we respond in this way even when there is no real threat.

This is because the fight-or-flight response can be triggered by both real and imaginary threats. Phobias are good examples of how the fight-or-flight response might be falsely triggered in the face of a perceived threat.

Constantly being in a state of fight-or-flight, such as when facing repeated stressors, can also be harmful to your health. Chronic stress can increase your risk of:

Is Anxiety a Fight-or-Flight Response?

Some research indicates that the body’s desire to fight or flee can increase a person’s risk of developing an anxiety disorder, making them more vulnerable to this type of mental health condition.

Common Examples

The fight-or-flight response can happen in the face of imminent physical danger, such as when encountering a growling dog during your morning jog. It can also be the result of a psychological threat, such as preparing to give a big presentation at school or work.

Another example of the fight-or-flight response is if a person who is terrified of heights has to go to the top floor of a skyscraper to attend a meeting. Their body might go on high alert, with their heartbeat and respiration rate increasing. If the response is severe, it can lead to a panic attack.

How to Calm Down After Fight or Flight Kicks In

Understanding the body’s natural fight-or-flight response is one way to help cope with such situations. When you notice that you are becoming tense, you can start looking for ways to calm down and relax your body.

Ways to calm the fight-or-flight response include:

The stress response is one of the major topics studied in the rapidly growing field of health psychology. Health psychologists are interested in helping people find ways to combat stress and live healthier, more productive lives.

By learning more about the fight-or-flight response, psychologists can help people explore new ways to deal with their natural reactions to stress.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Tan SY, Yip A. Hans Selye (1907-1982): Founder of the stress theory. Singapore Med J. 2018;59(4):170-171. doi:10.11622/smedj.2018043

  3. American Psychological Association. Stress effects on the body.

  4. Knezevic E, Nenic K, Milanovic V, Knezevic NN. The role of cortisol in chronic stress, neurodegenerative diseases, and psychological disorders. Cells. 2023;12(23):2726. doi:10.3390/cells12232726

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  6. Dhabhar FS. The short-term stress response – Mother nature’s mechanism for enhancing protection and performance under conditions of threat, challenge, and opportunity. Front Neuroendocrinol. 2018;49:175-192. doi:10.1016/j.yfrne.2018.03.004

  7. Mathôt S. Pupillometry: Psychology, physiology, and function. J Cogn. 2018;1(1):16. doi:10.5334/joc.18

  8. Passeron T, Zouboulis CC, Tan J, et al. Adult skin acute stress responses to short-term environmental and internal aggression from exposome factors. J Eur Acad Dermatol Venereol. 2021;35(10):1963-1975. doi:10.1111/jdv.17432

  9. Zieliński G, Ginszt M, Zawadka M, et al. The relationship between stress and masticatory muscle activity in female students. J Clin Med. 2021;10(16):3459. doi:10.3390/jcm10163459

  10. Lebel RD. Moving beyond fight and flight: A contingent model of how the emotional regulation of anger and fear sparks proactivity. Acad Manage Rev. 2016;42(2):190-206. doi:10.5465/amr.2014.0368

  11. American Psychological Association. Stress effects on the body.

  12. Mihić L, Čolović P, Ignjatović I, Smederevac S, Novović Z. Anxiety between personality and cognition: The gray zone. Person Indiv Diff. 2015;78:19-23. doi:10.1016/j.paid.2015.01.013

  13. Duval ER, Javanbakht A, Liberzon I. Neural circuits in anxiety and stress disorders: A focused review. Ther Clin Risk Manag. 2015;11:115-26. doi:10.2147/TCRM.S48528

Additional Reading

Kendra Cherry

By Kendra Cherry, MSEd

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the “Everything Psychology Book.”


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Self-Concept in Psychology: Definition, Development, Theories

Key Takeaways

  • Self-concept is your overall view of yourself and who you are, including your beliefs, identity, and abilities.
  • It develops over time and can be influenced by experiences, relationships, culture, and feedback from others.
  • While self-concept tends to be fairly stable, you can improve yours through reflection, self-awareness, and effort.

Self-concept is the image we have of ourselves. It is influenced by many forces, including our interaction with the important people in our lives. It is how we perceive our behaviors, abilities, and unique characteristics. For example, beliefs such as “I am a good friend” or “I am a kind person” are part of an overall self-concept.

Verywell / Cindy Chung 


Why Self-Concept Matters

Our self-concept impacts how we respond to life, so a well-developed self-concept helps us respond in ways that are more positive and beneficial for us and those around us. One way it does this is by enabling us to recognize our worth. A well-developed self-concept also helps keep us from internalizing negative feedback from others.

Self-concept also affects how we interact and communicate with others. For example, how you communicate with others is often tied to your self-concept and how you relate to your social group. If your social group communicates a certain way, you would likely choose to communicate that way as well. Studies on teens have connected high self-concept clarity with more open communication with parents.

How It Differs From Self-Esteem

Self-concept refers to a broad description of ourselves (“I am a good writer”), while self-esteem includes any judgments or opinions we have of ourselves (“I feel proud to be a good writer”). Put another way:

  • Self-concept answers the question: Who am I?
  • Self-esteem answers the question: How do I feel about who I am?

What Are Some Examples?

Examples of self-concept include:

  • How you view your personality traits, such as whether you are an extrovert or introvert
  • How you see your roles in life, such as whether you feel that being a parent, sibling, friend, and partner are important parts of your identity
  • The hobbies or passions that are important to your sense of identity, such as being a sports enthusiast or belonging to a particular political party or religious group
  • How you feel about your interactions with the world, such as whether you think that you are contributing to society

Our self-perception is important because it affects our motivations, attitudes, and behaviors. It also affects how we feel about the person we think we are, including whether we are competent or have self-worth.

Self-concept tends to be more malleable when we’re younger and still going through self-discovery and identity formation. As we age and learn who we are and what’s important to us, these self-perceptions become much more detailed and organized.

At its most basic, self-concept is a collection of beliefs one holds about oneself and the responses of others. It embodies the answer to the question: “Who am I?” If you want to find your self-concept, list things that describe you as an individual. What are your traits? What do you like? How do you feel about yourself?

How Carl Rogers Explained Self-Concept

Humanist psychologist Carl Rogers believed that self-concept is made up of three distinct parts: ideal self, self-image, and self-esteem. His theory explains what it means when these parts are congruent or incongruent with reality, which impacts your self-concept.

Three Parts of Self-Concept

Rogers described the self-concept as being composed of three parts:

  • Ideal self: The ideal self is the person you want to be. This person has the attributes or qualities you are either working toward or want to possess. It’s who you envision yourself to be if you were exactly the person you wanted to be.
  • Self-image: Self-image refers to how you see yourself at this moment in time. Physical characteristics, personality traits, and social roles affect your self-image.
  • Self-esteem: How much you like, accept, and value yourself contributes to your self-concept. Self-esteem can be affected by a number of factors, including how others see you, how you think you compare to others, and your role in society.

Incongruence and Congruence

Self-concept is not always aligned with reality. When it is aligned, it is said to be congruent. If there is a mismatch between how you see yourself (your self-image) and who you wish you were (your ideal self), your self-concept is incongruent. This incongruence can negatively affect self-esteem.

Rogers believed that incongruence has its earliest roots in childhood. When parents place conditions on their affection for their children (e.g., only expressing love if children “earn it” through certain behaviors and living up to the parents’ expectations), children begin to distort their memories of experiences that leave them feeling unworthy of their parents’ love.

Unconditional love, on the other hand, helps to foster congruence. Children who experience such love—also referred to as family love—feel no need to continually distort their memories in order to believe that other people will love and accept them as they are.

Unconditional Love

Unconditional love, on the other hand, helps to foster congruence between self-concept and reality and thereby nurtures positive self-esteem.

How It Develops Over Time

Self-concept develops, in part, through our interaction and observation of others. In addition to family members and close friends, other people in our community and in the media can contribute to our self-identity.

  • People who believe in you: For instance, one study found that the more a teacher believes in a high-performing student’s abilities, the higher that student’s self-concept. (Interestingly, no such association was found with lower-performing students.)
  • The characters we identify with: Self-concept can also be developed through the stories we hear. For example, one study found that female readers who were “deeply transported” into a story about a leading character with a traditional gender role had a more feminist self-concept than those who weren’t as moved by the story. Thus, relating to and identifying with the character may affect your emotional response and confirm or alter your own ideas about yourself.
  • The media: Both mass media and social media play a role in self-concept development. When these media promote certain ideals, we’re more likely to make them our own. The more often these ideals are presented, the more they affect our self-identity and self-perception.
  • Our culture: Different cultures have different beliefs. They have different ideas of how dependent or independent one should be, as well as religious beliefs and views on socioeconomic development. All of these cultural norms influence self-concept by providing the structure of what is expected within that society and how one sees oneself in relation to others.

When Does Self-Concept Stop Developing?

Self-concept development is never finished. Though self-identity is thought to be primarily formed in childhood, your experiences as an adult can also change how you feel about yourself. If your self-esteem increases later in life, for instance, it can improve your self-concept.

Can You Really Change Your Self-Concept?

Self-concept is not static, meaning that it can change. Our environment plays a role in this process:

  • Places we are exposed to, especially those that hold a lot of meaning to us, actively contribute to our future self-concept through how we relate these environments to ourselves and how society relates to them.
  • Self-concept can also change based on the people with whom we interact. This is particularly true for individuals in our lives who are in leadership roles. They can impact the collective self (the self in social groups) and the relational self (the self in relationships).
  • In some cases, a medical diagnosis can change self-concept by helping people understand why they feel the way they do, such as someone receiving an autism diagnosis later in life, finally providing clarity as to why they feel different.

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Alternative Ways to Think About Self-Concept

As with many topics within psychology, several other theorists have proposed different ways of thinking about self-concept.

Social Identity

Social psychologist Henri Tajfel developed social identity theory, which states that self-concept is composed of two essential parts:

  • Personal identity: The traits and other characteristics that make you unique
  • Social identity: Who you are based on your membership in social groups, such as sports teams, religions, political parties, or social class

This theory states that our social identity influences our self-concept, thus affecting our emotions and behaviors. If we’re playing sports, for instance, and our team loses a game, we might feel sad for the team (emotion) or act out against the winning team (behavior).

Multiple Dimensions

Psychologist Bruce A. Bracken had a slightly different theory and believed that self-concept was multidimensional, consisting of six independent traits:

In 1992, Bracken developed the Multidimensional Self-Concept Scale, a comprehensive assessment that evaluates each of these six elements of self-concept in children and adolescents.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Sampthirao P. Self-concept and interpersonal communication. Int J Indian Psychol. 2016;3(3):6. doi:10.25215/0303.115

  2. Van Dijk MPA, Branje S, Keijsers L, Hawk ST, Hale WW, Meeus W. Self-concept clarity across adolescence: Longitudinal associations with open communication with parents and internalizing symptoms. J Youth Adolesc. 2013;43:1861-1876. doi:10.1007/s10964-013-0055-x

  3. Mercer S. Self-concept: Situating the self. In: Mercer S, Ryan S, Williams M, eds. Psychology for Language Learning. Palgrave Macmillan; 2012. doi:10.1057/9781137032829_2

  4. Koch S. Formulations of the person and the social context. In: Psychology: A Study of a Science. Vol. III. McGraw-Hill;1959:184-256.

  5. Pesu L, Viljaranta J, Aunola K. The role of parents’ and teachers’ beliefs in children’s self-concept development. J App Develop Psychol. 2016;44:63-71. doi:10.1016/j.appdev.2016.03.001

  6. Vandenbosch L, Eggermont S. The interrelated roles of mass media and social media in adolescents’ development of an objectified self-concept: A longitudinal study. Communc Res. 2015. doi:10.1177/0093650215600488

  7. Vignoles V, Owe E, Becker M, et al. Beyond the ‘east-west’ dichotomy: Global variation in cultural models of selfhood. J Exp Psychol Gen. 2016;145(8):966-1000. doi:10.1037/xge0000175

  8. Prince D. What about place? Considering the role of physical environment on youth imagining of future possible selves. J Youth Stud. 2014;17(6):697-716. doi:10.1080/13676261.2013.836591

  9. Stagg SD, Belcher H. Living with autism without knowing: Receiving a diagnosis in later life. Health Psychol Behav Med. 2019;7(1):348-361. doi:10.1080/21642850.2019.1684920

  10. Brown R. The social identity approach: Appraising the Tajfellian legacy. Br J Soc Psychol. 2020;59(1):5-25. doi:10.1111/bjso.12349

  11. Scheepers D, Ellemers N. Social identity theory. In: Sassenberg K, Vliek MLW, eds. Social Psychology in Action. Springer International Publishing; 2019:129-143. doi:10.1007/978-3-030-13788-5_9

  12. Bracken BA. Multidimensional Self Concept Scale. American Psychological Association; 2016. doi:10.1037/t01247-000

Additional Reading

Kendra Cherry

By Kendra Cherry, MSEd

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the “Everything Psychology Book.”


Source link

Elizabeth Hartney, PhD

DSM 5 Criteria for Substance Use Disorders

Key Takeaways

  • The DSM-5 provides criteria that mental health professionals use to identify and diagnose substance use disorders.
  • Signs of substance use disorders include harmful patterns of drug and alcohol use that affect a person’s daily life and health.
  • Recognizing these signs plays an important part in diagnosis, treatment, and recovery.

The DSM-5 outlines the criteria that professionals use to diagnose substance use disorders, which helps them better identify harmful patterns and behavior when it comes to alcohol and drug use. It lists 11 key signs that indicate that a disorder may be present, including cravings, a loss of control, and withdrawal symptoms. Being able to recognize these criteria can help with early intervention and treatment.

Verywell / Brianna Gilmartin

The 11 DSM-5 Criteria for Substance Use Disorders

Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:

  1. Taking the substance in larger amounts or for longer than you’re meant to
  2. Wanting to cut down or stop using the substance, but not managing to
  3. Spending a lot of time getting, using, or recovering from use of the substance
  4. Cravings and urges to use the substance
  5. Not managing to do what you should at work, home, or school because of substance use
  6. Continuing to use, even when it causes problems in relationships
  7. Giving up important social, occupational, or recreational activities because of substance use
  8. Using substances again and again, even when it puts you in danger
  9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
  10. Needing more of the substance to get the effect you want (tolerance)
  11. Development of withdrawal symptoms, which can be relieved by taking more of the substance

The 11 criteria outlined in the DSM-5-TR can be grouped into four primary categories: physical dependence, risky use, social problems, and impaired control.

It is important to note that people can experience tolerance and withdrawal in the context of taking prescription drugs to treat a medical or mental health condition. However, this does not necessarily mean that they have a substance use disorder.

What Is the DSM-5?

The “Diagnostic and Statistical Manual of Mental Disorders”, Fifth Edition, text revision, often called the DSM-V-TR or DSM-5-TR, is the latest version of the American Psychiatric Association’s gold-standard text on the names, symptoms, and diagnostic features of every recognized mental illness, including addictions.

The DSM-5-TR criteria for substance use disorders are based on decades of research and clinical knowledge. The DSM-5-TR was published in 2013, and in 2022, a text revision was published that included updated criteria for more than 70 disorders, including the requirements for stimulant-induced mild neurocognitive disorder.

What is the most important information I should know about substance use disorders?

  • Substance use disorders (SUDs) are characterized by 11 criteria, including drug cravings, unsuccessful attempts to cut back, taking more of a substance than intended, and continued use despite negative consequences.
  • If you think you or someone you love has a substance use disorder, getting an official diagnosis is important and can ensure that you receive the appropriate treatment.

Which Substances Can Be Abused?

The DSM-5-TR recognizes substance-related disorders resulting from the use of 10 separate classes of drugs:

  • Alcohol
  • Caffeine
  • Cannabis
  • Hallucinogens
  • Inhalants
  • Opioids
  • Sedatives
  • Hypnotics, or anxiolytics
  • Stimulants (including amphetamine-type substances, cocaine, and other stimulants)
  • Tobacco

While some major groupings of psychoactive substances are specifically identified, the use of other or unknown substances can also form the basis of a substance-related or addictive disorder.

The activation of the brain’s reward system drives many of the problems tied to drug use. The rewarding feeling people experience due to taking drugs may be so profound that they neglect other normal activities in favor of taking the drug.

The pharmacological mechanisms for each class of drug are different. However, the activation of the reward system is similar across substances in producing feelings of pleasure or euphoria, often referred to as a “high.”

The DSM-5-TR recognizes that people are not all automatically or equally vulnerable to developing substance-related disorders. Some people have lower levels of self-control that predispose them to develop problems if exposed to drugs.

Substance-Use vs. Substance-Induced Disorders

There are two groups of substance-related disorders: substance-use disorders and substance-induced disorders.

  • Substance-use disorders are patterns of symptoms resulting from the use of a substance that you continue to take, despite experiencing problems as a result.
  • Substance-induced disorders, including intoxication, withdrawal, and other substance/medication-induced mental disorders, are caused by the effects of substances.

Understanding Substance-Induced Disorders

Substance-induced disorders involve problems that are caused by the effects of substances. Types of substance-induced disorders recognized in the DSM-5-TR include substance-induced mental disorders, intoxication, and withdrawal.

Substance/Medication-Induced Mental Disorders

Substance/medication-induced mental disorders are mental problems that develop in people who did not have mental health problems before using substances. They include:

  • Substance-induced psychotic disorder: This condition involves experiencing delusions, hallucinations, or both within one month of using or withdrawing from alcohol, illicit substances, or prescription drugs.
  • Substance-induced bipolar and related disorders: This condition involves experiencing manic/hypomanic symptoms, depressive symptoms, or both while using or during withdrawal from a substance.
  • Substance-induced depressive disorders: This is a form of depression that can occur after using drugs, alcohol, or medications. To be diagnosed with this condition, depressive symptoms must not be related to intoxication or withdrawal.
  • Substance-induced anxiety disorders: This condition involves experiencing anxiety or panic attacks due to using drugs, medications, or alcohol. Anxiety may occur during intoxication or withdrawal, but to be diagnosed, anxiety symptoms must not be symptoms of intoxication or withdrawal.
  • Substance-induced obsessive-compulsive and related disorders: This condition is marked by the onset of obsessive and compulsive symptoms caused by substance use. To be diagnosed, symptoms must cause distress and impairment in a person’s daily life.
  • Substance-induced sleep disorders: This condition involves insomnia and other sleep problems caused by using drugs, alcohol, or certain medications.
  • Substance-induced sexual dysfunctions: This condition involves experiencing difficulties with sexual arousal, desire, or performance due to substances and medications.
  • Substance-induced delirium: This condition is marked by symptoms of delirium due to intoxication from a psychoactive substance, including illicit drugs, medications, and alcohol.
  • Substance-induced neurocognitive disorders: This condition involves experiencing mild or major neurocognitive impairments caused by substance use that persist beyond the intoxication and acute withdrawal period.

In the text revision of the DSM-5, the information on substance-induced mild neurocognitive disorders was updated to include symptoms caused by stimulants such as methamphetamine and cocaine. Such additions were made in response to research demonstrating that prolonged stimulant use can produce lingering neurocognitive effects on learning, memory, and executive function.

Intoxication

Substance intoxication, a group of substance-induced disorders, details the symptoms that people experience when they are under the influence of drugs. Disorders of substance intoxication include:

  • Marijuana intoxication
  • Cocaine intoxication
  • Methamphetamine intoxication (stimulants)
  • Heroin intoxication (opioids)
  • Acid intoxication
  • Substance intoxication delirium

Withdrawal

Substance withdrawal involves experiencing physical, cognitive, and behavioral symptoms due to reducing or halting substance use. To be diagnosed with withdrawal, these symptoms must not be due to another mental disorder or medical condition.

Withdrawal from some substances (such as alcohol or barbiturates) can be severe and sometimes life-threatening. Other substances may not produce withdrawal effects when their use is halted. Some substances, such as opioids, may lead to withdrawal even when taken for a short period and for legitimate medical purposes.

Withdrawal symptoms can range from mild to severe; they can also sometimes be potentially dangerous. Talk to your doctor about how you can stop using a substance safely.

How Substance Abuse Disorders Are Diagnosed

Substance use disorders should be evaluated by a psychiatrist, psychologist, or licensed counselor specializing in drug and alcohol addictions. A health professional may utilize blood or urine tests to assess current drug use. However, it is important to note that there is not a lab test that can establish dependence or addiction. 

To diagnose a substance use disorder, a healthcare practitioner will evaluate the individual by completing a physical exam and taking a medical history. They will also ask questions about current and past substance use, including its frequency, amount, and duration.

Severity of Substance Use Disorders

The DSM-5-TR allows clinicians to specify how severe or how much of a problem the substance use disorder is, depending on how many symptoms are identified.

  • Mild: Two or three symptoms indicate a mild substance use disorder.
  • Moderate: Four or five symptoms indicate a moderate substance use disorder.
  • Severe: Six or more symptoms indicate a severe substance use disorder.

Clinicians can also add “in early remission,” “in sustained remission,” “on maintenance therapy” for certain substances, and “in a controlled environment.” These further describe the current state of the substance use disorder.

Understanding the severity of a substance use disorder can help doctors and therapists better determine which treatments to recommend. Choosing the appropriate level of care may improve a person’s chances of recovery.

Getting Help for a Substance Use Disorder

If you think that you or a loved one might have a substance use disorder, effective treatments are available that can help. The first step is to talk to your doctor or mental health professional about your options. Your treatment and recovery needs will vary depending on the nature and severity of your substance use. 

In some cases, suddenly stopping your substance use can be risky or potentially fatal. You should work with your doctor to devise a plan for medically-supervised detox. Your doctor may also recommend medications that can help you recover and manage withdrawal symptoms and cravings. 

Treatment options you might consider:

  • Residential treatment
  • Outpatient treatment
  • Day treatment/partial hospitalization
  • Sober living communities

Your treatment may involve psychotherapy, such as motivational-enhancement therapy (MET) or cognitive-behavioral therapy (CBT). Support groups can also aid your recovery, including in-person or online options.

Research also suggests that adequate social support is important during addiction recovery. Reach out to trusted friends and family who can help you through this process. Mutual support groups and 12-step recovery groups can also be great places to find encouragement, resources, and support.

There is no one-size-fits-all approach for treating substance use disorders. Work with your doctor to find the right approach to address your needs, provide appropriate support, and foster long-term recovery.

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

By Elizabeth Hartney, BSc, MSc, MA, PhD

Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada. 


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Identity vs. Role Confusion in Psychosocial Development

Key Takeaways

  • Identity vs. confusion is a key stage in Erikson’s theory that focuses on developing a clear sense of self during adolescence.
  • Forming a strong identity leads to confidence, purpose, and healthier relationships.
  • Setting goals and exploring your interests can strengthen your identity and help you overcome role confusion.

Identity versus role confusion is the fifth stage of ego in psychologist Erik Erikson’s theory of psychosocial development. This stage occurs during adolescence between the ages of approximately 12 and 18. During this stage, adolescents explore their independence and develop a sense of self.

Verywell / Nusha Ashjaee


Understanding Identity vs. Role Confusion

  • Psychosocial conflict: Identity vs. role confusion
  • Major question: “Who am I?”
  • Basic virtue: Fidelity
  • Important event(s): Social relationships

Identity vs. role confusion is a stage characterized by asking, “Who am I?” and learning more about one’s goals, values, and beliefs.

According to Erikson, people progress through several stages as they grow and change throughout life. During each stage, everyone faces a developmental conflict that must be resolved to successfully develop the primary virtue of that stage. Erikson was interested in how social interaction and relationships affect development and growth.

What Do Identity and Role Confusion Mean?

As they transition from childhood to adulthood, teens may begin to feel confused or insecure about themselves and how they fit into society. As they seek to establish a sense of self, teens may experiment with different roles, activities, and behaviors. According to Erikson, this is important to the process of forming a strong identity and developing a sense of direction in life.

One of the main elements of Erikson’s psychosocial stage theory is the development of ego identity. It is the conscious sense of self that we develop through social interaction, which is constantly changing due to new experiences and information we acquire in our daily interactions with others. 

Identity

Erikson defines identity as a “fundamental organizing principle which develops constantly throughout the lifespan.”

Identity involves the experiences, relationships, beliefs, values, and memories that make up a person’s subjective sense of self. This helps create a continuous self-image that remains fairly constant even as new aspects of the self are developed or strengthened over time. Identity provides:

  • Self-sameness: A sense of continuity within the self and in interaction with others
  • Uniqueness: A frame to differentiate between self and interaction with others
  • Psychosocial development: Mental and physical health for adolescents

During the identity vs. role confusion stage, the conflict is centered on developing a personal identity. Completing this stage leads to a strong sense of self throughout life.

Role Confusion

Kids who are not allowed to explore and test out different identities might be left with what Erikson referred to as role confusion, which can result in the following:

  • Being unsure of who you are and where you fit
  • Drifting from one job or relationship to another
  • Feeling disappointed and confused about your place in life

Other Influences on Identity

Some more recent theories have focused on the importance of social identity and how those identities, and the intersection of those identities, influence the development of individual identity and roles.

One such theory is known as the “Big 8.” It describes socially constructed identities that are defined by factors including social, physical, or mental characteristics. Some examples of social identities include:

Why Having a Strong Identity Matters

  • Commitment: Resolving the crisis at this stage of development involves committing to a particular identity. This might involve committing to a career path, deciding what social groups to associate with, and even developing a sense of personal style.
  • Self-confidence: Those who are able to develop a strong sense of identity are better able to have self-confidence, or a sense of trust in their abilities, qualities, and judgments.
  • Sense of independence: Those who receive proper encouragement and reinforcement through personal exploration will emerge from this stage with a strong sense of self and a feeling of independence and control. Those who remain unsure of their beliefs and desires will remain insecure and confused about themselves and the future.
  • Fidelity: Those who succeed in developing a strong identity also forge fidelity, a psychological virtue characterized by the ability to relate to others and form genuine relationships. This ability plays an important role in the upcoming stage known as intimacy versus isolation.
  • Better mental health and relationships: Research has shown that teens who have a strong sense of identity have better mental health. They are also more likely to have good relationships with their peers and have better emotional and psychological well-being.

Researchers have found that people who enter young adulthood with a strong sense of identity are also more successful in subsequent stages of life, including intimacy, generativity, and integrity.

What Shapes Your Sense of Identity

There are various factors that contribute to whether a person forms a strong identity:

  • Friends
  • Family
  • Schoolmates
  • Other social groups
  • Societal trends
  • Pop culture

Different identities can also intersect to shape a person’s overall sense of self.

Stages of Identity Development

Influenced in part by Erikson’s theory, psychologist James Marcia described four identity statuses. These statuses represent different points in the development of identity.

In Marcia’s theory, identity forms due to exploring different identity alternatives and then making commitments to different ideas and values. These four statuses are:  

  • Identity diffusion (role confusion): At this point, a person has not explored or made identity commitments. 
  • Identity foreclosure: This involves committing to an identity without exploring other options, often as a result of peer pressure, conformity, cultural expectations, or parental pressure.
  • Identity moratorium: This is a period of active exploration where an individual tries new things and seeks out alternatives.
  • Identity achievement: This status involves having explored different options and then making a commitment to an identity. This does not necessarily end with adolescence. It can ultimately be a long process that creates self-awareness and a strong sense of self.

Ways to Build a Stronger Sense of Identity

No matter where you are in your life, there are things you can do to help build a stronger sense of identity. For example

  • Consider your values: Thinking about what your values are helps solidify your identity. Core values are those things that are really important and meaningful to you and that motivate you and guide your decisions.
  • Learn about yourself: It’s important to spend time alone to get to know yourself better. Those quiet moments can help you focus on your priorities and improve your sense of self.
  • Practice self-compassion: Showing yourself kindness and compassion can help you better understand and accept your flaws and limitations.

Become skilled at things you enjoy. Taking time to find and practice hobbies can help you get greater acquainted with yourself.

What Happens When You Struggle With Role Confusion

Role confusion can have lasting consequences on a person’s life, including:

  • Difficulties with commitment: A stable personal identity allows individuals to have better relationships with others.
  • Worse mental health and well-being: Research has linked a strong sense of identity to better emotional and psychological well-being in adolescents.
  • Weak sense of self: Role confusion has been found to lead to a weak sense of self.
  • Lack of confidence: Poor self-identity can make it difficult for people to have confidence in themselves and their abilities.

How to Overcome Role Confusion and Find Direction

  • Build on your strengths: Identify the areas in your life in which you excel, and take time to develop and build on those strengths. As you develop those skills even more, you may find other aspects of yourself that are also important to your identity.
  • Try new things to discover what you like: Be open to trying new things and having new experiences. Think about your passions and interests. Brainstorm some ideas around things that excite you. Sometimes you might try things and decide you don’t like them. That’s also part of personal growth. It helps you clarify what matters to your identity and eliminates feelings of confusion.
  • Make commitments and set goals: While you can set goals in any part of your life, consider thinking about some common areas like health, career, finances, and education. Having goals gives you a better sense of what you want to work toward and which aspirations are central to your sense of self.
  • Participate in activities related to your interests: Whether church events or clubs for sports, take the initiative to become part of something that interests you. This might involve finding a new hobby, joining community groups, or even just getting together with friends to enjoy a shared pastime.
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  4. Ragelienė T. Links of adolescents identity development and relationship with peers: A systematic literature review. J Can Acad Child Adolesc Psychiatry. 2016;25(2):97-105.

  5. Mitchell LL, Lodi-Smith J, Baranski EN, Whitbourne SK. Implications of identity resolution in emerging adulthood for intimacy, generativity, and integrity across the adult lifespan. Psychol Aging. 2021;36(5):545-556. doi:10.1037/pag0000537

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  7. Branje S, de Moor EL, Spitzer J, Becht AI. Dynamics of identity development in adolescence: A decade in review. J Res Adolesc. 2021;31(4):908-927. doi:10.1111/jora.12678

Additional Reading

  • Erikson EH. Childhood and Society, 2nd ed. Norton; 1963.

  • Erikson EH. Identity: Youth and Crisis. Norton; 1968.

  • Erikson EH. The Life Cycle Completed. Norton; 1982.

Kendra Cherry

By Kendra Cherry, MSEd

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the “Everything Psychology Book.”


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